To complete this assessment, do the following: Provide a title slide.Identify the topic you selected (the same one you selected for Assessment 2 the attached essay please!) and briefly summarize the f

Healthcare Access Inequities and Preventive Care Utilization: An Annotated Bibliography and Research Discussion

Tori ODaniel

Capella University

12/01/2025

Healthcare Access Inequities and Preventive Care Utilization: An Annotated Bibliography and Research Discussion

Introduction

Topic Identification

Healthcare access disparities persist as a significant challenge in many countries with high levels of national income, such as the USA. Yet, despite high levels of per capita investment, gaps remain in areas of primary or preventive care. Such gaps in access to primary or preventive care lead to poorer health status, increased risk of being diagnosed at an advanced stage of the disease process, and a greater likelihood of a disadvantaged socioeconomic class and racial or ethnic group dying than those in a higher socioeconomic position, racial, or ethnic group. Research has recently demonstrated that people with lower incomes, less education, or who belong to a minority population are significantly more likely to report having unmet needs for accessing primary care, incur cost-sharing expenses, and underutilize recommended preventive services, e.g., cancer screenings.

Professional Relevance

For professionals in public health, epidemiology, and health services research to address access disparities within populations, achieving health equity, decreasing preventable morbidity and mortality, and developing effective interventions/policies is imperative. Access disparities in preventive services contribute to the overload of our emergency care systems, increased healthcare expenditures, and ultimately impact the development and planning of community health policy.

My Interest in The Problem

I find this issue particularly significant to me personally because of my work in public health analysis, of completing previous assignments, where I have learned and now understand that structural aspects of society, such as social determinants like income, education, insurance, and geography, have far-reaching health outcomes through the impact on factors beyond individual personal behaviors. Thus, understanding access inequities helps me align with my broader interests regarding population health, health equity, and the need for targeted intervention efforts for underserved populations.

Professional Experience with The Topic

My previous coursework focused on projects that utilized national datasets to examine patterns of healthcare service utilization (e.g., checkup attendance indicators from the BRFSS, emergency department visitation trends from 2016 to 2021) and revealed disparities in healthcare utilization across different populations. Through these projects, I became aware of the critical importance of equitable access to care for all patients, which has driven me to pursue a more in-depth literature review of the structural barriers to access.

Discussion of Research

Selection Process

To provide an evidence base on this issue, I performed a structured search within the academic literature and internet using the following parameters to identify three current (published within the last three years) peer-reviewed scholarly articles that focus on access inequities, use of preventive care, and social determinants of unmet primary care needs in the United States.

Search Process and Keywords.

I began with broad search terms such as:

• “healthcare disparities in United States preventive care utilization 2023.”

• “unmet need for primary care social determinants systematic review 2024.”

• “racial disparities cancer screening US 2024.”

• Then refined to more specific combinations: “cost sharing preventive care 2024 USA,” “primary care access immigrants rural America,” “telehealth use disparities US 2024.”

Databases and Sources Used

The databases I used for my search are primarily open-access databases (e.g., Springer, BMC, PubMed, MDPI) and Google Scholar. Due to the open-access restrictions on many databases, I will mainly select articles that are available as full-text documents to ensure a thorough reading of the methodology, findings, and limitations presented.

Selection Criteria

The criteria each resource must meet are as follows:

1. Be published between 2023 and 2025.

2. Be peer-reviewed or published in a reputable open-access journal.

3. Be focused directly on one or more of the following topics: access inequity, use of preventive care, primary care unmet needs, or the social determinants of those unmet needs.

4. Must include empirical data from either a cross-sectional study, systematic review, or mixed-methods study that used sound methodology.

5. Must pertain to the United States healthcare system such that the findings and implications of these articles will be generalizable to this context.

Through the literature review process, I found several candidate articles that I evaluated based on their credibility (appropriate peer review, being open access, having transparent methodology, and discussing limitations) and their relevance to the question. I selected three articles that offer a complementary view: an empirical study on racial/ethnic disparities regarding perinatal mental health service utilization, an empirical study on unmet primary care needs, and an empirical study on preventive care utilization in a minority population.

Annotated Bibliography

Alemu, F. W., Yuan, J., Kadish, S., Son, S., Khan, S. S., Nulla, S. M., ... & Ali, S. (2024). Social determinants of unmet need for primary care: A systematic review. Systematic Reviews, 13(1), 252. https://doi.org/10.1186/s13643-024-02647-5

A systematic review of the literature about the prevalence and social determinants of unmet primary care needs by Alemu et al (2024) revealed that Canada has 46 studies, with the most studies being cross-sectional. Most of the studies have a low risk of bias. The authors report that unmet primary care needs are between 6% to 25%. The authors found that having unmet needs is consistently associated with being low-income, having mental health challenges, and being a person with chronic conditions. The authors report that having more unmet needs is related to being older, having better perceived health, and having a regular family physician. Although Canada has a universal primary care system, the authors conclude that social determinants impact access.

Rokicki, S., Patel, M., Suplee, P. D., & D’Oria, R. (2024). Racial and ethnic disparities in access to community-based perinatal mental health programs: Results from a cross-sectional survey. BMC Public Health, 24(1), 1094. https://doi.org/10.1186/s12889-024-18517-7

The study by Rokicki et al. (2024) has examined racial/ethnic disparities in community-based perinatal mental health programs. The use of a nationwide survey to collect data from 33 program administrators across New Jersey identified significant gaps in the usage and access of Black, Hispanic, and Asian individuals to these programs, who represented less than 10% of the participants and facilitators within the majority of programs. These findings also demonstrated challenges in language access and geography. Program administrators identified many barriers, including stigma, fear of disclosure, social determinants of health, lack of awareness, and lack of a language-concordant workforce. To reduce inequities in perinatal mental health care services, the authors recommend: increasing outreach to the affected community, creating a more diverse workforce, and creating more accessible programs.

Tindall, J., Brown, M. J., & Hung, P. (2024). Mental health care disparities among US pregnant individuals in 2020–2021: A cross-sectional study. Journal of Racial and Ethnic Health Disparities, 1-11. https://doi.org/10.1007/s40615-024-02250-3

Tindall et al. (2024) investigated how the concept of rurality and race-ethnicity influence perceived unmet mental health needs and the types of mental health care settings accessed by pregnant women in America. Utilizing data gathered from 1097 respondents participating in the 2020-2021 National Survey on Drug Use and Health, the authors demonstrated that pregnant non-Hispanic Black women and those from nonmetropolitan or rural areas were less likely to perceive themselves as having unmet mental health needs compared to pregnant non-Hispanic White women and those in large metropolitan areas. However, the authors also indicated these same groups were less likely to have access to virtual mental health treatment and prescription medications for the treatment of mental health. The authors conclude that the availability of structurally inappropriate mental health programs, modified expectations, and disruptions created by COVID-19 all create barriers to accessing mental health services. Culturally responsive and accessible maternal mental health services are necessary.

Summary and Reflection

Creating this annotated bibliography gave me a better idea of how social determinants, such as income, race and ethnicity, insurance coverage, geographic location, etc., affect access to both primary and mental health care. The studies indicated that health disparities are rooted in structural and systemic barriers, rather than individual decisions; therefore, population-level and policy-driven solutions are required to improve access to health care for underserved populations.

Not only did this process improve my research abilities, but it also allowed me to gain a greater understanding of how to locate credible scholarly sources, use targeted keywords to enhance my ability to search effectively, and evaluate the quality of the methods used in the studies to determine if they are valid. Furthermore, this experience reinforced the difficulty in selecting relevant evidence from multiple studies and determining how to synthesize it into a cohesive approach for implementation in my practice. Ultimately, this experience confirmed my commitment to aligning research with policy and community-based strategies to address inequities and strengthened my desire to incorporate more equity into my future public health work.

References

Alemu, F. W., Yuan, J., Kadish, S., Son, S., Khan, S. S., Nulla, S. M., ... & Ali, S. (2024). Social determinants of unmet need for primary care: A systematic review. Systematic Reviews, 13(1), 252. https://doi.org/10.1186/s13643-024-02647-5

Rokicki, S., Patel, M., Suplee, P. D., & D’Oria, R. (2024). Racial and ethnic disparities in access to community-based perinatal mental health programs: Results from a cross-sectional survey. BMC Public Health, 24(1), 1094. https://doi.org/10.1186/s12889-024-18517-7

Tindall, J., Brown, M. J., & Hung, P. (2024). Mental health care disparities among US pregnant individuals in 2020–2021: A cross-sectional study. Journal of Racial and Ethnic Health Disparities, 1-11. https://doi.org/10.1007/s40615-024-02250-3