Carolyn A. Mendez-Luck

Heading South: Why Mexican Immigrants in California Seek Health Services in Mexico

Objectives:To Identify factors that explain why some Mexican immigrants in California use health services in Mexico. Methods:California Health Interview Survey 2001 data were analyzed for medical care, dental care, and/or prescription drug purchases in Mexico in the previous year. Logistic regressions estimated the effect on use of need, availability, accessibility, and acceptability among immigrants from Mexico. Results:An estimated 952,000 California adults used medical, dental, or prescription services in Mexico during the past year, of whom 488,000 were Mexican immigrants. Long-stay Mexican immigrants had the highest rate (15%), followed by short-stay Mexican immigrants (11.5%), US-born Mexican Americans (5.4%), and US-born nonLatino whites (2.1%). Predictors of use by immigrants included need, no insurance, delay seeking care, more recent immigration, limited English, and nonphysician provider use. Living closer to the border increased use, although half of immigrants seeking services lived more than 120 miles from the border. Mexican immigrants with long stays in the US have a somewhat different pattern of predictors from those with short stays. Conclusions:Mexican immigrants are the most likely to seek medical, dental, and prescription services in Mexico. A large number, but small percentages, of US-born nonLatino whites purchase prescription drugs there. Although proximity facilitates use, access and acceptability barriers in the US medical care system encourage immigrants to seek care in Mexico who would be helped by expanded binational health insurance.

Recruitment Strategies and Costs Associated With Community-Based Research in a Mexican-Origin Population

PURPOSE We describe the recruitment strategies and personnel and materials costs associated with two community-based research studies in a Mexican-origin population. We also highlight the role that academic-community partnerships played in the outreach and recruitment process for our studies. We reviewed study documents using case study methodology to categorize recruitment methods, examine community partnerships, and calculate study costs. RESULTS We employed several recruitment methods to identify and solicit 154 female caregivers for participation in qualitative interviews and quantitative surveys. Recruitment approaches included using flyers and word of mouth, attending health fairs, and partnering with nonprofit community-based organizations (CBOs) to sponsor targeted recruitment events. Face-to-face contact with community residents and partnerships with CBOs were most effective in enrolling caregivers into the studies. Almost 70% of participants attended a recruitment event sponsored or supported by CBOs. The least effective recruitment strategy was the use of flyers, which resulted in only 7 completed interviews or questionnaires. Time and costs related to carrying out the research varied by study, where personal interviews cost more on a per-participant basis (

Concepts of Burden in Giving Care to Older Relatives: A Study of Female Caregivers in a Mexico City Neighborhood

1,081) than the questionnaires (

Small-Area Estimation of Health Insurance Coverage for California Legislative Districts

298). However, almost the same amount of time was spent in the community for both studies. IMPLICATIONS Partnerships with CBOs were critical for reaching the target enrollment for our studies. The relationship between the University of California-Los Angeles (UCLA) Resource Center for Minority Aging Research/Center for Health Improvement for Minority Elderly and the Department of Aging provided the infrastructure for maintaining connections with academic-community partnerships. Nevertheless, building partnerships required time, effort, and resources for both researchers and local organizations.

Marianismo and Caregiving Role Beliefs Among U.S.-Born and Immigrant Mexican Women

This study examined how women in a Mexico City suburb conceptualized the construct of burden within the context of giving care to older relatives. Data were collected on 41 women through semi-structured interviews regarding their caregiving experiences to elderly relatives. Phenomenological principles were used to analyze meanings and understandings of caregiving experiences. Burden was a multi-dimensional construct that referred to specific situations that made caregivers feel emotionally or physical “heavy.” Burden also referred to “being a burden” by being in the way, making things difficult, or being a ‘weight’ on caregivers’ shoulders. However, women in this study also viewed burden as a positive sacrifice that involved love, initiative, and good will. This study is an important first step in defining the ways in which caregiving is positively and negatively meaningful for Mexican caregivers and their families. Our findings offer an additional dimension of caregiver burden to broaden our understanding and measurement of the construct. The development of culturally appropriate instruments to measure caregiving burden in Mexico is necessary to provide an empirical foundation for policy recommendations that address the growing need for institutional support of caregivers. Moreover, our findings suggest that researchers studying caregiving in Mexico should think about how burden is measured on existing instruments before adapting them for widespread use.

Community as a source of health in three racial/ethnic communities in Oregon: a qualitative study

OBJECTIVES To aid state and local policymakers, program planners, and community advocates, we created estimates of the percentage of the population lacking health insurance in small geographic areas of California. METHODS Finally, calibration ensured the consistency and stability of the estimates when they were aggregated. RESULTS Health insurance coverage among nonelderly persons varied widely across assembly districts, from 10% to 44%. The utility of local-level estimates was most apparent when the variations in subcounty uninsured rates in Los Angeles County (19%-44%) were examined. CONCLUSIONS Stable and useful estimates of health insurance rates for small areas such as legislative districts can be created through use of multiple sources of publicly available data.

A Portrait of Older Californians With Disabilities Who Rely on Public Services to Remain Independent

OBJECTIVES We aimed to explore how women of Mexican-origin conceptualized caregiving as a construct in terms of cultural beliefs, social norms, role functioning, and familial obligations. We examined the personal experiences of U.S-born and immigrant Mexican female caregivers to identify how these 2 groups differed in their views of the caregiver role. METHODS We conducted 1-time in-depth interviews with 44 caregivers living in Southern California. Our study was guided by marianismo, a traditional role occupied by women in the Mexican family. We analyzed data from a grounded theory approach involving the constant comparative method to refine and categorize the data. RESULTS The majority of all caregivers had similar views about caregiving as an undertaking by choice, and almost all caregivers engaged in self-sacrificing actions to fulfill the marianismo role. Despite these similarities, U.S.-born and immigrant caregivers used different words to describe the same concepts or assigned different meanings to other key aspects of caregiving, suggesting that these 2 groups had different underlying motivations for caregiving and orientations to the role. DISCUSSION Our findings highlight the complexity of language and culture in underlying caregiving concepts, making the concepts challenging to operationalize and define in a heterogeneous sample of Latinos.

Talk versus Action Comparing the Narratives and Behaviors of Diabetes Self-Management in Latino Caregiving Dyads

BackgroundA 2011 report by the Oregon Health Authority and the Department of Human Services documented disparities in its Latino and American Indian populations on multiple individual-level health indicators. However, research is lacking on the social contexts in which Latinos and American Indians in Oregon live and how these environments influence the health of communities as a whole. To help fill this gap, this study sought to contextualize the social environments that influence the health of Latinos and American Indian residents in three Oregon communities.MethodsGuided by an ecological framework, we conducted one-time semi-structured qualitative interviews with 26 study participants to identify the prominent health-related issues in the communities and to examine the factors that study participants perceived as enabling or inhibiting healthy lifestyles of community residents. We used a grounded theory approach to perform content and thematic analyses of the data.ResultsStudy participants identified preventable chronic conditions, such as diabetes, obesity, and hypertension, as the most pressing health concerns in their communities. Results showed that traditional and cultural activities and strong family and community cohesion were viewed as facilitators of good community health. Poverty, safety concerns, insufficient community resources, and discrimination were perceived as barriers to community health. Three themes emerged from the thematic analyses: social connectedness is integral to health; trauma has an ongoing negative impact on health; and invisibility of residents in the community underlies poor health.ConclusionsThis study’s findings provide insight to the social contexts which operate in the lives of some Latinos and American Indians in Oregon. While participants identified community-level factors as important to health, they focused more on the social connections of individuals to each other and the relationships that residents have with their communities at-large. Our findings may also help to explain how the intra- and inter-personal levels, the community/institutional level, and the macro level/public policy contexts can serve to influence health in these communities. For example, trauma and invisibility are not routinely examined in community health assessment and improvement planning activities; nonetheless, these factors appear to be at play affecting the health of residents.

Racial/Ethnic Variation in the Impact of the Affordable Care Act on Insurance Coverage and Access Among Young Adults

Low-income older adults with disabilities in California depend on a variety of public programs to help them remain in their own homes. The availability of those services has been in flux since 2009 because of cuts caused by the recession. This article reports on a qualitative study of 33 California seniors who depend on fragile arrangements of paid and unpaid assistance. Thematic analyses of in-depth interviews conducted with these older adults and their caregivers indicate that the disability needs of these individuals are often unstable, with both physical and mental health status sometimes changing day to day. Most have nowhere else to turn for help if their public services are cut. All share the common goal of staying at home and maintaining their independence. Public services serve as a crucial link in the support networks of these individuals.

Beliefs and expectations of family and nursing home care among Mexican-origin caregivers

Purpose The purpose of this longitudinal qualitative study was to explore Latino caregiving dyads’ experiences with managing diabetes in the home. Methods The authors used Sebern’s Shared Care construct as a framework for understanding the realities that some Latino older adults and their caregivers face in managing diabetes. Twelve caregiving dyads completed a semistructured interview followed by weekly participant observation in their homes over 3 to 4 months. Data were analyzed using a grounded theory approach. Results Diet was the most commonly discussed and observed aspect of diabetes care and also a source of strain within dyads. Dyads talked and acted congruently about food preparation and the challenges of diet adherence but had conflicting views on whether the care receiver’s diabetes was under control. Analysis also revealed a discordance between views and observed actions of diabetes care related to monitoring blood glucose levels. Conclusion Findings suggest that caregivers or other key family members should be considered as active participants in diabetes management among Latinos, which is consistent with American Diabetes Association and Institute of Medicine recommendations for a patient- and family-centered approach to improve care. In addition, family environments that are in flux, chaotic, or low in resources may benefit from increased support to initiate and maintain diabetes management behaviors.