Perceived Stigma and Accessing Health and Mental Healthcare in Rural Communities

Background: Research suggests that access to health and mental healthcare in rural locations in the United States is a challenge for many people. Research further suggests that accessing health and mental healthcare while possessing a stigmatized social identity in a rural community can present further barriers to receiving care, where stigmatized social identity refers to an identity that the community majority creates and maintains a negative social attitude toward an individual as a result of a perceived mental, physical, or social deficiency. The purpose of this research is to develop a perceived stigma scale to better understand the relationship between perceived stigma and access to health and mental healthcare in rural communities among persons possessing a stigmatized identity.

Methods: Logistic regression was used to conduct analyses of data from the All-of-US dataset, which resulted in an analytic sample of n = 5384 after assessing for rural placement and missing data. Perceived Stigma was developed using nine indicators of perceived community inclusiveness using correlation matrices and factor analyses, while stigmatized identity was developed from self-reported identities of race, sexual orientation, religion, socioeconomic status, sex and education level. After developing Perceived Stigma, logistic regression was used to assess the relationship between stigmatized social identity and access to health and mental healthcare, while comparison groups were developed from persons not claiming specific stigmatized identities. Interactions between stigmatized identities were not assessed in this research.

Results: Correlation matrices indicated high correlation among all nine perceived community inclusiveness items (r ≥ .70 for all measurements), and factor analyses indicated that all nine items factored together (Factor Loading ≥ 0.50). As a result, the composite variable of Perceived Stigma was created taking the average of these items (Chronbach’s α =.74), where higher scores indicated increased perceived stigma.

Logistic regression results indicated that compared to comparison groups, all other social identities experienced an increased of perceived stigma and accessed health and mental health less frequently, with the exception of females in comparison to males. Persons reporting the highest rates of perceived stigma were of the LGBTQ+ community and were the least likely to access health and mental healthcare (OR = 11.79; 95% CI: 10.09, 13.34) followed by Persons of Color (OR = 7.53; 95% CI: 4.72-9.21). Education level (OR = 3.14; 95% CI: 2.12, 3.97) and socioeconomic status (OR = 2.35; 95% CI: 2.28-3.11) had similar odds of accessing health and mental healthcare.

Implications: These results suggest that persons who maintain stigmatized identities experience stigma at varied severity among rural communities and that perceived stigma is correlated with accessing health and mental healthcare. Implications for practice, future research and policy are discussed.