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PubMed1991

Access to medical care for documented and undocumented Latinos in a southern California county.

To determine local access to medical care among Latinos, we conducted telephone interviews with residents of Orange County, California. The survey replicated on a local level the national access surveys sponsored by the Robert Wood Johnson Foundation. We compared access among Latino citizens of the United States (including permanent legal residents), undocumented Latinos, and Anglos, and analyzed predictors of access. Among the sample of 958 respondents were 137 Latino citizens, 54 undocumented Latinos, and 680 Anglos. Compared with Anglos, Latino citizens and undocumented immigrants had less access to medical care by all measures used in the survey. Although undocumented Latinos were less likely than Latino citizens to have health insurance, by most other measures their access did not differ significantly. By multivariate analysis, health insurance status and not ethnicity was the most important predictor of access. Because access to medical care is limited for both Latino citizens and undocumented immigrants, policy proposals to improve access for Latinos should consider current barriers faced by these groups and local differences in access to medical care.

Adult↗
PubMed2000

Dental care for children and young people who have a hearing impairment.

AIM: The aim was to determine whether there are indications that hearing-impaired children experience difficulties in accessing dental care and/or in receiving dental treatment. METHOD: The study was carried out by means of a questionnaire. Parents of 84 children contacted through the National Deaf Children's Society returned completed questionnaires. RESULTS: Eighty-two children (98%) had visited a dentist. Nearly two-thirds (63%) were reported to have at least one problem in communication while receiving dental care, this increased significantly as the severity of the hearing impairment increased. Fifty-nine children (70%) reported having at least one problem in communication at the doctors'. Fifty-two (62%) reported that the dentist had worn a mask while communicating with the child and 48 (57%) that there had been background noise in the surgery during appointments. CONCLUSIONS: Removing masks while talking, reducing background noise and learning to use simple signs may improve communication with hearing-impaired children.

Adolescent↗
PubMed2004

Health care barriers for Latino children and provision of culturally competent care.

The demography of the United States is rapidly changing. The impressive growth rate of Latino populations within the United States has great impact on health care. This article includes discussion of a significant increase from 1988 to 2000 in Latino utilization of emergency department and inpatient services at a pediatric medical center in Salt Lake City, Utah, information on health care barriers for Latinos, and suggestions for providing culturally competent care.

Acculturation↗
PubMed1997

Language as a barrier to the acquisition of anatomical knowledge.

The language of instruction for medical students at the University of Hong Kong is English, which is their second language. This presents a potential barrier to their academic learning. We have studied the extent of this problem by looking at the amount of terminology students have to assimilate during their anatomy course and the way in which the terminology is structured and explained (this provides, more generally, an indication of the factual loading to which medical students are exposed). We have also investigated the effect of the quality of students' language skills on their examination results in anatomy class tests and MBBS exams. It was found that students' entrance levels in English correlated well with their final examination results and that the quality and quantity of their English also correlated highly with scores in class tests. On this basis, we conclude that language is one of the most important barriers to students' academic success in the department and that current teaching materials may not be appropriate.

Anatomy↗
PubMed2004

Access to dental care: solving the problem for underserved populations.

BACKGROUND: Americans are enjoying an increasing level of oral health. However, oral health improvements are not being experienced evenly across the population. The poor, some minorities, institutionalized elderly people and other groups do not have adequate access to dental care. OVERVIEW: The author discusses the need to understand clearly the barriers to care affecting underserved populations and presents a framework for designing access-to-care programs. CONCLUSIONS: The author concludes that access-to-care problems are complex and will not be solved easily or quickly. A complete understanding of the barriers to care being experienced by any group under consideration must be achieved, and an improvement plan must be designed to address those specific barriers considering the demand for care, the dental work force and the economic environment. PRACTICE IMPLICATIONS: Failure to understand the barriers to care and address them adequately will result in limited success in enhancing access to dental care for underserved populations.

Adolescent↗
PubMed2001

Colorectal cancer screening by primary care physicians in two medical care organizations.

The objectives of this study were to (1) evaluate self-reported practices of colorectal cancer (CRC) screening among primary care physicians (PCPs) in medical organizations and (2) identify factors associated with screening performance. We surveyed a census sample of 204 PCPs from two medical organizations in Houston, TX. Outcomes were PCPs' self-reports of screening with fecal occult blood test (FOBT) and/or flexible sigmoidoscopy (FS).2-7 Independent variables included physician demographics, perception of screening efficacy, level of agreement with screening guidelines, and perceptions of screening barriers. Variables were compared using Student's t-tests, Chi-square, and Fisher's exact tests. Regression was used to examine factors associated with PCPs' reports of screening. Our response rate was 56% (n = 115). Many PCPs reported recommending and/or performing/ordering screening with both FOBT (82%) and FS (87%). They more often reported believing that FS was "very effective" for reducing mortality than was FOBT (76% vs. 37%). Physicians perceived that barriers to patient compliance with CRC screening were stronger than barriers to making screening recommendations. Significant test-specific differences in reported barriers to screening were found. Results revealed high awareness and self-reported practice of CRC screening in this study population. Further examination of how barriers influence CRC screening practices by PCPs in medical organizations will be important for improving population screening rates.

Adult↗
PubMed2004

Challenging linguistic barriers to health care: students as medical interpreters.

Inadequate medical interpretation services are a barrier to the delivery of optimal health care to persons with limited English proficiency. Even though Title VI of the Civil Rights Act of 1964 requires that interpretation services be available to persons speaking limited English, many health care institutions are struggling to reach full compliance. Communication through untrained interpreters is likely to include mistranslations or omissions of physicians' questions, truncated or slanted patient responses, and inadequate information to facilitate accurate diagnosis and treatment. The Interpreter's Aide Program (IAP) is a service-learning program that was implemented at Brown Medical School in 1997. The IAP is a collaborative effort among Brown students, the Rhode Island Hospital Department of Social Work, and Brown Medical School. This three-way partnership strengthens the IAP and expands interpretation services to Spanish- and Portuguese-speaking patients at Rhode Island Hospital. Bilingual undergraduate and medical students become trained medical interpreters and render community service while developing cross-cultural skills. The authors review the development and implementation of the IAP. There is potential for other academic health centers to develop similar partnerships with local colleges and universities, and to provide service-learning opportunities for future physicians and health care consumers.

Communication Barriers↗
PubMed2000

Interpretation of nonvocal behavior and the meaning of voicelessness in critical care.

This paper presents two interrelated psychosocial constructs, voicelessness and interpretation, which were derived from a participant observation study of critically ill older adults in the USA. Voicelessness occurs when physiological, psychosocial and/or technological barriers limit the abilities of critically ill patients to represent their thoughts, feelings, desires and needs fully to others. Voicelessness influences not only the responses of critically ill patients to their condition, environment and caregivers, but also profoundly effects the responses of family members and clinicians. Thus, communicative interactions as well as certain clinical and treatment decisions in ICU hinge on clinician and family member interpretation of patients' nonvocal behaviors. Conditions and factors contributing to interpretation are described and a hypothesis proposed, that interpretation mitigates the detrimental effects of voicelessness.

Adult↗
PubMed2001

The factors associated with disclosure of intimate partner abuse to clinicians.

OBJECTIVE: Our goal was to identify the prevalence, determinants of, and barriers to clinician-patient communication about intimate partner abuse. STUDY DESIGN: We conducted telephone interviews with a random sample of ethnically diverse abused women. POPULATION: We included a total of 375 African American, Latina, and non-Latina white women aged 18 to 46 years with histories of intimate partner abuse who attended 1 of 3 primary care clinics in San Francisco, California, in 1997. OUTCOMES MEASURED: We measured the relevance and determinants of past communication with clinicians about abuse and barriers to communication. RESULTS: Forty-two percent (159) of the patients reported having communicated with a clinician about abuse. Significant independent predictors of communication were direct clinician questioning about abuse (odds ratio [OR]=4.6; 95% confidence interval [CI] 3.2-6.6), and African American ethnicity (OR=1.8; 95% CI, 1.1-2.9). Factors associated with lack of communication about abuse included immigrant status (OR=0.6; 95% CI, 0.3-1.0) and patient concerns about confidentiality (OR=0.7; 95% CI, 0.5-0.9). Barriers significantly associated with lack of communication were patients' perceptions that clinicians did not ask directly about abuse, beliefs that clinicians lack time and interest in discussing abuse, fears about involving police and courts, and concerns about confidentiality. CONCLUSIONS: Clinician inquiry appears to be one of the strongest determinants of communication with patients about partner abuse. Other factors that need to be addressed include patient perceptions regarding clinicians' time and interest in discussing abuse, fear of police or court involvement, and patient concerns about confidentiality.

Adolescent↗
PubMed2004

Popular health promotion strategies among Chinese and East Indian immigrant women.

PURPOSE: To advance understanding about the popular health promotion strategies and factors associated with the successful transfer and uptake of health messages among Chinese and Indian immigrant women. METHODS: Eight focus groups were conducted with 46 immigrant women, 24 from Mainland China and 22 from India, who had lived less than 5 years in Canada. Audiotaped data were transcribed, translated and analyzed by identification of themes and subcategories within and between groups. RESULTS: In both ethnic groups, discussions on promoting health messages had five major themes, i.e., sources, barriers, facilitators, credibility and ways to improve access along with group specific sub-themes. Despite identification of several diverse sources of health information in the adopted country, Indian and Chinese immigrant women perceived most strategies as not very effective. The reasons of perceived ineffectiveness were barriers to accessing and comprehending the health messages; and limited prior exposure to institution based or formal health promotion initiatives. These women were more familiar with informal means of obtaining health information such as social networks, mass media and written materials in their mother tongue. CONCLUSION: Existing health communication and health promotion models need to be re-orientated from a one-way information flow to a two-way dialogue model to bridge the gap between program efficacy and effectiveness to reach underserved immigrant women. An "outside the box" approach of non-institutional informal health promotion strategies needs to be tested for the studied groups.

Adult↗
PubMedDate not supplied

Determinants of no-show appointment behavior: the utility of multivariate analysis.

A multitude of determinants have been identified as predictive of broken appointments. The majority of prior studies have been limited to univariate analysis of the relationship between predictors and appointment keeping behavior. The present report studied 25 independent predictors of no-show behavior using both univariate and multivariate analyses. A total of 579 kept appointments and 84 failed appointments were analyzed. Results of univariate analysis indicated the following significant relationships with appointment behavior: age, ethnicity, marital status, mode of payment, chronic illness, telephone in house, type of care, prior visits to center, cost of care, transportation to center, physician ethnicity, and linguistic capability. However, multiple logistic function analysis revealed only six significant associations: type of care, chronic illness, linguistic capability, mode of payment, physician-patient sex differences, and marital status of the patient. Multivariate analysis may yield a more accurate and clinically useful model of no-show behavior. For example, language barrier may be more of a problem than the race of the patient. Prospective studies might benefit from these considerations.

Appointments and Schedules↗
PubMed2006

The need for more research on language barriers in health care: a proposed research agenda.

Many U.S. residents who speak little English may face language barriers when seeking health care. This article describes what is currently known about language barriers in health care and outlines a research agenda based on mismatches between the current state of knowledge of language barriers and what health care stakeholders need to know. Three broad areas needing more research are discussed: the ways in which language barriers affect health and health care, the efficacy of linguistic access service interventions, and the costs of language barriers and efforts to overcome them. In each of these areas, we outline specific research questions and recommendations.

Communication Barriers↗
PubMed2004

Moving beyond disclosure: women's perspectives on barriers and motivators to seeking assistance for intimate partner violence.

To investigate women's perceptions of motivators and barriers to seeking help or accessing intimate partner violence (IPV), services six focus groups were conducted in rural and urban settings in North Carolina between June and August of 2002. Coding and theme analysis were used to summarize themes among the 67 focus group participants. The majority of participants were African-American (87%). Participants reported three main categories of motivators: gaining knowledge; reaching an emotional or physical breaking point; and growing concern about children's safety. Participants reported six main categories of barriers: pressure not to talk about, or address IPV; failure to recognize events as IPV, or that IPV was wrong; self-doubt and low self-esteem; fear of losses; fear of perpetrator; or desire to protect the perpetrator. This study documents the difficulties that women face accessing or using services related to IPV. We need to address perceived barriers and better use the opportunity when women experience motivation to seek help and access services.

Adult↗
PubMed2004

Acceptability of emergency contraception in Brazil, Chile, and Mexico. 2 - Facilitating factors versus obstacles.

A multi-center study was performed in Brazil, Chile, and Mexico to identify factors that may facilitate or hinder the introduction of emergency contraception (EC) as well as perceptions concerning emergency contraceptive pills. Background information on the socio-cultural, political, and legal context and the characteristics of reproductive health services was collected. The opinions of potential users and providers were obtained through discussion groups, and those of authorities and policymakers through semi-structured interviews. Barriers to introduction included: perception of EC as an abortifacient, opposition by the Catholic Church, limited recognition of sexual and reproductive rights, limited sex education, and insensitivity to gender issues. Facilitating factors were: perception of EC as a method that would prevent abortion and pregnancy among adolescents and rape victims; interest in the method shown by potential users as well as by some providers and authorities. It appears possible to reduce barriers through support from segments of society committed to improving sexual and reproductive health and adequate training of health care providers.

Adolescent↗
PubMed2000

The white world of nursing homes: the myriad barriers to access facing today's elderly minorities.

In this note, Ms. Aeschleman explores the cultural, social, and economic barriers faced by elderly minorities in need of nursing home care. Ms. Aeschleman argues that minority elders face greater economic barriers to nursing home access than Whites because of factors such as lower average incomes and a lack of access to and assistance with government programs. Culturally, Ms. Aeschleman argues that minorities face barriers to nursing home care because of language differences, the location of nursing homes within communities, traditions, and both overt and indirect acts of discrimination from nursing home staff, administrators, and White clients. Following a discussion of these barriers, Ms. Aeschleman suggests options to give elderly minorities equal access to nursing homes through federal and state incentives, as well as community-based activism and awareness campaigns.

Aged↗
PubMed1995

Values and ideals, isms and ologies: making contact across a desert of differences.

The issue of communication and dialogue between academic and service public health professionals is explored. It is noted that each individual operates within his/her own personal attitudes, values and beliefs framework which has the potential to produce serious obstacles to effective communication if not taken into account and managed. The preconceptions of academic public health professionals about their service counterparts and vice versa are identified and discussed. A workshop held at the Nuffield Institute for Health, Leeds, in June 1993 is used as an example of what can happen when these barriers to communication are identified and handled sensitively.

Education, Medical↗
PubMed2004

To telemedically err is human.

BACKGROUND: As telemedicine alters the process of health care and introduces new technology, the extent to which it introduces new errors or allows for the occurrence of familiar errors needs to be examined. TELEMEDICINE'S IMPACT ON PATIENT SAFETY FEATURES OF TRADITIONAL CARE: The accuracy of diagnostic decisions reached via telemedicine can be directly affected by the technology's limitations and the care providers' lack of training. Telemedicine could increase the risk of familiar types of patient-provider communication failure and introduce the possibility of cumulative errors. TELEMEDICINE'S IMPACT ON NEW CARE FEATURES AND CONCEPTS: Telemedical applications that use the Internet to enhance disease management and detection and monitoring of symptoms may place the privacy and confidentiality of individual health information at risk, which imposes a possible barrier to communication. In addition, home care patients' functional limitations need to be addressed by human factors engineering. RECOMMENDATIONS: Patient safety should be integrated in organizational readiness and budget planning for telemedical interventions in hospitals, academic settings, nursing homes, home care agencies, and other health care settings. Specific recommendations are proposed for the development and diffusion of standards in telemedical care, risk management and reduction, and continuous quality improvement. SUMMARY AND CONCLUSIONS: To address patient safety and provide high-quality care, a framework for addressing and examining telemedical errors needs to be established.

Humans↗