Use of preventive health services (physical, dental, and eye examinations, Pap smear and breast examinations) among Mexican American, Cuban American, and Puerto Rican adults (ages 20-74) was investigated with data from the HHANES. Analyses focused on the relative importance of two predictors of recency of screening: access to services (health insurance coverage, having a routine place for care, type of facility used, having a regular provider, travel time) and acculturation (spoken and written language, ethnic identification). Regression analyses controlling for age, education, and income indicated that utilization of the preventive services was predicted more strongly by access to care than by acculturation. For each Hispanic group, having a routine place for health care, health insurance coverage, and a regular provider were each significantly associated with greater recency of screening. Type of facility used and travel time produced less consistent effects. These results replicate past studies that ha...

https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.80.Suppl.11

Acculturation, access to care, and use of preventive services by Hispanics: findings from HHANES 1982-84.

OBJECTIVE: To examine associations of patient ratings of communication by health care providers with patient language (English vs Spanish) and ethnicity (Latino vs white).

/pdf/are-latinos-less-satisfied-with-communication-by-health-care-4oe9zk34xb.pdf

Are Latinos Less Satisfied with Communication by Health Care Providers

This paper presents a theoretical framework for understanding the impact of culture on the processes of symptom recognition, labeling, and help-seeking and consequently on large-scale epidemiological studies involving different ethnic groups. We begin with the assumption that the subjective experience of illness is culture- bound and that the cognitive and linguistic categories of illness characteristic of any culture constrain the interpretative and behavioral options available to individuals in response to symptoms. We hypothesize the existence of learned cognitive structures, through which bodily experiences are filtered, that influence the interpretation of deviations from culturally-defined physical and mental health norms. Certain contradictory findings concerning the self-reported health of Mexican Americans are discussed in order to illustrate the impact of culture on perceived health status.

The impact of culture on the cognitive structure of illness

• Utilization of general medical and mental health services by respondents in the Los Angeles Epidemiologic Catchment Area (ECA) site was compared with that in three ECA sites studied previously (New Haven, Conn, Baltimore, and St Louis). Within the Los Angeles sample, Mexican-American patterns of utilization were compared with those for non-Hispanic whites. Los Angeles respondents were less likely than those at other ECA sites to make ambulatory health care visits and to be hospitalized for physical or mental health reasons. Mexican Americans were less likely than non-Hispanic whites to report ambulatory health care but were as likely to have been hospitalized. Six percent of Los Angeles respondents reported a recent mental-health-care visit as compared with 6% to 7% of respondents at the other ECA sites. However, among respondents with Diagnostic Interview Schedule DSM-III disorders diagnosed within the six months prior to the interview, a lower proportion made a mental health visit in Los Angeles (14%) compared with the other sites (16% to 20%). Of those who made a mental-health-care visit, Los Angeles respondents with a recently diagnosed disorder were more likely than comparable respondents at the other ECA sites to visit a mental health specialist rather than a general medical care provider. Mexican Americans with a recently diagnosed mental disorder were only half as likely as non-Hispanic whites (11% vs 22%, respectively) to have made a mental health visit. However, when Mexican Americans with Diagnostic Interview Schedule/ DSM-III did make a mental health visit, they were as likely as non-Hispanic whites to see a mental health specialist.

Utilization of Health and Mental Health Services by Los Angeles Mexican Americans and Non-Hispanic Whites

Research has shown that Latinos average fewer physician visits per year than other ethnic groups.1,2 Many factors may contribute to Latinos' lower use of physician services, including lower rates of health insurance coverage,3 lower levels of income and education,3,4 and limited English proficiency.5–7 One study found that Latinos with limited English proficiency reported fewer visits than native English-speaking patients,8 while an analysis of the 1987 National Medical Expenditure Survey found that insurance was the predominant determinant of the number of physician visits and inability to speak English was not a significant predictor of physician visits.9

Patients with limited English proficiency may also utilize health care less because of dissatisfaction with the health care they have received in the past. Baker et al. found that Latino patients who communicated through an interpreter or who did not have an interpreter when they thought one was necessary were less satisfied with the patient-provider relationship.10 Similarly, Carrasquillo et al. reported that emergency department patients who said that English was not their first language were less satisfied overall and reported more communication problems.11 There may also be differences in how physicians care for Latino patients, and this may affect their satisfaction and future health care use. Todd et al. reported that Hispanics with isolated long-bone fractures were twice as likely as non-Hispanic whites to receive no pain medication in an emergency department.12

Latinos with limited English proficiency may also be less likely to receive follow-up appointments after an initial physician visit because of discrimination, communication barriers leading to misdiagnosis or lack of awareness of a problem, or even physician frustration over difficulty communicating. To our knowledge, no study has investigated the effects of limited English proficiency or communicating through an interpreter on physician referral patterns. Finally, Latinos with limited English proficiency might be less likely to comply with referral appointments because of dissatisfaction, or poor understanding of the reason for the referral, or simply because they are unaware that they are supposed to have a follow-up appointment. Manson found that asthmatic patients receiving extended follow-up care in an ambulatory care setting from a language-discordant physician were more likely to miss office appointments than were patients with a language-concordant physician.13 To further examine these issues, we conducted this study to determine the association between language barriers and (1) rates of referral for a follow-up appointment after an emergency department visit, (2) patients' knowledge that an appointment had been scheduled, and (3) actual compliance with scheduled follow-up appointments.

/pdf/effect-of-language-barriers-on-follow-up-appointments-after-1z6qgyuu2y.pdf

Effect of language barriers on follow-up appointments after an emergency department visit.

This paper considers the meaning of minority group status for the Hispanic population of the United States regarding access to medical care. A review of the relevant literature raises a number of questions concerning determinants of medical care utilization for Hispanics. They are explored using data from a national survey of health care utilization that oversampled the Hispanic population of the southwestern United States. Some indicators suggest that limited access to medical care for Hispanics in this region is associated with low levels of income, education, and health insurance coverage. Some implications of the findings for future research on Hispanics' access to medical care are presented.

Access to medical care among the Hispanic population of the southwestern United States.

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Access to medical care among the Hispanic population of the southwestern United States.