Original Research

Engaging rural communities to incorporate social determinants in developing strategies to improve access to health care in the Missouri Bootheel counties


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Ashish Shrestha
1 MPH, Research Assistant *

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Katherine Stamatakis
2 PhD, Associate Professor

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Janice Ballard
3 MPH, Executive Director

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Ardella Burgess
4 Program Assistant

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Elizabeth Baker
5 PhD, Professor


1, 5 Department of Behavioral Science and Health Education, Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri, USA

2 Department of Epidemiology and Biostatistics, Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri, USA

3, 4 Health in the Heartland, Caruthersville, MO, USA

ACCEPTED: 27 September 2022

early abstract:

Introduction: The purpose of the study was to engage community members and practice partners across multiple sectors in a participatory strategy development process to identify social and organizational determinants of accessing healthcare, collectively prioritize identified issues, and develop strategies for change.
Methods: Using concept mapping, a mixed-methods approach, a collaborative team of academics, practice partners, and community health workers collected data from community members and agency representatives (n=366) across four counties through facilitated community forums and an online survey in four counties in the Bootheel region of Missouri. These responses were consolidated into a set of statements that were used with a smaller group of participants (n=60, 15 per county) for sorting and rating purposes. The resulting concept maps were presented to community participants, who were guided through a structured process for prioritization of issues and strategy development.
Results: Participants identified several individual, social, community, and organization level barriers to accessing healthcare, including cost, lack of transportation, lack of information about services, lack of coordinated care, lack of trust, and racism and classism in local healthcare systems.
Conclusions: While the key social and organizational determinants of access to healthcare were similar across counties, the prioritization of these determinants and the strategies developed to address key issues differed across the counties.