4. Accessibility of Services:
What Barriers Impede Access Of Minority Immigrant Women To Health Services? To What Extent Were Access Barriers Reduced Or Removed?
In 2002, as part of the first health survey with Hispanic women (HS I), we asked a number of questions about women's experiences with the health care system (reported in more detail in an earlier section IV, Cancer Screening), which yielded information about some of the barriers women faced. Barriers also were identified by Hispanic women during in-depth interviews, by service providers during two focus groups, and by Hispanic LHP/PR s in a project-end focus group.
The table below summarizes the barriers to access identified by Hispanic women (Health Survey I; in-depth interviews); by Hispanic LHP/PRs (focus group); and by service providers (focus groups). Table 60 below is followed by a more detailed description of barriers to access as experienced by Hispanic women themselves, since there is little available literature from this perspective, and includes related findings from surveys of CCHC staff.
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Different data sources confirm that some barriers were perceived by all; for example, all respondent groups identified language and communication as a barrier. Other barriers, such as racism and discrimination, were identified by Hispanic respondents only (women interviewed in-depth, women surveyed, LHP/PRs); and some barriers, such as service fragmentation, lack of service resources, were only expressed by service providers.
The health care system as experienced by Hispanic women
LHP/PRs conducted 32 in-depth interviews with Hispanic women. Interviews were transcribed and analysed.
Language
Language is the main barrier identified by almost all of the women interviewed. It acts as a barrier to health and medical services in general, and to receiving cancer screening information and services in particular. The lack of doctors who speak Spanish, and the lack of services in Spanish, was mentioned as a barrier by several women. Not speaking English keeps people from finding out what services are available. In the case of emergencies, it is especially difficult to communicate when one only has a little bit of language. Several women provided examples of how not understanding the language can lead to serious miscommunication between doctor and patient.
Relationship with doctors
Several women noted that speaking one's language is insufficient: there are doctors who do not communicate well, even though speak Spanish; or who speak some Spanish, but don't share the background of the patient, and don't take the patient seriously. A number of women spoke of the importance of having a trusting, open relationship with good communication with one's doctor, and how difficult this is to establish in Canada with doctors one does not know. Many mention that doctors seem to be in a great hurry in Canada; don't spend very much time with patients; aren't able or interested in establishing a trusting relationship with them. Several women mention an unwillingness to bother the doctor with problems; or a habit of putting one's own health last, and not going to the doctor unless one is very ill. A couple emphasized that one shouldn't bother the doctor with minor things.
Information about the health system and how to navigate it
Not knowing anyone when one first arrives in Canada, can become a barrier to accessing services. Several women identified not knowing how to find a doctor, not knowing how to get a recommendation for a doctor, or not understanding the medical services system, especially when they first arrived in Canada. Some were using walk-in clinics, because they thought in Canada this was how the system worked.
Racism and discrimination
Many women identified discrimination and racism, as a persistent, if sometimes subtle, barrier to accessing services. Some particularly mention one group of service providers more than another, e.g., having felt discriminated against by front-line receptionists, but not by the doctors. Others had negative experiences with hospital nurses, doctors, and others are not quite sure, if they were discriminated against or not, just feeling bad about the way they had been treated.
Positive experiences with the health care system
Many women also spoke of positive experiences with medical care, once they were able to access the services. Some talk of health care professionals making a special effort to overcome the language barrier. Others have found Spanish-speaking professionals or interpreters who have helped them to access services; or, with the help of friends and other community members, have found information about the system or about their own health that has helped them.
Access and barriers to health information from the perspective of Hispanic women
31 out of 32 women interviewed spoke about access to health information. They described the various 'vehicles' through which information reached them; the health topics on which they had information, and provided the names of institutions and organizations that were the source of health information. Women also commented about why they might pay attention to some of the health information that they receive, and not to other; and also, what responsibility they felt about becoming informed, and what motivated them to seek out health information.
Again, having information only available in English was mentioned most frequently as a barrier. Women had received information through the following channels: written information in form of brochures, pamphlets, magazine and newspaper articles; the internet; television and radio; they had obtained information from doctors, chcs, ESL/FSL classes, settlement agencies, social services, hospitals, LAZO and MSCS; a great deal of information was transferred by 'word of mouth' through family members and friends. They suggested the following to improve access to health information:
- That the information be in Spanish
- That the information be easy to take home if it is in writing; or that it be sent to one's home
- Opportunity to speak calmly, with time, and with a trusted person, who would have the time and the ability to listen and to understand, especially about topics that one may be shy to talk about with strangers
- Having someone who understands the topic well with whom to talk about the topic; even if it is not an emergency at that particular moment, would be ideal- and not one of the very busy doctors or other professionals, whom they are reluctant to bother with simple questions.
- People are more interested in the topic if it is linked to what is happening to one at this moment; and if it is provided at a time when the person has the time to listen and be receptive to the information.
Identifying changes to service access: Was there an increase of Hispanic or ethnoracial minority women accessing services at CCHC, other CHCs, or OBSP?
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- The numbers of Hispanic clients who have accessed CCHC for primary care services and community program services are very small. Although the increases in terms of percentage in service use seem very large, the actual numbers indicate that there has been little or no change in service use. Many factors might have influenced these results, e.g., closing of physician practices; women’s lack of understanding about the role of nurse practitioners in primary care; challenges with data collection; difficulties for front-line staff to refer women appropriately; and doubts by the LHP/PRs about how welcoming CCHC might be towards minorities. As well, LHP/PRs identified the need for diversifying staff not only for communication purposes but to demonstrate to communities that their members were welcome. CCHC has begun to add diverse staff, which will assist in reducing barriers.
- Hispanic women in the post-intervention surveys clearly indicated an increase in their knowledge about CHCs, which can be attributed directly to the work of the LHPs. The self-reported likelihood that they will try to access a CHC for primary care and community services had increased. In the post intervention health survey (HS II), 22 Spanish speaking women indicated that they will access CCHC in the future. A small increase in the use of services by other linguistic minorities at CCHC is a promising trend, which requires more careful examination. CCHC may wish to continue to collect client data more rigorously to document client use of services, especially using the Census categories that were introduced as a result of the project’s involvement. Given the high success of OBSP in this regard (they were able to collect data on all variables from over 99% of their clients), CCHC might want to review how OBSP front-line staff presented the data-collection forms to clients.
- OBSP client data indicates that they are serving immigrant women proportionately to the Ottawa population, although they are not yet serving the non-White, non-English/French speaking in numbers that reflect the current Ottawa-area population. Since we were unable to collect data in 2001, changes cannot be tracked.
