health service utilization, and consequently <strong>the</strong> use of health services (Andersen,1995; Andersen & Newman, 1973).2.2.1. Health care system fac<strong>to</strong>rsFac<strong>to</strong>rs at <strong>the</strong> level of <strong>the</strong> health care system are also seen as determ<strong>in</strong>ants ofaccess <strong>to</strong> services (Andersen, 1995), primarily because <strong>the</strong> health systemstructures <strong>the</strong> provision of health services <strong>in</strong> society. The BHSU proposes that<strong>the</strong> health care system consists of three dimensions: health policy, health-relatedresources and health care organization (Andersen, 1995). Toge<strong>the</strong>r <strong>the</strong>sedimensions shape health service delivery and <strong>in</strong>fluence <strong>the</strong> extent <strong>to</strong> whichenabl<strong>in</strong>g resources are present <strong>in</strong> society, <strong>the</strong> degree <strong>to</strong> which health-relatedneeds are perceived, and <strong>the</strong> use of services (Phillips et al., 1998).More specifically, health (and social welfare) policies are unders<strong>to</strong>od <strong>to</strong> <strong>in</strong>fluencelegislation and social norms concern<strong>in</strong>g <strong>the</strong> structure and function<strong>in</strong>g of <strong>the</strong>health system, <strong>in</strong>clud<strong>in</strong>g resource allocation, tra<strong>in</strong><strong>in</strong>g of health workers, andhealth priorities (Andersen, 1995; Andersen & Newman, 1973). Health systemresources are def<strong>in</strong>ed <strong>in</strong> terms of <strong>the</strong> f<strong>in</strong>ancial and personnel resources allocatedfor health care (Andersen & Newman, 1973). These resources <strong>in</strong>clude personnelresponsible for service delivery, health care facilities, as well as technology,equipment and materials used <strong>to</strong> provide services (Andersen & Newman, 1973).The BHSU def<strong>in</strong>es <strong>the</strong> organizational dimension <strong>in</strong> terms of <strong>the</strong> distribution ofhealth resources, <strong>in</strong>clud<strong>in</strong>g <strong>the</strong> co-ord<strong>in</strong>ation and regulation of personnel andfacilities (Andersen & Newman, 1973). This dimension is comprised of twoelements; access and structure. <strong>Access</strong> refers <strong>to</strong> <strong>the</strong> way <strong>in</strong> which a personga<strong>in</strong>s entry <strong>in</strong><strong>to</strong> <strong>the</strong> system and is <strong>in</strong>dicated by eligibility requirements and systembarriers such as wait<strong>in</strong>g times, referral processes, and gatekeepers. In contrast,structure refers <strong>to</strong> fac<strong>to</strong>rs that determ<strong>in</strong>e <strong>the</strong> type of services received once aperson enters <strong>the</strong> system.19
This study focuses specifically on health care system fac<strong>to</strong>rs as <strong>the</strong>y apply <strong>to</strong><strong>substance</strong> <strong>abuse</strong> <strong>treatment</strong> services. The choice of <strong>substance</strong> <strong>abuse</strong> <strong>treatment</strong>system fac<strong>to</strong>rs is based on f<strong>in</strong>d<strong>in</strong>gs from national research (Myers, 2004). As<strong>in</strong>dica<strong>to</strong>rs of resource allocation and system organization are largely unavailablefor <strong>the</strong> South African <strong>substance</strong> <strong>abuse</strong> <strong>treatment</strong> system, this study usesqualitative methods <strong>to</strong> exam<strong>in</strong>e <strong>the</strong>se variables.2.2.2. Fac<strong>to</strong>rs with<strong>in</strong> <strong>the</strong> external environmentAccord<strong>in</strong>g <strong>to</strong> <strong>the</strong> BHSU, o<strong>the</strong>r contextual fac<strong>to</strong>rs that <strong>in</strong>fluence an <strong>in</strong>dividual’sability <strong>to</strong> access health care <strong>in</strong>clude external environmental <strong>in</strong>fluences, such as<strong>the</strong> economic, political, and social milieu, and prevail<strong>in</strong>g social norms (Andersen,1995; Litaker & Love, 2005; Phillips et al., 1998; Rew, 1998). This group of <strong>in</strong>terrelatedcharacteristics represents several basic <strong>in</strong>fluences that shape <strong>the</strong>opportunities available <strong>to</strong> <strong>in</strong>dividuals <strong>in</strong>dependently of <strong>the</strong>ir personalcharacteristics (Litaker & Love, 2005), by provid<strong>in</strong>g a context for health servicedelivery (Rew, 1998).This study weaves an understand<strong>in</strong>g of <strong>the</strong> socio-cultural context with<strong>in</strong> which <strong>the</strong>South African <strong>substance</strong> <strong>abuse</strong> <strong>treatment</strong> system is located throughout itsconceptual framework; particularly <strong>in</strong> <strong>the</strong> qualitative component of <strong>the</strong> studywhich explicitly explores <strong>the</strong> <strong>in</strong>fluence of contextual fac<strong>to</strong>rs on realized access.The <strong>in</strong>clusion of <strong>the</strong>se fac<strong>to</strong>rs is based on <strong>the</strong> understand<strong>in</strong>g that <strong>substance</strong><strong>abuse</strong> outcomes, <strong>the</strong> use of <strong>substance</strong> <strong>abuse</strong> services, and <strong>the</strong> structure andfunction<strong>in</strong>g of <strong>the</strong> <strong>substance</strong> <strong>abuse</strong> <strong>treatment</strong> system are shaped by political andeconomic ideologies, power relations and socially constructed roles <strong>in</strong>herent <strong>in</strong>any given society (Morgan et al., 2004; Zurayk, 2001).2.3. THE HEALTH BEHAVIOUR DOMAIN: UTILIZATIONThe conceptual model <strong>in</strong> this study focuses on one aspect of <strong>the</strong> BHSU’s healthbehaviour doma<strong>in</strong>, namely health services utilization. This is viewed as animmediate outcome of access <strong>to</strong> health care (Andersen, 1995). The BHSUdef<strong>in</strong>es health service utilization as obta<strong>in</strong><strong>in</strong>g health care provision <strong>in</strong> <strong>the</strong> 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
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monetary needs rise, subjects repor
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with improved awareness of services
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4.4.4.4. Predictors of “community
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• In historically disadvantaged c
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RESULTS: PHASE TWODuring qualitativ
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5.1.1.3. Government’s responses t
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“Part of the government's agenda
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putting extra strain and pressure o
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The impact of availability and affo
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availability of affordable services
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completed a hospital-based detoxifi
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“I have thirty beds that are unus
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“I don't see it amongst the bona
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going to be a good day. So, yes it
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in the fourth week they relapse, it
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esponses to treatment, in part, are
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• Awareness of appropriate treatm
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This perception is prevalent in Col
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substance abuse problem - without a
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o These community influences are lo
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6.2.1. Awareness of substance abuse
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informational support can improve a
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salient for low-income groups who h
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diminishing self-efficacy and motiv
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self-efficacy and negative percepti
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6.3. TREATMENT SYSTEM FACTORS ASSOC
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This study found that limited resou
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6.4. RECOMMENDATIONSBased on study
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• As findings suggest that female
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• While the affordability of trea
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To address these barriers, we argue
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o To ensure objectivity, this needs
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egistration process should gather i
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REFERENCESAday, L.A., & Awe, W.C. (
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First, MB; Spitzer, RL; Gibbon, M;
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Myers, B., & Parry, C.D.H. (2005).
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Ross, M.W., Williams, M.L., Timpson