scholarly journals Assessing healthcare access using the Levesque’s conceptual framework– a scoping review

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Anthony Cu ◽  
Sofia Meister ◽  
Bertrand Lefebvre ◽  
Valéry Ridde
Keyword(s):  
Conceptual Framework ◽  
Scoping Review ◽  
Assessment Tool ◽  
Empirical Studies ◽  
Healthcare Access ◽  
A Priori ◽  
Healthcare Services ◽  
Access To Healthcare ◽  
Health Providers ◽  
Universal Healthcare

Abstract Introduction Countries are working hard to improve access to healthcare through Universal Healthcare Coverage. To genuinely address the problems of healthcare access, we need to recognize all the dimensions and complexities of healthcare access. Levesque’s Conceptual Framework of Access to Health introduced in 2013 provides an interesting and comprehensive perspective through the five dimensions of access and the five abilities of the population to access healthcare. The objectives of this paper are to identify and analyze all empirical studies that applied Levesque’s conceptual framework for access to healthcare and to explore the experiences and challenges of researchers who used this framework in developing tools for assessing access. Methods A scoping review was conducted by searching through four databases, for studies citing Levesque et al. 2013 to select all empirical studies focusing on healthcare access that applied the framework. An initial 1838 documents underwent title screening, followed by abstract screening, and finally full text screening by two independent reviewers. Authors of studies identified from the scoping review were also interviewed. Results There were 31 studies identified on healthcare access using the Levesque framework either a priori, to develop assessment tool/s (11 studies), or a posteriori, to organize and analyze collected data (20 studies). From the tools used, 147 unique questions on healthcare access were collected, 91 of these explored dimensions of access while 56 were about abilities to access. Those that were designed from the patient’s perspective were 73%, while 20% were for health providers, and 7% were addressed to both. Interviews from seven out of the 26 authors, showed that while there were some challenges such as instances of categorization difficulty and unequal representation of dimensions and abilities, the overall experience was positive. Conclusion Levesque’s framework has been successfully used in research that explored, assessed, and measured access in various healthcare services and settings. The framework allowed researchers to comprehensively assess the complex and dynamic process of access both in the health systems and the population contexts. There is still potential room for improvement of the framework, particularly the incorporation of time-related elements of access.

scholarly journals Association Between Divorce and Access to Healthcare Services Among Married Immigrants: Propensity Score Approaches

2021 ◽  
Author(s):  
Suyeong Bae ◽  
James E. Graham ◽  
Sangun nam ◽  
Ickpyo Hong
Keyword(s):  
Propensity Score ◽  
Minority Groups ◽  
Healthcare Access ◽  
Healthcare Services ◽  
Social Determinant ◽  
Access To Healthcare ◽  
Multivariable Logistic Regression Analysis ◽  
Minority Population ◽  
Health Providers ◽  
Data Set

Abstract Background: Research is needed to improve access to healthcare services by minority groups. The population of married immigrants is increasing rapidly in Korea. While divorce is a social determinant of health among married immigrans, it is not clear about its association with access to healthcare services. Therefore, we examined healthcare services utilization in married immigrants.Methods: We retrieved data from 11,778 adults in the 2018 Korea National Multicultural Family Survey. We used propensity score matching methods. We analyzed whether the sex of divorced immigrants is associated with healthcare access using multivariable logistic regression analysis. Further, we analyzed the association between divorce and access to healthcare services among married immigrants. Results: There were 691 (5.8%) divorced immigrants in the data set. The married male immigrants had no association between divorce status and healthcare access (adjusted odds ratio = 1.059, 95% confidence interval [CI]=0.552–2.033, p = 0.8620). Divorced immigrants were less likely to receive healthcare services than married immigrants (adjusted OR=1.42, 95% CI=1.06–1.88). Conclusion: Our findings revealed that divorce increased the risk of limited healthcare services among immigrants. Policymakers and health providers should be aware of these potential disparities in this vulnerable minority population.

scholarly journals Social-Ecological Barriers to Access to Healthcare for Adolescents: A Scoping Review

2021 ◽  
Vol 18 (8) ◽  
pp. 4138
Author(s):  
Whitney Garney ◽  
Kelly Wilson ◽  
Kobi V. Ajayi ◽  
Sonya Panjwani ◽  
Skylar M. Love ◽  
...  
Keyword(s):  
United States ◽  
Scoping Review ◽  
Healthcare Access ◽  
Insurance Coverage ◽  
Healthcare Services ◽  
The United States ◽  
Access To Healthcare ◽  
Structural Barriers ◽  
Social Ecological ◽  
Ecological Barriers

Access to healthcare for adolescents is often overlooked in the United States due to federal and state-sponsored insurance programs such as Medicaid and the Children’s Health Insurance Program. While these types of programs provide some relief, the issue of healthcare access goes beyond insurance coverage and includes an array of ecological factors that hinder youths from receiving services. The purpose of this scoping review was to identify social-ecological barriers to adolescents’ healthcare access and utilization in the United States. We followed the PRISMA and scoping review methodological framework to conduct a comprehensive literature search in eight electronic databases for peer-reviewed articles published between 2010 and 2020. An inductive content analysis was performed to thematize the categories identified in the data extraction based on the Social-Ecological Model (SEM). Fifty studies were identified. Barriers across the five SEM levels emerged as primary themes within the literature, including intrapersonal-limited knowledge of and poor previous experiences with healthcare services, interpersonal-cultural and linguistic barriers, organizational-structural barriers in healthcare systems, community-social stigma, and policy-inadequate insurance coverage. Healthcare access for adolescents is a systems-level problem requiring a multifaceted approach that considers complex and adaptive behaviors.

scholarly journals Evidence-based health solutions for challenges women face during pandemics like COVID-19: A systematic review protocol

2020 ◽  
Author(s):  
Zhaohui Su ◽  
Shelly Wagers ◽  
Emme Lopez ◽  
Lori Ann Terjesen ◽  
Jaffar Abbas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Domestic Violence ◽  
Psychological Health ◽  
A Priori ◽  
Nursing Home Residents ◽  
Healthcare Services ◽  
Access To Healthcare ◽  
Evidence Based ◽  
Health Issues ◽  
Eligibility Criteria

Abstract Background One of the most vulnerable populations to COVID-19 is women. Multiple factors associated with violence against women (i.e. sexual assault, domestic violence, homelessness) create an increased vulnerability for women during the COVID pandemic. Women also constitute the majority of older nursing home residents and healthcare workers (e.g., nurses), who have the most pronounced exposure to COVID-19. These factors combined with resource restraints like rationing and lack of access to healthcare can further exacerbate women’s physical and psychological health issues. While literature has well-documented challenges that women face during COVID-19, there is a lack of evidence-based solutions that have the potential to mitigate these difficulties. Therefore, to address this issue, we aim to conduct a systematic review of the literature to: (1) identify interventions designed for women in the context of pandemics, (2) describe the characteristics and effects of these interventions concerning the distinctive traits of women and pandemics, and (3) present evidence-based health solutions for women to mitigate challenges they face amid and beyond COVID-19. Methods A systematic review of literature will be conducted on databases including PubMed, PsycINFO on the EBSCO platform, CINAHL on the EBSCO platform, and Scopus, based on a search strategy developed in consultation with an experienced medical librarian. Titles, abstracts, and full-text articles will be screened against eligibility criteria developed a priori. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be adopted as the reporting framework, and data extracted (e.g., intervention details) will be evaluated by a multidisciplinary research team. Results NA for now—This is a protocol study. Conclusions Findings of this study will fill an important void in the literature. Considering that, in times of pandemic, women are especially subject to grim health disparities, like pronounced exposure to COVID-19, reproductive health issues, elevated domestic violence, increased mental health challenges, and lack of access to healthcare services, the need for evidence-based health solutions that could address these unique challenges is of paramount importance. A comprehensive understanding of the characteristics and effects of health solutions available to women in the context of pandemics can also help researchers identify areas of improvement regarding intervention design and development. This may further safeguard women’s health and wellbeing amid pandemics like COVID-19 and beyond. Study Protocol Registration: PROSPERO CRD42020194003

scholarly journals Accessing health services in India: Experiences of seasonal migrants returning to Nepal.

2020 ◽  
Author(s):  
Pratik Adhikary ◽  
Nirmal Aryal ◽  
Raja Ram Dhungana ◽  
Radheyshyam Krishna KC ◽  
Pramod Raj Regmi ◽  
...  
Keyword(s):  
Migrant Workers ◽  
Healthcare Access ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Government Support ◽  
Poor People ◽  
Limited Information ◽  
Health Providers ◽  
Support Organizations ◽  
The Government

Abstract Background: Migration to India is a common livelihood strategy for poor people in remote Western Nepal. To date, little research has explored the degree and nature of healthcare access among Nepali migrant workers in India. This study explores the experiences of returnee Nepali migrants with regard to accessing healthcare and the perspectives of stakeholders in the government, support organizations, and health providers working with migrant workers in India. Methods: Six focus group discussions (FGDs) and 12 in-depth interviews with returnee migrants were conducted by trained moderators in six districts in Western Nepal in late 2017. A further nother 12 key persons working in the health and education sector were also interviewed. With the consent of the participants, FGDs and interviews were audio-recorded. They were then transcribed and translated into English and the data w ere as analysed thematically. Results: The interviewed returnee migrants worked in 15 of India’s 29 states, most as daily wage labourers. Most were from among the lowest castes so called-Dalits. Most migrants had had difficulty accessing healthcare services in India. The major barriers to access were the lack of insurance, low wages, not having an Indian identification card tied to individual biometrics so called: Aadhaar card. Other barriers were unsupportive employers, discrimination at healthcare facilities and limited information about the locations of healthcare services. Conclusions: Nepali migrants experience difficulties in accessing healthcare in India. Partnerships between the Nepali and Indian governments, migrant support organizations and relevant stakeholders such as healthcare providers, government agencies and employers should be strengthened so that this vulnerable population can access the healthcare they are entitled to. Keywords: Migrants, Returnees, Healthcare access, Qualitative research, Nepal, South Asia

scholarly journals Visual Impairment Prevalence, Causes, and Role of Healthcare Access: A Systematic Review and Meta-Analysis in Iran

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Mehrdad Afarid ◽  
Hossein Molavi Vardanjani ◽  
Hamideh Mahdaviazad ◽  
Marzieh Alamolhoda ◽  
Saman Farahangiz
Keyword(s):  
Systematic Review ◽  
Visual Impairment ◽  
Low Vision ◽  
Meta Analysis ◽  
Healthcare Access ◽  
Random Effect ◽  
Public Health Problem ◽  
Healthcare Services ◽  
Access To Healthcare ◽  
Pooled Prevalence

Purpose. Healthcare access is one of the determinants of visual impairment (VI), as a public health problem. The objective of this study was to estimate VI prevalence, related causes, and its correlation with access to physicians in Iran. Methods: This systematic review and meta-analysis include observational studies published in Iran. PubMed, Web of Science, Scopus, Google Scholar, and local databases were systematically searched by using the MeSH headings. Data on the provincial distribution of physicians, as an index of access to healthcare, was retrieved. A random-effect meta-analysis was performed to assess. Results. Eight articles were included. The pooled prevalence of blindness, low vision, and VI was 0.80% (95% CI: 0.61–0.99%), 2.92% (95% CI: 2.40–3.44%), and 5.57% (95% CI: 4.71–6.43%). Refractive errors were the most common causes of VI based on PVA with the pooled prevalence of 54.6% (95% CI: 43.4–65.8%). Based on BCVA, we found that the pooled prevalence of cataracts was 37.4% (95% CI: 29.5–45.3%) as the most common cause of VI. The results of metaregression showed that the greater number of general practitioners (GPs) ( P   value = 0.01 ) and pharmacists ( P   value = 0.024 ) per population were associated with a lower prevalence of blindness. Conclusion. Some of the main causes of visual impairment in Iran are preventable. Access to healthcare services may lead to early diagnosis of preventable causes of VI. Further well-designed studies and national surveys should be conducted to provide accurate data from different regions of Iran.

scholarly journals ‘Leaving no one behind’: a scoping review on the provision of sexual and reproductive health care to nomadic populations

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Moazzam Ali ◽  
Joanna Paula Cordero ◽  
Faria Khan ◽  
Rachel Folz
Keyword(s):  
Reproductive Health ◽  
Scoping Review ◽  
Healthcare Access ◽  
Health Providers ◽  
Cultural Dynamics ◽  
Major Barrier ◽  
Existing Structures ◽  
Barriers To Access ◽  
Nomadic Communities ◽  
Face Complex

Abstract Backgrund Marginalized groups, such as nomadic populations across the world, have perhaps the least access to modern reproductive health (RH) services. This scoping review aims to identify barriers to access to RH services faced by nomadic populations from the existing literature and to highlight possible opportunities to address them. Methods Key databases, including PubMed, Popline, Google Scholar, and Google Advanced were searched for relevant articles published between 2002 and 2019. A total 344 articles were identified through database online searches, and 31 were included in the review. Results Nomadic people face complex barriers to healthcare access that can be broadly categorized as external (geographic isolation, socio-cultural dynamics, logistical and political factors) and internal (lifestyle, norms and practices, perceptions) factors. To effectively address the needs of nomadic populations, RH services must be available, accessible and acceptable through tailored and culturally sensitive approaches. A combination of fixed and mobile services has proven effective among mobile populations. Low awareness of modern RH services and their benefits is a major barrier to utilization. Partnership with communities through leveraging existing structures, networks and decision-making patterns can ensure that the programmes are effectively implemented. Conclusion Further research is needed to better understand and address the RH needs of nomadic populations. Though existing evidence is limited, opportunities do exist and should be explored. Raising awareness and sensitization training among health providers about the specific needs of nomads is important. Improved education and access to information about the benefits of modern RH care among nomadic communities is needed. Ensuring community participation through involvement of nomadic women and girls, community leaders, male partners, and trained traditional birth attendants are key facilitators in reaching nomads. However, participatory programmes also need to be recognized and supported by governments and existing health systems.

scholarly journals Healthcare services utilization among international students in Ankara, Turkey: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Abednego Nzyuko Masai ◽  
Bahar Güçiz-Doğan ◽  
Polet Njeri Ouma ◽  
Israel Nyaburi Nyadera ◽  
Victor Kipkoech Ruto
Keyword(s):  
International Students ◽  
Health Services ◽  
Healthcare Access ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Health Providers ◽  
Access To Health Services ◽  
Cross Sectional ◽  
Exact Test ◽  
Services Utilization

Abstract Background While international students form an increasing population of higher education students in Turkey, there is limited empirical evidence about their health services utilization. The study aim was to investigate healthcare access among a group of international students studying in Ankara city and identify potential barriers that affect full healthcare utilization. Method A total of 535 international students from 83 countries completed an online-based questionnaire. The survey was conducted from September until October 2020. Variables between groups within the study sample were compared using ANOVA and Chi-square tests (with Fisher’s exact test). Logistic regression analysis was used to evaluate the relationships between variables related to access to health services. Results Of the study population, 80.6% accessed the general practitioner (GP), 40% accessed the student health centres, and 11.4% were admitted to the hospital at least once. About 80% of international students reported changing their views to access healthcare more because of the COVID-19 pandemic. Conclusion Lack of awareness of healthcare support systems, perceived stigma associated with mental health services, and language barriers were the main barriers affecting healthcare access by international students. Implications Study findings indicate the need for education of international students on available healthcare, targeted health promotion, and training of health providers on effective communication.

scholarly journals Accessing health services in India: Experiences of seasonal migrants returning to Nepal.

2020 ◽  
Author(s):  
Pratik Adhikary ◽  
Nirmal Aryal ◽  
Raja Ram Dhungana ◽  
Radheyshyam Krishna KC ◽  
Pramod Raj Regmi ◽  
...  
Keyword(s):  
Migrant Workers ◽  
Healthcare Access ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Government Support ◽  
Poor People ◽  
Limited Information ◽  
Health Providers ◽  
Support Organizations ◽  
The Government

Abstract Background: Migration to India is a common livelihood strategy for poor people in remote Western Nepal. To date, little research has explored the degree and nature of healthcare access among Nepali migrant workers in India. This study explores the experiences of returnee Nepali migrants with regard to accessing healthcare and the perspectives of stakeholders in the government, support organizations, and health providers working with migrant workers in India. Methods: Six focus group discussions (FGDs) and 12 in-depth interviews with returnee migrants were conducted by trained moderators in six districts in Western Nepal in late 2017. A further 12 key persons working in the health and education sector were also interviewed. With the consent of the participants, FGDs and interviews were audio-recorded. They were then transcribed and translated into English and the data were analysed thematically.Results: The interviewed returnee migrants worked in 15 of India’s 29 states, most as daily wage labourers. Most were from among the lowest castes so called-Dalits. Most migrants had had difficulty accessing healthcare services in India. The major barriers to access were the lack of insurance, low wages, not having an Indian identification card tied to individual biometrics so called: Aadhaar card. Other barriers were unsupportive employers, discrimination at healthcare facilities and limited information about the locations of healthcare services. Conclusions: Nepali migrants experience difficulties in accessing healthcare in India. Partnerships between the Nepali and Indian governments, migrant support organizations and relevant stakeholders such as healthcare providers, government agencies and employers should be strengthened so that this vulnerable population can access the healthcare they are entitled to.

scholarly journals Health Status and Health Determinants of Older Immigrant Women in Canada: A Scoping Review

2021 ◽  
Author(s):  
Sepali Guruge ◽  
Birpreet Birpreet ◽  
Joan A. Samuels-Dennis
Keyword(s):  
Health Status ◽  
Health Beliefs ◽  
Scoping Review ◽  
Immigrant Women ◽  
Healthcare Access ◽  
Cultural Beliefs ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Health Determinants ◽  
Healthcare Delivery System

Increasing international migration in the context of aging populations makes a comprehensive understanding of older immigrant women’s health status and determinants of their health particularly urgent. Using Arksey and O’Malley’s framework, we conducted a scoping review to examine the available literature on the health of older immigrant women in Canada. We searched CINAHL, PsycINFO, Embase,Medline, and Cochrane databases for the period of 1990 to 2014 for Canadian-based, peer-reviewed studies on the topic. A total of 20 articles met the inclusion criteria.These articles were divided into six areas of focus: physical health; mental health; abuse; health promotion and chronic disease prevention; barriers to healthcare access and utilization; and health beliefs, behaviours, and practices. Our results show that the health of older immigrant women is affected by the interplay of various social determinants of health including the physical and social environment; economic conditions; cultural beliefs; gendered norms; and the healthcare delivery system. Our results also revealed that older immigrant women tend to have more health problems, underutilize preventive services, such as cancer screening, and experience more difficulties in accessing healthcare services.

scholarly journals Comparison of Association Between Divorce and Access to Healthcare Services Among Married Immigrants

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 514-514
Author(s):  
Suyeong Bae ◽  
James Graham ◽  
Sanghun Nam ◽  
Ickpyo Hong
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Healthcare Access ◽  
Healthcare Services ◽  
Access To Healthcare ◽  
Minority Population ◽  
Service Access ◽  
Family Dissolution ◽  
History Of ◽  
Multicultural Family

Abstract The number of married immigrants is increasing in Korea, and family dissolution is also growing in this population. Although divorce could impact immigrants' health status, it is unclear whether they have difficulties accessing healthcare and medical services. Thus, we examined whether divorce in married immigrants is independently associated with access to healthcare services. A retrospective analysis of 11,778 adults who participated in the 2018 National Multicultural Family Survey. We used three different covariate adjustment methods (multivariate logistic regression, inverse probability of treatment weighting, 1:1 greedy propensity score matching) to examine the association between divorce and access to healthcare services after accounting for various demographic and clinical characteristics. Overall, 5.8% (n = 691) of married immigrants reported a history of divorce. The divorce group included 107 (15.5%) males and 584 (84.5%) females, with an average age of 45.17 years (SD = 10.9). The non-divorced group included 1992 males (18.0%) and 9095 (82.0%) females, with an average age of 39.1 years (SD = 10.5). After propensity score matching, all variables were balanced (all p>0.05). Individuals who experienced divorce were more likely to have difficulties in healthcare service access than those who did not experience divorce (adjusted odds ratio 1.423, 95% CI [1.075, 1.882]). Our findings revealed that divorce increased the risk of limited healthcare services among immigrants in Korea. Healthcare policymakers should be aware of the healthcare access issues in this minority population. In addition, to improve the lifestyles of minority populations, it is necessary to study their overall lives.

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