Seeking Care at Free Episodic Health Care Clinics in Appalachia

Abstract

Background People who live in rural Appalachia experience a wide variety of problems when seeking access to health care. Health care disparities continue to be one of the most complex and prevalent problems, and many barriers exist for impoverished men and women such as a lack of education, complications with health insurance, and personal distrust of healthcare providers. Purpose A critical gap in the literature is the unheard voice of persons in rural underserved areas. The purpose of this study was to explore the perspectives of persons in rural Appalachia who seek healthcare services at free episodic health care clinics, a common alternative source of care. Methods In Fall 2017, a qualitative approach was used to discover the perceptions of 12 men and women in rural Appalachia who were seeking medical care at a Remote Area Medical Clinic. A transdisciplinary research group provided insight and assistance with thematic analysis in Spring 2018–Spring 2019. Results Five overall themes emerged capturing the essence of how rural Appalachians view the experience of seeking healthcare, which include difficulties with insurance/finances, inconsistency in care, isolation in rural areas, seeking solutions, and need to feel valued. Implications A rich description of participant experiences portrays real-life complexities for Appalachian men and women who seek healthcare. Understanding the perceptions of persons who seek healthcare and the essence of their experiences is the first step in determining future sustainable solutions for social justice.

Loss of Obstetric Services in Rural Appalachia

“…Because the larger research study aimed to capture patient and provider experiences of health and health care, seven interviewees were practicing or retired healthcare providers (including nurses, physicians, a midwife, and a clinical social worker). Previous health-related qualitative studies in rural communities 11 , 15 – 17 have shown that a sample size of 14 is sufficient to reach theoretical saturation within the data. 11 , 18 All interviewees self-identified as white and non-Hispanic and ranged in age from 29 to 90 years.…”

“…Previous health-related qualitative studies in rural communities 11 , 15 – 17 have shown that a sample size of 14 is sufficient to reach theoretical saturation within the data. 11 , 18 All interviewees self-identified as white and non-Hispanic and ranged in age from 29 to 90 years. There were an equal number of male and female interviewees.…”

“…Documenting the sociocultural and structural factors that uniquely influence rural Appalachian residents’ perceptions of care is foundational to ensuring that people in these areas receive the healthcare services that they need. 11 Thus, this paper seeks to document how the loss of local obstetric services affects perceptions of health care among residents of a rural Appalachian community in western North Carolina (NC).…”

The importance of family relationships for the health of underserved Appalachians: An application and extension of the biobehavioral family model.

“…Individuals in the Appalachian region, especially rural Appalachia, face increased contextual stressors linked to disease development and morbidity (Lazar et al, 2020) and demonstrate culturally distinct close family ties. Given the health vulnerability of individuals in the Appalachian region (Cossman et al, 2007;Marshall et al, 2017;Spleen et al, 2014), the tendency toward close family networks (Keefe, 2005), and guided by the BBFM Wood, 1993;Wood et al, 2015), it is important to understand the links between family emotional climate (i.e., marital and family relationship quality) and biobehavioral reactivity and disease activity.…”

“…The limited literature examining the role of nonmarital relationships in adult populations indicates that marital and nonmarital family relationship quality is important for health outcomes. Still, this relationship-health pathway remains understudied in under-resourced populations with increased contextual stressors, including rural populations (Lazar et al, 2020).…”