Health status and health professional visits in a rural area

Misconceptions about health and disease prevention behaviors of rural Appalachian Americans

Background

Appalachia is one of the unhealthiest regions in the United States due to poor disease prevention behaviors.

Objective

Determine if self-perceived health of rural Appalachians is related to participation in disease prevention behaviors.

Methods

Rural Appalachian adults (n=437) were surveyed regarding their self-perceived health and disease prevention behaviors. Healthy behaviors included: moderate (≥ 90 min/wk) and vigorous (≥ 45 min/wk) physical activity, sugared drink consumption (≤ 1 sugared drink/d), smoking (non-smoker), alcohol consumption (≤ 1 drink/d), blood pressure (≤ 120/80 mm Hg), and fast food consumption (≤ 1 time/wk). Participants were grouped where healthy = (self-health rating > 5 on a 0-10 scale), BMI < 25, and blood pressure (≤ 120/80 mm Hg). Jaccard Binary Similarity (JBS) coefficients and Russell and Rao (RR) dichotomy coefficients determined the association and predictability of self-health ratings and disease prevention behaviors. T-tests determined group differences in the number of disease prevention behaviors.

Results

Individuals who reported being healthy had high JBS coefficients for having healthy sugared drink consumption (0.552), not smoking (0.704), low alcohol consumption (0.742), and low fast food consumption (0.481). RR results were similar to JBS results. Not smoking and low alcohol consumption were highly correlated (r=0.87). Those with a good health perception practiced more disease prevention behaviors (mean±SEM, 2.84±0.06) than those with a poor health perception (2.19±0.10, p<0.001). Good health perceptions were not strongly related to obesity and inactivity.

Conclusions

Appalachians are not indifferent about their health. However, Appalachians may not understand how inactivity and obesity relate to disease.

Variables associated with utilization of a centralized medical post in the Andean community of Pampas Grande, Peru

CONTEXT

Integral to the location of health resources is the distance decay of utilization observed in a population. In rural Peru, a nongovernmental organization planning to increase the availability of health services needed this information.

PURPOSE

To determine variables associated with utilization of a central medical clinic and determine whether, because of the mountainous topography, travel time (TT) would be a better predictor of utilization than distance.

METHODS

A door-to-door survey of all available households (81% of total), using a Spanish translation of questions excerpted from the Behavioral Risk Factor Surveillance System Survey, was conducted in the summer of 2008 to determine variables associated with self-reported history of clinic utilization.

RESULTS

Utilization was inversely related to TT and distance. Of those living within 5 minutes of the clinic, 61% had been to the clinic whereas only 25% of those living 30 or more minutes away had sought care. Female gender and fever predicted increased odds of clinic utilization. Having a disability reduced one's odds (OR 0.55) of visiting the clinic, after adjusting for gender, TT, and fever. The inverse correlation of utilization with travel distance and TT was not significantly different, thus failing to demonstrate that TT is a better predictor of utilization than distance.

CONCLUSION

In health service planning, care for common conditions should be available within 5 minutes' TT or a few kilometers' distance from each person's home in order to improve health care access and reduce health care disparities worsened by disability.

Self-rated health in rural Appalachia: health perceptions are incongruent with health status and health behaviors

BACKGROUND

Appalachia is characterized by poor health behaviors, poor health status, and health disparities. Recent interventions have not demonstrated much success in improving health status or reducing health disparities in the Appalachian region. Since one's perception of personal health precedes his or her health behaviors, the purpose of this project was to evaluate the self-rated health of Appalachian adults in relation to objective health status and current health behaviors.

METHODS

Appalachian adults (n = 1,576) were surveyed regarding health behaviors - soda consumer (drink ≥ 355 ml/d), or non-consumer (drink < 355 ml/d), fast food consumer (eating fast food ≥ 3 times/wk) or healthy food consumer (eating fast food < 3 times/wk), smoking (smoker or non-smoker), exercise (exerciser > 30 min > 1 d/wk) and sedentary (exercise < 30 min 1 d/wk), blood pressure medication (yes, no), and self-rated health. Blood pressure was measured through auscultation and serum cholesterol measured via needle prick. Weight status was based on BMI: normal weight (NW ≥ 18.5 and < 25.0), overweight (OW ≥ 25.0 and < 30.0), and obese (OB ≥ 30.0). Jaccard Binary Similarity coefficients, odds ratios, chi-square, and prevalence ratios were calculated to evaluate the relationships among self-rated health, objective health status, and health behaviors. Significance was set at p < 0.05.

RESULTS

Respondents reported being healthy, while being sedentary (65%), hypertensive (76%), overweight (73%), or hyperlipidemic (79%). Between 57% and 66% of the respondents who considered themselves healthy had at least two disease conditions or poor health behaviors. Jaccard Binary Similarity coefficients and odds ratios showed the probability of reporting being healthy when having a disease condition or poor health behavior was high.

CONCLUSIONS

The association between self-rated health and poor health indicators in Appalachian adults is distorted. The public health challenge is to formulate messages and programs about health and health needs which take into account the current distortion about health in Appalachia and the cultural context in which this distortion was shaped.

Subjective health and ill health-related behaviour

OBJECTIVE

The aim of this study was to investigate the relation between self-rated health measures and ill healthrelated behaviour.

DESIGN

The study design was based on a self-report questionnaire taken for three consecutive years.

METHOD

Path analysis was used to test the relations between (a) The Self-rated Health Scale (SRH) and the General Symptom Index (GSI) from the Symptom Checklist-90 (SCL-90), and (b) self-reports on sick leave, health care utilization and medication, in a group of 155 persons who had terminated psychotherapeutic treatment the year before our three-year panel survey. To investigate the potential moderating function of ongoing psychotherapeutic treatment, we repeated each test in a group of 152 patients in the midst of psychotherapeutic treatment.

RESULTS

Only weak or zero relations were found between the self-rated health measures and ill health-related behaviour. The multi-group analyses indicated between-group differences in model fit. The few significant specific between-group differences all concerned autoregressive relations.

CONCLUSIONS

Subjective health did not predict ill health-related behaviour. Ongoing psychotherapeutic treatment did not affect the predictive value of subjective health variables. The weak relations found in the current study illuminate paradoxical outcome differences between subjective well-being and ill health-related behaviour. Our findings are discussed in the light of cultural and personality factors.

Factors associated with health-related quality of life among an older population in a largely rural western region

CONTEXT

As elderly people become a larger proportion of the rural population, it is important to identify those at risk for poor health. Predictors of health-related quality of life can be useful in designing interventions.

PURPOSE

One objective of the present study was to profile the health-related quality of life of community-dwelling, elderly people in a southwestern region of the United States. A related objective was to identify the principal factors associated with health-related quality of life, thereby identifying population subgroups in greatest need of health or social services.

METHODS

A telephone survey of approximately 5,000 individuals 65 years and older collected data on need for assistance with activities of daily living, physical and mental health-related quality of life, and worry about health status measures. A modified version of the Behavioral Model was used to more clearly distinguish the different groups at risk for poor health.

FINDINGS

Those groups of community-dwelling, elderly people in the poorest health were older than 75 years, had less than a high school education, were retired or unemployed, and had low household income. No differences were found by urban, rural, and frontier residence.

CONCLUSIONS

To maintain the physical, social, and psychological health of older people residing in rural and urban areas, social services, medical care, and supportive services are needed, particularly among the most socially and economically disadvantaged.

Medical care usage and self-rated mental health

Background

Population studies frequently employ a single item dependent variable for overall health. Self-rated mental health has been the focus of attention less often. The purpose of this project was to investigate the relationship between use of medical care and poor mental health in an elderly population.

Methods

This study involved a cross-sectional telephone survey of persons over 65 years of age in West Texas, a sparsely-populated 108-county region. Independent variables included number of medical visits, race/ethnicity, age, gender and ability to pay for care. Mental health was measured by asking subjects how often they felt downhearted or blue.

Results

Multiple logistic regression analysis revealed that more medical visits were made by persons who were downhearted or blue. Females, persons who had difficulty paying for care, Hispanic respondents, and older persons were more likely to report poor mental health.

Conclusions

Elderly persons in this region who use more medical care are at greater risk of being in poor mental health. Public health agencies that are planning population-based approaches to improving mental health should consider targeting persons who are high users of medical care as well as those of limited means, women, persons of Hispanic ethnicity, and people who are of greater age.

Variation in the ecology of medical care

BACKGROUND

We wanted to quantify how the location in which medical care is delivered in the United States varies with the sociodemographic characteristics and health care arrangements of the individual person.

METHODS

Data from the 1996 Medical Expenditures Panel Survey (MEPS) were used to estimate the number of persons per 1,000 per month in 1996 who had at least 1 contact with physicians' offices, hospital outpatient departments, or emergency departments, hospitals, or home care. These data were stratified by age, sex, race, ethnicity, household income, education of head of household, residence in or out of metropolitan statistical areas, having health insurance, and having a usual source of care.

RESULTS

Physicians' offices were overwhelmingly the most common site of health care for all subgroups studied. Lacking a usual source of care was the only variable independently associated with a decreased likelihood of care in all 5 settings, and lack of insurance was associated with lower rates of care in all settings but emergency departments. Generally, more complicated patterns emerged for most sociodemographic characteristics. The combination of having a usual source of care and health insurance was especially related to higher rates of care in all settings except the emergency department.

CONCLUSION

Frequency and location of health care delivery varies substantially with sociodemographic characteristics, insurance, and having a usual source of care. Understanding this variation can inform public consideration of policy related to access to care.

Realized access to physician services among the elderly in West Texas

The purpose of this study is to identify populations in a sparsely populated region that are less likely to obtain medical care. We conducted a cross-sectional survey of more than 5,000 elderly persons who participated in telephone interviews after being identified through more than 65,000 calls to residential listings. Subjects were persons aged 65 years and older who resided in 108 counties in western Texas. The response rate was 72%. The probability of seeing a physician in the last 6 months for urban and rural residents was modeled using multiple logistic regression analysis. Among rural residents, characteristics that were significantly (p < 0.05) associated with not recently visiting a physician when health status is held constant included belief in home remedies, having less than a high school education, lack of health insurance, and low income. Among urban residents, Hispanic ethnicity and skepticism about medical care were negatively associated with having a recent visit, whereas being religious was positively associated. Despite the availability of Medicare coverage, several subgroups of the elderly population have impaired access to medical care in this sparsely populated region. Intensified outreach efforts are indicated.