Using the Social Ecological Model to identify barriers to accessing and using primary healthcare services by the rural Bangladeshi elderly: A systematic review.

Abstract

Bangladesh's government is focusing on the United Nations Sustainable Development Goal 3 to improve primary healthcare (PHC) services, although rural elderly populations still lack access. The systematic review aimed at exploring and synthesizing the multilevel barriers to accessing and using PHC services by the rural Bangladeshi elderly based on the Social Ecological Model (SEM). After completing registration in PROSPERO, electronic searches were conducted in March 2026 for a systematic literature search in the Scopus, PubMed, and ProQuest Sociological Abstracts databases, as well as in Google and Google Scholar. After a rigorous search, this review included 19 of 2099 articles, following the inclusion and exclusion criteria of the review. The quality of the articles was assessed using the Critical Appraisal Skills Programme and Mixed Methods Appraisal Tools. Barriers were identified using the thematic synthesis approach guided by the SEM. The 19 included articles were synthesized into five themes: individual, family, organizational, social and community, and policy barriers. The review findings revealed that the key individual-level barriers included less physical capability, financial insolvency, and lack of PHC service knowledge. The family-level barriers included less connectivity with family and relatives, family influence over healthcare decisions, and gender disparity in families. The organizational-level barriers incorporated limited infrastructural facilities, unsatisfactory attitudes of healthcare providers (HPs), preference for gender-specific HPs, and treatment expenses. Dependence on traditional healers and lack of mobility were the social and community-level barriers. Finally, the policy-level barriers included rural elderly health insurance gaps. The review recommends PHC awareness campaigns, family support, simplification of PHC service-related facilities, social assistance, and health coverage programs to help rural Bangladeshi elderly access PHC services.