Access to primary care is limited in rural communities across the United States. Evidence supports primary care as the cornerstone of healthcare. The purpose of this project was to explore community perceptions of barriers to primary care access with the aim of learning about ideas for possible interventions that could improve primary care access for Mifflin County residents. Penchansky and Thomas's model of healthcare access provided the theoretical framework for this qualitative phenomenological study. Using a community-based research approach, semistructured, open-ended telephone interviews and qualitative surveys were conducted with 26 participants, including physicians, nurses, and residents. Data were analyzed using Edward and Welch's extension of Colaizzi's 7-step method for qualitative data analysis. Key findings included perceptions that (a) primary care access is limited in Mifflin County due to inadequate health services emanating from insufficient community health centers, provider shortages, health insurance issues; (b) high cost and poor choice of services discourage residents from seeking preventative care; (c) distance from services reduce residents' ability to access primary care; (d) service problems impact the quality of care received, such as a lack of provider training in opiate addiction; and (e) providers and residents should be involved in primary care service planning since they can provide valuable information to help improve access to services. Positive social change could occur through improvement in access to primary care using a collaborative approach and community involvement, in policy formation and service planning.

Maternal Mortality Rate (MMR) in Ethiopia remains one of the highest in the world due in part to very limited use of maternal health services. However, the underlying factors for limited use of the services and hence the high MMR are not well known. The purpose of this study was to identify factors associated with use of maternal health services and maternal health risks, to analyze inequity patterns between use of maternal health services and maternal health risks, and to measure the magnitude and trends in inequity. Behavioral-cultural and structural theories of health inequalities were used to frame the study. Research questions included whether there were trends of inequity in use of maternal health services, if sociodemographic characteristics were associated with use of the services, and whether inequities in use of the services were associated with maternal health risks. The study design was quantitative and used data collected through Demographic and Health Surveys (DHS) conducted in 2000, 2005, and 2011. DHS had employed stratified 2-stage cluster design; this analysis used logistic regression method, odds ratio chi-square test, and correlation measures. The findings indicated statistically significant inequities on use of antenatal care and skilled birth attendant services associated with women's residence, level of education, income, administrative region, distance to a health facility, out-of-pocket payment for health services, and involvement in decision making. Based on the findings, it is recommended to design maternal health policies and programs that improve access and use of the services, specifically for women in rural areas, with no education and with limited economic capacity. Further research is also recommended for regions where sample size was limited. Maternal health policies and programs designed to reach the most disadvantaged women could increase service use and improve maternal health, leading to positive social change.

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The objective of this study was to examine if intra-racial income inequality contributes to higher infant mortality rates (IMRs) for African-Americans. The conceptual framework for this study is derived from Richard Wilkinson's psychosocial environment interpretation of the income inequality and health link. The hypotheses examined were that race/ethnicity-specific IMRs are influenced by intra-race/ethnicity income inequality, and that these effects of income inequality on health are mediated by level of social mistrust and/or risk profile of the mother. Using state-level data from several sources, the 2000 National Center for Health Statistics Linked Birth Infant Death database, 2000 U.S. Census, and 2000 General Social Survey, a number of regression equations were estimated. Results indicated that the level of intra-racial/ethnic income inequality is a significant predictor of non-Hispanic Black IMRs, but not the IMRs of non-Hispanic Whites or Hispanics. Additionally, among Blacks, the effect of their intra-racial income inequality on their IMRs was found to be mediated by the risk profile of the mother, namely, the increased likelihood of smoking and/or drinking and/or less prenatal care by Black women during pregnancy. Implications of the findings are discussed.

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Black women mortality rates are perceived to be impacted by communication barriers, trust issues, and the lack of quality preventive health services. The purpose of this phenomenological study was to explore communication barriers and trust issues perceived by Black women when seeking preventive health services. HMB was used to identify public attitudes around receiving preventive health services and to construct each question based on perceived susceptibility and perceived severity of communication barriers and trust issues. An ecological model of the communication process was used as a framework to identify fundamental relationships between the Black female patients and health care providers. Data were collected using open-ended interview questions from Black women in public health and health care professions in southeast Texas (N=10). Results were coded and evaluated by thematic analysis. NVivo 10 software was used to store and manage data. Study findings showed 4 participants voiced their beliefs that their healthcare provider was somewhat apathetic when it came to addressing their health care needs, and 3 of the participants who visited a doctor's office within the last 12 months reportedly expressed having poor communication and trust issues with their health care provider. Emerged themes included lack of attentiveness from health care providers and lack of a comfortable atmosphere or bedside manner when receiving preventive health care services from their healthcare provider. This research has implications for social change if the health inequalities of Black women are identified and addressed, then Black women may have a reduction in health disparities when receiving preventive health services and an increase healthier outcomes.

As the US population ages, public health agencies must examine better ways to measure the impact of adverse health outcome on a population. Many reports have asserted that more adverse health events occur in Appalachia. However, few studies have assessed the quality of life and burden of disease on those residing in Appalachia. Therefore, the overall aim of this dissertation was to assess the health status, burden of disease, and quality of life in Appalachia using available data and improved health outcome assessment measures. For this dissertation, 3 secondary data sources collected by the State of Tennessee and the National Center for Health Statistics (NCHS) were used. These data were used to calculate the index of disparity and absolute and relative disparity measures within the study area of 8 Appalachian counties in upper east Tennessee. Vital statistics data for the selected area were also used to calculate Disability Adjusted Life Years (DALYs) by gender for all cause mortality and stroke mortality. The Behavior Risk Factor Surveillance System (BRFSS) data were used for prevalence data and to determine what factors impact Health Related Quality of Life (HRQOL) within the study area. The Index of disparity (ID) for all cause mortality for the study area found that disparity is greatest in stroke mortality for the study area and TN and the least for all cause mortality and the US. The highest numbers of DALYs was found in the 45-59 age group for the Appalachian study population. Finally, the mean general health status did not vary significantly by gender; however, predictors of reporting excellent to good health status did vary based on gender. Predictors of fair to poor general health status were found to be low income, having diabetes, or having had a stroke or heart attack. The results within this dissertation are intended to assist health professionals with the creation of health interventions and policy development within the Appalachian area. This dissertation proposes a more comprehensive health status monitoring system for assessing health disparity at a regional level.

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No description available.