Conventional health care service utilization among cancer survivors that visit traditional and complementary providers in the Tromsø study: a cross-sectional study

Background Traditional and complementary medicine (T&CM) is commonly used among cancer patients worldwide. Cancer patients in Norway mainly visit T&CM providers in addition to conventional health care services. It is not known how their utilization of T&CM providers influences their use of conventional health care services. The aim of this study was to investigate the difference between the utilization of conventional health care services among cancer survivors that visit T&CM providers and those that do not, and their associated factors. Method Health care service utilization data were obtained from cancer survivors 40 years and above participating in the Tromsø Study: Tromsø 7 conducted in 2015–2016. Data were collected from self-administered questionnaires. Pearson chi-square tests, Fisher exact tests, t-test, and logistic regression were used, with the significance level considered at p < 0.05. Results Of 1553 individuals, 10% (n = 155) reported visiting T&CM providers in the past 12 months. As both cancer survivors visiting and not visiting T&CM providers were frequent users of conventional health care, no significant differences were found in the overall use of conventional health care (98.1vs.94.5%, p = .056). Users of T&CM providers were however more likely to visit physiotherapists (40.1% vs 25%, p < .001), emergency rooms (29.2% vs 16.5%, p < .001), chiropractors (17% vs 6%, p < .001), and psychologist/psychiatrist (8.9% vs 3.4%, p < .001). They also had more frequent visits to conventional health care (11.45 vs 8.31 yearly visits, p = 0.014), particularly to general practitioners (5.21 visits vs. 3.94 visits, p = .002). Conclusion Results from this study show that visits to T&CM providers are associated with more visits to conventional health care services among cancer survivors. Further studies are needed to investigate the reasons for this high use behavior.

Association between health insurance enrolment and maternal health care service utilization among women in Ethiopia

Background Health insurance was considered as the third global health transition which can increase access to health care services by eliminating monetary obstacles to maternal health care use, particularly in emerging nations. Hence, this study aimed to assess the association between health insurance enrolment and maternal health care service utilization among women in Ethiopia. Methods A cross-sectional study was conducted using the 2016 Ethiopia Demographic and Health Survey (EDHS) data set. About 4278 mothers who had delivered at least one child in the last five years of the survey were selected in the study. Multivariate logistic regression analysis was performed to measure the relationship between health insurance enrolment and maternal health care service utilization by controlling confounders An adjusted odds ratio with a 95% confidence interval and p-values < 0.05 were well-thought-out to state the imperative association. Results The overall health insurance coverage among the women was 4.7%. About, 18.1% of women from households in the poorest wealth quantile had no health insurance coverage for maternal health care services. Moreover, 84% of women lived in a rural area did not enclose by health insurance. According to multivariate logistic regression, the likelihoods of ANC utilization were 1.54 times (AOR: 1.54; 95% CI: 1.06–2.25) higher among mothers who were enrolled in health insurance compared to their counterparts. In the same vein, the likelihoods of been attended by a skilled birth attendant were 1.84 times (AOR: 1.84; 95% CI: 1.1–3.08) higher among mothers who were enrolled in health insurance. Conclusions This study has shown that women enrolled in health insurance were associated with skilled delivery and recommended ANC utilization than women who did not enroll in health insurance. Health insurance enrolment enterprises must be available to all pregnant women, particularly those of poorer socioeconomic rank.

Factors that influence healthcare service utilization during COVID-19 pandemic among pregnant women and caregivers with children under two years in Rongo sub-county, Migori County, Kenya

Background: Health systems have failed in past epidemics to maintain delivery of routine health essential services. Most resources including human and essential supplies are all diverted to address health emergency, sometimes resulting in lack of important basic and routine health services.Methods: This was a retrospective cross-sectional study with mixed data collection methods, where respondents were asked questions on how COVID-19 affected them with regard to utilization of MCH healthcare during the first peak of the COVID-19 in Kenya. Two high volume facilities were selected purposively based on volume and capacity of services offered. A random sample was drawn from the stratum using a list generated by community health workers (CHWs) attached to the health facilities. Key informant interviews were used to collect data among health care providers and structured questionnaire was used for pregnant women and caregivers. Independent variables, social distancing, social stigma, communication and human mobility restriction were associated with health care service utilization and significant at 0.05 p value.Results: Correlation analysis indicated social stigma (r-0.407, p<0.512), social distancing (r-0.324, p<0.001) and human mobility restrictions (r-0.606, p<0.001) negatively influenced service utilization. Whereas COVID-19 related communication (0.631, p<0.001) was protective and thus promoted service utilization. The hierarchical linear regression model explained 67.73% of the total variations in the health care service utilization, which was r=0.6773.Conclusions: From the findings social stigma, communication, social distancing and human mobility restrictions influence health care service utilization. Ministry of health should strengthen targeted community outreaches for pregnant women and caregivers with children under two years.

CULTURAL COMPETENCE OF HEALTH CARE WORKERS ON MATERNAL HEALTH CARE SERVICE UTILIZATION AMONG MOTHERS OF MOUNT ELGON CONSTITUENCY BUNGOMA, KENYA

Purpose: To determine cultural competence of health care workers on maternal health care service utilization among mothers of Mt. Elgon Constituency in Bungoma County. Methodology: A descriptive-analytical cross-sectional study design was adopted using mixed methods for data collection. Cultural competence tool was used to assess health care workers cultural competence. Qualitative data was collected using key informant interviews (KII) and focus group discussion (FGD). Data entry and analysis was done using SPSS Version 25 software. Descriptive and inferential statistical analyses were used. Bivariate and multivariate logistic regressions were applied and odds ratio used to determine the strength of association. A p-value of ≤ 0.05 was considered as statistical significance threshold. Findings: Unemployment (OR: 0.6; 95% CI: 0.4 – 0.9; p = 0.02); lack of mobile clinic (OR: 0.7; 95% CI: 0.4 – 1.0; p = 0.06 ); use of interpreter (OR: 0.2; 95% CI: 0.01 – 0.81; p = 0.02); service provided in public facilities (OR: 0.5; 95% CI: 0.3 – 0.8; p = 0.004); being too busy (OR: 0.5; 95% CI: 0.3 – 0.9; p = 0.02); consulting health care workers (OR: 0.5; 95% CI: 0.2 – 0.9; p = 0.03); not consulting elders (OR: 0.7; 95% CI: 0.4 – 1.0; p = 0.08) and culturally incompetent ( 100%) were significantly associated with utilization of maternal and child health services. The determinants of maternal health care service utilization in Mt. Elgon Sub-County are women who are employed (OR: 2.8; 95% CI: 1.1 – 7.3; p=0.03) and cultural incompetence of health care workers (100%). A unique contribution to theory, practice, and policy: The study findings have identified cultural competence gaps among health care workers which need to be addressed by policy makers to increase utilization in the study area and other similar environment

A longitudinal analysis of violence and healthcare service utilization in Mexico

Objectives We analyze the degree to which community violence in Mexico, largely due to organized crime violence, affects health care service utilization. Methods This study exploits temporal and geographic variation in monthly county-level homicide rates, matching outpatient service utilization from individual longitudinal measures. Sensitivity analyses test for an age specific concentration of violence, respiratory conditions that are likely unrelated to violence, insurance status and health center availability per capita. We test for distributional responses to violence by urban and rural localities. Results The likelihood of service utilization increases by 5.2% with each additional homicide per 100,000. When we include self-reported health conditions in the model, our main coefficient remains significant at 4.5%. We find no added effect to our results from interaction terms for age specific concentration of violence, respiratory conditions, insurance status, or health center availability. A substantial increase of 11.7% in the likelihood of service utilization occurs in localities with > = 100,000 inhabitants, suggesting that service utilization is sensitive to the location of violence. Conclusions Results highlight the relationship between and increase in violence at the local level and an increase in health care service utilization. This study is among the first to examine this relationship empirically in Mexico. Future research is needed to shed more light on this relationship and its mechanisms.

Challenges Faced by Mexican Americans when Accessing Mental Health Care Service Utilization along the South Texas – Mexico border

The purpose of this study was to explore and describe the challenges Mexican Americans face when accessing mental health care service utilization along the South Texas-Mexico border. Disparities in access and use of health and mental health services have led Latinos to be disproportionately represented among those most at-risk for chronic health and mental health illnesses and less likely to receive guideline congruent care. Research on mental health service utilization has documented the presence of economic, cultural, and structural barriers that contribute to the underutilization of health services by Latinos. Researchers conducted three focus groups with 25 mental health providers in the South Texas-Mexico border region. Researchers followed a semi-structured question list and probed for detail from group participants. Kleinman’s Explanatory Model [1] guided the question list. The researchers used ethnographic content analysis to analyze the transcripts. Providers reported several challenges when it came to accessing mental health services. The challenges included limited access to insurance, minimal knowledge of mental health, lack of family involvement, few providers, medication management, stigma, and culture.