Varieties of health services utilization by underserved Mexican American women

Varieties of health services utilization by medically underserved patients were examined in 250 Mexican American women attending a primary care clinic in San Diego, California. Less than half (48.4 percent) of these medically underserved women had obtained clinical preventive services conforming to recommended guidelines, 34.4 percent reported having obtained an annual physical examination in the past year, and 66.0 percent reported visiting a doctor only when they were sick. Lack of any form of health insurance, including Medi-Cal, was associated with underutilization of primary care services to a greater degree than the other variables examined. However, other factors such as full-time employment, low education, dissatisfaction with primary care delivery, and cultural preference for traditional ethnomedical alternative forms of health care, constitute important barriers to utilization of primary care services. Efforts to provide health care to the medically underserved must take these barriers into consideration if they are to be successful.     

Preventive and Curative Care Utilization Among Mexican Immigrant Women in Birmingham, AL

This study aims to describe the utilization of curative and preventive care among Mexican immigrant women in the country of origin versus the US, and to identify factors associated with preventive and curative care utilization. A cross-sectional sample of 185 Mexican immigrant women living in Birmingham, AL between 2004 and 2005 were included in this study. Fisher’s Exact tests showed that there was a statistically significant difference between seeking curative care (p?<?0.0001) and preventive care (p?<?0.0001) in country of origin versus the US. Differences in the reasons for lack of utilization of both curative and preventive care were also observed in the US and the country of origin. These findings suggest that difference in healthcare-seeking behaviors and utilization among Mexican immigrant women between the US and their country of origin may be useful in the development of interventions aimed at increasing the use of preventive and curative care services to this immigrant population in the US.     

The predictors of self-rated health and the relationship between self-rated health and health service needs are similar across socioeconomic groups in Canada

ObjectiveTo examine if there are systematic differences in the predictors of self-rated health (SRH) and to examine the relationship between SRH and health care utilization across socioeconomic groups.Study Design and SettingWe used cross-sectional data from the Canadian Community Health Survey linked to the Ontario Health Insurance Plan (N = 17,109). We examined relative differences in the factors associated with different levels of SRH across socioeconomic groups (as assessed by education and household income) using probit models separately for men and women. We then examined differences in expected health care costs, as assessed by adjusted clinical group weights using administrative health care records, between socioeconomic groups within the same level of SRH.ResultsWe found limited differences across the predictive ability of a broad range of physical, mental, health service/care utilization, and health behavior variables on SRH across socioeconomic groups. In addition, no differences were found in the expected health care utilization costs across socioeconomic groups within the same level of SRH.ConclusionsThe results of this study suggest that SRH assesses a broad variety of factors, including physical health status, mental health status, health service/care utilization, and health behaviors, relatively equally across socioeconomic groups, measured as either education or income.     

Factors Associated With the Utilization of Maternal Health Care Services Among Adolescent Women in Malawi

The poor maternal health care service utilization among adolescent women remains an intimidating challenge in Malawi. This study examines the factors associated with the utilization of selected maternal health care services among married adolescent women (aged 15–19 years) using data from the Malawi Demographic and Health Survey, 2010. Maternal age, household economic status, and status of the child were found to be significant factors associated with at least four antenatal care visits; whereas personal barriers, birth order and interval, religion, and ethnic group explain the variation in the utilization of postnatal care within 42 days of delivery.     

Barriers to Prenatal Care for Mexican and Mexican American Women

Despite the presumed health benefits, Latinas are less likely than women from other ethnic groups to receive adequate prenatal care during their pregnancy. However, it is unclear whether this trend is the result of political economic conditions that limit access of many Latinos in the United States to adequate health services in general, or of sociocultural conditions that restrict the use of such services even when they are made available. Furthermore, it is unclear whether these barriers pose a risk for adverse birth outcomes in this population. To address these issues, we conducted a two-phase study of the political economic and sociocultural barriers to use of prenatal care services among Mexican and Mexican American women living in San Diego, California, and their association with adverse birth outcomes in this population. A quantitative assessment of information abstracted from the medical records of 173 Latinas who had given birth at a university medical center found that absence of Medi-Cal benefits or other forms of health insurance was the only significant predictor of inadequate prenatal care during pregnancy. However, neither lack of insurance nor adequate prenatal care was associated with any adverse birth outcomes. A qualitative analysis of information obtained from interviews of 30 Latinas receiving prenatal care services at a medical clinic for the homeless and medically underserved residents of San Diego identified three major themes underlying the lack of adequate prenatal care: lack of trust in formal versus informal institutions, wanted versus unwanted pregnancies, and the importance of the social network.     

Healthcare Access and Utilization Among Women 40 and Older at the U.S.-Mexico Border: Predictors of a Routine Check-Up

Mexican Americans are more likely to experience barriers to access and utilization of healthcare services than any other U.S. Hispanic group. In Mexico, where the majority of the population has access to care, the pressing issue is the underutilization of preventive services among adults. This study was conducted to assess access and utilization barriers among a U.S.-Mexico border population. A cross-sectional, population-based survey was conducted during 1999–2000 in a pair of contiguous U.S.-Mexico border communities. Household surveys were administered to U.S. and Mexican women, 40 years of age and older, to assess healthcare access and utilization, participation in chronic disease screenings, orientation toward prevention and personal history of chronic disease. Analysis indicates few statistically significant differences (p < 0.05) among access and utilization variables by country. Mexican participants were more likely to have a regular source of care and to have had a blood sugar test within the past 12 months. U.S. participants more often reported having had a Pap smear and mammogram during the previous year. Factors independently positively associated with having had a routine check-up during the past 12 months included age and having a regular provider or place to go when sick. Only going to the doctor when ill was independently inversely associated with routine check-ups in the past 12 months. Findings suggest that U.S. and Mexican border populations are similar with regard to healthcare access and utilization characteristics. Efforts to increase utilization of preventive health screenings among women are needed at the U.S.-Mexico border.     

Barriers to breast cancer screening for low-income Mexican and Dominican women in New York City

The proportion of Mexican and Dominican women has increased rapidly in New York City and in other urban areas, and breast cancer screening rates continue to be lower for Latina women as a whole, but particularly for some nationality sub-groups. The current analysis explored the reasons why Mexican and Dominican women from medically underserved communities in New York City do not seek breast cancer screening. Data were collected through interviews with 298 Mexican and Dominican women aged 40–88 years; the interviews included an open-ended question on the barriers women face in seeking screening. The three most commonly cited barriers were not taking care of oneself (descuido) (52.3%), lack of information (49.3%), and fear (44.6%). Women who had been screened cited fear, pain, or other personal barriers more often, but women who had never had a mammogram cited cost or other logistical barriers. Responses from Dominican and Mexican women were significantly different, with Mexican women more often citing shame or embrarrassment and Dominican women more often citing fear. The dependent variable, barriers to screening, was grouped into major categories. When sociodemographic factors were controlled for, the effect of ethnicity disappeared. Multivariate logistic regression revealed that women with a source of health care were less likely to cite any logistical barriers, but significantly more likely to report only personal barriers (such as fear ordescuido). The analysis indicated that personal barriers were very prevalent in the communities studied. It may not be sufficient merely to increase access to breast cancer screening services for low-income Latinas: even when women have a source of health care, personal barriers may prevent many women from seeking screening. Outreach programs need to be tailored to the target communities as there are significant differences among groups of Latinas. Targeted outreach programs must work in tandem with programs to increase access to ensure that both personal and logistical barriers to screening are addressed.     

Oral health attitudes and practices among a German Mexican Mennonite farmworker community

The oral health needs of migrant farm laborers are greater and more immediate than those of comparable populations. However, little is known about the conditions of oral health care among German-speaking Mexican Mennonites, a distinctive cultural subgroup of migrant farm laborers. The purpose of this study was to examine the oral health practices, perceived oral health status, and barriers to obtaining dental care among a community of Low German-speaking Mexican Mennonites residing in Southwest Kansas. Interviews were conducted with a sample of 25 individuals, with questions addressing access/barriers to care, oral health practices, and perceived oral health status. The most frequently identified barriers to dental care were limited finances, lack of adequate health/dental insurance, and limited awareness of available dental services. Although the majority of participants reported experiencing no problems related to language or scheduling dental appointments, the results also indicated low utilization levels of oral care services. Findings suggest that: (1) this population is at-risk for periodontal disease, (2) culturally appropriate programs are needed for preventive oral care education, (3) community and statewide support may help improve access to affordable oral health care.     

Barriers to Contraceptive Access after Health Care Reform: Experiences of Young Adults in Massachusetts

ObjectiveTo explore how Massachusetts' 2006 health insurance reforms affected access to sexual and reproductive health (SRH) services for young adults.Study DesignWe conducted 11 focus group discussions across Massachusetts with 89 women and men aged 18 to 26 in 2009.ResultsMost young adults' primary interaction with the health system was for contraceptive and other SRH services, although they knew little about these services. Overall, health insurance literacy was low. Parents were primary decision makers in health insurance choices or assisted their adult children in choosing a plan. Ten percent of our sample was uninsured at the time of the discussion; a lack of knowledge about provisions in Chapter 58 rather than calculated risk analysis characterized periods of uninsurance. The dynamics of being transitionally uninsured, moving between health plans, and moving from a location defined by insurance companies as the coverage area limited consistent access to contraception. Notably, staying on parents' insurance through extended dependency, a provision unique to the post-reform context, had implications for confidentiality and access.ConclusionsYoung adults' access to and utilization of contraceptive services in the post-reform period were challenged by unanticipated barriers related to information and privacy. The experience in Massachusetts offers instructive lessons for the implementation of national health care reform. Young adult-targeted efforts should address the challenges of health service utilization unique to this population.     

Determinants and Inequities in Sexual and Reproductive Health (SRH) Care Access Among Im/Migrant Women in Canada: Findings of a Comprehensive Review (2008–2018)

Given growing concerns of im/migrant women’s access to sexual and reproductive health (SRH) services, we aimed to (1) describe inequities and determinants of their engagement with SRH services in Canada; and (2) understand their lived experiences of barriers and facilitators to healthcare. Using a comprehensive review methodology, we searched the quantitative and qualitative peer-reviewed literature of im/migrant women’s access to SRH care in Canada from 2008 to 2018. Of 782 studies, 38 met inclusion criteria. Ontario (n?=?18), British Columbia (n?=?6), and Alberta (n?=?6) were primary settings represented. Studies focused primarily on maternity care (n?=?20) and sexual health screenings (n?=?12). Determinants included health system navigation and service information; experiences with health personnel; culturally safe and language-specific care; social isolation and support; immigration-specific factors; discrimination and racialization; and gender and power relations. There is a need for research that compares experiences across diverse groups of racialized im/migrants and a broader range of SRH services to inform responsive, equity-focused programs and policies.

     

Barriers to health care access and service utilization of refugees in Austria: Evidence from a cross-sectional survey

This paper provides evidence on (1) refugees’ subjective well-being, (2) their access and barriers to health care utilization and (3) their perception of health care provision in Austria, one of the countries most heavily affected by the European ‘refugee crisis.’ It is based on primary data from the Refugee Health and Integration Survey (ReHIS), a cross-sectional survey of roughly five hundred Syrian, Iraqi and Afghan refugees. Results indicate that refugees’ self-rated health falls below the resident population’s, in particular for female and Afghan refugees. Whereas respondents state overall high satisfaction with the Austrian health system, two in ten male and four in ten female refugees report unmet health needs. Most frequently cited barriers include scheduling conflicts, long waiting lists, lack of knowledge about doctors, and language. Although treatment costs were not frequently considered as barriers, consultation of specialist medical services frequently associated with co-payment by patients, in particular dental care, are significantly less often consulted by refugees than by Austrians. Refugees reported comparably high utilization of hospital services, with daycare treatment more common than inpatient stays. We recommend to improve refugees’ access to health care in Austria by a) improving the information flow about available treatment, in particular specialists, b) fostering dental health care for refugees, and c) addressing language barriers by providing (web-based) interpretation services.     

Mexican Immigrant Male Knowledge and Support Toward Breast and Cervical Cancer Screening

Background We conducted a focus group study to assess the influence of partner communication on breast and cervical cancer screening and the perceived existing and potential support from male partners in participating in cancer screening. Secondarily, Mexican male and female views on health care and cancer were explored. Methods Seven focus groups (two female-only, three male-only, and two couples) were conducted in Spanish. Results Findings suggest that knowledge about cervical cancer was significantly less than knowledge about breast cancer among both men and women. Barriers to cancer screening included language barriers, lack of health insurance, and lack of awareness of the need for screening. Male partners expressed willingness to support their female partners in cancer screening activities. Conclusion Cervical cancer education is desperately needed, including education on the availability of free and low cost screening services. Education efforts should include the male community members, especially as the males perceive themselves as responsible for the financial burden of care.     

Barriers to the utilization of maternal health care in rural Mali

This study used data from the 2001 Demographic and Health Survey and multilevel logistic regression models to examine area- and individual-level barriers to the utilization of maternal health services in rural Mali. The analysis highlights a range of area-level influences on the use made of maternal health services. While the dearth of health facilities was a barrier to receipt of prenatal care in the first trimester, transportation barriers were more important for four or more prenatal visits, and distance barriers for delivery assistance by trained medical personnel and institutional delivery. Women's odds of utilizing maternal health services were strongly influenced by the practices of others in their areas of residence and by living in close proximity to people with secondary or higher education. Household poverty and personal problems were negatively related to all outcomes considered. The results highlight the importance of antenatal care and counseling about pregnancy complications for increasing the likelihood of appropriate delivery care, particularly among women living 15-29 km from a health facility. Area-level factors explained a greater proportion of the variation in delivery care than in prenatal care However, significant area variation in the utilization of maternal health services remained unexplained.     

Improving Access to Government Health Care in Rural Bangladesh: The Voice of Older Adult Women

Our purpose in this study was to provide an in-depth understanding of the health-system-related barriers to utilization of health services by older women living in rural Bangladesh. Interviews were conducted with 17 women in Bibirchar Union, Sherpur district, Bangladesh, in June 2006. Three main barriers were identified: perceived discrimination based on age, class, and gender; structural aspects of the health care delivery system; and quality of care. Recommendations for change in the delivery of health care in the rural regions of Bangladesh are made based on the insights provided by this marginalized group of health care service users.     

Improving access to government health care in rural bangladesh: the voice of older adult women

Our purpose in this study was to provide an in-depth understanding of the health-system-related barriers to utilization of health services by older women living in rural Bangladesh. Interviews were conducted with 17 women in Bibirchar Union, Sherpur district, Bangladesh, in June 2006. Three main barriers were identified: perceived discrimination based on age, class, and gender; structural aspects of the health care delivery system; and quality of care. Recommendations for change in the delivery of health care in the rural regions of Bangladesh are made based on the insights provided by this marginalized group of health care service users.     

Utilization of maternal care in rural HeBei Province, the People's Republic of China: individual and structural characteristics

PURPOSE: To study the effect of individual's socio-economic characteristics and the structure of the health services in the village on utilization of maternal care in rural HeBei, the People's Republic of China (PRC). DATA: Data were collected from 4273 women who gave birth to one child at least, living in a stratified sample of 288 villages in HeBei Province. FINDINGS: 54.8% of the women had at least one pre-natal care visit, 27.5% gave birth in a health care facility, and 18.1% had post-natal check-up. Utilization was inversely related to age and parity and positively to education. Occupation was related to use of pre- and post-natal services, but not to home birth. Per-capita income and living arrangement are not related to utilization. MCH worker in the village promote pre- and post-natal care, but also home delivery. Village doctors promote pre-natal care and hospital delivery but do not promote post-natal check-up. Women tend to avoid the maternal services in the township health centers but some are ready to travel to city hospitals for delivery and post-natal care. CONCLUSIONS: Health education programs regarding the importance of all three maternal care services are clearly needed. These programs should address not only women of child bearing age but also care providers, MCH workers in particular. Township health center should reach-out and motivate women to use their accessible services.     

The influence of child abuse on the pattern of expenditures in women's adult health service utilization in Ontario, Canada

Childhood maltreatment is a common and serious problem for women, particularly in relation to impairment in adulthood. To our knowledge, no system-wide study has addressed the influence of childhood maltreatment on the cost of these women's adult health service utilization. This paper examines this relationship. The 1990 Ontario Health Survey (OHS) gathered information regarding determinants of physical health status and the use of health services. The 1991 Ontario Mental Health Supplement (OHSUP) examined a variety of childhood experiences as well as the prevalence of psychiatric disorders from a sample of OHS respondents. These were province-wide population health surveys of a probability-based sample of persons aged 15 years and older living in household dwellings in Ontario. The OHSUP randomly selected one member from each participating OHS household to be interviewed regarding personal experiences and mental health. This analysis used data from women aged 15-64 who participated in both the OHS and OHSUP. Self-reported health service utilization was collected in four groups of women--those who reported no history of child abuse, those with a history of physical abuse only, those who reported sexual abuse only, and those who reported both physical and sexual (combined) abuse. We hypothesized that a history of child abuse would result in greater adult health care costs. The results indicated that having a history of combined abuse nearly doubles mean annual ambulatory self-reported health care costs to 775 dollars (95% CI 504 dollars-1045 dollars) compared to a mean cost of 400 dollars with no abuse (95% CI 357 dollars-443 dollars). Median annual ambulatory self-reported health care costs were also increased in the combined abuse group, to 314 dollars (95% CI 220 dollars-429 dollars), compared to 138 dollars (95% CI 132 dollars-169 dollars) in those with no abuse. We conclude that child abuse in women is significantly associated with increased adult self-reported health care costs.     

Serving Asians and Pacific Islanders with HIV/AIDS: challenges and lessons learned

This paper reports on findings from an evaluation of the Bridges Project, a community-based intervention implemented at the Asian and Pacific Islander Coalition on HIV/AIDS (APICHA), to reduce disparities in care for Asians and Pacific Islanders (APIs) living with HIV/AIDS in New York. Comparisons of participants by primary language (Asian language vs. English) and immigration status (undocumented vs. documented/citizen) show that Asian-primary-language and undocumented participants at baseline had a significantly lower rate of receipt of primary care services and experienced significantly more barriers per service than English-primary-language and documented participants. At follow-up, however, differences by primary language and immigration status disappeared, indicating that the Bridges Project was effective in improving service utilization and reducing barriers for the Asian-primary-language and undocumented participants. Barriers to services reported most frequently by participants were language and cost barriers, not knowing where to go for services, and confidentiality concerns. Study findings indicate that the capacity to address multiple API languages and cultures is essential in providing culturally competent care to APIs living with HIV.