Health seeking behavior among women in Bhimtar, Sindhupalchowk district of Nepal

Background: When assessing and monitoring the health of a population, it is important to describe not only classical mortality and morbidity indicators but also, perceived illness, visits to primary health services, and utilization of the healthcare services provided. Objectives of the study were to determine the health status and factors affecting health seeking behaviour of women.Methods: A descriptive study was done at Bhimtar, Sindhupalchowk District in Nepal, involving 147 subjects sampled by purposive sampling. Study population consisted of women. Data was collected by house to house interview with pretested questionnaire during month of September 2016. Data was entered and then analysed using Statistical Package for the Social Sciences (SPSS) 20. Simple measures of statistics like frequency, percentages, means were used to represent the data in tables as a part of descriptive analysis and chi-square test was applied to see the association with dependent variables.Results: Among 80.9% women who had gynaecological problems, the highest prevalence rate of the disease was low back pain (60.5%) followed by lower abdominal pain (35.2%), dysmenorrhea (27.3%) and menstrual irregularities (27.3%). The first approach of seeking health for the reported illness among women was the traditional healer (51%). Regarding attitude towards modern medicine, 47.6% respondents replied that facilities were not available locally. Similarly regarding hindering factors for not utilizing health services, lack of female doctors (43.75%) and far distance of health care centre (37.5%) were the most common ones.Conclusions:Higher percentage of women in Bhimtar sought after the traditional healer as the best way for utilizing health services. Modern health care utilization was less because of the distance to be covered during illness and lack of doctors in the health centre.

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Health-seeking cultural patterns in the use of available healthcare services among refugee groups in south-central Kentucky

International Journal of Migration Health and Social Care ◽

10.1108/ijmhsc-08-2018-0051 ◽

2020 ◽

Vol 16 (1) ◽

pp. 12-21

Author(s):

Chika Ejike ◽

Grace Lartey ◽

Randy Capps ◽

David Ciochetty

Keyword(s):

Health Care ◽

Health Services ◽

Care Facility ◽

Well Being ◽

Healthcare Services ◽

Health Seeking ◽

Content Type ◽

Refugee Population ◽

South Central ◽

Use Of Health Services

Purpose Refugees resettle in the USA every year to escape genocide, famine, civil wars and crises in their countries. The diverse cultural identities of the refugee population in south-central Kentucky make it essential to research into their health-care usage patterns. The purpose of this study is to examine the health-seeking patterns of refugees in relation to their culture and the usage of available health services. Design/methodology/approach This is a descriptive correlational study that culled 110 refugees who completed self-administered or interviewer-administered semi-structured questionnaires. Questionnaires were translated into four different languages. T-tests and ANOVA assessed differences between variables. Findings Findings indicate that a demographic factor such as refugees’ nationality plays a role in both the access and use of health services [F (5, 98) = 4.29, p < 0.001]. Refugees’ beliefs and social factors such as acculturation (t = −2.03, p < 0.04) and having health insurance (t = −3.35, p <0.001) also affect the use of health services. The level of cultural competency of the health-care facility or provider as depicted by the presence of interpreters (t = 1.92, p < 0.05) was associated with increased use of the health services provided. Research limitations/implications The sample of refugees is only representative of the general refugee population in south-central Kentucky; hence, there is inadequate generalization. Originality/value Cultural diversity should be included in the health and policymaking debates that surround the refugee population of south-central Kentucky to ensure their well-being.

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Multidimensional Social Support and Health Services Utilization Among Noninstitutionalized Older Persons in Ghana

Journal of Aging and Health ◽

10.1177/0898264318816217 ◽

2018 ◽

Vol 32 (3-4) ◽

pp. 227-239 ◽

Cited By ~ 12

Author(s):

Razak M. Gyasi ◽

David R. Phillips ◽

Padmore Adusei Amoah

Keyword(s):

Social Support ◽

Older Adults ◽

Health Care ◽

Health Services ◽

Health Services Utilization ◽

Community Dwelling ◽

Health Care Use ◽

Care Utilization ◽

Health Seeking ◽

Services Utilization

Objectives: This study examines multidimensional social supports as predictors of health services utilization among community-dwelling older Ghanaians. Method: Using data from a 2016/2017 Aging, Health, Psychological Wellbeing and Health-Seeking Behavior Study ( N = 1,200), Poisson regression models estimated the associations of aspects of informal social support and health facility utilization among older people. Results: Findings suggest that regular contacts with family/close friends (odds ratio [OR] = 1.299; 95% confidence interval [CI] = [1.111, 1.519]), social participation (OR = 1.021; 95% CI = [1.140, 1.910]), and remittances from adult children (OR = 1.091; 95%CI = [1.086, 1.207]) were associated with increased health services utilization with some gender variations. Having caregivers increased health care use generally (OR = 1.108; 95% CI = [1.016, 1.209]) and among men (OR = 1.181; 95% CI = [1.015, 1.373]). However, we found decrease in health care use among those who received pecuniary assistance (OR = 0.893; 95% CI = [0.805, 0.990]). Discussion: Perceived structural and functional social support domains appear influential in health care utilization among older adults in Ghana. The findings underscore the need for intervention programs and social policies targeted at both micro-factors and wider social factors, including the novel area of remittances to older adults.

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Covid-19 pandemic impact on maternal and child health services access in Nampula, Mozambique: a mixed methods research

BMC Health Services Research ◽

10.1186/s12913-021-06878-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Paulo Henrique das Neves Martins Pires ◽

Cynthia Macaringue ◽

Ahmed Abdirazak ◽

Jaibo Rassul Mucufo ◽

Martins Abudo Mupueleque ◽

...

Keyword(s):

Health Care ◽

Child Health ◽

Health Services ◽

Maternal And Child Health ◽

Mixed Methods Research ◽

Health Centre ◽

Healthcare Services ◽

Child Health Services ◽

Child Healthcare ◽

And Child Health

Abstract Background The Covid-19 pandemic has so far infected more than 30 million people in the world, having major impact on global health with collateral damage. In Mozambique, a public state of emergency was declared at the end of March 2020. This has limited people’s movements and reduced public services, leading to a decrease in the number of people accessing health care facilities. An implementation research project, The Alert Community for a Prepared Hospital, has been promoting access to maternal and child health care, in Natikiri, Nampula, for the last four years. Nampula has the second highest incidence of Covid-19. The purpose of this study is to assess the impact of Covid-19 pandemic Government restrictions on access to maternal and child healthcare services. We compared health centres in Nampula city with healthcare centres in our research catchment area. We wanted to see if our previous research interventions have led to a more resilient response from the community. Methods Mixed-methods research, descriptive, cross-sectional, retrospective, using a review of patient visit documentation. We compared maternal and child health care unit statistical indicators from March–May 2019 to the same time-period in 2020. We tested for significant changes in access to maternal and child health services, using KrushKall Wallis, One-way Anova and mean and standard deviation tests. We compared interviews with health professionals, traditional birth attendants and patients in the two areas. We gathered data from a comparable city health centre and the main city referral hospital. The Marrere health centre and Marrere General Hospital were the two Alert Community for a Prepared Hospital intervention sites. Results Comparing 2019 quantitative maternal health services access indicators with those from 2020, showed decreases in most important indicators: family planning visits and elective C-sections dropped 28%; first antenatal visit occurring in the first trimester dropped 26%; hospital deliveries dropped a statistically significant 4% (p = 0.046), while home deliveries rose 74%; children vaccinated down 20%. Conclusion Our results demonstrated the negative collateral effects of Covid-19 pandemic Government restrictions, on access to maternal and child healthcare services, and highlighted the need to improve the health information system in Mozambique.

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Building trust and enhancing localization to improve access to women’s health services in Afghanistan

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.928 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

F R Rab ◽

S S Stranges ◽

A D Thind ◽

S S Sohani

Keyword(s):

Health Care ◽

Health Services ◽

Vulnerable Populations ◽

Time Trend ◽

Health Workers ◽

Healthcare Services ◽

Delivery Of Healthcare ◽

Care Services ◽

Women And Children ◽

Delivery Of Health Services

Abstract Background Over 34 million people in Afghanistan have suffered from death and devastation for the last four decades as a result of conflict. Women and children have borne the brunt of this devastation. Afghanistan has some of the poorest health indicators in the world for women and children. In the midst of armed conflict, providing essential healthcare in remote regions in the throws of conflict remains a challenge, which is being addressed the Mobile Health Teams through Afghan Red Crescent (ARCS). To overcome socio-cultural barriers, ARCS MHTs have used local knowledge to hire female staff as part of the MHTs along with their male relatives as part of MHT staff. The present study was conducted to explore the impact of engaging female health workers as part of MHTs in conflict zones within Afghanistan on access, availability and utilization of maternal and child health care. Methods Quantitative descriptive and time-trend analysis were used to evaluate impact of introduction of female health workers. Qualitative data is being analyzed to assess the possibilities and implications of engaging female health workers in the delivery of health services. Results Preliminary results show a 96% increase in uptake of services for expectant mothers over the last four years. Average of 18 thousand services provided each month by MHTs, 70% for women and children. Service delivery for women and children significantly increased over time (p < 0.05) after inclusion of female health workers in MHTs. Delivery of maternity care services showed a more significant increase (p < 0.001). Time trend and qualitative analyses is ongoing. Conclusions Introduction of female health workers significantly improved uptake of health care services for women and children especially in extremely isolated areas controlled by armed groups in Afghanistan. Engaging with local stakeholders is essential for delivery of health services for vulnerable populations in fragile settings like Afghanistan. Key messages Understanding cultural norms results in socially acceptable solutions to barriers in delivery of healthcare services and leads to improvements in access for women and children in fragile settings. Building local partnerships and capacities and using local resources result in safe, efficient and sustainable delivery of healthcare services for vulnerable populations in fragile settings.

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Did the poor gain from India’s health policy interventions? Evidence from benefit-incidence analysis, 2004–2018

International Journal for Equity in Health ◽

10.1186/s12939-021-01489-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Sakthivel Selvaraj ◽

Anup K. Karan ◽

Wenhui Mao ◽

Habib Hasan ◽

Ipchita Bharali ◽

...

Keyword(s):

Health Care ◽

Health Policy ◽

Access To Health Care ◽

Healthcare Services ◽

Care Utilization ◽

Public Subsidy ◽

Policy Interventions ◽

The Poor ◽

Benefit Incidence Analysis ◽

The Rich

Abstract Background Health policy interventions were expected to improve access to health care delivery, provide financial risk protection, besides reducing inequities that underlie geographic and socio-economic variation in population access to health care. This article examines whether health policy interventions and accelerated health investments in India during 2004–2018 could close the gap in inequity in health care utilization and access to public subsidy by different population groups. Did the poor and socio-economically vulnerable population gain from such government initiatives, compared to the rich and affluent sections of society? And whether the intended objective of improving equity between different regions of the country been achieved during the policy initiatives? This article attempts to assess and provide robust evidence in the Indian context. Methods Employing Benefit-Incidence Analysis (BIA) framework, this paper advances earlier evidence by highlighting estimates of health care utilization, concentration and government subsidy by broader provider categories (public versus private) and across service levels (outpatient, inpatient, maternal, pre-and post-natal services). We used 2 waves of household surveys conducted by the National Sample Survey Organisation (NSSO) on health and morbidity. The period of analysis was chosen to represent policy interventions spanning 2004 (pre-policy) and 2018 (post-policy era). We present this evidence across three categories of Indian states, namely, high-focus states, high-focus north eastern states and non-focus states. Such categorization facilitates quantification of reform impact of policy level interventions across the three groups. Results Utilisation of healthcare services, except outpatient care visits, accelerated significantly in 2018 from 2004. The difference in utilisation rates between poor and rich (between poorest 20% and richest 20%) had significantly declined during the same period. As far as concentration of healthcare is concerned, the Concentrate Index (CI) underlying inpatient care in public sector fell from 0.07 in 2004 to 0.05 in 2018, implying less pro-rich distribution. The CI in relation to pre-natal, institutional delivery and postnatal services in government facilities were pro-poor both in 2004 and 2018 in all 3 groups of states. The distribution of public subsidy underscoring curative services (inpatient and outpatient) remained pro-rich in 2004 but turned less pro-rich in 2018, measured by CIs which declined sharply across all groups of states for both outpatient (from 0.21 in 2004 to 0.16 in 2018) and inpatient (from 0.24 in 2004 to 0.14 in 2018) respectively. The CI for subsidy on prenatal services declined from approximately 0.01 in 2004 to 0.12 in 2018. In respect to post-natal care, similar results were observed, implying the subsidy on prenatal and post-natal services was overwhelmingly received by poor. The CI underscoring subsidy for institutional delivery although remained positive both in 2018 and 2004, but slightly increased from 0.17 in 2004 to 0.28 in 2018. Conclusions Improvement in infrastructure and service provisioning through NHM route in the public facilities appears to have relatively benefited the poor. Yet they received a relatively smaller health subsidy than the rich when utilising inpatient and outpatient health services. Inequality continues to persist across all healthcare services in private health sector. Although the NHM remained committed to broader expansion of health care services, a singular focus on maternal and child health conditions especially in backward regions of the country has yielded desired results.

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Analysis of the Effect of Health Insurance on Health Care Utilization in Rwanda

10.20944/preprints202106.0277.v1 ◽

2021 ◽

Author(s):

Roger Muremyi ◽

Dominique Haughton ◽

François Niragire ◽

Ignace Kabano

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Services ◽

Health Care Utilization ◽

Health Care Services ◽

Insurance Coverage ◽

Secondary Data ◽

Living Condition ◽

Care Utilization ◽

Health Coverage

In Rwanda, more than 90% of the population is insured for health care. Despite the comprehensiveness of health insurance coverage in Rwanda, some health services at partner institutions are not available, causing insured patients to pay unintended cost. We aimed to analyze the effect of health insurance on health care utilization and factors associated with the use of health care services in Rwanda. This is an analysis of secondary data from the Rwanda integrated living condition survey 2016-2017. The survey gathered data from 14580 households, and decision tree and multilevel logistic regression models were applied. Among 14580 households only (20%) used health services. Heads of households aged between [56-65] years (AOR=1.28, 95% CI:1.02-1.61), aged between [66-75] years (AOR=1.52, 95% CI: 1.193-1.947), aged over 76 years (AOR=1.48, 95% CI:1.137-1.947), households with health insurance (AOR=4.57, 95% CI: 3.97-5.27) displayed a significant increase in the use of health services. This study shows evidence of the effect of health insurance on health care utilization in Rwanda: a significant increase of 4.57 times greater adjusted odds of using health services compared to those not insured. The findings from our research will guide policymakers and provide useful insights within the Rwanda context as well as for other countries that are considering moving towards universal health coverage through similar models.

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Does Integrated Medical Insurance System (IMIS) Alleviate the Difficulty of Using Cross-Region Health Care for the Migrant Parents in China

10.21203/rs.3.rs-249976/v1 ◽

2021 ◽

Author(s):

Chao Ma ◽

Shutong Huo ◽

Hao Chen

Keyword(s):

Health Care ◽

Medical Insurance ◽

Healthcare Services ◽

Care Utilization ◽

Inpatient Service ◽

Medical Expense ◽

Registration System ◽

Rural And Urban ◽

Urbanization In China ◽

Migrant Parents

Abstract Background: A large number of internal immigrants in the process of urbanization in China is Migrant Parents, the aging group who move to urban area involuntarily to support their family. They are more vulnerable economically and physically than the younger migrants. However, the fragmentation of rural and urban health insurance schemes divided by “hukou” household registration system limit migrant’s access to healthcare services in their resident location. Some provinces have started to consolidate the Urban Resident Basic Medical Insurance and the New Rural Cooperative Medical Scheme as one Integrated Medical Insurance Schemes (IMIS) to reduce the disparity between different schemes and increase the health care utilization of migrants. Results: Using China Migrants Dynamic Survey, we used OLS for regression in models. We found that the migrant parents who are covered by the IMIS are more likely to choose inpatient service and to seek medical treatment in the migrant destination, by improving the convenience of medical expense reimbursement and relieving the economic pressure. Conclusions: The potential mechanisms of our results could be that IMIS alleviates the difficulty of seeking medical care in migrant destinations by improving the convenience of medical expense reimbursement and relieving the economic constrain.

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Access to Home and Community Health Services for Older Adults With Serious, Life-Limiting Illness: A Study Protocol

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120920230 ◽

2020 ◽

Vol 38 (1) ◽

pp. 12-18

Author(s):

Jacob D. Hill ◽

Allison M. Cuthel ◽

Corita R. Grudzen

Keyword(s):

Health Care ◽

Emergency Medicine ◽

Health Services ◽

Health Care Utilization ◽

Qualitative Interviews ◽

Community Health Services ◽

Community Services ◽

Care Utilization ◽

Service Availability ◽

Access To Services

Objectives: The objective of this study is to identify contextual access factors to home and community health services for end-of-life support for older adults with serious life-limiting illness, as well as determine if access to home and community services is associated with health-care utilization. Design: This study includes an environmental scan, grey literature review, qualitative interviews, and health-care utilization analysis. This study is a subproject of the Grudzen et al. Primary Palliative Care for Emergency Medicine (PRIM-ER) study. Settings/Location: Analysis will include data collection from 17 health systems implementing the PRIM-ER intervention. Participants: For the qualitative interviews, one emergency medicine (EM) physician and one EM nurse will be interviewed from each of the 17 participating health systems. For the health-care utilization analysis, we will use the Senior Care Services Scale (SCSS), American Hospital Association Annual Survey of Hospitals (AHA-ASH), and Medicare claims for all emergency department (ED) visits for serious illness who present at each participating health system. Outcome Measures: The contextual analysis will obtain data on home and community services, such as hospice, home health services, assisted living, integrative medicine services, etc., available around each health system’s highest volume ED, federal and state regulations influencing access to services, as well as EM provider perspectives on access to services. The health-care utilization analysis will determine if SCSS scores, which measure service availability, are associated with health-care usage. High or low SCSS scores are determined by comparing health system service availability on the AHA-ASH to the national median SCSS value.

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