@article{fdi:010087521,
  title = {{P}redicting health services utilization using a score of perceived barriers to medical care : evidence from rural {S}enegal},
  author = {{C}oste, {M}. and {B}ousmah, {M}arwan-al-{Q}ays},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {E}nsuring access to healthcare services is a key element to achieving the {S}ustainable {D}evelopment {G}oal 3 of "promoting healthy lives and well-being for all" through {U}niversal {H}ealth {C}overage ({UHC}). {H}owever, in the context of low- and middle-income countries, most studies focused on financial protection measured through catastrophic health expenditures ({CHE}), or on health services utilization among specific populations exhibiting health needs (such as pregnancy or recent sickness). {M}ethods {T}his study aims at building an individual score of perceived barriers to medical care ({PBMC}) in order to predict primary care utilization (or non-utilization). {W}e estimate the score on six items: (1) knowing where to go, (2) getting permission, (3) having money, (4) distance to the facility, (5) finding transport, and (6) not wanting to go alone, using individual data from 1787 adult participants living in rural {S}enegal. {W}e build the score via a stepwise descendent explanatory factor analysis ({EFA}), and assess its internal consistency. {F}inally, we assess the construct validity of the factor-based score by testing its association (univariate regressions) with a wide range of variables on determinants of healthcare-seeking, and evaluate its predictive validity for primary care utilization. {R}esults {EFA} yields a one-dimensional score combining four items with a 0.7 {C}ronbach's alpha indicating good internal consistency. {T}he score is strongly associated-p-values significant at the 5% level-with determinants of healthcare-seeking (including, but not limited to, sex, education, marital status, poverty, and distance to the health facility). {A}dditionally, the score can predict non-utilization of primary care at the household level, utilization and non-utilization of primary care following an individual's episode of illness, and utilization of primary care during pregnancy and birth. {T}hese results are robust to the use of a different dataset. {C}onclusion {A}s a valid, sensitive, and easily documented individual-level indicator, the {PBMC} score can be a complement to regional or national level health services coverage to measure health services access and predict utilization. {A}t the individual or household level, the {PBMC} score can also be combined with conventional metrics of financial risk protection such as {CHE} to comprehensively document deficits in, and progress towards {UHC}.},
  keywords = {{H}ealthcare access ; {P}erceived barriers ; {P}rimary care ; {U}niversal health coverage ({UHC}) ; {R}ural {S}enegal ; {S}ub-{S}aharan {A}frica ; {SENEGAL} ; {AFRIQUE} {SUBSAHARIENNE}},
  booktitle = {},
  journal = {{BMC} {H}ealth {S}ervices {R}esearch},
  volume = {23},
  numero = {1},
  pages = {263 [11 p.]},
  year = {2023},
  DOI = {10.1186/s12913-023-09192-2},
  URL = {https://www.documentation.ird.fr/hor/fdi:010087521},
}