Transportation is a barrier greatly associated with rescheduled or missed medical appointments and delayed or unmet medical care, resulting in an increased financial burden for individuals and public health systems. Particularly for those with fewer socioeconomic resources, lack or inaccessibility of transportation exacerbates their healthcare management. In addition, rural areas further impede individuals from seeking timely healthcare services compared to their urban counterparts. This study aims to explore: (1) opinions on the transportation services in rural Alabama, including concerns and perceived challenges and (2) the impact of transportation on participants’ healthcare access and health.
This study utilized a qualitative phenomenology approach to understand the live experiences of transportation among people living in rural Alabama. Focus groups were used to obtain diverse and extensive data on the barriers and needs of transportation among rural communities. A total of four focus groups were conducted with four to five participants in each and lasted 40 to 60 minutes. A conventional content analysis approach and an inductive approach that aims to gather themes directly from the participants were used. Using NVivo, a verbatim transcript was analyzed by four research team members.
Participants highlighted two transportation challenges: limited transportation-related infrastructure and high transportation-related costs. Limited infrastructure included a low amount of gas stations. Due to the rurality, there was often one gas station per community or none that people had to travel some distance to access gas stations. The high transportation-related cost was another barrier, with individuals paying high to others for transportation services. Even among those who had their own vehicles, the price of gas was sometimes too high to afford. Overall, both groups had to plan in advance financially because their income was often limited to meet their basic needs. Hence, participants experienced difficulties in affording transportation-related expenses in order to access healthcare and other general services.
Our findings have highlighted the lack of public transportation in rural communities. Transportation has been listed as one of the important factors in the built environment domain of social determinants of health, indicating that transportation significantly impacts health and health outcomes. Our findings also demonstrated that transportation barriers are significantly related to limited access to food, health prevention services, and care for chronic conditions. Therefore, increasing transportation-related services is urgently needed. As people in the area could not afford personal vehicles or gas, traveling for basic needs and healthcare were challenging. Therefore, any mode of transportation for general purposes rather than only health-related services should be expanded. A possible solution is providing localized transportation that runs more frequently.