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Demand for community-based care services and its influencing factors among the elderly in affordable housing communities: a case study in Nanjing City.

ABSTRACT: BACKGROUND:Community-based care services refers to the professional services provided at home to the elderly with formally assessed demands. The growth of the elderly population has increased the demand for these services, and this issue is even worse in the affordable housing community (AHC) of China. Understanding of elderly's demands for different types of community-based care services and its determinations would enable the implementation of appropriate incentive schemes to promote utilization of community-based care services in the AHCs of China. METHODS:Guided by previous studies, a conceptual framework was developed. Then, a questionnaire was designed and a community based survey was conducted from May 10-20, 2018 in Daishan AHC of Nanjing City, China. Four hundred eight participants from 25,650 elderly people were selected by systematic random sampling technique. Binary logistic regression was applied to the data about the elderly' primary demands for community-based care services in the AHC, to quantify the elderly's demands and explore related individual-level factors. RESULTS:The finding indicates that more than 50% of respondents had the demand for an elderly care hotline, building health archives, on-call nursing and doctor visits, medical lectures, regular medical examinations and sporting fitness. The binary logistic regression models revealed that the primary demands of the elderly for community-based care services were influenced by distinct factors. CONCLUSIONS:Our findings help clarify different types of community-based care services and provide fresh information about the demand for community-based care among the elderly in AHCs. Several policy implications are discussed to enhance the efficiency of community-based care service provision.

SUBMITTER: Gu T

PROVIDER: S-EPMC7092588 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Demand for community-based care services and its influencing factors among the elderly in affordable housing communities: a case study in Nanjing City.

Gu Tiantian T Yuan Jingfeng J Li Lingzhi L Shao Qiuhu Q Zheng Chuanjun C

BMC health services research 20200323 1

<h4>Background</h4>Community-based care services refers to the professional services provided at home to the elderly with formally assessed demands. The growth of the elderly population has increased the demand for these services, and this issue is even worse in the affordable housing community (AHC) of China. Understanding of elderly's demands for different types of community-based care services and its determinations would enable the implementation of appropriate incentive schemes to promote u ...[more]

PMID: 32293427

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Project description:Adequate utilization of services is critical to maximize the impact of counselling on infant and young child feeding (IYCF), but little is known about factors affecting utilization. Our study examined supply- and demand-side factors associated with the utilization of IYCF counselling services in Viet Nam. We used survey data from mothers with children <2y (n = 1,008) and health staff (n = 60) from the evaluation of a program that embedded IYCF counseling into the existing government health system. The frequency of never users, one-time users, repeat users, and achievers of the recommended minimum number of visits at health facilities were 45.1%, 13.0%, 28.4% and 13.5%, respectively. Poisson regression showed that demand-generation strategies, especially invitation cards, were the key factors determining one-time use (Prevalence ratio, PR 3.0, 95% CI: 2.2-4.2), repeated use (PR 3.2, 95% CI: 2.4-4.2), and achievement of minimum visits (PR 5.5, 95% CI: 3.6-8.4). Higher maternal education was associated with higher utilization both for one-time and repeated use. Being a farmer, belonging to an ethnic minority, and having a wasted child were associated with greater likelihood of achieving the minimum recommended number of visits, whereas child stunting or illness were not. Distance to health center was a barrier to repeated visits. Among supply-side factors, good counselling skills (PR: 1.3-1.8) was the most important factor associated with any service use, whereas longer employment duration and greater work pressure of health center staff were associated with lower utilization. Population attributable risk estimations showed that an additional 25% of the population would have achieved the minimum number of visits if exposed to three demand-generation strategies, and further increased to 49% if the health staff had good counseling skills and low work pressure. Our study provides evidence that demand-generation strategies are essential to increase utilization of facility-based IYCF counselling services in Viet Nam, and may be relevant for increasing and sustaining use of nutrition services in similar contexts.

Project description:BackgroundHome and community-based services are considered an appropriate and crucial caring method for older adults in China. However, the research examining demand for medical services in HCBS through machine learning techniques and national representative data has not yet been carried out. This study aimed to address the absence of a complete and unified demand assessment system for home and community-based services.MethodsThis was a cross-sectional study conducted on 15,312 older adults based on the Chinese Longitudinal Healthy Longevity Survey 2018. Models predicting demand were constructed using five machine-learning methods: Logistic regression, Logistic regression with LASSO regularization, Support Vector Machine, Random Forest, and Extreme Gradient Boosting (XGboost), and based on Andersen's behavioral model of health services use. Methods utilized 60% of older adults to develop the model, 20% of the samples to examine the performance of models, and the remaining 20% of cases to evaluate the robustness of the models. To investigate demand for medical services in HCBS, individual characteristics such as predisposing, enabling, need, and behavior factors constituted four combinations to determine the best model.ResultsRandom Forest and XGboost models produced the best results, in which both models were over 80% at specificity and produced robust results in the validation set. Andersen's behavioral model allowed for combining odds ratio and estimating the contribution of each variable of Random Forest and XGboost models. The three most critical features that affected older adults required medical services in HCBS were self-rated health, exercise, and education.ConclusionAndersen's behavioral model combined with machine learning techniques successfully constructed a model with reasonable predictors to predict older adults who may have a higher demand for medical services in HCBS. Furthermore, the model captured their critical characteristics. This method predicting demands could be valuable for the community and managers in arranging limited primary medical resources to promote healthy aging.

Dataset Information

Demand for community-based care services and its influencing factors among the elderly in affordable housing communities: a case study in Nanjing City.

Publications

Demand for community-based care services and its influencing factors among the elderly in affordable housing communities: a case study in Nanjing City.

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