197830 A decade on the mean streets: A new typology for understanding health choices of those living in poverty's grasp

Tuesday, November 10, 2009: 11:30 AM

Ruth (Toni) B. Pickard, PhD , Department of Public Health Sciences / HSMCD, Wichita State University, Wichita, KS
Angela N. Roberts Miller, MPH , Department of Psychology, Kent State University, Kent, OH
Forest Kirkpatrick, MA , Department of Psychiatry, University of Kansas School of Medicine-Wichita, Wichita, KS
Social determinants of health are widely described but few researchers have more than cursory contact with those whose lives fall into the most impoverished epidemiological categories. Framing the problems as inappropriate emergency room visits and non-compliance with treatment regimens sheds little light on the choices driving such behaviors. Drawing on 11 years of working continually among residents of a highly diverse and grindingly poor urban neighborhood, this paper examines the meanings people assign to their health behaviors. It presents a new ‘care seeking typology' based on a content analysis of accounts shared in nearly 400 in-depth neighborhood interviews. When combined with close observations of patients in a small university affiliated, community based safety-net clinic, 10 health seeker types emerge. Each type is illustrated with authentic stories rarely surfaced by traditional scientific methods and validated through reviews by community participants. While several resulting composites mirror frequently cited stereotypes of downtrodden lives, others challenge prevailing beliefs about why and how the poor make health care decisions. Not surprisingly, money plays a central role in care seeking among the population studied. However, the connection is frequently misunderstood by health providers and policymakers, with frustratingly predictable results. Opportunities for more successful therapeutic engagement emerge from this new mapping of social perceptions.

Learning Objectives:
1. To be able correctly describe the new ‘care seeking typology’ for understanding health decisions of the poor 2. To be able to correctly formulate opportunities for successful interventions related to newly emergent categories of impoverished care seekers

Keywords: Community-Based Health Care, Health Behavior

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conducted the study on which the paper is based. I also founded and run the community-campus nonprofit organization in the target neighborhood.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Healthy Options for Kansas Communities (HOP) Founder and Executive Director of community-campus clinics and training programs Advisory Committee/Board and Employment (includes retainer)

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.