Factors influencing repeated non-utilized healthcare appointments: a qualitative study of patient and provider perspectives in a Saudi outpatient setting

Introduction Globally, multiple non-utilized appointments are linked to poorer health outcomes, increased emergency visits, higher hospitalization rates, gaps in preventive care, and increased mortality in patients with chronic conditions across primary and secondary healthcare. Studies of non-utilized appointments in Saudi Arabia have revealed barriers such as unequal access, lack of staff, lengthy wait times, and transportation issues leading to non-utilized appointments. However, no distinction has been made between single and multiple non-utilized appointments, or their causes in any depth. The aim of this study was to explore the factors contributing to multiple non-utilized appointments from the perspectives of both patients and healthcare providers, and to identify potential strategies for improving appointment utilization. Method A qualitative study was carried out within different outpatient specialties in a hospital in Saudi Arabia. Twenty healthcare providers and twenty adult patients with multiple non-utilized appointments from clinics with high no-show rates were included. Semi-structured interviews were conducted in Arabic or English from December 2023 to April 2024. Data were analysed using inductive reflexive thematic analysis. The themes were aligned with Levesque’s access framework, which included both demand-side and supply-side perspectives. Results Based on interviews with 40 participants (20 healthcare providers and 20 patients), the study identified five key themes contributing to multiple non-utilized appointments, with these factors affecting men and women differently: healthcare system determinants; patients’ attitudes and perceptions; communication support and engagement; health and well-being factors; and transportation, geographic and financial barriers. Potential interventions were grouped into two themes; firstly, enhancing healthcare delivery systems by improving appointment management and scheduling, implementation of a robust reminder system, improving communication system, optimizing staffing and improved collaboration with primary health centres. Secondly, improving patient accessibility and engagement; by enhancing transportation, fostering patient accountability, offering home visits, and enhancing patient motivation through educational initiatives and personal habit changes. Conclusion This study showed a need for vital healthcare system changes both within hospital outpatient departments and in broader primary care services. Addressing non-utilized appointments requires a shift from isolated fixes to comprehensive, equity-driven approaches that consider both system efficiency and patients’ lived realities and abilities.