Abstract
Background. Studies have shown that comprehensive urban and rural health centers can provide 80% of the health needs of the elderly population. However, elderly individuals often do not utilize these services. The present study aimed to investigate the reasons why elderly individuals do not access services provided by comprehensive rural and urban health centers in the southwest of Khuzestan Province, from the perspective of health center staff.
Methods. This descriptive-analytical study utilized a multi-stage random sampling method to select 338 employees of comprehensive health centers in southwestern Khuzestan. A survey questionnaire was developed and administered to collect information, including demographic data and 39 questions regarding reasons for non-attendance at health centers. The validity and reliability of the survey questionnaire were assessed prior to data collection.
Results. The majority of participants in this study were female (77.81%), married (74.26%), and had a bachelor's degree (32.25%). From the healthcare providers' perspective, preference for the private sector and personal factors related to the elderly or their families were identified as the main reasons for non-attendance at health centers. However, factors related to the physical condition of the centers, the quality of services provided, and the level of trust between elderly patients and healthcare providers were not found to have a significant impact on utilization of health center services.
Conclusion. The elderly population's willingness to utilize first-level services in the health and treatment networks was not viewed favorably by healthcare providers. Integrating some level two and level three services into the first level of service could potentially incentivize the elderly to make greater use of these services. In addition, healthcare providers suggested that traditional medicine services should be considered and incorporated at the first level of service, given the interest in traditional medicine among the elderly population.
Extended Abstract
Background
In today’s world, one of the developing phenomena is aging, referred to as the silent revolution. By 2050, the growth of older people will reportedly increase by 3.5 times, reaching approximately 16 percent of the world’s population.
Today, health centers in countries meet some of the needs of the elderly, so shifting the focus towards increasing the quality of life for older individuals is a preventive measure for not relying heavily on these centers, strengthening physical and mental abilities, and promoting health literacy.
Some studies have mentioned shortcomings in proper elderly facilities, lengthy counseling process, vague referral system, inadequate and outdated health education, drug management, compliance with care standards, feedback system, communication and clinical skills of employees, inadequate home care services, and inadequate social support.
So far, several studies have been conducted on the social participation of the elderly, abuse, empowerment in chronic diseases, lifestyle, quality of life, nutrition, independence, loneliness, physical activity, and so on. A thorough review of the literature revealed that no previous study had investigated the elderly population's utilization of rural and urban comprehensive health center services. Therefore, this study aimed to evaluate the elderly's use of comprehensive health center services in the southwest of Khuzestan Province, from the perspective of healthcare providers in 2023.
Methods
The current cross-sectional descriptive-analytical study was conducted involving a sample of 338 employees from both rural and urban health centers in the southwestern region of Khuzestan province.
Data were collected using a questionnaire. The questionnaire consisted of two parts: demographic questions and specialized questions (reasons for decreased attendances). The demographic part of the questionnaire included information about age, gender, education status, marital status, employment, economic status, and health status. The specialized part of the questionnaire included questions in eight domains using a 5-point Likert scale ranging from very little (1) to little (2), moderate (3), much (4), and very much (5). The first area of the questions related to "inadequate knowledge and knowledge about health services" (three questions), the second area of questions related to "lack of need to receive health services" (five questions), and the third area related to "family and personal issues" (five questions).
In data analysis, frequency (percentage) was used to describe the studied sample in terms of demographic characteristics. Then, the average score of each item was calculated, and by the univariate clustering method, these 39 items were divided into three groups of items based on importance: "high importance", "medium importance", and "low importance". Then, the score of each of the eight components was calculated from the sum of the mean scores of the items of that component.
Considering the difference in the number of items of the components and in order to ensure the comparability of the scores of the components and the importance of each component relative to each other, the mean scores of each component were calculated by dividing the score of the obtained component by the number of items of that component. The mean of the components was used to group the components into three groups, i.e.,"high importance", "medium importance", and "low importance" by the univariate clustering method. Finally, to compare the scores of components in different subgroups of demographic variables, Mann-Whitney and Kruskal-Wallis tests were employed.
Results
In this study, 338 employees of comprehensive health centers were studied. Most of the studied subjects were employees of Abadan health centers (40.53%), 31.66% were employees of Shadegan Holistic Health Centers, and 27.81% were from Khorramshahr city. Among the employees in the study, 77.81% were women. In segmenting the importance of the components, "private sector preference over public sector" and "family and personal issues" were two important components.
The components of "lack of proper response of personnel", "lack of knowledge about health services", and "lack of need to receive health services" were identified as important factors falling under the category of "moderate," while the components of "inappropriate physical conditions of the health centers", "quality of services", and "lack of trust of the elderly in health personnel" were categorized as "low" factors. The reasons for non-attendance at comprehensive health centers were identified from the perspective of staff members working at these centers. In comparison between male and female staff, female employees placed more importance on "inadequate knowledge and recognition of health services", "lack of need for health services", "inappropriate physical conditions of health centers", and "proper response of personnel to clients" (P< 0.05).
Among the three groups of employees, the "corporate" employment status attributed the most significant importance to five components: "inadequate knowledge and recognition about health services," "lack of need for health services," "family and personal issues," "inappropriate physical conditions of health centers," and "proper response of employees to clients." On the other hand, personnel with "formal contractual" employment status attributed the least importance to these components within the three employee groups. There was a significant difference in the importance of these five components (P < 0.05).
Conclusion
In general, the most important reasons for the elderly's lack of acceptance of comprehensive health centers are preference for private over public sector, family and personal issues, lack of proper response of personnel, and a tendency to use traditional medicine. Therefore, revising the structure and organization of the first level of prevention centers, integration of some services at the first level of prevention, and definition of traditional medicine at the first level can increase the interest of the elderly in health centers. In addition, attention and motivation of personnel in accepting and accompanying the provision of elderly services should not be ignored.
Therefore, due to the increase in the elderly population in the coming years, changes in type, method, process, quantity, and quality of services at the first level of prevention are inevitable.