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There has been growing interest in exploring factors that influence the success or otherwise of welfare policies in democratic countries, such as the interrelationships between the proposed policy and the context it will be introduced into, such as the sociodemographic characteristics of the population and the population's previous experience with welfare policies. However, there has been little exploration of factors that could influence general population support for long-term care for older people. The aim of this study was to investigate the general population's attitudes for determinants of high-quality aged care and different mechanisms for funding and any impact of individual characteristics on these. A representative sample of the Australian general population aged 18 years and over (N = 10,315, 52% female, 22% aged 65 years and over) drawn via quota sampling participated in the survey online. Participants were asked to rate the importance of a list of 10 determinants of quality care and their support for four models of funding, both using a five-point Likert scale. We identified consistently high expectations for long-term care services across the general population, especially among older people, females, those with a family member in care, and those living in rural or regional areas. In terms of how governments practically fund a high-quality long-term care system, we also identified broad support among the general population for both payment of a co-contribution towards the cost of care by older people using services and increased government funding for the system. Over 40% of participants said they would be willing to pay additional tax to improve access and quality of aged care services. While often neglected by governments in the past who assumed voter apathy on the topic, by comparison, our findings indicate that there is currently a strong appetite among the general population for improvements to the quality of care provided and that they are willing to consider changes to the funding model. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, the well-being of older adults has been highlighted as a significant public health concern. In this study, we investigated the role of psychological resilience in mediating the relationship between positive self-perceptions of aging (SPA) and the subjective well-being (SWB) of community-dwelling older adults in Taiwan during the pandemic. We collected data through face-to-face interviews conducted from October 2021 to February 2022, involving 1,095 participants aged 50 years or above residing in a southern city in Taiwan. More than half of the study participants were female, aged 65 or older, and had less than a high school education. More than two thirds were married and/or living with partners. More than a third had two or more noncommunicable diseases. We calculated scores for SWB, positive SPA, and psychological resilience and examined correlations among the outcome and predictor variables. Our findings indicated that higher positive SPA was significantly associated with better SWB among community-dwelling older adults in Taiwan and that this association was mediated by psychological resilience. Specifically, after controlling for covariates, structural equation modeling (SEM) analysis revealed a significant main effect of positive SPA on SWB (b = 0.412, β = 0187, and p < 0.001), while bootstrap mediation analysis showed a statistically significant indirect mediating effect from positive SPA on SWB via psychological resilience (0.597, 95% bootstrap CIs = [0.445, 0.749], and p < 0.001). These findings highlight the potential importance of cultivating positive self-perceptions of aging and implementing resilience-centered interventions to promote well-being among Chinese older adults in the community. [ABSTRACT FROM AUTHOR]

Iran is a developing country with low levels of economic development and globalization and is ruled by a theocratic government. To address the lack of national research on well-being in Iran, this retrospective observational study aims to examine life satisfaction and its main determinants among Iranian adults. Using World Gallup Poll data collected between 2006 and 2017, we examined life satisfaction as a cognitive aspect of subjective well-being in relation to various factors. Our results show that income is the strongest predictor of life satisfaction, followed by standard of living, gender, social support, age, negative affect, and education. In developing countries such as Iran, which face significant economic, political, and social challenges, individuals prioritize the satisfaction of basic needs by emphasizing factors such as the socioeconomic status. In contrast, developed countries with established welfare systems may emphasize other values such as social connections and healthy lifestyle behaviors as key factors in life satisfaction. This study contributes to a deeper understanding of the determinants of life satisfaction in Iran and provides insights for future research and policy making. [ABSTRACT FROM AUTHOR]

Women's health is the foundation of society's health and it can be achieved only by addressing all aspects of their health. The aim of this systematic review and meta-analysis is to investigate the prevalence of social health of Iranian women and related factors. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used for reporting; the terms "social health," "women," "Iran," and related keywords were searched in PubMed, Web of Science, Scopus, PsychoInfo, ProQuest and local databases, SID, Magiran, Irandoc, Elmnet, and Noormags up to August 2022. The published English or Persian quantitative primary studies which were conducted in Iran and reported social health or its dimensions among Iranian women were included. The studies were assessed by quality assessment tool for observational cohort and cross-sectional studies developed by National Heart, Lung, and Blood Institute. From the 786 studies retrieved, 22 studies were finally included surveying different groups of women. Age, marital status, education, employment, socioeconomic status, social support, social participation, social trust, social security, communication skills, and self-esteem were the factors affecting women's social health. Five studies entered meta-analysis and mean score of social health was 98.54 (95% CI: 87.56–109.51) and it was the lowest among women who were the head of households. Since women's social health has been less considered in the society and research studies, further policies, legislations, and capacity building in mentioned fields are necessary. As social health is an important aspect of health, it is necessary for governments to address the known determinants of women's social health in order to plan and promote the health of women, family, and finally society. [ABSTRACT FROM AUTHOR]

Chinese government promoted a family physician contract service system in order to establish a tiered healthcare system in June 2016, but there was little evidence to assess the policy performance. This study aimed to examine the association of family physician contract services with the healthcare utilization of community residents in urban China. A cross-sectional face-to-face survey was conducted from July to September, 2019, in four advanced and exemplary cities for family physician contract services in China. A multistage cluster random sampling method was adopted to recruit residents aged 18 and above, and a total of 1508 participants were included in this study. The count model and logit regression were adopted to examine the associations between family physician contract service and healthcare utilization, and the potential bias was addressed using the propensity score matching (PSM) method. There was an increase in number of monthly primary care visits and annual referrals for contracted residents compared to noncontracted residents. Participants who had contracted with a family physician were more likely to choose a primary healthcare facility after illness than those who had not. However, no significant change was found in the number of annual hospital admissions between contracted and noncontracted residents. Family physician contract services may effectively strengthen the use of primary care facilities by community residents and promote the formation of a tiered healthcare system in China. [ABSTRACT FROM AUTHOR]

People with disabilities are susceptible to mental disorders, so it is very important to check and monitor their access to mental health services. There has been no study in this regard in Iran. This study aimed to measure the prevalence and socioeconomic inequality of subjective unmet needs for mental healthcare services (SUNMH) among individuals with disabilities and the various reasons behind them in the west of Iran. This descriptive-analytical and cross-sectional study was conducted on 613 people with disabilities over 18 years of age in Sanandaj city in 2023. Simple random sampling was used, and a questionnaire was applied to collect the data. The multivariate logistic regression was used to determine significant predictors of SUNMH. The concentration index (C) and concentration curve (CC) were calculated to measure inequality in the prevalence of SUNMH. Data were analyzed using STATA software version 16.0 (Stata Corp, College Station, TX, USA. About 47% of people had experienced SUNMH. Lack of financial ability with 45%, insufficient payment of basic health insurance for mental health services with 27%, and noncoverage of mental health services by basic health insurance with 25% were the three main reasons for SUNMH. According to the logistic regression model, unemployment (OR: 2.70, 95% CI: 1.31–5.53), not having supplementary insurance (OR: 2.03, 95% CI: 1.11–4.74), having another member with a disability in the household (OR: 3.33, 95% CI: 1.34–8.29), and poor economic status increased the odds of experiencing unmet need for mental health services by about 3, 2, 3, and 21 times, respectively (OR: 21.11, 95% CI: 13.72–48.11). The concentration index was −0.496, indicating a greater concentration of SUNMH in people with low socioeconomic status. Access to health services is not suitable among people with disabilities and a significant percentage of them suffer from SUNMH. Policy recommendations are proposed to address the primary obstacle of financial barriers to SUNMH and increase access to the necessary services, which include increasing the allocation of financial resources to specialized mental health services for individuals with disabilities and expanding disability-specific health insurance coverage with government financial support. [ABSTRACT FROM AUTHOR]

Health education is one of the most effective and efficient ways to achieve the goal of universal health coverage and the sustainable development goals. The equity of access to health services (especially services from community healthcare centers) for internal migrants is an important issue of global concern. However, due to the registration system, long-term residence plan, education level, and other determinants, it is more difficult for internal migrants to enjoy equitable health education compared with local residents. At present, there is no research on signing up with family doctors mainly from community healthcare centers among internal migrants and their impact on access to health education services. In this nationwide cross-sectional study, we used the migrant population dynamic monitoring survey (MDMS) in 2018 to assess the disparities in signing up with a family doctor and its association with health education among internal migrants in China. Among the 151,892 participants, a total of 11.26% migrants had signed up with a family doctor and 81.37% internal migrants had received health education. There was a significant association between signing up with a family doctor and health education in the univariate model (aOR = 1.113; 95% CI: 1.095, 1.132) and the multivariate model (aOR = 1.107, 95% CI: 1.089, 1.126). Meanwhile, age (aORinteraction = 0.996, 95% CI: 0.994, 0.997), migration time (aORinteraction = 0.927, 95% CI: 0.907, 0.948), and migration range (aORinteraction = 0.994, 95% CI: 0.992, 0.997) also had an impact on the relationship between signing up with family doctors and health education. Due to the health education inequalities among internal migrants in China, we need to improve health education access and utilization of internal migrants. As signed up with family doctors was significantly associated with health education among migrants in China, we recommended that the government and healthcare facilities promote health education through family doctors. The number and professional ability of family doctors should also be improved especially in areas with weak healthcare service resources in the future. [ABSTRACT FROM AUTHOR]

Background. As part of the efforts being made to achieve universal health coverage, Ethiopia plans to introduce a social health insurance scheme for the formal sector. Although the contribution will be collected as 3% of an employee's gross salary from both the employee and employer, there is a concern that the premium may not be affordable for the majority of civil servants and that there could be limited interest in joining the scheme. As a result, the purpose of this study was to assess public servants' awareness, willingness to join, and affordability of social health insurance in Arba Minch, south Ethiopia. Methods and Materials. A cross-sectional study design was used with 713 randomly chosen public employees from Arba Minch town from January 1 to 30, 2019. The survey participants were selected based on a multistage stratified random sampling method. Descriptive statistics were used to summarize awareness and affordability of the scheme, and both bivariate and multivariable logistic regressions were used to examine factors driving the outcome variables. Variables that had a p value of less than 0.25 in bivariate analysis were changed to multivariate analysis, and a p value of less than 0.05 was cutoff point for multivariate analysis. The odds ratio and 95% CI were used to report the findings. Result. In this study, 692 people voluntarily participated, which corresponds to a response rate of 97%. As the results revealed, 347 (50.1%) respondents had never heard of SHI before, 607 (87.7%) were able to afford the 3% of gross salary per month as a scheme premium, and 254 (36.7%) were willing to join the scheme. Working sector, regularly listening for health information through mass media, and social network participation were significantly associated with awareness of the SHI scheme. Also, educational status, family size, and net income were found to be significant factors associated with the affordability of the SHI scheme. On the other hand, awareness of SHI, family size, regularly listening for health information, and participation in social networks were significantly associated with willingness to join SHI during multivariate analysis. Conclusion. Half of the participants were unaware of social health insurance, suggesting that the program is not well known. Although only one-third of respondents were willing to join and pay for the program, the majority were able to afford the proposed contribution of 3% of gross wages per month. [ABSTRACT FROM AUTHOR]

Family caregivers' sense of security benefits older adults who receive home care. Advance care planning (ACP) is reported to affect family caregivers' experience positively, but it might differ depending on family caregivers' kin relationships with the older adults. This study aimed to investigate whether ACP for older adults in home care settings is associated with family caregivers' sense of security and whether such an association depends on the family caregivers' status as spouses or adult children. Clarifying this association may offer practical support for implementing ACP while maintaining family caregivers' sense of security. This study was part of a prospective cohort study in Japan. The participants were older adults who used home-visit nursing services, their family caregivers, and the nurses who cared for them, recruited through the professional associations of home care nurses across Japan. Family caregivers answered a sense of security questionnaire, and the nurses were asked whether ACP was conducted. Data were collected three times from nurses and twice from family caregivers over a three-month period from August 2019 to June 2020. Multivariate logistic regression analyses were performed to examine the association between ACP implementation and positive changes in the sense of security scores after three months. Data from 169 cases were analyzed; 28.1% of the family caregivers were men and 55.6% were spouses. ACP was performed in 53.8% of the cases. The multivariate analysis showed an interactive effect between ACP implementation and family caregivers' kin relationships. For spouses, ACP was significantly associated with a positive change in their sense of security. For adult children, such an association was not found. Thus, ACP might have a positive effect on caregiving spouses' sense of security. Adult child caregivers, who often have multiple responsibilities and have difficulties facing their parents' physical decline, may need support in addition to ACP. [ABSTRACT FROM AUTHOR]

Carer-employees (CEs) are unpaid carers who are simultaneously working in paid employment. Workplace stress often compounds with caregiving stress to cause negative health effects for CEs. This analysis investigates cross-sectional data of the 2018 Canadian General Social Survey (GSS) to determine whether CEs who experienced work interferences (WIs), including taking time off work, turning down a job offer or promotion, and taking a less demanding job, were associated with poor mental health due to caregiving responsibilities. Carer-friendly work policies (CFWPs) and social support would lower the mental health impact of CEs and moderate the association between WIs and mental health. Of the 23,025 respondents, 4,291 were CEs. A series of multivariate logistic regressions were conducted on various mental health symptoms (e.g., feeling tired, experiencing appetite loss, and having trouble sleeping). Most WIs were positively associated with mental health symptoms. CFWPs, such as flexible scheduling, the option to work part-time, being able to take a leave of absence or an extended leave, and feeling that CFWPs can be taken without negative impacts on one's career, were negatively associated with at least one mental health symptom caused by the caregiving responsibilities. The option to telework was found to be nonsignificant. Generally, social support was associated with an increased chance of mental health symptoms, apart from help from the community. CEs who worked in workplaces that promoted CFWPs without negative impacts on their careers were less likely to feel anxious when turning down a job offer or promotion. Our study highlights the importance of CFWPs for CEs' mental health. As the number of CEs increases over time, the need for effective and wide-ranging CFWPs becomes more important. [ABSTRACT FROM AUTHOR]

Objectives. The study aims to determine the social care need among overweight and obese older adults by identifying the number of social care support receipts from different sources. Methods. A sample of 5640 participants (aged 50 years and over) taken from the English Longitudinal Study of Ageing Wave 8 dataset. Multivariate logistic regression analysis was performed to explore the relationship between the study variables. Results. The statistical analyses demonstrated that overweight and obese older adults are the recipients of increasing amounts of informal social care. Moderate and morbidly obese participants are the recipients of increasing amounts of formal care compared to their normal-weight counterparts, with morbid obesity being a strong predictor for receipt of formal care. Conclusions. The present study's findings demonstrate that for older adults aged 50 years presence of morbid obesity is a strongest predictor for receipt of formal care, and their well-being is not associated with formal or informal care receipt. The findings on how wider lifestyle factors influence the number of social care receipts, from different sources, may help policymakers and healthcare providers to allocate limited resources for adult social care services and promote healthy ageing rather than just focusing on weight loss alone. [ABSTRACT FROM AUTHOR]

Older people prefer to remain living in their own home for as long as possible; however, many require support to do so through health and other care services provided in the home. This study aimed to explore the trends in usage of a home-based care service by older people in metropolitan Melbourne and factors associated with unplanned hospitalisations. This longitudinal study analysed episodes of home-based care for people aged ≥65 years between 2006 and 2015. An episode of care was defined as the period of time during which the home care services were provided to the client. Care episodes culminated in a planned discharge from the service or an unplanned hospitalisation. Descriptive statistics and multivariable logistic regression were utilised to investigate the characteristics associated with unplanned hospitalisations. Utilisation of home-based care services over the 10-year period showed an increasing rate of use by people aged ≥85 years and a reduced usage rate by females aged 70–84 years and males 75–79 years old. Of 170,001 episodes of care, 43,608 (25.7%) resulted in an unplanned hospitalisation. Home-based care delivered to people aged ≥85 years showed an increasing rate of episodes ending in an unplanned transfer to the hospital. Between 2006 and 2015, individuals aged 85–89 years displayed a rate increase of 18.7% in episodes ending in an unplanned hospitalisation; for those aged ≥90 years, the rate rise was 43.6%. Factors associated with an unplanned hospitalisation included advancing age, male gender, living alone, cognitive dysfunction, and the complexity of medical issues. Health policy has focussed on providing services to enable older people to remain in their own home. The increasing rate of unplanned hospitalisations for community-dwellers aged ≥85 years suggests more support is required to enable ageing in place. [ABSTRACT FROM AUTHOR]

Background. Community-based health insurance (CBHI) is one of the strategies among others to be used for the achievement of universal health coverage (UHC) through providing financial protection to the citizens of a country. The schemes have been seen as effective in reducing out-of-pocket (OOP) payments and improving access to the healthcare services. This study tried to assess health-related quality of life between members and nonmembers of the scheme in rural southwest Ethiopia. Study Method. A community-based comparative cross-sectional study was conducted between the insured and uninsured populations. A standardized WHOQOL-BREF questionnaire was used. Cross-tab and frequency table analysis were done to tabulate for monovariable and bivariable analysis. Multiple linear regressions were employed to determine associations by adjusting for potential confounders. The association decision was made after fitted assumptions and adjustments done by modeling. Results. About six hundred thirty-four (634) households completed the survey with a response rate of 97.2%. More than 90% of the participants were illiterate and elementary education completed and farmers. Most uninsured family members claimed that they had difficulty affording annual payments 72.5%, P < 0.001. Willingness to pay was higher for insured members of households (72.2%), P < 0.001. Being insured had experienced a higher quality of life than uninsured, β (95% CI), 4.15 (2.52, 5.77), and P < 0.001. Marital status other than married had lower quality of life experiences than married alone, β (95% CI), −6.83 (−9.75, −3.92), and P < 0.001. Male respondents were experiencing lower quality than females, β (95% CI), −2.49 (−4.25, −0.72), and P = 0.006. Family number of the household and quality of life had positive linear relations, β (95% CI), 0.87 (0.43, 1.31), P < 0.001. Conclusions and Recommendations. Being insured had positive implications for quality of life. Inhabitants have to be encouraged to the scheme membership. [ABSTRACT FROM AUTHOR]

Participation by patients with chronic diseases under primary health care requires more attention to achieve effective disease management and better health outcomes. In 2016, China proposed accelerating the establishment of a system of family doctors (FDs) and strengthening doctor-patient communication to better meet residents' health service needs. This study aimed to describe perceived participation in primary health care among patients with chronic diseases in northeastern China and explore the impact of FD contract services and patient's trust on patients' perceived participation. A cross-sectional survey of 847 patients with chronic diseases in 16 primary healthcare institutions was conducted in Jilin Province, China. Among all participants, 453 patients reported signing up for FD contract services (62.93%). The perceived participation of patients with chronic diseases was at a low level (mean = 6.71 and SD = 3.35). After controlling for sociodemographic variables and health-related variables, FD contract services directly and indirectly influenced patients' perceived participation. The patient's trust was a mediator in the relationship between FD contract services and perceived participation. This study confirmed the valuation of family doctor contract services and provided a theoretical basis for the formulation of primary health service policies. Health organizations should continue to enhance the capacity of primary health services and attract more chronic disease patients to contract with FD teams, thereby enhancing doctor-patient trust and increasing patient's participation in primary health care. [ABSTRACT FROM AUTHOR]