methods to evaluate the effectiveness of a community-based selection of indigents

Methods to evaluate the effectiveness of a community-based selection of indigents

N Atchessi, V Ridde, E Bonnet, K Kadio, M-V Zunzunégui

CRCHUM, Health Research AxisEcohealth 2014, August, 12th 2014

Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies

Introduction• Burkina Faso, West Africa• Community-based selection of

indigents in 2010• Step 1: CSV selection• Step 2: CoGes Selection• Indigents retained are those

selected by CoGes.• Is this an effective selection

method?• Objective: describe two

methods used to evaluate the effectiveness of a community-based selection of indigents


Method• Method 1: Spatial analysis

• Hypothesis 1: The entities representing the communities (CSV and CoGes) tended to select indigents who were physically nearer to them.

• Method 2: Analysis of characteristics • Hypothesis 2: Indigents selected by CoGes

are the more socially and economically vulnerable

• Strategy: Compare two groups of indigents selected by 2 types of community organization

According to your context


Method

Why these methods?• Both methods use objective criteria to measure a

selection method based on the judgment and will of selection committee members

• Determinants of health care access are used to assess the effectiveness of the indigent selection



Method• Spatial analysis

Socially and spatially representative sample of indigents in the two groups

Variables: village location, indigents location (GPS), road, trails network, hydrographic network, administrative boundaries

Analysis: geographic distribution of indigents

• Analysis of characteristics Variables: (Andersen and Newman model)

predisposing factors; facilitating factors; needs.

Logistic regression: Factors associated with possession of indigent card



Method

Challenges and limitations• Spatial analysis

Not enough to assess effectiveness of selection when used alone

Scarcity of geographic data

• Analysis of characteristics Age over/under-estimated Self-reported variables

Strengths and opportunities• Spatial analysis

Assessment of effectiveness of selection with geographic determinants of health

Indicators based on distance

• Analysis of characteristics Cross-sectional design Multivariate analysis Andersen and Newman model:

a comprehensive model


Results

Analysis of characteristics

Including an example


Spatial analysis: CSV had no particular pattern of

selection CoGes tended to select Indigents

who were geographically nearest to health centers

Variables OR CI 95%

Predisposin

g factors

Sex ns

Age ns

Widowedvs. not widowed

1.40*

[1.10-1.78]

Facilitating

factors

Instrumental assistance ns

Lack of financial assistancevs. financial assistance

1.58*

[1.26-1.97]

Living aloneLiving with spousevs. Living with children

1.28*2.00*

[1.01-1.63]

[1.35-2.96]

Needs

Chronic illness ns

Vision impairmentvs. no vision impairment

1.45*

[1.14-1.84]

Good mobility/poor strengthvs. Good mobility/good strength

1.73*

[1.28-2.33]

References

Thank you!

1-Andersen R, Newman JF: Societal and individual determinants of medical care utilization in the United States. Milbank Memorial Fund Quarterly. Health and Society 1973. 51(1): 95-124. 3-Nagi SZ: An epidemiology of disability among adults in the United States. Milbank Memorial Fund Quarterly. Health and Society 1976. 54(4): 439-467. 4-Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. Journal of Gerontology 1994. 49(2): M85-94. 5-Arnaud M., Emery X. (2000), Estimation et interpolation spatiale, Paris, Hermes Science Publications.6-Banos A., Huguenin-Richard F. (2000), « Spatial distribution of road accidents in the vicinity of point sources : application to child pedestrian accidents », in Flahault A., Toubiana L. (eds), Geography and Medicine, Elsevier, pp. 54-64.

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methods to evaluate the effectiveness of a community-based selection of indigents

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