Rural residence adversely affects health status and health care accessibility in comparison to urban residence. Research has not adequately explained how rurality and other geographic variables interfere with access to health services. Based on the geographic concept of Central Place Theory, this research will show how rurality (defined for a county in terms of adjacency to metropolitan area and size of urban population), various measures of distance, transportation availability, and consumer activity spaces differentially affect the use of health services and how individual and household sociodemographic, cultural, and health status variables may reduce the effects of geographic variables. In an era of health care reform, understanding geographic accessibility and its interaction with other factors is needed to more effectively locate and improve the use of different types and levels of health services in rural areas.
The specific aims of this study are to (1) measure the effects of geographic factors on the use of health care facilities and practitioners by rural residents at the county level of analysis; (2) measure the extent to which sociodemographic, cultural, and health status characteristics reduce the effects of geographic factors on the use of health care facilities and practitioners by rural residents at the county level of analysis; and (3) measure the effect of geographic, sociodemographic, cultural, and health status characteristics on the use of health care facilities and practitioners by rural residents at the individual level of analysis. The study area is the Mountain Area Health Education Center region, located in the Appalachian mountains of western North Carolina. A sample of 1, 160 adults, and approximately 350 children, who reside in 12 counties in this region will be interviewed. The counties vary in rurality as defined by the Beale Codes. Active involvement of community leaders in the research will be solicited. Survey interviews will include items on (1) use of hospitals, public and private clinics, and primary care and specialist practitioners for regular, chronic and acute illness care; (2) distance traveled to care, transportation availability, and activity spaces; (3) individual and household sociodemographic characteristics; (4) health beliefs, health behavior, religiosity, and use of alternative practices, and (5) measured and perceived health status. Survey data collection will be conducted by the Research Triangle Institute. Analysis of confirmatory (county level) hypotheses will be based upon summary statistics; analysis of exploratory (individual level) hypotheses will be based upon survey regression methods. Consumer and provider locations, roads, and places visited for various activities will be entered into a Geographic Information System (GIS) to enhance measurement precision and create a coherent database to facilitate analyses.
