Date on Master's Thesis/Doctoral Dissertation

5-2013

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Nursing

Committee Chair

Hines-Martin, Vicki

Author's Keywords

Social determinants of health; Healthcare access disparities; Healthcare access; Critical ethnography; Hispanic Latino immigrants; Postcolonial theory

Subject

Health services accessibility--Kentucky--Louisville; Hispanic Americans--Medical care--Kentucky--Louisville; Immigrants--Medical care--Kentucky--Louisville

Abstract

In the last decade, the total foreign-born population in the U.S. has grown exponentially, with the Hispanic Latino immigrants (HLI) experiencing the greatest growth. The literature clearly identifies that HLI experience significant health disparities as a result of the negative impact of influential social determinants of health, such as access to healthcare services. Barriers to healthcare access among HLI are related to the access dimensions of accessibility, availability, affordability, and acceptability. Despite research on the barriers to healthcare for this population, issues of access from the perspective of immigrant community members are poorly understood. There is an increased need to understand barriers and facilitators to healthcare access as perceived by HLI themselves to develop culturally appropriate strategies aimed at eliminating healthcare access inequities and health disparities. The purpose of this dissertation was to critically explore the perceived barriers and facilitators to primary healthcare access among HLI residing in highly concentrated communities of the southern metropolitan city of Louisville, KY. Critical ethnographic methods and postcolonial theory were used to investigate access to healthcare in this community within historical, sociocultural, economic and political contexts. Twenty participants were interviewed for this study using a semi-structured interview guide and descriptive survey form. Participant observations, document reviews and geospatial analysis assisted in providing in-depth understanding of findings within various contexts. Research findings revealed that significant barriers and facilitators to healthcare access were closely related to historical, sociocultural, political and economic contexts that shaped HLI health experiences in Louisville. These social determinants of healthcare access were influenced by the underlying social structures of race, ethnicity, power and oppression embedded in the colonial histories of the Americas. Additionally, findings indicated that although providers and HLI recipients shared similar perspectives on healthcare access, discrepancies between the provision and utilization of healthcare services were perpetuated by the social determinants of healthcare access. Findings from this study provide several implications and recommendations for healthcare systems, community programs, nursing, policy reform and future programs of research focused on enhanced culturally appropriate interventions and programs addressing the perceived needs of HLI in the Louisville community.

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