Distance is Relative: Unpacking a Principal Barrier in Rural Healthcare

  • Colin Buzza
  • Sarah S. Ono
  • Carolyn Turvey
  • Stacy Wittrock
  • Matt Noble
  • Gautam Reddy
  • Peter J. Kaboli
  • Heather Schacht ReisingerEmail author
Original Research



Distance to healthcare services is a known barrier to access. However, the degree to which distance is a barrier is not well described. Distance may impact different patients in different ways and be mediated by the context of medical need.


Identify factors related to distance that impede access to care for rural veterans.


Mixed-methods approach including surveys, in-depth interviews, and focus groups at 15 Veterans Health Administration (VHA) primary care clinics in 8 Midwestern states. Survey data were compiled and interviews transcribed and coded for thematic content.


Surveys were completed by 96 patients and 88 providers/staff. In-depth interviews were completed by 42 patients and 64 providers/staff. A total of 7 focus groups were convened consisting of providers and staff.

Key results

Distance was identified by patients, providers, and staff as the most important barrier for rural veterans seeking healthcare. In-depth interviews revealed specific examples of barriers to care such as long travel for common diagnostic services, routine specialty care, and emergency services. Patient factors compounding the impact of these barriers were health status, functional impairment, travel cost, and work or family obligations. Providers and staff reported challenges to healthcare delivery due to distance.


Distance as a barrier to healthcare was not uniformly defined. Rather, its importance was relative to the health status and resources of patients, complexity of service provided, and urgency of service needed. Improved transportation, flexible fee-based services, more structured communication mechanisms, and integration with community resources will improve access to care and overall health status for rural veterans.

Key words

rural health veterans access to care qualitative research 



The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, Veterans Rural Health Resource Center-Central Region (VRHRC-CR), and the VA Health Services Research and Development (HSR&D) Service, Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) (HFP 04–149). Dr. Reisinger is supported by Research Career Development Award from the Health Services Research and Development Service, Department of Veterans Affairs (CD1 08-013-1).

The views expressed in this article are those of the authors and do not necessarily represent the views or policy of the Department of Veterans Affairs or the United States Government. This research was presented at the annual meeting of the Society of Applied Anthropology, March 2010, Merida, Mexico. The authors have no conflict of interests to report.

Supplementary material

11606_2011_1762_MOESM1_ESM.pdf (177 kb)
ESM 1 (PDF 176 kb)


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Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Colin Buzza
    • 1
  • Sarah S. Ono
    • 1
    • 2
  • Carolyn Turvey
    • 1
    • 2
    • 3
  • Stacy Wittrock
    • 1
  • Matt Noble
    • 1
  • Gautam Reddy
    • 1
  • Peter J. Kaboli
    • 1
    • 2
    • 4
  • Heather Schacht Reisinger
    • 1
    • 2
    • 4
    Email author
  1. 1.VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region (VRHRC-CR)Iowa City VA Medical CenterIowa CityUSA
  2. 2.The Center for Comprehensive Access and Delivery Research and Evaluation (CADRE)Iowa City VA Medical CenterIowa CityUSA
  3. 3.Department of PsychiatryUniversity of Iowa Carver College of MedicineIowa CityUSA
  4. 4.Division of General Internal Medicine, Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityUSA

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