Perceived Health Care Status and Needs of Women Aged 50-65 in Rural Missouri: A Qualitative Assessment

Background/Purpose: Little is known about the health care status and needs of older rural women and factors that facilitate or inhibit health-seeking behavior. We were funded by the Missouri Foundation for Health to conduct an assessment of health status and access to health services among rural-residing women 50-65 years of age in 10 rural Missouri counties in order to identify areas for intervention.

Methods: Eleven focus groups with 122 women occurred with Spanish speaking Latinas (2 groups), African-Americans (3 groups) and whites (5 groups). Women were queried about the health status of women in their community and about the facilitators and barriers to health care services for women in their age group. Discussion leaders were of the same ethnic/racial background as the participants.

Results: Analysis of focus group transcripts identified five major themes.

1.The interrelated challenges of minimal personal and infrastructure resources: Personal resource limitations, low income and lack of health insurance were mentioned frequently, often in tandem with transportation problems experienced when trying to access health services. Distance and the need to travel were understood to be the price of living in rural communities. However, for many women and their families, transportation was an ongoing problem, made worse when health problems hit, and diagnostic and treatment services were only available in larger, distant communities. Personal and family health problems intensified the challenges. Diabetes and being responsible for the care of grandchildren were frequently mentioned, as well as less common but real medical problems or a child with schizophrenia. Community resources were often not available to make up for these individual and family challenges.

2.Rural secrets of mental health problems, violence and substance use: Mental health problems present a special challenge in rural communities because of both limited awareness about these problem and few resources to address them. Stigma and the resultant desire for secrecy seem to be ever-present.

3.Denial: Whether from fear, lack of knowledge or sense of fate, most of the focus group discussions mentioned that there were women in their communities who just did not want to have any screening tests done or to see a health care provider about any issue. A general resistance to assistance of any sort was noted.

4.A badly stretched primary care system: Primary care, the basis of the health care system and the place where women can expect to receive appropriate health screening and education, was heavily overloaded in many of the counties in which we conducted focus group interviews. Communication was mentioned as a source of discontent with primary care.

5.Minimal health literacy: When asked about health, most women seemed to think about illness and insurance. Wellness was not a focus of attention. There seemed to be minimal knowledge about nutrition, many jokes about exercise and little discussion of prevention strategies such as stress relief or adult immunizations.

Conclusion: Barriers to accessing health care among rural older women included mental health and personal issues. The findings have important policy implications for improving their health care access and utilization.