Date of Award

Fall 2018

Document Type

Honors Thesis



First Advisor

Dr. Carole South-Winter

Second Advisor

Dr. Gerald Yutrzenka

Third Advisor

Dr. Holly Straub


Rural Healthcare, Preventive Healthcare, Immunization, Population Health, Germany, United States, National Healthcare System


The purpose of the qualitative self-report study is to further explore the perceptions and practices of German and American recipients of healthcare within rural areas in regard to barriers currently faced in accessing healthcare, possible reform of care practices, the current state of utilization of health system, and representative introduction of innovative methods. If studied, these factors allow healthcare directors, local and national governments, and the patients themselves to access information that supports informed planning and decision making. The sample consisted of 135 Americans and 133 Germans living in rural areas (e.g. south-eastern South Dakota and the Black Forest region of Germany). The method of data collection entailed distributing and collecting a self-report survey which was analyzed using a chi square test for independence. Literature at the time of the study depicted serious inequities between urban and rural populations and the rural resident’s ability to receive quality healthcare. Providing access to quality and affordable healthcare is delegated to lawmakers and healthcare executives who are encouraged to understand the issues reported by the people who currently use the system. Based on findings in both countries, there were possible reform options and recommendations presented along with topics for future research.



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