Article Text

  1. M. Arrieta1,
  2. J. B. Landry1,
  3. S. Nelson1,
  4. L. Roussel1,
  5. N. D. Guidry1,
  6. I. Naqvi1,
  7. H. Torres1,
  8. S. Walker1,
  9. E. Walker1
  1. 1Center for Healthy Communities, University of South Alabama, Mobile, AL


Purpose The purpose of this study was to identify barriers to health care access among subjects living in a medically underserved area.

Methods Focus groups were conducted on three topics: (1) perceptions of health care problems in the community, an emphasis on chronic diseases, (2) awareness of primary health care infrastructure, and (3) barriers to health care access. Purposeful sampling by zip code was used to determine either a community or health care provider recruitment site within the preestablished zip codes with over 20% of residents living at or below poverty. Primary data source was transcribed verbatim audiotapes of the focus group discussions and secondary data sources were field notes. The chronic care model (CCM) was used as a framework to evaluate participants' perceptions of barriers to health care access. The CCM is applicable both to describe elements of a system with positive health outcomes and to identify elements of a health care system (HCS) that are not perceived or realized by its consumers. Analysis was completed using the constant comparison method with established interrater reliability.

Results: Fifty-three persons participated in 13 focus groups. Most of the participants were African American. Over 85% had at least a high school education; 43.4% identified themselves as “self-pay” and 30.2% as having “private insurance” for health care; 24.5% identified health care payment source as Medicare, Medicaid, or a combination. In addition to usual barriers such as lack of transportation, prescription medication, and financial resources, other identified constructs were lack of understanding of preventive care, self-management support, and ability to navigate this HCS.

Conclusions Through the lens of the CCM, elements believed to encourage high-quality care were not identified by these participants. Specifically, participants did not perceive a “practice team” for self-management support. Hence, evidence of participants' knowledge of preventive care but not of an understanding of how to implement it into their lives. Participants' experiences suggested that the CCM's delivery system design structure was unconnected to consumers' reality of environmental and social barriers. Therefore, this HCS influenced behaviors that did not support positive health outcomes, such as using the emergency department for primary care. Further investigation from the patients' perspective of their current HCS may provide direction for individual systems to make improvements to chronic disease management.

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