Barriers to utilization of pre-hospital emergency medical services among residents in Libreville, Gabon: A qualitative study

Abstract

Introduction: In 2002, the West-African nation of Gabon established an emergency medical system (EMS), Service d’Aide Médicale Urgente (SAMU), in Libreville, yet few people access it. Our objective was to describe Libreville residents’ knowledge and attitudes toward the SAMU in an effort to understand why this service is underutilized. Methods: Qualitative interviews consisting of nine open-ended questions were conducted on a convenience sample of twenty patients, three visitors and two patient/visitor dyads at the Jeanne Ebori Hospital Emergency Centre in October 2009. Eligible subjects arrived in vehicles other than the SAMU and were ill enough to require hospital admission. Exclusion criteria were: under 21 years old, unable to speak French, or medically unstable. A bilingual team member audio-recorded the interviews in French and transcribed them into English. Investigators organized text into codes, then into themes and theoretical constructs. Intercoder agreement was excellent. Data were collected until theoretical saturation was achieved. Results: Analysis of data revealed no difference in response between patients and visitors. People underused SAMU because of financial costs, lack of awareness of the program, use of traditional modes of transportation, infrastructure flaws, perceived response times and other misconceptions. Conclusion: We identified remediable barriers to EMS (SAMU) access in Libreville, Gabon: lack of awareness, misperceptions, established alternatives, and cost. Interventions and future investigations designed to increase EMS utilization in Gabon should target these four areas.