Facilitators and Barriers Accessing Health Care Services from the Perspective of Adults with Chronic Diseases (STRESS) in Lebanon: A Qualitative Study

Abstract

Background: Access to healthcare in communities remains a crucial factor in achieving better health outcomes. In Lebanon, access to health care is of paramount importance, particularly for adults with chronic diseases. Chronic diseases, such as cardiovascular disease (CVD), diabetes, and cancer, are prevalent in the Lebanese population and contribute significantly to the burden of disease. Access to health care services is essential for timely diagnosis, proper management, and prevention of complications associated with these conditions.

Purpose: The purpose of this study is to describe the range of services, specialties, and type of reimbursement offered through the primary health care centers (PHCCs) for patients with chronic diseases, and to explore the facilitators and barriers that adults with chronic diseases face in accessing health care services.

Methods: A qualitative descriptive design based on a secondary data collected as part of the larger STRESS project that adopted an in-depth interview approach. The World Health Organization Availability, Accessibility (financial, physical, information, administrative and social), Acceptability and Quality (AAAQ) conceptual model was used as a framework to explore the potential facilitators and barriers in accessing services. Twenty-one Lebanese beneficiaries in total were interviewed, 7 were men and 14 women. They were underprivileged adults, aged between 48 and 82 years, with at least one chronic disease receiving services at designated PHCCs.

Results: Facilitators to health care access included: range of PHCC services offered to beneficiaries with chronic diseases; the subsidies to cover those services; the geographical location of the PHC coupled with the support from family, friends, and neighbors that facilitated physical accessibility through carpooling and rides; and the health campaigns from non-governmental organizations. Barriers to access to care encompassed shortages in a range of diagnostic services, shortage in health manpower, and chronic disease medications; lack of availability of various specialties for adults with chronic diseases; high cost of hospitals and private clinics when needed; out of pocket payment of medications; lack of insurance and social security (NSSF); and challenges in transportation and high fuel cost.

Conclusion: To address barriers and build on facilitators, it is important to develop targeted interventions that aim to improve access to health care services for adults with chronic diseases in the Lebanese community. A recovery program is needed, and prioritization is a key player in this national health hurdle.