Who uses NHS Direct? factors that impact on the uptake of telephone based healthcare

Abstract

This research aimed to investigate the socio-demographic characteristics alongside the psycho-social factors that impact on the uptake of telephone based healthcare using a socio-cognitive approach. The first study analysed four ‘one month’ periods of national NHS Direct call data (July 2010, October 2010, January 2011 and April 2011) for all 0845 4647 calls in England. Expected and actual usage of NHS Direct was determined for each ethnic group of the population and compared using Chi-square analysis. Results confirmed that White British used NHS Direct more than expected, alongside Mixed (Caribbean/African) and Asian Pakistani groups, with lower representation found for Asian Indian\Bangladeshi, Black African\Caribbean, alongside Chinese ethnic groups. No gender differences were noted. Calls were then analysed for age, gender and deprivation (IMD health, income, employment & education) using negative binominal regression. Results suggest that deprivation increases call rates for adult calls but reduced in calls about children (<15 years). This study also highlights that NHS Direct call rates (all ages combined) are highest in areas with deprivation levels at, or just above, the national average, which remains consistent when accounting for employment, income and education deprivation. The second study, adopted a qualitative approach to explore the psycho-social factors that impact on the uptake of telephone based healthcare. Focus groups were conducted with low user groups (Manchester (N=3) and Mendip (N=4)), alongside high service users (N=2) and service providers (N=2). Five themes emerged: attitudes, structural and perceived barriers, knowledge and awareness of NHS Direct alongside improving access. Findings highlight a preference for instant face-to-face reassurance in low user groups, whereby low users appear to have lower perceived confidence in self-management of symptoms and engaging with telephone based health services. In conclusion the findings suggest there is variation in usage of NHS Direct, influenced by ethnicity, gender, age and deprivation. This research has explored some of the barriers, and has provided a theoretical framework that can be applied to understand uptake of telephone based healthcare. This research can help enable the development of future promotional campaigns that can target particular sections of the population to encourage use of telephone based healthcare services.