Degree Name
DrPH (Doctor of Public Health)
Program
Public Health
Date of Award
5-2025
Committee Chair or Co-Chairs
Beth O'Connell
Committee Members
Casey Balio, Sam Pettyjohn
Abstract
Background: Sexual minority peripregnant people (SMPPs) face unique barriers to healthcare access during peripregnancy, which spans preconception care through postpartum. These include a lack of social support, difficulty obtaining relevant health information, and discrimination from healthcare providers. Similarly, Appalachians – particularly rural Appalachians – also face unique barriers to peripregnancy care, including cultural stigma surrounding sexual and reproductive health and maternity care deserts. However, there is a dearth of research on peripregnancy experiences, barriers, and facilitators of healthcare access among peripregnant people who are both sexual minorities and Appalachian.
Methods: A quantitative analysis and qualitative analysis were performed independently to examine healthcare access barriers in three Appalachian states: Pennsylvania; Tennessee; and Virginia. For the quantitative analysis, secondary data from the 2022 Pennsylvania LGBTQ Health Needs Assessment were used to assess the relationship between healthcare access barriers, healthcare access intermediaries, and self-reported health levels among Appalachian and non-Appalachian people capable of pregnancy using bivariate analyses and logistic regression. For the qualitative analysis, semi-structured, in-depth interviews were conducted with SMPPs in the Appalachian Highlands region of Northeast Tennessee and Southwest Virginia, recruited through a venue-based sampling scheme. Interview transcripts were analyzed by two coders using a rapid coding methodology.
Results: With regard to the quantitative analysis, Appalachian and non-Appalachian subsamples did not significantly differ. The selected financial barrier, cognitive barrier, decreased prevention intermediary, and decreased care intermediary were significantly associated with health level. With regard to the qualitative analysis, eleven SMPPs participated in semi-structured, in-depth interviews focused on healthcare access barriers and intermediaries. Major themes that emerged included: lack of health education surrounding peripregnancy; ease of contraception access; and the importance of social support throughout peripregnancy.
Discussion: SMPPs in the Appalachian Highlands face unique barriers to high-quality care access across the peripregnancy care spectrum. Recommendations for addressing these barriers to care include expansion of coverage for prenatal services, incorporation of principles of trauma-informed care, health sensitivity training for providers, and increased social support opportunities for SMPPs in the Appalachian Highlands. More research is needed across Appalachia in order to understand and improve healthcare access during peripregnancy for sexual minorities throughout the region.
Document Type
Dissertation - embargo
Recommended Citation
Sullivan, Olivia, "Healthcare Access Barriers Among Sexual Minority Peripregnant People in the Appalachian Highlands" (2025). Electronic Theses and Dissertations. Paper 4530. https://dc.etsu.edu/etd/4530
Copyright
Copyright by the authors.
Included in
Community Health and Preventive Medicine Commons, Health Services Research Commons, Maternal and Child Health Commons, Women's Health Commons