Prevalence and factors associated with the use of public health services for adult men

Arruda, Guilherme Oliveira de; Mathias, Thais Aidar de Freitas; Marcon, Sonia Silva

doi:10.1590/1413-81232017221.20532015

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Free Themes • Ciênc. saúde colet. 22 (1) • Jan 2017 • https://doi.org/10.1590/1413-81232017221.20532015 copy

Prevalence and factors associated with the use of public health services for adult men

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The aim of this study was to identify prevalence and factors associated with use of public health services by adult males residing in the city of Maringá, Paraná. A household survey was carried out with 410 men aged 20 to 59 years old. Analysis was performed by means of descriptive statistics and multiple logistic regression models. The prevalence of use of public services stood at 56.3%. Men who used public health services most often were those with little education, no health plan, no partner, unemployed, who had more contact with nurses and other professionals, sought the services due to disease/symptoms/emergency, had difficulties with the service, rated health services as regular and chose attention and promptness as the most important aspects of health services - variables adjusted for family income, economic class and need for treatment. Men's health care should be reorganized according to factors linked to the use of health services by them, with the promotion of greater contact between health services and men and the centering of assistance on users, expanding men's participation in promotional and preventive practices.

Key words
Use of health services; Men's health; Gender and health; Health policies

Sociodemographic Variables		n	%
Age Group
	20 to 29	91	22.2
	30 to 39	93	22.7
	40 to 49	113	27.6
	50 to 59	113	27.6
Skin Color
	White	237	57.8
	Non-white	173	42.2
Marital Status
	No Partner	134	32.7
	Partner	276	67.3
Children
	Yes	289	70.5
	No	121	29.6
Religion
	Yes	371	90.5
	No	39	9.5
Education
	Up to 4^th Grade	45	11.0
	Elementary School	99	24.1
	High School	153	37.3
	Higher Education	113	27.6
Job
	Yes	327	79.8
	No	83	20.3
Household Income
	Up to 2	68	16.6
	2 to 4	136	33.2
	4 to 6	94	22.9
	Over 6	112	27.3
Occupational Status
	Employer/Self-employed	167	40.7
	Employed	152	37.1
	Student	25	6.1
	Other	66	16.1
Health Plan
	Yes	197	48.0
	No	213	52.0
Economic Class
	Class A	32	7.8
	Class B	217	52.9
	Class C/D	161	39.3

Variables			n	%
Variables concerning use of Health Services
	Professional Contact
		Doctor	287	70.0
		Dentist	39	9.5
		Nurse	21	5.1
		Other	63	15.4
	Frequent Reason
		Checkup	113	27.5
		Disease/Symptoms/Emergency	254	62.0
		Other	43	10.5
Health Variables
	Reported Morbidity
		Yes	179	43.7
		No	231	56.3
	Need for Treatment
		Yes	133	32.4
		No	277	67.6
	Health Self-Perception
		Positive	314	76.6
		Negative	96	23.4
Variables concerning satisfaction with the Health Service
	Difficulties with the Service
		Yes	112	27.3
		No	298	72.7
	Preparation for the Service
		Yes	226	55.1
		No	183	44.9
	Rating of the Health Service
		Good/Very Good	267	65.1
		Regular	110	26.8
		Poor/Very Poor	33	8.1
	Health Service Recommendation
		Yes	362	88.3
		No	48	11.7
	Important Aspect
		Problem Solving	161	39.3
		Communication	62	15.1
		Attention	116	28.3
		Promptness	65	15.8
		Other	6	1.5

Sociodemographic variables		Use of Public Health Services
				Univariate Analysis		Multivariate Analysis^* * Adjusted for “household income” and “economic class”; Hosmer-Lemeshow Test = 0.434; Nagelkerke's R2 = 0.615 – the model explains 61.5% of the use of public health services by men.
		n	%	OR(95%CI)	P	OR(95%CI)	p
Age Group
	20 to 29	46	51.1	1	-		NS^# # NS = Non-Significant.
	30 to 39	48	52.2	1.04 (0.58;1.86)	0.886
	40 to 49	67	58.8	1.36 (0.78;2.37)	0.275
	50 to 59	76	66.7	1.91 (1.08;3.37)	0.025
Skin Color
	White	125	53.0	1	0.021		NS
	Non-White	112	64.4	1.60 (1.07;2.39)	0.021		NS
Marital Status
	No Partner	84	63.2	1.39 (0.91;2.12)	0.128	2.10 (1,10;3.99)	0.024
	Partner	153	55.2	1	0.128	1	0.024
Children
	Yes	175	60.3	1.42 (0.93;2.18)	0.105		NS
	No	62	51.7	1	0.105		NS
Religion
	Yes	209	56.5	1	0.100		NS
	No	28	70.0	1.79 (0.88;3.64)	0.100
Education
	Up to 4^th Grade	39	84.8	10.85 (4.43;26.54)	< 0.001	3.06 (0,85;10.91)	0.085
	Elementary School	81	83.5	9.85 (5.07;19.14)	< 0.001	3.94 (1,47;10.55)	0.006
	High School	78	51.3	2.05 (1.24;3.39)	0.005	1.36 (0,65;2.82)	0.408
	Higher Education	38	33.9	1	-	1	-
Job
	Yes	189	57.6	1	0.881		NS
	No	48	58.5	1.04 (0.64 – 1.70)	0.881		NS
Household Income
	Up to 2	54	79.4	11.03 (5.35;22.77)	< 0.001	1.71 (0,60;4.82)	0.310
	2 to 4	94	68.6	6.25 (3.59;10.90)	< 0.001	1.75 (0,77;3.94)	0.176
	4 to 6	60	64.5	5.20 (2.86;9.47)	< 0.001	1.60 (0,69;3.75)	0.271
	Over 6	29	25.9	1	-	1	-
Occupational Status
	Employer/ Self-Employed	105	62.9	2.15 (0.92;5.04)	0.077		NS
	Employed	76	50.0	1.27 (0.54;2.98)	0.579
	Other	45	68.2	2.72 (1.06;7.01)	0.037
	Student	11	44.0	1	-
Health Plan
	Yes	45	23.1	1		1
	No	191	89.3	27.68 (16.03;47.78)	< 0.001	20.44 (11.06;37.75)	< 0.001
Economic Class
	Class A	4	12.9	1	-	1	-
	Class B	95	44.0	5.30 (1.79;15.66)	0.003	0.96 (0,27;3.44)	0.956
	Class C/D	137	84.6	37.0 (11.91;114.88)	< 0.001	2.74 (0,64;11.65)	0.171

Variables Concerning Use of Health Services		Use of Public Health Services
		Univariate Analysis				Multivariate Analysis^* * Adjusted for “need for treatment”; Hosmer-Lemeshow Test= 0.993.
		n	%	OR(95%CI)	p	OR(95%CI)	p
Professional Contact
	Doctor	140	49.0	1	-	1	-
	Dentist	22	56.4	1.35 (0.68;2.65)	0.383	1.41 (0.69;2.87)	0.342
	Nurse	18	85.7	6.25 (1.80;21.71)	0.004	6.37 (1.81;22.44)	0.004
	Other	57	89.1	8.49 (3.74;19.25)	< 0.001	8.47 (3.68;19.52)	< 0.001
Frequent Reason
	Checkup	51	45.5	1	-	1	-
	Disease/Symptoms/Emergency	156	60.9	1.86 (1.19;2.92)	0.006	1.93 (1.18;3.15)	0.008
	Other	30	71.4	2.99 (1.39;6.43)	0.005	2.15 (0.92;4.99)	0.074
Reported Morbidity
	Yes	116	65.2	1.71 (1.14;2.56)	0.008	2.46 (1.22;4.95)	0.011
	No	121	52.2	1		1
Need for Treatment
	Yes	84	63.6	1.41 (0.92;2.17)	0.108	0.67 (0.32;1.42)	0.304
	No	153	55.2	1	0.108	1	0.304
Health Self-Perception
	Positive	171	54.5	1	0.014		NS^# # NS = Non-Significant.
	Negative	66	68.8	1.84 (1.13;2.99)

Variables concerning Satisfaction with the Health Service		Use of Public Health Services
		Univariate Analysis				Multivariate Analysis^* * Hosmer-Lemeshow Test = 0.874.
		n	%	OR (95%CI)	p	OR (95%CI)	p
Difficulties with Service
	Yes	88	78.6	3.69 (2.22;6,12)	< 0.001	3.19 (1.75;5.80)	< 0.001
	No	148	49.8	1	< 0.001	1	< 0.001
Preparation for the Service
	Yes	116	51.3	1	0.003		NS^# # NS = Non-Significant.
	No	121	65.8	1.82 (1.22;2,72)	0.003		NS^# # NS = Non-Significant.
Rating of the Health Service
	Good/Very Good	134	50.2	1	-	1	-
	Regular	79	71.8	2.53 (1.56;4,08)	< 0.001	1.77 (1.03;3.02)	0.036
	Poor/Very Poor	24	72.7	2.64 (1.18;5,90)	0.017	1.27 (0.49;3.28)	0.615
Health Service Recommendation
	Yes	200	55.2	1	0.005		NS
	No	37	77.1	2.72 (1.34;5,51)	0.005		NS
Important Aspect
	Problem Solving	75	47.2	1	-	1	-
	Communication	35	57.4	1.50 (0.83;2,73)	0.176	1.57 (0.84;2.93)	0.158
	Attention	74	63.8	1.97 (1.21;3,22)	0.007	2.22 (1.32;3.72)	0.002
	Promptness	47	70.1	2.63 (1.43;4,83)	0.002	3.02 (1.60;5.71)	0.001
	Other	5	83.3	5.60 (0.64;49,02)	0.120	3.39 (0.35;32.39)	0.288

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[1] Collaborations

GO Arruda, TAF Mathias and SS Marcon participated in the conception and composition of the article, in the critical review of the content and in the approval of the final version for publishing.