Dialogues in health最新文献_第4页

Erratum regarding missing declaration of non-involvement of the Editor-in-Chief (EIC) in Peer review of Editor-Co-Authored papers 关于主编（EIC）在编辑合著论文的同行评议中未参与声明的勘误

Dialogues in health

Pub Date : 2025-11-13 DOI: 10.1016/j.dialog.2025.100255

引用次数: 0

“Stories like ours continue”: A phenomenological exploration of the lived experiences of ex-serial clinical trial volunteers in South India “像我们这样的故事还在继续”：对印度南部前连续临床试验志愿者生活经历的现象学探索

Dialogues in health

Pub Date : 2025-11-07 DOI: 10.1016/j.dialog.2025.100256

Irene Sambath, Kalpana B. Kosalram

Purpose

Indian media has frequently highlighted the plight of vulnerable low-income groups who over-volunteer in clinical trials to make ends meet, often at the cost of their health. Despite these revelations, the lived experiences of these individuals remain insufficiently documented in academic literature. This study seeks to address this gap by exploring how clinical trial volunteers construct their world around their experiences of having taken part in multiple trials over a span of time. Additionally, the study aims to shed light on the current circumstances and challenges faced by these individuals and their families.

Methods

Using Interpretative Phenomenological Analysis, this study analyses in-depth interviews conducted using respondent-driven sampling. Participants include three ex-serial volunteers who discontinued clinical trial participation and three key informants of deceased serial trial volunteers, from a remote mandal in the state of Telengana, South India.

Results

Three superordinate themes emerged: A journey of strain and stain, Transcending all turmoil to remain acceptable to system and society, and Agony of the family, each with five subthemes. The personal narratives highlight how financial desperation coerced them into serial participation. Over time, repeated enrolment led to physical and emotional deterioration, concealment, stigma, and family distress. Families discovered trial involvement only after adverse events or death, highlighting systemic gaps in transparency and post-trial care.

Conclusion

Despite existing government regulations, the underground nature of recruitment networks and the persistent demand for willing participants enable these practices to thrive. Findings underscore the urgent need for a national registry, stronger oversight, and community-level awareness to ensure ethical, scientifically sound, and socially responsible clinical research in India.

目的：印度媒体经常强调弱势低收入群体的困境，他们为了维持生计而过度志愿参加临床试验，往往以牺牲健康为代价。尽管有这些启示，这些人的生活经历在学术文献中仍然没有充分的记录。本研究试图通过探索临床试验志愿者如何围绕他们在一段时间内参加多项试验的经历构建他们的世界来解决这一差距。此外，该研究旨在阐明这些个人及其家庭面临的当前环境和挑战。方法采用解释性现象学分析，本研究分析了采用受访者驱动抽样进行的深度访谈。参与者包括三名停止参加临床试验的前连续试验志愿者和三名已故连续试验志愿者的关键举报人，他们来自印度南部特伦加纳邦的一个偏远地区。结果出现了三个最高主题：紧张和污点之旅、超越一切混乱以保持对制度和社会的接受和家庭的痛苦，每个主题有五个副主题。他们的个人叙述强调了经济上的绝望是如何迫使他们连续参与的。随着时间的推移，重复登记导致身体和情绪恶化、隐瞒、耻辱和家庭痛苦。家庭只有在不良事件或死亡后才发现参与了试验，这突出了透明度和试验后护理方面的系统性差距。尽管有现行的政府法规，但招聘网络的地下性质以及对自愿参与者的持续需求使这些做法得以蓬勃发展。研究结果强调，迫切需要建立国家登记制度，加强监督，提高社区意识，以确保印度的临床研究符合伦理、科学合理和对社会负责。

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引用次数: 0

Beyond technical skills: How communication shapes patient satisfaction in Ghana's healthcare system 超越技术技能：加纳医疗保健系统中沟通如何塑造患者满意度

Dialogues in health

Pub Date : 2025-11-03 DOI: 10.1016/j.dialog.2025.100254

Mohammed Saani Abdulai, Eliasu Mumuni, Muhammed Abdulai

Purpose

Effective healthcare delivery depends not only on clinical expertise but also on the quality of communication and interpersonal relationships between healthcare providers and patients. Despite the recognized importance of these human-centered factors, limited research has explored their impact on patient satisfaction and service quality within the Ghanaian context. This study aims to examine the influence of communication competence and interpersonal relationships on patient satisfaction. This study examines how healthcare providers' communication competence and interpersonal relationships influence their perceived patient satisfaction with service delivery, thereby shifting attention from technical skills to the relational aspects of care.

Methods

A sequential mixed-methods design was employed. The quantitative phase involved a survey of 250 healthcare professionals. The qualitative phase comprised in-depth interviews with 20 participants,10 patients, and 10 healthcare staff. Data was analyzed using multiple regression techniques for the quantitative component and thematic analysis for the qualitative component.

Results

Verbal communication emerged as the most used method (70.4 %), followed by a combination of verbal and non-verbal strategies (19.6 %). Regression analysis revealed that both communication competence and interpersonal relationships had a significant impact on service quality and patient satisfaction. While interpersonal relationships displayed a negative coefficient in the regression model (B = −0.098) due to overlap with communication competence, qualitative findings confirmed that positive interpersonal interactions enhanced patient satisfaction. While technical skills contributed a smaller increase of 0.029. The Qualitative findings revealed that patients highly value empathetic communication, timely interactions, and non-verbal cues, such as physical touch and facial expressions, which enhance trust and satisfaction.

Conclusions

The findings highlight the importance of integrating communication and interpersonal skills development into healthcare training and professional practice in Ghana. Strengthening these competencies can enhance patient experiences, improve health outcomes, and contribute to the overall quality of care delivery.

目的：有效的医疗服务不仅取决于临床专业知识，还取决于医疗服务提供者和患者之间的沟通质量和人际关系。尽管认识到这些以人为中心的因素的重要性，有限的研究已经探讨了他们对患者满意度和加纳的服务质量的影响。本研究旨在探讨沟通能力和人际关系对患者满意度的影响。本研究探讨医疗保健提供者的沟通能力和人际关系如何影响他们对服务提供的感知患者满意度，从而将注意力从技术技能转移到护理的关系方面。方法采用顺序混合方法设计。定量阶段涉及对250名医疗保健专业人员的调查。定性阶段包括对20名参与者、10名患者和10名医护人员的深入访谈。数据分析使用多元回归技术的定量成分和专题分析的定性成分。结果使用最多的是言语交际（70.4%），其次是言语和非言语结合策略（19.6%）。回归分析显示，沟通能力和人际关系对服务质量和患者满意度均有显著影响。虽然人际关系在回归模型中由于与沟通能力重叠而呈现负系数（B = - 0.098），但定性研究结果证实，积极的人际互动提高了患者满意度。而技术技能贡献了0.029的小幅增长。定性研究结果显示，患者高度重视移情沟通、及时互动和非语言提示，如身体接触和面部表情，这增强了信任和满意度。结论研究结果强调了将沟通和人际交往技能发展纳入加纳医疗保健培训和专业实践的重要性。加强这些能力可以改善患者体验，改善健康结果，并有助于提高护理服务的整体质量。

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引用次数: 0

Prevention and control of dengue and Aedes mosquitoes in South and Southeast Asia: Interventions, challenges, and future recommendations 南亚和东南亚登革热和伊蚊的预防和控制：干预措施、挑战和未来建议

Dialogues in health

Pub Date : 2025-10-25 DOI: 10.1016/j.dialog.2025.100253

Iskandar Arfan , Lilis Sulistyorini , Muji Sulistyowati , Ayu Rizky , Saliza Mohd Elias

Dengue fever, caused by a virus transmitted through Aedes mosquitoes, has become a major health issue in South and Southeast Asia. This review explores various preventive and control interventions for dengue implemented in South and Southeast Asia, the challenges faced, and recommendations to enhance the sustainability and effectiveness of these control efforts. The scoping review was conducted by searching articles published between 2014 and 2024 through databases such as PubMed, Scopus, ScienceDirect, Web of Science, and ProQuest. A total of 1599 studies were identified, and 25 articles were eventually analyzed. The findings indicate various intervention approaches in both regions. Key challenges identified in this review include community engagement and participation, resource, logistics, and data management issues, public perceptions and knowledge, control methods and evaluation of effectiveness, and social and economic issues. These challenges hinder the effectiveness of interventions. Recommendations to strengthen future interventions include: enhancing community involvement through continuous training, improving monitoring and evaluation with technology-based solutions, and expanding the use of technologies like Wolbachia-infected mosquitoes and spatial repellents. Expanding public awareness campaigns, strengthening school and community-based education, and improving training for health workers are also essential. Lastly, adopting a combined approach is crucial for achieving more effective and sustainable results in dengue prevention.

登革热由一种通过伊蚊传播的病毒引起，已成为南亚和东南亚的一个主要卫生问题。本综述探讨了在南亚和东南亚实施的各种登革热预防和控制干预措施，面临的挑战，以及加强这些控制工作的可持续性和有效性的建议。范围审查是通过PubMed、Scopus、ScienceDirect、Web of Science和ProQuest等数据库检索2014年至2024年间发表的文章进行的。总共确定了1599项研究，最终分析了25篇文章。研究结果表明，在这两个地区有不同的干预方法。本次审查确定的主要挑战包括社区参与、资源、后勤和数据管理问题、公众认知和知识、控制方法和有效性评估以及社会和经济问题。这些挑战阻碍了干预措施的有效性。关于加强未来干预措施的建议包括：通过持续培训加强社区参与，利用基于技术的解决办法改进监测和评价，以及扩大使用感染沃尔巴克氏体的蚊子和空间驱蚊剂等技术。扩大公众认识运动、加强学校和社区教育以及改进对卫生工作者的培训也至关重要。最后，采取综合办法对于在登革热预防方面取得更有效和可持续的成果至关重要。

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引用次数: 0

Coping strategies and resilient behavior among frontline healthcare workers: A scoping review 一线医护人员的应对策略和弹性行为：范围审查

Dialogues in health

Pub Date : 2025-10-23 DOI: 10.1016/j.dialog.2025.100252

Bilal Ahmad , Khalid Rehman , Shawana Bangash , Rida Zarkaish , Mahdia Babak , Sana Rehman , Samina Ihsan , Farhad Ali Khattak , Muhammad Irfan , Asif Rehman , Abdul Jalil Khan , Zohaib Khan

This scoping review aimed to examine coping strategies and resilient behaviours for stress management among frontline healthcare workers as per the Sustainable Development Goal 3 (Ensure healthy lives and promote well-being for all). Five major databases (APA PsychInfo, Embase, MEDLINE, CINAHL, and Cochrane Library) were searched from their inception until December 2024, including peer-reviewed articles and the first three hundred results on Google Scholar. The review followed the JBI methodology for scoping reviews and PRISMA-ScR guidelines. The inclusion criteria were experimental and observational studies examining coping strategies and stress management interventions for frontline healthcare workers in any healthcare setting. Non-empirical studies, those without a clear methodology, and non-English-language studies were excluded. Data screening and selection were conducted using Rayyan software by two independent teams, with disagreements resolved through consensus with a third reviewer. Data extraction captured the study characteristics, population demographics, settings, and key findings. The cumulative sample size across all studies was 33,889 healthcare professionals, with significant gender disparity favouring female participants. This study spanned thirty countries across multiple continents, with the United States contributing the largest subset.

这项范围审查的目的是根据可持续发展目标3（确保健康生活和促进所有人的福祉），检查一线卫生保健工作者的压力管理应对策略和弹性行为。五个主要数据库（APA PsychInfo, Embase， MEDLINE， CINAHL和Cochrane Library）从成立到2024年12月进行了检索，包括同行评议的文章和谷歌Scholar上的前300个结果。审查遵循JBI的范围审查方法和PRISMA-ScR指南。纳入标准是实验性和观察性研究，检查任何医疗保健环境中一线医护人员的应对策略和压力管理干预措施。非实证研究、没有明确方法论的研究和非英语研究被排除在外。数据筛选和选择由两个独立的团队使用Rayyan软件进行，分歧通过与第三审稿人达成共识来解决。数据提取捕获了研究特征、人口统计、设置和主要发现。所有研究的累积样本量为33,889名医疗保健专业人员，女性参与者的性别差异明显。这项研究跨越了多个大洲的30个国家，其中美国贡献了最大的子集。

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引用次数: 0

The medical community must not remain silent about healthcare and water access denial in Palestine 医学界绝不能对巴勒斯坦的医疗保健和供水受阻保持沉默

Dialogues in health

Pub Date : 2025-10-15 DOI: 10.1016/j.dialog.2025.100251

Jade Pagkas-Bather , Sabrina Imam , Rachel Bender Ignacio , Asim Farooq , Baddr Shakhsheer , Feroze Sidhwa , Omar Al-Heeti , Thaer Ahmad , Tamathor Abughnaim , John Schneider

Physicians have a duty to oppose the human suffering and human rights abuses occurring in Gaza, particularly the violations of international humanitarian law (IHL). We especially call attention to the scarcity of potable water in Gaza, which has fueled outbreaks of hepatitis A, polio, and skin infections and has created a public health crisis that is further exacerbated by the destruction of healthcare infrastructure and targeting of healthcare workers. The time is long overdue for physicians to affirm that IHL, including guaranteed access to healthcare and potable water, must be upheld to protect the health and safety of all Palestinians. Moreover, as violence against Palestinians and mass displacement campaigns are escalating in the West Bank, this is a pivotal moment for action to prevent further harms.

医生有责任反对加沙发生的人类苦难和侵犯人权行为，特别是违反国际人道主义法的行为。我们特别提请注意加沙饮用水短缺的问题，这加剧了甲型肝炎、小儿麻痹症和皮肤感染的爆发，并造成了一场公共卫生危机，而破坏医疗基础设施和以医疗工作者为目标，进一步加剧了这一危机。医生早就应该申明，必须遵守国际人道法，包括保证获得医疗保健和饮用水，以保护所有巴勒斯坦人的健康和安全。此外，随着针对巴勒斯坦人的暴力和大规模流离失所运动在西岸不断升级，现在是采取行动防止进一步伤害的关键时刻。

引用次数: 0

Perceived risk factors and their influence on compliance with meat safety guidelines among butchers and fresh meat retailers in Ghana 感知到的风险因素及其对加纳屠夫和鲜肉零售商遵守肉类安全准则的影响

Dialogues in health

Pub Date : 2025-10-10 DOI: 10.1016/j.dialog.2025.100250

George Agana Akuriba , Dadson Awunyo-Vitor , Camillus Abawiera Wongnaa , Richard Owusu-Afriyie , Margaret Aba Sam Hagan , Benjamin Sarfo

Meat safety is critical for safeguarding public health, as contaminated meat poses serious risks, and compliance with safety guidelines largely depends on meat handlers' risk perceptions. This study assessed how butchers and fresh meat retailers in Ghana perceive risk factors contributing to unsafe meat production and examines the extent to which these perceptions influence their compliance with meat safety guidelines. The study used primary data obtained from 87 butchers and 299 fresh meat retailers. The data were analyzed using descriptive statistics, including means, standard deviations, and F-statistics, as well as Partial Least Squares Structural Equation Modeling (PLS-SEM). The findings on the perceived risk factors reveals a positive risk perception index of 0.88 and 0.86 for butchers and retailers respectively. This indicates a high level of awareness or concern about risks. The most highly perceived risk factors were institutional risks (1.30), financial risks (1.29), and microbiological/chemical risks (1.27). The PLS-SEM results revealed that butchers' compliance with safety guidelines was positively influenced by perceived environmental risk (β = 0.192, P = 0.10), and perceived financial risk (β = 0.257, P = 0.05) and negatively influenced by perceived market risk (β = −0.202, P = 0.066) while retailers' compliance was positively influenced by perceived microbiological risk (β = 0.351, P = 0.03), and perceived market risk (β = 0.117, P = 0.07). The study concludes that while butchers and fresh meat retailers in Ghana demonstrate generally high risk perceptions, their compliance with meat safety guidelines is shaped by different risk factors. The study recommends a collaborative monitoring and enforcement framework in which butchers and fresh meat retailers work closely with regulatory bodies to translate high institutional risk perceptions into compliance. This can be achieved through quarterly stakeholder meetings, streamlined licensing, and on-the-ground support, which together enhance practical adherence while minimizing bureaucratic challenges.

肉类安全对保障公众健康至关重要，因为受污染的肉类会带来严重风险，而遵守安全准则在很大程度上取决于肉类加工者的风险认知。本研究评估了加纳的屠夫和鲜肉零售商如何看待导致不安全肉类生产的风险因素，并考察了这些看法在多大程度上影响了他们遵守肉类安全准则。这项研究使用了来自87家肉店和299家鲜肉零售商的原始数据。数据分析采用描述性统计，包括均值、标准差和f统计，以及偏最小二乘结构方程模型（PLS-SEM）。在感知风险因素方面，肉贩和零售商的风险感知指数分别为0.88和0.86。这表示对风险有高度的认识或关注。最高感知的风险因素是制度风险（1.30）、金融风险（1.29）和微生物/化学风险（1.27）。调查结果显示，肉贩的环境风险感知（β = 0.192, P = 0.10）、财务风险感知（β = 0.257, P = 0.05）和市场风险感知（β = - 0.202, P = 0.066）对肉贩的安全遵循有正向影响，而零售商的微生物风险感知（β = 0.351, P = 0.03）和市场风险感知（β = 0.117, P = 0.07）对肉贩的安全遵循有正向影响。该研究的结论是，虽然加纳的屠夫和鲜肉零售商普遍表现出高风险意识，但他们对肉类安全准则的遵守程度受到不同风险因素的影响。该研究建议建立一个协作监测和执法框架，在该框架中，肉店和鲜肉零售商与监管机构密切合作，将对机构高风险的认识转化为合规。这可以通过季度利益相关者会议、简化的许可和实地支持来实现，这些共同增强了实际的遵守，同时最大限度地减少了官僚主义的挑战。

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引用次数: 0

Sick building syndrome and indoor air quality in Malaysian bank offices: A cross-sectional analysis 病态建筑综合症和室内空气质量在马来西亚银行办公室：横断面分析

Dialogues in health

Pub Date : 2025-10-10 DOI: 10.1016/j.dialog.2025.100249

Azli Abd Razak , Hamidi Saidin , Rafael Buralli , Leonel Cordoba , Tengku Nilam Baizura Tengku Ibrahim , Siti Nurshahida Nazli

Sick building syndrome (SBS) encompasses a range of non-specific symptoms experienced by occupants, commonly associated with poor indoor air quality (IAQ). This study investigated the associations between IAQ parameters and SBS symptoms among 124 office workers across six bank offices in Malaysia. Indoor PM2.5, PM10, CO2, TVOC, formaldehyde, temperature and relative humidity were measured using validated instruments, while SBS symptoms were assessed using standardized questionnaire adapted from the Industry Code of Practice of Indoor Air Quality (ICOPIAQ) 2010. Findings revealed that banks using split-unit air conditioning (AC) ventilation had higher concentration of PM2.5 and CO2, exceeding the recommended standards, compared to those using air-conditioning and mechanical ventilation (ACMV) ventilation type. The most prevalent symptoms were headache (47.6 %), cough (44.4 %), irritated and stuffy nose (38.7 %), irritation of eyes (35.5 %), fatigue (25 %), dizziness (25 %), feeling heavy-headed (24.2 %), and skin rash or itchiness (24.2 %). Among these, dizziness was significantly associated with PM2.5, PM10, CO2, and formaldehyde levels. These findings highlight the need for improved ventilation and IAQ management in bank offices. Public policies and interventions at organizational level are essential to mitigate SBS risks and safeguard worker health.

病态建筑综合征（SBS）包括居住者经历的一系列非特异性症状，通常与室内空气质量差（IAQ）有关。本研究调查了马来西亚6家银行124名办公室工作人员的室内空气质量参数与SBS症状之间的关系。使用经过验证的仪器测量室内PM2.5、PM10、CO2、TVOC、甲醛、温度和相对湿度，使用根据《2010年室内空气质量行业操作规范》（ICOPIAQ）编制的标准化问卷评估SBS症状。调查结果显示，与使用空调和机械通风（ACMV）通风类型的银行相比，使用分体式空调（AC）通风的银行PM2.5和CO2浓度更高，超过了建议标准。最常见的症状是头痛（47.6%）、咳嗽（44.4%）、鼻炎、鼻塞（38.7%）、眼睛刺激（35.5%）、疲劳（25%）、头晕（25%）、头重脚轻（24.2%）、皮疹或瘙痒（24.2%）。其中，头晕与PM2.5、PM10、CO2和甲醛水平显著相关。这些发现强调了改善银行办公室通风和室内空气质量管理的必要性。组织一级的公共政策和干预措施对于减轻SBS风险和保障工人健康至关重要。

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引用次数: 0

Impact of philanthropic investment on integrating social determinants of health into diabetes care at US federally qualified health centers 慈善投资对将健康的社会决定因素纳入美国联邦合格医疗中心糖尿病护理的影响

Dialogues in health

Pub Date : 2025-10-08 DOI: 10.1016/j.dialog.2025.100248

Sonak D. Pastakia , Alycia Clark , Katie Lewis , Damon Taugher , Omolola Adeoye-Olatunde , Kourtney Byrd , Kay Johnson , Andrew M. Gonzales , Nader Tossoun , Danielle Cortez , Alejandra Mata , Christy Ward , Pua Akana , Rachel Randall , Rina Ramirez

Study objective

Assess the impact of a change in a philanthropic funding strategy toward focusing on the inclusion of responses to the social determinants of health (SDOH) in diabetes care.

Design

Retrospective analysis of routinely collected clinical and social determinants of health data.

Setting

Federally Qualified Health Centers Across the United States who were selected to receive funding after applying.

Participants

People living with diabetes who received care support that was partially or wholly supported from philanthropic funding provided by Direct Relief.

Interventions

The primary intervention was the injection of funding from Direct Relief to support the integration of interventions responsive to the SDOH. Example interventions include referral to SDOH support, home based monitoring, inclusion of community health workers, virtual care, and community-based care.

Main outcome measures

The primary outcome measure was the change in HbA1c from baseline to two to four months for all patients contributing data.

Results

Participants in the HBHC program demonstrated a reduction in glycosylated hemoglobin of −1.25 points ([95 % CI, −1.45 - -1.06], p < 0.01) after 60-to-119-days. Participants with family and housing needs, nutrition needs, and social and emotional health needs had statistically significantly higher baseline HbA1c's than patients without these needs.

Conclusion

Future philanthropically supported efforts should encourage integration of SDOH interventions into clinical services for under-resourced patients living with diabetes. Additional prospective, controlled studies should be completed to more definitively determine the impact of investment on specific interventions designed to respond to the most frequently encountered SDOH needs.

研究目的：评估慈善资助策略的改变对糖尿病护理中健康社会决定因素（SDOH）响应的影响。设计对常规收集的临床和社会健康数据决定因素进行回顾性分析。在美国各地设立联邦合格的医疗中心，这些中心在申请后被选中接受资助。参与者：接受直接救济组织部分或全部慈善资金支持的糖尿病患者。干预措施主要的干预措施是直接救济组织的资金注入，以支持对SDOH作出反应的干预措施的整合。干预措施的例子包括转诊到SDOH支持、家庭监测、社区卫生工作者参与、虚拟护理和社区护理。主要结局指标主要结局指标是所有提供数据的患者的HbA1c从基线到2至4个月的变化。结果：HBHC项目的参与者在60- 119天后，糖化血红蛋白降低了- 1.25点（[95% CI, - 1.45 - -1.06], p < 0.01）。与没有这些需求的患者相比，有家庭和住房需求、营养需求、社会和情感健康需求的参与者的基线HbA1c有统计学意义上的显著提高。结论：未来慈善支持的努力应鼓励将SDOH干预纳入资源不足的糖尿病患者的临床服务中。应该完成更多的前瞻性对照研究，以更明确地确定投资对旨在应对最常见的SDOH需求的具体干预措施的影响。

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引用次数: 0

Socio-economic and insurance factors in preventive care: A two-stage weighted structural analysis 预防保健中的社会经济和保险因素：两阶段加权结构分析

Dialogues in health

Pub Date : 2025-10-06 DOI: 10.1016/j.dialog.2025.100243

Florent Nkouaga

This study investigates the key determinants influencing the utilization of preventive health services among insured individuals in the United States following the implementation of the Affordable Care Act (ACA). Leveraging nationally representative data from the 2024 Financial Inclusion Survey, the research employs weighted logistic regression and Structural Equation Modeling (SEM) to analyze how perceived insurance coverage quality, access to a primary care physician, financial knowledge, and experiences with healthcare costs are associated with the uptake of no-cost preventive care. The findings reveal that individuals who report higher satisfaction with their insurance coverage, maintain ongoing relationships with primary care providers, and demonstrate greater financial literacy are more likely to engage in preventive health behaviors. Notably, while cost-related barriers are initially associated with increased utilization, their direct influence diminishes when financial knowledge is accounted for, highlighting the mitigating role of financial literacy. The SEM approach further clarifies the complex interplay between latent constructs such as perceived coverage quality and cost experiences, showing that these factors interact with each other and with other determinants to shape preventive care decisions. Importantly, once these structural and informational dimensions are considered, traditional demographic variables — such as race and gender — lose statistical significance, underscoring the greater impact of systemic and educational factors. These results suggest that policies aimed solely at eliminating financial barriers may be insufficient to maximize preventive care participation. Instead, fostering trust in insurance coverage, strengthening primary care relationships, and enhancing financial literacy are critical strategies for increasing preventive service utilization. By addressing the informational, relational, and economic dimensions of healthcare access, policymakers and stakeholders can more effectively promote preventive health engagement and advance population health outcomes.

本研究调查了在实施平价医疗法案（ACA）后，影响美国参保个人使用预防性医疗服务的关键决定因素。利用来自2024年金融包容性调查的具有全国代表性的数据，该研究采用加权逻辑回归和结构方程模型（SEM）来分析感知保险覆盖质量、获得初级保健医生、财务知识和医疗保健成本经验如何与接受无成本预防性护理相关联。研究结果显示，那些对自己的保险覆盖面满意度较高、与初级保健提供者保持持续关系、并表现出更高的金融素养的个人更有可能参与预防性健康行为。值得注意的是，虽然与成本有关的障碍最初与提高利用率有关，但当考虑到金融知识时，它们的直接影响就会减弱，从而突出了金融知识的缓解作用。扫描电镜方法进一步阐明了潜在结构（如感知覆盖质量和成本经验）之间复杂的相互作用，表明这些因素相互作用，并与其他决定因素相互作用，形成预防性护理决策。重要的是，一旦考虑到这些结构和信息方面的因素，传统的人口变量- -例如种族和性别- -就失去了统计意义，强调了制度和教育因素的更大影响。这些结果表明，仅仅旨在消除经济障碍的政策可能不足以最大限度地提高预防保健的参与。相反，促进对保险范围的信任、加强初级保健关系和提高金融知识是提高预防性服务利用率的关键战略。通过处理卫生保健获取的信息、关系和经济层面问题，决策者和利益攸关方可以更有效地促进预防性卫生参与并推进人口健康成果。

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引用次数: 0