A Cross-Sectional Study to Examine Factors Associated with Primary Health Care Service Utilization among Older Adults in the Irbid Governorate of Jordan

Factors Associated with the Utilization of Home and Community-Based Services (HCBS) Among Older Adults: A Systematic Review of the Last Decade

Home and community-based services (HCBS) for older adults have been promoted worldwide to address the growing problems of aging. This systematic review included 59 studies published from 2013 to 2023 to explore factors influencing the utilization of HCBS among older adults. The review identified 15 common factors grouped into four levels of influence: individual, inter-relationship, community, and social contextual levels. The findings suggest that HCBS utilization is a dynamic process influenced by multiple factors at different levels. Gerontological social work should incorporate ecological thinking to improve practice and strengthen caregiver-recipient relationships.

Application and Use of Andersen's Behavioral Model as Theoretical Framework: A Systematic Literature Review from 2012-2021

Background

Anderson's model provides a theoretical structure to understand use of health service. This scoping review aimed to examine the application of Andersen's behavioral model in different studies.

Methods

Related studies that were published between 2012 and 2021 were retrieved by searching PubMed, Science Direct, and CINAHL databases. Fourteen studies satisfied the criteria for inclusion.

Results

The reviewed studies specified that the Andersen's Model has been used in numerous parts of the health system and concerning different illnesses. The reviewed studies revealed differences in the factors examined. Most of the studies examined age, education, gender, marital status, and employment status as predisposing factors, and income, medical insurance, and living location as enabling factors. While, the chronic illnesses and perceived general health status were examined as need factors, in addition to an extensive diversity of health conditions and illnesses. Though the associations were established among the key factors tested in the reviewed studies and health care service use, the findings were inconsistent. In the reviewed studies, the setting and the study population characteristics looked to have a strong influence on the direction and strength of these associations.

Conclusion

Merely a slight number of common factors were examined and there were enormous differences in the methods by which these factors were classified. Future and primary studies are necessary to deepen our understanding of the use of health care services and the complexity of the Andersen's behavioral model.

Experiences of Primary Health Care Clients in Jordan: Qualitative Study

Objective:

This paper aims to understand the experiences of clients in utilising primary health care services in Jordan.

Design:

A qualitative study.

Methods:

Three focus group interviews with 22 clients who sought medical advice at primary health care clinics. The data were analysed thematically.

Results:

Findings were summarized in three main themes: 1) Clients’ experiences with general practitioners; 2) Causes of not seeking advice at clinics; 3) Clients’ perceptions of the physicians’ capabilities and professionalism. There was comfort and full access to primary health care (PHC) service, although clients were not satisfied sometimes. This is due to the absence, inadequate, and poor quality of the service. This may lead to several visits without getting the service required.

Conclusion:

Listening to the experiences of the clients and users of PHC identifies what works and what does not work in the service and improves the quality. Measuring the experiences of the users and the satisfaction of the clients is an important aspect of quality.

The Utilization of Mobile Phones in Health Information Seeking in Rural China

This study aims to investigate the mobile phone utilization for health information seeking among adults who are 45 years or older in rural areas in China. Using Andersen’s Behavioral Model (BM), we examine the factors that influence the target group’s behaviors of online health information seeking and contacting healthcare providers via mobile phones. By using stratified sampling method, we conducted a survey among 607 rural adults who were 45 years or older from six villages in Jiangsu Province, China. The results reveal that participants can be excluded from such services for not using a smartphone. eHealth information literacy could serve as a strong influential factor for online health information seeking and contacting healthcare providers via mobile phones. Participants with lower emotional wellbeing are more inclined to seek health information online via mobile phones. The results indicate variables such as utilization of technological devices and eHealth literacy should be included in Andersen’s model when investigating the utilization of mHealth services. This study contributes to the literature on mHealth adoption in rural areas in China and has implications for practitioners to tailor the mHealth service for socio-economically disadvantaged groups.

Associated factors of doctor visits made by urban-dwelling older adults in Sri Lanka: an application of Anderson's model of health service utilization

Background

Although universal free healthcare is available for all Sri Lankan citizens, older adults face somewhat unique obstacles when utilizing available healthcare services. The aim of this study was to examine some vital predisposing, enabling, and need factors associated with doctor visits made by urban-dwelling older adults in Sri Lanka.

Methods

A representative sample of 880 urban-dwelling older adults (aged 60 years and above) was surveyed using an interviewer-administered questionnaire. Number of doctor visits, self-rated health, physical activity, and socio-demographic and self-report health conditions were collected. The data were analyzed using chi-squared tests and multinomial logistic regression.

Results

Participants’ mean age was 70.01 (± 6.02) years. The majority was women (75.0%). The mean number of doctor visits was 6.77 (± 5.92) per year. Nearly half of the participants (47.0%) had made, on average, at least one doctor visit per month. Older men and those of aged 80 years and above were the least likely to make frequent doctor visits. Participants who were physically active and who rated their health as poor were more likely to make frequent doctor visits after adjustment for age, gender, and educational level.

Conclusions

Doctor visits made by Sri Lankan older adults are satisfactory. The factors that best explain high frequency of doctor visits by older adults are female gender, younger age, higher physical activity and poor self-rated health. Attention should be paid to examine possible accessible and affordable issues related to doctor visits by bedridden or physically dependent older adults in advanced age categories.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03249-3.

Baseline situational analysis in Bangladesh, Jordan, Paraguay, the Philippines, Ukraine, and Zimbabwe for the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health

Introduction

Mental, neurological and substance use conditions lead to tremendous suffering, yet globally access to effective care is limited. In line with the 13^th General Programme of Work (GPW 13), in 2019 the World Health Organization (WHO) launched the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health to advance mental health policies, advocacy, and human rights and to scale up access to quality and affordable care for people living with mental health conditions. Six countries were selected as ‘early-adopter’ countries for the WHO Special Initiative for Mental Health in the initial phase. Our objective was to rapidly and comprehensively assess the strength of mental health systems in each country with the goal of informing national priority-setting at the outset of the Initiative.

Methods

We used a modified version of the Program for Improving Mental Health Care (PRIME) situational analysis tool. We used a participatory process to document national demographic and population health characteristics; environmental, sociopolitical, and health-related threats; the status of mental health policies and plans; the prevalence of mental disorders and treatment coverage; and the availability of resources for mental health.

Results

Each country had distinct needs, though several common themes emerged. Most were dealing with crises with serious implications for population mental health. None had sufficient mental health services to meet their needs. All aimed to decentralize and deinstitutionalize mental health services, to integrate mental health care into primary health care, and to devote more financial and human resources to mental health systems. All cited insufficient and inequitably distributed specialist human resources for mental health as a major impediment.

Conclusions

This rapid assessment facilitated priority-setting for mental health system strengthening by national stakeholders. Next steps include convening design workshops in each country and initiating monitoring and evaluation procedures.

Inequalities in Older age and Primary Health Care Utilization in Low- and Middle-Income Countries: A Systematic Review

The objective of this research was to systematically review and synthesize quantitative studies that assessed the association between socioeconomic inequalities and primary health care (PHC) utilization among older people living in low- and middle- income countries (LMICs). Six databases were searched, including Embase, Medline, Psych Info, Global Health, Latin American and Caribbean Health Sciences Literature (LILACS), and China National Knowledge Infrastructure, CNKI, to identify eligible studies. A narrative synthesis approach was used for evidence synthesis. A total of 20 eligible cross-sectional studies were included in this systematic review. The indicators of socioeconomic status (SES) identified included income level, education, employment/occupation, and health insurance. Most studies reported that higher income, higher educational levels and enrollment in health insurance plans were associated with increased PHC utilization. Several studies suggested that people who were unemployed and economically inactive in older age or who had worked in formal sectors were more likely to use PHC. Our findings suggest a pro-rich phenomenon of PHC utilization in older people living in LMICs, with results varying by indicators of SES and study settings.

Identification and Prioritization of Attributes for a Discrete Choice Experiment Using the Nominal Group Technique: Patients' Choice of Public Health Facilities in Cape Town, South Africa

OBJECTIVES

To date, there has been scant research on patient input regarding the desirable characteristics of healthcare facilities. This study uses the nominal group technique (NGT) to develop a discrete choice experiment (DCE) aimed at identifying and prioritizing, from the patient's perspective, essential characteristics for choosing public health facilities in Cape Town, South Africa.

METHODS

Four focus group discussions were conducted, including a total of 21 patients or their parents/companion at Bothasig and Goodwood community day centers (which offer primary care within substructure) in Cape Town. The group discussions followed the steps of NGT guidelines. At each facility, the frequency of an attribute being within the top 5 was determined, a weighted ranking was calibrated, and a subgroup analysis was performed.

RESULTS

The 6 most important attributes in choosing a facility were "treatment by a doctor/(family physician)" (66.7%), "distance to the community day center" (61.7%), "availability of medication" (61.7%), "confidentiality during treatment" (57.7%), and "waiting time" and "treatment by a nurse." The weighted results showed that distance was the most important, followed by treatment by the doctors, treatment confidentiality, availability of medication, and waiting time and treatment by a nurse.

CONCLUSION

This study confirms the feasibility and value of the NGT in identifying and prioritizing the attributes for a DCE. The NGT can be used to elicit patient preferences and, when used together with a DCE, can enhance information quality and quantity for decision making in tandem with patient satisfaction and experiences.

Preventive health care services utilization and its associated factors among older adults in rural communities in Anambra State, Nigeria

Introduction

quality of life and life expectancy of people are improved when preventive health care services are utilized because these identify treatable health problems and puts life-threatening diseases in check. Morbidity and mortality associated with age-related chronic disease among the older adults is on the increase, therefore, this study aims at determining preventive health care services utilization among older adults in rural communities in Anambra State.

Methods

a cross sectional design adopted for this study was carried out on older adults from the ages of 65 years and above in rural communities in Anambra State from October 2019 to January 2020. Data were collected through researcher-administered structured questionnaire. Data were analysed using univariable and multivariable regression analysis.

Results

a total of 1944 older adults participated with an overall cluster percentage of 40.6% older adults utilizing investigated preventive health care services. The results of the multivariable analysis indicates that the following factors were associated with utilization of preventive healthcare services: male gender (aOR: 0.443, 95%CI: 0.281 - 5.472, p=0.47), level of education; primary (aOR: 1.536, 95%CI: 1.201 - 5.261, p=0.00), secondary (aOR: 4.516, 95%CI: 3.192 - 6.242, p=0.00), and tertiary (aOR: 3.407, 95%CI: 3.199 - 5.666, p=0.00)], income of N50,000-N100,000 (aOR: 2.754, 95%CI: 1.066 - 10.766, p=0.01), and N100,000 and above (aOR: 4.233, 95%CI: 1.846 - 12.811, p=0.00)], and health insurance [aOR: 0.691, 95%CI: 0.422 - 1.945, p=0.03].

Conclusion

preventive health care services were under-utilized. Creating awareness on the importance of utilizing preventive health care services is highly recommended since most age-related chronic diseases once established may last a lifetime and affect quality of life and wellbeing.

Determinants of health insurance ownership in Jordan: a cross-sectional study of population and family health survey 2017-2018

OBJECTIVES

With about one-third of the population living below the poverty line, Jordan faces major healthcare, social and national development issues. Low insurance coverage among the poor and high out-of-pocket expenditure worsens the financial insecurity especially for the marginalised population. The Government of Jordan aims to achieve universal coverage of health insurance-a bold plan that requires research evidence for successful implementation. In this study, we aimed to assess the proportion of the population covered by any health insurance, and the determinants owing a health insurance.

DESIGN

A population-based prospective cohort study.

SETTING

Jordan.

METHODS

Data for this study were derived from the Jordan Population and Family Health Survey, which was implemented by the Department of Statistics from early October 2017 to January 2018. Sample characteristics were described as percentages with 95% CIs. Binary logistic regression models were used to estimate OR of health insurance ownership. Parsimonious model was employed to assess the sex and geographical differences.

RESULTS

Data revealed that in 2017-2018, 73.13% of the 12 992 men and women had health insurance. There was no indication of age of sex difference in health insurance ownership; however, marital status and socioeconomic factors such as wealth and education as well as internet access and geographical location appeared to be the important predictors of non-use of health insurance. The associations differed by sex and urbanicity for certain variables. Addressing these inequities may help achieve universal coverage in health insurance ownership in the population.

CONCLUSIONS

More than one-quarter of the population in Jordan were not insured. Efforts to decrease disparities in insurance coverage should focus on minimising socioeconomic and geographical disparities to promote equity in terms of healthcare services.

Behavioral factors associated with utilization of healthcare services among elderly in Pakistan: evidence from a nationally representative survey

BACKGROUND

In Pakistan, health system is facing unprecedented challenges to deal with the healthcare demand of the growing ageing population. Using conceptual framework, this study aims to analyze the factors associated with the utilization of healthcare services in private and public hospitals by the elderly population.

METHODS

This study used a sample of 5319 individuals aged 60 and above extracted from the Pakistan Social and Living Standards Measurement Survey 2014-15. We followed the Anderson's Behavioral model of healthcare utilization. The behavioral factors, including predisposing, enabling and need factors, associated with the use of healthcare care were analyzed using exploratory data analysis and binary logistic regressions. The utilization of healthcare service in the study refers to the visits to private and government hospital.

RESULTS

Out of total 5319 participants around three-fourth or 72.4% of participants visited private hospitals for their healthcare needs. Multivariate analysis showed that older age-group (80 years and above) and participants from urban were 1.35 and 1.53 times more likely to avail healthcare service in private hospitals, respectively. The elderly persons from Khyber Pakhtunkhwa were three times (AOR: 3.29, 95%CI 2.5-4.8) more likely to visit government hospitals than their peers in Punjab. Participants who attended school (AOR: 1.21, 95%CI 0.82-1.31) were more likely to utilize healthcare service in private hospitals. Elders from rich (AOR: 1.04, 95%CI 0.84-1.13) and richest (AOR: 1.29, 95%CI 0.89-1.87) wealth quintiles were more likely to use healthcare in private hospitals. The likelihood of the utilization of healthcare service in private hospitals was 1.7 times higher for three or more consulting visits than the single visit, and 1.5 times higher in the public hospital.

CONCLUSIONS

Our findings underscore a dire need for expanding the outreach of healthcare services for the elderly population. It calls for effective implementation of policies which aim at improving equitable access to private healthcare services, and upgrading of government hospitals Moreover, the knowledge generated through this research may be employed to make social protection programs more responsive to age-related healthcare needs, and focused on caregiving for elderly living without spouse.

Unmet Needs of Healthcare Services and Associated Factors among a Cohort of Ghanaian Adults: A Nationally Stratified Cross-Sectional Study Design

We estimated the prevalence of unmet needs of healthcare services (UNHS) and its associated factors among a cohort of older Ghanaian adults. World Health Organization (WHO) Study on Global AGEing and Adult Health for Ghana was used with a total of 4735 participants. Logistics regression analysis was performed using Stata 16 to assess associated factors. The overall UNHS was 3.7% (95% CI = 2.7-4.8) and the prevalence was significantly high amongst older adults aged 60 to 69 years (5.9%). Could not afford the healthcare (56.4%) was the main contender for UNHS. UNHS was influenced by; those aged 60 to 69 years [OR (95% CI) = 1.86 (1.19-2.91)]; no formal educational [aOR (95% CI) = 4.71 (1.27-17.38)], and no NHIS [OR (95% CI) = 1.78 (1.03-3.09)]. Participants needed care for joint pain (25.4%), and communicable diseases (19.1%). The inability to access healthcare was relatively higher for older adults more advanced in age, with low education, and for those without health insurance. Health system strengthening including financial protection by expanding the National Health Insurance Scheme to all Ghanaians in line with Ghana's Universal Health Coverage Roadmap would reduce the unmet healthcare needs of older adults.

A Review of the Short Form Health Survey-Version 2

BACKGROUND AND PURPOSE

The Short Form Health Survey version 2 (SF-12v2) is a commonly used measure of health-related quality of life (HRQOL). The purpose of this study was to review research articles that used the SF-12v2 survey for three age groups: adolescents, young to middle-aged adults, and middle to older-aged adults.

METHODS

EBSCO, CINAHL, and Ovid Journal databases were searched, and 12 articles were identified.

RESULTS

We found that the SF-12v2 was used with diverse age groups. Cronbach's alpha coefficients ranged from 0.60 to 0.87, which support the internal consistency and reliability. The convergent validity of the SF-12v2 was supported in some studies.

CONCLUSIONS

The current line of evidence indicated that the SF-12v2 is easy to use, reliable, and valid. Future research needs to evaluate the population health status and HRQOL changes over time.

Predictors of healthcare utilisation among poor older people under the livelihood empowerment against poverty programme in the Atwima Nwabiagya District of Ghana

BACKGROUND

Like many other low- and middle-income countries (LMICs), the Ghanaian healthcare system remains poor which is likely to affect the utilisation of healthcare services, especially among poor older people who are faced with multiple health problems. Yet, factors that explain healthcare use among poor older people in LMICs, particularly Ghana remain largely unexplored. Understanding the predictors of healthcare use among poor older people could have a huge impact on health policies in LMICs including Ghana. This study, therefore, examined factors associated with healthcare use among poor older people under the Livelihood Empowerment Against Poverty (LEAP) programme in the Atwima Nwabiagya District of Ghana.

METHODS

Cross-sectional data were obtained from an Ageing, Health, Lifestyle and Health Services (AHLHS) study conducted between 1 and 20 June 2018 (N = 200) in Atwima Nwabiagya District, Ghana. Sequential logistic regression models were performed to estimate the variables that predict healthcare use among poor older people. All test results were considered significant at 0.05 or less.

RESULTS

The fully adjusted model showed that respondents aged 85-89 years (AOR = 0.094, CI: 0.007-1.170), acquired basic education (AOR =0.251, CI: 0.085-0.987), received no family support (AOR = 0.771, CI: 0.120-0.620), with no past illness records (AOR = 0.236, CI: 0.057-0.197) and who were not diagnosed of chronic non-communicable diseases (AOR = 0.418, CI: 0.101-0.723) were significantly less likely to utilise health facility compared with their respective counterparts. Moreover, those with no disability (AOR = 19.245, CI: 2.415-29.921) and who consumed low fruits (AOR = 1.435 = CI: 0.552-8.740) and vegetables (AOR = 1.202 = CI: 0.362-10.20) had a higher likelihood to use healthcare.

CONCLUSION

The study has outlined multiple factors influencing utilisation of healthcare among poor older people under the LEAP programme in Ghana. The results, therefore, validate the importance of social and behavioural determinants of healthcare use in the Ghanaian poor older population. We highlight the need for health planners and stakeholders to consider demographic, socio-economic, health-related and lifestyle factors when formulating health policy for poor older people in Ghana.

Health-Seeking Behavior and Its Determinants among Mine Workers in the Karauli District of Rajasthan in India

<b><i>Background:</i></b> Mine workers often need healthcare services in order to continue working without discomfort, making accessible and affordable healthcare a necessity. As the duration of working in mines is prolonged, there is a high chance of having an adverse effect on health. One of the important factors that influence the severity of disease among mine workers is their health-seeking behavior. The purpose of this paper is to assess the relationship between health-seeking behaviors by mine workers and their socio-demographic characteristics. <b><i>Method:</i></b> This is a quantitative, cross-sectional study conducted in the Karauli district of Rajasthan, India, during the period of May to September 2014. A total of 218 mine workers (exposed group) in 10 randomly selected villages were approached for participation. At the same time, a total of 203 eligible persons (a mix of occupational groups of people from the same villages) were also interviewed for comparison purposes. Data regarding the utilization of healthcare services during the past 12 months along with socio-demographic information were recorded. Data were analyzed with χ² and bivariate logistic regression statistical techniques. <b><i>Results:</i></b> Healthcare services were used by 73% of the workers in the past 12 months. With regard to working status, 80% of the mine workers and 66% of the non-mine workers availed themselves of healthcare services. Among the mine workers, the main reason for using healthcare services was respiratory illness (45%); among the comparison group, it was infection (21%). Logistics regression analysis found that the mine workers were more likely to require utilization of healthcare than the subjects in the comparison group were. The factors associated with utilization of healthcare services included the caste, BMI, and self-reported illness of the workers. <b><i>Conclusion:</i></b> Healthcare utilization patterns in the Karauli district revealed high utilization rates among mine workers over 12 months. Mainly respiratory illness was found to be the reason for healthcare utilization among mine workers. However, due to indifferent services they were frequently compelled to pay for private healthcare.

General practice for the poor and specialist services for the rich: inequality evidence from a cross-sectional survey on Hangzhou residents, China

Background

Inequalities in health care services are becoming an increasing concern in the world including in China. This study measured the income-related inequalities of residents in Hangzhou of China in access to general practice and specialist care and identified socioeconomic factors associated with such inequalities.

Methods

A cross-sectional questionnaire survey was conducted on 1048 residents in ten urban communities in Hangzhou, China. The percentage and frequency of respondents visiting general practice (GP) and hospital specialist clinics over the past four weeks prior to the survey were estimated. Income-related inequalities in access to these services were measured by the concentration index. Logistic regression and Poisson regression models were established to decompose the contributions of socioeconomic factors (residency, income, education, marital status, and social health insurance) to the inequalities in the probability and frequency of accessing these services, respectively, after adjustment for the needs factors (age, sex and illness conditions).

Results

The GP services were in favor of the poor, with a concentration index of − 0.0464 and − 0.1346 for the probability and frequency of GP visits, respectively. In contrast, the specialist services were in favor of the rich, with a concentration index of 0.1258 and 0.1279 for the probability and frequency of specialist visits, respectively. Income is the biggest contributor to the inequalities, except for the frequency of visits to specialists in which education played the greatest role.

Conclusions

Income-related inequalities in GP and specialist care are evident in China. Policy interventions should pay increasing attention to the emergence of a two-tier system, potentially enlarging socioeconomic disparities in health care services.

Electronic supplementary material

The online version of this article (10.1186/s12939-019-0966-6) contains supplementary material, which is available to authorized users.

Functioning and primary healthcare utilization in older adults: a 1-year follow-up study

BACKGROUND/PURPOSE

Older adults are high users of healthcare services, mainly due to health conditions and their impact on daily activities, challenging the ability of health systems to provide timely and high-quality care. Conceivably, using disability-related variables to predict future healthcare utilization could contribute to reduce both older adults' disability and healthcare costs. This study aimed to explore the association between aspects of disability and older adults' primary healthcare utilization and hospitalization over a period of 1 year.

METHODS

Older adults (n = 129) were assessed for self-reported disability, lower limb performance, pain intensity and number of painful body sites, depressive symptoms, and self-reported physical activity. Data on primary healthcare utilization and hospitalization were collected for the period of 1 year through registries and phone interviews.

RESULTS

Regression analysis, adjusted for potential confounders, showed that self-reported disability and pain intensity were significantly associated with total primary healthcare utilization and together with a confounding variable (number of chronic conditions) explained 16% of its variance (p < 0.05). Increased physical activity was significantly associated with a decreased likelihood of being admitted to hospital (95% CI for exponentiation (B) = 0.27-0.81).

DISCUSSION

Data suggest that decreasing self-reported disability and increasing physical activity may decrease primary healthcare utilization and hospitalization, respectively.