Alavi Manijeh, Moradi-Lakeh Maziar, Setareh Forouzan Ameneh, Sajjadi Homeira, Shati Mohsen, Khodaie Ardakani Mohammad Reza
Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Deputy for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran.
Med J Islam Repub Iran. 2019 Mar 18;33:18. doi: 10.34171/mjiri.33.18. eCollection 2019.
Responsiveness as a nonmedical, nonfinancial aspect of a health system's goals requires special attention, particularly in people with physical disabilities. This study aimed to investigate the predictors of poor responsiveness of rehabilitation centers in Tehran. A cross sectional study was conducted to investigate 610 individuals with physical disabilities who referred to 10 comprehensive rehabilitation centers in Tehran using Quota sampling in 2016-2017. The following questionnaires were used in this study: Health System Responsiveness questionnaire, recommended by World Health Organization (WHO); Activities of Daily Living (ADL); and Instrumental Activity of Daily Living (IADL). Multiple logistic regression models were used to determine the sociodemographic characteristics (sex, age, perceived social class, etc.), self-assessed health, and physical functioning [(eg, Instrumental Activities of Daily Living (IADL)] as predictors of poor responsiveness in comprehensive rehabilitation centers of Tehran. The mean years of education of respondents was 12.57 (SD=5.07). The majority of the participants perceived themselves as belonging to the middle class. Among the participants, 17.1% were completely dependent in their instrumental activities of daily living (IADL). Respondents who were not satisfied with their health insurance accounted for 40.2% of the sample. Also, 20.9% of the participants reported poor responsiveness. Based on the logistic regression model, variables of education, perceived social class, satisfaction with health insurance, and IADL were predictors of overall poor responsiveness after adjusting other covariates. Level of education was a strong predictor of poor responsiveness. Insurance companies should make policies to facilitate people's access to rehabilitation services and increase customer satisfaction. Moreover, rehabilitation service providers should pay special attention to those with physical disabilities who are more severely disadvantaged.
响应性作为卫生系统目标中的一个非医学、非财务方面，需要特别关注，尤其是在身体残疾者中。本研究旨在调查德黑兰康复中心响应性差的预测因素。2016 - 2017年，采用配额抽样法对610名转诊至德黑兰10家综合康复中心的身体残疾者进行了横断面研究。本研究使用了以下问卷：世界卫生组织（WHO）推荐的卫生系统响应性问卷；日常生活活动（ADL）问卷；以及工具性日常生活活动（IADL）问卷。采用多元逻辑回归模型来确定社会人口学特征（性别、年龄、感知社会阶层等）、自我评估健康状况以及身体功能[如工具性日常生活活动（IADL）]，作为德黑兰综合康复中心响应性差的预测因素。受访者的平均受教育年限为12.57年（标准差 = 5.07）。大多数参与者认为自己属于中产阶级。在参与者中，17.1%在工具性日常生活活动（IADL）方面完全依赖他人。对医疗保险不满意的受访者占样本的40.2%。此外，20.9%的参与者报告称响应性较差。基于逻辑回归模型，在调整其他协变量后，教育程度、感知社会阶层、对医疗保险的满意度以及IADL等变量是总体响应性差的预测因素。教育程度是响应性差的一个强有力的预测因素。保险公司应制定政策，以方便人们获得康复服务并提高客户满意度。此外，康复服务提供者应特别关注那些处于更严重不利地位的身体残疾者。
