title: Determinants of Health Care Services Utilization among First Generation Afghan Migrants in Istanbul.
abstract: There is insufficient empirical evidence on the correlates of health care utilization of irregular migrants currently living in Turkey. The aim of this study was to identify individual level determinants associated with health service and medication use. One hundred and fifty-five Afghans completed surveys assessing service utilization including encounters with primary care physicians and outpatient specialists in addition to the use of prescription and nonprescription medicines. Multivariate logistic regression analyses were employed to examine associations between service use and a range of predisposing, enabling, and perceived need factors. Health services utilization was lowest for outpatient specialists (20%) and highest for nonprescription medications (37%). Female gender and higher income predicted encounters with primary care physicians. Income, and other enabling factors such as family presence in Turkey predicted encounters with outpatient specialists. Perceived illness-related need factors had little to no influence on use of services; however, asylum difficulties increased the likelihood for encounters with primary care physicians, outpatient services, and the use of prescription medications. This study suggests that health services use among Afghan migrants in Turkey is low considering the extent of their perceived illness-related needs, which may be further exacerbated by the precarious conditions in which they live.
authors.affiliation: Department of Social Work & Social Ecology, School of Behavioral Health, Loma Linda University, 1898 Business Center Drive, San Bernardino, CA 92408, USA. qalemi@llu.edu.
authors.forename: Qais
authors.initials: Q
authors.lastname: Alemi
authors.affiliation: Department of Sociology and Social Services, California State University, East Bay, 25800 Carlos Bee Blvd., Hayward, CA 94542, USA. carl.stempel@csueastbay.edu.
authors.forename: Carl
authors.initials: C
authors.lastname: Stempel
authors.affiliation: Department of Public Health Sciences, UCD School of Medicine, University of California, One Shields Avenue, Med Sci 1-C, Davis, CA 95616, USA. pmkoga@ucdavis.edu.
authors.forename: Patrick Marius
authors.initials: PM
authors.lastname: Koga
authors.affiliation: Department of Health Sciences, California State University, East Bay, 25800 Carlos Bee Blvd., Hayward, CA 94542, USA. valeriejs2@gmail.com.
authors.forename: Valerie
authors.initials: V
authors.lastname: Smith
authors.affiliation: Department of Sociology, Galatasaray University, Istanbul 34349, Turkey. didemdanis@yahoo.com.
authors.forename: Didem
authors.initials: D
authors.lastname: Danis
authors.affiliation: Department of Social Work & Social Ecology, School of Behavioral Health, Loma Linda University, 1898 Business Center Drive, San Bernardino, CA 92408, USA. kbaek@llu.edu.
authors.forename: Kelly
authors.initials: K
authors.lastname: Baek
authors.affiliation: Department of Social Work & Social Ecology, School of Behavioral Health, Loma Linda University, 1898 Business Center Drive, San Bernardino, CA 92408, USA. smontgomery@llu.edu.
authors.forename: Susanne
authors.initials: S
authors.lastname: Montgomery
mesh_terms: D000328:Adult; D000346:Afghanistan; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014171:Transients and Migrants / Q000523:psychology* / Q000706:statistics & numerical data*; D014421:Turkey; D055815:Young Adult; D016903:Drug Monitoring
keywords: Afghan; Andersen Model; Turkey; health services; medications; migrant; utilization