'What the doctor orders...is NOT available to all patients who need it:' Investigating Transportation Equity for Medical Appointments in Hampton Roads
Poster #: 145
Session/Time: B
Author:
Ashley Virginia Huang, BS
Mentor:
Julie Sill, PhD
Research Type: Public Health
Abstract
INTRODUCTION:
Transportation is more than a ride. It is often the difference between receiving care and going without it. Social Determinants of Health (SDoH) impact the availability, reliability, and safety of transportation, yet these factors remain largely invisible to healthcare systems. To better understand the problem of transportation equity from the patient's perspective, a team of twenty-one investigators embarked on a Community Based Participatory Research (CBPR) study in Hampton Roads. Inspired by conversations with community members, this innovative research effort incorporated community member input and decision-making in all phases of the research process to investigate how patient transportation, and ultimately access to care, may be impacted by SDoH. This presentation highlights the qualitative findings of phase 1 of the CBPR project.
METHODS:
This prospective, mixed-methods study was conducted in partnership with the Hampton Roads Community Collaborative (HRCC), a community group predominantly representing historically underserved neighborhoods. To better understand the phenomenon of transportation equity for medical appointments, the team collected three forms of qualitative data from both community members and EVMS patients. From June-December 2024, adults ≥18 years were recruited through convenience sampling at Hampton Roads, free community events, from EVMS-affiliated Medicine clinics, and the Ambulatory Care Center (ACC), a free clinic. Data sources included community questionnaires (n=252), semi-structured interviews (n=27), and public observations (n=24) of transportation to medical appointments. Qualitative data were coded via first (i.e., descriptive, In Vivo) and second rounds of coding (i.e., SDoH barriers, supports, and transportation equity terms) with iterative refinement and triangulation across three sources.
RESULTS:
Qualitative data analysis identified three major themes: Disconnection, Personal Strategy, and Human Assistance. Structural/system barriers were the most frequently reported challenges (192-interviews; 44-HRCQ; 9-observations). Human assistance and personal strategy emerged as key supports for helping patients get to medical appointments and to overcome the disconnection between the transportation system or other structural barriers.
CONCLUSION:
Although systemic and structural barriers are challenging to address, the findings from this study highlight the immense difficulty in solving medical transportation disparities in the HR. In collaboration with the HRCC, the team will devise an intervention to target the most feasible and sustainable areas of disparity for EVMS patients. At a minimum, action items include sharing the data with public and private medical transportation companies, local government legislature, and retirement living facilities. As one participant emphasized, "The need is greater than the public is aware of... individuals who have unique needs, such as Parkinson's disease, diabetes, need more assistance with transportation and require a lot of appointments... leads to the fact that what the doctor orders is NOT available to all patients who need it." This quote highlights the gap between this dire need to address medical transportation disparities and the lack of urgency or awareness that exists among the public.
Transportation is more than a ride. It is often the difference between receiving care and going without it. Social Determinants of Health (SDoH) impact the availability, reliability, and safety of transportation, yet these factors remain largely invisible to healthcare systems. To better understand the problem of transportation equity from the patient's perspective, a team of twenty-one investigators embarked on a Community Based Participatory Research (CBPR) study in Hampton Roads. Inspired by conversations with community members, this innovative research effort incorporated community member input and decision-making in all phases of the research process to investigate how patient transportation, and ultimately access to care, may be impacted by SDoH. This presentation highlights the qualitative findings of phase 1 of the CBPR project.
METHODS:
This prospective, mixed-methods study was conducted in partnership with the Hampton Roads Community Collaborative (HRCC), a community group predominantly representing historically underserved neighborhoods. To better understand the phenomenon of transportation equity for medical appointments, the team collected three forms of qualitative data from both community members and EVMS patients. From June-December 2024, adults ≥18 years were recruited through convenience sampling at Hampton Roads, free community events, from EVMS-affiliated Medicine clinics, and the Ambulatory Care Center (ACC), a free clinic. Data sources included community questionnaires (n=252), semi-structured interviews (n=27), and public observations (n=24) of transportation to medical appointments. Qualitative data were coded via first (i.e., descriptive, In Vivo) and second rounds of coding (i.e., SDoH barriers, supports, and transportation equity terms) with iterative refinement and triangulation across three sources.
RESULTS:
Qualitative data analysis identified three major themes: Disconnection, Personal Strategy, and Human Assistance. Structural/system barriers were the most frequently reported challenges (192-interviews; 44-HRCQ; 9-observations). Human assistance and personal strategy emerged as key supports for helping patients get to medical appointments and to overcome the disconnection between the transportation system or other structural barriers.
CONCLUSION:
Although systemic and structural barriers are challenging to address, the findings from this study highlight the immense difficulty in solving medical transportation disparities in the HR. In collaboration with the HRCC, the team will devise an intervention to target the most feasible and sustainable areas of disparity for EVMS patients. At a minimum, action items include sharing the data with public and private medical transportation companies, local government legislature, and retirement living facilities. As one participant emphasized, "The need is greater than the public is aware of... individuals who have unique needs, such as Parkinson's disease, diabetes, need more assistance with transportation and require a lot of appointments... leads to the fact that what the doctor orders is NOT available to all patients who need it." This quote highlights the gap between this dire need to address medical transportation disparities and the lack of urgency or awareness that exists among the public.