Overcoming the Challenges Faced by Immigrant Populations While Accessing Primary Care: Potential Solution-oriented Actions Advocated by the Bangladeshi-Canadian Community

Introduction: Immigrants continue to face significant challenges in accessing primary healthcare (PHC) that often negatively impact their health. The present research aims to capture the perspectives of immigrants to identify potential approaches to enhance PHC access for this group. Methods: Focus group discussions (FGDs) were conducted among a sample of first-generation Bangladeshi immigrants who had experience with PHC in Canada. A total of 13 FGDs (7 among women, 6 among men) were conducted with 80 participants (women = 42, men = 38) in their preferred language, Bangla. We collected demographic information prior to each focus group and used descriptive statistics to identify the socio-demographic characteristics of participants. We applied thematic analysis to examine qualitative data to generate a list of themes of possible approaches to improve PHC access. Results: The focus group findings identified different levels of approaches to improve PHC access: individual-, community-, service provider-, and policy-level. Individual-level approaches included increased self-awareness of health and wellness and personal knowledge of cultural differences in healthcare services and improved communication skills. At the community level, supports for community members to access care included health education workshops, information sessions, and different support programs (eg, carpool services for senior members). Suggested service-level approaches included providers taking necessary steps to ensure an effective doctor-patient relationship with immigrants (eg, strategies to promote cultural competencies, hiring multicultural staff). FGD participants also raised the importance of government- or policy-level solutions to ensure high quality of care (eg, increased after-hour clinics and lab/diagnostic services). Conclusions: Although barriers to immigrants accessing healthcare are well documented in the literature, solutions to address them are under-researched. To improve healthcare access, physicians, community health centers, local health agencies, and public health units should collaborate with members of immigrant communities to identify appropriate interventions.

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Abstract 047: Using Geospatial Data To Eliminate Disparities In Covid-19 Testing

Circulation ◽

10.1161/circ.143.suppl_1.047 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Gregory W Heath ◽

Tim Moreland ◽

Shannon Stephenson ◽

Jesse A Houser ◽

Colleen Schmitt

Keyword(s):

Community Health Centers ◽

Effective Means ◽

Age Distribution ◽

Healthcare Services ◽

Health Concern ◽

Behavioral Risk ◽

Local Health ◽

Social Vulnerability Index ◽

First Case ◽

Black Residents

Introduction: The first case of COVID-19 in Chattanooga/Hamilton County, Tennessee (CHC) was identified on March 13, 2020. By early April, 51 RT-PCR confirmed cases were identified, with white, non-Hispanic males and females representing 82% (41/51) of positive cases and remaining cases representing black residents (18%; 9/51). That few people from racial/ethnic minorities were being tested became a key public health concern. We hypothesized that local mapping of health-related data would identify regions where individuals at greater risk for COVID-19 live and work and have limited access to testing and healthcare services. Methods: The CDC 500 Cities data was used to generate layered maps of prevalence estimates for cardiovascular disease, type 2 diabetes mellitus, chronic lung disease, and the behavioral risk factors of physical inactivity and obesity. Layers also included the CDC Social Vulnerability Index, age distribution, gender, race, ethnicity, and zip codes. Maps were shared with intersectoral collaborators representing the black and Hispanic/Latinx communities who provided specific neighborhood information to the maps. Collaborators included hospital systems, the local health department, community health centers, the private sector, and non-profit organizations. Maps were used to identify geographic sites for mobile and strategic testing within communities at higher risk for the spread of the coronavirus. Specific diverse neighborhoods along with worksites were then provided with testing beginning in early May and ongoing. Results: Strategic and mobile testing beginning in early May increased three-fold the number of identified new cases of COVID-19. Seventy percent (652/932) of these positive tests were among ethnically Hispanic/Latinx and 16% (149/932) among black residents. Positive tests continued to increase at a greater rate among Hispanic/Latinx and black residents compared with white residents through the months of May-July (68/10K vs. 2.6/10K, OR = 4.85, 95% CI 2.66, 9.02). Conclusions: This example of inter-sectoral collaboration, data sharing, and data use through strategic mapping of vulnerable populations for COVID-19 was an effective means to enhance COVID-19 testing and identification of positive cases throughout CHC. This expanded partnering resulting in targeted testing may be a useful approach among similar communities and subsequent outbreaks.

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Barriers to healthcare access for Arabic-speaking population in an English-speaking country

Pharmacy Practice ◽

10.18549/pharmpract.2020.2.1809 ◽

2020 ◽

Vol 18 (2) ◽

pp. 1809

Author(s):

Ali A. Al Jumaili ◽

Kawther K. Ahmed ◽

Dave Koch

Keyword(s):

Health Insurance ◽

Health Literacy ◽

Focus Group ◽

Healthcare Access ◽

Healthcare Services ◽

Preventive Healthcare ◽

Physician Visits ◽

Barriers To Healthcare ◽

Arabic Speaking ◽

Barriers To Healthcare Access

Objective: To identify barriers to healthcare access, to assess the health literacy levels of the foreign-born Arabic speaking population in Iowa, USA and to measure their prevalence of seeking preventive healthcare services. Methods: A cross-sectional study of native Arabic speaking adults involved a focus group and an anonymous paper-based survey. The focus group and the Andersen Model were used to develop the survey questionnaire. The survey participants were customers at Arabic grocery stores, worshippers at the city mosque and patients at free University Clinic. Chi-square test was used to measure the relationship between the characteristics of survey participants and preventive healthcare services. Thematic analysis was used to analyze the focus group transcript. Results: We received 196 completed surveys. Only half of the participants were considered to have good health literacy. More than one-third of the participants had no health insurance and less than half of them visit clinics regularly for preventive measures. Two participant enabling factors (health insurance and residency years) and one need factor (having chronic disease(s)) were found to significantly influence preventive physician visits. Conclusions: This theory-based study provides a tool that can be used in different Western countries where Arabic minority lives. Both the survey and the focus group agreed that lacking health insurance is the main barrier facing their access to healthcare services. The availability of an interpreter in the hospital is essential to help those with inadequate health literacy, particularly new arriving individuals. More free healthcare settings are needed in the county to take care of the increasing number of uninsured Arabic speaking patients.

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Not a Problem at All or Excluded by Oneself, Doctors and the Law? Healthcare Workers’ Perspectives on Access to HIV-Related Healthcare Among Same-Sex Attracted Men in Tanzania

10.21203/rs.3.rs-498723/v1 ◽

2021 ◽

Author(s):

Alexander Ishungisa Mwijage ◽

Mucho Michael Mizinduko ◽

Samuel Lazarus Likindikoki ◽

Dan Dan Wolf Meyrowitsch ◽

Elia John Mmbaga ◽

...

Keyword(s):

Focus Group ◽

Work Experience ◽

Healthcare Workers ◽

Healthcare Access ◽

Healthcare Services ◽

Access To Healthcare ◽

Structural Barriers ◽

Same Sex ◽

Focus Group Discussions ◽

Group Discussions

Abstract Background: Same-sex attracted men in Tanzania are disproportionately affected by HIV. Drawing on qualitative research, the present study explores healthcare providers’ perspectives on access to HIV-related healthcare services among same-sex attracted men. Methods: A qualitative study was carried out among healthcare workers in in the cities of Dar es Salaam and Tanga in Tanzania between August 2018 and October 2019. Fieldwork entailed qualitative interviewing, focus group discussions and participant observation. A purposive sampling strategy was used to select study participants who varied with respect to age, education level, work experience, and the type and location of the facilities they worked in. Twenty-four interviews and six focus group discussions were conducted.Results: This paper describes four different discourses that were identified among healthcare workers with respect to their perception of access to healthcare services for SSAM. One held that access to healthcare was not a major problem at all, another that some SSAM did not utilize healthcare services although they were available, a third that some healthcare workers prevented SSAM from gaining access to healthcare and a fourth that healthcare for gender and sexual minority persons was made difficult by structural barriers. Conclusion: Although these are four rather different takes on the prevailing circumstances with respect to healthcare access for SSAM, we suggest that they may all be ‘true’ in the sense that they grasp and highlight different aspects of the same realities.

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Breaking Barriers to Healthcare Access: A Multilevel Analysis of Individual- and Community-Level Factors Affecting Women’s Access to Healthcare Services in Benin

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020750 ◽

2021 ◽

Vol 18 (2) ◽

pp. 750

Author(s):

Betregiorgis Zegeye ◽

Ziad El-Khatib ◽

Edward Kwabena Ameyaw ◽

Abdul-Aziz Seidu ◽

Bright Opoku Ahinkorah ◽

...

Keyword(s):

Low Income ◽

Economic Status ◽

Healthcare Access ◽

Healthcare Services ◽

Access To Healthcare ◽

Community Level ◽

Low Income Countries ◽

Outcome Variable ◽

National Education ◽

Individual Level

Background: In low-income countries such as Benin, most people have poor access to healthcare services. There is scarcity of evidence about barriers to accessing healthcare services in Benin. Therefore, we examined the magnitude of the problem of access to healthcare services and its associated factors. Methods: We utilized data from the 2017–2018 Benin Demographic and Health Survey (n = 15,928). We examined the associations between the demographic and socioeconomic characteristics of women using multilevel logistic regression. The outcome variable for the study was problem of access to healthcare service. Adjusted odds ratios (AORs) with 95% confidence intervals (95% CI) were estimated. Results: Overall, 60.4% of surveyed women had problems in accessing healthcare services. Partner’s education (AOR = 0.70; 95% CI; 0.55–0.89), economic status (AOR = 0.59; 95% CI; 0.47–0.73), marital status (AOR = 0.44; 95% CI; 0.39–0.51), and parity (AOR = 1.85; 95% CI; 1.45–2.35) were significant individual-level factors associated with problem of access to healthcare. Region (AOR = 5.24; 95% CI; 3.18–8.64) and community literacy level (AOR = 0.69; 95% CI; 0.51–0.94) were the main community-level risk factors. Conclusions: Enhancing husband education through adult education programs, economic empowerment of women, enhancing national education coverage, and providing priority for unmarried and multipara women need to be considered. Additionally, there is the need to ensure equity-based access to healthcare services across regions.

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COVID-19 Prevention Facilitators and Barriers among Specific Ethnic Minority Communities in Rural Ohio

10.1101/2021.10.21.21265302 ◽

2021 ◽

Author(s):

Paran Pordell ◽

Hammad Ali ◽

Gisela Medina Martinez ◽

Brandi Taylor ◽

Karthik Kondapally ◽

...

Keyword(s):

Rural Communities ◽

Ecological Model ◽

Health Department ◽

Workplace Safety ◽

Healthcare Services ◽

Plant Management ◽

Local Health ◽

Structural Level ◽

Community Members ◽

Community Culture

Abstract Objective: To assess knowledge, beliefs, and behaviors concerning COVID-19 among Guatemalan, Marshallese, and Amish populations in rural Ohio; identify individual, interpersonal, community, and structural level challenges within each community; and provide population-specific recommendations to prevent and mitigate further SARS-CoV-2 transmission among these rural communities. Methods: We conducted 30 key informant interviews in four rural counties in Ohio, in May 2020. Three teams of two investigators conducted interviews with local health department staff, community members, meat packing plant management, and community leaders from three communities disproportionately affected by the COVID-19 pandemic [Guatemalan (N=12), Marshallese (N=7), Amish (N=11)]. We used the Social Ecological Model to identify and categorize themes. Results: Emerging and overall themes were identified and defined. Investigators identified COVID-19 knowledge gaps, myths, and misinformation, food insecurity, community cohesion, stigma, community culture and norms, lack of workplace safety policies, and access to testing as key themes to COVID-19 prevention. Conclusions: Understanding specific barriers and identifying facilitators that most effectively provide resources, healthcare services, education, and social support tailored to specific communities would help deter SARS-CoV-2 transmission.

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Strategic yet delicate: the dilemma of involving health workers in facilitating birth registration in Indonesia

BMC Health Services Research ◽

10.1186/s12913-019-4594-z ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Clara Siagian ◽

Wenny Wandasari ◽

Feri Sahputra ◽

Santi Kusumaningrum

Keyword(s):

Health Personnel ◽

Health Workers ◽

Health Sector ◽

Birth Certificate ◽

Healthcare Services ◽

Vital Statistics ◽

Local Health ◽

Birth Registration ◽

Community Members ◽

Civil Registration

Abstract Background Birth registration provides the basis for population data. Previous studies have examined that collaboration between the health sector and civil registration can help improve birth registration rate. However, there was a little exploration into health workers’ understanding of civil registration and vital statistics (CRVS) and their perceived role in it. This study aims to fill this gap by focusing on the perspective of both health personnel in a managerial position and those who are involved in direct service provision to the community. Finally, we discussed the opportunities and challenges to strengthen the birth registration presented by health workers’ diverse views. Method This study uses a qualitative approach through semi-structured in-depth interviews with 23 provincial to village health personnel in Pangkajene Kepulauan (Pangkep) district of South Sulawesi province. The participants were selected through consultation with the Department of Planning and the head of the Department of Health at provincial and district level based on the relevance of their position with CRVS. At the frontline level, the informants were identified using a snowballing technique and recommendation from community members. Results This study finds that at the village level, health workers perceive CRVS as important since it supports them in delivering healthcare to community members. They see identification document like birth certificate as crucial for healthcare seekers to access the government’s health insurance and with that, proper and affordable treatment. Some health workers have been facilitating birth registration on a discretionary basis. Local health officials agree that accurate birth data lead to effective planning and financing for healthcare services and insurance. Despite the positive perception of birth registration, the majority of health workers do not want the additional burden for registering births. Health officials, however, are more open to taking some responsibilities. Conclusion This study concludes that the level of health workers’ understanding and appreciation of the CRVS system provides opportunities to engage them systematically in birth registration. It recommends that institutionalizing health workers’ participation in birth registration must consider their current workload, revision of legal instruments, capacity building plan, and operable linkage with civil registration authority.

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Family Planning Practices in Appalachia: Focus Group Perspectives on Service Needs in the Context of Regional Substance Abuse

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17041198 ◽

2020 ◽

Vol 17 (4) ◽

pp. 1198 ◽

Cited By ~ 1

Author(s):

Laura E. T. Swan ◽

Samantha L. Auerbach ◽

Gretchen E. Ely ◽

Kafuli Agbemenu ◽

Jessica Mencia ◽

...

Keyword(s):

Substance Abuse ◽

Family Planning ◽

Focus Group ◽

Healthcare Access ◽

Service Needs ◽

Opioid Use ◽

Community Members ◽

Family Planning Services ◽

Treatment Services ◽

Community Stakeholders

Reproductive health disparities in the Appalachian region may be driven by barriers to healthcare access. However, the barriers specific to accessing family planning services in Appalachia have not yet been identified from the perspectives of Appalachian community members. Moreover, it is unclear how community members might perceive elevated levels of opioid use in the region to impact family planning practices. To fill this gap in knowledge, the current qualitative study explored community perspectives about family planning in Appalachia in the context of the opioid epidemic for the purpose of developing a survey instrument based on these responses. We conducted three video call focus group interviews with community stakeholders, those who live, work and are invested in Appalachia (N = 16), and analyzed the responses using Levesque, Harris, and Russell’s (2013) five pillars of healthcare access as a framework to categorize family planning practices and perceptions of service needs in the context of regional substance abuse: (1) approachability, (2) acceptability, (3) availability and accommodation, (4) affordability, and (5) appropriateness. Subthemes within each of these five categories were also identified. Our findings highlight stakeholder concerns around a lack of knowledge about and access to family planning services in Appalachia. Community members also expressed concern around the lack of availability of substance use treatment services, which may negatively impact family planning use and access in the region.

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Factors influencing decision making for implementing e-health in light of the COVID-19 outbreak in Gulf Cooperation Council countries

International Health ◽

10.1093/inthealth/ihab003 ◽

2021 ◽

Author(s):

Fahad M Al-Anezi

Keyword(s):

Decision Making ◽

United Arab Emirates ◽

Healthcare Access ◽

Demographic Factors ◽

Quality Of Healthcare ◽

Healthcare Services ◽

Gulf Cooperation Council ◽

Factors Influencing ◽

Electronic Health ◽

Novel Coronavirus

Abstract Background Electronic health (e-health) approaches such as telemedicine, mobile health, virtual healthcare and electronic health records are considered to be effective in increasing access to healthcare services, reducing operational costs and improving the quality of healthcare services during the coronavirus disease 2019 (COVID-19) outbreak, a pandemic resulting from the spread of a novel coronavirus discovered in December 2019. In this context, the aim of this study was to identify the most important factors influencing decision making on the implementation of e-health in Gulf Cooperation Council (GCC) member states (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates), which are in the process of digitizing healthcare services. Methods This study reviewed the literature to identify the important factors influencing decision making on e-health. In addition, a questionnaire-based survey was conducted in order to identify the most important criteria to be considered in decision making on e-health. The survey link was forwarded to 978 healthcare practitioners and 42 experts (purposive sampling), from which a final sample of 892 (864 practitioners and 28 experts) was achieved, reflecting a response rate of 87.45%. Results Of the 44 factors identified under seven themes (strategic, quality, management, technology, function characteristics, economic, sociocultural and demographic factors), 22 factors were identified to be the most important criteria. Conclusions Findings from this study suggest that decision making in relation to e-health is a complex process that requires consideration of various factors. It was also found that attention should be paid to sociocultural and demographic factors, which may need to be considered in increasing healthcare access during the COVID-19 outbreak.

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A thematic study: impact of COVID-19 pandemic on rare disease organisations and patients across ten jurisdictions in the Asia Pacific region

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01766-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Claudia Ching Yan Chung ◽

Yvette Nga Chung Ng ◽

Ritu Jain ◽

Brian Hon Yin Chung

Keyword(s):

Focus Group ◽

Rare Disease ◽

Qualitative Data ◽

Healthcare Access ◽

Asia Pacific ◽

Pacific Region ◽

Group Meeting ◽

Asia Pacific Region ◽

Focus Group Meeting ◽

The Impact

Abstract Background This study assesses the areas and extent of impact of the Coronavirus Disease of 2019 (COVID-19) pandemic on rare disease (RD) organisations in the Asia Pacific region. There is no existing literature that focuses on such impact on RD organisations in any jurisdictions, nor RD populations across multiple jurisdictions in the Asia Pacific region. A cross-sectional survey was distributed to RD organisations between April and May 2020. Quantitative and qualitative data on the impact of COVID-19 on RD organisations and patients were collected from the organisation representative’s perspective. Qualitative data was analysed using thematic analysis. A follow-up focus group meeting was conducted in August 2020 to validate the survey findings and to discuss specific needs, support and recommendations for sustainable healthcare systems during the pandemic. Results A total of 80 RD organisations from Australia, Hong Kong Special Administrative Region of China, India, Japan, mainland China, Malaysia, New Zealand, the Philippines, Singapore and Taiwan participated in the study. Of all, 89% were concerned about the impact of pandemic on their organisations. Results indicate that 63% of the organisations functioned at a reduced capacity and 42% stated a decrease in funding as their biggest challenge. Overall, 95% believed their patients were impacted, particularly in healthcare access, social lives, physical health, psychological health and financial impact. Specifically, 43% identified the reduced healthcare access as their top impact, followed by 26% about the impact on daily living and social life. Focus group meeting discussed differential impact across jurisdictions and point towards telemedicine and digitalisation as potential solutions. Conclusions This serves as the first study to assess the impact of COVID-19 on RD patients and organisations across multiple jurisdictions in the Asia Pacific region, identifying major themes on the impact on both RD patients and organisations. By including 80 organisations from ten jurisdictions, our study presents the most comprehensive assessment of the pandemic’s impact to date. It highlights the need for mental health support and sheds light on moving towards telemedicine and digitalisation of organisation operation, which constitutes a sustainable model in times of pandemics and beyond.

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The contribution of political skill to the implementation of health services change: a systematic review and narrative synthesis

BMC Health Services Research ◽

10.1186/s12913-021-06272-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jenelle M. Clarke ◽

Justin Waring ◽

Simon Bishop ◽

Jean Hartley ◽

Mark Exworthy ◽

...

Keyword(s):

Leadership Development ◽

Health Services ◽

Mixed Methods Research ◽

Political Skill ◽

Group Processes ◽

Healthcare Services ◽

Narrative Synthesis ◽

Five Dimensions ◽

Individual Level ◽

Health System Change

Abstract Background The implementation of strategic health system change is often complicated by informal ‘politics’ in healthcare organisations. Leadership development programmes increasingly call for the development and use of ‘political skill’ as a means for understanding and managing the politics of healthcare organisations. The primary purpose of this review is to determine how political skill contributes to the implementation of health services change, within and across organisations. The secondary purpose is to demonstrate the conceptual variations within the literature. Methods The article is based upon a narrative synthesis that included quantitative, qualitative and mixed methods research papers, review articles and professional commentaries that deployed the concept of political skill (or associated terms) to describe and analyse the implementation of change in healthcare services. Results Sixty-two papers were included for review drawn from over four decades of empirically and conceptually diverse research. The literature is comprised of four distinct literatures with a lack of conceptual coherence. Within and across these domains, political skill is described as influencing health services change through five dimensions of leadership: personal performance; contextual awareness; inter-personal influence; stakeholder engagement, networks and alliances; and influence on policy processes. Conclusion There is a growing body of evidence showing how political skill can contribute to the implementation of health services change, but the evidence on explanatory processes is weak. Moreover, the conceptualisation of political skill is variable making comparative analysis difficult, with research often favouring individual-level psychological and behavioural properties over more social or group processes.

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