A qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access

Abstract

Background Ensuring access to healthcare is a complex, multi-dimensional health challenge. Since the inception of the coronavirus pandemic, this challenge is more pressing. Some dimensions of access are difficult to quantify, namely characteristics that influence healthcare services to be both acceptable and appropriate. These link to a patient’s acceptance of services that they are to receive and ensuring appropriate fit between services and a patient’s specific healthcare needs. These dimensions of access are particularly evident in rural health systems where additional structural barriers make accessing healthcare more difficult. Thus, it is important to examine healthcare access barriers in rural-specific areas to understand their origin and implications for resolution. Methods We used qualitative methods and a convenience sample of healthcare providers who currently practice in the rural US state of Montana. Our sample included 12 healthcare providers from diverse training backgrounds and specialties. All were decision-makers in the development or revision of patients’ treatment plans. Semi-structured interviews and content analysis were used to explore barriers–appropriateness and acceptability–to healthcare access in their patient populations. Our analysis was both deductive and inductive and focused on three analytic domains: cultural considerations, patient-provider communication, and provider-provider communication. Member checks ensured credibility and trustworthiness of our findings. Results Five key themes emerged from analysis: 1) a friction exists between aspects of patients’ rural identities and healthcare systems; 2) facilitating access to healthcare requires application of and respect for cultural differences; 3) communication between healthcare providers is systematically fragmented; 4) time and resource constraints disproportionately harm rural health systems; and 5) profits are prioritized over addressing barriers to healthcare access in the US. Conclusions Inadequate access to healthcare is an issue in the US, particularly in rural areas. Rural healthcare consumers compose a hard-to-reach patient population. Too few providers exist to meet population health needs, and fragmented communication impairs rural health systems’ ability to function. These issues exacerbate the difficulty of ensuring acceptable and appropriate delivery of healthcare services, which compound all other barriers to healthcare access for rural residents. Each dimension of access must be monitored to improve patient experiences and outcomes for rural Americans.

A Sensitive Public Health Issue—The Vaccine Acceptancy and the Anti-Pertussis Immune Status of Pregnant Women from a Romanian Metropolitan Area

“…In Romania, in 2019, the average mother’s age at first birth was 29 years in urban areas and 25 years in rural areas, while the average age at which a mother gives birth to her first child in the EU was 29.4 in 2019 [ 39 , 40 , 41 ]. It is known that developed countries are struggling with similar issues regarding the access to medical care in rural areas, starting with limited resources of healthcare providers and finishing with limited access to financial resources, compared with the urban areas [ 42 , 43 ].…”

Mental health of people with limited access to health services: a retrospective study of patients attending a humanitarian clinic network in Germany in 2021

“…Barriers can be conceptually grouped into 5 categories, which reflect the affordability, approachability, availability, acceptability, and appropriateness [ 47 – 50 ]. Our data covers in principle the categories affordability (cost) and approachability (bureaucracy, language).…”

Health and Social Determinants Associated With Delay of Care Among Community-Dwelling Rural Older Adults

“…This is particularly important in rural communities, in which residents tend to experience additional health care barriers. Public transportation issues and needing to travel a far distance to access health care are common barriers 14,37. Although distance to medical facility was not significantly associated with delays in care, distance from medical facility is a known barrier to health care access, though individual factors such as age, health, functional status, and needs of care (ie, specialized care, routine care, or emergent care) may impact the importance of this barrier 38.…”

“…Public transportation issues and needing to travel a far distance to access health care are common barriers. 14,37 Although distance to medical facility was not significantly associated with delays in care, distance from medical facility is a known barrier to health care access, though individual factors such as age, health, functional status, and needs of care (ie, specialized care, routine care, or emergent care) may impact the importance of this barrier. 38 Within our sample, we truncated the distance from medical facility into a binary variable (ie, <5 miles or >5 miles from medical facility), which may have led to a lack of variability in responses.…”