背景:尽管人们普遍承认,诉诸民事司法(ATJ)是健康(SDOH)的关键社会决定因素,现有文献缺乏支持ATJ作为特定健康维度的SDOH的经验证据。
方法:法律流行病学,横截面,2023年3月在香港对n=908的随机抽样参与者进行了邮政调查。收集的数据是对民事司法系统的看法,健康,和社会人口统计学。感知ATJ使用司法不可及性量表(IOJ)和感知司法不平等量表(PIJ)的修订版进行评估,即“修改的IOJ-PIJ”,由两个量表的原始13个项目中的12个组成,分为两个子域:“程序公平”,和“结果中立”。对于健康数据,使用香港版的世界卫生组织缩写生活质量问卷(WHOQOL-BREF(香港))评估生活质量,使用四项患者健康问卷(PHQ-4)评估心理困扰(包括焦虑和抑郁症状),使用Sangha的自我管理合并症问卷(SCQ)评估合并症。结构方程模型(SEM)用于研究感知的ATJ与测量的健康结果之间的关系。
结果:SEM表明ATJ的两个子域与所有生活质量子域均具有显着负相关(B<0;p<0.05),除了在结果中性与社会关系之间;ATJ的两个子领域与焦虑和抑郁都有显著正相关(B>0;p<0.05);并且,在调整了年龄之后,只有“程序公平性”与合并症呈显著正相关(B>0;p<0.05)。
结论:这项研究提供了经验证据,证明ATJ是特定健康方面的SDOH。这项研究的结果鼓励法律,政策,以及旨在改善ATJ的举措,以及法律和卫生部门通过卫生-司法伙伴关系的合作努力,来自更广泛的社区,通过加强ATJ来保障和促进公众健康。
BACKGROUND: Although it is widely acknowledged that access to civil justice (ATJ) is a key social determinant of health (SDOH), the existing literature lacks empirical evidence supporting ATJ as a SDOH for specific dimensions of health.
METHODS: A legal epidemiological, cross-sectional, postal survey was conducted on n = 908 randomly sampled participants in Hong Kong in March 2023. Data collected were perceptions of the civil justice system, health, and sociodemographics. Perceived ATJ was assessed using a modified version of the Inaccessibility of Justice scale (IOJ) and Perceived Inequality of Justice scale (PIJ), i.e. the \"modified IOJ-PIJ\", consisting of 12 of the original 13 items from both scales divided into two subdomains: \"procedural fairness\", and \"outcome neutrality\". For health data, quality of life was assessed using the Hong Kong version of the Abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF(HK)), psychological distress (including symptoms of anxiety and depression) was assessed using the four-Item Patient Health Questionnaire (PHQ-4), and having comorbidities was assessed using Sangha\'s Self-Administered Comorbidity Questionnaire (SCQ). Structural equation modelling (SEM) was used to investigate the relationships between perceived ATJ and the measured health outcomes.
RESULTS: SEM demonstrated that both subdomains for ATJ had significantly negative associations (B < 0; p < 0.05) with all quality-of-life subdomains, except for between outcome neutrality with social relationships; both subdomains for ATJ had significantly positive association (B > 0; p < 0.05) with both anxiety and depression; and, after adjusting for age, only \"procedural fairness\" had significantly positive association (B > 0; p < 0.05) with having comorbidities.
CONCLUSIONS: This study provided empirical evidence that ATJ is a SDOH for specific dimensions of health. The results of this study encourage laws, policies, and initiatives aimed at improving ATJ, as well as collaborative efforts from the legal and health sectors through health-justice partnerships, and from the broader community, to safeguard and promote public health by strengthening ATJ.