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Barriers To Accessing Rural Paediatric Speech Pathlogy Services
Barriers To Accessing Rural Paediatric Speech Pathlogy Services
June
2005133162171Original ArticleBARRIERS TO RURAL SPEECH PATHOLOGY SERVICESA. M. OCALLAGHAN
Et al.
Original Article
Barriers to accessing rural paediatric speech pathology
services: Health care consumers perspectives
Anna M. OCallaghan, Lindy McAllister and Linda Wilson
School of Community Health, Charles Sturt University, Albury-Wodonga, New South Wales, Australia
Abstract
Objective: An investigation of consumers perceived
barriers to access paediatric speech pathology services.
Design: Self-administered, mail-out questionnaire.
Setting: Rural and remote New South Wales (NSW).
Subjects: Three hundred and twenty-nine members of
the NSW branch of the Isolated Childrens and Parents
Association.
Results: Consumers living in rural and remote areas
experience a number of barriers that affected their ability to access speech pathology services. These barriers
include the lack, and limited choice, of speech pathologists in rural areas; long distances to travel to access
services, expensive travel costs, lack of public transport;
poor awareness of speech pathology services; and delays
in treatment due to waiting lists.
Conclusion: Barriers to access paediatric speech
pathology services limit rural and remote consumers
usage of health services, regardless of need, indicating a
possible inequity if compared to larger, more accessible
urban areas.
KEY WORDS: equity, isolated, paediatric, remote,
speech therapy.
Introduction
Rural health services within Australia command proportionally fewer resources and fewer staff than those
in urban areas.1 For example, 4.5% of Australian speech
pathologists provide services to over 30% of the population living in rural and remote areas.2,3 This finding
gives reason to question the equity of rural health services. Many of the sources of inequity in rural health
care have been documented in the literature, see Table 1.
Method
Informants
The informants in this study were 329 members of the
NSW branch of the Isolated Childrens and Parents
Association (ICPA). A summary of background information and characteristics for the informants is included
in Tables 2 and 3.
Questionnaire
A questionnaire (see Appendix I) was sent out by the
ICPA, with its quarterly newsletter, to the 1100 noninstitutional members. The questionnaire was designed
to determine the perceived needs and barriers that rural
and remote families in NSW face when trying to access
paediatric speech pathology services for their children.
Two weeks after the initial mail-out, follow-up letters
were sent, accompanied by another copy of the
questionnaire.
Data from each questionnaire were coded and
recorded in the project database and then analysed using
the Statistical Package for the Social Sciences (SPSS
Inc.). Results relating to consumers perceived barriers
to access and solutions to these barriers are listed below.
163
What
is
already
known
on
this
subject: Numerous studies have described the
inequities of rural health at a systemic level (e.g.
rural health policies of centralisation,
rationalisation, fiscal constraint) and at the level
of health professionals (e.g. no support, sole
positions, and reduced access to resources and
professional development). However, few have
explored the barriers that consumers face when
attempting to access rural health services,
particularly if allied health services such as
speech pathology are needed.
Results
TABLE 1:
References
4
4,5
6
4
4
79
7,8
7,8
7,8
79
7,8
7,8
7,8
4,10
5,11
12
1315
1315
13,15
1315
16
13
13
164
TABLE 2:
A. M. OCALLAGHAN ET AL.
Age
Number of children
Income
Education level
TABLE 3:
Range
Mode
25 to >65 years
1 to >5 children
<$10 000 to >$100 000
Primary school to postgraduate degree
35 to 44 years (44.4%)
3 children (37.1%)
$35 000 to $50 000 (23.7%)
Undergraduate degree (33.7%)
Informants characteristics
n (%)
Sex
Male
Female
Missing data
Ethnicity
ATSI
Caucasian
Other
Missing data
Marital status
Partnered
Single
Missing data
Discussion
25 (7.6)
295 (89.7)
9 (2.7)
0
317 (96.3)
2 (0.6)
10 (3.0)
312 (94.8)
8 (2.4)
9 (2.7)
that offered a list of potential access barriers. Informants were also given the opportunity to cite other
barriers not included in this list.
Travel schemes
One of the possible solutions, proposed by informants,
to alleviate the access barriers listed above included
subsidised client travel. However, only 42 (13%) of the
329 informants reported that they were eligible for any
form of travel allowance in order to access speech
pathology services. The travel schemes reported to have
been accessed by informants to subsidise the cost of
Access barriers
The majority of informants included in this study experienced some form of barrier when attempting to access
paediatric speech pathology services. A summary of
these barriers is presented below.
Service availability
Over 85% of consumers who reported access barriers
cited the lack of available speech pathologists as a prime
concern. This finding is supported by the speech pathology labour force survey compiled by Lambier,2 which
found that only 4.5% of respondents to the survey were
employed in moderately accessible, remote or very
remote regions of Australia, compared to 94% of the
workforce being employed in accessible or highly accessible areas.
Results from this study show that the current length
of wait for rural and remote paediatric speech pathology
services varies from less than 1 month to up to 2 years,
with the average being greater than 6 months. The
majority of informants stated that they found the current length of waiting lists unacceptable. Keens study
of parents acceptance of waiting list times when dealing
with paediatric speech pathology services in a community hospital in Western Australia also identified that
parents believed waiting list periods of between 4 and
165
TABLE 4:
Barriers
Frequency
Percentage
63
56
43
38
33
25
24
12
86
76
59
53
45
36
32
16
Other category responses included local residents negative experiences, which led to an informants decision to not access
services; cancelled appointments; no cooperation between states, for example one informant found that she was unable to access
Queensland community services as she lived in New South Wales; and lack of consistency of services.
TABLE 5:
Resolution strategies
n (%)
9 (15)
5 (8)
3 (5)
31
10
10
8
7
7
4
3
3
(51)
(16)
(16)
(13)
(12)
(15)
(7)
(5)
(5)
Other category responses include greater public transport, screening of all kindergarten children, reducing government red
tape, greater department collaboration (i.e. between the Department of Disability and Aged Care and the Department of Health
Services) and the use of information technology and telecommunications for the delivery of services.
TABLE 6:
Travel allowance schemes reported to be accessed by isolated families to travel to speech pathology services
Travel schemes
Frequency
Percentage
0
0
0
35
5
2
0.0
0.0
0.0
83.3
11.9
4.8
Other category responses included that the Royal Far West Childrens Health Service paid for its clients and one parent to
travel to Sydney, and according to one informant Medicare Benefit Fund subsidises travel if it is over 100 kilometres.
166
Distance decay
Distance decay refers to the phenomenon whereby the
further away a health service is located from a consumers home, the less likely it is to be accessed.9,17 The
effect of distance decay on the failure of consumers to
access paediatric speech pathology services has been
questioned.9 This study supports this as over 50% of
consumers who reported difficulties accessing speech
pathology services said the length of travel required was
an access barrier.
Choice of services
This study showed that because of the limited number
of speech pathologists employed in rural and remote
areas, choice of speech pathologists is not an option.
Consequently, if consumers feel dissatisfied with the service they receive there is no alternative. This finding is
compounded by that of Bourke who stated that should
any issue arise in rural and remote health care, consumers are unaware of where to complain.4 This implies that
rural and remote consumers accept difficulties in health
care provision because they have few service options
available.4
A. M. OCALLAGHAN ET AL.
167
between speech pathologists, consumers and government and nongovernment organisations is required to
overcome barriers and achieve equity of speech pathology service provision in rural and remote areas.
The results of this study gave rise to the formulation
of a number of recommendations aimed at improving
the equity of paediatric speech pathology services. These
recommendations include increased funding for more
speech pathologists and expanded speech pathology services in rural and remote areas; increased public awareness campaigns to make rural and remote consumers
aware of speech pathology services; increased incentives
to attract speech pathologists to rural and remote areas;
and improved schemes to enable consumers to travel to
speech pathology services together with better promotion of such schemes.
10
Acknowledgements
Speech Pathology Australia provided the first author
with a research grant to subsidise the research costs of
this project. The ICPA (NSW) assisted in the distribution of the questionnaires to its members.
References
1 WONCA Working Party on Rural Practice. Policy on
Rural Practice and Rural Health. Traralgon, Victoria:
Monash University School of Rural Health, 2001.
2 Lambier J. Labour Force Data: Part A. 2002. [Cited
15 October 2003]. Available from URL: http://www.
speechpathologyaustralia.org.au
3 Australian Bureau of Statistics. Australian Social Trends:
Population Characteristics and Remoteness. 2003. [Cited
15 October 2003]. Available from URL: http://
www.abs.gov.au
4 Bourke L. Australian rural consumers perceptions of
health issues. Australian Journal of Rural Health 2001;
9: 16.
5 Strasser RP, Harvey D, Burley M. The health needs of
small rural communities. Australian Journal of Rural
Health 1994; 2: 713.
6 Keen A. Speech pathology survey: parents acceptance of
waiting list times. Australian Communication Quarterly:
11
12
13
14
15
16
17
18
168
Appendix I: Questionnaire
A. M. OCALLAGHAN ET AL.
Appendix I: Continued
169
170
Appendix I: Continued
A. M. OCALLAGHAN ET AL.
Appendix I: Continued
171