Urban Spillover, Health Disparities, and Community Strengths in Small Towns in Central Texas.

: Small-town residents face healthcare inequities that result in poorer outcomes compared to those living in urban areas. These disparities are deeply rooted in socioeconomic and demographic factors as well as in access to healthcare services. This study aimed to explore health disparities and community strengths within small towns in Williamson County, Central Texas, intensified by urban spillover. : A qualitative study was designed using the Social Determinants of Health Model as the conceptual framework. We conducted eight in-depth interviews with local stakeholders. Each interview lasted 60-90 min and was audio-recorded, transcribed verbatim, and subjected to thematic analysis by trained researchers. : The participants reported that significant population growth, via individuals drawn from the rapidly expanding cities in proximity to their small towns, dramatically impacts lives. Eight main themes emerged: (1) low levels of community and professional health literacy and a lack of healthcare navigation support in schools and community-based support systems; (2) limited funding for healthcare services and limited capacity to support access to them; (3) limited access to food that can support healthy dietary patterns; (4) inadequate transportation services; (5) substance use, violence, and crime; (6) stressful community dynamics and an environment that negatively influences individual and community well-being; (7) financial instability and unreliable and insufficient infrastructure; and (8) community strengths and potential resources. : Our findings reveal critical healthcare disparities in these small towns. Harnessing funding support and community unity is vital for developing equitable healthcare solutions and improving the well-being of residents in these rapidly evolving locales.