Rural seniors' medication access: The problem of structural health literacy

            Seniors who live in rural areas often encounter barriers to medication access. In this study, low-income seniors from the San Luis Valley, a remote area in southern Colorado, were interviewed about their experiences in accessing their medications. Pharmacists were interviewed and primary care providers were surveyed to understand their perspectives on access barriers.

Purpose: The purpose of this study is to understand barriers to medication access and how seniors cope with barriers and inconsistent access.

Methods: 19 low-income seniors and one pharmacist from each of seven pharmacies were interviewed using semi-structured interviews. A card study was conducted with PCPs in eight clinics to gauge understanding of elderly patients’ potential for barriers to access of medications. The interviews were coded using the Grounded Theory method.

Results: The major barrier to medication access is seniors’ lack of structural health literacy – the knowledge of how to navigate structures that influence medication access. Such structures include government and corporate policies that drive access to entitlement programs.

Conclusion: Structural Health Literacy is a new construct within health literacy that has not been previously described. Structural health literacy is a major component of seniors’ ability to access medications and adhere to prescribed treatments. Public health professionals are best poised to work with communities to educate seniors about how to understand and navigate structural barriers inherent in entitlement programs such as Medicare. Without basic education on how entitlement programs function, medication access and adherence will remain a problem for seniors.