Exploring Whether and How People Experiencing High Deprivation Access Diagnostic Services: A Qualitative Systematic Review

• Published in: Health expectations : an international journal of public participation in health care and health policy Vol. 27; no. 4; pp. e14142 - n/a
• Main Authors: Vincent, Christine, Fenge, Lee‐Ann, Porter, Sam, Holland, Sharon
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01-08-2024; John Wiley and Sons Inc; Wiley
• Subjects: Access; barriers; Behavior; Codes; Colorectal cancer; Complexity; Conceptual models; Decision making; Deprivation; Design factors; Diabetes; Diagnostic Services; Diagnostic systems; diagnostics; Emotional behavior; Ethnicity; Experts; facilitators; Health disparities; Health Services Accessibility; Humans; Lung cancer; Medical screening; Motivation; Participation; Patients; Psychological aspects; Psychological factors; public involvement; Qualitative Research; Quantitative research; Review; Search strategies; Socioeconomic factors; Socioeconomic status; Systematic review; United Kingdom; United Kingdom; United Kingdom > UK; England; deprivation; public involvement; diagnostic services; diagnostics; barriers; facilitators
• ISSN: 1369-6513; 1369-7625; 1369-7625
• DOI: 10.1111/hex.14142

ABSTRACT
Introduction
To contribute to addressing diagnostic health inequalities in the United Kingdom, this review aimed to investigate determinants of diagnostic service use amongst people experiencing high deprivation in the United Kingdom.
Methods
A systematic review was conducted using three databases (EBSCO, Web of Science and SCOPUS) to search studies pertaining to diagnostic service use amongst people experiencing high deprivation. Search terms related to diagnostics, barriers and facilitators to access and deprivation. Articles were included if they discussed facilitators and/or barriers to diagnostic service access, contained participants' direct perspectives and focussed on individuals experiencing high deprivation in the United Kingdom. Articles were excluded if the full text was unretrievable, only s were available, the research did not focus on adults experiencing high deprivation in the United Kingdom, those not including participants' direct perspectives (e.g., quantitative studies) and papers unavailable in English.
Results
Of 14,717 initial papers, 18 were included in the final review. Determinants were grouped into three themes (Beliefs and Behaviours, Emotional and Psychological Factors and Practical Factors), made up of 15 sub‐themes. These were mapped to a conceptual model, which illustrates that Beliefs and Behaviours interact with Emotional and Psychological Factors to influence Motivation to access diagnostic services. Motivation then influences and is influenced by Practical Factors, resulting in a Decision to Access or Not. This decision influences Beliefs and Behaviours and/or Emotional and Psychological Factors such that the cycle begins again.
Conclusion
Decision‐making regarding diagnostic service use for people experiencing high deprivation in the United Kingdom is complex. The conceptual model illustrates this complexity, as well as the mediative, interactive and iterative nature of the process. The model should be applied in policy and practice to enable understanding of the factors influencing access to diagnostic services and to design interventions that address identified determinants.
Patient or Public Contribution
Consulting lived experience experts was imperative in understanding whether and how the existing literature captures the lived experience of those experiencing high deprivation in South England. The model was presented to lived experience experts, who corroborated findings, highlighted significant factors for them and introduced issues that were not identified in the review.