Access to substance abuse treatment in the Cape Town metropole ...

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health service utilization, and consequently the use of health services (Andersen,1995; Andersen & Newman, 1973).2.2.1. Health care system factorsFactors at the level of the health care system are also seen as determinants ofaccess to services (Andersen, 1995), primarily because the health systemstructures the provision of health services in society. The BHSU proposes thatthe health care system consists of three dimensions: health policy, health-relatedresources and health care organization (Andersen, 1995). Together thesedimensions shape health service delivery and influence the extent to whichenabling resources are present in society, the degree to which health-relatedneeds are perceived, and the use of services (Phillips et al., 1998).More specifically, health (and social welfare) policies are understood to influencelegislation and social norms concerning the structure and functioning of thehealth system, including resource allocation, training of health workers, andhealth priorities (Andersen, 1995; Andersen & Newman, 1973). Health systemresources are defined in terms of the financial and personnel resources allocatedfor health care (Andersen & Newman, 1973). These resources include personnelresponsible for service delivery, health care facilities, as well as technology,equipment and materials used to provide services (Andersen & Newman, 1973).The BHSU defines the organizational dimension in terms of the distribution ofhealth resources, including the co-ordination and regulation of personnel andfacilities (Andersen & Newman, 1973). This dimension is comprised of twoelements; access and structure. Access refers to the way in which a persongains entry into the system and is indicated by eligibility requirements and systembarriers such as waiting times, referral processes, and gatekeepers. In contrast,structure refers to factors that determine the type of services received once aperson enters the system.19
This study focuses specifically on health care system factors as they apply tosubstance abuse treatment services. The choice of substance abuse treatmentsystem factors is based on findings from national research (Myers, 2004). Asindicators of resource allocation and system organization are largely unavailablefor the South African substance abuse treatment system, this study usesqualitative methods to examine these variables.2.2.2. Factors within the external environmentAccording to the BHSU, other contextual factors that influence an individual’sability to access health care include external environmental influences, such asthe economic, political, and social milieu, and prevailing social norms (Andersen,1995; Litaker & Love, 2005; Phillips et al., 1998; Rew, 1998). This group of interrelatedcharacteristics represents several basic influences that shape theopportunities available to individuals independently of their personalcharacteristics (Litaker & Love, 2005), by providing a context for health servicedelivery (Rew, 1998).This study weaves an understanding of the socio-cultural context within which theSouth African substance abuse treatment system is located throughout itsconceptual framework; particularly in the qualitative component of the studywhich explicitly explores the influence of contextual factors on realized access.The inclusion of these factors is based on the understanding that substanceabuse outcomes, the use of substance abuse services, and the structure andfunctioning of the substance abuse treatment system are shaped by political andeconomic ideologies, power relations and socially constructed roles inherent inany given society (Morgan et al., 2004; Zurayk, 2001).2.3. THE HEALTH BEHAVIOUR DOMAIN: UTILIZATIONThe conceptual model in this study focuses on one aspect of the BHSU’s healthbehaviour domain, namely health services utilization. This is viewed as animmediate outcome of access to health care (Andersen, 1995). The BHSUdefines health service utilization as obtaining health care provision in the form of20
Page 1 and 2: Access to substance abuse treatment
Page 3 and 4: CONTENTSINTRODUCTION ..............
Page 5 and 6: 5.4. SUMMARY.......................
Page 7 and 8: al., 2004; Reddy et al., 2003; Shis
Page 9 and 10: 1.3. IS ACCESS TO SUBSTANCE ABUSE T
Page 11 and 12: 1.4.2. Racial disparities in the ne
Page 13 and 14: illegally and are unregulated by th
Page 15 and 16: CONCEPTUAL MODELThis study’s conc
Page 17 and 18: presenting problems and ability to
Page 19: need for services is the most immed
Page 23 and 24: METHOD3.1. STUDY AIMS & OBJECTIVESA
Page 25 and 26: the researcher to explore possible
Page 27 and 28: esidential areas from each of the s
Page 29 and 30: 3.3.2.4. Data collection: controlsF
Page 31 and 32: o Problem recognition, Desire for h
Page 33 and 34: Table 1.Domains and measures compri
Page 35 and 36: The 19-item MOS-SSS measures functi
Page 37 and 38: information on the accessibility of
Page 39 and 40: RESULTS: PHASE ONE4.1. VARIABLES AS
Page 41 and 42: efficacy to stop using drugs for mo
Page 43 and 44: (Table 6). Effect sizes were large
Page 45 and 46: were 2.4 times more likely to not a
Page 47 and 48: esteem scales (Table 9). Stigma als
Page 49 and 50: Table 10.Logistic regression coeffi
Page 51 and 52: 4.2.2. Model 2: Predisposing variab
Page 53 and 54: poverty scale, and the variable “
Page 55 and 56: of the model increased significantl
Page 57 and 58: controls had greater self-efficacy
Page 59 and 60: and R1000 per month than their fema
Page 61 and 62: subjects earning less than R500 per
Page 63 and 64: and race (Table 16). This indicates
Page 65 and 66: were 3 times more likely to earn le
Page 67 and 68: (which are higher for Black/African
Page 69 and 70: substance use or remain abstinent d
Page 71 and 72:
monetary needs rise, subjects repor
Page 73 and 74:
with improved awareness of services
Page 75 and 76:
4.4.4.4. Predictors of “community
Page 77 and 78:
• In historically disadvantaged c
Page 79 and 80:
RESULTS: PHASE TWODuring qualitativ
Page 81 and 82:
5.1.1.3. Government’s responses t
Page 83 and 84:
“Part of the government's agenda
Page 85 and 86:
putting extra strain and pressure o
Page 87 and 88:
The impact of availability and affo
Page 89 and 90:
availability of affordable services
Page 91 and 92:
completed a hospital-based detoxifi
Page 93 and 94:
“I have thirty beds that are unus
Page 95 and 96:
“I don't see it amongst the bona
Page 97 and 98:
going to be a good day. So, yes it
Page 99 and 100:
in the fourth week they relapse, it
Page 101 and 102:
esponses to treatment, in part, are
Page 103 and 104:
• Awareness of appropriate treatm
Page 105 and 106:
This perception is prevalent in Col
Page 107 and 108:
substance abuse problem - without a
Page 109 and 110:
o These community influences are lo
Page 111 and 112:
6.2.1. Awareness of substance abuse
Page 113 and 114:
informational support can improve a
Page 115 and 116:
salient for low-income groups who h
Page 117 and 118:
diminishing self-efficacy and motiv
Page 119 and 120:
self-efficacy and negative percepti
Page 121 and 122:
6.3. TREATMENT SYSTEM FACTORS ASSOC
Page 123 and 124:
This study found that limited resou
Page 125 and 126:
6.4. RECOMMENDATIONSBased on study
Page 127 and 128:
• As findings suggest that female
Page 129 and 130:
• While the affordability of trea
Page 131 and 132:
To address these barriers, we argue
Page 133 and 134:
o To ensure objectivity, this needs
Page 135 and 136:
egistration process should gather i
Page 137 and 138:
REFERENCESAday, L.A., & Awe, W.C. (
Page 139 and 140:
First, MB; Spitzer, RL; Gibbon, M;
Page 141 and 142:
Myers, B., & Parry, C.D.H. (2005).
Page 143 and 144:
Ross, M.W., Williams, M.L., Timpson
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