Transcript TELEMEDICINE

Reported Health Related Issues Among
Rural Illinois Hispanic Adults:
Results of Surveys in Five Communities
APHA Annual Meeting
Nov. 8, 2006, Boston, MA
Martin Krebill-MacDowell, DrPH (corresponding author)
Sergio Cristancho, PhD
Marcela Garcés, MD, MSPH
Ben Mueller, MS
Karen Peters, DrPH
Project Export and National Center for Rural Health Professions
University of Illinois at Rockford
E-mail [email protected]
Project support provided in part from the NCMHD funded
Project EXPORT - Center of Excellence in Rural Health
University of Illinois at Rockford
Purpose/Objectives
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Identify priority health related issues
reported by rural Hispanic residents in the
five study communities
Describe major relationships observed
between the family income and time in the
US to health related indictors in the five rural
communities
Identify communication methods most
preferred for obtaining health information by
rural Hispanic residents in the five
communities
Introduction
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The number of rural
communities with in-migration of
Hispanic residents in the
Midwest has increased during
the last ten years. The
immigration, language, and
socioeconomic characteristics of
these new residents have major
implications for public health and
health services organizations.
Methods
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An IRB approved purposive (convenience sample)
written survey was conducted without recording of
any personal identifiers. A Participatory Action
Research (PAR) approach was used in
cooperation with Hispanic community leaders and
Hispanic Health Advisory Councils in 5 rural Illinois
towns. Surveys having a Flesch-Kincaid grade
level of 7.4 were provided in either Spanish or
English based on respondent choice.
Surveys were completed (n=720) at Hispanic
events in the five Illinois communities. Specifically
Rochelle (n=58), DeKalb (n=239), Effingham
(n=119), Danville (n=49), and Beardstown (n=255).
Overview of Respondents
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91.3% answered the Spanish version of the survey
50.2% of the respondents were aged 30 or less
Those in US < 10 years were of younger ages p <.01
(parametric and non-parametric tests used)
Years in US 1O years or less mean age = 30.45 (n=403)
versus More than 10 years in US
mean age = 38.63 (n=120)
Gender was about equally balanced between male and
female
About 70% of respondents gave their country of birth as
Mexico (about 10%, 75 gave no answer)
Of those giving length of time in US, about 77% had lived in
the US < 10 years (122 gave no answer)
About 62% were currently married (48 gave no answer)
About 80% had children (47 gave no answer)
Data Analyses
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Frequencies were run for all variables related to
health problems, health risk behaviors, health
care access, and sources of health information
Cross tabulation of the study variables was done
for income and length of residence categories
Family income was categorized as < $20,000 and
$20,000 or more ($20,000 is poverty level for a
family of four) 1
Length of residence in US was categorized as 10
year in the US or less and more than 10 years in
the US.
Chi-square statistics were used to compare
differences in patterns of study variables
between income and length of residence
categories. Two-sided chi-square of .05 was
considered a statistically significant difference
when income and residence categories were
compared.
Percent "Yes"
Results – Reported priority health issues
50
45
40
35
30
25
20
15
10
5
0
*
*
*
Dent al
Diabet es
Problems
Total
* High Blood
* High
Kidney
Pressure
Cholest erol
problems
Residence LE 10 yr
* Obesit y
*
* Ast hma
*
* Psychological
*
* Art hrit is
problems
Residence > 10 yr
Notes: Other problems mentioned: Arthritis 8.5%, Health Disease 6.5%, Cancer or Tumors 3.5%,
Infectious Diseases 2.6%, Brain Conditions (e.g. stroke; epilepsy)2.2%, Physical Disability 2.1%, and
Misc. Other 10.1%
* indicates p < .05 difference in pattern between residency subgroups
Summary – health problems
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Dental problems were highest reported
problem in both length of residence
categories (39% if < 10 years, 47.1% if >
10 years and 40.6% overall
Reporting of diabetes and kidney problems
did not show statistically significant
differences between residence categories.
High blood pressure, high cholesterol,
obesity, asthma, psychological problems, and
arthritis were the next most commonly
reported problems – all were significantly
higher among those respondents residing in
the US 10 years or more.
Logistic regression results:
Prediction of health problems - effects of length
of residence, age and years of education
R2 is quite low for prediction of all problems and estimated relative risk due to
predictors is consistently low. For all problems except dental problems,
residing in US 10 or more years was a predictor of having the problem with
the effects of age and years of education held constant.
Results – Reported behavioral issues
influencing health
12
Percent "Yes"
10
8
6
4
2
0
Lack of physical
activity
Total
Smoking/Tobacco
Use
Alcohol Use or Drug
Use
Residence < 10 yr
Violence or
Domestic Abuse
Residence > 10 yr
No statistically significant differences occurred between
residency subgroups
Results – Health Related Behaviors
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Percentage reporting adverse health
related behaviors was less than
10% ranging from 9.6% for lack of
physical activity to 1.7% for
domestic violence.
No statistically significant
differences were observed between
length of residence categories for
health related behaviors.
Results - Reported positive responses
about health care
60
Percent "Yes"
50
40
30
20
10
0
Very satisfied or satisfied
Total
Residence < 10 yr
No problems getting care
Residence > 10 yr
No statistically significant differences occurred
between residency subgroups
Results - Reported problem issues
regarding health care
50
*
45
Percent "Yes"
40
35
30
25
20
15
*
10
5
0
Is concerned
that language
issues w ill
interfer w ith
getting correct
medical care
* Lack of health
insurance is a
problem
Total
Is concerned
that providers
w ill share
information w ith
health authorities
about
immigration
status
Have
transportation
problem to get
care
Feels
discrimianted
against w hen
seeks health
care
Residence < 10 yr
Can not get time
off w ork to get
care
Have problem * Concerned that
w ith child care
cultural beliefs
to get medical
and traditions
care
are not
understood
Residence > 10 yr
* Indicates p <.05 difference in pattern between residency subgroups
Results – Health care issues
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Percentage reporting adverse health
related behaviors was less than
10% ranging from 9.6% for lack of
physical activity to 1.7% for
domestic violence.
No statistically significant
differences were observed between
length of residence categories for
health related behaviors
Results – Preferences for obtaining
health related information
70
*
Percent "Yes"
60
50
40
30
20
10
0
* In Spanish at
schools, churches
and community
centers
In Spanish on TV
or Radio
Total
In mail at home
Hospital and
community health
organizations
Residence < 10 yr
Magazines and
new spapers
At English Lang.
classes
From home visits
Residence > 10 yr
* indicates p <.05 difference in pattern between residency subgroups
Results-Health information Preferences
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Preference for health information being conveyed
in Spanish at schools, churches, and community
centers was consistently over 60% in both
residence categories with a slight decline if
residence was > 10 years, p < .05.
Interest in other methods of communicating
health information were about the same (about
25% to 32% overall would had interest in getting
health information that way. No significant
differences were observed between length of
residence categories.
Interest in home visits was the lowest at 18%
overall with no difference observed between
length of residence categories.
Conclusions / Discussion
•
Dental care access, language impact on
health care delivered, and ability to obtain
health insurance are priority health issues
among those surveyed
•
Those having longer residence in the
country experiencing somewhat less
concern about these issues than recent
immigrants
•
A strong preference for health information
to be presented in community oriented
Hispanic health organizations instead of
conventional health promotion methods
(written or media) is indicated
Conclusions - continued
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Many chronic health conditions or chronic
disease risk factors are reported more
commonly among those residing in the US > 10
years than those in the US < 10 years
Adjusting for age and education, length of time
in the US of >10 years is a predictor of these
health problems or risk factors.
Community health organizations should seek to
reduce adoption of US lifestyle and nutrition
practices that increase risk of chronic conditions
and risks
Attention to language issues and reduction of
barriers to health care associated with lack of a
payment mechanism should be addressed.
Discussion
Variation between income groups was also
examined but is not presented due to space
limitations. Few differences were observed in
study variables between the two income
categories < $20,000 (76.6%) and
> $20,000 (23.4%); however, only 427 of the 720
survey respondents reported family income
which limits the usefulness of comparisons
between income categories.
 Results of the comparisons between income
categories are available upon request from the
corresponding author.
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Discussion of Limitations
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The survey is based on self reporting with
no clinical verification of health conditions
or risk factors
Social response bias may have influence
reporting of health behaviors and
reported percents of health risk behaviors
may actually be higher
Samples in each community were not
random samples of all Hispanics residing
in the community and were thus
“volunteers” who chose to come to
community meetings/events and
participate in the survey.