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Papanicolas I, Rajan D, Karanikolos M, et al., editors. Health system performance assessment: A framework for policy analysis [Internet]. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2022. (Health Policy Series, No. 57.)

Health system performance assessment: A framework for policy analysis [Internet].

Chapter 7 service delivery.

Ellen Nolte , Marina Karanikolos , and Bernd Rechel .

7.1. Introduction

Delivering services is a core function of health systems and this is influenced by and influences governance, financing and resource generation. Service delivery directly impacts intermediate health system objectives and, ultimately, the achievement of overarching health system goals. This chapter builds on the service delivery definition proposed by Murray & Frenk ( 2000 ), that is, “the combination of inputs into a production process that takes place in a particular organizational setting and that leads to the delivery of a series of interventions”. Within this, we define three sub-functions of service delivery: public health, primary care and specialist care.

Assessment of service delivery is not straightforward. This is in part because the performance of service delivery depends on, and is influenced by, the performance of other health system functions.

Assessments can also take different perspectives, which might include:

• service areas, such as primary or secondary care, or a programme, such as HIV or tuberculosis
• objectives, such as quality, safety, effectiveness, efficiency, accessibility or equity
• the nature of the organization providing services, for example, the level or mode of care.

This chapter begins by defining the service delivery function within the HSPA Framework for UHC and describing the service delivery sub-functions. It then sets out an approach to assess the performance of these functions and sub-functions that includes proposed indicative measures for each. The chapter concludes with a summary of the key proposals and discussion of the wider opportunities for and challenges of assessing the performance of service delivery as a key function of health systems.

7.2. Understanding the service delivery function

7.2.1. where service delivery fits in the framework.

Fig. 7.1 illustrates the HSPA Framework for UHC and position of the service delivery function within this framework. As this shows, service delivery is a product of the governance, financing and resource generation functions. Within service delivery we distinguish the three sub-functions of public health, primary care and specialist care, as well as the function-related governance mechanisms guiding the planning and operation of services. The framework illustrates how service delivery impacts directly on the intermediate objectives of effectiveness, safety and user experience, along with efficiency and equity of service delivery, and access. Together, these drive the achievement of final health system goals and make service delivery a means of assessing the core areas of health system performance.

Service delivery sub-functions. Source : Authors’ compilation.

7.2.2. Defining service delivery

As noted in the introduction, Murray & Frenk ( 2000 ) identified the provision of health services as one of the four core functions of health systems, defining it as “the combination of inputs into a production process that takes place in a particular organizational setting and that leads to the delivery of a series of interventions”. This definition builds on earlier work by Londoño & Frenk ( 1997 ) who spoke more specifically about “outputs (health services) which generate an outcome (changes in the health status of the consumer)”, rather than interventions.

So, while service delivery forms a core health system function, it is also an outcome of the governance, financing and resource generation functions, with inputs including human resources, physical capital and consumables ( Fig. 7.2 ) (Adams et al., 2003 ; WHO, 2010 ). This means that the performance of the service delivery function will reflect the performance of the governance, financing and resource generation functions.

Health service provision (Adams et al). Source : Adams et al. (2003).

In its 2007 framework for action on health system strengthening, WHO expanded the conceptualization of service delivery to include consideration of the service production process and the ways in which the organization and management of inputs and services “ensure access, quality, safety and continuity of care across health conditions, across different locations and over time”. It later argued that increasing inputs would result in better service delivery and access to services, and that “ensuring availability of health services that meet a minimum quality standard and securing access to them are key functions of a health system” (WHO, 2010 ).

Service delivery is a broad concept and difficult to separate into sub-functions without considering a specific country context or service organization. Differentiation is further complicated in that the term “health service” can refer to both the organization that delivers care and the specific product being delivered (Van Olmen et al., 2010 ). Murray & Frenk ( 2000 ) differentiated provision as personal and non-personal health services. Personal health services were seen as those “consumed directly by an individual, whether they are preventive, diagnostic, therapeutic or rehabilitative, and whether they generate externalities or not”, whereas non-personal health services were defined as referring to “actions that are applied either to collectivities (for example, mass health education) or to the non-human components of the environment (for example, basic sanitation)”.

The World Health Report 2000 (WHO, 2000 ) built on the conceptualization of service delivery as proposed by Murray and Frenk, but it did not differentiate the service delivery function beyond personal and non-personal health service delivery. Instead, the report distinguished different organizational forms, such as hierarchical bureaucracy, long-term contractual arrangements and short-term market-based interactions; public or private ownership; and service delivery configurations that could be dispersed. These were defined as “competitive production by small producing units” (for example, primary care); concentrated (for example, hospital care, central public health laboratories), or hybrid (for example, programmes to control infectious diseases) (WHO, 2000 ).

Clearly, there are different conceptualizations, and the differentiations above also combine different perspectives. For the purpose of a generalized framework for health systems performance assessment, we distinguish public health, primary care and specialist care as three sub-functions of service delivery, which we will describe. However, it may first be helpful to separate out the notions embedded in various conceptualizations, either implicitly or explicitly, which distinguish service delivery according to:

• the target population (for example, individual and collective health services)
• the primary purpose of consumption (for example, preventive, curative, rehabilitative, long-term care)
• the type of provider or delivery platforms (for example, primary health care unit, hospital)
• the level of provision (for example, primary, secondary, tertiary)
• the mode of provision (for example, inpatient, outpatient, day care, home care).

These conceptualizations provide a useful way to think about approaches to assessing service delivery performance, but they also show that there are multiple ways to differentiate the components of services. Appendix 7.1 provides a summary of these approaches to categorizing service delivery and discusses the challenges of each for HSPA.

7.3. Sub-functions

Having highlighted the various ways health service delivery may be classified and differentiated, and recognizing the need to enable performance assessment of areas within service delivery, we propose assessing service delivery in a way that allows for a degree of overlap between the various perspectives described above (target populations, purpose, platforms levels and modes), according to three broad sub-functions:

• public health
• primary care
• specialist care.

There are some challenges associated with this differentiation, but it is commonly used and allows for flexibility to adjust for the organization and structure of health services in any given country.

7.3.1. Public health

Public health has been conceptualized using different disciplinary and professional perspectives, with a common thread – seeing it as a collective or societal approach aimed at “improving health, prolonging life and improving the quality of life among whole populations” (WHO, 1998 ). Public health covers the spectrum of health and well-being, from the eradication of particular diseases (World Health Organization Regional Office for Europe, 2020 ), to an increasing recognition of the political, commercial, economic, social and environmental determinants of health and social inequalities (Lomazzi, Jemkins & Borisch, 2016 ).

The practical application of this overarching understanding has remained complex, and globally there is considerable variation in terms of the essential functions assigned to public health (Martin-Moreno et al., 2016 ). Common elements of existing frameworks include surveillance, governance and financing, health promotion, health protection and legislation, human resources and research (WHO, 2018 ). However, there is greater variation around activities such as disease prevention, health care, emergency preparedness, social participation and communication within public health. This reflects, to a great extent, differences in perspectives on what constitutes public health – particularly in relation to UHC – and to what degree health care should be considered a public health operation. Similarly, the aims of defining essential public health functions vary and range from capacity-building exercises to strategies to improve the overall performance of health systems.

7.3.2. Primary care

Definitions of what constitutes primary care also vary widely, although a common understanding is that primary care represents the first point of contact for unspecified and common health problems. Van Olmen et al. ( 2010 ) refer more broadly to “first line health services” – such as health centres, general practitioner practices or clinics – as the primary level of care because they are close to the people they serve, accessible to all, and able to address a wide range of health problems.

However, as indicated above, boundaries between what is referred to as primary care and public health at one end of the spectrum, and primary care and specialist care at the other end, are becoming increasingly blurred. As a result, many services that fulfil a wider public health function are provided in primary care settings (for example, vaccination, family planning), whereas in some countries primary care includes office-based specialists and fulfils a specialist care sub-function.

7.3.3. Specialist care

Specialist care is frequently distinguished into secondary and tertiary care. Secondary care is usually provided in local hospitals, whereas tertiary care comprises highly specialized care delivered in regional or national hospitals in order to concentrate expertise and complex, high-cost resources (Black & Gruen, 2005 ).

Again, boundaries between primary care and specialist care are becoming increasingly blurred. This is partly because, in some countries, specialists also work as office-based practitioners outside a hospital setting (Cacace & Nolte, 2011 ).

Perhaps more importantly, the delivery of health care services is changing. For example, new developments in medical technology, particularly telehealth and mobile technologies, make it possible to provide many services closer to the patient. This allows diagnostic or therapeutic interventions that previously required a hospital environment to be carried out in people’s homes or in ambulatory settings. In many countries there is also increasing recognition that the rising burden of chronic disease requires a different model of care, away from a dependence on hospital-based episodic delivery, towards one that offers some specialist care in the community. This is seen as a way to increase accessibility of services, enhance continuity of care and service responsiveness, and, potentially, reduce costs (WHO, 2016a ).

7.3.4. Governance of service delivery

Governance is a core area within each health system function, providing the basis and structure for their operation. Given the dependence of service delivery on other health system functions, its governance is, in part, a task of those functions. For example, the overall regulation and organization of health services is a task of the overall governance function of the system; whereas the purchasing of services and aspects of health service coverage is governed by the financing function; and the planning and distribution of services is governed by the resource generation function. However, as Adams et al. ( 2003 ) pointed out, there are distinct areas of governance specific to service delivery – decision-making authority and service integration – to which we add quality assurance mechanisms. We will return to these below.

7.4. Assessing the performance of the service delivery function

As noted, a key feature of service delivery is that it is both a health system function and an outcome of the governance, financing and resource generation functions. As a result, service delivery links directly into intermediate objectives. In addition to this, we identify decision-making authority, service integration and quality assurance mechanisms as distinct elements of service delivery governance ( Fig. 7.3 ).

Assessing service delivery. Source : Authors’ compilation.

Access and other identified assessment areas – effectiveness, safety, user experience, efficiency and equity of service delivery – are intermediate objectives of health system. Therefore, for consistency with the overarching framework, we refer to these assessment areas as intermediate objectives. They are also common to the assessment of the three service delivery sub-functions.

Regardless of the conceptualization of service delivery function in the HSA tools described in Chapter 2 (and, consequently, the country-specific HSA reports), this is the area that inevitably plays a key role in the HSA initiatives ( Box 7.1 ).

Service delivery in the HSA tools.

7.4.1. Intermediate health system objectives as areas of assessment of service delivery

Quality is central to the performance of health service delivery. But, as highlighted in Chapter 2 , there are many different ways to assess the quality of health services and systems. Most frameworks build on the seminal work by Donabedian, who argued that health services should be evaluated according to structure, process and outcome, as “good structure increases the likelihood of good process, and good process increases the likelihood of good outcome” (Donabedian, 1980 , 1988 ). This approach was used widely in the study of health service quality, although a further dimension of outputs was added to capture the immediate results of health services carried out by health workers or institutions ( Box 7.2 ).

Dimensions of health services and health systems.

The US Institute of Medicine described quality as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current medical knowledge” (Institute of Medicine, 2001 ); and it identified six dimensions to evaluate this:

• effectiveness
• patient-centredness

Other dimensions, including access, acceptability and continuity, have been added and there is a degree of overlap between dimensions (for an overview see Nolte et al., 2011 ).

A review of performance indicators which looked at eight high-income Organisation for Economic Cooperation and Development (OECD) countries found the most commonly used health system performance domains were effectiveness, access, safety and efficiency, and there was significant overlap of these domains (Braithwaite et al., 2017 ). We focus on the six most commonly used and widely considered core dimensions to measure the service delivery function of health systems. For the purposes of performance assessment, we use the definitions by Nolte et al. ( 2011 ) and the National Academies of Sciences and Medicine ( 2018 ):

• Effectiveness: Extent to which a service achieves the desired results or outcomes, at the patient, population or organizational level.
• Safety: Extent to which health care processes avoid, prevent and ameliorate adverse outcomes or injuries that stem from the processes of health care itself.
• User experience: Extent to which the service user perspective and experience of health care is measured and valued as an outcome of service delivery.
• Access: Extent to which services are available and accessible in a timely manner that does not undermine financial protection.
• Equity: Extent to which the distribution of health care and its benefits among a population is fair; it implies that, in some circumstances, individuals will receive more care than others to reflect differences in their ability to benefit or in their particular needs.
• Efficiency: Relationship between a specific product (output) of the health system and the resources (inputs) used to create the product (Palmer & Torgerson, 1999 ), distinguishing technical and allocative efficiency (see below).

Some dimensions describe the service delivery function specifically, in particular the quality domains of effectiveness, safety and user experience; whereas access, equity and efficiency reflect a broader interaction of all health system functions that ultimately work through service delivery. This approach is closest to the OECD framework for assessing the technical quality of health care, noting that quality in health care means that the care provided is effective, in that it achieves desirable outcomes based on need; safe, because it reduces harm caused in the delivery of health care processes; and person-centred (Kelley & Hurst, 2006 ).

Before exploring the assessment of sub-functions of service delivery – public health, primary care and specialist care – we briefly discuss the dimensions of access, equity and efficiency as cross-sectional areas related to service delivery that reflect broader aspects of health system performance.

7.4.1.1. Access

Access has been conceptualized in numerous ways and is most frequently defined in relation to the use of services. However, Levesque, Harris & Russell ( 2013 ) developed a broader framework that brings together the different dimensions and determinants of access to health services. This distinguishes approachability, acceptability, availability, accommodation, affordability and appropriateness, alongside what they termed population “abilities”. These are defined as the ability to identify, seek, reach, pay for and engage with health services. Clearly, the factors that determine the different dimensions of access to services go beyond the service delivery function. Thus, access is determined, largely, by governance decisions about the organization of services and the population covered. This is driven by financing decisions about what is covered and the degree of financial protection provided; and also by resource generation decisions around investment in human and physical capital.

Indicators of access include a number of direct markers such as:

• unmet need, instances where people need care but are unable to receive it
• financial reasons such as the cost of care
• geographical factors including distance and lack of transport
• service availability, which might be reflected in waiting lists.

Indirect markers include the health consequences of not being able to access timely care – such as amputation rates among people with diabetes or reduced survival due to late diagnosis. Another marker is the level of service utilization, although indicators of overuse and underuse of services should be interpreted with caution (Elshaug et al., 2017 ). Indicators such as utilization and outcomes, which can be used to measure access on both the demand and supply sides, need to be examined alongside each other to avoid misinterpretation and to ensure that decision-making is adequately informed.

Boundaries are not clear-cut, as can be seen in hospital admissions for chronic conditions such as diabetes or heart failure. As these are potentially avoidable when managed appropriately in primary care, high rates of admissions can be viewed as an indicator of poor access to primary care, or a lack of coordination between primary and specialist care. This could be the result of failings in quality or efficiency, or, indeed, both (Gibson, Segal & McDermott, 2013 ) (see also Box 7.3 ).

Expanding access to primary care services in Brazil.

7.4.1.2. Equity

Equity is a cross-sectional dimension of both the health system and its service delivery function because it encompasses fairness and equitable availability and distribution of health services, as well as resulting outcomes (see Chapter 3 ). In terms of service delivery, equity centres on the distributive effects of the quality and effectiveness of services delivered, and on the ability of different population groups to access those services. Equity has multiple strands, which are more, or less, relevant in each specific context. These could be geographical and include variation across countries or regional differences within countries; socioeconomic and span income and employment status; or demographic and vary by age, sex and ethnicity. Box 7.4 illustrates this issue using the example of antenatal care.

Equity in antenatal care quality.

7.4.1.3. Efficiency

Efficiency is also a cross-sectional dimension of both service delivery and health system performance ( Chapter 3 ), but there are different ways of thinking about efficiency in the context of service delivery.

Technical efficiency covers operational performance (Cylus, Papanicolas & Smith, 2017 ). Measures to enhance technical efficiency in service delivery include those aimed at reducing the duplication of services; limits on the use of expensive or unnecessary inputs through measures such as reduced prescribing of branded drugs and using nurses rather than physicians to provide services when appropriate; or reducing errors and adverse events at system, organizational and patient levels (Bentley et al., 2008 ).

Allocative efficiency relates to choices of inputs or outputs, and measures to enhance allocative efficiency include re-balancing services across the health system. This could include moving care into the community, co-ordinating care more effectively, or strengthening preventive care with measures such as incentives at the provider and system levels. Efficiency of service delivery is influenced by governance decisions including:

• uptake of cost-effective technologies and treatments
• wider quality assurance frameworks including national standards and guidelines
• financing decisions around the incentivization and reimbursement of service providers
• resource generation decisions about investment and the appropriate mix of skills, competencies and infrastructure needed to deliver the right care to the right people in the right place.

Additionally, there is an explicit service delivery assessment component relating to how well services use conditions set by the wider governance and financing framework (see Box 7.5 ).

Measuring efficiency in service delivery: antibiotic use.

7.4.2. Assessing the performance of sub-functions of service delivery

It is important to remember that the boundaries between delivery sub-functions are often poorly defined because their scope and breadth is determined, to a large extent, by the specific regional and country contexts within which these functions are organized and financed. For this reason, we propose a set of indicative measures aimed at a global assessment of effectiveness, safety, user experience, access, equity and efficiency, which draw on existing sources when these are available. By global we mean these indicators should be applicable to, and available for, countries at all stages of economic development. The proposed indicators are presented in Tables 7.1 to 7.3 , and are organized into structure, process and outcome indicators.

Indicative measures for public health

Indicative measures for primary care

Indicative measures for specialist care

7.4.2.1. Assessing public health

What constitutes good performance of public health as a sub-function may vary. This is reflected in the assessment tools for different frameworks, which vary in scope and depth (WHO, 2018 ). Available tools use country self-assessments, questionnaires and case studies to evaluate the performance of a given public health function. However, there is no overarching framework for the assessment of public health services that includes real-world indicators (Williams & Nolte, 2018 ). A review of strategies to ensure the quality of public health services in a range of European countries (Rechel et al., 2018 ) found that existing approaches focused on selected indicators of health protection such as vaccination rates; the notification and incidence rates of a range of infections; and indicators of disease prevention and health improvement, such as the use of tobacco and alcohol (Williams & Nolte, 2018 ). Existing approaches often include indicators of early diagnosis such as cancer screening, but there can be considerable overlap with the primary care function, particularly if screening is not population-based. Globally, several of the targets and indicators of the health-related Sustainable Development Goals capture the core public health domains of health protection, health promotion and disease prevention. In Table 7.1 , we propose a selection of these, or related indicators, along with the overarching indicator of preventable mortality – which we define as premature death from causes that can be avoided, or reduced, through public health policies, or policies in other sectors that impact public health (Nolte & McKee, 2004 ).

7.4.2.2. Assessing primary care

Primary care is central to the achievement of sustainable development (Pettigrew et al., 2015 ) and, in particular, UHC. The 2018 Astana Declaration reaffirmed the values and principles of the Declaration of Alma Ata seeing primary health care as the foundation of a sustainable health system (Global Conference on Primary Health Care, 2018 ). Against this background, the development of measures to assess the performance of primary health care systems globally has become increasingly important. Key initiatives include the Primary Health Care Performance Initiative (PHCPI), launched in 2015, which focuses on primary care improvements in low- and middle-income countries (PHCPI, 2018 ); and the European Commission prioritizing the assessment of the performance of primary care systems (European Commission, 2018 ). In line with the Astana Declaration, the WHO and UNICEF continue to assess and measure primary health care (WHO and UNICEF, 2018 ).

Notwithstanding the value and importance of these initiatives, they look at primary care systems in isolation, not as part of the wider health system. For example, the PHCPI framework describes governance, financing and resource generation functions, which focus on primary care, but are difficult to disentangle from aspects of the wider system level, such as financial coverage (PHCPI, 2018 ). Similarly, the proposed framework for assessing primary care within the European context considers 10 domains (Kringos et al., 2019 ) and includes functions or sub-functions, such as financing and purchasing and resource generation, in the form of infrastructure and human resources. This approach strengthens primary care generally and is valuable for assessments that focus on the performance of the primary care function in order to guide primary care reforms and investments in low- and middle-income countries (Veillard et al., 2017 ). However, performance assessments that focus on health systems as a whole need an overall assessment framework that incorporates a range of relevant measures. Drawing on existing primary care performance assessment frameworks, Table 7.2 proposes a selection of indicators that focus specifically on the primary care sub-function.

7.4.2.3. Assessing specialist care

Compared with public health and primary care, the performance of specialist – or more specifically, secondary and tertiary care – services has been measured more closely (Cacace et al., 2011 ; Rechel et al., 2016 ). Much of this has taken place in high-income countries, in the form of performance data of selected hospital services that are publicly reported in an effort to promote high quality, efficiently delivered specialist care. The OECD Health Care Quality and Outcomes programme – previously known as the Health Care Quality Indicators (HCQI) Project – has been developing internationally comparable indicators to assess what it refers to as acute care. In 2019, these indicators, along with selected indicators for primary care, mental health care and cancer care, involved almost 40 countries, and included non-OECD members including Singapore, Costa Rica and Malta (OECD, 2020 ). Many of these indicators rely on fairly advanced hospital-based data collection systems, which may not always be available in the majority of low- and middle-income countries.

Here, existing data on the quality of care are often generated within vertical programmes and focus only on specific areas of the health system. These are frequently maternal and child health, or HIV and tuberculosis, with an emphasis on inputs to health services (Kruk et al., 2018a ). Table 7.3 proposes a selection of performance indicators for specialist care.

7.4.3. Assessing the governance of service delivery: decision-making authority, service integration and quality assurance mechanisms

Building on the conceptualization by Murray & Frenk ( 2000 ), Adams et al. ( 2003 ) suggested assessing the performance of the service delivery function by examining three key themes ( Fig. 7.4 ):

• health system inputs, that is, financial, physical and human resources
• organizational structure and processes, which they defined as autonomy, integration and incentives
• outputs, that is the quantity and quality of health services as they relate to the health needs of the population.

Service provision assessment framework (Adams et al). Source : Adams et al. (2003).

The areas of health system inputs as conceptualized by Adams et al., are covered in the governance, financing and resource generation function chapters of this volume. Here, we focus on what Adams et al., described as organizational structure and processes, in particular autonomy and integration . We extend the concept of autonomy to consider decision-making authority more widely, and include quality assurance as a separate dimension of health service governance.

7.4.3.1. Decision-making authority

In conceptualizing the organizational structure of health services, Adams et al. ( 2003 ) highlight “the degree to which decision-making is delegated to semi-autonomous agencies such as hospitals or provider networks”, thus focusing on facilities providing specialist health services. Existing research has centred on the hospital sector and provider autonomy and, from the 1990s, this has occurred within the context of efforts to enhance hospital performance and a belief that the financial and administrative autonomy of public hospitals is key to improving health outcomes (Saltman et al., 2011 ; Chabrol, Albert & Ridde, 2019 ). Policies designed to achieve this autonomy have ranged from establishing quasi-independent organizations, which have some autonomy about decision-making but retain public ownership and government accountability, to fully independent organizations where direct lines of accountability to government have been replaced by other forms of public sector oversight (Ravaghi et al., 2018 ; Rechel, Duran & Saltman, 2018 ).

However, there is no clear evidence that increasing hospital autonomy has improved their performance, and, by implication, health system performance. In fact, the opposite may be true, as Ravaghi et al. ( 2018 ) have shown in a recent review of hospital autonomy reforms in low-resource settings. They found that these policies have not led to the desired outcomes in terms of improving quality, efficiency and accountability; and in some cases such reforms have led to increased hospital costs and out-of-pocket payments. There are a number of reasons for this including incomplete implementation of related policies with, for example, the central level not fully committing to moving responsibilities to the local institutional level (De Geyndt, 2017 ); or lack of scrutiny by the public sector and hospitals using public interest to increase their income by concentrating on more profitable services (Mills, 2014). Hence, any assessment of institutional autonomy needs to take account of wider governance arrangements for hospitals, such as hospital mandates on service quality; the integration of hospital and outpatient health care; and appropriate mechanisms to strengthen clinical governance (Bloom & Nolte, 2019 ). In addition, broader systems governance needs to be considered more generally, especially overall accountability mechanisms in place.

Discussions around autonomy have focused on hospitals as individual organizations and their performance, rather than the relationship of individual organizational performance to wider system performance. There is little systematic work considering autonomy with regard to public health and primary care institutions, or formal or informal provider networks. Here, the most relevant level of assessment is that of regional-tier administrations, such as local government or local health authorities, that oversee the organization and delivery of these services, and the degree of autonomy or decision-making authority they are granted.

7.4.3.2. Service integration

Integration as conceptualized by Adams et al. ( 2003 ), refers to “the extent to which different inputs, organization, management and service functions are brought together”. More broadly, interest in service integration reflects increasing concern about the continued focus of health systems on acute, episodic illness and dependence on hospital-based service delivery (Nolte, 2017 ). Apart from the high cost of these services, the changing disease burden and rising number of people with multiple chronic health problems, raises questions about the suitability and efficiency of this approach (Nguyen et al., 2019 ). Health services have developed in ways that have tended to fragment delivery. Typically, people receive care from many different providers, often in different settings or institutions and with little coordination between them. Failure to improve the coordination of services along the care continuum may result in adverse events, such as preventable hospitalizations and medication errors (Vogeli et al., 2007 ; Hajat & Stein, 2018 ).

It is against this background that health systems globally are exploring new approaches to service delivery that better link the different professions, providers and institutions along the care pathway in order to provide better support for people with long-standing health and care needs (Nolte & McKee, 2008a ; Nolte, Knai & Saltman, 2014 ; WHO, 2015a ). Integration efforts often occur alongside wider moves to strengthen primary care as a hub to coordinate care (WHO, 2008 ; Global Conference on Primary Health Care, 2018 ). This may include introducing and strengthening referral pathways between different providers and levels of care, or taking specialist services into the community to increase the effectiveness, efficiency and sustainability of service delivery – and so improve health system responsiveness generally (Winpenny et al., 2016 ).

Any effort to integrate services will have to be embedded in the wider governance of health systems. This should include the development of an appropriate regulatory framework and performance and monitoring systems, and place equal importance on the financing and resource generation functions to guarantee the financial, physical and human resources required to create more integrated service delivery systems (Nolte & McKee, 2008b ). Furthermore, as health systems globally are at different stages of integrating services, approaches to their assessment will differ. So, too, will the range of potential indicators to monitor and understand the performance of integrated care available to decision-makers and practitioners (European Commission, 2017 ). Published reviews point to a wide range of potential indicators – particularly process and outcome – to assess service integration across different domains (WHO, 2015b ; European Commission, 2017 ; Suter et al., 2017 ; Kelly et al., 2020 ). However, many of these indicators, particularly outcome measures, assess the performance of service delivery and systems more widely, so are not specific to integrated care. Examples include outcome measures such as mortality or self-reported health, or process measures such as length of hospital stay (European Commission, 2017 ; Suter et al., 2017 ). There is a need for indicators that specifically assess the performance of integrated service delivery, in particular indicators of structure. More widely, a common set of measures is needed to enable the comparative assessment of integration across systems and over time.

7.4.3.3. Quality assurance mechanisms

The quality of service delivery is largely determined by the overarching governance and regulatory framework at system level, which should define fundamental standards of care that service users and the wider population will receive. Quality assurance mechanisms include regulations and processes embedded in health system governance that define quality standards for health service provision and we therefore include quality assurance mechanisms as a distinct dimension of the governance of health service delivery.

Quality assurance mechanisms at system level include mandatory mechanisms, such as professional licences (including licence revocation or suspension), medical malpractice legislation, mandatory continuous improvement including quality reporting, mandated incident reporting, external audit and inspection. In addition, there are a range of market-based mechanisms, including incentive payments, governance by contracting, and provider benchmarking and performance league tables (Schweppenstedde et al., 2014 ) (see also Chapter 5 on resource generation). However, there is considerable overlap with existing mechanisms at an organizational level, particularly voluntary mechanisms such as voluntary facility accreditation and quality improvement initiatives, as well as clinical protocols and organization-level quality and safety monitoring where there is no nationally or regionally mandated system in place.

Some organization-level indicators are included in the indicative measures for performance assessment of the health service delivery functions (shown in Tables 7.1 to 7.3 ). These tend to focus on inputs, such as the availability of appropriate staff and equipment in low-income settings, which can be found in existing resources, including the WHO Service Availability and Readiness Assessment tool (WHO, 2020a ). Indicators that more comprehensively capture quality assurance mechanisms at operational level are needed. Such indicators should show the degree to which facilities and providers engage in the formulation and implementation of care standards locally and identify mechanisms for continued monitoring and reporting. This would enhance effectiveness, protect patient safety and ensure accountability.

7.4.3.4. Indicative measure for assessing governance of service delivery

As noted above, there is often a lack of clarity on specific indicators that reflect performance of governance of service delivery. Table 7.4 lists some indicative measures proposed by WHO ( 2021 ).

Indicative measures for governance of service delivery

7.5. Conclusions

This chapter sets out a proposed conceptualization of the service delivery function and sub-functions within a health system, along with suggestions for assessing the performance of service delivery, both as a product of the governance, financing and resource generation functions and as a means though which most health system goals are being achieved. We show that there are many possible ways to conceptualize and assess the health services function, and there remains a need for a generalizable framework for assessing this function in the context of overall health systems performance assessment. We propose a set of assessment areas – effectiveness, safety, user experience, access, equity and efficiency – for each sub-function of service delivery, along with decision-making authority, service integration and quality assurance to capture broader governance aspects of the service delivery functions.

Overall, there remains a degree of ambiguity and overlap between the core health system functions, which is particularly evident for service delivery. We have tried to minimize this overlap and duplication by attributing specified assessment areas to each function (see also Chapter 3 ). Given that governance, financing and resource generation impact largely on the service delivery function, it is difficult to assess service delivery independently from the other functions. Furthermore, as discussed in this chapter and Appendix 7.1 , service delivery can be conceptualized in many ways. We have chosen the sub-functions of public health, primary care and specialist care as this reflects the way service delivery is organized in most countries. This approach accommodates individual country settings in performance assessment and allows for countries to explore specific service areas – such as primary care, or the level of integration between primary and specialist care – in more detail.

In proposing indicative measures for the assessment of sub-functions we drew on indicators where data are available globally or for different regions, although this is subject to data quality, comparability and completeness. The measures we have proposed are not an exhaustive inventory of those available, but rather a selection of those we consider most useful. Where available, they can form the basis for, or complement more in-depth contextual and qualitative appraisal, which forms the core of most HSAs. Countries may elect to expand on these measures to better reflect their own service delivery organization and structure. Importantly, some areas are less well represented, in particular the governance of service delivery. There is a need for the development of suitable indicators that better capture these functions.

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• Appendix 7.1 A brief overview of approaches to categorizing service delivery

Target population

One broad categorization of the service delivery function is that of individual, person-based health services and collective, population-based health services, as proposed by Murray & Frenk ( 2000 ). A similar conceptualization was brought forward in the development of the System of Health Accounts, a framework for the systematic description of the financial flows related to health care (OECD, EUROSTAT & WHO, 2011 ). It distinguishes personal and collective health care services, with the latter comprising prevention and public health services, as well as health administration and health insurance ( Fig. 7.A1 ).

Categorization of service delivery according to the purpose of health care goods and services. Source : OECD, EUROSTAT & WHO (2011).

While providing a useful broad classification of health services, this conceptualization has the disadvantage of cutting across the range of services that can be directed at both individuals – screening or vaccination services, for example; and populations – for example, sanitation or health campaigns. Furthermore, services directed at groups of individuals, such as families or communities, will be difficult to categorize within this conceptualization of individual versus collective services.

Primary purpose of consumption

The System of Health Accounts framework mentioned above further differentiates the health service function according to the primary purpose of consumption, such as preventive, curative, rehabilitative or long-term care. This considers prevention and public health services as preventive, and rehabilitative or long-term care as curative, but include individual and collective goods and services (OECD, EUROSTAT & WHO, 2011 ). Here, prevention encompasses both primary and secondary prevention, whereas tertiary prevention is considered in the context of curative and rehabilitative care, with its primary aim being to reduce disease-related complications. Curative care is further broken down into general and specialized services.

Types of provider or delivery platforms

Van Olmen et al. ( 2010 ) emphasized that the provision of health services involves a range of services, delivery modes and providers. In relation to health care processes and structures, they use the term delivery platforms or channels ( Table 7.A1 ).

Example of delivery platforms for certain health services

Table 7.A1 shows that not all health services are provided by all providers or delivery platforms but, rather, a number of services are provided by several platforms. Notably, households are also recognized as a platform through which health services can be delivered. This is in line with the WHO framework for action for health system strengthening ( 2007 ), which identified the locations of service delivery and included people’s own homes, the community, the workplace and health facilities (WHO, 2007 ).

Similarly, Watkins et al. ( 2017 ) suggested a classification of five delivery platforms in low- and middle-income countries:

• population-based health interventions, including all non-personal or population-based health services
• community services, including health outreach and campaigns, schools and community health workers
• health centres, including higher and lower capacity health facilities
• first-level hospitals
• referral and specialized (second- and third-level) hospitals.

This approach was further refined by Kruk et al. ( 2018a ), who distinguished community outreach, primary and hospital care, and the links between them through referral systems and emergency medical services.

The notion of different types of provider or delivery platforms is attractive to policy-makers because health care organizations can be steered, and held to account on health outcomes, through the appropriate governance and financing instruments. However, health care providers frequently deliver a wide range of overlapping services, and health outcomes, including complications or death, often occur at the end of a complex chain of events involving different types of provider. This makes it difficult to attribute accountability for outcomes to single organizations (Nolte & McKee, 2004 ). Similarly, with the rise of chronic and multiple conditions, population health needs are becoming increasingly complex. This requires different providers and organizations to work together, in an integrated manner, to enhance outcomes (Nolte, 2017 ). Inevitably, this will increasingly be at odds with the notion of attributing accountability to individual providers, and will require greater focus on the agency or agencies overseeing the integration of services.

Levels and modes of provision

A commonly used approach to classifying health services is by level or mode of provision, typically delineating the levels of primary, secondary and tertiary care or the modes of inpatient care, outpatient care, day care and home-based care. Primary care has been defined as “the first port of call for the sick” (Porter, 1997 ) for individuals, the family and the community. It “constitutes the first element of a continuing health care process” (International Conference on Primary Health Care, 1978 ); and it is general rather than specialized, as it focuses on the initial response to unspecified and common health problems. Secondary care refers to specialist care that is usually provided in local hospitals or in outpatient care settings, while tertiary care comprises highly specialized services that are usually provided in regional or national hospitals (Black & Gruen, 2005 ), in order to concentrate expertise and complex and high-cost resources.

The aforementioned System of Health Accounts framework does not specifically distinguish levels of care, but categorizes provision into different modes of care. These are characterized by whether a patient is formally admitted to a health care facility (inpatient and day care) or not (outpatient and home-based care), whether this involves an overnight stay (inpatient care) or not (day care), as well as the location of service provision. For example, outpatient care is delivered from the health care providers’ premises, whereas home-based care is provided at the patient’s home (OECD, EUROSTAT & WHO, 2011 ).

Although this classification is useful, as it differentiates levels of complexity and specialization along with the mode of service delivery, boundaries are not always clear-cut. For example, hospitals may provide primary, preventive, rehabilitative or long-term care, while primary care centres in some countries are increasingly providing specialized services through, for example, specialist clinics for diabetes or other chronic conditions (Winpenny et al., 2016 ). Importantly, levels of care can vary across types of provider and differentiating between levels and modes of provision will be increasingly challenging as countries move to more integrated systems of service delivery and continue to blur these boundaries.

• Cite this Page Nolte E, Karanikolos M, Rechel B. Service delivery. In: Papanicolas I, Rajan D, Karanikolos M, et al., editors. Health system performance assessment: A framework for policy analysis [Internet]. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2022. (Health Policy Series, No. 57.) Chapter 7.
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• Published: 16 July 2022

Investigating experiences of frequent online food delivery service use: a qualitative study in UK adults

• Matthew Keeble 1 ,
• Jean Adams 1 &
• Thomas Burgoine 1  

BMC Public Health volume  22 , Article number:  1365 ( 2022 ) Cite this article

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Food prepared out-of-home is typically energy-dense and nutrient-poor. This food can be purchased from multiple types of retailer, including restaurants and takeaway food outlets. Using online food delivery services to purchase food prepared out-of-home is increasing in popularity. This may lead to more frequent unhealthy food consumption, which is positively associated with poor diet and living with obesity. Understanding possible reasons for using online food delivery services might contribute to the development of future public health interventions, if deemed necessary. This knowledge would be best obtained by engaging with individuals who use online food delivery services as part of established routines. Therefore, we aimed to investigate customer experiences of using online food delivery services to understand their reasons for using them, including any advantages and drawbacks.

Methods and results

In 2020, we conducted telephone interviews with 22 adults living in the UK who had used online food delivery services on at least a monthly basis over the previous year. Through codebook thematic analysis, we generated five themes: ‘The importance of takeaway food’, ‘Less effort for more convenience’, ‘Saving money and reallocating time’, ‘Online food delivery service normalisation’ and ‘Maintained home food practices’. Two concepts were overarching throughout: ‘Place. Time. Situation.’ and ‘Perceived advantages outweigh recognised drawbacks’.

After considering each of the accessible food purchasing options within the context of their location and the time of day, participants typically selected online food delivery services. Participants reported that they did not use online food delivery services to purchase healthy food. Participants considered online food delivery service use to be a normal practice that involves little effort due to optimised purchasing processes. As a result, these services were seen to offer convenient access to food aligned with sociocultural expectations. Participants reported that this convenience was often an advantage but could be a drawback. Although participants were price-sensitive, they were willing to pay delivery fees for the opportunity to complete tasks whilst waiting for delivery. Furthermore, participants valued price-promotions and concluded that receiving them justified their online food delivery service use. Despite takeaway food consumption, participants considered home cooking to be irreplaceable.

Conclusions

Future public health interventions might seek to increase the healthiness of food available online whilst maintaining sociocultural values. Extending restrictions adopted in other food environments to online food delivery services could also be explored.

Peer Review reports

Purchasing food that is prepared out-of-home and served ready-to-consume is prevalent across the world [ 1 ]. The neighbourhood food environment includes all physically accessible food outlets where individuals can purchase and consume foods, including food prepared out-of-home (often referred to as ‘takeaway food’) [ 2 ]. An increased number of outlets selling this food in the neighbourhood food environment may have contributed to normalising its consumption [ 3 ]. Purchasing formats represent ways to buy takeaway food. Although the opportunity to purchase this food was once limited to visiting food outlets in person or placing orders directly with food outlets by phone, additional purchasing formats such as online food delivery services now exist [ 4 ]. Unlike physically accessing outlets in the neighbourhood food environment or contacting outlets by telephone before collection or delivery, online food delivery services exist within a digital food environment. On a single online platform, customers receive aggregated information about food outlets that will deliver to them based on their location. Customers then select a food outlet, and place and pay for their order. Orders are forwarded to food outlets where meals are prepared before being delivered to customers [ 5 ]. Online food delivery services have been available in the UK since around 2006. However, widespread internet and smartphone access has increased their use [ 6 ], with global online food delivery service revenue estimated at £2.9 billion in 2021 [ 7 ]. The COVID-19 pandemic may have accelerated and perpetuated market development [ 8 ].

Food sold by takeaway food outlets, and therefore available online, is typically nutrient-poor and served in portion sizes that exceed public health recommendations for energy content [ 9 , 10 ]. More frequent takeaway food consumption has been associated with poorer diet quality and elevated bodyweight over time [ 11 ]. Although it is currently unclear, using online food delivery services might lead to more frequent and higher overall takeaway food consumption. In turn, this could lead to increased risk of elevated bodyweight and associated comorbidities. Since an estimated 67% of men and 60% of women in the UK were already considered overweight or obese in 2019 [ 12 ], the possibility that using online food delivery services increases overall takeaway food consumption is a major public health concern, as recognised by the World Health Organization [ 4 , 13 , 14 ].

With respect to the neighbourhood food environment, food outlet accessibility (number) and proximity (distance to nearest), food availability (presence of variety), and attitudinal dimensions (acceptability) contribute to takeaway food purchasing practices [ 15 ]. Each of these domains apply to takeaway food access through online food delivery services. In 2019, the number of food outlets accessible through the leading online food delivery service in the UK ( Just Eat ) was 50% greater in the most deprived areas compared with the least deprived areas [ 16 ]. Furthermore, adults living in the UK with the highest number of food outlets accessible online had greater odds of any online delivery service use in the previous week compared to those with the lowest number [ 17 ]. To our knowledge, however, attitudinal dimensions of online food delivery service use have not been investigated in the public health literature. Given the complexity of takeaway food purchasing practices, there are likely to be unique and specific reasons for using online food delivery services. Understanding these reasons from the perspective of customers could contribute to more informed public health decision-making and intervention, which is important since public health interventions that include online food delivery services may be increasingly necessary as their growth in popularity continues worldwide [ 13 , 18 ].

In our study, we investigated experiences of using online food delivery services from the perspective of adults living in the UK who use them frequently. We aimed to understand their reasons for using these services, the possible advantages and drawbacks of doing so, and how they coexist with other food-related practices.

Between June and August 2020, we used semi-structured telephone interviews to study experiences of using online food delivery services from the perspective of adults living in the UK. We used the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist to guide the development and reporting of our study [ 19 ].

The University of Cambridge School of the Humanities and Social Sciences Research Ethics Committee provided ethical approval (Reference: 19/220).

Methodological orientation

We used a qualitative description methodological orientation to investigate our study aims. Qualitative description has been framed as less interpretative than other approaches [ 20 ]. However, it is theoretically and epistemologically flexible and can facilitate a rich description of perspectives [ 21 ], which matched our study aims.

Participants and recruitment

We used convenience sampling to recruit adults that used online food delivery services frequently. For the purpose of our study, we defined frequent customers as those who had used online food delivery services on at least a monthly basis over the previous year. We believed this level of use would make participants well-positioned to provide their experiences of using this purchasing format within established takeaway food purchasing practices. We also based participant recruitment on reported sociodemographic characteristics of online food delivery service customers [ 22 , 23 ]. As data collection progressed, we additionally considered level of education so that our sample included frequent customers who were less highly educated (see Table 1 ).

We used two social media platforms (Twitter and Reddit) to recruit participants. Participant recruitment through social media platforms can be fast and efficient [ 24 , 25 , 26 ]. If targeted advertising is not used (as in our study), participant recruitment in this way is also typically free. In our study, participant recruitment through social media was particularly appropriate, given that our aims were related to understanding experiences of using a digital purchasing format. Twitter users can publish and re-publish information, images, videos, and links to external sites. Reddit users can publish information, images and videos, and discuss topics within focused forums known as ‘Subreddits’. For Twitter, the primary researcher (MK) published recruitment materials using his personal account and relied on existing connections to re-publish them. For Reddit, MK created an alias account (he did not have a personal account at the time of our fieldwork) and published recruitment materials in Subreddits for cities in the UK with large populations according to the 2011 UK census, those related to online food delivery services, and those that discuss topics relevant to the UK [ 27 ]. See Additional file 1 (Box A1) for a complete list of Subreddits.

Recruitment materials asked interested individuals to contact MK by email. When contacted, MK responded by email with screening questions that asked about self-reported frequency of online food delivery service use over the past year, age, and level of education. When eligibility was confirmed, MK provided information about the study by email. This information included the study aims, details about researchers involved, the offer of a £20.00 electronic high street shopping voucher, and a formal invitation to participate. After five business days with no response to the invitation, MK sent a further email. After another five business days, we classified individuals that did not respond as ‘non-respondents’.

Data collection

Before data collection.

Before starting data collection, we planned to complete a maximum of 25 interviews. We did not target data saturation. Food purchasing and consumption are highly individual and influenced by previous experiences, cultural backgrounds, and preferences [ 28 ]. Therefore, we felt that it would be difficult to conclude data saturation was achieved based on the traditional conceptualisation of no new information being reported by participants [ 29 , 30 ]. Instead, we prioritised conceptual depth and information strength. This approach was aligned with the qualitative description methodological orientation of our study [ 30 ].

We wanted to investigate experiences of using online food delivery services from before the COVID-19 pandemic, when there were no restrictions on accessing multiple purchasing formats or consuming food on the premises. Therefore, we pre-specified that we would stop data collection if it became difficult for participants to refer to the time before March 2020, which is when pandemic related travel and food outlet access restrictions were first introduced in the UK. MK piloted an initial protocol with an eligible individual to confirm this would be possible, and made amendments based on their feedback.

Before starting data collection, MK reflected on his position as a population health researcher, and his previous training and experience in qualitative research [ 31 ]. MK also reflected on his own takeaway food consumption and previous use of online food delivery services. As of June 2020, MK consumed takeaway food infrequently and had previously placed one order with an online food delivery service. Although he was not a frequent customer according to our classification, MK was familiar with online food delivery services operating in the UK. MK concluded that despite having a broad understanding about why online food delivery services might be used, he could not use his own experiences to provide detailed reasons for favouring this purchasing format over alternative options.

Throughout data collection

MK completed one-off semi-structured telephone interviews with participants at a convenient time selected by them. At the start of the interview process, MK confirmed the rationale for the study, gave participants the opportunity to ask clarifying questions and asked them to provide verbal consent. MK used a topic guide that was developed based on a priori knowledge, pilot interview feedback and previous research related to takeaway food and online food delivery services [ 22 , 32 , 33 ]. MK amended the topic guide as data collection progressed so that points not initially considered could be discussed in future interviews. Interview questions focused on reasons for using online food delivery services, the perceived advantages and drawbacks of using these services, and how using them coexisted with other purchasing formats and food-related practices (see Box A2 in Additional file 1 for the final topic guide).

Although MK completed interviews during the COVID-19 pandemic, he did not ask questions related to this period of time, and prompted participants to think about the time before March 2020 so that pre-pandemic experiences could be discussed. MK digitally recorded interview audio and made field notes to track points for discussion within the interview.

After data collection

MK immediately reflected on topics discussed, data collection progress, possible links with existing theory, and the ability of participants to think about the time before the COVID-19 pandemic. We used these post-interview reflections to help inform our decision to stop data collection.

Data analysis

A professional company transcribed interview audio verbatim. Whilst listening to the corresponding audio, MK quality assured each transcript and anonymised it. Participants did not review their transcripts.

We used codebook thematic analysis. When using this analytic approach, researchers develop a codebook based on the final topic guide used during data collection and data familiarity that is achieved by reviewing collected data [ 34 , 35 ]. Codebook thematic analysis is aligned with qualitative description methodological orientations as it allows researchers to remain ‘close to the data’ and facilitates an understanding of a topic through the ‘spoken word’ of participants [ 36 ]. In practice, MK developed an initial codebook. MK, JA, and TB then reviewed three transcripts (a 10% sample). This number was manageable and allowed us to discuss a sample of collected data [ 37 ]. After discussion, MK refined the initial codebook to collapse codes that overlapped and to add new codes, which formed the final codebook. MK coded each transcript with the final codebook and reviewed reflections written after each interview. MK then studied the coded data to generate themes that were discussed and finalised with JA and TB. In the context of our study, themes summarise experiences of using online food delivery services from the perspective of participants. After discussion, we also identified that across the themes we generated, there were overarching concepts. For our study, concepts should be seen to offer an overall and consistent structure that capture the common and overlapping elements of each of the generated themes.

MK used NVivo (version 12) to manage the data and facilitate interpretation.

Participant and data overview

MK conducted interviews with 22 frequent online food delivery service customers between June and August 2020. Interviews lasted between 35 and 61 min. There were 12 male participants, 13 participants were aged between 20 and 29 years, and 15 had completed higher education. Since initial adoption, participants had typically used online food delivery services at least fortnightly but as often as daily, and during interviews they consistently referred to using the three most well-established online food delivery services operating in the UK ( Just Eat, Deliveroo, and Uber Eats ) (see Table 2 ).

During the 19 th interview, conducted in August 2020, it was difficult for the participant to think about the time before the onset of the COVID-19 pandemic in March 2020. MK completed three further interviews and then concluded that this difficulty was consistent so stopped data collection. We included data from all interviews in analyses. In addition to those who took part, three interviews were scheduled but cancelled by individuals without providing a reason, and there were nine non-respondents.

Summary and structure

We generated two concepts that were overarching throughout our data: ‘Place. Time. Situation.’ and ‘Perceived advantages outweigh recognised drawbacks’. Within these overarching concepts, we generated five themes: ‘The importance of takeaway food’, ‘Less effort for more convenience’, ‘Saving money and reallocating time’, ‘Online food delivery service normalisation’ and ‘Maintained home food practices’.

In the following sections, we present the findings for each of the overarching concepts, followed by each of the themes. Whilst we discuss each concept and theme in turn, all of their elements were present throughout the data and should be thought of as dynamic, overlapping, and non-hierarchical. For example, participants consistently reflected on features of online food delivery services within the context of their location at a specific time. The conclusion of this process dictated whether a feature was viewed as an advantage or a drawback, and in some cases whether an online food delivery service would be used. We provide examples of this comparison process at the end of our Results (Table 3 ).

Overarching concepts

Place. time. situation..

Participants described how their location and the time of day impacted their ability to access different types of food, including both ‘takeaway’ food and other types of food. When choosing one type of food over another, participants had a multi-factorial thought process that considered their food at home, immediate finances available for food, and the food already eaten that day.

Although data collection focused on takeaway food, participants were clear that this type of food was not always appropriate. As participant 10 (Female: 20–29 years) stated; “ I don’t always just go and get a takeaway; sometimes I’ll walk to the shop, get some food, and make something ”. This view was shared by participant 11 (Male 30–39 years); “ some days I’ll decide that it’s too expensive and I’ll either get something else direct from the restaurant or go to the supermarket and then make food ”.

Nonetheless, participants indicated that purchasing takeaway food was preferable in many situations. For example, when acting spontaneously, when meals had not been planned or if other types of food could not satisfy needs, then takeaway food was appropriate.

“ I think you’re more likely to get delivery and order online when it’s unplanned and you need a pick-me-up, or you need something quick, or you don’t have something and you’re really hungry .” Participant 15 (Male: 40-49 years)

When participants decided to purchase takeaway food, they recognised that their location and the time of day dictated the purchasing formats they could access and potentially use. Access to multiple purchasing formats created a second decision making process. Participants considered the cuisines they wanted, delivery times estimated by online food delivery services versus the time it would take to travel to a food outlet, the weather, their willingness to leave home, and previous experience with accessible food outlets. Alongside these influential factors, choosing one purchasing format over another was often based on what was most convenient.

“ If I’m out and about, on the way home and I’m passing via an outlet, then I’ll pick it up. If I’m at home and just kind of, don’t want to leave the house, then I’ll order via an app or online, just because it’s just convenient .” Participant 2 (Male: 20-29 years)

Despite having apparently decided how they would purchase takeaway food, participants stated that they could change their mind. In the case of online food delivery services, if estimated delivery times failed to meet expectations, this purchasing format would no longer be appropriate and another purchasing format or type of food would be selected. The need for food practices to align with other routines and schedules, and therefore meet expectations, was particularly clear when participant 8 (Female: 40–49 years) described that they used online food delivery services when they could “ relax on a Friday night with the whole evening free ”. However, if they do not have time to select a food outlet, place their order, and then wait for delivery they “ normally just have some spaghetti because that takes 10 min ”.

Participants also referred to online food delivery service marketing in their day-to-day environments, including branded food outlet signs and equipment used by delivery couriers. Participants stated that these things did not always trigger immediate use of online food delivery services, however, their omnipresence reminded them that these services were available.

“ I don’t know if I ever go onto Just Eat after seeing it advertised, I don’t think that’s ever directly led me to do it. But it certainly keeps it in your mind, it’s certainly at the forefront of your mind whenever you think of takeaway .” Participant 11 (Male: 30-39 years)

Perceived advantages outweigh recognised drawbacks

Throughout the data, participants recognised that a single online food delivery service feature could be an advantage or a drawback based on their location and the time of day. This was clearest when participant 2 (Male: 20–29 years) discussed the number of food outlets accessible online compared with those available through other purchasing formats. There was value in having access to “ 20, 30, 40 food outlets ” through online food delivery services as it meant more options, otherwise “ you’re more limited just by the virtue of where you are or what shops you’re passing ”. However, access to a greater number of food outlets was a drawback when it meant that making a selection was difficult. The constant comparison of advantages and drawbacks prompted MK to ask participants why they kept using online food delivery services. There was a consensus that features of these services were unique, mostly advantageous, and outweighed the instances where they were seen as drawbacks. Since participants continued to use online food delivery services to access unique features, this practice appears to be self-reinforcing, even if this means accepting that the same feature can sometimes be a drawback.

Participants favoured online food delivery services in many situations. Nevertheless, they acknowledged that if the overall balance between advantages and drawbacks changed then they would purchase takeaway food in other ways. This solution emphasises that takeaway food can often be accessed in multiple ways dependent on place and time. As it stands, participants anticipated that they would continue to use online food delivery services indefinitely.

“ I can’t see any reason why I would [stop using online food delivery services] , unless something went wrong with Just Eat, you know, the service had a massive problem, but at the moment I can’t see any reason why I would. ” Participant 16 (Male: 20-29 years)

Analytic themes

We now present each of the five themes generated from our analyses. As described, elements of each theme overlapped within the two overarching concepts presented above.

The importance of takeaway food

Participants emphasised that, ultimately, it was “ the food ” that they valued, and that directed them towards using online food delivery services.

“ It’s the food really, that leads me to use [online food delivery service] apps .” Participant 10 (Female: 20-29 years)

Participants reported that they did not use online food delivery services with the intent of purchasing healthy food. Participants told us that they expected takeaway food to be unhealthy and that online food delivery services facilitated access to this food. This perspective influenced the types of food that participants were willing to purchase through online food delivery services. For example, pizza (seen as unhealthy) was appropriate but a salad (seen as healthy) was not. Moreover, participants recognised that if they wanted to consume healthy food, they would most likely cook for themselves.

Participants stated that takeaway food had social, cultural, and behavioural value. For many, purchasing and consuming takeaway food at the end of the working week signified the start of the weekend, which was seen as a time for relaxation and celebration. This tradition was carried forward from childhood, with Friday night referred to as “ takeaway night ”. For participants, using an online food delivery service allowed them to maintain, yet digitalise, traditions.

“ It’s always a weekend thing, besides it being a convenient, really quick way of accessing food that is filling and tastes nice, for me, it marks the end of a work week .” Participant 4 (Female: 30-39 years)

Participants reported that in some situations consuming takeaway food as a group could be a way to socialise. This was especially the case during life transitions such as leaving home to start university.

“ When you move out you’re concentrating on making friends and getting a takeaway was quite an easy way for everyone to sit down around the table and socialise and to have drinks .” Participant 14 (Female: 20-29 years)

Participants did not value online food delivery services to the same extent that they did takeaway food. This perspective reinforced that online food delivery services were primarily used to satisfy takeaway food purchasing needs.

“ If Just Eat as an entity disappeared, or all online takeaways disappeared, I wouldn’t be upset […] it’s a luxury, it makes life easier .” Participant 9 (Male: 30-39 years)

Less effort for more convenience

Participants reported that it took little effort to use online food delivery services because they receive information about all food outlets that will deliver to them on a single platform. Additionally, participants valued the opportunity to save payment details, previous orders, and favourite food outlets for future use. Participants also informed us that they had a greater number of food outlets and a more diverse range of foods and cuisines to choose from compared with other purchasing formats. Due to the number of accessible food outlets, the selection process was not always fast. Nonetheless, participants indicated that online food delivery services make purchasing takeaway food easier and more convenient than other purchasing formats where information is less readily available.

“Y ou’ve got all of the different options laid out in front of you, it’s like one resource where everything is there and you can choose and make a decision, rather than having to pull out leaflets from a drawer or Google different takeaways in the area. It’s all there and it’s all uniform and it’s in one place .” Participant 3 (Female: 20-29 years) “ I can pick through a whole wide selection rather than being limited to the few takeaways down on my road or having to drive somewhere .” Participant 21 (Male: 20-29 years)

Participants emphasised that smartphone applications had been optimised to enhance this experience.

“ I guess it’s the convenience of just being able to open the app on my phone, and not have to go searching for menus or phone numbers and checking if places are open. So yeah, it’s the convenience .” Participant 15 (Male: 40-49 years) “ For me it’s just the ease of going on, clicking what you want, paying for it and it arriving. You don’t have to move, you don’t have to cook, you don’t have to think, it’s just there ready to go, someone’s doing the hard work for you .” Participant 1 (Female: 20-29 years)

However, greater convenience was not always advantageous. Some participants were concerned that convenient and easy access to takeaway food through online food delivery services might have negative consequences for health and other things.

“ It’s quite addictive in the way that it’s just so convenient to order. I’m not making stuff fresh at home, and I’m eating unhealthier .” Participant 21 (Male: 20-29 years) “ I think it adds to a general kind of laziness that is not good for people really. If you actually got up and went for a walk to go and get this food, at least there’s a slightly positive angle there .” Participant 17 (Male: 30-39 years) “ The convenience is not necessarily a positive thing, these apps can be abused because it’s so easy to access foods .” Participant 10 (Female: 20-29 years)

Saving money and reallocating time

Participants were price-sensitive and valued the opportunity to save money. When discussing financial aspects of online food delivery service use, participants referred to special offers they had received by email or through mobile device push notifications. Participants recognised that direct discounts (e.g. 10% off), free items (e.g. free appetizers on orders over £20.00), free delivery (e.g. on orders over £30.00), or time-limited price-promotions (e.g. 40% off all orders for the next three-hours) can justify takeaway food purchasing and online food delivery service use.

“ Getting a takeaway is always a treat, every time I do it I know I shouldn’t but then basically I’m convinced to treat myself, if there’s a discount I’m much more likely to do it because I don’t feel like it’s such a waste of money .” Participant 18 (Male: 20-29 years)

Participants recognised takeaway food as a distinct food category. Nevertheless, they appreciated that that they could use online food delivery services to purchase ‘restaurant food’. Since this food is usually accompanied by a complete dining experience that online food delivery services cannot replicate, participants expected to spend less on this food purchased online compared to when they dined inside a restaurant.

“ Some restaurants deliver through Deliveroo, [places] where you can sit down and have an experience, a dining experience, well that’s different […] you might go there for the dining experience .” Participant 4 (Female: 30-39 years) “ Sometimes I’m deterred from using Uber Eats because I noticed that the restaurants increase their prices if you buy it through them rather than directly […] I don’t want to pay over £10 for a takeaway dish, whereas I would pay that if I ate at a restaurant .” Participant 3 (Female: 20-29 years)

Although participants considered the price of food when deciding which outlet to order from, they traded money for time. Participants compared the time they would spend cooking or travelling to takeaway food outlets with the time taken to place orders through online food delivery services plus the tasks they could complete whilst waiting for meal delivery. Paying a delivery fee to have the opportunity to use time that would not have otherwise been available was acceptable.

“ Yeah, it costs money but at the same time we’re getting more time with the kids, and more time to do other stuff, so it’s absolutely fine as far as I’m concerned .” Participant 9 (Male: 30-39 years)

However, some participants were unsure about the appropriateness of paying to have food delivered as it might be unfair to delivery couriers.

“ I don’t feel like it’s necessarily right to make a delivery driver drive two minutes up the road just because I can’t be bothered to go and collect something that’s not very far away .” Participant 10 (Female: 20-29 years)

Online food delivery service normalisation

Participants had positive previous experiences of using online food delivery services. These experiences influenced future custom and contributed to an overall sense that using this purchasing format was now a normal part of living in a digital society. Some participants referred to watching television online to exemplify this point.

The normalisation of using online food delivery services was particularly evident when MK prompted participants to think about the term ‘takeaway food’. Participants often referred to online food delivery services in the first instance and saw them as synonymous with takeaway food.

“ If you were to say ‘takeaway food’ I’d pull out my phone and I’d open one of the apps and say ‘okay, what should we order’, I wouldn’t say ‘oh let’s go to this road’, or ‘let’s go to that road’, I’d say ‘yeah, let’s look on the app’ .” Participant 21 (Male: 20-29 years)

For participants in our study, using online food delivery services replaced purchasing takeaway food in other ways. This perspective was linked to habitual takeaway food purchasing and sociocultural values. Participants rarely purchased takeaway food outside of set routines (for example only doing so at the weekend) because they did not think it was appropriate. As a result, participants reported that they had a limited number of opportunities to use multiple purchasing formats and thus increase their existing levels of consumption.

Maintained home food practices

Most participants were responsible for cooking at home, enjoyed doing so, and said they were competent at it. Nonetheless, cooking at home required personal effort and being “ lazy ” or “ tired ” or “ having nothing in the cupboards ” was used as a justification for using online food delivery services.

“ I cook, when I’m not using these apps I cook and prepare food for myself , it’s just on the odd occasion I might be feeling tired or want something different […] the rest of the time, I’m quite happy to cook .” Participant 10 (Female: 20-29 years)

Despite the apparent normalisation of using online food delivery services, participants did not feel that they would ever completely eliminate cooking at home. Most participants consumed home cooked food daily, whereas they consumed takeaway food less frequently. This contributed to the view that these two types of food were different. As a result, participants used online food delivery services to purchase food they could not or would not cook at home; for a break from normality, and as a “ cheat ” or “ treat ”.

Summary of findings

To our knowledge, this is the first published study in the public health literature to investigate experiences of using online food delivery services from the perspective of frequent customers.

Participants recognised that their location and the time of day meant that they could often access different types of food through multiple purchasing formats, at the same time. Participants stated that purchasing takeaway food was appropriate in many situations and typically favoured using online food delivery services. For many participants, using these services was now part of routines in their increasingly digital lives. As such, using online food delivery services appeared to be synonymous with takeaway food purchasing. This meant that participants expected food sold online to be unhealthy and that it was inappropriate to purchase healthy food in this manner. Participants consistently thought about how features of online food delivery services were an advantage or a drawback within the context of their location at any given point in time. This was a complex and dynamic thought process. Participants described how the advantages of these services were a strong enough reason to continue use, overcoming drawbacks such as the acknowledged unhealthfulness of takeaway food. Participants reported that using online food delivery services involved little effort as they were provided with food outlet information, menus, and payment facilities on one platform that had been optimised for use. Moreover, although the cost of food was an important consideration for participants, they were willing to pay a fee in exchange for the opportunity to complete tasks whilst waiting for meal preparation and delivery. Finally, using online food delivery services substituted purchasing takeaway food in other ways. Nevertheless, participants reported that cooking at home was a distinct food practice that occurred more frequently and was irreplaceable.

Interpretations

Participants described sociocultural values assigned to takeaway food. These values are proposed to develop from previous experiences [ 38 , 39 ]. For our participants, purchasing takeaway food at the weekend was a traditional routine that celebrated the end of the working week. In the past, this tradition might have meant visiting food outlets in the neighbourhood food environment. However, online food delivery services are now used and favoured. Since participants reported that it was takeaway food in and of itself that was a fundamental reason for seeking out online food delivery services, it is reasonable to conclude that sociocultural values linked to this food exist, and transfer, across purchasing formats.

Food purchasing has been recognised as situational and made in the context of place and time [ 40 , 41 ], with convenience reported as a consistent consideration [ 42 ]. Participants in our study reported that takeaway food was appropriate in many situations and acknowledged that it could often be accessed through multiple purchasing formats. Using one purchasing format over another came after considering multiple factors, including the level of effort required to find a suitable food outlet and place orders. As using online food delivery services took little effort, this purchasing format was often most convenient. However, participants were clear that although their decision had seemingly been made, it could be changed, especially if an online food delivery service feature that was supposedly an advantage became a drawback. For example, if estimated delivery times were too long or delivery fees were too high an alternative option would be considered. Our findings support that the decision about if and how to purchase takeaway food is dynamic and influenced by place and time [ 32 ].

Food access has previously been summarised within the domains of availability, accessibility, affordability, accommodation, and acceptability [ 15 ]. Although Caspi and colleagues described these domains in the context of physical food access, they are applicable to digital food environments. Broadly speaking, our research investigated the ‘acceptability’ of using online food delivery services, and participants made explicit reference to the domains of food ‘accessibility’ and ‘affordability’.

For example, participants told us that one particularly valuable aspect of using online food delivery services was the ability to access a greater number of food outlets compared with other purchasing formats. This finding speaks to our previous research that found a positive association between having the highest number of food outlets accessible online and any use of online food delivery services in the previous week amongst adults living in the UK [ 17 ]. The experiences of using online food delivery services reported in the current study support the possibility that having more food outlet choice contributes to the decision to adopt, and maintain, use of these services rather than necessarily increasing the frequency in which they are used. Other features of online food delivery services, such as having information about each of the accessible food outlets on one platform, likely amplify the perceived benefit of greater food outlet access. Notably, however, access to an increased number of food outlets was not always advantageous. This finding recognises a general awareness about the negative aspects of takeaway food consumption, previously captured from the perspectives of young adults in Australia and Canada [ 38 , 43 ].

Participants also discussed how the price of food influenced their use of online food delivery services. This reflects that food affordability is a fundamental purchasing consideration [ 32 ]. Beyond this, our findings provide insight into actions that food outlets registered to accept orders online might take to attract customers. Given that online food delivery service customers can often select from multiple food outlets at the same time, food outlets might aim to compete with one another by lowering the price of food sold or by introducing price-promotions in an attempt to capitalise on customer demand. Particularly in the case of the latter, participants acknowledged the importance of price-promotions. Previous evidence shows that price-promotions contribute to unhealthy food purchasing practices [ 44 , 45 ]. Access to price-promotions through online food delivery services has not been systematically documented. However, it is possible that their availability is positively associated with the number of food outlets accessible online. Since both price-promotions and the number of food outlets accessible online appear to influence online food delivery service use, the possibility of interaction between them is concerning for overall consumption of food prepared out-of-home, and subsequently, diet quality and health.

In some cases, participants reported that they used online food delivery services because they did not have time to cook at home. A number of tasks, including household chores, work, travel, and childcare, can limit the time available for, and take priority over, home cooking [ 46 ]. Using online food delivery services (and paying associated delivery fees) instead of cooking at home allowed participants in our study to complete non-food related tasks whilst waiting for meal preparation and delivery. Due to sociocultural values and perceived ‘rules’ about how frequently takeaway food 'should' be purchased, participants did not see online food delivery services as a complete replacement for cooking at home. Nevertheless, even partial replacement has implications for diet quality and health, especially since the food available and purchased online was acknowledged as unhealthy by participants in the current study.

Possible implications for public health and future research

Participants reported that using online food delivery services had mostly substituted, not supplemented, their use of other purchasing formats. Given the perspectives of participants in our study, an increasing number of food outlets could be registering to accept orders online to supply an apparent customer demand. Further research is required to understand the extent to which customer demand is driven by food outlet accessibility, and vice versa.

Participants in our study reported that despite using online food delivery services frequently, their overall takeaway food consumption had remained the same. We do not yet know if this perception would be reflected in objective assessment of takeaway food consumption. Further research that quantifies the use of multiple purchasing formats and takeaway food consumption over time is required to understand the potential public health implications as a result of using online food delivery services. Although evidence from Australia suggests that food sold through online food delivery services tends to be energy-dense and nutrient-poor [ 47 ], this has not been established in the UK, to our knowledge. Nor does it necessarily reflect the balance of what food is purchased. Objective assessment of the nutritional quality of foods available, and purchased, through online food delivery services in the UK could be the focus of future research. This evidence will help to better understand the extent to which public health concern is warranted.

With a few exceptions, food sold through online food delivery services is prepared in food outlets that are also physically accessible in the neighbourhood food environment [ 13 ]. From a public health perspective, this reinforces the intrinsic link between neighbourhood and digital food environments [ 48 ]. Therefore, public health interventions adopted in the neighbourhood food environment may also influence the digital food environment. For example, urban planning policies have been adopted to prevent new takeaway food outlets from opening in neighbourhoods [ 49 ]. By extension, this stops new food outlets from becoming accessible online. Other public health interventions that operate synergistically between physical and digital food environments might be increasingly required in the future. It will also be vital for any future interventions to consider how the geographical coverage of online food delivery services expands neighbourhood food outlet access [ 50 ], potentially undermining the effectiveness of interventions adopted in the neighbourhood food environment. Doing so would help address concerns that these services increase access to food prepared out-of-home [ 4 , 13 ]. Interventions of this nature could be particularly important in more deprived areas that have the highest number of accessible food outlets across multiple purchasing formats [ 16 , 51 ].

Participants recognised that online food delivery services provide access to takeaway food that was associated with being unhealthy. Participants were aware that they could purchase healthy food through online food delivery services, but this did not mean that they would . From a public health perspective, this finding indicates that the success of interventions intended to promote healthier takeaway food purchasing through online food delivery services might be limited by existing sociocultural values if they are not taken into consideration. A possible way to navigate this would be to improve the nutritional quality of food available online without necessarily making any changes salient. Interventions of this nature include healthier frying practices and reduced food packaging size [ 52 , 53 ]. Although these interventions were acceptable and feasible when implemented inside takeaway food outlets [ 54 ], further investigation is required to understand the extent to which they are appropriate in the context of online food delivery services. Changing the types of food available to purchase through online food delivery services could also lead to improved food access for those with limited kitchen facilities at home or limited mobility.

Public health interventions intended specifically for online food delivery services could also be developed. Potential approaches include preferential placement of healthy menu items, introducing calorie labelling and offering healthier food swaps. Embedding these approaches within existing online food delivery service infrastructures would allow implementation to be uniform [ 55 ], and their implementation could be optimised to enhance customer awareness and interaction. The potential success of approaches of this nature requires exploration. Nevertheless, in February 2022, the UK Behavioural Insights Team (formerly of the UK Government) published a protocol to investigate approaches to promoting the purchase of lower energy density foods through a simulated online food delivery service platform [ 56 ].

Price-promotions influenced and justified the use of online food delivery services. Legislation to restrict the use of volume-based price-promotions (e.g. buy-one-get-one-free, 50% extra free) on less healthy pre-packaged food sold both in-store and online were due to be introduced in England in October 2022 [ 57 ]. However, the introduction of this legislation has now been delayed. Although hot food served ready-to-consume was due to be excluded, given what is known about the impact of price-promotions on purchasing other food [ 58 ], and our participants’ description of the importance of price-promotions on their purchasing practices, extension of these restrictions to hot food served ready-to-consume might be warranted. Understanding how price-promotions influence food purchased from online food delivery services represents a first step to understand the need for future regulation.

Limitations

We recruited participants through two social media platforms, which means that our study sample was formed from a subset of all social media users. However, online recruitment was appropriate since we wanted to understand experiences of using a digital purchasing format. Moreover, the participants we recruited were mostly highly educated, potentially reflecting reported online food delivery service use amongst this socioeconomic group [ 22 , 23 ]. After 12 telephone interviews we acknowledged this and adjusted our recruitment strategy to ensure a more balanced sample with respect to level of education. Nevertheless, future research should explore the perspectives of frequent online food delivery service customers with lower levels of education, since it is possible that they have different reasons for using these services. Although we did not recruit infrequent online food delivery service customers or non-customers, they would not have been well-positioned to help us investigate our study aims. However, since we have described experiences of using online food delivery services from the perspective of frequent customers, future work should seek to understand perspectives of non-customers, customers who use them less frequently, and customers who use them for specific reasons.

As the first study in the public health literature to investigate frequent customer experiences of using online food delivery services, we chose a descriptive methodological orientation. Our descriptive approach meant that we did not investigate the underlying meaning of the language used by participants, however, this was not aligned with our aims. Furthermore, our descriptive methodological orientation allowed us to use codebook thematic analysis and include multiple researchers in analysis. Coding a 10% sample of interviews transcripts and discussing analytic themes would have been less appropriate with reflexive approaches to thematic analysis [ 34 , 35 , 59 ], but assisted with our interpretations.

We conducted fieldwork during the early stages of the COVID-19 pandemic, which might have altered the recent experiences of online food delivery service use and participant perspectives. However, MK asked participants to think about the time before the COVID-19 pandemic and reflected on their ability to do so. This reflexivity is in line with established practices regarding qualitative rigour [ 20 , 60 ], and allowed us to determine when it would be most appropriate to stop fieldwork. Nonetheless, we acknowledge the possibility that food-related practices have changed during the COVID-19 pandemic. As a result, it is possible that online food delivery services are now used for different reasons, both initially and over time, and by individuals with different sociodemographic characteristics than those in our study.

We used telephone interviews with frequent online food delivery service customers to investigate experiences of using this purchasing format. We found that the context of place and time influenced if and how takeaway food would be purchased. Online food delivery services were often seen as most appropriate. In part, this was due to the opportunity to access advantages not available through other purchasing formats, such as efficient and convenient ordering processes that had been optimised for customers. Fundamentally, however, online food delivery services provide access to takeaway food, which despite being acknowledged as unhealthy, has strong sociocultural value. There was a consistent awareness that some advantages of online food delivery services may also be drawbacks. Despite this, the drawbacks were not sufficiently negative to stop current or future online food delivery service use. Finally, price-promotions justified online food delivery service use and made this practice appealing. Public health interventions that seek to promote healthier food purchasing through online food delivery services may be increasingly warranted in the future. Approaches might include increasing the healthiness of the food available whilst maintaining sociocultural values and expectations, and extending restrictions on price-promotions to hot food prepared out-of-home.

Availability of data and materials

Processed and anonymised qualitative data from this study is available from the corresponding author upon reasonable request. Additional raw data related to this publication cannot be openly released; the raw data contains interview audio containing identifiable information.

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Matthew Keeble was funded by the National Institute for Health and Care Research (NIHR) School for Public Health Research (SPHR) [grant number PD_SPH_2015]. This work was supported by the Medical Research Council [grant number MC_UU_00006/7]. The views expressed are those of the authors and not necessarily those of any of the above named funders. The funders had no role in the design of the study, or collection, analysis and interpretation of the data, or in writing the manuscript. For the purpose of open access. the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising.

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Matthew Keeble: Conceptualization, Data curation, Formal analysis, Methodology, Writing – original draft, Writing – review & editing. Jean Adams: Conceptualization, Methodology, Supervision, Writing – review & editing. Thomas Burgoine: Conceptualization, Methodology, Supervision, Writing – review & editing. The author(s) read and approved the final manuscript.

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Box A1. Names of Subreddits used during participant recruitment. Box A2. Final telephone interview topic guide.

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Keeble, M., Adams, J. & Burgoine, T. Investigating experiences of frequent online food delivery service use: a qualitative study in UK adults. BMC Public Health 22 , 1365 (2022). https://doi.org/10.1186/s12889-022-13721-9

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• Gorvernment

Geographical Segmentation

Geographically, this report is segmented into several key regions, with sales, revenue, market share, and Service Delivery Platform market growth rate in these regions, from 2015 to 2030, covering

• North America (US, Canada and Mexico)
• Europe (Germany, UK, France, Italy, Russia and Turkey etc.)
• Asia-Pacific (China, Japan, Korea, India, Australia, Indonesia, Thailand, Philippines, Malaysia, and Vietnam)
• South America (Brazil, Argentina and Rest of South America)
• Middle East and Africa (Saudi Arabia, U.A.E, South Africa, Egypt, Israel, Rest of MEA)

Inquire or Share Your Questions If Any Before the Purchasing This Report: https://www.industryresearch.co/enquiry/pre-order-enquiry/20954470

Some Key Highlights of Service Delivery Platform Market:

• Characterize, portray and Forecast Service Delivery Platform item market by product type, application, manufacturers and geographical regions.
• Give venture outside climate investigation.
• Give systems to organizations to manage the effect of COVID-19.
• Give market dynamic examination, including market driving variables, and market improvement requirements.
• Give market passage system examination to new players or players who are prepared to enter the market, including market section definition, client investigation, conveyance model, item informing and situating, and cost procedure investigation.
• Stay aware of worldwide market drifts and give an examination of the effect of the COVID-19 scourge on significant locales of the world.
• Break down the market chances of partners and furnish market pioneers with subtleties of the cutthroat scene.

Key questions answered in the Service Delivery Platform Market are:

• What are the latest market trends and drivers shaping the Service Delivery Platform industry?
• What is the potential market size and growth rate of the Service Delivery Platform market in the forecast period?
• How will the COVID-19 pandemic impact the Service Delivery Platform market in the short and long term?
• Which regions are expected to experience the highest growth in the Service Delivery Platform market during the forecast period?
• What are the key challenges faced by players in the Service Delivery Platform market, and what are the strategies to overcome them?
• What are the most popular Service Delivery Platform product types and applications in the market?
• Who are the major competitors in the Service Delivery Platform market and what are their market shares?
• What are the potential growth opportunities and threats in the Service Delivery Platform market for new entrants and established players?

Global Service Delivery Platform: Drivers and Restraints:

The report provides valuable information on the production costs, supply chain dynamics, and raw materials that are essential to the Service Delivery Platform market. It also analyzes the impact of COVID-19 on the industry and provides recommendations on how businesses can adapt to the changing market conditions. The report identifies key market restraints, such as economic constraints in emerging countries and business market obstacles. By understanding these risks and challenges, businesses can develop strategies to mitigate them and achieve long-term success in this exciting and dynamic industry.

To Understand How COVID-19/ Russia-Ukraine War Influence affected this Service Delivery Platform Industry, click here: https://www.industryresearch.co/enquiry/request-covid19/20954470

TOC of the Service Delivery Platform Market is as follows:

1Service Delivery PlatformMarketOverview 1.1ProductOverview 1.2MarketSegmentation 1.2.1MarketbyTypes 1.2.2MarketbyApplications 1.2.3MarketbyRegions 1.3GlobalService Delivery PlatformMarketSize(2018-2028) 1.3.1GlobalService Delivery PlatformRevenue(USD)andGrowthRate(2018-2028) 1.3.2GlobalService Delivery PlatformSalesVolumeandGrowthRate(2018-2028) 1.4ResearchMethodandLogic 1.4.1ResearchMethod 1.4.2ResearchDataSource 2GlobalService Delivery PlatformMarketHistoricRevenue(USD)andSalesVolumeSegmentbyType 2.1GlobalService Delivery PlatformHistoricRevenue(USD)byType(2018-2023) 2.2GlobalService Delivery PlatformHistoricSalesVolumebyType(2018-2023) 3GlobalService Delivery PlatformHistoricRevenue(USD)andSalesVolumebyApplication(2018-2023) 3.1GlobalService Delivery PlatformHistoricRevenue(USD)byApplication(2018-2023) 3.2GlobalService Delivery PlatformHistoricSalesVolumebyApplication(2018-2023) 4MarketDynamicandTrends 4.1IndustryDevelopmentTrendsunderGlobalInflation 4.2ImpactofRussiaandUkraineWar 4.3DrivingFactorsforService Delivery PlatformMarket 4.4FactorsChallengingtheMarket 4.5Opportunities 4.6RiskAnalysis 4.7IndustryNewsandPoliciesbyRegions 4.7.1Service Delivery PlatformIndustryNews 4.7.2Service Delivery PlatformIndustryPolicies 5GlobalService Delivery PlatformMarketRevenue(USD)andSalesVolumebyMajorRegions 5.1GlobalService Delivery PlatformSalesVolumebyRegion(2018-2023) 5.2GlobalService Delivery PlatformMarketRevenue(USD)byRegion(2018-2023) 6GlobalService Delivery PlatformImportVolumeandExportVolumebyMajorRegions 6.1GlobalService Delivery PlatformImportVolumebyRegion(2018-2023) 6.2GlobalService Delivery PlatformExportVolumebyRegion(2018-2023)

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7NorthAmericaService Delivery PlatformMarketCurrentStatus(2018-2023) 8AsiaPacificService Delivery PlatformMarketCurrentStatus(2018-2023) 9EuropeService Delivery PlatformMarketCurrentStatus(2018-2023) 10LatinAmericaService Delivery PlatformMarketCurrentStatus(2018-2023) 11MiddleEastandAfricaService Delivery PlatformMarketCurrentStatus(2018-2023) 12MarketCompetitionAnalysisandKeyCompaniesProfiles 12.1MarketCompetitionbyKeyPlayers 12.1.1GlobalService Delivery PlatformRevenue(USD)andMarketShareofKeyPlayers 12.1.2GlobalService Delivery PlatformSalesVolumeandMarketShareofKeyPlayers 12.1.3GlobalService Delivery PlatformAveragePricebyPlayers 12.1.4MergersandAcquisitions,Expansion...... 13ValueChainoftheService Delivery PlatformMarket 14NewProjectFeasibilityAnalysis 14.1IndustryBarriersandNewEntrantsSWOTAnalysis 14.2AnalysisandSuggestionsonNewProjectInvestment 15GlobalService Delivery PlatformMarketRevenue(USD)andSalesVolumeForecastSegmentbyType,ApplicationandRegion 15.1GlobalService Delivery PlatformRevenue(USD)andSalesVolumeForecastbyType(2023-2028) 15.1.1GlobalService Delivery PlatformRevenue(USD)ForecastbyType(2023-2028) 15.1.2GlobalService Delivery PlatformSalesVolumeForecastbyType(2023-2028) 15.2GlobalService Delivery PlatformRevenue(USD)andSalesVolumeForecastbyApplication(2023-2028) 15.2.1GlobalService Delivery PlatformRevenue(USD)ForecastbyApplication(2023-2028) 15.2.2GlobalService Delivery PlatformSalesVolumeForecastbyApplication(2023-2028) 15.3GlobalService Delivery PlatformSalesVolumeForecastbyRegion(2023-2028) 15.4GlobalService Delivery PlatformRevenue(USD)ForecastbyRegion(2023-2028) 16ResearchFindingsandConclusion

For More About TOC - https://www.industryresearch.co/TOC/20954470#Tables?utm_source=Benzinga_MFK_ANGAD

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Press Release Distributed by The Express Wire

To view the original version on The Express Wire visit Service Delivery Platform Market Assessment: An Analysis of Industry Developments and Growth Forecast 2023-2030

COMTEX_439296156/2598/2023-08-31T06:42:25

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Free Research Paper Samples, Research Proposal Examples and Tips | UsefulResearchPapers.com

Research proposal on service delivery.

February 22, 2014 UsefulResearchPapers Research Proposals 0

Service delivery is the complex of decisions, solutions, policies and actions aimed at the on time and quality delivery of the production to the client. Naturally, when someone orders goods in the Internet, he expects to receive them as quick as possible and for the most affordable price.

Nowadays it is quite easy and probably the Internet buys are the most frequent and widespread purchases nowadays. Years ago the problem of service delivery was also urgent and this practice already existed in the 19th century. The courier’s services were very popular already at that time and goods were delivered by these special firms. With the run of time the situation has changed and companies have decided to deliver their production themselves. The well-organized sphere of logistics is supposed to organize the work of the firm, especially its material supply and delivery of its production. When the client orders a product, the company strives to deliver it professionally and safely. The greatest requirement of every customer is the affordable price, short terms and total safety of the delivery.

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It is obvious that the price and quality of the service delivery depends on the type of the chosen transportation. Delivery by plane is supposed to be very fast but a bit expensive and other types of delivery (by train, car, etc) are longer but cheaper. The major aim of every service is to maintain the quality of the delivery and to avoid any incidents like damage of the product during transportation, its stealth or other problems. A prestigious and responsible firm refunds all the problems which have occurred with the product during the transportation and delivers a new example of the item purchased by the client for free. This attracts client’s attention and improves the customer’s loyalty towards the firm.

Service delivery is the important component of the effectiveness of the company’s work. The student who is writing a research proposal should pay attention to the structure of the paper and the explanation of the choice of the topic. One should prove that the problem on service delivery is really interesting and worth detailed analysis. The student is able to share his ideas concerning the problems of service delivery and suggest the alternative solutions to the existing poor sides of this policy.

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Similar Posts:

• Research Proposal on Marketing Communication
• Research Report on Customer Satisfaction
• Research Proposal on Customer Care

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Latin America Customs Brokerage Market Report 2023-2028: Fast-tracking Deliveries: Last-Mile Logistics and E-commerce Fuel Specialized Customs Brokerage Services

Dublin, IRELAND

Dublin, Aug. 30, 2023 (GLOBE NEWSWIRE) -- The "Latin America Customs Brokerage Market Size & Share Analysis - Growth Trends & Forecasts (2023 - 2028)" report has been added to ResearchAndMarkets.com's offering.

The Latin America Customs Brokerage market is poised for significant growth, with projections indicating an expansion from USD 2.92 billion in 2023 to USD 3.44 billion by 2028. This growth is expected to be fueled by a Compound Annual Growth Rate (CAGR) of 3.31% during the forecast period of 2023 to 2028.

Key Highlights

The projected growth from USD 2.92 billion to USD 3.44 billion within the Latin America Customs Brokerage market, coupled with a compelling CAGR of 3.31%, highlights the substantial potential of the industry.

Market Drivers

Several key factors are driving the growth of the Latin America Customs Brokerage market:

• Streamlining Clearance for Essential Goods: The urgency to clear and release essential goods during the pandemic prompted countries like Peru, Panama, Colombia, and Chile to suspend deadlines and procedures. This quick action prevented goods from falling into legal abandonment and showcased the importance of efficient customs processes.
• Adoption of Technology for Efficiency: Companies in the logistics sector are actively embracing technology and software platforms to streamline customs processes, enhance documentation, and expedite customs clearance. This adoption of technology is contributing to improved operational efficiency.
• Last-Mile Deliveries and E-commerce Growth: The rise in last-mile deliveries and the demand for seamless, fast, end-to-end deliveries are driving the growth of specialized customs brokerage services. As e-commerce expands, the need for efficient customs processes becomes paramount.

Trends and Influences

Emerging trends and influences are shaping the Latin America Customs Brokerage market:

• Combating Bureaucracy: Bureaucracy and outdated clearance practices often lead to customs delays and corruption. Many customs officials are known to request bribes to expedite clearance, highlighting the need for streamlined customs procedures.
• Technology Adoption: The growing adoption of Internet of Things (IoT)-enabled devices and technology-driven logistics services is contributing to market growth. The development of the e-commerce industry and increased reverse logistics operations are also boosting the market.

Segmentation

The Latin America Customs Brokerage market is segmented based on mode of transport, end user, and country.

Mode of Transport:

• Cross-border Land Transport
• FMCG (Fast-moving Consumer Goods)
• Retail (Hypermarkets, Supermarkets, Convenience Stores, E-commerce)
• Fashion and Lifestyle (Apparel, Footwear)
• Reefer (Fruits, Vegetables, Pharmaceuticals, Meat, Seafood)
• Technology (Consumer Electronics, Home Appliances)
• Other End Users
• Rest of Latin America

The Latin America Customs Brokerage market is set for substantial growth, driven by streamlined clearance processes, technology adoption, and the expansion of e-commerce. As countries continue to enhance customs efficiency and adopt technology-driven solutions, the market is positioned for transformative expansion.

Competitive Profile

• Livingston International
• Rota Brasil
• Ibercondor Forwarding SA de CV
• Servicios de Aduanas Jimenez
• Aduana Cordero
• Deutsche Post DHL Group
• DSV Panalpina AS
• Expeditors International

For more information about this report visit https://www.researchandmarkets.com/r/yjeehe

About ResearchAndMarkets.com ResearchAndMarkets.com is the world's leading source for international market research reports and market data. We provide you with the latest data on international and regional markets, key industries, the top companies, new products and the latest trends.

• Latin America Customs Brokerage Market Container Port Cargo Throughput In Latin America Million T E U 2014 2021

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