Guo, Haoyue; (2025) Understanding The Role of Remote Services in Primary Care Access for Older Chinese Migrants in the UK. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: As technology advances, remote healthcare services where the patient and the clinician can communicate without physically meeting are being used increasingly. After the COVID-19 pandemic, the level of remote consultation has increased to unprecedented levels in the UK. While remote services can facilitate access, it also poses barriers to those less familiar with technology. Older Chinese migrants represent a group that experience barriers in healthcare access, potentially facing both challenges and benefits from remote primary care services. Understanding the role of remote services in primary care access for this group provides insights into optimising primary care access for a diverse population in a digital era. Methods: This thesis explores the role of remote services in primary care for older Chinese migrants through three studies: a systematic review of barriers and facilitators to healthcare access for older Chinese migrants in high-income countries; semi-structured interviews exploring older Chinese migrants’ experiences and opinions on remote primary care; and a policy and guideline review to understand the policy positioning of remote primary care. Results: Many practical, personal, social, and system factors could influence primary care access for older Chinese migrants. Although policies and guidelines proposed several benefits of remote services, in practice, older Chinese migrants experienced more challenges than benefits. In addition to mismatches between practice and recommendations, different viewpoints led to different perspectives on what remote services do for primary care. Policy makers considered it an opportunity to improve care, while most older Chinese migrants considered it a compromise of service quality. Conclusion: Comparison of different perspectives highlighted the importance of understanding user voices in service transformation. Existing service models should be continuously monitored and evaluated according to evidence. Active involvement of various patient groups through participatory approaches in service design will help to tackle inequities in access.

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