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Cited by 594Public Health and Social InequalitiesHealthcare Policy and ManagementHealth disparities and outcomes

The DOI matches its Crossref record; 38 of the 38 references it cites were found in a registry or an index.

The Effects of Geography and Spatial Behavior on Health Care Utilization among the Residents of a Rural Region

Open access
Arcury, Thomas A., Gesler, Wilbert M., Preisser, John S., Sherman, Jill, Spencer, John, Perin, Jamie·2005·Health Services Research
DOI 10.1111/j.1475-6773.2005.00346.xPMC PMC1361130
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Abstract

Objective.This analysis determines the importance of geography and spatial behavior as predisposing and enabling factors in rural health care utilization, controlling for demographic, social, cultural, and health status factors. Data Sources.A survey of 1,059 adults in 12 rural Appalachian North Carolina counties. Study Design.This cross‐sectional study used a three‐stage sampling design stratified by county and ethnicity. Preliminary analysis of health services utilization compared weighted proportions of number of health care visits in the previous 12 months for regular check‐up care, chronic care, and acute care across geographic, sociodemographic, cultural, and health variables. Multivariable logistic models identified independent correlates of health services utilization. Data Collection Methods.Respondents answered standard survey questions. They located places in which they engaged health related and normal day‐to‐day activities; these data were entered into a geographic information system for analysis. Principal Findings.Several geographic and spatial behavior factors, including having a driver's license, use of provided rides, and distance for regular care, were significantly related to health care utilization for regular check‐up and chronic care in the bivariate analysis. In the multivariate model, having a driver's license and distance for regular care remained significant, as did several predisposing (age, gender, ethnicity), enabling (household income), and need (physical and mental health measures, number of conditions). Geographic measures, as predisposing and enabling factors, were related to regular check‐up and chronic care, but not to acute care visits. Conclusions.These results show the importance of geographic and spatial behavior factors in rural health care utilization. They also indicate continuing inequity in rural health care utilization that must be addressed in public policy.

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Citations

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Show all 38 references

Research works printed but not linked: 12

  1. Aday L. A., 1997, Handbook of Health Behavior Research: Personal and Social Determinants, 153
  2. Butler M. A., 1994, Rural–Urban Continuum Codes for Metropolitan and Nonmetropolitan Counties, 1993
  3. Kaiser Family Foundation, 1999, Race & Ethnic Differences in Access to Medical Care: A Synthesis of the Literature
  4. Kasper J. D., 1998, Asking about Access, Health Services Research, 33, 715
  5. Kihl M. R., 1993, Aging in Rural America, 84
  6. Love D., 1995, The Geographic Accessibility of Hospitals to the Aged, Health Services Research, 29, 629
  7. Pearsall M., 1960, Healthways in a Mountain County, Mountain Life and Work, 36, 7
  8. Plaut T., 1988, Appalachian Mental Health, 161
  9. Ricketts T. C., 1994, Geographic Methods for Health Services Research, 91
  10. Research Triangle Institute, 2000, Data Collection Report. Geographic Accessibility of Health Care in Rural Areas Project RTI Project 743
  11. Shah B. V., 2001, SUDAAN User's Manual, Release 8.0.0
  12. Welch H. G., 1997, Could Distance Be a Proxy for Severity‐of‐Illness?, Health Services Research, 28, 441

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Metadata

Authors
Arcury, T. A., Gesler, W. M., Preisser, J. S., Sherman, J., Spencer, J., & Perin, J.
Affiliations
  • Wake Forest University Health Sciences (US)
  • University of North Carolina at Chapel Hill (US)
Corresponding author
Arcury, Thomas A.
ORCID
Venue
Health Services Research
Publisher
Wiley
Published
2005-01-21
Volume
40
Issue
1
Pages
135-156
ISSN
  • 0017-9124 (ISSN-L)
  • 1475-6773
DOI
10.1111/j.1475-6773.2005.00346.x
PMC
PMC1361130
OpenAlex
W2127606804
Cited by
594
References
38
Citations by year
2026: 15 · 2025: 26 · 2024: 23 · 2023: 30 · 2022: 23 · 2021: 36 · 2020: 35 · 2019: 31 · 2018: 41 · 2017: 34 · 2016: 39 · 2015: 45 · 2014: 39 · 2013: 29 · 2012: 35
FWCI
15.22
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Health Services Research (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Agency for Healthcare Research and Quality (R01 HS009624, R01 HS09624)
Topics
  • Social Sciences › Health › Public Health and Social Inequalities
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
  • Social Sciences › Health › Health disparities and outcomes
Keywords
spatial behavior, geographical factors, rural health disparities, driving licence, distance to care, chronic care, acute care, household income, physical and mental health, health care access
MeSH terms
Adult, Appalachian Region, Cross-Sectional Studies, Female, Geography, Health Services Accessibility, Health Status, Humans, Male, Models, Theoretical, North Carolina, Patient Acceptance of Health Care, Residence Characteristics, Spatial Behavior, Transportation, Health Behavior, Multivariate Analysis, Logistic Models, Rural Health Services

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