Factors affecting the uptake of cardiac rehabilitation services in a rural locality.

INTRODUCTION: A number of studies have investigated factors affecting uptake of cardiac rehabilitation services. However, little information on factors affecting uptake of services in rural localities is available. STUDY DESIGN: A cross-sectional survey. METHODS: A survey of patients eligible for cardiac rehabilitation was undertaken to investigate uptake of services. The effects of individual and geographic factors on service utilization were explored. RESULTS: Utilization rates for cardiac rehabilitation services within the South Staffordshire locality are low, with 59.3% of eligible patients invited to attend cardiac rehabilitation services following discharge from hospital, 38.6% attending and 22.5% completing the programme. Two factors were independently associated with low service utilization. Patients under the age of 65 years are 1.90 [95% confidence intervals (CI) 1.01-3.65] times more likely to complete rehabilitation than patients aged over 65 years, and women are only 0.48 (95% CI 0.22-1.03) times as likely as men to complete rehabilitation. The major reported barrier to utilization of services was access. This included problems with public transport, parking and the time and location of classes. Access and medical problems were significantly higher in older people and may have contributed to their low overall completion rate. Electoral ward deprivation, geographical access score, living in an urban or rural electoral ward, electoral ward of residence and provider were not significantly associated with service utilization. CONCLUSIONS: Overall, utilization rates were low. No geographical factors were associated with uptake of services, although the possible effect may have been mediated by the relative affluence of the locality. Two individual factors, age and sex, were most likely to influence uptake.

Information given to women invited for cervical screening: results of two postal surveys seven years apart.

In South Staffordshire, England, we compared women's views on information provided to them at different stages of the cervical screening program in 1994 with that provided in 2001. An age-stratified random sample of women aged 20-64 years who had a cervical smear taken between January and March 1994 (3856) or between January and March 2001 (4057) were sent postal questionnaires in June 1994 and July 2001, respectively. Response rates in 1994 (3124/3856, 81%) and 2001 (3288/4057, 81%) were similar. Compared to 1994, the proportion of women who thought the invitation letter was clear to read in 2001 increased (70% vs 98%, P < 0.0001); however, letters were thought to be less reassuring in 2001 compared to 1994 (P < 0.0001). In both study periods, 66% of women reported that the procedure was explained to them before the smear was taken. A greater proportion of women received their results by letter in 2001 compared to 1994 (57% vs 41%, P < 0.0001); however, 49% of women waited >4 weeks to receive their results in 2001 compared to 26% in 1994 (P < 0.0001). Bivariate analysis suggests that responses were age related, with older women (> or =45 years) experiencing poorer information provision. The issues highlighted by this study deserve further investigation in other areas.

An enquiry into the respiratory health effects on a rural community of a soil mound erected close to residential property.

The health concerns of a rural community were investigated following the erection of a soil mound in close proximity to residential property. Retrospective comparisons were made of respiratory and non-respiratory consultations with general practitioners between the exposed population and a sociodemographically similar comparison population. A 2-year period was examined, 1 year before and 1 year after the mound was erected. In the 1-year period prior to erection of the mound, similar consultation rates for both respiratory and non-respiratory conditions were observed in both populations. In the 1-year period following erection of the mound, the exposed population was more likely to consult for respiratory conditions than the comparison population (OR=4.10, 95% CI 2.26-7.44). No differences were observed for non-respiratory conditions. We identified a significant increase in respiratory consultations in the exposed population following erection of the soil mound. Limitations associated with this type of study should be considered when interpreting the results.

Knowledge of and preference for the DOMINO delivery option.

OBJECTIVE: To examine women's knowledge of and preference for the DOMINO (Domiciliary In and Out) delivery option in order to explain why uptake is lower than might be expected. DESIGN: Descriptive study using a self completion postal questionnaire. SETTING: Mid Staffordshire Health Authority (now part of South Staffordshire Health Authority). SUBJECTS: A systematic random sample of 1568 women aged 16-44 drawn from the Staffordshire Family Health Services Authority register of patients registered with a general practitioner. All women were included, regardless of childbirth experience. MAIN OUTCOME MEASURES: Preference and knowledge levels for this delivery option. MAIN FINDINGS: The response rate was 74%. Thirty-nine per cent had heard of the DOMINO option prior to receiving the questionnaire. Sixteen per cent expressed a preference for this option (95% CI 11.1-21.9). Some women who expressed a preference were excluded owing to high risk factors, giving an adjusted preference of 11% (95% CI 5.2-16.4). Preference was not related to either age, pregnancy experience or previous knowledge. CONCLUSIONS: More women expressed a preference for the option than would be expected from examination of national and local uptake figures. Lack of knowledge appears to be an important factor in explaining the low uptake. Purchasers, therefore, need to set contracts reflecting more realistic preferences and ensure that women have information on all options available to them, so that at the beginning of pregnancy women are enabled to make a shared decision on the choice of delivery. Both purchasers and providers need to monitor uptake and levels of knowledge.