title: Mixed methods study of management of health conditions in rural low-income families: implications for health care policy in the USA.
abstract: BACKGROUND
  The purpose of this mixed methods study was to examine the health issues and health management strategies utilized by rural low-income women and their families to inform the design, implementation, and evaluation of health reform in rural areas of the USA. METHODS;  Quantitative data was analyzed from 271 rural, low-income women and their families and qualitative data from a sub-sample of 44. Specifically explored were the: (1) types and perceived severity of health conditions rural, low-income individuals report; (2) perceived value and utilization of a usual source of care; and (3) strategies these individuals employ to manage their health.
  
  
  RESULTS
  Rural American families manage multiple healthcare needs with limited resources; 42.1% reported 1-4 chronic conditions in the family, 31.4% reported 5-8 conditions, and 17.7% reported 9 or more conditions. The majority of participants (79.0%) reported having a doctor or other healthcare professional that they usually see; 61.3% reported their partners had a usual provider, and 91.7% reported their children had a usual provider. Analysis of the qualitative data revealed two main themes regarding management of health conditions: (1) lack of engagement in managing overall health; and (2) ineffective utilization of health care.
  
  
  CONCLUSIONS
  Rural low-income individuals in the US may benefit from new policies that promote patient-centered, personalized care. However, any policy change must be carefully designed to consider the ways in which rural American families manage their health in order to improve individual health status and reduce rural health disparities.
authors.affiliation: Department of Medicine, Duke University, North Carolina, USA. leighann.simmons@duke.edu
authors.forename: L A
authors.initials: LA
authors.lastname: Simmons
authors.forename: C A
authors.initials: CA
authors.lastname: Huddleston-Casas
authors.forename: K A
authors.initials: KA
authors.lastname: Morgan
authors.forename: D
authors.initials: D
authors.lastname: Feldman
mesh_terms: D000328:Adult; D002648:Child; D002908:Chronic Disease / Q000453:epidemiology; D005260:Female; D018166:Health Care Reform; D006291:Health Policy; D006304:Health Status; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D055118:Medication Adherence; D010817:Physician-Patient Relations; D011203:Poverty; D019035:Rural Health Services / Q000592:standards / Q000706:statistics & numerical data*; D012424:Rural Population; D014481:United States; D055815:Young Adult