East Carolina University, Greenville, North Carolina, United States.
J Community Health. 2022 Oct;47(5):737-744. doi: 10.1007/s10900-022-01106-3. Epub 2022 Jun 8.
Previous research has identified three common reasons for healthcare avoidance, cost, complexity, and privacy. This study extends prior work by examining the antecedents to these barriers and determining the extent to which they contribute to healthcare avoidance in a rural population.
A cross-sectional, regional survey of rural residents from Eastern North Carolina was conducted with questions focused on self-perceived health, healthcare utilization, and healthcare avoidance. Bivariate logistic regression was employed to investigate the predictors of cost, complexity, and privacy-related avoidance.
Among 946 respondents, a quarter of the sample (N = 240) had not visited a doctor within the past year. Respondents who were uninsured were almost 6-times more likely to endorse avoiding healthcare due to cost (OR = 5.98) and those who had a chronic illness were 3-times as likely to report cost-related avoidance (OR = 3.01). Complexity-related avoidance was predicted by having a chronic illness (OR = 3.77) and a low perception of healthcare value (OR = 2.80). Lastly, privacy-related avoidance was related to being in fair/poor health (OR = 2.61), having a chronic illness (OR = 2.63), reporting low healthcare value (OR = 2.72), and having an external locus of control (OR = 2.96).
Among avoidant individuals, those with a chronic illness, who could benefit most from continuity of healthcare, are 3-times more likely to avoid healthcare due to cost, complexity, and privacy. The perceived value of healthcare is also associated with complexity- and privacy-related healthcare avoidance. Utilizing alternative methods of healthcare delivery, such as telemedicine and free or reduced cost mobile health clinics, could improve continuity of medical care for rural residents.
先前的研究已经确定了医疗保健回避的三个常见原因，即成本、复杂性和隐私。本研究通过检查这些障碍的前因，并确定它们在多大程度上导致农村人口回避医疗保健，从而扩展了先前的工作。
对来自北卡罗来纳州东部的农村居民进行了横断面、区域性调查，问题集中在自我感知健康、医疗保健利用和医疗保健回避上。采用双变量逻辑回归调查成本、复杂性和隐私相关回避的预测因素。
在 946 名受访者中，有四分之一的样本（N=240）在过去一年中没有看过医生。没有保险的受访者因成本而避免医疗保健的可能性几乎是 6 倍（OR=5.98），而患有慢性病的受访者因成本而避免医疗保健的可能性是 3 倍（OR=3.01）。复杂性相关回避由慢性病（OR=3.77）和低医疗保健价值感知（OR=2.80）预测。最后，隐私相关回避与健康状况一般/较差（OR=2.61）、患有慢性病（OR=2.63）、报告医疗保健价值低（OR=2.72）和外部控制源（OR=2.96）有关。
在回避的个体中，那些患有慢性病的人，他们最需要连续性的医疗保健，他们因成本、复杂性和隐私而回避医疗保健的可能性是没有慢性病的人的 3 倍。医疗保健的感知价值也与复杂性和隐私相关的医疗保健回避有关。利用远程医疗和免费或降低成本的移动健康诊所等替代医疗保健提供方式，可以改善农村居民的医疗保健连续性。
