scholarly journals Barriers to accessing preventive health care among African-born individuals in King County, Washington: A qualitative study involving key informants

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250800
Author(s):  
D. Allen Roberts ◽  
Seifu Abera ◽  
Guiomar Basualdo ◽  
Roxanne P. Kerani ◽  
Farah Mohamed ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Unmet Need ◽  
Community Outreach ◽  
Preventive Health Care ◽  
Preventive Health ◽  
King County ◽  
Engagement In Care ◽  
Care Providers ◽  
African Immigrant

Studies of African immigrant health in the U.S. have traditionally focused on infectious diseases. However, the rising burden of non-communicable diseases (NCDs) indicates the increasing importance of general preventive health care. As part of a series of community health events designed for African-born individuals in King County, Washington, we administered key informant interviews (KIIs) with 16 health event participants, medical professionals, and community leaders to identify barriers and facilitators to use of preventive health care among African-born individuals. We used descriptive thematic analysis to organize barriers according to the socio-ecological model. Within the individual domain, KII participants identified lack of knowledge and awareness of preventive health benefits as barriers to engagement in care. Within the interpersonal domain, language and cultural differences frequently complicated relationships with health care providers. Within the societal and policy domains, healthcare costs, lack of insurance, and structural racism were also reported as major barriers. Participants identified community outreach with culturally competent and respectful providers as key elements of interventions to improve uptake. In conclusion, African immigrant communities face several barriers, ranging from individual to policy levels, to accessing health services, resulting in substantial unmet need for chronic disease prevention and treatment. Community-centered and -led care may help facilitate uptake and engagement in care.

Recommendations of the Workshop on Immunization and Preventive Care

PEDIATRICS ◽  
1990 ◽  
Vol 86 (6) ◽  
pp. 1067-1067
Keyword(s):  
Health Care ◽  
Information System ◽  
Private Sector ◽  
Health Care Providers ◽  
Birth Certificate ◽  
Preventive Health Care ◽  
The United States ◽  
Preventive Health ◽  
Surveillance Program ◽  
Care Providers

1. Information and outreach systems should be improved so that high levels of immunization in preschool children will be reached in the United States. Because of a vastly improved ability to set up systems and to transfer data, a modern information system should function far better than the previous Infant Immunization Surveillance Program of about 20 years ago, which had no outreach element at all. 2. No matter how care is delivered, and several configurations of public vs private sector were discussed, responsibility should be placed on an individual or an agency to ensure that each child needing immunization and other preventive health services is identified and contacted. The information system should be keyed to the birth certificate. Reminders—mailed, phoned or, better still, delivered in person—should be provided for all children. 3. In both the public sector and the private sector, vaccines should be provided free of charge. (Methods of financing were not addressed directly, but most participants believed that the federal government would take financial responsibility.) 4. Health care providers should be taught the importance of assessing immunization status and administering needed immunizations at every appropriate contact with a child. 5. Immunization should be provided not as a solitary service, but as a part of a package of comprehensive preventive services. 6. A comprehensive school health education program should be established. 7. Consideration should be given to the use of incentives, either positive or negative, to improve the priority assigned to immunization and other preventive health care services.

scholarly journals SAT0640-HPR RHEUMATOLOGY CARE OF MIGRANTS FROM SUB-SAHARAN AFRICA; A QUALITATIVE PILOT STUDY OF PATIENTS’ PERSPECTIVES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1279.1-1279
Author(s):  
Z. Rutter-Locher ◽  
J. Galloway ◽  
H. Lempp
Keyword(s):  
Rheumatoid Arthritis ◽  
Health Care ◽  
Health Care Providers ◽  
Unmet Need ◽  
Primary Care Providers ◽  
Sub Saharan Africa ◽  
Care Providers ◽  
Specialist Care ◽  
Sub Saharan ◽  
The Uk

Background:Rheumatological diseases are common in Sub-Saharan Africa [1] but specialist healthcare is limited and there are less than 150 rheumatologists currently serving 1 billion people in Sub-Saharan Africa [2]. Rheumatologists practising in the UK NHS are likely to be exposed to migrant patients. There is therefore, an unmet need for health care providers to understand the differences in rheumatology healthcare provision between Sub-Saharan Africa and the UK and the barriers which migrants face in their transition of rheumatology care.Objectives:To gain an understanding of the experiences of patients with rheumatological conditions, about their past healthcare in Sub-Saharan Africa and their transition of care to the UK.Methods:A qualitative study using semi-structured interviews was conducted. Participants were recruited from two rheumatology outpatient clinics in London. Thematic analysis was applied to identify key themes.Results:Seven participants were recruited. Five had rheumatoid arthritis, one had ankylosing spondylitis and one had undifferentiated inflammatory arthritis. Participants described the significant impact their rheumatological conditions had on their physical and emotional wellbeing, including their social and financial implications. Compared to the UK, rheumatology healthcare in Sub-Saharan Africa was characterised by higher costs, limited access to specialists, lack of investigations and treatments, the use of traditional medicines and poor communication by clinicians. Barriers to transition of rheumatology care to the UK were: poor understanding of rheumatological conditions by the public and primary care providers, lack of understanding of NHS entitlements by migrants, fear of data sharing with immigration services and delayed referral to specialist care. Patient, doctor and public education were identified by participants as important ways to improve access to healthcare.Conclusion:This study has described, for the first time, patients’ perspectives of rheumatology health care in Sub-Saharan Africa and the transition of their care to the UK. These initial findings allow healthcare providers in the UK to tailor management for this migrant population and suggests that migrants need more information about their NHS entitlements and specific explanations on what non-clinical data will be shared with immigration services. To increase access to appropriate care, a concerted effort by clinicians and public health authorities is necessary to raise awareness and provide better education to patients and migrant populations about rheumatological conditions.References:[1]G. Mody, “Rheumatology in Africa-challenges and opportunities,” Arthritis Res. Ther., vol. 19, no. 1, p. 49, 2017.[2]M. A. M. Elagib et al., “Sudan and Sweden Active Rheumatoid Arthritis in Central Africa: A Comparative Study Between,” J. Rheumatol. J. Rheumatol. January, vol. 43, no. 10, pp. 1777–1786, 2016.Acknowledgments:We are grateful to the patients involved in this study for their time and involvement.Disclosure of Interests:None declared

scholarly journals Knowledge, Beliefs, and Attitudes About Breast Cancer Screening in Latin America and the Caribbean: An In-Depth Narrative Review

2018 ◽  
pp. 1-25
Author(s):  
Aubrey L. Doede ◽  
Emma M. Mitchell ◽  
Dan Wilson ◽  
Reanna Panagides ◽  
Mônica Oliveira Batista Oriá
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Latin America ◽  
Literature Review ◽  
Health Care Providers ◽  
Health Workers ◽  
Preventive Health Care ◽  
Educational Interventions ◽  
Care Providers ◽  
The Caribbean

Purpose Breast cancer (BCA) is the most common cancer and leading cause of cancer mortality among women in Latin America and the Caribbean (LAC), and the number of deaths from BCA is expected to continue to increase. Although barriers to care include the physical accessibility of screening resources, personal and cultural barriers must be explored to understand necessary next steps to increase access to preventive care. The purpose of this in-depth narrative literature review was to explore empiric literature that surrounds the knowledge, attitudes, and beliefs toward BCA screening practices among women in LAC. To our knowledge, this is the first literature review to include articles from all countries and national languages (Portuguese, English, and Spanish) that pertain to this topic. Methods OVID Medline, CINAHL, and Web of Science/SciELO were used to identify articles. Thirty-five articles were included according to inclusion and exclusion criteria. Results Themes identified in the literature included knowledge about screening procedures and cause of cancer; knowledge sources; catalysts and deterrents for screening, such as family support, family history; social support or taboo, fear, self-neglect, cost, and transportation; and the perception of the screening experience. Conclusion In addition to physical availability of resources and health care personnel, there is a necessity for culturally competent community educational interventions across all aspects of BCA screening and prevention. In light of the barriers to preventive health care, providers such as nurses and community health workers are uniquely qualified to provide culturally appropriate and individualized health education to address cultural and psychological barriers to BCA screening.

From state care to self-care: cancer screening behaviours among Russian-speaking Australian women

2013 ◽  
Vol 19 (2) ◽  
pp. 130 ◽  
Author(s):  
Victoria Team ◽  
Lenore H. Manderson ◽  
Milica Markovic
Keyword(s):  
Health Care ◽  
Cancer Screening ◽  
Soviet Union ◽  
Health Care Providers ◽  
Former Soviet Union ◽  
Preventive Health Care ◽  
Care Providers ◽  
Women's Participation ◽  
Health Related ◽  
Health Care Policies

In this article, we report on a small qualitative scale study with immigrant Russian-speaking Australian women, carers of dependent family members. Drawing on in-depth interviews, we explore women’s health-related behaviours, in particular their participation in breast and cervical cancer screening. Differences in preventive health care policies in country of origin and Australia explain their poor participation in cancer screening. Our participants had grown up in the former Soviet Union, where health checks were compulsory but where advice about frequency and timing was the responsibility of doctors. Following migration, women continued to believe that the responsibility for checks was their doctor’s, and they maintained that, compared with their experience of preventive medicine in the former Soviet Union, Australian practice was poor. Women argued that if reproductive health screening were important in cancer prevention, then health care providers would take a lead role to ensure that all women participated. Data suggest how women’s participation in screening may be improved.

scholarly journals Influences of Exclusive Breastfeeding Among Low-wage, Working Mothers in Kenya: Perspectives from Managers, Healthcare Providers, Daycare Directors, Mothers, and Fathers (OR30-02-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Scott Ickes ◽  
Hannah Sanders ◽  
Hellen Lemein ◽  
Joyceline Kinyua ◽  
Benson Singa ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Maternal Employment ◽  
Maternity Leave ◽  
Healthcare Providers ◽  
Community Outreach ◽  
Care Providers ◽  
Funding Sources ◽  
Employed Mothers ◽  
Immunization Services

Abstract Objectives Kenya has legislation and policies on maternity leave and workplace support for breastfeeding (BF), and breastmilk expression. The extent to which this framework influences the BF practices of low-wage mothers is unknown. The purpose of this study was to understand the influences of EBF for 6 mo among mothers employed in the commercial agriculture and tourism industries. Methods We conducted in-depth interviews with employed mothers (n = 25), husbands of employed mothers (n = 10), managers of commercial flower farms and hotels (n = 8), daycare directors (n = 22), and health care providers (n = 20) in Naivasha, Kenya. Results Despite a widespread recognition of the recommended 6 months duration for EBF, employed mothers describe early cessation of EBF in preparation for their return to work, following a mandated 3-mo maternity leave. Husbands of employed women support EBF and would like to see the duration of EBF extended, but note similar challenges. Managers support lactating mothers through flexible work schedules and duties, yet few farms or hotels have designated lactation areas, and most recognize that mothers prefer to arrive later or leave early rather than visit children to feed during the workday. Daycare directors describe lack of refrigeration for expressed milk, and low interest from mothers in leaving expressed milk to feed their children during the workday. Employers with on-site housing and/or daycare report a more favorable environment to support EBF. Health care providers perceive low-wage, maternal employment as a challenge to 6 months of EBF, yet see childcare and a strengthened continuum of education from antenatal care to immunization services and community outreach as opportunities to improve EBF promotion. Conclusions Beliefs about optimal BF practices do not align with practice. Mothers employed in low-wage work receive some benefits from their employers to support child care responsibilities, but distance from daycare, a low efficacy for expressing and storing milk, and lack of support for milk expression currently make EBF unattainable for most mothers in these industries. Interventions to improve the desirability and feasibility of milk expression are needed to strengthen the opportunity for EBF for employed mothers. Funding Sources Fogarty International Center, National Institutes of Health.

scholarly journals Ethnic disparity in health literacy related to interaction with the health care provider

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
S F Villadsen
Keyword(s):  
Health Care ◽  
Health Literacy ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Intercultural Competence ◽  
Preventive Health Care ◽  
Care Providers ◽  
Health Literacy Level ◽  
Literacy Level

Abstract With the current orientation towards patient-centered care, the health literacy level is an important predictor for the engagement in preventive health care services. Research has shown that adult immigrants have lower levels of health literacy compared to the host populations, however little is known about the health literacy of pregnant, immigrant women. The aim of this study was to analyze whether ethnic minority women found it more difficult to actively engage with their health professionals than ethnic Danish women did. Using cross-sectional data we studied the difference in the Health Literacy Questionnaire (HLQ) domain on actively engagement with health care providers between non-Western born and ethnic Danish women (n = 406). Pregnant women were recruited in 2016 from the largest maternity ward in Denmark. The mean health literacy level of actively engagement for ethnic Danish women was 4.15 and for non-Western born women, it was 3.97. In an adjusted model the non-Western born women had 1.15 (CI:-0.30; -0.01) lower levels of actively engagement compared to ethnic Danish women. These results indicate that this domain of the HLQ seems to be a useful link in understanding ethnic inequality in birth outcomes and thus relevant in the effect evaluation of the MAMAACT study. Currently, the health care system in Denmark has not focused on intercultural competence. The lower levels of self-reported ability to engage with health care providers and the known perspectives of lower patient safety in immigrant groups calls for more research in the interactional dynamics. A theoretical analysis using the concept of cultural health capital could be interesting for assessing how health care providers and non-Western women might value certain attitudes and behaviors exchanged during the encounter differently, which could lead to imbalance as the health care provider has more influence in this setting.

Coming Out to Health Care Providers in Puerto Rico: Opportunities for Prevention and Engagement in Care

2016 ◽  
Vol 28 (4) ◽  
pp. 318-324 ◽  
Author(s):  
Sandra Miranda De León ◽  
Carola T. Sánchez Díaz ◽  
Naydi Pérez-Ríos ◽  
Yadira Rolón Colón ◽  
Ileska M. Valencia-Torres ◽  
...  
Keyword(s):  
Health Care ◽  
Puerto Rico ◽  
Health Care Providers ◽  
Coming Out ◽  
Engagement In Care ◽  
Care Providers

scholarly journals Scoping review on exploring barriers to family planning service utilization and uptake among women in Iraq

2021 ◽  
Author(s):  
Yousuf Alrawi
Keyword(s):  
Health Care ◽  
Family Planning ◽  
Health Care Providers ◽  
Scoping Review ◽  
Unwanted Pregnancy ◽  
Unmet Need ◽  
Eastern Mediterranean Region ◽  
Care Providers ◽  
Family Planning Services ◽  
Services Utilization

Background: Family planning helps to avoid unwanted pregnancy and reduce maternal mortality and morbidity. Contraceptive prevalence is still relatively low (58%) in Iraq compared with other countries in the Eastern Mediterranean Region, and the unmet need (12%) and total fertility (4.2 children per woman) rates are still high. Services are available free of charge or heavily subsidized in many public and private health facilities, yet many women may still not use them due to social, cultural, financial or health care services constraints. Aims: This scoping review explores barriers to family planning services utilization and uptake among women in Iraq. Methods: The review uses an adapted conceptual framework from quality of care and human rights-based frameworks to analyse published scientific studies. Results: At policy level, the government has supported family planning but not enough resources were allocated. At the service level, low family planning promotion from health care providers (especially during antenatal care visits) along with provider bias for certain types of contraception, have contributed to inaccurate information and misconceptions. At the community and individual level, women’s choice is still largely influenced by the husband’s position on contraception as men are still considered the key decision-makers in regard to fertility. Valuing a large family is still a barrier to family planning services utilization and uptake whereas religion was found to support the use of family planning. Conclusion: There is a need to provide promotional messages and encouraging mutual fertility decisions.

The Unmet Need for Discussions Between Health Care Providers and Adolescents and Young Adults

2020 ◽  
Vol 67 (2) ◽  
pp. 262-269 ◽  
Author(s):  
John S. Santelli ◽  
Stephanie A. Grilo ◽  
Jonathan D. Klein ◽  
Yutao Liu ◽  
Hanying Yan ◽  
...  
Keyword(s):  
Health Care ◽  
Young Adults ◽  
Health Care Providers ◽  
Unmet Need ◽  
Adolescents And Young Adults ◽  
Care Providers

scholarly journals Preventive Health Care and Payment Systems

2003 ◽  
Vol 3 (1) ◽  
Author(s):  
Pedro P Barros ◽  
Xavier Martinez-Giralt
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Integrated Management ◽  
Care Center ◽  
Preventive Health Care ◽  
Preventive Health ◽  
Primary Care Center ◽  
Care Providers ◽  
Referral Decisions ◽  
Payment Schemes

Abstract Prevention has been a main issue of recent policy orientations in health care. This renews the interest on how different organizational designs and the definition of payment schemes to providers may affect the incentives to provide preventive health care. We focus on the externality resulting from referral decisions from primary to acute care providers. This makes our analysis complementary to most works in the literature allowing to address in a more direct way the issue of preventive health care. The analysis is performed through a series of examples combining different payment schemes at the primary care center and hospital. When hospitals are reimbursed according to costs, prevention efforts are unlikely to occur. However, under a capitation payment for the primary care center and prospective budget for the hospital, prevention efforts increase when shifting from an independent to an integrated management. Also, from a normative standpoint, optimal payment schemes are simpler under joint management.

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