Date of Award

Spring 2021

Document Type

Honors Thesis



First Advisor

Dr. Louisa Roberts

Second Advisor

Dr. Gerald Yutrzenka

Third Advisor

Dr. Dawn St. A. Bragg


Relational continuity of care, Primary Care Provider (PCP), college students, undergraduate student population, emerging adults, southeastern South Dakota, University of South Dakota (USD), USD Student Health Services, health care

Subject Categories

Community Health and Preventive Medicine | Health Services Research | Medicine and Health | Sociology


In health care, the patient’s relationship with his or her provider serves as a foundation upon which health care decisions are guided and health outcomes are addressed. Relational continuity of care refers to the presence of a sustained (long-term) relationship between a primary care provider (PCP) and a patient. Such continuity of care has been linked with improved health outcomes, reduced mortality, lower health care costs, increased patient satisfaction, and increased delivery of preventative services. Relational continuity of care tends to be low amongst young adults, especially college students. The reasons for this – and the salient barriers to relational continuity of care within the college student population – are as yet incompletely understood. This research project investigates why, focusing specifically on decision making processes, the role of parents, and the relative importance of different barriers to relational continuity of care amongst undergraduate college students in southeastern South Dakota. I conducted preliminary interviews with area health experts to better understand barriers to continuity of care in the southeast South Dakota region. Following this, fourteen interviews regarding relational continuity of care were conducted, with seven junior and senior undergraduate students attending the University of South Dakota, as well as separate interviews with the mother of each student. Since mothers have been found to play a strong role in young peoples’ health-related decision making, they may in some cases be better able to speak to the influence of some relevant factors. The undergraduate student population at a four-year university in southeastern South Dakota, the University of South Dakota (USD), was also surveyed to better understand what barriers students faced. Through interviews with and a survey of undergraduate students attending USD, it was found that main barriers to relational continuity of care in this population were: 1) PCP location and a long distance to travel to see PCPs; 2) college students’ perception of having good health and the related lack of emphasis that they place on routine preventative care; 3) college students’ lack of preparedness and comfort in assuming responsibility for their own health care; 4) college students’ lack of familiarity with and knowledge of USD Student Health Services; 5) the absence of a facilitated transition from a pediatric PCP to an adult PCP; and 6) college students’ schedules, which limit their amount of time available to receive routine health care. By using the University of South Dakota as a case study, I seek to advance our knowledge of barriers to relational continuity of care that are faced by undergraduate college students in general. It is hoped that, by improving our understanding of the barriers to relational continuity of care amongst undergraduate college students in southeastern South Dakota, this study will contribute to efforts to both reduce these barriers and provide quality health care for this population.



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