Seeking, delaying, and avoiding routine health care services: patient perspectives.

PURPOSE: To explore/identify patient perspectives regarding seeking, delaying, and avoiding health care services, particularly barriers and facilitators.
DESIGN: Face-to-face interviews with health plan survey respondents.
SETTING: An integrated health plan providing comprehensive care to 480,000 people in Oregon and Washington. PARTICIPANTS: Willing respondents randomly selected to maximize heterogeneity within the following strata: gender, health care utilization, and self-reported alcohol consumption (indicator of health practices). Participants were 75 men and 75 women (150 total), 21 to 64 years old, with ≥12 months of health plan membership.
METHOD: Participants were recruited by letter (52.5% agreed). Data collection stopped when planned interviews were completed; saturation (the point at which additional interviews were not producing novel information) was achieved for key study questions. Semi-structured interviews were recorded, transcribed, and coded. Reviews of codes related to care seeking and feelings/attitudes about providers produced common themes.
RESULTS: Facilitators of care seeking included welcoming staff, collaborative relationships with providers, and education about the value of preventive care. Barriers included costs, time needed for appointments, and cumbersome processes. Some participants delayed procedures, some avoided care until absolutely necessary, others framed care as routinely necessary.
CONCLUSION: Increasing comfort, improving appointment and visit-related processes, having positive patient-physician relationships, and enhancing communication and clinician-provided education may facilitate appropriate use of preventive services. Further research is needed with larger, representative samples to evaluate findings.