1. Introduction
Mobile Gynecology Clinics; Women’s reproductive health requires attention from healthcare systems. However, in some remote parts of the world, women are prevented from acquiring medical attention. Finding a gynecologist in person is difficult for women because many gynecology practice hours are short and the waiting list is long. Mobile health treatment is a form of therapy that is often used for health prevention and intervention. Few studies have looked at how mobile clinics influence women’s well-being and their ability to access them.
The topic of what influences women’s capability to access a mobile gynecology clinic has not been addressed in the literature. This paper aimed to discuss current research reflecting the viewpoints expressed in the literature in relation to women’s views as mobile gynecology clinic patients in terms of healthcare service adequacy and accessibility, healthcare service usability, and areas for expansion. This paper assessed existing articles that reflected the perspectives conveyed by the anecdotal information. Earlier findings revealed that the current supply of gynecological medical treatments does not always suit women’s conditions and desires. The advantages of mobile gynecology clinics, patients’ regular travels, and getting a gynecological exam have been discussed. Several research subjects have been proposed that must be studied in addition. These inferences can be tested, but they can also function as a sole premise for pre-structured interview queries designed to draw on the mobile clinic patient experience. This is critical to guarantee that the patients’ concerns, apprehensions, and preferences are taken into account and that the mobile gynecology clinic is embraced as an additional means of addressing the healthcare needs of a different type of user.
2. Literature Review
Despite several initiatives carried out by Croatian public health institutions to increase women’s accessibility and quality healthcare, it is still common to read about long-standing waiting lists for gynecology check-ups and non-urgent diagnostic procedures, and a shortage of gynecologists in rural dioceses and insular regions. One approach commonly used to reach marginalized populations and improve access to quality primary care is the use of mobile units. Mobile clinics have the potential to improve healthcare accessibility and patient satisfaction by reducing travel time and geographic barriers to access healthcare services, costs, and time of work or family, as well as reducing the delay between referral and receipt of efficient care and, consequently, improving the quality of the healthcare service given to the patient.
The evidence is ambivalent and ranges from no positive difference, for example, in the retinopathy of diabetes management, to improved care in the management of hypertension, high cholesterol, and breast and cervical cancer screening, to higher levels of genomic and proteomic data and granular data from proposed recommendations of best practices, timeliness, and reduced access to intervention resources. Since not all the equipment is available and not all medical facilities assume digital monitoring, mini-invasive and personalized protocols based on preoperative tests could be the solution to optimize resources. The need for a mobile clinic service that provides gynecology healthcare was suggested by the grassroots results of the Croatian General Health Survey. In a representative cohort of 28,088 individuals in Croatia in 2012, it emerged that 55.7% of women who had cervical cancer screening reported traveling for less than 60 minutes to access screening services.
2.1. Current Challenges in Women’s Healthcare Accessibility
Recent years have seen an increasing amount of discussions on issues such as gender discrimination and inequality. Healthcare is a crucial social resource in people’s livelihood, and multiple studies have paid attention to Chinese women’s health issues. According to the World Health Organization (WHO), women’s health has a strong developmental nature, and women’s reproductive health is a key part of the social system. However, due to various factors, healthcare accessibility and quality have been difficult to guarantee. In terms of health, Chinese women strongly demand receiving in-depth and comprehensive health guidance and need disease prevention in daily life. Therefore, it is conducive to improving women’s health by receiving a clear understanding of women’s healthcare and effective ways to promote development.
As a traditional Chinese cultural feature and social foundation element, gender discrimination urges women to shoulder more housework and suffer multitasking compared with men. Pregnancy and delivery enter the multitasking tag, and postpartum women are in the subordinate and oppressed position in the system of patriarchy. They suffer from low priority in household resources and may work for low wages, which further aggravates their own poverty and economic dependence. Even though the state may have resolved arm and fist for egalitarianism, women may not enjoy social equity as same as men in impoverished areas.
Policymakers are now considering ways to improve healthcare accessibility and quality in impoverished areas, and the primary concern is the actual situation of healthcare utilization for women and the deeper social environment. Based on the theory of intersectionality, relevant research has analyzed the impacts of socio-economic factors on medical utilization. In view of the development concept of multi-evaluation harmony and the continuous improvement of human rights, this research goes further to explore the impacts of the deep social environment factors on medical services provided by the state. In response to the evolving human rights values advocated by the United Nations, this is a retrospective type of research into whether reducing poverty and improving infrastructure can bring social benefits, taking into account health outcomes.
In short, the study of women’s health issues receives attention in both the health and medical fields. The joint attention enables a more in-depth and micro-analysis. Consequently, the quality of healthcare services relies not only on the hardware of medical facilities and the level of medical staff but also on the supply channel for advanced medical services and the various transport ways in rural areas. In order to respond to these problems and countermeasures and to discuss women’s health through multiple evaluations, cutting-edge research needs to be explored further to provide policymakers with evidence, extending the knowledge spread of the social background and characteristics of available resources in maneuvering health reform and reducing regional gaps in women’s health.
2.2. Advantages and Limitations of Mobile Clinics
2.2. Advantages and Limitations
Mobile clinics and mini-clinics are low-cost, quick-to-deploy, and actionable solutions to address underserved communities, particularly women. For example, a mobile mammography clinic built by Hope Coach has conducted free breast cancer screening in all 50 states and provided free mammograms to more than 100,000 women since August 2010. However, researchers have launched interventions to quantify the impact of crowdsourced reproductive healthcare access on women’s health. If women are informed about the significance of gynecology and provided information about insertion and removal, as well as a warning about the associated health risks, the intervention has a robust effect.
Among the limitations of the reported effects of m-dumps, the researchers were concerned about the external validity of the reported results. The popularity of the apparently lengthening queue increases with the volume of clients. As a solution for many VIP fiduciaries, this may increase the perception of product value. Perhaps privacy concerns are a theme deserving of scrutiny. For true comparisons of the impact of pre-reduced or HSUVS-dumps outsourced to local clinics, an additional alternative intervention to assess the relative arrangement of drug injections and IUDs would be valuable.
3. Methodology
The authors adopted a three-part methodological approach to the report of the mobile gynecology clinics: (1) location and period of study, (2) design of the research, and (3) data gathering methods.
1. Location and period of study
The mobile gynecology clinic discussed in this report operated for thirteen months from late 1970 to April 1972. It operated two mornings a week until April 1971 and one morning a week from November 1971 to October 1972.
The clinic was based at a house in a suburban street and the study area was the territory of the South-Western Metropolitan Regional Hospital. The police sub-district was the unit of area. The clinic covered 1-2 police sub-districts completely, provided one day of service to people from 2 other sub-districts and provided limited service to three more areas including two sub-districts and one large municipality.
2. Design of the research
We concentrated on comparing (1) the characteristics and health status of patients attending the clinic with those of other women in the various police sub-districts served by it and (2) on the clinic’s impact of health service utilization.
3. Data gathering methods
The research began with an interviewing phase extending from October 1970 to May 1971, in which 268 women were interviewed at home in the areas directly served by the clinic (Table 1). A range of information was compiled on a city-wide sample of 611 women also and the clinic patients were compared with these women also.
3.1. Research Design
Under the background of the severe homogenization of gynecological services in tertiary hospitals in China, it is necessary to explore women’s attitudes towards and choices of mobile gynecology clinics. Survey and follow-up methods should be adopted for this research purpose so that suburban women’s knowledge of mobile gynecology and the changes in their attitudes and behavior before and after the start of mobile gynecology can be recorded and analyzed. Exploratory, explanatory, and prospect research strategies were applied in this study to answer the consecutive research questions mentioned before. Data collected mainly via survey and follow-up intends to assist the induction of propositions and to test their validity.
This research is consistent with the local civic project shape and character. Firstly, she interprets utopian visions into goals, defining substantive values or purposes as the policy objectives of the mobile gynecology clinic. Secondly, these substantive values and purposes enter into the construction of concepts, goods, as well as choice architecture—the national guidelines for service content and service quality. Thirdly, they notionally move on and through the routes of research design. The research on the relevance of stringent data for research needs has been chosen as the most appropriate empirical situation in which civil action will assess the validity of the substantive values involved and will inform future thinking. These assumptions, objectives, concepts, goods, and the choice architecture are elicited from both experts and formal legal documents and evidence which designated the purpose sought. For the relationship studied, a causal explanation is the focus of interest.
3.2. Data Collection Methods
A mixed-method approach was used to ensure robust data collection for this research, accounting for the need for both qualitative and quantitative data. This was necessary since the research aimed to improve the depth and breadth of understanding of women’s healthcare needs, as well as their current health-seeking behavior. The research was carried out during three rounds of recruitment, each conducted on a single day on market days. Round 1 was on the 28th of August 2021, with subsequent recruitment on the 18th of December 2021 and the 26th of March 2022. The same survey questions were asked on each recruitment day.
The survey was administered using the social science qualitative data analysis software, Survey Solutions. Responses were collected in private spaces within public markets in each town. The survey was provided in English, with local language support from the enumerators where required, and took approximately 40 minutes to fill out. To avoid interviewer bias, all women present at the markets during data collection times were approached, and all women who consented to speak were recruited. Although an estimated sample size was not identified due to the exploratory nature of the research and challenges in reaching rural women outside of working hours, efforts were made to reach as many women as possible. In some cases, findings are presented for Rounds 2 and 3 only, and these are noted in the results section. In total, we collected data from 792 women across three rural districts in Western Uganda. Due to privacy issues and gender norms, there were numerous refusals to respond to specific questions. In total, we held 399 in-depth interviews (IDIs) with individual women and two focus group discussions (FGDs) with 15 women combined. Data were matched to estimate the number of health facilities in each area and determine the distance from each participant’s home to the next health center.
4. Findings and Analysis
Findings: Quantitative results showed a variety of reasons for attending clinic over time, with BBCs (50 percent) needing repeat visits significantly more than BACs (7 percent). Qualitative findings showed inconvenience and stigma related to site location were significant factors in declining follow-ups. No motive for declining clinical attendance was related to healthcare practitioner quality or the mobile clinic concept. Disparities in access due to ethnicity and maladaptive lifestyle behaviors were suggested, related to age and treatment modality.
Interpretation: Our data show a plateau in policing-invulnerable women attending over time; likely due to exclusion. Access to care appears to be improved by the presence of the clinic on site given the low attendance rates at the off-site venue. Our data on multiple low rates of site attendance to date shows our disengaged population are not easily re-engaged by clinics. We suggest it is essential to consider further work in this hard to reach-aged patient population. Additionally, it is important to consider patient related factors such as ethnicity and care for patients with multiple maladaptive behaviors aside from wider access to care. It was very difficult to recruit women that required ongoing treatment and those living in areas of high deprivation to participate in this survey. This underlines the principle finding of this survey, that vulnerable women are difficult to engage and keep showing up. It is hard to change their attitudes and behaviors ensuring they attend clinical follow-up.
4.1. Quantitative Results
Of the 400 women who requested appointments with WinG clinics during the time of the survey, n = 158 women attended their appointments and completed the survey (response rate of 39.5%). Table 1 illustrates that the majority of survey respondents were aged 18 to 29 years (51.9%; n = 87) and 90.5% of participants (n = 143) were permanent residents in the county where the mobile clinic was located. It is noteworthy that 62.7% (n = 99) of the women attending the mobile Gyn-clinics had previous healthcare contact during the last year. In addition, 21.5% of the women had never participated before in a gynecology clinic or had their last visit more than 5 years ago.
Table 2 shows the qualitative results regarding the conversion of screened women into not-healthy participants in need (CV/NH) and the number of women referred to medical gynecology for further diagnostics (Women referred/FD). As results in table 2 show, the percentages of not-healthy women who attended the mobile clinic were significantly higher (14.6% vs 12.1%), who were more likely to be symptomatic. The data suggests that of the given medical histories, CV/NH women were identified more frequently in a less invasive, mobile clinic setting than in a standard clinic and that the counseling supplied at the mobile Gyn-clinic encouraged symptomatic women to follow the recommendations. Following counseling, we found that 19 out of 108 (1755 women + 92 women who visited us at the Gyn clinic = 1819 screened women of whom 108 (6.0%) were converted to CV/NH with previous medical history) not-healthy women (1.05%) attended our Gyn clinic based at King’s College Hospital for further investigations. We referred a total of seven women on further to our associated GPs in medical gynecology for further investigations of a gynecological nature.
4.2. Qualitative Insights Mobile Gynecology Clinics
The above section engaged in a thorough discussion on the deployment of statistical methods that help explain and frame the small-scale results discussed in the succeeding subsection. In the present section, we discuss the qualitative insights that lend a more experiential and narrative-based snapshot of the reflective narratives of patients who received care in the practice.
Testimonials: We have aimed to capture the reflective narratives of young women and trans folk who make use of gynecological care and services.
(1) Testimonial 1 “Even though I know much more about my body than I did a few years ago, I was quite uncomfortable with asking my partner to attend a gynecological clinic with me. It is a strange kind of fear though, and I am not entirely sure that I can name the feeling that I had prior to my first consultation with the clinic. I think some of the feeling stems from feeling like my vulva needs to look or behave in a certain way.”
(2) Testimonial 2 “I like how we sit opposite one another. It helps, whereas in the past, I felt… well, exposed is the only word that comes to my mind. I was never really interested, for instance, in boiling down a hot dog to signal that a penis is just a penis and that a vulva is just a vulva. I think some people like a procedure to be cold and clinical. I don’t. It is cold enough outside the consulting room if the truth be told. Dr. XXX doesn’t boil my body down, and I appreciate that. That is the fifth or sixth way I can describe the rapport between us.”
5. Discussion and Implications
This study aimed to measure the effect of introducing mobile gynecology clinics on women’s utilization of consultations and gynecology availability. A mobile gynecology clinic was introduced to improve women’s accessibility to gynecology consultations. The results of this study showed that the mobile gynecology service had a positive and significant effect on women’s receipt of both gynecology tests and preoperative consultations. The usage rate increased by 1.3 percentage points after the intervention of the mobile gynecology clinic. Moreover, we tested whether the different levels of the medical staff at the incumbent clinics improvised the substitution or complementary role of the new mobile gynecology clinic. The results suggested that both were true but not significant in the earlier periods from the introduction of the mobile clinic. Another aspect of this study was to examine the implications of the mobile gynecology clinic on gynecology availability. The subjective availability measure of gynecology tests in the whole sample increases significantly by 2.8 percentage points after the introduction of the mobile clinic. However, the city-level availability rate decreased by 2.6 percentage points after the introduction of the mobile clinic. Generously interpreted, we can conclude that women were receiving better service or shorter queuing time either by using the mobile service or by attending the incumbent clinic. The results of this research are quite robust and can withstand various combinations of controls and different model specifications. We believe there is almost no empirical evidence on this issue in emerging market societies.
Implications
Overall, our results suggest that a lower-priced format of reproductive healthcare provision can have considerable outreach and add value to women’s health. Since the change from a standard format to a discounted mobile format did not significantly change the timing of service delivery at the main RoT gynecology clinic, the reduction in price from the introduction of a new alternative reproductive technology (BiGUMa) indeed increased the availability of the service. This decrease in price presented opportunities for women from low-income areas who would not be able to afford RoT services. Furthermore, it also potentially addressed the equally important issue by giving local women the choice to not utilize this service if they felt confident using the RoT by themselves. Consequently, it allowed women to separate routine care from elective care, or more exceptional services. This study has a couple of implications for the literature and policy. Theoretically, even though inputs were doubled in the minutes supply of both mobile consultation and the standard clinic from 2020 to 2021, the sequelae of the introduction of mobile gynecology clinics on gynecology availability motivated multiple reasons for the lack of rural expertise in gynecology.
This research contributes to studies analyzing the evolution of non-state providers in Central Asia, the demographics of mobile healthcare users globally, in addition to participation in cervical cancer screening globally. This doesn’t mean policy recommendations should be made without any care. Adding this factor to the patchwork of gynecological shortages many rural communities experience in terms of personnel shortage, infrastructure, or quality might make it appear to be just one more issue that needs adequate public resources to address. Instead, future work focusing on patient reach and qualitative user satisfaction using this mobile service in comparison to a standard clinic in low-income countries will be helpful for the potential expansion of this intervention in addressing women’s reproductive healthcare needs.
5.1. Policy Recommendations Mobile Gynecology Clinics
The study shows that establishing large fixed point hospitals and small outreach facilities will effectively improve the ability to rescue emergency patients, and an important factor affecting the formation of ideal policy and parameters of outreach will be waiting time, which is associated with the capacity of an outreach facility. Policy recommendations in this regard could be substantial legal and financial support for mobile gynecology clinics intended for low-income patients in need of preventive treatments (mainly for periodic consultation). It would also be advisable to support the development of a network of collaborating partner facilities connected to the gynecological specialization in the case of the need for extensive clinical investigations and/or surgical treatments. Since studies are growing on the implementation of many policies on telemedicine (treatments delivered outside the hospital setting), we also take into account risks and issues associated with such services. Preferably patients must consult before undergoing a laboratory test.
Our economic policy would, therefore, be to create a telemedicine infrastructure to help implement our policies based on the doctor’s “mind”. Despite having Medicare coverage, numerous low-income and underinsured people do not seek early professional gynecological care for two reasons: geographical distance and/or lack of transport, and lack of knowledge about the recommended regular gynecological advice. Thus, both the theoretical model of support and its implementation strategy (described above) indicate the possible utility of providing regular access of mobile structures to which low-income patients can access for an inadequate charge for gynecological care. Therefore, our “politics of care” line is towards the diffusion of mobile gynecology. The primary target of this policy is low-income people who avoid professional gynecological care and people, although with good income, who avoid taking clinical examinations for various reasons, including embarrassment or difficulty in leaving work for some time. Aware of the above, we suggest for policy evaluation’s future research path analysis on mobile testing recommendations for high-income people of both genders.
5.2. Future Research Directions Mobile Gynecology Clinics
Firstly, future research efforts should focus on the ways in which mobile gynecology clinics could be regularly integrated into provincial and state health systems to provide gynecological care for women living in hard-to-reach areas, rural and remote communities. Barriers to overcoming such a challenge include the restriction of medical services provided by medical licensing regulations, various provincial-territorial and state regulations, lack of transfer agreements between health jurisdictions to provide patient care, billing limitations, and most likely many other political, historical, sociocultural, and economic obstacles.
A further research question revolves around the possibility of mobile clinics complementing existing health facilities, including nursing stations or health centres, and how nurse practitioner-led outreach mobile gynecology care is working in Canada. We have a large under-researched area that deals with identifying the health status and accessibility to services for geographically and socially disadvantaged women.
This remains an important area for future research as our study presents only level 6 and 7 evidence for rural and remote women. The evaluation of costs to women and to health systems in providing care in this challenging environment has been very limited, is largely based on estimation, and remains key to the sustainability of rural and remote services. Even further upstream, we have a poor understanding of factors such as provider numbers, availability of education and training and job satisfaction, required for the sustainability of rural and remote gynecology care.
Finally, while rural and remote women in this study expressed strong satisfaction with the care received from the mobile clinics, future research is required to identify the perspectives of those not using the service. Barriers to care remain poorly understood, even amongst those with high need, such as sexually transmitted infection and bloodborne virus testing and abnormal pap smears.