Patient-perceived barriers to preventive health care among indigent, rural Appalachian patients

To examine perceptions of a cohort of rural Appalachian patients regarding barriers to the use of preventive health measures.

Consecutive new patients (N = 188) at a clinic for the indigent were confidentially surveyed about their use of six preventive health measures: blood pressure screening, cholesterol level, diphtheria-tetanus immunization, mammography, cervical Papanicolaou smear, and physical examination. When any of these measures was lacking, patients were asked why, and whether they would have the measure performed if the relevant barriers were removed.

Applicable screening measures lacking were as follows: blood pressure screening, 16%; cholesterol level, 60%; diphtheria-tetanus immunization, 67%; mammography, 69%; Papanicolaou smear, 22%; and physical examination, 32%. Of the patients, 85% were lacking at least one measure. Patients most often identified the following reasons for having omitted these measures: lack of knowledge about prevention (51%) and cost (36%). Older and less educated patients more often identified cost (P < .01 and P = .06, respectively), and men were more likely to list lack of knowledge (P = .04). If the identified barriers could be removed, 72% of those lacking a screen indicated they would obtain the screening measures.

This indigent population expressed a desire for preventive care. Our patients identified cost and lack of knowledge as the major reasons for omitting these health screening measures. Data obtained from health care providers, rather than patients, may fail to disclose the barriers these patients face. Adequate education about disease prevention may be as crucial as sufficient funding in improving compliance with preventive guidelines.