# Factors Influencing Healthcare Engagement Among Low-Income Women Experiencing Headaches

## TL;DR

This study explores why low-income women with headaches avoid healthcare, finding that geography, ethnicity, and headache duration are key factors.

## Contribution

The study introduces a novel seven-item Headache Severity and Affect Screening tool and identifies specific demographic and geographic barriers to care in low-income women.

## Key findings

- Women in medically underserved areas were less likely to consider their headaches serious.
- Rural women were more likely to believe physicians wouldn't take their symptoms seriously.
- Higher headache severity scores correlated with increased physician-seeking behavior.

## Abstract

Background

Headaches are a leading cause of disability among women, yet healthcare engagement in low-income populations remains poorly understood. Despite the high burden of disease, women with limited insurance coverage may delay or avoid seeking care due to barriers such as transportation difficulties, appointment wait times, and limited local providers. These challenges are often compounded in rural and medically underserved regions, where access to care is further reduced, and stigma or mistrust of the medical system may discourage care-seeking.

Objectives

This study aims to 1) assess care-seeking behaviors among Medicaid-enrolled or uninsured women with headache disorders and 2) identify demographic, geographic, and personal factors associated with barriers to care.

Methods

A cross-sectional survey was conducted among 156 Medicaid-enrolled or uninsured women recruited via community centers and email outreach to Ohio University-affiliated networks. Participants completed an online screening questionnaire to confirm insurance status and a novel seven-item Headache Severity and Affect Screening (HSAS) to assess headache burden. Eligible participants were surveyed on demographics, geographic location (categorized as rural, medically underserved area, or Appalachian), care-seeking behavior, and barriers to accessing care. Those who had sought treatment from a physician were asked about satisfaction with care and barriers; those who had not were asked about obstacles to care, such as stigma, transportation, cost, availability, language, mistrust, and perceived severity of headaches. Associations were assessed using chi-square and ANOVA.

Results

Perceived seriousness of headaches varied significantly by geography (χ² = 20.57, p = 0.005), with women in medically underserved areas less likely to consider their headaches serious. Women in rural areas were more likely to feel that physicians would not take their symptoms seriously (χ² = 5.99, p = 0.014). Race (χ² = 20.99, p = 0.021) and ethnicity (χ² = 24.15, p = 0.030) were associated with challenges related to insurance coverage. Higher HSAS scores were associated with increased physician-seeking behavior, F(2, 153) = 10.95, p < 0.001, η² = 0.13. A longer duration of experiencing headaches was also correlated with an increased likelihood of seeking care (χ² = 19.28, p = 0.037).

Conclusions

Factors such as geography, ethnicity, and duration of illness significantly shape healthcare engagement for low-income women with headaches. Future interventions should focus on improving provider availability, reducing access barriers, and building trust within affected communities. Limitations of this pilot study include recruitment challenges and an overrepresentation of a university-affiliated population, which may limit the generalizability of findings. Future studies should aim to recruit a larger and more diverse sample to validate these findings and identify additional patterns in care-seeking behavior.