April 7-9, 2022 • Hyatt Regency • Lexington, KY
Communication Strategies to Promote Comprehensive Well-being
Communication Strategies to Promote Comprehensive Well-being
Abstract: Preliminary Evidence of Appalachians’ Distrust of Local Healthcare Providers
Over 51 million Americans live in rural areas (Pender, Hertz, Cromartie, & Farrigan, 2019) and West Virginia and all of Appalachia contain many of these citizens. Rural residents have significant disparities in access to quality healthcare services, with higher levels of chronic disease and poor health outcomes (Agency for Healthcare Research and Quality, 2020). Reluctance or inability to seek healthcare in rural areas is often based upon cultural, financial, and travel constraints. This is compounded by service scarcity, lack of trained physicians, insufficient public transport, and poor Internet availability (Douthit, 2015). Another factor becoming more widely recognized, yet poorly studied, is patient distrust and low confidence in local healthcare. One study reports up to 80% of patients having some level of distrust in local healthcare, and 10-20% distrusting their primary provider (Armstrong, 2006). Some research finds that Appalachians doubt their providers’ competence (Bachman et al., 2018; McAlearney et al., 2012) and may instead seek care in population centers. However, studies observing this phenomenon only partially touch on its effect on care-seeking, resulting in no data speaking to how Appalachians view providers differently and how that impacts care access. This mixed-methods study serves as a pilot to study this phenomenon in Appalachia. The project team surveyed recent transfers to their institution’s academic hospital (N=72 patients), utilizing online open- and closed-ended surveys to better understand why patients transfer to the hospital based on their perceptions of local healthcare providers. Qualitative results indicate that patients transferred because they believed local providers could not perform certain procedures and were not knowledgeable enough to serve patients. Further, patients believed these providers made mistakes, provided insufficient care, and were not patient-centered. Providers at the university hospital, however, were seen as being more concerned with patients’ feelings, more expert, and overall preferred to other providers. Quantitative results (paired samples t-tests) found no differences in ratings of perceived patient-centered communication between local and university providers, nor in credibility or expertise. However, there were significant and substantial differences in ratings of distrust. Specifically, university providers were seen as substantially more trustworthy in terms of their decision-making and skill (M=4.69, SD=.67, 95% CI [4.53, 4.83], than local healthcare providers (M=2.37, SD=1.43 95% CI [2.07, 2.72]), t(74)=-11.91, p<.05, d=1.37, r=.69. For trustworthiness of the hospital, in terms of avoiding mistakes and being concerned more with patient needs than financial gain, the university hospital was rated higher (M=4.14, SD=.60, 95% CI [4.52, 4.83]) than healthcare closer to patients (M=3.21, SD=1.41, 95% CI [2.91, 3.56]), t(74)=-5.87, p<.05, d=.67, r=.34. Taking these mixed-methods findings together, it appears that patients largely view the academic hospital as more expert and capable than their local care, and even believe rural healthcare is more prone to error and negligence. These exploratory data provide evidence that this phenomenon under study is occurring in West Virginia and may explain some non-medically necessary transfers observed by healthcare provider co-authors. Additional work is underway to generalize these findings to the state’s general population and to Appalachia as a whole.