Examining effective and realized healthcare access in the west south central division.

This study explores realized and effective access domains outlined by Andersen’s Behavioral Model of Health Services Use. Exploring other domains of access is critical to understanding how the healthcare system functions (Kirby & Yabroff, 2020). This study evaluates rural-urban and racial/ethnic differences in access to care using two underresearched domains of healthcare access. It also allows for exploring access disparities within rural communities amongst minority populations. This dissertation is divided into five chapters. Chapter One provides an overview of health disparities and inequities and a brief overview of the study. Chapter Two details a high-level history of racism and its impacts on racial and ethnic groups. It introduces the Andersen Model of Health Services Use, structural racism, and structural urbanism. Individual and contextual factors affecting access to a usual source of care and patient satisfaction are identified. Chapter Three describes the methodological approach for the study. Chapter Four covers the results. Race/ethnicity and urbanicity/rurality were shown to be significant predictors of having a usual source of care. White, non-Hispanic individuals are 1.4 times more likely to have a usual source of care than their non-White or Hispanic counterparts. Those living in an urban area are .78 times (22%) less likely to have a usual source of care. The interaction between race/ethnicity and urbanicity/rurality was not significant. Furthermore, race/ethnicity and urbanicity/rurality were not significant predictors of patient satisfaction with care. The interaction between race/ethnicity and urbanicity/rurality was significant. The area in which patients lived determined the nature and direction of the association between race/ethnicity. In urban areas, there was a negative association, such that urban, White/non-Hispanic individuals had higher levels of satisfaction than their non-White, Hispanic counterparts. In rural areas, this association was positive: White/non-Hispanic individuals had lower levels of satisfaction than their non-White, Hispanic counterparts. Chapter Five discusses the meaning of these results and the potential advocacy opportunities social work may consider to improve access and satisfaction with care. Community health workers are situated as allies in the field and several policies are discussed