Critical social framework on the determinants of primary healthcare access and utilisation.

Mohammad Hamiduzzaman, Anita De Bellis, Wendy Abigail, Amber Fletcher

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This paper aims to contextualise ‘healthcare access and utilisation’ within its wider social circumstances, including structural factors that shape primary healthcare for marginalised groups. Mainstream theories often neglect complexities among the broader social, institutional and cultural milieus that shape primary healthcare utilisation in reality. A blended critical social framework is presented to highlight the recognition and emancipatory intents surrounding person, family, healthcare practice and society. Using the theoretical contributions of Habermas and Honneth, the framework focuses on power relationships, misrecognition/recognition strategies, as well as disempowerment/empowerment dynamics. To enable causal and structural analysis, we draw on the depth ontology of critical realism. The framework is then applied to the case of rural elderly women’s primary healthcare use in Bangladesh. Drawing on the literature, this article illustrates how a blended critical social perspective reveals the overlapping and complex determinants that affect primary healthcare utilisation, before concluding with the importance of situating healthcare access in sociocultural structures.
Original languageEnglish
Article numbere001031
Number of pages10
JournalFamily Medicine and Community Health
Issue numberSuppl. 1
Publication statusPublished - Nov 2021


  • Primary health care
  • Healthcare utilisation
  • Healthcare access
  • Rural elderly women
  • Bangladesh
  • community health services
  • health services accessibility
  • aging
  • delivery of health care
  • integrated


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