Rural women's unmet health care needs: Findings from a low-income sample

Background and Significance: Addressing rural health disparities, including disparities in access to care, is a documented priority of the Federal Office of Rural Health Policy. Research shows rural residents experience important barriers to accessing health care, including limited financial resources, lack of health insurance, lack of transportation, distance to care facilities, and shortages of qualified practitioners. However, few studies have examined the personal and community barriers that specifically impede rural women from receiving adequate health care. This knowledge is important, because rural women are at significantly higher risk for poor health outcomes than their urban counterparts. Additionally, public health professionals need to better understand the components of and barriers to women's health decisions in order to develop appropriate interventions. Methods: The purpose of this study was to examine personal and community factors associated with not accessing care when needed. The research questions guiding this study were: Which individual and community level factors influence whether rural, low-income women visit a doctor when needed? Which of these factors influence whether rural women delay or forgo filling prescription medications? Self-reported data were from NC-1011 Rural Families Speak (N=266), a multi-state study of rural, low-income families in the U.S. STATA 9.0 was utilized to compute descriptive statistics and fit multiple logistic regression models for the two outcome variables (accessing a physician when needed and delaying or forgoing filling a prescription). Results: After controlling for demographic characteristics, women with depressive symptoms (OR = 4.44, P = 0.001) and more chronic health conditions (OR = 1.38, P = 0.02) were significantly less likely to access a physician when needed. Conversely, health insured women (OR = 0.29, P = 0.01) and women who believed primary care physicians were available in their community (OR = 0.21, P = 0.01) were significantly more likely to access a physician when needed. Women with health insurance also were less likely to delay or forgo filling prescriptions (OR = 0.27, P = 0.01), while women with injuries and illnesses were more likely to not fill prescriptions (OR = 3.92, P = 0.01). Conclusions: Public health professionals should work to increase knowledge about available medical care services in rural areas. Additionally, campaigns to increase awareness about Medicaid and prescription assistance program eligibility may improve access to these important resources. Finally, given the high rates of unintentional injury in rural areas, future research should test interventions aimed at improved medication compliance after injury treatment.