Why do middle-aged adults use or avoid health services? A study of social and demographic determinants

Middle-aged adults experience distinctive health issues, yet underutilize preventive care despite Iran's strong primary healthcare (PHC) system. This research investigates social and demographic determinants of healthcare services utilization among middle-aged adults in Qom, Iran, to inform the development of targeted community-based screening initiatives.

A cross-sectional study was conducted in underprivileged suburbs of Qom (June-September 2024) among 697 adults aged 30-59, randomly sampled by cluster sampling. Awareness of available services, utilization, and satisfaction with PHC service information were collected via phone interviews. Multivariate logistic regression identified predictors of service utilization.

Only 11.8% (n = 82) of the participants were aware of middle-aged health services, and 24.2% (n = 169) had utilized them in the past year. Women had at least one PHC visit 2.5 times more than men (35.3% vs 13.9%, p < 0.001), and utilization increased with age (31.1% among 50-59-year-olds vs. 19.6% in 30-39 years-old, p = 0.023).The strongest predictor was awareness: aware adults had 22.4-fold higher odds of use (95% CI: 11.60-43.29, p < 0.001). Dissatisfaction (by 7.7% of users) was linked to gaps in staff communication (38%), overcrowding (38%), and perceived incompetence (30%) (multiple responses permitted). Work and education were not independently associated with service use after adjustment, suggesting indirect impacts.

PHC utilization among middle-aged population is handicapped by low awareness and gender/age disparities. Interventions should prioritize health literacy programs, staff training to improve patient-provider communication, and systemic modifications to reduce overcrowding. Increased outreach to men and younger adults is necessary to ensure equitable preventive care.