Rural hospital closures and perceived access to care: A qualitative descriptive study in an Appalachian county of Tennessee

Background: Tennessee has suffered more hospital closures per capita than anywhere else in the nation. The impact of hospital closures on access to care in rural and economically distressed Appalachian counties of Tennessee is of particular concern because these communities experience great health disparities. Hospital closures may exacerbate these disparities and create additional barriers when accessing care.

Objectives: The aim of this study was to describe community residents’ perceptions of health and access to care following a hospital closure in a rural and economically distressed Appalachian county of Tennessee.

Methods: This study used a qualitative descriptive approach to present community residents’ perceptions of health and access to care following a hospital closure. Penchansky and Thomas’ framework of healthcare access, which accounts for five different dimensions of access, was employed as the conceptual framework. Semi-structured interviews were conducted via telephone with 24 community residents from a rural and economically distressed Appalachian county of Tennessee that recently experienced a hospital closure. Interviews were analyzed using conventional content analysis to identify themes.

Results: Results from interviews revealed that perceptions of health and access to care were associated with the hospital. Four themes that emerged from the data were access to care; stress and reactions; value for the hospital; and unrest in the community. Access to care was negatively affected across all five dimensions of the health care access framework. Stress and reactions described an increase in stress after the hospital closure and, consequently, community residents reacted in different ways such as putting off care or having hope. Value for the hospital described the importance of a hospital for community viability and health outcomes. Unrest described the state of dissatisfaction among community residents after the closing of the hospital.

Conclusion: This study revealed that a rural hospital closure has a multi-dimensional, negative impact on the community, and community residents valued their hospital for more than accessing health care. The results of this study provide a critical perspective to inform local elected officials, health care professionals, and community leaders on how to more effectively and efficiently meet the health needs of their community.