PRCC Presentation Jhb

619 views

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
619
On SlideShare
0
From Embeds
0
Number of Embeds
16
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

PRCC Presentation Jhb

  1. 1. Young Mothers’ Perspectives on Navigating the Local Health Care System in Greater Humboldt Park Jennifer Hebert-Beirne, PhD, MPH
  2. 2. Interest Area: Health Care Access Among Mothers in Greater Humboldt Park Area <ul><li>Classic Measures </li></ul><ul><ul><li>Usual Source of Care (USC) </li></ul></ul><ul><ul><li>Delay in Receipt of Needed Care </li></ul></ul><ul><ul><li>Ambulatory Care Sensitive Conditions (ACSC) </li></ul></ul><ul><ul><li>Emergency Department Usage </li></ul></ul><ul><ul><li>Immunizations </li></ul></ul><ul><ul><li>Medical Visit: Type of Provider </li></ul></ul>
  3. 3. Why the Disparity in Access to Health Care for Children? <ul><li>Availability  </li></ul><ul><li>Affordability  </li></ul><ul><li>Accessibility  </li></ul><ul><li>Accommodation </li></ul><ul><li>Acceptability </li></ul>Penchansky, 1981
  4. 4. Chicago’s Westside Primary Health Care System <ul><li>43% of providers </li></ul><ul><li>Increased 150% </li></ul><ul><li>Number of sites (1990- 2002) </li></ul>CDPH, 2005
  5. 5. Chicago’s Westside Health Care Primary Health Care Providers <ul><li>Local health care system </li></ul><ul><li>- 26 Community health centers </li></ul><ul><li>- 7 Publicly-operated sites </li></ul><ul><li>- 2 Free Clinics </li></ul><ul><li>MCH indicators </li></ul><ul><li>Receipt of prenatal care </li></ul><ul><li>Very low birth weight </li></ul><ul><li>Lead screenings </li></ul>CDPH, 2005
  6. 6. Ecological Case Study Young Mothers FLC Dr. Pedro Ablizu Puerto Rican HS Pasea Boricua Greater Humboldt Park
  7. 7. Research Participants <ul><li>Adolescent Mothers </li></ul><ul><ul><li>Mothers are Gatekeepers </li></ul></ul><ul><ul><li>Nascent </li></ul></ul><ul><ul><li>FLC Mothers </li></ul></ul><ul><ul><li>same developmental juncture/ common characteristics </li></ul></ul><ul><ul><li>FLC curriculum </li></ul></ul><ul><ul><ul><li>Critical thinking </li></ul></ul></ul><ul><ul><ul><li>Sense of culture/community/identity </li></ul></ul></ul><ul><ul><ul><li>Unique group of women </li></ul></ul></ul>
  8. 8. Methods: Mixed <ul><li>Face to Face semi-structured interviews (21) </li></ul><ul><li>Participant Demographic and Utilization Surveys (21) </li></ul><ul><li>2 Debriefing Sessions </li></ul><ul><li>Role as Participant Observer </li></ul>
  9. 9. Findings: Consumer Typologies “ I looove to ask questions” Empowered “ I bother them good” Defensive “ It’s all kinda weird to me” Perplexed “ I don’t have a bond with none of ‘em” Disengaged Quote Consumer Type
  10. 10. Findings: Health Service Utilization 3 Freestanding doctor’s office 1 Publicly-operated Health Centers 8 Federally Qualified Health Centers and Look Alikes (FQHC/LA) 8 Hospital Outpatient # Usual Source of Care
  11. 11. <ul><li>Multiple providers </li></ul><ul><li>Strategic use of ER/ Freestanding </li></ul><ul><li>Use of providers outside community </li></ul>Findings: Continuity of Care
  12. 12. <ul><ul><li>Distrust </li></ul></ul><ul><ul><li>Skepticism </li></ul></ul>Findings: Medical Home Principles
  13. 13. Findings: Anticipatory Guidance <ul><li>Saliency </li></ul><ul><li>Relevancy – given role that grandmothers and fathers play </li></ul>
  14. 14. Findings: Perceived Disposition of Provider <ul><li>As Mother </li></ul><ul><ul><li>“are you the mother?” </li></ul></ul><ul><ul><li>Leaving mother out of health care visit </li></ul></ul><ul><ul><li>Mostly in prenatal setting </li></ul></ul><ul><ul><ul><li>Leaving wet sheets on bed </li></ul></ul></ul><ul><ul><ul><li>Not Speaking to Delivering Mother </li></ul></ul></ul><ul><li>As Competent Advocate </li></ul><ul><ul><li>Disrespectful behavior </li></ul></ul><ul><ul><li>Condescending behavior </li></ul></ul><ul><ul><ul><li>Nurse behavior </li></ul></ul></ul>
  15. 15. Findings: Provider’s Perspectives <ul><li>Provider perceived </li></ul><ul><li>incompetence </li></ul><ul><ul><li>Role of mother </li></ul></ul><ul><ul><li>Role as competent advocate </li></ul></ul>
  16. 16. Findings: Context <ul><li>Reinforcing Circumstances </li></ul><ul><ul><li>Perception of Place </li></ul></ul><ul><ul><li>Maternal Social Norms </li></ul></ul><ul><li>Adverse Circumstances </li></ul><ul><ul><li>Poverty </li></ul></ul><ul><ul><li>Violence/Gangs </li></ul></ul><ul><ul><li>Gentrification </li></ul></ul>
  17. 17. Findings: Summary <ul><li>Negative Health Care Experiences </li></ul><ul><li>Non-compliance with provider recommendations </li></ul><ul><li>Delays in subsequent care </li></ul><ul><li>Lack of continuity of care </li></ul>
  18. 18. Implications <ul><li>Practice </li></ul><ul><ul><li>Intervention points </li></ul></ul><ul><ul><li>Provider-consumer communication </li></ul></ul><ul><li>Theory </li></ul><ul><ul><li>Role of Context </li></ul></ul><ul><li>Health Services Research </li></ul><ul><ul><li>Measurement </li></ul></ul>
  19. 19. Implications: Practice <ul><li>Community-Level Education - Anticipatory Guidance/Health System Info </li></ul><ul><ul><li>Grandmothers & Fathers </li></ul></ul><ul><li>Health Literacy </li></ul><ul><ul><li>Bright Futures </li></ul></ul><ul><li>New Model of Service Delivery </li></ul><ul><ul><li>Address Distrust </li></ul></ul><ul><li>Freestanding Doctor’s offices </li></ul><ul><li>Local Health Planning Efforts </li></ul><ul><ul><li>Incorporate mixed methods </li></ul></ul>
  20. 20. Implications: Health Services Research <ul><li>Measurement </li></ul><ul><ul><li>Common definitions health system </li></ul></ul><ul><li>Social Constructs </li></ul><ul><ul><li>Distrust </li></ul></ul><ul><ul><ul><li>Nurse trust </li></ul></ul></ul><ul><ul><ul><li>Reciprocal trust </li></ul></ul></ul><ul><ul><li>Dissatisfaction </li></ul></ul><ul><li>Consumer Perspectives </li></ul><ul><ul><li>Patterns of decisions </li></ul></ul>
  21. 21. Conclusion <ul><li>Maternal Narratives </li></ul><ul><ul><li>Negative Experiences </li></ul></ul><ul><ul><ul><li>Non Compliance </li></ul></ul></ul><ul><ul><ul><li>Delays in Care </li></ul></ul></ul><ul><ul><li>Constructs in Acceptability Dimension </li></ul></ul><ul><ul><ul><li>Nature of the Distrust </li></ul></ul></ul><ul><li>Closing the Gaps </li></ul><ul><ul><li>Validate Consumer Perspective </li></ul></ul><ul><ul><li>Engage Communities </li></ul></ul>
  22. 22. For more information <ul><li>Jeni Hebert-Beirne </li></ul><ul><li>773 305 8206 </li></ul><ul><li>[email_address] </li></ul>

×