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Policymakers push online health services delivery, relying on consumers to independently engage with online services. Yet, a growing cluster of vulnerable patients do not engage with or disengage from these innovative services. There is a need to understand how to resolve the tension between the push of online health service provision and unengagement by a contingent of health-care consumers. Thus, this study aims to explore the issue of digital unengagement (DU) (i.e. the active or passive choice to engage or disengage) with online health services to better inform service design aligned to actual consumer need.

Adopting a survey methodology, a group of 486 health services consumers with a self-declared (acute or chronic) condition were identified. Of this group, 110 consumers were classified as digitally unengaged and invited to write open-ended narratives about their unengagement with online health services. As a robustness check, these drivers were contrasted with the drivers identified by a group of digitally engaged consumers with a self-declared condition (n = 376).

DU is conceptualized, and four levels of DU drivers are identified. These levels represent families of interrelated drivers that in combination shape DU: subjective incompatibility (misalignment of online services with need, lifestyle and alternative services); enactment vulnerability (personal vulnerabilities around control, comprehension and emotional management of online services); sharing essentiality (centrality of face-to-face co-creation opportunities plus conflicting social dependencies); and strategic scepticism (scepticism of the strategic value of online services). Identified challenges at each level are the mechanisms through which drivers impact on DU. These DU drivers are distinct from those of the digitally engaged group.

Adding to a nascent but growing literature on consumer unengagement, and complementing the engagement literature, the authors conceptualize DU, positioning it as distinct from, not simply a lack of, consumer engagement. The authors explore the drivers of DU to provide insight into how DU occurs. Encapsulating the dynamic nature of DU, these drivers map the building blocks that could help to address the issue of aligning the push of online service provision with the pull from consumers.

This paper offers insights on how to encourage consumers to engage with online health services by uncovering the drivers of DU that, typically, are hidden from service designers and providers impacting provision and uptake.

There is a concern that there will be an unintentional disenfranchisement of vulnerable segments of society with a generic policy emphasis on pushing online services. The paper sheds light on the unforeseen personal and social issues that lead to disenfranchisement by giving voice to digitally unengaged consumers with online health services.

Offering a novel view from a hard-to-reach digitally unengaged group, the conceptualization of DU, identified drivers and challenges inform policymakers and practitioners on how to facilitate online health service (re)engagement and prevent marginalization of segments of society.

Older women living in medically underserved areas (MUA) might have particular problems with access to health care. This is an in-depth report of the accessibility issues raised by six frail older women (age 82–93 years) during a longitudinal descriptive phenomenological study of the experience of home care. Three White women lived in the same rural MUA, and three Black women lived in the same urban MUA. The need for health service was understood subjectively and prospectively as the personal perception of a situation requiring relief or supply. Some women reported presenting needs for accessibility to providers, whereas others reported needs for their future accessibility to providers or services. Some intentions were likely linked to residence location, and residence in a rural MUA was relevant to the phenomenon of securing the help that I might need down the road. Feasibility was proposed as a new parameter of access. Research and practice implications were proposed.

This study aims to improve accessibility to frontline psychological services for youths in difficulty. In the province of Quebec, Canada, the first significant intervention must take place within 30 days for at least 75% of the clients. Achieving this target is challenging. This was observed in the Youth Programme of a health-care network in Montreal (Centre Intégré (Universitaire) de la Santé et des Services Sociaux Centre-Sud-de-l’île-de-Montréal).

Lean Six Sigma (LSS) approach within the Action Research methodology was used. Define, Measure, Analyse, Innovate, Implement and Control structure combined with Lean techniques and a Kaizen event were implemented.

In total 69% of the clients have now had their first intervention within 30 days and 91% within 60 days. Improving accessibility to frontline services led to improving accessibility to second-line services. Communicating performance objectives to employees led to increasing their awareness about the importance of performance assessment and their willingness to contribute to improvement. The Kaizen event was a driving force that enabled more collaboration and trust. The participation of a partner-client in the Kaizen helped finding client-centred solutions. The large number of participants in the Kaizen added complexity.

It was difficult to sort and rank a large number of solutions during the Kaizen. The impact of hiring additional employees has not been investigated. Despite the significant improvements, the targets were not achieved. More research is required to identify more accurately critical factors that have a major impact on the success of LSS projects involving complex processes.

This study contributes to the body of knowledge in Lean health care. It describes Lean tools/techniques used, solution implementation and improvements achieved in a real context. 10 success factors and 4 challenges were identified. The study provides a model for other organizations for developing their own roadmap to improve accessibility to their services, notably in large and complex processes.

The purpose of this study is to explain predictors that discriminate users’ preferences for online health services, focusing on a downtown area in a developing country.

Drawing on rational choice theory (RCT), the authors test a model that links the frequency of online health service usage to access-activators and access-inhibitors. Multivariate analysis of variance (MANOVA) and the discriminant analysis model were used to analyze data from a sample of 215 internet users.

Results confirm the significance of responsiveness, user’s attitude, accessibility and perceived ease of use, indicating their discriminating role in the usage of online health services.

The study demonstrates the relevance of RCT in measuring perceived online health service quality in an emerging context. Future research should consider the influence of electronic health (eHealth) literacy, norms and trustworthiness to increase the generalizability of the findings.

The findings of this study can help enhance the eHealth service quality by encouraging service providers to improve the interactivity and ease of use of their platforms, thus delivering value to both consumers and firms and improving the well-being of the society at large.

Few existing studies draw attention to access-activators and access-inhibitors to predict users’ preferences for online health services. This study shows the applicability of RCT in preparing the instrumental dimensions of online health service quality.

The purpose of this paper is to evaluate socio-economic inequalities in the use, accessibility and satisfaction with health services amongst 60-84 year old people from seven European urban communities.

Data for this study were collected in 2009. The target population was people aged 60-84 years from Stuttgart (Germany), Athens (Greece), Ancona (Italy), Kaunas (Lithuania), Porto (Portugal), Granada (Spain) and Stockholm (Sweden). The total sample comprised 4,467 respondents with a mean response rate across these countries of 45.2 per cent.

The study demonstrated that the majority of respondents had contact with a health care provider within the last 12 months. The highest percentages were reported by respondents from Spain (97.8 per cent) and Portugal (97.7 per cent). The results suggest that 13.0 per cent of respondents had refrained from seeking care services. The highest rates were amongst seniors from Lithuania (24.0 per cent), Germany (16.2 per cent) and Portugal (15.4 per cent). Logistic regression suggests that seniors who refrained from seeking health care was statistically significant associated with those with higher levels of education (odds ratios (OR)=1.21; 95 per cent confidence intervals (CI)=1.01-1.25) and financial strain (OR=1.26; 95 per cent CI=1.16-1.37). Furthermore, the majority of respondents were satisfied with health care services.

The findings from the “Elder Abuse: a multinational prevalence survey” study indicate the existence of significant variations in use, accessibility and satisfaction with health services by country and for socio-economic factors related to organizing and financing of care systems.

This paper is an attempt to bridge the gap between, on the one hand, the mobility behaviour of households and their perception of accessibility to urban amenities and, on the other hand, house price dynamics as captured through hedonic modelling.

In order to analyse the mobility behaviour of individuals and households, their sensitivity to travel time from home to service places is estimated so as to assess their perceived accessibility, using “subjective” indices based on actual trips, as reported in the 2001 origin‐destination survey designed for Quebec City. For comparative purposes, both objective and subjective accessibility indices based, in the former case on observed travel times and, in the latter case on fuzzy logic criteria, are computed and used as a complement to a centrality index in a hedonic model of house prices.

Findings indicate that there are statistically significant differences in the way accessibility is structured depending on trip purposes and household profiles. They also suggest that, while an objective measure of accessibility yields good results, resorting to subjective, and more comprehensive, accessibility indices derived from fuzzy logic provides greater insight into the understanding of commuting patterns and travel behaviour of people.

Better understanding the complexity of individuals’ and households’ mobility behaviour should result in more adequate initiatives and decisions being taken by transportation and city planning authorities.

Accessibility to jobs and services has long been known as a major determinant of urban, residential and non residential, rents. Yet, it is more often than not assumed to derive from a rather straightforward process, which this paper shows is not the case.

Access to services for consumers with disabilities (CwD) has gained increased attention from researchers and service providers in recent years. Consequently, ensuring that services are designed and maintained in a manner that is more inclusive and accessible to CwD has become imperative. However, academic literature is fragmented and thus, this study aims to provide a state-of-the-art synthesis for further theoretical development.

This study reviews 77 relevant articles in the domain using a multidisciplinary review following the PRISMA protocol, and a thematic analysis was conducted.

The study thoroughly synthesizes the theories, contexts and methods used in the extant literature. Next, the study presents a new theoretical framework with four broader dimensions: beyond regulations, towards accessibility, value co-creation, inclusion of CwD and role of stakeholders. Furthermore, it highlights the related sub-dimensions attributed to the service design stages (planning, usage and post-usage). Based on this, the study offers critical avenues for future research using the Double Diamond framework.

The study contributes significantly to service design literature for CwD and transformative service research by developing a new consolidated theoretical framework. The findings should direct service providers towards better service designs in related fields. Socially, the study has implications for promoting accessibility and inclusion for CwD, while providing them the freedom of choice.

This study aimed to identify the proportion and factors influencing the use of maternal health services (MHS) in rural Thawang, Rolpa, Nepal.

This was a community-based cross-sectional study conducted among 417 mothers who had given birth in the previous two years. Bivariate and multivariate logistic regression was applied to identify associations and predictors.

The results showed that the use of maternal health services was 50.8%. Adjusting for all other factors in the final model, age group 25–30 years (AOR: 2.30; 95% CI: 1.199–4.422), spouse communication (AOR: 7.31; 95% CI: 2.574–20.791), high accessibility (AOR: 2.552, 95% CI: 1.402–4.643) and high affordability (AOR: 10.89; 95% CI: 4.66–25.445) were significant predictors.

This is a community-based cross-sectional study, and hence cannot establish causal relationships. The research was conducted in a limited rural area mid-Western Nepal, and this may limit the generalization of results to other settings of the country.

This research supports to local level government and district health authority to develop and implement need based action to increase maternal health service in the local context.

Underutilization of maternal health services is the result of socioeconomic dynamics, poor access to health services and other physical developments. To increase utilization of maternal health services in rural areas, there is a need to tackle the root cause of health inequality such as reducing poverty, increasing female education, involving women in employment and increasing access to health as a priority development agenda by government authorities. This research supports local level government and district health authorities to develop and implement needs-based action to increase MHS in the local context.

Reducing inequity in health between the poor and the rich is one of the challenges of the Iranian health sector. Access to health services in Iran is lower in the lowest-income quarter, and the rich use health services more. The purpose of this study is to provide a comprehensive framework for enabling financial access by the poor to health services in Iran.

Policy options were validated and approved by experts and specialists in two stages using the Delphi technique. The sample was consisted of 22 well-known experts on the subject who were selected based on purposive sampling. To evaluate the reliability of the questionnaire, a pilot study was conducted with five participants. Dimensional validity of the policy model, which was agreed upon by more than 75% of the participants was acceptable.

The main aspects of the model were divided into five categories: identifying the poor, policymaking to prevent the aggravation of health poverty, providing targeted funding, highlighting the importance of coherent regulation and ensuring financial accessibility to health services for the poor. This model could align the activities of all stakeholders in the form of a network and considers its prerequisites.

Prevention of dire financial consequences in the case of referral to follow up the treatment alongside exemption and financial protection policies through the networking activities of organizations involved in this field is a crucial step in securing financial support for the poor. Although the researchers included a wide range of policymakers in the Delphi study to gather all perspectives about options for financially support the poor, there may be some potential neglected policy advices.

The purpose of this paper is to discuss a GIS application created for health care planning at Jeddah city, Saudi Arabia. The application covers important health care facilities planning issues including defining accessibility to health care facilities, identifying and classifying the distribution of health demand at Jeddah city and modeling spatial variation of patient locations.

In order to build this application, a geo‐database is created that covers points, lines and polygon features such as health care facility location, road network and population districts. In addition, raster surface models are produced using Kriging function which produces raster surfaces for predicting health demand values at the study area.

The outputs of this application can be used to help health care planners in evaluating the existing location of health care facilities and see if these locations are concentrated at certain city districts. In addition, local health planners can use the created models when deciding where to allocate a new health care facility at Jeddah city.

This application is considered as a spatial decision support system for health planners in Jeddah city. It can be used to define and evaluate location of health centers as well as to identify the spatial accessibility to health centers.