Salimi Nona, Javan-Noughabi Javad, Ghavami Vahid, Matinfar Reza, Kokabisaghi Fatemeh
Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
BMC Public Health. 2025 Jul 2;25(1):2199. doi: 10.1186/s12889-025-23230-0.
Poor access to health services endangers children's health and development. Parents' perspectives are essential for understanding barriers to children's healthcare access, as they often serve as primary caregivers and decision-makers. This research aimed to explore parents' perspective on children's access to healthcare services and its associated factors.
In this cross-sectional study, 317 parents of children aged ≤ 18, chosen by two-stage cluster sampling participated. Data was collected by the standard questionnaire of the European Patient Forum with some changes. It evaluates overall access to healthcare and its five main dimensions: information availability, affordability, physical accessibility, appropriateness and adequacy. Translation of the questionnaire into Persian included forward and backward translations and expert committee discussions. Cronbach's alpha was 0.935 approving questionnaire's reliability. A 5-point Likert scale was used to rate the status of access (very low = 1, very high = 5). Descriptive statistics and ordinal logistic regression were used to assess the factors associated with access. Data analysis was performed in STATA17 at a significant level of p < 0.05.
Most study participants were women (n = 189, 60%) 31-40 years old (n = 132, 42%), had a high school degree (n = 198, 60.7%), 2-3 children (n = 158, 49.8%), average income (n = 126, 39.7%) and basic health insurance (n = 222,7%). The mean score of children's overall access to health services was 2.8 ± 1.2, and for its dimensions from highest to the lowest was physical accessibility: 3.19 ± 0.87, appropriateness: 2.81 ± 1.1, information availability: 2.76 ± 0.98, adequacy: 2.60 ± 1.07 and affordability: 1.36 ± 1.07. There was a significant relationship parents' education level, income and supplementary health insurance and access to healthcare services (p < 0.05).
From parents' perspective, the access of children and it's all dimensions: information availability, affordability, physical accessibility, appropriateness and adequacy need improvement. Policymakers should ensure all children receive necessary care by providing affordable subsidized health services. Children should have access to age-friendly health information and be supported to participate in healthcare decisions. To make health services more appropriate, it is necessary to train the staff about professional ethics and equal treatment of all patients.
难以获得医疗服务危及儿童的健康与发展。父母的观点对于理解儿童获得医疗保健服务的障碍至关重要，因为他们通常是主要照顾者和决策者。本研究旨在探讨父母对儿童获得医疗服务及其相关因素的看法。
在这项横断面研究中，采用两阶段整群抽样法选取了317名18岁及以下儿童的父母参与。通过对欧洲患者论坛标准问卷进行一些修改后收集数据。该问卷评估医疗服务的总体可及性及其五个主要维度：信息可得性、可负担性、实际可及性、适宜性和充分性。问卷翻译成波斯语包括正向和反向翻译以及专家委员会讨论。克朗巴哈系数为0.935，证明问卷具有可靠性。采用5点李克特量表对可及性状况进行评分（非常低=1，非常高=5）。使用描述性统计和有序逻辑回归来评估与可及性相关的因素。在STATA17中进行数据分析，显著性水平为p<0.05。
大多数研究参与者为女性（n=189，60%），年龄在31-40岁（n=132，42%），拥有高中学历（n=198，60.7%），育有2-3个孩子（n=158，49.8%），收入中等（n=126，39.7%）且拥有基本医疗保险（n=222，7%）。儿童总体获得医疗服务的平均得分为2.8±1.2，其各维度得分从高到低依次为：实际可及性：3.19±0.87，适宜性：2.81±1.1，信息可得性：2.76±0.98，充分性：2.60±1.07，可负担性：1.36±1.07。父母的教育水平、收入和补充医疗保险与获得医疗服务之间存在显著关系（p<0.05）。
从父母的角度来看，儿童获得医疗服务及其所有维度：信息可得性、可负担性、实际可及性、适宜性和充分性都需要改善。政策制定者应通过提供可负担的补贴医疗服务，确保所有儿童获得必要的护理。儿童应能够获得适合其年龄的健康信息，并得到支持以参与医疗决策。为使医疗服务更适宜，有必要对工作人员进行职业道德和公平对待所有患者方面的培训。
