Break down barriers to gynecologic care
The doors to your family planning clinic may be open, but many women may not be entering them. Why? While lack of health insurance and cost of care may present barriers, a national survey of African-American, Hispanic and Caucasian women shows that many women avoid gynecologic care due to language and cultural differences between women and their health care professionals, discomfort with a physician, and fear of diagnosis and embarrassment.1
"Barriers deterring women from their physicians, such as language and cultural differences, can lead to serious long-term health problems," says Linda Alexander, PhD, FAAN, executive director and chief executive officer of the Research Triangle Park, NC-based American Social Health Association (ASHA), which released the survey results. "As a leading organization in the field of consumer health education, we see these survey results as a call to action for more education and for women to proactively seek gynecologic health care."
Alexander says the survey was conducted to determine attitudes and behavior toward a number of issues related to gynecological health care, specifically treatment of vaginal yeast infections. The survey results indicate that women may not be addressing important health issues, she notes.
"Many sexually transmitted diseases may appear similar to a yeast infection," Alexander says. "If women are not seeking care for yeast infections, then it is likely that they are not seeking care for infections that may have more serious health implications."
Look at the results
According to the telephone survey, conducted among Caucasian, African-American and Hispanic adult women ages 18 and older, the top barriers to seeking gynecologic care are:
- cost (25%, 16%, and 20%, respectively);
- language/cultural differences (21%, 21%, and 20%);
- discomfort with a physician (21%, 17%, and 23%);
- fear of diagnosis (12%, 15%, and 15%);
- embarrassment (9%, 8%, and 18%).
More than one-half (55 %) of women surveyed, regardless of ethnicity, said that at least one of these barriers has interfered with their obtaining gynecologic health care. According to the survey responses, 25% of women have not visited a physician for even a routine gynecologic annual examination in the past year, and 28% said they do not go for a routine annual exam.
The Seattle-King County (WA) Department of Public Health works on many fronts to see that patients receive culturally competent care. According to Shari Wilson, coordinator of the department’s Refugee Health Access and Interpretation Program, the agency began to offer interpretation for all services in 1991, and since that time, has seen a continued increase in the number of limited English proficiency clients accessing all of the programs, including family planning.
All Public Health — Seattle and King County Family Planning clinics provide interpreters, and in many cases, bilingual staff, says Michelle Pennylegion, MPH, coordinator of the Family Planning Health Education and Outreach Program. Interpreters participate in clinical visits and facilitate scheduling, she notes.
Wilson says the public is made aware of the interpretation program’s services in a variety of ways: word of mouth by its interpreters and clients in the refugee and immigrant communities; its participation in refugee and immigrant community forums and fairs; and the Public Health — Seattle and King County’s web site (www.metrokc.gov/health), outreach materials, signage, and events.
Increasing the number of minority staff members may be helpful in addressing the needs of a diverse population. According to the Department of Health and Human Services, minorities now total more than 25% of the total U.S. population, but are just 10% of the health care work force.
In an effort to increase the number of health professionals who are racial or ethnic minorities, the department awards grants through its Centers of Excellence program to support education programs targeted to racial and ethnic students who are underrepresented in the health professions. Nine such grants totaling $5.4 million were announced in September 2001. The grants, which were established in 1987, are distributed to qualified schools of medicine, osteopathic medicine, dentistry, and pharmacy. Since that time, more than 250 qualified schools have received grants worth $153 million to train some 52,000 students.
Health care providers from all disciplines should become sensitive to the many and varied cultural factors that influence health, according to the Washington, DC-based American College of Obstetricians and Gynecologists, whose Committee on Health Care for Underserved Women addresses the cultural competence issue. The more physicians learn about a patient’s health beliefs and practices, the more likely it is that culturally appropriate health care will be delivered, positive health outcomes will result, and patient satisfaction will improve, according to the association. (Check out Internet sources for multicultural information, in this issue.)
Reference
1. American Social Health Association. Many women avoid routine gynecologic care, national survey says. Press release. Research Triangle Park, NC; Oct. 10, 2001.
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