Academic journal article Journal of Health and Human Services Administration

Wait, Won't! Want: Barriers to Health Care as Perceived by Medically and Socially Disenfranchised Communities

Academic journal article Journal of Health and Human Services Administration

Wait, Won't! Want: Barriers to Health Care as Perceived by Medically and Socially Disenfranchised Communities

Article excerpt

This research was supported by a grant from the National Institute on Minority Health and Health Disparities (RC2 MD004760).


Objectives. We explored barriers to healthcare as perceived by members of medically and socially disenfranchised communities.

Methods. We conducted focus groups with 28 women and 32 men from Northeast Ohio who identified themselves as African-American, Hispanic/Latino, lesbian/gay/bisexual/transgendered, and/or Russian immigrant.

Results. Participants described their experiences of waiting, things they won't tolerate, when they won't participate, and what they want from providers. They described behaviors, actions and relationship characteristics that they want from their providers and characteristics that they prefer in health systems.

Conclusions. The themes of Wait, Won't, and Want have healthcare practice and policy implications. Patient-provider interactions are known to be significant determinants of healthcare outcomes and these exploratory findings suggest that they might also affect patient self-management strategies. Future efforts should focus on developing and testing patient-centered strategies that address the themes identified to increase engagement to increase self-management of health.

Keywords: African Americans, gays and lesbians, health care disparities, immigrants/migrants, Latino/Hispanic people

While it has been recognized that there are patient-level and system-level factors that contribute to healthcare disparities, much of the effort to date to reduce health disparities has focused on the composition of the healthcare workforce (Custodio, Gard & Graham, 2009; Heron, Lovell, Wang & Bowman, 2009; Norris, et. al., 2009; Smith, Nsiah-Kumi, Jones & Pamies, 2009a, 2009b), the cultural competence of providers (Betancourt & Cervantes, 2009; Lo, 2010; Star & Wallace, 2009; Sullivan, 2009; Telfair, Bronheim & Harrison, 2009), the role of community participation (Bogart & Uydea, 2009; Strauss, Stein, Edwards & Nies, 2009), changing access to care (Witt, et. al., 2009; Yanagihara, Chang & Ernst, 2009) and mobilization in promoting health (Cohen, et. al., 2010; Corbie-Smith, Goldmon & Isler, 2010). However, healthcare workforce and system changes can only go so far. Health outcomes can be optimized only when individuals take a more active role and contribute to their own healthcare (Beasley, et. al., 2004). Individuals who recognize that they are partners in their healthcare understand that self-management assures their health is appropriately managed (Gallagher, 2010; Audulv, Asplund & Norbergh, 2010). Activated, engaged patients have been shown to contribute to better health outcomes and better care experiences (Hibbard & Greene, 2013). It is optimal when healthcare is delivered in a provider-patient partnership (Jonsdottir &Ingadottir, 2011) where both parties make contributions to the treatment plan tailored to the individual (Griffiths, et. al, 2010). A chronic health condition, in particular, creates the need for patients to make changes in lifestyle, such as diet, exercise, medication management and monitoring clinical and metabolic parameters. Because chronic conditions are largely self-managed where individuals and their informal support system provide most of the needed care--daily decisions and adopted behaviors have strong influences on health outcomes (Funnell, 2009). While the responsibility for outcomes, such as metabolic control and complications, are shared with the health care team, individuals create a workable daily solution to manage their own health (Blair, et. al., 2009; Brownson, Hoerger, Fisher & Kilpatrick, 2009; Cameron, Worrall-Carter, Riegel, Lo & Stewart, 2009; Cobden, Niessen, Barr, Rutten & Redekop, 2010; Corser & Xu, 2009; Dashiff, Vance, Abdullatif & Wallander, 2009; Gazmararian, Ziemer & Barnes, 2009; Gomersall, Madill & Summers, 2011; Lee, et. …

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