McCall-Hosenfeld Jennifer S, Weisman Carol S
Pennsyvania State University College of Medicine, Hershey, Pennsyvania, USA.
Rural Remote Health. 2011;11(1):1617. Epub 2011 Jan 28.
Preventive health interventions often occur less frequently among rural women compared to urban women. Preventive counseling is an important feature of comprehensive preventive healthcare provision, but geographic disparities in the receipt of preventive counseling services have not been fully described. In this study the framework of the behavioral model of healthcare utilization was employed to investigate the association between rurality and receiving preventive counseling. It was hypothesized that demographic differences in rural and urban communities, as well as differential healthcare resources, explain rural-urban healthcare disparities in preventive counseling.
Data were collected by telephone survey during 2004-2005 for 2002 participants aged 18-45 years in the Central Pennsylvania Women's Health Study. Measures of preventive counseling were based on US Preventive Services Task Force recommendations as of 2004. Multivariable models assessed the independent contribution of rurality to the receipt of counseling for smoking, alcohol/drug use, birth control, nutrition, weight management, and physical activity. Rurality was assessed using Rural-Urban Community Area Codes. All models controlled for variables that predispose individuals to use health services (age, race/ethnicity, educational level), variables that enable or impede healthcare access (having a usual healthcare provider, using an obstetrician-gynecologist, poverty, and continuous health insurance coverage) and need-based variables (health behaviors and indicators).
In bivariate analysis, the rural population was older, had lower educational attainment, and was more likely to be White, non-Hispanic. Urban women tended to report seeing an obstetrician-gynecologist more frequently, and engaged more frequently in binge drinking/drug use. Preventive counseling was low among both rural and urban women, and ranged from 12% of the population for alcohol/drug use counseling, to 37% for diet or nutrition counseling. The degree of rurality appeared to impact counseling, with women in small or isolated rural areas significantly less likely than urban women and women in large rural areas to receive counseling related to smoking, alcohol/drug use and birth control. Overall, rural women reported less counseling for alcohol/drug use, smoking, birth control, nutrition and physical activity. In multivariable analysis, rurality was independently associated with lack of preventive counseling for physical activity. However, adjusting for predisposing, enabling and need-based variables fully attenuated the effect of rurality in the remaining models. Younger age, higher educational attainment, and seeing any obstetrician-gynecologist were associated with receipt of counseling in several models.
Most women do not receive recommended preventive counseling. While rural women are less likely than urban women to receive counseling, rurality generally was not independently associated with receipt of counseling once demographics, access to health care, and health behaviors and indicators were controlled. This suggests that both demographic differences between rural and urban communities as well as aspects of healthcare access govern rural-urban healthcare disparities in preventive counseling. These results speak to important targets for reducing urban-rural healthcare disparities in receiving preventive counseling, improving the health literacy of the rural population, educating rural healthcare providers about the need for preventive counseling, and the expansion of access to obstetrician-gynecologists in rural communities.
与城市女性相比，农村女性接受预防性健康干预的频率往往较低。预防性咨询是全面预防性医疗保健服务的一个重要特征，但预防性咨询服务获取方面的地理差异尚未得到充分描述。在本研究中，采用医疗保健利用行为模型框架来调查农村地区与接受预防性咨询之间的关联。研究假设农村和城市社区的人口统计学差异以及不同的医疗资源可以解释预防性咨询方面的城乡医疗差距。
在2004 - 2005年期间，通过电话调查收集了宾夕法尼亚州中部女性健康研究中2002名年龄在18 - 45岁之间参与者的数据。预防性咨询的衡量标准基于截至2004年美国预防服务工作组的建议。多变量模型评估了农村地区对吸烟、酒精/药物使用、节育、营养、体重管理和体育活动咨询接受情况的独立影响。使用城乡社区区号评估农村地区。所有模型都控制了使个体倾向于使用医疗服务的变量（年龄、种族/族裔、教育水平）、促进或阻碍医疗服务获取的变量（有常规医疗服务提供者、使用妇产科医生、贫困和持续的医疗保险覆盖）以及基于需求的变量（健康行为和指标）。
在双变量分析中，农村人口年龄较大，教育程度较低，更有可能是白人、非西班牙裔。城市女性往往更频繁地报告看妇产科医生，并且更频繁地参与狂饮/药物使用。农村和城市女性的预防性咨询比例都较低，酒精/药物使用咨询占人口的12%，饮食或营养咨询占37%。农村程度似乎影响咨询情况，与城市女性和大农村地区的女性相比，小的或孤立农村地区的女性接受吸烟、酒精/药物使用和节育咨询的可能性显著降低。总体而言，农村女性报告在酒精/药物使用、吸烟、节育、营养和体育活动方面接受的咨询较少。在多变量分析中，农村地区与缺乏体育活动预防性咨询独立相关。然而，在其余模型中，对倾向、促进和基于需求的变量进行调整后，农村地区的影响完全减弱。在几个模型中，年龄较小、教育程度较高以及看任何妇产科医生都与接受咨询相关。
大多数女性未接受推荐的预防性咨询。虽然农村女性比城市女性接受咨询的可能性小，但一旦控制了人口统计学、医疗服务获取以及健康行为和指标，农村地区通常与咨询接受情况无独立关联。这表明农村和城市社区之间的人口统计学差异以及医疗服务获取方面的因素共同导致了预防性咨询方面的城乡医疗差距。这些结果指出了减少城乡在接受预防性咨询方面的医疗差距、提高农村人口的健康素养、教育农村医疗服务提供者关于预防性咨询的必要性以及扩大农村社区妇产科医生的可及性等重要目标。
