Browsing by Subject "Barriers to care"

Background: Robeson County, North Carolina was ranked as the least healthy county in the state, in 2020. In Robeson, accessing surgical care is a health challenge, and two known risk factors are its rural location and high proportion of racial minority groups. Applying the three-delays model, the aim of this study was to identify and assess the perceived barriers to surgical care. Methods: To obtain a diverse perspective of how access to surgical care in Robeson County is perceived, interviews were conducted with surgical patients, surgical providers, and community leaders. Duke healthcare personnel, who work in Robeson County, assisted with identifying appropriate stakeholders and surgical patients to interview initially. Additional interviewees were identified through snowball sampling, until saturation was reached. Two researchers independently examined and categorized the responses using the constant comparative method, categorizing quotes from participants in an iterative fashion to identify recurring themes. Results: A total of eleven participants were interviewed (2 nurses, 7 patients, and 2 community leaders). Themes identified included: comfort level with the health system, transportation, logistics of the health system, health system capacity, alternative medicine, community beliefs, county’s historical and cultural context, financing, and suggestions from the participants. Conclusions: This preliminary study suggests that along with Robeson’s rural geography and high proportion of minority groups, the county’s historical and cultural context, the stigmatization of surgical diseases, and the knowledge gap in resource availability also contribute to barriers to accessing surgical care in the county.

Background: Indigenous People around the world experience inequalities in health care. In Brazil, Indigenous inequalities in health are exacerbated by the poor system of health care delivery. The aim of this study is to understand barriers to care as defined from the Indigenous perspective.

Methods: This study was conducted on three Indigenous reserves of the Xavante people in Mato Grosso, Brazil. We utilized a mixed methods approach. In the quantitative portion of the study, we surveyed 50 individuals using an adapted version of the World Health Organization 2002 World Health Survey. Participants for the quantitative survey were recruited from a randomized list of prospective patients for a medical outreach mission. In the qualitative portion of the study, we interviewed 37 individuals, including patients, health care providers, and village chiefs, about their experiences with health care. Participants for the qualitative interviews were recruited randomly from a medical outreach patient listing (Expedicionários da Saúde).

Results: Overall, participants reported dissatisfaction with health-seeking experiences. We identified five barriers to obtaining satisfactory care: lack of transportation, lack of health care services and medication, attitudes of health care workers, lack of culturally appropriate services, and social determinants.

Conclusions: Given an overall sense of dissatisfaction with health care use among indigenous people, future research should focus on identifying interventions to help overcome key barriers to accessing care. Private-public partnerships and other innovative health systems models should be explored to meet the needs of underserved indigenous communities.

Background: Globally, there is often a gap between medical need and access to care, and this is particularly true for surgical care for children. In Guatemala, for instance, families frequently pursue care outside of the government health system. Using a structured anthropologic approach, we sought to explore the barriers to surgical care for children in Guatemala, suspecting both financial and cultural barriers were the primary obstacles families had to face.

Study design: Twenty-nine parents/guardians of children receiving surgical care at two non-governmental organizations (NGOs) in Guatemala and 7 health care providers participated in semi-structured interviews to explore what they believed to be the impediments to care. Transcripts were analyzed using a grounded theory approach. Current models for barriers to care were critiqued and a novel Framework for Barriers to Pediatric Surgery in Guatemala (FBPSG) was developed, which highlights both the existence, and centrality, of fear and mistrust in families' experience.

Results: Families and providers identified financial costs, geography, and systems limitations as the primary barriers to care. Mistrust and fear were also voiced. In addition, health literacy and cultural issues were also thought to be relevant by providers.

Conclusions: Due to biases inherent in this sample, parents/guardians did not necessarily report the same perceived barriers as healthcare providers - e.g., education/health literacy and language - and may have represented a "best case" scenario compared to more disadvantaged populations in this specific Central American context. Nonetheless, financial concerns were some of the most salient barriers for families seeking pediatric surgical care in Guatemala, with systems limitations (waiting time) and geographic factors (distance/transit) also being highlighted. Fear and mistrust were found to be deeper barriers to care and warrant reevaluation of organizational heuristics to date. NGOs can address these worries by working with individuals and organizations already known by and trusted in target communities and by providing good quality medical treatment and interpersonal care.