Understanding barriers and facilitators to pediatric surgical access for rural patients: A qualitative study

This study explored the experiences and perspectives of the barriers and facilitators to pediatric surgical care for families accessing care from rural communities.

From April 2024 to March 2025, we conducted semi-structured interviews with parents/guardians/caregivers of children who had surgery at a large free-standing children's hospital. The interviews were recorded and transcribed verbatim. Thematic analysis was based on grounded theory, employing a reflexive approach, with two research team members performing coding. Participants were recruited and interviewed until thematic saturation was achieved, and no new themes emerged.

13 interviews were conducted to achieve thematic saturation. Three major themes emerged regarding barriers to care: (1) physician shortages - families noted a lack of specialist and family physicians in rural communities; (2) financial barriers - families endured the additional costs of travel, childcare, hotels and parking during their care, and (3) personal logistics - families noted that time off work and travelling back and forth to access care was a major barrier. Three major themes regarding facilitators also emerged: (1) creating opportunities for specialists to visit rural communities, (2) offering telehealth services, and (3) improving support for families through navigating pediatric surgical care by social workers/other services.

Families from rural communities experience multiple barriers to care with various opportunities for improved facilitators. Co-creating strategies to address access to surgery for pediatric patients is essential to improve access for children from rural communities.