Population Perspectives on Impact of the COVID-19 Pandemic on Essential Health Services—Behavioral Insights from the Federation of Bosnia and Herzegovina
Abstract
:1. Introduction
2. Methods
2.1. Study Design, Population, and Data Collection
2.2. Data Analysis
2.3. Ethical Considerations
3. Results
3.1. Demographic Characteristics
Access to Care
3.2. Out-of-Pocket Expenses for Health Care
3.3. Postponements of Health Care
3.4. Mental Health
3.5. Satisfaction with Health Care
3.6. Predictors of Need and Access to Health Care
4. Discussion
4.1. Main Findings
4.2. Interpretation and Comparison with Published Literature
4.3. Study Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Disclaimer
Open Access Statement
References
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Variable Name | Sex of Respondents (n, %) | |||
---|---|---|---|---|
Males 514 (48%) | Females 554 (52%) | Total 1068 | p-Value | |
Access to health care | ||||
Needed and received care (n, % Yes) | 314/514 (61%) | 372/554 (67%) | 686/1068 (64%) | 0.046 |
Way of not getting needed care (n, % Yes) | ||||
Postponed visit to the family doctor | 100/200 (50%) | 97/182 (53%) | 197/382 (52%) | 0.588 |
Postponed planned surgery | 32/200 (16%) | 27/182 (15%) | 59/382 (15%) | 0.863 |
Not able to book an appointment at family doctor, specialist, hospital | 107/200 (54%) | 99/182 (54%) | 206/382 (54%) | 0.942 |
Needed medication was not available | 36/200 (18%) | 33/182 (18%) | 69/382 (18%) | 1 |
Other | 65/200 (33%) | 57/182 (31%) | 122/382 (32%) | 0.891 |
Increased out-of-pocket expenses for medicines (n, % Yes) | 188/483 (39%) | 225/530 (42%) | 413/1013 (41%) | 0.281 |
Increased out-of-pocket expenses for health services (n, % Yes) | 137/479 (29%) | 166/523 (32%) | 303/1002 (30%) | 0.312 |
Postponements of care | ||||
Postponed medical care (n, % Yes) | 165/514 (32%) | 239/554 (43%) | 404/1068 (38%) | <0.001 |
Main reason for postponement (n, % Yes) * | ||||
Condition was not serious enough | 129/165 (78%) | 202/239 (85%) | 331/404 (82%) | 0.135 |
No appointment/long waiting time | 122/165 (74%) | 154/239 (64%) | 276/404 (68%) | 0.056 |
Facility was closed | 67/165 (41%) | 70/239 (29%) | 137/404 (34%) | 0.024 |
Fear of infection with SARS-CoV-2 | 108/165 (65%) | 168/239 (70%) | 276/404 (68%) | 0.358 |
Other | 42/165 (25%) | 47/239 (20%) | 89/404 (22%) | 0.208 |
Mental health | ||||
Taking prescription medication to help with emotions, concentration, behavior, or mental health (n, % Yes) | 63/493 (13%) | 94/539 (17%) | 157/1032 (15%) | 0.046 |
Receiving counselling or therapy from a mental health professional in past 9 months (n, % Yes) | 30/498 (6%) | 33/541 (6%) | 63/1039 (6%) | 1 |
Currently receiving counselling or therapy from a mental health professional (n, % Yes) | 22/496 (4%) | 22/544 (4%) | 44/1040 (4%) | 0.874 |
Variable Name | Residence of Respondents (n, %) | |||
---|---|---|---|---|
Rural 398 (37%) | Urban 670 (63%) | Total 1068 | p-Value | |
Access to health care | ||||
Needed and received care (n, % Yes) | 258/398 (65%) | 428/670 (64%) | 686/1068 (64%) | 0.806 |
Way of not getting needed care (n, % Yes) | ||||
Postponed visit to the family doctor | 70/140 (50%) | 127/242 (52%) | 197/382 (52%) | 0.718 |
Postponed planned surgery | 16/140 (11%) | 43/242 (18%) | 59/382 (15%) | 0.132 |
Not able to book an appointment at family doctor, specialist, hospital | 76/140 (54%) | 130/242 (54%) | 206/382 (54%) | 1 |
Needed medication was not available | 18/140 (13%) | 51/242 (21%) | 69/382 (18%) | 0.061 |
Other | 47/140 (34%) | 75/242 (31%) | 122/382 (32%) | 0.684 |
Increased out-of-pocket expenses for medicines (n, % Yes) | 149/379 (39%) | 264/634 (42%) | 413/1013 (41%) | 0.507 |
Increased out-of-pocket expenses for health services (n, % Yes) | 99/377 (26%) | 204/625 (33%) | 303/1002 (30%) | 0.040 |
Postponements of care | ||||
Postponed medical care (n, % Yes) | 156/398 (39%) | 248/670 (37%) | 404/1068 (38%) | 0.519 |
Main reason for postponement (n, % Yes) | ||||
Condition was not serious enough | 125/156 (80%) | 206/248 (83%) | 331/404 (82%) | 0.539 |
No appointment/long waiting time | 104/156 (67%) | 172/248 (69%) | 276/404 (68%) | 0.649 |
Facility was closed | 57/156 (37%) | 80/248 (32%) | 137/404 (34%) | 0.437 |
Fear of infection with SARS-CoV-2 | 104/156 (67%) | 172/248 (69%) | 276/404 (68%) | 0.649 |
Other | 31/156 (20%) | 58/248 (23%) | 89/404 (22%) | 0.480 |
Mental health | ||||
Taking prescription medication to help with emotions, concentration, behavior, or mental health (n, % Yes) | 48/382 (13%) | 109/650 (17%) | 157/1032 (15%) | 0.084 |
Receiving counselling or therapy from a mental health professional in past 9 months (n, % Yes) | 22/390 (6%) | 41/649 (6%) | 63/1039 (6%) | 0.758 |
Currently receiving counselling or therapy from a mental health professional (n, % Yes) | 18/389 (5%) | 26/651 (4%) | 44/1040 (4%) | 0.740 |
Variable Name | Chronic Disease Present (n, %) | |||
---|---|---|---|---|
No 731 (76%) | Yes 237 (24%) | Total 968 | p-Value | |
Access to health care | ||||
Needed and received care (n, % Yes) | 447/731 (61%) | 178/237 (75%) | 625/968 (65%) | <0.001 |
Way of not getting needed care (n, % Yes) | ||||
Postponed visit to the family doctor | 138/284 (49%) | 37/59 (63%) | 175/343 (51%) | 0.067 |
Postponed planned surgery | 41/284 (14%) | 10/59 (17%) | 51/343 (15%) | 0.770 |
Not able to book an appointment at family doctor, specialist, hospital | 141/284 (50%) | 44/59 (75%) | 185/343 (54%) | <0.001 |
Needed medication was not available | 47/284 (17%) | 12/59 (20%) | 59/343 (17%) | 0.608 |
Other | 89/284 (31%) | 19/59 (32%) | 108/343 (31%) | 1 |
Increased out-of-pocket expenses for medicines (n, % Yes) | 245/691 (35%) | 124/233 (53%) | 369/924 (40%) | <0.001 |
Increased out-of-pocket expenses for health services (n, % Yes) | 184/690 (27%) | 85/220 (39%) | 269/910 (30%) | <0.001 |
Postponements of care | ||||
Postponed medical care (n, % Yes) | 229/731 (31%) | 130/237 (55%) | 359/968 (37%) | <0.001 |
Main reason for postponement (n, % Yes) | ||||
Condition was not serious enough | 199/229 (87%) | 96/130 (74%) | 295/359 (82%) | 0.003 |
No appointment/long waiting time | 152/229 (66%) | 92/130 (71%) | 244/359 (68%) | 0.459 |
Facility was closed | 74/229 (32%) | 49/130 (38%) | 123/359 (34%) | 0.360 |
Fear of infection with SARS-CoV-2 | 155/229 (68%) | 87/130 (67%) | 242/359 (67%) | 0.975 |
Other | 47/229 (21%) | 30/130 (23%) | 77/359 (21%) | 0.665 |
Mental health | ||||
Taking prescription medication to help with emotions, concentration, behavior, or mental health (n, % Yes) | 87/713 (12%) | 53/229 (23%) | 140/942 (15%) | <0.001 |
Receiving counselling or therapy from a mental health professional in past 9 months (n, % Yes) | 35/711 (5%) | 20/235 (9%) | 55/946 (6%) | 0.061 |
Currently receiving counselling or therapy from a mental health professional (n, % Yes) | 27/710 (4%) | 13/235 (6%) | 40/945 (4%) | 0.34 |
Variable Name | Age Group of Respondents (n, %) | ||||
---|---|---|---|---|---|
18–34 Years 327 (31%) | 35–54 Years 473 (44%) | 55+ Years 268 (25%) | Total 1068 | p-Value | |
Access to health care | |||||
Needed and received care (n, % Yes) | 191/327 (58%) | 316/473 (67%) | 179/268 (67%) | 686/1068 (64%) | 0.031 |
Way of not getting needed care (n, % Yes) | |||||
Postponed visit to the family doctor | 64/136 (47%) | 90/157 (57%) | 43/89 (48%) | 197/382 (52%) | 0.168 |
Postponed planned surgery | 21/136 (15%) | 25/157 (16%) | 13/89 (15%) | 59/382 (15%) | 0.963 |
Not able to book an appointment at family doctor, specialist, hospital | 61/136 (45%) | 91/157 (58%) | 54/89 (61%) | 206/382 (54%) | 0.028 |
Needed medication was not available | 26/136 (19%) | 21/157 (13%) | 22/89 (25%) | 69/382 (18%) | 0.078 |
Other | 32/136 (24%) | 52/157 (33%) | 38/89 (43%) | 122/382 (32%) | 0.010 |
Increased out-of-pocket expenses for medicines (n, % Yes) | 99/303 (33%) | 196/453 (43%) | 118/257 (46%) | 413/1013 (41%) | 0.002 |
Increased out-of-pocket expenses for health services (n, % Yes) | 76/305 (25%) | 141/442 (32%) | 86/255 (34%) | 303/1002 (30%) | 0.046 |
Postponements of care | |||||
Postponed medical care (n, % Yes) | 103/327 (31%) | 185/473 (39%) | 116/268 (43%) | 404/1068 (38%) | 0.010 |
Main reason for postponement (n, % Yes) | |||||
Condition was not serious enough | 88/103 (85%) | 154/185 (83%) | 89/116 (77%) | 331/404 (82%) | 0.202 |
No appointment/long waiting time | 71/103 (69%) | 122/185 (66%) | 83/116 (72%) | 276/404 (68%) | 0.589 |
Facility was closed | 42/103 (41%) | 61/185 (33%) | 34/116 (29%) | 137/404 (34%) | 0.189 |
Fear of infection with SARS-CoV-2 | 72/103 (70%) | 126/185 (68%) | 78/116 (67%) | 276/404 (68%) | 0.912 |
Other | 22/103 (21%) | 35/185 (19%) | 32/116 (28%) | 89/404 (22%) | 0.207 |
Mental health | |||||
Taking prescription medication to help with emotions, concentration, behavior, or mental health (n, % Yes) | 37/314 (12%) | 74/459 (16%) | 46/259 (18%) | 157/1032 (15%) | 0.108 |
Receiving counselling or therapy from a mental health professional in past 9 months (n, % Yes) | 20/312 (6%) | 32/466 (7%) | 11/261 (4%) | 63/1039 (6%) | 0.340 |
Currently receiving counselling or therapy from a mental health professional (n, % Yes) | 14/307 (5%) | 20/469 (4%) | 10/264 (4%) | 44/1040 (4%) | 0.900 |
Score | Gender | Residence | Age Group | Chronic Disease | Total | |||||
---|---|---|---|---|---|---|---|---|---|---|
Males | Females | Urban | Rural | 18–34 | 35–54 | 55+ | YES | NO | ||
Mean Score (95% CI) | 3.2 (3.1–3.3) | 3.2 (3.1–3.4) | 3.2 (3.1–3.4) | 3.2 (3.1–3.3) | 3.2 (3.1–3.4) | 3.2 (3.1–3.3) | 3.2 (3.1–3.4) | 3.3 (3.1–3.4) | 3.3 (3.1–3.4) | 3.2 (3.2–3.3) |
p-value | 0.745 | 0.810 | 0.947 | 0.936 |
Predictor | Needed and Received Health Care | Postponed the Needed Health Care | Increased Expenses for Essential Medicines | Increased Expenses for Health Care | ||||
---|---|---|---|---|---|---|---|---|
OR (95% CI) | p-value | OR (95% CI) | p-Value | OR (95% CI) | p-value | OR (95% CI) | p-Value | |
Age | 1.01 (1.002–1.02) | 0.016 | 1.01 (1.002–1.02) | <0.01 | 1.01 (1.01–1.02) | <0.01 | 1.01 (1.004–1.02) | 0.04 |
Sex | ||||||||
Female (vs. Male) | 1.3 (1.03–1.7) | 0.039 | 1.6 (1.2–2.1) | <0.001 | 1.2 (0.9–1.5) | 0.254 | 1.2 (0.9–1.5) | 0.28 |
Education | ||||||||
Primary/HS (vs. College) | 1.08 (0.81–1.44) | 0.569 | 0.85 (0.64–1.13) | 0.282 | 0.83 (0.62–1.1) | 0.205 | 0.51 (0.38–0.69) | <0.001 |
Residence | ||||||||
Rural (vs. Urban) | 1.04 (0.8–1.35) | 0.756 | 1.1 (0.84–1.4) | 0.477 | 0.91 (0.7–1.2) | 0.466 | 0.73 (0.55–0.98) | 0.035 |
Income | ||||||||
Worse (vs. Same/improved) | 1.09 (0.78–1.31) | 0.946 | 1.8 (1.4–2.3) | <0.001 | 1.9 (1.5–2.5) | <0.001 | 1.8 (1.4–2.4) | <0.001 |
Chronic disease | ||||||||
Present (vs. No) | 1.91 (1.38–2.66) | <0.001 | 2.7 (2–3.6) | <0.001 | 2.1 (1.5–2.8) | <0.001 | 1.7 (1.3–2.4) | <0.001 |
Health Literacy | ||||||||
Point increase (7-point scale) | 1.2 (1.1–1.4) | <0.001 | 0.9 (0.82–0.98) | 0.025 | 0.85 (0.77–0.93) | <0.01 | 0.82 (0.74–0.9) | <0.001 |
Information Use | ||||||||
Point increase (7-point scale) | 1.2 (1.1–1.4) | <0.001 | 1.1 (1.04–1.2) | <0.01 | 1.03 (0.96–1.1) | 0.393 | 0.97 (0.89–1.06) | 0.484 |
Trust in Professionals | ||||||||
Point increase (7-point scale) | 1.3 (1.2–1.4) | <0.001 | 1.08 (1.01–1.2) | 0.032 | 0.95 (0.88–1.03) | 0.251 | 0.92 (0.84–0.99) | 0.038 |
Trust in Institutions | ||||||||
Point increase (8-point scale) | 1.3 (1.2–1.4) | <0.001 | 0.95 (0.88–1.04) | 0.302 | 0.92 (0.85–0.99) | 0.047 | 0.82 (0.75–0.9) | <0.001 |
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Cilović-Lagarija, Š.; Musa, S.; Hasanica, N.; Čerkez, G.; Palo, M.; Majdan, M.; Scherzer, M.; Habersaat, K.B.; Smallwood, C.; Tahirukaj, A.; et al. Population Perspectives on Impact of the COVID-19 Pandemic on Essential Health Services—Behavioral Insights from the Federation of Bosnia and Herzegovina. Behav. Sci. 2022, 12, 495. https://doi.org/10.3390/bs12120495
Cilović-Lagarija Š, Musa S, Hasanica N, Čerkez G, Palo M, Majdan M, Scherzer M, Habersaat KB, Smallwood C, Tahirukaj A, et al. Population Perspectives on Impact of the COVID-19 Pandemic on Essential Health Services—Behavioral Insights from the Federation of Bosnia and Herzegovina. Behavioral Sciences. 2022; 12(12):495. https://doi.org/10.3390/bs12120495
Chicago/Turabian StyleCilović-Lagarija, Šeila, Sanjin Musa, Nino Hasanica, Goran Čerkez, Mirza Palo, Marek Majdan, Martha Scherzer, Katrine Bach Habersaat, Catherine Smallwood, Ardita Tahirukaj, and et al. 2022. "Population Perspectives on Impact of the COVID-19 Pandemic on Essential Health Services—Behavioral Insights from the Federation of Bosnia and Herzegovina" Behavioral Sciences 12, no. 12: 495. https://doi.org/10.3390/bs12120495