title: STRUCTURAL AND HIDDEN BARRIERS TO A LOCAL PRIMARY HEALTH CARE INFRASTRUCTURE: AUTONOMY, DECISIONS ABOUT PRIMARY HEALTH CARE, AND THE CENTRALITY AND SIGNIFICANCE OF POWER.
abstract: OBJECTIVE
  To examine a local primary health care infrastructure and the reality of primary health care from the perspective of residents of a small, urban community in the southern United States.
  
  
  METHODS
  Data derive from 13 semi-structured focus groups, plus three semi-structured interviews, and were analyzed inductively consistent with a grounded theory approach.
  
  
  RESULTS
  Structural barriersto the local primary health care infrastructure include transportation, clinic and appointment wait time, and co-payments and health insurance.Hidden barriersconsist of knowledge about local health care services, non-physician gatekeepers, and fear of medical care. Community residents have used home remedies and the emergency department at the local academic medical center to manage these structural and hidden barriers.
  
  
  CONCLUSIONS
  Findings might not generalize to primary health care infrastructures in other communities, respondent perspectives can be biased, and the data are subject to various interpretations and conceptual and thematic frameworks. Nevertheless, the structural and hidden barriers to the local primary health care infrastructure have considerably diminished the autonomy community residents have been able to exercise over their decisions about primary health care, ultimately suggesting that efforts concerned with increasing the access of medically underserved groups to primary health care in local communities should recognize the centrality and significance of power.
  
  
  CONCLUSIONS
  This study addresses a gap in the sociological literature regarding the impact of specific barriers to primary health care among medically underserved groups.
authors.affiliation: Department of Sociology, Anthropology and Social Work, University of South Alabama.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Freed
authors.affiliation: Center for Healthy Communities, University of South Alabama.
authors.forename: Shantisha T
authors.initials: ST
authors.lastname: Hansberry
authors.affiliation: Center for Healthy Communities, University of South Alabama.
authors.forename: Martha I
authors.initials: MI
authors.lastname: Arrieta
keywords: Autonomy; Decisions; Health disparities; Local primary health care infrastructure; Power; Structural and hidden barriers