A Systematic Review of Interventions to Minimize Transportation Barriers Among People with Chronic Diseases

Abstract

Transportation is an important social determinant of health. Transportation barriers disproportionately affect the most vulnerable groups of society who carry the highest burden of chronic diseases; therefore, it is critical to identify interventions that improve access to transportation. We synthesized evidence concerning the types and impact of interventions that address transportation to chronic care management. A systematic literature search of peer-reviewed studies that include an intervention with a transportation component was performed using three electronic databases-PubMed, EMBASE, and CINAHL-along with a hand-search. We screened 478 unique titles and abstracts. Two reviewers independently evaluated 41 full-text articles and 10 studies met eligibility criteria for inclusion. The transportation interventions included one or more of the following: providing bus passes (n = 5), taxi/transport vouchers or reimbursement (n = 3), arranging or connecting participants to transportation (n = 2), and a free shuttle service (n = 1). Transportation support was offered within multi-component interventions including counseling, care coordination, education, financial incentives, motivational interviewing, and navigation assistance. Community health/outreach workers (n = 3), nurses (n = 3), and research or clinic staff (n = 3) were the most common interventionists. Studies reported improvements in cancer screening rates, chronic disease management, hospital utilization, linkage and follow up to care, and maternal empathy. Overall, transportation is a well-documented barrier to engaging in chronic care among vulnerable populations. We found evidence suggesting transportation services offered in combination with other tailored services improves patient health outcomes; however, future research is warranted to examine the separate impact of transportation interventions that are tested within multi-component studies.

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Nudging New York: adaptive models and the limits of behavioral interventions to reduce no-shows and health inequalities

“…Low-income populations face profound personal, social, economic, and political barriers to primary care practices and preventive care [8]. These barriers include a lack of transportation [9], miscommunications [3], anxiety [9], forgetting the appointment [3], a lack of respect perceived in treatment [9], and a lack of understanding of the (financial) impact of a no-show [9]. Given these barriers, there is a clear space for behavioral interventions to support attendance for those that might wish to attend.…”

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“…The six LRs that included the financial arrangements domain were of an average quality [ 26 , 43 , 50 , 53 – 55 ]. The category of “mechanisms for the payment of health services” was the most common within this domain (Table 2 ), which focused on providing financial support to disadvantaged groups to guarantee health care – for example, transportation aid (paying for transport tickets or reimbursement of tickets) to socioeconomically disadvantaged groups, improving access to the different care services [ 53 ]. Interventions with economic incentives accompanied by other types of interventions were also found, aiming to provide a comprehensive package such as self-care interventions and technology management, which improve access to diagnostic cancer detection procedures [ 26 ] or tuberculosis [ 43 ].…”

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