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Improving Access to Health Care: Evaluation of the Montgomery County Migrant Hispanic Coalition

Improving Access to Health Care: Evaluation of the Montgomery County Migrant Hispanic Coalition. Mar í a de Lourdes G ó mez, MPH University of Kentucky College of Public Health. Purpose of the Study. The purpose of this study is to evaluate:

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Improving Access to Health Care: Evaluation of the Montgomery County Migrant Hispanic Coalition

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  1. Improving Access to Health Care: Evaluation of the Montgomery County Migrant Hispanic Coalition María de Lourdes Gómez, MPH University of Kentucky College of Public Health

  2. Purpose of the Study The purpose of this study is to evaluate: • Access to health care for the Hispanic population in Montgomery County, Kentucky • The promotion of cultural and linguistic competency among health care providers who serve this population

  3. Part of a four-year project funded by the United States Department of Agriculture (2001-2005) “Coalitions to improve health access for Hispanics in rural Kentucky and Tennessee” Coalition approach Background

  4. Montgomery County Health Department Montgomery County UK Cooperative Extension Service Mary Chiles Hospital Rural Family Care Clinic (Federally funded Rural Health Clinic) Montgomery County Public School System Chamber of Commerce Industrial Authority City and County Government Northeast AHEC (Area Health Education Center) Law Enforcement Faith Community Coalition Membership

  5. Overview of the LiteratureCoalition Evaluation • The literature of coalition development and evaluation is largely descriptive • Presents an array of methodologies, measures and case studies applied for researchers and practitioners • One study reported that little empirical evidence existed supporting effectiveness (Butterfoss et al., 1993) • Another study emphasized the effectiveness of coalitions by presenting reports of coalition processes and outcomes; this data is used to provide feed-back to coalitions (Francisco et al., 1993) • Evaluation plays a key role in developing and sustaining coalitions. (Butterfoss & Francisco, 2004)

  6. Health Problem • Agriculture Industry employs between 3 and 5 migrant farmworkers (Magana & Hovey, 2003) • Migrant farmworkers are considered a vulnerable population • Many do not have access to either health care or health insurance. Lack of preventive care is also noted • Language and cultural barriers, immigration status, financial issues

  7. Overview of the LiteratureCoalition Evaluation Model Level 1: Processes that sustain/renew coalition functioning Level 2: Programs/activities Level 3: Changes in health access/status or the community Butterfoss & Francisco (2004)

  8. Study Design Two types of study were conducted for the evaluation: • New data collected from self-administered questionnaire among coalition members • Data available from administrative records of coalition meetings and programs in the community level were examined (historical records)

  9. Sample • Self-administered survey: Convenience sample of 35 members of the Migrant coalition • Administrative records included: Coalition minutes, events, meetings, grant proposals, agendas, newspapers, items produced by the coalition such as brochures, flyers, and a scrapbook • Counting of health services provided by the health department from years 2001-2005

  10. Montgomery County Migrant Hispanic CoalitionFall 2003

  11. Data collection • Thirty-five questionnaires were mailed to coalition members. • The Chair of the Migrant Coalition provided a list with the names of members. • The survey was designed shaping key measures and included questions defined in five parts (59 questions): • Perception of access to health care (3 questions) • Impact in the community (9 questions) • Coalition functioning: Ten domains were considered. Purpose, structure, leadership, roles and responsibilities, communication, decision making, conflicts, membership, diversity, and involvement (33 questions) • The role of the coalition as an organization (10 questions) • Demographics (4 questions)

  12. Data collection • Administrative records were provided by the Community Specialist Interpreter from the health department • Database of health services were provided by the Nurse Supervisor from the health department • Documentation was classified in chronological order • Documentation was categorized in two domains: 1) Access to health care and 2) Cultural and Linguistic competency • Database of health services was summarized in two categories: 1) Hispanic and 2) Non-Hispanic health services

  13. Evaluation /MeasuresButterfoss and Francisco (2004) model

  14. Data Analysis 1. Survey: • The data were entered and verified using EPI-Info Version 6.0 • Descriptive statistics were run using SAS version 9.1 2. Documentation: • Qualitative methods were used to review and assess the existing documentation in order to assign the correspondent domain/measures: Health access and Cultural-Linguistic Competency improvement.

  15. Results 15 out of 35 surveys were returned. Response rate of 42.8% • Gender: 12 females, 2 males. 1 missing • Race: 10 White, 4 Latinos. 1 missing

  16. Results Members assessment of access to health care. They reported main barriers and health disparities face by the Hispanic community

  17. Results Impact of the Coalition • Nearly all respondents (93%) agreed the coalition has made contributions to the community and has provided cultural awareness for serving Hispanic residents. • Almost three quarters (73%) felt the coalition has improved their cultural competency and they have an adequate level of cultural competency; as the self-reported examples: • Referred them to the proper agencies in the community and helping them with translations. • Participated in focus group to understand the barriers faced by Hispanics. • Immersion program, Spanish classes and reading Spanish materials. • Spanish Language • Community has become more aware of other cultures. • Understanding of immigration laws. Better knowledge of farmworkers needs and Mexican culture.

  18. Results Impact of the coalition Most significant outreach program 1st Health Fairs 2nd Health Education 3rd Screening tests 4th ESL (English as a Second Language) classes 5th HANDS (Health Access Nurturing Developing Services) • 93% of coalition members felt confident that the coalition has been personally helpful to them • 85% felt pleased with the coalition effort • 40% of coalition members said they were not bilingual at all

  19. ResultsHealth Access Programs • Four Health Fairs • Fit Kids Day camp targeting immunizations and screening tests for children • Issue of Health Directory in Spanish • Healthy Kentucky grant awarded for prevention services • Flyers in Spanish in the community promoting health services and immunizations • Joint Meetings: Research materials, funding opportunities • HRSA Application grants • Social Services as the benevolent fund to help Hispanic families

  20. Results Cultural Linguistic Competency • Interpreter hired at the health department • Spanish immersion program in Morelia, Mexico; 2 nurses from the Montgomery County Health Department • Spanish Language Training for health providers • Cultural competency trainings • Cultural Competency conferences sponsored by the Migrant Coalition • Medical Interpretation conferences • Cultural Simulation Exercise “Reality Workshop” • Spanish classes at Morehead State University • ESL (English as a Second Language) classes – Adult Training Education (school system)

  21. Cultural Competency Training

  22. Results Community Level: • Spanish teachers hired by the Montgomery County Public School System for each elementary school year 2005-2006 (3) • ESL (English as a Second Language) through the Adult Education training (school system) • Screening health services provided at the outreach level Health Fairs: 255 over the 4 years.

  23. Limitations • The survey response was small (n=15) • Possible bias of the general assessment of coalition development. Responses may be from the more involved members • Small number of responses do not allow exploring the relationship between variables: race, age, gender, representation • Data of medical records or Hispanic Epidemiological databases were not available • Data of number of health services is only from the health Department. Health services provided by the Mary Chiles Hospital and the Rural Family Health Clinic were not available. Hence, the results in health services may be higher • Accurate demographic information of Hispanic population was not available • Evaluation conducted only for the Montgomery Coalition one of the 3 coalitions participating in the USDA grant. Simultaneous evaluation of the three coalitions may provide comparisons and enhance the process and feed-back

  24. Conclusions • Three levels of measures were applied to evaluate 1) Processes of coalition functioning 2) Processes of program activities/outcomes 3) Changes in access to health services • Findings suggest that the Migrant Coalition has accomplished favorable outcomes while serving the target population. • Significant progress has been made to the mission • Coalition members feel the work of the coalition is very successful and they are engaged in strategic planning, addressing health needs, and gaps in primary care. • The Migrant Coalition has matured and developed and is ready for the continuation of the project if funded by HRSA in May 2006, Rural Health Outreach Program. • Promotora program is one of the major outcomes to be implemented in the near future. • The implementation of health access activities, social programs, quality of care, and bilingual environment reported serve as evidence of the effectiveness of the Montgomery County Migrant Hispanic Coalition.

  25. Implications for Public Health • Collaborative efforts of community partners and academia make possible significant changes in health problems through outreach work • The model of this coalition can serve as a model for other rural communities with increasing Hispanic workers • Cooperative Extension is an important collaborator with Public Health agencies developing a unique model of partnership • Health organizations are facing new challenges as language and cultural issues to provide quality of health services • There is a need for addressing health access for underserved and vulnerable populations. There are about 44 million uninsured people in the U.S • The Hispanic population is growing and the media age is relatively young, 25.9 years, representing a big impact in the work force, public health system and managed of health care • Health status indicators and health survey data are needed for new approaches of interventions and policies at the community level

  26. Recommendations • Developing strategies to bring more health practitioners to the coalition, for example the medical community in the area • Strategies for recruitment Latinos. • Develop Hispanic Epidemiological database, for example Injuries • Provide orientation for new members. • Promote fundraising • Continue assessment of the Hispanic health needs in Montgomery County (qualitative and quantitative studies)

  27. Acknowledgements • Funding provided by the Southeast Center Center for Agricultural Health and Injury Prevention, College of Public Health University of Kentucky through grant from USDA (agreement number 2001-36201-11289) and NIOSH/CDC

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