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Self-identified barriers to rural mental health services in Iowa by older adults with multiple comorbidities: qualitative interview study.

ABSTRACT: OBJECTIVES:Individuals in rural areas face critical health disparities, including limited access to mental healthcare services and elevated burden of chronic illnesses. While disease outcomes are often worse in individuals who have both physical and mental comorbidities, few studies have examined rural, chronically-ill older adults' experiences accessing mental health services. The aim of the study was to determine barriers to finding, receiving and adhering to mental health treatments in this population to inform future interventions delivering services. DESIGN:We conducted a qualitative study of barriers and facilitators to mental healthcare access. 19 interviews were analysed deductively for barriers using a modified version of Penchansky and Thomas's theory of access as an analytical framework. SETTING:This study was conducted remotely using telephonic interviews. Patients were located in various rural Iowa towns and cities. PARTICIPANTS:15 rural Iowan older adults with multiple physical comorbidities as well as anxiety and/or depression. RESULTS:We found that while patients in this study often felt that their mental health was important to address, they experienced multiple, but overlapping, barriers to services that delayed care or broke their continuity of receiving care, including limited knowledge of extant services and how to find them, difficulties obtaining referrals and unsatisfactory relationships with mental health service providers. CONCLUSIONS:Our findings indicate that intervention across multiple domains of access is necessary for successful long-term management of mental health disorders for patients with multiple chronic comorbidities in Iowa.

SUBMITTER: Pass LE

PROVIDER: S-EPMC6858190 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Self-identified barriers to rural mental health services in Iowa by older adults with multiple comorbidities: qualitative interview study.

Pass Lauren Elizabeth LE Kennelty Korey K Carter Barry L BL

BMJ open 20191103 11

<h4>Objectives</h4>Individuals in rural areas face critical health disparities, including limited access to mental healthcare services and elevated burden of chronic illnesses. While disease outcomes are often worse in individuals who have both physical and mental comorbidities, few studies have examined rural, chronically-ill older adults' experiences accessing mental health services. The aim of the study was to determine barriers to finding, receiving and adhering to mental health treatments i ...[more]

PMID: 31685497

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Project description:BackgroundSocial disconnection is a public health concern among rural Australian older adults. While research suggests technology can enhance social wellbeing and protect against social disconnection, many older adults are not digitally literate, and little is known as to why and how technology adoption could be promoted in rural contexts. This study aimed to (1) explore the barriers and facilitators of technology adoption among rural older adults and (2) determine the potential utility of technology to promote social connectedness in the aged population. The Theoretical Domains Framework and the Behaviour Change Wheel (BCW) were employed to gain a comprehensive understanding of the digital and social behaviours of rural Australian older adults.MethodsSemi-structured interviews were conducted with a convenience sample of 33 rural older adults aged between 65 and 87 years. Interviews were conducted over the phone, audio-recorded, and transcribed. Interview transcripts were coded and analysed using thematic analysis and the BCW.ResultsNumerous barriers and facilitators of technology adoption were identified, with the most prominent being knowledge, perceived value, perceived self-efficacy, and social support. Findings suggest that older adults' technology adoption is not simply a technical matter, but influenced by various individual, social, and environmental contexts. Consideration of these factors during development, marketing, training and implementation may facilitate technology adoption among older adults. With regard to social connectedness, several rural barriers emerged, including low population density, geographic isolation, limited community opportunities and poor public transport infrastructure.ConclusionTechnology was consistently identified as a facilitator of the social experience, indicating that technology is a promising tool to enhance social connectedness among older adults, particularly those living in rural areas. Future research should focus on enhancing the capability, opportunity and motivation of older adults in technology adoption, with reference to the rural contexts.

Dataset Information

Self-identified barriers to rural mental health services in Iowa by older adults with multiple comorbidities: qualitative interview study.

Publications

Self-identified barriers to rural mental health services in Iowa by older adults with multiple comorbidities: qualitative interview study.

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