Exploring the relationships among dimensions of collective efficacy, barriers to healthcare, and having a regular doctor in low-income urban neighborhoods

This presentation explores whether and how individuals' reported barriers to healthcare and having a regular doctor are determined by perceived collective efficacy, defined as sense of trust and shared values among community members (social cohesion) and perceived likelihood that neighbors will intervene for the common good (social control). Data are from the Queens Library HealthLink project, an NCI-funded Community-Based Participatory Research project designed to increase access to cancer screening and treatment in 20 low-income Queens, NY neighborhoods.

Encountering healthcare barriers, having a regular doctor, collective efficacy, and personal characteristics were measured in anonymous street-intercept interviews conducted with 30-40 individuals in each neighborhood every 16 weeks (n=5701). Two dimensions of collective efficacy, social cohesion and social control, were each comprised of 5 Likert-scaled items; scores ranged from 5 (low cohesion/control) to 25 (high cohesion /control). Controlling for race, gender, education, insurance status, and foreign-born status, logistic regression revealed that a one unit increase in social cohesion was associated with a 5% decreased likelihood of encountering any barriers to healthcare (p<.001), but had no significant effect on having a regular doctor. Similarly, a one unit increase in social control was associated with a 4% increased likelihood of having a regular doctor (p<.001), even controlling for barriers to healthcare. However, social control had no significant effect on encountering healthcare barriers.

These data suggest that perceptions of the social and built environment impact healthcare access and health behavior; however, that relationship is complex. This presentation addresses these complexities and implications for policy and planning.