Why do middle-aged adults use or avoid health services? A study of social and demographic determinants.

Introduction: Middle-aged adults experience distinctive health issues, yet underutilize preventive care despite Iran's strong primary healthcare (PHC) system. This research investigates social and demographic determinants of healthcare services utilization among middle-aged adults in Qom, Iran, to inform the development of targeted community-based screening initiatives. Methods: A cross-sectional study was conducted in underprivileged suburbs of Qom (June-September 2024) among 697 adults aged 30-59, randomly sampled by cluster sampling. Awareness of available services, utilization, and satisfaction with PHC service information were collected via phone interviews. Multivariate logistic regression identified predictors of service utilization. Results: Only 11.8% (n = 82) of the participants were aware of middle-aged health services, and 24.2% (n = 169) had utilized them in the past year. Women had at least one PHC visit 2.5 times more than men (35.3% vs 13.9%, p < 0.001), and utilization increased with age (31.1% among 50-59-year-olds vs. 19.6% in 30-39 years-old, p = 0.023).The strongest predictor was awareness: aware adults had 22.4-fold higher odds of use (95% CI: 11.60-43.29, p < 0.001). Dissatisfaction (by 7.7% of users) was linked to gaps in staff communication (38%), overcrowding (38%), and perceived incompetence (30%) (multiple responses permitted). Work and education were not independently associated with service use after adjustment, suggesting indirect impacts. Conclusion: PHC utilization among middle-aged population is handicapped by low awareness and gender/age disparities. Interventions should prioritize health literacy programs, staff training to improve patient-provider communication, and systemic modifications to reduce overcrowding. Increased outreach to men and younger adults is necessary to ensure equitable preventive care.