PATIENT-PERCEIVED BARRIERS TO PREVENTIVE HEALTH-CARE AMONG INDIGENT, RURAL APPALACHIAN PATIENTS

Objective: To examine perceptions of a cohort of rural Appalachian pat ients regarding barriers to the use of preventive health measures. Met hods: Consecutive new patients (N=188) at a clinic for the indigent we re confidentially surveyed about their use of six preventive health me asures: blood pressure screening, cholesterol level, diphtheria-tetanu s immunization, mammography, cervical Papanicolaou smear, and physical examination. When any of these measures was lacking, patients were as ked why, and whether they would have the measure performed if the rele vant barriers were removed. Results: Applicable screening measures lac king were as follows: blood pressure screening, 16%; cholesterol level , 60%; diphtheria-tetanus immunization, 67%; mammography, 69%; Papanic olaou smear, 22%; and physical examination, 32%. Of the patients, 85% were lacking at least one measure. Patients most often identified the following reasons for having omitted these measures: lack of knowledge about prevention (51%) and cost (36%). Older and less educated patien ts more often identified cost (P<.01 and P=.06, respectively), and men were more likely to list lack of knowledge (P=.04). If the identified barriers could be removed, 72% of those lacking a screen indicated th ey would obtain the screening measures. Discussion: This indigent popu lation expressed a desire for preventive care. Our patients identified cost and lack of knowledge as the major reasons for omitting these he alth screening measures. Data obtained from health care providers, rat her than patients, may fail to disclose the barriers these patients fa ce. Adequate education about disease prevention may be as crucial as s ufficient funding in improving compliance with preventive guidelines.