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Barriers to domestic violence help seeking: implications for intervention.

Data were obtained from the Chicago Women's Health Risk Study, in which 491 abused women were interviewed in public health centers and a hospital. Responses of a subgroup of these women who did not seek help through the identified interventions are examined. Common themes emerge across the help-seeking interventions studied: individual thresholds for the seriousness of the violence, a perceived requirement to end the relationship, and certain specific barriers. The responses provide a glimpse into abused women's reasons for not seeking particular interventions. Implications for public health, mental health, domestic violence counseling agencies, and the police are discussed.

Adult↗

Hispanics and the politics of health care.

Difficulties with health care for Hispanics are many and complex and have consequences. These difficulties are aggravated by their inability to access health care. Other issues partner the major problem. They are language barriers, culturally insensitive service, no medical coverage and scarce minority health professionals and minority researchers to provide critical data. Self-imposed isolation and suspicion by the Hispanic community add to the difficulties in accessing care. Discussion is followed by recommendations.

Attitude of Health Personnel↗

Issues of health care mistrust in East Harlem.

Barriers to the delivery of health care services to the Latino community are described and analyzed. Fear of deportation, unfamiliarity with modern medicine, inability to speak English and reliance upon traditional curing practices all contribute to the harmful underutilization of medical services which we see in the Latino community. Health care providers who serve that community need to overcome these obstacles by expanding their cultural awareness and increasing the effectiveness of their communication.

Attitude to Health↗

Cataract and barriers to cataract surgery in a US Hispanic population: Proyecto VER.

OBJECTIVES: To report the prevalence of visually significant cataract and cataract surgery and to determine demographic and socioeconomic factors that influence use of cataract surgery in a US Hispanic population. METHODS: Proyecto VER is a population-based study of Hispanic individuals, 40 years or older, living in southern Arizona. Visual acuity was measured monocularly, and a dilated ophthalmic examination was performed to determine lens opacities. Visually significant cataract was defined as severe levels of opacity and acuity worse than 20/40. Risk factors were compared between those who obtained cataract surgery in the past and those having visually significant cataract. RESULTS: A majority of the 4774 participants in this study were of Mexican descent; 2.8% had visually significant cataract and 5.1% had undergone bilateral cataract surgery. Among those currently or previously needing surgery, having medical insurance (odds ratio, 2.88; P<.001) and speaking English (odds ratio, 1.80; P = .04) were significantly associated with having obtained surgery in the past. CONCLUSIONS: Visually significant cataract appears to be high among US Hispanic individuals of Mexican descent, as evidenced by rates of cataract and cataract surgery. Language and financial barriers in this population impede access to surgery. Further work to remove these barriers and provide sight restoration is warranted among Hispanic individuals of Mexican descent living in the United States.

Adult↗

Participation of Asian-American women in cancer chemoprevention research: physician perspectives.

To the authors' knowledge, little is known regarding the participation of Asian Americans in cancer prevention research. In 2002, the authors mailed surveys to primary care physicians in Northern California to assess their knowledge, attitudes, behaviors, and barriers concerning the participation of Asian-American women in breast cancer chemoprevention research. The response rate was 52.3% (n=306 physicians). For physician barriers, most respondents selected lack of study knowledge (73%) and effort required to establish eligibility (75%) and to explain risks and benefits (68%). For patient barriers, most physicians chose the following: physicians did not inform patients about trials (76%), limited English proficiency (78%), researcher-participant language discordance (74%), and complex protocols (69%). Significantly more Asian-American physicians than non-Asian-American physicians (but a majority of each) selected as patient barriers a lack of culturally relevant information on breast cancer, a lack of knowledge about research concepts, and fear of experimentation. A majority of Asian-American physicians also selected the following patient barriers: lack of knowledge of preventive care or breast cancer, work concern, misperception that experimental treatment is inferior, personal modesty, and lack of personal benefit. In multivariate analyses, physicians who were in practice longer, who spent more time with patients, or who knew of tools to estimate breast cancer risk were more likely to discuss such trials with Asian-American women; whereas male physicians and those who believed that Asian-American women's deference to physicians was a barrier were less likely to have discussed such trials with Asian-American women. Efforts to increase research participation among Asian Americans should include physician education and linguistically appropriate recruitment efforts.

Asian↗

Influence of ethnicity and language concordance on physician-patient agreement about recommended changes in patient health behavior.

The purpose of this study is to examine the association of ethnicity and language concordance with physician-patient agreement about physicians' recommendations for patient health behavior in the following areas: diet, exercise, medication, smoking, stress, and weight. Twenty-seven resident physicians at the University of New Mexico's internal medicine and family practice clinics and 427 of their patients participated. Random effects models were used to estimate the influence of ethnicity and language concordance on whether patients and physicians agreed about specific recommended changes in patient behavior. Ethnicity concordance was not significantly associated with physician-patient agreement. Language concordance positively influenced the likelihood of agreement about exercise but negatively influenced agreement about medications. The lowest percentage of agreement occurred in the area of medication regimens (60%). The results from this study indicate that language is an important barrier to physician-patient agreement, while ethnicity concordance has no effect. However, the influence of whether the physician and patient speak the same language on agreement is unclear and warrants further research.

Adolescent↗

Research utilization among medical and surgical nurses: a comparison of their self reports and perceptions of barriers and facilitators.

BACKGROUND: Although the number of studies on research utilization is steadily growing, there are only a few specialty-specific studies. AIMS: This study focuses on medical and surgical nurses. It compares their reported use of research utilization and their perceptions of barriers and obstacles. METHODS: A convenient sample of 210 medical nurses and 269 surgical nurses, from 10 general hospitals in 14 Trusts in Northern Ireland (NI), was surveyed. RESULTS: The results showed that the reported extent of research utilization was high, with less than 10% in each group reporting never/seldom using research. The reported difference between the medical and surgical nurses was very small, with medical nurses reporting a slightly higher rate of utilization. However, this was not statistically significant at 5% level. CONCLUSIONS: The Barriers Scale (Funk et al. 1991a) used in this study to assess their perceptions of barriers and facilitators revealed a similar picture for both groups. The top two barriers were "Management will not allow implementation" and "The nurse does not feel she/he has enough authority to change patient care procedures". These findings, as well as the need to take research utilization studies further, are discussed.

Attitude of Health Personnel↗

Bridges and barriers: educational mobility of Hispanic nurses.

The lack of data on the educational mobility of the Hispanic nurse presents major barriers in designing effective strategies to diversify the nursing work force. However, such data are necessary to ensure parity of representation of Hispanics in nursing. The purpose of this project was to identify barriers and bridges to educational mobility experienced by Hispanic nurses. Focus groups were conducted in six sites throughout the country. Separate groups were conducted with Hispanic ADN nurses who had completed their BSN and with BSN nurses who had completed their MSN. Barriers encountered and identified by participants included financial burdens, institutional barriers, perceived discrimination by faculty and peers, and cultural values such as the importance of the family and prescribed gender roles. Conversely, bridges to completing degree requirements included family, peers, and faculty. Recommendations to facilitate educational mobility of Hispanic nurses are provided.

Communication Barriers↗

[Labour epidural analgesia in Martinique: evaluation of quality and accessibility to epidural analgesia by the patients in level one obstetric clinic].

OBJECTIVES: The main aim of this study was to evaluate real-life experience and the quality of labor epidural analgesia (LEA) by the patients, from the anaesthesia consultation to leaving the clinic after childbirth. STUDY DESIGN: Descriptive study. PATIENTS AND METHODS: This study took place over a period of 8 weeks, at the level I obstetric clinic in Martinique. One hundred and thirty-four successive patients completed an anonymous questionnaire following childbirth. RESULTS: During the study period (134 patients completed the questionnaire, corresponding to 100% return) 127 women had asked for LEA (94%), which was possible in 94%, with a patient satisfaction level of 94% and an average mark for quality at 18/20. The quality of information given at the anaesthesia consultation was judged excellent for 97%, and 91% were reassured by the consultation. The delay between the demand and the LEA procedure was less than 15 min in 63%, and in 39% the procedure was done during the night. The procedure was painless in 63%, and 97% of women were ready to begin the same procedure again. CONCLUSION: This study seems to underline the fact that the needs and the acceptability of LEA are the same in Martinique as in mainland France. This study does not support the hypothesis of the cultural barrier to justify the low level of LEA in the Overseas Departments. An obvious result seems to be that good organization of anaesthesia and obstetric services results in a natural increase in LEA demand.

Adult↗

Hispanic healthcare disparities: challenging the myth of a monolithic Hispanic population.

BACKGROUND: Hispanic Americans are often treated as a monolithic ethnic group with a single pattern of healthcare utilization. However, there could be considerable differences within this population. We examine the association between use of healthcare services and Hispanic Americans'country of ancestry or origin, language of interview, and length of time lived in the United States. METHODS: Our data come from the Medical Expenditure Panel Survey, a nationally representative survey of healthcare use and expenditures. Descriptive statistics and logistic regression results are presented. RESULTS: Multivariate models show that Mexicans and Cubans are less likely, and Puerto Ricans more likely, to have any emergency department visits than non-Hispanic whites. Mexicans, Central American/Caribbeans, and South Americans are less likely to have any prescription medications. All Hispanics are less likely to have any ambulatory visits and prescription medications, whereas only those with a Spanish-language interview are less likely to have emergency department visits and inpatient admissions. More recent immigrants are less likely to have any ambulatory care or emergency department visits, whereas all Hispanics born outside the United States are less likely to have any prescription medications. CONCLUSIONS: The Hispanic population is composed of many different groups with diverse health needs and different barriers to accessing care. Misconceptions of Hispanics as a monolithic population lacking within-group diversity could function as a barrier to efforts aimed at providing appropriate care to Hispanic persons and could be 1 factor contributing to inequalities in the availability, use, and quality of healthcare services in this population.

Adolescent↗

Barriers and aids in conducting research with older homeless individuals.

Field notes of a qualitative pilot study of older homeless people in Cincinnati identified several barriers and aids to the study of homeless elders. Identified research barriers were researcher's lack of contextual wisdom (street smarts), locating elders, substance abuse, attrition, victimization, credibility of informants, and xenophobia. Identified research aids were friendliness of certain elders, openness of the researcher, attractive incentives in exchange for interviews, and service providers' willingness to share experiences.

Aged↗

Assessing communicative intents: a situated pragmatics approach.

The analysis of communicative intents is described as it has developed over time, beginning with J.L. Austin's work published in 1975. Recommendations for best practice are offered in which a situated approach is advocated. Key elements of this approach are a focus on contextual variables and open-ended, rather than list-oriented, assessments of range of intents. It is argued that intents must be assessed relative to the environment, with documentation of environmental variables such as barriers to communicative opportunity. Further, caution is urged in using lists of intents as the sole guide to analysis, because such lists serve to limit awareness of individual differences and multifunctionality of utterances.

Child↗

Psychotherapy with older adults: benefits and barriers.

Psychotherapeutic treatments are known to be effective in older adults with mental illnesses. Depression, anxiety, and complicated bereavement must be considered psychiatric illnesses, rather than normal consequences of aging. To improve the rate of psychotherapy use among older adults, stigma surrounding psychiatric treatment, as well as misconceptions that older adults are incapable of change, must be unlearned and eliminated.

Aged↗

How do ethnicity and primary language spoken at home affect management practices and outcomes in children and adolescents with asthma?

BACKGROUND: Lower rates of preventive medication use and higher rates of hospitalization and emergency department use have been documented among Latino children and adolescents with asthma. However, little is known about how language barriers influence asthma management practices and outcomes. OBJECTIVE: To examine the effects of language on asthma management practices and asthma-related outcomes. DESIGN: Cross-sectional survey of asthma management practices, perceived efficacy, asthma knowledge, family functioning, and health-related quality of life in 405 white non-Latino, African American non-Latino, and Latino children and adolescents from English- and Spanish-speaking homes. RESULTS: Latino children and adolescents from Spanish-speaking homes had lower rates of goal setting and peak flow monitoring, poorer asthma knowledge, and greater negative family impact than white children and adolescents (P < .05 for all). Although Latino children and adolescents from English-speaking homes did worse than their non-Latino white peers, the decrements were modest and not statistically significant (P>.16 for all). Management practices and outcomes for non-Latino African American children and adolescents closely approximated those of white children and adolescents. CONCLUSIONS: Language barriers seem to contribute to poorer asthma management practices and knowledge among Latino children and adolescents. Efforts to increase knowledge in this group may enhance asthma self-care and limit the morbidity associated with asthma.

Adolescent↗

Patient-related barriers to cancer pain management in a palliative care setting in Hong Kong.

This article reviews a study of pain management and its barriers in Hong Kong. Using an interview technique, several measures were used to understand the level of concern in patients about pain, the patients' hesitancy in reporting pain, use of analgesics, and adequacy of medication for pain. A total of nine barriers were identified, which include "addiction," "tolerance," "side effects," "physician distraction," "good patient," "fear of injection," "time interval," "fatalism," and "disease progression." Thirty-nine interviews were carried out. The interviewees were all cancer patients with pain in a palliative setting in Hong Kong. When the findings in Taiwan and the United States were compared, it was found that the cancer patients in Hong Kong had a higher level of concern toward the patient-related barriers. It was also found that the level of concern was generally higher in the group with hesitancy in reporting pain and using analgesics. Last of all, this project also identified the educational needs of patients and health care workers in Hong Kong.

Adult↗

Impact of a community-based multiple risk factor intervention on cardiovascular risk in black families with a history of premature coronary disease.

BACKGROUND: Black subjects with a family history of premature coronary heart disease (CHD) have a marked excess risk, yet barriers prevent effective risk reduction. We tested a community-based multiple risk factor intervention (community-based care [CBC]) and compared it with "enhanced" primary care (EPC) to reduce CHD risk in high-risk black families. METHODS AND RESULTS: Black 30- to 59-year-old siblings of a proband with CHD aged <60 years were randomized for care of BP > or =140/90 mm Hg, LDL cholesterol > or =3.37 mmol/L, or current smoking to EPC (n=168) or CBC (n=196) and monitored for 1 year. EPC and CBC were designed to eliminate barriers to care. The CBC group received care by a nurse practitioner and a community health worker in a community setting. The CBC group was 2 times more likely to achieve goal levels of LDL cholesterol and blood pressure compared with the EPC group (95% CI, 1.11 to 4.20 and 1.39 to 3.88, respectively) with adjustment for baseline levels of age, sex, education, and baseline use of medications. The CBC group demonstrated a significant reduction in global CHD risk, whereas no reduction was seen in the EPC group (P<0.0001). CONCLUSIONS: Eliminating known barriers may not be sufficient to reduce CHD risk in primary care settings. An alternative community care model that addresses barriers may be a more effective way to ameliorate CHD risk in high-risk black families.

Adult↗

Perspectives on obesity and barriers to control from workers at a community center serving low-income Hispanic children and families.

Community center workers serving children and families in a predominantly Hispanic, low-income neighborhood were interviewed qualitatively, to ascertain their perspectives on obesity and barriers to control and prevention, to design a practical and culturally appropriate intervention for obesity control. All 19 respondents recognized obesity as a problem, identified healthy eating and physical activity as requisites for controlling obesity, and mentioned fast food and cultural influences in Hispanic families as contributory factors. Lack of time emerged as a major barrier to all preventive practices related to eating healthy or being physically active. Safety concerns and lack of safe places for walking and running were mentioned as a barrier to being physically active. Further studies have to be conducted with parents of at-risk children, to understand time constraints. Community health workers should be sensitive to issues of time constraints and incorporate time management recommendations into obesity prevention and education.

Adult↗