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Exploring the dimensions and internal mechanisms of perceived barriers to medical care (PBMC) among community residents
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DOI：10.1186/s13690-026-02040-9.png)
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Abstract
En 中文
Perceived Barriers to Medical Care (PBMC) reflect individuals’ subjective psychological and behavioral obstacles during healthcare seeking, yet their structural dimensions and internal mechanisms remain insufficiently understood. This study aimed to explore the prevalence, dimensional structure, and interaction mechanisms of PBMC among community residents in Yunnan Province, Southwest China. A mixed-methods design was adopted. Semi-structured interviews were first conducted to identify manifestations of PBMC and construct the item pool. Subsequently, a cross-sectional survey involving 1,509 community residents in Yunnan Province, China, was performed between September and December 2024. Hierarchical cluster analysis (HCA), exploratory factor analysis (EFA), exploratory graph analysis (EGA), network analysis, and structural equation modeling (SEM) were applied. Among respondents, 88.9% reported experiencing at least one form of PBMC. HCA, EFA, and EGA consistently identified a four-dimensional structure comprising concern, resistance, privacy, and delay. Concern mainly reflected anxiety regarding medical processes, costs, and service quality, whereas resistance represented reluctance or distrust toward medical procedures. Privacy involved concerns about personal information exposure, and delay reflected the postponement of medical consultation. Network analysis demonstrated high internal connectivity among PBMC dimensions, with resistance showing the highest centrality within the network. SEM further showed that resistance directly influenced delay and indirectly affected delay through privacy and concern (all P ＜ 0.05). Among community residents in Yunnan Province, Southwest China, PBMC appears to be a multidimensional and interconnected psychological-behavioral system centered on resistance. Interventions targeting resistance reduction, privacy protection, and optimization of healthcare processes may help alleviate PBMC and improve healthcare accessibility and patient experience.
Keywords:
Perceived barriers to medical care
Dimension
Subjective experiences
Network
Structural equation model
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