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This paper uses a unique nationwide survey data derived from the 2003 Utilisation of Health Services Survey (UHSS) in Iran (n=16,935) to analyse inequities of health care utilisation.

Concentration indices are used to measure socioeconomic inequality in actual use of the five types of health services, and in unmet need for two of those types of service (any ambulatory care and hospital admissions). Horizontal inequity indices are employed to examine inequity in ambulatory and hospital care. Generalised linear model (GLM) was employed to investigate factors contributing to the phenomena of “unmet need” and “met unneed”. Moreover, a decomposition analysis of inequality is performed to determine the contributions of each factor to the inequality of “unmet need”.

Results suggest that self‐reported need for ambulatory and inpatient care is concentrated among the poor, whereas the utilisation of ambulatory and inpatient care were generally distributed proportionally. Results of horizontal inequity indices show that the distributions of any ambulatory care and hospital admissions are pro‐rich. The probability of “unmet need” for ambulatory care was higher among wealthier individuals. The decomposition analysis demonstrates that the wealth index, health insurance, and region of residence are the most important factors contributing to the concentration of “unmet need” for ambulatory health care among the poor. Results also illustrate that higher wealth quintiles used more unneeded ambulatory care than their poorer counterparts.

A special characteristic of the UHSS is that it contains questions about the need for medical services use and about actual services use. This characteristic provides an opportunity to measure the inequality of health care consumption against self‐assessed treatment needs, as well as an analysis of which observables are associated with “unmet need”. Moreover, the incidence of health care use when it is reported as not needed can be analysed with this dataset. The analysis of this phenomenon – which we refer to as “met unneed” – is another novel aspect of this work.

The main objective of the study is to investigate unmet needs of Black African and Caribbean Heritage (BAH) patients with and without a concurrent diagnosis of antisocial personality disorder (ASPD).

A total of 79 participants were recruited from ten psychiatric inpatient wards across two hospital sites in South London. Personality disorder was assessed using the SCID‐II for DSM‐IV, the prevalence of unmet needs was assessed by The Camberwell Assessment of Need Short Assessment Schedule and substance misuse problems measured using well validated drug and alcohol use disorder identification tools.

The presence of a concurrent ASPD was independently associated with a greater number of unmet needs. ASPD was associated with lower qualifications and a greater risk of homelessness and substance misuse. Unmet need was associated with lower qualifications and substance misuse. In a stepwise linear regression model alcohol dependence and drug misuse were the most significant predictors of unmet need.

Further research is required to identify the reasons why these needs are not being met and establish reasons for these patients' high‐dropout rates from treatment.

The present findings suggest BAH psychiatric inpatients with ASPD are at greater risk of alcohol dependence and drug misuse and report a greater number of unmet needs thus requiring a greater volume of services; however, current services are not meeting these needs. Mental health teams should ensure thorough needs assessment procedures are incorporated into general psychiatric service practice ensuring effective treatment packages are tailored to these patients needs.

The research identifies a previously under‐researched sub‐group of psychiatric inpatients with a high proportion of unmet health and social needs and suggests further research to develop service improvements supporting their management.

The purpose of this study was to assess the self-perceived need, seeking and use of dental care and its main determinants in Kurdistan province, Iran.

A total of 1,056 adults in Kurdistan province were included in this cross-sectional study. Multistage sampling approach was used to select the samples. Data on sociodemographic characteristics, economic status, self-perceived need, seeking and use of dental care were collected using a self-administrated questionnaire. Multivariate logistic regression model was used to assess factors affecting the use of dental care. In addition, socioeconomic inequality relating to dental care needs and use of dental care were examined using concentration curve and concentration index.

In this study, unmet dental care need was 62.7%. There was a perceived need for dental care among 13.7% (n = 145) of the participants in the past month, with only 39.3% (n = 57) seeking the care. The most important reasons for unmet dental care need were “Could not afford the cost” and “Insurance did not cover the costs.” Multivariate logistic regression showed that supplementary insurance status and household economic status were identified as main determinants affecting dental care-seeking behavior. The result of concentration index revealed that seeking dental care was more concentrated among the rich, whereas the perceived dental care need is more prevalent among the poor.

This study demonstrated that the prevalence of unmet dental care needs is high in the study setting. Also, financial barrier was identified as the main determinant of unmet dental care needs.

The purpose of this study is to investigate the status of perceived need, seeking behavior and utilization of health services in the elderly population of Sanandaj (west of Iran).

This is a cross-sectional study conducted on 800 elderly people in Sanandaj. Subjects were selected using multistage sampling and data were collected using self-report questionnaires. A multivariate logistic model with odds ratios (ORs) was used to determine the relationship of independent variables with seeking perceived need. Also, the concentration index was used to measure the inequality in using health services.

The perceived need for outpatient (during the last 30 days) and inpatient health-care services (during the past 12 months) was 69.7% and 29.7%, respectively. Among them, the unmet need for outpatient and inpatient health-care services was 46.6% and 17%, respectively. Having health insurance (adjusted OR 12.08; 95% confidence interval [CI] 1.04–140.11), middle economic status (adjusted OR 5.18; 95% CI 1.30–20.51) and being in an age group of 65–70 years (adjusted OR 7.60; CI 1.42–40.61) increased the chance of seeking inpatient care. Also, being in an age group of 60–65 years (adjusted OR 0.41; 95% CI 0.18–0.95) reduced the chance of seeking outpatient care. There was also a pro-rich inequality in using outpatient health services.

The elderly population suffers from unmet health-care needs, especially in outpatient services. The most important reason for not seeking outpatient and inpatient services was financial barriers and self-medication, respectively. So, designing targeted policies and interventions to address barriers in the conversion of need to demand in the elderly population is essential.

Health is one of the most basic human rights. This study aims to examine the pattern of unmet health services needs and barriers to use health services among people with disabilities.

This cross-sectional study was conducted among people with disabilities in Sanandaj, the capital of a less economically developed province in western Iran in 2020. In total, 548 samples were selected using random sampling, and data were collected using a questionnaire. Chi-square test and Fisher's exact test were used to examine the relationship between independent variables including demographic variables and dependent variables. Statistical tests were performed using STATA software package.

About 64% and 23% of participants needed outpatient and inpatient services, respectively. The gap between the perceived need and using health services for outpatient and inpatient services was reported to be 55% and 30%, respectively. The main reasons for not seeking the required health care were “insufficient coverage of costs by insurance” and “lack of physical access.” Having supplementary insurance and better economic status were significantly correlated with using outpatient care and having supplementary insurance and type of disability had a significant relationship with using inpatient care.

There was a big gap between the perceived need, seeking for and receiving health services in people with disabilities. Designing and implementing appropriate interventions to reduce barriers on the way of transforming, the need for health services into demand in the population of people with disabilities should be on the agenda of policymakers and relevant managers in the country.

The purpose of this research was to determine the extent of the unmet need for modern contraceptives (MC) and its associated factors.

This community-based cross-sectional survey was conducted via interview among 306 women. Percentages, means, standard deviations, Chi-square tests and multiple logistic regression were completed for data analysis.

In total, 46.7% of respondents had total unmet need (24.8% spacing and 21.9% limiting). Multiple logistic regression for spacing showed the number of living children (AOR = 40.893, 95% CI = 6.930–241.292), no previous experience of MC (AOR = 30.149, 95% CI = 11.572–78.548) and level of knowledge (AOR = 5.587, 95% CI = 1.366–22.851). With regard to limiting pregnancies, respondent's age (AOR = 12.470, 95% CI = 1.264–86.734), number of living children (AOR = 21.257, 95% CI = 4.825–93.639) and no previous experience of MC (AOR = 120.542, 95% CI = 31.044–486.062) were recorded. Findings revealed that no previous experience of MC (AOR = 714.511, 95% CI = 160.646–3177.955) was a significant predictor of total unmet need.

Experience and knowledge of MC play a vital role in the unmet need of MC use. A comprehensive education program to promote decision-making on MC choice and integrated family planning services at local communities by capacity building of service providers should be scaled up.

The purpose of this paper is to ascertain the oral health experiences of people living with HIV/AIDS in the provinces of Kwazulu-Natal (KZN) and Western Cape (WC) in South Africa. Many studies have reported that people living with HIV have unmet needs for dental care and this study considered the various factors that affect the accessibility and utilisation of dental services as these factors are even more pertinent for the people living with HIV who have increased need for dental care.

The participants were selected among HIV-positive people attending selected Community Health Centre and regional hospital HIV clinics in KZN and WC provinces. The sample consisted of people living with HIV that were 18 years or older and who had given written, informed consent. The sample (n=435) comprised mainly of black females in the age group 20-29 years. In total, 347 participants (79.8 per cent) had an oral health problem of which 83 per cent (n=288) received care.

Of those that received care, 56.6 per cent (n=163) of the participants stated that the staff were aware of their HIV status. Almost a third of the participants who received care reported a negative experience at the clinic. If the participant lived in a metropolitan area, the participant was 3.647 times more likely to receive care than if the participant lived in a non-metropolitan area (p < 0.01) If the participant earned R5,000 or less, the participant was 0.106 times less likely to receive care (p=0.048). If the participant lived 1-5 km from the clinic, the participant was 3.371 times more likely to receive care (p=0.015).

The results are specific to KZN and WC and cannot be extrapolated with caution to the rest of South Africa. However, to the best of the author’s knowledge, there is no other study that has compared differences in the use of oral health care services by people with HIV in South Africa and these results serve as an indication of some the important issues in this regard. Additionally, this study did not have a control group of HIV-negative people which would have enabled one to determine whether certain barriers were unique to people living with HIV.

The study highlighted the barriers to care existing within the current public health system relative to the provision of oral health services for people living with HIV in KZN and WC. It was anticipated that by ascertaining the nature and extent of unmet needs and barriers to dental care for people living with HIV, measures can be put in place to remove or at least reduce the barriers to care and improve the quality of life for people living with HIV/AIDS in South African communities.

The high prevalence of oral health problems in people living with HIV makes it imperative for the DOH to make every attempt to remove barriers to oral health care and thereby secure equitable, affordable and accessible oral health care which is acceptable for people living with HIV and accountable to the greater society.

This study emphasises the importance of embracing people that are being discriminated and marginalised by society such as people living with HIV to ensure that they feel a franchised member of society who can take the initiative to be in control of their own health and, with the necessary aid from public resources and societal support, join forces to reduce the public health burden and its impact on the socio-economic milieu.

The purpose of this paper is to assess the health promotion needs of vulnerable young prisoners and the existing health promotion activities in custodial settings in seven European Union (EU) Member States.

The research comprised two components: the first involved identifying existing health promotion practices. The second involved mapping out young offenders’ health promotion needs by carrying out a needs assessment. Both quantitative and qualitative methods were adopted. The quantitative element comprised surveys among young prisoners and prison staff and focused on the availability and perceived importance of health promotion activities in prison. The qualitative element comprised focus groups with young offenders and individual interviews with prison staff, field experts and NGO members.

The findings from the research have identified a number of similar, but also some diverse areas of unmet need for health promotion activities in prison settings across these diverse seven EU countries. There is no consistency of approach within and between countries regarding health promotion policy, guidance, resources and programmes for young prisoners. In order to improve the health of young prisoners and to establish and increase sustainability of existing health promotion programmes, there is a need for the establishment of National and EU standards.

Providing health promotion activities for young prisoners while in custodial settings is key to addressing their unmet health and well-being needs and to facilitate their reintegration back into the community. Despite the barriers identified by this research, health promotion is to some extent being delivered in the partner countries and provides a foundation upon which further implementation of health promotion activities can be built especially when the benefits of health promotion activities, like dealing with the common problems of alcohol and drug addiction, mental health and communicable diseases are linked to successful reintegration.

This research project explored how refugee community organisations (RCOs) could become more involved in the government's health agenda to improve the level of consultation and responsiveness in the design and provision of mental health services for ethnic minorities. The method involved a review of relevant literature, interviews with refugee community organisation leaders and community workers, and a survey of refugee service users' involvement with RCOs. The research found that the causes and effects of mental ill health in refugees as understood by interviewees were consistent with much of the literature in this area. The mental health needs of refugees are very similar across nationalities and ethnicities, and distinct from those of the general population and of other migrant groups. Appropriate responses, as understood by community leaders and professional community workers, are currently only partly and insufficiently provided by statutory health services, and there is extensive unmet need.

This paper is an account of the discussions and recommendations by the exper t advisory panel on potential metrics and ‘sentinel indicators’ for improved outcomes in housing and mental health, as par t of an inter‐agency seminar called to advise on the development of metrics and measures for community mental health, for Fair Society, Healthy Lives: The Marmot Review (Marmot, 2010). The seminar covered all aspects of mental health in both its broadest and narrower senses.Much of the background material for these discussions, therefore, cuts across familiar knowledge silos between the fields of health and housing. Where it is necessary to elucidate the text, references are included to relevant research and policy frameworks that may be unfamiliar to the general reader. This paper is not, however, intended as a general literature review nor is it an evaluation of the available research. A paper on this subject will feature in a future issue of the Journal.1The conclusions from the panel discussion are presented in four main areas, reflecting the need to specify metrics across the wide‐ranging interface between housing and mental health, while still keeping the task manageable. Five current or potential health service metrics were proposed as having par ticular value as signal indicators. Two of these (relating to primary care prevention and public health) have no precision as yet, par tly as new services and approaches are still evolving. Among existing health datasets, the Mental Health Minimum Dataset (MHMDS) (NHS Information Centre, 2009a), SITuation REPor ts (SITREPS) (Department of Health, 2003), and the Summary Care Record data were singled out, though each is thought to need more work to improve the current data categories as well as data collection.One rather more fundamental point made was that the identifying, assessing and encouraging of effective inter‐sector par tnership work will be the key to tackling health inequalities. The use of other, non‐health services data therefore holds great potential for a better recognition both of needs and of outcomes in successful par tnership work, especially where this can be interpreted at local level. These wider comments are elaborated in the context of housing, but may be applicable to all effor ts to evidence and work with the social determinants and the social outcomes of mental health. For the future, a combination of well‐crafted nationally sanctioned metrics and the ‘soft intelligence’ of locally identified meaning may be most effective.Subsequent developments confirm the potential in cross‐sector development work, and indicate the potential for fur ther collaboration via the local performance framework. As policy frameworks continue to evolve rapidly, the ar ticle ends with a Codex, updating the relevant policy frameworks context since the seminar (in Spring 2009) and especially in the context of a new coalition government with aspirations to ar ticulate and promote public health in the context of the local performance framework and the ‘new localism’ agenda. This final section and comments therein are therefore entirely the responsibility of the author.