Integration of the Healthcare Utilization Model to Understand Barriers to HIV Prevention and Treatment Services Among MSM in Rural Georgia: A Qualitative Study Open Access

Abstract

BACKGROUND Men who have sex with men (MSM) living in the Southeast region of the United States are at highest risk of contracting HIV. Furthermore, MSM that live in rural communities experience unique challenges in access to HIV treatment and prevention services. The purpose of this study was to examine barriers to HIV prevention and treatment services among MSM that live in rural Georgia.

METHODS: An exploratory qualitative study was conducted to examine barriers of HIV-negative and HIV-positive MSM living in rural Georgia, as well as healthcare workers in that area. The Andersen Healthcare Utilization Model (HUM) was used to guide the investigation of barriers to HIV prevention and treatment services. This study was conducted in two phases. For Phase I, seven healthcare workers were enrolled and participated in semi-structured in-depth interviews. For Phase II, 17 MSM participants were enrolled and participated in semi-structured, in-depth interviews. Thematic analysis was utilized to explore themes within the data.

RESULTS: The Andersen Healthcare Utilization Model was an appropriate framework to describe the barriers to HIV prevention and treatment services. Population characteristics, including Predisposing factors, Enabling factors, Need factors, as well as Health Behavior and Health Outcomes served as facilitators and barriers to HIV prevention and treatment services among MSM. Stigma, lack of knowledge, lack of prevention services, lack of personal and community resources, perceived health and health status, and social structure of rural life acted as barriers to HIV prevention and treatment services among MSM in rural Georgia.

CONCLUSIONS: MSM living in rural Georgia experience a variety of barriers to HIV prevention and treatment services. Overcoming barriers associated with HIV prevention and treatment services is necessary to achieve fewer cases of HIV infection and increase the care of people living with HIV. Future research is needed explore the impact of barriers related to healthcare utilization among MSM living in rural communities.

Table of Contents

Chapter I: Introduction

Introduction 1-6

Study Purpose 7

Study Objectives 7

Significance of the Study 7-8

Theoretical Framework 8-11

Figure 1: Revisited Framework of Healthcare Utilization Model 10

Figure 2: Theoretical Framework Map: Constructs and Sample Measures 11

Chapter II: Literature Review

Introduction 12

Rural MSM and HIV in Georgia 12-13

Rural Life 14

MSM in Rural Areas 14-15

Barriers to HIV Prevention/Treatment 15-18

Theoretical Framework 18-19

Summary 19-20

Chapter III: Methodology

Introduction 21

Study Population 21-22

Figure 3: Map of Georgia's Sixteen Healthcare Districts 23

Participants 23-24

Participant Recruitment 24-26

Data Collection Methods 26-27

Data Analysis 27-30

Data Quality 30-32

Chapter IV: Results

Introduction 33

Participant Demographics 33-37

Table 1: Healthcare Worker Demographics 34

Table 2: MSM Demographics 36-37

Overview of Themes 37

Social Structure 37-42

Available Community Resources 43-46

Personal Resources 46-49

Services Utilized and Health Practices 49-53

Barriers to Services 53-60

Critiques of Services and Satisfaction with Care 60-66

Recommendations 66-71

Summary 71

Chapter V: Discussion

Introduction 72

The Healthcare Utilization Model: An Appropriate Model 72-74

Figure 4: The Integrated Healthcare Utilization Model 73

Social Structure 75

Personal and Community Resources 75-77

Health Practices and Services Utilized 77-78

Additional Barriers 78

Critiques to Services and Satisfaction with Services 79

Limitations 79-80

Further Directions and Conclusions 80-82

References 83-86

Appendices

Appendix A: Healthcare Worker Eligibility Form 87

Appendix B: Healthcare Worker Consent Form 88-92

Appendix C: MSM Participant Eligibility Form 93

Appendix D: MSM Participant Consent Form 94-95

Appendix E: Recruitment Script for Healthcare Workers 96

Appendix F: Recruitment Flyer 97

Appendix G: Sample Conversation on "Hook-Up" Apps 98

Appendix H: Healthcare Worker Interview Guide 99-103

Appendix I: MSM Interview Guide 104-108

Appendix J: Healthcare Worker Demographic Form 109

Appendix K: MSM Demographic Form 110-112

Appendix L: Transcriptionist Confidentiality Agreement 113

Appendix M: Codebook 114-120

Appendix N: Emory University IRB Approval Letter 121-123

Appendix O: GDPH IRB Approval Letter 124

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Psychology, Behavioral
Keyword	Andersen Model Qualitative men who have sex with men Georgia Rural health MSM Helathcare Utilization Model Healthcare access HIV
Committee Chair / Thesis Advisor	Nehl, Eric J., Emory University
Committee Members	Carnes, Neal, Centers for Disease Control and Prevention Sullivan, Patrick S, Emory University
Partnering Agencies	Georgia state or local health department

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