title: Predictors of access to healthcare: what matters to rural Appalachians?
abstract: OBJECTIVE
  Lack of access to healthcare is frequently cited as a primary reason for health disparities globally, especially in poor, rural areas such as Appalachia in the U.S. This study examined predictors of perceived access to healthcare among residents in a poor, medically underserved, rural Appalachian community.
  
  
  METHODS
  The study was guided by the revised behavioral model of healthcare services utilization. Self-reported survey data were obtained from a convenience sample of 921 residents in rural Tennessee.
  
  
  RESULTS
  The majority of respondents in this study did not perceive access to healthcare to be a problem in their community. Financial factors, health status, and associated social factors negatively affected only a small number respondents' perceptions of access to healthcare.
  
  
  CONCLUSIONS
  Despite the presence of multiple factors previously shown to affect access to healthcare, the majority of respondents in this study did not perceive access to healthcare to be a problem in their community. Results of this study suggest that to understand an individual's passage through the healthcare system, the contextual aspects of healthcare utilization, should be added to coverage, services, timeliness, and workforce as a fifth component of access to healthcare. Assessing perceived need and associated cultural factors that affect individuals' concepts of health and wellness represent important areas for future exploration to explain observed health disparities. Additionally, findings showed that having sufficient quality and quantity of healthcare professionals and services in a community or region may be necessary, but not sufficient to explain health disparities and the underlying reasons why individuals choose or choose not to seek health services.
authors.affiliation: Department of Public Health Sciences, New Mexico State University, Las Cruces, NM, USA. wilsonsl@nmsu.edu
authors.forename: Susan L
authors.initials: SL
authors.lastname: Wilson
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kratzke
authors.forename: Jill
authors.initials: J
authors.lastname: Hoxmeier
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001061:Appalachian Region; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D011788:Quality of Life; D012424:Rural Population / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult