Barriers Faced by Healthcare Service Users Based on Disability Levels: A Comparison between a Private Hospital and a Public Hospital

Abstract

Objective: The study aims to classify healthcare users by disability level and identify service-related issues while also comparing private and public hospitals. Materials and Methods: The scope of this descriptive, cross-sectional study includes patients visiting the outpatient services of one private and one public hospital. A face-to-face questionnaire was conducted with 181 outpatients from private hospitals and 180 from public hospitals. Data meeting normality were analyzed using descriptive statistics, factor analysis, correlation, and variance analysis. Results: 51.2% of healthcare service users reported experiencing at least minor difficulties in one or more areas of disability. Among the scale factors according to institution type, there is a significant difference only in the social security dimension (t=9.20, p<0.000). Significant differences were found in the social security dimension (F = 4.50, p < 0.05) and the auxiliary factors dimension (F = 3.26, p < 0.01) between the groups based on their level of disability. There was a statistically significant negative relationship between the institution variable and the social security dimension (r=-0.437, p<0.000) and the access (r=-0.215, p<0.000). On the other hand, significant positive relationships were determined between the institution variable and the psychological (r=0.294, p<0.000) and the physical/environmental dimensions (r=0.138, p<0.000). Conclusions: Disability-related problems in private and public hospitals relate to social security and auxiliary factors. State hospitals should improve physical and environmental conditions, such as ramps, seating quality, and signage. Additionally, private hospitals need to address social security coverage and ensure that all types of healthcare services are included.

Keywords

• Disability level
• disabled health service users
• polyclinic service

Sağlık Hizmet Kullanıcılarının Engellilik Düzeylerine Göre Karşılaştıkları Problemler: Bir Özel Hastane ve Kamu Hastanesi Karşılaştırması

Öz

Amaç: Bu çalışma, sağlık hizmeti kullanıcılarını engellilik seviyelerine göre sınıflandırmayı ve hizmetle ilgili sorunları belirlemeyi, ayrıca özel ve kamu hastanelerini karşılaştırmayı amaçlamaktadır. Materyal ve Metot: Tanımlayıcı ve kesitsel türdeki bu çalışmanın kapsamı, bir özel ve bir kamu hastanesinin poliklinik hizmetlerine başvuran hastaları içermektedir. 181 özel hastane ve 180 kamu hastanesinden hasta ile yüz yüze anket yapılmıştır. Normallik şartlarını sağlayan veriler tanımlayıcı istatistikler, faktör analizi, korelasyon ve varyans analizi ile analiz edilmiştir. Bulgular: Sağlık hizmeti kullanıcılarının %51,2'si bir veya daha fazla engellilik alanında en azından küçük zorluklar yaşadığını bildirdi. Kurum türüne göre ölçek faktörlerinden sadece sosyal güvenlik boyutunda anlamlı farklılık bulunmaktadır (t=9,20, p<0,000). Engellilik düzeyine göre gruplar arasında sosyal güvenlik boyutunda (F = 4,50, p < 0,05) ve yardımcı faktörler boyutunda (F = 3,26, p < 0,01) anlamlı farklılıklar bulunmuştur. Kurum değişkeni ile sosyal güvenlik boyutu (r=-0,437, p<0,000) ve erişim (r=-0,215, p<0,000) arasında istatistiksel olarak anlamlı negatif ilişki vardı. Diğer taraftan kurum değişkeni ile psikolojik (r=0,294, p<0,000) ve fiziksel/çevresel boyutlar (r=0,138, p<0,000) arasında pozitif yönde anlamlı ilişkiler saptanmıştır. Sonuç: Engellilikle ilgili sorunlar, özel ve kamu hastanelerinde sosyal güvenlik ve yardımcı faktörlerle ilişkilidir. Kamu hastaneleri, rampalar, oturma kalitesi ve işaretleme gibi fiziksel ve çevresel koşulları iyileştirmelidir. Ayrıca, özel hastaneler sosyal güvenlik kapsamını gözden geçirmeli ve tüm sağlık hizmetlerinin dahil edilmesini sağlamalıdır.

Anahtar Kelimeler

• Engellilik düzeyi
• engellilik sağlık hizmeti kullanıcıları
• poliklinik hizmeti

Kaynakça

1. World Health Organization. World Report on Disability, WHO Library Cataloguing in Publication Data, Malta 2011. https://www.who.int/teams/noncommunicable-diseases/sensory-functions-disability-and-rehabilitation/world-report-on-disability. Accessed September 13, 2023.
2. TÜİK. Engelli ve Yaşlı İstatistik Bülteni, 2023. https://data.tuik.gov.tr. Accessed December 10, 2023.
3. United Nations Washington Group on Disability Statistics. Washington Group Extended Question Set on Functioning (Proposal endorsed at the joint Washington Group/ Budapest Task Force Meeting 3-5 November 2010, Luxembourg), Washington 2011.
4. http://www.cdc.gov/nchs/data/washington_group/WG_Extended_Question_Set_on_ Functioning.pdf. Accessed September 23, 2023.
5. Ekenci MT. Regarding disabled individual’s official data collection tools at national level use in prevalence estimates. T.C. Ministry of Family and Social Policies, General Directorate of Disabled and Elderly Services. Specialist Thesis, Ankara, Türkiye. 2014.
6. Dejong G, Palsbo SE, Beatty PW, Jones GC, Knoll T, Neri MT. The organization and financing of health services for persons with disabilities. Milbank Q. 2002;80(2):261-301.
7. Afacan MI. Disability and sports sociology. Mediterranean J Sport Sci. 2023;6(ÖS1):1112-1122.
8. Aköğretmen M. A brief history of disabled labor in the West: An evaluation in the context of disability models. Hak İş Int Labor Soc J. 2023;12(32):129-144. doi:10.31199/hakisderg.1209599

9. Danayiyen A, Kılıç CH, Kavsur Z. Evaluation of service quality in a tertiary hospital based on the SERVQUAL model according to patients’ disability status. 2nd International 12th National Health and Hospital Administration Congress; October 11-13, 2018; Muğla, Turkey.
10. Kördeve MK. Problems encountered by individuals with disabilities in accessing healthcare services. Int J Health Manag Strat Res. 2017;3(2):14-24.
11. Kılıç CH. Measuring the perceived quality of healthcare services for individuals with disabilities and developing hospital service design using quality function deployment matrix. Marmara University, Institute of Health Sciences, Department of Health Management, Doctorate Thesis. Istanbul, Turkey. 2020.
12. Shiner CT, Li I, Millard M, Mahoney AE. Chronic health conditions and disability are prevalent among community users of a digital mental health service: a scoping survey. Disabil Rehabil Assist Technol. 2024;1-10.
13. De Klerk S, Eloff L, Naudé Z, et. al. Non-attendance of occupational and physiotherapy appointments at Western Cape Rehabilitation Centre: A description of associated factors. SAJOT. 2019;49(3):54-63.
14. Sotelo-Daza J, Jaramillo YE, Chacón MV. Nurses’ perception about their role in reducing health inequalities in community contexts. Rev Lat Am Enfermagem, 2024;32:e4299. doi:10.1590/1518-8345.7245.4299
15. Sharma R, Kumar A, Suri V, Kaur S, Singh A. Physical access related user-friendliness of sexual and reproductive health services for women with disabilities in various hospitals in a city in North India: An Integrated qualitative and quantitative Study. Cureus, 2023; 15(1): e34276. doi:10.7759/cureus.34276
16. Ünal V. Evaluation of approaches to disability in Turkey from a social policy perspective. Cumhuriyet Univ Fac Sci Lett J Soc Sci. 2021;45(2):235-258.
17. Üngör I. A Sociological perspective on the perception of disability in Turkey. Marmara University, Institute of Middle Eastern and Islamic Studies, Department of Middle Eastern Sociology and Anthropology, Master’s Thesis. İstanbul, Turkey. 2019.
18. Jia WY. Survey & quantitative design strategies on hospital accessible signs. Appl Mech Mater. 2014;507:31-35.