Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health


Health Promotion

First Committee Member

Dr. Jennie Hill, PhD

Second Committee Member

Dr. Paul Estabrooks, PhD

Third Committee Member

Ms. Melissa Leon, MPH


Background: Minimally invasive surgery (MIS) is associated with less pain, faster recovery, and lower complication rates. Despite being the standard of care, it remains underutilized in rural Nebraska. Surgeon shortages and limited studies describing patient and provider factors influencing treatment gaps contribute to unnecessary complications and healthcare expenditure. Our study aimed to understand rural surgical care barriers and facilitators encountered by patients, providers, and stakeholders in Nebraska. Methods: This exploratory mixed methods study involved 17 semi-structured interviews using a snowball sampling of eligible participants affiliated with an MIS Advisory Committee. Two coders analyzed data using NVivo12. A follow-up review of commonly used surgical databases was completed using the data dictionaries and user guides. Results: The majority of participants were rural (58% vs. 41%), included providers (n=7), surgical stakeholders (n=6), patients (n=4) and a caregiver (n=1). The analysis identified three interrelated themes related to barriers to surgical care (travel/distance, insurance/reimbursement, limitations to providers), and three interrelated themes related to facilitators of surgical care (referrals, institutional assistance of patients, telehealth). The American College of Surgeons National Surgical Quality Improvement Program, Healthcare Cost and Utilization Program’s National Inpatient Sample and Vizient provide differing levels of information regarding surgical provider availability in Nebraska. Conclusion: Unique perspectives were captured from various healthcare professionals involved in the management and treatment of surgical care patients. The database review reveals a gap in information related to availability of providers in Nebraska. We offer insight into the complex factors contributing to rural patient barriers and identify key strategies to promote access for all patients requiring surgical treatment.