Access to health care for Latina adolescents: a critical review

Development of a Mobile App on Contraceptive Options for Young African American and Latina Women

Young African American and Latina women aged 15 to 24 are more likely to adopt short-acting forms of contraception over long-acting reversible contraception. Mobile applications and other forms of digital media may be useful for providing adolescents with information about sexual and reproductive health both inside and outside of the health care setting. The miPlan app was designed in accordance with principles of user experience design, and its content was informed by the theory of planned behavior and the transtheoretical model of behavior change. A university-based design team engaged young African American and Latina women to inform app development and provide input on app design, conducting multiple rounds of usability testing. Researchers then evaluated the acceptability of the miPlan app in family planning clinics among African American and Latina women aged 15 to 24. Participants rated the app highly acceptable, finding it both easy to use and highly informative. We demonstrate that mobile applications designed in conjunction with user populations may be effective at providing health information due to users' ability to identify with them and their accessibility.

Factors Associated With Delayed Childbearing: From the Voices of Expectant Latina Adults and Teens in California

There has been limited research on the protective factors that help Latinas delay childbearing until adulthood. In-depth interviews were conducted with 65 pregnant Latina teenage and adult women in California who were about to have their first child. Lack of or inconsistent birth control use as teens was attributed to wanting or ambivalence toward childbearing, concern about contraceptive side effects and infertility, and/or inadequate contraceptive information. Parental influence was cited as the primary reason for avoiding teen childbearing, as well as the feeling that a baby would have interfered with life plans. Close parental supervision and positive relationships with parents appeared to protect some adults from teen childbearing. The findings from this study point to the need to improve Latinos’ birth control knowledge and strengthen parents’ ability to establish supportive relationships with their children.

Routine physical examination and forgone health care among Latino adolescent immigrants in the United States

Knowledge concerning patterns of health care utilization among Latino-adolescent immigrants is needed to develop culturally-appropriate programs. The objectives of this study were to estimate the annual prevalence of having had a routine physical exam and episodes of adolescents' not seeking health care when they thought they should (forgone health care) among Latino adolescents by immigrant-generational status. Cross-sectional analysis of data from Latino adolescents in Wave I of the National Longitudinal Adolescent Health Study. First-generation immigrants who had lived in the U.S. < or = 5 years were less likely to receive routine care than third-generation immigrants (39.0% vs. 54.9%). This disparity decreased after adjustment for insurance status, parental education and poverty among Mexican origin adolescents. On average, 16.0% of first-generation immigrants who had lived in the U.S. < or = 5 years and 22.5% of third-generation immigrants reported forgoing health care. After adjustment for age, insurance status, parental education and routine care, recent arrivals were less likely than third-generation immigrants to forgo health care. Recent arrivals were less likely to receive a routine physical exam and to forgo care than third-generation immigrants. Future studies should explore the effect of acculturation on knowledge, beliefs and perceptions about health, illness and care-seeking behaviors.

Barriers to adolescents' getting emergency contraception through pharmacy access in California: differences by language and region

CONTEXT

In California, emergency contraception is available without a prescription to females younger than 18 through pharmacy access. Timely access to the method is critical to reduce the rate of unintended pregnancy among adolescents, particularly Latinas.

METHODS

In 2005-2006, researchers posing as English- and Spanish-speaking females-who said they either were 15 and had had unprotected intercourse last night or were 18 and had had unprotected sex four days ago-called 115 pharmacy-access pharmacies in California. Each pharmacy received one call using each scenario; a call was considered successful if the caller was told she could come in to obtain the method. Chi-square tests were used to assess differences between subgroups. In-depth interviews with 22 providers and pharmacists were also conducted, and emergent themes were identified.

RESULTS

Thirty-six percent of all calls were successful. Spanish speakers were less successful than English speakers (24% vs. 48%), and callers to rural pharmacies were less successful than callers to urban ones (27% vs. 44%). Although rural pharmacies were more likely to offer Spanish-language services, Spanish-speaking callers to these pharmacies were the least successful of all callers (17%). Spanish speakers were also less successful than English speakers when calling urban pharmacies (30% vs. 57%). Interviews suggested that little cooperation existed between pharmacists and clinicians and that dispensing the method at clinics was a favorable option for adolescents.

CONCLUSIONS

Adolescents face significant barriers to obtaining emergency contraception, but the expansion of Spanish-language services at pharmacies and greater collaboration between providers and pharmacists could improve access.

Concerns about contraceptive side effects among young Latinas: a focus-group approach

To identify perceptions and attitudes about contraceptive side effects in young, low-income Latina adolescents through focus-group conversations. We conducted seven focus-group discussions with Latino females in an outpatient clinic and community setting. Qualitative methodology was used to analyze data. Participants were recruited from the outpatient gynecology clinic at the University of Illinois at Chicago, and from the Easter Seals Day Care Center. Women were recruited if they were Latino and between the ages of 18 and 26 years (N = 40). Participants cited both perceptions of side effects as well as personal experience with side effects as reasons for not using or discontinuing the use of contraception. Women also demonstrated incorrect knowledge about contraception, and tended to value anecdotal information over information from health professionals. These factors led to reliance on less-effective methods of contraception, placing participants at risk for unintended pregnancy. Concern about side effects, fear of health consequences and misinformation were identified as barriers to effective contraceptive use in young, low-income Latinas. Providers caring for this population should address potential concerns about side effects of contraception as well as assess patients' understanding in light of cultural and language barriers.

Young Latinas recall contraceptive use before and after pregnancy: a focus group study

STUDY OBJECTIVE

To understand factors influencing use and nonuse of contraception in young, low-income Latina adolescents through focus group conversations.

DESIGN

We conducted seven focus group discussions with Latino females in an outpatient clinic and community setting. Qualitative data analyses techniques were used.

SETTING

Participants were recruited from the outpatient gynecology clinic at the University of Illinois at Chicago, and from the Easter Seals Day Care Center.

PARTICIPANTS

Women were recruited if they were Latina and between the ages of 18-26 (n=40).

RESULTS

Due to lack of information and family beliefs prohibiting birth control use and sexual activity, sexually active teenagers had high rates of contraceptive non-use and relied on irregular use of condoms and withdrawal for pregnancy prevention. Following pregnancy, participants had greater access to contraception and more determination to use it. Yet, persistent use of withdrawal and irregular use of hormonal contraception may place Latina mothers at risk for repeat pregnancy.

CONCLUSIONS

Different approaches are needed for prevention of the first pregnancy compared to subsequent ones among Latino adolescents and young adults.

An evaluation of a breast-feeding education intervention among Spanish-speaking families

This study assessed the impact of an educational breast-feeding intervention on the knowledge, attitudes and perceived ability to access breast-feeding resources among Spanish-speaking Latino families making breast-feeding decisions. Conducted in cooperation with the local office of The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), this university-based, multidisciplinary outreach and research project was held in a semirural part of Utah, where Latinos constitute the fastest and largest growing group of the population and have the lowest breast-feeding duration rates. The results suggested that teaching a lactation class in Spanish to Latino women significantly increased their willingness to breast-feed and empowered them by increasing their belief that they could breast-feed even if they work or attend school, that they would not have a problem with insufficient milk, and that they would not need to limit their diet to breast-feed. Additionally, the study indicated that Latino women are more likely to access health care services from agencies providing services in Spanish, regardless of their secondary fluency in English.

Issues of separation and reunification in immigrant Latina youth

Latinos make up 12.5% of the total U.S. population, and the largest source of migration to the United States is from Mexico. The intersection of acculturation and risk for Latino immigrant youth is complex, with recent arrivals being protected in the context of strong family ties. Youth, and particularly young women who have been separated from their parents during migration and later reunited, face particular problems that have not been well studied. This article discusses possible stresses facing reunified families, with implications for nursing practice and suggestions for future research.

The impact of language barriers on the health care of Latinos in the United States: a review of the literature and guidelines for practice

Although Spanish was the primary language of an estimated 11 % of adults in the year 2000, the U.S. health care system is largely geared toward serving English speakers. A systematic review was conducted of studies published in biomedical journals from 1990 to 2000 examining language barriers in health care for Latino populations. Aspects of the problem examined were access to health care, quality of care, and health status/health outcomes. Five (55%) of the nine studies examining access to care found a significant adverse effect of language; three (33%) found mixed or weak evidence that language affected access. Six (86%) of the seven studies evaluating quality of care found a significant detrimental effect of language barriers. Two of the three studies examining health status or outcomes found language to be a risk factor for adverse outcomes. Evidence was mixed as to the level of importance attributable to language when access to care is considered; however, non-English-speaking status was a marker of a population at risk for decreased access. Solid evidence showed that language barriers can adversely affect quality of care. Health care practitioners are recommended to devise an effective strategy to bridge language barriers in their setting. National laws and policies are discussed; practical guidelines and resources for providing language access in health care are provided. This article is intended to supply basic knowledge for providers and institutions in devising effective strategies for bridging the language barrier.

Cross-cultural surveys of adolescent health and behavior: progress and problems

Adolescent health surveys administered in different countries or regions often are described as cross-cultural. Although most include youth of different ethnic and cultural groups, few attempt to define these constructs or to collect data that allow their characterization. This paper explores four challenges shared by large-scale surveys of adolescent health-related behaviors and beliefs. First, adolescent health investigators have used the terms culture and ethnicity loosely. The growing interest in contextual analysis demands standardization of the definitions as they apply to adolescents, followed by correct usage of the terms. Hypotheses regarding the associations between race, ethnicity, culture, health-related behaviors, and health outcomes should be clearly stated and incorporated into conceptual models. Second, cross-cultural analyses are interpretable only when the study designs and sampling methods provide adequate representation of cultural and ethnic minorities and when the survey items allow differentiation of factors related to race, ethnicity, culture, and socioeconomic factors. Third, cross-cultural research may expose traditions, beliefs, and behaviors that are supported by one population yet criticized by another. Investigators must recognize their own personal biases and must work collaboratively to analyze and interpret their data correctly. Fourth, generalizations about cultural/ethnic comparisons can evoke powerful emotional reactions. Interpretation and dissemination of research findings should be done sensitively and with the help of experts from the cultural/ethnic groups that have been studied.

Preventing HIV transmission: the perspective of inner-city Puerto Rican adolescents

PURPOSE

To examine the development of HIV prevention strategies that address the concerns and needs of urban Puerto Rican adolescents.

METHODS

The study included 542 Puerto-Rican adolescents, divided into age sets of 12 to 14 years and 15 to 19 years. Participants were recruited from community work programs, recreation centers, schools, drug rehabilitation programs, and directly from neighborhood streets in North Philadelphia. A hierarchical series of peer-facilitated group techniques and interviews allowed adolescents to generate, prioritize and explain strategies. The study question was developed in focus groups. Ideas were generated and prioritized in Nominal Technique Groups. The ideas with the highest priority were used to develop a survey that allowed participants to rank those they believed would be most effective. Participants then clarified the top-ranked ideas in open focus groups.

RESULTS

In both age sets, the strategy perceived as the most effective in preventing HIV-risk behaviors was "Have people who are HIV-infected talk to teens." Similar ideas addressing this theme varied in perceived effectiveness. The second and third rated ideas among participants aged 12 to 14 years were "Teach teens how HIV infects them, " and "Show teens how people die from AIDS." The second and third rated ideas among participants aged 15 to 19 years were "Show teens what AIDS does to people " and "Have parents be more supportive of teens, so if they are having sex, they can encourage them to use condoms." Other top-ranked ideas included the development of community programs, increased efficacy and availability of condoms, and assessing partners for the risk of HIV infection. Three items revealed significant gender differences. Males were more likely to rate "Give out more free condoms" and "Educate teens in schools about AIDS." Females aged 15 to 19 years were more likely to rate "Teens should know their partner's background before having sex."

CONCLUSIONS

To develop effective prevention strategies for youth, their views of the problems and interpretations of proposed solutions must be understood.

Usual sources, patterns of utilization, and foregone health care among Hispanic adolescents

PURPOSE

To describe and differentiate the usual sources of health care, patterns of utilization of services, and reasons for foregone health care among Hispanic adolescents by place of birth (U.S. mainland versus Puerto Rico or other country) and gender.

METHODS

All subjects who identified themselves as Hispanic (n = 717) in a larger survey of 10,059 students in 7th (n = 3,596), 9th (n = 3,691), and llth (n = 2,772) grades in the state of Connecticut in 1996 were included in this secondary analysis. Data were analyzed using Pearson product-moment coefficients, Chi-squares, and logistic regression.

RESULTS

The majority of usual sources of medical care services were community clinics or private doctors' offices. Subjects born in Puerto Rico or countries other than the United States were more likely to use a doctor's office. About 5% reported no usual source of care. Over 25% reported not going to a doctor or other health care provider when they thought they should (foregone care). There were significant gender differences in reasons given for foregone care. Feeling connected to others was a significant predictor of having had a physical examination and negatively associated with foregone care for girls. For boys, connectedness and use of alcohol were negative predictors of foregone care.

CONCLUSIONS

The majority of Hispanic youth in this sample report having a usual source of medical care and the source differs by place of birth. Adolescents who do not report high levels of connectedness are more likely to have foregone care. The most frequent explanation given for not having sought care was that subjects thought the problem would go away. Socialization about how to access and use health care services, as well as what to expect, is needed by Hispanic adolescents who may be at risk.