An exploration of rural–urban differences in healthcare-seeking trajectories: Implications for measures of accessibility

Haggerty, Jeannie; Roberge, Danièle; Lévesque, Jean‐Frédéric; Gauthier, Josée; Loignon, Christine

doi:10.1016/j.healthplace.2014.03.005

Cited by 82 publications

(77 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…On the one hand, compared to urban residents, rural residents have been found to have lower human capital characteristics (e.g., income, educational attainment; Byun et al, 2012; Roscigno & Crowle, 2001), a higher proportion of manual labor occupations (McGranahan, 2003), less access to illicit street drugs (James et al, 2002), worse self-rated health (Monnat & Pickett, 2011), less psychological distress (Dhingra et al, 2009), greater frequency of emergency department (ED) use (Haggerty et al, 2014; Haggerty et al, 2007), and higher arrest rates for crimes like domestic violence and drunk driving (Logan, Walker, & Leukefeld; Olson, Weisheit, & Ellsworth). Each of these factors have been found to be associated with POM in various adult populations (Rigg & DeCamp, 2014; Dowling, Stor & Chilcoat, 2006; Becker et al, 2008; Harrell & Broman, 2009; Cicero et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Urban vs. rural differences in prescription opioid misuse among adults in the United States: Informing region specific drug policies and interventions

Rigg

Monnat

2015

International Journal of Drug Policy

102

View full text Add to dashboard Cite

Background In the United States, prescription opioid misuse (POM) has increased dramatically over the past two decades. However, there are still questions regarding whether rural/urban differences in adult POM exist, and more important, which factors might be driving these differences. Methods Using data from the 2011 and 2012 National Survey on Drug Use and Health, we conducted unadjusted and adjusted binary logistic regression analyses to determine the association between metropolitan status and POM. Results We found that urban adults were more likely to engage in POM compared to rural adults because of their higher use of other substances, including alcohol, marijuana, and other illicit and prescription drugs, and because of their greater use of these substances as children. Conclusions This study fills an important gap in the literature by not only identifying urban/rural differences in POM, but by also pointing out factors that mediate those differences. Because patterns and predictors of POM can be unique to geographic region, this research is critical to informing tailored interventions and drug policy decisions. Specifically, these data suggest that interventions should be aimed at urban illicit drug users and adults in manual labor occupations.

show abstract

Section: Introductionmentioning

confidence: 99%

Urban vs. rural differences in prescription opioid misuse among adults in the United States: Informing region specific drug policies and interventions

Rigg

Monnat

2015

International Journal of Drug Policy

102

View full text Add to dashboard Cite

show abstract

“…First, spatial accessibility may not pose a major barrier to the receipt of routine dental care among this study population. Previous research in Canada has shown that geographic accessibility (i.e., travel time to medical care) is less of a burden to rural residents than urban dwellers -perhaps related to expected, everyday travel demands for rural residents (Haggerty et al, 2014). It is also possible that the variables we chose to measure spatial accessibility did not adequately capture this dimension of accessibility; future studies should include information about travel time, such as distance to the nearest provider.…”

Section: Discussionmentioning

confidence: 99%

Geographic variation of dental utilization among low income children

McKernan¹,

Kuthy²,

Hanley³

et al. 2015

Health & Place

View full text Add to dashboard Cite

“…In the first and qualitative phase, we explored through 11 focus groups the similarities and differences between metropolitan, rural and remote settings in the first‐contact care‐seeking trajectory. We found that rural residents invested more efforts than did urban residents in exploring care alternatives before travelling to their preferred option and that their regular providers were more likely to accommodate to their urgent needs . However, the consequences of access difficulties were similar across settings: having to restart the care‐seeking process; abandonment of care seeking; resorting to the hospital emergency room; and/or aggravation of the health problem.…”

Section: Introductionmentioning

confidence: 88%

Validation of a new measure of availability and accommodation of health care that is valid for rural and urban contexts

Haggerty

Lévesque

2016

Health Expectations

Self Cite

View full text Add to dashboard Cite

ContextPatients are the most valid source for evaluating the accessibility of services, but a previous study observed differential psychometric performance of instruments in rural and urban respondents.ObjectiveTo validate a measure of organizational accessibility free of differential rural–urban performance that predicts consequences of difficult access for patient‐initiated care.DesignSequential qualitative–quantitative study. Qualitative findings used to adapt or develop evaluative and reporting items. Quantitative validation study.SettingPrimary data by telephone from 750 urban, rural and remote respondents in Quebec, Canada; follow‐up mailed questionnaire to a subset of 316.Main measures and analysesItems were developed for barriers along the care trajectory. We used common factor and confirmatory factor analysis to identify constructs and compare models. We used item response theory analysis to test for differential rural–urban performance; examine individual item performance; adjust response options; and exclude redundant or non‐discriminatory items. We used logistic regression to examine predictive validity of the subscale on access difficulty (outcome).ResultsInitial factor resolution suggested geographic and organizational dimensions, plus consequences of access difficulty. After second administration, organizational accommodation and geographic indicators were integrated into a 6‐item subscale of Effective Availability and Accommodation, which demonstrates good variability and internal consistency (α = 0.84) and no differential functioning by geographic area. Each unit increase predicts decreased likelihood of consequences of access difficulties (unmet need and problem aggravation).ConclusionThe new subscale is a practical, valid and reliable measure for patients to evaluate first‐contact health services accessibility, yielding valid comparisons between urban and rural contexts.

show abstract

An exploration of rural–urban differences in healthcare-seeking trajectories: Implications for measures of accessibility

Cited by 82 publications

References 16 publications

Urban vs. rural differences in prescription opioid misuse among adults in the United States: Informing region specific drug policies and interventions

Urban vs. rural differences in prescription opioid misuse among adults in the United States: Informing region specific drug policies and interventions

Geographic variation of dental utilization among low income children

Validation of a new measure of availability and accommodation of health care that is valid for rural and urban contexts

Contact Info

Product

Resources

About