Self-identified barriers to rural mental health services in Iowa by older adults with multiple comorbidities: qualitative interview study

Abstract

ObjectivesIndividuals in rural areas face critical health disparities, including limited access to mental healthcare services and elevated burden of chronic illnesses. While disease outcomes are often worse in individuals who have both physical and mental comorbidities, few studies have examined rural, chronically-ill older adults’ experiences accessing mental health services. The aim of the study was to determine barriers to finding, receiving and adhering to mental health treatments in this population to inform future interventions delivering services.DesignWe conducted a qualitative study of barriers and facilitators to mental healthcare access. 19 interviews were analysed deductively for barriers using a modified version of Penchansky and Thomas’s theory of access as an analytical framework.SettingThis study was conducted remotely using telephonic interviews. Patients were located in various rural Iowa towns and cities.Participants15 rural Iowan older adults with multiple physical comorbidities as well as anxiety and/or depression.ResultsWe found that while patients in this study often felt that their mental health was important to address, they experienced multiple, but overlapping, barriers to services that delayed care or broke their continuity of receiving care, including limited knowledge of extant services and how to find them, difficulties obtaining referrals and unsatisfactory relationships with mental health service providers.ConclusionsOur findings indicate that intervention across multiple domains of access is necessary for successful long-term management of mental health disorders for patients with multiple chronic comorbidities in Iowa.

Identification of Functional, Social, and Health Needs of Older Residents in Nonurban Settings: A Community Risk Assessment

“…These findings demonstrate the cumulative disadvantage of individuals who were resource poor, whether financially, socially, or both, which increases risk of experiencing adverse healthcare situations. This also raises concern about the risks associated with having unmet care needs (Pass et al, 2019; Weaver & Roberto, 2019) and experiencing social isolation; the deleterious effects of loneliness (Hawkley et al, 2019) include decline in functional status (Shankar et al, 2017).…”

“…While there is no standard definition for what constitutes "rural," government agencies have moved beyond the basic binary classification. For example, counties are designated as metropolitan (urban), micropolitan (rural), or neither (rural) by the Office of Management and Budget (Myers et al, 2016). However, the National Center for Health Statistics (NCHS) classifies counties using a 6-point urbanrural continuum indicating the most urban (large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan) to the most rural (micropolitan and noncore; Ingram & Franco, 2014).…”

“…Aging in place enables older people to maintain independence, autonomy, and connection to social support and helps to avoid or prolong the need for high-cost institutional care (Wiles et al, 2012). Efforts to age in place have been hindered by older adults’ experiences with unmet or under-identified needs, specifically, inadequate informal assistance from family/friend caregivers (Davey et al, 2013; Kaye et al, 2010) or formal services provided by community health agencies (Casado et al, 2011; Pass et al, 2019). Individuals with advanced age, high level of disability, multiple difficulties with basic and instrumental activities of daily living (ADLs), cognitive impairment, and low socioeconomic status are more likely to experience unmet needs in their daily routine (Davey et al, 2013).…”

The impact of the COVID-19 pandemic on people who inject drugs accessing harm reduction services in a rural American state

“…We used the model of access proposed by Penchansky and Thomas, [29], later modified by Saurman [30] as a theoretical framework to identify issues of access along six dimensions: awareness, accessibility, availability, acceptability, affordability, and accommodation. The model, which has been used in prior health service-related studies [31][32][33], recognizes that people cannot access a service unless six basic considerations are met: First, that people who use services are aware the service exists and know how to access it. Second, that people are able to reach the service in some way (accessibility).…”

Prevalence of and factors associated with depression among hill tribe individuals aged 30 years and over in Thailand

“…The total years lived with disability (YLD) associated with depression was reported to be 724/100,000 people [5]. Although highly effective drugs and treatments are available for depression, people living in low-and middle-income countries face several barriers to accessing drugs and other treatments [6,7]. It is also well known that depression results from complex interactions among different factors, including personal characteristics, interpersonal relationship skills, family relationships, brain injury, medical conditions, drug use, and other biological factors, such as chemical imbalances in the brain [8].…”