People living without health insurance in Durham County, North Carolina : an action-oriented community assessment
Creators: name: Pham, Victoria
name: Earnhardt, Samantha
name: Scott, Michael
name: Hughes, Jessica
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2007

description: This document details the methods and findings from an Action-Oriented Community Assessment (AOCA) of people living without health insurance in Durham County, North Carolina. A group of four graduate students from the University of North Carolina School of Public Health conducted this assessment from September 2006 to April 2007 under the direction of preceptors Sarah Covington, the Coordinator of the Partnership for a Healthy Durham, and Tekola Fisseha, Director of Health Education at the Durham County Health Department (DCHD). The overarching goals of this AOCA were to: 1) inform the DCHD’s countywide health assessment with findings on the strengths and needs among people living without health insurance, in general, and those served by Lincoln Community Health Center (LCHC), in particular; and 2) engage the Lincoln community and service providers in discussing AOCA findings to determine concrete action steps for initiating change. We began the process by conducting participant observations of local neighborhoods and community events to define and gain entry into our community of interest. Next, we collected and reviewed secondary data sources for background information and also to inform our interview guides. We spoke with 47 community members and service providers to the uninsured, including 27 individual interviews and two focus groups. Our data analysis revealed nine themes on needs. Of these, the forum planning committee prioritized four as the most important and changeable for discussion at the community forum. The forum was attended by approximately 50 participants and was held at the Lyon Park Community Center in Durham on Thursday, April 19th, from 6:00 – 8:00 p.m. The purpose was to engage community members and service providers in discussing our findings and generating their own action steps. A description of these themes, as well as key action steps that were generated during the forum, are as follows: Access to Healthcare. Many people in Durham are uninsured or underinsured. Because Lincoln is the only healthcare option for many, the extent of healthcare is limited by what Lincoln is able to provide. Action Steps: 1. Begin research and planning within health department for creation of a bumper sticker that has a main telephone number for all Durham services. 2. Plan and host a health fair at a participant’s church. 3. Increase participation in the Access to Healthcare Committee of the Partnership for a Healthy Durham. Crime and Safety. Most people agree that crime and safety are important issues within the community. Although steps have been taken to address these issues, most people feel that something more can be done. Action Steps: 1. Put pressure on church congregations to take a role in making neighborhoods safer. 2. Parents will make efforts to stress the importance of obeying the law to their children. 3. Make a connection with the kids in your neighborhood and community. Education. Community members agree that limited education hinders their ability to obtain adequate employment, health insurance, and a living wage. Action Steps: 1. Increase awareness of educational opportunities available in Durham. 2. Develop programs for parents promoting the importance of education for their children. 3. Increase the variety of educational opportunities in Durham, such as more certificate programs. Race Relations. Durham is rich with diversity. The increasing diversity of the community sometimes results in misunderstandings and conflict between different racial and ethnic groups. These tensions intensify pre-existing racism, which negatively affects daily interactions within the community. Action Steps: 1. Advocate for cultural competency at workplaces. 2. Speak to youth groups about race relations in Durham. 3. Step out of one’s comfort zone. Other domains and themes found, but were not discussed at the community forum were: Transportation: Access to, safety of, and other limitations of available transportation affect people’s ability to access healthcare settings, employment opportunities, and other local resources. Employment: Limited options for employment in the community combined with limited work experience and educational attainment increase the difficulty to obtain adequate employment. Housing: The ability to obtain quality and affordable housing is limited and is a fundamental issue in the community which affects all aspects of life (i.e. employment, transportation, healthcare, etc). Health & Healthy Living: Despite a variety of community resources that promote healthy living, there are also numerous barriers (i.e. limited time and money for proper diet and exercise). Healthy living is often not prioritized by individuals because of these and other more immediate concerns.