Semester Reflection
A. Objectives
My objective in doing this study was to learn about the availability and accessibility of quality health care to the Hispanic population, especially in the United States. This particular area is interesting to me because I am studying to become a doctor, and I would like to serve populations that do not have access to a high quality of care. This area of study is not offered as a formal class at my university, and I hoped that through this study, I would achieve a greater understanding of the barriers Hispanics face in the US in regards to health care, how to interact with Hispanic patients in my future career, and how this interaction could improve health outcomes.
B. What I knew (or what I thought I knew)
From my experiences overseas, I knew that health care is not as accessible in Latin America, largely due to the amount of poverty and lack of resources in those countries. I knew that there are barriers to access to quality health care for Hispanics in the US, which is largely related to language barriers and to poverty.
C. Questions
1. What are health disparities?
2. How does poverty affect health outcomes?
3. How do language barriers affect health outcomes?
4. What are the barriers to healthcare for Hispanics in the US?
5. How can health care providers in the US provide a higher quality of care for Hispanic patients?
6. How can health care providers interact effectively with their Hispanic patients?
D. Methods of research
Website:
1. I used search engines such as JSTOR, EBSCO, and Google Scholar to find both popular and research articles related to the questions stated above.
2. In order to find articles related to a specific topic and published around the same time as a specific study, I searched for articles cited in the References section of the
paper.
3. In order to find more recent studies related to an article, I inserted the title of the specific paper or study into Google Scholar and looked under the “Cited” link to find
articles that cited the study.
Volunteer:
I volunteered at a free health clinic in town and had the opportunity to shadow the medical Spanish interpreter and observe the interaction between the patient, health care provider, and interpreter.
E. Problems I encountered
Website:
I found very little information (in the form of a research study) on the health of indigenous populations in Latin America. There could be several reasons for this. First, the articles I read indicated that it was difficult to identify the indigenous population within the general population due to unclear parameters for identifying oneself as indigenous or an unwillingness to identify oneself as indigenous. For example, some may identify themselves as indigenous due to their lifestyle while others may do so because they speak an indigenous language. Second, it is difficult to perform research or surveys on indigenous populations that are not integrated into the general population because they are isolated and language and cultural barriers are present. This also may have occurred because I was searching for articles written in English. It is possible that there is more information on the health of indigenous populations, but the information is presented in a language other than English.
I had difficulty finding recent information on the topics I researched. Many of the articles and studies I found were published between 2001 and 2006. Even using the research methods stated above, which included looking at articles that had cited the articles I used, I was unable to find very recent research. In this field of research, I am not sure how frequently new information is published or how recent information must be in order for it to be credible.
Volunteering:
I found that my target population was not as easily accessible as I had anticipated. I volunteered at the same time as the Spanish interpreter, so I do not believe
that the majority of patients were coming at a different time. This may be due to the smaller Hispanic population when compared to large cities such as Chicago or New York or when compared with the southern part of the country, such as Florida or California.
F. What I learned
My research and the development of this website have broadened my understanding of the factors affecting health for both Hispanics and the American population in general. Factors popularly associated with poor health include unsafe drinking water, a lack of proper sanitation, and a lack of health insurance. However, the subject of health is much more complex. For example, I had never considered how social stratification could affect one’s health, but I learned that those living in poverty often do not have insurance, do not have time off to see the doctor, and may not have transportation to go to the doctor’s office. In addition, many living in poverty have labor-intensive jobs, or jobs in which they must move around throughout the day. In this case, injury or disability can severely affect livelihood. The most surprising factor affecting health that I researched was the neighborhood in which the individual lives. Neighborhood poverty levels are shown to influence health, and this is believed to be due to factors such as access to transportation, access to healthy food, social cohesion, and safety, which is linked to both stress and access to safe places to exercise. The effects of any factor on health, however, are intricately linked to many other factors. For example, even within neighborhoods there are differences in individual diet, activity or smoking and drinking habits. Through these examples of social determinants of health, I learned that the factors affecting health are so intertwined that it is difficult to analyze any one factor separately.
Before starting this project, I believed that Hispanics’ poor access to health care was mainly due to language. Again, I learned that this is an oversimplification. Hispanic health is influenced by language, but it is also influenced by socioeconomic status, immigration status, and cultural differences. As previously described, poverty can affect health through a variety of factors, and recent immigrants from Latin America are more likely to live in poverty. Immigration status can also affect health. Illegal immigrants cannot receive medical coverage through government programs, and legal immigrants cannot be enrolled in Medicaid until they have lived in the US for five years. This excludes a number of people who are here legally from obtaining necessary health care, and this can worsen their health and quality of life. In addition, many legal immigrants are afraid to use government assistance programs for fear that it will negatively affect their immigration status. These rumors must be combatted with knowledge. It is important to inform immigrants of their options in obtaining proper health care. Perhaps the most important aspect affecting Hispanic health is cultural differences. Studies have shown that even English-speaking Hispanic patients are less satisfied with the quality of patient-physician interaction, which shows that language is not the only factor affecting access to quality care. These cultural differences include views on health, the family’s role in the patient’s life, and cultural aspects that affect effective communication in a clinical setting. Understanding all of these aspects can improve patient cooperation and patient outcome.
Due to my career goals, cultural differences and interaction in a clinical setting was the most important aspect that I learned during the course of the semester. The most significant cultural differences that I encountered were the importance of family and the cultural rules regarding respect. The family plays a vital role in the life of an individual. Understanding this can help a health care worker to interact appropriately with the patient’s family members, who will likely be present during an office visit. The family will be key in obtaining patient compliance in treatment, and this will improve patient health. In addition, understanding social rules regarding respect, which causes individuals to refrain from disagreeing or asking questions, can enhance the patient-physician relationship. If the health care worker is informed, he or she can consider this cultural difference and encourage the asking of questions. This will improve patient compliance with treatment as well as patient outcome.
Finally, during the course of the semester, I read articles about integration of culturally appropriate health care and health interventions. While this has
shown to be effective in some circumstances, many factors influence success. One factor, which I had not previously considered, is the nationality of participants. While patients may all be considered Hispanic or Latino, they come from many different countries with many different customs. Therefore, trying to tailor a program to be “culturally appropriate” for all participants when participants come from different countries and cultures can be especially difficult. In addition, because an individual identifies themselves as Hispanic does not mean that they still hold to all of their traditional customs. Living in the United States, individuals will have varying degrees of acculturation. More acculturated individuals may not be willing to participate in a culturally tailored program, and that type of program may not benefit them as it would an individual who practices customs that are more traditional. In any clinical situation, it is important to assess the practices of each individual separated from cultural expectations or bias.
Clinical Aspect:
Over the course of the semester, I volunteered in a free health clinic, where I shadowed a trained medical interpreter. The clinical work that I performed during the course of the semester allowed me to understand patient-physician and patient-physician-interpreter interactions. After observing this interaction, I was able to use the skills I learned in interacting with patients of other nationalities that needed an interpreter. In addition, my clinical experience allowed me to experience the cultural
differences that I had learned about during my research, such as the strong belief regarding the interaction between the body and the mind or emotions. Seeing the real-world application of these concepts helped to reinforce them and helped me to understand their importance in practice.
My objective in doing this study was to learn about the availability and accessibility of quality health care to the Hispanic population, especially in the United States. This particular area is interesting to me because I am studying to become a doctor, and I would like to serve populations that do not have access to a high quality of care. This area of study is not offered as a formal class at my university, and I hoped that through this study, I would achieve a greater understanding of the barriers Hispanics face in the US in regards to health care, how to interact with Hispanic patients in my future career, and how this interaction could improve health outcomes.
B. What I knew (or what I thought I knew)
From my experiences overseas, I knew that health care is not as accessible in Latin America, largely due to the amount of poverty and lack of resources in those countries. I knew that there are barriers to access to quality health care for Hispanics in the US, which is largely related to language barriers and to poverty.
C. Questions
1. What are health disparities?
2. How does poverty affect health outcomes?
3. How do language barriers affect health outcomes?
4. What are the barriers to healthcare for Hispanics in the US?
5. How can health care providers in the US provide a higher quality of care for Hispanic patients?
6. How can health care providers interact effectively with their Hispanic patients?
D. Methods of research
Website:
1. I used search engines such as JSTOR, EBSCO, and Google Scholar to find both popular and research articles related to the questions stated above.
2. In order to find articles related to a specific topic and published around the same time as a specific study, I searched for articles cited in the References section of the
paper.
3. In order to find more recent studies related to an article, I inserted the title of the specific paper or study into Google Scholar and looked under the “Cited” link to find
articles that cited the study.
Volunteer:
I volunteered at a free health clinic in town and had the opportunity to shadow the medical Spanish interpreter and observe the interaction between the patient, health care provider, and interpreter.
E. Problems I encountered
Website:
I found very little information (in the form of a research study) on the health of indigenous populations in Latin America. There could be several reasons for this. First, the articles I read indicated that it was difficult to identify the indigenous population within the general population due to unclear parameters for identifying oneself as indigenous or an unwillingness to identify oneself as indigenous. For example, some may identify themselves as indigenous due to their lifestyle while others may do so because they speak an indigenous language. Second, it is difficult to perform research or surveys on indigenous populations that are not integrated into the general population because they are isolated and language and cultural barriers are present. This also may have occurred because I was searching for articles written in English. It is possible that there is more information on the health of indigenous populations, but the information is presented in a language other than English.
I had difficulty finding recent information on the topics I researched. Many of the articles and studies I found were published between 2001 and 2006. Even using the research methods stated above, which included looking at articles that had cited the articles I used, I was unable to find very recent research. In this field of research, I am not sure how frequently new information is published or how recent information must be in order for it to be credible.
Volunteering:
I found that my target population was not as easily accessible as I had anticipated. I volunteered at the same time as the Spanish interpreter, so I do not believe
that the majority of patients were coming at a different time. This may be due to the smaller Hispanic population when compared to large cities such as Chicago or New York or when compared with the southern part of the country, such as Florida or California.
F. What I learned
My research and the development of this website have broadened my understanding of the factors affecting health for both Hispanics and the American population in general. Factors popularly associated with poor health include unsafe drinking water, a lack of proper sanitation, and a lack of health insurance. However, the subject of health is much more complex. For example, I had never considered how social stratification could affect one’s health, but I learned that those living in poverty often do not have insurance, do not have time off to see the doctor, and may not have transportation to go to the doctor’s office. In addition, many living in poverty have labor-intensive jobs, or jobs in which they must move around throughout the day. In this case, injury or disability can severely affect livelihood. The most surprising factor affecting health that I researched was the neighborhood in which the individual lives. Neighborhood poverty levels are shown to influence health, and this is believed to be due to factors such as access to transportation, access to healthy food, social cohesion, and safety, which is linked to both stress and access to safe places to exercise. The effects of any factor on health, however, are intricately linked to many other factors. For example, even within neighborhoods there are differences in individual diet, activity or smoking and drinking habits. Through these examples of social determinants of health, I learned that the factors affecting health are so intertwined that it is difficult to analyze any one factor separately.
Before starting this project, I believed that Hispanics’ poor access to health care was mainly due to language. Again, I learned that this is an oversimplification. Hispanic health is influenced by language, but it is also influenced by socioeconomic status, immigration status, and cultural differences. As previously described, poverty can affect health through a variety of factors, and recent immigrants from Latin America are more likely to live in poverty. Immigration status can also affect health. Illegal immigrants cannot receive medical coverage through government programs, and legal immigrants cannot be enrolled in Medicaid until they have lived in the US for five years. This excludes a number of people who are here legally from obtaining necessary health care, and this can worsen their health and quality of life. In addition, many legal immigrants are afraid to use government assistance programs for fear that it will negatively affect their immigration status. These rumors must be combatted with knowledge. It is important to inform immigrants of their options in obtaining proper health care. Perhaps the most important aspect affecting Hispanic health is cultural differences. Studies have shown that even English-speaking Hispanic patients are less satisfied with the quality of patient-physician interaction, which shows that language is not the only factor affecting access to quality care. These cultural differences include views on health, the family’s role in the patient’s life, and cultural aspects that affect effective communication in a clinical setting. Understanding all of these aspects can improve patient cooperation and patient outcome.
Due to my career goals, cultural differences and interaction in a clinical setting was the most important aspect that I learned during the course of the semester. The most significant cultural differences that I encountered were the importance of family and the cultural rules regarding respect. The family plays a vital role in the life of an individual. Understanding this can help a health care worker to interact appropriately with the patient’s family members, who will likely be present during an office visit. The family will be key in obtaining patient compliance in treatment, and this will improve patient health. In addition, understanding social rules regarding respect, which causes individuals to refrain from disagreeing or asking questions, can enhance the patient-physician relationship. If the health care worker is informed, he or she can consider this cultural difference and encourage the asking of questions. This will improve patient compliance with treatment as well as patient outcome.
Finally, during the course of the semester, I read articles about integration of culturally appropriate health care and health interventions. While this has
shown to be effective in some circumstances, many factors influence success. One factor, which I had not previously considered, is the nationality of participants. While patients may all be considered Hispanic or Latino, they come from many different countries with many different customs. Therefore, trying to tailor a program to be “culturally appropriate” for all participants when participants come from different countries and cultures can be especially difficult. In addition, because an individual identifies themselves as Hispanic does not mean that they still hold to all of their traditional customs. Living in the United States, individuals will have varying degrees of acculturation. More acculturated individuals may not be willing to participate in a culturally tailored program, and that type of program may not benefit them as it would an individual who practices customs that are more traditional. In any clinical situation, it is important to assess the practices of each individual separated from cultural expectations or bias.
Clinical Aspect:
Over the course of the semester, I volunteered in a free health clinic, where I shadowed a trained medical interpreter. The clinical work that I performed during the course of the semester allowed me to understand patient-physician and patient-physician-interpreter interactions. After observing this interaction, I was able to use the skills I learned in interacting with patients of other nationalities that needed an interpreter. In addition, my clinical experience allowed me to experience the cultural
differences that I had learned about during my research, such as the strong belief regarding the interaction between the body and the mind or emotions. Seeing the real-world application of these concepts helped to reinforce them and helped me to understand their importance in practice.