A scoping review on the experiences and preferences in accessing diabetes-related healthcare information and services by British Bangladeshis

Diabetes is a chronic condition requiring lifelong self-management. Patients are encouraged to access appropriate services to facilitate optimum management of diabetes. Although equitable access to healthcare in the United Kingdom is a legal right, not all groups and individuals in the community experience equity. Despite various equality laws and numerous efforts to minimise health inequalities related to access, particular community groups are more likely to experience inequitable access than others. The Bangladeshi community are one such community who experience some of the worst diabetes-related health outcomes in the United Kingdom. Little is known about their experiences and preferences in accessing diabetes healthcare information and services. Consequently, we undertook a scoping review of the literature by following the York Scoping Reviews Framework to identify the experiences and preferences of Bangladeshi patients and carers when gaining access to diabetes-related healthcare information and services. We identified eight articles and reported our results in relation to four domains of access: health service availability, health service utilisation, health service outcomes and the notion of equity. The review identified that language and literacy issues were the most common barriers hindering access to information and services. Patient knowledge regarding diabetes and its management was generally low, and friends and family were frequently being used as information sources and as informal interpreters. Additionally, there were feelings of isolation from mainstream information and services possibly resulting in the high prevalence of depression in the Bangladeshi community with women more affected than men. Social networks combined with religious and cultural beliefs as well as wider societal duties played a crucial role in accessing information and services for this population, and the identification of these issues merit further research and are possible avenues towards improved access to healthcare information and services for the Bangladeshi population.     

Rating maternal and neonatal health services in developing countries

OBJECTIVE: To assess maternal and neonatal health services in 49 developing countries. METHODS: The services were rated on a scale of 0 to 100 by 10 - 25 experts in each country. The ratings covered emergency and routine services, including family planning, at health centres and district hospitals, access to these services for both rural and urban women, the likelihood that women would receive particular forms of antenatal and delivery care, and supporting elements of programmes such as policy, resources, monitoring, health promotion and training. FINDINGS: The average rating was only 56, but countries varied widely, especially in access to services in rural areas. Comparatively good ratings were reported for immunization services, aspects of antenatal care and counselling on breast feeding. Ratings were particularly weak for emergency obstetric care in rural areas, safe abortion and HIV counselling. CONCLUSION: Maternal health programme effort in developing countries is seriously deficient, particularly in rural areas. Rural women are disadvantaged in many respects, but especially regarding the treatment of emergency obstetric conditions. Both rural and urban women receive inadequate HIV counselling and testing and have quite limited access to safe abortion. Improving services requires moving beyond policy reform to strengthening implementation of services and to better staff training and health promotion. Increased financing is only part of the solution.     

The Focus They Deserve: Improving Women Veterans’ Health Care Access

PurposeVeterans Health Administration (VHA) initiatives aim to provide veterans timely access to quality health care. The focus of this analysis was provider and staff perspectives on women veterans' access in the context of national efforts to improve veterans’ access to care.MethodsWe completed 21 site visits at Veterans Health Administration medical facilities to evaluate the implementation of a national access initiative. Qualitative data collection included semistructured interviews (n = 127), focus groups (n = 81), and observations with local leadership, administrators, providers, and support staff across primary and specialty care services at each facility. Deductive and inductive content analysis was used to identify barriers, facilitators, and contextual factors affecting implementation of initiatives and women veterans’ access.ResultsParticipants identified barriers to women veterans' access and strategies used to improve access. Barriers included a limited availability of providers trained in women's health and gender-specific care services (e.g., women's specialty care), inefficient referral and coordination with community providers, and psychosocial factors (e.g., childcare). Participants also identified issues related to childcare and perceived harassment in medical facility settings as distinct access issues for women veterans. Strategies focused on increasing internal capacity to provide on-site women's comprehensive care and specialty services by streamlining provider training and credentialing, contracting providers, using telehealth, and improving access to community providers to fill gaps in women's services. Participants also highlighted efforts to improve gender-sensitive care delivery.ConclusionsAlthough some issues affect all veterans, problems with community care referrals may disproportionately affect women veterans’ access owing to a necessary reliance on community care for a range of gender-specific services.     

Acculturation, access to care and use preventive health services by Vietnamese women

PURPOSE OF THE PAPER. The purposes of this study were to examine the relationships between acculturation and (1) access to health services and (2) use of preventive services among Vietnamese women in western Massachusetts. METHODS. The telephone survey method was conducted with 141 Vietnamese women ages 18 years or over. PRINCIPAL FINDINGS. Of the acculturation variables, language acculturation was significantly related to having a routine place for health care and a regular provider. Women tended to have better access to health service with an increase in the length of residence in the US. Length of residence in the US was an independent predictor of prior use of Pap test and clinical breast examination. CONCLUSIONS. Utilization level of preventive health services among study group participants was low. The findings indicate that length of residence and increase in language capacity (more English usage) lead to more adequate access to health care. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS. This study is particularly relevant to Vietnamese American women in the U.S. KEY WORDS. Vietnamese women; acculturation; preventive heaslth services; Massachusetts.     

Factors conditioning primary care services utilization. Empirical evidence and methodological inconsistencies

INTRODUCTION: In Spain, the degree and characteristics of primary care services utilization have been the subject of analysis since at least the 1980s. One of the main reasons for this interest is to assess the extent to which utilization matches primary care needs. In fact, the provision of an adequate health service for those who most need it is a generally accepted priority. FACTORS CONDITIONING USE: The evidence shows that individual characteristics, mainly health status, are the factors most closely related to primary care utilization. Other personal characteristics, such as gender and age, could act as modulators of health care need. Some family and/or cultural variables, as well as factors related to the health care professional and institutions, could explain some of the observed variability in primary care services utilization. Socioeconomic variables, such as income, reveal a paradox. From an aggregate perspective, income is the main determinant of utilization as well as of health care expenditure. When data are analyzed for individuals, however, income is not related to primary health utilization. METHODOLOGICAL INCONSISTENCIES: The situation is controversial, with methodological implications and, above all, consequences for the assessment of the efficiency in primary care utilization. Review of the literature reveals certain methodological inconsistencies that could at least partly explain the disparity of the empirical results. Among others, the following flaws can be highlighted: design problems, measurement errors, misspecification, and misleading statistical methods.Some solutions, among others, are quasi-experiments, the use of large administrative databases and of primary data sources (design problems); differentiation between types of utilization and between units of analysis other than consultations, and correction of measurement errors in the explanatory variables (measurement errors); consideration of relevant explanatory variables (misspecification); and the use of multilevel models (statistical methods).     

Exploring the influence of family level and socio-demographic factors on women’s decision-making ability over access to reproductive health care services in Balkh province,Afghanistan

Abstract

In this paper, we analyze the family level and socio-demographic factors affecting women’s decision-making ability over access to reproductive health care services in rural communities of Balkh province, Afghanistan. A questionnaire survey was conducted with a total of 176 married women. Using logistic regression analysis, we found that four out of seven variables significantly influenced women’s decision-making ability over access to Reproductive Health Care Services (RHCS): extended family structure (OR = 14.31, p?<?0.01), husbands accompanying their wives to RHCS (OR = 4.12, p?<?0.05), discussing issues related to reproductive health with partner (OR = 3.57, p?<?0.05), and distance from home to a health facility (OR =0.86, p?<?0.01). Therefore, some policies or programs designed to improve husband-wife communication, in particular fostering discussions related to reproductive health and encouraging husbands to accompany their wives to health centers, are recommended to improve women’s decision-making ability over access to RHCS.     

Politics and inter-medicality in the Upper Xingu: from model to practice in indigenous health care

The indigenous healthcare model in Brazil is premised on comprehensive care combined with the notion of differentiated care and provides for respect for cultural diversity, seeking to incorporate traditional therapeutic practices into the health services that serve indigenous peoples. This study aimed to determine how to reconcile universal access to health goods and services with a model of care that guarantees differentiation, without interfering in the quality of services. It is also necessary to define which parameters should be used for evaluating the quality and efficacy of such services in an intercultural context. Based on a case study - the implementation of health services in the Upper Xingu - the author addresses some issues related to the political uses and "dangers" associated with "health spaces" and the distinct concepts (indigenous and non-indigenous) of what constitutes health and quality of health services. These issues affect not only health services but also the local political situation.     

Correlates of mammography screening among Hispanic women living in lower Rio Grande Valley farmworker communities.

Factors contributing to the underuse of mammography screening by female Hispanic farmworkers aged 50 years and older in the Lower Rio Grande Valley were determined through home-based, Spanish-language personal interviews (N = 200). Questions covered adherence to screening mammography guidelines (mammogram within 2 years), healthcare access, sociodemographic characteristics, and theoretical constructs related to breast cancer screening in the literature. Multivariate findings indicated that adherent women were 3.6 times more likely to have health insurance. Self-efficacy for obtaining a mammogram and decisional balance were also significantly related to adherence; age, income, and education variables were not associated, perhaps because of restricted variation. Results indicate continuing efforts are needed to ensure that medically underserved migrant farmworker women have access to health care services. In addition, efforts to increase their self-efficacy in obtaining a mammogram and to counter negative attitudes and opinions by stressing the positive prognosis associated with early detection are warranted.     

Influences on Women’s Care Seeking at Planned Parenthood Health Centers in Two Southern States

IntroductionIn the context of a shifting health care landscape, better understanding of the factors that motivate women to seek services from specialized family planning clinics like Planned Parenthood (PP) can provide insights about potential changes in the role of specialized family planning clinics.MethodsWe surveyed 725 women seeking services at two PP health centers in Louisiana and Kentucky from March 2016 to May 2017. We examined differences in care-seeking between women who had varying levels of access including those who did and did not have insurance instability or a regular source of care (RSOC) besides the clinic.ResultsMore than 60% of women attending the health centers did not have a regular source of care and nearly 40% experienced instability in insurance. Women who experienced insurance instability and a lack of a regular source of care more frequently sought primary preventive services such as pap tests and well-woman care at PP than women with better access. For women with better access, PP health centers also served important roles for those seeking contraceptive and sexually transmitted infection–related services. The most frequent reasons for choosing PP were that it was faster to get an appointment, wanting to go to the PP clinic more than other clinics, and the confidentiality of services.ConclusionsOur analysis suggests that PP health centers in Southern states still provide vital services for women with and without other sources of care and are critical for women needing access to timely services for preventive and sexually transmitted infection–related care.     

Factors related to the use of antenatal care services in Ethiopia: Application of the zero-inflated negative binomial model

The major causes for poor health in developing countries are inadequate access and under-use of modern health care services. The objective of this study was to identify and examine factors related to the use of antenatal care services using the 2011 Ethiopia Demographic and Health Survey data. The number of antenatal care visits during the last pregnancy by mothers aged 15 to 49 years (n = 7,737) was analyzed. More than 55% of the mothers did not use antenatal care (ANC) services, while more than 22% of the women used antenatal care services less than four times. More than half of the women (52%) who had access to health services had at least four antenatal care visits. The zero-inflated negative binomial model was found to be more appropriate for analyzing the data. Place of residence, age of mothers, woman’s educational level, employment status, mass media exposure, religion, and access to health services were significantly associated with the use of antenatal care services. Accordingly, there should be progress toward a health-education program that enables more women to utilize ANC services, with the program targeting women in rural areas, uneducated women, and mothers with higher birth orders through appropriate media.     

Use of health care services by women who use crack cocaine

Chronic drug users demonstrate a need for access to health care due to both acute health problems related directly to substance use and to other existing medical problems. This study attempts to examine how women differ from men in their utilization of health services. Also, it analyzes how crack use affects men and women differentially. The study population is a community-based sample of 624, comprised equally of men and women, as well as crack users and non-users of crack. Results indicate that women utilized health care more than men; however, crack use among women appears to be an inhibitory factor in the utilization of health services by women.     

Challenges Facing Minority Women in Achieving Good Health: Voices of Arab Women in Israel

ABSTRACT

Arab women citizens of Israel bear a heavier burden of health problems compared with Jewish women. These inequalities were examined by conducting 6 focus groups that explored obstacles to achieving good health and strategies for maintaining good health as articulated by 86 Arab-Moslem women from the Triangle area in central Israel. Perceived obstacles ranged from personal to socio-political: unhealthy lifestyles, obedience to patriarchal norms, rapid lifestyle transitions, the political situation, poverty and lower socioeconomic status, and limited access to specific health care services. These multi-layered obstacles appeared to operate synergistically to limit women's access to social support and health care systems, intensify feelings of powerlessness, and further promote unhealthy behaviors. Moreover, these perceptions differed by the socioeconomic status of the group. The relatively more advantaged groups did not address issues related to poverty or access to health care services. Most health maintenance strategies discussed were personal and conservative, and ‘considerate’ of traditional Arab cultural norms. The findings provide a basis for developing more culturally competent and adequate health care services for Arab women in Israel and for further research concerning Arab women's health in the region.     

The organization and financing of health services for persons with disabilities

Americans with disabilities are rarely considered a distinct group of health care users in the same way as are older Americans, children, racial and ethnic minorities, and others who are perceived to have different needs and access issues. Indeed, to some extent individuals with disabilities overlap with all these groups. But they also have distinct needs with material implications for the organization, delivery, and financing of health care services. Despite the disproportionate health care needs and expenditures of many--though not all--individuals with disabilities, the mainstream health services research community has largely neglected them. This article outlines the most pressing health service research issues in addressing the health care needs of individuals with disabilities.     

Access to health care, reproductive health and disability: a large scale survey in Sierra Leone

This is the first study to compare health status and access to health care services between disabled and non-disabled men and women in urban and peri-urban areas of Sierra Leone. It pays particular attention to access to reproductive health care services and maternal health care for disabled women. A cross-sectional study was conducted in 2009 in 5 districts of Sierra Leone, randomly selecting 17 clusters for a total sample of 425 households. All adults who were identified as being disabled, as well as a control group of randomly selected non-disabled adults, were interviewed about health and reproductive health. As expected, we showed that people with severe disabilities had less access to public health care services than non-disabled people after adjustment for other socioeconomic characteristics (bivariate modelling). However, there were no significant differences in reporting use of contraception between disabled and non-disabled people; contrary to expectations, women with disabilities were as likely to report access to maternal health care services as did non-disabled women. Rather than disability, it is socioeconomic inequality that governs access to such services. We also found that disabled women were as likely as non-disabled women to report having children and to desiring another child: they are not only sexually active, but also need access to reproductive health services. We conclude that disparity in access to government-supported health care facilities constitutes a major and persisting health inequity between persons with and without disabilities in Sierra Leone. Ensuring equal access will require further strengthening of the country's health care system. Furthermore, because the morbidity and mortality rates of pregnant women are persistently high in Sierra Leone, assessing the quality of services received is an important priority for future research.     

“Yo No Sabía...”—Immigrant Women’s Use of National Health Systems for Reproductive and Abortion Care

Half of pregnancies worldwide are unintended; half of these end in abortion. Immigrant women encounter more obstacles to reproductive healthcare than non-immigrant women, and access to national healthcare is a particularly important factor in abortion access. Spain’s government recently liberalized abortion laws, including abortion services in the national health system available to immigrants. Evidence suggests that immigrant women in Spain experience difficulties navigating the health system—the impact of the changed abortion laws on immigrant’s women’s access to care is not yet clear. Through a literature review and analysis, this paper examines the experiences of immigrant women with national health systems, and their use of such systems for reproductive and abortion care, in order to explore what could be expected in Spain as the national health system expands to include abortion care, and to illuminate immigrant women’s experiences with using national health systems for reproductive healthcare more broadly.     

Determinants of the use of maternal health services in rural Bangladesh

Utilization of health services is a complex behavioral phenomenon. Empirical studies of preventive and curative services have often found that use of health services is related to the availability, quality and cost of services, as well as to social structure, health beliefs and personal characteristics of the users. In this paper an attempt is made to examine the factors associated with the use of maternal health care services in Bangladesh on the basis of data from a survey of maternal morbidity in Bangladesh, conducted by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERHT). The results from both the bivariate and multivariate analyses confirmed the importance of mother's education in explaining the utilization of health care services. Female education retains a net effect on maternal health service use, independent of other women's background characteristics, household's socioeconomic status and access to healthcare services. The strong influence of mother's education on the utilization of health care services is consistent with findings from other studies. Women whose husbands are involved in business/services also positively influenced the utilization of modern health care services. However, the study results are inconclusive with respect to the influence of other predisposing and enabling factors, such as women's age, number of previous pregnancies and access to health facilities. Multivariate logistic regression estimates do not show any significant impact of these factors on the use of maternal health care. The influence of severity of disease condition in explaining the utilization of maternal health care appears to be significant. Multivariate analysis indicate that women having had a life-threatening condition are little over two times more likely to seek care from a doctor or nurse to treat their maternal morbidities.     

Eliminating mother-to-child HIV transmission will require major improvements in maternal and child health services

Although some low- and middle-income countries have made progress toward eliminating mother-to-child transmission of HIV, others lack health systems that can deliver accessible and reliable care. We modeled how access to maternal and child health services and the effective delivery of interventions would affect efforts to eliminate HIV transmission during pregnancy and after childbirth in low- and middle-income countries. In countries with high HIV rates, our model predicts transmission rates of 19.7 percent at current levels of access and efficiency of maternal and child health and HIV treatment. Even if current treatment programs were carried out at or near perfect levels, we predict that significant residual mother-to-child transmission (7.9 percent) would remain. The model suggests that under current conditions, poor access to routine health services contributes three times more to overall mother-to-child HIV transmission than do current suboptimal levels of efficiency of anti-HIV-transmission interventions. We conclude that current efforts to optimize programs to prevent mother-to-child HIV transmission will not, on their own, eliminate HIV in newborns. Access to maternal and child health services will need to be dramatically improved, as will prevention measures, such as identifying and treating HIV before pregnancy.     

Disparities in women's health and health care experiences in the United States and Israel: findings from 1998 National Women's Health Surveys

OBJECTIVE AND METHODS: Using data from bi-national 1998 surveys of adult women in the U.S. and in Israel, this article examines health, access, and care experiences among women in two countries with very different health care systems. We examine how well each country's system serves those vulnerable due to lower socio-economic status. The Israeli health care system-characterized by universal coverage for all its residents-relies on a system of competing health funds that employ many features typical of U.S. managed care plans. The analysis explores the extent to which such a system helps to equalize access experiences with contrasts to the experiences of U.S. women. FINDINGS: We find that U.S. and Israeli women report similar rates of disability and chronic conditions with prevalence of health problems sharply higher for low income and less educated women. We also find disparities in access: women in both countries reported unequal access experiences by education and income. In Israel, these experiences appear to be linked to health plan structural features rather than cost barriers. CONCLUSION: The findings indicate that achieving more equitable access to health care requires attention to non-financial as well as financial barriers to care. Despite the lack of financial barriers to care in Israel, administrative controls typical of managed care organizations appear to make health care systems difficult to navigate for low income and less educated women. The finding that disparities in health persist in a country with universal coverage indicates that improving women's health will require attention to broader social influences on health as well as improving access to health care.     

Barriers to hospital births: why do many Bolivian women give birth at home?

OBJECTIVES: This study investigated the low rates of hospital/health center births recorded in Yapacaní, Bolivia, that persist despite the national maternal-infant insurance program designed to ensure equitable access to free center-based health care services for pregnant women. The purpose of this study was to identify the multilevel factors inhibiting access to and utilization of public health centers for labor and delivery. METHODS: Qualitative research methods were used, including participant observation, semistructured interviews of 62 community members, and key informant interviews with eight regional experts. Data were coded and analyzed using the grounded theory approach. RESULTS: From the semistructured interview data, five reasons for the low rate of institutional births and their frequency were identified: (1) fear or embarrassment related to receiving care at a public health care center (37%); (2) poor quality of care available at the health care centers (22%); (3) distance from or other geographic issues preventing timely travel to health care services (21%); (4) economic constraints preventing travel to or utilization of health care services (14%); and (5) the perception that health care services are not necessary due to the experience of "easy birth" (6%). CONCLUSIONS: The reasons for the low rate of births in public health centers exist within the context of deficient resources, politics, and cultural differences that all influence the experience of women and their partners at the time of birth. These large scale, contextual issues must be taken into account to improve access to quality health care services for all Bolivian women at the time of birth. Resources at the national level must be carefully targeted to ensure that governmental services will successfully instill confidence in Bolivian women and facilitate their overcoming the cultural, geographic, economic, and logistical barriers to accessing "free" services.     

'Reasonable access' to primary care: assessing the role of individual and system characteristics

Access to health care continues to be an important issue for health policy makers, researchers, service providers and consumers alike. In countries with universal health care coverage, services are generally free at the point of delivery which is intended to provide equitable access to care for all residents regardless of their individual situations. Past studies have pointed to the importance of individual characteristics such as age, gender, and socioeconomic status in shaping access to health care but much less is known about the role of health system characteristics. The purpose of this study is to explore, by means of qualitative research methods, the extent to which individual and system factors shape access to primary health care services for residents living in two contrasting neighbourhoods in Hamilton, Ont., Canada. Semi-structured, in-depth interviews were conducted with 40 men and women. The interviews probed participants about their experiences with primary care, barriers to receiving care and their general perceptions of the health care system. The interviews demonstrated the existence of many system-related barriers to receiving health care (e.g., wait times, geographic inaccessibility and quality of care) and some individual-related barriers (e.g., work or family responsibilities). While the findings revealed little difference between the neighbourhoods in terms of accessibility problems and barriers, differences between men and women were evident.