Understanding access challenges in primary healthcare: A comprehensive view from healthcare providers and people living in socio-economically disadvantaged conditions

Emilie Op De Beeck, Hilde Bastiaens, Caroline Masquillier, Josefien Van Olmen, Edwin Wouters

Background:

Even though access to primary healthcare (PHC) is essential for people’s health and wellbeing, there are still people with difficulties in accessing PHC (PDAP). They predominantly comprise people who live in socio-economically vulnerable conditions (e.g. people with a low income and/or low educational attainment). There is a lack of knowledge on the possible cumulative effects of barriers encountered over time.

Research questions:

The aim of this qualitative research is to explore the barriers to access PHC over time, experienced by people living in socio-economically difficulties and healthcare providers (HCP) as well as the interplay between healthcare seekers and HCP, regarding access to PHC.

Method:

A qualitative longitudinal approach using semi-structured interviews with people living in socio-economically difficulties was conducted. In addition, semi-structured interviews with HCP, such as general practitioners, dentists, pharmacists and therapists, were performed. A combination of purposive and snowball sampling was used as sampling strategy. Interviews were audiotaped, transcribed and thematic analysis was done guided by the access to care framework of Levesque, et al (2013).

Results:

In general, PDAP postpone seeking care due to stigma, financial barriers, extended waiting times, and perceived cultural gap between PDAP and HCP. Assistance from healthcare and welfare professionals or informal social network can help to overcome these barriers. Additionally, HCP confirm the challenges presented by financial problems and complex health issues as well leading to postponement in care. Furthermore, HCP are confronted with cultural and language barriers that make it difficult to provide appropriate care. One of the domains where the aforementioned barriers are particularly prevalent is mental health care.

Conclusions:

Barriers in accessing care can accumulate, leading to delays, especially in mental health care. Stigma and expected cultural differences challenge patients to seek care, while long waiting lists and high costs make it difficult to obtain the services needed.

Points for discussion:

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