Understanding the Context of Healthcare Utilisation for Children Under-five with Diarrhea in the DRC: Based on Andersen Behavioural Model
Bibliographic record
Abstract
Abstract Background Diarrhea is one of the leading causes of death among children under five years old in the Democratic Republic of the Congo (DRC). Despite positive effects on prognosis, there is limited literature about the healthcare-seeking behaviours of children with diarrhoea, especially in the DRC. This study used the Andersen Behavioural Model, a theoretical framework, which was commonly adopted to study healthcare utilisation, to investigate and predict factors associated with the use of healthcare to treat diarrhoea in the DRC. Methods Using structural equation modelling (SEM), we tested both direct and indirect relationships among four latent variables: predisposing traits, enabling resources access, health needs, and health services use. Guided by the Andersen Behavioural Model, the Confirmatory Factor Analysis model was also modified based on the DRC context. Results The modified model had the goodness of fit index (GFI) of 0.959 and RMSEA of 0.060 (95% CI: 0. 058, 0.061). Health needs (especially diarrhoea) had the largest positive direct effect on healthcare utilisation (standardized regression coefficient [β] = 0.79, P < 0.001), followed by “enabling resources” (β = 0.033, P < 0.001). Health needs also emerged as a mediator for the negative effect of predisposing traits on utilisation (indirect effect, β= -0.021; P < 0.001). Aside from predisposing traits, the proposed relationships (enabling resources access, health needs) were positively associated with healthcare utilisation. Discussion Results demonstrated that mothers with higher educational attainment, from wealthier households, and living in environments conducive to seeking health services were more likely to have positive healthcare utilisation behaviours when treating their children’s diarrhoea. Efforts are needed to strengthen and improve the caregivers’ awareness of children’s disease status, as well as communication between the healthcare system and the community. This will contribute to raising awareness of child diarrhoeal illness and their subsequent use of the healthcare system.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".