Access in the U.S. and Canada: A Qualitative Inquiry

University Of North Carolina Chapel Hill, Chapel Hill NC

Investigators

Abstract

[unreadable] DESCRIPTION (provided by the applicant): Traditional access to care theory, on which much empirical access research is based, does not incorporate individual perceptions and beliefs and has been unsuccessful at predicting and explaining enough variation in health care use. The tendency to study access qualitatively has also led to a fragmented understanding of access. As such, this study qualitatively investigates the following questions: (1) What is the access to care experience, including barriers and supports for accessing care, from the vulnerable individual's point of view? (2) How does the vulnerable individual's access to care experience interact with the health care system?, and (3) How does the vulnerable individual conceptualize access to care? What are the implications of these results for traditional access to care theory? What alternatives to current access to care theory are suggested by this research? [unreadable] [unreadable] This study will be a grounded theory study. Primary data collection will consist of individual, in-depth, semi-structured interviews to explore the access to primary care experience from the individual's point of view. Participants will be asked to reflect on their access to care experiences. The sampling frame for individuals will comprise those individuals most likely to experience trouble using the health care system and to have the most need for primary health care. This study defines these individuals as those disadvantaged by poverty, lack of education, minority status, unemployment, and under insurance or lack of insurance. Disadvantaged individuals will be purposefully sampled from one rural and one semi-rural community in the United States and from one rural and one semi-rural community in Canada. The exact sample size is not possible to predict in advance, but the expected sample size will be approximately 10 persons per community, for a total of 40 persons. Analysis will be conducted iteratively with data collection to inform the purposeful sampling strategy. Analysis steps will follow traditional grounded theory approaches. Results will be compared with traditional access to care theory. [unreadable] [unreadable] The results of this study could be used to inform revisions to access to care theory, to develop new access to care theory, to better design empirical research on access to care, and to help policy makers design programs that better meet individuals' needs with respect to access to care. [unreadable] [unreadable]