Predictors of Undiagnosed Diabetes among Middle-Aged and Seniors in China: Application of Andersen’s Behavioral Model

Undiagnosed diabetes is a threat to public health. This study aims to identify potential variables related to undiagnosed diabetes using Andersen’s behavioral model. Baseline data including blood test data from the China Health and Retirement Longitudinal Study (CHARLS) were adopted. First, we constructed health service related variables based on Andersen model. Second, univariate analysis and multiple logistic regression were used to analyze the relations of variables to undiagnosed diabetes. The strength of relationships was presented by odds ratios (ORs) and 95% confidence intervals (CIs). Finally, the prediction of multiple logistic regression model was assessed using the Receiver Operating Characteristic (ROC) curve and the area under the ROC curve (AUC). According to diagnosis standards, 1234 respondents had diabetes, among which 560 were undiagnosed and 674 were previously diagnosed. Further analysis showed that the following variables were significantly associated with undiagnosed diabetes: age as the predisposing factor; medical insurance, residential places and geographical regions as enabling factors; having other chronic diseases and self-perceived health status as need factors. Moreover, the prediction of regression model was assessed well in the form of ROC and AUC. Andersen model provided a theoretical framework for detecting variables of health service utilization, which may not only explain the undiagnosed reasons but also provide clues for policy-makers to balance health services among diverse social groups in China.

Disparities in Physical Accessibility among Rural Thais Under Universal Health Coverage

This study aims to explore various barriers in accessing outpatient care among the participants from different age groups and to identify determinants associated with physician visits. The study had adopted Andersen’s Behavioral Model (ABM) of Health Services Use. A cross-sectional study design was adopted to collect data from 417 participants through a questionnaire survey. Poisson regression models were used to explore determinants for explaining the differences in outpatient care use. The regression results revealed that divergent relationships existed among age groups. Children and elderly participants tended to decrease the probability of seeking care. Elderly participants confronted more difficulties in access and were dependent on family members. Despite free care provisions, participants visited and spent their out-of-pocket expenditure mostly at non-universal health coverage (non-UHC) facilities. Convenience and the availability of specialist physicians led the higher-income parents to seek care of their children at non-UHC facilities. Highly educated people of working age preferred more self-care or institutionalized care to save time. Children up to the primary level of education were more likely to visit a doctor. We concluded that investments in education or well-informed health services provision would improve health care utilization. Findings of Andersen’s Behavioral Model variables suggested that improvements in the quality of services, medical professional skills, and efficient resource allocation may induce seeking care at UHC facilities. Consequently, it will reduce the number of referred cases, caseloads at tertiary care units, and visits to non-UHC facilities at longer distances.

Use of rehabilitation services by persons with disabilities in Brazil: A multivariate analysis from Andersen’s behavioral model

Background For many years, discussions about health care for people with disabilities (PwD) in Brazil have not been treated as a priority; however, based on the advances made at the beginning of this century, new policies have been developed with the aim of improving access of these people to health services. Therefore, the aim of this study was to analyze how individual characteristics and contextual indicators are associated with access to rehabilitation services for PwD in Brazil. Methods A multivariate analysis was performed based on data from the National Health Survey 2013, considering access to rehabilitation services by PwD as the primary outcome and individual and contextual factors selected from Andersen’s behavioral model as independent variables. The contextual variables were reduced to two composite indicators (1-primary health care coverage and unfavorable socioeconomic conditions, and 2-economic inequality) from the analysis of the principal components. Poisson regression analysis with robust variance was performed to estimate the prevalence ratio (PR) and the respective 95% confidence interval (95%CI). Results Access to rehabilitation services by PwD was more prevalent in people aged 0 to 17 years (PR = 3.28; 95%CI 2.85–3.78), who are illiterate (PR = 1.24; 95%CI 1.09–1.40), whose socioeconomic level is A or B (PR = 1.60; 95%CI 1.35–1.88), who have health insurance (PR = 1.31; 95%CI 1.15–1.49), who have severe limitations (PR = 3.09; 95%CI 2.64–3.62), who live in states with a good offer of Specialized Rehabilitation Centers, both type II (PR = 1.20; CI95% 1.08; 1.33) and type IV (PR = 1.29; CI95% 1.15; 1.44), and who have greater coverage of primary health care, but unfavorable socioeconomic conditions (PR = 1.15; CI95% 1.03–1.28). Conclusion The results clarify the social inequities that exist regarding access to rehabilitation services for PwD in Brazil and highlight the need to formulate and implement public policies that guarantee the realization of the rights of these people.

Health Care–Seeking Behavior in a Scheduled Tribe Community in India: A Mixed-Methods Research Using the Framework of Andersen’s Behavioral Model

India’s scheduled tribe population very often bears the brunt of inequity in accessing health care. The mixed-method research assessed the health care–seeking behavior (HSB) of a tribal community residing in the eastern fringes of Kolkata metropolis. An adult, preferably the head, in 209 households was interviewed followed by qualitative interviews with relevant stakeholders. Conceptual framework of Andersen’s behavioral model helped in identifying the potential predisposing, enabling, and need factors that influenced HSB. A total of 25.4% respondents reportedly sought informal care during last illness episode. Multivariable hierarchical-regression model (Nagelkerke R2 = 0.381) showed that respondents’ education level (adjusted odds ratio [AOR]; 95% confidence interval [CI]: 2.52 [1.22-5.21]), household size (AOR [95% CI]: 3.14 [1.41-6.95]), nonenrollment to health insurance (AOR [95% CI]: 2.47 [1.08-5.59]), decision making by household head (AOR [95% CI]: 2.40 [1.23-4.71]), distance from the nearest urban primary health center (AOR [95% CI]: 3.18 [1.44-7.03]), and poor perception to illness severity [AOR [95% CI]: 2.24 [1.07-4.72]) were significantly associated to inappropriate HSB. Predominant health system barriers that emerged from qualitative interviews were irregular logistics, unfavorable outpatient timing, absence of female doctors, and nonretention of doctors at local urban primary health center. Community level barriers were poor awareness, self-medication practices, poor health insurance coverage, and poor public transportation. Recognition of these determinants may help in developing health promotion interventions tailored to their needs.

Analysis of the Elders’ Intentions for Care and Its Influencing Factors Based on Andersen’s Behavioral Model

Background Aging is a very pressing global situation, and with it comes the issue of care for the elderly. The objectives of this study were: ⑴ to understand the elders’ intention for care in Henan, China, and ⑵ to explore the association of intention based on Andersen’s Behavioral Model. Methods With multi-stage stratified cluster sampling, base on Andersen’s Behavioral Model, from the predisposing factors, enabling factor, and demand factor studying the influence factors of the elderly‘s intention. Results Home-based care is the main choice for the elderly, followed by institutional care, and finally community care. Enabling factors to have the greatest influence in this study. Factors influencing aged intention included: living status and total net monthly household income (enabling factors) and disability, life abilities objectively (need factors). Conclusions Home-based care for the aged is the main intention in Henan province. Marital status, living style, and income all have a relatively large impact on their old-age willingness. Old people with different physical conditions should provide different services so that they can have a comfortable life in old age.