Health Inequalities in Access to Care among Latino Patients

Cortez, Dagoberto, Austin TX

Investigators

Abstract

This award was provided as part of NSF's Social, Behavioral and Economic Sciences (SBE) Postdoctoral Research Fellowships (SPRF) program and SBE's Social Psychology program. The goal of the SPRF program is to prepare promising, early career doctoral-level scientists for scientific careers in academia, industry or private sector, and government. SPRF awards involve two years of training under the sponsorship of established scientists and encourage Postdoctoral Fellows to perform independent research. NSF seeks to promote the participation of scientists from all segments of the scientific community, including those from underrepresented groups, in its research programs and activities; the postdoctoral period is considered to be an important level of professional development in attaining this goal. Each Postdoctoral Fellow must address important scientific questions that advance their respective disciplinary fields. Under the sponsorship of Dr. Mark Hayward at The University of Texas at Austin, this postdoctoral fellowship award supports an early career scientist investigating the influence that social inequalities exert on terminal cancer care for Latino patients. Research across multiple disciplines shows that Latino patients lack access to high-quality cancer care, are less likely to receive standard end-of-life care than other racial and ethnic groups, and face persistent health inequalities due to additional socioeconomic challenges. Yet, we know far less about how these social and health disparities influence care-seeking behavior. Additionally, we know even less about how patients attempt to overcome structural barriers and navigate the healthcare system. This project can produce societal benefits by providing key insights policymakers and community organizations can use to address health inequalities in Latino communities. This research explores the processes by which terminal Latino cancer patients and their family members access medical facilities, navigate healthcare institutions, attempt to treat the cancer, and plan for death. This project uses a multi-method design, which includes ethnographic observations, qualitative geographic imaging system (QGIS), "go alongs", and in-depth interviews. Specifically, data collection includes documenting and mapping the physical routes participants take to access care, observing how participants navigate healthcare bureaucracies, examining how participants talk about death (or ignore the subject) with loved ones, and analyzing how patients and family members come to some sort of consensus about future goals considering the dire medical circumstances. A multi-method qualitative research design generates various types of data, which allows for fine grain analyses, which in turn help trace the different mechanisms through which health inequalities are reproduced and the ways patients respond to experiencing such inequalities. This project makes novel contributions to existing knowledge by uncovering the ways health inequalities shape terminal cancer care for Latino patients. Studying how racial/ethnic inequalities influence healthcare access and the resources (both material and social) that patients use to navigate healthcare institutions can help generate policies that help lessen health disparities and support the care-seeking strategies patients are already successfully using. Findings from this study can also provide new insights for future researchers that want to study the relationship between race/ethnicity and health inequalities and the influence that socioeconomic factors have of healthcare access. This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.