Applying Research Skills

Limited access or lack of access to health care is a large problem which people and communities have to tackle in order to receive the care they need. Socio-economic, geographical and inadequacy of health care service providers are some of the barriers faced at the community level, which make the problem worse. Eliminating the access gap will exacerbate preventable diseases, unnecessary hospitalisations, and thereby increase the cost of health care. This is one of the hurdles to be overcome to improve health and to minimise the burden on the health system.

Overview of the Issue

Limited access to health care is a systemic problem which restricts access to individuals and infrastructure. The ratio of health professionals to people is very low in more than 30 million Americans in the Health Professional Shortage Areas (HPSAs) designated by the U.S. Department of Health and Human Services (2024). I have worked in many rural health care environments, witnessed these barriers in first-hand experiences and participated in numerous initiatives to implement telehealth and community-based approaches to improve access to health care.

Finding Articles in Scholarly Peer-Reviewed Journals

I selected recent articles from credible databases (PubMed, CINAHL) published by academics who had limited access to health-care information so that it would be both credible and relevant. I used specific keywords in the search to narrow my results down to things that were relevant to healthcare access barriers, the differences between being in the city and the rural area, healthcare affordability, telehealth, and community health programs and limited this search to studies published in the past 5 years. Filters used included peer-reviewed journals and full text availability, as well as the design of the studies, for scholarly integrity and applicability of the studies to the student’s study. In order to cross-reference, I checked the credentials of publications and the methods utilised in the studies. In this way, it provided the selected articles with a balanced picture of the problem(s) and solutions presented in the cases of limited healthcare.

Relevance to the Topic

The chosen peer-reviewed articles are all quite relevant to the topic of limited access to health care, and give valuable indications of effective interventions. The study provides evidence of how mobile health units can improve access to primary and specialist care, as well as cost savings, and how they can help to lower inequities in low-income communities by offering preventive care and education. Coombs et al. (2022) mention some systemic barriers, such as insurance access and a lack of providers and suggest increasing Medicaid enrollment and offering incentives to providers in shortage areas. Lastly) discuss various strategies, such as advocating or providing health services in the community, to address challenges to accessing health services.

Credibility and Accuracy of the Sources

For the topic, I based my credibility and relevance on the CRAAP test with regard to the sources I considered. Access to healthcare is particularly relevant as technology, policies and social/economic conditions can impact access over time, which in turn can impact the currency. I have opted to perform the search on the past five years and generated only articles published within that time frame to make the search more relevant and bring the results more recent data and trends. Relevance was assured, as articles concerned the above-mentioned challenges to accessing healthcare, these could be geographical, financial, transport and insurance, or the interventions included – telemedicine, community health clinics and policy changes. One of them was the issue of authority. Peer-reviewed sources from authors who are recognised in the healthcare policy and rural telemedicine fields and are in academia and/or a healthcare institution were selected. To ensure the accuracy of the data, information obtained on any particular topic was correlated with that of a number of authoritative sources to make sure that the data reported did not differ from that reported in other publications. Finally, a subject-specific tool called Purpose was used to evaluate articles published for any promotional (as opposed to knowledge) content that was obvious.

Reason for Considering Source Relevant

Having identified the sources, these sources are then well-suited to bring light to the challenges in access to healthcare facilities. For example, in relation to healthcare delivery through video conference, there is existing literature on how distance and lack of provision are a challenge in remote areas and how video can overcome these. Similarly, the topic of health policy change and expansion of insurance coverage is strongly associated with the theme of improving access to health care, as it brings to mind successful practice with regard to enrollment of those groups with limited access to services. These sources are useful as they provide solutions with the back-up of research, and the authors are experts in the delivery system of healthcare, making them credible and useful.

Annotated bibliography

Coombs, N. C., Campbell, D. G., & Caringi, J. (2022). A qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access. BioMed Central Health Services Research, 22(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8976509/.

Within the scope of this article, the authors aim to tackle, evaluate and discuss the inapt barriers and the opposing troubles of appropriateness in concurrent stages of rural countries and their corresponding barriers to the use of health care in rural countries. This research is a qualitative analysis of the cultural factors, communication between patient and health care provider and communication between health care providers, determining access to healthcare in Montana’s rural facilities. The article highlights five major themes: conflict between the patient’s own sense of rural identity and the health care system; a lack of recognition and respect for cultural differences in health care; concerns about resources; and a focus on profit over tackling issues related to access to health care. The decision to include this article was informed by the article’s comprehensive treatment of barriers unique to the rural environment, which offers a great deal of information for the experience of the underserved population. The results show that the lack of a unified communication, the lack of adequate providers, and inefficiencies at the system level all contribute to the challenges of providing appropriate and acceptable healthcare services.

Dawkins, B., Renwick, C., Ensor, T., Shinkins, B., Jayne, D., & Meads, D. (2021). What factors affect patients’ ability to access healthcare? An overview of systematic reviews. Tropical Medicine & International Health, 26(10), 1177–1188. https://doi.org/10.1111/tmi.13651

The aim of the article is to bring together the global evidence on factors affecting access to healthcare services for both low and middle-income countries (LMICs) and high-income countries (HICs), as well as to highlight how these barriers differ by context to help inform the development of policies that are tailored to each context. 58 articles (23 from LMICs and 35 from HICs) were studied, and the barriers and facilitators to healthcare access were identified. The results indicate that there are barriers in both settings, but in HICs, it’s more about how the health services experience the patient, and in LMICs, it’s more about the lack of health services. This article was included because it discusses the access problems for healthcare in various economic settings, and describes some of the differences which exist between each different group. The article concludes that strategies for enhancing access to healthcare must be tailored to the specific health system and that the cultural, financial and Socio-Environmental profile of each must all be taken into account.

Dorcoo, S. A., Delgado, R., Gupta, A., Bennet, J., Oriol, N. E., & Jain, S. H. (2020). Mobile health clinic model in the COVID-19 pandemic: Lessons learned and opportunities for policy changes and innovation. International Journal for Equity in Health, 19(1). https://doi.org/10.1186/s12939-020-01175-7.

This article aims to emphasise the great potential of mobile health clinics to help alleviate healthcare access problems, especially during disaster situations. While the article points out the flexibility and adaptability of mobile clinics, in socially vulnerable communities of the rural population, it suggests three steps to facilitate their proliferation: demonstrate economic contribution, make it a part of the health care system and emergency preparedness, and further utilise technology. The article is relevant for inclusion as it supports the key points in this call to action, particularly the need for mobile health clinics to be part of the healthcare continuum, particularly in underserved communities. The results indicate that there is a need to incorporate mobile health clinics into healthcare systems, as these findings suggest that a targeted approach to supporting mobile health clinics, utilising certain policies, is essential to effectively fulfil their role during times of healthcare crisis and improve access to care for vulnerable groups.

Ssemata, A. S., Smythe, T., Sande, S., Abdmagidu Menya, Hameed, S., Waiswa, P., Femke Bannink Mbazzi, & Kuper, H. (2024). Suggested solutions to barriers in accessing healthcare by persons with disability in Uganda: A qualitative study. BioMed Central BMC Health Services Research, 24(1). https://doi.org/10.1186/s12913-024-11448-4

The article attempts to highlight some of the local and community-based solutions and recommendations from patients towards improving the delivery of health care to persons with disabilities in Rural Uganda. Twenty-seven semi-structured interviews were used in the study to generate themes in the missing billion disability inclusive Health Systems Framework. They encompass advocacy, socio-economic mentoring, provision of disability awareness and community-based health care for doctors, among other things. The participants also discussed how to make services more available and accessible, how to recruit disabled health workers, extending discounts to the disabled, how to have clinic days for disabled people and what steps will remove the barriers. The results underscore the multifaceted issues encountered by PWDs and recommend a holistic and long-lasting approach in providing PWDs access to healthcare systems. Relevant as it offers evidence-based perspectives on demand and supply side solutions to improve health access for people with disabilities, which is covered by the theme on health equity and access.

Summary

For instance, in the article by Dawkins et al. (2021), the researchers address the disparity in access to health care of LMICs and UMICs, suggesting that different approaches be taken. According to a study, the efficiency of using mobile health clinics has been proven as an effective model to increase access to care, especially in emergency situations like the COVID-19 pandemic. Delivering healthcare in rural areas is tough, according to a study, due to a mismatch in culture and communication, communication that is broken up, and a few income and material resources may be restricted. Ssemata et al. (2024) identified people with disabilities in Uganda and offered solutions to them through a disability-sensitive health systems (DSHS) approach from the patient’s point of view. This was relevant in terms of shifting the focus away from the lack of applicability of the context, and emphasising the value of the systems and qualitative approaches to complement the demonstrated quantitative solutions to disparities in healthcare.