Integrating behavioral and primary health care in rural clinics: What does culture have to do with it?

Emery R. Eaves, Heather J. Williamson, Katharine C. Sanderson, Kristan Elwell, Robert T. Trotter, Julie A. Baldwin

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Successful integration of health care in rural and underserved communities requires attention to power structures, trust, and disciplinary boundaries that inhibit team-based integration of behavioral and primary health care. This paper reports on perceived successes and ongoing challenges of integrating primary and behavioral health care from the perspectives of providers, community leaders, and community members. Data collection consisted of semi-structured qualitative interviews and focus groups conducted as part of a regional health equity assessment in northern Arizona. The authors explore barriers and successes in integrating health care in rural clinics using the perspective of a social ecological framework and the mediating role of culture. Differing expectations, differing professional areas, and interpersonal interactions were primary factors challenging movement toward integrated health care. Results suggest that providers and policymakers working toward health care integration should consider culture and interpersonal interaction as dynamic mediators, particularly in underserved and rural health care contexts.

Original languageEnglish (US)
Pages (from-to)201-217
Number of pages17
JournalJournal of health care for the poor and underserved
Issue number1
StatePublished - Feb 2020


  • Integrated health care
  • Provider culture
  • Rural health
  • Social ecology
  • USA

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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