Examining the Role of Social Networks and Partnership Status in Healthcare Access for Individuals with Disabilities

Background and Purpose:

In the U.S., adults with disabilities are more likely to encounter barriers to necessary healthcare, making them vulnerable to adverse outcomes. The structural factors contributing to these disparities have been documented: physical barriers, financial constraints, discrimination, and issues with healthcare coverage. Social factors remain understudied. Individuals who are unpartnered/unmarried, and who therefore may lack informal caregiving support, may face additional barriers to healthcare, further increasing their precarity. Understanding the role of social networks is especially critical for this group as they may rely more heavily on non-spousal support systems to navigate healthcare access. To inform effective interventions, this study employed a multifactorial framework to examine: (1) whether social networks and other enabling/disabling factors explain disparities in healthcare access barriers for people with disabilities, and (2) whether the relationships between enabling/disabling factors and healthcare access barriers vary by disability status and marital/partnership status.

Methods:

Utilizing the Network Episode Model and data from the Health Equity and Intersectionality Study (n = 335), we conducted hierarchical linear regression analyses to examine whether enabling/disabling factors (200% of federal poverty level; childhood adversity; discrimination in healthcare systems; partnership/marital status; health facility advisors; health information confidants; health support confidants; and community engagement) mediated the relationship between disability and healthcare access barriers (lack of transportation; care uncertainty; and care unavailability). For our second research question, we tested three-way interactions between enabling/disabling factors, disability status, and marital/partnership status. All models controlled for age, gender, sexual orientation, race and ethnicity, and number of chronic conditions.

Results:

Of structural factors, perceived discrimination in the healthcare system consistently mediated the relationship between disability and higher barriers to healthcare. The relationship between disability and higher barriers related to transportation was also mediated by poverty, childhood adversity, and a greater number of health information confidants. We also found significant interaction effects, suggesting that the relationships between enabling/disabling factors and healthcare access differed across disability and partnership/marital status groups. Specifically, the association between the number of health information confidants and perceived care availability significantly varied by disability and partnership status (p = .048). Additionally, the association between poverty and both lack of transportation (dy/dx = 0.931, p < .001 vs. –0.193, p = .377) and perceived unavailability of care (dy/dx = 0.407, p = .036 vs. –0.488, p = .021) was considerably stronger for disabled individuals who were single compared to those who were partnered or married.

Conclusion:

Our findings highlight the critical role of structural factors in shaping healthcare access barriers for individuals with disabilities. While the number of health information confidants mediated some transportation barriers, the role of social networks as enablers of healthcare access warrants further investigation. Our finding that poverty intensifies transportation barriers and care uncertainty for unmarried/unpartnered individuals with disabilities suggests informal care from a partner/spouse may help buffer these barriers. Future research should focus on reducing the impact of discrimination and poverty on healthcare access for individuals with disabilities and explore how social networks can be leveraged to address care gaps for unmarried/unpartnered individuals.