Unraveling the Barriers to Medical Care in Developing Countries: An Integrated Grey DEMATEL-ANP Approach to Understanding Avoidance.

INTRODUCTION

Timely access to medical care is essential for maintaining public health. However, many individuals deliberately avoid seeking medical attention, resulting in poorer health outcomes and increased healthcare costs. Understanding the underlying reasons for medical care avoidance is therefore crucial for developing effective healthcare interventions and policies.

AIM: This study aimed to identify, analyse, and prioritise the interrelated factors contributing to medical care avoidance in European countries classified as developing countries according to the OECD definition, using an integrated Grey-DEMATEL-ANP decision-making framework.

DESIGN

A cross-sectional decision-analytic study was conducted employing an integrated Grey-DEMATEL-ANP approach.

METHODS

The Grey-DEMATEL method was used to determine the causal relationships among the key barriers to medical care avoidance, while the Analytic Network Process (ANP) was applied to prioritise their relative importance based on expert evaluations conducted in June 2026.

RESULTS

Systemic concerns, psychological concerns, financial concerns, lack of information and perception, and logistical factors were identified as the major dimensions influencing medical care avoidance. Financial concerns emerged as the most influential barrier, accounting for 93.29% of the overall importance. When financial concerns were excluded from the analysis, systemic concerns became the dominant factor (40.31%), followed closely by psychological concerns, which demonstrated a comparable level of importance.

CONCLUSION

The findings provide a structured decision-making framework for policymakers and healthcare professionals to develop targeted interventions aimed at reducing medical care avoidance. Addressing the identified barriers may improve patient engagement, enhance health outcomes, and support more efficient allocation of healthcare resources.