Idaho Partnership for Hispanic Health Key Informant Analysis January 2007
This publication was supported by Grant No. 5 R24 MD001711-02 from the National Center on Minority Health and Health Disparities within the National Institutes of Health.
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Report of analysis of Key Informant Interviews January 2007 Idaho Partnership for Hispanic Health
Jennifer Crowe
“When they come from Mexico they get here okay and things get worse for them here…coming over here affects their health.” (KI 12)
Background
The following report summarizes 32 key informant interviews carried out in the Fall of 2006 with individuals from Idaho who are considered to have important insights, expertise and experience with the health issues that face Hispanics in Idaho. The key informants were recommended by Community Advisory Board (CAB) members for the Idaho Partnership for Hispanic Health (IPHH). This report is a synthesis of the data collected to provide insight into the following research questions: 1. What are the main health concerns for the Hispanici population in Idaho? 2. What elements are important to understand about those concerns and how people think about them? Data are summarized and quotes are used to help clarify specific points and to remain true to the words used by participants where possible. Footnotes are included to allow for comments from the researcher and to point out information that is important to understanding the data and its future use or the data in relation to the previously reported focus groups. Table 1 provides basic demographic information about the key informants and figures 1-12 provide this information in graphical format.
Methods
Key informants (KIs) were contacted individually and an interview location was agreed upon by the interviewer and the KI. Each potential KI was assigned a number even though eventually they may not have participated. KIs were asked for permission to tape record the interviews. In the case that the KI did not want to be tape recorded, the interviewer simply took notes on the discussion. The recorded interviews were transcribed verbatim mistakes and all and then translated (when necessary) into English. The transcripts were then read and “coded” (labels were put on pieces of the transcript that talked about a particular topic, for example, “diabetes.”) These “coded” segments were then read and grouped together according to their relationships. Then, they were examined for the specific information and overall themes that are presented in this report.
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Results and Discussion Health Concerns and Problems
KIs were asked to name the top three major Hispanic health conditions or problems of concern in Southwestern Idaho. The results of that question can be seen in Table 2. Those topics are described below listed in order of total times mentioned by KIs as a top three major condition or problem. Cost of Care, Lack of Insurance and Inability to Access Care The cost of healthcare, the lack of insurance, and access to care were each named in the top three health conditions or problems by 9, 5 and 4 speakers respectively. As one KI put it, the lack of economic resources for care can limit the ability to access help and can also limit the willingness of providers to treat patients.
"The other [issue] is lack of funds, financial. If they have any kind of resource, monetary resource, I think that they would feel more confident in asking. But not only [are] they are lacking the information, but they also are lacking funds, money, which is a big problem..." (KI 39) "Many are not well attended because the providers think these people do not have money or insurance. They make them wait until there is an open appointment." (KI 24) "For example, my husband, the reason that we are not in his medical insurance plan is because it would cost $600 for the whole family and that’s very expensive. Then, something that is more accessible. I know that we’re not the only ones in this same situation, there are many of people as well. If we pay $600 a month for medical insurance we have to work more and limit ourselves." (KI 28) "…but my relatives that do not have medical insurance and are sick have a hard time getting medical attention. They can go to the clinic for simple things, but if they need to see a specialist or if they want to have some analysis done, they have to think twice, because they would have to pay and it can be very expensive." (KI 28)
Access to care was named as a “top three” concern by four KIs. For the most part, access is restricted by cost and lack of insurance, but it can also be restricted due to barriers such as language and culture. Diabetes More KIs talked about diabetes than any other health concern. There were a total of 19 who talked about it and out of those, 17 named it in their “top three.” Diabetes was talked about as a current problem, a concern for the future and something we do not know enough about. Unfortunately, few of the KIs talked about diabetes in any detail. Several KIs said that the Hispanic community does not understand enough about diabetes or its possible negative outcome. Page 3 of 25
“…I think diabetes. To me is like the AIDS epidemic. The diabetes epidemic, a lot people do not even understand it or relize that when they have problems with diabetes that means that they could either loose their kidneys or eye sight, or just so many things…” (KI 7) “Well I think so. Us as Hispanics think that diabetes happens all of a sudden because we do not have a lot of knowledge about it.“ (KI 20)
Another common comment was concern for children:
"Um I think in the trend that we are going now you’ll start seeing more and more kids with problems that adults had before, like diabetes is going to become more prevalent in little kids." (KI 1)
Cardiovascular (Heart Problems/High Blood Pressure/Hypertension) Heart problems were named by 3 KIs in the “top three” as was blood pressure or hypertension; Multiple KIs mentioned both issues during the course of their interview. Something interesting to note is that every person who talked about hypertension or high blood pressure also talked about diabetes in the same sentence.ii Cancer Cancer was named by 9 KIs as a “top three” problem, but there is almost no detail about why it is of such concern. Leukemia is the only cancer mentioned by name. Cultural Differences and Language Cultural differences and language was named by 6 KIs as a “top three” problem, but there was significant detail and a separate section was developed to capture the discussion. Refer to page 8 for this discussion. Obesity Twelve KIs talked about obesity using the word "obesity" (5 as a top three and 2 as a number one). It was usually talked about in relation to diabetes. There were various comments about the possible causes of obesity – the most common of which were: changes in economic level, changes in work conditions, and lack of knowledge:
"I think that it also has to do with economics; in the sense that the more money we got the more food we bought. The availability of things that we indulge in was a contributing factor..." (KI 13) "I think that the other thing is, when we were eating all these fattening food, we were working our little buns off, out in the fields, we were working our fat off, and now we get these jobs that we do not have to get out and sweat because agriculture became more mechanized. So, we either drive a tractor or other kind
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of things that are not as physical. I think that became a contributing factor to our obesity and all the related type of illnesses." (KI 13) "What kind of things? Well, sometimes the way we eat. Hispanic people do not have a lot of knowledge on how to diet. Our parents did not teach us to pay attention to our diet." (KI 29)
Colds and Viruses Interestingly, viruses made the “top three” issues for four KIs and colds for one KI. During the course of the interviews, the flu was mentioned twice, West Nile Virus was mentioned three times and “problems with mosquitoes” were mentioned twice. Despite what seems to be some fear associated with mosquito-related illnesses, the following quote is the extent of the information we have from the KI interviews:
"…Problems having to do with mosquito’s because there have been some deaths..." (KI 32)
Substance Abuse (Alcohol Abuse/Drugs/Self-Medication) Three KIs name alcohol abuse in their “top three” issues and two others talk about it later in their interviews. One KI talked about it extensively as being a major issue especially for men that come to Idaho alone:
"For the most part, I think is loneliness. A lot of the men that come here come without their families. A lot of other people get this habit since their youth. From what I know, I am from Mexico. I know that the youth grow up in an environment where it is very easy to drink alcohol without any excuses. I remembered, for example, in the town where I grew up, the main activity on Sundays was to play soccer. If they lose they would drink because they lost, if they win they would drink because they won and if they tied they would drink because they tied. There was always an excuse to drink.” (KI 12)iii
Drug abuse and gangs were also mentioned by various KIs as a rising concern that may be a bigger problem in the future. Self-medication was of concern to multiple speakers, referring to the number of Hispanics (specifically Mexicans) who will seek Mexican medications from friends or family that go to Mexico or from businesses that sell them in Idaho. Dental
Five KIs mention dental problems or lack of dental care in their “top three” issues. The interviews provide very little detail, but there are comments that it is expensive, that there is a lack of awareness of its Importance, and the possible problems lack of dental care can cause. "Dental hygiene [is] a serious problem as well, a cavity or gingivitis might not cause problems right away, but eventually it will affect the dental hygiene of a person. I heard that there is a connection between heart attacks and many [dental] problems." (KI 28)
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Lack of Information Many people talked about lack of information as a major health concern and three KIs named it in their “top three.” Perhaps most interesting is that two of the three people that name lack of information or lack of awareness as a "top three" condition mention differences based on the length of time people have been in the United States. (These generational differences are further discussed in other sections of this report.) Respiratory problems Respiratory problemsiv were talked about as a top three issue for three KIs and additional comments were made by other speakers throughout the course of their interviews. Comments were in relation to children, a concern about the air quality in the future and concern for the work conditions for farmworkers.
"…my friend [who worked in farming] used to talk about because he would say that asthma comes from that; the dust causes asthma." (KI 23)
Racism Two people actually used the word “racism” and various KIs talk about being treated fairly or equally.
"Another problem could be racism. For example, when we go to the Hospital here in Ontario, the receptionist says that if we do not any have money to pay then we cannot go at all." (KI 20) “I think that the most important thing regardless of where you’re at is being treated with respect. Not making assumptions because of my color. I think that really bringing medical terminology down to that speaks to me because I know none of us want to look like a fool in front of our medical providers but we need to challenge and need to be respected and be a partner in the dialogue. In many cases we are not and this is from someone who has the ability to select to move to a different medical provider when I am not getting that. But I think in most cases most of our folks you know don’t challenge a person in authority like that. And really don’t have the options to do it and almost take it the way it is. That makes it hard.” (KI 36)
Appendix Two KIs mentioned appendix as a top three concern but no further information was provided.
Cholesterol Four KIs talk about cholesterolv. KIs worry about the eating habits of most Hispanics and their relationship to high cholesterol levels.
"I think that I am not sure how to say it, but our physical well being. I think culturally the foods that we eat can put us in a compromising position in terms of
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cholesterol and glucose and things that most Hispanic families are not aware of. For example, my own my grandmother said; I do not understand why my cholesterol is high I gave up red meat. You know that has nothing to do with red meat, or there are other things that played a larger role in those kinds of things." (KI 11)
HIV/AIDS and Sexual Health Although HIV/AIDS was named a s a “top three” problem by only one KI, HIV and/or AIDS were talked about by 8 of the KIs as either a present or a future concern. KIs are concerned that the two illnesses are becoming more prevalent in Idaho Hispanics and are also worried about the lack of information about HIV and AIDS. In addition, three KIs named sexuality and or sexual health as an area of rising concern, and one that is not talked enough about.
"For me the most important and it is biased opinion, it is HIV/AIDS because it is my field. I am starting to see the influx of Latino patients coming into our clinic. And they are coming into our clinic in a very serious disease AIDS. And not one is talking about these issues, little known in the general community or culture, but even more so in our culture." (KI 11) "I think that we have a serious problem with AIDS. I know a lot of people that do not talk about it. And I know that older generations never talk about it. But there is a serious problem with that. People that are getting AIDS are a lot higher of what we hear about. If people would look into the numbers out there at the health department, they will know that is a serious thing." (KI 7) “You know, we did a survey recently not too long [ago] of individuals over at the labor camp in Caldwell… and twenty five years into this HIV disease, people still think that mosquitoes play a large part in the transmission of HIV. And also misinformation is still getting out there.” (KI 11)
Abuse Abuse, physical, emotional and sexual, were all brought up by KIs. Domestic violence, particularly against women was talked about and related to the “machismo” attitude and the lack of empowerment for women.
"I think that abuse in homes; domestic violence. Help is being provided for that, but it is very difficult. How to prevent it, once it starts it is like a cycle that continues and continues, and if you leave it and you don’t stop it, it continues to get worse." (KI 6) "I think that domestic violence is the most (one), that is where everything comes from. Because the husband says you have to eat this here, even though the wife has gone to a class and has learned that you need to eat better. The husband says that you have to make pork roast, and I don’t want that food. Because there are definitely men who choose the food..." (KI 8)
Sexual abuse was also of concern, particularly to one KI.
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"A large number of children have been abused in their countries because there are not strict laws. Many of them have never sought medical help.” In my work1 “before I would not have asked them those questions, but now I do: Have any of you been abused in your childhood? By observing their facial expressions I know. I tell them that the reason I am asking is because If you have not resolved that kind of problem you are going to have them in your marriage. More women that men have been abused in their childhood, so this is an important topic to talk about. It is not only, one, two, or three people I know more than that in my work, so can you imagine other places." (KI 12)
One speaker also mentioned a concern about what Idaho police consider abuse, which the KI says is often times a culture difference regarding the way children are disciplined.
"...a lot of times the parents try to discipline their children and they end up having problems with the law for disciplining their kids. In our culture, the parents do not let their kids do whatever they feel like doing. In the Anglo culture they do. This is one of the cultural aspects that create fear in the parents disciplining their kids. There is a tremendous conflict, a lot of times the police do not talk to the parents; they do not listen to their point of view because it is not the same to spank someone than to really abuse. It is true that some parents abuse their kids, but in general they only spank them. If a kids says that his father is abusing him, the police quickly responds, and the police, being for language or other differences do not listen to the parents..." (KI 12)
Other Health Conditions of Concern There were several issues that were talked about extensively despite not being common on the “top three” list. Mental health, depression and the lack of mental health care facilities available to Hispanics and Spanish speakers was a concern for multiple KIs. The strain of immigrating to a new place and the “culture shock” it causes was mentioned by several KIs as a major source of depression and starting point for other health conditions. Nutrition (different from obesity) was mentioned by a couple of speakers. One speaker referred to children not eating school lunches and one speaker talked about eating disorders. Vision care was named by several speakers as well, mainly in relation to children who are not able to do well in school due to lack of glasses that they need. Several comments were made about the environment including concern for air pollution causing respiratory problems or headaches, the over-chlorination of the water, and the chemicals used in food and fields. Those Most Affected According to the KIs, those most affected by the health issues described above are: immigrants (especially recent immigrants, elderly and those that are undocumented), women, the poor, the elderly, farmworkers (those that
1
Quoted verbatim with identifying information removed
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work in cherries and those that migrate were singled out) and those who are overweight.
Cultural Differences that Affect Health
In addition to the various health conditions and problems of concern to the Idaho Hispanic community, there are a number of important factors that affect health and need to be understood in order to address health problems. The main themes that KIs talked about are described below. “Different Culturas Even Though We Are Mexicanos” One of the common themes among most of the interviews was the point that there are many cultures embedded within what is labeled “Hispanic” or “Latino.” One key point made by KIs was that not all Hispanics in Idaho are Mexicanvi and not all those with Mexican background were born in Mexico.
“…I am very proud to be from Mexican, but sometimes [people] are not educated. For example, I get asked all the time what part of Mexico are you from? And I tell them, I wish I had visited Mexico, but I have never been down there. They think that all the Mexican people are the same.” (KI 29)
The biggest differences in culture that KIs talked about were those that exist between generations. Each generation has the potential to experience several participants labeled as “culture shock,” which they said can lead to various health problems or lack of care. Likewise, the generation of an individual or the length of time they have been in the United States affects his or her information sources and access to care.
"...A lot of recent immigrants, also migrant workers including new immigrants or those who travel according to seasons. I think most of it has do with length inside the community and length inside the environment. Time within inside a cultural setting…it just depends on how long you had lived here to know what types of services are available." (KI 9)
Generational Differences 1st Generationvii There are two main types of first generation Hispanics in Idaho. One is typically young men who come alone to work. The other is parents who come and raise children here. This second category includes a generation of people who are now senior citizens and the parents of grown children. Interestingly, one KI who is a Hispanic senior citizen shared his feeling that some of the young men he sees currently coming to Idaho to work are from a different culture than his own.
“…they are mostly males, young males…they bring the mentality from Mexico, you know, ‘yo soy el macho, voy a tomar, (I am the man, I am going to drink) and do not bother me.’ So I see that in some cases these women are being violated in many ways, including we had a couple of deaths…So you have those kinds of things that are happening. They are different culturas even though we are
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mexicanos…you need to understand the wider view in terms of how it affects my gente (people) physically and mentally…A lot of it has to do with we are culturally different. We have a different situation as people.” (KI 13)
There were also a number of comments about the first generation of immigrants who have been here for many years. KIs felt that in many cases, this generation struggles more with language and cultural barriers than their children’s generation.
“Sometimes I think the kids are more informed than the parents. Because they have access to the information some times parents don’t.”(KI 9) “I find that a lot of the things that come down do not reach our community. Especially the seniors…Somebody comes over and gives a presentation in Ingles and my people do not know what the hell they are talking about...” (KI 39)
2nd and 3rd Generations Those who are a part of the second or third generations (the children or grandchildren of people who immigrated,) face challenges that are different from those of their parents. Many of these challenges stem from being a part of two cultures at once. The differences range from what one KI called the “secondgeneration diet” to struggling to define one’s cultural identity.
“I would say diet is a big thing seen myself as a Mexican-American second generation, diet is the big thing…we fall into the American diet, the fast food." (KI 39) "[My parents] never really became Americans…But my generation - that would be the second generation, all my cousins and me, and everybody else we were part of the dominant majority culture. I make a distinction between these two you can be the majority culture or you can be the dominant culture and be a minority culture. (KI 39) “About my culture, I think… well my culture, people have asked me and I talk to kids about it, I ask them ‘are you guys mexicanos?’ And they say ‘Yeah we are Mexican’ and I say, ‘no, you are not Mexican. You are an American, you have a Mexican surname, you are being raised in a household that has a lot Mexican culture, but you are an American.’…I think I, personally I am mix pot of two cultures. I am certainly an American citizen; my culture is one of a Mexican, both my father and mother are from Mexico. But I am an American…” (KI 4)
Other generational issues can be seen in relation to family dynamics (further described below.) Second generation Hispanics (those born to parents who immigrated to the United States) struggle to help their parents understand and deal with health issues. One KI shared his strategy for getting his parents to go to the doctor for preventative care.
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“So the reason I go in is because, again, if I take care of something small then wait until it becomes a major issue and I want to make sure my parents see that because I am also a model for my parents. I need to make sure that they see that I’m going to see my doc and trying to take care of these issues while they are small because if not, it could be really costly and its important for them to do that too. So instead of me saying, ‘Dad go see a doc’ and not following suit, I can say ‘Dad I saw my doc this year and all is good. Have you seen yours?’ Better strategy.” (KI 36)
Family Is Central to Understanding and Acting on Health Some KIs felt that the breakdown of traditional family structures for Hispanics is a source of some health problems. These KIs felt that the “dominant culture” in the United States does not support the family structures that Hispanics depend on.
"The Mexican population in general does not know what to do when the family breaks down. They are family oriented, they have extended family, they all together, aunts and uncles, that take care of each other, but when that breaks down that’s [the] worst. (KI 39)
For those who are operating within a traditional family structure, family is central to health. Family and friends are the number one source of information for Hispanics. Information received from friends and family is more likely to be believed than information that comes through other channels. As one KI pointed out, despite having a college degree and working in the health field, she still turns to her mother for advice on health issues and, as pointed out in other sections, second and third generation Hispanics are likely to use this information in combination with information they get from other places.
“…I know now I still ask my mom for suggestions: ‘Mom I don’t know what’s wrong with him.’ Oh, she has an immediate response: ‘this is what it is.’…It may not be that …but if she may a remedy for that [and that’s] okay. Its okay to have it in addition to whatever the doctor tells me.”
Customs and Beliefs about Illnesses and Healing Multiple KIs talked about the differences in beliefs regarding illnesses and healing between Hispanics and the Western-style medicine found in Idaho. Several mentioned the need for healthcare providers to understand these cultural values and one person said that the spirituality of people needs to be taken into consideration for healing. More than one KI expressed frustration with healthcare providers who do not accept alternative reasons for illness or alternative remedies.
"...For example, Hispanics think that if their child has diarrhea it is because “se le voltio el huevo” or is sick with “mal de ojo”, or someone is trying to harm them." (KI 15) "...when one gets sick due to catching a chill (aires), the doctors don’t believe in that. They believe its an infection; They're confused." (KI 38)
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"Sometimes the homeopathic remedies are those which have an effect on us. [For] example, a tea and the doctor does not believe in this. It is difficult for them to accept our culture." (KI 35)
More than one KI made the point that the two belief systems do not always have to contradict each other. Instead, they suggested looking for ways to combine them.
“It’s important to know that in the Hispanic culture we do have our little beliefs and our little remedies for things but not say ‘No, that’s not going to help,’… but don’t drop all the medications your doctor’s prescribing just because there is this remedy, but do it in combination.” (KI 1) "I think many of them delay care and I think a small number of them wait. I think many of them also wait until they go back to Mexico to take care of these issues and then a small number kind of do that: mix of utilizing their traditional remedies with things they can bring back from Mexico, and I would say a very small percentage of them utilize the cuaranderos - you know, the spiritual healing that we know is out there..." (KI 36)
Moving Toward Solutions
In addition to the suggestion to combine the belief systems about illness and healing, the interviews provide a number of key elements to understand when trying to improve health for Idaho Hispanics. KIs also had comments about what is already being done. A list of this information can be found in Appendix A. They also gave an impressive number of specific potential solutions, which are carefully described in Appendix B according to their classification as individual, community or state/national level solutions. Below are some specifics about some specific things the interviewers asked: information sources, good work already being done in Idaho, and issues that need more research. Where Hispanics in Idaho get their information There were a number of comments that lack of information contributes to poor health. This makes understanding sources of health information particularly important. KIs provided extensive detail about where Hispanics in Idaho get their information. First and foremost, Hispanics in Idaho get their information about health from family members and friends. After friends and families, many Hispanics get their information from the radio, which many speakers thought was a better source than television, especially since it provides local information.
"Radio primarily, television, the first generation, the kids, they all speak English. The other generation, they mostly listen to radio..." (KI 39) "There are so many people that are isolated and it is very difficult to get to them. A lot of the information that they receive is not local, for example, they watch the TV from Mexico and they are not well informed of the things that are happening in the area. And in that aspect the radio is the one that helps a lot since it reaches those who are so dispersed..." (KI 12)
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One KI felt quite the opposite and said that the local radio was not a good source of information and that television was better and more “believable.”
"...when I worked out at Terry Reilly most people would tell me about something because they heard it on Univision or something new that came out. And radio, I think. But sometimes it almost seems like when you listen to it on the radio, it almost seems...like TV is more believable. The radio I don’t know, to me sometimes I listen to the radio and I think oh my gosh. The TV, I think its more believable because its so structured instead of spontaneous. On the radio you have the DJ’s just talking saying this and this happened..." (KI 1)
Even those that felt radio was a good source of information felt that it is not being used to its potential.
"Utilizing this information in a way that can help us correct some of the misinformation out there or start to inform folks correctly. I think that would be really valuable. Utilizing some of the vehicles that we talked about to share that because we do have a couple of great Spanish radio stations. Unfortunately our Spanish stations don’t really have that local angle, I think some of them do a little bit but we need to utilize this information in a way that would be impactful to these folks now." (KI 36)
The Idaho Unido, a Spanish newspaper was mentioned, but in general, KIs thought it was limited because it was not local enough and not everyone reads Spanish. Two KIs mentioned getting information in the mail, but did not elaborate on it.viii Only one speaker mentioned an alternative source of information for people: the Laundromat.
" A lot people, do not have a washer or drier, so they go to the Laundromat. There are a lot post-its." (KI 7)
A Positive Model – The Terry Reilly Clinic Although one person said that the Catholic hospitals were taking positive steps, the only medical institution talked about in detail was the Terry Reilly Clinic. KIs talked about the clinic as the only alternative to the emergency room for Hispanics. They applauded the outreach programs and the low-cost or free care. One KI said that people who go to the Terry Reilly Clinic are well informed about health issues.
"…here in Boise we have been looking for places where it is not as expensive to get medical treatment and have not been able to find any. The only place that we have found that is accessible is in Nampa. Terry Reilly is the only place is not expensive." (KI 40) "And when I have asked where [my students and their parents go for care] they say 'Oh it’s over the bridge.' If you really hurt you go to the emergency room; if you’re sick you go to the Terry Reilly clinic." (KI 9)
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Researchix There were a number of comments that pointed to the fact that many KIs do not feel that research would be a good sole outcome of this project. Some of the KIs felt that there had been enough research while others said that current health research does not adequately consider Hispanics.
"What I hope happens [with the IPHH project] is that we take the information and maximize it and don’t make it into something that we need to do more research on. Because more and more of our folks are dying every day more and more of our folks are misinformed or not informed at all and believe they are well informed. Utilizing this information in a way that can help us correct some of the misinformation out there or start to inform folks correctly I think that would be really valuable..." (KI 36) "I think that we have researched the crap out of stuff. I think that it doesn’t matter how much you research something; that it is more important to think about what something means to the folks that are affected by it...What we need is not more research what we need is more action based on these activities. In other words, we know how folks think about these issues in southwest Idaho. What is a really good thing to hone in on or what is or what are myths that we really need to dispel? In other words, marketing. Why can’t we do that instead of more research?" (KI 36) "…If you are going to do any research, do it with our gente. Do not go and do research in Chicago or Massachusetts with the white folks. That’s my way of putting it, if you are going to do research, do it with our gente...Yes, you can do all kind of research, they will take Anglos and possible Blacks, but our comunidad might be an entirely different situation." (KI 13)
Although a few KIs mentioned topics they thought might benefit from more research, only one KI talked about research in a positive light.
"I’m a science teacher, and as well behind that, the more information you have the better conclusions you can draw. Without sufficient information you draw conclusions that are hypothetical. And hypothetical can be a problem they may be right sixty percent of the time but what happens the other forty percent of the time? So I think anytime we have an issue we need to study it meticulously." (KI 9)
Conclusion
In conclusion, there are a number of health conditions and problems that are of concern to Idaho Hispanics. Almost all of these health problems, however, can be better understood by understanding some cultural information. First of all, it is important to realize that there are different cultures within the “Hispanic” culture and each one has different needs. Secondly, there are a number of culturally held beliefs about illness and healing that conflict with the Western-style medicine found in Idaho, but it is often possible to combine the two systems. When looking towards solutions, it is essential to increase the amount of information that people get. The number one source of information about health is from family and close friends, but after that, radio seems to be a under-utilized source with a great deal of potential in Idaho. Research will only be
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an acceptable next step if it is specific to Hispanics or if it is combined with more actionoriented work.
During the focus groups, the terms “Hispanic” and “Latino” were used by speakers. In this report, both terms have been used interchangeably. If CAB members have a suggestion for how the terms should be used, we can easily make changes. ii This may be worth exploring. It may be a coincidence, but it may be that the community believes the two conditions are always associated with each other. iii This KI talked at length about alcohol abuse and had a number of suggestions for ways to address the problem. That information is easily available if it would be helpful to the project. iv Five KIs mention respiratory problems (three as top three - one of them as number 1) of some sort. The most common word used is "pulmonary." I don't know if this is from the translator or from the KIs, but it might be worth knowing what word people use when talking about respiratory problems. Only two people specifically mentioned asthma. v Just like in the focus group analysis, it seems important that people say they "have cholesterol" rather than saying they "have high cholesterol." If cholesterol levels are a part of anything that IPHH decides to work on, this subtle wording difference may be important. vi Seven (22%) of the 32 key informants were born in Peru. There was also a Puerto Rican and two Columbians. vii KIs used the term “first generation” differently. Some called the first generation born in the U.S. the “first generation.” Here, first generation refers to the generation that moves to the United States to live. viii This was also mentioned in the focus groups. It might be a good idea to look into what people are referring to, who mails it, and the quality or type of information they receive, especially because it seems that people read it. ix There were two questions on the interview guide intended to get KIs to talk about what they thought needed to be researched, but neither one of them was well understood by KIs. Looking at the transcripts, answers are a mix of what needs more scientific reearch and what topics are ones that Hispanics need more information on. It was impossible to distinguish the two, so there is no list of topics that could benefit from further research. The following topics appear to be ones that at least one KI felt could use further scientific research: sexuality and sexual health; HIV/AIDS (“in terms of understanding risk and why people participate in risk factors, and how those issues are impacting the individual within the community;” cancer; why a lot of people resort to as much alcohol [as they do];” migrane headaches and their possible connection to the environment; stomach problems related to nutrition; diabetes; mental health economic variables; access to care; domestic violence; mental health issues (especially for migrant farm workers.)
i
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Idaho Partnership for Hispanic Health Tables, Figures and Appendices
Table 1. Demographics
Gender male female Age 18-25 26-35 36-45 46-55 56-65 66 & over Marital status Married Single Divorced Living w/significant other Widowed Separated Education elementary school junior high high school some college college grad Income less than 10,000 10-19,999 20-39,999 40-49,999 over $50,000.00 Country born Colombia Mexico Peru Puerto Rico USA Yrs lived in USA 0-5 yrs 6-10 yrs 11-15 yrs 16-20 yrs 21-25 yrs 26-30 yrs more than 30 whole life n 2 11 7 1 11 n 1 5 15 3 8 n 3 8 3 3 15 n 23 5 3 1 0 0 19 13 n 2 11 8 6 4 1 n % n=32 59 41 % n=32 6.3 34.4 25.0 18.8 12.5 3.1 % n=32 71.9 15.6 9.4 3.1 0.0 0.0 % n=32 9.4 25.0 9.4 9.4 46.9 % n=32 3.1 15.6 46.9 9.4 25.0 % n=32 6.3 34.4 21.9 3.1 34.4 % n=32 9.4 9.4 9.4 15.6 12.5 9.4 3.1 31.3 Worked in health Children under 18 in house Job
Key Informant Interviews
n Healthcare Industry Social work Service Industry Educator Business Retired Priest Student Ag worker Carpenter Translator 7 3 5 3 5 1 3 1 3 1 1 n Ada Gem Canyon Elmore Payette Washington No answer n 0 1 2 3 4 n Yes No 14 18 n Yes No 18 14 12 3 6 7 4 9 6 5 4 5 1 2
% n=33 21.2 9.1 15.2 9.1 15.2 3.0 9.1 3.0 9.1 3.0 3.0 % n=32 28.1 18.8 15.6 12.5 15.6 3.1 6.3 % n=32 37.5 9.4 18.8 21.9 12.5 % n=32 43.8 56.3 % n=32 56.3 43.8
County
Communic. w/health wkr.
n 3 3 3 5 4 3 1 10
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Idaho Partnership for Hispanic Health Tables, Figures and Appendices
Key Informant Interviews
Figures 1-12. Demographic Information (See Table 1).
Figures 1-12. Graphical representation of the demographical backgrounds of the Key Informants. Figure 1.
G ender of K Is
Figure 4.
E ducation level of K (n=32) is
elem entary school 9%
fem ale 41%
college grad 48%
junior high 25%
m ale 59%
high school 9% som college e 9%
Figure 5.
Income levels of K (n=32) Is
Figure 2.
Age groups of K (n=32) Is
over $50,000.00 25% less than 10,000 10-19,999 3% 16%
66 & over 3% 56-65 13%
18-25 6%
40-49,999 9% 20-39,999 47%
46-55 19%
26-35 34%
Figure 6.
K Country born in (n=32) I
36-45 25%
C olom bia 6% U SA 34%
Figure 3.
Marital status of K (n=32) is Living w/significant other 3% D ivorced 9% Single 16% M arried 72%
M exico 35%
W idowed 0% S eparated 0%
P uerto R ico 3% P eru 22%
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Idaho Partnership for Hispanic Health Tables, Figures and Appendices
Figure 7.
Y ears lived in the U A of K (n=32) S Is
Key Informant Interviews
Figure 10.
N umber of children under 18 living in the K household I's (n=32)
0-5yrs 9% whole life 32% 6-1 yrs 0 9%
4 children 13% 0 children 37%
1-1 yrs 15 9%
3 children 22%
m oretha 30 n 3% 26-30 yrs 9%
1 6-20 yrs 1 6% 21 -25yrs 1 3%
2 children 19%
1 child 9%
Figure 11.
K that have worked in healthcare (n=32) Is
Figure 8.
Jobs held byK (n=33) Is
C arpenter 3% Ag worker 9% Student 3% P riest 9% R etired 3% Business 15% T ranslator 3%
H ealthcare I ndustry 22%
Yes 44%
Social work 9%
N o 56%
E ducator 9%
S ervice Industry 15%
Figure 9.
County K live in Is N answer o 6% W ashington 3% P ayette 16%
Figure 12.
K that have direct contact with healthcare workers Is (n=32)
Ada 27%
E ore lm 13% G em 19%
N o 44% Yes 56%
C anyon 16%
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Idaho Partnership for Hispanic Health Tables, Figures and Appendices
Key Informant Interviews
Tb 2 A s es i n o tp he ” e l cn i n a d rb ms The following table gives the a l . nw r g e t “ tre h a h o d i s n po l . e v o t t o e n mb r fi e c tp w s i nn ep ne o h q et n “ a d yuv wa te o tre u e ot me ah o i a g e irso s t te u so ,Wh t o o i s h tp he c v i e major Hispanic health conditions or problems in Southwestern Idaho?
TOTALS Number 1 Answer Access/costs/insurance Diabetes Cardiovascular (heart/hypertension) Cancer Cultural differences/language Obesity Colds/viruses Substance abuse (alcohol/drugs/selfmedication) Dental Lack of information Respiratory problems Racism Appendix Cholesterol Being undocumented Chronic conditions Depression 9 10 0 1 1 2 1 1 1 1 1 0 1 0 1 0 0 TOTALS Number 2 Answer 5 4 2 4 4 1 3 0 3 0 0 0 0 1 1 0 0 TOTALS Number 3 Answer 4 3 4 1 1 2 1 3 0 2 2 2 1 1 0 1 1 TOTAL TIMES NAMED AS A TOP 3 18 17 6 6 6 5 5 4 4 3 3 2 2 2 2 1 1
Living environment Muscular pain HIV/AIDS Lack of immunizations Nutrition Pre-natal care Vision
0 0 1 0 0 0 1
0 0 0 1 1 1 0
1 1 0 0 0 0 0
1 1 1 1 1 1 1
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Idaho Partnership for Hispanic Health Tables, Figures and Appendices
Key Informant Interviews
Appendix A. Health Work Already Being Done
When asked if anyone was doing anything to address the problems being discussed, Key Informants shared their knowledge of what was already being done. In most cases, very little detail was provided, but all things that were named are listed here because they may be worth following up on for more information. The following organizations were named: A.R. (Access to Recovery) - Alcoholism Catholic church - General help Clinics - nurses and doctors give trainings on diabetes, obesity and high blood pressure Coalition forces - not clear what they are or what they do Community health centers –provide low-cost care Community members –advocacy for affordable healthcare Congress and Senate - legalization and other help for Hispanics “ Doctor from Ontario”- not clear what he does, but related to Hispanic (farmworker?) health issues Farmworker Appreciation Day - information there. Maybe from the YMCA? Fast food restaurants - offering brochures - diabetes and cancer Federal government - funding Hispanic health issues Local HIV/AIDS organization - studies “ disconnect between providers that Say that the HIV problem foes not exist in our communities, to what we see in the h si l op a t” Local hospital –working on improving language issue IMC - no detail “ e t man from Nampa hospital”- not clear what he does (maybe related to G nl e HIV/AIDS) Mass media - information about prevention Mercy Medical –working with schools on preventative measures (not clear which) Migrant help organizations - ESL classes Salud y Provecho –holds discussions about problems in the home; have advocates; lawyers School counselors - helping with access to care School programs (not clear which school(s) –eye care for free, classes on the effects of alcohol, tobacco, STDs for parents and students Senior citizen project –no details, but started by one of the KIs Terry Reilly Clinics –outreach and treatment for Hispanics and field worker WIC –provide information, food and birth control YMCA - have bilingual staff - people can come in and ask questions and get information
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Idaho Partnership for Hispanic Health Tables, Figures and Appendices
Key Informant Interviews
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Idaho Partnership for Hispanic Health Tables, Figures and Appendices
Key Informant Interviews
Appendix B. Suggested Solutions
Possible Solutions Based on their experience, KIs offered a number of possible solutions to the concerns they talked about. Here they are presented according the level they would need to be implemented at: individual level, local/community level; and the state/national level. Individual Level Solutions Two KIs felt that it is very important to convince Hispanics to learn English in order to improve their health.
"...I think that I would emphasize as much as possible to the Hispanic community that English needs to become a priority, not only for the immediate, but definitely for the future success for the Hispanic community. And not just only in health care in every way..."(KI 4)
Some KIs feel that providing more information, especially on an individual level would be effective in improving health.
"Teach people how to eat a healthy diet. Promote a clear explanation of the diseases and where they come from, what we have to be cautious about. Give plenty of information and open low income clinics to help people." (KI 40)
Getting Hispanics in Idaho to take leadership roles was an individual-level solution suggested by more than one person.
"...I really think is time for the second generation of Latinos to start taking leadership roles and start being in the front of some of these programs to better facilitate access to all programs, education, health, to legal, all the others things related to health. We need to start voicing our opinions and our concerns; we need to start really educating ourselves." (KI 11)
Finally, one KI suggested that health could be improved by reducing the number of children per family so that they are more capable to care for them financially.
"I think that we not only as a, not necessarily as a Hispanic issue, but country wide, b t ti w … n i o n h rb , su d ey or l B t ti ta w ray u Ih k e a dt u d or l i o n vrh rb . u Ih k h t e e l n s ie t ie n l need to focus on individuals having more offspring, having more children that they can take care of. It is horrible thing to say, but I believe that when I see families with six or seven kids all of them in Medicaid, that is not a good thing. And I mean that from a social cultural point of view, because those children need services, they need health services, they need to educated, and when that occurs that burden is put on the rest of society. And I see this happening over and over again, I think as we grow in over the next fifteen, twenty years, I think more and more of that is going to be put on
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Idaho Partnership for Hispanic Health Tables, Figures and Appendices
Key Informant Interviews
te h u es foi y n s smeh gs o e b u i S Ih k h t a ae h so l r o sc tu l s o ti id n a o t . o ti ta’ n ra d e e n t n s that needs to be looked at. I feel bad saying that, but I think it is the truth honestly." (KI 4)
Local/Community Level Solutions One KI said that it is a good idea to understand what the strengths of the community are before beginning any work.
"And I would really try to access the strength the community has already because somehow, one way or another they are taking care of themselves. Try to understand those informal networks and how they work. Have them take a leading role in the cmmu i’h a h ae (I 1 o n y e l cr. K 1 ) ts t " "...we are resilient. I think that we need to tap into that resource. For the most part we do a good job taking care of ourselves. We have been doing for ourselves for so long but with better information I think we will be alright." (KI 11)
Other major suggestions were to increase the training of healthcare providers and increase the number or Hispanic and bilingual healthcare providers. It was suggested that there be efforts to coordinate the services being offered in the area and that focusing on outreach and flexible, alternative, low-cost places for healthcare outside of regular 8-5 business hours (including mobile clinics, using schools, taking advantage of parent-teacher conferences in Spanish, and providing crisis intervention) would be good ideas. Improving Care Although most KIs stated that Hispanics will not seek preventative care and will only seek emergency room care when they cannot wait any longer, they said that this is not necessarily a cultural trait. It is, on the contrary, the only option they feel they have because preventative care is too expensive, is not available outside of normal working hours, and is not always available in Spanish. In addition, some said that Hispanics, especially the first generation, do not understand what programs they qualify for or where they can seek care.
“ ma y ae te n o t n e ae to delay care which is kind of crazy I n cssh o l pi w h v is n y o b cuet le o k o ,o d n di yu cr t te ru d ni o h v t ea s i i yu n w yu o ’ re o r a i o h go n u tyu ae o ’ k s t v n l replace the whole thing. The idea is that you want to put gas into the car; you want to change the oil, right? You wan to do the preventive things that are most cost effective. (KI 36) "Because sometimes our employment to say it this way, we are not given much opportunity to miss work to take our children to get immunizations, to take them to d c r a p i me t. (I ) ot ’ p o t ns. K 5 os n . "
There were several suggested solutions to this problem such as training providers and creating flexible healthcare options. Training Providers Page 23 of 25
Idaho Partnership for Hispanic Health Tables, Figures and Appendices
Key Informant Interviews
One KI made the point that providers need to know that Hispanics have the cultural tendency not to speak up or question a healthcare provider. Providers need to know that their Hispanic patients may not tell them what they need or do not understand. Special trainings for providers might help improve the quality of healthcare for this set of people.
"First of all I w u t ip o l S cn o a, eh p ma e nneca g o l r n e p … eo d f lp ra s k a i r n e d a e l t h between doctors and nurses who know our people because there is a lack of this. There are a few bilingual doctors, but very few from our race. It is very important to count on people who know the cultural characteristics of our people, mainly in relation to health." (KI 12) "I would have more Hispanic staff and I would closely monitor how friendly these individuals are. That they be friendly with Hispanic people." (KI 5)i
Alternative and Flexible Options There were a number of creative solutions that included free memberships to the YMCA, giving people rides to medical appointments, and using the schools as a place to transfer health information. Other solutions included taking health care to locations other than clinics and increasing the amount of information in Spanish.
"....For example, I have noticed that normally at Wal-Mart there is a person talking about diabetes or about Medicare. But they are normally in English and the brochures are in English. So then, Hi a i d n ee g tee (KI 5) s n s o ’ vn o h r. p c t " "...And in Spanish too, because I think that if we started going into the churches because we are really into the churches going into the churches and start having like the priest make an announcement like you know what this is what you need to do about health about specific things or maybe having a walking group after church developing a personal network within your close knit communities and start that way. They do it during lent. They do thi s ui l tta’i ta’te x n."K 1 n d r ge ,h t t h t h et t. (I ) g n n ss e . . "Can youmai i e a le you know there by the Albertsons off of Broadway? i g ef h di … n w k There is an urgent care. Like if that was preventive care where you could go in and check your blood sugar; you could do that and that was covered. You just want to check your cold quickly - ti sh t r n t re t h t ’moe rvni . me n h g ta ae o ugn, a i n t t s r pee te I a v that might be an interesting model. If that were covered that would be great...prevention versus you know, waiting till it gets too late. The simple things well not the simple things, the hard things and those are the issues - the ones it all goes back to. It is easier said than done. You know because our folks are working mon g id s. h fl w o o ’have paid time off or sick time off. Most of the ri t uk Te o s h d n n l l k t poi r o th r o e w e te’ w ri a d l e w e te n t "K 3 ) rv es u tee p n h n h ye ok g n c sd h n h i o… (I 6 d r n o r
State or National-Level Solutions There were a few suggestions for solutions on the state or national level including increasing the budget for Hispanic-specific health care programs and asking the Mexican government to help with those programs. There were several comments about a need to help people become legalized. One KI suggested bringing doctors from Mexico to the United States. There were a number of people who Page 24 of 25
Idaho Partnership for Hispanic Health Tables, Figures and Appendices
Key Informant Interviews
suggested that the real solution exists in overhauling the healthcare system in the USA. One KI suggested providing scholarships for Hispanic students in Idaho to pursue health careers. Another KI had the idea of providing incentives for healthy behavior. This was based on her experience doing outreach work and feeling that it was not effective in changing behavior.
". io t ah n I iao o pee t n d ct n b t d n th n e h i . d ur c a d d l f rvni e uai … u I i o ca g te . d e I d t o o d r behavi .h y i ’ca g te b h v rS u is l sle h r n e so o T e d n h ne h i e ai . o mm t a r dt r o i motk tee e d t i be some kind of incentive, a kind of incentive to meet your like a goal. Almost like when you file your taxes if you are completely healthy and you do not have anything you pay would a little less...You know something set up like that because sometimes you just need that kind of accountability. Something like behavior change is really hard." (KI 37)
i
In the focus groups, unfriendly service, particularly by the receptionists at clinics was talked about by a number of speakers as a barrier to healthcare. This suggestion might be an idea for addressing that.
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