# Perspectives of Community Health Center Employees on Public Bus Transportation in Rural Hawai‘i County

## TL;DR

This study explores how unreliable public bus transportation in rural Hawai‘i County affects access to healthcare and other services, based on perspectives from community health center employees.

## Contribution

The study provides novel insights from rural health center employees on transportation barriers and opportunities for improving public transit to support health equity.

## Key findings

- Most employees found the bus system unreliable and inconvenient for commuting.
- Participants highlighted safety concerns and inflexible schedules as major barriers.
- Improved bus service could help patients access healthcare, pharmacies, and groceries.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Transportation is a social determinant of health.Rural communities are underserved by public transportation.

Transportation is a social determinant of health.

Rural communities are underserved by public transportation.

Public health significance—Why is this work of significance to public health?
This study examines employee perspectives on accessing a rural community health center by bus.Employees and patients faced multiple barriers to using the bus to access the community health center.

This study examines employee perspectives on accessing a rural community health center by bus.

Employees and patients faced multiple barriers to using the bus to access the community health center.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
More reliable and accessible bus service would benefit both community health center employees and patients.The community health center can play a role in advocating for improvements to the public bus system to increase access to healthcare, employment, and other critical services and resources.

More reliable and accessible bus service would benefit both community health center employees and patients.

The community health center can play a role in advocating for improvements to the public bus system to increase access to healthcare, employment, and other critical services and resources.

People living in rural communities are typically underserved by public transportation services and face challenges in accessing healthcare, jobs, stores, and other destinations. Understanding the lived experiences of people who use public transportation in rural communities can help to inform a more equitable transportation system. This qualitative study gathered the perspectives of community health center employees about the public bus system for Hawai‘i Island, a rural county in the United States. Using a community-engaged research approach, the evaluation team interviewed 10 employees through either in-person small group interviews or online individual interviews between April and July 2023. Transcripts were coded and analyzed using a thematic analysis approach. While all study participants were selected for their interest in commuting to work by bus, most believed the bus was not a reliable or convenient option. Participants shared their experiences about not being able to rely on the bus schedule, feeling unsafe while walking to bus stops or waiting for the bus, and other barriers to using the bus system. Participants also shared their insights about how a reliable bus system would benefit community health center patients who needed transportation to more than just their medical appointments, but also to places like pharmacies, laboratory services, and grocery stores. These findings can be used to initiate discussions around the ways that community health centers can further address transportation as a social determinant of health and inform transportation providers about how to best plan and invest in transportation infrastructure and services to meet the needs of rural populations.