Financial and Health Barriers and Caregiving-Related Difficulties Among Rural and Urban Caregivers

Erin D. Bouldin, Lynn Shaull, Elena M. Andresen, Valerie J. Edwards, Lisa C. McGuire

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


Purpose: To assess whether financial or health-related barriers were more common among rural caregivers and whether rural caregivers experienced more caregiving-related difficulties than their urban peers. Methods: We used data from 7,436 respondents to the Caregiver Module in 10 states from the 2011-2013 Behavioral Risk Factor Surveillance System. Respondents were classified as caregivers if they reported providing care to a family member or friend because of a long-term illness or disability. We classified respondents as living in a rural area if they lived outside of a Metropolitan Statistical Area (MSA). We defined a financial barrier as having an annual household income <$25,000 or not being able see a doctor when needed in the past year because of cost. We defined a health barrier as having multiple chronic health conditions, a disability, or fair or poor self-rated health. Findings: Rural caregivers more frequently had financial barriers than urban caregivers (38.1% vs 31.0%, P =.0001), but the prevalence of health barriers was similar (43.3% vs 40.6%, P =.18). After adjusting for demographic differences, financial barriers remained more common among rural caregivers. Rural caregivers were less likely than their urban peers to report that caregiving created any difficulty in both unadjusted and adjusted models (adjusted prevalence ratio = 0.90; P <.001). Conclusions: Informal caregivers, particularly in rural areas, face financial barriers. Rural caregivers were less likely than urban caregivers to report caregiving-related difficulties. Rural caregivers’ coping strategies or skills in identifying informal supports may explain this difference, but additional research is needed to explore this hypothesis.

Original languageEnglish (US)
Pages (from-to)263-274
Number of pages12
JournalJournal of Rural Health
Issue number3
StatePublished - Jun 1 2018


  • epidemiology
  • geography
  • geriatrics
  • long-term care
  • observational data

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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