142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Uninsured Adults: Current Experiences and Environment in Health Access and Healthcare in One Urban Upstate New York Community

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

Amanda Coyle, MS, RN, FNP-BC , Department of Nursing, The College at Brockport, State University of New York, Brockport, NY
The purpose of this focused ethnography research was to explore the experiences of the uninsured, and those who provided them healthcare, during the time period leading up to the implementation of the Affordable Care Act (ACA). This research was conducted in an urban community, in a non-profit, independent agency that provided comprehensive healthcare to the uninsured. A fieldwork approach was utilized that included semi-structured interviews with patients and agency staff, researcher observations of activities within the agency and the larger healthcare community, and collection of relevant artifacts important to healthcare access and health insurance eligibility. Data analysis included inductive data coding, category development, and within and between-case comparisons to develop themes. Thematic topics included the emotional, socio-economic, and health-related impacts of being uninsured, as well as the challenges of caring for the uninsured. Conflicting realities were observed. For example, many were grateful for their stable health, despite having undertreated chronic illness. They believed their behavioral choices would protect them from health threats, yet knew this state was tentative and were wholly unprepared to manage looming health concerns. Guilt, shame, and embarrassment were often expressed about being uninsured, yet most were suspicious of healthcare reform. Some uninsured expressed both resentment and envy of those who possessed public health insurance. Other uninsured provided compelling narratives of how financial concerns drove their healthcare decision making, despite the severity of illness. Agency staff detailed their challenges of working with a vulnerable population within a confusing maze of programming that existed to provide services to the uninsured. The findings of this research are timely because great personal and political resistance to embracing and adhering to the ACA persists, which may result in many remaining uninsured. This research can guide practitioners because it contextualizes the experiences of the uninsured and those who care for them.

Learning Areas:

Advocacy for health and health education
Other professions or practice related to public health
Program planning
Provision of health care to the public
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Describe the emotional, socio-economic and health-related impacts of being uninsured. Describe the challenges of healthcare administrators and practitioners in providing healthcare to the uninsured.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the sole investigator of this independently formulated research. This research was conducted as a doctoral dissertation in partial fulfillment of the requirements for a PhD degree. I am also a practicing family nurse practitioner. My clinical experiences in urban and rural acute and primary care settings served as inspiration and motivation to develop this research topic. Additionally, I am a nurse educator in a baccalaureate nursing program.
Any relevant financial relationships? No

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.