Health Care Avoidance Among Rural Populations: Results From a Nationally Representative Survey

Abstract

Background Previous research suggests that certain populations, including rural residents, exhibit health care avoidant behaviors more frequently than other groups. Additionally, health care avoidance is related to sociodemographics, attitudes, social expectations, ability to pay for care, and prior experiences with providers. However, previous studies have been limited to specific geographic areas, particular health conditions, or by analytic methods. Methods The 2008 Health Information Trends Survey (HINTS) was used to estimate the magnitude of health care avoidance nationally and, while controlling for confounding factors, identify groups of people in the US who are more likely to avoid health care. Chi-square procedures tested the statistical significance (P < .05) of bivariate relationships. Multivariable analysis was conducted through a weighted multiple logistic regression with backward selection. Results For 6,714 respondents, bivariate analyses revealed differences (P < .05) in health care avoidance for multiple factors. However, multiple regression reduced the set of significant factors (P < .05) to rural residence (OR=1.69), male sex (OR=1.24), younger age (18-34 years OR=2.34; 35-49 years OR=2.10), lack of health insurance (OR=1.43), lack of confidence in personal health care (OR=2.24), lack of regular provider (OR=1.49), little trust in physicians (OR=1.34), and poor provider rapport (OR=0.94). Conclusion The results of the current study will help public health practitioners develop programs and initiatives targeted and tailored to specific groups, particularly rural populations, which seek to address avoidant behavior, thereby reducing the likelihood of adverse health outcomes.

Predictors of lifestyle behaviors, trust of health care provider, and utilization of health services among adolescents living in a rural area.

“…This study found fewer mean ER visits in the past 12 months than the most recent national data, but a greater proportion using the ER at least once. Once again, these results support previous research that has reported rural residence as a risk factor for avoidance of health services (Spleen et al, 2014).…”

“…These results in combination with previous results (Rew, et al, 2007), suggest that healthy lifestyle behaviors may be lowest at approximately ages 17-19. Steinberg posits that high-risk reward-seeking behavior associated with normal cognitive development peaks around age 15 and declines with further cognitive development that improves adolescents' self-regulation abilities (Steinberg, 2010 (Spleen et al, 2014) and the sample in this study was consistent with this pattern. It seems unlikely that adolescents living in a rural area would have less need for HCP visit than urban adolescents-especially considering the high rates of HCP diagnosed conditions reported by this sample.…”

“…Typically, older female adolescents utilize more health services (Hoover et al, 2010;Simpson et al, 2005;Simpson et al, 2004), related to contraceptive, STD, and obstetric care among older adolescent females (Hoover et al, 2010). Overall-in both the U.S. and internationally-males tend to utilize fewer health services than females (Hoover et al, 2010;Ma et al, 2005;Mulye et al, 2009;Spleen et al, 2014). In this study, females were more likely than males to have a HCP visit, but no difference was seen between males and females for ER visits.…”

“…A nationally representative survey demonstrated health services avoidance is a significant problem among rural people, especially among adolescents and young men (Spleen, Lengerich, Camacho, & Vanderpool, 2014). Focus groups with women living in rural areas revealed that the combination of low-income, lack of social support, and low priority applied to disease prevention results in delayed HCP visits, increased emergency room utilization, and progression of chronic disease (Murimi & Harpel, 2010).…”

“…Overall-in both the U.S. and internationally-men tend to utilize less health services than women, among adults (Babitsch et al, 2012) as well as adolescents (Hoover et al, 2010;Ma et al, 2005;Mulye et al, 2009). Older adolescent males (age 18-25) are least likely of any group to utilize health services (Spleen et al, 2014).…”