Department of Economics, Faculty of Social Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
Climate Action and Agricultural Sustainability Program, Inter-American Institute for Cooperation in Agriculture (IICA), 16 Factory Road Building #3, Brechin Castle, Couva, Trinidad and Tobago.
Health Policy Plan. 2023 Apr 11;38(4):464-473. doi: 10.1093/heapol/czad012.
Measuring health-care acceptability presents conceptual and contextual challenges, particularly in data-poor Multi-Island Micro States (MIMSs). Thus, there has been limited evidence on the acceptability of health care in MIMS and scarce use of acceptability metrics in policy design and health system evaluation. In the present study, we developed and empirically validated a theoretical framework for measuring users' acceptability of health care in a MIMS in the Caribbean. Using a minimum-data approach, we used a synoptic review of health-care literature and consultations with experts and health system stakeholders to define, scope and select constructs for the theoretical framework of health-care acceptability. Empirical validation of the modelled framework was performed using data collected from household expenditure and health-care utilization surveys in Carriacou and Petite Martinique (n = 226), island dependents of Grenada in the Caribbean. Data were used to create health utilization profiles and analyse measurement scales of the health-care acceptability framework using non-linear partial least square structural equation modelling. The modelled framework included 17 items integrating economic and psychosocial concepts, with 1 dependent construct (utilization) and 3 independent constructs (users' perception, experience and knowledge of health facility). Model analysis and validation indicated that the framework was significant, explaining 19% of the variation in health-care acceptability. Users' experience construct was influenced by perception and knowledge of health facility and was the only construct with a significant negative relationship with acceptability. Health-care acceptability declined with increased waiting and travel times and unsuitable opening hours. We conclude that acceptability comprises a complex multidimensional concept, which is highly dependent on various interacting variables and contextual characteristics of the health system. Therefore, policies and actions to improve acceptability should be context specific and focused on evaluating factors infringing health-care acceptability. Routine acceptability and/or satisfaction studies represent baseline evidence towards understanding and integrating acceptability in health-care assessment.
衡量医疗保健的可接受性存在概念和背景方面的挑战，尤其是在多岛屿微型国家（MIMS）数据匮乏的情况下。因此，关于 MIMS 中医疗保健的可接受性的证据有限，并且在政策设计和卫生系统评估中很少使用可接受性指标。在本研究中，我们开发并实证验证了一种用于衡量加勒比地区 MIMS 中医疗保健用户可接受性的理论框架。我们采用最小数据方法，通过对医疗保健文献的综合审查以及与专家和卫生系统利益相关者的磋商，定义、范围界定和选择了理论框架的构建模块，以构建医疗保健可接受性的理论框架。使用在加勒比地区格林纳达的附属岛屿卡里亚库和小马丁尼克岛进行的家庭支出和医疗保健利用调查中收集的数据，对建模框架进行了实证验证（n=226）。数据用于创建医疗利用概况，并使用非线性偏最小二乘结构方程模型分析医疗保健可接受性框架的度量量表。所建框架包括 17 个整合经济和心理社会概念的项目，有 1 个因变量（利用）和 3 个自变量（用户对医疗机构的感知、体验和了解）。模型分析和验证表明，该框架具有重要意义，可解释 19%的医疗保健可接受性变化。用户体验结构受到对医疗机构的感知和了解的影响，并且是与可接受性唯一存在显著负相关关系的结构。随着等待时间和旅行时间的增加以及不适当的开放时间，医疗保健的可接受性会降低。我们得出结论，可接受性是一个复杂的多维概念，高度依赖于卫生系统的各种相互作用的变量和背景特征。因此，为了提高可接受性，政策和行动应具有针对性，重点评估影响医疗保健可接受性的因素。常规的可接受性和/或满意度研究代表了理解和将可接受性纳入医疗保健评估的基本证据。
