Understanding patient barriers and enablers to accessing community resources: A qualitative study to inform navigation service delivery

BACKGROUND: Individuals face multifaceted barriers to accessing community resources, which can significantly impact their ability to obtain necessary support and services. This study examines barriers and enablers to access community resources among primary care patients and explores the interplay between individual- and system-level factors that influence access to resources. 

METHODS: In this qualitative study, we conducted 32 semi-structured interviews with primary care patients who participated in a social prescribing trial that compared two navigation services: ARC (patient-centered longitudinal support) vs. Ontario-211 (free 24-hour helpline service) in two regions, Ottawa and Sudbury, in the province of Ontario, Canada. We conducted thematic data analysis with a deductive/inductive hybrid approach, employing Levesque's theoretical framework for access to health that examines the various system and individual level factors influencing access to healthcare services. 

FINDINGS: At the system level, various systemic barriers encompassing broader organisational, structural, and policy-related elements influenced patients' access to community resources (outreach, availability, location, costs and accommodations for patient needs and preferences). These factors directly interacted with various patient-level factors (awareness of needs, ability to seek support, to reach resources and to pay for those, their physical and mental health, motivation, and confidence to engage in care) to determine access. 

CONCLUSIONS: Our findings highlight individual- and system-level barriers and enablers for accessing community resources among socially complex primary care patients with multiple unmet needs. As governments and organizations in Canada are increasingly investing in community-based services to address adverse social determinants of health (SDH), an upstream approach that reduces both systemic and individual-level barriers to access is warranted.