Dableh Saydeh, Frazer Kate, Azar Mathilde, Kroll Thilo
School of Nursing, Midwifery, and Health Systems, University College Dublin, Dublin, Ireland.
Nursing Program, University of Balamand, Beirut, Lebanon.
Health Expect. 2025 Oct;28(5):e70449. doi: 10.1111/hex.70449.
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.
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).
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.
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.
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.
在低收入和中等收入国家，老年人获得初级医疗保健的经历被忽视，导致医疗服务获取不公平，以患者为中心的护理服务提供受限。在黎巴嫩，经济危机加剧了老年人的脆弱性以及他们对初级医疗保健中心（PHCCs）所提供服务的依赖。本研究探讨了：（1）影响使用初级医疗保健中心决策的因素；（2）从老年人自身、家庭成员和服务提供者三个角度，了解老年人使用初级医疗保健中心的经历；（3）家庭成员使用初级医疗保健中心的经历；（4）黎巴嫩北部一个地区的服务提供者在初级医疗保健中心为老年人提供护理的经历。
本研究采用定性描述设计和归纳性内容分析法。通过七次焦点小组讨论和15次个人访谈（n = 57，涉及老年人、家庭成员和服务提供者）收集数据。
影响使用初级医疗保健中心服务决策的因素包括社会经济地位、对服务的了解、家庭成员的影响、感知到的服务质量和距离、与年龄相关的变化，以及提供者的态度和行为。老年人报告了因个人、组织、社区、政府和全球层面的因素而产生的不同就医经历。积极的经历包括增强自主性、对获得所需服务的感激、感知到的护理质量和社交机会。然而，消极的经历包括羞辱和不适、焦虑、依赖、感知到的地位下降、感知到的质量差以及成为负担的感觉。虽然一些家庭成员表示因获得负担得起的护理而感到宽慰，但另一些人则表示不适、感知到的地位下降、因忽视而受到指责以及在协调多个提供者的护理方面面临挑战。服务提供者的经历包括为支持老年人而感到自豪，但因薪酬不公平而感到不满。
研究结果揭示了老年人和家庭成员欣赏的护理方面以及其他导致负面经历的方面。老年人、家庭成员和服务提供者的经历相互关联。质量改进需要全面的方法来满足他们的需求。研究结果为从业者和政策制定者提供信息，以设计多维度和以患者为中心的方法，最大限度地扩大医疗服务的可及性。
本研究或分析未采用患者和公众参与方法。然而，研究结果为与老年人的讨论提供了信息，并促进了合作，共同设计一项后续研究，重点是开发解决方案。
