Nurse practitioners and physician assistants have provided a partial solution to the shortage of primary care services in medically underserved rural areas. This paper describes the results of a study exploring community acceptance of nurse practitioners and physician assistants in rural medically underserved areas. Community acceptance in the context of this study implies not only satisfaction with care received, but also willingness of the community to support NP/PA practice through its infrastructure and encourage members to initially seek and continue to receive care from an NP or PA. Five focus groups were conducted in each of five rural medically underserved communities. The two most pervasive findings were the lack of previous exposure to NPs and PAs and the general belief that NPs and PAs would be accepted in these communities if certain conditions could be met. The theme of conditional acceptance included both personal and system factors. Personal factors included friendliness, competence, willingness to enter into the life of the community, and the ability to keep information confidential. System factors considered critical for acceptance included service type, integration with the existing health care system, cost, geographic proximity, and availability. The results of this study offer insight into community attitudes and suggest marketing strategies for those who plan to introduce NP or PA services into rural communities.
The purpose of this study was to identify the significant dimensions of the concept of community acceptance of nurse practitioners/physician’s assistants and to construct areliable and valid instrument which would reflect these dimensions. The methodological approach included: conceptualization of categories, development of items for each category, development of the tool, administration of the tool, and psychometric analysis of results. Community input through focus-group interviews and post-administration questions provided qualitative data. The survey tool, consisting of items in four conceptualized categories (knowledge, access, competence, and trust), was administered in five rural communities. The responses of 967 residents were analyzed through factor analysis. The criterion, eigenvalue > 1.0, resulted in seven factors. Oblique rotation was applied to the seven factors and marker variables (loadings > .70) facilitated the identification of the underlying dimensions of each factor. Overall, 98% of the items assigned to the original categories were maintained after factor analysis. The identification of these dimensions helped to simplify the description and understanding of community acceptance of nurse practitioners and physicians’ assistants. Community acceptance of these advanced health care providers is a necessary precursor to use of services.
The purpose of this study was to determine the accessibility and perceived value of health services in five selected rural communities in South Fulton County, Illinois. The Health Services Accessibility and Value Scale (HSAVS) component of the larger Fulton County Health Care Survey was used in the investigation. The 12 items comprising the HSAVS surveyed participant perceptions relative to medical, dental, nursing, and public health department services available to them as rural residents. The HSAVS was completed by 1709 subjects. The reliability of the HSAVS was assessed by computing coefficient alpha. The scale had acceptable internal consistency reliability (alpha = .7884). To examine the construct validity of the scale, a principle component factor analysis was completed. This analysis resulted in a four factor solution which accounted for 66.6% of the cumulative total variance. Item means were calculated and were used to rank the HSAVS statements. Emergency and primary medical services were valued the most by the survey participants. Relatively high in importance to the rural residents surveyed were access to pharmacy, eye care, dental care, and immunization services. Availability of home health care, transportation to and from health care facilities, and access to mental health services were considered to be of lesser value to persons living in the rural area studied. Of least importance were alcohol and other drug counseling services, prenatal care/well baby services, and family planning services. HSAVS total scores and individual statements were also analyzed by sex, age, place of residence, and income and the results were reported.
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