Definition and categorization of "rural" and assessment of realized access to care

Whitney E Zahnd; Natalie Del Vecchio; Natoshia Askelson; Jan M Eberth; Robin C Vanderpool; Linda Overholser; Purnima Madhivanan; Rachel Hirschey; Jean Edward

doi:10.1111/1475-6773.13951

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Definition and categorization of "rural" and assessment of realized access to care

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Definition and categorization of "rural" and assessment of realized access to care

Whitney E Zahnd, Natalie Del Vecchio, Natoshia Askelson, Jan M Eberth, Robin C Vanderpool, Linda Overholser, Purnima Madhivanan, Rachel Hirschey and Jean Edward

Health services research, Vol.57(3), pp.693-702

02/11/2022

DOI: 10.1111/1475-6773.13951

PMCID: PMC9108055

PMID: 35146771

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Abstract

To examine how three measures of realized access to care vary by definitions and categorizations of "rural". Health Information National Trends Survey (HINTS) data, a nationally representative survey assessing knowledge of health-related information, were used. Participants were categorized by county-based Urban Influence Codes (UICs), Rural-Urban Continuum Codes (RUCCs), and census tract-based Rural-Urban Commuting Area (RUCAs). Three approaches were used across categories of UICs, RUCCs, and RUCAs: 1) non-metropolitan/metropolitan, 2) 3-group categorization based upon population size, and 3) 3-group categorization based on adjacency to metropolitan areas. Wald Chi-square tests evaluated differences in sociodemographic variables and three measures of realized access across 3 of Penchansky's "A's of access" and approaches. The three outcome measures included: having a regular provider (realized availability), self-reported "excellent" quality of care (realized acceptability), and self-report of the provider "always" spending enough time with you (provider attentiveness--realized accommodation). The average marginal effects corresponding to each outcome were calculated. N/A PRINCIPAL FINDINGS: All approaches indicated comparable variation in sociodemographics. In all approaches, RUCA-based categorizations showed differences in having a regular provider (e.g., 68.9% of non-metropolitan and 64.4% of metropolitan participants had a regular provider). This association was attenuated in multivariable analyses. No rural-urban differences in quality of care were seen in unadjusted or adjusted analyses regardless of approach. After adjustment for covariates, rural respondents reported greater provider attentiveness in some categorizations of rural compared to urban (e.g., non-metropolitan respondents reported 6.03 percentage point increase in probability of having an attentive provider [CI = 0.76-11.31%] compared to metropolitan). Our findings underscore the importance of considering multiple definitions of rural to understand access disparities and suggest that continued research is needed to examine the interplay between potential and realized access. These findings have implications for federal funding, resource allocation, and identifying health disparities. This article is protected by copyright. All rights reserved.

rural populations

health services

health services accessibility

Details

Title: Subtitle: Definition and categorization of "rural" and assessment of realized access to care
Creators: Whitney E Zahnd - Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA
Natalie Del Vecchio - Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
Natoshia Askelson - Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA
Jan M Eberth - Health Communication and Informatics Research Branch, National Cancer Institute, Bethesda, MD
Robin C Vanderpool - Department of Epidemiology and Biostatistics, Arnold School of Public Health, Columbia, SC
Linda Overholser - Department of Internal Medicine, University of Colorado, Denver, CO
Purnima Madhivanan - Health Promotion Sciences Department, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
Rachel Hirschey - School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
Jean Edward - College of Nursing, University of Kentucky, Lexington, KY
Resource Type: Journal article
Publication Details: Health services research, Vol.57(3), pp.693-702
DOI: 10.1111/1475-6773.13951
PMID: 35146771
PMCID: PMC9108055
NLM abbreviation: Health Serv Res
eISSN: 1475-6773
Grant note: DOI: 10.13039/100000030, name: Centers for Disease Control and Prevention, award: U48 DP006389, U48 DP006401, U48 DP006399, U48 DP00641; DOI: 10.13039/100006545, name: National Institute on Minority Health and Health Disparities, award: 1K23MD015719‐01
Language: English
Date published: 02/11/2022
Academic Unit: Health Management and Policy; Epidemiology; Injury Prevention Research Center; Public Policy Center (Archive); Community and Behavioral Health
Record Identifier: 9984221747402771

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