Understanding challenges in healthcare access: qualitative insights from healthcare providers and people living in socio-economically vulnerable circumstances

Abstract

INTRODUCTION: Equitable access to healthcare is fundamental to improving population health outcomes, yet persistent disparities leave many underserved, particularly those in socio-economically vulnerable circumstances. In Belgium, unmet healthcare needs are disproportionately concentrated among low-income groups, migrants and individuals with low educational attainment. These structural inequities are reflected in poorer health outcomes, including reduced life expectancy and limited access to essential services such as dental, mental, and specialist care. Existing research has primarily taken cross-sectional approaches, failing to capture how barriers accumulate over time. To address this gap, this study adopts a longitudinal perspective to explore the cumulative nature of healthcare access barriers among socio-economically vulnerable populations in Belgium. It also incorporates the perspectives of both patients and healthcare providers. METHOD: A qualitative longitudinal approach using semi-structured interviews at three time-points with 16 people living in socio-economically circumstances was conducted. In the same period, 17 semi-structured interviews with healthcare providers (HCPs), such as general practitioners (GPs), dentists, pharmacists and psychologists were carried out. The sampling strategy included a combination of purposive and snowball sampling. Interviews were audiotaped and transcribed, then reflexive thematic analysis was carried out to ensure a transparent and rigorous analysis. RESULTS: The study revealed that barriers to accessing care accumulate over time, particularly in the context of a fragmented healthcare system. Individuals living in socio-economically vulnerable circumstances often deprioritise their healthcare and need to repeatedly navigate the healthcare access continuum to address different health concerns, often involving multiple healthcare providers. Each iteration can introduce new provider-specific barriers, compounding the challenges and increasing the complexity of accessing healthcare. Participants with an informal social network or support from HCPs and societal organisations could temporarily overcome the barriers to access care. CONCLUSION: The study reveals the complex and cumulative barriers to healthcare access for socio-economically vulnerable individuals, including competing priorities, system fragmentation, and cultural and language challenges. While informal social networks provide some support, they are insufficient to address systemic issues. Integrating these networks with formal community outreach initiatives could improve coordination and access to healthcare.

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