EPIC: A Framework for the Factors That Influence the Selection of Health-Care Providers

The decision about where to seek health-care services once the need for care has been established is an important step in health-care access. We conducted a systematic review of the maternal and child health literature to identify articles about health services accessibility. We then used a qualitative thematic synthesis approach to develop themes from the codes in eligible articles and to integrate those themes into a comprehensive model of the factors that affect health-care provider selection once the decision to seek formal medical care has been made. The EPIC model captures four main provider selection factors from the included articles: environment (such as travel distance and transportation access), provider (level of care, services, ownership, staffing, equipment and supplies, and reputation), individual (socioeconomic and health status), and cost (price and time). All aspects of the EPIC model should be considered when studying and developing location-specific strategies to improve access to and choice of health-care providers.