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1- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
2- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
3- Social Development and Health Promotion Research Center, Health Policy and Promotion Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran ,sinaahmadi25@gmail.com
2- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
3- Social Development and Health Promotion Research Center, Health Policy and Promotion Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran ,
Abstract: (36 Views)
Objectives Population aging is one of the most significant demographic transitions of the present century, posing substantial challenges to health systems. This study aimed to identify and explain the barriers and challenges affecting older adults’ utilization of health services in Kermanshah, with emphasis on their lived experiences
Methods & Materials This qualitative study was conducted using a inductive content analysis approach. Participants included 20 older adults (10 women and 10 men), aged 65 to 89 years, selected through purposive sampling with maximum variation in age, gender, education, place of residence, insurance type, and income level. Data were collected through in‑depth semi‑structured interviews and analyzed using Graneheim and Lundman’s method. Lincoln and Guba’s criteria were applied to ensure data trustworthiness. Data management and coding were performed using MAXQDA2020
Results Data analysis resulted in 239 initial codes, 9 subcategories, and three main categories: macro‑level challenges (economic difficulties, inadequate insurance support, and socio‑cultural barriers), meso‑level challenges (physical and environmental barriers to access, quality‑related issues, and digital exclusion), and micro‑level challenges (therapeutic self‑censorship, personal limitations, and unawareness of available services). Two core concepts emerged: “therapeutic self‑censorship,” referring to hiding one’s health needs due to feeling burdensome, and the “multi‑layered deprivation cycle,” representing the dynamic interaction of multiple barriers. Digital exclusion specifically refers to the inability of older adults to utilize health technologies, health-related applications, and online appointment systems, thereby limiting their access to services, especially in the context of the pandemic and the increasing reliance on online platforms
Conclusion The barriers to effective use of health services by the elderly in Kermanshah are multi‑level and intertwined, encompassing a wide range of economic, structural, environmental, technological, and individual challenges. The findings indicate that weak insurance coverage, lack of adequate supportive policies, digital exclusion, and self‑censorship in treatment are among the most important barriers. Therefore, designing and implementing comprehensive interventions tailored to the real needs of the elderly – with an emphasis on reducing economic inequalities, improving physical access, and enhancing digital health literacy – is essential for achieving health equity in this growing population group.
Methods & Materials This qualitative study was conducted using a inductive content analysis approach. Participants included 20 older adults (10 women and 10 men), aged 65 to 89 years, selected through purposive sampling with maximum variation in age, gender, education, place of residence, insurance type, and income level. Data were collected through in‑depth semi‑structured interviews and analyzed using Graneheim and Lundman’s method. Lincoln and Guba’s criteria were applied to ensure data trustworthiness. Data management and coding were performed using MAXQDA2020
Results Data analysis resulted in 239 initial codes, 9 subcategories, and three main categories: macro‑level challenges (economic difficulties, inadequate insurance support, and socio‑cultural barriers), meso‑level challenges (physical and environmental barriers to access, quality‑related issues, and digital exclusion), and micro‑level challenges (therapeutic self‑censorship, personal limitations, and unawareness of available services). Two core concepts emerged: “therapeutic self‑censorship,” referring to hiding one’s health needs due to feeling burdensome, and the “multi‑layered deprivation cycle,” representing the dynamic interaction of multiple barriers. Digital exclusion specifically refers to the inability of older adults to utilize health technologies, health-related applications, and online appointment systems, thereby limiting their access to services, especially in the context of the pandemic and the increasing reliance on online platforms
Conclusion The barriers to effective use of health services by the elderly in Kermanshah are multi‑level and intertwined, encompassing a wide range of economic, structural, environmental, technological, and individual challenges. The findings indicate that weak insurance coverage, lack of adequate supportive policies, digital exclusion, and self‑censorship in treatment are among the most important barriers. Therefore, designing and implementing comprehensive interventions tailored to the real needs of the elderly – with an emphasis on reducing economic inequalities, improving physical access, and enhancing digital health literacy – is essential for achieving health equity in this growing population group.
Keywords: older adults, Elderly, Health service utilization, Health, Qualitative study, Kermanshah, Treatment
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