Introduction: While cervical cancer rates have declined in the US, rates continue to be high among certain groups, including Hispanic immigrants. Cervical cancer is almost entirely preventable through screening and treatment of precancerous cells. However, cervical cancer screening is low among Hispanic immigrants, primarily due to inadequate access to preventative health services. Barriers to screening are heightened among undocumented immigrants (without valid US visas or residency papers), who face additional obstacles that limit access and use of healthcare services. The purpose of this study is to describe healthcare access and use characteristics, as well as barriers to healthcare use, among undocumented Central American immigrant women in Houston, Texas. Central Americans are the fastest growing sector of the US Hispanic immigrant population and have high rates of cervical cancer.
Methods: The study population for the survey comprised Guatemalan, Honduran, and El Salvadoran women, ages 18 to 50 years, living in Houston without a valid US visa or residency papers. Women of other nationalities were excluded because they comprise less than 10% of the Central American population in Houston. Participants were recruited using respondent driven sampling (RDS). RDS is a social research method that uses social networks to access members of hidden populations that lack a sampling frame and whose members may be reluctant to participate in surveys due to privacy concerns. Current health insurance or coverage was used as an indicator of healthcare access; visiting a healthcare provider in the past 12 months was used as an indicator of healthcare use. Asking participants if they experienced any issues when trying to access needed healthcare services in Houston assessed barriers to healthcare use. RDSAT 6.0 was used to generate RDS-adjusted prevalence estimates that account for differences in participants’ social network sizes and recruitment dynamics.
Results: A total of 226 participants were recruited, of which 210 were eligible, consented, and provided information about healthcare behaviors. Thirty five percent reported having current health insurance or coverage. Coverage was predominantly through the indigent healthcare program (83%). Fifty percent of participants reported seeing a healthcare provider in the past 12 months. Most participants (75%) reported that they went to a public healthcare clinic at their last visit. The main barrier to healthcare use was not having money or insurance to pay for the visit (84%), followed by not having transportation (48%) and not knowing where to go (47%). Other barriers were doctor or clinic staff did not speak Spanish (34%), unable to get childcare (33%), did not have time (28%), afraid of immigration authorities (24%), clinic was not open when I needed it (22%), clinic could not see me that day (21%), and afraid of doctors or being told that I was sick (20%).
Conclusions: The prevalence of healthcare access and use was high among our study participants compared to what has been reported for other populations of undocumented immigrants. This seems to be due to immigrant women's access to public health services through the Harris County Hospital District, which provides healthcare to all indigent residents regardless of immigration status. Nevertheless, participants reported multiple barriers when seeking needed healthcare services in Houston, among which financial issues was the primary barrier. Other prevalent barriers, such as lacking knowledge of available healthcare resources and the logistical means to reach them, reflect challenges of navigating through a new and unfamiliar environment. Such barriers may represent additional obstacles to regular cervical cancer screening among undocumented Central American immigrant women in Houston.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B30.