Exploring access to primary health care among diabetic patients In Oman

Thesis

Access is an essential and yet only vaguely understood component of Universal Health Coverage. In this thesis, my aim is to measure patients’ experiences of access to healthcare in Oman and to understand how this access is associated with disease outcome and quality of life.

Initially, I carried out a concept analysis of access to primary healthcare, in which I identified the attributes, antecedents and consequences of access, and then utilised these attributes to map items for a patient experience questionnaire, using existing tools. This questionnaire, which I named Access-31, was subsequently tested for face and content validity through focus groups and individual interviews before it was utilised to conduct a survey of diabetes-2 patients attending primary healthcare services in Oman. The survey involved the use of Access-31, a quality of life measure, glycated haemoglobin data (HbA1c) and socio-economic indicators for study participants.

The domains of access are as follows: geographical access, access to information, organisational access, affordability, cultural acceptability and availability of services and medicines. The cross-sectional survey showed that 28.3% of the respondents reported having had at least one problem related to geographical access, while 83.2%, 61.2%, 4.9%, 35.7% and 47.8% respectively experienced at least one problem with access to information, organisational access, affordability, cultural acceptability and availability of services and medicines. The composite access score indicated that 6.0% of the participants reported no problems with access, 38.4% 1-3 problems, 39.6% 4-6 problems, and 15.9% more than six problems. Geographical access, organisational access, cultural acceptability and overall access were associated with self-reported quality of life (P-value<0.01), and the odds ratio for the relationship between availability of services and medicines and HbA1c was 3.02 (P-value<0.01), while for access overall this figure was 2.56 (P-value=0.01).

Access-31 is a promising tool that would appear to reward further testing as regards the measurement of accessibility in healthcare. Poor access to healthcare is associated with poor health outcomes, and policymakers in Oman are advised to investigate variations among governorates and to take appropriate action.

Authors: Alasfoor, D

• DOI: 10.5287/ora-aqvqj25q0
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: primary healthcare; geographical access; cultural acceptability; glaciated haemoglobin; quality of life; affordability; universal health coverage; accessibility; diabetes
• Subjects: accessibility; health systems; quality of life; diabetes control; universal health coverage