Determinants of healthcare access and patient satisfaction in rural and semi-urban Madurai district, India: A geo-medical analysis using structural equation modeling

Background: Equitable access to quality healthcare remains a major public health challenge in rural and semi-urban India. Healthcare utilization and patient satisfaction are influenced by socio-economic, demographic, infrastructural, and behavioral factors.Objective: This study examined the determinants of healthcare access and patient satisfaction in rural and semi-urban areas of Madurai District, Tamil Nadu, using Structural Equation Modeling (SEM).Methods: A community-based cross-sectional survey was conducted among 300 respondents during 2023-2024 using a structured questionnaire. Exploratory Factor Analysis (EFA) identified latent dimensions influencing healthcare access and patient satisfaction, while Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM) were used to evaluate the relationships among these constructs. Data suitability was assessed using the Kaiser-Meyer-Olkin (KMO) measure and Bartlett's Test of Sphericity.Results: Seven latent factors explained 71.28% of the total variance. The KMO value (0.720) and Bartlett's Test of Sphericity (χ² = 1629.172, df = 120, p < 0.001) confirmed the suitability of the data for factor analysis. The SEM demonstrated an excellent model fit (χ²/df = 0.436, GFI = 0.998, CFI = 1.000, RM-SEA = 0.001). Healthcare Access and Preferences (β = 0.365, p < 0.001) and Healthcare Behaviour and Awareness (β = 0.173, p = 0.001) significantly influenced Healthcare Infrastructure and Demographics, whereas the other latent constructs showed no significant effects.Conclusion: Healthcare accessibility and community awareness are the principal determinants of perceived healthcare infrastructure and patient satisfaction. Strengthening healthcare accessibility, improving health literacy, and enhancing healthcare infrastructure through evidence-based policies may promote more equitable and patient-centered primary healthcare services in rural and semi-urban communities.