Structural disadvantage, capital, and constrained agency: A qualitative analysis of health care inaccessibility in rural Kashmir

BackgroundHealth care accessibility in rural regions remains a critical global concern, shaped by the intersection of geographic isolation, economic precarity, infrastructural deficits, and socio-cultural constraints.Study AimThis study examines health care access in the remote villages of Akhal and Naranag in District Ganderbal, Jammu and Kashmir.MethodsThe study employed a qualitative research design grounded in an interpretive paradigm. Data were generated using semi-structured interviews and focus group discussions with 18 rural residents and 8 health care providers, and thematically analysed.ResultsThe findings reveal five interrelated dimensions of health care inaccessibility: (i) geographic and logistical barriers, where difficult terrain and poor connectivity delay or prevent timely care; (ii) resource and personnel shortages, resulting in inconsistent service delivery and eroded trust in public health systems; (iii) economic constraints, where high out-of-pocket expenditure and indirect costs compel households to defer or forgo treatment; (iv) cultural and social influences, including gender norms and reliance on traditional healing systems that shape health care-seeking behaviour; and (v) resilience and coping strategies, where communities and providers develop adaptive mechanisms such as informal transport networks, barter systems, and outreach practices to navigate systemic gaps. Drawing on critical sociology, the study conceptualizes health care inaccessibility as a product of unequal distribution of capital, embedded structural disadvantage, and constrained agency within rigid social structures.ConclusionThe findings demonstrate that health care inequities in rural Kashmir are not isolated service failures but manifestations of deeply entrenched structural and socio-cultural processes. By providing a context-specific and empirically grounded analysis, this study contributes to the limited body of literature on rural health care in geographically remote regions of India. It underscores the need for integrated policy interventions that combine infrastructural development, financial protection, and culturally responsive health care delivery, while also recognizing and strengthening community-based resilience.