Perceived difficulty accessing primary health care in a violence-affected community in the municipality of Rio de Janeiro, by sociodemographic characteristics and mental health status, 2024

Abstract

Abstract Background: Barriers to access in Primary Health Care (PHC) can be exacerbated by contexts of social vulnerability and armed violence. This study analyzed perceived difficulty in accessing PHC according to sociodemographic characteristics and mental health conditions. Methods: Cross-sectional study conducted in 2024 in the Manguinhos community (Rio de Janeiro), using a quota sample of 1,000 residents. A structured questionnaire was administered in REDCap, collecting sociodemographic data, service use, and mental health symptoms (GAD-2 and PHQ-2). Perceived difficulty of access was assessed with six narrative vignettes. We used chi-square tests (χ²) and psychometric models—graded response model (GRM) and Rasch—to estimate item parameters and latent scores (θ). Comparisons of θ by sex, race/skin color, and age group were performed with Mann–Whitney and Kruskal–Wallis tests (α = 5%). Results: Only 5.5% of participants aged 18–29 reported regular mental health follow-up, versus 19.3% among those aged 30–44 and 23.3% among those aged ≥ 45 (χ²=31.54; p < 0.001). Regular consultations were more frequent among women (20.9%) than men (13.7%; χ²=11.14; p = 0.003) and among non-Black participants (21.7%) than Black participants (15.8%; χ²=6.96; p = 0.030). Symptoms of anxiety (43.2% women vs. 32.6% men; χ²=18.89; p < 0.001) and depression (38.9% vs. 30.6%; χ²=11.64; p = 0.003) were more prevalent among women and Black participants. Latent scores (θ) did not differ by sex (U = 110,402; p = 0.245), race/skin color (U = 89,187; p = 0.871), or age group (H = 1.98; p = 0.372). Conclusion: Despite inequalities in mental health, perceived difficulty in accessing PHC was homogeneous across the sociodemographic groups assessed.