Barriers to healthcare access for Arabic-speaking population in an English-speaking country
Objective: To identify barriers to healthcare access, to assess the health literacy levels of the foreign-born Arabic speaking population in Iowa, USA and to measure their prevalence of seeking preventive healthcare services.
Methods: A cross-sectional study of native Arabic speaking adults involved a focus group and an anonymous paper-based survey. The focus group and the Andersen Model were used to develop the survey questionnaire. The survey participants were customers at Arabic grocery stores, worshippers at the city mosque and patients at free University Clinic. Chi-square test was used to measure the relationship between the characteristics of survey participants and preventive healthcare services. Thematic analysis was used to analyze the focus group transcript.
Results: We received 196 completed surveys. Only half of the participants were considered to have good health literacy. More than one-third of the participants had no health insurance and less than half of them visit clinics regularly for preventive measures. Two participant enabling factors (health insurance and residency years) and one need factor (having chronic disease(s)) were found to significantly influence preventive physician visits.
Conclusions: This theory-based study provides a tool that can be used in different Western countries where Arabic minority lives. Both the survey and the focus group agreed that lacking health insurance is the main barrier facing their access to healthcare services. The availability of an interpreter in the hospital is essential to help those with inadequate health literacy, particularly new arriving individuals. More free healthcare settings are needed in the county to take care of the increasing number of uninsured Arabic speaking patients.
Arab American Institute. National Arab American Demographics. Available at: https://www.aaiusa.org/demographics (accessed Apr 7, 2018).
Patricia de la Cruz G, Brittingham A. The arab population: 2000. Washington: U.S.Department of Commerce EaSA; 2003.
Abuelezam N N, El-Sayed A M, Galea S. Arab american health in a racially charged U.S. Am J Prev Med. 2017;52(6):810-812. https://doi.org/10.1016/j.amepre.2017.02.021
Brown ER. Access to health insurance in the united states. Med Care Rev. 1989;46(4):349-385. https://doi.org/10.1177/107755878904600402
Ayanian JZ, Weissman JS, Schneider EC, Ginsburg JA, Zaslavsky AM. Unmet health needs of uninsured adults in the united states. JAMA. 2000;284(16):2061-2069. https://doi.org/10.1001/jama.284.16.2061
Gar¬eld R, Majerol M, Damico A, Foutz J. The uninsured: A primer. Key facts about health insurance and the uninsured in the era of health reform. Washington: Kaiser Family Foundation; 2015.
Luque JS, Soulen G, Davila CB, Cartmell K. Access to health care for uninsured latina immigrants in south carolina. BMC Health Serv Res. 2018;18(1):310. https://doi.org/10.1186/s12913-018-3138-2
Smith D A, Akira A, Hudson K, Hudson A, Hudson M, Mitchell M, Crook. The effect of health insurance coverage and the doctor-patient relationship on health care utilization in high poverty neighborhoods. Prev Med Rep. 2017;7:158-161. https://doi.org/10.1016/j.pmedr.2017.06.002
Sarsour L, Tong V S, Jaber O, Talbi M, Julliard K. Health assessment of the arab american community in southwest brooklyn. J Community Health. 2010;35(6):653-659. https://doi.org/10.1007/s10900-010-9260-7
Abdulrahim S, Baker W. Differences in self-rated health by immigrant status and language preference among arab americans in the detroit metropolitan area. Soc Sci Med. 2009;68(12):2097-2103. https://doi.org/10.1016/j.socscimed.2009.04.017
Tocher T M, Larson E. Quality of diabetes care for non-english-speaking patients. A comparative study. West J Med. 1998;168(6):504-511.
Manson A. Language concordance as a determinant of patient compliance and emergency room use in patients with asthma. Med Care. 1988;26(12):1119-1128. https://doi.org/10.1097/00005650-198812000-00003
Taira DA. Improving the health and health care of non-english-speaking patients. J Gen Intern Med. 1999;14(5):322-323. https://doi.org/10.1046/j.1525-1497.1999.00345.x
Jacobs EA, Lauderdale DS, Meltzer D, Shorey JM, Levinson W, Thisted RA. Impact of interpreter services on delivery of health care to limited-english-proficient patients. J Gen Intern Med. 2001;16(7):468-474. https://doi.org/10.1046/j.1525-1497.2001.016007468.x
Jacobs EA, Sadowski LS, Rathouz PJ. The impact of an enhanced interpreter service intervention on hospital costs and patient satisfaction. J Gen Intern Med. 2007;22(Suppl 2):306-311. https://doi.org/10.1007/s11606-007-0357-3
Flores G. The impact of medical interpreter services on the quality of health care: A systematic review. Med Care Res Rev. 2005;62(3):255-299. https://doi.org/10.1177/1077558705275416
Green AR, Ngo-Metzger Q, Legedza AT, Massagli MP, Phillips RS, Iezzoni LI. Interpreter services, language concordance, and health care quality: Experiences of asian americans with limited english proficiency. J Gen Intern Med. 2005;20(11):1050-1056. https://doi.org/10.1111/j.1525-1497.2005.0223.x
Alzubaidi H, Mc Namara K, Browning C, Marriott J. Barriers and enablers to healthcare access and use among arabic-speaking and caucasian english-speaking patients with type 2 diabetes mellitus: A qualitative comparative study. BMJ Open. 2015;5(11):e008687. https://doi.org/10.1136/bmjopen-2015-008687
Flores G. Language barriers to health care in the united states. N Engl J Med. 2006;355(3):229-231. https://doi.org/10.1056/NEJMp058316
Hacker K, Anies M, Folb BL, Zallman L. Barriers to health care for undocumented immigrants: A literature review. Risk Manag Healthc Policy. 2015;8:175-183. https://doi.org/10.2147/RMHP.S70173
Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77-101.
Andersen R M. Revisiting the behavioral model and access to medical care: Does it matter? J Health Soc Behav. 1995;36(1):1-10.
Al-Jumaili A A, Al-Rekabi M D, Sorofman B. Evaluation of instruments to assess health literacy in arabic language among Iraqis. Res Social Adm Pharm. 2015;11(6):803-813. https://doi.org/10.1016/j.sapharm.2015.02.002
Morris NS, MacLean CD, Chew LD, Littenberg B. The single item literacy screener: Evaluation of a brief instrument to identify limited reading ability. BMC Fam Pract. 2006;7:21. https://doi.org/10.1186/1471-2296-7-21
Alkhaldi TM, Al-Jumaili AA, Alnemer KA, Alharbi K, Al-Akeel ES, Alharbi MM, Alshabanah O, Juwair AB, Khoja A. Measuring the health literacy level of arabic speaking population in saudi arabia using translated health literacy instruments. Pharm Pract (Granada). 2018;16(3):1223. https://doi.org/10.18549/PharmPract.2018.03.1223
The university of iowa international student and scholar services. https://international.uiowa.edu/isss (accessed Apr 7, 2018).
United states census bureau. https://census.gov/en.html (accessed Apr 7, 2018).
Hoffman C, Paradise J. Health insurance and access to health care in the united states. Ann N Y Acad Sci. 2008;1136:149-160. https://doi.org/10.1196/annals.1425.007
Iowa department of public health. http://idph.iowa.gov/ (accessed Jan 8, 2018).
Ornstein SM, Jenkins RG, Litvin CB, Wessell AM, Nietert PJ. Preventive services delivery in patients with chronic illnesses: Parallel opportunities rather than competing obligations. Ann Fam Med. 2013;11(4):344-349. https://doi.org/10.1370/afm.1502
Culica D, Rohrer J, Ward M, Hilsenrath P, Pomrehn P. Medical checkups: Who does not get them? Am J Public Health. 2002;92(1):88-91. https://doi.org/10.2105/ajph.92.1.88
Sentell T, Braun K L. Low health literacy, limited english proficiency, and health status in asians, latinos, and other racial/ethnic groups in california. J Health Commun. 2012;17(Suppl 3):82-99. https://doi.org/10.1080/10810730.2012.712621
Chen X, Goodson P, Acosta S, Barry AE, McKyer LE. Assessing health literacy among chinese speakers in the u.S. With limited english proficiency. Health Lit Res Pract. 2018;2(2):e94-e106. https://doi.org/10.3928/24748307-20180405-01
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