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Valuing diversityIdentifying and addressing barriers to healthcare and their connection to breastfeeding through culturally sensitive practices
Purpose• This tutorial is designed to
• Identify the barriers minorities in Louisiana, Mississippi and Arkansas face when accessing healthcare services
• Identify avenues for public health agencies to promote breastfeeding with minorities while keeping in mind the barriers they face while accessing healthcare
• These ideas are presented to spark the thought processes. Theories, practices and ideas can be adapted to fit many different situations
Outline
• Disparities in Healthcare Access for minorities
• Addressing the Gap• Breastfeeding Among Minorities
• Barriers• Trends• Practices that work
• WIC 3
Disparities in the Target Area
The following slides show some of the
disparities in the target region.
These challenges are specifically relevant for
Maternal and Child Public Health workers
• In Louisiana, Mississippi, and Arkansas:• poor quality of healthcare• High minority population • Rate of low birth weight
high among minorities
THECOMMONWEALTH
FUND
5States with the largest percentage of white residentshave the highest Medicare quality rankings.
0
20
40
60
80
100
NH VT ME ND UT IA CO WI CT MN OR NE FL AL NJ CA OK IL GA AR TX MS LA PR
1 2 3 4 5 6 7 8 9 10 11 12 41 42 43 44 45 46 47 48 49 50 51 52
Note: Medicare rankings are shown for the top 12 and the bottom 12 states only.
Sources: S. F. Jencks et al., “Change in the Quality of Care Delivered to Medicare Beneficiaries,1998–1999 to 2000–2001,” Journal of the American Medical Association, Jan. 15, 2003 289(3):305–12; United States Census Bureau, Census 2000. Chart 6-3
Percentage of population that is non-Hispanic white according to2000 census by Medicare Quality Ranking for 2000–2001
The target area has the lowest quality ranking and lower percentage
of white residents
Low birth weight percentage in the target area for minority populations
March of Dimes Peristats
Disparities in US Healthcare
These factors limit minority populations from accessing care.
Evidence shows that these factors cause some Hispanic populations to
not even seek care.
• Transportation • Childcare• Language• Cultural Barriers• Financial barriers• Lack of social supports• Lack of Insurance
The Commonwealth Fund Chartbook March 2008
Addressing the Gap
• Insurance coverage for vulnerable minority populations
• Interpreter services for those with English as a second language
• Providing more permanent solutions to racial and ethnic disparities is key
The Commonwealth Fund Chartbook March 2008
Addressing the Gap
Culturally Competent Training
• Training for Healthcare workers
• Educational materials for minorities that are culturally competent• Language• Respectful of beliefs and
practices
Providing a Medical Home
• Developing a relationship with a primary care provider is associated with better overall healthcare
• Regular source of care gives the patient access to more services and resources• (see next slide)
The Commonwealth Fund Chartbook March 2008
THECOMMONWEALTH
FUND
10
Racial and ethnic differences in getting neededmedical care are minimal for adults with medical homes;
disparities decline substantially compared with adults withno regular source of care.
Percentage of adults ages 18 to 64 reportingalways getting care they need when they need it
Note: Having a medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone, or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.
Source: The Commonwealth Fund. Health Care Quality Survey. 2006. Chart 7-4
74767474
50525352
343138
44
0
20
40
60
80
100
Total White Black Hispanic
Medical home
Regular source of care, not a medical home
No regular source of care/ER
BREASTFEEDING AMONG MINORITIES
Barriers TrendsPractices that Work
Breastfeeding Rates in the target area
http://www.cdc.gov/breastfeeding/data/reportcard.htm
Barriers to BreastfeedingRural Populations
• Lower income populations• Higher rates of poverty
• Lack of resources that promote breastfeeding
• Lack of specialized services in hospitals or clinics to support Maternal and Child Health (Sparks 2010)
African American Populations
• Lack of individual and generational education about breastfeeding
• Lack of social support• Lack of support from the
work environment• Cultural norms that
support formula feeding and early feedings with solid foods (Chin, Myers, Magnus 2008)
Barriers to Breastfeeding
Latin American Populations• Lack of support from extended
family• Lack of support services that
understand Latin American culture or traditions
• US cultural norms that support formula feeding through availability and marketing of formula
• Lack of communication with providers • Language barriers
(Denman-Vitale & Murillo, 1999)
PRACTICES THAT WORK
WIC• Incentives for breastfeeding mothers• Loving Support Project• Other Initiatives
Women, Infants and Children• Although research by Chin, Myers and Magnus (2008)
associated participation in WIC with lower rates of breastfeeding; WIC has initiated a strong campaign to promote breastfeeding
• The following highlight the practices WIC uses to promote breast feeing among minority populations. Their methods include : incentives, peer support, and targeted cultural campaigning
WIC Incentives
By using incentives, WIC promotes
breastfeeding and offers support for mothers who face
financial challenges or work related
barriers
• WIC mothers choosing to breastfeed are provided information through counseling and breastfeeding educational materials.
• Breastfeeding mothers receive follow-up support through peer counselors.
• Breastfeeding mothers are eligible to participate in WIC longer than non-breastfeeding mothers.
• Mothers who exclusively breastfeed their infants receive an enhanced food package.
• Breastfeeding mothers can receive breast pumps, breast shells or nursing supplements to help support the initiation and continuation of breastfeeding
http://www.fns.usda.gov/wic/Breastfeeding/breastfeedingmainpage.HTM
WIC “Loving Support Makes Breastfeeding
Work” Campaign
Campaign sponsored by WIC and Best Start Social Marketing
Used to promote breastfeeding in States
Provides information on how other states have successfully implemented or expanded peer support breast feeding programs
Provides information about training workers .
• This document created by WIC shares the successes of several States WIC supported breastfeeding peer counseling programs
• Use the above link to access the document
Breastfeeding Peer Support – Implementation and Expansion Resource
Also see the presentation on Peer Counseling
http://www.nal.usda.gov/wicworks/Learning_Center/bfshowcase.pdf
Breastfeeding a Magical Bond of Love
WIC initiative specifically designed to promote breastfeeding in Hispanic families.
Created from a study that looked at the perceptions that Hispanic women have of breastfeeding in the United States
Provides educational materials for mothers, fathers, and grandmothers in English and Spanish
http://www.nal.usda.gov/wicworks/Learning_Center/support_bond.html
Promotional videos• Video by Mississippi WIC
is highly representative of minority populations in the State
• Highlight minorities populations breastfeeding• Teenage mothers• Single mothers• Black, Hispanic and Asian
mothers
http://vimeo.com/13649529
Conclusions• Using a diverse approach to addressing health disparities is an
effective way to target programing• Culturally competent training and practices help provide services
that are sustainable and effective• Barriers to Breastfeeding among minority populations may be
seeded in cultural norms, lack of resources or lack of support services.
• WIC provides various services that could be replicated or improved upon to promote breastfeeding among diverse populations• Key programs provides education, support and incentives