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      Unmet Needs of Healthcare Services and Associated Factors among a Cohort of Ghanaian Adults: A Nationally Stratified Cross-Sectional Study Design

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          Abstract

          We estimated the prevalence of unmet needs of healthcare services (UNHS) and its associated factors among a cohort of older Ghanaian adults. World Health Organization (WHO) Study on Global AGEing and Adult Health for Ghana was used with a total of 4735 participants. Logistics regression analysis was performed using Stata 16 to assess associated factors. The overall UNHS was 3.7% (95% CI = 2.7-4.8) and the prevalence was significantly high amongst older adults aged 60 to 69 years (5.9%). Could not afford the healthcare (56.4%) was the main contender for UNHS. UNHS was influenced by; those aged 60 to 69 years [OR (95% CI) = 1.86 (1.19-2.91)]; no formal educational [aOR (95% CI) = 4.71 (1.27-17.38)], and no NHIS [OR (95% CI) = 1.78 (1.03-3.09)]. Participants needed care for joint pain (25.4%), and communicable diseases (19.1%). The inability to access healthcare was relatively higher for older adults more advanced in age, with low education, and for those without health insurance. Health system strengthening including financial protection by expanding the National Health Insurance Scheme to all Ghanaians in line with Ghana’s Universal Health Coverage Roadmap would reduce the unmet healthcare needs of older adults.

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          Association of the built environment with physical activity and obesity in older persons.

          We examined whether older persons who live in areas that are conducive to walking are more active or less obese than those living in areas where walking is more difficult. We used data from the Adult Changes in Thought cohort study for a cross-sectional analysis of 936 participants aged 65 to 97 years. The Walkable and Bikable Communities Project previously formulated a walkability score to predict the probability of walking in King County, Washington. Data from the cohort study were linked to the walkability score at the participant level using a geographic information system. Analyses tested for associations between walkability score and activity and body mass index. Higher walkability scores were associated with significantly more walking for exercise across buffers (circular zones around each respondent's home) of varying radii (for men, odds ratio [OR]=5.86; 95% confidence interval [CI]=1.01, 34.17 to OR=9.14; CI=1.23, 68.11; for women, OR=1.63; CI=0.94, 2.83 to OR=1.77; CI=1.03, 3.04). A trend toward lower body mass index in men living in more walkable neighborhoods did not reach statistical significance. Findings suggest that neighborhood characteristics are associated with the frequency of walking for physical activity in older people. Whether frequency of walking reduces obesity prevalence is less clear.
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            When the patient is the expert: measuring patient experience and satisfaction with care

            Abstract In 2018, three independent reports were published, emphasizing the need for attention to, and improvements in, quality of care to achieve effective universal health coverage. A key aspect of high quality health care and health systems is that they are person-centred, a characteristic that is at the same time intrinsically important (all individuals have the right to be treated with dignity and respect) and instrumentally important (person-centred care is associated with improved health-care utilization and health outcomes). Following calls to make 2019 a year of action, we provide guidance to policy-makers, researchers and implementers on how they can take on the task of measuring person-centred care. Theoretically, measures of person-centred care allow quality improvement efforts to be evaluated and ensure that health systems are accountable to those they aim to serve. However, in practice, the utility of these measures is limited by lack of clarity and precision in designing and by using measures for different aspects of person-centeredness. We discuss the distinction between two broad categories of measures of patient-centred care: patient experience and patient satisfaction. We frame our discussion of these measures around three key questions: (i) how will the results of this measure be used?; (ii) how will patient subjectivity be accounted for?; and (iii) is this measure validated or tested? By addressing these issues during the design phase, researchers will increase the usability of their measures.
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              The relation between neighborhood built environment and walking activity among older adults.

              The association of neighborhood built environment with walking activity has received growing attention, although most studies have relied upon subjective measures of the built environment and few have examined the relation between built environment and walking among older adults. This 2001 study examined the relation between objectively measured characteristics of the local neighborhood and walking activity among a sample of 546 community-dwelling older adults in Portland, Oregon. A geographic information system was used to derive measures of the built environment within a quarter-mile (0.4 km) and half-mile (0.8 km) radius around each participant's residence. Multilevel regression analysis was used to examine the association of built environment with walking behavior. No association between built environment and the likelihood of walking or not walking was observed in this cohort of older adults. However, among those participants who reported some degree of walking activity, average time spent walking per week was significantly associated with amount of automobile traffic and number of commercial establishments in their local neighborhood. These findings suggest that built environment may not play a significant role in whether older adults walk, but, among those who do walk, it is associated with increased levels of activity.
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                Author and article information

                Journal
                Inquiry
                Inquiry
                INQ
                spinq
                Inquiry: A Journal of Medical Care Organization, Provision and Financing
                SAGE Publications (Sage CA: Los Angeles, CA )
                0046-9580
                1945-7243
                28 June 2021
                Jan-Dec 2021
                : 58
                : 00469580211028172
                Affiliations
                [1 ]Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
                Author notes
                [*]Alfred Edwin Yawson, Department of Community Health, University of Ghana Medical School, College of Health Sciences, P.O. Box 4236, Accra, Ghana. Emails: aeyawson@ 123456ug.edu.gh , aeyawson@ 123456yahoo.com
                Author information
                https://orcid.org/0000-0002-1986-4103
                Article
                10.1177_00469580211028172
                10.1177/00469580211028172
                8243108
                34180280
                1f0cd60d-344a-40fa-9815-edb352e50d6c
                © The Author(s) 2021

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 4 December 2020
                : 26 May 2021
                : 7 June 2021
                Categories
                Original Research
                Custom metadata
                January-December 2021
                ts1

                unmet needs,healthcare service,adults,ageing,universal health coverage,cross-sectional,ghana

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