JMIR Publications

ABSTRACT

Background:

Background:

Urban communities affected by chronic violence face persistent challenges in accessing primary health care (PHC). Although violence is widely recognized as a determinant of health inequities, limited evidence exists on how direct exposure to violent events relates to individuals’ perceptions of difficulty in accessing PHC services in highly vulnerable urban environments.

Objective:

Objective:

This study examined how sociodemographic characteristics and exposure to violent events are associated with perceptions of difficulty in accessing PHC, assessed through vignette-based responses in a community affected by chronic urban violence in Rio de Janeiro.

Methods:

Methods:

A cross-sectional survey was conducted with >1,000 residents who completed four PHC vignettes and reported past-year exposure to violent events. Participants completed a structured questionnaire that included sociodemographic information, past-year exposure to interpersonal violence, and evaluations of four hypothetical vignettes describing different clinical or social situations. Vignette responses were recorded using an ordinal Likert-type scale ranging from “very easy” to “extremely difficult.” Descriptive analyses were performed for all variables, and associations between sociodemographic characteristics and violence indicators were examined using Pearson’s chi-square tests. Differences in vignette ratings across sociodemographic groups were assessed using Kruskal–Wallis tests. To explore the underlying relationships among violence indicators, vignette responses, and sociodemographic variables, exploratory factor analysis and multiple correspondence analysis were conducted.

Results:

Results:

Violence exposure was frequent. Threats of harm were reported by 27.7% of Black participants and 30.5% of people from other ethnicities participants. Slapping was reported by 20.8% of Black individuals and 28% of people from other ethnicities individuals, while being pushed or restrained affected 21.2% and 26.7%, respectively. Significant sex differences emerged for being punched or kicked (female 17.2% vs. male 23.9%, p=.024). Kruskal–Wallis tests indicated few differences in vignette-based perceptions across groups, except for race in the alcohol-dependence vignette (χ² = 7.384, p=.0066). Factor analysis identified two dimensions: violence variables loaded strongly on one factor (0.83-0.96) and vignette responses on another (0.66-0.83). MCA results showed forms of violence contributing mainly to Dimension 1 (11-15%) and vignette categories to Dimension 2 (8-12%).

Conclusions:

Conclusions:

Exposure to violence is widespread but differently perceived and experienced by men and women. Perceived difficulty in accessing PHC was found to be independent of previous violent episodes. Strengthening PHC in violent urban settings requires addressing structural barriers that shape residents’ access to healthcare. Clinical Trial: Not aplicable