Analysis of Position Paper for Vurnable Population 2023

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ANALYSIS OF POSITION PAPER FOR VULNERABLE 1 Analysis of Position Paper for Vulnerable Population Juanita Saqibuddin Capella University MSN-FP6026 Dr. Kathy Sheppard February 10, 2023

ANALYSIS OF POSITION PAPER FOR VULNERABLE 2 Analysis of Position Paper for Vulnerable Population Health Disparities in the Hispanic Community The Hispanic community is one of the largest growing vulnerable populations in the US. The Hispanic population is also a targeted group of people who continues to receive minimal health care due to the unavailability of clinics to provide primary care due to staffing and funding. Since there are several reasons for disparities in the Hispanic community, I will focus on communication. The Hispanic population continues to have hope for the fundamental American dream for their family and themselves. My position is to explain reasons for the ongoing disparities in the US and lay out possible Health care reasons why we have these disparities and what is needed to grow and improve primary healthcare for the increase of the Hispanic population. The Hispanic population is a majority of the working-class people who are part of the backbone of the essential workforce in the US. Many of the working class have poor- paying jobs, jobs that many American-born people would not want to do that particular job. Unfortunately, these jobs offer low wages with no healthcare benefits, and many will work an abundance of overtime. Many will avoid medical care due to several factors, such as cost, inability to communicate, or fear of the red tape challenge of being treated by medical personnel. The Hispanic population will seek medical care as a last resort if the cultural home remedies do not work and their illness becomes unbearable at this point. To continue to work is a thought-out decision that the uninsured member of the family's breadwinner would have to decide, and just maybe it is time to take off from work. Many Hispanic people may put off health care to continue to provide for the family because if they do not work, they do not earn for that day, which can affect the entire family economically. “ Hispanic adults also report communication challenges in health care settings; just under half (46%) say

ANALYSIS OF POSITION PAPER FOR VULNERABLE 3 they have a close friend or family member who needs a Spanish-speaking health care provider or translator. Nadeem, R. (2022, June 14).” It is noted that a cultural communication barrier between underinsured and noninsured are an unfortunate obstacle in health care access. Preventive healthcare is not an option because this population will only see a medical professional if it is the last resort. Once they feel better, they will continue to work. The Hispanic population understands that health care can be out of reach, so their solution is to eat well and a lot to keep the energy going, unfortunately not a healthy balanced diet. The diet may be full of Carbs, no exercise, smoking, drinking, and not resting well, possibly working two jobs. Many of the issues of Morbidity, Obesity, Hypertension, Cancers, and job-related injuries are preventable if health information can be communicated better. “ Hispanics in the United States have disproportionately high rates of obesity, hypertension, and diabetes and poorer access to preventive health services.( Brown LD, Vasquez D, Salinas JJ, Tang X, Balcázar H 2018).” How health care is provided for the Hispanic population can be challenging with limited medical staff and language barriers to this growing population. As the number of Hispanic people rises, so do their healthcare needs. One of the main issues is what the community can change to help this population and how communication can be improved to help the Hispanic population. In addition to Health care communication, minimal health workers and facilities can care for the growing Hispanic population. The healthcare systems and the overpopulated clinics can cause healthcare workers to communicate poorly with this group of people because of the lack of qualified bilingual staff. “There are insufficient Spanish-speaking physicians to

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ANALYSIS OF POSITION PAPER FOR VULNERABLE 4 effectively serve a large and rapidly growing Spanish-speaking patient population. ( Oliver M, Fernberg T, Lyons P, Elango S, Green GJ, Talib ZM.2022 )” Developing the Role of The Interprofessional Team The Healthcare Interprofessional team in facilitating improvement and challenges for the Treatment of Health in the Hispanic population can be challenging but also can be accomplished. To have a goal to improve health care, one needs to reach out to other medical team members and work collaboratively with the community and politicians for funding to reach a collaborative goal; in a study conducted by an Advisory board collaborating with a medical team to try and come up with a solution for healthcare disparities. “ A community advisory board (CAB) composed of researchers and potential implementers (e.g., social workers, primary care physicians) used the collaborative intervention planning framework, an approach that combines community-based participatory research principles and intervention mapping (IM) procedures, to inform intervention adaptations. Cabassa LJ, Gomes AP, Meyreles Q, Capitelli L, Younge R, Dragatsi D, Alvarez J, Manrique Y, Lewis-Fernández R 2014” To focus on and target this vulnerable group, the medical healthcare team can understand how improvements can be made to help the Hispanic population. The issues are evident with the current numbers of Morbidity and mortality rates increasing in this population. As a group, healthcare workers working together can improve change to communicate care with the Hispanic group. “ Based on Title VI of the Civil Rights Act, LEP patients and families must have meaningful access to language services. 16 The National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS standards) issued by the US Department of Health and Human Services guide Title VI compliance. Cabassa LJ, Gomes AP,

ANALYSIS OF POSITION PAPER FOR VULNERABLE 5 Meyreles Q, Capitelli L, Younge R, Dragatsi D, Alvarez J, Manrique Y, Lewis-Fernández R. 2014” Several studies show how this ongoing problem can be solved. What can communities do with the healthcare communication of the Hispanic population? How can we provide this group with education, resources, and health behavior? Communication and empathy in understanding the Hispanic culture can also help by understanding the Hispanic population's decisions for their health. “ The adaptation process included four steps: fostering collaborations between CAB members; understanding the needs of the local population through a mixed-methods needs assessment, literature reviews, and group discussions; reviewing intervention objectives to identify targets for adaptation; and developing the adapted intervention. Cabassa LJ, Gomes AP, Meyreles Q, Capitelli L, Younge R, Dragatsi D, Alvarez J, Manrique Y, Lewis-Fernández R 2014” The Hispanic population remains to have a communication barrier at times when seeking or asking for medical advice. The Hispanic community can feel comfortable with their healthcare worker by communicating with that person. If the patient cannot speak well with the healthcare worker, trust is lost because no effort was made for sharing with them. “In addition to proven clinical care deficiencies encountered through a need for interpretation, these services create an added burden on the health system through increased patient encounter time [ 10 – 12 ].( Oliver M, Fernberg T, Lyons P, Elango S, Green GJ, Talib ZM.2022)” As healthcare workers understanding and knowing are own limitation is to step back and seek assistance to communicate with the Hispanic population. We need to utilize our available resources and not just rush to care for the patient but listen and try to understand what they may have to say. To make a difference in this population, we must step back and understand the

ANALYSIS OF POSITION PAPER FOR VULNERABLE 6 reasoning behind this group's decision. Many of these decisions are caused due to limited education, cultural beliefs, and employment experience that is necessary to maintain the family and little thought for the home's breadwinner, even to think they deserve to care about their health. “ Understanding the targeted population is essential to gaining insight into their health care needs and usage of health care services. The economic, legal, social, educational, and cultural background of Hispanics in the United States helps to explain some of the barriers that they have related to their access and usage of health care.” When reviewing, the collective data on communication “Language barrier” for Hispanic patients showed disappointing results. The Healthcare team acknowledges the challenges the group may face in working together or facilitating improvements. This particular study on language barriers and improvement in healthcare decisions for the Hispanic population. “This study aims to describe the perspectives of LEP (Limited English Proficiency) Latina mothers on their experiences with language services in pediatric health care to inform the development of more patient- and family-centered language services. Steinberg EM, Valenzuela-Araujo D, Zickafoose JS, Kieffer E, DeCamp LR.” This study targeted the Hispanic population of mothers with children with access to health care and their experience. The questions asked what language they speak and which language is preferred, and most of the answers were to receive information and education in Spanish for health care. The study questions were completed at the client's home with an incentive of $25.00 for participating. The study results are that the participant was happy with the care they received but reported a more negative experience with the language barrier in specialty areas in healthcare. Per the study, many mothers felt that the healthcare encounter could be like a “battle” in different areas of healthcare, except for their primary

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ANALYSIS OF POSITION PAPER FOR VULNERABLE 7 physician. One of the findings was a lack of interpreter service and that sometimes nurses were used to interpreting but did not communicate clearly. “The study also showed that some moms could “get by” with some Spanish some health workers tried to explain with their poor Spanish. Some parents did not want to be a burden, cause trouble, or become a problem with the staff. Despite these limitations, this study fills a significant gap in health services research by identifying and understanding patient perspectives on language barriers in health care. Steinberg EM, Valenzuela-Araujo D, Zickafoose JS, Kieffer E, DeCamp LR.” As a Healthcare worker in the NICU, language is everything. A misunderstanding of a diagnosis or the Plan of care can be overwhelming or devastating for a family that does not speak the language. Every client must be informed appropriately by a professional interpreter or the Language line iPad. As healthcare workers, we need to assess and ask ourselves does the client truly understands and do we need to take the initiative to find interpreter resources for the family, so families don’t just agree to anything the medical staff says, “get by,” or feel they are “burden” to the medical team. Evaluating the evidence from this study was to confirm how our system in healthcare remains to help the Hispanic population understand the care they will or have received, and new resources are still a work in progress. “Training staff with new initiatives to help disparities in healthcare should be available to constantly provide and prevent language barrier and healthcare to become more “patient-centered.” Healthcare workers need to understand how to prevent healthcare disparities. Our findings demonstrate that decisions regarding managing language barriers are complex and involve choices on behalf of the patient and provider. Current training on appropriate management of language needs primarily focuses on services and programs to be

ANALYSIS OF POSITION PAPER FOR VULNERABLE 8 offered by health systems and choices that providers make during individual encounters. Steinberg EM, Valenzuela-Araujo D, Zickafoose JS, Kieffer E, DeCamp LR. 2016”. Future Healthcare providers could try to solve the language barriers that can cause health disparities in the community. Healthcare Leadership members should continue to reach out to the minority healthcare workforce or have more programs for healthcare workers, Cultural Diversity classes and increase interpreter services, when possible, to better understand why communication is essential. When developing the role of the Interprofessional team: Addressing the developmental program for expanding the use of medical personnel in all areas, such as Nurse practitioners, Physician assistants, and RNs, to help provide more resources to help with communication. “In this period where there has been a spotlight placed on racial inequities, it is crucial that the medical field take the lead with tangible changes to patient care for minority communities. To critically address the inequitable care, we currently provide for Hispanic patients, we must create programs that effectively train physicians working in communities with these growing patient populations. This will not only enhance medical care but will also create better community leaders. Oliver M, Fernberg T, Lyons P, Elango S, Green GJ, Talib ZM 2022” The initial goal of the interprofessional team will focus on the development and training of medical staff. Healthcare facilities are the key stakeholders in helping medical staff to reach this goal. “ Furthermore, a high percentage of Hispanics are Spanish-speaking only or have limited proficiency, which makes it more difficult to receive appropriate care, get information, and communicate with their physicians. Data showed that the likelihood of receiving appropriate and timely treatment is lower for Hispanics (DeNavas-Walt, Proctor, & Smith, [18]; DuBard & Gizlice, [19]; National Center for Health Statistics, [50]).”

ANALYSIS OF POSITION PAPER FOR VULNERABLE 9 There are multiple viewpoints on the disparities in Hispanic communities. Unfortunately, with our current time and politics in our country, health care can still be challenging to access, let alone be accommodating to the Hispanic group since many of the population will seek help when they are sick, and other obstacles would be to communicating issues in health without a language barrier. C urrent approaches to healthcare quality have failed to reduce healthcare disparities. “Despite dramatic increases in the use of quality measurement and associated payment policies, there has been no special implementation of measurement strategies to reduce health disparities. Anderson, A. C., O'Rourke, E., Chin, M. H., Ponce, N. A., Bernheim, S. M., & Burstin, H. (2018).” Acknowledges challenges the team may face in working together or facilitating improvements. We identified disparities in the Hispanic communities, such as language barriers and medical access. Some of the interventions would be to provide qualified interpreters and have staff identifying with the population in need. Easier Accessibility to health care may reduce disparities. We are providing an area in the clinic where clients are not afraid to ask questions or even answer questions that may make them feel vulnerable. Supportive Position There has been a large amount of empirical research supporting Language barriers as the cause of poor communication for patients and healthcare workers. Much of the research has been supported and acknowledge that improvement of communication with healthcare worker for the Hispanic population is much needed. The focus Study LEP explained the much-needed language support would help the Hispanic population and improve their well-being in the care they would receive. The results of the studies show that the Hispanic population overall is happy with healthcare staff, but understanding the Plan of care and education was difficult for the families. For many in

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ANALYSIS OF POSITION PAPER FOR VULNERABLE 10 the Hispanic population, communication should be optimal for their understanding of their health when participating in the survey. Still, many were happy with the incentive after completing the questionnaires. “ This lack of communication leads to unequal access to health information and inadequate participation of the minority health seeker in health care decision making (Alegria et al.,2008; Kreps, 2006; Perez et alAL.,2009).” Unsupportive Position Many reviews of the literature have questioned the validity of multiple studies. Several foci of morbidity and mortality, politics and race, and economics with funds available for healthcare under Medicaid and Medicare can help with resources for the community health facility. In Hispanic Health, disparities are Communication mainly continues to be an area of distinction in the Hispanic community in health care. Healthcare recruitment with bilingual workers for the community would help to decrease disparities. Based on currently available research, the near future would involve city officials, the community, and healthcare facilities to find better solutions to help Health communication disparities in the Hispanic community. Conclusion

ANALYSIS OF POSITION PAPER FOR VULNERABLE 11 References Anderson, A. C., O’Rourke, E., Chin, M. H., Ponce, N. A., Bernheim, S. M., & Burstin, H. (2018). Promoting health equity and eliminating disparities through performance measurement and payment. Health Affairs , 37 (3), 371–377. https://doi.org/10.1377/hlthaff.2017.1301 Askim-Lovseth, M. K., & Aldana, A. (2010). Looking beyond “affordable” health care: Cultural understanding and sensitivity—necessities in addressing the health care disparities of the u.s. hispanic population. Health Marketing Quarterly , 27 (4), 354–387. https://doi.org/10.1080/07359683.2010.519990 Brown, L. D., Vasquez, D., Salinas, J. J., Tang, X., & Balcázar, H. (2018). Evaluation of healthy fit: A community health worker model to address hispanic health disparities. Preventing Chronic Disease , 15 . https://doi.org/10.5888/pcd15.170347 Cabassa, L. J., Gomes, A. P., Meyreles, Q., Capitelli, L., Younge, R., Dragatsi, D., Alvarez, J., Manrique, Y., & Lewis-Fernández, R. (2014). Using the collaborative intervention planning framework to adapt a health-care manager intervention to a new population and provider group to improve the health of people with serious mental illness. Implementation Science , 9 (1). https://doi.org/10.1186/s13012-014-0178-9 Denavas-walt, C., Proctor, B. D., & Smith, J. C. (2012). Income, poverty, and health insurance coverage in the united states: 2012 (poverty in the united states) . United States Govt Printing Office.

ANALYSIS OF POSITION PAPER FOR VULNERABLE 12 Oliver, M., Fernberg, T., Lyons, P., Elango, S., Green, G. J., & Talib, Z. M. (2022). Addressing health disparities in hispanic communities through an innovative team-based medical spanish program at the medical school level – a single-institution study. BMC Medical Education , 22 (1). https://doi.org/10.1186/s12909-022-03151-x Steinberg, E. M., Valenzuela-Araujo, D., Zickafoose, J. S., Kieffer, E., & DeCamp, L. (2016). The “battle” of managing language barriers in health care. Clinical Pediatrics , 55 (14), 1318–1327. https://doi.org/10.1177/0009922816629760 .

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ANALYSIS OF POSITION PAPER FOR VULNERABLE 13

Analysis of Position Paper for Vurnable Population 2023

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