Fuld J, Weiss L, Bauer T; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1308.
The New York Academy of Medicine, New York Forum for Child Health, 1216 Fifth Avenue, New York, NY 10029 Tel. 212.822.7390 Fax 212.822.7369
RESEARCH OBJECTIVE: Immigrant families and particularly children face many obstacles to accessing health services in New York City. Research demonstrates that children in immigrant families are more likely to be uninsured, have no regular source of care and face other barriers than children in native citizen families, but little is known qualitatively about these issues. This research examines the experiences immigrant parents have navigating the health insurance and health care system in NYC. In this current analysis, we compared Haitian, Latino and Russian parents' experiences with language access issues during children's health care visits over the past two years. STUDY DESIGN: We conducted 75 semi-structured interviews of immigrant parents living in New York City, from August 2003 - December 2003 (25 Haitian, 25 Latino, 25 Russian). Interviews were conducted in Haitian-Creole, Spanish and Russian and audio-taped. Respondents were recruited using purposive sampling through collaboration with community-based organizations. All eligible respondents had to be an immigrant parent caring for a child (under age 18). The child had to be uninsured at the time of the parent's interview, or insured with CHP A (Medicaid) or CHP B but to also have also had a period of uninsurance within the past two years. Coding and analysis of qualitative data was conducted with the aid of Atlas.ti. POPULATION STUDIED: The population studied was Haitian, Latino, and Russian immigrant parents and children living in New York City. We limited our sample to children in immigrant families who are uninsured but eligible for CHP A (Medicaid) or CHP B and children who are insured with CHP A or CHP B. Children in immigrant families with private insurance were excluded. PRINCIPAL FINDINGS: Most parents were limited English proficient (LEP) and were caring for young children. Parents described being continually frustrated and feeling that they were getting only a partial picture of their children's health during many health care visits. Parents who had taken their children to the emergency room described experiences where they were not provided any type of language assistance, they were not properly informed about their child's health, they were told to sign forms in English that they could not read and they felt dismissed by the doctors because they were LEP and doctors were not bilingual. In contrast, parents described experiences at community-based health centers as more positive and as visits with doctors and staff who were bilingual. Parents believed that as these visits, in relation to hospital visits, they left with a better understanding of their child's health and healthcare needs. Differences among the three groups included: Haitian parents often bring along a Haitian friend or family member who speaks English to children's health care visits since they expect to be provided with no language assistance in Haitian-Creole; Latino parents often resign themselves to a stranger or staff person with very poor Spanish to provide language assistance during a child's visit since they feel that it is likely someone at the location will speak some Spanish, even if it is extremely limited; and Russian parents seek out Russian doctors in their community. CONCLUSIONS: Immigrant parents in all three immigrant groups, face many barriers during children's health care visits when there is limited language assistance available. Parents negotiate a health care system that provides limited language assistance at many places by relying on culturally-based norms that reflect factors such as the size of the immigrant group, geographic settlement patterns, social support and coping strategies. Overall, parents report that their knowledge of their children's health is comprised by limited language assistance and that each negative health care visit cumulatively impacts their ability to care for their child's development. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: It is critical that immigrant parents are able to communicate with and understand the health care providers who care for their children. These findings add to the growing evidence that New York City health care providers, especially hospitals, need to improve language access services and that ad-hoc interpreters such as strangers, friends and other family members are not a substitute for medical interpretation.
Publication Types:
Keywords:
- Asian Americans
- Child
- Child Welfare
- Delivery of Health Care
- Emigration and Immigration
- Family
- Health Services
- Health Services Accessibility
- Hispanic Americans
- Humans
- Insurance, Health
- Interviews as Topic
- Language
- Medicaid
- Medically Uninsured
- New York City
- Parents
- Poverty
- economics
- hsrmtgs
UI: 103624342
From Meeting Abstracts