Mar 11, 2026
Version 2
Barriers and facilitators to accessing healthcare services in coastal communities: A Scoping Review Protocol V.2
- Tonya Miles1,
- Sheena Asthana1,
- Sube Banerjee2,
- Megan Armstrong3,
- Christine Carter4,
- Nicolas Farina1
- 1Faculty of Health, University of Plymouth;
- 2Faculty of Medicine and Health Sciences, University of Nottingham;
- 3University College London;
- 4Queen Mary University of London
- Test
Protocol Citation: Tonya Miles, Sheena Asthana, Sube Banerjee, Megan Armstrong, Christine Carter, Nicolas Farina 2026. Barriers and facilitators to accessing healthcare services in coastal communities: A Scoping Review Protocol. protocols.io https://dx.doi.org/10.17504/protocols.io.e6nvwwqe9vmk/v2Version created by Nicolas Farina
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: March 11, 2026
Last Modified: March 11, 2026
Protocol Integer ID: 313063
Keywords: coastal community influences healthcare access, healthcare services in coastal community, potential health benefits to coastal living, coastal community, coastal living, levesques conceptual framework for healthcare access, access to healthcare, healthcare access, accessing healthcare service, examining barrier, having poorer health outcome, perceived barrier, poorer health outcome, healthcare, influencing access, potential health benefit, barrier, scoping review protocol people
Funders Acknowledgements:
Alzheimer's Society
Grant ID: 643
Disclaimer
The view expressed in this publication are those of the authors and not necessarily those of the National Institute for Health Research, Department of Health and Social Care, or the Alzheimer’s Society.
Abstract
People living in coastal communities are often cited as having poorer health outcomes compared to those living in non-coastal communities, yet it is not wholly clear why this might be the case, particularly in light of evidence that there are potential health benefits to coastal living. This scoping review aims to map the existing literature examining barriers and facilitators influencing access to healthcare within coastal communities. The review will systematically search and synthesise relevant literature to identify perceived barriers and facilitators affecting access to healthcare in coastal communities and how they align with Levesques conceptual framework for healthcare access. The review will also help identify knowledge gaps in the literature. Findings from this review will better inform how living in a coastal community influences healthcare access and support the development of more responsive and equitable provision.
Troubleshooting
Research question
What are the barriers and facilitators to accessing healthcare services in Coastal Communities? (see Figure 1 for PCC).
Sub questions:
- How are coastal communities conceptualised and defined in the literature?
- What types of evidence are available on this topic?
- What key knowledge gaps are in the existing literature?
Objectives:
a) To systematically identify all relevant studies published on the barriers and facilitators of accessing healthcare services in coastal communities.
b) To map and chart the characteristics of the literature, including the study designs, sample populations and geographical settings.
c) To synthesise and describe common and unique barriers and facilitators to accessing healthcare services in coastal communities.
d) To describe how coastal communities are defined, operationalised and measured across different studies.
e) To identify and report on key knowledge gaps and areas needing further research.
Methods
| Population: | Individuals or communities living in coastal areas, including the general public, service users or healthcare professionals. | |
| Concept: | Barriers and facilitators to accessing healthcare services, including but not limited to: · Geographical/physical barriers will be broad in scope to capture all perceptions of perceived barriers. · Perceived facilitators to accessing healthcare services and the benefits of being a coastal community. · Transport will also include travel times, as many coastal communities are set in rural coastlines. · Workforce shortages will be inclusive of a lack of physical staff and the lack of qualifications, which may or may not impact on service organisation and/or fragmentation. | |
| Context: | Coastal communities, given the lack of a universal definition, we will adopt an inclusive definition. |
Figure 1: Population, Concept, context:
Eligibility criteria
Inclusion Criteria
- Studies involving participants who must be living, working or accessing healthcare in a coastal community.
- Studies are required to conceptualise their research in relation to coastal communities (e.g. stated within the aims or objectives).
- Participants can be the general public, service users or healthcare professionals. There is no restriction to specific health conditions.
- Qualitative, quantitative or mixed methods design studies that explore the perceptions or experiences to accessing healthcare within the coastal community.
- There will be no restrictions placed on year of publication to ensure a variety of data is explored.
- There is no restriction to the country of origin.
Exclusion Criteria:
- Non-primary data studies (e.g. systematic reviews, editorials, commentaries or reports).
- Non-English language full texts. Whilst wanting to remain transparent and without bias, the barriers for this review include time, insufficient funding for translators, and locating papers and their translations.
- Studies in which perceptions and experiences are explored following a disaster (e.g. oil spill).
- Studies in which perceptions about healthcare were not explored in a sample or subsample of participants living, working or accessing healthcare in a coastal community.
Sources of Information
The initial data-base search will include PubMed, PsycINFO, Scopus, and CINAHL. We will hand search reference lists of included studies to identify other potentially pertinent studies. We will include grey literature searches (e.g. OATD.org) to identify other available literature, reducing the risk of missing relevant literature, and minimising bias.
Search Strategy
Search terms will be applied to identify the setting (e.g coast), concept of interest (e.g healthcare provision) and the outcomes (e.g barriers to accessing healthcare). To increase specificity, searches will be limited to Keywords, Title and Abstracts. The NOT function will be applied to try and reduce the increased false negatives highlighted in the pilot searches (eg. Animals OR fish).
We will apply the Joanna Briggs ‘three-step’ search strategy. Initial step will be to complete a limited search on two data bases relevant to the question, followed by an analysis of the titles and abstracts to be used in a second search for all included databases. Lastly, we will review the reference lists of selected articles (Peters et al 2020).
Search syntax examples:
TITLE-ABS-KEY (("healthcare access" OR "access to healthcare" OR "health service access" OR "healthcare services" OR "health services" OR "service utilisation" OR "service utilization" OR "primary care" OR "secondary care" OR hospital OR clinic* OR GP* OR physician* OR nurse*)AND TITLE-ABS-KEY ("coastal communit*" OR "coastal population*" OR "coastal resident*" OR "seaside communit*" OR "seaside town*" OR "coastal region" OR "remote coastal" OR “coastal area”)AND TITLE-ABS-KEY ( barrier* OR obstacle* OR challenge* OR facilitator* OR enabl* OR perception* OR experience* OR inequalit* OR disparit* OR inequ*)AND NOT TITLE-ABS-KEY ( animal* OR fish* OR marine OR ocean* OR wastewater OR soil* OR sediment* OR estuar* OR groundwater OR concrete OR engineering OR material* OR pollut* OR hydrolog*)
Selection process and Data management
References following searches will be extracted and collated on a single reference management platform (e.g. Zotero). The references will be de-duplicated uploaded to a review management platform (e.g. Ryyan.ai). A single reviewer will manually review all the Title and Abstracts against the inclusion and exclusion criteria. In addition, a second review will independently review 10% of Titles and Abstracts as a calibration exercise to ensure consistency (Tricco et a., 2016). Disagreements will be discussed and used to provide clearer guidance surrounding inclusion and exclusion criteria.
The full-text articles will be obtained for shortlisted studies. Full-text articles will be independently reviewed in duplicate. Inter-rater reliability will be assessed using Cohen’s kappa, with a greater score representing better agreement (McHugh, 2021). For this review, a value above 0.6 (substantial agreement) will be used as a threshold of success. Statistical evidence of this process will be recorded. Disagreements will be discussed between reviewers, if consensus cannot be achieved a third reviewer will make the final decision (Micoh etal, 2021). The selection process will be presented both as a narrative and a flow chart.
Data Charting
Please see Appendix A for-charting table.
Synthesising data and presentation
A ‘narrative review’ method will be used to synthesise the data. The number, types and characteristics of studies will be initially summarised, presenting findings in graphs and tables where possible. Subsequently, studies will be grouped using an interpretive approach, within an analytical framework (Arksey and O’Malley, 2005). Should enough of the characteristics of the studies be similar we will also attempt to conceptualise the areas of accessibility into groups in alignment with Levesque conceptual framework for healthcare access (Levesque, 2013) (e.g approachability, accessibility, availability , affordability and appropriateness). We will identify any overlap or double counting of papers, by merging or linking any multiple data sources to the primary data source, identified through authors, citations and institutions (Levac, 2010).
Key figures and tables
Tables and/or graphs will be used to present the data once the groupings have been identified and PRISMA as a flow diagram will be used to show the selections of studies.
Critical Appraisal
The purpose of the scoping review is providing an overview of available research; therefore, the sources of information will not be critically assessed or appraised.
Appendix A
Data Source Template.
| Notes of data extracted | ||
| Publication | ||
| Title | ||
| Citation details | ||
| Year | ||
| Country | ||
| Data Collection Methods | ||
| Aims and Objectives | Quote of the study aims | |
| Study design | Observational; Cross-sectional; Experimental; Randomised control studies; diagnostic; descriptive | |
| Methodology | Quantitative; qualitative; mixed methods. | |
| Data collection | Interviews; surveys; observations; focus groups | |
| Study location | Geographic location (e.g. town, county). | |
| Conceptual definition of coast | Quote of what the author defines as a coastal community. | |
| Population | ||
| Coastal characteristics of the sample | Descriptive statistics of the sample in relation to the coast (e.g. Distance from coast) | |
| Description of coastal features of recruitment area. | Quotes to describing the region and how it relates to the coast. Can include historic, cultural or economic features. | |
| Age | Average age (e.g. Mean, SD) | |
| Gender | Frequency (n) | |
| Health status | Where relevant, the specific health conditions the sample represents e.g., heart disease, diabetes, dementia, etc | |
| Participant perspective | Who are the participants (n, %) e.g. Patient, carer, professional, volunteer, service provider | |
| Findings (split by each of Levesque domain) | ||
| Relevant theme or subtheme | For relevant qualitative studies, a quotation of the theme/subtheme that aligns with the relevant Levesque domain. | |
| Qualitative data | Supporting quotes that aligns with the relevant Levesque domain. | |
| Descriptive quantitative data related barriers | Descriptive data (mean, median, frequency) of outcome measures that align with the Levesque domain (e.g. percentage or people reporting transportation issues) | |
| Statistical associations with coastal features | Co-efficient (e.g. r, b) and statistical associations (p-values) between coastal features (e.g. distance to coast) and outcomes related to Levesque domain. | |
| Key findings | Summary of the authors main findings. |
Protocol references
Afni, 2023; Brundishi et al., 2013; Parsons et al., 2021; Thorn 26 Olley 2023.
Afni, N. (2023). Disparities in Healthcare Access: Addressing Systemic Barriers in Urban and Rural Communities. Journal of Health Literacy and Qualitative Research, 3_, 112–122. https://doi.org/10.61194/jhlqr.v3i2.543
Asbar, R. A., 6 T, S. (2025). Healthcare Access Disparities in Coastal Regions: A Review. Journal of Health Science and Pharmacy, 2_(2), 185–201. https://doi.org/10.36685/jhsp.v2i2.1173
Asthana, S., Gibson, A., (2021). Averting a public health crisis in England's coastal communities: a call for public health research and policy. Journal of Public Health, 14_(3), 642-650. https://doi.org/10.1093/pubmed/fdab130
Arksey, H., 6 O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8_(1), 19–32. https://doi.org/10.1080/1364557032000119616
Barton, C., Balogun, B., Brien, P., Cromarty, H., Murray, A., Powell, A., Ward, M. (2025). House of Commons Library: Coastal communities. https://researchbriefings.files.parliament.UK/documents/CDP-2025-0059/CDP-2025-0059.pdf
Brundisini, F., Giacomini, M., DeJean, D., Vanstone, M., Winsor, S., 6 Smith, A. (2013). Chronic Disease Patients’ Experiences With Accessing Health Care in Rural and Remote Areas. Ontario Health Technology Assessment Series, 13_(15), 1–33.
_Chief Medical Officer annual report 2021_. (n.d.). GOV.UK. Retrieved 22 November 2025, from https://www.gov.uk/government/news/chief-medical-officer-annual-report-2021
_Coastal communities, characteristics of built-up areas, England and Wales—Office for National Statistics_. (n.d.). Retrieved 23 November 2025, from https://www.ons.gov.uk/peoplepopulationandcommunity/housing/articles/coastalcommunitiesandcharacteristicsofbuiltupareasenglandandwales/census2021#coastal-classification-of-built-up-areas
Depledge, M., Lovell, R., Wheeler, B., Morrissey, K., White, M., Fleming, L. (2017). Future of the SEA: Health and Wellbeing of Coastal Communities. https://www.gov.uk
Iqbal, Md. H. (2019). Disparities of health service for the poor in the coastal area: Does Universal health coverage reduce disparities? Journal of Market Access 6 Health Policy, 7_(1), 1575683. https://doi.org/10.1080/20016689.2019.1575683
Levesque, Jean-Frederic, Mark F. Harris, and Grant Russell. 2013. ‘Patient-Centred Access to Health Care: Conceptualising Access at the Interface of Health Systems and Populations’. International Journal for Equity in Health 12_(1): 18. doi:10.1186/1475-9276-12-18.
McHugh, M. L. (2012). Interrater reliability: The kappa statistic. Biochemia Medica, 22_(3), 276–282. https://pmc.ncbi.nlm.nih.gov/articles/PMC3900052
Micah, P., Marinie, C., Tricco, A., Khalil, H. (2021). Updated methodological guidance for the conduct of scoping reviews. BBI Evidence Implementation https://doi.org/10.1097/XEB.0000000000000277
Parsons, K., Gaudine, A., 6 Swab, M. (2021). Experiences of older adults accessing specialized health care services in rural and remote areas: A qualitative systematic review. JBI Evidence Synthesis, 19_(6), 1328. https://doi.org/10.11124/JBIES-20-00048
Peters, MDJ., Godfrey, C., McInerney, P., Munn, Z., Tricco, AC. (2020) Aromataris, E., Lockwood, C., Porritt, K., Jordan, Z, editors. JBI Manual for Evidence Synthesis JBI; 2024. https://doi.org/10.46658/JBIMES-24-09
Thorn, H., 6 Olley, R. (2023). Barriers And Facilitators to Accessing Medical Services in Rural And Remote Australia: A systematic review. Asia Pacific Journal of Health Management_. https://doi.org/10.24083/apjhm.v18i1.1755
Tricco, Andrea C., Erin Lillie, Wasifa Zarin, Kelly O'Brien, Heather Colquhoun, Monika Kastner, Danielle Levac, et al. 2016. ‘A Scoping Review on the Conduct and Reporting of Scoping Reviews’. BMC Medical Research Methodology 16: 15. doi:10.1186/s12874-016-0116-4.
Wheeler, B. W., Lovell, R., Higgins, S. L., White, M. P., Alcock, I., Osborne, N. J., Husk, K., Sabel, C. E., 6 Depledge, M. H. (2015). Beyond greenspace: An ecological study of population general health and indicators of natural environment type and quality. International Journal of Health Geographics, 14_, 17. https://doi.org/10.1186/s12942-015-0009-5
Wheeler, B.W., White, M., Stahl-Timmins, W., 6 Depledge, M.H. (2012). Does living by the coast improve health and wellbeing? Health 6 Place, 18_(5),1198-1201. https://doi.org/10.1016/j.healthplace.2012.06.015
Acknowledgements
Miles’ PhD studentship is part Alzheimer’s Society Doctoral Training Centre for Integrated Dementia Care (Grant number:643) Farina and his independent research are supported by the University of Plymouth. National Institute for Health Research Applied Research Collaboration South West Peninsulas.