Rural health care challenges go beyond a lack of doctors

People living in rural areas have long had difficulty accessing health care, a situation usually attributed to a lack of nearby care providers. But a new study suggests the problem also lies in the financial, cultural and interpersonal challenges many rural residents face when they seek care, especially for chronic conditions. 

A team of researchers reviewed 62 studies involving more than 1,350 patients with cancer, behavioral health problems, HIV/AIDS and diabetes living in rural areas. Their goal was to study and synthesize the patients’ experiences when it came to accessing health care services.

The authors found four major “analytic themes,” and accompanying challenges, associated with the patients’ attempts to obtain care for their chronic conditions. They identified these as:

• Navigating the rural environment: This category included challenges such as the need to travel long distances for routine health care services while experiencing poor health, having to to rely on spouses and other caregivers for transportation, and the belief that the care available nearby was worse than that in more-distant locations.
• Navigating the health care system: Problems in this category included delays in getting care due to limited availability of specific clinicians, barriers to maintaining a continuous relationship with specific doctors or organizations, inadequate communication between different providers, and frustration with inflexible scheduling and long in-clinic wait times—often followed by what they felt was inadequate time with their clinician.
• Financing disease management: In half of the studies analyzed, patients said that living in a remote area meant they had to bear costs of transportation, overnight lodging and childcare to obtain needed care. Many patients also cited low pay and overall economic hardship in their communities as challenges in financing their care.
• Rural life: While many participants said they liked living in a close-knit community with high levels of social support, they also cited the accompanying lack of privacy as a barrier to obtaining health care, especially for stigmatized conditions such as AIDS or mental health. Others complained of a lack of cultural sensitivity and stereotyping of rural residents among health care professionals and clinic support staff. Native Americans in particular, the authors say, “characterized western practitioners as paternalistic, condescending, and openly skeptical of tribal healing practices.”

The authors note that despite the overall growth of telehealth during the COVID-19 pandemic, it has been used less for patients in rural settings compared with those in urban areas. They recommend that future researchers explore how telehealth services affect the experience of care access for rural patients with chronic health conditions.

The study, “Rural Patient Experiences of Accessing Care for Chronic Conditions: A Systematic Review and Thematic Synthesis of Qualitative Studies” appears in the May 2022 issue of Annals of Family Medicine.