Impact of Educational Attainment, Illness Perception, Service Quality, and Accessibility on the Utilization of Internal Medicine Outpatient Services: A Scoping Review / Dampak Tingkat Pendidikan, Persepsi Penyakit, Kualitas Pelayanan, dan Aksesibilitas terhadap Pemanfaatan Layanan Rawat Jalan Penyakit Dalam: Scoping Review

Background: Outpatient healthcare utilization, particularly in internal medicine, plays a crucial role in early diagnosis, continuity of care, and clinical outcomes. However, disparities in the utilization of these services remain a challenge due to multiple interrelated determinants. Objective: This scoping review aimed to map and synthesize the evidence regarding the influence of educational attainment, illness perception, service quality, and accessibility on the utilization of internal medicine outpatient services. Methods: The review followed the Arksey and O'Malley framework and was reported in accordance with the PRISMA-ScR guidelines. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar for studies published between 2016 and 2026. A total of 16 studies met the inclusion criteria and were analyzed. Results: Most included studies employed quantitative cross-sectional designs, while several used qualitative and mixed-methods approaches. Educational attainment was reported as a significant determinant in 12 studies (71%), accessibility in 14 studies (82%), illness perception in 8 studies (47%), and service quality in 6 studies (35%). A combination of individual, psychological, service-related, and structural factors influenced outpatient service utilization. Educational attainment and accessibility were the most frequently reported determinants, whereas illness perception and service quality played roles in shaping healthcare-seeking behavior and continuity of care. Heterogeneity in study design, measurement approaches, and healthcare system contexts was a major limitation. Conclusion: Outpatient internal medicine service utilization is multidimensional and requires integrated strategies, including enhancing health literacy, strengthening patient-centered service quality, and reducing financial and geographical barriers, to achieve more equitable and effective healthcare delivery.

Latar Belakang: Pemanfaatan layanan kesehatan rawat jalan, khususnya di bidang penyakit dalam, berperan penting dalam diagnosis dini, kontinuitas perawatan, dan luaran klinis pasien. Namun, disparitas pemanfaatan layanan ini masih menjadi tantangan akibat berbagai determinan yang saling terkait. Tujuan: Penelitian ini bertujuan untuk memetakan dan mensintesis bukti ilmiah mengenai pengaruh tingkat pendidikan, persepsi penyakit, kualitas pelayanan, dan aksesibilitas terhadap pemanfaatan layanan rawat jalan penyakit dalam. Metode: Studi ini merupakan scoping review yang mengikuti kerangka kerja Arksey dan O’Malley serta dilaporkan berdasarkan pedoman PRISMA-ScR. Pencarian literatur dilakukan pada basis data PubMed, Scopus, Web of Science, ScienceDirect, dan Google Scholar untuk publikasi periode 2016–2026. Sebanyak 16 studi memenuhi kriteria inklusi dan dianalisis. Hasil: Sebagian besar studi menggunakan desain kuantitatif potong lintang, sementara beberapa lainnya menggunakan pendekatan kualitatif dan metode campuran. Tingkat pendidikan dilaporkan sebagai determinan signifikan pada 12 studi (71%), aksesibilitas pada 14 studi (82%), persepsi penyakit pada 8 studi (47%), dan kualitas pelayanan pada 6 studi (35%). Kombinasi faktor individu, psikologis, pelayanan, dan struktural terbukti memengaruhi pemanfaatan layanan. Tingkat pendidikan dan aksesibilitas merupakan determinan yang paling sering dilaporkan, sedangkan persepsi penyakit dan kualitas pelayanan berperan dalam membentuk perilaku pencarian layanan serta kontinuitas perawatan. Heterogenitas desain studi, pendekatan pengukuran, dan konteks sistem kesehatan menjadi keterbatasan utama. Kesimpulan: Pemanfaatan layanan rawat jalan penyakit dalam bersifat multidimensi dan memerlukan strategi terintegrasi, meliputi peningkatan literasi kesehatan, penguatan kualitas layanan yang berpusat pada pasien, serta pengurangan hambatan finansial dan geografis, guna mewujudkan pelayanan kesehatan yang lebih adil dan efektif.