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Cited by 1Healthcare Quality and SatisfactionHealthcare Systems and ReformsPublic Health and Social Inequalities

Identifying the accessibility barriers for chronic disease management in health care delivery system amongst the Urban Poor of Kolkata, West Bengal, India

Open access
Roy, Priyanka, Bardhan, Mainak·2025·Journal of Family Medicine and Primary Care
DOI 10.4103/jfmpc.jfmpc_1050_24PMC PMC12296226
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Abstract

A BSTRACT: Background: Challenges the socioeconomically vulnerable urban population faces in managing chronic diseases are compounded by deficiencies and lacunae in the healthcare delivery system. In the socioeconomic context of chronic disease management (CDM) under the ambit of the healthcare delivery system under National Urban Health Mission (NUHM), there is a dearth of adequate provision of health services and its delivery mechanisms to mitigate the issues. The objective of this research was to identify the barriers that lead to the snowballing of the deficiencies and inadequacies of the healthcare delivery mechanism related to CDM amongst the urban poor of Kolkata. Materials and Methods: The design of this study was a sequential explanatory mixed method using both structured and semistructured tools. The quantitative and qualitative data were collected separately at different time intervals and integrated to establish the interpretation. The study locations were Kalighat, Khidirpur, Mominpur, Ekbalpur, Ultadanga, and Brace Bridge under Kolkata Municipal Corporation, West Bengal. The total number of respondents was 271, which included NUHM programme officers at the state level, service providers at Urban Primary Health Centres (UPHCs), and urban poor population beneficiaries. Results: The accessibility barriers were the location of UPHCs, logistics barriers, quality of care and patients dissatisfaction, out-door timing, lack of medicines, diagnostics facilities, job loss due to repeated health visits, patients’ choice, preference over secondary and tertiary care delivery centres, inadequate information, education and communication, and dysfunctional referral system. Conclusions: There are several accessibility barriers to appropriate healthcare relevant to CDM and a huge implementation gap under NUHM policy.

AI snapshot

Written from the paper’s full text.

TL;DR

This sequential explanatory mixed-methods study in Kolkata slums identifies multiple accessibility barriers to chronic disease management under NUHM, including distant or late-opening UPHCs, poor chronic care quality, medicine and diagnostic shortages, referral failures, and financial/IEC barriers. It concludes there is a large implementation gap between NUHM policy and grassroots delivery for the urban poor.

Key findings

  • Structural and service barriers were prominent: 49% (n=102) spent about one hour reaching the nearest UPHC, 58% (n=121) used a bus, and 68% of UPHCs started after 10:00 am.
  • Chronic disease care was weak: only 13% (n=28) reported receiving chronic disease treatment, 55% (n=115) were not satisfied with UPHC delivery for CDM, 89% (n=186) could not get referral service when needed, and 90% (n=188) had never been asked for health-related information at UPHCs.
  • Medicines, diagnostics, and information were inadequate: 31% (n=63) received medicines for 7 days, 53% (n=110) went to private laboratories for chronic disease diagnostics, and 85% (n=177) had no idea about attending any counselling clinic after diagnosis.
  • Financial and social barriers compounded access: 41% incurred INR 101–500 for medicines, 31% (n=64) earned an average of INR 8,000 per month, and 64% (n=133) had attended school only up to class V.

Methods

  • Sequential explanatory mixed-methods design conducted from January 2018 to December 2019 under Kolkata Municipal Corporation, West Bengal, in nine slums; selected chronic conditions were hypertension, COPD/asthma, diabetes mellitus, and osteoarthritis.
  • Quantitative phase surveyed 208 respondents from Kolkata slum areas using self-developed close-ended tools (response rate 83.2%, out of 250 respondents); qualitative phase purposively selected 45 individuals for in-depth semistructured interviews, with additional IDIs involving NUHM officials, MOICs/MOs, lab technicians, pharmacists, and exit interviews with 35 patients/accompanying persons.
  • Data were integrated at interpretation level through narrative and joint displays; quantitative descriptive statistics used Microsoft Excel, and qualitative data used template analysis.

Limitations

  • The paper states that necessary administrative approvals were not available to access chronic disease management data under KMC jurisdiction, so a replacement policy was adopted for selecting ward health units, which can compromise sample randomness.
  • Evident from the text: reported respondent totals are inconsistent across sections (abstract total 271; quantitative 208 plus qualitative 45; later “approximately 108 respondents” in qualitative data collection), which may affect clarity about the full sample.
  • Evident from the text: the study is confined to selected Kolkata slum areas and uses purposive sampling for the qualitative phase, limiting generalizability beyond this setting.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.4103/jfmpc.jfmpc_1050_24

Cites

42 of 42 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

2 of 27 cited sources checked · 0 supported · 0 flagged · accuracy not yet measured

  • Findingown data

    Almost 42% (n=87) of patient respondents had to wait for one hour before the turn for check-up.

    “Almost 42% (n=87) patients respondents had to wait for one hour before the turn for check-up.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The self-developed quantitative and qualitative tools validly measured accessibility barriers to chronic disease management.
    • Rests on an assumption: The purposively selected respondents are representative of the urban poor population of Kolkata with chronic diseases.
    • Rests on an assumption: The respondents' self-reported experiences accurately reflect the accessibility barriers in the healthcare delivery system.
  • Findingown data

    42% (n=88) respondents were not satisfied with the role of health professionals.

    “The quantitative data showed that 42% (n=88) respondents were not satisfied with the role of health professionals.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The self-developed quantitative and qualitative tools validly measured accessibility barriers to chronic disease management.
    • Rests on an assumption: The purposively selected respondents are representative of the urban poor population of Kolkata with chronic diseases.
    • Rests on an assumption: The respondents' self-reported experiences accurately reflect the accessibility barriers in the healthcare delivery system.
  • Findingown data

    Almost 69% (n=144) reported that they were not examined by the doctors at outdoor.

    “Almost 69% (n=144) reported that they was not examined by the doctors at outdoor.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The self-developed quantitative and qualitative tools validly measured accessibility barriers to chronic disease management.
    • Rests on an assumption: The purposively selected respondents are representative of the urban poor population of Kolkata with chronic diseases.
    • Rests on an assumption: The respondents' self-reported experiences accurately reflect the accessibility barriers in the healthcare delivery system.
  • Findingown data

    About 41% respondents had expenditure of INR101-500 for their medicines.

    “About 41% respondents had the expenditure of INR101-500 for their medicines.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The self-developed quantitative and qualitative tools validly measured accessibility barriers to chronic disease management.
    • Rests on an assumption: The purposively selected respondents are representative of the urban poor population of Kolkata with chronic diseases.
    • Rests on an assumption: The respondents' self-reported experiences accurately reflect the accessibility barriers in the healthcare delivery system.
  • Findingown data

    43% (n=90) respondents availed diagnostics facilities both at Government.

    “43% (n=90) respondents availed the diagnostics facilities both at Government.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The self-developed quantitative and qualitative tools validly measured accessibility barriers to chronic disease management.
    • Rests on an assumption: The purposively selected respondents are representative of the urban poor population of Kolkata with chronic diseases.
    • Rests on an assumption: The respondents' self-reported experiences accurately reflect the accessibility barriers in the healthcare delivery system.
  • May combine two claims. 25
  • Classified as probably not a substantial claim. 30

  • May combine two claims.

    Premisecitation

    Mainz (2003) and Santalahti et al. (2020) highlighted issues such as nonavailability of medicine, lack of basic diagnostic facilities, and gross differentiation among providers in care for similar illnesses.

    “These findings align with studies conducted by Mainz (2003)[41] and Santalahti et al. (2020),[38] who highlighted issues such as nonavailability of medicine, lack of basic diagnostic facilities, and gross differentiation among providers in care for similar illnesses.[42]”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [41] Mainz J Defining and classifying clinical indicators for quality improvement Int J Qual Health Care 2003 15 523 30 14660535 source
    • cites [38] Santalahti M Sumit K Perkiö M Barriers to accessing health care services: A qualitative study of migrant construction workers in a southwestern Indian city BMC Health Serv Res 2020 20 1 7 PMC7339387 32631320 source

      The Results section (“Distrust in public health services as a barrier”; page not provided) reports problems with the availability of medicine and equipment and describes perceived differences between public and private care. It does not identify the equipment as basic diagnostic facilities or report gross differences in how providers care for similar illnesses. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [42] Goudge J Gilson L Russell S Gumede T Mills A Affordability, availability and acceptability barriers to health care for the chronically ill: Longitudinal case studies from South Africa BMC Health Serv Res 2009 9 1 18 19426533 PMC2694171 source

      The Results section reports repeated drug stock-outs, and the Discussion describes a lack of functional diagnostic equipment. The Results also give one example of differing diagnoses by a clinic and hospital, but do not establish gross differences in care among providers for similar illnesses. No page numbers are available in our copy. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    The study identified accessibility barriers to chronic disease management among the urban poor of Kolkata including location of UPHCs, logistics barriers, quality of care and patient dissatisfaction, out-door timing, lack of medicines, diagnostics facilities, job loss due to repeated health visits, patients' choice, preference over secondary and tertiary care delivery centres, inadequate IEC, anda

    “The accessibility barriers were the location of UPHCs, logistics barriers, quality of care and patients dissatisfaction, out-door timing, lack of medicines, diagnostics facilities, job loss due to repeated health visits, patients’ choice, preference over secondary and tertiary care delivery centres, inadequate information, education and communication, and dysfunctional referral system.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The self-developed quantitative and qualitative tools validly measured accessibility barriers to chronic disease management.
    • Rests on an assumption: The purposively selected respondents are representative of the urban poor population of Kolkata with chronic diseases.
    • Rests on an assumption: The respondents' self-reported experiences accurately reflect the accessibility barriers in the healthcare delivery system.

  • Classified as probably not a substantial claim.

    Findingown data

    Four major themes were derived and presented: challenges at health care service delivery at UPHC, service availability at UPHCs, barriers at health care services receiving end, and NUHM approach towards chronic disease management.

    “Four major themes were derived and presented, namely a) Challenges at Health Care Service Delivery at UPHC, b) Service Availability at UPHCs, c) Barriers at Health Care Services Receiving End, and d) National Urban Health Mission (NUHM) Approach Towards Chronic Disease Management [Table 2].”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    22% (n=45) respondents attended school up to class VIII.

    “22% (n=45) respondents up to class VIII.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The self-developed quantitative and qualitative tools validly measured accessibility barriers to chronic disease management.
    • Rests on an assumption: The purposively selected respondents are representative of the urban poor population of Kolkata with chronic diseases.
    • Rests on an assumption: The respondents' self-reported experiences accurately reflect the accessibility barriers in the healthcare delivery system.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    About 18% (n=37) respondents were working as seller of vegetables, fish, snack, sweet etc.

    “About 18% (n=37) respondents were working as seller of vegetables, fish, snack (chop, fast food), sweet etc.,”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The self-developed quantitative and qualitative tools validly measured accessibility barriers to chronic disease management.
    • Rests on an assumption: The purposively selected respondents are representative of the urban poor population of Kolkata with chronic diseases.
    • Rests on an assumption: The respondents' self-reported experiences accurately reflect the accessibility barriers in the healthcare delivery system.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    About 7% (n=15) of respondents worked as daily wager at different jobsite.

    “About 7% (n=15) of respondents worked as daily wager at different jobsite (construction sites, road, building etc.)”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The self-developed quantitative and qualitative tools validly measured accessibility barriers to chronic disease management.
    • Rests on an assumption: The purposively selected respondents are representative of the urban poor population of Kolkata with chronic diseases.
    • Rests on an assumption: The respondents' self-reported experiences accurately reflect the accessibility barriers in the healthcare delivery system.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    18% (n=37) respondents earned INR 4,000 per month.

    “18% (n=37) respondents earned INR 4,000 per month.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The self-developed quantitative and qualitative tools validly measured accessibility barriers to chronic disease management.
    • Rests on an assumption: The purposively selected respondents are representative of the urban poor population of Kolkata with chronic diseases.
    • Rests on an assumption: The respondents' self-reported experiences accurately reflect the accessibility barriers in the healthcare delivery system.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    About 34% (n=72) women were housewife.

    “About 34% (n=72) women were housewife.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The self-developed quantitative and qualitative tools validly measured accessibility barriers to chronic disease management.
    • Rests on an assumption: The purposively selected respondents are representative of the urban poor population of Kolkata with chronic diseases.
    • Rests on an assumption: The respondents' self-reported experiences accurately reflect the accessibility barriers in the healthcare delivery system.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Amongst respondents 64% (n=133) had attended school up to class V.

    “Amongst the respondents 64% (n=133) had attended school up to class V”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The self-developed quantitative and qualitative tools validly measured accessibility barriers to chronic disease management.
    • Rests on an assumption: The purposively selected respondents are representative of the urban poor population of Kolkata with chronic diseases.
    • Rests on an assumption: The respondents' self-reported experiences accurately reflect the accessibility barriers in the healthcare delivery system.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Women working as domestic helpers comprised 14% (n=29) respondents.

    “Women were working as domestic helpers which was comprised of 14% (n=29) respondents.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The self-developed quantitative and qualitative tools validly measured accessibility barriers to chronic disease management.
    • Rests on an assumption: The purposively selected respondents are representative of the urban poor population of Kolkata with chronic diseases.
    • Rests on an assumption: The respondents' self-reported experiences accurately reflect the accessibility barriers in the healthcare delivery system.

  • May combine two claims.

    Findingown data

    Respondents' monthly incomes varied: 31% earned INR 8,000, 19% earned INR 6,000, and 18% earned INR 4,000.

    “The majority of respondents, that is 31% (n = 64), earned an average of INR 8,000 per month, and 19% (n = 41) respondents earned INR 6,000, and 18% (n = 37) respondents earned INR 4,000 per month.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among chronic patients, medicine supply duration varied: 31% got medicines for 7 days, 19% for 6 days, 18% for 5 days, and 19% for 4 days.

    “There was no protocol for medicine distribution amongst chronic patients: 31% (n = 63) respondents said they got medicines for 7 days, 19% (n = 40) respondents got medicines for 6 days, 18% (n = 37) respondents got medication for 5 days, and 19% (n = 40) respondents got medicines for 4 days.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    2% of respondents stated that their family income was very low, which was INR 2,000 per month.

    “Only 2% (n = 4) of respondents had stated that their family income was very low, which was INR 2,000 per month.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Patients had to travel far and spent more money accessing healthcare services.

    “It was found that the patients had to travel far and spent more money accessing healthcare services.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    64% of respondents had attended school up to class V and 22% up to class VIII.

    “Among the respondents, 64% (n = 133) had attended school up to class V and 22% (n = 45) up to class VIII.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Many patients with hypertension or diabetes had to go to work for their earnings without attending UPHCs or buying medicines over the counter during emergency health situations.

    “Many patients with hypertension or diabetes had to go to work for their earnings without attending UPHCs or buying medicines over the counter during emergency health situations.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The response rate was 83.2%, and out of 250 respondents, 208 appeared.

    “The response rate was 83.2%, and out of 250 respondents, 208 appeared.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    To describe the whole issue, either quantitative or qualitative methods were not sufficient; mixing both ways complements each other and gives a more robust, comprehensive result.

    “To describe the whole issue, either quantitative or qualitative methods were not sufficient to address the research problem; therefore, mixing both ways complements each other and gives a more robust, comprehensive result by ‘taking the advantages of the strength of each’.[2425]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2425]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Premisecitation

    The literature does not specifically mention accessibility barriers for patients with chronic diseases.

    “However, the literature does not specifically mention accessibility barriers for patients with chronic diseases.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] Report recommendation of TRG for NUHM 2013

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    These pertinent issues generate a vicious cycle for the urban socioeconomically challenged population suffering from chronic diseases and abject poverty.

    “These pertinent issues generate a vicious cycle for the urban socioeconomically challenged population suffering from chronic diseases and abject poverty.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Integration happened at three stages: at the beginning, at the intermediate stage, and after the whole data collection process was completed.

    “In this study, integration happened at three stages: at the beginning, when the research design was formulated; at the intermediate stage, where quantitative data collection was done, and the next set of participants were selected for qualitative data collection; and after the whole data collection process was completed and while the outcomes were interpreted and presented through narrative and jo”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2530]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The study engaged approximately 108 respondents, ensuring a robust collection of qualitative data to support the research objectives.

    “Overall, the study engaged approximately 108 respondents, ensuring a robust collection of qualitative data to support the research objectives.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    There are several accessibility barriers to appropriate healthcare relevant to CDM and a huge implementation gap under NUHM policy.

    “There are several accessibility barriers to appropriate healthcare relevant to CDM and a huge implementation gap under NUHM policy.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The self-developed quantitative and qualitative tools validly measured accessibility barriers to chronic disease management.
    • Rests on an assumption: The purposively selected respondents are representative of the urban poor population of Kolkata with chronic diseases.
    • Rests on an assumption: The respondents' self-reported experiences accurately reflect the accessibility barriers in the healthcare delivery system.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Triangulation was done at the time of interpretation level.

    “The triangulation was done at the time of interpretation level [Figure 1].”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Low-income patients faced barriers such as long waiting times and geographic location.

    “The previous research reported that low-income patients faced barriers such as long waiting times and geographic location[22323334];”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 22323334

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Low demand could be attributed to a lack of knowledge and information among the underprivileged population.

    “Arokiasamy and Pradhan’s 2013 study emphasized the importance of both service availability and demand for service in healthcare utilization, noting that low demand could be attributed to a lack of knowledge and information among the underprivileged population.[48]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Arokiasamy P Pradhan J Maternal health care in India: Access and demand determinants: Primary health care research and development Prim Health Care Res Dev 2013 14 373 93 23308406 source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Premisecitation

    Limited opening hours and inadequate quality of care are significant barriers low and middle-income groups face.

    “Limited opening hours and inadequate quality of care are significant barriers low and middle-income groups face.[40]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] Santos Cruz M Andrade T Bastos FI Leal E Bertoni N Lipman L Patterns, determinants and barriers of health and social service utilization among young urban crack users in Brazil BMC Health Serv Res 2013 13 536 24373346 PMC3893546 source

      Checked before — its earlier verdict is held back until a new check runs.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Patients with higher education had a better understanding of disease prevalence and complications, making them more influential and socially connected, which enhanced their access to chronic disease management.

    “Kyriopoulos et al. in 2014[34] stated that patients with higher education had a better understanding of disease prevalence and complications, making them more influential and socially connected. This enhanced their access to chronic disease management.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Kyriopoulos II Zavras D Skroumpelos A Mylona K Athanasakis K Kyriopoulos J Barriers in access to healthcare services for chronic patients in times of austerity: An empirical approach in Greece Int J Equity Health 2014 13 1 7 25062725 PMC4113665 source

      Checked before — its earlier verdict is held back until a new check runs.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Ethical approval was given by the institutional ethics committee, JNU, New Delhi (IERB Ref. No. 2017/Student/137; dated 25th January, 2018).

    “The ethical approval was given by the institutional ethics committee, JNU, New Delhi (IERB Ref. No. 2017/Student/137; dated 25th January, 2018).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Individuals with poor socioeconomic status were more affected by chronic diseases.

    “The World Health Organization (WHO) reported that individuals with poor socioeconomic status were more affected by chronic diseases, as noted by Suhrcke et al. in 2006.[49]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [49] Suhrcke M Nugent RA Stuckler D Rocco L Chronic disease: An economic perspective London Oxford Health Alliance 2006 11

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There is a direct connection between low income, unemployment, and the inability to afford the cost of care for chronic disease management.

    “Yach and colleagues in 2004 discussed the direct connection between low income, unemployment, and the inability to afford the cost of care for chronic disease management.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [47] Yach D Hawkes C Gould CL Hofman KJ The Global Burden of Chronic Diseases: Overcoming impediments to prevention and control J Am Med Assoc 2004 291 2616 22 15173153 source

  • May combine two claims.

    Interpretationreasoning

    Insufficient health records contribute to resource allocation failures and hinder evidence-based advocacy and priority setting for CDM.

    “Insufficient health records contribute to resource allocation failures and hinder evidence-based advocacy and priority setting for CDM.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Lack of referral facilities and the availability of medicines and free diagnostics further compound the challenges in healthcare service delivery.

    “However the lack of referral facilities and the availability of medicines and free diagnostics further compound the challenges in healthcare service delivery.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Jacobs et al. and other studies demonstrated the financial burden placed on individuals with chronic diseases.

    “Studies[144546] Jacobs et al and other studies demonstrated demonstrated the financial burden placed on individuals with chronic diseases, while the lack of research data on the gap between supply and demand in public healthcare settings limits utilization.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 144546

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Long distance to healthcare facilities and mode of transport hindered access to healthcare services among vulnerable migrant worker populations in urban areas.

    “the long distance to healthcare facilities and mode of transport hindered their access to healthcare services among vulnerable migrant worker populations in urban areas.[35363738]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 35363738

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Education and occupation are social structure determinants in the Health Care Access Barrier (HCAB) Model.

    “The Health Care Access Barrier (HCAB) Model, widely used to understand accessibility, considers various determinants, with education and occupation being social structure determinants, as highlighted by Carrillo et al. in 2011.[39]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Carrillo JE Carrillo VA Perez HR Salas-Lopez D Natale-Pereira A Byron AT Defining and targeting health care access barriers J Health Care Poor Underserved 2011 22 562 75 21551934 source

  • May combine two claims.

    Interpretationnone given

    The preventive and promotive care strategy for controlling CDs fails because of no training facility for healthcare workers, overburdened healthcare workers with communicable disease control programmes, and lack of tracking system because of unavailability of health records of NCD patients.

    “The important strategy to control CDs is preventive and promotive care, as written in the mission document, which fails because of no training facility for healthcare workers, overburdened healthcare workers with communicable disease control programmes, lack of tracking system because of unavailability of health records of NCD patients.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Individuals without insurance or with insufficient coverage are left without a treatment summary or history, resulting in reduced healthcare presentation, delayed treatment, and decreased overall care.

    “However, individuals without insurance or with insufficient coverage are left without a treatment summary or history, resulting in reduced healthcare presentation, delayed treatment, and decreased overall care.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Carrillo JE Carrillo VA Perez HR Salas-Lopez D Natale-Pereira A Byron AT Defining and targeting health care access barriers J Health Care Poor Underserved 2011 22 562 75 21551934 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Lack of information about public health services, high illiteracy rates, and limited access to technology acted as cognitive barriers for individuals with chronic diseases.

    “Santalahti and colleagues in 2020 highlighted how the lack of information about public health services, high illiteracy rates, and limited access to technology acted as cognitive barriers for individuals with chronic diseases.[38]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Santalahti M Sumit K Perkiö M Barriers to accessing health care services: A qualitative study of migrant construction workers in a southwestern Indian city BMC Health Serv Res 2020 20 1 7 PMC7339387 32631320 source

      Checked before — its earlier verdict is held back until a new check runs.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Long waiting times act as barriers, independently or in conjunction with financial obstacles, impeding disease prevention and management.

    “Carrillo and colleagues also emphasized that long waiting times act as barriers, independently or in conjunction with financial obstacles, impeding disease prevention and management.[39]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Carrillo JE Carrillo VA Perez HR Salas-Lopez D Natale-Pereira A Byron AT Defining and targeting health care access barriers J Health Care Poor Underserved 2011 22 562 75 21551934 source

  • May combine two claims.

    Interpretationreasoning

    No record-keeping system tracks any patient with chronic conditions, which explains why patients were not asked for health-related information.

    “This happened because no record-keeping system tracks any patient with chronic conditions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

    Premisecitation

    Patients with insurance benefit from a comprehensive database, facilitating their treatment and follow-up better.

    “They argued that patients with insurance benefit from a comprehensive database, facilitating their treatment and follow-up better.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Carrillo JE Carrillo VA Perez HR Salas-Lopez D Natale-Pereira A Byron AT Defining and targeting health care access barriers J Health Care Poor Underserved 2011 22 562 75 21551934 source

  • May combine two claims.

    Interpretationreasoning

    There are extensive lacunae at the grass-root levels, causing patients suffering from chronic diseases to face surmounting health-related issues.

    “Therefore, it can be concluded that there are extensive lacunae at the grass-root levels, as a consequence of which patients suffering from chronic diseases face surmounting health-related issues.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The NUHM mission was to give universal access for all patients, particularly the socioeconomically vulnerable section.
    • Rests on an assumption: The formation of UPHCs under NUHM aimed to provide an assured minimum service package, including outreach services so that people do not need to travel much for basic health services.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Affordability posed a challenge for individuals who required frequent and complex primary healthcare consultations, lacked health insurance, needed expensive medications or diagnostics, faced high out-of-pocket consultations, and had to travel long distances.

    “A review study conducted by D.J. Russel and colleagues in Australia revealed that affordability posed a challenge for individuals who required frequent and complex primary healthcare consultations, lacked health insurance, needed expensive medications or diagnostics, faced high out-of-pocket consultations, and had to travel long distances.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Russell DJ Humphreys JS Ward B Chisholm M Buykx P McGrail M Helping policy-makers address rural health access problems Aust J Rural Health 2013 21 61 71 23586567 source

  • May combine two claims.

    Interpretationreasoning

    There is no scope for building up a good doctor-patient relationship because doctors did not examine patients.

    “thus, there is no scope for building up a good doctor–patient relationship.”
    Quote in the paperNot a substantial claim
45 of 45

  • The paper relies on this without support.

    The self-developed quantitative and qualitative tools validly measured accessibility barriers to chronic disease management.

    “At first, the quantitative data of participants’ experience, understanding of the existing healthcare system, and gaps between the demand and supply side of healthcare delivery service were collected from the people from the urban slum using self-developed close-ended tools.”
    “The qualitative data collection for the study involved an in-depth interviews (IDIs) within diverse range of respondents using semistructured tools.”

  • The paper relies on this without support.

    The purposively selected respondents are representative of the urban poor population of Kolkata with chronic diseases.

    “The sample of respondents for the interview was selected from nine slums in different locations of Kolkata city using a community-based sample format of contacts.”
    “The purposive sampling was designed to recruit respondents from different age groups 18–29 years, 30–39 years, 40–49 years, 50–59 years, equal or above 60 years, to capture any similarities or dissimilarities in perspective between the above age groups.[927]”

  • The paper relies on this without support.

    The respondents' self-reported experiences accurately reflect the accessibility barriers in the healthcare delivery system.

    “The quantitative data of participants’ experience, understanding of the existing healthcare system, and gaps between the demand and supply side of healthcare delivery service were collected from the people from the urban slum using self-developed close-ended tools.”

  • The paper relies on this without support.

    The NUHM mission was to give universal access for all patients, particularly the socioeconomically vulnerable section.

    “The mission of NUHM was to give universal access for all patients, particularly the socioeconomically vulnerable section.”

  • The paper relies on this without support.

    The formation of UPHCs under NUHM aimed to provide an assured minimum service package, including outreach services so that people do not need to travel much for basic health services.

    “The formation of UPHCs under NUHM aimed to provide an assured minimum service package, including outreach services so that people do not need to travel much for basic health services.”

  • The paper relies on this without support.

    The concept of primary care given at UPHCs was designed so that population-based disease surveillance can be documented by screening NCDs among chronic patients, and the database would help people for secondary care through a network of UPHCs and UCHCs with referral transport.

    “The concept of primary care given at UPHCs was also designed in such a manner that a population-based disease surveillance can be documented by screening the NCDs amongst chronic patients, and the database would help people for secondary care through a network of UPHCs and UCHCs with the help of referral transport.”
6 of 6

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Medicine-duration percentage does not match the respondent count

    Minor

    The study reports 208 survey respondents. Of those, 63 is 30.3%, which rounds to 30%, not the reported 31%.

    Reported 31 · recomputed 30.288462

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. 2013, Report recommendation of TRG for NUHM
  2. Geneau, 2011, Chronic diseases : Chronic diseases and development 1 raising the priority of preventing chronic diseases, Lancet, 376, 1689, 10.1016/s0140-6736(10)61414-6 · DOI

Cited by

Sorted by citations

Related

Authors
Roy, P., & Bardhan, M.
Affiliations
  • Government of West Bengal (IN)
  • Indian Council of Medical Research (IN)
Corresponding author
Roy, Priyanka
ORCID
Venue
Journal of Family Medicine and Primary Care
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2025-06
Volume
14
Issue
6
Pages
2158-2167
ISSN
  • 2249-4863 (ISSN-L)
  • 2278-7135
DOI
10.4103/jfmpc.jfmpc_1050_24
PMC
PMC12296226
OpenAlex
W4411785449
Semantic Scholar
2839c6c1156706aab45a1bb8a0beee86720c832a
Cited by
1
References
42
Citations by year
2026: 1
FWCI
1.26
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Family Medicine and Primary Care (publishedVersion, cc-by-nc-sa)
  • PubMed Central (publishedVersion, cc-by-nc-sa)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Health Professions › General Health Professions › Healthcare Quality and Satisfaction
  • Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
  • Social Sciences › Health › Public Health and Social Inequalities
Keywords
chronic disease management, urban poor, health care delivery, referral systems, patient dissatisfaction, Kolkata

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-11-03.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-11-03.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

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