1

A CORRELATIONAL STUDY ON BARRIERS TO

HEALTHCARE ACCESS AND LIVING CONDITIONS AMONG

OLDER ADULTS IN RURAL AREAS

Hernandez, Ella Joyce Marie M.

Galvez, Kate Louise DC.

Ladisla, Jannella R.

Obina, Keisley Eunice L.

Department of Psychology, Wesleyan University- Philippines

PSYCH 7: Field Methods in Psychology

Mrs. Fiona Corinne G. Esteban

April 4, 2024
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Abstract

The number of elderly persons in contemporary society is rising. The WHO (2021)

estimated that the older population would double in the next 30 years; poverty among the older

age group also exhibited its rampancy. In the Philippines, the proportion of the poor in rural

areas, including farmers and fisherfolk, is 25.7 percent. As of 2021, approximately 2.7 million

farmers and fisherfolk, constituting 30 percent of their population, live below the national

poverty threshold. Thus, older adults are continuously dwelling with difficulties in health

access and living conditions (The Borgen Project, 2019). The relationship between living

circumstances and barriers to healthcare access for older individuals is emphasized in this

study. Living conditions are referred to as circumstances that influence an individual's way of

life (Habitat for Humanity GB, 2021). On the other hand, the barriers to healthcare access are

factors that prohibit or barricade the ability of specific individuals to acquire substantial

healthcare services (Loignon et al., 2017). Overall, the participants who were eligible are

elderly Filipinos living in the designated barrio and 65 years of age or older. The study utilized

a descriptive correlational quantitative methodology and analyzed the data using frequency

distribution, mode, and a spearman rank test for correlation.

Keywords: Living conditions, Barriers to Healthcare Access, Older Adult

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A Correlational Study on Barriers to Healthcare Access and Living Conditions among

Older Adults in Rural Areas

Problem Rationale

An aging population, characterized by a rising proportion of individuals aged 60 years

and above, presents significant challenges and implications for healthcare systems and social

policies in many countries, including the Philippines. As of the latest census in 2020, the

Philippines recorded a total of 9.22 million senior citizens, constituting 8.5 percent of the

population. This marked a substantial increase from 2000 when the elderly accounted for only

5.9 percent of the population, totaling 4.5 million. With the aging demographic, there is a

corresponding increase in the demand for healthcare services, as older individuals are

susceptible to various health issues such as degenerative diseases, infections, visual

impairment, mobility difficulties, and chronic conditions like osteoporosis and arthritis.

However, the provision of healthcare services in the Philippines faces challenges, as

highlighted by the World Health Organization (WHO), including fragmented health systems

and disparities in access to quality care between rural and urban areas. Economic inequality

and geographical barriers contribute to disparities in healthcare access, with only 25% of rural

Filipinos having access to needed health services compared to 46% of urban dwellers. Despite

government efforts to improve healthcare access through initiatives like the Universal Health
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Care (UHC) Bill, significant gaps remain in healthcare quality and accessibility nationwide.

Although remarkable progress has been made on public health initiatives in recent years, there

are still significant cultural and social barriers that prevent Filipinos from accessing the care

they need. Factors such as poverty, geographical distance, religious beliefs, gender norms, and

language proficiency play a major role in determining access to appropriate medical services.

As the world delves into the continuum of time, people are statistically and evidently

living longer. It has been estimated that by the year 2050 the current population of people

ranging from ages 60 and over would double and result in an outstanding 2.1 billion. Population

aging – in first world countries has started earlier whereas most of them comprise a large

percentage of the older adult population. Low-income or third world countries are now rising

to the trend and are gradually experiencing the same population shift (WHO, 2021). Asian

countries have also shown a rampant elevation in older adult population, whereas it has been

projected to reach 923 million by mid-century and may be considered as the oldest continent

population amongst all countries (Asian Development Bank, 2017). Parallel to these population

growths worldwide, the Philippines contributed a fair share increase as its population of senior

citizens exceeded 10 million at the end of 2021 (Commission on Population and Development,

2021). As per 2050 the Philippine older adult population is perceived to reach 15 million

(United Nations, 2017).

The Philippines, being categorized as a third world country, also confronted the

increasing older adult population. In the 2018 Philippine health system review, it revealed an
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increasing old-age dependency ratio reflecting the growing population of Filipinos ages 65 and

over (Dayrit, Lagrada et.al., 2018). A high dependency ratio indicates a larger number of the

economically inactive compared to the economically active population, a rapid increase in

older-age dependency ratio may result in a decreasing productivity growth of the economy

(Pettinger, 2017). This dependency ratio gravely affects the distribution and adequate

providence of security, social services and predominantly healthcare services. This increase

also indicates a demanding healthcare expenditure for the older adult population.

The Republic Act 11223 Universal Health Care Law (UHC) signed by President

Rodrigo Duterte in February of 2019 states that “All Filipinos are guaranteed equitable access

to quality and affordable health care goods and services, and protected against financial risk.

The UHC helps ensure every Filipino is healthy, protected from health hazards and risks, and

has access to affordable, quality, and readily available health service that is suitable to their

needs” (Department of Health, 2019). The 2019 UHC substantiates that every Filipino citizen

has the right to healthcare regardless of status and age. Nonetheless health disparities still exist

among older adults due to their expanding number, whereas these are also considered as

barriers to healthcare, inhibiting the older-age population to achieve and maintain an optimal

health (National Institute of Health, 2020).

This study was constructed based upon the observations of the researchers towards the

selected barangay. There are apparent marginalized areas within the barangay where older adult

populations foster, wherein their living conditions have affected the way they are exposed to
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the availability of healthcare. Along these keen observations the researchers identified the

problems and specified factors that had potentially hoisted barriers to healthcare accessibility.

This study aim to identify the relationship between the barriers to healthcare access and

the living conditions among older adults in the marginalized area of the selected barangay. This

study will delve into unveiling the definite factors within the older adults’ living conditions

which heightens their vulnerability towards the uprising barriers to healthcare access.

Statement of the Problem

The study will explore the correlation of the living conditions and the barriers to

healthcare amongst older adults in the marginalized area of the selected barangay. Specifically,

this research sought to answer the following research questions:

1. What is the demographic profile of the respondents in terms of the following?

1.1 Age

1.2 Sex

1.3 Educational attainment

1.4 Type of family

1.5 Gross family income

2. How satisfied are older adults with their living conditions in terms of?

2.1 Housing
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2.2 Food

2.3 Access to healthcare

3. What are the biggest challenges older adults face in accessing healthcare in terms of?

3.1 Personal responsiveness to health concerns

3.2 Quality of healthcare

3.3 Financial capacity

3.4 Transportation accessibility

3.5 Family support

4. Is there a significant correlation between the indicators towards the living conditions and the

indicators towards barriers to healthcare access among older adults?

Research Hypothesis

HO: There is a significant correlation between the indicators towards the living conditions and

the indicators towards the barriers to healthcare access among older adults.

H1: There is a significant correlation between the indicators towards the living conditions and

the indicators towards the barriers to healthcare access among older adults.

Significance of the Study

The result of the study may be beneficial to the following:

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To the older adults: Being the main focus of the research, the study sought to improve the

living conditions of the older adult population in order to adequately meet their needs for

healthcare. It also sought to address any deficiencies or barriers to healthcare access that they

may have encountered.

To the local health units: This study will benefit the local health units in identifying factors

that hindered older adults from acquiring healthcare.

To the future researchers: The number of older adults has significantly increased, demanding

ongoing research into the many problems and dilemmas that come with these population

growths. Future scholars will benefit from this study as it will enable them to continue

searching for solutions to issues and challenges that arise as the population grows.

Scope and Limitations

This study will be carried out in Barangay Magsalisi, Jaen, Nueva Ecija. According to

the 2015 Census, old dependent population consisting of the senior citizens, those aged 65 and

over, total 3.54% (118) in all. The barangay is a small area at the southern part of Nueva Ecija.

The researchers will conduct the research study in the said barangay because it caters the target

population, which are the older adults in barangay Magsalisi. This research will comprise of

60 respondents from the selected barangay the specific inclusions and exclusions of the

respondents would include [1] both male and female; [2] 65 years old and above; [3] Filipino
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citizen; [4] resident of barangay Magsalisi, Jaen, Nueva Ecija; [5] older adults who are capable

of giving personal consent; [6] willing to participate to the study. The research study would

delve only with the primary factor affecting living conditions and its indicators which are the;

housing, food, sanitation, and access to healthcare. The study also considers the following

primary factors when analyzing barriers to healthcare access: financial capacity, family

support, healthcare quality, and accessibility to transportation. The demographic profile

variables are as follows; age, educational attainment, sex, type of family, and the gross family

income.

Review of Related Literature

Access to health care is defined as having timely use of personal health services to

achieve the best possible health outcome (International Organization for Migration, 1993).

Access requires gaining entry into the health-care system, getting access to sites of care where

patients can receive needed services, and finding providers who meet the needs of patients and

with whom patients can develop a relationship based on mutual communication and trust

(AHRQ, 2010). Clinicians note that timely access to health care is important inasmuch as it

might enable patients and physicians to prevent illness, control acute episodes, or manage

chronic conditions, any of which could avoid exacerbation or complication of health conditions

(NCHS, 2017b).

More recently Levesque et al. (2013) defined access to health care by presenting five

dimensions of accessibility: approachability, acceptability, availability and accommodation,

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affordability, and appropriateness. They saw access as the opportunity to identify health-care

needs; to reach, obtain, or use health-care services; and to have the need for services fulfilled.

According to the 2014 RUPRI Health Panel report, Access to Rural Health Care - A

Literature Review and New Synthesis, barriers to healthcare result in unmet healthcare needs,

including a lack of preventive and screening services and treatment of illnesses. A vital rural

community is dependent on the health of its population. While access to medical care does not

guarantee good health, access to healthcare is critical for a population's well-being and optimal

health. The challenges that rural residents face in accessing healthcare services contribute to

health disparities.

Residents of rural areas differ from residents of urban areas in several important

characteristics that correlate with health-care utilization. Rural residents have low incomes: the

incidence of poverty is much higher among rural inhabitants measured as 36 percent compared

to 13 percent in urban residents. (International Fund for Agricultural Development,) According

to National Health Council (2023), “Poverty is directly correlated with poor health outcomes,

and it is important to acknowledge the impact that financial and social limitations can have on

one’s health and quality of life.” as poverty plays a vital role in patient experience, hindering

adequate access to health care and resources. Furthermore, the National Health Council (2023)

also stated that patients' unwillingness to interact with the health care ecosystem is hindered by

their inability to rely on transportation or financial stability. Income correlates highly with risk

factors for chronic disease: for example, people who have lower family income have higher
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rates of heart disease, stroke, diabetes, or hypertension, and have four or more common chronic

conditions (NCHS, 2017b). People in families whose income is less than 200 percent of the

federal poverty level are more likely to be obese and to smoke cigarettes than wealthier people.

Adults who live in poverty are also more likely to have self-reported serious psychologic

distress, as measured by a series of questions about their perceived mental health. From 2000

to 2010, the percentage of people 18–64 years old who did not get or delayed seeking needed

medical care during the preceding 12 months because of cost increased in all family income

groups. During that period, the percentage who had unmet needs for medical care decreased as

family income increased from below 200 percent of the poverty level to 400 percent or more

of the poverty level. Failure to receive needed medical care because of cost was equally likely

in families below the poverty level and those whose income was 100–199 percent of the

poverty level.

In addition, more recent findings indicate that in 2014 28.6 percent of adults who were

living under the poverty level had one or more ED visits compared with 13.5 percent of adults

who were at 400 percent of the poverty level, and 8.1 percent of adults under the poverty level

had at least one hospitalization compared with 3.8 percent of adults at 400 percent of the

poverty level. Despite the high utilization of health-care services by low-income people, adults

under the poverty level reported greater rates of not receiving or of delaying medical care,

obtaining prescription drugs, and receiving dental care because of costs than adults who were

at 400 percent of the poverty level. Thus, healthcare needs of those under the poverty level are

still being unmet despite their higher utilization of emergency and hospital services (NCHS,

2017).
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However, some barriers to health service utilization are due to the service system, such

as appointments, availability of services, health insurance, and bureaucratic procedures. A

study examined patient's satisfaction with access to treatment in public and private healthcare

sectors in London, Britain found that clients were dissatisfied with the time taken to schedule

appointments (Owusu-Frimpong, Nwankwo, & Dason, 2010). Limited availability of services

is also considered a reason that forced some patients to avoid local health services (Liu,

Bellamy, & McCormick, 2007).

The amount of time a patient waits to be seen by a health care provider affects health

services utilization. Healthcare institutions and providers should apply measures that reduce

waiting time and ensuring patient satisfaction (Umar, Oche, & Umar, 2011). The commonest

reason for the long waiting time reported in previous literature was the large numbers of

patients with few healthcare workers (Oche & Adamu, 2013).

Moreover, transportation from and to medical facilities is a geographical barrier that

affects access to healthcare services. Rural populations are more likely to have to travel long

distances to access healthcare services, particularly subspecialist services. This can be a

significant burden in terms of travel time, cost, and time away from the workplace. In addition,

the lack of reliable transportation is a barrier to care. (RHI Hub). Furthermore, a national study

in Jordan that examined the role of substandard care and delays in maternal deaths found that

there was a problem of access for women in the study. Twelve women (15.8%) failed to get

transportation at appropriate times. Families in this study reported that this was due to financial

problems (50%), living in a remote area far away from regular transportation (33.3%), and
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transportation became available only after 30 min after midnight (16.6%) (Okour, Khader,

Amarin, Jaddou, & Gharaibeh, 2012).

The distance of the healthcare facility is another geographical barrier that affects health

service utilization. One study that examined the relationship between distance and the

utilization of healthcare services by a group of elderly residents in rural Vermont, United States

of America confirmed that increased distance from a provider does reduce utilization (Nemet

& Bailey, 2000). Traveling distance and traveling time was reported by patients as a reason for

skipping inpatient care among patients living in Critical Access Hospital service areas (Liu et

al., 2007).

While existing research acknowledges the challenges faced by rural older populations

in accessing healthcare, there's a gap in focusing on the specific context of small barangays in

rural areas. Barangays, the smallest administrative divisions in the Philippines (NIH, 2023),

can have unique characteristics that influence healthcare access and living conditions for older

adults. To be more specific, the problems with these barangays are that they are often far from

health centers, and require allot of travel and expenses for older adults to reach such medical

facilities, furthermore, they are out of reach or outside of affordable mass public transport. To

address this gap in the literature, this study will focus on elderly people within a small rural

barangay. This study will take an approach to investigate and understand how the challenges

of living in rural barangays connected to the difficulties older adults face in getting the

healthcare they need.

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Theoretical Framework

This study utilized concepts within the Health Belief Model (HBM), this is a theoretical

model establishing the elements that guides the realms of health promotion and disease

prevention. Health belief model seeks to identify and understand certain health behaviors based

upon the adherence and perceived beliefs in health practices. HBM comprises components

namely the (a) individual perceptions which include the perceived severity and susceptibility

of a specific disease; (b) modifying factors involving the demographic profile, socio-

psychological variables, and structural variables and lastly (c) likelihood of actions

incorporating the perceived benefits and perceived barriers to action (Bastable, 2019).

Based on a complementary write up by LaMorte (2019) of the Boston University of

Public Health, The HBM was made in order to comprehend the inadequacy of people to accept

and adapt to disease prevention strategies such as screening tests for disease detection. Another

is the use of HBM to identify the responses, the evident symptoms and the compliance of

individuals to medical interventions. The 6 HBM constructs are as follows (1) perceived

susceptibility refers to one’s subjective perceptive vulnerability in acquiring illnesses or

diseases. (2) Perceived severity regards the seriousness of acquiring disease. (3) Perceived

benefits present the valuable actions and interventions that are used to reduce or prevent the

threat of illnesses. (4) Perceived barriers included the dilemma an individual faces while

exhibiting the recommended and beneficial health actions. (5) Cue to action is a generating

factor which starts up the interest of an individual to take the health action into consideration.
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(6) Self-efficacy involves a person’s esteem towards fruitfully performing the behavior or

health action thus also deciding it was desirable or either way.

This study highlighted the variables living conditions and barriers to healthcare access

which resulted and affirmed a correlation. The Health Belief Model was utilized as it comprises

constructs that similarly define the variables of the study as well as its output. In synthesizing

the results of the study to the Health Belief Model the researchers employed the 6 constructs

and accustomed the variables of the study in order to identify how older adults behave towards

health care promotion and disease prevention. The Modifying Factors regarded the

demographic variables of the study namely the age and educational attainment which presented

a significant correlation with the variables living conditions and barriers to healthcare access.

The Perceived susceptibility contained the recognized problems based on the level of

agreement of older adults towards indicators under living conditions and barriers to healthcare.

The perceived severity, emphasized the experienced severity of their living circumstances and

the rampancy of barriers to healthcare access. The perceived benefits, expounded on an

optimistic approach to resolve the dilemmas experienced regarding the variable, wherein these

benefits are subtracted to the perceived barriers hence indicating that there is a lack of ability

to actualize pertinent actions for the problems identified.

This framework was chosen because it fits and supports the concept that the researchers

would like to see as they develop the study. This would also be a great help in unleashing the

objectives of the study because of its relevance and implications. Moreover, it also helped the
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researchers to craft their own research design and in the development of the appropriate method

and questionnaires.
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Research Methods

Participants

The participants will include community members in a rural barangay in Magsalisi,

Jaen, Nueva Ecija, who are 65 years old and above, male or female, and agreed to participate

in the study.

Conceptual Framework
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Figure 2: Barriers to Healthcare Access and Living Conditions Correlation Study

Framework.

The figure above showed that the demographic profile was linked to both the living

conditions and the barriers to healthcare access among older adults in rural areas. The indicators

of living conditions are access to healthcare, food, and shelter as well as sanitary conditions.

While the primary indications of barriers to healthcare access include personally

responsiveness to health concerns, financial ability, family support, healthcare quality, and

accessibility to transportation. The figure illustrated the relationship between the indicators of

living conditions and the barriers to accessing healthcare. The process described the population
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sampling process, the exact method of collecting the data, and the data analysis that included

all the statistical methods used in the study.

Research Instrument/Materials

The researchers will utilize surveys in the form of self-administered and researcher-

constructed questionnaires as the research instrument for the data collection process. The

survey questionnaire consisted of three parts. In part I, the researchers will pertain to the

demographic profile of the respondents that consist of 5 questions; it determined the age, sex,

educational attainment, type of family structures, and the gross family income of the

respondents. On the other hand, part II consisted of questions where the respondents will be

asked about the living conditions of older adults in the marginalized or poor lying areas of the

selected barangay. Succeeding, part III consisted of questions where the researchers will ask

the barriers that affect the accessibility of older adults in healthcare. The part II and part III of

the survey questionnaire is composed of a series of statements relevant to the given indicators

for every sub-variable; the answers will be based on the respondent's level of agreement guided

by a 5- point Likert Scale as the survey’s rating system. In which respondents specify their

level of agreement to a statement in five points: (5) strongly agree; (4) agree; (3) neutral; (2)

disagree; and (1) strongly disagree. In this way, the research instrument obtained valid

responses from the respondents. The scope and contents of the self- administered survey

questionnaire will be translated to Filipino language which extracted effective results as well
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as established its ethical and constructive appropriateness to the study being conducted. A pilot

study will also be conducted.

Procedure

The research procedure will involve the following steps:

Recruitment: Participants will be recruited through community centers, senior centers, and

local healthcare facilities in rural areas. Information about the study objectives and eligibility

criteria will be provided, and interested individuals meeting the inclusion criteria will be invited

to participate.

Informed Consent: Prior to participation, potential participants will be approached by the

researchers in person. The researchers will provide a detailed explanation of the study's

purpose, procedures, risks, and benefits. Participants will be given an informed consent form

to read and sign if they agree to participate.

Questionnaire Administration: The researchers conducting the study will personally distribute

the structured questionnaires to the participants.

Data Collection: Responses from the completed questionnaires will be collected immediately

after participants finish filling them out. The researchers will collect the questionnaires from
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the participants personally to ensure timely and accurate data collection. The collected data

will be stored securely to maintain confidentiality and anonymity of participants.

Reliability and Validity

Validity: Content validity will be ensured through expert review and consultation with the

research advisor during the development of the questionnaire. Construct validity will be

assessed through factor analysis to confirm distinct factors related to hidden barriers and

healthcare utilization among rural older adults.

Research Design

In this study, the research design utilized descriptive correlational quantitative research

(School.org, 2020). This research enabled the collection and analysis of quantitative data for

the researchers to evaluate and explain the result of the study in a thorough manner. The

researchers only focused primarily on describing relationships among variables, specifically

the barriers of health care access and the living conditions of older adults (Quarta, 2017).

Complementary to the quantitative design, the focus of descriptive correlational research was

to describe the connection between variables rather than to infer cause and effect (ProQuest,

2021).

Data Analysis
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All gathered data from the collection process will be analyzed based upon certain parameters

set for the population. The data collated from the survey questionnaires which included the

following parts;

Respondent’s demographic profile, indicators pertaining to the living conditions and the

barriers to healthcare access among older adults in the selected barangay, will be subjected to

an analysis in order to answer the research questions and establish the set goals of the study.

Research question one (1) which sought to determine the demographic profile will utilize

frequency and percentage distribution to identify relevant profiling among the conveniently

selected respondents. Research question two (2) and three (3) ascertained the agreement of

respondents towards the indicators under the living conditions and barriers to healthcare access

of older adults; responses from each question will be summarized along with the identification

of the frequency, valid percentage, and mode. The mode is the value that is most frequently

appearing in a data set. The Likert-scale interpretation is based on the identified mode

following the allocated values of; (5) Strongly Agree, (4) Agree, (3) Neutral, (2) Disagree and

(1) Strongly Disagree. Maneuvering the IBM SPSS statistics tool, the researchers will first test

the data normality by using the Shapiro-Wilk normality test, by employing the descriptive

statistics analyzation tool in SPSS, this will generate the Test for Normality table wherein the

computed data will be implicated; Research question four (4) which aimed to identify the

significant correlation interchangeably among the three variables, will be treated with the use

of a non-parametric test. In doing so the SPSS statistics tool was also be accustomed. To

explicate the computed data the P-value perceived as (sig) in the generated table was
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interpreted within an alpha coefficient of 0.05; if the p-value was greater than the 0.05 alpha

coefficient the variables contained a no significant correlation which also heightened the

probability of accepting the null hypothesis; on the contrary if the p-value was less than the

0.05 alpha coefficient the variables obtained a significant correlation therefore a high

probability of rejecting the null hypothesis. In interpreting the correlation coefficient or the rho

coefficient; it is expounded within the conditions that if the coefficient was greater than or

equal to positive one (+1) therefore there was a positive correlation between variables; and if

the coefficient was equal of less than negative one (-1) therefore there was a negative

correlation between the variables and both moves in opposite direction.

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