title: The utility of rural and underserved designations in geospatial assessments of distance traveled to healthcare services: implications for public health research and practice.
abstract: Health disparities research in rural populations is based on several common taxonomies identified by geography and population density. However, little is known about the implications of different rurality definitions on public health outcomes. To help illuminate the meaning of different rural designations often used in research, service delivery, or policy reports, this study will (1) review the different definitions of rurality and their purposes; (2) identify the overlap of various rural designations in an eight-county Brazos Valley region in Central Texas; (3) describe participant characteristic profiles based on distances traveled to obtain healthcare services; and (4) examine common profile characteristics associated with each designation. Data were analyzed from a random sample from 1,958 Texas adults participating in a community assessment. K-means cluster analysis was used to identify natural groupings of individuals based on distance traveled to obtain three healthcare services: medical care, dental care, and prescription medication pick-up. Significant variation in cluster representation and resident characteristics was observed by rural designation. Given widely used taxonomies for designating areas as rural (or provider shortage) in health-related research, this study highlights differences that could influence research results and subsequent program and policy development based on rural designation.
authors.affiliation: Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, 330 River Road, 315 Ramsey Center, Athens, GA 30602, USA. matthew.smith@srph.tamhsc.edu
authors.forename: Matthew Lee
authors.initials: ML
authors.lastname: Smith
authors.forename: Justin B
authors.initials: JB
authors.lastname: Dickerson
authors.forename: Monica L
authors.initials: ML
authors.lastname: Wendel
authors.forename: Sangnam
authors.initials: S
authors.lastname: Ahn
authors.forename: Jairus C
authors.initials: JC
authors.lastname: Pulczinski
authors.forename: Kelly N
authors.initials: KN
authors.lastname: Drake
authors.forename: Marcia G
authors.initials: MG
authors.lastname: Ory
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D012111:Residence Characteristics; D019035:Rural Health Services; D012424:Rural Population / Q000145:classification; D009626:Terminology as Topic; D013781:Texas; D014195:Travel; D055815:Young Adult