Preventive health screenings are generally underutilized in the United States by the elderly, especially those residing in rural areas. This problem persists despite general consensus that screenings are a key health indicator and offer the potential for improved health and functional status, longer survival, and enhanced quality of life. Considering that about one-quarter of the total elderly population in the United States reside in rural communities, surprisingly little is known about their use of preventive health services. Most of the research to date has used limited datasets, focused on subpopulations, or concentrated on only a few specific screenings.

Using an integrative approach, including secondary data analysis of a large nationally representative dataset and complementary qualitative interviews with rural elders, the proposed research study aims for a more complete understanding of the factors influencing use of these practices. The analytic framework for the study is based on a widely-used theoretical model of healthcare access and utilization for disadvantaged populations (the Behavioral Model for Vulnerable Populations), which links factors of vulnerability with use of healthcare services. The study's primary purposes are the following:

1. Describe utilization of best practice preventive healthcare screenings and vaccinations among a national rural sample of Medicare beneficiaries, as compared to urban elders;
2. Identify individual level factors associated with utilization of these practices;
3. Explore community and health system factors which impede or facilitate the utilization of best practice screenings and vaccinations among rural elders.

The study will use secondary data analysis of a nationally representative sample of aged rural Medicare beneficiaries, 65 years of age or older (from the Medicare Current Beneficiary Survey (MCBS) to identify factors associated with receiving "gold standard" healthcare screenings and vaccinations. The MCBS includes extensive questions on preventive care and health screenings, as well as a rich set of demographic, social, economic, health status and functioning, satisfaction with and access to care, informal care and support networks, and insurance coverage variables.

Qualitative in-depth group and individual interviews with 85 elders living in rural Barnstable County, Massachusetts will add depth and detail to the quantitative findings, helping to make sense of the survey results. A Study Advisory Committee, including health and elder service providers, Councils on Aging members, county policy makers, and others with expertise in the topic area will be convened to, among other tasks, inform the research on contextual factors and review and interpret study findings and their policy implications.

With screening rates well below the goals set forth in Healthy People 2010, study findings will inform policymakers, health planners, researchers, and healthcare providers at all levels to encourage and promote healthier lifestyles for rural elders. A policy brief and working paper, as well as conference presentations, will help disseminate findings to a national audience.

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