Département de Médecine Sociale et Préventive, Université de Montréal, CP 6128 Succ, Centre-Ville, Montréal, Québec H3C 3J7, Canada.
BMC Public Health. 2012 Feb 27;12:147. doi: 10.1186/1471-2458-12-147.
In sub-Saharan Africa, women must overcome numerous barriers when they need modern healthcare. Respect of gender norms within the household and the community may still influence women's ability to obtain care. A lack of gender-sensitive instruments for measuring women's ability to overcome barriers compromises attempts to adequately quantify the burden and risk of exclusion they face when seeking modern healthcare. The aim of this study was to create and validate a synthetic measure of women's access to healthcare from a publicly available and possibly internationally comparable population-based survey.
Seven questionnaire items from the Burkina Faso 2003 DHS were combined to create the index. Cronbach's alpha coefficient was used to test the reliability of the index. Exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were applied to evaluate the factorial structure and construct validity of the index while taking into account the hierarchical structure of the data.
The index has a Cronbach's alpha of 0.75, suggesting adequate reliability. In EFA, three correlated factors fitted the data best. In CFA, the construct of perceived ability to overcome barriers to healthcare seeking emerged as a second-order latent variable with three domains: socioeconomic barriers, geographical barriers and psychosocial barriers. Model fit indices support the index's global validity for women of reproductive age in Burkina Faso. Evidence for construct validity comes from the finding that women's index scores increase with household living standard.
The DHS items can be combined into a reliable and valid, gender-sensitive index quantifying reproductive-age women's perceived ability to overcome barriers to healthcare seeking in Burkina Faso. The index complies conceptually with the sector-cross-cutting capability approach and enables measuring directly the perceived access to healthcare. Therefore it can help to improve the design and evaluation of interventions that aim to facilitate healthcare seeking in this country. Further analyses may examine how far the index applies to similar contexts.
在撒哈拉以南非洲地区，女性在需要现代医疗保健时必须克服众多障碍。家庭和社区内部的性别规范可能仍然会影响到女性获得护理的能力。缺乏衡量女性克服障碍能力的性别敏感工具，使得人们难以充分量化她们在寻求现代医疗保健时所面临的负担和排斥风险。本研究旨在创建和验证一种综合的医疗保健获取指数，该指数来自一项公开的、可能具有国际可比性的基于人群的调查。
从布基纳法索 2003 年 DHS 中选择了七个问卷项目来创建指数。克朗巴赫α系数用于测试指数的可靠性。同时考虑到数据的层次结构，应用探索性因子分析（EFA）和验证性因子分析（CFA）来评估指数的因子结构和构建效度。
该指数的克朗巴赫α系数为 0.75，表明可靠性适中。在 EFA 中，三个相关因子最适合数据。在 CFA 中，感知克服寻求医疗保健障碍的能力结构作为一个二阶潜在变量出现，包含三个领域：社会经济障碍、地理障碍和心理社会障碍。模型拟合指数支持该指数在布基纳法索育龄女性中的总体有效性。结构效度的证据来自于这样一个发现，即女性的指数得分随着家庭生活水平的提高而增加。
可以将 DHS 项目组合成一个可靠且有效的、性别敏感的指数，用于量化布基纳法索育龄女性感知克服寻求医疗保健障碍的能力。该指数在概念上符合跨部门能力方法，并能够直接衡量感知的医疗保健获取。因此，它可以帮助改善旨在促进该国寻求医疗保健的干预措施的设计和评估。进一步的分析可以检验该指数在类似背景下的适用程度。
