Navigating barriers: examining social equality through transportation disadvantages and perceived healthcare accessibility in South Carolina

Transportation inequities significantly contribute to health disparities, particularly in socially and geographically diverse regions like South Carolina. Prior research predominantly relied on objective measurements, like travel time or distance, to assess healthcare accessibility. However, limited attention has been given to the subjective perceptions of transportation barriers. To address this gap, we designed a comprehensive survey consisting of 61 questions (including 32 five-point Likert-scale items) capturing demographic, socioeconomic, and travel behavior data from a diverse sample of South Carolina residents. Urban and rural contexts were distinguished using county categorization and built environment measures. Exploratory Factor Analysis (EFA) was employed to identify latent factors, including Financial and Time Constraints, Safety and Security Concerns, and Accessibility Challenges, related to perceived transportation barriers. Structural Equation Modeling (SEM) was subsequently applied to analyze interactions among these factors shaping accessibility perceptions of access demographic groups. Our findings highlight that Financial and Time Constraints represent the most significant barriers, disproportionately affecting low-income and minority populations. Additionally, built environment factors such as population density appear as important predictors of perceived accessibility, with urban residents reporting better access than rural residents. The study provides targeted policy recommendations to improve public transit affordability and enhance transportation safety, emphasizing the importance of addressing both objective and subjective obstacles to achieve better health equity.