Health service accessibility and service users’ position in the social space in Salvador, Bahia, Brazil, 2006: a cross-sectional study

This was a cross-sectional study carried out in primary health care centers in Salvador, Bahia, Brazil, where a project for improving accessibility was implemented. Pearson's chi-square test and logistic regression were used.

Results:

467 users took part in the study, 75.6% had not finished high school; 78.7% had <2 minimum wages; 51.8% had intermediate/qualified occupations. Low income was associated with starting to queue at the health care center the night before or before 8 a.m. (odds ratio = 2.09 - 95%CI 1.13;3.87) and spending more time scheduling an appointment (odds ratio = 2.13 - 95%CI 1.05;4.31). Having an elementary occupation was associated with face-to-face appointment scheduling (odds ratio = 1.68 - 95%CI 1.14;2.45). Education and social trajectory showed no significant association with use of health services.

Conclusion:

Social inequalities in access to health services remained after the intervention to improve accessibility.

Keywords:
Health Services Accessibility; Primary Health Care; Health Status Disparities; Cross-Sectional Studies.

Characteristics	n	%
Sex
Male	106	22.7
Female	361	77.3
Age group (in years)
10-19	55	11.8
20-49	302	64.7
50-59	43	9.2
≥60	67	14.3
Schooling
Medium/low	353	75.6
High	114	24.4
Marital Status
Single	140	29.9
Widower/widow	20	4.3
Married/live with someone	282	60.4
Divorced	25	5.4
Professional situation
Employee	135	28.9
Unemployed	332	71.1
Family income (in minimum wages)^a,b,c
<2	350	78.7
≥2	95	21.3
Residence time in the municipality
Not a resident	4	0.9
<10	47	10.1
≥10	166	35.5
Have always resided	250	53.5
Socio-occupational category^b
Elementary	222	48.2
Intermediate and qualified	239	51.8

Access indicators		Time of arrival				Type of scheduling				Waiting time				Scheduling time
Social Space		n	Did not have to queue	Night before until 6 a.m Between 6 a.m and 8a.m	P-value^a	n	Over the phone, health worker, waiting list Face-to-face		P-value^a	n	Did not wait/waited up to 15 minutes	From 15 minutes to more than 1 hour	P-value^a	n	Same day up to 2 weeks	Between 3 weeks and More than 1 month	P-value^a
Cultural capital	Medium-low	353	74.8	25.2	0.814	352	37.2	62.8	0.351	352	80.7	19.3	0.528	325	68.6	31.4	0.180
Cultural capital	High	114	73.7	26.3	0.814	114	42.1	57.9	0.351	114	83.3	16.7	0.528	106	75.5	24.5	0.180
Economic^b capital	Low	350	73.4	26.6	0.017	349	37.3	62.8	0.074	349	79.9	20.1	0.032	317	67.5	32.5	0.048
Economic^b capital	Medium-high	95	85.3	14.7	0.017	95	47.4	52.6	0.074	95	89.5	10.5	0.032	92	78.3	21.7	0.048
Socio-occupational^b category	Elementary	222	72.9	27.0	0.433	222	31.9	68.0	0.007	222	80.6	19.4	0.720	206	67.5	32.5	0.249
Socio-occupational^b category	Intermediate and qualified	239	76.1	23.9	0.433	238	44.1	55.9	0.007	238	81.9	18.1	0.720	219	72.6	27.4	0.249
Trajectory^b	Falling and stable	187	78.6	21.4	0.662	187	40.6	59.4	0.203	187	85.0	15.0	0.791	169	66.9	33.1	0.619
Trajectory^b	Rising	99	80.8	19.2	0.662	99	48.5	51.5	0.203	99	83.8	16.2	0.791	94	63.8	36.2	0.619

Access indicators	Time of arrival		Type of scheduling		Waiting time		Scheduling time
Social space	OR^b	IC95%^c	OR^b	IC95%^c	OR^b	IC95%^c	OR^b	IC95%^c
Cultural capital
High	1.00		1.00		OR^b	IC95%^c	OR^b	IC95%^c	1.00	1.00
Medium-low	0.95	0.67;1.36	1.08	0.90;1.29	1.15	0.72;1.84	1.27	0.88;1.85
Economicb^b capital
Medium-high	1.00		1.00		1.00		1.00
Low	2.09	1.13;3.87	1.19	0.96;1.46	2.13	1.05;4.31	1.49	0.98;2.27
Socio-occupational^b capital
Intermediate and qualified	1.00		1.00		1.00		1.00
Elementary	1.13	0.82;1.54	1.68	1.14;2.45	1.07	0.73;1.56	1.18	0.88;1.58
Trajectory^a
Rising	1.00		1.00		1.00		1.00
Falling and stable	1.11	0.68;1.81	1.15	0.92;1.44	0.92	0.52;1.62	0.91	0.64;1.29

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Correspondence: Daiane Celestino Melo - Universidade Federal da Bahia, Instituto de Saúde Coletiva, Rua Basílio da Gama, s/n, Campus Universitário, Canela, Salvador, BA, Brazil. Postcode: 40110-040 E-mail: daianecelestino@hotmail.com