Improving access: modifying Penchansky and Thomas’s Theory of Access

TLDR

Access is defined as the degree of fit between users and services, optimized by dimensions of accessibility, availability, acceptability, affordability, and adequacy, which are independent yet interconnected. The authors argue that awareness is a missing dimension that should be incorporated into Penchansky and Thomas’s Theory of Access. They propose adding awareness as a permanent component of the theory to be applied when developing, implementing, or evaluating health‑care services and access.

Abstract

Access is defined as the degree of fit between the user and the service; the better the fit, the better the access. Using the theory developed by Penchansky and Thomas, access is optimized by accounting for the different dimensions of access: accessibility; availability; acceptability; affordability; and adequacy in service design, implementation and evaluation. These dimensions are independent yet interconnected and each is important to assess the achievement of access. However, I argue that one dimension is missing – awareness. I propose that awareness is integral to access, that it should become a permanent part of the theory, and be applied whenever using the theory to develop, implement, or evaluate health care services and access more generally.