Investigation of vulnerable citizens experiences and opinions towards navigation in health services in Greece

Introduction: The unsuccessful navigation of citizens to health care services is a major issue in health care systems. Health care systems should seek to minimize any access barriers and aim for the continuous improvement of services. Aim: To explore the experiences of a small number of citizens in Greece, with emphasis on how they perceive their access to health care services. Methods: A small qualitative study was carried out via semi-structured interviews with users of health care services in Athens and at one of the Greek islands from December 2014 to April 2015. A World Health Organization questionnaire based on Tanahashi's theoretical framework guided the interview process. A convenience sample was used. The study also utilised Tanahashi's theoretical framework as a guide regarding availability, access, acceptability, coverage and effectiveness of health services. The material was analyzed according to the methodology of Braun & Clarke’s qualitative thematic content analysis. Results: The emerging obstacles were the following: (a) labor shortage and infrastructure regarding the availability of health services, (b) dire economic situation, lack of security, lack of information about facilities, geographical distance and informal payments regarding access to healthcare, (c) waiting lists and social discrimination regarding acceptance of care, (d) identified operational problems regarding coverage upon contact, (e) lack of confidence public structures, financial hardship and directed prescribing regarding effective coverage. The emerging facilitating factors were health professionals' efforts and the assistance of users' families. Conclusions: A great number of obstacles were identified, while access to health services was facilitated by health professionals and users' families.

Keywords: Effectiveness, availability, economic crisis, access, health services