Objectives We examined differences in, and factors associated with, access to health services among Mexican im/migrants to the U.S. across migration phases, including pre-departure, destination, interception, and return. Methods Using data from a cross-sectional survey conducted in Tijuana, Mexico (N=1,541), we computed descriptive statistics and staged logistic regressions to estimate health care access indicators and factors associated with access to services. Results Im/migrants at post-migration phases had lower likelihood of receiving health care and having a usual source of care, and higher rates of forgone care, than their counterparts at pre-departure. These differences were partly explained by length of migration phase, health insurance status, transportation barriers, and detention or imprisonment. Conclusions Mexican im/migrants face challenges in accessing health services across the migration continuum, especially at post-migration phases. Binational efforts to provide affordable insurance coverage and reduce transportation limitations and incarceration could contribute to improving health care access among Mexican im/migrants.
Our objective was to describe when Hmong- and Spanish-speaking limited English proficient (LEP) patients perceive an interpreter was needed and how they perceive the decision to utilize an interpreter is made in a health care encounter. We interviewed a total of 20 LEP patients. We used a number of strategies to recruit LEP patients including posting language-appropriate flyers at clinics, sending letters to LEP patients and asking our participants to refer their family and friends to participate in our study. Tape-recorded interviews were transcribed, translated, and systematically coded using directed content analysis. Patients identified two factors that influenced LEP Hmong-and Spanish-speaking patients' perception of when interpreters were needed are as follows: (1) their self-identified level of English proficiency and (2) the anticipated complexity of the health care communication. They described three factors that they perceived influenced the decision to utilize interpreters: (1) their self-identified level of English proficiency, (2) access to interpreters; and (3) health system automation of interpreter use. The findings show that patients consider a wide variety of factors when determining if an interpreter is necessary and how the decision to utilize interpreters is made. Given that health care decision making is complex, healthcare systems need to do more to help educate LEP patients of the importance of utilizing interpreters in all healthcare encounters. Additionally, future research should to explore how patients conceptualize the need for and utilization of interpreters in order to provide LEP patients with linguistically appropriate care in ways that are sensitive to their perceptions and needs.
Objective Mobile populations are at high risk for communicable diseases and can serve as a bridge between sending and receiving communities. The objective of this study is to determine the rates of, and factors associated with, seasonal influenza vaccination among Mexican migrants traveling through the US-Mexico border. Methods We used a 2013 cross-sectional population-based survey of adult mobile Mexican migrants traveling through the Mexico-U.S. border region (N = 2,313; weighted N = 652,500). We performed a multivariable logistic regression analysis to model the odds of receiving an influenza vaccination in the past year by sociodemographics, migration history, health status, and access to health care. Results The seasonal influenza vaccination rate in this population was 18.6%. Gender, health status, and health insurance were associated with the likelihood to receive an influenza vaccination. Conclusion Overall, the rates of seasonal influenza vaccination in circular Mexican migrants are low compared to adults in Mexico and the U.S. Efforts are needed to increase influenza vaccination among this highly mobile population, particularly in adults with chronic conditions.
Objective The objective of this population-based study was to determine if and to what extent there are differences in asthma self-efficacy by race/ethnicity and income, and whether health status, levels of acculturation, and health care factors may explain these differences. Methods We conducted a secondary data analysis of asthma self-efficacy using the 2009 and 2011-2012 California Health Interview Survey, in adults with asthma (n = 7874). In order to examine if and how the effect of race /ethnicity and income on asthma self-efficacy may have been altered by health status, acculturation, and health care factors, we used staged multivariable logistic regression models. We conducted mediation analyses to evaluate which of these factors might mediate disparities in self-efficacy by race/ethnicity and income. Results 69.8% of adults reported having high asthma self-efficacy. Latinos (OR 0.66; 95% CI 0.51–0.86), African-Americans (OR 0.50; 95% CI 0.29–0.83), American Indian/Alaskan Natives (OR 0.55; 95% CI 0.31–0.98), and Asian/Pacific Islanders (OR 0.34; 95% CI 0.23–0.52) were less likely to report high self-efficacy compared to Whites. Individuals with income below the federal poverty level (OR 0.56; 95% CI 0.40-0.78) were less likely to report high self-efficacy compared to higher income individuals. The relationship between income and self-efficacy was no longer significant after further adjustment for health care factors; however, the differences in race and ethnicity persisted. Receiving an asthma management plan mediated the relationship in certain subgroups. Conclusions Addressing modifiable health care factors may play an important role in reducing disparities in asthma self-efficacy.
The purpose of this project was to identify the self-care needs of adults with diabetes who experience food insecurity. A cross-sectional study design and methodology were used to attain the study data.We invited 153 adults with diabetes who utilized the St Vincent de Paul Food Pantry to complete the diabetes knowledge test. The reliability of the sample was calculated using Cronbach's coefficient α. To determine validity, differences in test scores were examined by diabetes type and treatment, educational attainment, and receipt of diabetes education.Results-The coefficient α for the general test and the insulin-use subscale indicated that both were moderately reliable, α > 0.60. General test scores were significantly associated with educational attainment (p<0.01) and prior diabetes education (p<0.05). We found that participants who attained education beyond high school or previously received diabetes education scored significantly higher on the test compared to those with less than high school education or not receiving diabetes education (p<0.05). Adults with type 1 diabetes had higher general and insulin use scores compared to adults with type 2 diabetes, however the difference was not statistically significant.While general knowledge about diabetes is not a predictor of self-care behavior, it is needed to perform daily self-care activities. Health care providers should assess diabetes knowledge in low income patients who experience food insecurity regularly to identify any gaps in knowledge that can compromise self-care behaviors.
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