Health care access and utilization among African-immigrants in the District of Columbia Metro area in the United States :  a comparative analysis
Creators: name: Boundaoni, Idirs Ahmed
Publisher: name: Maryland Shared Open Access Repository
Year: 2015
Subjects: acculturation
African immigrants
health care access
health culture
healthy immigrant effect
usual sources of care

description: The aim of this study was to investigate health status, health behaviors, and health care access and utilization of African immigrants in the District of Columbia Metro Area (DCMA). The review of the literature revealed a paucity of studies in medical care access and utilization of African immigrants. Most of these research conflate African immigrants’ health care issues into their African-American counterparts. Hence, very little is known about African immigrants’ medical care access, health care utilization, health behavior, and health status in the United States. This study essays to address that. The study also compared and contrasted the level of medical care access, specific health care behaviors, and health care utilization of African immigrants with that of the civilian non-institutionalized U.S adult population by race. Two data sources, primary and secondary, were utilized in this study. The primary data for the study was derived from both quantitative and qualitative sources, with priority given to the quantitative source. The secondary data were derived from the 2013 National Health Interview Survey (NHIS) in the Sample Adult dataset. The NHIS data served as a baseline data. To provide an expanded appreciation of the research problems, mixed methods research (quantitative and qualitative) were employed in the study. In 2013, data were collected for first-generation African immigrants aged 18 and over in the DCMA. The target population for the study was 125,209 civilian non-institutionalized African immigrants in the DCMA. African immigrants excluded were those who were less than years, and inmates of correctional institutions.  A total of 400 African immigrants were eligible sample size. Survey participants were solicited on the basis of non-probability convenience sampling method.  Thus, persons were selected based on their availability in designated and targeted areas in the DCMA. Data were collected on two hundred and eighty one (281) civilian non-institutionalized African immigrants in the DCMA. Accordingly, the response rate was about 70 percent; the number of completed questionnaire divided by the total number of eligible sample size. The survey instrument consisted of twenty-six (26) structured and standardized questionnaires and one (1) qualitative question. Both internet and face-to-face interviews were used to administer the survey instrument. The internet survey was conducted via the Survey Monkey, while face-to-face survey was conducted at designed locations frequented by African immigrants in the DCMA including African grocery shops, Churches, Mosques, social clubs and social e vents. The face-to-face survey data was inputted into the SPSS with the aid of Survey Monkey collectors' link. The IBM SPSS statistics 22 was used to perform the data analyses.Furthermore, Andersen's Behavioral Model of Health Services, a model that has been deployed extensively in public health studies to investigate access to and use of health care services among vulnerable groups, was employed.  Independent variables, in this study, were derived from the three major components of the model’s individual health care access indicators (predisposing, need, and enabling indicators).  The main outcome measures were usual source of medical care (potential access) and the use of health care services (realized access), defined as the use of preventive medical care. Descriptive, bivariate, and binomial logistic regression were used to assess the effect of specific predisposing, need, and enabling explanatory constructs on access to and utilization of health care  services of African immigrants in the DCMA. The results of the dissertation corroborated findings of earlier research with respect to the healthy immigrant paradox. The results suggested that African-immigrants living in the District of Columbia had higher odds of excellent or very good health status relative to the U.S general population nationwide and the U.S-born in the Northeast region. Conversely, few differences in perceived-health status were found when intra and inter racial as well as regional comparative analyses were performed among African-immigrants and non-Hispanic White, Hispanics, non-Hispanic Black. African-immigrants in the DCMA were less likely to utilize health care services compared with all the major three races in the United States. Further, non-Hispanic White (Caucasians) were more likely than African-immigrants to have higher odds of excellent health status. Approximately 85 percent of African immigrants in the DCMA had a usual source of care. Of those with a usual source of care, 44 percent considered it to be a doctor's office or health maintenance organization (HMO).  Compared with other African immigrants in the DCMA, Nigerians (40 percent) were more likely to have a usual source of care. African immigrants in the DCMA who had a usual source of care were more likely to have higher odds of utilizing of health care services than those who did not have a usual source of care. What is more, a little over a third (32 percent) of African immigrants had realized access to health care services in the DCMA. When the results were considered by gender, women (71 percent) were more likely than men (66 percent) to have realized access to health care services within the previous 12 months. The study highlighted that about 92 percent of African immigrants aged 60 and more had realized access to health care services, and about 74 percent are those with health insurance coverage.  However, the vast majority of the African immigrants had lower odds of utilizing health care services compared with Whites, African-Americans, and Hispanics. Moreover, the study brought to light that influenza vaccination behavior of African-immigrants in the DCMA was not radically distinct from the U.S adult population. Both African-immigrants in the DCMA and the U.S adult population exhibited lower odds of obtaining influenza vaccination in 2013. Compared with the U.S non-elderly population (19-64 years), African immigrants in the DCMA reported lower uninsured rate (4 percent versus percent). The findings suggested that African immigrants depended heavily on employer-sponsored group health insurance to finance their medical care consumption (10 percent for both Medicaid and Medicare versus 73 percent for employer sponsored health insurance). Another key finding was that African immigrants in the DCMA (63 percent) were less likely to use African folk or traditional remedies to meet their health care needs. As established in this study, an overwhelming majority of African immigrants in the DCMA had a usual source of health care services. That said, they do not efficiently utilize health care services. Specifically, a large of majority of African immigrants in the DCMA reported not using preventive health care services. The study calls for sustained efforts from state and local health agencies to reverse the trend as ensuring access to primary and preventive care for everyone, regardless of immigration status, in the United States will likely be critical to the success of the novel national health reforms aimed at arresting the galloping trends in health spending, enhancing quality of life for everyone, and mitigating health and health care disparities. Like other vulnerable population, African immigrants in the DCMA face a series of health and health care challenges in the United States. Accordingly, public health research into such issues is imperative, and this will more likely enhance policy makers' appreciation of the health care needs and behavior of African immigrants in the DCMA so as to design and execute effective health programs to improve health care access and utilization for African immigrants in the DCMA. Future research might essay to assess the impacts of acculturation on African immigrants' health care access, health care utilization, and health behavior.  Future research might also consider employing national dataset to investigate health care access and utilization among African immigrants in the United States. The study enriches current multicultural health policy, social equity, health care access and utilization, and quality health services for all racial and ethnic population sub-groups in the United States. The study proposes health care reform programs aimed at integrating African-immigrants into the U.S health care system to enhance their effective use of routine, preventive health care services.