Concordance and variation in women's healthcare priorities across racial, ethnic and national boundaries

Differential utilization of healthcare services has been linked to racial/ethnic and socioeconomic categories. Attempts to provide healthcare to a complex population must incorporate culturally dependent patient priorities and expectations. This study tested the hypothesis that the major determinants of healthcare seeking behavior are similar among women of differing ethnic, racial and national backgrounds. Data were collected with an anonymous written questionnaire distributed to a convenience sample of 500 patients with non-emergent gynecologic and obstetric complaints in the Parkland Memorial Hospital OB/GYN emergency room. Parkland is the main teaching hospital of the University of Texas Southwestern Medical School and the largest public hospital in North-East Texas, serving primarily a low income and indigent population. The questionnaire was designed to elucidate the reasons why women chose the emergency department for their care on the day of participation, and to identify the factors subjects deemed most important in choosing where to receive medical care in general. Descriptive statistics were generated, the importance of different factors evaluated by a goodness of fit test and subgroups compared with chi-squared analysis. The results indicated that there were both common themes and striking differences in healthcare priorities among participants. Rapid access to care was the single most important healthcare determinant for: English speakers, African American and Hispanic subjects as well as both US and foreign born subgroups. The single most important factor for non-Hispanic Caucasian women was whether a prepayment was required. There were no significant differences in the primary determinants of healthcare seeking behavior between US and foreign born women, English and Spanish speakers, nor between Hispanic and non-Hispanic Caucasian women. However, chi-squared analysis showed significant differences in priorities between Hispanic and African American women (p <.001) and between African Americans and Caucasians (p <.05).

The ability to provide accessible and culturally sensitive healthcare requires knowledge of the priorities and expectations of the target population. Our data indicate that among a primarily low income group of culturally and racially diverse women presenting to an urban emergency room with non-emergent gynecologic and obstetric complaints there may be both a striking degree of concordance but also significant differences in healthcare priorities. These data help identify necessary components of healthcare systems designed to address the needs of these culturally diverse women.