Assessing Health Concerns and Barriers in a Heterogeneous Latino Community
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Journal of Health Care for the Poor and Underserved 17.4 (2006) 899-909


Assessing Health Concerns and Barriers in a Heterogeneous Latino Community
Abstract

Introduction. Major health issues and barriers to health services for Latino immigrants were identified through community-based participatory research in Baltimore city. Methods. In collaboration with community partners, five focus groups were conducted among Latino adults from 10 countries and health service providers. Findings. Priorities across groups included chronic diseases, HIV/AIDS and STDs, mental health, and the need for ancillary services. Community members and providers did not always agree on what health matters were of primary concern. Participants expected to receive health information at the point of service. Barriers to receiving health services and information span linguistic, financial, logistical, legal, and cultural matters. Conclusions. This formative research illustrates the complexity and interrelatedness of health priorities and barriers created by social issues such as employment, legal status, and related stressors.

Keywords
Hispanic Americans, community-based participatory research, needs assessment, minority groups, health services accessibility.

An increasingly diverse and growing population,1 Latinos present challenges in health care access and service delivery at the local level that include, but are not limited to, limited English language proficiency and lack of health insurance.2–3 Nationally, disparities in access to health care, risk factors (e.g., obesity), and morbidity (e.g., diabetes) disfavor Latinos under 65 years of age in comparison with their non-Latino White (NLW) counterparts.4–7 Information that is relevant for addressing disparities at the local level where services are rendered is sparse.8

While Latinos appear to have lower overall mortality in adulthood than NLWs, this mortality advantage holds largely for immigrant Mexicans, Dominicans, and Central and South Americans.9 Latinos receive lower quality of care than NLWs for half of the available quality measures and have worse access to care for about 90% of access measures.4 In Maryland, the uninsured rate among low-income Latinos is 64%, the highest for any population subgroup.10

Maryland's Latino population is the fastest growing minority group in the state (5.4% in 2004).11 In 2004, 2.2% (13,204) of Baltimore City's population (10% in [End Page 899] Southeast Baltimore) was Latino.12 Community leaders and providers, who have seen an unprecedented increase in service usage, believe that official estimates are undercounts due to immigration and legal status concerns. Despite a general lack of information on the health status of Latinos in Baltimore City, there is growing recognition of the challenges to health care access for this population.13–14

Description of Focus Groups
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Table 1
Description of Focus Groups

To better understand the health of Latinos in Baltimore,15 and to provide formative data for community-based interventions and future research, we conducted five focus groups with community members and service providers under the direction of a Community Advisory Board (CAB). Community-based participatory research (CBPR) incorporates community input at all stages of the research process to enhance capacity building and overcome barriers to research raised by matters of trust, communication, cultural differences, power, and representation.17–20

Methods

Prior Institutional Review Board approval was obtained from Johns Hopkins University and the University of Maryland.

Population recruitment

Established with the aid of a city-wide network of service providers, a CAB including representatives from local universities and community service agencies recruited focus group participants. Inclusion criteria for the community member focus groups were self-identification as Latino, and residence, work, or receipt of services in Baltimore City. Health service providers in Baltimore City were recruited in order to compare their perspectives with those of the community they serve.

Focus group participants were recruited to one of five focus groups: 18–59 year old women (n=6), 18–59 year old men (n=4), parents of children under 18 years of age (n=11), Latinos at least 60 years of age (n=6), and...