Barriers to Healthcare

Autoimmune conditions with overlapping dermatological and rheumatological manifestations present significant management challenges in rural healthcare settings. The aim of this study was to evaluate whether a newly established combined dermatology–rheumatology clinic could improve healthcare access and patient satisfaction while maintaining clinical effectiveness. This service was delivered through cross-trust collaboration between two hospitals situated approximately 30 miles apart, serving a geographically dispersed population with significant access barriers. A 6-month prospective quality improvement initiative was conducted from April to October 2022. Monthly combined consultant-led clinics were evaluated using structured questionnaires assessing patient satisfaction, operational efficiency and educational impact. The service integrated specialist care between distinct National Health Service trusts, centralizing care delivery at a single site to enhance healthcare equity for traditionally underserved rural populations. Data collection included both quantitative metrics and qualitative responses from patients attending these integrated clinics. Data were analysed using descriptive statistics, with 95% confidence intervals (CIs) calculated for key metrics. Qualitative responses were coded thematically to identify common patterns. The study demonstrated unanimous patient satisfaction at 100% (49 of 49, 95% CI 92.7–100) with the combined clinic format. Healthcare access improved significantly, with 92% (45 of 49, 95% CI 78.1–98.3) reporting reduced travel costs and 96% (44 of 46, 95% CI 85.5–99.5) citing streamlined appointment coordination. This impact is particularly significant given the region’s poor public transport infrastructure, which has seen a substantial decline in bus services over the past decade. Employment impact analysis revealed that while 31% (15 of 49, 95% CI 17.7–43.5) of patients previously required time off work for separate appointments, the combined clinic significantly reduced this burden. Qualitative analysis identified consistent themes of improved comprehensive care delivery and enhanced time efficiency. The clinic proved particularly beneficial for managing complex conditions such as psoriatic arthritis and systemic lupus erythematosus, where concurrent specialist evaluation facilitated more precise diagnostic formulation and therapeutic planning. Educational benefits were noted among participating medical students, who reported enhanced understanding of interdisciplinary care and complex disease management. In conclusion, the combined dermatology–rheumatology clinic demonstrates significant efficacy in addressing healthcare inequities in rural settings, with high patient satisfaction and operational efficiency. This cross-trust collaborative model shows particular value in managing complex autoimmune conditions requiring multispecialty input while simultaneously reducing travel burden and improving care coordination. These findings support the broader implementation of integrated specialty clinics across geographically dispersed regions, with potential applications for other specialty combinations.

Parenting support services and programs develop and strengthen existing parenting skills. However, in the UK and despite the 2010 UK Equality Act’s provisions, these programs are generally not accessible for Deaf parents whose first and/or preferred language is British Sign Language (BSL) because the medium of instruction is typically spoken and written English. This small-scale qualitative interview study gauged North Walian Deaf parents’ needs and preferences for accessing parenting classes. A structured interview assessed a small group of North Walian Deaf parents’ language practices, their perceptions of parenting support and accessibility, and their needs and preferences when it comes to parenting classes. An additional case study of a Deaf parent’s experience of participating in an 11-week-long parenting course with an English-BSL interpreter provides further insight into how such classes can be made accessible to Deaf parents. The main interview findings were that the partici...

Temporomandibular disorders (TMDs) develop as a result of alterations in the structure/function of the temporomandibular joint (TMJ), masticatory muscles, and/or osseous components. TMDs may be caused by both non-inflammatory (e.g.: myalgia) and inflammatory disorders (e.g.: rheumatoid arthritis (RA)). Common signs and symptoms of TMDs include: TMJ pain, dysfunction, fatigue, and limited ranges of motion. These issues impact on oral functions such as mastication, with potential implications for overall eating and possibly swallowing. However, there has been limited research on this topic, with the potential for restricted care provision. Based on the Student's clinical and personal experience of a TMD, and from the available literature, it is hypothesised that eating and potentially swallowing problems are prevalent in adults with TMDs and that intervention related to eating and swallowing may be limited. The aim of this research was to determine the epidemiology, nature, impact, and management of eating and swallowing difficulties in adults with TMDs caused by a range of non-inflammatory and inflammatory conditions, to provide information on these problems, and to suggest avenues for future research and clinical developments. To explore the epidemiology, nature, and impact of these problems, systematic reviews with meta-analyses were conducted, informing the design of two cross-sectional prospective patient studies. Treatment-seeking adults with TMDs presenting to national specialist care centres were recruited for these studies, with data collected using both established subjective and investigator reported outcome measures (IROM) and newly designed cohort-specific assessments. In addition, the typical management of eating and swallowing issues in this group was investigated by surveying professional and patient perspectives on, and satisfaction with, typical care delivery for patients with both non-inflammatory and inflammatory TMDs in Ireland. Descriptive and statistical analyses were conducted. Results of the studies conducted within this thesis confirm that eating and swallowing difficulties are commonly reported by this group, with 99% of treatment-seeking adults with TMDs reporting at least one such symptom, with reported repercussions on nutrition, activity, participation, and emotional well-being. As hypothesised, masticatory difficulties were reported most frequently (89%), yet 53% of participants also reported additional swallowing difficulties such as: choking on medication (45%), or experiencing a 'strangling sensation' on swallowing (48%). Patients with TMDs reported that these eating and swallowing difficulties impact moderately on daily, social, recreational, and family activities, with a mild impact on their ability to work and their occupational productivity. Patients with TMDs associated with RA reported higher rates of oropharyngeal swallowing difficulties than those with non-inflammatory conditions, suggesting the need for specifically targeted management programs, although limited numbers of participants with RA were recruited here.

This reflection explores my journey working with Deaf communities around improving mental health and learning how Deaf people are affected by health inequalities. It includes information on why Deaf people are at risk of mental health problems and how we can work together to improve mental health services particularly for Deaf people.

Background: Southeastern Appalachian Ohio has more than double the national average of diabetes and a critical shortage of healthcare providers. Paradoxically, there is limited research focused on primary care providers’ experiences treating people with diabetes in this region. This study explored providers’ perceived barriers to and facilitators for treating patients with diabetes in southeastern Appalachian Ohio. Methods: We conducted in-depth interviews with healthcare providers who treat people with diabetes in rural southeastern Ohio. Interviews were transcribed, coded, and analyzed via content and thematic analyses using NVivo 12 software (QSR International, Chadstone, VIC, Australia). Results: Qualitative analysis revealed four themes: (1) patients’ diabetes fatalism and helplessness: providers recounted story after story of patients believing that their diabetes was inevitable and that they were helpless to prevent or delay diabetes complications. (2) Comorbid psychosocial i...

Despite increasing appreciation for the medical needs of transgender individuals, the organization of transgender medical care remains suboptimal. Transgender individuals report difficulty in finding providers who have adequate expertise in caring for transgender patients, a lack of provider cultural competence, health system barriers, and discrimination in healthcare settings. At Boston Medical Center (BMC), we sought to address these gaps within an existing academic medical center. In February 2016, BMC established a Center for Transgender Medicine and Surgery (CTMS) to provide a single address for patients to obtain transgender-specific services across a spectrum of healthcare needs. With the establishment of a CTMS at BMC, we were able to leverage broad transgender medical coverage across multiple specialties within an existing academic medical framework. Furthermore, the development of the CTMS resulted in our identification of multiple gaps in transgender healthcare which we c...

Background: Individuals who have a transgender or gender nonconforming (TGGNC) experience belong to a marginalized segment of the U.S. population, and healthcare can be difficult for them to navigate. Although emergency departments (EDs) traditionally serve as healthcare ''safety nets'' for vulnerable populations, quantitative studies outside the United States have found that TGGNCexperienced persons tend to avoid EDs and/or have negative experiences. This qualitative study primarily describes the ED experiences of people with a TGGNC history; furthermore, the study explores reasons why this population avoids U.S. EDs and their recommendations for improvements to ED care. Methods: This qualitative study used data about TGGNC-historied persons' experiences in U.S. EDs from retrospective, anonymous, written surveys (paper or web based). National data collection took place from June 2012 through December 2014. Participant responses (n = 240) were examined using thematic analysis. Results: Using a framework that recognized positive and negative responses, the themes of Self-Efficacy and Power Inequity surfaced. These themes exposed the tension between patients with TGGNC experiences and clinicians who were perceived to lack training in this area, resulting in negative patient experiences. When practitioners had specific training about this population, participants reported positive care experiences. Conclusions: This study indicates that many TGGNC-historied persons who use U.S. EDs have negative experiences, largely due to lack of provider sensitivity toward and training about this patient population. Data from this investigation suggest that training of U.S. ED providers and institutional support would help improve care for this marginalized group.

Background Communication between a health care provider and a patient is a prerequisite for any intervention to occur in the process of health care. Deaf patients depend on interpreters when seeking health care. Confidentiality is an issue since interpreters are involved in the Deaf community. Health care workers (HCWs) are tasked to ensure that the delivery of information to the patient is accurate and kept confidential. Aim of the study The aim of the study was to explore and describe the experiences of HCWs regarding maintenance of confidentiality concerning hearing challenged people in selected public health settings in eThekwini District, KwaZulu-Natal in South Africa. Methodology A descriptive exploratory qualitative design was used in this study. The study population comprised health care workers who worked with hearing challenged patients. Purposive sampling, which is a type of non-probability sampling, was used to select the study participants from the population. Structured interviews, using an interview schedule, were used to collect data. Data was collected until data saturation was reached. Data was analysed using Tesch's eight steps of thematic analysis. Findings Six major themes that emerged from the data analysis were (a) training of health care workers, (b) communication preferences for hard of hearing patients, (c) communication challenges, (d) health care worker-patient relationship, (e) involvement of family members as interpreters and (f) measures to maintain confidentiality. The findings revealed that the majority of participants experienced iii communication challenges with patients who are hard of hearing since only few HCWs are trained in sign language. Conclusion The findings of this study will contribute to addressing issues related to the maintenance of confidentiality of hard of hearing patients. This study does not claim to exhaust the subject but to raise awareness of new investigations in other realities. Further research in the larger representative population of HCWs and hard of hearing patients is necessary to make the health care system more accessible and communication with HCWs more satisfying and effective. A doctoral study is necessary to develop a practice framework to facilitate communication between hard of hearing patients and HCWs.

this study attempts to describe nurses' relationship with deaf and hard of hearing (D&HH) population; nurses' communication skills, their preferred methods in communicating with D&HH patients, and their usage of interpretation services. Non-random stratified sample was designed; three strata hospitals in Riyadh were selected purposively as deaf patients are expected to visit more, then 200 nurses were selected accidently due to limitation of time and 140 of them have participated (response rate 70%). Results showed that 74% of the participants had to treat deaf patients in some points in their career, 71% haven't had instructions on communicating with those patients during their nursing studies and only 21% found it very critical to deal with deaf patients. Out of the study sample, 62% used paper and pen to communicate with deaf patients. While 28% of the study participants had to use interpreter, 58% communicated with the patient before the interpreter arrived and 62% reported that it takes more than one hour for the interpreter to arrive. Finally, 90% of the participants did not know if interpreters were available around the clock. In conclusion, this study showed the need to equip nurses with adequate deafness communication skills beside the necessity to employ the interpretation service properly to improve the level of services provided to D&HH patients.

Background: We conducted a randomized controlled trial to test the effectiveness of an asthma question prompt list with video intervention to engage the youth during clinic visits. We examined whether the intervention was associated with 1) providers including youth and caregiver inputs more into asthma treatment regimens, 2) youth and caregivers rating providers as using more of a participatory decision-making style, and 3) youth and caregivers being more satisfied with visits. Methods: English-or Spanish-speaking youth aged 11-17 years with persistent asthma and their caregivers were recruited from four pediatric clinics and randomized to the intervention or usual care groups. The youth in the intervention group watched the video with their caregivers on an iPad and completed a one-page asthma question prompt list before their clinic visits. All visits were audiotaped. Generalized estimating equations were used to analyze the data. Results: Forty providers and their patients (n=359) participated in this study. Providers included youth input into the asthma management treatment regimens during 2.5% of visits and caregiver input during 3.3% of visits. The youth in the intervention group were significantly more likely to rate their providers as using more of a participatory decision-making style (odds ratio=1.7, 95% confidence interval=1.1, 2.5). White caregivers were significantly more likely to rate the providers as more participatory (odds ratio=2.3, 95% confidence interval=1.2, 4.4). Youth (beta=4.9, 95% confidence interval=3.3, 6.5) and caregivers (beta=7.5, 95% confidence interval=3.1, 12.0) who rated their providers as being more participatory were significantly more satisfied with their visits. Youth (beta=-1.9, 95% confidence interval=-3.4,-0.4) and caregivers (beta=-8.8, 95% confidence interval=-16.2,-1.3) who spoke Spanish at home were less satisfied with visits. Conclusion: The intervention did not increase the inclusion of youth and caregiver inputs into asthma treatment regimens. However, it did increase the youth's perception of participatory decision-making style of the providers, and this in turn was associated with greater satisfaction.

Gender-nonconforming patients are at higher risk for medical problems that require prompt medical and mental health intervention. Barriers to healthcare for transgender individuals have been well characterized in the literature, but not in low resource settings. The purpose of this paper is to present the barriers encountered when bringing healthcare to transgender children, adolescents, and adults in a medically underserved, predominantly Hispanic area of the United States. In this medically underserved area on the U.S.-Mexico border, there is a severe shortage of medical expertise for transgender individuals at both the primary- and specialty-care levels. Further, given the mainly Hispanic population, there is an additional culturally based barrier to obtaining medical care for transgender patients. It is important for academic centers in these regions to collaborate to overcome these barriers through a multidisciplinary approach that includes providing education for medical stude...

Gender-nonconforming patients are at higher risk for medical problems that require prompt medical and mental health intervention. Barriers to healthcare for transgender individuals have been well characterized in the literature, but not in low resource settings. The purpose of this paper is to present the barriers encountered when bringing healthcare to transgender children, adolescents, and adults in a medically underserved, predominantly Hispanic area of the United States. In this medically underserved area on the U.S.-Mexico border, there is a severe shortage of medical expertise for transgender individuals at both the primary- and specialty-care levels. Further, given the mainly Hispanic population, there is an additional culturally based barrier to obtaining medical care for transgender patients. It is important for academic centers in these regions to collaborate to overcome these barriers through a multidisciplinary approach that includes providing education for medical stude...

This article uses the ideas of New Museology as a model to discuss a planning phase of the Community Museum Project in Langley Park, Maryland. It considers that a community museum is an agent for managing change that links education, culture, and power. The methodology is based on educational and psychological concepts of lifelong learning and life-stage development, which seeks to establish conditions to enable communities to learn about themselves and their needs, and to act upon that knowledge. The community museum concept establishes a role for the museum as a mediator in the process of cultural transition .

This article uses the ideas of New Museology as a model to discuss a planning phase of the Community Museum Project in Langley Park, Maryland. It considers that a community museum is an agent for managing change that links education, culture, and power. The ...

The Latino population has more than tripled in six southern US states. Little research exists describing the Latino population in the rural South and the unique cancer control needs of this group. This article reviews existing literature on Latinas with a focus on rural southern settlement processes and applicable breast and cervical cancer control research. Recommendations for effective cancer control programs include developing special outreach efforts conducted with monolingual Latinas, incorporating important cultural components and values related to family, spirituality, and community, and designing programs that incorporate low-literacy materials and messages or that do not require literacy to participate. Understanding the social, cultural, and economic issues that Latinas face is an important first step in designing culturally relevant breast and cervical cancer control.

Few studies have examined the health behaviours and factors that may help or hinder the d/Deaf population’s ability to maintain health in the UK, and none specifically in Wales. In view of the reported inequalities, a better understanding of what helps and hinders d/Deaf individuals’
ability to be healthy is needed. This work will help inform actions towards a healthier, cohesive and more equal Wales, addressing the  aspirations of the Wellbeing of Future Generations Act.
Researchers at Bangor University, Wales, and the University of Graz, Austria, were commissioned by Public Health Wales to complete a literature review on the health and care needs of the d/Deaf communities in the UK and Wales; and undertake a qualitative pilot study to explore (1) the barriers and enablers to staying healthy in d/Deaf communities, and (2) potential actions for different professional groups (e.g. local authority, planning, health promotion materials, health service (pharmacy, GPs, hospital care).

This report can be downloaded in either Welsh or English and viewed in BSL at the following website: http://deaf-communities-wales.bangor.ac.uk

Many studies focus on the explanatory models, or beliefs, that people have about illness. And numerous studies have identified several barriers to accessing health care. Compared to the copious amount of studies on barriers, only a few medical anthropological studies have focused on the significant lack of consensus between provider and client perceptions of these barriers. Consensus between provider and client, or specifically, lack of consensus, is one of the most significant sociocultural barriers in accessing health care. In an effort to add to the anthropological literature on provider-client consensus, this paper will provide a review of the literature and an analysis of fieldwork conducted on provider and client perceptions about barriers in accessing health care at a community health clinic in College Park, Maryland.

I developed, implemented, and evaluated a culturally appropriate pilot health education intervention at a community health clinic. My methods included identifying potential clients with indicators of high cholesterol, hypertension, and/or diabetes, developing curricula, and offering both individual counseling sessions and group workshops. Through eliciting the clients’ explanatory models of their chronic diseases and their typical diet and physical activity behaviors, the counseling sessions and workshops aimed to improve participants’ dietary, physical activity, and cardiovascular/diabetes self-care behaviors. A very small percentage of targeted clients attended the workshops, so a process evaluation was performed to assess clients’ actual and providers’ perceived barriers to accessing the workshops. Clients reported that structural barriers prevented them from attending, while providers perceived the clients’ barriers as sociocultural and structural. The evaluation provides evidence supporting the continuation of the workshops, as well as several recommendations for removing barriers to accessing them.

List for the last year and a half. Her current research is on issues of self-maintenance of Type II diabetes and their relation to development of other health complications. After graduation in May of 2008, Davis plans to attend graduate school to pursue a doctorate in anthropology. During her postgraduate studies, Davis plans to conduct research in the field of nutritional anthropology and the role food plays in culture at large. She wishes to combine this interest with her interest in public health and chronic disease. Davis"s ultimate goal is to make herself and her family proud by being the first person in her family to receive a Ph.D.

Type 2 diabetes, a chronic illness, is reaching epidemic proportions in North America. Pharmaceutical and consumer companies alike are embracing ethnography as a means to gain insight into the condition and to meet the complex needs of diabetics. This paper explores three topics that emerged from our ethnographic work in this area. First, we discuss the contribution of ethnography towards understanding the lived experience of Type 2 diabetes. Second, we suggest Type 2 diabetes should be viewed as a meta-transition that encapsulates four types of transition, each of which is an important aspect of the diabetic experience, and which may provide critical insights in an applied context. Third, we argue that applied ethnography can be dramatically enriched by an anthropologically and theoretically informed approach, without which the experience of, and transitions within, Type 2 diabetes cannot be fully understood and the social and business benefits maximized.