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Journal of Immigrant and Minority Health

Published in:

01-08-2017 | Original Paper

Immigrant Health in Rural Maryland: A Qualitative Study of Major Barriers to Health Care Access

Authors: Thurka Sangaramoorthy, Emilia M. Guevara

Published in: Journal of Immigrant and Minority Health | Issue 4/2017

Abstract

Immigration to rural areas in new receiving communities like Maryland’s Eastern Shore is growing. Despite a rapid rise in immigration and diminishing health system resources, little attention has been focused on barriers to health care access in this region for immigrants. A total of 33 in-depth key informant interviews with providers and immigrants were conducted. Qualitative analysis employing a constant comparison approach was used to explore emergent themes related to barriers to health care access for a growing immigrant population. Participants perceived limited health care resources, lack of health insurance coverage, high health expenditures, language barriers, and non-citizenship status as barriers to immigrants’ access of health care. Findings imply that immigrants living and working on the rural Eastern Shore face serious barriers to health care access. Additional work on immigrant health in rural areas and the impacts of immigration to rural health systems are needed.

Jensen L. New immigrant settlements in rural America: problems, prospects, and policies. Available from: http://scholars.unh.edu/cgi/viewcontent.cgi?article=1016&context=carsey. Accessed 12 Aug 2015.

Martin P, Fix M, Taylor JE. The new rural poverty: agriculture and immigration in California. Washington, DC: The Urban Institute Press; 2006.

Baker PL, Hotek DR. Perhaps a blessing: skills and contributions of recent mexican immigrants in the rural Midwest. Hispanic J Behav Sci. 2003;25(4):448–68.CrossRef

Cravey AJ. The changing south: Latino labor and poultry production in rural north carolina. Southeast Geographer. 1997;37(2):295–300.CrossRef

Ricketts TC. The changing nature of rural health care. Annu Rev Public Health. 2000;21:639–57.CrossRefPubMed

Hunsaker M, Kantayya VS. Building a sustainable rural health system in the era of health reform. Dis Mon. 2010;56:698–705.CrossRefPubMed

Arcury TA, Quandt SA. Delivery of health services to migrant and seasonal farmworkers. Annu Rev Public Health. 2007;28:345–63.CrossRefPubMed

Heyman JM, Núñez GG, Talavera V. Healthcare access and barriers for unauthorized immigrants in El Paso County, Texas. Fam Community Health. 2009;32(1):4–21.CrossRefPubMed

Casey MM, Blewett LA, Call KT. Providing health care to Latino immigrants: community-based efforts in the rural Midwest. Am J Public Health. 2004;94(10):1709–11.CrossRefPubMedPubMedCentral

10.

Cristancho 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.CrossRefPubMed

11.

US Census Bureau: American FactFinder 2000, 2010; Maryland, 2015. Available at: http://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml. Accessed 12 Aug 2015.

12.

Maryland Department of Health and Mental Hygiene: 2010 primary care needs assessment. Baltimore, MD, 2011. Available at: http://phpa.dhmh.maryland.gov/IDEHASharedDocuments/PCO_Needs_Assessment_11_16_11.pdf. Accessed 12 Aug 2015.

13.

US Department of Health and Human Services: find shortage areas: HPSA by State & County, 2015. Available at: http://hpsafind.hrsa.gov/. Accessed 12 Aug 2015.

14.

US Department of Health and Human Services: medically underserved areas/populations, 2015. Available at: http://www.hrsa.gov/shortage/mua/. Accessed 12 Aug 2015.

15.

US Department of Health and Human Services. The affordable care act—what it means for rural america. Available at: http://www.hhs.gov/healthcare/facts/factsheets/2013/09/rural09202013.html. Accessed 1 Sept 2015.

16.

Kaiser Family Foundation: the affordable care act and insurance coverage in rural areas. Available at: http://kff.org/uninsured/issue-brief/the-affordable-care-act-and-insurance-coverage-in-rural-areas/. Accessed 15 Sept 2015.

17.

Kaiser Family Foundation: how will the uninsured in Maryland fare under the affordable care act? Available at: http://kff.org/health-reform/fact-sheet/state-profiles-uninsured-under-aca-maryland/. Accessed 13 Aug 2015.

18.

Zuckerman S, Waidmann TA, Lawton E. Undocumented immigrants, left out of health reform, likely to continue to grow as share of the uninsured. Health Aff. 2011;30(10):1997–2004.CrossRef

19.

Glaser BG, Strauss A. The discovery of grounded theory: strategies for qualitative research. Chicago: Aldine; 1967.

20.

Miles MB, Huberman AM. Qualitative data analysis: an expanded sourcebook. 2nd ed. Los Angeles: Sage Publications; 1994.

21.

Glaser BG. Emergence vs. forcing: basics of grounded theory analysis. Mill Valley: Sociology Press; 1992.

22.

Bazeley P, Jackson K. Qualitative data analysis with NVivo. Thousand Oaks: Sage Publications; 2013.

23.

Corbin J, Strauss A. Basics of qualitative research: techniques and procedures for developing grounded theory. 3rd ed. Thousand Oaks: Sage; 2008.CrossRef

24.

Ricketts TC. Rural health in the United States. New York: Oxford University Press; 1999.

25.

Hartley D. Rural health disparities, population health, and rural culture. Am J Public Health. 2004;94(10):1675–8.CrossRefPubMedPubMedCentral

26.

Bolin JN, Bellamy GR, Ferdinand AO, Vuong AM, Kash BA, Schulze A, Helduser JW. Rural healthy people 2020: new decade same challenges. J Rural Health. 2015;31(3):326–33.CrossRefPubMed

27.

Hart LG, Salsberg E, Philiips DM, Lishner DM. Rural health care providers in the United States. J Rural Health. 2002;18(Suppl):211–32.CrossRefPubMed

28.

Daniels ZM, Vanleit BJ, Skipper BJ, Sanders ML, Rhyne RL. Factors in recruiting and retaining health professional for rural practice. J Rural Health. 2007;23(1):62–71.CrossRefPubMed

29.

Jones CA, Parker TS, Ahearn M, Mishra AK, Variyam JN. Health status and health care access of farm and rural populations. Available at: http://www.ers.usda.gov/media/155453/eib57_1_.pdf. Accessed 13 Aug 2015.

30.

Ziller EC, Lenardson JD, Coburn AF. Health care access and use among the rural uninsured. J Health Care Poor Underserved. 2012;23(3):1327–45.CrossRefPubMed

31.

Douthit N, Kiv S, Dwolatzky T, Biswas S. Exposing some important barriers to health care access in the rural USA. Public Health. 2015;129(6):611–20.CrossRefPubMed

32.

Gamm LD, Hutchison LL, Dabney BJ, Dorsey, AM. Rural healthy people 2010: a companion document to healthy people 2010. Available at: http://sph.tamhsc.edu/srhrc/docs/rhp-2010-volume2.pdf. Accessed 13 Aug 2015.

33.

Cunningham P, Banker M, Artiga S, Tolbert J. Health coverage and access to care for Hispanics in “new growth communities” and “major Hispanic centers.” Available at: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7551.pdf. Accessed 13 Aug 2015.

34.

Derose KP, Escarce JJ, Lurie N. Immigrants and health care: sources of vulnerability. Health Aff. 2007;26(5):1258–68.CrossRef

35.

US Department of Health and Human Services. The affordable care act: coverage implications and issues for immigrant families. Available at: http://aspe.hhs.gov/hsp/11/ImmigrantAccess/Coverage/ib.pdf. Accessed 13 Aug 2015.

36.

Jacobs EA, Shepard DS, Suaya JA, Stone E-L. Overcoming language barriers in health care: costs and benefits of interpreter services. Am J Public Health. 2004;94(5):866–9.CrossRefPubMedPubMedCentral

37.

Ku L, Flores G. Pay now or pay later: providing interpreter services in health care. Health Aff. 2005;24(2):435–44.CrossRef

38.

Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res. 2007;42(2):727–54.CrossRefPubMedPubMedCentral

39.

Rhodes SD, Mann L, Simán FM, Song E, Alonzo J, Downs M, Lawlor E, Martinez O, Sun CJ, O’Brien MC, Reboussin BA, Hall MA. The impact of local immigration enforcement policies on the health of immigrant Hispanics/Latinos in the United States. Am J Public Health. 2015;105(2):329–37.CrossRefPubMedPubMedCentral

40.

Martinez O, Wu E, Sandfort T, Dodge B, Carballo-Dieguez A, Pinto R, Rhodes S, Moya E, Chavez-Baray S. Evaluating the impact of immigration policies on health status among undocumented immigrants: a systematic review. J Immigr Minor Health. 2013;17(3):1–24.

41.

Fuentes-Afflick E, Hessol NA. Immigration status and use of health services among Latina women in the San Francisco bay area. J Women’s Health. 2009;18(8):1275–80.CrossRef

42.

Toomey RB, Umaña-Taylor AJ, Williams DR, Harvey-Mendoza E, Jahromi LB, Updegraff KA. Impact of Arizona’s SB 1070 immigration law on utilization of health care and public assistance among Mexican-origin adolescent mothers and their mother figures. Am J Public Health. 2014;104(Suppl):S28–34.CrossRefPubMedPubMedCentral

43.

Ortega AN, Fang H, Perez VH, Rizzo JA, Carter-Pokras O, Wallace SP, Gelberg L. Health care access, use of services, and experiences among undocumented Mexicans and other Latinos. Arch Intern Med. 2007;167(21):2354–60.CrossRefPubMed

44.

Campbell RM, Klei AG, Hodges BD, Fisman D, Kitto S. A comparison of health access between permanent residents, undocumented immigrants and refugee claimants in Toronto. Can J Immigr Minor Health. 2014;16(1):165–76.CrossRefPubMed

45.

Bustamante AV, Fang H, Garza J, Carter-Pokras O, Wallace SP, Rizzo JA, Ortega AN. Variations in healthcare access and utilization among Mexican immigrants: the role of documentation status. J Immigr Minor Health. 2012;14(1):146–55.CrossRef

46.

Maldonado CZ, Rodriguez RM, Torres JR, Flores YS, Lovato LM. Fear of discovery among Latino immigrants presenting to the emergency department. Acad Emerg Med. 2013;20(2):155–61.CrossRefPubMed

47.

Malat J. Social distance and patients’ rating of healthcare providers. J Health Soc Behav. 2001;42(2):360–72.CrossRefPubMed

48.

Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA. Gender differences in the utilization of health care services. J Fam Pract. 2000;49(2):147–52.PubMed

49.

US Census Bureau: State and County quickfacts. Available at: http://quickfacts.census.gov/qfd/states/24000.html. Accessed 14 Aug 2015.

Title: Immigrant Health in Rural Maryland: A Qualitative Study of Major Barriers to Health Care Access
Authors: Thurka Sangaramoorthy
Emilia M. Guevara
Publication date: 01-08-2017
Publisher: Springer US
Published in: Journal of Immigrant and Minority Health / Issue 4/2017
Print ISSN: 1557-1912
Electronic ISSN: 1557-1920
DOI: https://doi.org/10.1007/s10903-016-0417-z

At a glance: The STEP trials

Springer Medicine

Immigrant Health in Rural Maryland: A Qualitative Study of Major Barriers to Health Care Access

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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