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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 28  |  Issue : 2  |  Page : 578-582

Utilization and assessment of school healthcare services provided to schoolchildren by family physicians in Menoufia, Egypt


1 Department of Community Medicine, Faculty of Medicine, Menoufia University, Menufia, Egypt
2 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menufia, Egypt

Date of Submission31-Mar-2014
Date of Acceptance09-May-2014
Date of Web Publication31-Aug-2015

Correspondence Address:
Mohamed Ahmed Hasan
Shebin El-Kom Health Sdministrator, Ministry of Health, 45 Sadat Street, Kafr El-Moseilha, Shebin El Kom, Menoufia Governorate
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.163921

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  Abstract 

Objectives
The aim of the study was to assess parents' satisfaction in as well as utilization of school healthcare services provided for their children.
Background
School healthcare services provide education and counseling in a variety of health and wellness topics and aid in controlling the spread of communicable diseases, serving as a medical resource in the development of policies and procedures in the school. Thus, improving school healthcare services will have a remarkable effect on children's health and on the community at large.
Participants and methods
This is a cross-sectional study involving 230 children older than 10 years chosen randomly from two grades from two schools, one from an urban area (Taha Hussein School in Shebin El Kom City, Menoufia Governorate) and the other from a rural area (Meet masoad primary school in Meet Masoad village, Menoufia Governorate), both schools having been chosen at random. This age group was selected so that the children were old enough to understand and help their parents fill up the questionnaire. The predesigned questionnaires were sent home with children to their parents and only 200 (86.95%) completed questionnaires were returned. The questionnaire include data on measurements of satisfaction in different services provided in the healthcare unit of the school, quality of school healthcare services, availability of school healthcare services, and degree of utilization of these services. The obtained data were tabulated and analyzed statistically.
Results
The study showed that there was no statistically significant difference between urban and rural areas with regard to the availability of school healthcare services.
The study also showed that about 74% of parents in the rural area seek medical advice in primary healthcare, represented by the family health unit.
Question No. 8 in our questionnaire asked about the type of medical care that was the participant's first choice (private clinic, hospital, or primary healthcare). Participants whose first choice was primary healthcare were classified as regular utilizers and the other participants were classified as nonregular utilizers. All 200 children were utilizers of school healthcare services. The study showed that differences in residence and parent satisfaction were highly significantly different between regular utilizers and nonregular utilizers (P < 0.01), whereas differences in availability of school healthcare services were nonsignificant between the two groups.
The study showed that 35% of rural parents considered the services to be expensive compared with 11% of urban parents.
Conclusion
The quality of school healthcare services is poor, as evaluated through the responses in our questionnaire. We recommend regular measurement of satisfaction in services provided to children in order to improve quality as well as provide regular training programs for medical staff to update their knowledge and improve their performance.

Keywords: accessibility, healthcare services, satisfaction, school health


How to cite this article:
Abu Salem ME, Salama AA, Hasan MA. Utilization and assessment of school healthcare services provided to schoolchildren by family physicians in Menoufia, Egypt. Menoufia Med J 2015;28:578-82

How to cite this URL:
Abu Salem ME, Salama AA, Hasan MA. Utilization and assessment of school healthcare services provided to schoolchildren by family physicians in Menoufia, Egypt. Menoufia Med J [serial online] 2015 [cited 2020 Feb 26];28:578-82. Available from: http://www.mmj.eg.net/text.asp?2015/28/2/578/163921


  Introduction Top


Family physicians provide promotive, preventive, and curative care to both healthy and sick children. Family physicians treat many children who are at risk because of lack of access to medical care, poor family support, lack of education, poverty, and other problems [1] .

Children and adolescents of the school-age group 5-19 years represent a large sector of the Egyptian population (38.6%), as they represent the future of this country for renaissance and development [2] .

The Students Health Insurance Programme was started in Egypt in the year 1992 when decree No. 99 was passed with its revisions, and executive decisions were issued in 1993. It introduced compulsory health insurance for all schoolchildren in kindergarten, primary, preparatory, and secondary schools in both the public and the private sector. The program is planned to provide a convenient, comprehensive, and acceptable source of care, as well as offer the opportunity to avail of preventive and primary care services [3] .

The goal of child healthcare is to have a healthy future generation and 'ensure that every child, whenever possible, lives and grows in a family unit, with love and security, in healthy surroundings, receives adequate nourishment, health supervision, and efficient medical care, and taught the elements of healthy living' [4] .

A comprehensive school healthcare program is an integrated set of planned, sequential, school-affiliated strategies, activities, and services designed to promote the optimal physical, emotional, social, and educational development of students. The program involves and is supportive of families and is determined by the local community, based on community needs, resources, standards, and requirements. It is coordinated by a multidisciplinary team and is accountable to the community for program quality and effectiveness [5] .

School healthcare services have two important functions:

  1. Support student health and educational success by providing day-to-day healthcare management for all students.
  2. Provide comprehensive healthcare services to students who would not otherwise have access to healthcare.
The first of these functions typically falls under the purview of school nurses, whereas the second function is accomplished mainly through school-based healthcare centers with linkages with community partners and resources [6] .

Utilization is proof of access or is evidence that access has been achieved. The type of services, whether or not the service can be reached, the cost of the service, the client's perceptions of the relative worth of the service, and the acceptability of services provided, all influence access and the utilization of services [7] .


  Participants and methods Top


This cross-sectional study was conducted on 200 children and their parents in both an urban and a rural area in Shebin El Kom District, Menoufia Governorate. Taha Hussein primary School in Shebeen El Koom City, representing a school in an urban area, and Meet-Masood primary School in Meet Masoud village, representing a school in a rural area, were selected through multistage random sampling.

Two grades from each school were chosen through random sampling, including boys and girls aged 10 years and above who were old enough to understand and help their parents in filling the questionnaire.

Parents of about 250 children were asked for their consent and 230 parents agreed to take part. Predesigned questionnaires were sent home with children to these parents and only 200 completed questionnaires were returned (incomplete questionnaires were excluded).

While preparing our questionnaire we collected and reviewed numerous questionnaires that were related to our study, although many covered only a part of the aim of our work, as well as many questionnaires used by the ministry of health in other countries, in order to aid us in preparing the most suitable one.

The questions were collected from questionnaires from the Egyptian ministry of health for measurement of patient satisfaction in primary healthcare models and questionnaires from the United States ministry of health for improvement of school healthcare services in Virginia State. We added some questions from other studies conducted by Al Kasr El Ainy for measurement of the quality of healthcare services. We selected the most important questions that would serve our study purpose.

The questionnaire covered the following:

  1. The socioeconomic status of the participants (seven questions).
  2. Degree of utilization of school healthcare services (11 questions), discussing availability of school healthcare services and whether it is the first choice.
  3. Quality of school healthcare services (28 questions), namely, the quality of laboratory services, pharmacy, dealing with teamwork, infection control, cost of services, and quality of introduction of the healthcare services.
  4. Measurement of satisfaction of different healthcare services provided - for example, by the pharmacy, the dentist, nurses, etc. (10 questions).
The data obtained were tabulated and analyzed using the statistical package of social science (SPSS) version 11 (Chicago, Illinois, USA) using an IBM personal computer) with significance at less than 5%.

Quantitative data were expressed as mean and SD (x ± SD) and compared using the Student Z-test. Qualitative data were expressed as number and analyzed by applying the χ2 -test. P values equal to 0.05 were considered significant, less than 0.05 were considered statistically significant, and more than 0.05 were considered statistically insignificant.


  Results Top


A total of 230 questionnaires were sent home with children to their parents and 200 (86.95%) completed questionnaires were returned with full data, which were tabulated and analyzed.

The results show that about 74% of parents in rural areas seek medical advice in primary healthcare centers represented by the family health unit, whereas about 10% of parents prefer hospitals and 16% of parents prefer private clinics. In contrast, in urban areas about 26% of parents seek medical advice in primary healthcare centers represented by the family healthcare center and about 27% of parents prefer hospitals and 47% prefer private clinics. These results show highly significant differences between rural and urban areas (P < 0.001) [Figure 1].
Figure 1: Comparison of utilization of different healthcare facilities between urban and rural areas

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[Table 1] Question No 8 in our questionnaire asks about the type of medical care that is the participant's first choice (private clinic, hospital, or primary healthcare?). Participants whose first choice was primary healthcare were classified as regular utilizers, and the other participants were classified as nonregular utilizers. All 200 children were utilizers of school healthcare services and we studied the utilization of healthcare services between regular and nonregular utilizers.
Table 1 Determinant of utilization of school healthcare services provided to schoolchildren by family physicians in the selected group

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The study shows that residence and parent's satisfaction in school healthcare services constitute the main determinants of utilization of these available services, with a highly significant difference between regular utilizers and nonregular utilizers (P < 0.01); in contrast, availability of school healthcare services showed insignificant difference between the two groups (P = 0.06) [Table 1].

The study shows a statistically significant difference (P < 0.001) between rural and urban areas as regards the time needed to reach the nearest family healthcare unit or center and a statistically significant difference (P < 0.001) between the two as regards the cost of service. Thirty-five percent of rural parents considered the services expensive compared with 11% of urban parents [Table 2].
Table 2 Comparison between accessibility of school healthcare services as a determinant of healthcare services between urban and rural areas

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  Discussion Top


Limitations of the study

Methodological limitations

The number of students was too small to give accurate data for statistical tests and obtain an accurate result. The parents may not have understood the seriousness of this study and may have provided unreliable data, which could have affected our results. Another limitation of the study was lack of prior research studies on the topic. Moreover, some questions in the ministry of health questionnaire were insufficient to give us accurate data.

Limitation of the researcher

It was very difficult to obtain legal consent from authorities to administer our questionnaire through schools because of the connection to the education ministry. It was very hard to define our study to parents, especially in the rural area, because of their cultural limitations.

Our study reported that about 26% of participants in urban areas seek medical advice in primary healthcare, represented by the family healthcare unit, whereas about 74% of participants in rural areas reported the same. These results were highly significantly different between rural and urban areas (P < 0.001) [Figure 1].

Our results are in agreement with those of Wade et al. [8] who reported that about 59.3% of rural children prefer primary care as the first choice for healthcare compared with about 53.2% of urban children, indicating higher utilization of primary healthcare in rural than in urban groups. In contrast, in a Greek study Mariolis et al. [9] reported that utilization of primary care by urban children is higher than that by rural children because of greater satisfaction from services provided in the center and short waiting time in the center than in the unit.

Our study shows that 69.6% of children in the urban group are regular utilizers of school healthcare services, whereas 30.4% of the urban group are regular utilizers. Residence and patient satisfaction show a highly significant difference between regular utilizers and nonregular utilizers (P < 0.01), whereas availability of school healthcare services shows nonsignificant difference between the two groups [Table 1].

These results agreed with those of the study on Geographic Access to HealthCare by Chan et al. [10] , who reported that utilization of school healthcare services is higher in rural than in urban areas. Seventy-four percent of rural participants and 54% of urban participants are utilizers of the services.

In the study by Katic et al. [11] one of the most common parameters referred to by the study participants - often the sole or fundamental one - was the level of satisfaction with medical care. This is actually the domain of quantitative research. In qualitative research also this kind of categorization is possible, although it does not concern the participants but rather their utterances. The lengthy transcripts from 36 in-depth interviews contained 1305 statements to which a positive or negative connotation could be attributed: 689 (52.8%) were positive and 616 (47.2%) were negative. The difference in the distribution of positive and negative statements was statistically significant (χ2 = 102.02; P < 0.001).

In contrast, the study by Farmer et al. [12] on healthcare in Scotland reported statistically nonsignificant differences between rural and urban utilizers of school healthcare services: 76% of utilizers among both urban and rural participants rated the service as being between excellent and very good service.

The study shows that 75% of participants in the rural group take less than 15 min to reach the nearest healthcare unit, whereas 15% in the urban group reported the same time to reach the nearest healthcare unit. There was a statistically highly significant difference (P < 0.001) between rural and urban areas as regards the time needed to reach the nearest family healthcare unit or center and a statistically highly significant (P < 0.001) difference between the two as regards the cost of service. Thirty-five percent of rural parents considered the service to be expensive compared with 11% of urban parents [Table 2].

This agreed with the results of Edwards and Staniszewska [13] who reported that access to and availability of school healthcare services was expected to be greater in urban areas, and hence higher use can be seen among urban children than among those in rural areas; however, they found that participants in urban areas of Karnataka were less likely to receive healthcare compared with those living in rural areas. In case of Andhra Pradesh, there was no significant difference between rural and urban residency regarding the utilization of school healthcare services.

In contrast, the study by Lenardson et al. [14] reported that rural residents are more likely to experience difficulty in accessing their usual source of care as rural residents are much more likely to have trouble reaching their usual source of care compared with urban groups (37 and 29%, respectively).

Another study by DeVoe JE et al. [15] reported that 83% of rural residents are aware of the availability of school healthcare services compared with 79% of urban residents.


  Conclusion Top


Although most of the participants were aware of the availability of school healthcare services in both urban and rural areas, there is limited utilization of school healthcare services because several barriers that prevent ideal utilization.

The participants gave variable responses for the cost of services: most urban participants considered the cost normal, whereas most rural residents considered it expensive. This difference may be due to the difference in economic status of urban and rural residents but we hope to make school healthcare services totally free to achieve optimum utilization.

We are in need of improving the role of family physicians and nurses in school healthcare programs and providing regular training programs for medical staff to update their knowledge and improve their performance. Further, children should be followed up through family healthcare records in primary healthcare centers as it is a good source of information about the child's medical condition.


  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Phillips RL, Dodoo MS, McCann JL. Report to the task force on the care of children by family physicians. Washington, DC: Robert Graham Center; 2005, Available at: http://www.grahamcenter.org/PreBuilt/Child_Care_Report.pdf. [Accessed 1 June 2006]  Back to cited text no. 1
    
2.
El-Zanaty F, et al. Egypt Demographic and Health Survey 1995. Cairo, Egypt: National Population Council; 1996.  Back to cited text no. 2
    
3.
Nandakumar A, Reich M, Chawla M, Berman P, Yip W. Health reform for children: the Egyptian experience with school health insurance. Health Policy 2000; 50 :155-170.  Back to cited text no. 3
    
4.
WHO. Promoting health through schools. The WHO global school health initiative. Geneva, World Health Organization 1996.  Back to cited text no. 4
    
5.
Allensworth D, Lawson E, Nicholson L, Wyche Jeds. School & Health: Our Nation's Investment. Washington, DC: National Academy Press; 1997. p. 2.  Back to cited text no. 5
    
6.
American Academy of Pediatrics [AAP]. Committee on School Health. School health centers and other integrated school health services. Pediatrics 2001; 107 :198-201.  Back to cited text no. 6
    
7.
Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care 1981; 19 :127-140.  Back to cited text no. 7
    
8.
Wade TJ, Line K, Huentelman T. A prescription for success: how school-based health centers affect health status and health care use and cost. Cincinnati: The Health Foundation of Greater Cincinnati; 2005. School-based health centers (SBHC) evaluation project.  Back to cited text no. 8
    
9.
Mariolis A, Merkouris B, Lionis C. Introducing general practice in urban Greece: focus on morbidity profile. Eur J Gen Pract 2004; 10 :105-106.  Back to cited text no. 9
    
10.
Chan L, Hart L, Goodman D. Geographic access to health care for rural medicare beneficiaries. J Rural Health 2006; 22 :140-146.  Back to cited text no. 10
    
11.
Katic M, Budak A, Ivankovic D, Mastilica M, Lazic D, Babic-Banaszak A, Matkovic V. Patients' views on the professional behaviour of family physicians. Fam Pract 2001; 18 :42-47.  Back to cited text no. 11
    
12.
Farmer J, Hinds K, Richards H, Godden D. Urban versus rural populations' views of health care in Scotland. J Health Serv Res Policy 2005; 10 :212-219,   Back to cited text no. 12
    
13.
Edwards C, Staniszewska S. Accessing the user's perspective. Health Soc Care Community 2002; 8 :417-424.  Back to cited text no. 13
    
14.
Lenardson JD, Ziller EC, Coburn AF, Anderson N. Profile of rural health insurance coverage: a chartbook. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; 2009.  Back to cited text no. 14
    
15.
DeVoe JE, Fryer GE, Phillips R, Green L. Receipt of preventive care among adults: insurance status and usual source of care. Am J Public Health 2003; 93 :786-791.  Back to cited text no. 15
    


    Figures

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    Tables

  [Table 1], [Table 2]



 

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Introduction
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