Hearty as an ox, or fit as a fiddle—such time-worn expressions are frequently used to describe rural Americans. Country living, at least in the minds of urban and suburban Americans, offers “just what the doctor ordered” in the form of active lifestyles, fresh air and a healthy, farm-to-table diet. But reality for many rural Americans looks more like Grapes of Wrath than Field of Dreams.
And with repeal of the Affordable Care Act on the Congressional agenda, rural communities could find themselves struggling even more. Let’s set the record straight about some common misconceptions about rural medically underserved populations.
1. All Medically Underserved Populations Are the Same
The biggest myth is also the easiest to dispel. The Stanford Medicine Rural Health Fact Sheet offers a concise snapshot of rural versus urban populations—and the differences are clear. While 20 percent of Americans live in rural communities, fewer than 10 percent of physicians practice in them. By contrast, 79 percent of Americans live in urban communities, and 90 percent of physicians practice in them. Other variations include:
- 14 percent of rural Americans live below the poverty level versus 11 percent of urban Americans
- 18 percent of rural Americans are 65 or older versus 15 percent of urban Americans
- The average per capita income of rural Americans is $7,000 less than urban Americans
- Rural adults are 7 percent more likely than urban ones to describe their health as fair or poor
Rural Americans also lag behind their urban counterparts in private insurance, Medicare and Medicaid coverage.
Importantly, rural Americans are not one unified population who all think and act alike, either. c2b solutions looked at the psychographics of American rural populations and found a distribution across five distinct psychographic segments. Psychographics pertain to people’s attitudes, values, lifestyles and personalities, and are the key to understanding their motivations and communication preferences. Segmentation groups people according to these shared characteristics for efficiencies in targeting and messaging.
The c2b Psychographic Segments include:
- Self Achievers: The most health-proactive and wellness oriented group, who invest what is necessary to improve their health and appearance. They are goal oriented and need measures to show how they are progressing against these goals.
- Balance Seekers: The next most proactive and wellness oriented, Balance Seekers want choices and options and downplay the role of healthcare professionals, as they believe they know their bodies better than anyone else.
- Priority Jugglers: Reactive in their own healthcare but proactive for others, Priority Jugglers will sacrifice their own wellbeing to make sure their loved ones get the care they need. They handle many responsibilities and have a strong sense of duty in their personal and professional lives.
- Direction Takers: This group is reactive in their health but are relatively high utilizers of the health system. They desire directive guidance from healthcare professionals and don’t like to be asked a lot of questions; they like to “cut to the chase” and assume a credentialed clinician has all the answers.
- Willful Endurers: The most reactive group and least engaged in health and wellness. Willful Endurers live in the “here and now” and do not make healthy habits a priority. This does not mean they are unhealthy, they just don’t focus on preventative care or future consequences.
The distribution of the five psychographic segments differ between rural Americans and the general population. Specifically, Balance Seekers and Direction Takers are over-represented, while Willful Endurers and Self Achievers are underdeveloped.
2. Conservative Values of Rural Americans Keep Them Healthier
The picture that Hollywood often paints of rural life is dominated by conservative values that support clean and healthy living. It is, after all, what Kevin Bacon railed against in Footloose. In contrast, urban life is rife with bad choices and unhealthy habits—if Hollywood is to be believed. The statistics, however, tell a different story.
- 25 percent of rural children are overweight, compared to 19 percent of urban children
- Rural 12 to 17-year-olds are 8 percent more likely to smoke than urban adolescents
- At 49.5 percent, the teen birthrate in rural areas is 10.3 percent higher than in urban areas
Moreover, rural adults are more likely than their urban counterparts to smoke; abuse alcohol and other substances; be overweight; and be physically inactive. Most surprisingly, many rural adults have poor access to healthy foods. Again, the impression people are most likely to have is that most “food deserts” are in urban areas, based on the public service ads on television.
3. Rural Hospitals Aren’t Up to the Challenge
Certainly, rural hospitals have struggled in recent years. With every announcement that a rural hospital is shutting down, the challenges of delivering healthcare services to medically underserved populations grow.
But don’t count out rural hospitals when it comes to innovation. According to Hospitals & Health Networks magazine, hospitals are adopting novel approaches to improve care and stay in the black. For example, some hospitals build collaborative relationships with senior centers, public health departments, colleges and other community organizations to build a stronger support network for patients.
One hospital that served both rural and metro patients introduced a care team program that reduced ER visits by 91 percent and readmission rates by 94 percent. How? By using health coaches and care teams to help patients with grocery shopping, housekeeping services and other “small” barriers that mounted up and led to poor health.
4. Rural Americans Are Less Engaged in Health and Wellness
This is a common myth for most medically underserved populations, but as we’ve noted before, engagement is influenced by several factors, including individual attitudes when it comes to health and wellness. Using psychographic segmentation, healthcare providers can gain actionable insights into what individuals believe, who they trust for healthcare advice, and how they can be motivated to stay activated and engaged in their personal health. As the chart in Point # 1 above shows, Balance Seekers — one of the most health-proactive segments — are overdeveloped among rural populations, and Willful Endurers are underdeveloped.
PatientBond is a platform for automating patient engagement through emails, text messages and Interactive Voice Response, and uses psychographic insights in its messaging to enhance patient receptive and behavior change. A health system that focused on Medicaid, Hispanic and rural populations employed PatientBond to reduce missed appointments. Missed appointments were reduced 22 percent, resulting in many more patients getting the care they need — not to mention, the health system realized an added $75,000 per month in revenues.
For many in rural communities, the larger issue—one that also impacts engagement—is one of geography. In rural areas—and in the west, even more remote “frontier” areas—the need to travel great distances to access needed health services remains a barrier. In addition to distance, rural areas may also face extreme weather conditions and a lack of public transportation that limits access to care.
Finding ways to speak to individual patient needs and expectations—along with technology like telehealth and automated patient engagement that shrinks geographic barriers—could help relieve the engagement problems for rural Americans in medically underserved communities.