Background
Justification and study aim
Theoretical underpinning of access to primary care
Methods
Data sources and linkage
Patient selection
Variable selection and measurement model
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Healthcare experience was measured using four questions from the GPPS about quality of care. Other quality of care measures from the GPPS were dropped because they were highly correlated or did not statistically significantly contribute to the model, such as GP listening or if the patient would recommend the surgery to someone moving to the area. Quality of care measures in ELSA were not included because the low number of patients with data.
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Self-esteem was not directly measured in the dataset. Therefore we constructed a latent variable consisting of questions from the Satisfaction with Life Scale, which has a high correlation with self-esteem [22].
Theoretical concept | Indicator variables | Measurement scale | Dataset |
---|---|---|---|
Reflective variables | |||
Assertiveness | Feeling determined during past 30 days | 5 point scale | ELSA W6 |
Describes self as outgoing | 4 point scale | ELSA W6 | |
Feeling proud during past 30 days | 5 point scale | ELSA W6 | |
Self-esteem | Reporting life to be close to ideal | 7 point scale | ELSA W6 |
Reporting conditions in life to be excellent | 7 point scale | ELSA W6 | |
Reporting satisfaction with life | 7 point scale | ELSA W6 | |
Reporting no regrets in life | 7 point scale | ELSA W6 | |
Reporting that he/she has got the important things in life | 7 point scale | ELSA W6 | |
Health care experience | Proportion of people who were not overheard in the surgery, or were, but did not mind | Percent | GPPS |
Proportion of people who reported time given by GP was good or very good | Percent | GPPS | |
Proportion of people who reported explanation given by GP was good or very good | Percent | GPPS | |
Proportion of people who reported the GP involved them in decisions as good or very good | Percent | GPPS | |
Formative variable | |||
Transport | How often individual gets lift from friends or family not living with them | 6 point scale | ELSA W6 |
Road travel time from home to GP practice | Continuous | ELSA W6 | |
How often public transport is used | 6 point scale | ELSA W6 |
Theoretical concept | Variable | Type | Dataset |
---|---|---|---|
Health literacy | Number of correct health literacy tests | 5 point scale | ELSA W5 |
Education | Level of educational qualification | Categorical | ELSA W6 |
Technology | Frequency of using the internet | 6 point scale | ELSA W6 |
Convenience | Proportion of people who found the appointment very or fairly convenient | Percent | GPPS |
Ease at booking | Proportion of people who wound it very or fairly easy to get through to someone at the surgery | Percent | GPPS |
Clear information | Proportion of people who know how to contact out of hours | Percent | GPPS |
Obtaining an appointment | Proportion that were able to get appointment when needed | Percent | GPPS |
Structural model
Results
Variable | Number | Percent | |
---|---|---|---|
Female | 169 | 61.2 | |
Age | 50–54 years | 11 | 4.0 |
55–59 years | 27 | 7.8 | |
60–64 years | 57 | 20.9 | |
70–74 years | 65 | 23.6 | |
75–79 years | 47 | 17.0 | |
80+ years | 35 | 12.0 | |
Not available | 1 | 0.4 | |
Educational attainment | No qualification | 99 | 35.9 |
CSE or equivalent | 24 | 8.7 | |
GCE O level or equivalent | 63 | 22.8 | |
GCE A level or equivalent | 22 | 8.0 | |
Higher education below degree | 36 | 13.0 | |
Degree or equivalent | 13 | 4.7 | |
Not available | 19 | 6.9 | |
Occupation | Routine occupations | 74 | 26.8 |
Semi-routine occupations | 134 | 48.6 | |
Lower supervisory and technical occupations | 63 | 22.8 | |
Small employers and own account workers | 3 | 1.1 | |
Not available | 2 | 0.7 | |
Use of public transport | Every day or nearly every day | 11 | 4.0 |
Two or three times a week | 26 | 9.4 | |
Once a week | 19 | 6.9 | |
Two or three times a month | 24 | 8.7 | |
Once a month or less | 83 | 30.1 | |
Never | 113 | 40.9 | |
Road travel time to GP surgery (minutes) | 4.80a | 2.76 to 7.88b | |
Frequency of lifts from family or friends not living with them | Every day or nearly every day | 1 | 0.4 |
Two or three times a week | 17 | 6.2 | |
Once a week | 22 | 8.0 | |
Two or three times a month | 17 | 6.2 | |
Once a month or less | 25 | 9.1 | |
Never | 194 | 70.3 | |
Frequency of internet or email use | Every day or almost every day | 80 | 29.0 |
At least once a week (but not every day) | 42 | 15.2 | |
At least once a month (but not every week) | 11 | 4.0 | |
At least once every 3 months (but not every month) | 4 | 1.5 | |
Less than every 3 months | 6 | 2.2 | |
Never | 112 | 40.6 | |
Not available | 2 | 7.6 | |
Questions answered correctly in health literacy tests | 0 | 1 | 0.4 |
1 | 9 | 3.3 | |
2 | 17 | 6.2 | |
3 | 45 | 16.3 | |
4 | 180 | 65.2 | |
Not available | 24 | 8.7 |
Context | Mechanism | Outcome | Direct effecta | Indirect effect b | Model fit indicesc | ||||
---|---|---|---|---|---|---|---|---|---|
β | 95% CI | β | 95% CI | RMSEA | CFI | TLI | |||
Clear information | Health literacy | Obtain an appointment | 0.084 | −0.056 to 0.224 | 0.000 | −0.006 to 0.006 | 0.047 | 0.923 | 0.908 |
Higher education including degree or equivalent | Baseline | NA | Baseline | NA | |||||
GCE A level or equivalent | −0.028 | − 0.115 to 0.060 | 0.007 | − 0.008 to 0.021 | |||||
GCE O level or equivalent | −0.026 | − 0.145 to 0.093 | 0.005 | − 0.007 to 0.016 | |||||
CSE or equivalent | 0.006 | −0.072 to 0.085 | 0.004 | −0.006 to 0.013 | |||||
No qualification | 0.009 | −0.126 to 0.144 | 0.011 | −0.011 to 0.032 | |||||
Self esteem | Assertiveness | −0.095 | − 0.213 to 0.024 | 0.035 | − 0.045 to 0.116 | ||||
Clear information | 0.084 | −0.056 to 0.224 | −0.002 | − 0.014 to 0.009 | |||||
Technology | Convenience | 0.080 | −0.041 to 0.201 | 0.029 | −0.021 to 0.079 | ||||
Health care experience | −0.078 | − 0.240 to 0.084 |
0.088
|
0.018 to 0.158
| |||||
Ease of getting through to surgery |
0.514
|
0.407 to 0.620
|
0.140
|
0.067 to 0.214
| |||||
Transport | 0.011 | −0.209 to 0.232 | 0.018 | −0.038 to 0.075 | |||||
Clear information | 0.084 | −0.056 to 0.224 | 0.037 | −0.020 to 0.094 |