The Experience of Accessing Primary Healthcare Centres in a Lebanese Community: Perspectives of Older People, Family Members and Service Providers

Abstract

Introduction

Older people's experiences with access to primary healthcare are overlooked in LMICs, leading to inequitable access and limited delivery of person-centred care. In Lebanon, the economic crisis has increased older people's vulnerabilities and reliance on services provided through primary healthcare centres (PHCCs). This study explores (1) factors shaping decisions of using PHCCs; (2) experiences of older people accessing PHCCs from three perspectives: the older people themselves, family members and service providers; (3) family members' experiences with accessing PHCCs; and (4) service providers' experiences with providing care for older people within PHCCs in a Northern Lebanese district.

Methods

This study adopts a qualitative descriptive design with an inductive content analysis approach. Data were collected through seven focus group discussions and 15 individual interviews (n = 57 older people, family members, and service providers).

Results

Factors shaping decisions of using PHCCs' services include socio-economic status, knowledge of services, influences of family members, perceived service quality and proximity, age-related changes, and providers' attitudes and behaviours. Older people reported varied access experiences shaped by factors at individual, organisational, communal, governmental and global levels. Positive experiences included enhanced autonomy, gratitude for receiving needed services, perceived care quality and socialising opportunities. However, negative experiences included humiliation and discomfort, anxiety, dependency, perceived status regression, perceived poor quality and a sense of being a burden. While some family members reported relief from getting affordable care, others reported discomfort, perceived status regression, blame for neglect and challenges with coordinating care across multiple providers. Service providers' experiences included pride in supporting older people, but resentment due to unfair remuneration.

Conclusion

Findings reveal aspects of care that older people and family members appreciate and others that contribute to negative experiences. Experiences of older people, family members and service providers are interconnected. Quality improvement requires comprehensive approaches addressing their needs. Findings inform practitioners and policymakers to design multidimensional and people-centred approaches to maximise healthcare access.

Patient and Pubic Contribution

No PPI engagement methods were applied in this study or analysis. However, the findings informed discussions with older people and facilitated partnerships to co-design a follow-up study focused on developing solutions.