Access to health care for uninsured Latina immigrants in South Carolina.
ABSTRACT: South Carolina is considered a "new destination" state for Latino immigrants. Language barriers, transportation difficulties, low socioeconomic status, inflexible work schedules, different cultural norms, and anxiety and fear related to the current anti-immigrant political climate all negatively impact Latino immigrants' frequency of contact with the health care system, and consequently they suffer poor health outcomes. The study objective was to explore uninsured Latina immigrant women's access to health care and alternative treatment strategies in coastal South Carolina.The study design was a qualitative interview design. Thirty women participated in semi-structured interviews in community sites. Thematic analysis identified salient categories of topics across interview participants.The themes were organized into four primary categories including: 1) Barriers and Facilitators to Healthcare, 2) Health Behaviors and Coping Mechanisms, 3) Disease Management Strategies, and 4) Cultural Factors. 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 assisting 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.
Project description:Latino immigrants constitute a large portion of the Spanish and US immigrant populations, yet a dearth of research exists regarding barriers to retention in behavioral health care.To identify and compare perceived barriers related to behavioral health care among first- and second-generation Latinos in Boston, Madrid, and Barcelona, and evaluate whether the frequency of behavioral health care use in the last year was related to these barriers.Data were obtained from the International Latino Research Partnership project. First- or second-generation self-identified Latino immigrants aged 18 years and more who resided more than 1 year in the host country were recruited from community agencies and primary care, mental health, substance abuse, and HIV clinics.Eleven barriers were assessed and compared across sites. The relationship between barriers and behavioral services visits within the last year was evaluated, adjusting for sociodemographics, clinical measures, degree of health literacy, cultural, and social factors.Wanting to handle the problem on one's own, thinking that treatment would not work, and being unsure of where to go or who to see were the most frequently reported barriers for Latino immigrants. Previous treatment failure, difficulties in transportation or scheduling, and linguistic barriers were more likely to be reported in Boston; trying to deal with mental health problems on one's own was more commonly reported in Barcelona and Madrid. Two barriers associated with the number of visits were concerns about the cost of services and uncertainty about where to go or who to see.After adjusting for sociodemographics, clinical measures, degree of health literacy, cultural, and social factors, barriers still differed significantly across sites. Efforts to improve behavioral health services must be tailored to immigrants' context, with attention to changing attitudes of self-reliance and outreach to improve access to and retention in care.
Project description:Objective:Immigrants, especially refugees, face unique barriers to accessing health care relative to native born Americans. In this study, we examined how immigration status, health, barriers to access, and knowledge of the health care system relate to the likelihood of having a regular health care provider. Methods:Using logistic regression and data from a community-based participatory study, we estimated the relative likelihood that an African immigrant woman would have a regular health care provider compared with an African American woman. Results:Immigrant status remains a powerful predictor of whether a woman had a regular health care provider after controlling for covariates. African immigrants were 73% less likely to have a regular health care provider than were otherwise similar African American women. Conclusion:Expanding health care educational efforts for immigrants may be warranted. Future research should examine how cultural beliefs and time in residence influence health care utilization among US immigrants.
Project description:In the USA, undocumented Latino immigrants may have poorer health because of barriers to health care, stressors, and detrimental effects of immigration enforcement. Previous immigrant health research, however, suggests that recently arrived Latino immigrants have better health than US-born Latinos and their health deteriorates over time. Given the current environments that undocumented immigrants face, legal status is a structural factor that likely influences the patterns of immigrant health. Therefore, the aim of this study was to examine the extent to which physical and mental health differed by legal status and duration in the USA for the Latino population in Los Angeles County, California. We conducted analysis of Latino respondents (n = 1396) to the Los Angeles Family and Neighborhood Survey (L.A.FANS) Wave II. We examined self-reported health, depression measured by the Composite International Diagnostic Interview-Short Form, and blood pressure collected by trained interviewers. Respondents reported their legal status, time in the USA, and other sociodemographic characteristics. Regression models were used to test associations between each outcome and 1) legal status and 2) legal status by duration (? 15 and > 15 years) in the USA. Without taking duration into account, we found no significant differences in outcomes between undocumented, documented, or US-born Latinos. Taking duration into account, shorter duration undocumented immigrants had worse self-reported health than the US born. Undocumented immigrants, regardless of duration, had higher blood pressure than documented immigrants who had been in the USA for less time and the same level of blood pressure as the US born. In contrast, shorter duration documented immigrants had lower blood pressure compared to longer duration documented immigrants and US-born counterparts, and marginally lower blood pressure than shorter duration undocumented immigrants. The findings suggest that the "health advantage" generally presumed to exist among immigrants may not affect undocumented immigrants.
Project description:Toughened immigration policies exacerbate barriers to public benefits and health care for immigrants. The objective of this study is to examine the impact of the immigration climate on the utilization of pediatric emergency and ambulatory care services and elucidate ways to best support Latino immigrant families. This is a cross-sectional study involving surveys and interviews with Latino parents (??18 years) in the pediatric emergency department. Forty-five parents completed surveys and 40 were interviewed. We identified two themes on health care utilization: fear of detention and deportation in health care settings, and barriers to pediatric primary care; and two themes on how pediatric providers can best support Latinos: information and guidance on immigration policies, and reassurance and safety during visits. Despite immigration fears, Latino parents continue to seek health care for their children. This highlights the unique access that pediatric providers have to this vulnerable population to address immigration fears and establish trust in the health care system. Health care providers are also perceived as trusted figures from whom Latino families want more information on the latest immigration policies, immigration resources, and education on legal rights during medical visits.
Project description:Immigrant women face greater barriers to health care, especially mental health care, than non-immigrant women. However, immigrants are a heterogeneous group and bring with them a range of different personal, social, cultural and economic factors, which impact both mental health and access to care. In this study, we explored factors that influence Filipina immigrants' perceptions of help seeking from a general practitioner for mental health problems in Norway.Using data from semi-structured interviews, we applied a post-colonial feminist perspective to identify factors that affect perceptions of help seeking.Findings indicated that a combination of the women's beliefs and values, stigma, experiences with healthcare services in Norway and familiarity with mental health services influence perceptions of help seeking. Some factors represented structural barriers to healthcare seeking in general, while others related to mental healthcare seeking in particular. The significance of each factor varied depending on the women's backgrounds.Socioeconomic status, educational background, familiarity with health services and experience of mental health can influence immigrant women's perceptions of, and barriers for, help seeking for mental health problems. There are a number of barriers to address at a structural level to improve both the propensity to seek healthcare in general, as well as mental healthcare in particular. Efforts to increase awareness of primary mental healthcare services may also help change the perception that professional help is only appropriate for serious mental health disorders.
Project description:The United States is home to 47 million foreign-born individuals, which currently represents over 14% of the U.S. population. With greater length of U.S. residence, immigrants experience increased risk for chronic disease including selected cancers; yet, they are less likely to access preventive health care services and undergo cancer screening. As a result, there have been concerted efforts to address disparities in cancer screening in immigrant populations. This minireview describes current progress in promoting participation in cancer screening among U.S. immigrants and explores potential opportunities for improving impact. Of the 42 studies included in the review, the majority targeted Asian and Latino immigrant populations and included some form of culturally specific educational programming, often delivered in-person by community health workers and/or using a multimedia format. Twenty-eight of the 42 studies also offered navigation assistance to help overcome logistical and access barriers to care, and these studies yielded somewhat greater increases in screening. Yet, despite considerable effort over the past 20+ years, screening rates remain well below national goals. Opportunities to harness digital health tools to increase awareness and engagement, evaluating nonclinic-based screening paradigms to promote greater participation, and increasing efforts to address the needs of other immigrant subgroups are likely to have beneficial outcomes. Together, these strategies may help reduce inequities in access and uptake of cancer screening in U.S. immigrant populations.See all articles in this Special Collection Honoring Paul F. Engstrom, MD, Champion of Cancer Prevention.
Project description:<h4>Objectives</h4>To identify knowledge, barriers and discourses about breast cancer screening in Spain among female immigrants from low-income countries and native Spanish women from a low socioeconomic class.<h4>Design</h4>Qualitative interview study with thematic analysis interpreted using cultural mediators.<h4>Setting</h4>Mallorca, Spain.<h4>Participants</h4>Thirty-six in-depth interviews, using cultural mediators, of immigrant women living in Mallorca who were 50-69?years old and were from Maghreb, Sub-Saharan Africa, Eastern Europe, Latin America, China or were native to Spain and from a low socioeconomic class.<h4>Results</h4>We analysed the interviews to assess breast cancer perceptions and beliefs, discourses about breast cancer prevention and barriers to accessing breast cancer prevention programmes. Although the women reported an association of breast cancer with death, they acknowledged the effectiveness of early detection. They also exhibited reluctance to talk about cancer. Discourses about cancer prevention tended to be proactive or fatalistic, depending on the woman's country of origin. For all women, fear of results and lack of time were barriers that limited participation in breast cancer prevention programmes. Language barriers, frequent changes of residence and fear due to status as an irregular (undocumented) immigrant were barriers specific to immigrant women.<h4>Conclusions</h4>The culture of origin affects whether an immigrant has a fatalistic or proactive approach toward breast cancer screening. Immigrants from low-income countries and Spanish natives from a low socioeconomic class experience barriers in access to breast cancer screening. Frequently changing homes is also a barrier for immigrant women.
Project description:In the United States, there is concern that recent state laws restricting undocumented immigrants' rights could threaten access to Medicaid and the Children's Health Insurance Program (CHIP) for citizen children of immigrant parents. Of particular concern are omnibus immigration laws, state laws that include multiple provisions increasing immigration enforcement and restricting rights for undocumented immigrants. These laws could limit Medicaid/CHIP access for citizen children in immigrant families by creating misinformation about their eligibility and fostering fear and mistrust of government among immigrant parents. This study uses nationally-representative data from the National Health Interview Survey (2005-2014; n = 70,187) and comparative interrupted time series methods to assess whether passage of state omnibus immigration laws reduced access to Medicaid/CHIP for US citizen Latino children. We found that law passage did not reduce enrollment for children with noncitizen parents and actually resulted in temporary increases in coverage among Latino children with at least one citizen parent. These findings are surprising in light of prior research. We offer potential explanations for this finding and conclude with a call for future research to be expanded in three ways: 1) examine whether policy effects vary for children of undocumented parents, compared to children whose noncitizen parents are legally present; 2) examine the joint effects of immigration-related policies at different levels, from the city or county to the state to the federal; and 3) draw on the large social movements and political mobilization literature that describes when and how Latinos and immigrants push back against restrictive immigration laws.
Project description:Undocumented status is widely recognized as an important social determinant of health. While undocumented immigrants have lower levels of health care access, they do not have consistently poorer physical health than the US-born or other immigrant groups. Furthermore, heterogeneity by race/ethnicity has been largely ignored in this growing literature. This paper used the 2001, 2004, 2008 panels of the restricted Survey of Income and Program Participation (SIPP), one of the only representative surveys equipped to adequately identify Asian undocumented immigrants, to compare health patterns between Asians and Latinos by immigration status. We examined three general measures of health/health access: self-rated health, disability, and current health insurance. Latino undocumented immigrants displayed some advantages in self-rated health and disability but had lower insurance coverage compared to US-born Latinos. In contrast, Asian undocumented immigrants did not differ from US-born Asians in any of the three outcomes. While undocumented status has been proposed as a fundamental cause of disease, we found no evidence that Latino and Asian undocumented immigrants consistently fare worse in health access or physical health outcomes than immigrants in other status categories. Different racial groups also appeared to have unique patterns between immigration status and health outcomes from one another.
Project description:Since the late 1950's, a steadily increasing immigrant population in Germany is resulting in a subpopulation of aging immigrants. The German health care system needs to adjust its services-linguistically, culturally, and medically-for this subpopulation of patients. Immigrants make up over 20% of the population in Germany, yet the majority receive inadequate medical care. As many of the labor immigrants of the 1960s and 1970s are in need of hospice and palliative care (HPC), little is known about this specialized care for immigrants. This epidemiological study presents utilization of HPC facilities in Berlin with a focus on different immigrant groups.A validated questionnaire was used to collect data from patients at 34 HPC institutions in Berlin over 20 months. All newly admitted patients were recruited. Anonymized data were coded and analyzed by using SPSS and compared with the population statistics of Berlin.4118 questionnaires were completed and included in the analysis. At 11.4% the proportion of immigrants accessing HPC was significantly (p<0,001) below their proportion in the general Berlin population. This difference was especially seen in the age groups of 51-60 (21.46% immigrants in Berlin population, 17.7% immigrants in HPC population) and 61-70 years (16,9% vs. 13,1%). The largest ethnic groups are Turks, Russians, and Poles, with a different weighting than in the general population: Turkish immigrants were 24% of all Berlin immigrants, but only 13.6% of the study immigrant population (OR: 0.23, 95%CI: 0.18-0.29, p<0.001). Russian and Polish immigrants account for 5.6% and 9.2% in the population, but 11.5% and 24.8% in the study population respectively (Russian: OR 0.88, 95%CI: 0.66-1.16; Polish: OR 1.17, 95%CI: 0.97-1.42). Palliative care wards (PC) were used most often (16.7% immigrants of all PC patients); outpatient hospice services were used least often by immigrants (11.4%). Median age at first admission to HPC was younger in immigrants than non-immigrants: 61-70 vs. 71-80, p = 0.03.Immigrants are underrepresented in Berlin´s HPC and immigrants on average make use of care at a younger age than non-immigrants. In this regard, Turkish immigrants in particular have the poorest utilization of HPC. These results should prompt research on Turkish immigrants, regarding access barriers, since they represent the largest immigrant group. This may be due to a lack of cultural sensitivity of the care-providers and a lack of knowledge about HPC among immigrants. In the comparison of the kinds of institutions, immigrants are less likely to access outpatient hospice services compared to PC. Apparently, PC appear to be a smaller hurdle for utilization. These results show a non-existent, but oft-cited "healthy immigrant effect" of the first generation of work immigrants, now entering old age. These findings correspond with studies suggesting increased health concerns in immigrants. Focused research is needed to promote efforts in providing adequate and fair access to HPC for all people in Berlin.