{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:43:19Z","timestamp":1792629799474,"version":"4.5.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Partnerships between the state and faith-based providers, such as the Christian Health Association of Ghana (CHAG), are crucial for expanding healthcare coverage in lower-middle-income countries. However, limited evidence exists on how communities perceive these services and what factors are associated with continued use among those who access them. We conducted a quantitative cross-sectional facility-exit survey among 799 current and past users recruited at CHAG facility exits across four regions between October and December 2024. Data were collected using a structured questionnaire guided by the Sustainability of Innovation Framework. Descriptive statistics, \u03c72 tests, and exploratory multivariable logistic regression evaluated factors associated with continued use of CHAG facilities among existing users. Among this facility-exit sample, continued use was remarkably high (94.1%) and 95.1% preferred mission facilities over alternatives. Geographic access and socioeconomic status were not significantly associated with continued use patterns (P &amp;gt; .05), though this finding reflects the sampling strategy that over-represents users and should not be interpreted as community-level prevalence. Perceptual factors dominated the exploratory regression analysis: positive self-rated health (AOR = 3.88, 95% CI: 1.98\u20137.63), perceived service quality (AOR = 7.48, 95% CI: 3.46\u201316.18), and feeling safe at the facility (AOR = 9.12, 95% CI: 4.36\u201319.08) were exploratorily associated with continued use. These effect sizes should be interpreted with caution given the near-complete separation in the outcome (94% users) and the small number of non-users (n = 47), which may inflate odds ratios in logistic regression. Objective factors, paying fees and medication stock-outs were not significant in the adjusted model (P &amp;gt; .05). Among non-users (n = 47), key barriers were high cost and service unavailability. Continued use of state-faith-based partnership facilities are exploratorily associated with trust rooted in perceived quality, safety, and responsiveness. Persistent challenges with medication stock-outs and costs highlight areas for systemic strengthening. Future community-based research is needed to identify determinants of non-utilization and test generalizability.<\/jats:p>","DOI":"10.1093\/heapol\/czag115","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T11:37:46Z","timestamp":1790681866000},"source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with continued use of mission health facilities in Ghana: a facility-exit survey of user perceptions"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7249-1475","authenticated-orcid":false,"given":"Joseph Atta","family":"Amankwah","sequence":"first","affiliation":[{"name":"Department of Health Policy, Management and Economics, School of Public Health, College of Health Sciences, KNUST , Post Office Box LG 112, Kumasi ,","place":["Ghana"]},{"name":"Methodist Faith Healing Hospital , Post Office Box 1256, Ankaase, Ashanti Region ,","place":["Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7876-412X","authenticated-orcid":false,"given":"Emmanuel Kwasi","family":"Afriyie","sequence":"additional","affiliation":[{"name":"Emergency Medicine Directorate, Komfo Anokye Teaching Hospital , Post Office Box 1934, Kumasi, Ashanti Region ,","place":["Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9845-7161","authenticated-orcid":false,"given":"Justine Ti-Baliana Martha","family":"Naab","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Management and Economics, School of Public Health, College of Health Sciences, KNUST , Post Office Box LG 112, Kumasi ,","place":["Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reginald Kofi","family":"Sefa Nkansah","sequence":"additional","affiliation":[{"name":"Methodist Faith Healing Hospital , Post Office Box 1256, Ankaase, Ashanti Region ,","place":["Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enoch Nana Kwabena","family":"Osafo","sequence":"additional","affiliation":[{"name":"Methodist Health Trust , Wesley House, E252\/2 Liberia Road, Ridge, Greater Accra ,","place":["Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8737-3130","authenticated-orcid":false,"given":"Kofi Mensah","family":"Akohene","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Management and Economics, School of Public Health, College of Health Sciences, KNUST , Post Office Box LG 112, Kumasi ,","place":["Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8464-0053","authenticated-orcid":false,"given":"Peter","family":"Agyei-Baffour","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Management and Economics, School of Public Health, College of Health Sciences, KNUST , Post Office Box LG 112, Kumasi ,","place":["Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"2026102120120027300_czag115-B1","volume-title":"Survey methods in community medicine","author":"Abramson","year":"1974"},{"key":"2026102120120027300_czag115-B2","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1017\/S1744133118000191","article-title":"Willingness to pay for improved public health care services in Saudi Arabia: a contingent valuation study among heads of Saudi households","volume":"15","author":"Al-Hanawi","year":"2020","journal-title":"Health Econ Policy Law"},{"key":"2026102120120027300_czag115-B3","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1002\/jgf2.600","article-title":"Sample size determination: A practical guide for health researchers","volume":"24","author":"Althubaiti","year":"2023","journal-title":"J Gen Fam Med"},{"key":"2026102120120027300_czag115-B4","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1093\/heapol\/czaf082","article-title":"State-church partnerships as an innovative strategy in healthcare delivery for universal health coverage in sub-Saharan Africa: a scoping review","volume":"41","author":"Amankwah","year":"2026","journal-title":"Health Policy Plan"},{"key":"2026102120120027300_czag115-B5","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1093\/inthealth\/ihac017","article-title":"Towards achievement of sustainable development goal 3: multilevel analyses of demographic and health survey data on health insurance coverage and maternal healthcare utilisation in sub-Saharan Africa","volume":"15","author":"Amu","year":"2023","journal-title":"Int Health"},{"key":"2026102120120027300_czag115-B6","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/s12992-016-0171-y","article-title":"The effect of the National Health Insurance Scheme\u00a0(NHIS) on health service delivery in mission facilities in Ghana: a retrospective study","volume":"12","author":"Aryeetey","year":"2016","journal-title":"Global Health"},{"key":"2026102120120027300_czag115-B7","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1186\/s41182-025-00772-y","article-title":"Sociocultural and structural determinants of healthcare-seeking of people affected by leprosy in Sierra Leone\u2019s Western area: a qualitative study","volume":"53","author":"Asboeck","year":"2025","journal-title":"Trop Med Health"},{"key":"2026102120120027300_czag115-B8","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1111\/tmi.12433","article-title":"Factors influencing the decision to drop out of health insurance enrolment among urban slum dwellers in Ghana","volume":"20","author":"Atinga","year":"2015","journal-title":"Trop Med Int Health"},{"key":"2026102120120027300_czag115-B9","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1186\/s12913-023-09129-9","article-title":"Tools for measuring client experiences and satisfaction with healthcare in low- and middle-income countries: a systematic review of measurement properties","volume":"23","author":"Banda","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"2026102120120027300_czag115-B10","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000433","article-title":"Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies","volume":"8","author":"Berendes","year":"2011","journal-title":"PLoS Med"},{"key":"2026102120120027300_czag115-B11","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1093\/heapol\/czae018","article-title":"Public\u2013Private engagement and health systems resilience in times of health worker strikes: a Ghanaian case study","volume":"39","author":"Buabeng-Baidoo","year":"2024","journal-title":"Health Policy Plan"},{"key":"2026102120120027300_czag115-B12","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1093\/heapol\/czx182","article-title":"How far is mixed methods research in the field of health policy and systems in Africa? A scoping review","volume":"33","author":"De Allegri","year":"2018","journal-title":"Health Policy Plan"},{"key":"2026102120120027300_czag115-B13","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1186\/s12913-023-09320-y","article-title":"Sustainability of community health programme using community-based organizations: a challenge for stakeholders","volume":"23","author":"Donessoun\u00e9","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"2026102120120027300_czag115-B14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0001028","article-title":"Geographic barriers to care persist at the community healthcare level: evidence from rural Madagascar","volume":"2","author":"Evans","year":"2022","journal-title":"PLOS Glob Public Health"},{"key":"2026102120120027300_czag115-B15","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1071\/AH14031","article-title":"A theoretical framework to support research of health service innovation","volume":"39","author":"Fox","year":"2015","journal-title":"Aust Health Rev"},{"key":"2026102120120027300_czag115-B16","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.14466","article-title":"Understanding, assessing, and improving social health resource referrals in healthcare organizations","volume":"60","author":"Garcia","year":"2025","journal-title":"Health Serv Res"},{"key":"2026102120120027300_czag115-B17","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1186\/s12939-018-0810-4","article-title":"Towards universal health coverage: a mixed-method study mapping the development of the faith-based non-profit sector in the Ghanaian health system","volume":"17","author":"Grieve","year":"2018","journal-title":"Int J Equity Health"},{"key":"2026102120120027300_czag115-B18","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1016\/j.fmre.2024.08.002","article-title":"Supply chain resilience: a review from the inventory management perspective","volume":"5","author":"Guo","year":"2025","journal-title":"Fundam Res"},{"key":"2026102120120027300_czag115-B19","doi-asserted-by":"publisher","DOI":"10.3389\/fdgth.2025.1508686","article-title":"Redefining and solving the digital divide and exclusion to improve healthcare: going beyond access to include availability, adequacy, acceptability, and affordability","volume":"7","author":"Hollimon","year":"2025","journal-title":"Front Digit Health"},{"key":"2026102120120027300_czag115-B20","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.14237","article-title":"Financing community partnerships for health equity: findings and insights from cross-sector professionals","volume":"59","author":"Hoornbeek","year":"2024","journal-title":"Health Serv Res"},{"key":"2026102120120027300_czag115-B21","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1093\/heapol\/czr038","article-title":"Addressing access barriers to health services: an analytical framework for selecting appropriate interventions in low-income Asian countries","volume":"27","author":"Jacobs","year":"2012","journal-title":"Health Policy Plan"},{"key":"2026102120120027300_czag115-B22","doi-asserted-by":"publisher","first-page":"10806","DOI":"10.3390\/su141710806","article-title":"Perceived accessibility and key influencing factors in transportation","volume":"14","author":"Jamei","year":"2022","journal-title":"Sustainability"},{"key":"2026102120120027300_czag115-B23","doi-asserted-by":"publisher","first-page":"94","DOI":"10.3390\/ejihpe10010009","article-title":"Ghana\u2019s journey towards universal health coverage: the role of the national health insurance scheme","volume":"10","author":"Kipo-Sunyehzi","year":"2019","journal-title":"Eur J Investig Health Psychol Educ"},{"key":"2026102120120027300_czag115-B24","doi-asserted-by":"publisher","first-page":"607","DOI":"10.2147\/RMHP.S366759","article-title":"Achieving universal health coverage in low-and middle-income countries: challenges for policy post-pandemic and beyond","volume":"16","author":"Kodali","year":"2023","journal-title":"Risk Manag Healthc Policy"},{"key":"2026102120120027300_czag115-B25","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/j.addbeh.2017.05.005","article-title":"The relationship between social desirability bias and self-reports of health, substance use, and social network factors among urban substance users in Baltimore, Maryland","volume":"73","author":"Latkin","year":"2017","journal-title":"Addict Behav"},{"key":"2026102120120027300_czag115-B26","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0224260","article-title":"Age, sex and primary care setting differences in patients\u2019 perception of community healthcare seeking behaviour towards health services","volume":"14","author":"Lim","year":"2019","journal-title":"PLoS One"},{"key":"2026102120120027300_czag115-B27","doi-asserted-by":"publisher","first-page":"168","DOI":"10.11604\/pamj.2022.43.168.32983","article-title":"The impact of faith-based organizations on maternal and child health care outcomes in Africa: taking stock of research evidence","volume":"43","author":"Nicol","year":"2022","journal-title":"Pan Afr Med J"},{"key":"2026102120120027300_czag115-B28","doi-asserted-by":"publisher","first-page":"1765","DOI":"10.1016\/S0140-6736(15)60251-3","article-title":"Understanding the roles of faith-based health-care providers in Africa: review of the evidence with a focus on magnitude, reach, cost, and satisfaction","volume":"386","author":"Olivier","year":"2015","journal-title":"Lancet"},{"key":"2026102120120027300_czag115-B29","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s12939-021-01608-x","article-title":"Equity in health insurance schemes enrollment in low and middle-income countries: a systematic review and meta-analysis","volume":"21","author":"Osei Afriyie","year":"2022","journal-title":"Int J Equity Health"},{"key":"2026102120120027300_czag115-B30","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1007\/s43994-024-00153-x","article-title":"Sample size calculation in biomedical, clinical and biological sciences research","volume":"11","author":"Sadiq","year":"2025","journal-title":"J Umm Al-Qura Univ Appl Sci"},{"key":"2026102120120027300_czag115-B31","doi-asserted-by":"publisher","first-page":"505","DOI":"10.4103\/0019-5154.190118","article-title":"Methodology series module 5: sampling strategies","volume":"61","author":"Setia","year":"2016","journal-title":"Indian J Dermatol"},{"key":"2026102120120027300_czag115-B32","doi-asserted-by":"publisher","first-page":"1614","DOI":"10.1001\/jama.2021.18236","article-title":"Strengthening the reporting of observational studies in epidemiology using Mendelian randomization: the STROBE-MR statement","volume":"326","author":"Skrivankova","year":"2021","journal-title":"JAMA"},{"key":"2026102120120027300_czag115-B33","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1177\/13558196221111708","article-title":"Challenges to the delivery of clinical diabetes services in Ghana created by the COVID-19 pandemic","volume":"28","author":"Tagoe","year":"2023","journal-title":"J Health Serv Res Policy"}],"container-title":["Health Policy and Planning"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/heapol\/advance-article-pdf\/doi\/10.1093\/heapol\/czag115\/71670579\/czag115.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/heapol\/advance-article-pdf\/doi\/10.1093\/heapol\/czag115\/71670579\/czag115.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:12:07Z","timestamp":1792627927000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/heapol\/advance-article\/doi\/10.1093\/heapol\/czag115\/8876613"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,8]]},"references-count":33,"URL":"https:\/\/doi.org\/10.1093\/heapol\/czag115","relation":{},"ISSN":["0268-1080","1460-2237"],"issn-type":[{"value":"0268-1080","type":"print"},{"value":"1460-2237","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,8]]},"article-number":"czag115"}}