RESUMEN
OBJECTIVES: Sixty-three percent of Latinos/as/x in Alabama, speak English "not well" or "not at all." Effective provider-patient communication is the foundation of successful clinical interactions. Medical interpretation is important to the healthcare provision for patients with limited English proficiency (LEP). We examined Alabama providers' perceptions of working with medical interpreters to identify strategies to improve healthcare provision for LEP patients. METHODS: We conducted nine semistructured qualitative interviews with primary healthcare providers in western Alabama. We used NVivo to conduct thematic coding and content analysis. RESULTS: Of the nine providers, one self-identified as Latina and the others identified as White. Four participants worked in community clinics and five worked at university-based clinics. Four themes emerged: preference for in-person interpreters over technology-based interpretation; providers' perceptions and expectations of the roles of professional interpreters; challenges in the communication process; and use of family members or other ad hoc interpreters. CONCLUSIONS: To meet the needs of Latino/a/x communities, clinical settings should invest in adequate staffing of in-person interpreters, infrastructure and workflow improvements, and the hiring and training of polylingual providers. Capacity-building opportunities to establish team building between interpreters and providers could be useful tools in improving healthcare provision for LEP patients.
Asunto(s)
Actitud del Personal de Salud , Atención Primaria de Salud , Humanos , Atención Primaria de Salud/métodos , Femenino , Alabama , Masculino , Investigación Cualitativa , Hispánicos o Latinos/psicología , Hispánicos o Latinos/estadística & datos numéricos , Traducción , Barreras de Comunicación , Dominio Limitado del Inglés , Entrevistas como Asunto , Adulto , Personal de Salud/psicologíaRESUMEN
OBJECTIVES: Alabama's Latino/a/x population grew 278% from 2000 to 2018. Tuscaloosa County, located in the largely rural region of western Alabama, also experienced a significant influx of Latino/as/x during this time frame. Geographic healthcare access (GHA) to primary care and hospitals is crucial for immigrant Latino/as/x to care for their health, but few studies have characterized it. The goals of this article were to describe the availability (defined as number of provider locations) and accessibility (defined as travel impedance between potential patients and provider locations) of primary healthcare services and to discuss potential strategies to address these healthcare access challenges. METHODS: We drew data from the US Census Bureau, American Community Survey 5-year estimates, Blue Cross Blue Shield national doctor and hospital finder database, the Alabama Department of Public Health, and Tuscaloosa Transit Authority. We used geographic data, geographic information systems, and spatial analyses to characterize the availability and accessibility of primary care services and hospitals for Latinos/as/x in Tuscaloosa County using ESRI, ArcGIS 10.6.1. We showed the distribution of Latinos/as/x by census tract with choropleth mapping and mapped primary healthcare providers alongside public transit routes and hospital driving times to support our findings. RESULTS: This work demonstrated that Latinos/as/x in Tuscaloosa County were concentrated in more rural areas surrounding the county's city center, presenting significant barriers to GHA. These areas had fewer primary care providers and limited public transit. Many Latinos/as/x in this county had to travel ≥45 minutes to a hospital. CONCLUSIONS: Outreach and technology-based approaches, including home visit programs, mobile health units, and telemedicine, may be particularly important in bridging the GHA gaps for this and other largely rural populations the southeastern United States. Some of this potential was unlocked during the coronavirus disease 2019 crisis. These gains should be leveraged toward sustainable healthcare access initiatives for rural Latino/a/x populations.
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COVID-19 , Humanos , Alabama/epidemiología , Hispánicos o Latinos , Accesibilidad a los Servicios de Salud , Atención Primaria de SaludAsunto(s)
Emigrantes e Inmigrantes , Salud Reproductiva , Adolescente , Humanos , Femenino , Americanos Mexicanos , MéxicoRESUMEN
A review of the literature shows that racial and ethnic minority children (eg, African American, Asian, and Hispanic) received diagnoses for developmental concerns later in life compared with their age-matched white counterparts. Research has also documented disparities in access to and receipt of health care services among children with developmental concerns as compared with children with other disabilities. OBJECTIVES: We examined health care providers' (HCPs') responses to parents' developmental concerns about their children. We looked at the association with race, ethnicity, gender, rurality, and time to diagnosis. METHODS: All data were secondary and derived from the Centers for Disease Control and Prevention's Survey of Pathways to Diagnosis and Services. Participants consisted of 1321 parents of children who had received early intervention services as reported by respondents' data collected in 2011. RESULTS: From a nationally representative sample of families receiving early intervention services, 76% were white, 10% were African American, 3% were Asian, 5% were Native American, and 9% were Hispanic. Families who were Hispanic were more likely to have received only a delaying response from HCPs. The average time to a developmental delay diagnosis was 5 months longer for families who received a delaying HCP response. CONCLUSIONS: Families who were Hispanic or who were from rural areas were most likely to receive a delayed HCP response; for parents who received a delayed HCP response, a developmental delay diagnosis took 5 months longer than for families from the other groups listed.
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Población Negra/estadística & datos numéricos , Discapacidades del Desarrollo/terapia , Intervención Educativa Precoz/estadística & datos numéricos , Etnicidad/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Negro o Afroamericano , Actitud del Personal de Salud , Niño , Discapacidades del Desarrollo/diagnóstico , Discapacidades del Desarrollo/etnología , Hispánicos o Latinos , Humanos , Población Rural , Estados Unidos/epidemiología , Población BlancaRESUMEN
Young Latina women (YLW) in the US and in Alabama are disproportionately affected by sexual health disparities. Our community based participatory research (CBPR) study's purpose was to examine YLW's perceptions and experiences of sexual healthcare access (SHCA) toward developing community-driven, multilevel intervention strategies. We conducted 20 semi-structured qualitative interviews with YLW between 15 and 19 years old and who had been in the US for 5 or more years. We content-analyzed the data guided by the Socioecological Model of Sexual Health (SEMSH). We began analyses by coding independently, built consensus on the codes, then finished coding transcripts independently. Sixty-five percent of participants were US-born and 60% had health insurance. Participants identified barriers/facilitators to SHCA including discrimination in clinical settings and embarrassment/stigma about SHCA. Our study is the first in AL to use CBPR to work with YLW. Interventions should consider the multi-level and intersectional nature of SHCA challenges.
Asunto(s)
Disparidades en Atención de Salud/etnología , Hispánicos o Latinos/psicología , Servicios de Salud Reproductiva , Conducta Sexual/etnología , Adolescente , Alabama , Investigación Participativa Basada en la Comunidad , Anticoncepción/métodos , Características Culturales , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Entrevistas como Asunto , Investigación Cualitativa , Estigma Social , Factores Socioeconómicos , Estereotipo , Traducción , Salud de la Mujer , Adulto JovenRESUMEN
Young Latina women (YLW) in Alabama are disproportionately affected by sexual health disparities. However, to access needed reproductive services, YLW must navigate a healthcare landscape that restricts access for youth. YLW also face racialized immigration enforcement in their communities which is designed to attrition the region's emergent Latina/o/x immigrant population. This paper describes the intersectional, structural forces that contribute to experienced systemic violence for YLW as they try to access sexual healthcare services. In 2017, we conducted semi-structured qualitative interviews with 20 YLW and 24 key stakeholders (parents, providers, Latino/a/x community leaders etc.) in West Alabama to examine attitudes and perceptions about sexual health and healthcare access (HCA) among YLW in the region. We used purposeful convenience sampling and snowballing to recruit a community-based sample. That is, we purposefully recruited YLW, adjusting through the recruitment period for a diverse sample, who represented the various voices that we were trying to capture in the study (i.e., younger and older adolescents, adolescents born in the U.S. and those born in other countries etc.). Through a focus on YLW's access to sexual/reproductive healthcare, we conclude that YLW experience systemic violence and resulting precarity because laws and health policies restrict access to evidence-based sexual health education and reproductive healthcare services. We discuss implications for future research and policy recommendations.
RESUMEN
African Americans are disproportionately affected by diabetes and colorectal cancer. Although studies have shown the effectiveness of spiritually based health interventions delivered by community health workers to African Americans, few have described the development of the capacity-building component. This article describes this process. The development of the Healthy Congregations Healthy Communities Program (HCHC) was guided through a community-based participatory research lens and included: 1) establishment of a community coalition; 2) identification by coalition members of churches as the best venues for health promotion strategies among African Americans; 3) recruitment of churches; 4) development of a training manual; 5) recruitment and training of congregational health leaders (CHLs); and 6) "Passing of the torch" from the coalition to the CHLs who implemented the intervention in their congregations. We trained 35 CHLs to promote awareness about diabetes and colorectal cancer using a culturally relevant, spiritually based curriculum. Pre- and post-test paired t-tests showed significant increases in CHLs' knowledge of wellness (P<.001), colorectal cancer (P<.002), nutrition (P<.004), and lifestyle changes (P<.005). The community-academic partnership was successful in developing a culturally relevant, spiritually based capacity-building program for African American CHLs to implement health promotion strategies in their congregations and communities.
Asunto(s)
Negro o Afroamericano , Neoplasias Colorrectales/prevención & control , Diabetes Mellitus/prevención & control , Promoción de la Salud/organización & administración , Religión , Adulto , Anciano , Creación de Capacidad , Agentes Comunitarios de Salud , Investigación Participativa Basada en la Comunidad , Femenino , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud/métodos , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Desarrollo de Programa , Sudeste de Estados Unidos , EspiritualidadRESUMEN
PURPOSE: Among young men who have sex with men (YMSM), aged 13-24 years, Blacks/African Americans and Hispanics/Latinos are disproportionately affected by HIV, accounting for 58% and 21%, respectively, of diagnoses of HIV infection in the United States. In the District of Columbia (DC), YMSM of color are also disproportionately affected by HIV. National goals are that 80% of HIV-infected persons be retained in HIV care. We analyzed DC surveillance data to examine retention among YMSM living with HIV infection in DC. METHODS: We characterized correlates of retention in HIV care (≥2 clinical visits, ≥3 months apart, within 12 months of diagnosis) among YMSM in DC to inform and strengthen local HIV care efforts. We analyzed data from DC HIV surveillance system for YMSM aged 13-29 years diagnosed between 2005 and 2012 and alive in 2013. We also combined demographic and clinical variables with sociodemographic data from the U.S. American Community Survey (ACS) by census tracts. RESULTS: From 2005 to 2012, 1034 YMSM were diagnosed and living with HIV infection in DC; 83% were Black or Latino. Of the 1034 YMSM, 910 (88%) had census tract data available and were included in analyses (72% Black, 10% Latino, and 17% White); among the 854 (94%) linked to care, 376 (44%) were retained in care. In multivariate analyses, retention in care was less likely among 19-24 year YMSM compared with 13-18-year-old YMSM (adjusted prevalence ratios [aPR] = 0.89, 95% confidence intervals [CI] 0.80-0.99). CONCLUSION: Retention in HIV care was suboptimal for YMSM. Increased retention efforts are warranted to improve outcomes and reduce age and racial/ethnic disparities.
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Infecciones por VIH/etnología , Infecciones por VIH/terapia , Disparidades en Atención de Salud/etnología , Homosexualidad Masculina , Aceptación de la Atención de Salud/etnología , Minorías Sexuales y de Género , Adolescente , Adulto , Factores de Edad , District of Columbia , Geografía Médica , Humanos , Modelos Logísticos , Masculino , Análisis Multivariante , Vigilancia en Salud Pública , Adulto JovenRESUMEN
Latinas in the U.S. are disproportionately affected by breast and cervical cancer. This project sought to develop and evaluate a culturally relevant training for Community Health Advisors (CHA) to promote breast and cervical cancer screening among Latina immigrants in Alabama. The Empowerment Model guided training development and implementation supported by a formative evaluation and a Community Advisory Committee. The 16-hour CHA training included two intertwined components: knowledge and skills.Fifty-six (56) Latinas participated in the CHA training in six Alabama counties. The training increased the CHAs' (1) knowledge of cancer screening and other health topics and (2) their perceived confidence to communicate with women in their communities about cancer screening and to motivate them to attain cancer screenings. This work demonstrates the application of a transformative philosophical framework to promote capacity-building among CHAs toward the development and implementation of strategies to promote breast and cervical cancer screening among Latina immigrants.
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Neoplasias de la Mama/diagnóstico , Detección Precoz del Cáncer , Emigrantes e Inmigrantes , Hispánicos o Latinos , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Alabama , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Salud PúblicaRESUMEN
Adolescent Latinas in the United States (US) are disproportionately affected by early pregnancy, sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) in comparison to their non-Hispanic white counterparts. However, only a few studies have sought to understand the multi-level factors associated with sexual health in adolescent Latinas. Adhering to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we conducted a systematic literature review to better understand the correlates and predictors of sexual health among adolescent Latinas in the US, identify gaps in the research, and suggest future directions for empirical studies and intervention efforts. Eleven studies were identified: five examined onset of sexual intercourse, nine examined determinants of sexual health/risk behaviors (e.g., number of sexual partners and condom use), and three examined determinants of a biological sexual health outcome (i.e., STIs or pregnancy). Two types of variables/factors emerged as important influences on sexual health outcomes: proximal context-level variables (i.e., variables pertaining to the individual's family, sexual/romantic partner or peer group) and individual-level variables (i.e., characteristics of the individual). A majority of the studies reviewed (n=9) examined some aspect of acculturation or Latino/a cultural values in relation to sexual health. Results varied widely between studies suggesting that the relationship between individual and proximal contextual variables (including acculturation) and sexual health may be more complex than previously conceived. This review integrates the findings on correlates and predictors of sexual health among adolescent Latinas, and supports the need for strengths-based theoretically guided research on the mechanisms driving these associations.
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Aculturación , Conducta del Adolescente/etnología , Salud Reproductiva/etnología , Conducta Sexual/etnología , Adolescente , Femenino , Hispánicos o Latinos , Humanos , Embarazo , Embarazo no Planeado , Salud Reproductiva/tendencias , Asunción de Riesgos , Sexo Seguro , Enfermedades de Transmisión Sexual/etnología , Estados UnidosRESUMEN
BACKGROUND: Approximately 80% of new HIV infections among U.S. women are among black/African American and Hispanic women. HIV risk may be associated with intimate partner violence (IPV); data regarding IPV for women in high-HIV prevalence areas are scarce. PURPOSE: To examine prevalence and correlates of IPV among women. METHODS: Heterosexual women and their male partners in cities with high HIV prevalence were enrolled. During 2006-2007, participants completed interviews about HIV risk factors and IPV (physical violence or forced sex) experiences. Data were analyzed during 2012-2013 using multivariate logistic regression to identify individual- and partner-level IPV correlates. RESULTS: Of 1,011 female respondents, 985 (97.4%) provided risk factor and demographic data. Most were non-Hispanic black/African American (82.7%); living at or below poverty (86.7%); and tested HIV-negative (96.8%). IPV-physical violence was reported by 29.1%, and IPV-forced sex by 13.7%. Being married/living with a partner (AOR=1.60, 95% CI=1.06, 2.40); non-injection drug use (AOR=1.74, 95% CI=1.22, 2.48); and ever discussing male partners' number of current sex partners (AOR=1.60, 95% CI=1.15, 2.24) were associated with IPV-physical violence. Women reporting concurrent sex partners (AOR=1.80, 95% CI=1.04, 3.13) and ever discussing number of male partners' past sex partners (AOR=1.85, 95% CI=1.13, 3.05) were associated with IPV-forced sex. Feeling comfortable asking a male partner to use condoms was associated with decreased IPV-physical violence (AOR=0.32, 95% CI=0.16,0.64) and -forced sex (AOR=0.37, 95% CI=0.16, 0.85). CONCLUSIONS: Prevention interventions that enhance women's skills to decrease HIV and IPV risk are important strategies for decreasing racial/ethnic disparities among women.
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Infecciones por VIH , Promoción de la Salud , Sexo Seguro , Parejas Sexuales/psicología , Maltrato Conyugal , Violencia , Adulto , Población Negra , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/etiología , Infecciones por VIH/prevención & control , Promoción de la Salud/métodos , Promoción de la Salud/organización & administración , Hispánicos o Latinos , Humanos , Relaciones Interpersonales , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Prevalencia , Violación/prevención & control , Violación/psicología , Violación/estadística & datos numéricos , Factores de Riesgo , Sexo Seguro/etnología , Sexo Seguro/psicología , Factores Socioeconómicos , Maltrato Conyugal/etnología , Maltrato Conyugal/psicología , Estados Unidos/epidemiología , Violencia/etnología , Violencia/prevención & control , Violencia/psicologíaRESUMEN
The purpose of this paper was to describe romantic relationships from the perspective of urban, adolescent girls, to address gaps in our understanding of their relationship dimensions. Minority adolescent girls (n = 17) participated in private semi-structured interviews aimed to elicit the understanding of the adolescents' perspectives on their own relationship experiences and dynamics. The research team conducted conventional content analysis of the interview transcripts. Four major themes emerged about romantic relationships: (1) influence of male pursuit and social norms on relationship initiation factors; (2) a romantic partner is a confidant, friend, and companion; (3) negotiating intimacy respectfully; and (4) relationship conflict through control and abuse. Adolescents described sub-themes of social norms of male pursuit and relationship pressures that dictated relationship initiation. Relationships were depicted by emotional support, caring, and companionship. Adolescents described positive negotiation skills. However, relationship conflict, including controlling behaviors and violence, was illustrated in these same relationships. This study provides a rich description of romantic relationships from the perspectives of urban, adolescent girls. Most salient findings included social pressures and a combination of both positive and negative attributes. Implications include the need for intervention development at the community level to address social pressures, recognition of positive adolescent relationship attributes, and facilitation of skills to identify and address low-quality relationship characteristics.
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Amor , Grupos Minoritarios/psicología , Conducta Sexual/psicología , Población Urbana , Adolescente , Femenino , Identidad de Género , Conocimientos, Actitudes y Práctica en Salud , Humanos , Entrevista Psicológica , Violencia de Pareja/prevención & control , Violencia de Pareja/psicología , Negociación/psicología , New YorkRESUMEN
Hispanics/Latinos are disproportionately affected by HIV infection, but access HIV care less often than non-Hispanic whites in the USA. The majority of new HIV diagnoses among Hispanics/Latinos occur in the southern USA; however, data are lacking regarding factors associated with HIV care access for Hispanics/Latinos in the South. We conducted a qualitative review of peer-reviewed articles using the HIV continuum of care framework to assess HIV care for Hispanics/Latinos in the US South. We identified 13 studies conducted in southern states that were informed by the continuum of care: testing and diagnosis of HIV infection (n = 9); linkage and retention in care (n = 2); and prescription of and adherence to ART (n = 2). Barriers to health care access included stigma, lack of Spanish-speaking health-care providers, and fear of deportation. Facilitators to health care access included provider endorsement of HIV tests and regular health care. Innovative solutions (e.g., patient navigators), tailored strategies (e.g., community outreach) and organizational-level interventions (e.g., increasing provider endorsement of HIV tests) can improve access for Hispanics/Latinos in the South.
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Continuidad de la Atención al Paciente/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Hispánicos o Latinos/estadística & datos numéricos , Cumplimiento de la Medicación/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Infecciones por VIH/etnología , Infecciones por VIH/prevención & control , Seropositividad para VIH/tratamiento farmacológico , Accesibilidad a los Servicios de Salud , Humanos , Sudeste de Estados Unidos/epidemiología , Sudoeste de Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricosRESUMEN
This study examined the association between sexual relationship power, intimate partner violence, and condom use among African American and Hispanic urban girls. In this sample of 56 sexually active girls, 50% did not use condoms consistently and therefore were at higher risk for acquiring HIV or sexually transmitted diseases (STDs). Teens who experienced more intimate partner violence had a significantly higher likelihood of inconsistent condom use and therefore a greater risk for HIV/STDs. Girls' sense of sexual control in their relationships was not directly associated with inconsistent condom use but was inversely related to verbal and emotional abuse. Interventions aimed at reducing HIV/STD risk for adolescent girls need to address patterns of dominance and control in adolescent relationships as well as multiple forms of partner violence. This suggests the need for multilevel intervention approaches that promote girls' agency and multiple ways to keep girls safe from perpetrators of partner abuse.