Barriers to Healthcare Seeking and Provision Among African American Adults in the Rural Mississippi Delta: Community and Provider Perspectives

Abstract

The objective of this project was to identify barriers to healthcare seeking and healthcare provision among rural African American adults in the Mississippi Delta from the perspective of volunteer community health advisors (CHAs), community residents, and healthcare providers. Ten focus groups (20 males, 37 females) were conducted with CHAs and community residents from nine counties in one public health district. An additional focus group was conducted with healthcare providers (3 males, 2 females, 4 African American, 1 Other) from medical clinics and a hospital located in the same public health district. Two key informant interviews were also conducted with a district public health officer and a chairman of a local health advocacy foundation board of directors. All interviews were transcribed and data were analyzed using the constant comparative method to identify major themes and sub‐themes related to barriers to healthcare seeking and provision. Findings were broadly categorized as structural and interpersonal barriers with structural barriers encompassing issues of poverty (unemployment/underemployment), lack of health insurance, rurality (such as lack of transportation and medical specialists), perceptions of racism, and medical mistrust. Interpersonal barriers included fear of a serious medical diagnosis, gender socialization (going to the doctor as a sign of weakness among men) and age (not going to see the doctor until age 50 for first screening). Differences also emerged in the perceptions between community members and healthcare providers. While both groups were critical of medical insurance, providers viewed insurance guidelines as restricting their ability to provide the most current treatment. Community members and some CHAs viewed providers as conspiring with insurance and pharmaceutical companies to receive “kick‐backs.” Additionally, whereas racism emerged as a major structural barrier in the community interviews, this topic was not mentioned in any of the provider interviews. Results indicate significant efforts are needed to overcome both structural and interpersonal barriers to healthcare seeking and provision in order to reduce health disparities.Support or Funding InformationThis project was funded through a Patient‐Centered Outcomes Research Institute (PCORI) Eugene Washington PCORI Engagement Award (1514‐USM). The statements presented in this abstract are solely the responsibility of the authors and do not necessarily represent the views of PCORI, its Board of Governors or Methodology Committee.