title: Rural health in Jamaica: examining and refining the predictive factors of good health status of rural residents.
abstract: BACKGROUND
  Poverty is mainly concentrated in rural areas. Rural populations also generally experience excessive deficiencies in healthcare access, social services, and other goods and services needed for healthy living. This study investigated the health status and determining factors of Jamaican rural residents in order to provide healthcare practitioners and policy makers with research findings to assist in effectively addressing health in rural Jamaica.
  
  
  METHODS
  The current research used a sub-sample of 15 260 respondents. The sub-sample was taken from a national cross-sectional study of 25 018 respondents from the 14 parishes of the island. The survey from which the present study is drawn used a stratified random probability sampling technique to draw the 25 018 respondents. Descriptive statistics were used to provide background information on the demographic characteristics of the sub-sample population. The model will be established using logistic regression using statistically significant (p <0.05) variables.
  
  
  RESULTS
  The sub-sample population of this study constituted 15 260 respondents of which 99.1% responded to the gender question. Of the 99.1%, 50.7% were males and 49.3% females. It was found that 17.2% of the population reported poor health (n = 2554), 82.8% (n = 12 285) reported good health and 5.9% (n = 873) reported private health insurance coverage. The model used had statistically significant predictive power (model chi2 = 15939.9, p <0.001; Hosmer and Lemeshow goodness of fit, chi2 = 14.46, p = 0.71). It was found that 85.1% (n = 4738) of the data were correctly classified. Of those with good health, 97.2% (n = 4387) were correctly classified, while of those with poor health, 38.6% (n = 451) were correctly classified. Some 12 factors can be used to predict the health status of rural residents in Jamaica with chi2(28) = 1595.03, p <0.001; -2 Log likelihood = 4181.232, which accounted for 38.4% of the variability in health status. An examination of the predictors revealed that the six most influential in descending order were: health insurance coverage (Wald statistic = 492.556; OR = 0.044, 95% CI: 0.033-0.058, p <0.001); age of respondents (Wald statistic = 222.211; OR = 0.957, 95% CI: 0.951-0.962, p < 0.001); secondary level education (Wald statistic = 28.403; OR = 0.580, 95% CI: 0.475-0.709, p <0.001); gender (Wald statistic = 27.804; OR = 1.602, 95% CI: 1.345-1.909, p <0.001); negative affective conditions (Wald statistic = 14.608; OR = 0.949, 95% CI: 0.924-0.975, p <0.001) and positive affective conditions (Wald statistic = 12.208; OR = 1.063, 95% CI: 1.027-1.100, p <0.0010), and number of children in the household (Wald statistic = 11.850; OR = 1.141, 95% CI: 1.058-1.230, p <0.01).
  
  
  CONCLUSIONS
  The study showed that approximately 83% of rural residents reported good health, and the 12 factors accounted for 38% of the variability in good health. Of the 12 factors, ownership of health insurance was the most significant and this is negatively associated with good health status. The other factors that are predictors of health status of rural residents included age, secondary level education, gender of respondents, and negative and positive affective psychological conditions. Within the context of high poverty and the role of health seeking behaviour of rural residents on health status, there is a need to use an inter-sectoral approach to accomplish better quality of life through improved health status.
authors.affiliation: Department of Community Health and Psychiatry, Faculty of Medical Sciences, Unviersity of the West Indies, Kingston, Jamaica, West Indies. paulbourne1@yahoo.com
authors.forename: Paul A
authors.initials: PA
authors.lastname: Bourne
authors.forename: Donovan A
authors.initials: DA
authors.lastname: McGrowder