According to the National Institute of Nursing Research (NINR), """"""""Rural populations, in comparison to urban populations, experience greater morbidity and have higher crude rates of mortality and higher rates of chronic illness"""""""" (1995, p. 4). Despite the need for health care in rural areas, the Institute of Medicine (IOM) (1996) speaks of a """"""""geographic maldistribution of primary care clinicians"""""""" (p. 172) with inadequate access to primary health care services in rural areas. IOM recommends addressing this issue of geographic maldistribution and identifies measuring the quality of rural primary health care as a research priority. This proposed study will evaluate client outcomes of health risk reduction in a rural population in order to examine one aspect of the effectiveness of rural community based primary health care coordinated by nurse practitioners in a previously underserved area, and evaluate six process variables considered indicators of quality primary care--availability, accessibility, affordability, appropriateness, adequacy, and acceptability (NINR, 1995). The research is the first step in measuring the multifaceted outcomes of the primary health care provided at the clinic. The study will combine quantitative and qualitative methods in a naturalistic setting. A quasiexperimental design, with individuals serving as their own controls, will be used to examine reduction in five specific health risk behaviors (tobacco use, obesity and/or poor diet, physical inactivity, emotional stress, and lack of knowledge and/or ability to manage chronic illness) following the independent variable of primary health care. The estimated sample sizes range from 38 to 170 for each of the health risk behaviors. In addition, focus groups will help to evaluate and interpret the quantitative data. It is hoped that the research can serve as a model for evaluating community-based primary health care for rural, underserved populations.
