Int J Health Geogr - A spatial analysis of variations in health access: linking geography, socio-economic status and access perceptions.


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CKGROUND: This paper analyses the relationship between public perceptions of access to general practitioners (GPs) surgeries and hospitals against health status, car ownership and geographic distance. In so doing it explores the different dimensions associated with facility access and accessibility.METHODS: Data on difficulties experienced in accessing health services, respondent health status and car ownership were collected through an attitudes survey. Road distances to the nearest service were calculated for each respondent using a GIS. Difficulty was related to geographic distance, health status and car ownership using logistic generalized linear models. A Geographically Weighted Regression (GWR) was used to explore the spatial non-stationarity in the results.RESULTS: Respondent long term illness, reported bad health and non-car ownership were found to be significant predictors of difficulty in accessing GPs and hospitals. Geographic distance was not a significant predictor of difficulty in accessing hospitals but was for GPs. GWR identified the spatial (local) variation in these global relationships indicating locations where the predictive strength of the independent variables was higher or lower than the global trend. The impacts of bad health and non-car ownership on the difficulties experienced in accessing health services varied spatially across the study area, whilst the impacts of geographic distance did not.CONCLUSIONS: Difficulty in accessing different health facilities was found to be significantly related to health status and car ownership, whilst the impact of geographic distance depends on the service in question. GWR showed how these relationships were varied across the study area. This study demonstrates that the notion of access is a multi-dimensional concept, whose composition varies with location, according to the facility being considered and the health and socio-economic status of the individual concerned.

Resumo Limpo

ckground paper analys relationship public percept access general practition gps surgeri hospit health status car ownership geograph distanc explor differ dimens associ facil access accessibilitymethod data difficulti experienc access health servic respond health status car ownership collect attitud survey road distanc nearest servic calcul respond use gis difficulti relat geograph distanc health status car ownership use logist general linear model geograph weight regress gwr use explor spatial nonstationar resultsresult respond long term ill report bad health noncar ownership found signific predictor difficulti access gps hospit geograph distanc signific predictor difficulti access hospit gps gwr identifi spatial local variat global relationship indic locat predict strength independ variabl higher lower global trend impact bad health noncar ownership difficulti experienc access health servic vari spatial across studi area whilst impact geograph distanc notconclus difficulti access differ health facil found signific relat health status car ownership whilst impact geograph distanc depend servic question gwr show relationship vari across studi area studi demonstr notion access multidimension concept whose composit vari locat accord facil consid health socioeconom status individu concern

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