Patient experiences of digital-first primary care in England: A qualitative study of university students

Digital-first primary care has expanded in England, but evidence on how patients experience these services in routine use remains limited, particularly among younger adults who are often assumed to be confident users of digital care.

To examine how university students experienced digital-first primary care and to identify the factors shaping acceptability, trust, and willingness to use these services again.

We conducted a qualitative study using semi-structured telephone interviews with 20 university students who had used digital-first primary care services. Interview data were analyzed using grounded theory procedures (open, axial, and selective coding). Supplementary computational text analysis was used to support interpretation of recurring concerns. Reporting was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ). The Technology Acceptance Model (TAM) was used as an interpretive framework for understanding adoption-related perceptions.

Participants described a facilitating pathway alongside three interrelated inhibiting categories. The facilitating pathway reflected context-specific value: suitability for straightforward or transactional needs, reduced logistical burden, and complementarity with hybrid care. The inhibiting pathway comprised service accessibility barriers, consultation effectiveness barriers, and digital trust and patient engagement barriers. Participants reported inconsistent interfaces, repetitive or unclear communication, inflexible appointment systems, limited confidence in remote symptom assessment, slow responses, and difficulty escalating to in-person review when needed. A TAM-informed interpretive integration linked these qualitative categories to perceived ease of use, perceived usefulness, trust and perceived agency, and willingness to re-use digital-first services.

Digital-first primary care was experienced as a conditional and complementary form of care. It was most acceptable for simple, transactional, or logistically burdensome needs, but less trusted when symptoms were complex, uncertain, urgent, or difficult to assess remotely. Implementation should preserve patient choice, clinically appropriate escalation, and hybrid options.