Acceptability of primary care : a study of one community in Montana

Abstract

INTRODUCTION: Access to health care is a concept that is of primary importance to health care providers, clients, and policy makers throughout America. This is especially true in rural communities, where researchers in one study indicated that it was the highest priority (Gamm, et al., 2003). Access is a multi-dimensional construct that includes the availability, accessibility, accommodation, affordability, and acceptability of health care. DESIGN AND PURPOSE: This study used a descriptive survey design to examine one dimension of access, acceptability of primary care, in one rural community in Western Montana. The purpose of this study was to examine the "fit" between the perceptions of rural residents about the acceptability of local primary care and the perceptions of the primary care providers about the acceptability of local primary care. The purpose was addressed by answering the following research question: How does the rural health care client's perception of acceptability of primary care available in their community compare with the rural primary care provider's perception of the acceptability of primary care delivered? The tool used was an adaptation of the Acceptability Scale (Shreffler, 1996) to determine the "fit" between clients and primary care providers.

RESULTS: The range of the possible Acceptability Scale scores in this study was a minimum score of 8 and a maximum score of 40. The mean Acceptability Scale score was 17.25 (n=97) for the client responses and 11 (n=3) for the provider responses. These scores are similar and indicate an above average opinion of primary care services offered in that community. There were, however, five of the eight items on the Acceptability Scale that had a difference in mean rating of 1 or greater, possibly indicating the need for improvement in "fit." Those items were: overall quality of care (diff=1.1), competence of primary care providers (diff=1.4), concern/compassion for patient (diff=1.0), "personal" aspects of care (diff=1.1), and acceptability of provider as a source of care (diff=1.2). The ratings in this study are the opinions of the respondents; no direct measure of these dimensions was made. One limitation of this study was in the ability to statistically analyze the difference in Acceptability Scale scores related to small sample size and disparity in sample size between clients and providers. Additional qualitative research in this population may better clarify the degree of "fit" between the clients and providers regarding the acceptability of primary care.