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PubMed1999

Barriers to Pacific women's use of cervical screening services.

OBJECTIVE: The present study explored barriers to the use of cervical screening information and services from the perspective of Pacific women. METHOD: Qualitative, face-to-face interviews based on a snowball sampling approach were used in Palmerston North, New Zealand, in 1997, to assess attitudes among 20 Pacific women. RESULTS: The study found a high level of awareness of a local cervical screening program. Specific barriers determined were: a resistance to being defined as socially problematic, embarrassment, belief in the sacred nature of human sexuality, an anxiety about lack of confidentiality within small community groups, and a perceived relationship between cervical smears and sexual activity. CONCLUSIONS: Participants strongly preferred that information on cervical screening should be transmitted by interpersonal means, though pamphlets on screening services were also sought. The women agreed that the preferable role of a Pacific Island health professional would be in disseminating information, rather than actually serving as a smear-taker. IMPLICATIONS: The need for smear-taking should not be stereotyped as a 'Pacific problem'. Multi-racial images of women should be used in advertising to demonstrate that cervical smears are necessary regardless of ethnicity. Information providers need to show great sensitivity when providing information relevant to human reproduction or sexuality.

Adult↗
PubMed1998

Administrative update: utilization of services. II. Utilization of mental health services in a tri-ethnic sample of adolescents.

In our study of a tri-ethnic sample of 2528 junior and high school students, we examined utilization of outpatient mental health services in relation to a number of variables cited in the literature as leading to potential biases and barriers to care. These include: age, gender, ethnicity, socioeconomic status, family size and composition, and linguistic fluency in Hispanic youth. The impact of service availability was examined through differences between the two regions studied: a well-served region of coastal southeast Texas and the markedly under served lower Rio Grande Valley. The impact of symptomatology was evaluated using the total problem score on the Youth Self Report by Achenbach. Hispanic youth had significantly lower mean service utilization than non-Hispanic whites. Multiple regression analyses demonstrated that socioeconomic status and family composition had a greater relative impact on utilization than all other non-clinical factors, both for the total sample as well as for the Hispanic sample. Ethnicity may play a significant role in child mental health services utilization through its close association to socioeconomic status.

Adolescent↗
PubMed2004

Bridging the divide: a survey of nurses' opinions regarding barriers to, and facilitators of, research utilization in the practice setting.

BACKGROUND: Many researchers have explored the barriers to research uptake in order to overcome them and identify strategies to facilitate research utilization. However, the research-practice gap remains a persistent issue for the nursing profession. AIMS AND OBJECTIVES: The aim of this study was to gain an understanding of perceived influences on nurses' utilization of research, and explore what differences or commonalities exist between the findings of this research and those of studies that have been conducted in various countries during the past 10 years. DESIGN: Nurses were surveyed to elicit their opinions regarding barriers to, and facilitators of, research utilization. The instrument comprised a 29-item validated questionnaire, titled Barriers to Research Utilisation Scale (BARRIERS Scale), an eight-item scale of facilitators, provision for respondents to record additional barriers and/or facilitators and a series of demographic questions. METHOD: The questionnaire was administered in 2001 to all nurses (n=761) working at a major teaching hospital in Melbourne, Australia. A 45% response rate was achieved. RESULTS: Greatest barriers to research utilization reported included time constraints, lack of awareness of available research literature, insufficient authority to change practice, inadequate skills in critical appraisal and lack of support for implementation of research findings. Greatest facilitators to research utilization reported included availability of more time to review and implement research findings, availability of more relevant research and colleague support. CONCLUSION: One of the most striking features of the findings of the present study is that perceptions of Australian nurses are remarkably consistent with reported perceptions of nurses in the US, UK and Northern Ireland during the past decade. RELEVANCE TO CLINICAL PRACTICE: If the use of research evidence in practice results in better outcomes for our patients, this behoves us, as a profession, to address issues surrounding support for implementation of research findings, authority to change practice, time constraints and ability to critically appraise research with conviction and a sense of urgency.

Adult↗
PubMed1999

Barriers to early detection of cervical-uterine cancer in Mexico.

In Mexico, a woman dies of cervical-uterine cancer every 2 hours, indicating a low impact by the national program for early detection of this cancer, principally because of problems related to quality and coverage. Through a qualitative study, we identified the principal barriers to use of the detection program from the point of view of actual and potential program users. Four focus groups were organized in standard conditions in Mexico City (urban, developed) and in the southern state of Oaxaca (rural, economically disadvantaged area). Participants were either women with at least one previous Papanicolaou (Pap) test or women who had never had the test. Barriers to Pap test use included (1) lack of knowledge about cervical-uterine cancer etiology, (2) not knowing that the Pap test exists, (3) the conception that cancer is an inevitably fatal disease, (4) problems in doctor/medical institution-patient relationships, (5) giving priority to unmet needs related to extreme poverty, (6) opposition by the male sexual partner, (7) rejection of the pelvic examination, (8) long waits for sample collection and receiving results, and (9) perceived high costs for care. To increase coverage of the early detection program for cervical-uterine cancer in Mexico, the needs, perceptions, and beliefs of women and their partners must be taken into account when developing policy and planning, given the role these factors play in the decision-making process that leads to their participation or nonparticipation in this program.

Adult↗
PubMed2006

A 4-year survey on palivizumab respiratory syncytial virus (RSV)-prophylaxis: how can compliance be improved?

OBJECTIVE: To identify compliance-influencing factors and to suggest strategies for overcoming barriers in a preventive medicine program. METHODS: A survey was conducted to evaluate compliance in children receiving palivizumab prophylaxis for respiratory syncytial virus (RSV) infections. Demographics, neonatal variables, and parental attitudes capable of influencing the outcome of prophylaxis were studied in 216 children over a four-year period. RESULTS: The overall compliance rate with all recommended doses of palivizumab was 87%. Among the neonatal characteristics, low birth weight and a younger age at the beginning of the program were significantly associated with good compliance (p < 0.05). The strongest factor influencing poor compliance was being foreign-born or a non-native speaker (p < 0.01). CONCLUSIONS: Compliance to RSV infection prophylaxis is reduced in infants born to foreign-born or non-native speakers. In order to enhance compliance, parents should be provided with adequate information in their own language explaining the advantages of the palivizumab prophylaxis program for RSV infections.

Antibodies, Monoclonal↗
PubMed2005

Race, ethnicity, and linguistic isolation as determinants of participation in public health surveillance surveys.

INTRODUCTION: To plan, implement, and evaluate programs designed to improve health conditions among racial and ethnic minority populations in the United States, public health officials and researchers require valid and reliable health surveillance data. Monitoring chronic disease and behavioral risk factors among such populations, however, is challenging. This study assesses the effects of race, ethnicity, and linguistic isolation on rates of participation in the Behavioral Risk Factor Surveillance System (BRFSS). METHODS: County-level data from the 2003 BRFSS survey and 2000 U.S. census were used to examine the effects of race, ethnicity, and linguistic isolation on six measures of survey participation (i.e., rates of resolution, screening, cooperation, response, language barriers, and refusal). RESULTS: Participation rates were significantly lower in counties with higher percentages of black people and people who did not speak English. Response rates decreased by 4.6% in counties with the highest concentration of black residents compared with counties with few black residents. Likewise, response rates decreased by approximately 7% in counties in which a larger percentage of the population spoke only Spanish or another Indo-European language compared with counties in which all residents spoke English. CONCLUSION: The negative relationship between the percentage of Spanish-only-speaking households and participation rates is troubling given that the BRFSS is conducted in both Spanish and English. The findings also indicate that more needs to be done to improve participation among other minorities. Researchers are investigating several ways of addressing disparities in participation rates, such as using postsurvey adjustments, developing more culturally appropriate data-collection procedures, and offering surveys in multiple languages.

Adolescent↗
PubMedDate not supplied

The multilingual videotape project: community involvement in a unique health education program.

The large number of Southeast Asian, Hispanic, and Portuguese immigrants in Rhode Island face formidable language and cultural barriers in gaining access to the health care that they need. As the funding for refugee-specific programs diminishes, the focus is on programs that encourage self-sufficiency, assist in gaining access to mainstream health care, and involve a collaboration among service agencies and the communities they serve. On behalf of a coalition of health care and community agencies, Women and Infants Hospital of Rhode Island received a private foundation grant to produce nine multilingual videotapes that would educate immigrants and refugees about health issues specific to them and help them access the health care system. The project was structured to maximize the involvement of the various communities and to "empower" community members in working with mainstream service agencies. Coalition and other community members provided input into topic selection, script content, and presentation methods for the videotapes that would be culturally appropriate. During the 2-year project, nine videotapes were produced with narration in seven languages. Copies of the videotapes were distributed free of charge to coalition members.

Asia, Southeastern↗
PubMed2006

Language barriers and paediatric burns: does education make a difference?

A focused first aid education campaign was conducted in Sydney in 1996 for parents of children from Non-English speaking backgrounds (NESB) to improve their knowledge of correct burns first aid treatment (BFAT). This study sought to determine the correlation, if any, between the reported beneficial results of this education campaign and the subsequent severity of burns in children. A retrospective review of all patients admitted to the state Burns Unit at The Children's Hospital at Westmead (CHW) over a 7-year period from January 1995 to December 2001 was performed. Number of patients, language spoken at home (English, Chinese, Arabic, Vietnamese or Other) and the rate of burns requiring skin grafting was assessed. A total of 1,283 patients were admitted over 7 years. Skin grafting was required in 544 (42%). NESB children required grafting in up to 88% of cases prior to the first aid education campaign, reducing to a minimum of 37% at 1 year and 65% at 5 years following the campaign. This compared to 40 and 36%, respectively, for English speaking children. While the initial decrease in grafting requirements may reflect an effective education campaign, the subsequent rise suggests the need for reinforcement.

Adolescent↗
PubMed2000

Korean nurses' adjustment to hospitals in the United States of America.

Korean nurses' adjustment to hospitals in the United States of America Due to shortage of nurses, more nurses from other countries are employed in health care settings in the United States of America (USA). Little attention has been paid to understanding how culturally different international nurses adjust to USA hospitals. The purpose of this study was to investigate how Korean nurses adjust to USA hospital settings. Grounded theory method was used for sampling procedure, data collection and analysis in order to describe Korean nurses' experiences from their perspective and to develop a substantive theory that explains their process of adjustment. Data were collected using semi-structured formal interviews with a purposive sample of 12 Korean nurses. The interviews were audio-taped and transcribed. Analysis of data, using the constant comparative method, revealed 'adjustment to USA hospitals' as the basic social psychological process. Five categories composed the process: (1) relieving psychological stress; (2) overcoming the language barrier; (3) accepting USA nursing practice; (4) adopting the styles of USA problem-solving strategies; and (5) adopting the styles of USA interpersonal relationships. These five categories capture the essential aspects of the adjustment process and each category contains a set of sub-categories that describe Korean nurses' day-to-day experiences that are critical and also problematic to their adjustment. The process evolves in two stages. In the initial stage, the first three of the five categories greatly influenced the nurses' adjustment. From the perspective of the nurses in the study, the initial stage lasts about 2 to 3 years. The remaining two categories are principal components of the later stage. It takes an additional 5 to 10 years to complete this stage. This model highlights both distress and accomplishments of Korean nurses during their adjustment to USA hospitals. The results of the study may help USA nurses gain insight in designing and implementing orientation programmes to facilitate and support Korean nurses' adjustment to USA hospitals.

Acculturation↗
PubMed2003

Health services research.

The major barriers to the collection of primary population-based dental services data are: (1) Dentists do not use standard record systems; (2) few dentists use electronic records; and (3) it is costly to abstract paper dental records. The value of secondary data from paid insurance claims is limited, because dentists code only services delivered and not diagnoses, and it is difficult to obtain and merge claims from multiple insurance carriers. In a national demonstration project on the impact of community-based dental education programs on the care provided to underserved populations, we have developed a simplified dental visit encounter system. Senior students and residents from 15 dental schools (approximately 200 to 300 community delivery sites) will use computers or scannable paper forms to collect basic patient demographic and service data on several hundred thousand patient visits. Within the next 10 years, more dentists will use electronic records. To be of value to researchers, these data need to be collected according to a standardized record format and to be available regionally from public or private insurers.

Communication Barriers↗
PubMed2005

Listening to patients: cultural and linguistic barriers to health care access.

BACKGROUND AND OBJECTIVES: Full access to medical care includes cultural and linguistic access as well as financial access. We sought to identify cultural and linguistic characteristics of low-income, ethnic minority patients' recent encounters with health care organizations that impede, and those that increase, health care access. METHODS: We conducted four focus groups with ethnically homogeneous African American, Latino, Native American, and Pacific Islander patients. Study participants were "walked" through the stages of a medical encounter and asked to identify physician and staff behaviors that made the patient feel more comfortable (a surrogate for increasing access) and behaviors that made the patient feel less comfortable (a surrogate for decreasing access). RESULTS: African American and Native American patients in particular expressed overall satisfaction with their physicians' services. Patients from all groups saw nonphysician staff as frequently impeding access. Based on perceptions of negative stereotypes, Native American and Pacific Islander patients reported hostility toward physicians' efforts at prevention and patient education. CONCLUSIONS: For the ethnic minority patients in our study, most perceived that cultural impediments to access involved nonphysician staff. Closer collaborations between health care organizations and ethnic minority communities in the recruitment and training of staff may be needed to improve cultural and linguistic access to care.

Adult↗
PubMed1999

Barriers to meeting the mental health needs of the Chinese community.

BACKGROUND: This study aimed to identify the barriers encountered by Chinese people with mental health needs in England which hindered their obtaining appropriate help from the National Health Service (NHS). METHODS: Attenders at Chinese community centres in health authority districts with resident Chinese population in excess of 2000 were invited to fill in a 12-item Chinese Health Questionnaire (12-CHQ). Individuals who scored two or above, indicating a high probability of a mental health problem, were invited to undertake a semi-structured interview. RESULTS: A total of 401 completed the 12-CHQ. Eighty-six (21.4 per cent) screened positive and 71 (82.6 per cent) agreed to be interviewed. Although 70 (98.6 per cent) were registered with a general practitioner (GP), there were long delays before they made contact with health professionals, and the GP was the first port of call for help in only 27 (38.6 per cent) interviewees. Fifty-two (74.3 per cent) had encountered difficulties when they sought professional help. The main barriers were language, interviewees' perceptions of symptoms as somatic rather than psychiatric in origin, lack of knowledge about statutory services, and lack of access to bilingual health professionals. Doctors, particularly GPs, were pivotal in the management of their conditions. The majority were prescribed psychiatric medication with only a small number in contact with community psychiatric services. Unemployment and social exclusion were common. Stigma associated with mental illness and limited knowledge in the community were identified as the causes for the widespread discrimination experienced by the interviewees. CONCLUSION: The mental health needs of these Chinese people were not adequately met by statutory services, nor could they rely on family and friends for care and support. Training for health service staff and access to health advocates are essential to maximize the effectiveness of health professional-patient contacts. The promotion of better understanding of mental illness by the Chinese community is important, and greater flexibility within the NHS is required to ensure those professionals with bilingual skills are used to the best effect.

Adult↗
PubMed2005

Explanations, explanations, explanations: how do patients with limited English construct narrative accounts in multi-lingual, multi-ethnic settings, and how can GPs interpret them?

BACKGROUND: The gap is widening between understanding the subtle ways patients and GPs manage their talk, and superficial discussion of the 'language barrier' among linguistic minority patients. All patients have to explain themselves, not just those for whom English is their first or main language. Patients' explanations reflect how they want the doctor to perceive them as a patient and as a person: they reveal patients' identities. Yet interpretations are not easy when patients' style of talking English is influenced by their first language and cultural background. OBJECTIVE: To explore in detail how patients with limited English and GPs jointly overcome misunderstandings in explanations. METHODS: Using discourse analysis and conversation analysis, we examine how GPs and their patients with limited English negotiate explanations and collaborate to manage, repair or prevent understanding problems. RESULTS: 31% of patients said English was not their first language. Misunderstandings arise owing to a range of linguistic and cultural factors, including stress and intonation patterns, vocabulary, the way a patient sequences their narrative, and patient and GP pursuing different agendas. CONCLUSION: When talk itself is the problem, patients' explanations can lead to misunderstandings, which GPs have to repair if they cannot prevent. Careful interpretation by skillful GPs can reveal patients' knowledge, experience and perspective.

Communication Barriers↗
PubMedDate not supplied

Barriers to health care for Vietnamese refugees.

This study was undertaken to determine the dynamics of why Vietnamese refugees may not optimally use existing health services in the United States. A random sample of 75 refugees was interviewed by a bilingual translator. Multivariate analysis of variance was used to analyze the effects of time of arrival on whether the following are barriers to care: not having a translator available in health care facilities, feeling understood by health care providers, being able to understand the written and verbal instructions of providers, and not having a primary provider. The hypothesis, that time-of-arrival groups would differ significantly on these variables, was supported (F = 4.81; df = 8,136; P less than .001). Concern about not having a translator in health care facilities ranked first in distinguishing the groups (F = 17.09; df = 2.71; P less than .001), followed by primary provider (F = 5.68; df = 2.71; P less than .01), feeling understood by the provider (F = 5.15; df = 2.71; P less than .01), and being able to understand written and verbal instructions given by the provider (F = 4.25; df = 2.71; P less than .05). The time-of-arrival groups also differed significantly on supplemental analyses. Subjects expressed willingness to seek more frequent health care if translators were available in health care facilities (F = 18.22; df = 2.72; P less than .001) and to change health care sites to gain a translator (F = 13.74; df = 2.72; P less than .001).

Analysis of Variance↗
PubMed2003

Evidence-based medicine in primary care: qualitative study of family physicians.

BACKGROUND: The objectives of this study were: a) to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM) in primary care; b) to investigate the influence of patient preferences on clinical decision-making; and c) to explore the role of intuition in family practice. METHOD: Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians. RESULTS: Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician. DISCUSSION: Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour.

Access to Information↗
PubMed2003

Medical messages in the media--barriers and solutions to improving medical journalism.

CONTEXT: Medical issues are widely reported in the mass media. These reports influence the general public, policy makers and health-care professionals. This information should be valid, but is often criticized for being speculative, inaccurate and misleading. An understanding of the obstacles medical reporters meet in their work can guide strategies for improving the informative value of medical journalism. OBJECTIVE: To investigate constraints on improving the informative value of medical reports in the mass media and elucidate possible strategies for addressing these. DESIGN: We reviewed the literature and organized focus groups, a survey of medical journalists in 37 countries, and semi-structured telephone interviews. RESULTS: We identified nine barriers to improving the informative value of medical journalism: lack of time, space and knowledge; competition for space and audience; difficulties with terminology; problems finding and using sources; problems with editors and commercialism. Lack of time, space and knowledge were the most common obstacles. The importance of different obstacles varied with the type of media and experience. Many health reporters feel that it is difficult to find independent experts willing to assist journalists, and also think that editors need more education in critical appraisal of medical news. Almost all of the respondents agreed that the informative value of their reporting is important. Nearly everyone wanted access to short, reliable and up-to-date background information on various topics available on the Internet. A majority (79%) was interested in participating in a trial to evaluate strategies to overcome identified constraints. CONCLUSIONS: Medical journalists agree that the validity of medical reporting in the mass media is important. A majority acknowledge many constraints. Mutual efforts of health-care professionals and journalists employing a variety of strategies will be needed to address these constraints.

Australia↗
PubMed2003

Sharing digital teaching resources: breaking down barriers by addressing the concerns of faculty members.

PURPOSE: Regional and institutional databases have been created to improve access to educational resources and to avert unnecessary duplication. The growth and success of these databases depend upon the willingness of faculty members to contribute their materials. This qualitative study seeks to identify the barriers that block the free exchange of educational multimedia and the incentives that could be created to overcome educators' concerns. METHOD: In 2001, 34 faculty members from 13 U.S. medical schools each participated in one of five focus groups. They responded to three hypothetical scenarios depicting opportunities for sharing educational resources. Participants' responses were categorized hierarchically and sent back to them for feedback. RESULTS: Participants strongly supported multimedia databases, particularly those that serve a national audience. Obstacles for contributing materials included the lack of institutional recognition for educational innovation, confusing intellectual property policies, the hassle involved in sharing materials, and the perceived commercial potential of the materials. Peer review of educational materials was seen as an important incentive. CONCLUSIONS: Medical schools could benefit from the free exchange of high-quality educational multimedia but need to address the concerns of faculty by clarifying institutional copyright rules, streamlining the donation process, and providing assistance with cataloging assets. Removing departmental pressures to commercialize materials and recognizing peer-reviewed donations as academic achievement could foster a culture of sharing.

Attitude of Health Personnel↗
PubMed1992

Maternal care coordination for migrant farmworker women: program structure and evaluation of effects on use of prenatal care and birth outcome.

Nearly three fourths of the migrant farmworkers in the U.S. are Hispanic. Cultural and social barriers, along with constant travel, make coordination of care a significant concern for migrant health centers providing perinatal services to female farmworkers. As part of a demonstration project, a migrant-specific maternal care coordination program was developed that used bilingual staff, outreach services, lay health advisers, and a multistate tracking system. Following the initiation of the project, first-trimester entry into prenatal care and number of prenatal visits increased over a five-year period among the target population. Successful tracking methods provided outcome data on more than 80 percent of participants during the project period. The results of this study suggest that migrant health centers should focus on employing public health-oriented bilingual or bicultural health professionals and that an outreach strategy must be an integral part of a health care delivery system serving migrant farmworkers. Without these key ingredients, health care services will not be accessible or acceptable for this hard-to-reach population. Collaboration among the National Migrant Resource Program, the Migrant Clinicians Network, and the National Perinatal Association can facilitate development of a regionwide perinatal service system for female migrant farmworkers.

Communication Barriers↗