Abstract

Objectives

Inequities in access to and utilization of health care greatly influence the health and quality of life of American Indian elders (AIEs). This study explores the importance and perceived prevalence of factors affecting health care use within this population and assesses the changeability of these factors to produce a list of action items that are timely and relevant to improving health care access and utilization.

Method

Concept mapping was conducted with AIEs (n = 65) and professional stakeholders (n = 50), including tribal leaders, administrators of public-sector health systems, outreach workers, and health care providers. Data were analyzed using multidimensional scaling and cluster analyses.

Results

The final concept-map model comprised nine thematic clusters related to factors affecting elder health care: Difficulties Obtaining and Using Insurance; Insecurity from Lack of Knowledge; Limited Availability of Services; Scheduling Challenges; Provider Issues and Relationships; Family and Emotional Challenges; Health-Related Self-Efficacy and Knowledge; Accessibility and Transportation Barriers; and Tribal/National Policy.

Discussion

Findings suggest that improvements in access to and utilization of health care among AIEs will require actions across multiple domains, including health system navigation services, workforce improvements, and tribal, state, and federal policy. A multilevel socioecological approach is necessary to organize and undertake these actions.

中文翻译：

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美洲印第安人老年人的医疗保健获取和利用：概念映射研究。

摘要

目标

在获得和利用医疗保健方面的不平等现象极大地影响了美洲印第安人长者的健康和生活质量。这项研究探讨了影响该人群中医疗保健使用的因素的重要性和普遍性，并评估了这些因素的可变性，以产生一系列及时且与改善医疗保健获取和利用相关的行动项目。

方法

与AIE（n = 65）和专业利益相关者（n = 50）进行了概念图绘制，其中包括部落领导人，公共部门卫生系统的管理人员，外展人员和卫生保健提供者。使用多维缩放和聚类分析来分析数据。

结果

最终的概念图模型包括9个主题组，这些组与影响老年保健的因素有关：获取和使用保险的困难；因缺乏知识而产生的不安全感；服务有限；安排挑战；提供商问题和关系；家庭和情感挑战；与健康有关的自我效能和知识；可达性和运输障碍；和部落/国家政策。

讨论区

研究结果表明，要改善AIE中获得和利用卫生保健的水平，就需要跨多个领域采取行动，包括卫生系统导航服务，员工队伍的改善以及部落，州和联邦政策。必须采取多层次的社会生态学方法来组织和采取这些行动。