ASPO Abstracts
Does perceived rurality contribute to health disparities and rural health: The development of Rural Perception Scale
Category: Cancer Health Disparities
Conference Year: 2019
Abstract Body:
Purpose: There is increasing research attention on enhancing health equity, especially for underserved rural populations. Often with lack of access to resources, knowledge diffusion, and geographical isolation, people living in rural areas experience poorer health outcomes and lower cancer screening rates than their urban counterparts. Validated measurement of rural perception is a missing, but critical link in tying rurality to health behaviors/exposures and outcomes. We developed a psychometrically sound survey scale that assesses key dimensions of perceived rurality.Methods: To assess perceived rurality, we conducted systematic reviews and adapted survey items measuring perceived isolation, loneliness, attitudes toward rural people/living in rural areas, attitudes toward living in urban areas, and perceived social capital. We leveraged a crowdsourcing platform and social media paid advertisements to recruit residents in rural states (NH, VT, KY) in the Fall of 2017. We measured an array of demographic characteristics as well as cancer-related (HPV, cancer information seeking), and other health-related questions (stress, sleep, and opioid use). Results: For this analysis, we included VT and NH respondents (N=698) to cover a geographically contiguous area. Mean age was 42.4 years, nearly half (49.1%) of respondents had some college education, and median annual household income was between $35,000 and $50,000. Explorative and confirmatory factor analyses, and measurement models in the structural equation framework revealed four latent constructs (ΔR2=.64), including ‘sense of connected community’, ‘positivity toward rural living’, ‘self-identity with rural people’, and ‘perceived potential to grow’. Good items loadings (coefficients >.60) and good model fits were confirmed, CFA=.98, NFI=.98, RSMR=.08. Also, there were significant subgroup differences in rural perceptions by demographic characteristics (e.g., education, house hold incomes) and geographic characteristics of residential areas (e.g., zip-code based rural/urban designation). Conclusion: We examined the psychometric properties of rural perception questionnaires and identified four key sub-factors that explain how people in rural states perceive rural environments and rural life styles.
Keywords: Rural health; rural perception, health disparity