title: An exploration of rural-urban differences in healthcare-seeking trajectories: implications for measures of accessibility.
abstract: Comparing accessibility between urban and rural areas requires measurement instruments that are equally discriminating in each context. Through focus groups we explored and compared care-seeking trajectories to understand context-specific accessibility barriers and facilitators. Rural care-seekers rely more on telephone access and experience more organizational accommodation but have fewer care options. Urban care-seekers invoke the barrier of distance more frequently. Four consequences of accessibility problems emerged across settings which could be used for valid comparisons of access: having to restart the care-seeking process, abandoning it, using emergency services for primary care, and health deterioration due to delay.
authors.affiliation: Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neige, 3rd floor, Montreal, Quebec, Canada H3S 1Z1. Electronic address: jeannie.haggerty@mcgill.ca.
authors.forename: Jeannie L
authors.initials: JL
authors.lastname: Haggerty
authors.affiliation: Department of Community Health Sciences, Université de Sherbrooke, Faculté de médecine et des sciences de la santé, 3001, 12e Avenue Nord, Sherbrooke, Quebec, Canada J1H 5N4.
authors.forename: Danièle
authors.initials: D
authors.lastname: Roberge
authors.affiliation: Population Health and Health Services Team, Public Health Directorate for Montreal, Montreal Health and Social Services Agency, 1301 Sherbrooke Street East, Montreal, Quebec, Canada H2L 1M3; Institut National de Santé Publique du Québec (INSPQ), 945 Wolfe Avenue, Quebec, Canada G1V 5B3; University of Montreal Hospital Research Centre, Tour Viger, Pavilion R, 900 Saint-Denis Street, Montreal, Quebec, Canada H2X 0A9.
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Lévesque
authors.affiliation: Institut National de Santé Publique du Québec (INSPQ), 945 Wolfe Avenue, Quebec, Canada G1V 5B3.
authors.forename: Josée
authors.initials: J
authors.lastname: Gauthier
authors.affiliation: Department of Community Health Sciences, Université de Sherbrooke, Faculté de médecine et des sciences de la santé, 3001, 12e Avenue Nord, Sherbrooke, Quebec, Canada J1H 5N4.
authors.forename: Christine
authors.initials: C
authors.lastname: Loignon
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D002170:Canada; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011369:Professional-Patient Relations; D019035:Rural Health Services; D012424:Rural Population; D019037:Urban Health Services; D014505:Urban Population
keywords: Health services research; Outcome and process assessment; Primary health care; Qualitative research; Rural health services