1. Involving Communities in Multicultural Network: From Screening to Access to Care
Watson, M.R. (1); Izquierdo, A.M. (2); Markey, M. (1); Kaltman, S. (3); and Community Collaborators (4).
Primary Care Coalition of Montgomery County, Maryland (2) Spanish Catholic Center, Washington, DC
(3) Georgetown University Center for Trauma and the Community (4) See list below.
RESULTS
ABSTRACT
METHODS
COMMUNITY-SUGGESTED STRATEGIES FOR INCREASING ACCESS TO CARE:
Sp. Aim 3
Development of
targeted intervention
Sp. Aim 1
Gathering and documenting
local resources for access to care
Sp. Aim 2
Validation of Data & Needs
Sp. Aim 4
Implementation of our
community-driven intervention
Sp. Aim 5
Evaluation and Refinement of
CBPR process and intervention.
Sp. Aim 6
Dissemination of
Findings
Adaptation of PRECEED-PROCEDE model
Community
Collaboration
This community-based participatory research (CBPR) project aims to reduce disparities in access to health care among uninsured African-American, Asian-American, and Latino communities in Montgomery County, Maryland. Through the participatory research process, the project seeks to garner suggestions on culturally-appropriate approaches to improve outreach and access to care specifically in the area of cardiovascular risk factors. Methods: We are conducting a delayed CBPR (intervention) control study design to measure the differences in access to care in three groups (African American, Asian American, and Latinos). Specifically, we first measured actual return for medical care following a screening session without carrying out any community outreach efforts; we then implement the community participatory approach and then, a year later, we again screen and monitor return for medical care to determine whether community-based efforts made a difference in attendance of follow-up appointments. Convenience samples of Latinos (n=116), Asian-Americans (n=57), and African-Americans (n=104) were recruited for cardiovascular risk screenings in their communities, and we measured body mass index, waist-hip ratio, blood pressure, and blood glucose. Project staff then scheduled follow-up appointments for at-risk patients at Montgomery County clinics for the uninsured and tracked patient attendance. Focus groups are being conducted in the various communities to assess and document major barriers to health care access and determine appropriate interventions as suggested by the participating communities. Ultimately, findings will be used to develop an innovative, community-based model for improving access to health care within an established safety net system of care [NIH: 1 R21-HL ]
% ATTENDING FOLLOW-UP APPOINTMENTS AFTER HEALTH FAIR (Year 1):
REASONS FOR NON-ATTENDANCE:
Other priorities or concerns
Could not get out of work
Cost of care
No one to transport patient (esp. elderly)
FOCUS GROUP FINDINGS ON MAJOR BARRIERS TO HEALTH CARE ACCESS: 3 COMMUNITIES
System-related barriers (e.g. poor customer service, unwieldy eligibility requirements, cost of care, long wait times, inconsistent quality of care)
Immigration-related concerns (e.g. fear of approaching a public location or providing identifying information)
Lack of information (lack of info on available services, lack of knowledge about preventive health care
Language barriers (No bilingual staff or interpreters available, providers use unfamiliar terminology, documents in English difficult to understand)
Increase opportunities for preventive health promotion and preventive focus
Improve services available, especially for uninsured adults
Increase staff/provider sensitivity and professionalism
Train laypeople in health advocacy and self-advocacy in order to help people to navigate the system
Increase community outreach on services available to the uninsured, especially through media outlets and by “going where the people are”
Increase documentation of needs
Share findings with local officials
Provide interpretation services
Provide relevant documents and information in the appropriate language(s)
Focus outreach and screening on uninsured service sector workers
Number screened
Number referred
Number attending appt
% attending
Latino
112 46 24
52.17%
African-American
104 11 6
54.55%
Chinese 57 7
100.00%
Cambodian 32
At Health Fair:
Greatest barrier
Barrier #2
Barrier #3
Others
Latino
System-related barriers
Immigration-related concerns
Lack of information
Language
African-American
Language (provider/
patient communication)
Distrust of medical system
Asian-American
Language/
communication
Long wait for appointment
No one to accompany older family members
SIGNIFICANT LEARNINGS THUS FAR
Informed consent & registration
Cardiovascular screening
In our community, we found that health fairs were an effective mechanism for facilitating access to care for uninsured persons. However, community members pointed out the need for health fairs to have the following attributes:
Implementation of an educational component, not just flyers and freebees;
Tendering free medical screenings (not just information);
Offering follow-up appointments at local safety-net clinics;
Providing hours and locations (of the fair) that accommodate schedules of service sector workers;
Supplying detailed information about public transportation access and/or providing shuttles to and from health fair site;
Targeting outreach and publicity prior to the fair to the desired community.
Community advocates, navigators, and/or health promoters who follow patients through the process can provide important support in assisting patients to prepare for their appointments (so that they do not get lost in the follow-up process) – in terms of how to get there, what documents they need to bring, potential fees, and what to expect at the visit.
If health services provision depends on a set of “eligibility requirements,” these requirements should consider the barriers for community members to be able to comply with supplying required documentation.
Community Collaborators:
The African American Health Program of Montgomery Co.
The Asian American Health Initiative of Montgomery Co.
Capital Technology Information Services, Inc.
CASA de Maryland
CBPR Advisory Panel
The Chinese Cultural and Community Center (CCACC)
The Latino Health Initiative of Montgomery Co.
Glorifying Our Spiritual & Physical Existence for Life (G.O.S.P.E.L.) Program,
Georgetown University Center for Trauma and the Community
George Washington University
Montgomery Cares clinics for the uninsured:
Community Clinics Incorporated (CCI)
Community Ministries of Rockville
Mercy Health Clinic
Mobile Med
Proyecto Salud
Spanish Catholic Center
Peoples Community Wellness Center (PCWC)
Pan Asian Health Care (PAHC)
Holy Cross Health Center
The National Kidney Foundation of the National Capital Area
Primary Care Coalition volunteers and interns
Suburban Hospital
Follow-up appointment for at-risk patients
Baseline data collection
Data collected:
Clinical data – cardiovascular screening/ risk factors, i.e., body mass index, waist-hip ratio, blood pressure, and blood glucose.
Demographic info – gender, age, marital status, occupation, insurance status, length of time in U.S., country of origin
Acculturation scale – measures acculturation by language used
Social support scale – instrumental, emotional, community-level
Computer literacy index – measures computer ability and access
Post health fair:
Follow-up phone call to find out experience at scheduled appointment, and if patient did not attend, reasons why
Focus groups with health promoters and community members to determine major barriers to health care access and potential strategies for improving access to health care.
Learn more about the Primary Care Coalition at: