Evaluation of Healthy Life Center Services within Primary Care: A Cross- Sectional Study of User Perspectives

Background Primary healthcare services are the fundamental system that facilitates access to preventive healthcare services for the community and supports healthy lifestyle behaviours. Healthy Life Centers (HLCs) were established to protect individuals and the community from health-related risks, promote a healthy lifestyle, strengthen primary healthcare services, and facilitate access to these services. The acceptance of HLCs in the community is closely related to the existence of the service, how individuals evaluate this service, their level of satisfaction, and their willingness to continue using the service. This study was conducted to examine accessibility, perceived service quality, satisfaction, intention to continue using the service, recommendation behaviour, out-of-pocket expenditure, and willingness to pay for the service among individuals receiving services from HLCs. Method The study is a cross-sectional study conducted between August and September 2025. The study group consisted of individuals aged 18 and over who applied to the HLC, agreed to participate in the study, and could speak and understand Turkish. No separate sample size calculation was made for the study, and the aim was to include all individuals who applied to the HLC in the study. This research was approved by the Istanbul Medipol University Non-Interventional Clinical Research Ethics Committee. Data were collected using a semi-structured questionnaire administered through face-to-face interviews. It was conducted within the framework of the access model developed by Levesque and colleagues in order to evaluate the factors affecting access to HLC in a multidimensional manner. The form included questions on sociodemographic characteristics, use of HLC, perceived service quality, satisfaction, recommendation and intention to continue using the service, out-of-pocket expenditure, loss of income, and willingness to pay. In the analysis of the data, descriptive statistics were used; for categorical variables, the number and percentage were given, and for numerical variables, the median, interquartile range, minimum and maximum were given. Comparisons were made using the Chi-square test , Mann Whitney U test and the the logistic regression analysis. In all statistical analyses, the significance value was accepted as p<0.005. Results Results: In total, 567 participants were included; most reported high overall satisfaction with HLC services (88.9%) and stated they would recommend the center to others (89.2%), while 83.8% indicated an intention to continue using HLC services. Intention to continue use differed by educational status (p<0.001) and social security coverage (p=0.009) in bivariate analyses, while age was also associated with continuation tendency (p=0.007). In the multivariate logistic regression model for intention to continue using HLC services, having social security was independently associated with higher odds of intended continued use (OR=1.81, 95% CI 1.01–3.25; p=0.045). Compared with illiterate participants, high school graduates (OR=9.03, 95% CI 2.22–36.7; p=0.002) and university/postgraduate graduates (OR=4.30, 95% CI 1.04–17.77; p=0.043) were more likely to report intention to continue, whereas age was not significant in the adjusted model (OR=0.99, 95% CI 0.99–1.01; p=0.481). Conclusion The study demonstrates that HLCs generate high levels of satisfaction, recommendation, and willingness to continue the service within the community; this indicates that the services are valued by the community. Out-of-pocket expenditures are low, and direct income loss is limited. HLCs play a significant role in reducing health access issues arising from income inequality at the primary level. The findings show that HLCs perform a balancing function in accessing healthcare services, particularly for individuals with low levels of education and limited social security. Ensuring that individuals with low income levels or no social security can sustainably benefit from HLC services will both reduce inequalities and significantly protect public health. Increasing the awareness of HLCs within the community would also be an important step in this direction. The fact that our study was conducted at a single center limits its generalisability, and the fact that we only spoke to those who applied to the HLC and agreed to be interviewed limits it in terms of selection bias.