title: Choice of primary health care source in an urbanized low-income community in Singapore: a mixed-methods study.
abstract: BACKGROUND
  Cost and misperceptions may discourage lower income Singaporeans from utilizing primary care. We investigated sources of primary care in a low-income Singaporean community in a mixed-methods study.
  
  
  METHODS
  Residents of a low-income public rental flat neighbourhood were asked for sociodemographic details and preferred source of primary care relative to their higher income neighbours. In the qualitative component, interviewers elicited, from patients and health care providers, barriers/enablers to seeking care from Western-trained doctors. Interviewees were selected via purposive sampling. Transcripts were analyzed thematically, and iterative analysis was carried out using established qualitative method.
  
  
  RESULTS
  Participation was 89.8% (359/400). Only 11.1% (40/359) preferred to approach Western-trained doctors, 29.5% (106/359) preferred alternative medicine, 6.7% (24/359) approached family/friends and 52.6% (189/359) preferred self-reliance. Comparing against higher income neighbours, rental flat residents were more likely to turn to alternative medicine and family members but less likely to turn to Western-trained doctors (P < 0.001). For the qualitative component, a total of 20 patients and 9 providers were interviewed before data saturation was reached. Patient and provider comments fell into the following content areas: primary care characteristics, knowledge, costs, priorities, attitudes and information sources. Self-reliance was perceived as acceptable for 'small' illnesses but not for 'big' ones, communal spirit was cited as a reason for consulting family/friends and social distance from primary care practitioners was highlighted as a reason for not consulting Western-trained doctors.
  
  
  CONCLUSIONS
  Western-trained physicians are not the first choice of lower income Singaporeans for seeking primary care. Knowledge, primary care characteristics and costs were identified as potential barriers/enablers.
authors.affiliation: Yong Loo Lin School of Medicine and.
authors.forename: Liang En
authors.initials: LE
authors.lastname: Wee
authors.forename: Li Yan
authors.initials: LY
authors.lastname: Lim
authors.forename: Tong
authors.initials: T
authors.lastname: Shen
authors.forename: Elis Yuexian
authors.initials: EY
authors.lastname: Lee
authors.forename: Yet Hong
authors.initials: YH
authors.lastname: Chia
authors.forename: Andrew Yen Siong
authors.initials: AY
authors.lastname: Tan
authors.forename: Gerald Choon-Huat
authors.initials: GC
authors.lastname: Koh
mesh_terms: D000328:Adult; D002755:Choice Behavior; D000529:Complementary Therapies / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008519:Medicine, Traditional / Q000523:psychology / Q000706:statistics & numerical data; D008875:Middle Aged; D057240:Patient Preference / Q000523:psychology / Q000706:statistics & numerical data*; D011203:Poverty / Q000523:psychology / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012846:Singapore; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: Asia; low income; primary care; qualitative; traditional medicine.