Using the Theoretical Domains Framework to identify the barriers and enablers to access and use of primary and maternal healthcare services by rural Bangladeshi women: a qualitative study 

Abstract In Bangladesh, increasing the use of primary healthcare (PHC) and maternal healthcare (MHC) services is the main focus of achieving the United Nations Sustainable Development Goal-3, ensuring healthy lives and wellbeing for all. However, little is known about the sociocultural barriers and enablers to accessing and using PHC and MHC services among rural Bangladeshi women. This qualitative study aimed to identify sociocultural barriers and enablers to accessing and using PHC and MHC services among Bangladeshi rural women by using the Theoretical Domains Framework (TDF). This exploratory qualitative study used focus groups and interviews to collect data from women, their husbands and healthcare providers. Data were analysed using Framework approach underpinned by the TDF. Four main themes emerged from data analysis, of which key barriers were summarised in three themes: (i) family barriers including lack of family reinforcement, (ii) social barriers including gender of healthcare providers, and (iii) cultural barriers including superstition to access and use of healthcare services. The remaining theme, sociocultural support, included information about key enablers, such as family support, neighbourhood connection and media influence. Several key behavioural constructs that aligned with the TDF need to be targeted when developing an intervention to promote access and use of PHC and MHC services.