Access barriers to care for patients with silent cerebrovascular disease (SCD) in rural China: A cross-sectional questionnaire-based study

Abstract

Background

Timely diagnosis and treatment of silent cerebrovascular disease (SCD) are critical for future cerebrovascular disease prevention, whereas asymptomatic specificity of SCD can lead to a lack of reasonable healthcare utilization. In China, access barriers to care for SCD patients is rarely studied. This study aimed to estimate the access barriers to care for SCD patients in rural China and explored associated factors.

Methods

We constructed a demand-side questionnaire using the six-dimensional model of access barriers to care, and collected survey data in Guizhou province, China. Data from SCD patients were collected including demographics, health status, and self-perceived access barriers to care. Linear regression was used to estimate the association between access barriers to care and self-reported health status.

Results

A total of 162 SCD patients were included in the analysis. The questionnaire’s measures are adoptable with reliability (Cronbach’s α = 0.86) and validity (KMO = 0.774, Bartlett’s test p-value < 0.05). The average score of access barriers to care for SCD patients in Guizhou was 13.41 (SD = 4.08). Average scores vary across the six dimensions, and affordability has the highest score of 3.07 (SD = 0.13), indicating the highest level of access barriers in terms of affordability. The lowest scored dimension is acceptability which score is 1.62 (SD = 0.33), indicating SCD patients had a relatively high willingness in receiving healthcare services. Regression outcome reported that self-reported worse health status was significantly associated with higher level of access barriers (p-value < 0.01).

Conclusion

This study estimated overall and by-dimension access barriers to care for patients with SCD in rural China and investigated the association between health status and access barriers to care. The varied level of different dimensions of access barriers to care suggested that interventions designed to facilitate healthcare utilization should be specific and target those SCD patients who are in poorer health status and have difficulty affording healthcare expenses.