Listening to rural Hispanic communities in the Midwest: A community based participatory assessment of major barriers to healthcare access and use

Hispanic immigrants are increasingly residing in rural communities including the Midwestern United States. Limitations in the ability of rural Hispanics to access and utilize healthcare contribute to patterns of poor health and health disparity. Project EXPORT Center of Excellence in Rural Health in Illinois formed 10 local partnerships in rural communities between 2003 and 2006 with the objective of investigating health disparities among underserved populations in rural Midwestern communities. A conceptual model of ‘vulnerability' guides this community based participatory assessment project designed to explore rural Hispanics perceived barriers to accessing and utilizing health care. Findings from a series of 19 focus groups with 181 participants from three communities in the upper Midwest identified perceived barriers at the individual and health care system levels. The most commonly perceived barriers were the lack of and limitations in health insurance coverage, high costs of healthcare services, communication issues involving both patients and providers, legal status/discrimination and transportation concerns. Findings imply that these barriers could be addressed using multiple educational and health service delivery policy related strategies that consider the vulnerable nature of this growing population