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.
Similar content being viewed by others
References
Chronic diseases and health promotion. (2012a). Retrieved May 15, 2012, from http://www.cdc.gov/chronicdisease/overview/index.htm.
Chronic diseases and health promotion. (2012b). Retrieved May 15, 2012, from http://www.who.int/chp/en/.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Healthcare Disparities and Barriers to Healthcare. Accessed February 20, 2013 from http://ruralhealth.stanford.edu/health-pros/factsheets/disparities-barriers.html.
Branch, L. G., & Nemeth, K. T. (1985). When elders fail to visit physicians. Medical Care, 23(11), 1265–1275.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
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.
Nemet, G. F., & Bailey, A. J. (2000). Distance and health care utilization among the rural elderly. Social Science & Medicine 1982, 50(9): 1197–1208.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Rittner, B., & Kirk, A. B. (1995). Health care and public transportation use by poor and frail elderly people. Social Work, 40(3), 365–373.
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.
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.
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.
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.
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.
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.
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.
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.
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
Authors and Affiliations
Corresponding author
Rights 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
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10900-013-9681-1