Applying the Three-Delays Model to Assess the Perceived Barriers to Surgical Care in Robeson County, North Carolina

Abstract

Background: Robeson County, North Carolina was ranked as the least healthy county in the state, in 2020. In Robeson, accessing surgical care is a health challenge, and two known risk factors are its rural location and high proportion of racial minority groups. Applying the three-delays model, the aim of this study was to identify and assess the perceived barriers to surgical care. Methods: To obtain a diverse perspective of how access to surgical care in Robeson County is perceived, interviews were conducted with surgical patients, surgical providers, and community leaders. Duke healthcare personnel, who work in Robeson County, assisted with identifying appropriate stakeholders and surgical patients to interview initially. Additional interviewees were identified through snowball sampling, until saturation was reached. Two researchers independently examined and categorized the responses using the constant comparative method, categorizing quotes from participants in an iterative fashion to identify recurring themes. Results: A total of eleven participants were interviewed (2 nurses, 7 patients, and 2 community leaders). Themes identified included: comfort level with the health system, transportation, logistics of the health system, health system capacity, alternative medicine, community beliefs, county’s historical and cultural context, financing, and suggestions from the participants. Conclusions: This preliminary study suggests that along with Robeson’s rural geography and high proportion of minority groups, the county’s historical and cultural context, the stigmatization of surgical diseases, and the knowledge gap in resource availability also contribute to barriers to accessing surgical care in the county.