Study Protocol and Methodological Design for an Integrated Anderson-Donabedian Framework Analysis

Primary Health Care (PHC) plays a main role in the promotion of equitable access, continuity of care and progress towards Universal Health Coverage. Nevertheless, understanding healthcare utilization needs consideration on the one hand of individual determinants of healthcare-seeking behavior and on the other hand, of the organizational conditions under which services are delivered. The current paper proposes an integrated conceptual and methodological framework. The framework concerns primary healthcare utilization and quality’s assessment within the Albanian public healthcare system. The framework combines Andersen’s Behavioral Model of Health Services Use with Donabedian’s Structure-Process-Outcome model. Thereby, it links patient-level predisposing, enabling and need factors with healthcare-center-level structures, with care processes and finally, with the results that are patient-reported. The study adopts a quantitative, explanatory, whose design is cross-sectional. It integrates data that are collected from adult PHC users with organizational information obtained through structured assessments of the healthcare centers that participated. A stratified multistage sampling strategy is proposed. It covers urban, peri-urban and rural settings across Albania. There is an anticipated research sample of approximately 350-420 patients from 32-35 primary healthcare centers. As for the patient-level measures, they include healthcare utilization, accessibility, care experience, trust and satisfaction. Organizational measures include staffing, infrastructure, equipment, medicines, documentation systems and organizational protocols. The analytical strategy combines multivariable and multilevel regression with Structural Equation Modelling. Therefore, it examines direct, indirect and moderating relationships among the constructs of the study. By the integration of behavioral and organizational perspectives, the current proposed framework addresses the fragmented examination of PHC utilization and healthcare quality in previous Albanian research. Finally, the current study is expected to offer a holistic methodological basis for the identification of determinants of access, continuity, patient experience and quality of care. It is also expected to generate evidence that is relevant to the primary healthcare service’s further strengthening in Albania.