{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T07:55:31Z","timestamp":1791186931614,"version":"4.1.0"},"reference-count":50,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Access to healthcare remains a major challenge in low\u2010 and middle\u2010income countries, including Ethiopia, where financial and geographic barriers limit service utilization. Community\u2010Based Health Insurance (CBHI) has been introduced to enhance financial protection and improve healthcare access. This study examined factors associated with women's perceptions of CBHI in improving healthcare access in the Sidama Region, Southern Ethiopia, in 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A community\u2010based cross\u2010sectional study was conducted among women using a multistage stratified sampling approach. Data were collected through face\u2010to\u2010face interviews using the KoBoTool platform. Multilevel logistic regression analysis using Stata 18 examined individual\u2010 and community\u2010level determinants of women's perceptions of healthcare access. Adjusted odds ratios (AORs) with 95% confidence intervals were reported. Statistical significance was set at\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 845 women sampled, 835 (98.8%) were interviewed. Women residing in low\u2010poverty communities had significantly higher odds of perceiving improved access compared to those in high\u2010poverty areas (AOR\u2009=\u20094.6; 95% CI: 1.8\u20139.1). Rural residents were less likely to report improvements than urban residents (AOR\u2009=\u20090.37; 95% CI: 0.18\u20130.68). Recent health facility visits increased positive perceptions more than fourfold (AOR\u2009=\u20094.1; 95% CI: 1.9\u20138.2), whereas missed visits reduced the likelihood by 45% (AOR\u2009=\u20090.55; 95% CI: 0.34\u20130.88). Perceived inadequacy of the CBHI package and unfair contributions were associated with substantially lower odds of positive perception. Acceptance of CBHI emerged as the strongest predictor (AOR\u2009=\u20096.3; 95% CI: 2.1\u201313.6).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Women's perceptions of CBHI are shaped by socioeconomic conditions, residence, healthcare utilization, and views on fairness and adequacy. Strengthening equitable and culturally responsive CBHI implementation may enhance healthcare access in Ethiopia and similar settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.73097","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T10:03:57Z","timestamp":1787738637000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multilevel Analysis of Women's Perceptions of Community\u2010Based Health Insurance on Healthcare Access in Sidama Region, Ethiopia: A Community\u2010Based Cross\u2010Sectional Study"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6118-9153","authenticated-orcid":false,"given":"Kare Chawicha","family":"Debessa","sequence":"first","affiliation":[{"name":"School of Public Health, College of Medicine and Health Sciences Hawassa University Hawassa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7708-6370","authenticated-orcid":false,"given":"Amanuel","family":"Yoseph","sequence":"additional","affiliation":[{"name":"School of Public Health, College of Medicine and Health Sciences Hawassa University Hawassa Ethiopia"},{"name":"School of Public Health University of Saskatchewan Saskatoon Canada"},{"name":"Department of Epidemiology and Biostatistics, Faculty of Health Sciences Western University London Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3961\/jpmph.21.542"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-018-0721-4"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-022-07889-4"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0320218"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/22799036251388587"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.worlddev.2018.01.023"},{"key":"e_1_2_11_8_1","volume-title":"Ethiopia's Economic Reboot: Turning USAID Cuts Into A Catalyst for Change","author":"Muleta E.","year":"2025"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0316948"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-023-15434-z"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1067773"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmhs.2025.100066"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1051\/e3sconf\/202565002025"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.54393\/nrs.v3i02.47"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12982-025-00998-5"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0004310"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-024-11617-5"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/27707571.2024.2338943"},{"key":"e_1_2_11_19_1","first-page":"1","volume-title":"The Constitution of the Sidama National Regional State","author":"Sidama National Regional Council","year":"2020"},{"key":"e_1_2_11_20_1","volume-title":"The Sidama National Regional State Health Sector report","author":"Bureau SNRH"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-021-06846-x"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.3390\/land11081298"},{"key":"e_1_2_11_23_1","author":"Qassimi N.","year":"2023","journal-title":"Ensuring Ethical Research Practices: A Comprehensive Examination of Actions Aligned With Ethical Principles"},{"key":"e_1_2_11_24_1","first-page":"2015","volume-title":"Ethiopia's Community\u2010Based Health Insurance: A Step on The Road to Universal Health Coverage. Health Finance And Governance","author":"USAID","year":"2015"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.15171\/jcvtr.2019.14"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0315681"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1525\/collabra.33267"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0234028"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0175925"},{"key":"e_1_2_11_30_1","doi-asserted-by":"crossref","unstructured":"L.Bokonda O. T.Khadija andN.SouissiMobile Data Collection Using Open Data Kit.2019. p. 543\u2010550.","DOI":"10.1007\/978-3-030-36778-7_60"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.13005\/ojcst13.0203.03"},{"issue":"8","key":"e_1_2_11_32_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2023-012639","article-title":"Alternative Approaches for Creating a Wealth Index: The Case of Mozambique","volume":"8","author":"Kexin X.","year":"2023","journal-title":"BMJ Global Health"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0219854"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-018-2016-6"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.4097\/kja.19087"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.21580\/square.2022.4.1.11297"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2024.08.025"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2020-316519"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdeveco.2018.05.014"},{"key":"e_1_2_11_40_1","first-page":"333","volume-title":"Innovation, Entrepreneurship and the Informal Economy in Sub\u2013Saharan Africa: A Sustainable Development Agenda","author":"Uzoma A. B.","year":"2024"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-28099-4_106"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0002420"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.3798\/tia.1937-0237.2109"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2014.07.018"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0272959"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.4103\/jpgm.jpgm_533_24"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.2147\/CEOR.S293847"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.4103\/2249-4863.192376"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1177\/22799036231163382"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmedr.2023.102234"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12962-024-00541-4"}],"container-title":["Health Science Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hsr2.73097","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hsr2.73097","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hsr2.73097","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T07:41:14Z","timestamp":1791186074000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hsr2.73097"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":50,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/hsr2.73097"],"URL":"https:\/\/doi.org\/10.1002\/hsr2.73097","archive":["Portico"],"relation":{},"ISSN":["2398-8835","2398-8835"],"issn-type":[{"value":"2398-8835","type":"print"},{"value":"2398-8835","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]},"assertion":[{"value":"2025-08-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e73097"}}