Factors responsible for healthcare avoidance among rural adults in the Eastern Region of North Carolina

Purpose: Previous research has identified three common reasons for healthcare avoidance, cost, complexity, and privacy. This study extends prior work by examining the antecedents to these barriers and determining the extent to which they contribute to healthcare avoidance in a rural population.

Methods: A cross-sectional, regional survey of rural residents from Eastern North Carolina was conducted with questions focused on self-perceived health, healthcare utilization, and healthcare avoidance. Bivariate logistic regression was employed to investigate the predictors of cost, complexity, and privacy-related avoidance.

Results: Among 946 respondents, a quarter of the sample (N = 240) had not visited a doctor within the past year. Respondents who were uninsured were almost 6-times more likely to endorse avoiding healthcare due to cost (OR = 5.98) and those who had a chronic illness were 3-times as likely to report cost-related avoidance (OR = 3.01). Complexity-related avoidance was predicted by having a chronic illness (OR = 3.77) and a low perception of healthcare value (OR = 2.80). Lastly, privacy-related avoidance was related to being in fair/poor health (OR = 2.61), having a chronic illness (OR = 2.63), reporting low healthcare value (OR = 2.72), and having an external locus of control (OR = 2.96).

Conclusions: Among avoidant individuals, those with a chronic illness, who could benefit most from continuity of healthcare, are 3-times more likely to avoid healthcare due to cost, complexity, and privacy. The perceived value of healthcare is also associated with complexity- and privacy-related healthcare avoidance. Utilizing alternative methods of healthcare delivery, such as telemedicine and free or reduced cost mobile health clinics, could improve continuity of medical care for rural residents.