Psychometric Properties of the Access of Older Adults to Outpatient Primary-Care Health Services Scale.

This study evaluates the psychometric properties of the Access of Older Adults to Outpatient Primary-Care Health Services Scale (AOAOPHSS), in research conducted among 707 Mexican older adults selected by convenience from 14 rural and one urban locations. The AOAOPHSS explores 10 dimensions of two integrated subscales: Accessibility and Personal Abilities. Data analysis was performed in five phases. First, potentially biased responses were identified. Second, the response efficiency of the items and their association with external variables were evaluated. Third, the basic properties of the scores for the subscales' dimensions of the AOAOPHSS were identified using non-parametric Mokken Scaling Analysis (MSA). Fourth, the Structural Equation Modeling methodology was used to identify the properties of the internal structure of the latent construct. Finally, reliability and internal consistency were evaluated at both score and item levels. The following findings emerged. 13 items with inefficient response options were removed, and 24 were retained using the MSA. The latent structure of the latter was defined based on 21 items of five Accessibility Subscale dimensions. Its internal consistency reliability ranged between 0.67 and 0.81 (omega coefficients) and between 0.61 and 0.78 (alpha coefficients). Accordingly, this paper discusses the overall implications of using the Accessibility Subscale.

Content Validity of a Scale Designed to Measure the Access of Older Adults to Outpatient Health Services.

The objective of this work was to validate the content of a scale formulated in Spanish for older adults in Mexico, with the aim of comprehensively measuring the access of this population group to outpatient primary-care services. To this end, we carried out a methodological content-validity study in four stages: (1) construction of the scale; (2) evaluation of item legibility; (3) quantitative content evaluation by two groups of judges selected by convenience: participant-judges including older adults with adequate reading comprehension, surveyed in person (n = 23), and expert-judges comprised of researchers specialized in the fields of health services, psychometrics and aging, surveyed online (n = 7); and (4) collection of qualitative feedback from several of the participant-judges (older adults, n = 4). The content was validated both by sequentially examining the level of consensus in the responses of both groups of judges, using the Tastle and Wierman method, and by calculating Aiken's Validity Coefficient with a 90% confidence interval. The scale contained 65 items pertaining to 10 dimensions of two major constructs: accessibility (n = 39) and personal abilities (n = 26). Five items were eliminated in accordance with the minimum-consensus criterion (0.5). This is the first psychometric scale to be developed in Mexico with the view of integrating the characteristics of health-care services and the abilities of the older adults in a single questionnaire designed to measure the access of this population group to outpatient primary-care services.

Revisión y análisis sobre los determinantes de acceso a los servicios de atención primaria en población adulta mayor rural y urbana / Review and analysis of the determinants of access to primary care services in the rural and urban elderly population / Revisão e análise dos determinantes do acesso aos serviços de atenção primária na população idosa rural e urbana / Révision et analyse des déterminants de laccès des personnes âgées aux services de soins primaires en milieu rural et urbain

Resumen Objetivo Identificar los determinantes de acceso a los servicios de atención primaria en adultos mayores, residentes en áreas rurales y urbanas de diferentes regiones del mundo. Materiales y Métodos Se realizó una revisión sistemática de la literatura en bases electrónicas, a partir de publicaciones cualitativas y cuantitativas de fuente primaria o secundaria, descritas entre 2015 y 2019. Se determinaron palabras clave enmarcadas bajo el Modelo de Dimensiones y habilidades de Levesque, Harris y Russell. El análisis se efectuó utilizando una lista de chequeo con cinco criterios técnicos de evaluación, elegidos por conveniencia técnico-académica. Resultados La búsqueda inicial identificó 118 manuscritos para revisión. Los estudios fueron analizados y clasificados en cinco segmentos que involucran a cinco regiones del mundo. Los principales determinantes de acceso encontrados, fueron clasificados en habilidades personales de los adultos mayores y características propias del sistema de salud, tanto para el área rural como urbana. Conclusiones A nivel mundial el principal determinante de acceso a los servicios de atención primaria en adultos mayores, residentes de áreas rurales es la falta de disponibilidad de servicios; mientras los de población urbana, mantienen las barreras financieras como el principal obstáculo para su acceso a la salud.

Abstract Objective The determinants of access to primary care services in elderly people living in rural and urban areas of different regions of the world. Material and Method A systematic review of the literature in electronic databases was carried out from qualitative and quantitative publications, of primary or secondary source, described between 2015 and 2019. Key words were determined framed under the Levesque Dimensions and Skills Model, Harris and Russell. The analysis was carried out using a checklist with five technical evaluation criteria chosen for technical-academic convenience. Results The initial search identified 118 manuscripts for review. The studies were analyzed and classified in to five segments that involve five regions of the world. The main determinants of access found were classified in to personal skills of the elderly and characteristics of the health system for both rural and urban areas. Conclusions It is concluded that at the global level the main determinant of access to primary care services in elderly residents of rural areas is the lack of availability of services; while urban older adults maintain financial barriers as the main obstacle to their access to health.

Resumo Objetivo Identificar os determinantes do acesso aos serviços de atenção primária em idosos, residentes em áreas rurais e urbano de diferentes regiões do mundo. Material e Método Foi realizada uma revisão sistemática da literatura sobre bases eletrônicas com base em publicações qualitativas e quantitativas de fonte primária ou secundária descritas entre 2015 e 2019. Foram determinadas as palavras-chave enquadradas no Modelo de Dimensões e Habilidades de Levesque, Harrise Russell. A análise foi realizada pormeio de uma lista de verificação com cinco critérios de avaliação técnica, escolhidos por conveniência técnico-acadêmica. Resultados A pesquisa inicial identificou 118 manuscritos para revisão. Os estudos foram analisados e clasificados em cinco segmentos, envolvendo cinco regiões do mundo. Os principais determinantes de acesso encontrados foram classificados em habilidades pessoais dos idosos e características do sistema de saúde, tanto nas áreas rurais quanto nas urbanas. Conclusões O principal determinante do acesso a serviços de atenção primária a idosos residentes em áreas rurais é a falta de disponibilidade de serviços; enquanto a população urbana mantém as barreiras financeiras como o principal obstáculo ao acesso à saúde.

Résumé Objectif Identifier les déterminants de l'accès aux services de soins primaires de personnes âgées vivant en zone rurale et urbaine de différentes régions du monde. Matériel et Méthode Une revue systématique de la littérature a été réalisée en cherchant dans des bases de données électroniques des publications qualitatives et quantitatives, de source primaire ou secondaire, décrites entre 2015 et 2019. Les mots-clés ont été déterminés d'après le modèle de dimensions et compétences de Levesque, Harris et Russell. L'analyse a été effectuée à l'aide d'une liste de contrôle avec cinq critères techniques d'évaluation, choisis par convenance technique et académique. Résultats La recherche initiale a permis d'identifier 118 manuscrits à examiner. Ces études ont été analysées et classées en cinq segments correspondant à cinq régions du monde. Les principaux déterminants de l'accès trouvés ont été classés selon les capacités personnelles des personnes âgées et selon les caractéristiques propres du système de santé, tant pour les zones rurales que pour les zones urbaines. Conclusions Mondialement, le principal déterminant de l'accès aux services de soins primaires de la part des personnes âgées vivant en zone rurale est le manque de disponibilité des services; tandis que pour la population urbaine, il s'agit de barrières financières.