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Access to healthcare, while globally recognized as a human right, presents significant disparities, particularly in urgent care accessibility and equity within Riyadh's neighborhoods. This study addresses the existing gaps in understanding how disparities in urgent care access can impact the broader goal of personalized healthcare in Riyadh's primary healthcare centers (PHCs). The study aims to examine the equity and accessibility of urgent care services in PHCs across Riyadh, Saudi Arabia, evaluating how these factors contribute to personalized healthcare. We hypothesized that significant differences exist in the accessibility and equity of urgent care services among various Riyadh neighborhoods. We conducted a cross-sectional online survey with 359 participants from diverse Riyadh neighborhoods. Data were collected using a structured questionnaire and analyzed using SPSS Version 23.0 to explore regional differences in urgent care accessibility and perceptions of equity. The study revealed significant regional disparities in urgent care accessibility within Riyadh, Saudi Arabia. Specifically, residents in the Western region reported the highest access and awareness (80.84% availability within 30 minutes), while those in the Eastern region reported the least (76.19% access to healthcare centers). Additionally, 32.6% of the participants were from the Western region, 24.5% from the Eastern region, 21.7% from the Southern region, and 21.2% from the Northern region. A notable preference was found for seeking urgent care in secondary and military hospitals, attributed to perceived better resources and specialist availability. The findings emphasize the need for targeted interventions to enhance PHC capabilities and utilization, ensuring alignment with personalized healthcare principles that cater to specific regional needs and conditions. [ABSTRACT FROM AUTHOR]

In Ghana, some pregnant women may not seek antenatal care due to the unavailability of such services in their communities, although preventive service can help reduce maternal mortality with high-quality care. This study aimed to understand the antenatal care opinions of Ghanaian mothers who sought antenatal care, the barriers they faced, and their suggestions for improvement in antenatal care in Ghana. This study's data were collected in the Central and Ashanti regions in Ghana from June 2023 to January 2024. Four hundred and fifty mothers in Ghana who indicated that they had given birth within the last 10 years of the data collection period took part in the study. Our findings revealed that 93.6% of Ghanaian mothers perceived their antenatal care to be of good quality due to proper examinations, friendly provider–patient interactions, reassurance, fair treatment, and proper education, whereas 6.5% of Ghanaian mothers perceived their care to be of poor quality due to long wait times, impersonal interactions, inadequate facility resources, and barriers to communication. For Ghanaian mothers to receive better outcomes for themselves and their children, it is worth improving healthcare facilities, healthcare provider preparedness, local transportation, and addressing financial constraints to go from suboptimal to optimal health services. [ABSTRACT FROM AUTHOR]

Objective: The coronavirus disease 2019 (COVID-19) pandemic has caused significant transformations in healthcare. Many countries began the rapid development and adoption of telemedicine to avoid the spread of the pandemic and created an innovative model for healthcare delivery. This study identified the critical antecedents that affected the considered healthcare outcomes via teleophthalmology in Eastern Taiwan during the COVID-19 pandemic. Methods: This study's participants included residents of five towns in Taitung County who had experience with teleophthalmology. This study analyzed the structured questionnaires completed by the participants to validate the proposed research framework. Statistical methods were used to verify the research models, including descriptive statistical analysis, confirmatory factor analysis, and structural equation modeling. The date of this study was from 1 October 2020 to 31 July 2023. Results: The results of this study reveal that the average monthly use of teleophthalmology by individuals in rural areas increased annually. Females tended to utilize teleophthalmology services more than males. There were no significant differences across any of the constructs with respect to age or educational level. Additionally, the patients' awareness of healthcare accessibility via and the communication quality of teleophthalmology simultaneously affected teleophthalmology's adoption and service quality, which in turn jointly affected health outcomes. Both healthcare accessibility and communication quality were the antecedents of the healthcare outcomes. The health outcomes refer to the impact of teleophthalmology on the quality of the patients' health and well-being. Additionally, teleophthalmology's adoption and service quality acted as mediators. Conclusions: This study's findings are expected to increase attention to the healthcare outcomes and antecedents of teleophthalmology to promote better telemedicine practices and services for rural residents. [ABSTRACT FROM AUTHOR]

Abstract Background The Healthy Child Programme (HCP) in England, delivered by Health Visitors (HV) and Nursery Nurses (NN), aims to assess growth and development in pre-school age children. This qualitative analysis aimed to evaluate the perceptions and experiences of HCP providers and parents located in a London borough. Methods This qualitative analysis is part of a larger study piloting an automated growth screening algorithm in a London borough. We conducted three focus group discussions; two with parents of pre-school children participating in the pilot study, one in English (n = 6) and one in Sylheti (n = 5), and one with HVs and NNs (n = 11). Sampling was purposeful, and written informed consent was obtained. Groups were facilitated by the same bilingual researcher using semi-structured topic guides. Data were analysed using reflexive thematic analysis and assessed for intercoder reliability. Results Three broad themes were identified in the data: (1) lack of clarity around the role of the HV and NN; (2) a lack of resources; and (3) a desire for a preventative service. Underlying these themes was a sense of disempowerment shown by HVs/NNs and parents, as well as systemic issues in terms of the accessibility and practicality of the service. Nevertheless, parents and HVs/NNs all stressed the importance of the service in providing information, reassurance and advice. Conclusions Various challenges prevent the HCP from providing equitable and effective care to every child. However, the service was recognised as very valuable by users and providers despite systemic difficulties.

The study of access to health centers is gaining global attention due to it is critical role in ensuring equitable and easily accessible healthcare services for all citizens, leading to long-term social equity and an improved quality of life. This paper aims to assess the efficiency of healthcare facility locations in Istanbul from two perspectives: accessibility of healthcare facilities and sufficiency of healthcare capacity. The analysis of accessibility considers the geographic locations of health services, the road network, and traffic conditions, particularly during two peak travel times in Istanbul. The evaluation of healthcare capacity utilizes the ratio of the number of beds to the population in each district. According to the findings, while the majority of the population has reasonable access to the nearest hospital, there exists a significant disparity in hospital location and bed availability in Istanbul. This indicates notable challenges in achieving a balanced distribution of hospitals based on their bed capacity. Addressing this imbalance is crucial in selecting suitable locations for new health facilities. To enhance the accessibility and effectiveness of public and private hospitals, decisions regarding site selection should aim to mutually support one another. Additionally, it is recommended to plan new healthcare facilities based on the population and density distribution of the city to increase public interest and optimize the efficiency of health services. [ABSTRACT FROM AUTHOR]

This study assesses the impact and potential enhancements of a Pharmacy Vending Machine (PhVM) program implemented at Purdue University since January 2021. Aimed at addressing the accessibility gap for essential healthcare items, particularly sexual and reproductive health products, and over-the-counter medications, the program has expanded from two to eight PhVMs on campus. A web-based survey was completed by a random University sample (n=469) to evaluate the program's efficacy and identify avenues for improvement. Survey responses and sales data from January 2021 to April 2023 were analyzed. Findings demonstrate a positive reception of the PhVMs, highlighting a preference for increased accessibility to sexual and reproductive healthcare items. Word-of-mouth remains a key source of awareness for vending machines, suggesting the significance of targeted marketing strategies and information dissemination within on-campus groups. Sales data trends underscore the necessity for ongoing assessment to optimize student access to PhVMs. This study is a comprehensive evaluation, emphasizing the importance of continual refinement in healthcare vending initiatives to cater effectively to campus community needs.

Asthma affects 25 million people in the United States, and its prevalence is increasing. Access to care and adherence to prescribed asthma-treatment programs remain the principal formidable challenges for asthma management. Telemedicine offers substantial opportunities for improved asthma care of patients across the full range of socioeconomic strata. Ever-improving digital tools for asthma assessment and treatment are key components of telemedicine platforms for asthma management. These include a variety of remote patient-monitoring devices, digital inhaler systems, and mobile-health applications that facilitate ongoing assessment and adherence to treatment protocols. Digital tools for monitoring treatment focus on tracking medication use, inhalation technique, and physiological markers such as peak-flow rate and pulse-oximetry. Telemedicine visits allow for elements of assessment via video, approximating or duplicating many aspects of in-person visits, such as evaluating a patient's general appearance, breathing effort, and cough. Challenges remain in ensuring equitable access to these technologies, especially in rural and low-income areas, and in maintaining patient privacy and data security in digital platforms.

Abstract Background Investigating the factors associated with unmet medical needs is important since it can reflect access to healthcare. This study examined the relationship between the unmet medical needs of patients with hypertension and their satisfaction with the healthcare services available in their neighborhoods. Methods Data were from the 2021 Korean Community Health Survey. The sample included individuals aged 19 years who were diagnosed with hypertension. The main outcome measure was unmet medical need. The relationship between the outcome measure and independent variables were analyzed using multivariate logistic regressions, along with a subgroup analysis based on whether patients were currently receiving treatment for hypertension. Results Unmet medical needs were found in 4.3% of the study participants. A higher likelihood of unmet medical needs was found in individuals not satisfied with the healthcare services at proximity (adjusted OR = 1.69, 95% CI: 1.49–1.92) compared to those satisfied with services nearby. Similar tendencies were found regardless of whether individuals were currently receiving treatment for hypertension, although larger differences were found between groups in participants who were currently not receiving treatment. Conclusions The findings infer the need to consider patient satisfaction with nearby healthcare services in implementing public health policies that address unmet medical need in patients with hypertension.

Access to healthcare services using public transportation (PT-based healthcare accessibility) is a crucial aspect in achieving healthcare equity as it affects individuals’ ability to receive healthcare. Previous research has focused on the spatial features of healthcare accessibility. However, less attention has been given to its temporal characteristics, which can be influenced by transit schedules, multimodal connectivity, congestion, and other factors. This study proposes a framework to better understand the impacts of temporally varying PT-based healthcare accessibility on healthcare equity. A case study of Shanghai, China is used to illustrate the temporal variation of healthcare accessibility, with a focus on hourly inter- and intra-regional disparities. These disparities are captured using the Gini coefficient and Theil index. Additionally, the study introduces bivariate local Moran’s I to identify healthcare shortage areas and evaluate the spatial autocorrelation between population density and healthcare accessibility. The findings of this study reveal that the accessibility to healthcare services experiences significant fluctuations throughout the day, leading to temporal variations in healthcare equity. Subway service quality contributes more to temporal variations than bus service quality. The lowest point of such equity is reached when PT operates at its full capacity. On a spatial level, individuals residing in newly developed regions, which surround the historical urban core or recently planned city subcenters, tend to experience decreased accessibility to healthcare via public transportation. Consequently, it results in a heightened reliance on motorized transportation in these areas. These findings provide insights that can inform the design of PT accessibility-based strategies, healthcare improvement plans and inclusive housing policies, to address healthcare equity issues in metropolitan areas. By considering both spatial and temporal factors, we can better understand the complex relationships between transportation and healthcare accessibility to promote equitable access to healthcare services and foster social equity.

Introduction Cervical cancer is a significant global health concern, especially in low- and middle-income countries with limited access to preventive healthcare. India’s vast rural population amplifies the challenge, demanding immediate action. Despite advancements, cervical cancer remains prevalent among underserved rural communities, hindered by barriers to Human Papillomavirus (HPV) screening uptake, including socioeconomic and financial constraints. This study aims to evaluate the economic challenges encountered by rural women when accessing HPV screening. Methods A cross-sectional survey was conducted among 1502 women aged 30 to 45 in Pondicherry, India, utilizing the Andersen Model as a conceptual framework. Household questionnaires gathered data on HPV screening expenses, including patient travel costs, productivity loss, and companion costs. The analysis utilized regression models, to identify the factors impacting the economic challenges associated with accessing HPV screening. Results Employment status and higher education significantly increase total costs by 73.483 (p < 0.001) and 90.169 units (p < 0.001) respectively. Income level, though with a minimal coefficient (B = 0.000), shows a significant effect (p = 0.019) on total costs. Longer travel hours raise costs by 5.129 units (p < 0.001), while having a companion increases costs by 106.095 units (p = 0.004). Prolonged patient time at Primary Health Center (PHC) contributes to a 2.357-unit increase in costs (p < 0.001). Conclusions The study highlights the multifaceted economic challenges faced by rural populations accessing HPV screening for cervical cancer prevention in India. Notwithstanding diverse demographics and varying proximity to healthcare facilities, individuals encounter significant barriers such as travel time and associated costs. Addressing these challenges necessitates targeted interventions to reduce socioeconomic disparities and improve healthcare accessibility for vulnerable populations, thereby advancing cervical cancer prevention efforts and promoting health equity in rural communities.

ABSTRACTEvaluating the inequity of healthcare accessibility across demographic groups in the post-COVID era is of critical importance for an aging society like Japan – it helps to achieve better social equity via distributing healthcare resources in health planning and policy making. Our study contributes to the first post-covid evaluation of multi-modal healthcare accessibility in Tokyo, Japan, the most populated metropolis in the world. A further novelty goes to the multi-dimensional examination of the inequity of healthcare accessibility (i.e. hospitals) by public transit, driving and walking – the horizontal inequity across urban space and the vertical inequity across three demographic groups (the young, adult and elderly) through network analysis, spatial accessibility analysis and inequity indexing. We find that low healthcare access areas mainly appear in the peri-urban space as well as regions less covered by public transit. Compared to the adult group, the elderly group experiences significant inequity of healthcare access particularly in the peri-urban areas where driving is the dominant transport mode to access healthcare facilities. We provide timely evidence to the Japanese government and health authorities to have a holistic and latest understanding of multi-modal healthcare access across different demographic groups in the post-COVID era.

Texas consistently accounts for approximately 10% of annual national births, the second highest of all US states. This temporal study aimed to evaluate incidences of neonatal surgical conditions across Texas and to delineate regional pediatric surgeon accessibility. The Texas Birth Defects Registry was queried from 1999 to 2018, based on 11 well-established regions. Nine disorders (30,476 patients) were identified as being within the operative scope of pediatric surgeons: biliary atresia (BA), pyloric stenosis (PS), Hirschsprung's disease, stenosis/atresia of large intestine/rectum/anus, stenosis/atresia of small intestine, tracheoesophageal fistula/esophageal atresia, gastroschisis, omphalocele, and congenital diaphragmatic hernia. Annual and regional incidences were compared (/10,000 births). Statewide pediatric surgeons were identified through the American Pediatric Surgical Association directory. Regional incidences of neonatal disorder per surgeon were evaluated from 2010 to 2018 as a surrogate for provider disparity. PS demonstrated the highest incidence (14.405/10,000), while BA had the lowest (0.707/10,000). Overall, incidences of PS and BA decreased significantly, while incidences of Hirschsprung's disease and small intestine increased. Other diagnoses remained stable. Regions 2 (48.24/10,000) and 11 (47.79/10,000) had the highest incidence of neonatal conditions; Region 6 had the lowest (34.68/10,000). Three rural regions (#2, 4, 9) lacked pediatric surgeons from 2010 to 2018. Of regions with at least one surgeon, historically underserved regions (#10, 11) along the Texas–Mexico border consistently had the highest defect per surgeon rates. There are temporal and regional differences in incidences of neonatal conditions treated by pediatric surgeons across Texas. Improving access to neonatal care is a complex issue that necessitates collaborative efforts between state legislatures, health systems, and providers. • With its vast size and regional diversity, Texas may face unique challenges in access to care. • There have been significant temporal and regional differences in statewide incidences of neonatal conditions. • Regional disparities in access to pediatric surgeons and intensive care centers exist. • Disparities are most concerning along underserved, rural regions. • Collaborative efforts informed by geographic and epidemiological analyses must be leveraged. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Early intervention is imperative for potentially fatal dermatologic diseases such as pemphigus vulgaris. In rural Nepal, limited public awareness, home remedies, and delays in healthcare access lead to poor outcomes. Although biopsy confirms the diagnosis, experienced dermatologists can make an accurate clinical diagnosis when characteristic skin lesions are present. [ABSTRACT FROM AUTHOR]

Background: Investigating the factors associated with unmet medical needs is important since it can reflect access to healthcare. This study examined the relationship between the unmet medical needs of patients with hypertension and their satisfaction with the healthcare services available in their neighborhoods. Methods: Data were from the 2021 Korean Community Health Survey. The sample included individuals aged 19 years who were diagnosed with hypertension. The main outcome measure was unmet medical need. The relationship between the outcome measure and independent variables were analyzed using multivariate logistic regressions, along with a subgroup analysis based on whether patients were currently receiving treatment for hypertension. Results: Unmet medical needs were found in 4.3% of the study participants. A higher likelihood of unmet medical needs was found in individuals not satisfied with the healthcare services at proximity (adjusted OR = 1.69, 95% CI: 1.49–1.92) compared to those satisfied with services nearby. Similar tendencies were found regardless of whether individuals were currently receiving treatment for hypertension, although larger differences were found between groups in participants who were currently not receiving treatment. Conclusions: The findings infer the need to consider patient satisfaction with nearby healthcare services in implementing public health policies that address unmet medical need in patients with hypertension. [ABSTRACT FROM AUTHOR]

This study provides an innovative collaborative spatial decision support system (SDSS) that aims to ensure an equitable spatial distribution of healthcare services. Evaluating the equality of access to health services across different geographical areas is important, as it requires the analysis of various criteria such as the proximity of health centres and hospitals (HCHs), the quality of services offered, connectivity to primary roads, the availability of public transportation hubs, and the density and distribution patterns of HCHs. This purpose is accomplished via the use of geographic information systems (GIS) and multi-criteria decision analysis (MCDA) methods. The proposed model includes the weights of the criteria, which are determined through the ordered weighted average (OWA) and evaluated based on their ORness, which ranges from 0 to 1. Furthermore, this model is improved by the best–worst fuzzy method (F-BWM). This approach produces a spatial map that clearly shows the equity of healthcare systems in urban environments. The findings show that the maximum score observed in this study was 0.38% (with an ORness value of 1), whilst the minimum score recorded was 0.28%. In the most severe scenario (ORness = 0), over 70% of the region shows different degrees of fairness, ranging from moderate to suitable and very suitable conditions. Governments and health authorities can use this information strategically to allocate resources and address inequities in access to healthcare facilities. [ABSTRACT FROM AUTHOR]

Several methods have been applied to measure healthcare accessibility, ie, the Euclidean distance, the network distance, and the transport time based on speed limits. However, these methods generally produce less accurate estimates than actual measurements. This research proposed a method to estimate historical healthcare accessibility more accurately by using taxi Global Positioning System (GPS) traces. The proposed method’s advantages were evaluated vis a case study using acute myocardial infarction (AMI) cases in Beijing in 2008. Comparative analyses of the new measure and three conventionally used measures suggested that the median estimated transport time to the closest hospital with percutaneous coronary intervention (PCI) capability for AMI patients was 5.72 minutes by the taxi GPS trace-based measure, 2.42 minutes by the network distance-based measure, 2.28 minutes by the speed limit-based measure, 1.73 minutes by the Euclidean distance-based measure; and the estimated proportion of patients who lived within 5 minutes of a PCI-capable hospital was 38.17%, 89.20%, 92.52%, 95.05%, respectively. The three conventionally used measures underestimated the travel time cost and overestimated the percentage of patients with timely access to healthcare facilities. In addition, the new measure more accurately identifies the areas with low or high access to healthcare facilities. The taxi GPS trace-based accessibility measure provides a promising start for more accurately estimating accessibility to healthcare facilities, increasing the use of medical records in studying the effects of historical healthcare accessibility on health outcomes, and evaluating how accessibility to healthcare changes over time.

Abstract Background Autistic individuals encounter numerous barriers in accessing healthcare, including communication difficulties, sensory sensitivities, and a lack of appropriate adjustments. These issues are particularly acute during MRI scans, which involve confined spaces, loud noises, and the necessity to remain still. There remains no unified approach to preparing autistic individuals for MRI procedures. Methods A cross-sectional online survey was conducted with parents and carers of autistic individuals in the UK to explore their experiences, barriers, and recommendations concerning MRI scans. The survey collected demographic information and experiential accounts of previous MRI procedures. Quantitative data were analysed descriptively, while key themes were identified within the qualitative data through inductive thematic analysis. Results Sixteen parents/carers participated. The majority reported difficulties with communication, inadequate pre-scan preparation, and insufficient adjustments during MRI scans for their autistic children. Key barriers included an overwhelming sensory environment, radiographers’ limited understanding of autism, and anxiety stemming from uncertainties about the procedure. Recommended improvements encompassed accessible communication, pre-visit familiarisation, noise-reduction and sensory adaptations, staff training on autism, and greater flexibility to meet individual needs. Conclusions There is an urgent need to enhance MRI experiences for autistic individuals. This can be achieved through improved staff knowledge, effective communication strategies, thorough pre-scan preparation, and tailored reasonable adjustments. Co-producing clear MRI guidelines with the autism community could standardise sensitive practices. An individualised approach is crucial for reducing anxiety and facilitating participation. Empowering radiographers through autism-specific education and incorporating insights from autistic individuals and their families could transform MRI experiences and outcomes.

Objective: The coronavirus disease 2019 (COVID-19) pandemic has caused significant transformations in healthcare. Many countries began the rapid development and adoption of telemedicine to avoid the spread of the pandemic and created an innovative model for healthcare delivery. This study identified the critical antecedents that affected the considered healthcare outcomes via teleophthalmology in Eastern Taiwan during the COVID-19 pandemic. Methods: This study’s participants included residents of five towns in Taitung County who had experience with teleophthalmology. This study analyzed the structured questionnaires completed by the participants to validate the proposed research framework. Statistical methods were used to verify the research models, including descriptive statistical analysis, confirmatory factor analysis, and structural equation modeling. The date of this study was from 1 October 2020 to 31 July 2023. Results: The results of this study reveal that the average monthly use of teleophthalmology by individuals in rural areas increased annually. Females tended to utilize teleophthalmology services more than males. There were no significant differences across any of the constructs with respect to age or educational level. Additionally, the patients’ awareness of healthcare accessibility via and the communication quality of teleophthalmology simultaneously affected teleophthalmology’s adoption and service quality, which in turn jointly affected health outcomes. Both healthcare accessibility and communication quality were the antecedents of the healthcare outcomes. The health outcomes refer to the impact of teleophthalmology on the quality of the patients’ health and well-being. Additionally, teleophthalmology’s adoption and service quality acted as mediators. Conclusions: This study’s findings are expected to increase attention to the healthcare outcomes and antecedents of teleophthalmology to promote better telemedicine practices and services for rural residents.

This paper explores the implications of the digital advancements on patient empowerment and the role of healthcare professionals. It examines the challenges and opportunities presented by this digital shift, including data privacy concerns, the need for continuous technological adaptation, and the potential for increased healthcare accessibility. The paper underscores the critical importance of legal and ethical considerations in shaping a sustainable and equitable digital healthcare landscape. Through this exploration, the paper aims to provide a comprehensive overview of the ongoing digital revolution in French healthcare and its broader implications for the global healthcare sector. [ABSTRACT FROM AUTHOR]

(1) Background: Military personnel and veterans meet unique health challenges that stem from the complex interplay of their service experiences, the nature of warfare, and their interactions with both military and civilian healthcare systems. This study aims to examine the myriad of injuries and medical conditions specific to this population, encompassing physical and psychological traumas. (2) Methods: A scoping review (systematic search and non-systematic review) was performed to evaluate the current landscape of military healthcare. (3) Results: A significant change in the injury profile over time is identified, linked to shifts in combat strategies and the integration of advanced technologies in warfare. Environmental exposures to diverse chemical or natural agents further complicate the health of service members. Additionally, the stressors they face, ranging from routine stress to traumatic experiences, lead to various mental health challenges. A major concern is the gap in healthcare accessibility and quality, worsened by challenges in the civilian healthcare system's capacity to address these unique needs and the military healthcare system's limitations. (4) Conclusions: This review underscores the need for holistic, integrated approaches to care, rigorous research, and targeted interventions to better serve the health needs of military personnel and veterans. [ABSTRACT FROM AUTHOR]

Key Clinical Message Early intervention is imperative for potentially fatal dermatologic diseases such as pemphigus vulgaris. In rural Nepal, limited public awareness, home remedies, and delays in healthcare access lead to poor outcomes. Although biopsy confirms the diagnosis, experienced dermatologists can make an accurate clinical diagnosis when characteristic skin lesions are present.

The ongoing novel coronavirus (COVID-19) pandemic has highlighted the need for individuals to have easy access to healthcare facilities for treatment as well as vaccinations. The surge in COVID-19 hospitalizations during 2020 also underscored the fact that accessibility to nearby hospitals for testing, treatment and vaccination sites is crucial for patients with fever or respiratory symptoms. Although necessary, quantifying healthcare access is challenging as it depends on a complex interaction between underlying socioeconomic and physical factors. In this case study, we deployed a Multi Criteria Decision Analysis (MCDA) approach to uncover the barriers and their effect on healthcare access. Using a least cost path (LCP) analysis we quantified the costs associated with healthcare access from each census block group in the Los Angeles metropolitan area (LA Metro) to the nearest hospital. Social vulnerability reported by the Centers for Disease Control and Prevention (CDC), the daily number of COVID-19 cases from the Los Angeles open data portal and built environment characteristics (slope of the street, car ownership, population density distribution, walkability, traffic collision density, and speed limit) were used to quantify overall accessibility index for the entire study area. Our results showed that the census block groups with a social vulnerability index above 0.75 (high vulnerability) had low accessibility owing to the higher cost of access to nearby hospitals. These areas were also coincident with the hotspots for COVID-19 cases and deaths which highlighted the inequitable exposure of socially disadvantaged populations to COVID-19 infections and how the pandemic impacts were exacerbated by the synergistic effect of socioeconomic status and built environment characteristics of the locations where the disadvantaged populations resided. The framework proposed herein could be adapted to geo-target testing/vaccination sites and improve accessibility to healthcare facilities in general and more specifically among the socially vulnerable populations residing in urban areas to reduce their overall health risks during future pandemic outbreaks.

Diabetic retinopathy (DR) is a pervasive public health challenge, particularly in underserved rural regions like Nepal. Timely detection and management of DR are imperative to prevent vision impairment and blindness among individuals with diabetes. However, the scarcity of advanced medical facilities and trained ophthalmologists in remote areas hampers early diagnosis. This study addresses this critical issue by harnessing deep learning technology, specifically MobileNet, to develop an accessible and cost-effective solution for the early detection of diabetic retinopathy in Nepal's rural communities. The research aims to design and implement a robust DR detection system capable of operating on resource-constrained mobile devices. MobileNet, renowned for its efficiency and suitability for mobile applications, serves as the cornerstone of the solution. Through fine-tuning MobileNet on a comprehensive dataset comprising diverse DR manifestations, the model learns to accurately classify the presence of retinopathy. Recognizing the challenge of limited internet connectivity in rural Nepal, the project explores on-device inference techniques. This enables the model to run directly on mobile devices, minimizing the dependence on continuous internet access and making the diagnostic tool available even in remote regions. The anticipated impact of this project is twofold: firstly, it empowers healthcare workers in rural Nepal to provide early and precise DR screenings, facilitating timely intervention and reducing avoidable blindness. Secondly, it demonstrates the feasibility of deploying deep learning and mobile technology to address healthcare challenges in resource-limited settings beyond diabetic retinopathy.By harnessing MobileNet-based deep learning, this solution has the potential to significantly enhance healthcare accessibility and contribute to the overall well-being of the diabetic population in underserved areas.

Abstract Socioeconomic development, subsidence, and climate change have led to high flood risks in coastal cities, making the vulnerable, especially elderly people, more prone to floods. However, we mostly do not know how the accessibility of life-saving public resources for the elderly population will change under future scenarios. Using Shanghai as a case, this study introduced a new analytical framework to fill this gap. We integrated for the first time models of coastal flooding, local population growth, and medical resource supply-demand estimation. The results show that under an extreme scenario of coastal flooding in the year 2050, in the absence of adaptation, half of the elderly population may be exposed to floods, the supply of medical resources will be seriously insufficient compared to the demand, and the accessibility of emergency medical services will be impaired by flooding. Our methodology can be applied to gain insights for other vulnerable coastal cities, to assist robust decision making about emergency responses to flood risks for elderly populations in an uncertain future.

The purpose of palliative care is to ease the suffering of individuals with a serious and often life-limiting illness throughout the course of their disease by providing holistic care that considers the physical, spiritual, and psychosocial dimensions of health and well-being. Research shows that a palliative approach to care is cost-effective for the healthcare system and results in improved quality of life for patients and their loved ones. However, it is well-documented in the literature that structurally vulnerable populations have greater difficulty accessing equitable and culturally safe palliative care. Several domains are identified as contributing factors to the disparities seen in the literature, including systemic racism, cultural differences around death and suffering, and language barriers. Although Canada has had a national palliative care framework since 2018, ongoing issues of access and equity continue to disproportionately impact certain groups, including racially marginalized, immigrant, and low-income communities. In this commentary, successes and ongoing gaps in providing culturally safe and anti-racist palliative care are explored. In these proposed interventions, we advocate for a palliative approach to care that is grounded in equity, justice, and human rights.

Abstract Background Postnatal care is crucial to prevent the child mortality. Despite the improvement in the PNC coverage for the neonates, it is still far away from the universal health coverage. Along with, some specific regions mostly are natural hazard prone areas of India show very under coverage of PNC for the neonates. Considering the substantial spatial variation of PNC coverage and natural hazard prevalence, present study aimed to examine spatial variation of PNC coverage and its association with natural hazard at the district level. Methods The cross-sectional exploratory study utilized National Family Health Survey, 2019-21, which included 1,76,843 children using multistage stratified sampling method to examine postnatal care within 42 days for neonates born within five years prior to the survey. Additionally, the study utilized Vulnerability Atlas of India,2019 maps to categorize regions into hazardous (flood, earthquake, and landslide) and non-hazardous areas. Spatial univariate and bivariate analyses, logistic and geographically weighted regressions were conducted using ArcGIS Pro, GeoDa, and Stata 16.0 software to identify associations between PNC coverage, hazard exposure, and spatial variation. Results The univariate spatial analysis showed some specific regions such as north, east, and north-east region of India had a high concentration of natural hazard and low access of PNC coverage. Bivariate analysis also showed that PNC coverage was low in flood (75.9%), earthquake (68.3%), and landslide (80.6%) effected areas. Compared to the national PNC coverage (81.1%), all these natural hazards effected areas showed low coverage. Further, logic regression showed that these hazard prone areas were less (OR:0.85 for flood, 0.77 for earthquake, and 0.77 for landslide) likely to get PNC coverage than their counterparts. LISA cluster maps significantly showed low PNC and high disaster concentration in these disaster-prone areas. Geographic weighted regression results also showed similar result. Conclusions The present study elucidates notable heterogeneity in the coverage of postnatal care (PNC) services, with lower concentrations observed in disaster-prone areas. In order to enhance the accessibility and quality of PNC services in these areas, targeted interventions such as the deployment of mobile health services and fortification of health systems are recommended.

Immigrant and refugee populations face multiple barriers to accessing mental health services. This scoping review applies the (Levesque et al. in Int J Equity Health 12:18, 2013) Patient-Centred Access to Healthcare model in exploring the potential of increased access through virtual mental healthcare services VMHS for these populations by examining the affordability, availability/accommodation, and appropriateness and acceptability of virtual mental health interventions and assessments. A search in CINAHL, MEDLINE, PSYCINFO, EMBASE, SOCINDEX and SCOPUS following (Arksey and O'Malley in Int J Soc Res Methodol 8:19–32, 2005) guidelines found 44 papers and 41 unique interventions/assessment tools. Accessibility depended on individual (e.g., literacy), program (e.g., computer required) and contextual/social factors (e.g., housing characteristics, internet bandwidth). Participation often required financial and technical support, raising important questions about the generalizability and sustainability of VMHS' accessibility for immigrant and refugee populations. Given limitations in current research (i.e., frequent exclusion of patients with severe mental health issues; limited examination of cultural dimensions; de facto exclusion of those without access to technology), further research appears warranted. [ABSTRACT FROM AUTHOR]

Introduction: This study describes the experiences of eight mothers from the Wheatbelt region of Western Australia who shared their stories of travelling and/or temporarily relocating for birth. Objective: The aim of this study was to describe rural and remote Western Australian mothers' experiences of travelling long distances and/or relocating to give birth. Design: This study was based on Crotty's four elements of qualitative research. This study was underpinned by a constructivist epistemology, a feminist theoretical lens and a narrative approach using semistructured, story‐based interviews. Participants narrated their stories of birthing away from home by telephone interview. Findings: Five major themes were identified utilising thematic analysis. These were (1) feeling forgotten in the system, (2) accessibility and choice, (3) compounded social isolation, (4) doing it hard: financial and logistical challenges and (5) building strength: advocating for myself and baby. Discussion: Mothers' stories were reflective of current and historical failures of rural maternal health policy, including widespread closures of rural birthing hospitals. Mothers described the logistical barriers they faced with little support and suggested multiple solutions that would improve their experiences. Conclusion: Mothers faced significant obstacles which impeded their access to equitable maternal healthcare. This study highlights the complexities of birthing as a rural mother and the need to address maternal health inequities between rural and metropolitan women. [ABSTRACT FROM AUTHOR]

Socioeconomic development, subsidence, and climate change have led to high flood risks in coastal cities, making the vulnerable, especially elderly people, more prone to floods. However, we mostly do not know how the accessibility of life-saving public resources for the elderly population will change under future scenarios. Using Shanghai as a case, this study introduced a new analytical framework to fill this gap. We integrated for the first time models of coastal flooding, local population growth, and medical resource supply-demand estimation. The results show that under an extreme scenario of coastal flooding in the year 2050, in the absence of adaptation, half of the elderly population may be exposed to floods, the supply of medical resources will be seriously insufficient compared to the demand, and the accessibility of emergency medical services will be impaired by flooding. Our methodology can be applied to gain insights for other vulnerable coastal cities, to assist robust decision making about emergency responses to flood risks for elderly populations in an uncertain future. [ABSTRACT FROM AUTHOR]

The purpose of palliative care is to ease the suffering of individuals with a serious and often life-limiting illness throughout the course of their disease by providing holistic care that considers the physical, spiritual, and psychosocial dimensions of health and well-being. Research shows that a palliative approach to care is cost-effective for the healthcare system and results in improved quality of life for patients and their loved ones. However, it is well-documented in the literature that structurally vulnerable populations have greater difficulty accessing equitable and culturally safe palliative care. Several domains are identified as contributing factors to the disparities seen in the literature, including systemic racism, cultural differences around death and suffering, and language barriers. Although Canada has had a national palliative care framework since 2018, ongoing issues of access and equity continue to disproportionately impact certain groups, including racially marginalized, immigrant, and low-income communities. In this commentary, successes and ongoing gaps in providing culturally safe and anti-racist palliative care are explored. In these proposed interventions, we advocate for a palliative approach to care that is grounded in equity, justice, and human rights. [ABSTRACT FROM AUTHOR]

Liver disease is associated with substantial morbidity and mortality, likely incurring financial distress (i.e. healthcare affordability and accessibility issues), although long-term national-level data are limited. Using the National Health Interview Survey from 2004 to 2018, we categorised adults based on report of liver disease and other chronic conditions linked to mortality data from the National Death Index. We estimated age-adjusted proportions of adults reporting healthcare affordability and accessibility issues. Multivariable logistic regression and Cox regression were used to assess the association of liver disease with financial distress and financial distress with all-cause mortality, respectively. Among adults with liver disease (n = 19,407) vs. those without liver disease (n = 996,352), those with cancer history (n = 37,225), those with emphysema (n = 7,937), and those with coronary artery disease (n = 21,510), the age-adjusted proportion reporting healthcare affordability issues for medical services was 29.9% (95% CI 29.7–30.1%) vs. 18.1% (95% CI 18.0–18.3%), 26.5% (95% CI 26.3–26.7%), 42.2% (95% CI 42.1–42.4%), and 31.6% (31.5–31.8%), respectively, and for medications: 15.5% (95% CI 15.4–15.6%) vs. 8.2% (95% CI 8.1–8.3%), 14.8% (95% CI 14.7–14.9%), 26.1% (95% CI 26.0–26.2%), and 20.6% (95% CI 20.5–20.7%), respectively. In multivariable analysis, liver disease (vs. without liver disease, vs. cancer history, vs. emphysema, and vs. coronary artery disease) was associated with inability to afford medical services (adjusted odds ratio [aOR] 1.84, 95% CI 1.77–1.92; aOR 1.32, 95% CI 1.25–1.40; aOR 0.91, 95% CI 0.84–0.98; and aOR 1.11, 95% CI 1.04–1.19, respectively) and medications (aOR 1.92, 95% CI 1.82–2.03; aOR 1.24, 95% CI 1.14–1.33; aOR 0.81, 95% CI 0.74–0.90; and aOR 0.94, 95% CI 0.86–1.02, respectively), delays in medical care (aOR 1.77, 95% CI 1.69–1.87; aOR 1.14, 95% CI 1.06–1.22; aOR 0.88, 95% CI 0.79–0.97; and aOR 1.05, 95% CI 0.97–1.14, respectively), and not receiving the needed medical care (aOR 1.86, 95% CI 1.76–1.96; aOR 1.16, 95% CI 1.07–1.26; aOR 0.89, 95% CI 0.80–0.99; aOR 1.06, 95% CI 0.96–1.16, respectively). In multivariable analysis, among adults with liver disease, financial distress (vs. without financial distress) was associated with increased all-cause mortality (aHR 1.24, 95% CI 1.01–1.53). Adults with liver disease face greater financial distress than adults without liver disease and adults with cancer history. Financial distress is associated with increased risk of all-cause mortality among adults with liver disease. Interventions to improve healthcare affordability should be prioritised in this population. Adults with liver disease use many medical services, but long-term national studies regarding the financial repercussions and the effects on mortality for such patients are lacking. This study shows that adults with liver disease are more likely to face issues affording medical services and prescription medication, experience delays in medical care, and needing but not obtaining medical care owing to cost, compared with adults without liver disease, adults with cancer history, are equally likely as adults with coronary artery disease, and less likely than adults with emphysema—patients with liver disease who face these issues are at increased risk of death. This study provides the impetus for medical providers and policymakers to prioritise interventions to improve healthcare affordability for adults with liver disease. [Display omitted] • Adults with liver disease are more likely to report issues affording medical services and prescription medication. • Adults with liver disease facing healthcare affordability and accessibility issues are at 24% higher risk of death. • Women, age <65 years, residence in the US South region, and lower income were risk factors for affordability/accessibility issues. [ABSTRACT FROM AUTHOR]

The area surrounding California’s Salton Sea, which lies within Riverside and Imperial counties, has particularly negative health outcomes. Imperial County, a primarily rural region that encompasses the lake, has pediatric asthma-related emergency healthcare visits that double the state average. This paper seeks to assess the level of emergency healthcare access in the Salton Sea region of Imperial County, drawing from spatial science methods. For this study, the "Salton Sea region" is defined as all Imperial County census tracts that include the Salton Sea within its boundaries. To measure "access," this study calculated driving travel times from census tracts to hospitals within Imperial County rather than Euclidean distance to account for geography and urban infrastructures such as road networks and traffic conditions. This study also used the Rational Agent Access Model, or RAAM, to assess access. RAAM scores account for the supply and demand for hospitals in addition to travel times. Results showed that the average travel time for Salton Sea region residents to drive to Imperial County emergency healthcare facilities ranged from 50–61 minutes, compared to 14–20 minutes for other Imperial County tracts. RAAM scores, compared to other Imperial County tracts, were about 30% higher in the Salton Sea region, meaning that healthcare supply is limited in the region. State and county policy should account for spatial inaccessibility to healthcare institutions in order to address emergency healthcare access.

Background: Postnatal care is crucial to prevent the child mortality. Despite the improvement in the PNC coverage for the neonates, it is still far away from the universal health coverage. Along with, some specific regions mostly are natural hazard prone areas of India show very under coverage of PNC for the neonates. Considering the substantial spatial variation of PNC coverage and natural hazard prevalence, present study aimed to examine spatial variation of PNC coverage and its association with natural hazard at the district level. Methods: The cross-sectional exploratory study utilized National Family Health Survey, 2019-21, which included 1,76,843 children using multistage stratified sampling method to examine postnatal care within 42 days for neonates born within five years prior to the survey. Additionally, the study utilized Vulnerability Atlas of India,2019 maps to categorize regions into hazardous (flood, earthquake, and landslide) and non-hazardous areas. Spatial univariate and bivariate analyses, logistic and geographically weighted regressions were conducted using ArcGIS Pro, GeoDa, and Stata 16.0 software to identify associations between PNC coverage, hazard exposure, and spatial variation. Results: The univariate spatial analysis showed some specific regions such as north, east, and north-east region of India had a high concentration of natural hazard and low access of PNC coverage. Bivariate analysis also showed that PNC coverage was low in flood (75.9%), earthquake (68.3%), and landslide (80.6%) effected areas. Compared to the national PNC coverage (81.1%), all these natural hazards effected areas showed low coverage. Further, logic regression showed that these hazard prone areas were less (OR:0.85 for flood, 0.77 for earthquake, and 0.77 for landslide) likely to get PNC coverage than their counterparts. LISA cluster maps significantly showed low PNC and high disaster concentration in these disaster-prone areas. Geographic weighted regression results also showed similar result. Conclusions: The present study elucidates notable heterogeneity in the coverage of postnatal care (PNC) services, with lower concentrations observed in disaster-prone areas. In order to enhance the accessibility and quality of PNC services in these areas, targeted interventions such as the deployment of mobile health services and fortification of health systems are recommended. Highlights: • PNC coverage was low in the area affected by flood (75.9%), earthquake (68.3%), and landslide (80.6%). • All-natural disaster-affected areas had low coverage of Post-Natal Care (PNC) compared to the national PNC coverage (81.1%). • Focusing at the geographical variation for PNC coverage, all the states and UTs performed well, with the exception of the central, eastern, and northeastern states. Results clearly demonstrated that certain regions—such as the north, east, and northeast regions—performed poorly in terms of PNC coverage because they were more vulnerable. [ABSTRACT FROM AUTHOR]

It is important to investigate whether anxiety is a barrier to accessing eye examinations for autistic adults, because existing research suggests this population are more likely to develop ophthalmic abnormalities. Anxiety influences healthcare accessibility for autistic people without learning disabilities. Previous qualitative studies by the research team, with a small sample of autistic adults, have indicated several aspects of eyecare services which cause anxiety. Considering the limited existing research suggesting autistic individuals are more likely to develop ophthalmic abnormalities, this study explored whether this population more widely experiences anxiety when accessing eye examinations. A total of 322 UK-based autistic adults completed the Optometric Patient Anxiety Scale (OPAS) online, between July and December 2020. Rasch analysis was used to validate this questionnaire for an autistic adult population, and compare optometric anxiety levels to the general population. Item infit (0.77 to 1.39) and outfit (0.78 to 1.33) values, the person separation index (2.64), and item (0.99) and person (0.97) reliability coefficients suggested that all 10 items in the OPAS are useful to assess optometric anxiety in an autistic adult population. Item probability curves confirmed the response scale to be appropriate. A comparison of optometric anxiety between the autistic population in the current study and a general population in previous work found no statistically significant difference. The OPAS is a statistically valid tool for use in the autistic adult population. It appears to suggest no significant difference in optometric anxiety between the autistic adult and general population. However, it is possible that it underestimates the true optometric anxiety of autistic adults since the items do not include some of the anxiety provoking factors for this population which have been indicated in previous studies by the research team. [ABSTRACT FROM AUTHOR]

The distribution and spatial analysis of public healthcare in Indonesia are rarely discussed, with most studies predominantly focusing on quantity and quality. Therefore, this study aims to investigate the relationship between health facilities selection and geographic conditions by integrating medical facilities data and the number of doctors using spatial analysis approach. The selected study areas were referral health facilities chosen by Dengue Hemorrhagic Fever (DHF) patients in Purwosari District, Gunungkidul Regency. Furthermore, data were collected through interviews, field measurements (altitude and location plotting), and secondary sources (hospital type, number of doctors, and number of beds). The data collection and analysis employed GPS, Altimeter, ArcGIS, and SPSS. Spatial analysis method included kernel density, buffer, ruler, and altitude of each facility. Meanwhile, the medical analysis approach used Pearson's correlation and multinomial logistic regression in SPSS. Spatial analysis results showed that DHF patients in Purwosari dominantly chose hospitals located in Bantul Regency due to closer proximity, relatively short travel time, lower elevation, and the availability of numerous health facilities centers. Puskesmas Purwosari (Sub-district level Primary Health center) was primarily chosen as an early reference and a place for treating mild dengue patients. In addition, distance, duration of travel time, and the number of doctors exhibited a strong relationship based on Pearson's correlation. These three variables demonstrated strong linear relationship with the response variable. Some variables like elevation, number of doctors, hospital type, and number of beds were considered by patients in choosing a hospital, as revealed by multinomial logistic regression analysis. [ABSTRACT FROM AUTHOR]

Abstract Background Despite a publicly-funded healthcare system, alarming cancer-related health and healthcare inequities persist in Canada. However, it remains unclear how equity is being understood and taken up within the Canadian cancer context. Our objective was to identify how health and healthcare equity are being discussed as goals or aims within the cancer care sector in Canada. Methods A rapid scoping review was conducted; five biomedical databases, 30 multidisciplinary websites, and Google were searched. We included English-language documents published between 2008 and 2021 that discussed health or healthcare equity in the Canadian cancer context. Results Of 3860 identified documents, 83 were included for full-text analysis. The prevalence of published and grey equity-oriented literature has increased over time (2008-2014 [n = 20]; 2015-2021 [n = 62]). Only 25% of documents (n = 21) included a definition of health equity. Concepts such as inequity, inequality and disparity were frequently used interchangeably, resulting in conceptual muddling. Only 43% of documents (n = 36) included an explicit health equity goal. Although a suite of actions were described across the cancer control continuum to address equity goals, most were framed as recommendations rather than direct interventions. Conclusion Health and healthcare equity is a growing priority in the cancer care sector; however, conceptual clarity is needed to guide the development of robust equity goals, and the development of sustainable, measurable actions that redress inequities across the cancer control continuum. If we are to advance health and healthcare equity in the cancer care sector, a coordinated and integrated approach will be required to enact transformative and meaningful change.

Abstract Background: Accessibility to stroke treatments is a challenge that depends on the place of residence. However, recent advances in medical technology have improved health outcomes. Nevertheless, the geographic heterogeneity of medical resources may increase regional disparities. Therefore, evaluating spatial and temporal influences of the medical system on regional outcomes and advanced treatment of cerebral infarction are important from a health policy perspective. This spatial and temporal study aims to identify factors associated with mortality and to clarify regional disparities in cerebral infarction mortality at municipality level. Methods: This ecological study used public data between 2010 and 2020 from municipalities in Hokkaido, Japan. We applied spatial and temporal condition autoregression analysis in a Bayesian setting, with inference based on the Markov chain Monte Carlo simulation. The response variable was the number of deaths due to cerebral infarction (ICD-10 code: I63). The explanatory variables were healthcare accessibility and socioeconomic status. Results: The large number of emergency hospitals per 10,000 people (relative risk (RR) = 0.906, credible interval (Cr) = 0.861 to 0.954) was associated with low mortality. On the other hand, the large number of general hospitals per 10,000 people (RR = 1.123, Cr = 1.068 to 1.178) and longer distance to primary stroke centers (RR = 1.064, Cr = 1.014 to 1.110) were associated with high mortality. The standardized mortality ratio decreased from 2010 to 2020 in Hokkaido by approximately 44%. Regional disparity in mortality remained at the same level from 2010 to 2015, after which it narrowed by approximately 5% to 2020. After mapping, we identified municipalities with high mortality rates that emerged in Hokkaido’s central and northeastern parts. Conclusion: Cerebral infarction mortality rates and the disparity in Hokkaido improved during the study period (2010–2020). This study emphasized that healthcare accessibility through places such as emergency hospitals and primary stroke centers was important in determining cerebral infarction mortality at the municipality level. In addition, this study identified municipalities with high mortality rates that require healthcare policy changes. The impact of socioeconomic factors on stroke is a global challenge, and improving access to healthcare may reduce disparities in outcomes.

Purpose – This paper critically examines the state of tribal health in India by analyzing the accessibility and availability of traditional medicine and modern healthcare. Design/methodology/approach – This essay is the product of an extensive review of the literature and authors' personal experience in working with the tribal communities. Findings – The traditional medicinal practices once very prevalent among the tribal communities are diminishing due to various socio-economic, environmental and political factors. Modern healthcare in India's tribal region is characterized by a lack of availability, accessibility and affordability. As a result of the diminishing traditional practices and inaccessible modern healthcare provisions, tribal communities depend on quacks and magico-religious practices. Originality/value – This essay advocates for urgent policy interventions to integrate traditional medicine and modern healthcare practices to address critical tribal health issues. Preservation of traditional medicinal knowledge-base and improving research in the field have the potential to address the health of tribal communities and of others. The accessibility and availability of modern healthcare facilities in tribal regions should be improved to ensure better health outcomes.

Background: Women with prenatal substance use have been identified as at‐risk for the lack of engagement in perinatal services, such as medical care and home visitation programs. This issue is of particular concern in Florida (United States) where rates of fetal substance exposure have been steadily increasing. Methods: To identify pathways of and barriers to perinatal system and service engagement, journey mapping was used to compile various personas of perinatal women with substance use. A structured guide was developed to elicit maternal personas, system and service touchpoints, and system strengths and weaknesses from focus group participants with statewide stakeholders, including perinatal service administrators and community coalition members within three Florida communities. Workshop transcripts, debriefing, and member‐checking sessions were transcribed verbatim and analyzed manually. Results: Six journey‐mapping workshops and two member‐checking meetings with mothers in‐recovery were conducted with a total of 109 participants. Four personas were identified: women who (1) have substance use on a recreational basis, (2) have prescription drug use/misuse, (3) have chronic substance dependence, and (4) are in‐recovery from substance dependence. Pathways that promote and barriers that prevent perinatal women with substance use from being identified, referred, or willing to accept and engage in medical care and social services were identified. Conclusions: While these personas shed light on differential pathways experienced by women with OUD, they were not intended as fixed‐member groups but rather fluid descriptions of circumstances in which individuals could shift over time. These personas are beneficial to understand differences in circumstances, as well as variations in pathways and barriers to service engagement. Additionally, personas may be used to identify approaches to optimize service engagement by perinatal women with substance use and to support system improvements and integrations. [ABSTRACT FROM AUTHOR]

This study proposed a two-stage dual-game model methodology to evaluate the existing difficulty of healthcare accessibility in China. First, we analyzed a multi-player El Farol bar game with incomplete information by mixed strategy to explore the Nash equilibrium, and then a weighted El Farol bar game was discussed to identify the existence of a contradiction between supply and demand sides in a tertiary hospital. Second, the overall payoff based on healthcare quality was calculated. In terms of the probability of medical experience reaching that expected level, residents are not optimistic about going to the hospital, and the longer the observation period is, the more pronounced this trend becomes. By adjusting the threshold value to observe the change in the probability of being able to obtain the expected medical experience, it is found that the median number of hospital visits is a key parameter. Going to the hospital did bring benefits to people with consideration of the payoffs, while the benefits varied significantly with the observation period among different months. This study is recommended as a new method and approach to quantitatively assess the tense relationship in access to medical care between the demand and supply sides and a foundation for policy and practice improvements to ensure the efficient delivery of healthcare.

Background: Despite a publicly-funded healthcare system, alarming cancer-related health and healthcare inequities persist in Canada. However, it remains unclear how equity is being understood and taken up within the Canadian cancer context. Our objective was to identify how health and healthcare equity are being discussed as goals or aims within the cancer care sector in Canada. Methods: A rapid scoping review was conducted; five biomedical databases, 30 multidisciplinary websites, and Google were searched. We included English-language documents published between 2008 and 2021 that discussed health or healthcare equity in the Canadian cancer context. Results: Of 3860 identified documents, 83 were included for full-text analysis. The prevalence of published and grey equity-oriented literature has increased over time (2008-2014 [n = 20]; 2015-2021 [n = 62]). Only 25% of documents (n = 21) included a definition of health equity. Concepts such as inequity, inequality and disparity were frequently used interchangeably, resulting in conceptual muddling. Only 43% of documents (n = 36) included an explicit health equity goal. Although a suite of actions were described across the cancer control continuum to address equity goals, most were framed as recommendations rather than direct interventions. Conclusion: Health and healthcare equity is a growing priority in the cancer care sector; however, conceptual clarity is needed to guide the development of robust equity goals, and the development of sustainable, measurable actions that redress inequities across the cancer control continuum. If we are to advance health and healthcare equity in the cancer care sector, a coordinated and integrated approach will be required to enact transformative and meaningful change. [ABSTRACT FROM AUTHOR]

Background: With the proliferation of the internet and the development of internet‐based healthcare interventions, eHealth is expected to be an effective complement to traditional healthcare services. However, without understanding the characteristics of the user population, eHealth itself can isolate older adults. Aim: This study aims to identify the characteristics of internet use and the factors associated with eHealth use among older adults. Methods: A secondary data analysis was conducted from a cross‐sectional descriptive study. A convenience sample of 186 community dwelling older adults was recruited at two senior welfare centres in Korea. The data collected included demographic characteristics, health related characteristics, internet use, eHealth use and eHealth literacy. Multiple linear regression was utilized to determine factors related to eHealth use. Results: Among 186 respondents, 98 reported that they used the internet. Internet usage was associated with educational attainment, marital status, cognitive function and possession of internet‐enabled devices. The results of multiple regression analysis showed that greater eHealth usage was related to more positive perception of eHealth usability and better eHealth literacy among older adults. Conclusion: Educational programmes for older adults should be developed to facilitate digital capability and eHealth literacy. Useful and effective online health resources that are easy to use should be also developed. Summary statement: What is already known about this topic? With an ageing society, health promotion and management of chronic diseases are becoming increasingly important; thus, the social burden of healthcare is expected to increase.eHealth can help individuals manage chronic disease effectively and promote changing behaviours for better health, but older adults may not be able to use the internet and eHealth. What this paper adds? This paper identified the factors related to internet use in adults aged 65 and over: higher educational level, married/partnered marital status, better cognitive function and possession of internet‐enabled devices.This paper identified factors facilitating eHealth use: older adults who perceived eHealth as more useful and had better eHealth literacy used eHealth more frequently. The implications of this paper: Education for older adults to enhance their skills to use internet‐enabled devices and increase their capability to interpret health‐related information can facilitate eHealth accessibility and enable them to take advantage of the benefits of health technologies.Useful online health resources that are evidence‐based and easy‐to‐use can encourage older adults to use eHealth. [ABSTRACT FROM AUTHOR]

Speech-in-noise tests are used to assess the ability of the human auditory system to perceive speech in a noisy environment. Early diagnosis of hearing deficits helps health professionals to plan for the most appropriate management. However, hospitals and auditory clinics have a shortage of reliable Arabic versions of speech-in-noise tests. Additionally, access to specialized healthcare facilities is associated with socioeconomic status. Hence, individuals with compromised socioeconomic status do not have proper access to healthcare. Thus, In the current study, a mobile and cost-effective Arabic speech-in-noise test was developed and tested on 30 normal-hearing subjects, and their ability to perceive words-in-noise was evaluated. Moreover, a comparison between two different background noises was explored (multi-talker babble noise and white noise). The results revealed a significant difference in the thresholds between the two types of background noises. The percent-correct scores ranged from 100% to 54.17% for the white background noise and 91.57% to 50% for the multi-talker babble background noise. The proposed Arabic word-in-noise screening tool has the potential to be used effectively to screen for deteriorated speech perception abilities, particularly in low-resource settings. [ABSTRACT FROM AUTHOR]

During the first year of the COVID-19 pandemic in Jakarta, Indonesia, the government designated some hospitals as specific COVID-19 healthcare centers to meet demand and ensure accessibility. However, the policy demand evaluation was based on a purely spatial approach. Studies on accessibility to healthcare are widely available, but those that consider temporal as well as spatial dynamics are lacking. This study aims to analyze the spatiotemporal dynamics of healthcare accessibility against COVID-19 cases within the first year of the COVID-19 pandemic, and the overall pattern of spatiotemporal accessibility. A two-step floating catchment area (2SFCA) was used to analyze the accessibility of COVID-19 healthcare against the monthly data of the COVID-19 infected population, as the demand. Such a spatiotemporal approach to 2SFCA has never been used in previous studies. Furthermore, rather than the traditional buffer commonly used to define catchments, the 2SFCA in this study was improved with automated delineation based on the road network using ArcGIS Service Areas Analysis tools. The accessibility tends to follow the distance decay principle, which is relatively high in the city's center and low in the outskirts. This contrasts with the city's population distribution, which is higher on the outskirts and lower in the center. This research is a step toward optimizing the spatial distribution of hospital locations to correspond with the severity of the pandemic condition. One method to stop the transmission of disease during a pandemic that requires localizing the infected patient is to designate specific healthcare facilities to manage the sick individuals. 'What-if' scenarios may be used to experiment with the locations of these healthcare facilities, which are then assessed using the methodology described in this work to obtain the distribution that is most optimal. [ABSTRACT FROM AUTHOR]

• Incorporated spatial-temporal factors to quantify healthcare accessibility. • Investigated temporal variations in both horizontal and vertical equity. • Case study: Shanghai's PT and PV accessibility to multi-tier hospitals. • Proposed multi-faceted strategies to improve healthcare accessibility and equity. Understanding healthcare accessibility, or the ability to access healthcare services, has significant implications for both individual well-being and community equity. However, existing studies seldom account for temporally varying factors such as traffic conditions and hospital schedules, resulting in miscalculation of accessibility. This study addresses this gap by introducing a framework that evaluates accessibility to multi-tier hospitals, factoring in both spatial and temporal aspects, using public transit (PT) and personal vehicles (PVs), and assesses its impact on horizontal and vertical equity. Implemented in Shanghai, China, we employ the Gaussian two-step floating catchment area method for accessibility quantification and utilize map APIs for dynamic travel time data. Our analysis reveals: (i) notable temporal fluctuations in healthcare accessibility, especially for PT, and their significant impact on both horizontal and vertical equity due to varying travel times and hospital schedules; (ii) larger disparities in higher-tier hospital accessibility compared to lower-tier ones; (iii) greater horizontal equity using PV-based accessibility and higher vertical equity using PT-based accessibility. These findings highlight the need to offer customized transit to healthcare facilities, expand telehealth services, incorporate equity in healthcare resource allocation, incentivize healthcare professionals to work in underserved areas, and develop outreach programs to improve accessibility and equity. [ABSTRACT FROM AUTHOR]

Healthcare accessibility and equality have attracted extensive attention, but few in metropolitan areas, which are characterized by intense intercity connections. Despite of the policy focus on intercity patient mobility in metropolitan areas, the quantitative impact of intercity patient mobility on healthcare accessibility and equality remains understudied. This study develops a comprehensive framework to quantify such impacts by comparing two scenarios (i.e., intercity and intracity) of accessibility to existing and optimized healthcare services. A two-step optimization method, integrating efficiency and equality, is applied to optimize healthcare resources. These analyses are conducted within the context of the Shenzhen metropolitan area. The results reveal that intercity patient mobility can improve efficiency and equality of healthcare accessibility to existing services by 8% and 6%, respectively. Furthermore, optimization that considers intercity patient mobility can improve healthcare accessibility efficiency and equality by 37% and 19% compared to the status quo. The framework and methods developed in this study are valuable for measuring and optimizing healthcare accessibility in metropolitan areas, which is transferrable to other areas with significant regional disparity. This study also provides quantitative evidence of the positive effects of intercity patient mobility on healthcare efficiency and equality in metropolitan areas, which is fundamental for policymaking and planning. • Regional disparity in high-quality healthcare services leads to intercity patient mobility within metropolitan areas. • Intercity patient mobility can improve both healthcare efficiency and equality in Shenzhen metropolitan area. • Healthcare accessibility is measured as both proximity and supply-demand ratio. • 2SO4SAI approach is used for spatial optimization to balance efficiency and equality. • Countermeasures facilitating intercity patient mobility are suggested for regional planning of healthcare services. [ABSTRACT FROM AUTHOR]