Degree Type


Date of Award


Degree Name

Doctor of Philosophy


Family and Consumer Sciences Education and Studies

First Advisor

Alyce M. Fanslow


The purpose of this study was to conduct a community assessment to determine the barriers to accessing primary health care for children in Chickasaw County, Iowa. Bronfenbrenner's (1986) ecological perspective on the interaction between the family and the environment was adapted to explain the barriers to health care. Based on this framework, barriers to preventive services, prenatal care, well-child care, immunizations, and health education were identified;Data were collected in two phases. First, existing data about the county's population, families, income and poverty, and child health were compiled into a health and social indicator profile. Second, a consumer survey was conducted to identify parents' perceptions of the health-care system, experiences with the system, and health education needs. A telephone interview was constructed with 29 questions about well-child health care, immunizations, health insurance, health education, and general information. The interview was administered to a systematic sample of 164 parents with children in school and living in the county; 151 parents completed interviews;Frequencies and percentages were generated for all variables in the consumer survey. Families with incomes of less than 20,000 per year (n = 31) were compared to families with incomes of \20,000 or more (n = 107);Community factors that could inhibit accessibility were identified from the health and social indicator profile. These factors were: county's rural nature; high percentage of working parents; and almost 25% of families with low incomes. Furthermore, statistics on infant mortality, prenatal care, nutrition, and suicides showed that some children were not obtaining needed services;The consumer survey found that the sample had generally positive attitudes about the health-care system and 85% had few or no problems accessing services. The other 15% had problems accessing services or participating in education because of time constraints related to work and family. Over 58% of low-income families were not using public assistance programs for which they were eligible;Recommendations were given for reducing the system barriers to services and education for working parents and families with low-incomes; for improving the county's health status indicators; and for conducting future community assessments.



Digital Repository @ Iowa State University,

Copyright Owner

Karen Glisczinski Shirer



Proquest ID


File Format


File Size

140 pages