Abstract
BackgroundNHS 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’.MethodsFocus 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.ResultsThe 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.ConclusionsAn 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0487-3) contains supplementary material, which is available to authorized users.
Highlights
NHS Direct, introduced in 1998, has provided 24/7 telephone-based healthcare advice and information to the public in England and Wales
In 2012, NHS Direct was replaced with the new nonemergency ‘111’ telephone-based healthcare service
The introduction of ‘111’ has marked the end of NHS Direct [2], it has highlighted the increased role that telephone-based healthcare has within the NHS structure
Summary
NHS Direct, introduced in 1998, has provided 24/7 telephone-based healthcare advice and information to the public in England and Wales. NHS Direct provided 24 hour/7 day a week nurse led telephone-based healthcare advice and information to the public in England and Wales [7,8] (see Additional file 1). This service, introduced in 1998, marked a strategic shift towards the self-care movement [9] which encouraged the population to take an increased responsibility for their own health [8,10,11]. Self-care is being viewed as an inextricable part of the individual care pathway, from maintaining a healthy lifestyle to caring for minor, acute and long-term health conditions [15]
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