Access to Healthcare: Perceptions of Higher Socioeconomic African-Americans in the South

Friday, July 15, 2011: 11:10 AM

Elizabeth NeSmith, PhD, MSN, RN
Department of Physiological and Technological Nursing, Georgia Health Sciences University, Augusta, GA
Rosalind Jones, DNP, PMHCNS-BC
Department of Biobehavioral Nursing, Georgia Health Sciences University, Augusta, GA
Laurie Landrum, BSN, MSN
School of Graduate Studies, Georgia Health Sciences University, Augusta, GA
Jeannette O. Andrews, PhD, APRN, BC
College of Nursing, Medical University of South Carolina, Charleston, SC

Learning Objective 1: Identify three perceived barriers to health care access from socioeconomically-advantaged African-Americans in the southeast.

Learning Objective 2: Compare and contrast results with international health policy discussions and trends in improving access for veterans of in the United States military.


Health disparities have been reported for African Americans (AAs) for nearly all major causes of death and disability. Lack of access to care is a contributor to health disparities. While studies have shown that low socioeconomic status has been a significant barrier to health care access, differences in access persist for AAs even when socioeconomic status is not a factor.  The purpose of this study was to identify perceived barriers to health care access among socioeconomically-advantaged AAs in the southeast.


We conducted a qualitative study using community-based participatory research methods and focus group methodology. We recruited AAs age ≥18 years from a health disparities community advisory board mailing list, local churches, and the community-at-large. Focus group questions were developed by a qualitative research expert. Interviews were conducted by an AA Psychiatric Clinical Nurse Specialist with expertise in focus group techniques. Recorded sessions were transcribed verbatim, analyzed, and categorized into recurrent themes by qualitative research experts.


We interviewed three focus groups with 8-10 participants each. Mean age of participants was 48.8 years (range 24-69 years). All were high school graduates; >60% were college educated. Participants identified cost, race/racism, and challenges navigating the system as barriers to health care. 


Results support that socioeconomically advantaged AAs perceive cost, race/racism, and navigating the system as primary barriers to health care access. Two of these themes are consistent with national health care initiatives: cost is an on-going health care policy issue and navigational difficulties have been acknowledged by the United States government as a primary barrier to care for wounded soldiers.  Racism however, is a unique and persistent concern for AAs that transcends socioeconomic status.  Implications for future research include utilizing community-based participatory research methods and qualitative inquiry as key methods to identify and improve health disparities and health care access.