Improving access to primary care; Participatory research with six marginalised groups
According to the World Health Organization primary care should be accessible, acceptable and available to all people in the community equally. There are national and international policy imperatives for public and patient involvement (PPI) in the planning and development of this care. It is known, however, that certain marginalised groups have difficulty in accessing care and their voices are often completely absent from planning processes. The aim of this study was to consult with various marginalised groups to explore their experiences of accessing primary healthcare and to identify their priorities and suggestions for improving its delivery.
Purposeful sampling was employed to recruit participants from the Irish Travelling community, migrants and refugees, homeless people, young mothers from deprived areas of the city, sex-workers and drug users. A combination of participatory learning and action (PLA) style focus groups and interviews were used to explore their experiences of accessing primary healthcare and their suggestions for improvements by health service planners. Data were initially co-analysed by participants and researchers together using thematic analysis with each marginalised group. Data from all six groups were then analysed by the research team for overarching themes across the groups. The quality and rigour of data analysis was enhanced by the co-analysis process and member checking.
Twenty-one participants across the six marginalised groups participated. Four overarching themes were identified. The first explored the importance of the home environment and its potential to enable or obstruct access to primary care. The second theme highlighted potential personal and structural barriers that many marginalised people face when seeking care in the community. Examples included the chaos of living with addiction and the competing priorities this can create, and the government levy on prescription medications which can create a barrier to attending pharmacies. The third theme shows the importance of personal stories and experiences of engaging with the health system and the effects these interactions can have on the likelihood of that same individual, or others in their network, will seek care from the same source again. The last theme looks at potential facilitators for improving primary healthcare access from the viewpoint of the participants. They highlighted some existing initiatives that they felt were vital e.g. key worker support, and also suggested some new interventions that could make a difference.
PLA techniques worked effectively to allow marginalised groups to identify their priorities for healthcare provision in the community. There were common suggestions across many of the groups that if addressed may help healthcare planners to improve access for wider array of marginalised patients. The findings also indicate the need for work on the many complex personal and structural problems that create barriers to healthcare for these groups.