title: Using Q-methodology to explore people's health seeking behavior and perception of the quality of primary care services.
abstract: BACKGROUND
  Information on health seeking behavior and beneficiaries' perception of the quality of primary care can help policy makers to set strategies to improve health system. With scarcity of research on this particular field in Iraqi Kurdistan region, we sought to explore the patterns of health seeking behavior and perception of the quality of primary care services of a sample of population.
  
  
  METHODS
  This explorative study was carried out in Erbil governorate, Iraq. Data were collected using the novel approach of Q-methodology for eliciting subjective viewpoints and identifying shared patterns among individuals. Forty persons representing different demographic and socioeconomic groups and living in different areas of Erbil governorate sorted 50 statements reflecting different aspects of health-seeking behavior and primary care services into a distribution on a scale of nine from "disagree most" to "agree most". By-person factor analysis through centroid factor extraction and varimax rotation of factors were used to derive latent viewpoints.
  
  
  RESULTS
  Four distinct patterns of health seeking behavior and viewpoints toward the primary care services were identified. People in factor 1 are extremely critical of the services at primary health care centers and are regular users of the private health sector. People in factor 2 positively recognize the services at primary health care centers but mainly turn to inappropriate health seeking behavior. People in factor 3 have satisfaction with the services at primary health care centers with minimal use of these services, but mainly turn to the private sector. People in factor 4 are slightly satisfied with the services at primary health care centers but mainly rely on these services.
  
  
  CONCLUSIONS
  This study highlighted the typical characterizations that were associated with each uncovered factor. Informing on the beneficiaries' concerns about the primary care services can help to improve the system through further exploring the issues raised by the respondents and directing particular action on these issues. The characterizing and distinguishing statements can be used as a set of questions to conduct community-based survey on this important aspect of health services.
authors.affiliation: Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq. nazarshabila@gmail.com.
authors.forename: Nazar P
authors.initials: NP
authors.lastname: Shabila
authors.forename: Namir G
authors.initials: NG
authors.lastname: Al-Tawil
authors.forename: Tariq S
authors.initials: TS
authors.lastname: Al-Hadithi
authors.forename: Egbert
authors.initials: E
authors.lastname: Sondorp
mesh_terms: D000288:Administrative Personnel; D000328:Adult; D005163:Factor Analysis, Statistical; D005260:Female; D015438:Health Behavior; D006296:Health Services / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007493:Iraq; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D010465:Perception; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data; D017149:Private Sector; D011787:Quality of Health Care