Abstract
As the Hispanic/Latinx population in the United States continues to grow, disparities in health outcomes for this population continue to widen. Worse health outcomes can be attributed to a variety of barriers to healthcare specific to this population, but scant literature exists that presents the connections among them. Many of these barriers to healthcare stem from institutional racism, disparities in socioeconomic status, and xenophobia. To synthesize barriers that hinder the Hispanic/Latinx population from receiving quality healthcare, we propose a cyclical model. The model begins with obstacles present before even visiting a healthcare provider, including structural inequalities, cultural beliefs, documentation status, scheduling, and transportation. Next, the model poses barriers during the visit with a healthcare provider, including problems with provider bias, cultural barriers, and interpretation services. Finally, the model presents barriers that occur after the medical encounter, including payment, medication adherence, indigent care, and follow-up appointments or referrals. Once the patient needs to schedule a follow-up appointment or referral, the cycle restarts with the barriers present before accessing care. All of these barriers to healthcare are areas for potential mitigation of the healthcare disparities that currently disadvantage the Hispanic/Latinx population. The proposed Hispanic Cyclical Healthcare Barrier (HCHB) model helps organize solutions to the barriers, illustrating the need for multiple interventions due to the interconnectedness of the barriers.
Similar content being viewed by others
Notes
The terms Hispanic, Latino, and Latinx are used interchangeably but have slightly different connotations. The term “Hispanic” refers to people of the Americas or Spain who speak Spanish [1]. This term suggests a connection of this population with Spain, which colonized the Americas. Avoiding this connection to imperialism, the term “Latino” refers to people of Latin American heritage living in the US who may speak any language. Later, the term “Latinx'' arose as a gender-neutral version of “Latino,” which is a masculine noun [1]. This paper uses the terms “Hispanic” and “Latinx'' interchangeably to refer to the US population of Latin American origin who speak Spanish, as neither of these terms perfectly encompasses the population desired to be described.
References
Department of Organizational Strategy, Initiatives, and Culture. Hispanic vs. Latinos vs. Latinx explained. Yes Prep. 2020. https://www.yesprep.org/news/blog/featured/~board/blog/post/hispanic-vs-latinos-vs-latinx-explained. Accessed 12 Dec 2022.
Funk C, Hugo Lopez M. A brief statistical portrait of U.S. Hispanics. Pew Research Center Science & Society. 2022. https://www.pewresearch.org/science/2022/06/14/a-brief-statistical-portrait-of-u-s-hispanics/. Accessed 12 Dec 2022.
Income and wealth in the United States: an overview of the latest data. Peter G. Peterson Foundation. 2022. https://www.pgpf.org/blog/2022/11/income-and-wealth-in-the-united-states-an-overview-of-recent-data. Accessed 12 Dec 2022.
Velasco-Mondragon E, Jimenez A, Palladino-Davis AG, Davis D, Escamilla-Cejudo JA. Hispanic health in the USA: a scoping review of the literature. Public Health Rev. 2016;37(1):31. https://doi.org/10.1186/s40985-016-0043-2.
Labor force characteristics by race and ethnicity, 2014. U.S. Bureau of Labor Statistics. 2015. Accessed 7 April 2023.
Guzman NJ. Epidemiology and management of hypertension in the Hispanic population. Am J Cardiovasc Drugs. 2012;12(3):165–78. https://doi.org/10.2165/11631520-000000000-00000.
Franzini L, Ribble JC, Keddie AM. Understanding the Hispanic paradox. Ethn Dis. 2001;11(3):496–518.
Morales LS, Lara M, Kington RS, Valdez RO, Escarce JJ. Socioeconomic, cultural, and behavioral factors affecting Hispanic health outcomes. J Health Care Poor Underserved. 2002;13(4):477–503. https://doi.org/10.1177/104920802237532.
Krogstad JM, Hugo Lopez M. Hispanic nativity shift. Pew Research Center. 2014. https://www.pewresearch.org/hispanic/2014/04/29/hispanic-nativity-shift/. Accessed 12 Mar 2023
Boen CE, Hummer RA. Longer—but harder—lives?: the Hispanic health paradox and the social determinants of racial, ethnic, and immigrant-native health disparities from mid- through late-life. J Health Soc Behav. 2019;60(4):434–52. https://doi.org/10.1177/0022146519884538.
Tripp-Reimer T, Choi E, Kelley LS, Enslein JC. Cultural Barriers to Care: Inverting the Problem. Diabetes Spectrum. 2001;14:13–22. https://doi.org/10.2337/diaspect.14.1.13.
Sewell N. Continuous quality improvement in acute health care: creating a holistic and integrated approach. Int J Health Care Qual Assur. 1997;10(1):20–6. https://doi.org/10.1108/09526869710159598.
Borrell LN. Racial identity among Hispanics: implications for health and well-being. Am J Public Health. 2005;95(3):379–81. https://doi.org/10.2105/AJPH.2004.058172.
Palmer-Wackerly AL, Chaidez V, Wayment C, Baker J, Adams A, Wheeler LA. Listening to the voices of community health workers: a multilevel, culture-centered approach to overcoming structural barriers in U.S. latinx communities. Qual Health Res. 2020;30(3):423–36. https://doi.org/10.1177/1049732319855963.
Abubakar I, et al. Confronting the consequences of racism, xenophobia, and discrimination on health and health-care systems. Lancet Lond Engl. 2022;400(10368):2137–46. https://doi.org/10.1016/S0140-6736(22)01989-4.
Gast J, Peak T, Hunt A. Latino health behavior: an exploratory analysis of health risk and health protective factors in a community sample. Am J Lifestyle Med. 2017;14(1):97–106. https://doi.org/10.1177/1559827617716613.
Pérez-Stable EJ, Sabogal F, Otero-Sabogal R, Hiatt RA, McPhee SJ. Misconceptions about cancer among Latinos and Anglos. JAMA. 1992;268(22):3219–23. https://doi.org/10.1001/jama.1992.03490220063029.
Lujan J, Campbell HB. The role of religion on the health practices of Mexican Americans. J Relig Health. 2006;45(2):183–95.
Shapiro J, Saltzer E. Cross-cultural aspects of physician-patient communications patterns. Urban Health. 1981;10(10):10–5.
Cabral J, Cuevas AG. Health inequities among Latinos/Hispanics: documentation status as a determinant of health. J Racial Ethn Health Disparities. 2020;7(5):874–9. https://doi.org/10.1007/s40615-020-00710-0.
Rodríguez MA, Vargas Bustamante A, Ang A. Perceived quality of care, receipt of preventive care, and usual source of health care among undocumented and other Latinos. J Gen Intern Med. 2009;24(3):508. https://doi.org/10.1007/s11606-009-1098-2.
Wolfe MK, McDonald NC, Holmes GM. Transportation barriers to health care in the United States: findings from the national health interview survey, 1997–2017. Am J Public Health. 2020;110(6):815–22. https://doi.org/10.2105/AJPH.2020.305579.
Risser AL, Mazur LJ. Use of folk remedies in a Hispanic population. Arch Pediatr Adolesc Med. 1995;149(9):978–81. https://doi.org/10.1001/archpedi.1995.02170220044006.
Hacker K, Anies M, Folb BL, Zallman L. Barriers to health care for undocumented immigrants: a literature review. Risk Manag Healthc Policy. 2015;8:175–83. https://doi.org/10.2147/RMHP.S70173.
Martinez O, et al. Evaluating the impact of immigration policies on health status among undocumented immigrants: a systematic review. J Immigr Minor Health Cent Minor Public Health. 2015;17(3):947–70. https://doi.org/10.1007/s10903-013-9968-4.
Lewis JM. Internet access and racial/ethnic disparities in using internet health resources. U.S. Census Bureau. 2017. https://www.census.gov/content/dam/Census/library/working-papers/2017/demo/SEHSD-WP2017-31paper.pdf. Accessed 7 Apr 2023.
Car Access. National Equity Atlas. 2022. https://nationalequityatlas.org/indicators/Car_access#/. Accessed 13 Dec 2022.
Kandel W. Rural Hispanics at a glance. USDA Economic Research Service. https://www.ers.usda.gov/webdocs/publications/44570/29566_eib8_002.pdf?v=8391.3. Accessed 16 Dec 2022.
Arcury TA, Preisser JS, Gesler WM, Powers JM. Access to transportation and health care utilization in a rural region. J Rural Health. 2005;21(1):31–8. https://doi.org/10.1111/j.1748-0361.2005.tb00059.x.
Bean MG, Stone J, Moskowitz GB, Badger TA, Focella ES. Evidence of nonconscious stereotyping of Hispanic patients by nursing and medical students. Nurs Res. 2013;62(5):362–7. https://doi.org/10.1097/NNR.0b013e31829e02ec.
Funk C, Hugo Lopez M. Hispanic Americans’ experiences with health care. Pew Research Center. 2022. https://www.pewresearch.org/science/2022/06/14/hispanic-americans-experiences-with-health-care/. Accessed 14 Dec 2022).
Hall WJ, et al. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health. 2015;105(12):e60–76. https://doi.org/10.2105/AJPH.2015.302903.
Diversity in Medicine: Facts and Figures 2019. AAMC. https://www.aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019. Accessed 14 Dec 2022.
Davila YR, Reifsnider E, Pecina I. Familismo: influence on Hispanic health behaviors. Appl Nurs Res. 2011;24(4):e67–72. https://doi.org/10.1016/j.apnr.2009.12.003.
Floríndez LI, Floríndez DC, Como DH, Secola R, Duker LIS. Differing interpretations of health care encounters: a qualitative study of non-Latinx health care providers’ perceptions of Latinx patient behaviors. PLOS One. 2020;15(8):e0236706. https://doi.org/10.1371/journal.pone.0236706.
Calzada EJ, Fernandez Y, Cortes DE. Incorporating the cultural value of respeto into a framework of Latino parenting. Cultur Divers Ethnic Minor Psychol. 2010;16(1):77–86. https://doi.org/10.1037/a0016071.
Schmitz RM, Tabler J. Traversing barriers to health care among LGBTQ+ Latinx emerging adults: utilizing patient experiences to model access. Patient Exp J. 2021;8(2):33–42. https://doi.org/10.35680/2372-0247.1491.
Alencar-Albuquerque G, et al. Access to health services by lesbian, gay, bisexual, and transgender persons: systematic literature review. BMC Int Health Hum Rights. 2016;16(1):2. https://doi.org/10.1186/s12914-015-0072-9.
Tylee A, Haller DM, Graham T, Churchill R, Sanci LA. Youth-friendly primary-care services: how are we doing and what more needs to be done? The Lancet. 2007;369(9572):1565–73. https://doi.org/10.1016/S0140-6736(07)60371-7.
Denson DJ, et al. Health care use and HIV-related behaviors of Black and Latina transgender women in 3 US metropolitan areas: results from the transgender HIV behavioral survey. J Acquir Immune Defic Syndr 1999. 2017;75(Suppl 3):S268–75. https://doi.org/10.1097/QAI.0000000000001402.
National CLAS Standards. US Department of Health and Human Services. https://thinkculturalhealth.hhs.gov/clas/standards. Accessed 15 Dec 2022.
Reynolds JF, Orellana MF. New immigrant youth interpreting in white public space. Am Anthropol. 2009;111(2):211–23. https://doi.org/10.1111/j.1548-1433.2009.01114.x.
Jacobs B, Ryan AM, Henrichs KS, Weiss BD. Medical interpreters in outpatient practice. Ann Fam Med. 2018;16(1):70–6. https://doi.org/10.1370/afm.2154.
Baker DW, Parker RM, Williams MV, Coates WC, Pitkin K. Use and effectiveness of interpreters in an emergency department. JAMA. 1996;275(10):783–8.
Krystallidou D, Bylund CL, Pype P. The professional interpreter’s effect on empathic communication in medical consultations: a qualitative analysis of interaction. Patient Educ Couns. 2020;103(3):521–9. https://doi.org/10.1016/j.pec.2019.09.027.
Kravitz RL, Helms LJ, Azari R, Antonius D, Melnikow J. Comparing the use of physician time and health care resources among patients speaking English, Spanish, and Russian. Med Care. 2000;38(7):728.
Zagaar M, Ndefo UA. Medication Nonadherence in the Latino Population: A Challenge and an Opportunity for Specialized Services. Pharm Times. 2017.https://www.pharmacytimes.com/view/medication-adherence-in-the-latino-population. Accessed 15 Dec 2022.
McQuaid EL, et al. Beliefs and barriers to medication use in parents of Latino children with asthma. Pediatr Pulmonol. 2009;44(9):892–8. https://doi.org/10.1002/ppul.21074.
Davis SH, et al. Translating discharge instructions for limited English-proficient families: strategies and barriers. Hosp Pediatr. 2019;9(10):779–87. https://doi.org/10.1542/hpeds.2019-0055.
Smith PC, Brice JH, Lee J. The relationship between functional health literacy and adherence to emergency department discharge instructions among Spanish-speaking patients. J Natl Med Assoc. 2012;104(11):521–7. https://doi.org/10.1016/S0027-9684(15)30218-2.
Shiro AG, Reeves RV. Latinos often lack access to healthcare and have poor health outcomes. Brookings. 2020. https://www.brookings.edu/blog/how-we-rise/2020/09/25/latinos-often-lack-access-to-healthcare-and-have-poor-health-outcomes-heres-how-we-can-change-that/. Accessed 15 Dec 2022.
Escarce JJ, Kapur K. Access to and quality of health care. In: Tienda M, Mitchell F, editors. Hispanics and the Future of America. Washington, DC: National Academies Press; 2006. pp. 410–446.
Economic well-being of U.S. households in 2020 - banking and credit. Board of Governors of the Federal Reserve System. 2021. https://www.federalreserve.gov/publications/2021-economic-well-being-of-us-households-in-2020-banking-and-credit.htm. Accessed 15 Dec 2022.
Ghaddar S, Byun J, Krishnaswami J. Health insurance literacy and awareness of the affordable care act in a vulnerable Hispanic population. Patient Educ Couns. 2018;101(12):2233–40. https://doi.org/10.1016/j.pec.2018.08.033.
Indigent care trust fund. Georgia Department of Community Health. https://dch.georgia.gov/providers/provider-types/hospital-providers/indigent-care-trust-fund. Accessed 17 Dec 2022.
Gaffney A, McCormick D. The affordable care act: implications for health-care equity. Lancet. 2017;389(10077):1442–52. https://doi.org/10.1016/S0140-6736(17)30786-9.
Van Natta M, et al. Stratified citizenship, stratified health: examining Latinx legal status in the U.S. healthcare safety net. Soc Sci Med. 2019;220:49–55. https://doi.org/10.1016/j.socscimed.2018.10.024.
Kegler MC, Wolff T, Christens BD, Butterfoss FD, Francisco VT, Orleans T. Strengthening our collaborative approaches for advancing equity and justice. Health Educ Behav. 2019;46(1_suppl):5S-8S. https://doi.org/10.1177/1090198119871887.
Chapman MV, et al. Making a difference in medical trainees’ attitudes toward Latino patients: a pilot study of an intervention to modify implicit and explicit attitudes. Soc Sci Med. 2018;199:202–8. https://doi.org/10.1016/j.socscimed.2017.05.013.
Baig AA, Lopez FY, DeMeester RH, Jia JL, Peek ME, Vela MB. Addressing barriers to shared decision making among Latino LGBTQ patients and healthcare providers in clinical settings. LGBT Health. 2016;3(5):335–41. https://doi.org/10.1089/lgbt.2016.0014.
Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev. 2005;62(3):255–99. https://doi.org/10.1177/1077558705275416.
Simon AE, Fenelon A, Helms V, Lloyd PC, Rossen LM. HUD housing assistance associated with lower uninsurance rates and unmet medical need. Health Aff (Millwood). 2017;36(6):1016–23. https://doi.org/10.1377/hlthaff.2016.1152.
Author information
Authors and Affiliations
Contributions
Samantha Brener had the idea for the article. All authors performed the literature search and contributed to drafting the article. Samantha Brener drafted the introduction, “Barriers Before Healthcare,” and “Strategies to Minimize Barriers” sections. Stephanie Jiang drafted the “Barriers During Healthcare” section. Emma Hazenberg drafted the “Barriers After Healthcare” section. Daniel Herrera drafted the conclusion section.
Corresponding author
Ethics declarations
Competing Interests
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Brener, S., Jiang, S., Hazenberg, E. et al. A Cyclical Model of Barriers to Healthcare for the Hispanic/Latinx Population. J. Racial and Ethnic Health Disparities 11, 1077–1088 (2024). https://doi.org/10.1007/s40615-023-01587-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40615-023-01587-5