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Communication

2014

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Full-Text Articles in Medicine and Health Sciences

Research Brief: "The Potential For Health-Related Uses Of Mobile Phones And Internet With Homeless Veterans: Results From A Multisite Survey", Institute For Veterans And Military Families At Syracuse University Dec 2014

Research Brief: "The Potential For Health-Related Uses Of Mobile Phones And Internet With Homeless Veterans: Results From A Multisite Survey", Institute For Veterans And Military Families At Syracuse University

Institute for Veterans and Military Families

This brief is about the use of mobile phones among homeless veterans for medical appointment reminders, and other health services provided by healthcare practitioners. In policy and practice, social workers and counselors should determine whether mobile communication would benefit homeless veterans with whom they work and should identify certain barriers to mobile communication that could exist; the VA should expand its mobile notification efforts and look for programs that reduce barriers to regular access to mobile communication. Suggestions for future research include expanding the sample of homeless veterans to include those who are living on the streets or in a …


Launching A Virtual Decision Lab: Development And Field-Testing Of A Web-Based Patient Decision Support Research Platform, Aubri S. Hoffman, Hilary A. Llewellyn-Thomas, Anna N. A. Tosteson, Annette M. Oconnor Dec 2014

Launching A Virtual Decision Lab: Development And Field-Testing Of A Web-Based Patient Decision Support Research Platform, Aubri S. Hoffman, Hilary A. Llewellyn-Thomas, Anna N. A. Tosteson, Annette M. Oconnor

Dartmouth Scholarship

Over 100 trials show that patient decision aids effectively improve patients’ information comprehension and values-based decision making. However, gaps remain in our understanding of several fundamental and applied questions, particularly related to the design of interactive, personalized decision aids. This paper describes an interdisciplinary development process for, and early field testing of, a web-based patient decision support research platform, or virtual decision lab, to address these questions.


Impact Of Improving Throughput In The Emergency Department, Katherine J. Edrington Dec 2014

Impact Of Improving Throughput In The Emergency Department, Katherine J. Edrington

Doctor of Nursing Practice (DNP) Projects

The purpose of this project was to evaluate the patient experience in the emergency department (ED) and in the inpatient setting while correlating increased throughput and patient outcomes at a suburban Acute Care facility in Ohio. The culture in the organization has lacked accountability and ownership of the patients. The ED admitted length of stay (ALOS) was 358 minutes in the beginning of 2013. For the first time in the organization’s history, the ED ALOS is now typically less than the recommended benchmark of 300 minutes. A report of findings among ED’s surveyed showed the ALOS best practice is 244 …


Implementing And Evaluating A Clinical Information Interface Between An Electronic Medical Record And A Patient Classification System, Tanya Osborne-Mckenzie Dec 2014

Implementing And Evaluating A Clinical Information Interface Between An Electronic Medical Record And A Patient Classification System, Tanya Osborne-Mckenzie

Doctor of Nursing Practice (DNP) Projects

As a result of the Affordable Care Act and the Institute of Medicine’s initiatives, hospitals are challenged to improve outcomes as efficiently as possible. How does the national initiative of RNs partnering with other healthcare professionals to improve the quality of patient care at a lower cost, cascade down to individual organizations? One answer may come by focusing on nurse staffing in acute care hospitals. Considering the impact RNs have on patient quality outcomes and the bottom line of hospitals, appropriate management of the RN workforce is one of the most important areas hospitals can focus on in order to …


Combating Hiv/Aids In Marginalized Communities: Papua And West Papua Provinces, Indonesia, Bani Cheema Dec 2014

Combating Hiv/Aids In Marginalized Communities: Papua And West Papua Provinces, Indonesia, Bani Cheema

Master's Theses

My study focuses on foreign aid and local initiatives for HIV/AIDS prevention in eastern Indonesia using the provinces of Papua and West Papua as a case study. The two provinces are home to indigenous tribal groups that are socioeconomically marginalized and most affected by the epidemic. My research investigates behavior change communication as a principal strategy undertaken by multiple organizations for HIV/AIDS prevention in this region. I take a qualitative approach by examining the effectiveness of this strategy in local communities and by revealing social and cultural barriers that impede success. Obstacles that negatively impact prevention efforts include structural violence, …


Correlating Coworker Relations, Employee Involvement, And Leadership With Associate Commitment In Select Healthcare Companies Using A Mixed Sequential Explanatory Design, Kimberly Ann Lee Dec 2014

Correlating Coworker Relations, Employee Involvement, And Leadership With Associate Commitment In Select Healthcare Companies Using A Mixed Sequential Explanatory Design, Kimberly Ann Lee

Theses & Dissertations

Increasing patient demands and decreasing reimbursement require better efficiency and effectiveness in health care systems and, subsequently, in health care teams. These environmental and societal factors are further complicated by the complex initiatives set forth by the Affordable Care Act (2010). In this study, the researcher sought to examine and identify the strongest variables of health care teaming and to explore resulting themes through the perception of groups of health care associates. This mixed sequential explanatory design first examined the relationships between coworker relations, employee involvement, and leadership with associate commitment and with each other. An existing database of associate …


Women's Health And Abortion Culture In China: Policy, Perception And Practice , Naomi Bouchard Dec 2014

Women's Health And Abortion Culture In China: Policy, Perception And Practice , Naomi Bouchard

Independent Study Project (ISP) Collection

Since China’s implementation of the Family Planning Policy in 1973, much research has been dedicated to analyzing the effects of a policy that strictly controls the reproductive lives of a population now comprisedof 1.35 billion people. Analyses focus on the rise of abortions in China, now at an annual rate of at least 13 million, but offer little insight into the perceptions of the population in regard to China’s new abortion culture. This study aims to shed light on current perceptions through a range of in-person, qualitative interviews conducted in Kunming, China. The study is limited to a sample size …


College Student Lay Health Information Mediary Behavior: An Examination Of Ehealth Literacy And Unrequested Health Advice, Andrew William Cole Dec 2014

College Student Lay Health Information Mediary Behavior: An Examination Of Ehealth Literacy And Unrequested Health Advice, Andrew William Cole

Theses and Dissertations

Lay health information mediary behavior (LHIMB) describes individuals seeking health information to relay to others. The current study examines LHIMB as a relationship between eHealth literacy and unrequested health advice (UHA). 254 undergraduate students completed a survey addressing eHealth literacy levels, general UHA behaviors and specific UHA episodes. Results on general UHA behaviors indicate no significant relationship exists between eHealth literacy and utilizing UHA in health decision-making or frequency of offering UHA. However, self-perceived health status and degree of health worry significantly predict using UHA in health decision-making. Further, as health worry increases, participants appear significantly more likely to receive …


Impact Of An Interprofessional Communication Course On Nursing, Medical, And Pharmacy Students’ Communication Skill Self-Efficacy Beliefs, Nicholas E. Hagemeier, Rick Hess, Kyle S. Hagen, Emily L. Sorah Dec 2014

Impact Of An Interprofessional Communication Course On Nursing, Medical, And Pharmacy Students’ Communication Skill Self-Efficacy Beliefs, Nicholas E. Hagemeier, Rick Hess, Kyle S. Hagen, Emily L. Sorah

ETSU Faculty Works

Objective. To describe an interprofessional communication course in an academic health sciences center and to evaluate and compare interpersonal and interprofessional communication self-efficacy beliefs of medical, nursing, and pharmacy students before and after course participation, using Bandura’s self-efficacy theory as a guiding framework.

Design. First-year nursing (n=36), first-year medical (n=73), and second-year pharmacy students (n=83) enrolled in an interprofessional communication skills development course voluntarily completed a 33-item survey instrument based on Interprofessional Education Collaborative (IPEC) core competencies prior to and upon completion of the course during the fall semester of 2012.

Assessment. Nursing students entered the course with higher interpersonal …


I Get By With A Little Help From My Friends: A Qualitative Study Of Nurse Close Work Friendship And Social Support, Jennifer Ptacek Dec 2014

I Get By With A Little Help From My Friends: A Qualitative Study Of Nurse Close Work Friendship And Social Support, Jennifer Ptacek

Masters Theses

The nursing profession is laden with numerous job, emotional labor, and communication stressors, which come from both patients and healthcare organizations. These frequent and simultaneous pressures can result in nurse burnout and turnover (Tracy, 2009). Socially supportive workplace communication has been identified as a solution to reducing nurse stress, burnout, and turnover (Apker & Ray, 2003), but has not specifically considered social support in nurse work friendships. A mixed qualitative method study was conducted with five nurse best friend pairs, using job observations of participants’ work friendship communication and individual and joint interviews. Two major communication themes emerged from the …


Health Literate Organizations: Are Clinical Trial Sites Equipped To Recruit Minority And Limited Health Literacy Patients?, Jennifer Livaudais-Toman, Nancy J. Burke, Anna Napoles, Celia P. Kaplan Nov 2014

Health Literate Organizations: Are Clinical Trial Sites Equipped To Recruit Minority And Limited Health Literacy Patients?, Jennifer Livaudais-Toman, Nancy J. Burke, Anna Napoles, Celia P. Kaplan

Journal of Health Disparities Research and Practice

Background. Racial/ethnic minority patients are less likely than non-Latino white patients to participate in cancer clinical trials. A key barrier to participation is limited health literacy which is more common among minorities. At the organizational level, it is important that clinical trials sites become better equipped to recruit minority patients by expanding their organizational health literacy including language competency and outreach efforts. We explored the characteristics of clinical trial sites that are associated with these health literate behaviors.

Methods. We identified 353 breast clinical trials recruiting participants in 2006 from four states (California, Florida, Illinois, and New York) through the …


Transmedial Documentation For Non-Visual Image Access, Melody J. Mccotter Nov 2014

Transmedial Documentation For Non-Visual Image Access, Melody J. Mccotter

Proceedings from the Document Academy

In my doctoral studies on information accessibility for the individual who is blind or visually impaired, I’ve been exploring the ways we can make image documents more accessible. This requires using an alternative sensory modality, and translating the document into a different format. The questions that arise when we consider this process are many, but among them are:

  • Is it the same document once we’ve converted it to an audio narrative about the work, or a 3D topographic map of an artwork, or a musical interpretation?
  • If it is not the same document, how truthful can the “trans-medial” translation be …


Hearing The Patient Voice: Using Video Intervention/Prevention Assessment To Understand Teens With Cystic Fibrosis, Susan Horky Lscw, Laura E. Sherman Msw, Julie Polvinen, Michael Rich Md Nov 2014

Hearing The Patient Voice: Using Video Intervention/Prevention Assessment To Understand Teens With Cystic Fibrosis, Susan Horky Lscw, Laura E. Sherman Msw, Julie Polvinen, Michael Rich Md

Patient Experience Journal

This qualitative study asked two questions: 1) How do teens with cystic fibrosis (CF) feel about their treatments; and 2) What factors lead teens to adhere, or not adhere, to treatments. To answer these questions we used an innovative approach (Video Intervention/Prevention Assessment or VIA), to learn about the experiences of teens with CF. We loaned video camcorders to teens with CF and asked them to create visual narratives of their lives. Researchers logged and coded videotapes, identifying themes that arose from the material. A primary theme was “Doctors don’t understand.” Participants also highlighted the value of routines and parental …


Enhancing Patient Experience By Training Local Trainers In Fundamental Communication Skills, Calvin L. Chou, Laura Cooley, Ellen Pearlman, Maysel Kemp White Nov 2014

Enhancing Patient Experience By Training Local Trainers In Fundamental Communication Skills, Calvin L. Chou, Laura Cooley, Ellen Pearlman, Maysel Kemp White

Patient Experience Journal

Medical centers have a vested interest in improving patient experience through enhancing communication skills. The American Academy on Communication in Healthcare has helped institutions across the country establish internal expertise through delivering train-the-trainer programs. The phases of the program include preparing for implementation of the program, having program participants undergo a fundamental communication skills workshop and then understanding the theoretical and practical rationales underlying the workshop, setting up practice sessions for participants to achieve mastery, and ensuring long-term viability of a communication skills improvement initiative. Outcomes for participants include increased self-assessed personal communication skill, optimism about rolling out a communication …


Word Recognition In Noise Among Young And Older Listeners: A Combined Behavioral And Electrophysiological Study, Victoria Ann Williams-Sanchez Nov 2014

Word Recognition In Noise Among Young And Older Listeners: A Combined Behavioral And Electrophysiological Study, Victoria Ann Williams-Sanchez

USF Tampa Graduate Theses and Dissertations

Word recognition is based on the complex interplay of bottom up processing of acoustic input and corresponding top-down processing based on linguistic redundancies (i.e., contextual cues). Friedrich and Kotz (2007) investigated the timeline of integrating top-down and bottom-up processes among young adults with normal hearing using sentences presented in quiet. As a follow-up study, also with young adults with normal hearing (Experiment 1 of this dissertation), we used sentences embedded in multi-talker background noise and found similar results to Friedrich and Kotz (2007); but, with the use of principal component analysis (PCA) unveiled additional effects of phonological and semantic integration …


Exploring The Use Patterns Of A Mobile Health Application For Alcohol Addiction Before The Initial Lapse After Detoxification, Ming-Yuan Chih Nov 2014

Exploring The Use Patterns Of A Mobile Health Application For Alcohol Addiction Before The Initial Lapse After Detoxification, Ming-Yuan Chih

Health and Clinical Sciences Faculty Publications

How patients used Addiction-Comprehensive Health Enhancement Support System (A-CHESS), a mobile health intervention, while quitting drinking is worthy exploring. This study is to explore A-CHESS use patterns prior to the initial lapse reported after discharge from inpatient detoxification programs. 142 patients with alcohol addiction from two treatment agencies in the U.S. were included. A comprehensive set of A-CHESS use measures were developed based on a three-level system use framework and three A-CHESS service categories. In latent profile analyses, three A-CHESS system use patterns-inactive, passive, and active users-were found. Compared to the passive users (with the highest chance of the initial …


Assessing Technologies For Information-Seeking On Prostate Cancer Screening By Low-Income Men, Susan W. Mcroy, Emily M. Cramer, Hayeon Song Nov 2014

Assessing Technologies For Information-Seeking On Prostate Cancer Screening By Low-Income Men, Susan W. Mcroy, Emily M. Cramer, Hayeon Song

Journal of Patient-Centered Research and Reviews

Purpose: This paper presents a multipart investigation of the benefits and challenges in deploying automated question-answering as an alternative to web-based searching to provide information about prostate cancer screening for low-income men age 40 years and older.

Methods: The study comprised: 1) a survey assessing current use of the Internet, mobile phones and texting; 2) a controlled observational study of both web-based searching and automated question-answering for information about prostate cancer; and 3) a formative field study in which subjects interacted with a health department nurse using text messages.

Results: Survey results suggest the target population has greater access to, …


Systematic Review Of The Use Of Online Questionnaires Of Older Adults, Meegan Remillard, Kathleen Mazor, Sarah Cutrona, Jerry Gurwitz, Jennifer Tjia Nov 2014

Systematic Review Of The Use Of Online Questionnaires Of Older Adults, Meegan Remillard, Kathleen Mazor, Sarah Cutrona, Jerry Gurwitz, Jennifer Tjia

Jennifer Tjia

OBJECTIVES: To describe methodological approaches to population targeting and sampling and to summarize limitations of Internet-based questionnaires in older adults.

DESIGN: Systematic literature review.

SETTING: Studies using online questionnaires in older adult populations.

PARTICIPANTS: English-language articles using search terms for geriatric, age 65 and over, Internet survey, online survey, Internet questionnaire, and online questionnaire in PubMed and EBSCO host between 1984 and July 2012. Inclusion criteria were study population mean age 65 and older and use of an online questionnaire for research. Review of 336 abstracts yielded 14 articles for full review by two investigators; 11 articles met inclusion criteria. …


Desktop Medicine, Jason Karlawish Nov 2014

Desktop Medicine, Jason Karlawish

Jason Karlawish

No abstract provided.


Policymakers Identify Priorities For Phssr, Katherine Froeb Papa Nov 2014

Policymakers Identify Priorities For Phssr, Katherine Froeb Papa

Frontiers in Public Health Services and Systems Research

A major goal for the health services research community is to provide evidence policymakers can use to improve the public’s health. However, it can be difficult to know what evidence policymakers want and how they decide what research to fund.

In order to understand where policymakers turn for evidence and how they make funding decisions amid fiscal and political constraints, AcademyHealth conducted a 3-part Fireside Chat series in the spring of 2014. This editorial summarizes the evidence gaps identified, and provides strategies for communicating with decision makers.


Black Infant Deaths Point To Flaw In U.S. Health Care System, Vanessa Lopez-Littleton Oct 2014

Black Infant Deaths Point To Flaw In U.S. Health Care System, Vanessa Lopez-Littleton

UCF Forum

In a recent interview on The Daily Show, TV host Jon Stewart asked Fox political commentator Bill O’Reilly: “Does white privilege exist?” O’Reilly denied the existence of white privilege but conceded that as a collective, blacks carry more of a burden than whites.


Exploring Communication Apprehension And Its Relationship To Communication Attitude And Socio-Communicative Functioning In Children With Velopharyngeal Insufficiency, Agnieszka Dzioba Oct 2014

Exploring Communication Apprehension And Its Relationship To Communication Attitude And Socio-Communicative Functioning In Children With Velopharyngeal Insufficiency, Agnieszka Dzioba

Electronic Thesis and Dissertation Repository

Myriad findings on children with velopharyngeal insufficiency (VPI) indicate the potential for this population of children to experience feelings of apprehension specific to communication and the potential for other psychological and social difficulties. The purpose of the present investigation was to explore the construct of communication apprehension (CA) and its potential relationship to social and communicative functioning in a diverse group of children with VPI. Potential linkages between CA and multiple socio-communicative constructs including attitude, speech satisfaction, speech and language skill, social competence, and speech severity were explored in a cohort of children with and without VPI, followed by an …


The Politics Of Hpv Vaccination Advocacy: Effects Of Source Expertise On Effectiveness Of A Pro-Vaccine Message, Roger Gans Oct 2014

The Politics Of Hpv Vaccination Advocacy: Effects Of Source Expertise On Effectiveness Of A Pro-Vaccine Message, Roger Gans

Proceedings of the New York State Communication Association

The Politics of HPV Vaccination Advocacy:

Effects of Source Expertise on Effectiveness of a Pro-Vaccine Message

Persistent public resistance to an apparently safe, effective and life-saving public health practice such as HPV vaccination illustrates a significant issue in the communication of behavioral recommendations based on evidence-based scientific data and consensus views of scientific and medical experts. This study examines the influence of source expertise on pro-HPV-vaccine advocacy messaging effectiveness among audiences of differing political ideologies. The findings support prior research indicating greater resistance to HPV vaccination among political conservatives. Subjects who self-identified politically as Centrists and Conservatives were significantly less …


Chess Improves Cancer Caregivers' Burden And Mood: Results Of An Ehealth Rct, Lori L. Dubenske, David H. Gustafson, Kang Namkoong, Robert P. Hawkins, Amy K. Atwood, Roger L. Brown, Ming-Yuan Chih, Fiona Mctavish, Cindy L. Carmack, Mary K. Buss, Ramaswamy Govindan, James F. Cleary Oct 2014

Chess Improves Cancer Caregivers' Burden And Mood: Results Of An Ehealth Rct, Lori L. Dubenske, David H. Gustafson, Kang Namkoong, Robert P. Hawkins, Amy K. Atwood, Roger L. Brown, Ming-Yuan Chih, Fiona Mctavish, Cindy L. Carmack, Mary K. Buss, Ramaswamy Govindan, James F. Cleary

Community & Leadership Development Faculty Publications

OBJECTIVE: Informal caregivers (family and friends) of people with cancer are often unprepared for their caregiving role, leading to increased burden or distress. Comprehensive Health Enhancement Support System (CHESS) is a Web-based lung cancer information, communication, and coaching system for caregivers. This randomized trial reports the impact on caregiver burden, disruptiveness, and mood of providing caregivers access to CHESS versus the Internet with a list of recommended lung cancer websites.

METHODS: A total of 285 informal caregivers of patients with advanced nonsmall cell lung cancer were randomly assigned to a comparison group that received Internet or a treatment group that …


Percepciones De La Salud Mental En Cochabamba / Femicide In Bolivia After Perceptions Of Mental Health In Cochabamba, Phoebe House Oct 2014

Percepciones De La Salud Mental En Cochabamba / Femicide In Bolivia After Perceptions Of Mental Health In Cochabamba, Phoebe House

Independent Study Project (ISP) Collection

El propósito de este proyecto es examinar las actitudes que existen en Cochabamba, Bolivia hacia la salud mental y los trastornos mentales. Usé principalmente las entrevistas para descubrir las opiniones de profesionales de la salud mental, estudiantes de psicología y las trabajadoras de un hogar de niños que se llama la Casa de Amor para Niños, donde hice un voluntariado. Aunque los resultados de este proyecto no son generalizables a la población entera de Cochabamba, hay evidencia de opiniones generalmente negativas hacia la salud mental y los trastornos mentales. Sin embargo, también hay evidencia que estas opiniones se pueden mejorar …


Neglected Or Non-Compliant? Assessing The Difficulties Of Tuberculosis Patients In Salvador-Ba, Brazil, Erin Slatery Oct 2014

Neglected Or Non-Compliant? Assessing The Difficulties Of Tuberculosis Patients In Salvador-Ba, Brazil, Erin Slatery

Independent Study Project (ISP) Collection

Objective: The aim of this study is to analyze how Instituto Brasileiro para Investigação da Tuberculose (IBIT), a philanthropic tuberculosis clinic in Salvador, Brazil, maintains treatment abandonment rates much lower than those of surrounding public clinics. This study also aims to evaluate how professionals conceptualize and address the difficulties faced by patients.

Methods: Interviews were conducted with 8 IBIT professionals and 16 patients in treatment for tuberculosis in the aforementioned institution via semi-structured and structured questionnaires, respectively. Participant observation guided the analysis of relationships between patients and professionals.

Results: Patients found varying aspects of treatment difficult depending on personal circumstances, …


Interpersonal Communication In The Context Of Dementia: Examining Family Caregivers' Appraisals And Burden, Stacy Lynn Barnes Oct 2014

Interpersonal Communication In The Context Of Dementia: Examining Family Caregivers' Appraisals And Burden, Stacy Lynn Barnes

Dissertations (1934 -)

Purpose and Objectives: The purpose of this study was to explore dementia family caregivers' appraisals of communication behaviors and strategies, and their relationships to caregiver burden. Study objectives were to investigate: 1) the relationship between frequency of dementia-related communication behaviors and caregivers' appraisals of frustration; 2) the relationship between caregivers' use of communication strategies and appraisals of helpfulness; 3) the structural relationships between communication behavior appraisal, communication strategy appraisal, problem behaviors, and caregiver burden; and 4) caregiver education level as a moderating variable of the final structural model. Methods: A written, mailed questionnaire was developed to capture dementia family caregivers' …


Infusing Cultural Competency Into Medical School Curricula, Debbie Salas-Lopez, Maria Soto-Greene, Catherine Bolder, Robert Like Sep 2014

Infusing Cultural Competency Into Medical School Curricula, Debbie Salas-Lopez, Maria Soto-Greene, Catherine Bolder, Robert Like

Debbie Salas-Lopez MD, MPH

No abstract provided.


An Ecological Approach To Organizational Transformation: The Growth Of Cross-Cultural Health Care Delivery In An Academic Community Health Network, James Geiger, Judith Sabino, Eric Gertner, Jarret Patton, Llewellyn Cornelius, Debbie Salas-Lopez Sep 2014

An Ecological Approach To Organizational Transformation: The Growth Of Cross-Cultural Health Care Delivery In An Academic Community Health Network, James Geiger, Judith Sabino, Eric Gertner, Jarret Patton, Llewellyn Cornelius, Debbie Salas-Lopez

Debbie Salas-Lopez MD, MPH

No abstract provided.


Barriers And Facilitators For Colorectal Cancer Screening Practices In The Latino Community: Perspectives From Community Leaders, Ana Natale-Pereira, Jonnie Marks, Marielos Vega, Dawne Mouzon, Shawna Hudson, Debbie Salas-Lopez Sep 2014

Barriers And Facilitators For Colorectal Cancer Screening Practices In The Latino Community: Perspectives From Community Leaders, Ana Natale-Pereira, Jonnie Marks, Marielos Vega, Dawne Mouzon, Shawna Hudson, Debbie Salas-Lopez

Debbie Salas-Lopez MD, MPH

BACKGROUND: Colorectal cancer (CRC) is the second-leading cause of cancer-related death in the United States and the third most commonly diagnosed cancer among Latinos. While Latinos represent one of the fastest-growing ethnic groups in the United States, their participation in cancer prevention and treatment trials is low. METHODS: Thirty-six Latino community leaders participated in five focus groups that examined factors affecting CRC screening practices among Latinos. RESULTS: The top four barriers identified were low knowledge and awareness of CRC, language barriers, lack of insurance, and undocumented legal status. Additional barriers included seeking health care only when sick, fatalism, fear, denial …