Date of Award


Document Type

Campus Access Dissertation


Health Services and Policy Management

First Advisor

Janice C Probst


The number of uninsured has been estimated to be over 46.3 million nationally, which means 15.4% of the US residents face barriers when attempting to utilize health care services. These barriers have critical implications for South Carolina where rural residents make up 25% of the state population and the state's uninsured rate is 20.5%, exceeding the national rate. To address these high rates, the national focus on rural health calls for the development of interorganizational partnerships (IOP) to improve healthcare quality and access. IOP offer rural communities the opportunity to secure needed resources and build capacity for expanding access of local health care services to the uninsured. At the same time, inherent contextual conditions of rural areas inevitably mean more challenges to maintaining organizational motivations to develop an IOP as well as to remain committed to the processes of IOP development.

My qualitative research sought to investigate organizational motivations along with the contextual challenges faced by organizations in rural areas. I also examined the components of an IOP that determine continued engagement by organizations in IOP development. I used a two-phase study approach and conducted semi-structured interviews of organizational representatives (N=20) from two IOP in rural counties of South Carolina. In the first study phase I examined contextual factors and organizational motivations, while in the second study phase I examined the characteristics of IOP components. I used thematic analysis including inductive and deductive techniques as well as the constant comparison method.

In the first study phase, findings suggest that although each organization may have different expectations of an IOP, similar motivations provide a unifying engagement in IOP development processes. In the second study phase, findings regarding IOP components suggest that organizational engagement in IOP development was enhanced by leadership, interactions, trust and satisfaction. Findings also suggest distrust as a threat to organizational engagement. Several suggestions for supporting IOP development and organizational engagement from both study phases have implications for leaders seeking to develop IOP in rural areas and ideas for further research.