Complete the Capstone Abstract. See PowerPoint and use the example capstone abstract as guide. 120-180 words

CHAPTER 1: INTRODUCTION

Student

National University

COH 694B

July 16, 2023

CHAPTER 1: INTRODUCTION

Introduction to the problem

Access to healthcare in rural communities is a challenge globally (Tan, 2022). Rural areas have little development, which restricts the communities from accessing proper healthcare services (Rodgers & Yee, 2014). Health is the most important basic need, and everyone is entitled to quality services. However, this is not the case because millions worldwide still struggle to get effective and efficient services (Charalambous, 2023).

Background of the Problem

Rural communities in the United States have lagged when it comes to accessing quality healthcare. This has been the case since time immemorial and is a great concern since it affects the overall health situation in the country. More than 18% of Americans (60 million) live in rural areas; on average, they are older than urban dwellers (US Government Accountability Office, 2023). Additionally, they are comparatively poorer than those who reside in urban areas. Their access to healthcare is challenging as they cannot afford the best services. Resources are also limited, affecting the quality of care they can access (Patton, 2014).

Statement of the Problem

The problem is the lack of access to proper healthcare for rural communities in the United States despite health being a basic need. This challenge needs to be addressed and a possible solution found.

Purpose of the Study

The study aims to understand why rural communities in the United States have challenges accessing healthcare. The study will also reveal factors leading to this situation. A study must have a purpose (Miller & Wilson, 2014).

Research Question

This project looks forward to answering the following research question: what factors lead to poor access to healthcare by communities in rural America?

Significance of the Study

This study is significant because it will reveal the factors that lead to poor access to healthcare in rural communities within the United States. The findings will also include suggestions and recommendations that can be implemented to solve the problem. Research should be useful in revealing information that can help solve problems (Griffiths, 2009).

Assumptions

The sample used in the research will represent the entire population. More than 60 million are affected and cannot be interrogated; they will be represented. Samples represent the population (Arnab, 2017). The research will also be done using reliable methods and tools; therefore, the outcomes will be valid.

Limitations

There are financial constraints. Therefore, the research will not be extensive. The sample will also be small for easier handling, although it might not reveal the accurate reality of the population. The level of accuracy might be 95%. Studies have challenges that affect the outcomes.

Summary

Many studies have been conducted regarding different areas of healthcare. Still, they have not paid attention to why there is a problem with access to healthcare in rural communities within the United States. This research will find why the situation is the way it is and recommend possible solutions to the problem. More literature related to the topic will be analyzed to help understand the facts (Creswell, 2014). Literature is important as it provides additional information from other researchers' discoveries (Bowling, 2023).

References

Arnab, R. (2017). Survey Sampling Theory and Applications. Amsterdam: Elsevier.

Bowling, A. (2023). Research Methods in Health: Investigating Health and Health Services. Open University Press.

Charalambous, P. (2023). Less Staff, Longer Delays, and Fewer Options: Rural America Confronts a Healthcare Crisis. Retrieved from https://abcnews.go.com/Health/staff-longer-delays-fewer-options-rural-america-confronts/story?id=97911613

Creswell, J. (2014). Research Design. London: SAGE.

Griffiths, F. (2009). Research Methods for Healthcare Practice. Los Angeles: SAGE.

Miller, K. & Wilson, S. (2014). Cognitive Interviewing Methodology. Hoboken: Wiley.

Patton, M. (2014). Qualitative Research & Evaluation Methods. London: SAGE.

Rodgers, P. & Yee, J. (2014). The Routledge Companion to Research Design. London: Routledge.

Tan, W. (2022). Research Methods: A Practical Guide for Students and Researchers. World Scientific.

US Government Accountability Office. (2023). Why Healthcare is Harder to Access in Rural America. Retrieved from https://www.gao.gov/blog/why-health-care-harder-access-rural-america

,

CHAPTER 2: LITERATURE REVIEW

Student

National University

COH 694B

July 23, 2023

CHAPTER 2: LITERATURE REVIEW

Challenges in Accessing Healthcare in Rural Areas Worldwide

Healthcare is one of the basic human needs in the sense that it deals with the health of people. Regardless of the situation, healthcare is a fundamental need that must be met. Despite the sensitivity of healthcare, millions of people across the globe still have challenges when it comes to accessing healthcare. Rural communities are among the most affected by the lack of proper access to healthcare. According to the United Nations, more than 56% of people living in rural areas cannot access critical healthcare services (UN, 2015). Different countries have different levels of access but generally, all rural areas worldwide have inadequate access to healthcare, and those who are lucky to access it, do not get the right quality that guarantees them efficiency and effectiveness. It is a global challenge that must be addressed to ensure equity in access to healthcare services regardless of location.

One of the significant reasons why rural communities across the globe do not have access to proper healthcare services is the lack of adequate infrastructure at the available healthcare facilities. It should be noted that healthcare facilities require costly investment so that necessary equipment can be availed for the locals to be served as they deserve. However, this is not the case, as most facilities in local areas lack even the basic equipment (Samuels et al. 2014). This situation is attributed to decades of underinvestment or lack of investment in the healthcare sector in rural areas. National health systems have continually neglected rural areas, making them lag in development. As a result, the local communities are deprived of essential services that could mean the difference between life and death for them (Charalambous, 2023).

The law guarantees healthcare in many governments, and all citizens are entitled to adequate healthcare. Despite all these ideal situations, the reality is different. In most countries, health sector development focuses only on urban areas because of the significant demand available. Rural areas are usually neglected and this takes a toll on the communities. The lack of sufficient workers in rural healthcare facilities worsens the situation. Most professionals prefer working in urban centers due to the benefits and opportunities they are exposed to. As a result, healthcare facilities in rural areas are understaffed, creating a considerable workload on available workers. This affects their ability to deliver the best healthcare services and leads to poor access to healthcare by the locals. The International Labor Organization reports that 23% of healthcare professionals are deployed to rural areas even though half of the world population resides in rural areas. As aforementioned, the rates differ from one country to another but generally, it is a global problem.

Inadequate funding significantly contributes to rural areas' lack of essential healthcare services. There is a massive gap in terms of resources as well as financial resources between healthcare facilities in urban centers and rural areas. Lack of workers, inadequate facilities, and out-of-pocket payments have limited access to healthcare. This problem has existed since time immemorial and continues to affect different rural communities across the globe. As much as people wish to access the best services, it is not easy because of the numerous limitations. In other words, there is more demand than supply of healthcare services in rural areas. Many people require the services but for different reasons, they cannot get them. This limits their access to healthcare services.

Lack of Access to Healthcare for Rural Communities in the United States

Access to healthcare services is critical for all Americans. Healthcare is a fundamental need that every citizen is entitled to, regardless of where they live. Rural residents face different barriers to accessing quality healthcare, putting them at various risks (AAMC, 2017). A study conducted in 2014 by RUPRI revealed that there is a need for additional measures to be taken to reduce or eliminate barriers that hinder local communities in the United States from accessing quality healthcare services. According to the health requirements in the United States, citizens should confidently and conveniently access at least basic healthcare services such as primary care, behavioral care, dental care, and public health services, among others (Rural Health Information Hub, 2022). Accessing such healthcare services is important for many reasons, which include the following:

· Improving overall physical, mental, and social health status

Lack of access to quality healthcare denies rural communities in the United States the chance to improve their overall health. Accessing proper healthcare services ensures that different dimensions of health are catered for. It is essential for rural communities to access healthcare as this will ensure their overall health status is improved.

· Prevention of diseases

Accessing proper healthcare would enable rural communities to prevent diseases (NCSL, 2020). Many diseases are preventable but if rural communities cannot access the right healthcare services, they will not prevent diseases. They are at risk of suffering from a wide variety of health complications.

· Detecting, diagnosing, and treating illnesses

Proper access to quality healthcare makes detecting, diagnosing, and treating illnesses possible. When illnesses are detected early enough, they can be handled and the damage controlled (HRSA, 2022). However, rural communities do not experience this due to a lack of access to healthcare. Some of them have undetected illnesses; it could be too late by the time they are detected.

· Improving the quality of life

To a large extent, the quality of life is determined by the quality of healthcare received. To improve their quality of life, rural communities need to access quality healthcare services (Griffiths, 2009). Without access to the right quality of healthcare, the quality of life is compromised, putting the locals at risk.

· Avoiding preventable loss of life

Studies have also revealed that access to proper healthcare can save a life. According to the Federal Emergency Management Agency (2022), 8% of fires in the United States occur in rural areas. These are emergency cases that need immediate attention. Without access to healthcare, such cases lead to loss of life.

· Increasing life expectancy

Everyone wants to live a long, healthy life, but this is determined by the quality of healthcare they receive. According to the American Journal of Preventive Medicine, it is 76.7 years, while in urban centers, it is 79.1 years (Singh & Siahpush, 2013). The low life expectancy in rural areas can be increased by increasing access to quality healthcare. Inadequate healthcare compromises the quality of life and this reduces life expectancy.

Residents in rural areas are often disadvantaged that they miss out on the basic benefits of access to quality healthcare services. Healthcare services are limited and the available ones are not timely. This is a challenge that compromises the quality of healthcare received. In instances where adequate healthcare has been availed in rural communities in the United States, there are still factors that make it difficult for the residents to access the services (Bergum & Catlin, 2016).

Bridging the Gap to Increase Access to Healthcare in Rural Communities in the United States

Mobile Health

Mobile health clinics are in place to increase access to healthcare in rural communities in the United States (Waldrop & Gee, 2022). Mobile clinics enable healthcare professionals to provide healthcare services where the patient is. In conventional healthcare, it is the patient who visits the healthcare facility. However, in this case, it is the reverse. Mobile health providers are always on the move to ensure patients get the services in the comfort of their homes or places of work. They are usually referred to as "clinics on wheels" because they are always on the move. They help solve transportation problems that most residents in rural communities face. In 2020, a study by the International Journal of Equity on Health reported that 55% of mobile health clients are women and racial minorities at 59%. The study also revealed that most recipients of mobile services were not insured. Mobile clinics receive financial support from philanthropists because they primarily serve patients with financial problems.

Telehealth

Telehealth is a significant solution to increase access to healthcare in rural communities in the United States. This innovative solution enables patients to receive healthcare services without necessarily meeting with providers. Telehealth is usually done online, implying that there needs to be a stable internet service on both ends (Mayo Clinic, 2022). A smartphone or computer is also required for this service to be offered. Telehealth increases access to healthcare by reducing waiting time. In others, services are provided as soon as they are needed. Through a video call, a medical officer describes what patients should do to care for themselves (Regis College, 2023). This has ensured that healthcare services are available even in the most rural locations.

Partnerships and Collaborations

The delivery of quality healthcare is a collective responsibility. It requires the input of different stakeholders to make it achievable. Rural communities are challenging to reach. Therefore, organizations need to play different roles in ensuring people access services. An organization such as Families USA accesses the most rural areas in the United States and provides them with healthcare services (Tulane University School of Public Health and Tropical Medicine, 2023). The organization partners with others that cannot physically reach the rural areas. They provide resources such as finances and other items needed in service delivery. In other words, different organizations join their efforts and play different roles to ensure rural communities in the United States can access quality healthcare. As aforementioned, healthcare is a collective responsibility and various stakeholders have different roles to play to provide rural communities in the United States can access proper services. Partnerships and collaborations are essential because they enable rural communities to experience the following benefits:

· Efficient delivery of care

Partnerships ensure the available resources are utilized correctly (Rushton & Youde, 2017). There are no wastes, implying that maximum output is received from minimal resources.

· Improved services and performance

Partnerships and collaborations increase rural communities' resources, leading to improved services and better performance (PhRMA, 2022). Providers are motivated and patients are satisfied.

· More flexibility in terms of payment options

Flexibility in payment models is a benefit brought through partnerships and collaborations. Rural communities have a variety of options that they can use to make payments for healthcare services received (Tulane University School of Public Health and Tropical Medicine, 2023).

· More recruitment and retention of staff

Partnerships provide more resources, enabling rural healthcare facilities to recruit more employees. An increase in staff is good news for local communities in the United States. It allows them to receive better services because there is more manpower.

When smaller local facilities partner with larger ones, the rural communities are the greatest beneficiaries because they are the final consumers of the services.

Common Barriers to Access to Health by Rural Communities in the United States

Despite the efforts by different agencies and stakeholders to make sure rural communities can access quality healthcare, many barriers still hinder them from achieving their purpose. There are obstacles that they must deal with before services are delivered to rural communities.

Scarcity of Services

One of the significant barriers to accessing quality health care in rural communities in the United States is the scarcity of services (Harvard University, 2019). It is noted that some services need a lot of investment to be availed. However, this is not the case. Most rural healthcare facilities only offer essential services and this limits what communities can access. When patients need advanced care, they have to travel to cities or major urban centers. The lack of such services in rural areas implies that most people cannot access them. Most facilities only offer primary basic care and cannot handle more complicated healthcare problems. Healthcare is about having a variety of services. When services ate limited, access is also limited.

Lack of Trained Physicians

Most trained physicians prefer working in urban areas because they get better incentives and are exposed to more opportunities that can help them to advance in their careers. This is a situation that limits the trained personnel available at rural healthcare facilities. Physicians who are not well trained cannot offer all the services patients need. Patients are not guaranteed that they access all the services that they need. This is a major barrier that interferes with the provision of healthcare services for rural communities in the United States. Sufficient staffing is required to provide the needed services so that patients can be served as they deserve. The lack of trained physicians implies that not all services can be offered. It is a situation that does not promote access to healthcare.

Transportation Challenges

Transportation is an important element in the delivery of healthcare. Without proper transport, it isn't easy to access healthcare. Rural areas have poor road networks, making it difficult for patients to get to a hospital. They spend too much time on the road and depending on the patient's condition, the outcome might be undesirable. Most healthcare facilities in rural areas also depend on roads to deliver supplies. Suppliers use roads to provide different items needed in the facilities. Due to poor roads, it is a challenge for the supplies to reach the facilities on time. In instances where perishable drugs should be delivered to facilities, it is a challenge because they are often given late, and sometimes they are already expired by the time they are delivered. Poor roads make transport difficult, which challenges patients and other stakeholders who need to be physically at the healthcare facility for different reasons.

Poor Internet Connectivity

The modern world is digitally connected and heavily relies on the internet for communication and research, among other important activities. Communities in rural areas do not experience the full benefits of the Internet because of poor connectivity. It is also tricky for telehealth to be operated when there is no internet. This is a concept where a healthcare professional links up with a patient through video calls or other forms of online communication (Strasser, 2003). It is a service that requires stable and fast internet connectivity. However, most rural areas in the United States are not lucky enough to access high-speed internet. This implies that the services they receive are limited. In the modern world, it is difficult to access even the most basic of services without the internet. The impact is felt in the healthcare sector as stakeholders cannot effectively be in touch with one another.

Healthcare facilities also need an internet connection to interact with other stakeholders. The lack of internet makes this communication difficult and significantly limits the services that can be offered in the facility.

Benefits of Accessible Health to Rural Communities in the United States

There are dozens of barriers to access to quality healthcare in rural communities in the United States. Most of these barriers are similar in most of the places. Before the community can realize benefits, the barriers must be eliminated. It should be noted that for a problem to be solved, it must first be understood (Bowling, 2023). It is the responsibility of relevant stakeholders, such as decision-makers, to understand the different barriers faced in different rural areas of the United States. Once the obstacles have been understood, corrective solutions can be devised to ensure they are solved in the best way possible (Advent Health University, 2022). Studies have indicated that organizations need to invest in understanding a problem before investing in implementing a solution.

Once the barriers have been addressed, solutions can be implemented and locals will start experiencing the benefits of accessing quality healthcare (Rural Health Information Hub, 2023). One of the barriers addressed is poor transportation. If this is handled, there will be better roads in the rural areas and this implies that it will be easier for locals to reach healthcare facilities for them to be treated for different needs. Healthcare is a basic need that everyone is entitled to. With proper access to healthcare, people will live healthier lives and life expectancy will also be increased (US Government Accountability Office, 2023). When people are healthy, they will have time to focus on other aspects of their lives that enable them to live happily. The government and other stakeholders must put their efforts together to ensure healthcare is accessible in rural areas (CDC, 2023).

References

AAMC. (2017). Health disparities affect millions in rural U.S. communities. Retrieved from https://www.aamc.org/news/health-disparities-affect-millions-rural-us-communities

Advent Health University (2022). How to improve healthcare in rural areas. Retrieved from https://www.ahu.edu/blog/improve-healthcare-in-rural-areas

Bergum, A. & Catlin, B. (2016). What works? Strategies to improve rural health. Retrieved from https://www.countyhealthrankings.org/reports/what-works-strategies-improve-rural-health

Bowling, A. (2023). Research methods in health: Investigating health and health services. Open University Press.

CDC. (2023). About rural health. Retrieved from https://www.cdc.gov/ruralhealth/about.html

Charalambous, P. (2023). Less staff, longer delays, and fewer options: Rural America confronts a healthcare crisis. Retrieved from https://abcnews.go.com/Health/staff-longer-delays-fewer-options-rural-america-confronts/story?id=97911613

CMS. (2022). Rural health strategy. Retrieved from https://www.cms.gov/files/document/rural-strat-guide-08-may.pdf

Federal Emergency Management Agency. (2022). The rural fire problem in the United States. Retrieved from https://www.usfa.fema.gov/downloads/pdf/statistics/rural.pdf

Griffiths, F. (2009). Research Methods for Healthcare Practice. Los Angeles: SAGE.

Harvard University (2019). Poll: Financial insecurity and limited access to health care plague many rural Americans. Retrieved from https://www.hsph.harvard.edu/news/hsph-in-the-news/poll-financial-insecurity-and-limited-access-to-health-care-plague-many-rural-americans/

HRSA (2022). Rural access to healthcare services request for information. Retrieved from https://www.hrsa.gov/rural-health/rfi-rural-health-care-access

Mayo Clinic (2022). Telehealth: Technology meets healthcare. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/telehealth/art-20044878#:~:text=What%20is%20telehealth%3F,technology%20you%20use%20from%20home .

NCSL (2020). Improving rural health: State policy options for increasing access to healthcare. Retrieved from https://www.ncsl.org/health/improving-rural-health

PhRMA. (2022). Addressing health disparities – Addressing barriers in health. Retrieved from https://phrma.org/equity?utm_campaign=2023-q2-equ-acc&utm_medium=pai_srh_cpc-ggl-adf&utm_source=ggl&utm_content=clk-pat-tpv_scl-geo_std-usa-all-pai_srh_cpc-ggl-adf-EquityEvergreenSearchWCDCKeyStatesMemberCo2-pra_equ-edu-inf-lrm-soc_txt-std-vrb-adf&utm_term=&gclid=Cj0KCQjw8NilBhDOARIsAHzpbLD_iy8DNZDGQv_622Qw48OgVFy79se3wPj1a–2uRnhwg7SynBEUWEaAoYaEALw_wcB

Regis College. (2023). Improving access to rural healthcare. Retrieved from https://online.regiscollege.edu/blog/rural-health-care/

Rural Health Information Hub. (2022). Health access in rural Communities. Retrieved from https://www.ruralhealthinfo.org/topics/healthcare-access

Rural Health Information Hub. (2023). Families USA. Retrieved from https://www.ruralhealthinfo.org/organizations/968

Rushton, S. & Youde, J. (2017). Routledge Handbook of global health security. Routledge.

Samuels, K., McClellan, M., Patel, K., & Darling, M. (2014). Transforming rural healthcare: High-quality, sustainable access to quality care. Retrieved from https://www.brookings.edu/articles/transforming-rural-health-care-high-quality-sustainable-access-to-specialty-care/

Singh, G. & Siahpush, M. (2013). Widening rural-urban disparities in life expectancy, U.S., 1969-2009. American Journal of Preventive Medicine, 46(2): 19-29.

Strasser, R. (2003). Rural health around the world: Challenges and solutions. Family Practice, 20(4): 457-463.

Tulane University School of Public Health and Tropical Medicine. (2023). How to improve healthcare in rural areas. Retrieved from https://publichealth.tulane.edu/blog/how-to-improve-health-care-in-rural-areas/

United Nations (2015). New UN report finds bulk of world’s rural populations excluded from healthcare access. Retrieved from https://www.un.org/sustainabledevelopment/blog/2015/04/new-un-report-finds-bulk-of-worlds-rural-populations-excluded-from-healthcare-access/#:~:text=The%20ILO's%20findings%20%E2%80%93%20published%20in,cent%20of%20rural%20inhabitants%20are

US Government Accountability Office. (2023). Why healthcare is harder to access in rural America. Retrieved from https://www.gao.gov/blog/why-health-care-harder-access-rural-america

Waldrop, T. & Gee, E. (2022). How states can expand healthcare access in rural communities. Retrieved from https://www.americanprogress.org/article/how-states-can-expand-health-care-access-in-rural-communities/

,

Chapter 3: Methodology

Student name

National University

COH 694B

July 31, 2023

CHAPTER 3: METHODOLOGY

The research design that will be used in this study is the qualitative research method. This type of research method focuses on collecting and analyzing non-numerical data to understand the reality of the situation (Bowling, 2023). Different research methods can be used in a study; therefore, the researcher needs to understand the nature of their research to use the most effective method to collect and analyze data. This research will use qualitative study because it has various benefits. It addresses two important questions "How?" and "Why?". This ensures that detailed data is collected, and the reality will be revealed through analysis. Interviews are not restricted. Therefore, more profound and more helpful information will be gathered. The qualitative research method is beneficial because it makes it possible to use multiple ways to collect data. The technique is also efficient because few resources are used, but the output is enormous.

Research Question

A research question is what the research focuses on. When research is conducted, it intends to make some revelations. Research questions guide the process. In other words, the entire research is focused on answering the research questions. In this study, the research question is:

What factors lead to poor access to healthcare by communities in rural America?

Previous research has revealed that rural communities in the United States have challenges accessing proper healthy care. This study will focus on unearthing the reasons for the situation and providing recommendations.

Description of the Participants

Participants are the people the research is focused on; they are the subjects the research will target to collect data (Bowling, 2023). Selecting participants is one of the most essential steps in a research process. They are the data sources; therefore, they should be chosen carefully. In this research, participants were residents of rural areas in the United States. They are the recipients of the services and will play a critical role in providing information concerning the research question. These participants were selected because they were directly affected by the situation. They will provide first-hand information that will help in understanding the problem.

Another lot of participants is made of healthcare service providers. These are professionals of different capacities in the healthcare sector working in facilities in the rural communities of the United States. They were selected randomly from different healthcare facilities in the rural areas. They have a deeper understanding of why their services are insufficient. They will be essential in providing information, especially about the resources available. The recommendations made after data analysis will primarily rely on the feedback received from healthcare professionals. They come in direct contact with the patients and the situation on the ground; therefore, they have helpful information to help make decisions to solve the problems.

Government agencies responsible for different types of infrastructure, such as roads and communication, will also participate. They will help address how infrastructure can be used to increase accessibility in rural areas. Every research has different participants. It is vital to ensure that the participants have relevant information about the study.

Instrumentation

The internet is a rich source of information. Several websites were used to obtain data. One of the websites used is www.gao.gov . This is the website for the U.S. Government Accountability Office, which is responsible for assisting Congress in overseeing federal programs and operations to make sure they are accountable to the American people. Rural health is one of the areas that the GAO website has valuable information, which is why it was used to obtain data. The U.S. Department of Health also has vital statistics about access to healthcare services by rural communities in the United States. These websites are reliable because the data and information available are based on professional research. They have factual content that can be used to make strategic decisions. Instruments used in research should be reliable because their content must be accurate and research-based (Samuels et al, 2014).

Data Collection Procedures

Informed consent was used in the process. Respondents and participants were educated about the research, its purpose, procedures, and potential impacts. They voluntarily decided to take part in the process. Informed consent is an important element in healthcare research. It is in line with ethical requirements. Participants have a right to understand what is entailed in a research process (Rushton & Youde, 2017). Interviews and questionnaires were used to collect data. They contained sets of questions that aimed at the primary research question. Most of the open-ended questions allowed respondents to speak their minds. Depending on the nature of the research, different data collection procedures can be used to obtain the best outcomes.

Data Analysis and Results

The most common type of data collected was ordinal data. This data type has ordered or ranked categories (Griffiths, 2009). For instance, ordinal data ranks the levels of satisfaction of patients. To prepare data for analysis, it will first be assembled from the different tools used in the collection process. The next step involves cleaning. This implies that errors will be removed or corrected to ensure everything is accurate. The data will then be labeled so that it is easy to identify different data sets. Lastly, the data will be validated and visualized. The data will be coded depending on the participants it collected from. For instance, data from residents will be coded differently from those from healthcare professionals. Data will be initially analyzed through the grounded theory. The methodology explains the experiences of people participating in the research; it gives meaning to their interactions.

Ethical Considerations

The first ethical consideration is the use of the informed consent protocol. Participants were educated about the research, and they confirmed that they understood what it entailed. They willingly took part in the process. The study promotes the aims by revealing problems in the system and recommending how the problem can be solved. It also enables the values of collaborative work because different stakeholders are putting their efforts together to get the job done. The research promotes moral and social values by focusing on improving accessibility to healthcare in rural communities in the United States.

References

Bowling, A. (2023). Research methods in health: Investigating health and health services. Open University Press.

Griffiths, F. (2009). Research Methods for Healthcare Practice. Los Angeles: SAGE.

Rushton, S. & Youde, J. (2017). Routledge Handbook of global health security. Routledge.

Samuels, K., McClellan, M., Patel, K., & Darling, M. (2014). Transforming rural healthcare: High-quality, sustainable access to quality care. Retrieved from

,

10

Chapter 5. Discussion and Conclusion

Ivory Coachman

National University

COH 694B

August 13, 2023

CHAPTER 5. DISCUSSION AND CONCLUSION

Introduction

The current chapter provides a discussion of the study findings, which answers the study question that focused on investigating some of the factors that lead to poor access to healthcare among the American communities living in rural America. The qualitative study using a grounded theory design reviewed 40 articles that answered the question of some factors contributing to poor healthcare service access in rural America. Some of the articles also suggested some of the strategies that can be implemented to enhance healthcare services access in rural America. The study findings indicate that people living in rural America have problems accessing medical services (Bergum & Catlin, 2016). The barriers to accessing medical services identified in the study include limited healthcare facilities, insufficient medical practitioners, healthcare facilities being located far from the people, and transportation to healthcare facilities being a problem (Rushton & Youde, 2017). The findings indicate that adopting healthcare technology such as telehealth and telemedicine will help increase access to healthcare services in rural America.

Most of the study findings that were reviewed in this study have confirmed that there is an urgent need to improve medical service access among the people living in rural America. Such strategies will reduce unwarranted deaths, reduce morbidity and mortality, and improve the well-being of the people living in rural America. Findings indicate that many obstacles, including demography, terrain, poor internet connection, lack of insurance coverage, and poor staffing of the health facilities, hinder healthcare access in rural America (Rushton & Youde, 2017). The authors agreed that mobile health, telehealth, and telemedicine technology could help increase healthcare access in rural areas. The role of medical technology in delivering health care to people in the rural area presents an exclusive avenue where this system/s were used to address patient needs. Still, the focus of this study was access to care and eliminating barriers.

Findings of a study by Rural Health Information Hub. (2022) noted that American citizens are entitled to receive access to at least basic healthcare services such as primary care, behavioral care, dental care, and public health services, among others. However, this is not possible in rural America, where it is estimated that more than 45% of the population has no or limited access to healthcare services. Indeed the listed healthcare services are basic and should be accessed by all Americans (Bergum & Catlin, 2016). However, many Americans cannot access the services because of the many barriers to healthcare services that are more prevalent in rural areas. The dangers or the impacts of limited access to healthcare in America were revealed in a study by Singh and Siahpush (2013). Singh and Siahpush (2013) noted that life expectancy in rural America was 76.7 years, while in urban was 79.1 years. This evidence proves the health disparities in America, yet technology can be used to bridge the disparities.

Findings indicate that although mobile health clinics are in place to increase access to healthcare in rural communities in the United States, many parts of the country cannot be accessed, limiting the use of mobile clinics (Waldrop & Gee, 2022). Mobile clinics enable healthcare professionals to provide healthcare services where the patient is. In conventional healthcare, the patient visits the healthcare facility. However, in this case, it is the reverse. Mobile health providers are always on the move to ensure patients get the services in the comfort of their homes or places of work. Mobile clinics have been found to solve the transportation problem as a barrier to healthcare access. Evidence from studies shows that telehealth is a significant solution to increase access to healthcare in rural communities in the United States.

Telehealth and telemedicine enable patients to receive healthcare services without necessarily meeting with providers. Telehealth is usually done online, implying that there needs to be a stable internet service on both ends (Mayo Clinic, 2022). Mobile health clinics are in place to increase access to healthcare in rural communities in the United States (Waldrop & Gee, 2022). Mobile clinics enable healthcare professionals to provide healthcare services where the patient is. In conventional healthcare, the patient visits the healthcare facility. The delivery of quality healthcare is a collective responsibility (CDC, 2023). It requires the input of different stakeholders to make it achievable. Rural communities are challenging to reach. Therefore, organizations need to play different roles in ensuring people access services.

An organization such as Families USA accesses the most rural areas in the United States and provides them with healthcare services (Tulane University School of Public Health and Tropical Medicine, 2023). The authors agreed that solutions could be implemented once the barriers have been addressed, and locals will start experiencing the benefits of accessing quality healthcare (Rural Health Information Hub, 2023). One of the barriers addressed is poor transportation. If this is handled, there will be better roads in the rural areas, which implies that it will be easier for locals to reach healthcare facilities to be treated for different needs.

A study by Strasser (2003) revealed that the modern world is digitally connected and heavily relies on the Internet for communication and research, among other essential activities. Communities in rural areas do not experience the full benefits of the Internet because of poor connectivity. Poor connectivity and limited internet connection are barriers to telemedicine and telehealth use in the United States (NCSL, 2020). Healthcare professionals in rural areas cannot utilize the benefits of telehealth without internet connectivity. In this way, the federal and state government should improve internet connectivity in rural areas to ensure that telemedicine and telehealth are utilized optimally to increase healthcare services access in rural areas. It is a service that requires stable and fast internet connectivity. However, most rural areas in the United States are not lucky enough to access high-speed Internet (CDC, 2023). This implies that the services they receive are limited. Accessing even the most basic of services without the Internet is difficult in the modern world. Healthcare facilities also need an internet connection to interact with other stakeholders. The lack of Internet makes this communication difficult and significantly limits the services that can be offered in the facility.

Limitations

The current study's limitations are that only articles published on the subject from 2003 to date were used to synthesize the findings. The study did not incorporate literature and research findings from books which may have provided a more professional and credible assessment of the current healthcare situation in rural areas. Similarly, the review did not include data from reliable state and federal government agencies to test the legitimacy of the findings from different publications reviewed herein. Again, the study used some articles not published in America, which may have provided or induced a different perspective on the American system; hence the actual pictures of the state of healthcare services access in America may have been compromised.

Conclusion

Healthcare is one of the basic human needs for people's health. Regardless of the situation, healthcare is a fundamental need that must be met. Despite the sensitivity of healthcare, millions of people across the globe still have challenges when it comes to accessing healthcare. Rural communities are among the most affected by the lack of proper access to healthcare. Findings indicate that American citizens are entitled to receive access to at least basic healthcare services such as primary care, behavioral care, dental care, and public health services, among others. However, this is not possible in rural America, where it is estimated that more than 45% of the population has no or limited access to healthcare services. The federal government should implement telehealth, mobile clinics, and telemedicine strategies in rural areas to increase access to medical services among the people living in rural areas. Implementing medical technology health programs in rural areas will play a significant role in bridging the healthcare disparities in America, which are caused by infrastructure and structural deficiencies.

Recommendations for Further Study

The current study focused on understanding some factors impeding medical services access in rural America. Many of the studies reviewed in this study investigated a range of barriers to medical service access, which may have limited the recommendations because of the broad scope of the study. Future studies should be done to focus on sociocultural factors that hinder healthcare services access in rural America. The findings of such a study will play a significant role in addressing healthcare disparities caused by social and cultural factors other than focusing on economic factors. Similarly, many studies have been done to investigate factors that hinder healthcare access in rural areas. However, most of these studies have adopted a qualitative approach to investigate the issue. Quantitative studies should be conducted in the future to investigate factors that impede access to healthcare services in rural America today. The findings of such a study will reveal current and practical aspects so that they can be mitigated through policy advocacy.

References

AAMC. (2017). Health disparities affect millions in rural U.S. communities. Retrieved from https://www.aamc.org/news/health-disparities-affect-millions-rural-us-communities

Advent Health University (2022). How to improve healthcare in rural areas. Retrieved from https://www.ahu.edu/blog/improve-healthcare-in-rural-areas

Bergum, A. & Catlin, B. (2016). What works? Strategies to improve rural health. Retrieved from https://www.countyhealthrankings.org/reports/what-works-strategies-improve-rural-health

Bowling, A. (2023). Research methods in health: Investigating health and health services. Open University Press.

CDC. (2023). About rural health. Retrieved from https://www.cdc.gov/ruralhealth/about.html

Charalambous, P. (2023). Less staff, longer delays, and fewer options: Rural America confronts a healthcare crisis. Retrieved from https://abcnews.go.com/Health/staff-longer-delays-fewer-options-rural-america-confronts/story?id=97911613

CMS. (2022). Rural health strategy. Retrieved from https://www.cms.gov/files/document/rural-strat-guide-08-may.pdf

Federal Emergency Management Agency. (2022). The rural fire problem in the United States. Retrieved from https://www.usfa.fema.gov/downloads/pdf/statistics/rural.pdf

Griffiths, F. (2009). Research Methods for Healthcare Practice. Los Angeles: SAGE.

Harvard University (2019). Poll: Financial insecurity and limited access to health care plague many rural Americans. Retrieved from https://www.hsph.harvard.edu/news/hsph-in-the-news/poll-financial-insecurity-and-limited-access-to-health-care-plague-many-rural-americans/

HRSA (2022). Rural access to healthcare services request for information. Retrieved from https://www.hrsa.gov/rural-health/rfi-rural-health-care-access

Mayo Clinic (2022). Telehealth: Technology meets healthcare. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/telehealth/art-20044878#:~:text=What%20is%20telehealth%3F,technology%20you%20use%20from%20home .

NCSL (2020). Improving rural health: State policy options for increasing access to healthcare. Retrieved from https://www.ncsl.org/health/improving-rural-health

PhRMA. (2022). Addressing health disparities – Addressing barriers in health. Retrieved from https://phrma.org/equity?utm_campaign=2023-q2-equ-acc&utm_medium=pai_srh_cpc-ggl-adf&utm_source=ggl&utm_content=clk-pat-tpv_scl-geo_std-usa-all-pai_srh_cpc-ggl-adf-EquityEvergreenSearchWCDCKeyStatesMemberCo2-pra_equ-edu-inf-lrm-soc_txt-std-vrb-adf&utm_term=&gclid=Cj0KCQjw8NilBhDOARIsAHzpbLD_iy8DNZDGQv_622Qw48OgVFy79se3wPj1a–2uRnhwg7SynBEUWEaAoYaEALw_wcB

Regis College. (2023). Improving access to rural healthcare. Retrieved from https://online.regiscollege.edu/blog/rural-health-care/

Rural Health Information Hub. (2022). Health access in rural Communities. Retrieved from https://www.ruralhealthinfo.org/topics/healthcare-access

Rural Health Information Hub. (2023). Families USA. Retrieved from https://www.ruralhealthinfo.org/organizations/968

Rushton, S. & Youde, J. (2017). Routledge Handbook of global health security. Routledge.

Samuels, K., McClellan, M., Patel, K., & Darling, M. (2014). Transforming rural healthcare: High-quality, sustainable access to quality care. Retrieved from https://www.brookings.edu/articles/transforming-rural-health-care-high-quality-sustainable-access-to-specialty-care/

Singh, G. & Siahpush, M. (2013). Widening rural-urban disparities in life expectancy, U.S., 1969-2009. American Journal of Preventive Medicine, 46(2): 19-29.

Strasser, R. (2003). Rural health around the world: Challenges and solutions. Family Practice, 20(4): 457-463.

Tulane University School of Public Health and Tropical Medicine. (2023). How to improve healthcare in rural areas. Retrieved from https://publichealth.tulane.edu/blog/how-to-improve-health-care-in-rural-areas/

United Nations (2015). A New U.N. report finds most of the world's rural populations excluded from healthcare access. Retrieved from https://www.un.org/sustainabledevelopment/blog/2015/04/new-un-report-finds-bulk-of-worlds-rural-populations-excluded-from-healthcare-access/#:~:text=The%20ILO's%20findings%20%E2%80%93%20published%20in,cent%20of%20rural%20inhabitants%20are

US Government Accountability Office. (2023). Why healthcare is harder to access in rural America. Retrieved from https://www.gao.gov/blog/why-health-care-harder-access-rural-america

Waldrop, T. & Gee, E. (2022). How states can expand healthcare access in rural communities. Retrieved from https://www.americanprogress.org/article/how-states-can-expand-health-care-access-in-rural-communities/

,

A SYSTEMATIC REVIEW OF THE EFFECTIVENESS OF TELEHEALTH/TELEMEDICINE

IN IMPROVING ACCESS TO CARE AND PATIENT SATISFACTION

Student Name

Capstone Project

In partial fulfillment of the degree Master of Public Health

National University

End of Course Date

I accept this capstone project on behalf of the Community Health Department, School of Health and Human Services, National University. Below the faculty who taught the capstone course, and the MPH Program Director will sign.

__________________________________________ ___________

Faculty/Professor of Capstone Date

Brandon Eggleston PhD

__________________________________________ ___________

MPH Program Director Date

Tyler Smith PhD

iii

Abstract

Objective: This systematic literature review aims to provide a comprehensive synthesis of the impact of Telehealth and Telemedicine in improving access to care and increasing patient satisfaction in various healthcare services before, during, and maybe after the COVID-19 pandemic.

Design: Systematic literature review.

Methods: This systematic review was conducted from January to February 2022 using comprehensive and general searches throughout the National University Smart Search, EBSCO Host, ProQuest, and Google Scholar databases. The publication date range was from 2008 to 2022. After collecting articles from databases, further selection was performed by reading the abstract and results. The chosen articles were further studied by reading the entire text to analyze the research questions.

Results: The articles studied in this systematic review strongly supports that telehealth and telemedicine play an essential role in increasing access to care and improving satisfaction rate. During the COVID-19 pandemic, telehealth and telemedicine were deployed unprecedentedly, providing continuous care for patients of various services.

Conclusion: Telehealth/Telemedicine has a remarkable impact in widening access to care and a high satisfaction rate. It is poised to provide public health, relieve pressure on to healthcare workforce, and help to reduce financial stress to many.

ii

iii

Keywords: Telehealth, Telemedicine, Barriers, Access to Care, Patient Satisfaction

2

2

,

,

1

Chapter 4. Data Collection, Analysis and Results

Student’s Name

Name of the Institution

Course Number and Name

Professor

Due Date

CHAPTER 4. DATA COLLECTION, ANALYSIS, AND RESULTS

Introduction

In the present chapter, I will discuss the study results based on the findings from literature review. A deep analysis of the findings will be done to present the study results. The methods and steps to identify the selected articles used in this study will be explained. The reviewed articles' results are also presented in this chapter.

Data Collection Procedures

The systematic literature review using PRISMA model was done to investigate some of the factors that lead to poor access to healthcare among the American communities living in rural America. Since its publication more than a decade ago, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement has become the widely used reporting guideline in biomedical literature. The statement has undergone several reviews including the recent PRISMA2020, which was an updated version to include more important guidelines that guide systematic reviews in biomedical. The PRISMA Statement and its extensions are an evidence-based, minimum set of recommendations designed primarily to encourage transparent and complete reporting of SRs. This growing set of guidelines have been developed to aid authors with appropriate reporting of different knowledge synthesis methods (such as SRs, scoping reviews, and review protocols) and to ensure that all aspects of this type of research are accurately and transparently reported. Previous research has revealed that rural communities in the United States have challenges accessing proper health care. This study, therefore, focused on unearthing the reasons for the situation and providing recommendations. The study also examined how medical technology can improve healthcare access in rural areas. The study focused on a review of published literature on the topic and related subjects.

From the onset of the study, several articles were retrieved from different databases and were subjected to further scrutiny. A total of (n=77) articles were identified and selected initially. After reading the abstracts of the articles, which include article overview, results, discussion, and conclusion, (n=53) were identified but (n=13) articles were deleted from the list of identified because they did not meet the inclusion criteria. The remaining articles ( n = 40) were grouped into three; one group talked about access to care ( n = 19); the second group was all about how access can be improved ( n =11); the third group focused on access and improvement strategies ( n = 6). Figure 1: (Appendix 1) and Table 1: (Appendix 2) show the article identification, selection map, and articles incorporated in the review.

General overviews of the article findings indicate that many obstacles, including demography, terrain, poor internet connection, lack of insurance coverage, and poor staffing of the health facilities, hinder healthcare access in rural America. The authors agreed that mobile health, telehealth, and telemedicine technology could help increase healthcare access in rural areas. The role of medical technology in delivering health care to people in rural areas presents an exclusive avenue where this system/s was used to address patient needs. Still, the focus of this study was access to care and eliminating barriers.

Data Analysis and Results

The titles, authors' names, and the date of publication of the articles reviewed in this study are provided in Appendix 2. The findings of the studies indicate that lack of access to healthcare or limited access is a huge problem that the American healthcare system must address. For instance, a study that Rural Health Information Hub did. (2022) that American citizens are entitled to access at least basic healthcare services such as primary care, behavioral care, dental care, and public health services, among others. However, this is not possible in rural America, where it is estimated that more than 45% of the population has no or limited access to healthcare services. Similarly, authors of the articles that were reviewed in this study agree that access to healthcare in rural America is imperative for several reasons presented in Table 1 below:

No	Importance Of Healthcare Services Access	Article In-Text Citation
1.	Improving overall physical, mental, and social health status	(Rural Health Information Hub, 2022)
2.	Prevention of diseases	(NCSL, 2020)
3.	Detection, diagnosis, and treatment of illnesses	(HRSA, 2022)
4.	Improving the quality of care	(Griffiths, 2009)
5.	Avoiding preventable loss of life	(Federal Emergency Management Agency (2022)
6.	Increasing life expectancy	(Singh & Siahpush, 2013)

Table 1: Significance of health care services access

Data and findings from the studies that have focused on understanding the impacts of limited or no access to health care services in rural areas in Table 1 above show an urgent need to solve the health care problem. For instance, a study by Singh and Siahpush (2013) noted that life expectancy in rural America was 76.7 years, while in urban was 79.1 years.

The article's authors found that telehealth is a significant solution to increase access to healthcare in rural communities in the United States. This innovative solution enables patients to receive healthcare services without necessarily meeting with providers. Telehealth is usually done online, implying that there needs to be a stable internet service on both ends (Mayo Clinic, 2022). Mobile health clinics are in place to increase access to healthcare in rural communities in the United States (Waldrop & Gee, 2022). Mobile clinics enable healthcare professionals to provide healthcare services where the patient is. In conventional healthcare, the patient visits the healthcare facility. The delivery of quality healthcare is a collective responsibility. It requires the input of different stakeholders to make it achievable. Rural communities are challenging to reach. Therefore, organizations need to play different roles in ensuring people access services.

An organization such as Families USA accesses the most rural areas in the United States and provides them with healthcare services (Tulane University School of Public Health and Tropical Medicine, 2023). The authors agreed that solutions could be implemented once the barriers have been addressed, and locals will start experiencing the benefits of accessing quality healthcare (Rural Health Information Hub, 2023). One of the barriers addressed is poor transportation. If this is handled, there will be better roads in the rural areas, which implies that it will be easier for locals to reach healthcare facilities to be treated for different needs.

References

AAMC. (2017). Health disparities affect millions in rural U.S. communities. Retrieved from https://www.aamc.org/news/health-disparities-affect-millions-rural-us-communities

Advent Health University (2022). How to improve healthcare in rural areas. Retrieved from https://www.ahu.edu/blog/improve-healthcare-in-rural-areas

Bergum, A. & Catlin, B. (2016). What works? Strategies to improve rural health. Retrieved from https://www.countyhealthrankings.org/reports/what-works-strategies-improve-rural-health

Bowling, A. (2023). Research methods in health: Investigating health and health services. Open University Press.

CDC. (2023). About rural health. Centers for Disease Control and Prevention Rural Health Page. Retrieved from https://www.cdc.gov/ruralhealth/about.html

Charalambous, P. (2023). Less staff, longer delays, and fewer options: Rural America confronts a healthcare crisis. Retrieved from https://abcnews.go.com/Health/staff-longer-delays-fewer-options-rural-america-confronts/story?id=97911613

CMS. (2022). Rural health strategy. Retrieved from https://www.cms.gov/files/document/rural-strat-guide-08-may.pdf

Federal Emergency Management Agency. (2022). The rural fire problem in the United States. Retrieved from https://www.usfa.fema.gov/downloads/pdf/statistics/rural.pdf

Griffiths, F. (2009). Research methods for healthcare practice. SAGE.

Harvard University (2019). Poll: Financial insecurity and limited access to health care plague many rural Americans. Retrieved from https://www.hsph.harvard.edu/news/hsph-in-the-news/poll-financial-insecurity-and-limited-access-to-health-care-plague-many-rural-americans/

HRSA (2022). Rural access to healthcare services request for information. Retrieved from https://www.hrsa.gov/rural-health/rfi-rural-health-care-access

Mayo Clinic (2022). Telehealth: Technology meets healthcare. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/telehealth/art-20044878#:~:text=What%20is%20telehealth%3F,technology%20you%20use%20from%20home.

NCSL (2020). Improving rural health: State policy options for increasing access to healthcare. Retrieved from https://www.ncsl.org/health/improving-rural-health

PhRMA. (2022). Addressing health disparities – Addressing barriers in health. Retrieved from https://phrma.org/equity?utm_campaign=2023-q2-equ-acc&utm_medium=pai_srh_cpc-ggl-adf&utm_source=ggl&utm_content=clk-pat-tpv_scl-geo_std-usa-all-pai_srh_cpc-ggl-adf-EquityEvergreenSearchWCDCKeyStatesMemberCo2-pra_equ-edu-inf-lrm-soc_txt-std-vrb-adf&utm_term=&gclid=Cj0KCQjw8NilBhDOARIsAHzpbLD_iy8DNZDGQv_622Qw48OgVFy79se3wPj1a–2uRnhwg7SynBEUWEaAoYaEALw_wcB

Regis College. (2023). Improving access to rural healthcare. Retrieved from https://online.regiscollege.edu/blog/rural-health-care/

Rural Health Information Hub. (2022). Health access in rural Communities. Retrieved from https://www.ruralhealthinfo.org/topics/healthcare-access

Rural Health Information Hub. (2023). Families USA. Retrieved from https://www.ruralhealthinfo.org/organizations/968

Rushton, S. & Youde, J. (2017). Routledge Handbook of global health security. Routledge.

Samuels, K., McClellan, M., Patel, K., & Darling, M. (2014). Transforming rural healthcare: High-quality, sustainable access to quality care. Retrieved from https://www.brookings.edu/articles/transforming-rural-health-care-high-quality-sustainable-access-to-specialty-care/

Singh, G., & Siahpush, M. (2013). Widening rural-urban disparities in life expectancy, U.S., 1969-2009. American Journal of Preventive Medicine, 46(2), 19-29.

Strasser, R. (2003). Rural health around the world: Challenges and solutions. Family Practice, 20(4), 457-463.

Tulane University School of Public Health and Tropical Medicine. (2023). How to improve healthcare in rural areas. Retrieved from https://publichealth.tulane.edu/blog/how-to-improve-health-care-in-rural-areas/

United Nations (2015). A New U.N. report finds most of the world's rural populations excluded from healthcare access. Retrieved from https://www.un.org/sustainabledevelopment/blog/2015/04/new-un-report-finds-bulk-of-worlds-rural-populations-excluded-from-healthcare-access/#:~:text=The%20ILO's%20findings%20%E2%80%93%20published%20in,cent%20of%20rural%20inhabitants%20are

US Government Accountability Office. (2023). Why healthcare is harder to access in rural America. Retrieved from https://www.gao.gov/blog/why-health-care-harder-access-rural-america

Waldrop, T., & Gee, E. (2022). How states can expand healthcare access in rural communities. American Progress Organization. Retrieved from https://www.americanprogress.org/article/how-states-can-expand-health-care-access-in-rural-communities/

APPENDIX 1: ARTICLE SELCTION PROCESS

Figure 1. Study Selection Flow Diagram