Traveling Towards Disease: Transportation Barriers to Health Care Access

Abstract

Transportation barriers are often cited as barriers to healthcare access. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. These consequences may lead to poorer management of chronic illness and thus poorer health outcomes. However, the significance of these barriers is uncertain based on existing literature due to wide variability in both study populations and transportation barrier measures. The authors sought to synthesize the literature on the prevalence of transportation barriers to health care access. A systematic literature search of peer-reviewed studies on transportation barriers to healthcare access was performed. Inclusion criteria were as follows: (1) study addressed access barriers for ongoing primary care or chronic disease care; (2) study included assessment of transportation barriers; and (3) study was completed in the United States. In total, 61 studies were reviewed. Overall, the evidence supports that transportation barriers are an important barrier to healthcare access, particularly for those with lower incomes or the under/uninsured. Additional research needs to (1) clarify which aspects of transportation limit health care access (2) measure the impact of transportation barriers on clinically meaningful outcomes and (3) measure the impact of transportation barrier interventions and transportation policy changes.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. 1.

    Chronic diseases and health promotion. (2012a). Retrieved May 15, 2012, from http://www.cdc.gov/chronicdisease/overview/index.htm.

  2. 2.

    Chronic diseases and health promotion. (2012b). Retrieved May 15, 2012, from http://www.who.int/chp/en/.

  3. 3.

    Wallace, R., Hughes-Cromwick, P., Mull, H., & Khasnabis, S. (2005). Access to health care and nonemergency medical transportation: Two missing links. Transportation Research Record: Journal of the Transportation Research Board, 1924, 76–84.

    Article  Google Scholar 

  4. 4.

    Kim, M. M., Swanson, J. W., Swartz, M. S., Bradford, D. W., Mustillo, S. A., & Elbogen, E. B. (2007). Healthcare barriers among severely mentally ill homeless adults: Evidence from the five-site health and risk study. Administration and Policy in Mental Health, 34(4), 363–375. doi:10.1007/s10488-007-0115-1.

    PubMed  Article  Google Scholar 

  5. 5.

    Garwick, A. W., Kohrman, C., Wolman, C., & Blum, R. W. (1998). Families’ recommendations for improving services for children with chronic conditions. Archives of Pediatrics and Adolescent Medicine, 152(5), 440–448.

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Cristancho, S., Garces, D. M., Peters, K. E., & Mueller, B. C. (2008). Listening to rural hispanic immigrants in the midwest: A community-based participatory assessment of major barriers to health care access and use. Qualitative Health Research, 18(5), 633–646. doi:10.1177/1049732308316669.

    PubMed  Article  Google Scholar 

  7. 7.

    Buzza, C., Ono, S. S., Turvey, C., Wittrock, S., Noble, M., Reddy, G., et al. (2011). Distance is relative: Unpacking a principal barrier in rural healthcare. Journal of General Internal Medicine, 26(Suppl 2), 648–654. doi:10.1007/s11606-011-1762-1.

    PubMed  Article  Google Scholar 

  8. 8.

    Bambra, C., Gibson, M., Sowden, A., Wright, K., Whitehead, M., & Petticrew, M. (2010). Tackling the wider social determinants of health and health inequalities: Evidence from systematic reviews. Journal of Epidemiology and Community Health, 64(4), 284–291. doi:10.1136/jech.2008.082743.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Goins, R. T., Williams, K. A., Carter, M. W., Spencer, M., & Solovieva, T. (2005). Perceived barriers to health care access among rural older adults: A qualitative study. The Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association, 21(3), 206–213.

    Article  Google Scholar 

  10. 10.

    Moneyham, L., McLeod, J., Boehme, A., Wright, L., Mugavero, M., Seal, P., et al. (2010). Perceived barriers to HIV care among HIV-infected women in the deep south. The Journal of the Association of Nurses in AIDS Care: JANAC, 21(6), 467–477. doi:10.1016/j.jana.2010.03.003.

    PubMed  Article  Google Scholar 

  11. 11.

    Garcia Popa-Lisseanu, M. G., Greisinger, A., Richardson, M., O’Malley, K. J., Janssen, N. M., Marcus, D. M., et al. (2005). Determinants of treatment adherence in ethnically diverse, economically disadvantaged patients with rheumatic disease. The Journal of Rheumatology, 32(5), 913–919.

    PubMed  Google Scholar 

  12. 12.

    Keating, A., Lee, A., & Holland, A. E. (2011). What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review. Chronic Respiratory Disease, 8(2), 89–99. doi:10.1177/1479972310393756.

    PubMed  Google Scholar 

  13. 13.

    Ahmed, S. M., Lemkau, J. P., Nealeigh, N., & Mann, B. (2001). Barriers to healthcare access in a non-elderly urban poor American population. Health and Social Care in the Community, 9(6), 445–453.

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Blazer, D. G., Landerman, L. R., Fillenbaum, G., & Horner, R. (1995). Health services access and use among older adults in North Carolina: Urban vs rural residents. American Journal of Public Health, 85(10), 1384–1390.

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Crain, E. F., Kercsmar, C., Weiss, K. B., Mitchell, H., & Lynn, H. (1998). Reported difficulties in access to quality care for children with asthma in the inner city. Archives of Pediatrics and Adolescent Medicine, 152(4), 333–339.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Duran, B., Bulterys, M., Iralu, J., Graham Ahmed Edwards, C. M., Edwards, A., & Harrison, M. (2000). American Indians with HIV/AIDS: Health and social service needs, barriers to care, and satisfaction with services among a western tribe. American Indian and Alaska Native Mental Health Research (Online), 9(2), 22–35.

    Article  CAS  Google Scholar 

  17. 17.

    Cunningham, W. E., Andersen, R. M., Katz, M. H., Stein, M. D., Turner, B. J., Crystal, S., et al. (1999). The impact of competing subsistence needs and barriers on access to medical care for persons with human immunodeficiency virus receiving care in the United States. Medical Care, 37(12), 1270–1281.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Diamant, A. L., Hays, R. D., Morales, L. S., Ford, W., Calmes, D., Asch, S., et al. (2004). Delays and unmet need for health care among adult primary care patients in a restructured urban public health system. American Journal of Public Health, 94(5), 783–789.

    PubMed  Article  Google Scholar 

  19. 19.

    Hoffmann, R. L., Rohrer, W. M., 3rd, South-Paul, J. E., Burdett, R., & Watzlaf, V. J. (2008). The effects of barriers on health related quality of life (HRQL) and compliance in adult asthmatics who are followed in an urban community health care facility. Journal of Community Health, 33(6), 374–383. doi:10.1007/s10900-008-9108-6.

    PubMed  Article  Google Scholar 

  20. 20.

    Johnson, P. J., Carlson, K. F., & Hearst, M. O. (2010). Healthcare disparities for American Indian veterans in the United States: A population-based study. Medical Care, 48(6), 563–569. doi:10.1097/MLR.0b013e3181d5f9e1.

    PubMed  Article  Google Scholar 

  21. 21.

    Reif, S., Whetten, K., Ostermann, J., & Raper, J. L. (2006). Characteristics of HIV-infected adults in the deep south and their utilization of mental health services: A rural vs urban comparison. AIDS Care, 18(Suppl 1), S10–S17. doi:10.1080/09540120600838738.

    PubMed  Article  Google Scholar 

  22. 22.

    Rust, G., Ye, J., Baltrus, P., Daniels, E., Adesunloye, B., & Fryer, G. E. (2008). Practical barriers to timely primary care access: Impact on adult use of emergency department services. Archives of Internal Medicine, 168(15), 1705–1710. doi:10.1001/archinte.168.15.1705.

    PubMed  Article  Google Scholar 

  23. 23.

    Zullig, L. L., Jackson, G. L., Provenzale, D., Griffin, J. M., Phelan, S., & van Ryn, M. (2012). Transportation—a vehicle or roadblock to cancer care for VA patients with colorectal cancer? Clinical Colorectal Cancer, 11(1), 60–65. doi:10.1016/j.clcc.2011.05.001.

    PubMed  Article  Google Scholar 

  24. 24.

    Flores, G., Abreu, M., Olivar, M. A., & Kastner, B. (1998). Access barriers to health care for latino children. Archives of Pediatrics and Adolescent Medicine, 152(11), 1119–1125.

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Giambruno, C., Cowell, C., Barber-Madden, R., & Mauro-Bracken, L. (1997). The extent of barriers and linkages to health care for head start children. Journal of Community Health, 22(2), 101–114.

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Guidry, J. J., Aday, L. A., Zhang, D., & Winn, R. J. (1997). Transportation as a barrier to cancer treatment. Cancer Practice, 5(6), 361–366.

    PubMed  CAS  Google Scholar 

  27. 27.

    Musey, V. C., Lee, J. K., Crawford, R., Klatka, M. A., McAdams, D., & Phillips, L. S. (1995). Diabetes in urban african-americans. I. cessation of insulin therapy is the major precipitating cause of diabetic ketoacidosis. Diabetes Care, 18(4), 483–489.

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Ide, B. A., Curry, M. A., & Drobnies, B. (1993). Factors related to the keeping of appointments by indigent clients. Journal of Health Care for the Poor and Underserved, 4(1), 21–39.

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Drainoni, M., Lee-Hood, E., Tobias, C., Bachman, S. S., Andrew, J., & Maisels, L. (2006). Cross-disability experiences of barriers to health care access: Consumer perspectives. Journal of Disability Policy Studies, 17(2), 101–115.

    Article  Google Scholar 

  30. 30.

    Ensign, J., & Panke, A. (2002). Barriers and bridges to care: Voices of homeless female adolescent youth in Seattle, Washington. USA. Journal of Advanced Nursing, 37(2), 166–172.

    Article  Google Scholar 

  31. 31.

    Iezzoni, L. I., Killeen, M. B., & O’Day, B. L. (2006). Rural residents with disabilities confront substantial barriers to obtaining primary care. Health Services Research, 41(4 Pt 1), 1258–1275. doi:10.1111/j.1475-6773.2006.00534.x.

    PubMed  Google Scholar 

  32. 32.

    Kempf, M. C., McLeod, J., Boehme, A. K., Walcott, M. W., Wright, L., Seal, P., et al. (2010). A qualitative study of the barriers and facilitators to retention-in-care among HIV-positive women in the rural southeastern united states: Implications for targeted interventions. AIDS Patient Care and STDs, 24(8), 515–520. doi:10.1089/apc.2010.0065.

    PubMed  Article  Google Scholar 

  33. 33.

    Wheeler, K., Crawford, R., McAdams, D., Robinson, R., Dunbar, V. G., & Cook, C. B. (2007). Inpatient to outpatient transfer of diabetes care: Perceptions of barriers to postdischarge followup in urban African American patients. Ethnicity and Disease, 17(2), 238–243.

    PubMed  Google Scholar 

  34. 34.

    Weathers, A., Minkovitz, C., O’Campo, P., & Diener-West, M. (2004). Access to care for children of migratory agricultural workers: Factors associated with unmet need for medical care. Pediatrics, 113(4), e276–e282.

    PubMed  Article  Google Scholar 

  35. 35.

    Healthcare Disparities and Barriers to Healthcare. Accessed February 20, 2013 from http://ruralhealth.stanford.edu/health-pros/factsheets/disparities-barriers.html.

  36. 36.

    Branch, L. G., & Nemeth, K. T. (1985). When elders fail to visit physicians. Medical Care, 23(11), 1265–1275.

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Arcury, T. A., Preisser, J. S., Gesler, W. M., & Powers, J. M. (2005). Access to transportation and health care utilization in a rural region. The Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association, 21(1), 31–38.

    Article  Google Scholar 

  38. 38.

    Salloum, R. G., Smith, T. J., Jensen, G. A., & Lafata, J. E. (2012). Factors associated with adherence to chemotherapy guidelines in patients with non-small cell lung cancer. Lung Cancer (Amsterdam, Netherlands), 75(2), 255–260. doi:10.1016/j.lungcan.2011.07.005.

    Article  Google Scholar 

  39. 39.

    Pesata, V., Pallija, G., & Webb, A. A. (1999). A descriptive study of missed appointments: Families’ perceptions of barriers to care. Journal of Pediatric Health Care: Official Publication of National Association of Pediatric Nurse Associates & Practitioners, 13(4), 178–182. doi:10.1016/S0891-5245(99)90037-8.

    Article  CAS  Google Scholar 

  40. 40.

    Rask, K. J., Williams, M. V., Parker, R. M., & McNagny, S. E. (1994). Obstacles predicting lack of a regular provider and delays in seeking care for patients at an urban public hospital. JAMA, the Journal of the American Medical Association, 271(24), 1931–1933.

    Article  CAS  Google Scholar 

  41. 41.

    Yang, S., Zarr, R. L., Kass-Hout, T. A., Kourosh, A., & Kelly, N. R. (2006). Transportation barriers to accessing health care for urban children. Journal of Health Care for the Poor and Underserved, 17(4), 928–943. doi:10.1353/hpu.2006.0137.

    PubMed  Article  Google Scholar 

  42. 42.

    Silver, D., Blustein, J., & Weitzman, B. C. (2012). Transportation to clinic: Findings from a pilot clinic-based survey of low-income suburbanites. Journal of Immigrant and Minority Health/Center for Minority Public Health, 14(2), 350–355. doi:10.1007/s10903-010-9410-0.

    PubMed  Article  Google Scholar 

  43. 43.

    Roadblocks to health: Transportation barriers to healthy communities. (2002). Center for Third World Organizing (CTWO), People United for a Better Oakland (PUEBLO), Transportation and Land Use Coalition (TALC).

  44. 44.

    Heckman, T. G., Somlai, A. M., Peters, J., Walker, J., Otto-Salaj, L., Galdabini, C. A., et al. (1998). Barriers to care among persons living with HIV/AIDS in urban and rural areas. AIDS Care, 10(3), 365–375. doi:10.1080/713612410.

    PubMed  Article  CAS  Google Scholar 

  45. 45.

    Probst, J. C., Laditka, S. B., Wang, J. Y., & Johnson, A. O. (2007). Effects of residence and race on burden of travel for care: Cross sectional analysis of the 2001 US national household travel survey. BMC Health Services Research, 7, 40. doi:10.1186/1472-6963-7-40.

    PubMed  Article  Google Scholar 

  46. 46.

    Skinner, A. C., & Slifkin, R. T. (2007). Rural/urban differences in barriers to and burden of care for children with special health care needs. The Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association, 23(2), 150–157. doi:10.1111/j.1748-0361.2007.00082.x.

    Article  Google Scholar 

  47. 47.

    Sarnquist, C. C., Soni, S., Hwang, H., Topol, B. B., Mutima, S., & Maldonado, Y. A. (2011). Rural HIV-infected women’s access to medical care: Ongoing needs in California. AIDS Care, 23(7), 792–796. doi:10.1080/09540121.2010.516345.

    PubMed  Google Scholar 

  48. 48.

    Kruzich, J. M., Jivanjee, P., Robinson, A., & Friesen, B. J. (2003). Family caregivers’ perceptions of barriers to and supports of participation in their children’s out-of-home treatment. Psychiatric Services Washington DC, 54(11), 1513–1518.

    Article  Google Scholar 

  49. 49.

    Canupp, K. C., Waites, K. B., DeVivo, M. J., & Richards, J. S. (1997). Predicting compliance with annual follow-up evaluations in persons with spinal cord injury. Spinal Cord, 35(5), 314–319.

    PubMed  Article  CAS  Google Scholar 

  50. 50.

    Okoro, C. A., Strine, T. W., Young, S. L., Balluz, L. S., & Mokdad, A. H. (2005). Access to health care among older adults and receipt of preventive services. Results from the behavioral risk factor surveillance system, 2002. Preventive Medicine, 40(3), 337–343. doi:10.1016/j.ypmed.2004.06.009.

    PubMed  Article  Google Scholar 

  51. 51.

    Nemet, G. F., & Bailey, A. J. (2000). Distance and health care utilization among the rural elderly. Social Science & Medicine 1982, 50(9): 1197–1208.

    Google Scholar 

  52. 52.

    Lamont, E. B., Hayreh, D., Pickett, K. E., Dignam, J. J., List, M. A., Stenson, K. M., et al. (2003). Is patient travel distance associated with survival on phase II clinical trials in oncology? Journal of the National Cancer Institute, 95(18), 1370–1375.

    PubMed  Article  Google Scholar 

  53. 53.

    Littenberg, B., Strauss, K., MacLean, C. D., & Troy, A. R. (2006). The use of insulin declines as patients live farther from their source of care: Results of a survey of adults with type 2 diabetes. BMC Public Health, 6, 198. doi:10.1186/1471-2458-6-198.

    PubMed  Article  Google Scholar 

  54. 54.

    Strauss, K., MacLean, C., Troy, A., & Littenberg, B. (2006). Driving distance as a barrier to glycemic control in diabetes. Journal of General Internal Medicine, 21(4), 378–380. doi:10.1111/j.1525-1497.2006.00386.x.

    PubMed  Article  Google Scholar 

  55. 55.

    Borders, T. F. (2004). Rural community-dwelling elders’ reports of access to care: Are there hispanic versus non-hispanic white disparities? The Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association, 20(3), 210–220.

    Article  Google Scholar 

  56. 56.

    Call, K. T., McAlpine, D. D., Johnson, P. J., Beebe, T. J., McRae, J. A., & Song, Y. (2006). Barriers to care among American Indians in public health care programs. Medical Care, 44(6), 595–600. doi:10.1097/01.mlr.0000215901.37144.94.

    PubMed  Article  Google Scholar 

  57. 57.

    Williams, D. R. (1999). Race, socioeconomic status, and health. The added effects of racism and discrimination. Annals of the New York Academy of Sciences, 896, 173–188.

    PubMed  Article  CAS  Google Scholar 

  58. 58.

    Martinez, J., Bell, D., Dodds, S., Shaw, K., Siciliano, C., Walker, L. E., et al. (2003). Transitioning youths into care: Linking identified HIV-infected youth at outreach sites in the community to hospital-based clinics and or community-based health centers. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 33(2 Suppl), 23–30.

    Article  Google Scholar 

  59. 59.

    Smith, S. R., Highstein, G. R., Jaffe, D. M., Fisher, E. B., Jr, & Strunk, R. C. (2002). Parental impressions of the benefits (pros) and barriers (cons) of follow-up care after an acute emergency department visit for children with asthma. Pediatrics, 110(2 Pt 1), 323–330.

    PubMed  Article  Google Scholar 

  60. 60.

    Fitzpatrick, A. L., Powe, N. R., Cooper, L. S., Ives, D. G., & Robbins, J. A. (2004). Barriers to health care access among the elderly and who perceives them. American Journal of Public Health, 94(10), 1788–1794.

    PubMed  Article  Google Scholar 

  61. 61.

    Malmgren, J. A., Martin, M. L., & Nicola, R. M. (1996). Health care access of poverty-level older adults in subsidized public housing. Public Health Reports (Washington DC 1974), 111(3), 260–263.

    CAS  Google Scholar 

  62. 62.

    Rittner, B., & Kirk, A. B. (1995). Health care and public transportation use by poor and frail elderly people. Social Work, 40(3), 365–373.

    PubMed  CAS  Google Scholar 

  63. 63.

    Washington, D. L., Bean-Mayberry, B., Riopelle, D., & Yano, E. M. (2011). Access to care for women veterans: Delayed healthcare and unmet need. Journal of General Internal Medicine, 26(Suppl 2), 655–661. doi:10.1007/s11606-011-1772-z.

    PubMed  Article  Google Scholar 

  64. 64.

    Kripalani, S., Henderson, L. E., Jacobson, T. A., & Vaccarino, V. (2008). Medication use among inner-city patients after hospital discharge: Patient-reported barriers and solutions. Mayo Clinic Proceedings. Mayo Clinic, 83(5), 529–535.

    PubMed  Google Scholar 

  65. 65.

    Welty, T. E., Willis, S. L., & Welty, E. A. (2010). Effect of limited transportation on medication adherence in patients with epilepsy. Journal of the American Pharmacists Association: JAPhA, 50(6), 698–703. doi:10.1331/JAPhA.2010.09081.

    PubMed  Article  Google Scholar 

  66. 66.

    Tierney, W. M., Harris, L. E., Gaskins, D. L., Zhou, X. H., Eckert, G. J., Bates, A. S., et al. (2000). Restricting medicaid payments for transportation: Effects on inner-city patients’ health care. The American Journal of the Medical Sciences, 319(5), 326–333.

    PubMed  Article  CAS  Google Scholar 

  67. 67.

    Levine, D. A., Kiefe, C. I., Howard, G., Howard, V. J., Williams, O. D., & Allison, J. J. (2007). Reduced medication access: A marker for vulnerability in US stroke survivors. Stroke: a Journal of Cerebral Circulation, 38(5), 1557–1564. doi:10.1161/STROKEAHA.106.478545.

    Article  Google Scholar 

  68. 68.

    Pheley, A. M. (1999). Mass transit strike effects on access to medical care. Journal of Health Care for the Poor and Underserved, 10(4), 389–396.

    PubMed  Article  CAS  Google Scholar 

  69. 69.

    Hayden, C., & Mauldin, B. (2002). On the road: Car ownership as an asset building strategy for reducing transportation related barriers to work. Oakland: National Economic Development and Law Center.

    Google Scholar 

  70. 70.

    Bader, M. D., Purciel, M., Yousefzadeh, P., & Neckerman, K. M. (2010). Disparities in neighborhood food environments: Implications of measurement strategies. Economic Geography, 86(4), 409–430.

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

We would like to acknowledge Dr. Shannon Zenk and Kathy Korytkowski for their editing and support in the preparation of this manuscript.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Samina T. Syed.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Syed, S.T., Gerber, B.S. & Sharp, L.K. Traveling Towards Disease: Transportation Barriers to Health Care Access. J Community Health 38, 976–993 (2013). https://doi.org/10.1007/s10900-013-9681-1

Download citation

Keywords

  • Healthcare access
  • Transportation barriers
  • Medication access
  • Healthcare barriers