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Metrics details. The study de was a qualitative interview de. Thirty women participated in semi-structured interviews in community sites. Thematic analysis identified salient of topics across interview participants. Participants demonstrated determination for accessing care but reported that their primary health care access barriers included the high cost of services, lack of health insurance, family and work responsibilities, and language barriers.
Coping mechanisms included activating their social networks, visiting family and friends and Hispanic seeking Charleston or woman one another with navigating life challenges. Participants overcame obstacles to obtain healthcare for themselves and their family members despite the multiple barriers presented. Social networks were leveraged to protect against some of the negative effects of financial barriers to health care access.
Peer Review reports. For Latino immigrants specifically, health and income disparities are even more pronounced, and the current US immigration policy, which essentially criminalizes unauthorized immigrants, is associated with negative health outcomes for all Latinos, irrespective of immigration status [ 456 ].
According to a conceptual model developed in a community-engaged study in Massachusetts, the anti-immigrant climate caused immigrants to experience fear and distrust of institutions, which in turn led to increased feelings of marginalization, poor mental health, and missed appointments or unfilled prescriptions [ 7 ]. These negative health behaviors and practices ultimately led to negative health outcomes such as uncontrolled hypertension or diabetes and were also associated with a lack of preventive health screenings.
studies have reported that recent Latino immigrants are less likely to be knowledgeable about access to health care and other health-related resources e. While the Patient Protection and Affordable Care Act ACA of extended health insurance coverage to many uninsured individuals, undocumented immigrants were specifically excluded from purchasing health insurance coverage through the health exchanges created by the law [ 1011 ].
Our two primary research questions were: 1 What are the major individual and structural barriers facing this population for accessing health care? This study examined sociocultural factors associated with preventive health care for common chronic diseases affecting Latino immigrant women, such as cancer, cardiovascular disease, diabetes, and hypertension. Interview questions included standard close-ended survey questions for demographic and health history data and open-ended qualitative questions adapted from a similar study of health care access for an immigrant community in North Carolina refer to Additional file 1 [ 17 ].
We employed purposive sampling to recruit Hispanic seeking Charleston or woman, Latina immigrant women between the ages of 21 to 64 years old who lived in the tri-county Charleston metropolitan area. Interview sites included two free health clinics, two churches, a suburban flea market, and a community center. Fourteen participants were recruited from the free health clinics, six participants from churches, and 10 participants from the community.
Audio-recorded interviews were conducted in Spanish with study participants following verbal informed consent. Interviews ranged in length from 45 min to an hour. The data transcription and analysis were all completed in Spanish. Interviews were transcribed in Spanish in batches by a third-party company. Next, the two coders proceeded to code all the Spanish transcripts until all the interviews were completed. A third coder, the first author, then resolved any disagreements in the coding. Summaries were created for each code category with example quotes listed under corresponding themes which emerged from the coding activities.
In the following section, we report the qualitative findings and describe the major themes that emerged from the data. Illustrative quotes were translated from Spanish to English. Different participants are listed by ID s with basic demographic characteristics age, marital status, and country of origin to protect confidentiality and differentiate interview participants.
Table 2 details the sociodemographic characteristics and health status of the 30 study participants.
Participants had an average age of 40, ranging from 26 to 63 years old. Most women were married, unemployed, and from Mexico. The average length of time they had been living in the US was 14 years, ranging from 3 to 27 years. Many participants reported having a chronic health condition such as diabetes or hypertension, and 7 participants reported mental health issues, such as depression or anxiety. Regarding preventive screenings, 26 participants were up-to-date with cervical cancer screenings, three out of 12 women aged 40 years and older were up-to-date with screening mammograms, and 21 women had received their last blood glucose test within the past 12 months.
Finally, 14 women had received their last routine check-up within the past 12 months. The following sections present the of the qualitative data analysis. While the study participants described different strategies for accessing care, the primary barriers included the high cost of services, especially for emergency room care, lack of health insurance, family and work responsibilities, and language barriers. These were all more pressing concerns affecting access than other potential barriers mentioned such as transportation or discrimination in health care encounters. Facilitators to health care included access to interpretation services, social support from friends and faith leaders, and availability of low-cost prescriptions.
Another participant explained that they once had to pay a very high price for insulin at a pharmacy. Additional complaints about perceived high costs of prescription drugs and health care services were frequent, particularly since participants did not have health insurance to offset the costs.
Hispanic seeking Charleston or woman instance, some participants lamented the cost of health care and explained that they could not afford it because costs were not offset by health insurance.
Basically, there went half of my weekly income. However, some participants did report that costs could be reduced at some clinics after submitting some paperwork to justify sliding scale fees. Nevertheless, the lack of insurance and high costs of health care could result in a failure to access care for those with serious illnesses or even lead them to return to their countries of origin to seek care. This sentiment was expressed by one participant. Personally, what worries me is that if someone gets a serious illness, and because of lack of insurance or money it cannot be treated here.
ID 4, age 30—34, Mexico. In addition, because of high medication prices, some patients do not refill their medications, leading to unfortunate outcomes from chronic conditions, such as uncontrolled hypertension. In some cases, patients had to set up payment plans due to their lack of prescription drug coverage.
I go to work and dedicate my time to my job, so my health is affected. There was a complicated relationship between work and health.
An additional barrier to accessing care was language difficulty. Even though some participants had tried to learn English, they ultimately were not successful. On the other hand, in terms of facilitators to health care, some participants reported that they had not felt discrimination in health care facilities and received interpretation assistance and prescription drug discounts.
That helps a lot, the Latino communities … there are times in the community, if they have the medicine, they will give it to you in the pharmacy for free. The most common negative health behavior reported was unhealthy dietary habits. This negative behavior was discussed as being a consequence of the cultural transition from their native countries in Latin America to the US, where food was natural and not processed or frozen and served as a protective effect against disease.
A general theme emerged that these women had greater access to inexpensive fresh fruits and vegetables in their native countries compared to the US. As a result, Latina immigrants experienced dietary changes and limitations that contributed to negative health behaviors. Additionally, participants acknowledged an unhealthy excess of fat consumption.
Another participant explained a generational shift in eating habits that were linked with overall health. ID 6, age 40—44, Mexico. Participants were generally able to identify desired positive health behaviors such as drinking lots of water, eating a healthy diet, and getting enough physical activity.
During the interview process, many women also identified several preventive measures they would take to stay healthy including blood pressure screening, Pap tests, mammograms, taking vitamins, and getting eight hours of sleep on average. Strategies for managing depression and anxiety included coping mechanisms for self-help as well as helping others.
None of the women sought professional psychological care or medication and relied instead on activities such as listening to music, knitting, reading, exercising, and cleaning to distract themselves from negative thoughts. Some women attributed their anxiety or depression to social isolation experienced from living in a non-Latino community due to language barriers and separation from family in their home countries.
In addition, there was Hispanic seeking Charleston or woman related to crime and immigration enforcement, as well as consternation when people exhibited racist attitudes. Since the interviews occurred during the Presidential election season, participants were very sensitive to the anti-immigrant rhetoric on display in the Republican campaign.
They are talking about how Trump is going to remove all the Latinos, and he will get them all out. This bothered me. Women also helped each other cope by activating their social networks, visiting family and friends, and assisting one another with navigating life in the US. Many women identified their faith community as a source of social support.
It makes me feel good when I can help other women with whatever I can. And we pray, we share. That helps a lot with our mental health. Study participants identified 15 different clinic choices in the Charleston area, the most common being an uptown free clinic, health department clinics, the university hospital and hospital emergency rooms. The uptown free clinic was listed most often because 13 of the 30 interviews were conducted there. Some participants reported no clinic preference and could not remember when they last saw a doctor.
Participants were wary of incurring debt from an emergency room visit and used it as a last resort. Participants also reported discrimination in clinic waiting rooms due to language barriers and their uninsured status.
When asked about dental care, most women had not found an affordable solution, so they avoided going to the dentist in the US. Some local clinics offer free screenings but not free treatments or preventive care. Other clinics only offer free emergency tooth extractions. Women reported motivating factors for managing their health as well as their thought processes for deciding how to manage their health. A common motivator for these women was their families. They wanted to stay healthy, so they would be able to continue taking care of their children. Another motivating factor for these women was to prevent the progression of chronic diseases, such as high blood pressure and diabetes, which were the most prevalent chronic conditions among participants.
Many women described similar disease management processes for deciding when and how to visit a doctor for their health concerns. At the first of illness, they typically consult friends or family members, and many participants explained that they would try alternative medicine first to feel better before visiting a doctor. Most women reported having a threshold for when they decide to visit a doctor. In the meantime, you take a pill or something. When asked where they get their medications, 14 women reported using Wal-Mart as a primary pharmacy choice for over-the-counter medications.
One participant from El Salvador reported difficulties obtaining a prescription from a large chain drugstore by showing a Hispanic seeking Charleston or woman for identification. Six women referenced tiendas mexicanas Mexican stores as a source of over-the-counter medicines, and one participant referenced a former bad habit of buying antibiotics at one of these stores and not taking the medicine correctly. A general theme from these interviews is the idea of self-medication in which women attempt to self-treat their health problems before going to a doctor for a prescription.
Finally, women often choose generic or off-brand medications instead of name-brands as a cheaper option. Other participants mentioned shopping at the Mexican grocery stores for their over-the-counter medications. Responses around s and symptoms of illness served as indicators and cues to action that would cause women to acknowledge their health condition and seek care or treatment. In general, women reported that symptoms are s of illness from their bodies.
The top three most important community health concerns reported by study participants were: 1 diabetes, 2 obesity, and 3 cancer. When ranking these health concerns, women recalled family history and referenced people they knew in the community with certain diseases. Participants also discussed perceived causes of disease, such as poor nutrition, drinking soda and lack of exercise. One participant mentioned that she did not want to take ownership or identify with her disease.
Some women believed they had control over their health, while others expressed less control. The role of the family was discussed by most interview participants. Women admitted that when they were sick, they were very depressed because they could not help with housework or attend to their children, expressing traditional gender norms. This Hispanic seeking Charleston or woman you feel bad. While participants valued the advice of their elder relatives for treatment advice, many women were very dependent on their children for English assistance.
Since participants did not speak English very well, they often relied on their children to translate for them in many situations. And, the children, they go with you and translate for you… they help you. Most participants spoke about the role of religion in their life and the importance of prayer. I pray to her always. Participants felt a sense of community in their churches and a relief from the outside stressors. Study participants also employed several home remedies to possibly delay or avoid having to take on the extra out-of-pocket costs that a clinic visit would entail.Hispanic seeking Charleston or woman
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