Spatial barriers as moral failings: What rural distance can teach us about women's health and medical mistrust

Abstract

Policy attention to growing rural “health care deserts” tends to identify rural distance as a primary spatial barrier to accessing care. This paper brings together geography, health policy, and ethnographic methods to instead theorize distance as an expansive and illuminating concept that highlights place-based expertise. It specifically engages rural women's interpretations of rural distance as a multifaceted dimension of accessing health care, which includes but is not limited to women's health services and maternity care. Presenting qualitative research with 51 women in a rural region of the U.S., thematic findings reveal an interpretation of barriers to rural health care as moral failings rather than as purely spatial or operational challenges, along with wide communication of negative health care experiences owing to spatially-disparate but trusted social networks. Amid or owing to the rural crisis context, medical mistrust here emerges as a meaningful but largely unrecognized barrier to rural women's ability—and willingness—to obtain health care. This underscores how a novel interpretation of distance may inform policy efforts to address rural medical deserts.

Barriers to and facilitators of early childhood immunization in rural areas of the United States: A systematic review of the literature

“…In Oregon, as rurality increased and moved farther from a metropolitan area, vaccine rates decreased ( Fagnan et al, 2011 ). These rural specific challenges have been found in previous research and reflect the health disparities and structural barriers to health care access that exist in rural communities ( Statz and Evers, 2020 , Lam et al, 2018 ). Even though there is evidence that regionality and community differences influence the extent that barriers affect healthcare in rural communities ( Lam et al, 2018 ), the reasons for difficulties in health care delivery to rural areas are complex.…”

The role of digital health technology in rural cancer care delivery: A systematic review

“…While medical mistrust was not a theme that emerged in the articles examined in the present review, it is relevant to the discussion of rural health care delivery. Trust in the provider and health care system has been documented as impacting rural health care seeking behaviors, [88][89][90][91][92] and there is emerging evidence that trust plays a role in digital health intervention utilization as well. [93][94][95] For instance, rural residents have reported concern that not being able to visually see the provider when communicating health information could result in individuals other than qualified medical professionals reviewing their information.…”

Rurality as Concordance: Mental Health Service Delivery for Rural Survivors of Intimate Partner Violence

“…From a spatial perspective, RPEs noted that the women they work with experience significant and even prohibitive travel burdens in accessing mental health care and other resources. This owes to rural and remote locations, poor roads and infrastructure, and absent public transportation (DeKeseredy et al 2016; Statz and Evers 2020). These results are consistent with what other scholars have documented, namely that rural women not only experience higher rates of IPV and a greater severity of physical abuse, but they also tend to live farther from available resources (Peek-Asa et al 2011; Tittman et al 2016).…”