Search results

Since health behaviors of elderly Asian Americans are often underreported, the study, based on the health behavioral model (Andersen’s model), was to examine if there is a reciprocal relationship between healthcare utilization and health outcomes, and how social characteristics play their role in this relationship between US-born and foreign-born elderly Asian Americans.

Using structural equation modeling, this research examined the proposed hypotheses which consisted of direct and indirect effects among health outcomes, healthcare utilization and social characteristics, as well as the disparities of the effects between US-born and foreign-born elderly Asian Americans (65 + ). A sample size of elderly Asian Americans was divided into a US-born group (N = 1,305) and a foreign-born group (N = 4,902) from the National Health Interview Survey (NHIS) 1998–2012. Health outcomes consisted of current health status and health change. Healthcare utilization included general doctor visit, ER, and mental health professional visit. Social characteristics of population included predisposing characteristics (such as age, sex, marital status, and region of residency) and enabling resources (such as education, family size, and family income).

Results from the study indicated that first, there was a reciprocal relationship between health outcomes and healthcare utilization for both groups. Second, predisposing characteristics had a direct effect on health outcomes, and enabling resources had an indirect effect on health outcomes via healthcare utilization. In addition, living in the West had both direct and indirect effects on health outcomes. Third, regarding disparities of the effects between both groups, the US-born elderly are more likely to attain health benefits from healthcare utilization and their social characteristics than the foreign-born. As a result, the interactive relationship between health outcomes, healthcare utilization, and social characteristics, as well as disparities of healthcare outcomes through health utilization and social characteristics for elderly Asian Americans is highlighted.

First, due to the design of NHIS, this research was limited to fully present the needs and more characteristics of elderly Asian Americans. This shows the great need for a large scale, representative study for health behaviors of elderly Asian Americans. Second, in the dataset, the study was limited to explore health behaviors of elderly Asian Americans into each Asian ethnic subgroup. Since the culture of Asian Americans is heterogeneous, it is recommended that future research can explore differences and commonalities of the health behaviors between Asian subgroups. Third, based on the health behavioral model and the design of the dataset, this study was limited to illustrate variations of life experiences between both groups. These differences regarding their needs and desires for healthcare services and health outcomes can become an important foundation for service providers and policy makers to provide appropriate services that improve the quality of the later lives of elderly Asian Americans.

First, the study applied the health behavioral model and proved that the effect of healthcare utilization and social characteristics on health outcomes is greater for the US-born elderly Asian Americans than for the foreign-born. Second, this study confirmed that the healthcare services in US society are still beneficial for the health outcomes of elderly Asian Americans. Third, the study found that when family is used to explain the social behaviors of elderly Asian Americans, researchers need to be more careful to identify various family factors in accordance to its dynamics, such as interpersonal relationship, material supply, and emotional support.

The purpose of this study was to review existing healthcare service quality-measurement models.

A review of the literature was conducted utilizing keywords “healthcare’’, “service quality’’, “measurement models”, “SERVQUAL”, “SERVPERF”, “HEALTHQUAL”, “PubHosQual” and “HospitalQual”. These investigations were selected from the “Emerald’’, “ABI/Inform”, “ScienceDirect” and “EBSCOhost” databases. A range of studies used in the makeup of the healthcare quality-measurement model for a 36 years period (1979 to 2015) were examined in an exhaustive survey of the literature. Of 137 studies reviewed, 74 studies were selected for analysis.

As yet, no consensus has been reached among scholars on the definition and indicators and factors of the quality of the healthcare services. Moreover, most of the current models are of Western origin and incongruent with the cultural and economic contexts of developing countries. The previous studies create scales resembling the generic measures of service quality, which may not be completely appropriate for assessing the perceived quality of healthcare services. Furthermore, previous studies were too narrow, overemphasizing the quality of healthcare only as far as the functional aspect of the services were concerned and paying too little attention to the technical aspects, using the experience of healthcare providers. These results have much room for failures. This is therefore advising healthcare organizations that need to develop their own models for measuring the quality of their services.

Generic models no longer suffice in measuring the quality of healthcare services. Developing countries should try and develop their own models for measuring the quality of healthcare services.

Purpose: The primary purpose of this study is to examine the association between Internet use, skills, and health-related Internet activities, on the one hand, and perceived health outcomes of health-related Internet use, use of healthcare services, and self-rated health (SRH), on the other hand, the latter conceptualized as gains constituting the “third digital divide.” Secondarily, we seek to examine whether the above associations are maintained after accounting for demographic characteristics.

Methodology: A nationally representative random-digital-dial (RDD) telephone household survey of Israeli adult population (aged 21 and older, N = 819). The survey measured different dimensions of Internet use – frequency, experience, Web 1.0 general consumption and health-related activities, Web 2.0 production activities (general and health-related), and content evaluation. Potential health benefits included perceived outcomes of Internet use for health purposes, use of healthcare services and SRH.

Findings: In a multiple hierarchical regression model, adjusting for demographic variables, Internet use was associated with increased use of healthcare services and better perceived outcomes of Internet use for health purposes, but not with SRH.

Research Implications and Limitations: Health-related Internet use is associated with a sense of empowerment and enhanced use of healthcare services, but – after accounting for background variables – is not associated with SRH. Limitations include self-reports and a cross-sectional design, the latter precluding inference on causality.

Practical Implications: Internet use, specifically Web 1.0 consumption activities, is associated with increased use of healthcare services and is positively associated with perceived health outcomes. No such relationships were found for Web 2.0 activities. Future technological developments in services should take the digital divide into account and design products that will benefit disadvantaged groups.

Originality/Value: While rigorously assessing various dimensions of Internet use, the study distinguishes between various benefits of Internet use in the health domain, clarifying which benefits are associated with Internet use for health purposes.

The purpose of this paper is to evaluate the nonlinear impact of users’ memories on their general evaluation of outpatient healthcare services by the integration of two methodologies: critical incidents technique (CIT) and penalty-reward contrast analysis (PRCA).

The authors carried out a survey with 356 respondents, users of seven outpatient clinics located in the city of Blumenau/SC, Brazil, during 2016. The participants were asked about their perceptions of positive and negative aspects of the service; and, using CIT, the answers were categorized according to the following dimensions: empathy, communication, facilities, access, promptness, medicines availability, complementary services, safety/confidentiality and service performance. Then, the authors evaluated the nonlinear impact of critical incidents on users’ general evaluation of the service using the identified incidents as input variables in a PRCA.

The findings show that users of healthcare services tend to remember emotion and health aspects positively, while technical and formal aspects tend to be more negatively than positively remembered. On the other hand, PRCA identifies that incidents of three dimensions positively influence the overall perception of the service (empathy, complementary services and privacy) and five negatively (empathy, facilities, speed, drugs/pharmacy and health performance), explaining 26.3 percent of the variation in clients’ general satisfaction.

The present paper explores the integration of two methodologies, showing how we can use open listening to healthcare service users to identify the nonlinear impact of different incidents on their general evaluation of the service. The results show that what customers remember does not necessarily influence overall customer satisfaction. The present approach allows companies to improve the process of listening to customers. There are no other papers exploring this approach, particularly in relation to healthcare services.

Traditionally, the role of technology on health services has been argued from the supply side. The purpose of this paper is to use a demand side perspective to examine the effect of Information and Communication Technologies (ICTs) on the use of maternal health services in Ghana.

Study used data from the 2008 Ghana Demographic and Health Surveys and binary response regression models to examine the effect of women's access to ICTs on maternal healthcare utilization in Ghana. Three variables on maternal healthcare utilization were employed: use of contraception, antenatal care and place of delivery.

Results from the study show that the effect of the use of technology is both positive and significant. In particular, among the other ICTs (i.e. landline phone, listening to radio, watch television, color television in household, computer in household), the coefficients of mobile phone ownership tends to be consistently significant across all four reproductive health services. Therefore, ICTs have a good capacity to influence women's demand of health information. This needs to be taken into account when designing maternal health policies and interventions.

This is one of the few papers examining the effect of ICTs on utilization of maternal health services from the demand side compared to the popular supply side argument often found in the literature.

The study examined the utilisation patterns of healthcare services among tea garden workers and analysed the factors influencing utilisation in an Indian context.

The authors employed a mixed-method approach and an explanatory sequential design for the study. A survey was conducted in the beginning followed by in-depth interviews in a north-eastern state of India (Assam). Andersen health behaviour model was used to explore the factors influencing healthcare utilisation. The sample size for the survey and in-depth interviews were 300 and 19, respectively, recruited employing multistage random and purposive sampling techniques.

Out of 300 workers surveyed, 169 (56.3%) were females, 257 (85.7%) were married, 77 (25.7%) were illiterates and 229 (76.3%) had monthly household income less than 100 US$. The survey also found that 47.3% and 15.3% had non-communicable and communicable disease respectively. Most of the workers (67.3%) utilised government facilities, and close to one third (28.7%) utilised tea garden hospitals. About 63.3% had health insurance, but a majority (78.9%) did not use it previously. The analyses of interviews explored the need, enabling, predisposing factors under three important themes influencing utilisation of healthcare services among the workers.

The study generates evidence to strengthen the Indian Plantation Labour Act, 1951 for tea garden worker's welfare protection and warrants transition from colonial-era policies to contemporary industry realities in order to improve their living, employment, nutritional and health conditions.

The research adds to the existing literature on overall healthcare services utilisation (including coverage and utilisation of health insurance) among blue collar workers who usually lack access to healthcare facilities and explores important factors that determine utilisation in the Indian context.

In 2017, the WHO presented a framework of priorities and guiding principles to promote the health of refugees and migrants (WHO, 2017). The purpose of this paper is to analyze a crucial but understudied aspect for the implementation of this framework, namely, healthcare providers’ images of refugees and their use of health services.

A preliminary study first addresses images of refugees and their use of health services derived from the literature. This is followed by an empirical case study of antenatal and delivery service to Eritrean refugee women in Israel. The case study explores providers’ (n=8) images of Eritrean women and their use of services as well as Eritrean women’s (n=10) reflections on their own use of these services, examining the degree to which providers’ images correspond with Eritrean women’s realities.

The preliminary study shows how the literature largely tends to picture refugees as medicalized and disempowered. The case study illustrates that providers of Israeli antenatal and delivery services embrace similar images, although they are more nuanced. The reflections of Eritrean women show that providers’ images partially reflect their realities. However, Eritrean women attribute these images to external constraints, whereas providers attribute these images to innate characteristics of Eritrean women. Together, these findings suggest that implementation of the recently introduced WHO framework is at stake.

This study raises awareness of a crucial but understudied aspect regarding implementation of a recently introduced universal framework for promoting the health of refugees and migrants.

The purpose of this paper is to assess the trends of socioeconomic-related inequalities in maternal healthcare utilization in Ghana between 2003 and 2014 and examine the causes of inequalities in maternal healthcare utilization in Ghana.

Data are drawn from three rounds of the Ghana Demographic and Health Survey collected in 2003, 2008 and 2014, respectively. The authors employ two alternative measures of socioeconomic inequalities in health – the Wagstaff and Erreygers indices – to examine the trends of socioeconomic inequalities in maternal healthcare utilization. The authors proceed to decompose the causes of inequalities in maternal healthcare by applying a recently developed generalized decomposition technique based on recentered influence function regressions.

The study finds substantial pro-rich inequalities in maternal healthcare utilization in Ghana. The degree of inequalities has been decreasing since 2003. The elimination of user fees for maternal healthcare has contributed to achieving equity and inclusion in utilization. The decomposition analysis reveals significant contributions of individual, household and locational characteristics to inequalities in maternal healthcare. The authors find that educational attainment, urban residence and challenges with physical access to healthcare facilities increase the socioeconomic gap in maternal healthcare utilization.

There is a need to target vulnerable women who are unlikely to utilize maternal healthcare services. In addition to the elimination of user fees, there is a need to reduce inequalities in the distribution and quality of maternal health services to achieve universal coverage in Ghana.

This study investigates the effect of user fees on access and waiting time in Nigeria. For access, the effect of user fees on both preventive and curative care; and the effect of user fees on waiting time at public healthcare facilities were examined. User fees are vital for the fiscal sustainability of healthcare provision for most African economies. Its imposition could debar healthcare access by the poor while its removal can reduce quality of care and induce longer waiting time.

The wave 3 of the Nigerian General Household Survey (2015/16) data was used for users of public health facilities. Access to healthcare was modelled using utilization data in a logistic regression model while waiting time was through the Negative Binomial Regression Model (NBRM).

The analyses showed significant effects of user fees on access to both preventive and curative care and on time spent waiting to make use of healthcare services. Individuals were able to access healthcare services regardless of amounts paid. Also, there was a non-negative effect of user fee imposition on waiting time.

Nigeria should improve healthcare facilities to address the enormous demand for healthcare services when designing policy for health sector.

This paper shows that even with the imposition of user fees, healthcare facilities could still not cater for the rising healthcare needs of the populace but cautioned that its abolition may not be a preferred option.

The purpose of this paper is to develop and evaluate the Standards of Healthcare Facility for Thai Female Inmates (SHF-TFI) through healthcare service improvement.

This research and quality improvement project was comprised of three phases. Surveying healthcare facilities and in-depth interviews with female inmates as well as prison nurses were employed in Phase I. Expert reviews and public hearing meetings were used for developing the SHF-TFI in Phase II. Satisfaction questionnaires, focus group interviews of the female inmates, and in-depth interviews with nurses and prison wardens were utilized to evaluate feasibility and effectiveness of SHF-TFI implementation in Phase III.

The SHF-TFI was elaborated in order to be more specific to the context of the correctional institutes and correspond with healthcare as to the needs of female inmates. It was divided into three main aspects: administrative standards, health service standards and outcome standards. After implementation, nurses reflected on the feasibility and benefits of the SHF-TFI on the organizations, inmates and nurses. The female inmates perceived remarkable improvement in the healthcare services including physical activity promotion and screening programs for non-communicable diseases, the physical environment and sufficiency of medical equipment. Moreover, the pregnant inmates and incarcerated mothers with children shared their views on better antenatal and child developmental care, as well as availability of baby supplies.

The findings support the feasibility and effectiveness of the SHF-TFI for quality care improvement and applicability of the Bangkok Rules in women’s correctional institutes.