Barriers and Facilitators to Accessing and Delivering Chronic Healthcare Services among Rural Areas in Makkah Region of Saudi Arabia: Perspectives of Rural Women and Healthcare Providers

Abstract

Background: Health disparities exist for rural residents, particularly women, due to multiple, complex barriers to accessing healthcare. Studies from around the world have identified factors influencing women's access to healthcare. Despite the Saudi Health Ministry’s efforts to reduce health disparities and provide comprehensive care for rural regions, Saudi Arabia (SA) still lacks comprehensive healthcare services for rural women. In recent years, the prevalence of chronic diseases has increased significantly in SA and people diagnosed with chronic conditions require continued medical attention and easy access to healthcare services. In SA, limited research has been conducted on the experiences of rural women with chronic conditions and their access to healthcare services.

Aim: This PhD thesis aims to explore barriers and facilitators for accessing, receiving, and delivering healthcare services for rural women diagnosed with chronic diseases (Diabetes Mellitus (DM type 1 & 2) and/or Cardiovascular Diseases (CVD) in rural areas near Taif city in Saudi Arabia. Methods: A qualitative study, using semi-structured interviews, was conducted remotely. The participants included rural women (n = 13) living with chronic conditions and healthcare providers (n = 15). Participants were recruited from three different primary healthcare centres located in three rural areas and two secondary healthcare facilities located in Taif city. The responses from participants in the interviews were analysed using inductive-deductive thematic analysis guided by Levesque’s conceptual model of access to healthcare from the patient and the providers’ sides.

Findings: Several barriers and facilitators were identified including health literacy, language barriers, cultural norms, transportation, and financial constraints which were all found to impact their access to, and experiences of, health services. Healthcare providers identified other barriers including communication difficulties, gender-related cultural norms, resource limitations, and fragmented referral systems. These barriers intersect to make access to healthcare services and management of rural patients’ chronic conditions difficult. Barriers can be minimized by facilitators such as family support, maximizing access to two levels of healthcare facilities - Primary Healthcare Centres (PHCCs) and Secondary Healthcare Facilities (SHCF), long work experience of HCPs, reforming the healthcare system and women’s rights.

Conclusion: Despite international efforts to enhance women’s health, rural women still struggle to take advantage of improvements in the healthcare system. In the context of rural areas in SA, increasing distribution of PHCCs in rural areas and the provision of free services may not necessarily address the healthcare needs of rural women with chronic conditions. Researchers, policymakers, and rural community members need to work collaboratively to develop strategies to address barriers and prioritize rural dwellers’ needs. Improving healthcare access for rural women can help meet the country’s Vision 2030 objectives which include enhancing accessibility to healthcare services, health quality, and women's empowerment.