A Levesque-Guided Qualitative Study to Understand Equity in Child and Family Health Services: Insights from an Australian Health District

Background Child and Family Health Services (CFHS) provide universal early childhood health and developmental support in Australia, aiming to give every child an equitable start in life. However, despite this universal intent, not all families are able to access or sustain engagement with these services in a timely way. Guided by Levesque’s Conceptual Framework for Healthcare Access, this study examined how system design and service delivery processes influence families’ ability to perceive, seek, reach, and engage with CFHS within a metropolitan Local Health District. Methods A qualitative design was used, incorporating four focus groups with 42 service providers and six semi-structured interviews with parents or carers who accessed CFHS in the preceding 12 months. Data was collected between August and October 2023. Thematic analysis followed Braun and Clarke’s six-phase approach, combining deductive coding using Levesque’s five dimensions of access with inductive identification of emerging themes. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guided reporting. Results Five inter-related themes described access determinants across the Levesque framework: (1) system complexity and navigation burden, (2) variation in prioritisation and advocacy, (3) service demand and workflow duplication, (4) hidden costs of workforce and system inefficiency, and (5) mismatched referrals and family readiness. Families and referrers frequently encountered unclear entry points and fragmented communication, while staff described duplicated triage processes and capacity-driven rather than needs-driven allocation. Centralised intake and free-of-charge services were key enablers, though operational pressures limited responsiveness and timeliness. Conclusions Findings highlight how system fragmentation and inconsistent operational practices translate into inequitable access, even within a universal model. Addressing these gaps requires standardised, equity-weighted triage, integrated digital referral pathways, and flexible service delivery aligned with family circumstances. Applying Levesque’s framework provided a practical lens to connect organisational variation with the lived experience of access, informing service redesign toward more equitable, timely care.