Abstract
To qualitatively examine facilitators and barriers to dental care access and quality services among Mexican migrant women and their families living in North San Diego County, California. Six focus groups were conducted, with 52 participants. Three focus groups were with community residents (average group size of 10), and three were with community health workers/leaders (called Lideres; average group size of 7). The behavioral model for vulnerable populations theoretical framework guided qualitative data analyses. Predisposing factors to dental care access varied and included immigration status, language, and dental care experiences. Barriers to accessing quality dental services included high cost, lack of insurance coverage, dissatisfaction with providers, long wait times and discrimination. Participants expressed a desire for health policy changes, including affordable coverage for immigrants and their families. This study provided insights into how dental care providers, community health centers, and policymakers can improve dental care access and services to migrant populations.
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References
US Department of Health and Human Services. Oral health in America: a report of the surgeon general. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000.
Vujicic M, Nasseh K. A decade in dental care utilization among adults and children (2001–2010). Health Serv Res. 2014;49(2):460–80. doi:10.1111/1475-6773.
US Department of Commerce. Profile America facts for features hispanic heritage month 2013: Sept. 15–Oct. 15. 2013. http://www.census.gov/newsroom/releases/pdf/cb13ff-19_hispanicheritage.pdf. 8 May 2016.
DeNavas-Walt C, Proctor BD, Smith JC. Income, poverty, and health insurance coverage in the United States: 2009. US Census Bureau, Department of Commerce. 2010. p. 60–238.
Centers for Control Disease and Prevention [CDC]. Oral health status and access to oral health care for US adults aged 18–64: National Health Interview Survey, 2008. Vital Health Stat. 2012;47(253):1–22.
American Dental Association [ADA]. Action for dental health: bringing disease prevention into communities, a statement from the American Dental Association. 2013. http://www.ada.org/~/media/ADA/Public%20Programs/Files/bringing-disease-prevention-to-communities_adh.ashx. 8 May 2016.
Hunter LP, Yount SM. Oral health and oral health care practices among low-income pregnant women. J Midwifery Women Health. 2011;56(2):103–9.
Office of Minority Health. Health status of Hispanic/Latina women 2011. http://minorityhealth.hhs.gov/omh/content.aspx?ID=3722&lvl=3&lvlID=314.
California Health Interview Survey [CHIS]. AskCHIS search query summary 2009. http://healthpolicy.ucla.edu/chis/Pages/default.aspx. 8 May 2016.
Quesada J, Hart LK, Bourgois P. Structural vulnerability and health: Latino migrant laborers in the United States. Med Anthropol. 2011;30(4):339–62. doi:10.1080/01459740.2011.576725.
US Department of Health and Human Services. Health Resources and Services Administration. Section 330 of the Public Health Service Act (42 USCS § 254b), Authorizing Legislation. http://bphc.hrsa.gov/policiesregulations/legislation/index.html. 8 May 2016.
Arcury T, Quandt S. Delivery of health services to migrant and seasonal farmworkers. J Community Health Nurs. 2007;25(3):153–60. doi:10.1146/annurev.publhealth.27.021405.102106.
Larson AC. Migrant and seasonal farmworker enumeration profiles study: North Carolina, Final 2000. http://www.ncfhp.org/Data/Sites/1/documents/journalarticles/nc-msfw-enumeration-study-bph-hrsa-2000.pdf.
Finlayson TL, Gansky SA, Shain SG, Weintraub JA. Dental utilization among Hispanic adults in agricultural worker families in California’s Central Valley. J Public Health Dent. 2010;70(4):292–9. doi:10.1111/j.1752-7325.2010.00184.x.
Denti-Cal. Denti-Cal California medical dental bulletin 2011. https://www.denti-cal.ca.gov/provsrvcs/bulletins/Volume_29_Number_21.pdf. 8 May 2016.
Wides C, Alam SR, Mertz E. Shaking up the dental safety-net: Elimination of optional adult dental Medicaid benefits in California. J Health Care Poor Underserved. 2014;25(1):151–64. doi:10.1353/hpu.2014.0072.
Gelberg L, Andersen RM, Leake BD. The behavioral model for vulnerable populations: application to medical care use and outcomes for homeless people. Health Serv Res. 2000;34(6):1273–302.
Small LF. Determinants of physician utilization, emergency room use, and hospitalizations among populations with multiple health vulnerabilities. Health. 2011;15(5):491–516. doi:10.1177/1363459310383597.
Andersen RM. Revisiting the behavioral model and access to medical care: Does it matter? J Health Soc Behav. 1995;36(1):1–10.
Christancho S, Garces DM, Peters KE, Mueller BC. Listening to rural Hispanic immigrants in the Midwest: a community-based participatory assessment of major barriers to health care access and use. Qual Health Res. 2008;18(5):633–46. doi:10.1177/1049732308316669.
Horton S, Barker JC. Stigmatized biologies: examining the cumulative effects of oral health disparities for Mexican American farmworker children. Med Anthropol Q. 2010;24(2):199–217.
National Rural Health Association. Rural America’s oral health care needs 2013. file:///Users/velezdiane/Downloads/RuralAmericasOralHealthCareNeed%20(2).pdf. http://www.ruralhealthweb.org/index.cfm?objectid=93082C39-3048-651AFE09F5038E3556D1. 8 May 2016.
Finlayson TL, Hoffman L, Palomo-Zerfas A, Gonzalez M, Stamm N, Rocha M. Boca Sana, Cuerpo Sano/healthy mouth, healthy body: a community-based participatory research (CBPR) oral health project 2014. A paper presented at the American Public Health Association Annual Meeting and Exposition, New Orleans, LA.
San Diego Prevention Research Center [SDPRC]. Boca Sana, Cuerpo Sano 2013. http://hhs.sdsu.edu/research/other-projects/boca-sana-cuerpo-sano-healthy-mouth-healthy-body/. 8 May 2016.
Elder JP, Ayala GX, McKenzie T, Litrownik AJ, Gallo L, Arredondo EM, Talavera G, Kaplan RM. Athree decade evolution to transdisciplinary research: community health research in California Mexico border communities. Prog Community Health Partnersh Res Educ Action. 2014;8(3):397–404.
Vista Community Clinic. Community Health: Migrant health and community engagement 2012. http://www.vistacommunityclinic.org/community-health/. 8 May 2016.
Byrd TL, Law JG. Cross-border utilization of health care services by United States residents living near the Mexican border. Rev Panam Salud Publica. 2009;26(2):95–100.
Bergmark R, Barr D, Garcia R. Mexican immigrants in the us living far from the border may return to Mexico for Health Services. J Immigr Minor Health. 2010;12(4):610–4. doi:10.1007/s10903-008-9213-8.
Ruiz-Beltran M, Kamau JK. The socio-economic and cultural impediments to well-being along the US–Mexico border. J Community Health. 2001;26(2):123–32.
Acevedo-Garcia D, Bates LM. Latino health paradoxes: empirical evidence, explanations, future research, and implications. In: Rodriguez H, Saenz R, Menjivar C, editors. Latina/os in the United States: changing the face of America. New York, NY: Springer; 2008. p. 101–13.
Syed ST, Gerber BS, Sharp LK. Traveling towards disease: transportation barriers to health care access. J Community Health. 2013;38(5):976–93.
Ransford HE, Carrillo FR, Rivera Y. Health care-seeking among Latino immigrants: blocked access, use of traditional medicine, and the role of religion. J Health Care Poor Underserved. 2010;21(3):862–78.
Blendon RJ, Buhr T, Cassidy EF, Perez DJ, Hunt KA, Fleischfresser C, Herrmann MJ. Disparities in health: perspectives of a multi-ethnic, multi racial America. Health Aff. 2007;26(5):1437–47.
Harper PR, Gamlin HM. Reduced outpatient waiting times with improved appointment scheduling: a simulation modeling approach. OR Spectr. 2003;25(2):207–22.
Gallucci G, Swartz W, Hackerman F. Brief reports: impact of the wait for an initial appointment on the rate of kept appointments at a mental health center. Am Psychiatr Assoc. 2005;56(3):344–6.
UCLA Center for Health Policy Research. Mexican and Central American immigrants in the United States: health care access 2012. http://healthpolicy.ucla.edu/publications/search/pages/detail.aspx?PubID=239. 8 May 2016.
Diaz-Perez MJ, Farley T, Cabanis CM. A program to improve access to health care among Mexican immigrants in rural Colorado. J Rural Health. 2004;20(3):258–64.
González-Block MA, Vargas Bustamante A, De la Sierra LA, Martínez Cardoso A. Redressing the limitations of the Affordable Care Act for Mexican immigrants through bi-national health insurance: a willingness to pay study in Los Angeles. J Immigr Minor Health. 2014;16(2):179–88.
Medicaid. Policy and Program Eligibility 2014. http://medicaid.gov/medicaid-chip-program-information/medicaid-and-chip-programinformation.html. 8 May 2016.
California Department of Health Care Services. Beneficiary utilization and provider participation 2015. http://www.dentical.ca.gov/WSI/Prov.jsp?fname=stakeholders_info. 8 May 2016.
California State Senate. SB-1005 health care coverage: immigrant status 2015. http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140SB105. 8 May 2016.
Acknowledgments
This study was supported by a planning grant funded by the DentaQuest Foundation in partnership with the Centers for Disease Control and Prevention’s National Community Committee through the Oral Health Initiative.
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Author Finlayson, Palomo-Zerfas, and Nunez-Alvarez received research grant support from the DentaQuest Foundation to conduct this study. Authors Velez and Ayala declare that they have no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Ana Palomo-Zerfas was previously with Vista Community Clinic.
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Velez, D., Palomo-Zerfas, A., Nunez-Alvarez, A. et al. Facilitators and Barriers to Dental Care Among Mexican Migrant Women and Their Families in North San Diego County. J Immigrant Minority Health 19, 1216–1226 (2017). https://doi.org/10.1007/s10903-016-0467-2
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DOI: https://doi.org/10.1007/s10903-016-0467-2