A Step towards Understanding and Tackling Health Inequalities: The Use of Secondary Prevention Services and the Need for Health Promotion in a Rural Setting
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Sociodemographic Characteristics
3.2. Health Status
3.3. Participation in Secondary Prevention
3.4. Health System Needs
4. Discussion
4.1. Health Inequalities in the Study Group
4.2. Health Status
4.3. Participation in Secondary Prevention
4.4. Access to Services
4.5. Healthcare Staff and a Key Role of GPs as Health Promoters
4.6. Study Strengths and Limitations
5. Conclusions
- The central or provincial governments could support the local authorities in developing local health policies through both financing and training;
- PHC personnel could use their high status in rural populations and their position of health system gatekeepers responsibly, remembering that it largely depends on them if and how their patients access and use health services;
- University staff could translate theoretical knowledge into practice by becoming more involved in field work and engage local communities in the area of health promotion in CPBR projects;
- The findings from field studies regarding health needs and inequalities should be more intensely publicised and discussed among the key players of the health system, who should be held responsible for sharing experiences and helping to develop, finance, and implement good practices.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
BMI | body mass index |
CanCon | Joint Action on Cancer Control |
CBPR | community-based participatory research |
GP | general practitioner |
iPAAC | Innovative Partnership for Action Against Cancer |
NFZ | National Health Fund (Polish: Narodowy Fundusz Zdrowia) |
PHC | primary healthcare |
PHP | public health programme |
WHO | World Health Organization |
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Variable | n | % | Education (%) | Economic Status (%) | Occupation (%) | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Primary | Lower Secondary | Vocational | Secondary | Higher | Bad | Average | Good | Very Good | Farmers | Other Manual Workers | Office Workers or Other Specialists | Health Professionals | Teachers/Educators | Unemployed | ||||
Total | 122 | 100 | 17.2 | 1.6 | 26.2 | 35.2 | 19.7 | 4.1 | 32.8 | 58.2 | 4.9 | 53.3 | 16.4 | 10.7 | 6.5 | 5.7 | 7.4 | |
Gender | F | 88 | 72.1 | 14.8 | 2.3 | 21.6 | 42 | 19.3 | 2.3 | 33 | 60.2 | 4.5 | 51.1 | 11.3 | 13.6 | 8 | 8 | 8 |
M | 34 | 27.9 | 23.5 | 0 | 38.2 | 17.6 | 20.6 | 8.8 | 32.3 | 52.9 | 5.9 | 58.8 | 29.4 | 2.9 | 2.9 | 0 | 5.9 | |
Age | <25 | 9 | 7.3 | 0 | 22.2 | 22.2 | 44.5 | 11.1 | 0 | 33.3 | 55.6 | 11.1 | 0 | 33.3 | 11.1 | 0 | 0 | 55.6 |
25–44 | 39 | 32 | 5.1 | 0 | 18 | 28.2 | 48.7 | 7.7 | 12.8 | 74.4 | 5.1 | 43.6 | 25.7 | 5.1 | 5.1 | 15.4 | 5.1 | |
45–64 | 50 | 41 | 22 | 0 | 26 | 44 | 8 | 2 | 38 | 54 | 6 | 66 | 8 | 10 | 10 | 2 | 4 | |
65 or older | 24 | 19.7 | 33.3 | 0 | 41.7 | 25 | 0 | 4.2 | 54.2 | 41.7 | 0 | 62.5 | 12.5 | 20.8 | 4.2 | 0 | 0 | |
Professional status | employed | 67 | 54.9 | 10.5 | 0 | 25.4 | 31.3 | 32.8 | 3 | 23.9 | 68.6 | 4.5 | 49.3 | 23.9 | 8.9 | 8.9 | 8.9 | 0 |
retired | 46 | 37.7 | 28.3 | 0 | 28.3 | 39.1 | 4.3 | 4.3 | 43.5 | 50 | 2.2 | 69.6 | 8.7 | 15.2 | 4.3 | 2.2 | 0 | |
unemployed | 4 | 3.3 | 25 | 0 | 50 | 25 | 0 | 25 | 25 | 25 | 25 | 0 | 0 | 0 | 0 | 0 | 100 | |
students | 5 | 4.1 | 0 | 40 | 0 | 60 | 0 | 0 | 60 | 20 | 20 | 0 | 0 | 0 | 0 | 0 | 100 |
Variable | n | BMI | Self-Perceived Health (%) | |||||||
---|---|---|---|---|---|---|---|---|---|---|
% of Normal Results | p | Very Bad | Bad | Fair | Good | Very Good | p | |||
Total | 122 | 37.7 | 0.8 | 4.1 | 49.2 | 36.9 | 9 | |||
Age | <25 | 9 | 88.9 | <0.0001 a | 0 | 0 | 11.1 | 33.3 | 55.6 | <0.0001 d r = −0.55 |
25–44 | 39 | 56.4 | 0 | 5.1 | 23.1 | 59 | 12.8 | |||
45–64 | 50 | 20 | 2 | 2 | 58 | 36 | 2 | |||
65 or older | 24 | 25 | 0 | 8.3 | 87.5 | 4.2 | 0 | |||
Gender | F | 88 | 38.6 | 0.7327 b | 0 | 4.5 | 50 | 36.4 | 9.1 | 0.8459 a |
M | 34 | 35.3 | 2.9 | 2.9 | 47.1 | 38.2 | 8.8 | |||
Education | primary | 21 | 28.6 | 0.1404 a | 4.8 | 4.8 | 76.2 | 14.3 | 0 | 0.0034 d r = 0.26 |
lower secondary | 2 | 100 | 0 | 0 | 0 | 0 | 100 | |||
vocational | 32 | 28.1 | 0 | 3.1 | 56.3 | 31.3 | 9.4 | |||
secondary | 43 | 37.2 | 0 | 4.7 | 44.2 | 44.2 | 7 | |||
higher | 24 | 54.2 | 0 | 4.2 | 29.2 | 54.2 | 12.5 | |||
Professional status | employed | 67 | 46.3 | 0.0002 c | 0 | 1.5 | 35.8 | 52.2 | 10.4 | <0.0001 e |
retired | 46 | 19.6 | 2.2 | 6.5 | 76.1 | 15.2 | 0 | |||
unemployed | 4 | 25 | 0 | 25 | 25 | 25 | 25 | |||
students | 5 | 100 | 0 | 0 | 0 | 40 | 60 | |||
Occupation | farmers | 65 | 32.3 | 0.1753 c | 1.5 | 1.5 | 61.5 | 29.2 | 6.2 | 0.0605 e |
other manual workers | 20 | 45 | 0 | 0 | 35 | 55 | 10 | |||
office workers or other specialists | 13 | 38.5 | 0 | 15.4 | 38.5 | 46.2 | 0 | |||
health professionals | 8 | 12.5 | 0 | 12.5 | 37.5 | 50 | 0 | |||
teachers/educators | 7 | 57.1 | 0 | 0 | 57.1 | 28.6 | 14.3 | |||
unemployed | 9 | 66.7 | 0 | 11.1 | 11.1 | 33.3 | 44.4 | |||
Economic status | bad | 5 | 40 | 0.6431 a | 0 | 0 | 100 | 0 | 0 | 0.0002 d r = 0.33 |
average | 40 | 32.5 | 2.5 | 5 | 62.5 | 27.5 | 2.5 | |||
good | 71 | 40.8 | 0 | 4.2 | 39.4 | 46.5 | 9.9 | |||
very good | 6 | 33.3 | 0 | 0 | 33.3 | 16.7 | 50 | |||
Attitude to screening | does not attend | 60 | 50 | 0.0013 b | 1.7 | 3.3 | 35 | 45 | 15 | 0.0055 a |
attends | 53 | 20.8 | 0 | 5.7 | 64.2 | 26.4 | 3.8 | |||
Family history of cancer | no | 45 | 45.2 | 0.2991 b | 2.4 | 0 | 47.6 | 40.5 | 9.5 | 0.5996 a |
yes | 66 | 35.3 | 0 | 5.9 | 50 | 35.3 | 8.8 |
Variable | n | Reported Cancer Screening Attendance (%) | Main Reasons for Non-Attendance among the Non-Attending Participants (%) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No | Yes | p | Lack of Time, Lack of Need, Feeling Healthy | p | GPs’ Reluctance to Refer Patients for Screening Tests | p | Long Waiting Times to See Specialists | p | Fear of Costs | p | |||
Total | 122 | 49.2 | 43.4 | 32.8 | 8.2 | 17.2 | 9 | ||||||
Age | <25 | 9 | 88.9 | 0 | <0.0001 a | 55.6 | 0.3101 a | 11.1 | 0.279 a | 11.1 | 0.2391 a | 0 | 0.0901 a |
25–44 | 39 | 71.8 | 20.5 | 64.5 | 22.6 | 32.3 | 16.1 | ||||||
45–64 | 50 | 38 | 54 | 54.2 | 8.7 | 34.8 | 17.4 | ||||||
65 or older | 24 | 20.8 | 75 | 33.3 | 0 | 40 | 40 | ||||||
Gender | F | 88 | 42 | 52.3 | 0.0025 b | 59.5 | 0.622 b | 14.6 | 1 c | 34.1 | 0.4728 b | 19.5 | 0.5059 c |
M | 34 | 67.6 | 20.6 | 53.6 | 14.8 | 25.9 | 11.1 | ||||||
Education | primary | 21 | 42.9 | 52.4 | 0.6507 a | 55.6 | 0.4864 a | 0 | 0.0222 a | 22.2 | 0.2796 a | 22.2 | 0.9627 a |
lower secondary | 2 | 100 | 0 | 0 | 0 | 0 | 0 | ||||||
vocational | 32 | 53.1 | 37.5 | 57.1 | 10 | 25 | 15 | ||||||
secondary | 43 | 41.9 | 48.8 | 59.1 | 13.6 | 40.9 | 13.6 | ||||||
higher | 24 | 58.3 | 37.5 | 62.5 | 33.3 | 33.3 | 20 | ||||||
Professional status | employed | 67 | 55.2 | 34.3 | 0.0005 c | 66.7 | 0.8872 b | 18.2 | 0.395 c | 31.8 | 0.0655 b | 18.2 | 0.2549 c |
retired | 46 | 32.6 | 65.2 | 31.3 | 13.3 | 40 | 20 | ||||||
unemployed | 4 | 100 | 0 | 75 | 0 | 0 | 0 | ||||||
students | 5 | 80 | 0 | 40 | 0 | 20 | 0 | ||||||
Occupation | farmers | 65 | 43.1 | 50.8 | <0.0001 c | 51.5 | 0.8872 c | 21.9 | 0.395 c | 46.9 | 0.0655 c | 15.6 | 0.2549 c |
other manual workers | 20 | 75 | 15 | 64.7 | 11.8 | 11.8 | 17.6 | ||||||
office workers or other specialists | 13 | 46.2 | 46.2 | 57.1 | 0 | 33.3 | 16.7 | ||||||
health professionals | 8 | 0 | 100 | 0 | 0 | 0 | 0 | ||||||
teachers/educators | 7 | 42.9 | 42.9 | 75 | 25 | 25 | 50 | ||||||
unemployed | 9 | 88.9 | 0 | 55.6 | 0 | 11.1 | 0 | ||||||
Economic status | bad | 5 | 100 | 0 | 0.2026 a | 60 | 0.4367 a | 0 | 0.1023 a | 0 | 0.6425 a | 20 | 0.946 a |
average | 40 | 45 | 37.5 | 64 | 4.2 | 37.5 | 16.7 | ||||||
good | 71 | 46.5 | 50.7 | 52.8 | 25.7 | 31.4 | 14.3 | ||||||
very good | 6 | 66.7 | 33.3 | 50 | 0 | 25 | 25 | ||||||
Family history of cancer | no | 45 | 59.5 | 38.1 | 0.0585 b | 42.3 | 0.1958 c | 11.5 | 0.7153 c | 23.1 | 0.389 c | 15.4 | 0.6906 c |
yes | 66 | 38.2 | 52.9 | 60.6 | 16.1 | 35.5 | 9.7 |
Diagnostic Test | Participants Who Ever Had the Test (%) | Participants Who Had the Test and Whose GPs Suggested It (%) | Test Financing (%) | Frequency of Testing (%) | Reason for Testing (%) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Public | Out-of-Pocket Only | 1 × Year | 1 × 2 Years | 1 × 3 Years | 1 × 4 Years | 1 × 5 Years | Less Often | 1 × A Lifetime | Check-Up/Prevention | Confirming a Diagnosis | Ailment/Pain | Other | |||
Chest X-ray | 65.6 | 57.5 | 92.5 | 7.5 | 5.1 | 11.4 | 11.4 | 6.3 | 6.3 | 32.9 | 25.3 | 37.0 | 29.6 | 21 | 7.4 |
Abdominal ultrasound | 54.1 | 65.2 | 69.7 | 30.3 | 7.6 | 16.7 | 7.6 | 4.6 | 12.1 | 18.2 | 31.8 | 30.4 | 29 | 39.1 | 1.5 |
Thyroid ultrasound | 25.4 | 61.3 | 41.9 | 58.1 | 22.6 | 12.9 | 6.5 | 3.2 | 0 | 12.9 | 38.7 | 45.2 | 32.3 | 16.1 | 3.2 |
Upper endoscopy | 25.4 | 58.1 | 71 | 29 | 0 | 3.2 | 9.7 | 6.5 | 9.7 | 22.6 | 48.4 | 22.6 | 22.6 | 51.6 | 3.2 |
Colonoscopy | 20.5 | 60 | 84 | 16 | 4 | 0 | 0 | 0 | 32 | 16 | 48 | 48 | 12 | 36 | 4 |
FOBT | 11.5 | 42.9 | 92.9 | 7.1 | 0 | 0 | 7.1 | 0 | 21.4 | 14.3 | 50 | 71.4 | 7.1 | 14.3 | 7.1 |
Tumour markers | 7.4 | 44.4 | 66.7 | 33.3 | 22.2 | 11.1 | 11.1 | 0 | 0 | 22.2 | 22.2 | 44.4 | 44.4 | 11.1 | 0 |
Dermatoscopy | 7.4 | 66.7 | 66.7 | 33.3 | 11.1 | 0 | 11.1 | 0 | 0 | 33.3 | 44.4 | 60 | 30 | 10 | 0 |
PSA * | 32.4 | 72.7 | 81.8 | 18.2 | 9.1 | 0 | 18.2 | 0 | 27.3 | 9.1 | 36.4 | 54.6 | 36.4 | 9.1 | 0 |
Smear test ** | 75 | 28.8 | 51.5 | 48.5 | 15.2 | 39.4 | 19.7 | 6.1 | 1.5 | 12.1 | 4.6 | 82.6 | 4.4 | 10.1 | 0 |
Mammography ** | 80.9 | 41.5 | 98 | 2 | 2.4 | 65.9 | 14.6 | 2.4 | 4.9 | 4.9 | 4.9 | 95.1 | 2.4 | 2.4 | 0 |
Breast ultrasound ** | 43.2 | 42.1 | 63.2 | 36.8 | 2.6 | 23.7 | 15.8 | 2.6 | 10.5 | 21.1 | 21.1 | 79.5 | 10.3 | 15.4 | 0 |
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Karasiewicz, M.; Chawłowska, E.; Lipiak, A.; Więckowska, B. A Step towards Understanding and Tackling Health Inequalities: The Use of Secondary Prevention Services and the Need for Health Promotion in a Rural Setting. Int. J. Environ. Res. Public Health 2021, 18, 8492. https://doi.org/10.3390/ijerph18168492
Karasiewicz M, Chawłowska E, Lipiak A, Więckowska B. A Step towards Understanding and Tackling Health Inequalities: The Use of Secondary Prevention Services and the Need for Health Promotion in a Rural Setting. International Journal of Environmental Research and Public Health. 2021; 18(16):8492. https://doi.org/10.3390/ijerph18168492
Chicago/Turabian StyleKarasiewicz, Monika, Ewelina Chawłowska, Agnieszka Lipiak, and Barbara Więckowska. 2021. "A Step towards Understanding and Tackling Health Inequalities: The Use of Secondary Prevention Services and the Need for Health Promotion in a Rural Setting" International Journal of Environmental Research and Public Health 18, no. 16: 8492. https://doi.org/10.3390/ijerph18168492