Presentations

Abstract

Introduction: Healthcare disparities are often fueled by obstacles that patients face when attempting to access care. Transportation is a necessary component when evaluating patient access. Though not always obvious to healthcare systems or providers, social determinants of health (SDoH) impact the availability, reliability, and safety of transportation. This can prevent patients from regularly accessing healthcare and negatively impact long-term population health outcomes. In order to positively impact transportation equity in the region, better understanding the problem from the patient perspective is crucial. This innovative research effort incorporates community member input in all phases of the research process to investigate how patient transportation to provider office visits may be impacted by SDoH.

Methods: Aims: To identify transportation barriers to outpatient healthcare services in Hampton Roads. To evaluate the influence of SDoH on transportation equity for medical appointments. Design: Prospective, mixed-methods research design utilizes an innovative participatory action/community engaged approach. Team members partnered with community members from the Hampton Roads Community Collaborative (HRCC) whose individual members are predominantly people of color from historically economically challenged neighborhoods in the Hampton Roads (HR) region. HRCC team members participated in the topic selection, research design, implementation, analysis, and dissemination of results. Inclusion criteria & sampling: All adults 18 years or older residing in the HR region were eligible to participate in a 24-item community questionnaire. Convenience sampling was utilized at local community events, EVMS outpatient medicine clinics, & the Sentara Ambulatory Care Clinic. Data Collection/Convergent Analysis: The mixed methods study design includes both quantitative and qualitative data from: 1) community questionnaires, 2) individual interviews (EVMS patients), and 3) public observations of transportation used for medical appointments (EVMS locations). Recruitment flyers with links to questionnaires were strategically placed in areas of high foot traffic on the EVMS campus and at local businesses in the HR region. Team members also recruited participants from community events and completed observations of public behavior to note the types of transportation utilized for medical appointments and any barriers or supports that patients encountered when arriving to/departing from provider office visits. Convergence of the data will create a body of evidence that is focused on the types of transportation utilized for medical appointments, the quality, reliability, and safety of chosen transportation methods, and the self-reported patient barriers and needed supports of HR patients.

Results: Preliminary results (2.5 months of data collection) highlight self-reported information from N=76 participants in 6 out of 7 Hampton Roads cities via the community questionnaire. Observational data from 4 clinic sites reveal the utilization of 19 medical transport companies, 12 non-medical transportations companies, and 351 private/personal vehicles or types of public transportation utilized for medical appointments. Initial frequency counts & descriptive codes highlight transportation equity via four themes, 1) equipment, 2) location, 3) infrastructure, & 4) human support, demonstrating the barriers or supports that today's patients face with transportation for healthcare appointments. Dissemination/Conclusion: Findings will point to better-informed, patient-directed interventions that aim to identify & reduce healthcare disparities, and improve transportation equity for all patients in HR.

Conclusion: This mixed methods, participatory-action research project leveraged input from patients & community members to identify transportation barriers for healthcare appointments. Preliminary results highlight specific transportation hurdles that are associated with attending outpatient office visits. Community engaged approach elevated community partners and guided them in utilizing research as a catalyst for change, showing value to their interpretation/synthesis of data & to their chosen forms of dissemination.