Access to care: a study of mothers' utilization of services in Newfoundland and Labrador

Mothers play an influential role in defining family dynamics, child development and wellbeing, and accessing services for the family. The prevailing gender norms of intensive mothering places unrealistic demands on motherhood, negatively impacts maternal wellbeing, and contributes to mothers’ experience of blame for health issues of their children. Despite integral role of mothers and the documented negative impacts of intensive motherhood ideology, there is a dearth of literature on the typical Canadian maternal experience and consideration of the family context on access to services for mothers living in the community and coping with a wide range of mental health challenges. Access to services is a critical determinant of individual and population health outcomes and understanding health service use is important for planning of resource allocation in the community. Further research is needed on the health and wellbeing of Canadian mothers residing in the community and the factors that impact their access to services for themselves and their children. Utilizing Andersen’s (1995) fourth iteration of the Behavioural Model of Health Service Use in conjunction with a feminist lens, this explorative cross-sectional study captured the maternal experience of health and need for services of mothers living in the community in Newfoundland and Labrador (NL) and developed a comprehensive predictive model of mothers’ utilization of healthcare services for themselves and their children. Secondary data analysis was completed on a sample of 1082 mothers residing in NL who completed a province wide survey of their socio-demographic characteristics and measures of wellbeing and family life (e.g., OQ-45, PSOC, QCPCS). Univariate analyses were completed to characterize the sample and bivariate analyses were completed to compare the current sample of NL mothers to the Canadian census data available through Statistics Canada to assess for representativeness and generalizability of the motherhood survey. Separate stepwise binomial logistic regressions and binomial linear regressions were completed to build predictive models for engagement with services and quantity of services accessed by mothers in NL in the previous 12 months for themselves and their children. Environment factors, population characteristics (i.e., predisposing, enabling resources, need) and health behaviour variables supported by the literature to be potentially related to health service utilization for adults and children were included in the multivariate analyses. The significant predictors of maternal use of adult services explained 22.5% of variance while the significant predictors of maternal use of a range of adult services conditional on initial access accounted for 21.8% of the variance. The significant predictors of maternal access of at least one child service accounted for 38.1% of the variance and the significant predictors of maternal use of a range of child services conditional on initial access accounted for 17.9% of the variance. These findings can allow for the provincial health system to better support access to care for mothers and children at risk for needing but not accessing services and provide support for an integrative approach to providing services for families. These results are discussed in terms of their clinical relevance to health policy