This cross sectional study assessed the physical and mental health, health literacy and social support of the uninsured utilizing a free clinic to develop intervention programs and research projects to improve the health of free clinic patients. Free clinics are nonprofit organizations that provide underserved and uninsured individuals access to a broad array of free or low cost healthcare services. English or Spanish speaking patients (N = 187) aged 18 years or older completed a self-administered survey. Physical, mental and oral health, health literacy, and social support were measured using standardized instruments. Eighty-two participants (45 US born and 37 non-US born) chose the English version of the survey (English speakers) while 105 participants (2 US born and 103 non-US born) chose the Spanish version (Spanish speakers). Overall, both the physical and mental health functioning of the participants was lower than that of the US general population. The participants reported being moderately depressed. US-born English speakers reported the poorest physical and mental health while Spanish speakers reported the best physical health and the lowest level of depression. A higher level of health literacy was associated with better physical health functioning, whereas reporting higher social support was associated with better mental health functioning and less severe depression. Because most free clinics have limited resources, developing services and programs that fit free clinics' circumstances are needed. Our study finding indicates that health literacy education, mental health services, and social support are key services needed by free clinic patients to achieve better health.
Free clinics provide free or reduced fee health services to the un- or under-insured. Patient engagement is important to understand patients' needs and to improve healthcare systems. There are few studies that examined patient engagement and satisfaction among the underserved and how patients perceive the quality of healthcare services in a free clinic setting. This study examined free clinic patients' satisfaction in order to better understand how free clinic patients perceive quality of healthcare services. English or Spanish speaking patients (N = 351), aged 18 years or older completed a self-administered survey using standardized measures of patient satisfaction and health status. Additional questions of patient satisfaction and experience with healthcare which fit a free clinic setting were developed. While the satisfaction with interpreter services was overall high, there were potential issues of a family member as an interpreter and unmet needs for interpreter services. Participants reported different levels of patient satisfaction by three language categories: native English speakers, non-native English speakers, and Spanish speakers. Health status is an important indicator to determine patient satisfaction. To improve patient satisfaction and engagement among free clinic patients, factors such as: quality of a family interpreter, unmet needs for interpreter services, social support, and health education programs may need to be considered. The differences in these three language groups indicate that not all free clinic patients may be combined together into a general category of free clinic patients. It may be necessary to provide customized treatment for each of these groups.
Food insecurity is a significant public health issue that affects the physical and mental health of people of all ages. Higher levels of self-efficacy may reduce levels of food insecurity. In addition, acculturation is potentially an important factor for food insecurity among immigrant populations. The purpose of this study is to examine food insecurity associated with self-efficacy and acculturation among low-income primary care patients in the United States. A self-administered survey was administered in May and June 2015 to uninsured primary care patients (N = 551) utilizing a free clinic that provides free primary care services to low-income uninsured individuals and families in the United States. On average, participants reported low food security. Higher levels of self-efficacy were associated with lower levels of food insecurity. Higher levels of heritage language proficiency were related to lower levels of food insecurity. US-born English speakers, women, and unmarried individuals potentially have higher risks of food insecurity and may need interventions to meet their specific needs. Self-efficacy should be included in nutrition education programs to reduce the levels of food insecurity. Future studies should further examine why these groups have a high risk to better understand needs for interventions.
Intimate partner violence is associated with poor health outcomes, especially for U.S.-born participants. Further research is warranted to understand causal mechanisms and to aid patients.
Free clinics provide free or reduced fee healthcare to individuals who lack access to primary care and are socioeconomically disadvantaged. There has been a paucity of free clinic research with the few studies employing a quantitative design. The purpose of this study is to conduct an in-depth qualitative exploration of free clinic patients' experience and perceptions of healthcare services, community resources, and the Patient Protection and Affordable Care Act (ACA). Free clinic adult patients (n=35) participated in four focus groups between June and July 2014 (one Spanish group in June, and two English groups and one Spanish group in July) in a classroom of a free clinic. More than 80% of the participants were non-US born from Mexico, Central/South America, South or East Asia, Pacific Islands, or Western Europe. While participants reported being satisfied overall with free clinic services, they indicated that they desire more specialty services and health education programs. Furthermore, they reported being frustrated by long waiting times-both in the waiting room and when making an appointment, phone communication, and interpreter services. It is necessary to find effective ways to provide information about health education opportunities and the ACA to free clinic patients because participants appeared not to have received sufficient information about available resources. Health education programs for free clinic patients should not only focus on increasing knowledge but also changing behaviors.
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