Decisions to Access Health Care: Voices From Rural Residents in Southeast Australia

OBJECTIVE: Despite significant literature on access to, and utilisation of, health care, less attention has been given to the agency of rural service users to use, or not use, health services. This paper aims to understand the decisions of residents from two rural communities to use, or not use, health services. SETTING: Participants were recruited from Neighbourhood Houses in two rural communities in northern Victoria, Australia, located relatively close to a regional centre. PARTICIPANTS: Twenty participants with significant socioeconomic needs were included. DESIGN: The study used a qualitative design and constructivist paradigm to undertake semi-structured interviews which were analysed thematically. RESULTS: Three types of decisions to access health services were identified. First, regular users prioritised their health, valued health care, and usually had a trusted healthcare navigator. Second, sometimes users identified barriers to accessing services, primarily not having a trusted GP and cost. Third, avoiders of health services suggested they did not prioritise their own health, it was easier to not attend, they did not believe health services led to better health outcomes, and poverty or other social issues prevented use. Some respondents moved between the three types, being regular users for children and when they had a trusted GP, and sometimes users for themselves or when barriers arose. CONCLUSION: This study identified the strong role of GPs and the relational aspects of accessing and utilising health care. It calls for stronger engagement with disadvantaged rural residents to build trust in health care among those avoiding health services.