An examination of sociocultural factors associated with cervical cancer screening among low-income Latina immigrants of reproductive age

The purpose of this study was threefold: 1) to examine whether low-income Latina immigrants were less likely to receive a Pap smear than low-income non-Latinas; 2) to examine ethnic differences regarding cervical cancer knowledge; and 3) to examine the sociocultural factors associated with cervical cancer screening among low-income Latina immigrants. Participants included 225 low-income women of reproductive age attending a WIC (Women, Infants, and Children) clinic (50% Latina immigrants and 50% non-Latinas). Latina immigrants were less educated, less likely to have health insurance, and more likely to be married or living with a partner than non-Latinas (ps < 0.05). All non-Latinas had a Pap smear in the past compared to 81.3% of Latina immigrants (p < 0.001). Latina immigrants displayed significantly less knowledge regarding cervical cancer than non-Latinas (ps < 0.01). Latina immigrants tended to display culturally based knowledge and beliefs regarding cervical cancer and screening that may influence getting a Pap smear.     

四川省城乡居民就医路径及医疗机构选择的影响因素研究

目的 通过纵向随访数据分析四川省城乡居民的就医路径特征和就医机构选择的影响因素。方法 从四川省第五次卫生服务调查的样本区(县)中抽取1个城市点和1个农村点,监测居民3个月的卫生服务利用行为,定性描述居民就医路径特征,采用重复测量资料的多水平Logistic模型分析就诊医疗机构选择的影响因素。结果 患病后,城市点以遵医嘱治疗为主,农村点则以就诊为主;就诊时,城市以县(市、区)级医疗机构为主,农村以基层医疗机构为主;影响就诊医疗机构选择的因素有就业状况、是否患有慢性疾病。结论 四川省城乡居民就医路径特征不同,城市居民就诊机构的流向存在不合理分布。应加强城市点分级诊疗制度的推行,规范城市居民就医行为。     

肺结核可疑症状者求医行为模式及影响因素

我国是全球22个结核病高负担国家之一^[1].提高患者发现率是我国控制结核病的重点和难点,而肺结核可疑症状者的求医行为模式是决定发现率的关键因素.国外对肺结核可疑症状者求医行为模式的研究多是以社区为基础,而我国的研究则多以医院为基础,鲜见针对社区人群的研究^[2,3],其结论难以代表社区中全部可疑症状者.为此本文综述肺结核可疑症状者的求医行为及影响因素,为改善求医行为模式,提高我国结核病患者发现率提供参考依据.     

四川省城乡居民就医行为现状及其影响因素分析

目的了解四川省城乡居民就医行为的现状及其影响因素。方法基于2018年四川省卫生服务调查数据描述四川省城乡居民两周内患病就诊及就诊机构选择的基本特征,采用多水平logistic回归分析居民两周内患病是否就诊以及就诊机构选择的影响因素。结果居民两周患病率为41.7%,其中选择就诊的比例为46.4%;影响居民患病后是否就诊以及就诊机构选择的因素主要是居民是否患有慢性病、自感患病伤的严重程度、病伤的持续天数和患者受教育程度(均P<0.05);基本医疗保险类型是就诊机构选择的重要影响因素(P<0.05);居民选择就诊机构并无城乡差异,但少数民族地区的居民选择基层医疗机构就诊的可能性是非少数民族地区居民的2.627倍(P<0.001)。结论四川省居民两周患病后就诊的比例较低,应进一步完善不同类型基本医疗保险制度,提高基层医疗机构服务水平并加强健康教育,合理规范居民就医行为。     

男性绝育者健康状况及就医行为分析

目的 了解绝育术后男性一般健康状况及就医行为,为推进男性绝育术提供科学依据。方法 采用分层随机整群抽样的方法抽取已施行男性绝育术的3264人为调查对象。采用自制调查表进行调查;采用SPSS12.0软件进行分析。结果 调查中,80.5%(2608人)的人自觉健康状况良好,仅19.5%(636人)的人感觉自身健康不佳。自感不适者选择不治疗或自已随便买药吃的人占31.6%,选择县、市以上医疗单位就医者仅占5.7%,选择乡卫生院者占12.0%,选择计生服务站占50.5%。结论 男性绝育术者健康情况良好,卫生服务利用水平低,计生服务者应加强对于男性绝育者的关心。     

福建省城乡居民就医行为和应急能力调查及其影响因素分析

目的了解福建省城乡居民就医行为和应急能力及其影响因素,为有效解决因不合理就医导致的医疗资源浪费现象和因应急能力低下引发的对生命安全的威胁提供对策。方法采用分层多阶段随机抽样的方法对福建省城乡居民2041人进行调查。结果城乡居民拥有至少一种医疗保险的占95.6%,在身体感到不舒服时首先选择自行购药的占64.5%,城乡居民应急知识中知道正确拨打120急救电话的只有22.3%,知道怎么做心肺复苏的有18.4%,认识生物安全标识的有3.7%,89.9%的居民没有接受过合理就医的指导;94.3%的居民没有接受过心肺复苏的急救培训。年龄、离家最近的医疗机构为其他对应急能力的影响为负作用,文化程度、职业为专业技术人员、平均月收入在1000元以上、离家最近的医疗机构为社区卫生服务中心（站）和乡镇卫生院（村卫生所）对应急能力的影响为正作用。结论急需动员社会各有关部门利用各种机会对城乡居民进行正确就医和应急知识和技能的强化培训,以提高大众合理就医和应急能力。     

已婚流动妇女生殖道感染求医行为干预效果研究

目的:评估一项综合干预措施对促进已婚流动女性生殖道感染求医行为的影响。方法:2008年在青岛市随机选择5个工厂进行为期6个月的干预,干预前后分别对研究对象进行调查。结果:已婚流动女性生殖道感染症状的自我报告率为42.2%。干预前的就诊率为54.3%,干预后为74.8%,干预前、后就诊率有显著差异(P<0.001),调整后OR为2.50(95%CI:1.79～3.48)。结论:实施综合干预后,自觉有生殖道感染的流动女性更可能去寻求健康服务。     

甘肃省居民科学就医素养状况及影响因素

目的 了解甘肃省居民科学就医素养现状及影响因素,为开展有针对性的健康教育和健康促进工作提供科学依据。方法 2014年10-12月,采用多阶段概率与规模成比例（PPS）法随机抽取24个县区 6 487 名15~69岁居民,采用《中国居民健康素养调查问卷（2014版）》进行面对面调查。结果 甘肃省居民科学就医素养水平为15.7%,科学就医素养相关问题总体答对率为 51.8%;对“关于国家基本公共卫生服务的理解”和“全国统一的免费卫生热线电话号码”等问题的答对率较低,分别为 32.0%（2 079/6 487）和 9.5%（619/6 487）;认为“只要进了医院病就会好转”、“治不好病就是医院的责任”的居民分别占到29.4%（1 910/6 487）、21.6%（1 399/6 487）;认为“住院时间越长治疗效果越好”、“住院时间过短是医生不负责任的表现”的分别占23.2%（1 503/6 487）、10.5%（678/6 487）;认为“一生病就应该去大医院”的占18.5%（1 202/6 487）。单因素分析显示不同地域、性别、民族、年龄、文化程度、职业、家庭收入、家庭人口数、慢病患病情况、自评健康状况和健康素养的居民科学就医素养差异有统计学意义（P<0.05）。多因素logistic回归分析显示是否具备健康素养、家庭人口数、文化程度、职业以及家庭月收入是甘肃省居民科学就医素养的影响因素。结论 甘肃省居民科学就医素养水平较低,应进一步加大健康教育和健康促进工作力度,提高居民健康素养水平,引导居民合理利用医疗卫生资源,建立和谐医患关系。     

Environmental factors associated with primary care access among urban older adults

Disparities in primary care access and quality impede optimal chronic illness prevention and management for older adults. Although research has shown associations between neighborhood attributes and health, little is known about how these factors - in particular, the primary care infrastructure - inform older adults' primary care use. Using geographic data on primary care physician supply and surveys from 1260 senior center attendees in New York City, we examined factors that facilitate and hinder primary care use for individuals living in service areas with different supply levels. Supply quartiles varied in primary care use (visit within the past 12 months), racial and socio-economic composition, and perceived neighborhood safety and social cohesion. Primary care use did not differ significantly after controlling for compositional factors. Individuals who used a community clinic or hospital outpatient department for most of their care were less likely to have had a primary care visit than those who used a private doctor's office. Stratified multivariate models showed that within the lowest-supply quartile, public transit users had a higher odds of primary care use than non-transit users. Moreover, a higher score on the perceived neighborhood social cohesion scale was associated with a higher odds of primary care use. Within the second-lowest quartile, nonwhites had a lower odds of primary care use compared to whites. Different patterns of disadvantage in primary care access exist that may be associated with - but not fully explained by - local primary care supply. In lower-supply areas, racial disparities and inadequate primary care infrastructure hinder access to care. However, accessibility and elder-friendliness of public transit, as well as efforts to improve social cohesion and support, may facilitate primary care access for individuals living in low-supply areas.     

Impact of social factors on health status and help seeking behavior among migrants and Germans

Several studies show significant differences between Germans and migrants in health status, help-seeking behavior and utilization of health care facilities. Social factors are potential determinants partially explaining these differences. The main objective of the present cross-sectional study is to study the impact of social factors on health status and health care utilization including preventive services among Germans and migrants in the German health care system. A survey was conducted among 565 adults (mostly parents; 49% migrants, 51% Germans) accompanying their children at the compulsory medical school entry examination. The survey aimed at the self-reported health status of the adults, the help-seeking behavior, social and demographic variables as well as factors describing the ethnic background and the process of migration. As a result we found a statistically significant lower level of health care utilization for migrants compared to Germans whereas the self-reported health status was similar between Germans and migrants and not dependant on social factors. Social factors accounted for differences in health care utilization including the use of preventive services among both groups (Germans and migrants). Despite the ethnic background, a low social class was significantly associated with a decreased use of health care facilities among Germans and migrants compared to adults from a high social class. Further studies are needed to identify certain obstacles to utilizing the German health care system by adults from a low social class. Public health interventions could be suitable for addressing these difficulties.     

Contextual effects on health care access among immigrants: Lessons from three ethnic communities in Hawaii

Immigrant health care is the product of the dynamic interaction between societal factors and the individual's socio-economic and cultural characteristics. Our knowledge about immigrant health care, however, has been limited to individual characteristics, without paying attention to the social context in which immigrants reside. This paper explores the effects of social contexts on access to health care among recent immigrants. As a natural experiment, it compares health care experiences of three immigrant groups in Hawaii – Filipinos, Koreans, and Marshallese – who are situated in different social contexts including immigrant health policy, ethnic community, and individual networks. Through household surveys conducted between October 2005 and January 2006, information of 378 recent immigrant adults on health care access, health insurance status, socio-demographic characteristics, linguistic and cultural factors, health status, ethnic community social capital, and social networks was obtained. The results of analyses show that Marshallese respondents have better access to health care than the other two groups, in spite of their lowest socioeconomic status. The high insurance rate of the Marshallese, mainly associated with a state health policy that provides health insurance assistance for the Marshallese, is the major contributor of their greater health care access. While Filipino immigrants do not benefit from state insurance assistance, high levels of health care resources and social capital within the Filipino community enable them to have significantly better health care access than Koreans, who have higher income and educational attainment. Interestingly, the advanced family/kinship networks are associated with better levels of immigrant health care access, while the increase of co-ethnic friend networks is related to lower access to health care. This study implies that restoration of immigrants' eligibility for public health insurance assistance, development of health care resources and social capital within ethnic communities, and mobilization of immigrant networks would be effective starting points to improve health care access among immigrants.     

苏北农村地区县级医院门诊慢性咳嗽患者就医行为和医疗可及性的影响因素探讨

目的 评价社会经济因素和人口学因素对于慢性咳嗽患者(潜在结核病患者)就医行为的影响。方法 描述慢性咳嗽患者从开始咳嗽至就诊的首诊延误以及从开始咳嗽至正规医疗机构就诊的正式就诊延误情况,通过x~2检验、Kaplan-Meier生存分析、Cox回归和logistic多元回归等方法分析影响患者就诊延误的因素,并对患者的首诊医疗机构选择和痰检情况进行分析。结果 结核病控制项目县和非项目县在慢性咳嗽患者延误时间上存在差异,职业,医疗制度是影响患者就医行为的主要因素,其中未成年人与农民相比到医疗机构(RR=1.66,95％CI:1.16～2.38)尤其是乡以上医院就诊的机会多(RR=1.90,95％CI:1.27～2.84);未成年人相对农民多选择乡及乡以上医院作为首诊机构(RR=2.06,95％CI:1.12～3.80);公费比自费患者有更多的机会去乡及乡以上医院就诊(RR=1.64,95％CI:1.35～2.10)。在综合医院就诊的咳嗽满2周的患者中仅有约2.5％获得痰检建议。结论 职业和医疗保险是影响慢性咳嗽患者就医行为和医疗可及性的重要因素。无论是在结核病控制项目县还是非项目县,慢性咳嗽尚未成为综合医院医生诊断结核病的一个重要警示症状。     

广西感染性腹泻病例求医行为特征及影响因素研究

目的了解广西居民腹泻病例的求医行为特征及其影响因素,为进一步行为干预提供依据。方法采用社区整群随机抽样,开展入户调查。从中筛选出腹泻病例,收集相关信息进行分析。结果夏、冬季节2次调查总共访问家庭11 865户,共42 330人。调查中收集腹泻病例442例,其中21.04%的病例未做任何治疗,50.90%的病例选择自行服药治疗,26.02%的病例到各级医疗机构门诊求医,2.04%的病例到医疗机构住院治疗。腹泻病例的单日最高腹泻次数、腹泻天数、病例年龄是求医行为强度的影响因素。冬季腹泻病例的求医行为强度高于夏季腹泻病例,城市腹泻病例和农村腹泻病例之间、男性腹泻病例和女性腹泻病例之间的求医行为强度差异无统计学意义。结论本次调查样本量大,收集腹泻病例多,抽样较为合理。广西居民对腹泻病这一类发病普遍、有自限性的疾病关注程度不高,其求医的意愿并不强烈,腹泻病就诊率较低。大部分病例选择自行服药治疗。居民对低年龄和高年龄的＂老幼＂人群的健康关注程度较高,其求医行为强度也相应较高。     

The effect of wealth status on care seeking and health expenditures in Afghanistan

This paper analyses the effect of wealth status on care-seekingpatterns and health expenditures in Afghanistan, based on anational household survey conducted within public health facilitycatchment areas. We found high rates of reported care-seeking,with more than 90% of those ill seeking care. Sick individualsfrom all wealth quintiles had high rates of care-seeking, althoughthose in the wealthiest quintile were more likely to seek carethan those from the poorest (odds ratio 2.2; 95% CI 1.6, 3.0).The nearest clinic providing the government's Basic Packageof Health Services (BPHS) was the most commonly sought firstprovider (53% overall), especially for relatively poor households(62% in poorest vs. 42% in least poor quintile, P < 0.0001).Sick individuals from wealthier quintiles used hospitals andfor-profit private providers more than those in poorer quintiles.Multivariate analysis showed that wealth quintile was the strongestpredictor of seeking care, and of going first to private providers.More than 90% of those seeking care paid money out-of-pocket.Mean (median) expenditures among those paying for care in theprevious month were 873 Afghanis (200 Afghanis), equivalentto US$17.5 (US$4). Expenditures were lowest at BPHS clinicsand highest at private providers. Financing care through borrowingmoney or selling assets/land (‘any distress’ financing)was reported in nearly 30% of cases and was almost twice ashigh among households in the poorest versus the least poor quintile(P < 0.0001). Financing care through selling assets/land(‘severe distress’ financing) was less common (10%overall) and did not differ by wealth status. These findingsindicate that BPHS facilities are being used by the poor wholive close to them, but further research is needed to assessutilization among populations in more remote areas. The highout-of-pocket health expenditures, particularly for privatesector services, highlight the need to develop financial protectionmechanisms in Afghanistan.     

孕期妇女生命知识现状及影响因素分析

目的 了解孕期妇女生命知识知晓现状并探讨相关影响因素，为针埘性开展孕期妇女生命知识健康教育提供理论依据。方法 随机抽取240名孕期妇女进行调查，采用面对面访谈形式获取孕妇关于孕期相关生命知识的资料；应用构成比和知晓率对资料进行描述，应用非条件Logistic回归分析探讨可能影响孕期妇女生命知识知晓率的因素。结果 孕期妇女生命知识知晓水平较低；影响孕期妇女生命知识知晓率的因素主要有家庭年均收入、对分娩的紧张情绪、与公婆关系和居住地4个因素。结论 卫生管理部门和妇幼保健人员应针对性地加强孕期妇女的健康教育工作，不断提高孕期妇女生命知识的知晓率、自我保健意识和防病技能，更好地保障孕期妇女的健康。     

Correlates of care seeking for infertility treatment in Europe: Implications for health services and research

Study: To compare care seeking and non-care seeking coupleswith infertility in order to describe potential differenceswhich may have consequences for health care planning and research.Design: multicentre surveys of randomly selected women of child-bearingage. Setting: seven centres in five countries: Denmark, Germany(two centres), Italy (two centres), Poland and Spain. Data werecollected from 1991 to 1993 as part of a European concertedaction. Participants: population-based samples of women between25 and 44 years. The samples ranged from 442 women in Polandto 2, 729 women in Italy. The participation rates ranged from54% in Germany to 88% in Poland. Data: data were collected duringface to face interviews by means of highly structured questionnaires.Questions were asked about life style factors, work exposures,pregnancy history, fecundity and care seeking behaviour. Mainoutcome measures: seeking medical advice and help for infertilityamong couples who had tried to become pregnant for more than12 months. Main results: nulliparity was the strongest predictorfor seeking help in all the European centres and more than 50%of the nulliparous women sought help in all the centres. Thefrequency of care seeking among couples with secondary infertilityvaried to a large extent between the different centres. Womenwith a paid job and smokers were less likely to seek help inmost centres (except in Spain and Italy). Conclusion: far fromall those with an infertility problem seek medical advice andhelp, and the correlates of care seeking differ to a large extentbetween different cultural and health care settings. Researchbased upon clinical samples could easily be biased if the topicof research correlates with care seeking behaviour.     

Heterogeneity in health seeking behaviour for treatment,prevention and urgent care in four districts in western Kenya

ObjectivesThe impact of effective, life-saving health interventions is limited by access to and use of health services. Health seeking behaviour is likely to vary geographically and by type of health concern. However, little is known about the extent of this heterogeneity.Study designA representative cluster-randomized sample of households in four districts in western Kenya was interviewed using a structured, interviewer-administered survey. GPS coordinates of all households and all local health facilities were also collected.MethodsHousehold surveys measured health seeking behaviour for three distinct health needs: family planning which is a form of prevention, delivery which is an urgent care need but can be planned in advance, and childhood febrile illness which is an unexpected and potentially life-threatening concern. Logistic regression models were used to explore the relationship between seeking health services and maternal and household characteristics, with special attention to geographic and financial access to care.ResultsUse of health services for these three different health issues varied between the districts and also differed from national estimates. Place of delivery was most strongly correlated with the type of health services available to the family, whereas family planning was correlated with the relationship of the mother to the head of household. There was no strong interaction between socio-economic status and distance to services.ConclusionsThe level of services available nearest to households rather than the distance to travel influences treatment-seeking behaviour, particularly for urgent care. Maternal factors and household wealth were often important but, even within the same households, their effect changes based on the type of health concern. Generalizing from nationwide surveys may obscure important local heterogeneity, particularly in delivery location and fever treatment.     

高血压患者健康自我评价对其就医决策的影响研究

目的:探讨高血压患者健康自我评价情况及对其就医决策的影响,发现高血压患者进行就医决策时存在的问题,为提高其健康生命质量、改善科学就医决策提供参考。方法:利用2016年居民卫生服务利用动态监测调查数据,采用安德森卫生服务利用行为模型为理论基础,进行倾向特征、能力因素、需要因素的单因素分析,并构建logistic多因素回归模型,分析影响高血压患者就医决策的主要因素。结果:单因素分析显示,性别、年龄、城乡(倾向性因素)、人均家庭年收入、商业医疗保险(能力因素)、自我照顾能力、VAS健康评分(需要因素)对高血压患者就医决策有影响。多因素logistic回归分析表明,城乡、收入水平、自我照顾能力、VAS评分对高血压慢病患者就医决策产生重要影响。结论:高血压患者健康自我评价对其就医决策影响较大;能力因素是影响高血压患者就医决策的主要因素;不同人口学倾向特征的高血压患者具有不同就医倾向;需要因素促进高血压患者就医行为。建议政策制定者重视高血压患者的健康自我评价,关注高血压患者抑郁和焦虑问题,提高城乡高血压患者医疗服务利用公平性。     

加拿大亚洲移民健康状况及影响因素研究

目的 评估加拿大亚洲移民的健康状况及相关影响因素.方法 采用横断面研究,利用加拿大统计局提供的2003年加拿大人群健康状况调查数据进行分析.采用描述性分析比较不同人群中健康影响因素分布差异.通过对患病率进行年龄标化,比较亚洲移民、非移民及其他移民的慢性病患病情况差异.利用多因素logistic回归分析控制可能影响因素,比较不同人群中选定的6种慢性病指标的0R值及95%CI.结果 经年龄标化后,亚洲移民患有1～5种慢性病患病率与非移民无明显差异,患有5种以上慢性病的患病率为3.56%,明显低于非移民慢性病患病率5.31%.亚洲移民患有至少一种慢性病的风险(0R=0.49,95%CI:0.46-0.51)明显低于非移民患病风险(0R=1.00).新移民患病风险(0R=0.34,95%CI:0.31～0.37)低于老移民的患病风险(0R=0.62,95%CI:0.58～0.66).调整社会经济特征和生活方式等冈素后,亚洲移民4种常见病的患病风险仅有微小改变,除心脏病的患病风险变化明显.结论 亚洲移民总体慢性病的患病率及患病风险低于非移民,但这种健康优势随着在加拿大的居住年限的推移逐渐消失.社会经济特征和生活方式的不同不能完全解释亚洲移民和非移民的健康状况差异.     

甘南州妇女生殖道感染就医行为干预效果评价

目的评价综合性健康教育对甘肃省甘南州育龄妇女生殖道感染就医行为的影响。方法采用分层整群抽样的方法获得样本,对干预组进行为期14个月的多种形式生殖健康教育干预,采用同一问卷调查,比较干预前后干预组和对照组已婚育龄妇女有生殖道感染自觉症状就医率的变化。结果干预后有症状的妇女就医率明显提高,干预组和对照组分别提高了39.04%和27.32%,干预组的干预效果好于对照组,相对干预效果为16.13%。接受过干预、民族为藏族、妇女接受过生殖健康咨询、丈夫接受过生殖健康培训、生殖健康知识得分高是影响有症状妇女就医的正向因素,尤其接受了健康教育干预对妇女的就医率影响强度最大,OR值为1.486。结论生殖健康教育是改善藏区妇女生殖道感染就医行为的有效措施。