Perceptions, Attitudes, and Expectations Toward Primary Health Care Service Provision and Their Association with...

Primary health care (PHC) utilization in rural communities may depend not only on service availability but also on residents' knowledge of available services, beliefs about service providers, and expectations regarding the value of care. This analytical cross-sectional study examined factors associated with PHC utilization among adults in the catchment areas of subdistrict health promoting hospitals (SHPHs) in Roi Et Province, Northeastern Thailand.

Using multistage sampling, 10 districts, 20 subdistricts, and 20 villages were selected, followed by convenience recruitment of eligible adults within the sampled villages. A total of 461 participants completed a structured questionnaire assessing sociodemographic characteristics, perception, attitudes, expectations, and PHC utilization. Content validity was supported by Index of Item-Objective Congruence values of 0.67 to 1.00, and Cronbach's alpha coefficients ranged from 0.97 to 0.98. Data were analyzed using descriptive statistics, correlation analysis, and multivariable linear regression.

Participants were predominantly female (65.08%), with a mean age of 49.90 years (SD = 15.23). Using predefined equal-width score intervals, perception was classified as moderate (M = 3.59, SD = 0.36), attitudes as positive (M = 3.91, SD = 0.50), expectations as high (M = 4.18, SD = 0.47), and PHC utilization as high (M = 4.13, SD = 0.53). Relatively higher expectation (β = 0.388, p < 0.001), attitude (β = 0.279, p < 0.001), and perception scores (β = 0.149, p < 0.001) were independently associated with greater overall PHC utilization. The adjusted analysis included 446 participants and explained 46.8% of the variance in PHC utilization (R² = 0.468; adjusted R² = 0.453; overall model p < 0.001).

These findings identify residents' service-related knowledge, beliefs, and anticipated value as factors associated with PHC utilization and as potential areas for further evaluation in communication and service-improvement initiatives. However, causal direction cannot be established, and the findings should not be generalized beyond the sampled communities in Roi Et Province without further research.