Table 1

Example data extracts demonstrating the hierarchical coding process

Original textFree codesDescriptive themesAnalytical themes
“That's the worst of staying out here in the wilds out here because they speak about this 9 min and stuff o’ this kind, but that is impossible staying oot here, like…”3.45 Difficult/impossible for ambulances to arrive quickly/meet response time targets in geographically remote areas
3.46 Acknowledgement that living in rural area necessarily has (disadvantage) of time delay in getting emergency care
Rurality and remoteness: there are consequences of living in a rural or remote area in terms of how quickly ambulance care can be accessed. Patients recognise and even accept this constraint and adapt their expectations and the way they decide to physically access care and the way in which they get to the location of treatment.Practical domain: whatever the perceived health need may be, and regardless of who may be involved assessing it, there are physical practicalities that sometimes override all other aspects of the decision-making process and take precedence. These can be related to geography and space, access to modes of transport, physical limitations of an individual's capability to care for themselves or the perceived need for immediate, expert care that can only be provided by ambulance staff.
Process domain: being influenced by others—perception of whether one would be a burden on one's relatives shapes the decision-making process about how to access urgent treatment (subtle or ‘invisible’ influence of relatives).
“If it was very severe, I would get my husband… to drive me to the hospital.”3.72 Very severe illness requires hospital treatment
3.73 Assistance from relative required to access appropriate care
3.74 Decision to drive/make own way to hospital instead of call and wait for ambulance
“I could have gone in my car… I would have made a lot of work for my relatives, which I don't think is right.”2.92 Health condition such that could have gone by car but active decision not to due to convenience
2.93 Assistance from relative required to access care
2.94 Reluctance to inconvenience relatives as a result of own illness
Transport: role of seeing the ambulance service as a transport when other options are discounted as unsuitable or inconvenient, even when they may be entirely suitable as the clinical condition is relatively minor