Access, Predictive Factors, and Outcomes of Primary Health Care Services Among Older Adults in Urban Communities
Keywords:
Health care access, Health service delivery, Older adults, Primary health care, Urban communityAbstract
Thailand has become a complete aged society, resulting in a significant increase in primary health care service demands. However, older adults in urban communities continue to face multidimensional barriers to service access. This study aimed to examine the level of primary health care access, analyze predictive factors, and explore primary health care service outcomes among older adults in urban communities. An explanatory sequential mixed methods design was employed. Quantitative data were collected from 180 older adults in an urban community in a northeastern province, using proportional stratified sampling, and qualitative data were gathered from 111 key informants. Quantitative data were analyzed using descriptive statistics and multiple regression analysis, while qualitative data were analyzed using thematic analysis.
The findings revealed that older adults accessed primary health care at a high level overall (M = 3.90, SD = 0.55). The highest dimension was service acceptability, followed by affordability, physical accessibility, availability, and accommodation, respectively. Significant predictors of health care access included monthly income, distance to health service units, activities of daily living (ADL) level, presence of a caregiver, and health rights knowledge. The model explained 48.0% of the variance in health care access (R² = .480, Adjusted R² = .460, p < .001). The qualitative findings enabled the synthesis of four integrated service delivery models: home ward care, NCD clinic and NCD school, community pharmacy, and telemedicine through VHV networks. Overall satisfaction with primary health care services was at a high level, particularly regarding interpersonal relations and staff competency.
The findings indicate a positive direction for primary health care service delivery in urban communities. However, proactive service delivery, reduction of physical access barriers, bridging the digital divide, and strengthening community support systems are needed to ensure equitable and sustainable care for older adults.
References
Alkhawaldeh, A., AlBashtawy, M., Rayan, A., Abdalrahim, A., Musa, A., Eshah, N., Abu Khait, A., Qaddumi, J., Khraisat, O., & AlBashtawy, S. (2023). Application and use of Andersen's behavioral model as theoretical framework: A systematic literature review from 2012–2021. Iranian Journal of Public Health, 52(7), 1346–1354. https://doi.org/10.18502/ijph.v52i7.13236
Andersen, R. M. (1968). Behavioral model of families’ use of health services (Research Series No. 25). Center for Health Administration Studies, University of Chicago.
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
Cherdchoo, A., Boonshuya, C., & Chareonku, C. (2019). Accessibility to Health Care Service of the Elderlyin Bang Pa-in District, Ayutthaya Province. Journal of Safety and Health, 12(2), 1–13. https://he01.tci-thaijo.org/index.php/JSH/article/view/196465 (in Thai)
Creswell, J. W., & Creswell, J. D. (2022). Research design: Qualitative, quantitative, and mixed methods approaches (6th ed.). SAGE.
Cu, A., Meister, S., Lefebvre, B., & Ridde, V. (2021). Assessing healthcare access using the Levesque's conceptual framework- a scoping review. International Journal for Equity in Health, 20(1), 116. https://doi.org/10.1186/s12939-021-01416-3
Department of Provincial Administration. (2023). Population registration statistics: Population classified by age [Data set]. Ministry of Interior. https://stat.bora.dopa.go.th (in Thai)
Donabedian, A. (1988). The quality of care: How can it be assessed? JAMA, 260(12), 1743–1748. https://doi.org/10.1001/jama.1988.03410120089033
Faul, F., Erdfelder, E., Buchner, A., & Lang, A. G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149–1160. https://doi.org/10.3758/BRM.41.4.1149
Gentilini, A., Kasonde, L., & Babar, Z. U. (2025). Expanding access to NCD services via community retail pharmacies in LMICs: A systematic review of the literature. Journal of Pharmaceutical Policy and Practice, 18, 2462450. https://doi.org/10.1080/20523211.2025.2462450
Hanson, K., Brikci, N., Erlangga, D., Alebachew, A., De Allegri, M., Balabanova, D., Blecher, M., Cashin, C., Esperato, A., Hipgrave, D., Kalisa, I., Kurowski, C., Meng, Q., Morgan, D., Mtei, G., Nolte, E., Onoka, C., Powell-Jackson, T., Roland, M., … Wurie, H. (2022). The Lancet Global Health Commission on financing primary health care: Putting people at the centre. The Lancet Global Health, 10(5), e715–e772. https://doi.org/10.1016/S2214-109X(22)00005-5
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. SAGE.
Mohd Rosnu, N. S., Singh, D. K. A., Mat Ludin, A. F., Ishak, W. S., Abd Rahman, M. H., & Shahar, S. (2022). Enablers and barriers of accessing health care services among older adults in South-East Asia: A scoping review. International Journal of Environmental Research and Public Health, 19(12), 7351. https://doi.org/10.3390/ijerph19127351
Morse, J. M. (1995). The significance of saturation. Qualitative Health Research, 5(2), 147–149. https://doi.org/10.1177/104973239500500201
Moscrop, A., Ziebland, S., Roberts, N., & Papanikitas, A. (2019). A systematic review of reasons for and against asking patients about their socioeconomic contexts. International Journal for Equity in Health, 18, 112. https://doi.org/10.1186/s12939-019-1014-2
Ngamkham, S., Suwanphong, N., Thipayamongkolkul, M., & Manmee, J. (2018). Access to health services among older adults in Thawi Watthana District, Bangkok. Kuakarun Journal of Nursing, 25(2), 91–104. https://he01.tci-thaijo.org/index.php/kcn/article/view/161070 (in Thai)
Nguyen, M. P. (2022). Health services utilization among older adults in Vietnam: Evidence from the national household living standard survey 2016. Asia-Pacific Journal of Public Health, 34(1), 57–64. https://doi.org/10.1177/10105395211044616
Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd ed.). McGraw-Hill.
Penchansky, R., & Thomas, J. W. (1981). The concept of access: Definition and relationship to consumer satisfaction. Medical Care, 19(2), 127–140. https://doi.org/10.1097/00005650-198102000-00001
Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.
Royal Thai Government Gazette. (2019). Primary health system act B.E. 2562 (2019). Royal Thai Government Gazette, 136(56 kor), 165-185. https://ratchakitcha.soc.go.th/documents/17087273.pdf (in Thai)
Tabachnick, B. G., & Fidell, L. S. (2019). Using multivariate statistics (7th ed.). Pearson.
Thansa, K. (2025). Trends and disparities in non-communicable diseases among Thai older adults: Analysis of national health examination surveys, 2008–2020. Interprofessional Journal of Health Sciences, 23(2), IJHS-0813. https://li05.tci-thaijo.org/index.php/IJHS/article/view/813/478
World Health Organization. (2021). Global strategy on digital health 2020–2025. https://www.who.int/publications/i/item/9789240020924
World Health Organization. (2022). Integrated care for older people (ICOPE): Guidance for person-centred assessment and pathways in primary care. World Health Organization.
World Health Organization. (2023). Healthy ageing: A priority for delivering universal health coverage (Technical Brief). https://www.who.int/publications/m/item/healthy-ageing--a-priority-for-delivering-universal-health-coverage
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