Electronic Theses and Dissertations Archive

Date

2026

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Nursing

Committee Chair

Annapoorna Mary

Committee Member

Annapoorna Mary

Committee Member

Gloria Carr

Committee Member

Jill Dapremont

Committee Member

Sheri Howard

Abstract

Homebound adults represent a medically vulnerable and rapidly growing population at heightened risk for unmet healthcare needs. Although quantitative studies document disparities in utilization and outcomes, less is known about how homebound individuals experience healthcare access. Grounded in Husserlian transcendental phenomenology, this qualitative study explored the lived experiences of homebound adults facing healthcare access barriers and examined how those experiences align with Levesque et al.’s patient-centered conceptual framework of access. Twenty homebound adults were recruited from a single residential care setting in the southeastern United States. Data were collected through semi-structured interviews and analyzed using an inductive phenomenology approach. Initial coding remained inductive to preserve participant voice and experiential meaning. Thematic findings were interpreted through Levesque’s five population abilities to perceive, seek, reach, pay for, and engage in care. Five themes emerged: (1) Transportation and Mobility Dependence, (2) System Navigation and Communication Barriers, (3) Financial and Insurance Gaps, (4) Relational Trust and Communication with Providers, and (5) Personal Agency, Resilience, and Meaning. Barriers included immobility, fragmented communication, financial gaps despite insurance coverage, and information exclusion. Facilitators included caregiver support, insurance funded transportation, home-based services, trusting provider relationships, and personal-spiritual resilience. Transportation limitations most strongly reflected challenges in the ability to reach care, while relational dynamics shaped the ability to engage. This study extends access theory by providing qualitative insight into how homebound adults negotiate barriers within structurally constrained environments. Findings suggest that healthcare access among homebound adults is neither solely structural nor purely individual but emerges from the interaction of system-level factors and personal abilities. Strengthening facilitators while reducing structural barriers may improve equitable, timely, and person-centered care for this population. These findings contribute qualitative depth to access theory and inform education, policy, practice, research and future intervention development. Keywords: Homebound, adult homebound patients, access to healthcare, access barriers, and access facilitators

Comments

Data is provided by the student.

Library Comment

Dissertation or thesis originally submitted to ProQuest/Clarivate.

Notes

Open Access

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