Barriers to health promotion and disease prevention in the Latino population

doi:10.1016/S1098-3597(04)80061-9

Clinical Cornerstone

Volume 6, Issue 3, 2004, Pages 16-29

https://doi.org/10.1016/S1098-3597(04)80061-9 Get rights and content

The Latino population of the United States is expected to increase substantially in the next 25 years. Although recent health promotion and disease prevention interventions have improved the health of the majority of Americans, the Latino community has derived less benefit from these advances. This is due to a number of interrelated factors, including a disproportionate representation of Latino Americans in the low socioeconomic strata and in the uninsured population. Even when insured, Latino Americans face significant barriers to health promotion and disease prevention. This policy analysis identifies barriers at the organizational and structural level of health care delivery, as well as at the level of the medical encounter. It provides a practical framework for intervention that is founded on the recruitment of Latino Americans into the health care workforce and leadership, the restructuring of health systems to be more responsive to the needs of diverse populations, and health care provider education on how to improve cross-cultural understanding and communication. By investing in a multifaceted approach that addresses barriers to health promotion and disease prevention in the Latino population, we can improve the quality of care delivered to this population and help eliminate racial and ethnic disparities in health care.

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One unique aspect of our study was that a majority of our patients were Latino (71.9%) and Spanish-speaking (61.7%), groups underrepresented in prior TDRS studies and glaucoma adherence studies despite growing rapidly in the United States over the past decade.29 Because of these changing demographics, the number of persons with POAG by 2050 will be highest among Latinos, a concerning forecast given that Latinos are believed to use health services less frequently because of language barriers, lower socioeconomic backgrounds, and the highest uninsured rate in the United States.30–32 Specifically, Lee et al33 found that the most common self-reported barrier to attending in-person ophthalmic appointments for Latino patients was language difficulties.
To evaluate rates and risk factors associated with follow-up adherence to in-person glaucoma evaluations and confirmed glaucoma diagnosis in glaucoma suspects identified through teleretinal diabetic retinopathy screening (TDRS).
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Retrospective chart review was performed to obtain demographic and clinical information for patients with cup-to-disc ratios concerning for glaucoma on TDRS. Patients who completed an in-person follow-up appointment within 1 year of teleretinal screening were adherent. Factors associated with follow-up adherence and diagnosis of glaucoma were analyzed with chi-square and independent t tests along with multivariable logistic regressions.
The proportion of patients with suspected glaucoma who adhered with in-person follow-up examination, proportion of patients with confirmed glaucoma diagnosis, and factors associated with follow-up adherence and glaucoma diagnosis.
Eight-hundred seventeen patients with optic discs suspicious for glaucoma were included. Five-hundred thirty-four (65.4%) patients successfully completed an in-person glaucoma evaluation. Among these patients, 62.9% and 24.5% received a diagnosis of glaucoma suspect and glaucomatous optic neuropathy, respectively. Compared with patients aged < 50 years, patients aged 50 to 64 years had 1.57 times higher odds of being adherent with in-person visits (P = 0.036), whereas no difference was seen in those aged ≥ 65 years. For every $10 000 increase in the zip code median income, patients had 11% lower odds of being adherent (P = 0.031). Compared with Latino patients, Black patients had 3.52 times (P < 0.001) higher odds of having confirmed glaucoma.
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Three hundred thirty-eight participants completed the questionnaire, 68% of participants completed the questionnaire in Spanish, and 51% of all participants had low OHK. Participants were less likely to correctly answer questions pertaining to children’s oral health, periodontal disease, and oral cancer. Low OHK was associated with having less than 12th grade education, lack of dental insurance, and preference for a Spanish-speaking oral health care provider.
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In addition, one of the regular providers was a certified Spanish interpreter. Our study does not elucidate if the patients failed to keep their appointment because they feared they would not be understood and hence receive inadequate care or alternatively if language is a surrogate marker for other barriers and attitudes that prevented the patient from arriving at our clinic.2,3,7,36,44 Other reasons for no-shows to appointments identified in studies besides communication problems are the medical reason for the appointment (and the urgency or severity associated with it), lack of a personal physician, issues concerning transportation, emotions, perceived disrespect from the health care system, fear of the physician encounter, and patient forgetfulness.4,12,14,19-21,30,37,38,46
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Barriers to health promotion and disease prevention in the Latino population

J Gen Intern Med

Prev Med

J Natl Cancer Inst Monogr

Ethnicity Dis

Population of the United States by age, sex, race, and Hispanic origin: 1995 to 2050

Racial and Ethnic Disparities in Health: Response to the President's Initiative on Race

Eliminating Racial and Ethnic Disparities in Health

The impact of ethnicity, family income, and parental education on children's health and use of health services

Am J Public Health

Barriers to health care access for Latino children: A review

Fam Med

Latino access to health care: The role of insurance, managed care, and institutional barriers

National Hispanic/Latino Health Initiative

Public Health Rep

Delay in seeking care for cancer symptoms: A population-based study of elderly New Mexicans

J Natl Cancer Inst

Ethnicity, survival, and delay in seeking treatment for symptoms of breast cancer

Cancer

Gender and ethnic differences in hospital-based procedure utilization in California

Arch Intern Med

Racial and ethnic differences in the use of invasive cardiac procedures among cardiac patients in Los Angeles County, 1986 through 1988

Am J Public Health

Resident population of the US: Estimates by sex, race, and Hispanic origins, with median age

Increasing minority representation in health care management

Health Forum J.

The rationale for minority-targeted programs in medicine in the 1990s

JAMA

The rationale for minority-targeted programs in medicine in the 1990s

JAMA

Detailed Occupation and Other Characteristics from the EEO File for the United States, 1990 (Census of Population Supplementary Reports)

Population Division National population estimates-characteristics

Patient-physician racial concordance and the perceived quality and use of health care

Arch Intern Med

Physicians' race and care of minority and medically indigent patients

JAMA

The role of black and Hispanic physicians in providing health care for underserved populations

N Engl J Med

Are Latinos less satisfied with communication by health care providers?

J Gen Intern Med

Minority Students in Medical Education

The Right Thing to Do, The Smart Thing to Do. Enhancing Diversity in the Health Professions

Site of medical care. Do racial and ethnic differences persist?

Yale J Health Policy, Law, Ethics

Working Without Benefits: The Health Insurance Crisis Confronting Hispanic-Americans

HEDIS (Health Plan Employer Data and Information Set)