Demand for health services or professionals among adolescents: a multilevel study

Peixoto, Alisse Maria Chaves de Lima; Melo, Thaise Queiroz de; Ferraz, Livia Almeida Amaral; Santos, Carolina da Franca Bandeira Ferreira; Godoy, Fabiana de; Valença, Paula Andréa de Melo; Menezes, Valdenice Aparecida de; Colares, Viviane

doi:10.1590/1413-81232021267.08582021

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ARTICLE • Ciênc. Saúde Colet. 26 (07) • July 2021 • https://doi.org/10.1590/1413-81232021267.08582021 copy

Demand for health services or professionals among adolescents: a multilevel study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aimed to analyze the demand for health services or professionals by adolescents with individual determinants and contextual variables (school teaching modality and Social Vulnerability Index). Data were collected from March to June 2018, in state public schools in Olinda, Pernambuco, Brazil, through a structured questionnaire with questions from the Youth Risk Behavior Survey (YRBS) and the National School Health Survey (PeNSE). Among the 2,454 adolescents, the proportion of those looking for a health service was higher among women; in adolescents whose mothers had a minimum of nine schooling years; in the physically active; and whose parents did not receive a family aid (Bolsa Família). We observed that the contextual variables did not influence the demand for health services among adolescents. In the third model of the multilevel analysis, which analyzed the individual variables, we observed that only females (OR=1,80), having a mother with schooling greater than or equal to 9 years of study (OR=1,30), not receiving Bolsa Família (OR=1,23), and physically active (OR=1,32) were associated with an increased demand for health services or professionals.

Key words:
Adolescent; Health services accessibility; Adolescent health services; Patient health care acceptance

Variables	Categories	Demand for health services				Total	p
		No		Yes
		n	%	n	%
Gender	Female	696	52.02	642	47.98	1,338	0.000
Gender	Male	675	63.92	381	36.08	1,056	0.000
Age	14-16	732	56.74	558	43.26	1,290	0.539
Age	17-19	665	57.98	482	42.02	1,147	0.539
Maternal schooling	< 9 years of study	434	60.11	288	39.89	722	0.001
Maternal schooling	≥ 9 years of study	662	52.58	597	47.42	1,259	0.001
Ethnicity	White	214	53.50	186	46.50	400	0.127
Ethnicity	Non-white	1,163	57.63	855	42.37	2,018	0.127
Binge drinking	No	961	58.17	691	41.83	1,652	0.125
Binge drinking	Yes	423	54.86	348	45.14	771	0.125
Tobacco use	No	1,231	57.31	917	42.69	2,148	0.839
Tobacco use	Yes	149	56.65	114	43.35	263	0.839
Physical Activity	Active	245	52.69	220	47.31	465	0.030
Physical Activity	Inactive	1,147	58.22	823	41.78	1,970	0.030
Number of sexual partners	One or none	249	57.77	182	42.23	431	0.569
Number of sexual partners	Two and over	447	56.09	350	43.91	797	0.569
Monthly income	More than one minimum wage	324	48.87	339	51.13	663	0.000
Monthly income	Up to one minimum wage	539	58.14	388	41.86	927	0.000
“Bolsa Família” (Family Aid)	Yes	658	60.70	426	39.30	1,084	0.001
“Bolsa Família” (Family Aid)	No	695	53.75	598	46.25	1,293	0.001
Self-perceived health	Not at all healthy / Not very healthy	441	57.65	324	42.35	765	0.797
Self-perceived health	Healthy / Very healthy / Completely healthy	962	57.09	723	42.91	1,685	0.797

	Empty Model (Model 1)	Random intercept. fixed-effect contextual variables (Model 2)	Random intercept. fixed-effect individual variables (Model 3)	Random intercept. fixed-effect (individual + contextual) variables (Model 4)
Fixed part	0.74*** [0.66-0.84]	0.64* [0.41-1.00]	0.36*** [0.27-0.48]	1.07 [0.66-1.76]
Individual factors
Constant
Female vs. Male			1.80^*** [1.48-2.19]	0.56^*** [0.46-0.68]
Maternal schooling ≥ 9 years of study vs. < 9 years			1.30* [1.06-1.59]	0.79^* [0.64-0.96]
Bolsa Família (No vs. Yes)			1.23^* [1.02-1.49]	1.21^* [1.00-1.47]
Binge drinking (Yes vs. No)			1.08 [0.88-1.32]	1.08 [0.89-1.32]
Physical activity (Active vs. Inactive)			1.32^* [1.04-1.68]	0.76^* [0.60-0.96]
Self-perceived health (Healthy/ Very healthy/Completely healthy vs. Not at all healthy/Not very healthy)			1.19 [0.97-1.46]	0.84 [0.68-1.03]
Contextual factors (Schooling level)
Semi-full period/Full period vs. Regular period		0.81 [0.66-1.00]		0.88 [0.72-1.06]
Neighborhood social vulnerability index (high/very high vs. medium/low/very low)		2.31 [0.66-8.05]		2.29 [0.71- 7.41]
Random part
Variation in the area (Random intercept)	0.22 [0.13-0.38]	0.16 [0.07-0.37]	0.07 [0.002- 3.17]	2.91e-08
PCV^&		- 27.3%	- 68.2%	- 99.9%
Median Odds Ratio	MOR = 1.23420	MOR = 1.16792	MOR = 1.07166	MOR = 1
Observations	2,454	2,454	1,842	1,842

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[1] Collaborations

AMCL Peixoto, TQ Melo e LAA Ferraz contributed to the acquisition, analysis, and interpretation of data and the writing of the manuscript; CFBF Santos, F Godoy, PAM Valença, VA Menezes, and V Colares contributed to the preparation and design of the study, data analysis and interpretation, and review of the manuscript.