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With population aging, governments have become increasingly involved in the administration, funding, and regulation of formal long-term care (LTC) systems. We examine the association between institutional trust and formal LTC service utilization among older adults aged ≥60 years with care needs in South Korea's public LTC scheme. Using data from the Korean Longitudinal Study of Aging and hierarchical logistic regressions, we evaluate the respective roles of trust in government and trust in the LTC program on service utilization. Results show that trust in the LTC scheme is significantly associated with service utilization: a unit increase in the level of trust is associated with a 29% increase in the odds of service use on average, controlling for need-related factors (e.g., chronic conditions) and other covariates. Furthermore, the positive relationship between trust and LTC utilization increases in magnitude with age. Older adults who are aged 80 and above, unmarried, with more ADL limitations, with psychiatric disease, or with arthritis are more likely to utilize formal LTC services. Our findings are robust to variations in sample inclusion criteria. Policymakers and health administrators should pay attention to building and maintaining institutional trust in public LTC schemes through good governance and other relevant strategies. [ABSTRACT FROM AUTHOR]

Abstract Background The aim of this study was to explore predictors associated with reasons for visiting an oral healthcare professional (OHP) and satisfaction with OHPs in the Netherlands among the Indian migrants and the host population. Methods A random sample was obtained for this cross-sectional questionnaire study. Variables were classified according to the Andersen Behavioural Model of Health Services Utilization. Multivariable binary logistic regression analysis was conducted to identify significant predictors for reasons for visiting an oral healthcare professional (OHP) (routine checkups and preventive care or visiting only for pain and/or treatment) and satisfaction with OHPs (satisfied or dissatisfied). Results The sample consisted of 391 participants (Indian migrants = 147 and host population = 244). Indian migrants with higher internal locus of control (LoC) [OR = 7.73 (95% CI: 2.13;27.99)], more trust in OHPs [OR = 4.12 (95% CI:1.68;10.14)] and higher integration level [OR = 1.09 (95% CI:1.03;1.17)] had higher odds of visiting an OHP for routine checkups and preventive care. In the host population, having dental insurance [OR = 2.64 (95% CI:1.00;6.95)] was significantly associated with increased odds of visiting an OHP for routine checkups and preventive care. For satisfaction, Indians with low paid jobs [OR = 16.26 (95% CI:2.83;93.36)] and those with higher integration levels [OR = 1.29 (95% CI:1.16;1.42)] had higher odds of being satisfied with the Dutch OHPs. Among the host population, those with more trust in OHPs [OR = 2.86 (95% CI:1.19;6.88)] had higher odds of being satisfied. Conclusion Our study emphasize that integration levels and trust emerged as two crucial factors, policy makers can leverage upon to improve access to care for Indian migrants. Clinical trial N.A as this is a survey based cross sectional study.

Background: The aim of this study was to explore predictors associated with reasons for visiting an oral healthcare professional (OHP) and satisfaction with OHPs in the Netherlands among the Indian migrants and the host population. Methods: A random sample was obtained for this cross-sectional questionnaire study. Variables were classified according to the Andersen Behavioural Model of Health Services Utilization. Multivariable binary logistic regression analysis was conducted to identify significant predictors for reasons for visiting an oral healthcare professional (OHP) (routine checkups and preventive care or visiting only for pain and/or treatment) and satisfaction with OHPs (satisfied or dissatisfied). Results: The sample consisted of 391 participants (Indian migrants = 147 and host population = 244). Indian migrants with higher internal locus of control (LoC) [OR = 7.73 (95% CI: 2.13;27.99)], more trust in OHPs [OR = 4.12 (95% CI:1.68;10.14)] and higher integration level [OR = 1.09 (95% CI:1.03;1.17)] had higher odds of visiting an OHP for routine checkups and preventive care. In the host population, having dental insurance [OR = 2.64 (95% CI:1.00;6.95)] was significantly associated with increased odds of visiting an OHP for routine checkups and preventive care. For satisfaction, Indians with low paid jobs [OR = 16.26 (95% CI:2.83;93.36)] and those with higher integration levels [OR = 1.29 (95% CI:1.16;1.42)] had higher odds of being satisfied with the Dutch OHPs. Among the host population, those with more trust in OHPs [OR = 2.86 (95% CI:1.19;6.88)] had higher odds of being satisfied. Conclusion: Our study emphasize that integration levels and trust emerged as two crucial factors, policy makers can leverage upon to improve access to care for Indian migrants. Clinical trial: N.A as this is a survey based cross sectional study. [ABSTRACT FROM AUTHOR]

COVID-19 vaccination is a critical public health measure to control the pandemic, but disparities in vaccination uptake remain a concern. This study investigates the determinants of COVID-19 vaccination among Korean adults using the Andersen model. Data from 231,784 participants in the community health survey were analyzed using chi-square testing and logistic regression. The risk of non-vaccination was higher among those aged 19–64 (95% CI: 1.52–1.74), males (95% CI: 1.11–1.24), the unemployed (95% CI: 2.21–2.47), unmarried individuals (95% CI: 1.12–1.24), those with unmet healthcare needs (95% CI: 1.41–1.67), recipients of national basic livelihood guarantees (95% CI: 1.45–1.73), those with lower subjective health (95% CI: 1.20–1.30), individuals with depression (95% CI: 1.28–1.44), current smokers (95% CI: 1.13–1.30), and those skipping breakfast (95% CI: 1.04–1.16). Conversely, the risk was lower for those with less than a high school education (95% CI: 0.72–0.81), individuals with psychological concerns about infection (0.87, 95% CI: 0.82–0.92) or public criticism (0.91, 95% CI: 0.86–0.97), individuals with chronic diseases (95% CI: 0.64–0.72), and current alcohol consumers (95% CI: 0.52–0.58). These findings underscore the need for targeted intervention strategies and support systems to promote vaccination in vulnerable populations. Further research should explore the long-term impact of these interventions on vaccination uptake. [ABSTRACT FROM AUTHOR]

The purpose of this study is to identify factors influencing depression among elderly people in island regions. To achieve this research objective, the study used raw data from the "Community Health Survey 2021" conducted by the Korea Disease Control and Prevention Agency. Its actual analysis was based on raw data from the "Community Health Survey 2021", targeting 450 elderly people aged 65 or older residing in Sinan-gun, Jeollanam-do, surveyed by Sinan-gun Public Health Center. In addition, a regression analysis was performed using SPSS version 29.0 to test the research hypotheses. The results of verifying the research hypotheses showed that gender, economic activity, pain, subjective health, and subjective stress would have signiflcant effects on depression among elderly people in island regions. Based on these research flndings, various practical and policy recommendations were presented to help manage depression among the elderly in island regions. [ABSTRACT FROM AUTHOR]

Abstract Background Residing in a nursing home (NH) may increase emergency department (ED) utilization in patients with dementia; however, evidence regarding the status of and predictors for ED utilization of NH residents with dementia remains unclear, especially in Asia. This study aimed to assess the incidence density of ED visits and associated factors for the risk of ED utilization among NH residents with dementia. Methods This one-year cohort study followed 6595 NH residents with dementia aged ≧ 40 years from Taiwan’s National Health Insurance Research Database between 2012 and 2014. The Andersen-Gill extension of Cox regression analysis with death as a competing risk was applied to investigate the association of the risk of all causes and the most common causes of ED utilization with the predisposing, enabling, and need factors as defined by the Andersen model. Results All participants encountered 9254 emergency visits in the 5371.49 person-years observed, representing incidence densities of ED visits of 1722.80 per 1000 person-years. Among them, respiratory disease was the most common cause of ED visits. The significant predictors for the risk of all-cause and respiratory-cause ED visits included: (1) predisposing factors (i.e., age and gender); (2) enabling factors (i.e., regional variables); and (3) need factors (i.e., prolonged ventilator dependence and comorbidity status). Conclusions Predisposing, enabling, and need factors could influence ED visits among studies patients. NH providers should consider these factors to develop strategies for reducing ED utilization.

Many factors contribute as facilitators of or barriers to adolescents' use of dental services. Guided by the expanded Andersen model for dental service utilization, the aim of this study was to identify factors associated with the use of dental services among adolescents ages 12–16 in south Mexico City (n = 247). Adolescents answered a questionnaire on predisposing factors (age and gender), enabling factors (socioeconomic status, oral health support, parental years of education, and previous dental treatments), and psychosocial and behavioral factors (attitudes towards oral health; knowledge of gingivitis; alcohol, drug, and tobacco use; and depressive symptoms), and they underwent a visual clinical exam to determine their need factors (caries and gingivitis). The adolescents reported whether or not they had attended a dental visit in the last year for any reason. Multiple logistic regression was used to evaluate these factors. Having oral health support increased the odds of a dental visit by 2.69 (95% CI = 1.24–5.84). Previous dental treatment increased the odds of a dental visit by 2.25 (95% CI = 1.12–4.52). The presence of depressive symptoms reduced the odds of a dental visit by 4% (OR = 0.96, 95% CI = 0.94–0.99). Enabling and psychosocial factors of oral health support and previous dental treatment were positively associated with the utilization of dental services, while depressive symptoms were negatively associated. [ABSTRACT FROM AUTHOR]

Abstract Background Studies in Nigeria and elsewhere in sub-Saharan Africa (sSA) have explored factors influencing usage of intermittent preventive treatment of malaria in pregnancy (IPTp). Most studies, however, are not model or theory-based, which provides less satisfactory guidance to malaria control programming. This study fills the knowledge gap by adapting Andersen’s behavioral model of health care use to IPTp usage in Nigeria. Methods This study adopted a cross-sectional design that utilized secondary data extracted from the 2018 Nigeria Demographic and Health Survey (NDHS). A weighted sample of 4,772 women who had given birth in the past year preceding the survey, was analyzed. Outcome variable was usage of IPTp, dichotomized into optimal or otherwise. Explanatory variables cut across individual and community levels and were divided into predisposing, enabling and need factors in line with the theoretical constructs of the Andersen model. Two multilevel mixed-effects logistic regression models were fitted to identify factors which influenced optimal usage of IPTp. Analyses were performed using STATA 14. Statistical significance was set at 5%. Results Realised level of optimal IPTp usage was 21.8%. Factors that either predispose or enable pregnant women to take optimal doses of IPTp were maternal education, being employed, being autonomous in their own healthcare, health insurance enrolment, partner education, receiving antenatal care in public health facilities, rural residence, being resident in northern geo-political zones, community literacy level and community perception of the consequences of malaria. Two significant need factors affecting optimal usage of IPTp were timing of the first antenatal care visit and sleeping under mosquito bed nets. Conclusion Optimal usage of IPTp is low among pregnant women in Nigeria. There is a need to devise additional public health educational programs promoting IPTp usage through the formation of Advocacy, Communication and Social Mobilisation (ACSM) in every ward in all local government areas, particularly in the rural and northern parts of the country. In addition, health planners should adopt the Andersen model for assessing key determinants of IPTp usage among childbearing women in Nigeria.

Abstract Background Poverty vulnerability has been defined as the likelihood of a family falling into poverty in the upcoming months. Inequality is a major cause of poverty vulnerability in developing countries. There is evidence that establishing effective government subsidies and public service mechanisms significantly reduces health poverty vulnerability. One of the ways to study poverty vulnerability is by using empirical data such as income elasticity of demand to perform the analysis. Income elasticity refers to the extent to which changes in consumers’ income affect changes in demand for commodities or public goods. In this work, we assess health poverty vulnerability in rural and urban China. We provide two levels of evidence on the marginal effects of the design and implementation of government subsidies and public mechanisms in reducing health poverty vulnerability, before and after incorporating the income elasticity of demand for health. Methods Multidimensional physical and mental health poverty indexes, according to the Oxford Poverty & Human Development Initiative and the Andersen model, were implemented to measure health poverty vulnerability by using the 2018 China Family Panel Survey database (CFPS) as the data source for empirical analysis. The income elasticity of demand for health care was used as the key mediating variable of impact. Our assessment was conducted by a two-level multidimensional logistic regression using STATA16 software. Results The first level regression indicates that the marginal utility of public mechanism (PM) in reducing urban and rural vulnerability as expected poverty on physical and mental health (VEP-PH&MH) was insignificant. On the other hand, government subsidies (GS) policies had a positive suppression effect on VEP-PH&MH to a relatively low degree. The second level regression found that given the diversity of health needs across individual households, i.e., the income elasticity of demand (HE) for health care products, PM and GS policies have a significant effect in reducing VEP-PH&MH in rural and urban areas. Our analysis has verified the significant positive impact of enacting accurate GS and PM policies on effectively reducing VEP-PH&MH in rural as well as urban areas. Conclusions This study shows that implementing government subsidies and public mechanisms has a positive marginal effect on reducing VEP-PH&MH. Meanwhile, there are individual variations in health demands, urban-rural disparities, and regional disparities in the effects of GS and PM on inhibiting VEP-PH&MH. Therefore, special consideration needs to be given to the differences in the degree of health needs of individual residents among urban and rural areas and regions with varying economic development. Furthermore, considerations of this approach in the current worldwide scenario are analyzed.

Abstract Background Cervical cancer, a major public health problem in many developing countries, is usually associated with a poor survival related to an advanced disease at diagnosis. In Côte d’Ivoire and other developing countries with high cervical cancer prevalence, little is known about factors associated with advanced cervical cancer stages in a context of limited access to screening services. Methods From May to July 2019, we conducted a cross-sectional study using a mixed, quantitative and qualitative method. Information on socio-demographic and history of the disease was extracted from a rapid case ascertainement study performed by the cancer registry of Côte d’Ivoire that enrolled all women diagnosed with cervical cancer between July 2018 and June 2019. In-depth semi-structured interviews were conducted among a subset of these women (12 women) and six healthcare providers to further capture barriers to early cervical cancer diagnosis. Factors associated with an advanced stage III, IV (according to FIGO classification) were estimated by a logistic regression model. Qualitative data were analyzed using a thematic analysis technique guided by the treatment pathway model and triangulated with quantitative data. Results In total, 95 women with cervical cancer [median age = 51 (IQR 42–59)] years, were included. Among them, 18.9% were living with HIV and only 9.5% were covered by a health insurance. The majority (71.5%) were diagnosed with advanced cervical cancer. Being HIV-uninfected (aOR = 5.4; [1.6–17.8], p = 0.006) and being uninsured (aOR = 13.1; [2.0-85.5], p = 0.007) were independently associated with advanced cervical cancer in multivariable analysis. Qualitative data raised additional factors potentially related to advanced cervical cancer stages at diagnosis, including the lack of patient information on cervical cancer by healthcare providers and inadequate national awareness and screening campaigns. Conclusion In a context of challenges in access to systematic cervical cancer screening in Côte d’Ivoire, access to health insurance or integrated healthcare program appear to be key determinants of early diagnosis of cervical cancer.

Background: Residing in a nursing home (NH) may increase emergency department (ED) utilization in patients with dementia; however, evidence regarding the status of and predictors for ED utilization of NH residents with dementia remains unclear, especially in Asia. This study aimed to assess the incidence density of ED visits and associated factors for the risk of ED utilization among NH residents with dementia. Methods: This one-year cohort study followed 6595 NH residents with dementia aged ≧ 40 years from Taiwan's National Health Insurance Research Database between 2012 and 2014. The Andersen-Gill extension of Cox regression analysis with death as a competing risk was applied to investigate the association of the risk of all causes and the most common causes of ED utilization with the predisposing, enabling, and need factors as defined by the Andersen model. Results: All participants encountered 9254 emergency visits in the 5371.49 person-years observed, representing incidence densities of ED visits of 1722.80 per 1000 person-years. Among them, respiratory disease was the most common cause of ED visits. The significant predictors for the risk of all-cause and respiratory-cause ED visits included: (1) predisposing factors (i.e., age and gender); (2) enabling factors (i.e., regional variables); and (3) need factors (i.e., prolonged ventilator dependence and comorbidity status). Conclusions: Predisposing, enabling, and need factors could influence ED visits among studies patients. NH providers should consider these factors to develop strategies for reducing ED utilization. [ABSTRACT FROM AUTHOR]

Background: Studies in Nigeria and elsewhere in sub-Saharan Africa (sSA) have explored factors influencing usage of intermittent preventive treatment of malaria in pregnancy (IPTp). Most studies, however, are not model or theory-based, which provides less satisfactory guidance to malaria control programming. This study fills the knowledge gap by adapting Andersen's behavioral model of health care use to IPTp usage in Nigeria. Methods: This study adopted a cross-sectional design that utilized secondary data extracted from the 2018 Nigeria Demographic and Health Survey (NDHS). A weighted sample of 4,772 women who had given birth in the past year preceding the survey, was analyzed. Outcome variable was usage of IPTp, dichotomized into optimal or otherwise. Explanatory variables cut across individual and community levels and were divided into predisposing, enabling and need factors in line with the theoretical constructs of the Andersen model. Two multilevel mixed-effects logistic regression models were fitted to identify factors which influenced optimal usage of IPTp. Analyses were performed using STATA 14. Statistical significance was set at 5%. Results: Realised level of optimal IPTp usage was 21.8%. Factors that either predispose or enable pregnant women to take optimal doses of IPTp were maternal education, being employed, being autonomous in their own healthcare, health insurance enrolment, partner education, receiving antenatal care in public health facilities, rural residence, being resident in northern geo-political zones, community literacy level and community perception of the consequences of malaria. Two significant need factors affecting optimal usage of IPTp were timing of the first antenatal care visit and sleeping under mosquito bed nets. Conclusion: Optimal usage of IPTp is low among pregnant women in Nigeria. There is a need to devise additional public health educational programs promoting IPTp usage through the formation of Advocacy, Communication and Social Mobilisation (ACSM) in every ward in all local government areas, particularly in the rural and northern parts of the country. In addition, health planners should adopt the Andersen model for assessing key determinants of IPTp usage among childbearing women in Nigeria. [ABSTRACT FROM AUTHOR]

Background: Poverty vulnerability has been defined as the likelihood of a family falling into poverty in the upcoming months. Inequality is a major cause of poverty vulnerability in developing countries. There is evidence that establishing effective government subsidies and public service mechanisms significantly reduces health poverty vulnerability. One of the ways to study poverty vulnerability is by using empirical data such as income elasticity of demand to perform the analysis. Income elasticity refers to the extent to which changes in consumers' income affect changes in demand for commodities or public goods. In this work, we assess health poverty vulnerability in rural and urban China. We provide two levels of evidence on the marginal effects of the design and implementation of government subsidies and public mechanisms in reducing health poverty vulnerability, before and after incorporating the income elasticity of demand for health. Methods: Multidimensional physical and mental health poverty indexes, according to the Oxford Poverty & Human Development Initiative and the Andersen model, were implemented to measure health poverty vulnerability by using the 2018 China Family Panel Survey database (CFPS) as the data source for empirical analysis. The income elasticity of demand for health care was used as the key mediating variable of impact. Our assessment was conducted by a two-level multidimensional logistic regression using STATA16 software. Results: The first level regression indicates that the marginal utility of public mechanism (PM) in reducing urban and rural vulnerability as expected poverty on physical and mental health (VEP-PH&MH) was insignificant. On the other hand, government subsidies (GS) policies had a positive suppression effect on VEP-PH&MH to a relatively low degree. The second level regression found that given the diversity of health needs across individual households, i.e., the income elasticity of demand (HE) for health care products, PM and GS policies have a significant effect in reducing VEP-PH&MH in rural and urban areas. Our analysis has verified the significant positive impact of enacting accurate GS and PM policies on effectively reducing VEP-PH&MH in rural as well as urban areas. Conclusions: This study shows that implementing government subsidies and public mechanisms has a positive marginal effect on reducing VEP-PH&MH. Meanwhile, there are individual variations in health demands, urban-rural disparities, and regional disparities in the effects of GS and PM on inhibiting VEP-PH&MH. Therefore, special consideration needs to be given to the differences in the degree of health needs of individual residents among urban and rural areas and regions with varying economic development. Furthermore, considerations of this approach in the current worldwide scenario are analyzed. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer, a major public health problem in many developing countries, is usually associated with a poor survival related to an advanced disease at diagnosis. In Côte d'Ivoire and other developing countries with high cervical cancer prevalence, little is known about factors associated with advanced cervical cancer stages in a context of limited access to screening services. Methods: From May to July 2019, we conducted a cross-sectional study using a mixed, quantitative and qualitative method. Information on socio-demographic and history of the disease was extracted from a rapid case ascertainement study performed by the cancer registry of Côte d'Ivoire that enrolled all women diagnosed with cervical cancer between July 2018 and June 2019. In-depth semi-structured interviews were conducted among a subset of these women (12 women) and six healthcare providers to further capture barriers to early cervical cancer diagnosis. Factors associated with an advanced stage III, IV (according to FIGO classification) were estimated by a logistic regression model. Qualitative data were analyzed using a thematic analysis technique guided by the treatment pathway model and triangulated with quantitative data. Results: In total, 95 women with cervical cancer [median age = 51 (IQR 42–59)] years, were included. Among them, 18.9% were living with HIV and only 9.5% were covered by a health insurance. The majority (71.5%) were diagnosed with advanced cervical cancer. Being HIV-uninfected (aOR = 5.4; [1.6–17.8], p = 0.006) and being uninsured (aOR = 13.1; [2.0-85.5], p = 0.007) were independently associated with advanced cervical cancer in multivariable analysis. Qualitative data raised additional factors potentially related to advanced cervical cancer stages at diagnosis, including the lack of patient information on cervical cancer by healthcare providers and inadequate national awareness and screening campaigns. Conclusion: In a context of challenges in access to systematic cervical cancer screening in Côte d'Ivoire, access to health insurance or integrated healthcare program appear to be key determinants of early diagnosis of cervical cancer. [ABSTRACT FROM AUTHOR]

Abstract Background China completed the task of eliminating absolute poverty, following the 18th National Congress. However, after 2020, rural poverty in China has entered a new stage that is characterised by transformational secondary poverty and relative poverty; thus, the poverty vulnerable group is the new target group. Public transfer payments play a vital role in reducing the vulnerability of rural households to healthcare poverty. Assessing the effectiveness of public transfer payments in rural households can improve the vulnerability of rural households to healthcare poverty. Methods In total, 5754 rural households were included each year, which accounted for a total of 16,722 rural households during the three-year study period. The multidimensional poverty and the vulnerability to healthcare poverty of rural households were assessed and compared. Two series of multivariate logistic regression models were further used to assess the effects of public transfer payments on improving the vulnerability of rural households to healthcare poverty. Results When the poverty line was set at $1.90 and $3.20, rural households in all the three study years exhibited a higher vulnerability to healthcare poverty than the actual incidence of multidimensional poverty in healthcare, and the Eastern regions exhibited higher vulnerability to poverty than the Western regions of China. The series of multivariate logistic models employed to evaluate the effects of public transfer payments on the rural households’ vulnerability to healthcare poverty indicated that considering the differences in rural households’ demands for healthcare is vital for the government to fulfill the effects of public transfer payments. When income elasticity indicators for health care needs were included, the effect of public transfer payments on improving the vulnerability of rural households changed from less significant in 2014 and 2016. In 2018, however, the effect of public transfers on improving the vulnerability of rural households has increased compared to the non-inclusion elasticity. Conclusions The imbalance of development between urban and rural areas in China is increasing, and rural households with heavy economic burdens are facing the risk of low healthcare services. Our findings highlight the importance of government departments in improving public transfer payments to reduce rural households’ vulnerability to healthcare poverty.

Background: While the community health service system was initially established in rural areas of mainland China, the utilization of community health service resources by the rural elderly population is not clear. Methods: Cross-sectional studies on the utilization of community health services by the rural elderly population in mainland China published within the last 10 years were retrieved from the China National Knowledge Infrastructure (CNKI), Wan Fang, Medline and Web of Science (WOS) databases. The quality of the article was evaluated by the Critical Appraisal Skills Programme (CASP), and obstacles to the utilization of community health services by the rural elderly population were analyzed based on the Andersen model. Results: Twenty-four studies were analyzed, and 3 gaps were found. (i) The cognition of rural elderly residents does not match the current health security system. (ii) There is a gap between the supply of health service resources in rural communities and the health needs of the elderly residents in these areas. (iii) The health services provided by rural primary health service institutions are not targeted. Conclusions: In mainland China, the provision of community health services to the rural elderly population has improved significantly. However, several factors from the individual level to the system level lead to low levels of access and utilization. This finding means that under the leadership of the government, it is necessary to integrate the strength of multiple departments to cooperate in improving the welfare system, policy publicity, health education, financial support, system guarantees and resource exchange and sharing for the elderly population in rural areas and to jointly promote community health services for the elderly population in rural areas. [ABSTRACT FROM AUTHOR]

Abstract Background Rural residents with chronic conditions have a stronger need for health services, which should make using family doctor contract services a priority. This study aimed to evaluate the rate of willingness among rural residents with chronic conditions to contract with family doctors and examine its determinants. Methods A cross-sectional study was conducted from May, 2018 to June, 2018 in Shandong Province in China. A total of 769 rural unsigned residents with chronic conditions were included in the analysis. Using the Andersen model as the theoretical framework, logistic regression models were chosen to analyse the factors associated with willingness to contract with family doctors. Results This study found that the rate of willingness to contract with family doctors among chronic patients in rural Shandong was 46.7%. A higher willingness was observed in those living a further distance from the village clinic (more than 600 m: OR = 1.85, 95%CI =1.17–2.93), having received publicity for family doctor contract services (OR = 1.71, 95% CI = 1.06–2.76), reporting need for utilizing a chronic disease management program (OR = 3.36, 95% CI = 2.20–5.23), and reporting need for higher medical insurance reimbursement (OR = 1.91, 95% CI = 1.28–2.83). Conclusions The prevalence of contract willingness was relatively low among unsigned rural residents with chronic conditions in rural Shandong, China. The need factors were powerful factors affecting their willingness to contract with family doctors. The government should therefore strengthen targeted publicity and education to rural residents with chronic conditions and provide targeted healthcare services, such as chronic disease management programs and medical services with higher reimbursement rates, to promote their willingness to contract with family doctors.

Background: One of the most significant challenges of implementing a multi-provider bundled payment contract is to determine an appropriate, casemix-adjusted total bundle price. The most frequently used approach is to leverage historic care utilization based on claims data. However, those claims data may not accurately reflect appropriate care (e.g. due to supplier induced demand and moral hazard effects). This study aims to examine variation in claims-based costs of post-discharge primary care physical therapy (PT) utilization after total knee and hip arthroplasties (TKA/THA) for osteoarthritis patients.Methods: This retrospective cohort study used multilevel linear regression analyses to predict the factors that explain the variation in the utilization of post-discharge PT after TKA or THA for osteoarthritis patients, based on the historic (2015-2018) claims data of a large Dutch health insurer. The factors were structured as predisposing, enabling or need factors according to the behavioral model of Andersen.Results: The 15,309 TKA and 14,325 THA patients included in this study received an average of 20.7 (SD 11.3) and 16.7 (SD 10.1) post-discharge PT sessions, respectively. Results showed that the enabling factor 'presence of supplementary insurance' was the strongest predictor for post-discharge PT utilization in both groups (TKA: β = 7.46, SE = 0.498, p-value< 0.001; THA: β = 5.72, SE = 0.515, p-value< 0.001). There were also some statistically significant predisposing and need factors, but their effects were smaller.Conclusions: This study shows that if enabling factors (such as supplementary insurance coverage or co-payments) are not taken into account in risk-adjustment of the bundle price, they may cause historic claims-based pricing methods to over- or underestimate appropriate post-discharge primary care PT use, which would result in a bundle price that is either too high or too low. Not adjusting bundle prices for all relevant casemix factors is a risk because it can hamper the successful implementation of bundled payment contracts and the desired changes in care delivery it aims to support. [ABSTRACT FROM AUTHOR]

There is insufficient empirical evidence on the correlates of health care utilization of irregular migrants currently living in Turkey. The aim of this study was to identify individual level determinants associated with health service and medication use. One hundred and fifty-five Afghans completed surveys assessing service utilization including encounters with primary care physicians and outpatient specialists in addition to the use of prescription and nonprescription medicines. Multivariate logistic regression analyses were employed to examine associations between service use and a range of predisposing, enabling, and perceived need factors. Health services utilization was lowest for outpatient specialists (20%) and highest for nonprescription medications (37%). Female gender and higher income predicted encounters with primary care physicians. Income, and other enabling factors such as family presence in Turkey predicted encounters with outpatient specialists. Perceived illness-related need factors had little to no influence on use of services; however, asylum difficulties increased the likelihood for encounters with primary care physicians, outpatient services, and the use of prescription medications. This study suggests that health services use among Afghan migrants in Turkey is low considering the extent of their perceived illness-related needs, which may be further exacerbated by the precarious conditions in which they live.

Abstract Background Mental health and well-being among older women is an important topic due to the feminization of later life as women tend to have longer life expectancy resulting in elderly women being more advanced in age and outnumbering men. Older women generally play a key role in their families lifelong and mostly depend on social support from their family and close friends in older age to cope with any limitations they face as a result of age-related changes in their health and functional ability. Methods We examine which factors predict mental health and well-being in older women using the Third Wave of the 2010 Female Social Status Survey conducted by the All-China Women’s Federation (n = 3527). Applying the Andersen Model, regression analysis exploring predisposing, enabling and health need variables were tested using SPSS version 22 predicting a mental health scale. Results Results showed that living with a spouse was not a significant predictor of mental health for women, while it was for men (b = − 1.2, p

Background: China completed the task of eliminating absolute poverty, following the 18th National Congress. However, after 2020, rural poverty in China has entered a new stage that is characterised by transformational secondary poverty and relative poverty; thus, the poverty vulnerable group is the new target group. Public transfer payments play a vital role in reducing the vulnerability of rural households to healthcare poverty. Assessing the effectiveness of public transfer payments in rural households can improve the vulnerability of rural households to healthcare poverty.Methods: In total, 5754 rural households were included each year, which accounted for a total of 16,722 rural households during the three-year study period. The multidimensional poverty and the vulnerability to healthcare poverty of rural households were assessed and compared. Two series of multivariate logistic regression models were further used to assess the effects of public transfer payments on improving the vulnerability of rural households to healthcare poverty.Results: When the poverty line was set at $1.90 and $3.20, rural households in all the three study years exhibited a higher vulnerability to healthcare poverty than the actual incidence of multidimensional poverty in healthcare, and the Eastern regions exhibited higher vulnerability to poverty than the Western regions of China. The series of multivariate logistic models employed to evaluate the effects of public transfer payments on the rural households' vulnerability to healthcare poverty indicated that considering the differences in rural households' demands for healthcare is vital for the government to fulfill the effects of public transfer payments. When income elasticity indicators for health care needs were included, the effect of public transfer payments on improving the vulnerability of rural households changed from less significant in 2014 and 2016. In 2018, however, the effect of public transfers on improving the vulnerability of rural households has increased compared to the non-inclusion elasticity.Conclusions: The imbalance of development between urban and rural areas in China is increasing, and rural households with heavy economic burdens are facing the risk of low healthcare services. Our findings highlight the importance of government departments in improving public transfer payments to reduce rural households' vulnerability to healthcare poverty. [ABSTRACT FROM AUTHOR]

To investigate perceptions of informal caregivers of community-dwelling persons with dementia (PwD) regarding health and social care services and their correlates using the Behavioral Model of Healthcare Utilization as the theoretical framework. This was a cross-sectional study using a purposive sampling technique to identify, through community-based health and social care services, caregivers of PwD. Face-to-face interviews were conducted with 118 informal caregivers (78.8% female, mean age = 58.9 years) via a structured questionnaire. Three 'Perceptions of Services' subscales were identified: 'Availability and Adequacy of Services' (AAS), 'Physicians' Competence' (COMP), and 'Professionals' Behavior' (PB). Predisposing factors (gender, employment, familism) and enabling/impeding factors (caregiving impedes work, quality of life aspects – environment and social relationships, information about dementia) were significant correlates of the AAS and COMP subscales. Familism was negatively associated with the AAS subscale. PwD's perceived declined physical and behavioral functioning was related to worse perceptions regarding professionals' behavior (PB) toward the PwD. Understanding the factors associated with caregivers' perceptions of health and social care community services may guide the development of interventions that facilitate the appropriate use of those services, provide increased support to PwD and their caregivers, and delay potential institutionalization. [ABSTRACT FROM AUTHOR]

BACKGROUND: While the community health service system was initially established in rural areas of mainland China, the utilization of community health service resources by the rural elderly population is not clear. METHODS: Cross-sectional studies on the utilization of community health services by the rural elderly population in mainland China published within the last 10 years were retrieved from the China National Knowledge Infrastructure (CNKI), Wan Fang, Medline and Web of Science (WOS) databases. The quality of the article was evaluated by the Critical Appraisal Skills Programme (CASP), and obstacles to the utilization of community health services by the rural elderly population were analyzed based on the Andersen model. RESULTS: Twenty-four studies were analyzed, and 3 gaps were found. (i) The cognition of rural elderly residents does not match the current health security system. (ii) There is a gap between the supply of health service resources in rural communities and the health needs of the elderly residents in these areas. (iii) The health services provided by rural primary health service institutions are not targeted. CONCLUSIONS: In mainland China, the provision of community health services to the rural elderly population has improved significantly. However, several factors from the individual level to the system level lead to low levels of access and utilization. This finding means that under the leadership of the government, it is necessary to integrate the strength of multiple departments to cooperate in improving the welfare system, policy publicity, health education, financial support, system guarantees and resource exchange and sharing for the elderly population in rural areas and to jointly promote community health services for the elderly population in rural areas. [ABSTRACT FROM AUTHOR]

Objective: The first aim of this study was to explore expected demands of the oldest old and their determinants for different types of elderly care services. The second aim was to investigate preferred choices of living arrangements among the oldest old and the influencing factors.Methods: Data of 4,738 participants aged ≥80 years were extracted from the Chinese Longitudinal Health Longevity Survey carried out in 2014. Using the Andersen model as the analysis framework, a multiple logistic regression analysis was performed to analyze the relationship between the expected elderly care services and living arrangements and other influencing factors. The odds ratios were calculated to indicate the relationship between the influencing factors and the dependent variables.Results: From the descriptive analysis results, we found that the oldest old showed high anticipated needs for home visits (83.5%) and health education (76.4%). Further, there existed a huge imbalance between the supply and demand of care services for the aged. Living with children is still the most important way of providing for the oldest old. The regression results showed that the expected demands for elderly care services and anticipated living arrangements among the oldest old in China are influenced by age, residence, housing property rights, economic status, loneliness, and activities of daily living (ADLs). The oldest old who are older without housing property rights, childless, and have restricted ADLs were more frequently observed to live in long-term care institutions.Conclusions: There is an inequality of the supply and expected demand for elderly care services, and living with children is still a preferred choice of the Chinese oldest old. Our findings indicate that when planning how to promote elderly care services among the oldest old, it is important to consider their expectations, especially for the subgroup that is relatively disadvantaged. Related policies should be developed to offer incentives to family caregivers when they live with the oldest old.

Background: Rural residents with chronic conditions have a stronger need for health services, which should make using family doctor contract services a priority. This study aimed to evaluate the rate of willingness among rural residents with chronic conditions to contract with family doctors and examine its determinants. Methods: A cross-sectional study was conducted from May, 2018 to June, 2018 in Shandong Province in China. A total of 769 rural unsigned residents with chronic conditions were included in the analysis. Using the Andersen model as the theoretical framework, logistic regression models were chosen to analyse the factors associated with willingness to contract with family doctors. Results: This study found that the rate of willingness to contract with family doctors among chronic patients in rural Shandong was 46.7%. A higher willingness was observed in those living a further distance from the village clinic (more than 600 m: OR = 1.85, 95%CI =1.17–2.93), having received publicity for family doctor contract services (OR = 1.71, 95% CI = 1.06–2.76), reporting need for utilizing a chronic disease management program (OR = 3.36, 95% CI = 2.20–5.23), and reporting need for higher medical insurance reimbursement (OR = 1.91, 95% CI = 1.28–2.83). Conclusions: The prevalence of contract willingness was relatively low among unsigned rural residents with chronic conditions in rural Shandong, China. The need factors were powerful factors affecting their willingness to contract with family doctors. The government should therefore strengthen targeted publicity and education to rural residents with chronic conditions and provide targeted healthcare services, such as chronic disease management programs and medical services with higher reimbursement rates, to promote their willingness to contract with family doctors. [ABSTRACT FROM AUTHOR]

Objective This study explored factors that underpin decisions to seek emergency department (ED) care for chronic noncancer pain in patients identifying as culturally and linguistically diverse (CALD) or Australian born. Design and Methods This mixed-methods study was underpinned by the Behavioral Model of Health Services Use conceptual framework. Consenting consecutive patients attending the ED for a chronic pain condition were recruited to a CALD (n = 45) or Australian-born (n = 45) cohort. Statistical comparisons compared the demographic, pain, health literacy, and episode of care profiles of both cohorts. Twenty-three CALD and 16 Australian-born participants consented to an audio-recorded semi-structured interview (n = 24) or focus group (n = 5 focus groups) conducted in their preferred language. Interviews were translated and transcribed into English for analysis using applied thematic analysis, guided by the conceptual framework. Data were triangulated to investigate the patterns of ED utilization and contributing factors for both cohorts. Results ED attendance was a product of escalating distress, influenced by the degree to which participants' perceived needs outweighed their capacity to manage their pain. This interaction was amplified by the presence of predisposing factors, including constrained social positions, trauma exposure, and biomedical health beliefs. Importantly, experiences varied between the two cohorts with higher degrees of pain catastrophizing, lower health literacy, and greater social challenges present for the CALD cohort. Conclusion This study highlights the role contextual factors play in amplifying pain-related distress for CALD and Australian-born patients with chronic pain. The findings support a need for health care providers to recognize features of higher vulnerability and consider streamlining access to available support services. [ABSTRACT FROM AUTHOR]

Abstract Backgrounds Tooth loss is one of the major oral health problems among older Thai people. However, there is the existence of socioeconomic-related inequalities in dental service utilization, especially denture service. The aim of this study was to assess the determinants associated with inequalities in denture service utilization among older Thai people using the Andersen Behavioural model. Method This cross-sectional study involved secondary data analysis of the 2014 survey of older Thai people (N = 38,695). The dependent variable was a public denture service utilization over the past 5 years. Determinants were classified as predisposing and enabling factors. Predisposing variables included age, sex, education, economic condition and dependency status. Enabling variables included working status, health behaviours, health care utilization experience and social/community support. Data were analysed by using bivariate and multivariable analyses at α = 0.05. For bivariate analysis, chi-square test was used to determine the association between dependent and each independent variable. Then, all variables were incorporated into a multivariable binary logistic regression. Results The odds of denture service utilization were significantly higher for individuals who were older, female, and had a higher educational level and health-promoting behaviors. A positive dose-response relationship was demonstrated between denture service utilization and increased quartile of household assets. Conclusions Predisposing variables had a greater impact than enabling variables in denture service utilization among older Thai people. Despite free public denture service, socioeconomic-related inequalities persist. The government needs to reduce socioeconomic disparities to improve denture treatment inequality.

Purpose: This study aimed to ascertain the general characteristics of injured patients and use the Andersen Model to identify factors affecting health-related quality of life (QOL) in injured patients with or without activity limitations. Methods: We used data of 1602 injured patients from 2014 to 2017 from the population-based Korea National Health and Nutrition Examination Survey, South Korea. QOL was measured using the EQ-5D-3L, and activity limitations were analyzed alongside predisposing factors (gender, age, education level, and marital status), enabling factors (basic living security, health insurance type, private insurance status, household income, and living with family), need factors (number of chronic diseases, subjective health status, and unmet medical needs), and health behaviors (smoking status, alcohol consumption, physical activity, and health screening). Data were analyzed using homogeneity testing, t tests, and logistic and multiple regression. Results: The mean EQ-5D index was 0.8 with activity limitations and 0.9 without activity limitations. In mobility domain, patients without activity limitations showed significant effects of age, education level, number of chronic diseases, subjective health status, and unmet medical needs on mobility, whereas patients with activity limitations only showed a significant effect of age. In self-care domain, age, household income, and number of chronic diseases showed significant factors on patients without activity limitations, but there was no significant factor associated with activity limitations. Among the factors affecting usual activities, gender was found to have a significant effect only on patients with activity limitations, and subjective health status was found to have a significant effect regardless of activity limitations. Among the factors affecting pain/discomfort, living with family only affected pain/discomfort in patients with activity limitations. Among the factors affecting anxiety/depression, gender and alcohol consumption had significant effects only on patients with activity limitations. Conclusion: Factors affecting the QOL of injured patients differed depending on whether patients had activity limitations. Therefore, when assessing injured patients, it may be necessary to ascertain the extent of activity limitations, and medical institutions and local communities need when implementing education and interventions to improve their QOL. [ABSTRACT FROM AUTHOR]

Background and aim Oral health is an integral part of overall general health. Understanding the variables that affect the use of dental services can help overcome the challenges and lessen disparities in oral health. There are no significant reliable questionnaires available for determining factors that influence dental care utilization. This study aimed to develop and validate a questionnaire based on the Andersen model of healthcare utilization to assess these factors. Materials and methods A preliminary questionnaire consisting of 34 items was developed based on the Andersen model of healthcare utilization. The questionnaire's final version consisted of 24 items after five subject area experts analyzed its face validity and content validity. Content validity ratio (CVR) was used to evaluate the validity of the questionnaire. The Cronbach's alpha coefficient was then used to establish the internal consistency and test-retest for the reliability of the questionnaire. Results The final version of the questionnaire included 24 items based on CVR, and the data of the final version suited the model well. The internal consistency measured with Cronbach's alpha coefficient was above the threshold for each item. The Cronbach's alpha value for test-retest reliability was found to be 0.72, which was acceptable. Conclusions The current results show that the proposed questionnaire for dental utilization based on the Andersen model has satisfactory validity and reliability. This questionnaire can be used as an instrument to determine the various factors that affect the utilization of dental services., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethical Committee, SRM Medical College and Hospital issued approval SRMIEC-ST0523-507. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, . et al.)

Background: We aimed to investigate the factors affecting healthcare utilization among patients with single and multiple chronic diseases using the Andersen healthcare utilization model. Methods: We used a combination of the data from the sixth and seventh Korea National Health and Nutrition Survey (2014–2016). The study population was 3,901 patients with single chronic disease and 1,829 patients with multiple chronic diseases as defined by the WHO. Participants were aged 19 yr or older. Multiple regression analysis was employed using the Andersen model to identify factors affecting healthcare utilization (inpatient and outpatient). Results: According to the Andersen model (comprising predisposing, enabling, and need factors and health behaviors), the factors that increased outpatients with single chronic disease were female, being aged 65 yr or older, having basic livelihood security benefit, immobility, and poor subjective health status. Factors that increased inpatients with single chronic disease were being aged under 65, having private insurance, immobility, poor subjective health status, and nondrinking. Moreover, factors that increased outpatients and inpatients with multiple chronic diseases were female, being aged under 65, immobility, and poor subjective health status and immobility, poor subjective health status, nondrinking, and not engaging in physical activity, respectively. Conclusion: We identified factors affecting outpatient and inpatient care utilization among patients with single and multiple chronic diseases, using the Andersen healthcare utilization model. The findings can be used as foundational data to develop preventive and management strategies in healthcare utilization among patients with single and multiple chronic diseases.

Abstract Background We propose using neighborhood characteristics as demand-related morbidity adjusters to improve prediction models such as the risk equalization model. Results Since the neighborhood has no explicit ‘place’ in healthcare demand models, we have developed the “Neighborhood and healthcare utilization model” to show how neighborhoods matter in healthcare utilization. Neighborhood may affect healthcare utilization via (1) the supply-side, (2) need, and (3) demand for healthcare – irrespective of need. Three pathways are examined in detail to explain how neighborhood characteristics influence healthcare utilization via need: the physiological, psychological and behavioral pathways. We underpin this theoretical model with literature on all relevant neighborhood characteristics relating to health and healthcare utilization. Conclusion Potential neighborhood characteristics for the risk equalization model include the degree of urbanization, public and open space, resources and facilities, green and blue space, environmental noise, air pollution, social capital, crime and violence, socioeconomic status, stability, and ethnic composition. Air pollution has already been successfully tested as an important predictive variable in a healthcare risk equalization model, and it might be opportune to add more neighborhood characteristics.

Using Andersen's behavioral model of service utilization, this study aimed to understand how predisposing, enabling, and need factors were associated with two types of service utilization among caregivers of people with dementia. Caregiver participants (N = 637) were from the Resources for Enhancing Alzheimer's Caregivers Health (REACH II) study. Binary logistic and linear regression analyses were conducted to predict whether participants used services and the frequency of such service utilization. Results showed that some enabling and need factors were significantly associated with both discretionary and non-discretionary service utilization. Results also indicated some need factors were significant factors of the frequency of use for both discretionary and non-discretionary services. In addition, being Hispanic or African American moderated the association between some enabling or needs factors and service utilization. Practice attention needs to be paid on several enabling and needs factors among Hispanic and African American caregivers of people with dementia. [ABSTRACT FROM AUTHOR]

Population ageing in China calls for evidence-based solutions, especially in terms of fulfilling long-term care needs among frail older adults. Respite services are identified as effective resources for alleviating care-giver burden and promoting the wellbeing of both older adults and their family care-givers. However, respite care is often under-used in China. This research aimed to examine factors associated with intention to use respite services among informal care-givers in Shanghai, mainland China. This study was part of the Longitudinal Study on Family Caregivers for Frail Older Adults in Shanghai. Pairs of older adults and their care-givers (N = 583) who successfully completed the 2013 and 2016 waves were included in the data analysis. Two logistic regression models were conducted, one with time-invariant and one with time-variant factors. The model with time-variant factors had greater explanatory power than the original Andersen model with time-invariant factors influencing intention to use respite services among care-givers. Care-givers had higher odds of intending to use respite services if they had higher care-giving burden, were caring elderly people who experienced care-giver transitions, or were caring for elderly people with increased function of ambulation or decreased function of feeding. The findings imply that change in functional health was a significant determinant of intention to use respite care. Relevant policy and service implications will be discussed. [ABSTRACT FROM AUTHOR]

Background: Mental health and well-being among older women is an important topic due to the feminization of later life as women tend to have longer life expectancy resulting in elderly women being more advanced in age and outnumbering men. Older women generally play a key role in their families lifelong and mostly depend on social support from their family and close friends in older age to cope with any limitations they face as a result of age-related changes in their health and functional ability.Methods: We examine which factors predict mental health and well-being in older women using the Third Wave of the 2010 Female Social Status Survey conducted by the All-China Women's Federation (n = 3527). Applying the Andersen Model, regression analysis exploring predisposing, enabling and health need variables were tested using SPSS version 22 predicting a mental health scale.Results: Results showed that living with a spouse was not a significant predictor of mental health for women, while it was for men (b = - 1.2, p < .01), ownership of property is significant only for men (b = -.96, p < .05), whereas women's mental health is more strongly predicted by current exercise (b = -.89, p < .01) and participation in leisure activities (b = -.69, p < .001). Close relationships with neighbors, qualifying for old-age benefit programs and being in better overall health supports positive mental health for both men and women. Reporting delayed medical treatment is associated with a negative impact on mental health for men, but oddly women who report the same actually report better mental health, perhaps suggesting older women take pride in their self-sacrifice.Conclusion: The findings of this study suggest that gender differences in wealth, living alone, and social participation are interpreted differently by women, who have longer lives with generally fewer material resources. Enabling factors tend to be more associated with financial factors for men, while women rely on a social convoy to thrive longer than their male counterparts. [ABSTRACT FROM AUTHOR]

This qualitative study explored the fit between on-reserve First Nations community members' conceptualizations of help-seeking for mental health concerns and the Andersen Behavioral Model of Health Services Use. Youth, adults and elders (N = 115) living and or working in eight distinct First Nations communities within a tribal council area in Canada participated in focus groups or individual interviews that were transcribed, coded and then analyzed using a thematic analysis approach informed by grounded theory methodology. Resulting themes were then mapped onto the Andersen Behavioral Model of Health Services Use. Participants' conceptualizations of predisposing characteristics including social structures, health beliefs and mental illness, enabling and impeding resources had a high degree of fit with the model. While perspectives on perceived need for mental health care, and spirituality as a health and lifestyle practice had only moderate fit with the model, these domains could be modified to fit First Nations' interpretations of help-seeking. Participants' perceptions of avoidant strategies and non-use of mental health services, however did not map onto the model. These findings suggest conceptualizations of help-seeking for mental health issues in these First Nations communities are only partially characterized by the Andersen Behavioral Model, suggesting there are a number of considerations to Indigenize the model. Findings also highlight potential explanations for why some members of this population may not access or receive appropriate mental health treatment. Multi-pronged efforts are warranted to link culturally normed pathways of help-seeking with effective mental health supports for First Nations community members in Canada. [ABSTRACT FROM AUTHOR]

Background: Electronic cigarette (e-cigarette) use has increased dramatically in the United States among adults and adolescents. Patients with asthma may be most vulnerable to the chemical components of e-cigarettes as they may be a potential asthma trigger.Objective: To assess the prevalence of e-cigarette use among adult asthmatics and to evaluate the factors associated with e-cigarette use.Methods: This was a retrospective, cross-sectional study that used data from the 2014-2017 National Health Interview Survey (NHIS) database. The study sample included current asthmatics who were 18-85 years old. The outcome variable was ever use of an e-cigarette (Yes/No). The Andersen Behavioral Model of Health Services Utilization was used to identify independent variables with the potential to influence the patient's decision to try e-cigarettes. Descriptive statistics were used to describe the sample. Factors associated with e-cigarette use were assessed using logistic regression. All analyses were stratified by age group. Appropriate survey weights were used to account for the complex survey design.Results: The study sample included 10,578 adults with current asthma and about 18% of the sample had ever tried an e-cigarette. About 20% of males and 20% of non-Hispanic Whites reported ever trying an e-cigarette. From 2014 to 2017, the e-cigarette use among the 18-24 year old age group increased the most from 20.3% to 29.1%. Current smokers were more likely to have tried e-cigarettes than former/never smokers (18-24 years OR: 11.5 CI: 7.4-18.0). This trend was significant among all age groups. Non-Hispanic Blacks were less likely to have tried e-cigarettes than non-Hispanic Whites (50-64 years OR: 0.34 CI: 0.22-0.52).Conclusion: The prevalence of e-cigarette use among adult asthmatics has continued to increase over time. Smoking status was the most consistent predictor of e-cigarette use among all age groups in this asthmatic population. [ABSTRACT FROM AUTHOR]

Objectives: In the current study, the Anderson model is used to determine equitable access to dementia care in Europe. Predisposing, enabling, and need variables were investigated to find out whether there is equitable access to dementia-specific formal care services. Results can identify which specific factors should be a target to improve access.Methods: A total of 451 People with middle-stage dementia and their informal carers from eight European countries were included. At baseline, there was no use of formal care yet, but people were expected to start using formal care within the next year. Logistic regressions were carried out with one of four clusters of service use as dependent variables (home social care, home personal care, day care, admission). The independent variables (predisposing, enabling, and need variables) were added to the regression in blocks.Results: The most significant predictors for the different care clusters are disease severity, a higher sum of (un)met needs, hours spent on informal care, living alone, age, region of residence, and gender.Conclusion: The Andersen model provided for this cohort the insight that (besides need factors) the predisposing variables region of residence, gender, and age do play a role in finding access to care. In addition, it showed us that the numbers of hours spent on informal care, living alone, needs, and disease severity are also important predictors within the model's framework. Health care professionals should pay attention to these predisposing factors to ensure that they do not become barriers for those in need for care. [ABSTRACT FROM AUTHOR]

In Singapore, policy makers expect families to remain actively involved in the care of their frail older relatives, as manifestly expressed in its Many Helping Hands approach to long-term care. To enable families to fulfill this expectation, the government has enacted policies that encourage the hiring of foreign domestic workers (FDWs) to complement or supplement informal caregiving efforts. Using the Andersen Behavioral Model, we were interested in identifying caregiver and care receiver characteristics that might predict the hiring of FDWs. With data from a convenience sample of 488 informal caregivers, we ran logistic regression regressing the hiring of an FDW on various predisposing, enabling, and need factors. Of interest, enabling factors such as household income, housing type, and educational level were predictive of hiring an FDW in the home. Only one need factor, time spent in caregiving, was predictive of the increased likelihood to hire an FDW. Policies that encourage the marketization of care are likely to favor those with financial means and inadvertently ignore the caregiving burdens of lower income families. In addition, we suggest research and policies to ensure the well-being and protection of FDWs who have become a key component of the long-term care policy and practice in Singapore. [ABSTRACT FROM AUTHOR]

The role of the food environment in shaping nutrition and health has gained substantial attention from policymakers, public health researchers, and advocacy groups. To promote equities in food access and nutrition outcomes, understanding factors linked with the utilization of local community food resources is crucial. Using Andersen's service utilization model, we explained how adults use their neighborhood food resources. In a cross-sectional study design, an online survey was conducted in REDCap Version 13.4.0 via the Amazon Mechanical Turk (MTurk) involving 1830 adults with a mean age of 37.9  ±  12.1 years. Participants answered questions on predisposing, enabling, and need factors that influence their use of different community food resources. The predisposing factors that were statistically significant included age, family size, marital status, race, and ethnicity. The enabling factors included travel time, travel mode, income, and shopping decision motivators (such as being able to use Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) vouchers, delivery services, great sales, and coupons). Food security and community food resources need for lower food price were the significant need factors. However, these factors vary by the types of food resources. In conclusion, enhancing the utilization of community-based food access initiatives and programs among underserved families requires consideration of family composition, racial and ethnic diversity, and transportation access.

Objective: The purpose of this study was to investigate the determinants of the health‐related quality of life of elderly people in Korea by applying the Andersen model. Design and Sample: This study was a descriptive survey. Participants were 240 elderly people over 65 years of age living in a community. Measures: A hierarchical multiple regression was performed to analyze the factors related to the health‐related quality of life, including predisposing, enabling, and need factors, and health behaviors. Results: Need factors, that is, self‐reported health status, were the most significant in influencing the health‐related quality of life of the elderly people; predisposing factors were age and education level, and enabling factors were income and activities of daily living. Conclusion: The findings of this study can be used to develop a community‐based intervention program and to establish a policy for improving the quality of life of elderly people. [ABSTRACT FROM AUTHOR]

Latino day laborers (LDLs) are at elevated risks for disease and injury because of the environments in which they work. Despite this recognition, a comprehensive examination of factors related to LDLs’ health service use remains unexamined. Using the Andersen model, the current exploratory study examined predisposing (age, education level, location of educational training, legal status, and marital status), enabling (income, trust in medical personnel, whether the respondent has someone they consider their personal doctor, and whether their doctor speaks the same language, perceived barriers to care), and need (self-rated health, number of chronic conditions) variables to predict use of health services among a purposive sample of LDLs (N = 150). Cross-sectional data were collected in 2012 from 4 day laborer sites in Dallas and Arlington, Texas. Regression results suggest that the strongest predictor of health care use was trust in medical providers (β = .41). LDLs who were U.S legal residents (β = .21), reported multiple chronic conditions (β = .16), and had a doctor who spoke their language (β = .15) reported significantly higher levels of health care usage. In terms of barriers, not being able to pay for services (β = −.23), lacking health care insurance coverage (β = −.22), and being embarrassed or having a family member not approve of utilizing services (β = −.18) were significantly associated with lower health care usage among LDLs. These findings suggest that LDLs are faced with a number of predisposing, enabling, and need factors that comprise health care use. [ABSTRACT FROM AUTHOR]

Patients with alcohol-use disorders (AUDs) are highly heterogenous and account for an increasing proportion of general medical hospital visits. However, many patients with AUDs do not present with severe medical or psychiatric needs requiring immediate attention. There may be a mismatch between some patients' needs and the available services, potentially driving re-admissions and re-encounters. The current study aims to identify subgroups of AUD patients and predict differences in patterns of healthcare service use (HSU) over time. Latent class analysis (LCA) was conducted using hospital data incorporating sociodemographic, health behavior, clinical, and service use variables to identify subtypes of AUD patients, then class membership was used to predict patterns of HSU. Results. Four classes were identified with the following characteristics: (1) Patients with acute medical injuries (30 %); (2) Patients with socioeconomic and psychiatric risk factors, (11 %); (3) Patients with chronic AUD with primarily non-psychiatric medical needs (18 %); and (4) Patients with primary AUDs with low medical-treatment complexity (40 %). Negative binomial models showed that Class 4 patients accounted for the highest frequency of service use, including significantly higher rates of emergency department reencounters at 30 days and 12 months. The profile and patterns of HSU exhibited by patients in class 4 suggest that these patients have needs which are not currently being addressed in the emergency department. These have implications for how resources are allocated to meet the needs of patients with AUDs, including those who make frequent visits to the emergency department without high acuity medical needs. • Clinically-meaningfully subgroups of patients with AUDs were derived from readily available hospital records data. • Subgroups derived at a single encounter were able to predict patterns of service use over 30-days and 12-months. • Patients with less severe needs received the fewest services and had the highest rates of service use. • These patterns may disencentivize treatment for less severe needs in this population. • This study employs a novel approach that considers both the frequency and amount of services used. [ABSTRACT FROM AUTHOR]

This study examined individual behavioral predictors of help-seeking using the frameworks of the Andersen model and the theory of planned behavior in a sample of help-seeking female survivors of intimate partner violence (IPV). In-person interviews were conducted with 372 women (Mage = 34.41 years, 66% African American). Results indicated that variables suggested by the Andersen model, including age, depression, psychological aggression, and posttraumatic stress-related arousal symptoms, were significant predictors of help-seeking. Variables suggested by the theory of planned behavior, including perceived helpfulness of resource and perceived controllability of the violence, were also significantly related to help-seeking. However, a combined model including variables from both theoretical approaches accounted for the most variance in help-seeking behavior. Overall, results suggest that these models are useful conceptualizations of help-seeking in an IPV population and that it is important to consider personal characteristics, need-based variables, and cognitive factors in outreach efforts. [ABSTRACT FROM AUTHOR]

Background Infant deaths account for a majority of all pediatric deaths. However, little is known about the factors that influence parents to use hospice care for their infant with a life-threatening health condition. Methods Data were used from 2007 to 2010 California Medicaid claims files (N = 207). Analyses included logistic and negative binomial multivariate regression models. Results More than 15% of infants enrolled in hospice care for an average of 5 days. Infant girls and infants with congenital anomalies were more likely to enroll in hospice care and to have longer stays. However, cardiovascular and respiratory conditions were negatively related to hospice enrollment and hospice length of stay. Conclusions This study provides insights for nurses and other clinicians who care for infants and their families at end of life and suggests that nurses can assist families in identifying infant hospice providers who may help families understand their options for end-of-life care. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify key points and time intervals in the patient pathway to the diagnosis of oral cancer, from the detection of a bodily change to the start of treatment. A systematic search of three databases was performed by two researchers independently. Articles reporting original data on patients with symptomatic primary oral or oropharyngeal squamous cell carcinoma that was pathologically confirmed were included. These articles had to include an outcome variable of ‘diagnostic delay’, ‘time interval’, or ‘waiting time to diagnosis’, or report time intervals from first symptom to treatment. Furthermore, the outcome variable had to have a clearly defined start point and end point, with the time measurement presented as a continuous or categorical variable. A total of 1175 reports were identified; 28 articles on oral cancer studies and 13 on oral and oropharyngeal cancer studies were finally included. These papers showed poor quality in terms of questionnaire validation, acknowledgement of biases influencing time-point measurements, and strategies for verification of patient self-reported data. They also showed great heterogeneity. The review findings allowed the definition of key points and time intervals within the Aarhus framework that may better suit the features of the diagnostic process of this neoplasm, particularly when assessing the impact of waiting time to diagnosis. [ABSTRACT FROM AUTHOR]

Background: Domestic abuse is a significant public health issue. It occurs more frequently among disabled women than those without a disability and evidence suggests that a great deal of domestic abuse begins or worsens during pregnancy. All women and their infants are entitled to equal access to high quality maternity care. However, research has shown that disabled women who experience domestic abuse face numerous barriers to accessing care. The aim of the study was to identify the priority areas for improving access to maternity services for this group of women; develop strategies for improved access and utilisation; and explore the feasibility of implementing the identified strategies.Methods: This multi-method study was the third and final part of a larger study conducted in the UK between 2012 and 2014. The study used a modified concept mapping approach and was theoretically underpinned by Andersen's model of healthcare use. Seven focus group interviews were conducted with a range of maternity care professionals (n = 45), incorporating quantitative and qualitative components. Participants ranked perceived barriers to women's access and utilisation of maternity services in order of priority using a 5-point Likert scale. Quantitative data exploration used descriptive and non-parametric analyses. In the qualitative component of each focus group, participants discussed the barriers and identified potential improvement strategies (and feasibility of implementing these). Qualitative data were analysed inductively using a framework analysis approach.Results: The three most highly ranked barriers to women's access and utilisation of maternity services identified in the quantitative component were: 1) staff being unaware and not asking about domestic abuse and disability; 2) the impact of domestic abuse on women; 3) women's fear of disclosure. The top two priority strategies were: providing information about domestic abuse to all women and promoting non-judgemental staff attitude. These were also considered very feasible. The qualitative analysis identified a range of psychosocial and environmental barriers experienced by this group of women in accessing maternity care. Congruent with the quantitative results, the main themes were lack of awareness and fear of disclosure. Key strategies were identified as demystifying disclosure and creating physical spaces to facilitate disclosure.Conclusions: The study supports findings of previous research regarding the barriers that women face in accessing and utilising maternity services, particularly regarding the issue of disclosure. But the study provides new evidence on the perceived importance and feasibility of strategies to address such barriers. This is an important step in ensuring practice-based acceptability and ease with which improvement strategies might be implemented in maternity care settings. [ABSTRACT FROM AUTHOR]