title: Barriers and facilitators to using NHS Direct: a qualitative study of 'users' and 'non-users'.
abstract: BACKGROUND
  NHS Direct, introduced in 1998, has provided 24/7 telephone-based healthcare advice and information to the public in England and Wales. National studies have suggested variation in the uptake of this service amongst the UK's diverse population. This study provides the first exploration of the barriers and facilitators that impact upon the uptake of this service from the perspectives of both 'users' and 'non- users'.
  
  
  METHODS
  Focus groups were held with NHS Direct 'users' (N = 2) from Bedfordshire alongside 'non-users' from Manchester (N = 3) and Mendip, Somerset (N = 4). Each focus group had between five to eight participants. A total of eighty one people aged between 21 and 94 years old (M: 58.90, SD: 22.70) took part in this research. Each focus group discussion lasted approximately 90 minutes and was audiotape-recorded with participants' permission. The recordings were transcribed verbatim. A framework approach was used to analyse the transcripts.
  
  
  RESULTS
  The findings from this research uncovered a range of barriers and facilitators that impact upon the uptake of NHS Direct. 'Non-users' were unaware of the range of services that NHS Direct provided. Furthermore, 'non-users' highlighted a preference for face-to face communication, identifying a lack of confidence in discussing healthcare over the telephone. This was particularly evident among older people with cognitive difficulties. The cost to telephone a '0845' number from a mobile was also viewed to be a barrier to access NHS Direct, expressed more often by 'non-users' from deprived communities. NHS Direct 'users' identified that awareness, ease of use and convenience were facilitators which influenced their decision to use the service.
  
  
  CONCLUSIONS
  An understanding of the barriers and facilitators which impact on the access and uptake of telephone-based healthcare is essential to move patients towards the self-care model. This research has highlighted the need for telephone-based healthcare services to increase public awareness; through the delivery of more targeted advertising to promote the service provision available.
authors.forename: Erica J
authors.initials: EJ
authors.lastname: Cook
authors.forename: Gurch
authors.initials: G
authors.lastname: Randhawa
authors.forename: Shirley
authors.initials: S
authors.lastname: Large
authors.forename: Andy
authors.initials: A
authors.lastname: Guppy
authors.forename: Angel M
authors.initials: AM
authors.lastname: Chater
authors.forename: Nasreen
authors.initials: N
authors.lastname: Ali
mesh_terms: D004739:England; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006302:Health Services Research; D015277:Hotlines; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D015397:Program Evaluation; D036301:Qualitative Research; D013222:State Medicine / Q000458:organization & administration*; D013689:Telephone; D014852:Wales