Health Professions Students at the U.S. -

Mexico Border: Decreasing Barriers to Accessing Care

Marylyn McEwen, MS, APRN, BC

Marion K. Slack, Ph.D.

University of Arizona

Purpose

• To present a model for preparing interdisciplinary students (pharmacy, nursing, public health, medicine, social work, and nutrition) to provide culturally relevant care that results in decreasing barriers to accessing care for residents in a rural U.S. - Mexico border community.

Barriers to Accessing Care

• Providers not prepared to provide culturally relevant care– Lack of familiarity with:

• Cultural values and beliefs of clients served• Community resources• Eligibility requirements for care / services• Language

• Immigration and Immigrant health policies• Client unfamiliar with U.S. health care system• Cultural, financial, linguistic barriers

Promotoras

• Community Health Workers• Community members• Share clients’ culture and language• Cultural brokers

– Connectors between client, provider, & student– Promote health to groups that have lacked access

to care– Facilitate student cultural self-awareness– Provide social support– Build student cultural self-efficacy

Students

• Graduate and Undergraduate students from the disciplines of:– Pharmacy– Nursing– Public Health– Nutrition– Social Work– Medicine

Clients• Residents of a rural U.S. - Mexico border community• Primarily Hispanic (Mexican) who maintain

connections with family in Mexico• At risk of / diagnosed with diabetes, primarily

diabetes type 2 and gestational diabetes• Age range 14 months - 95 years• Primarily undocumented residents, below poverty

level, underemployed or unemployed• Spanish speaking / limited English language skills

with less than a high school education• Uninsured / underinsured receiving care at private

provider, community health center, and in Mexico

Interdisciplinary Case

Management Model • Structure

– Interdisciplinary rural health training grant– Curriculum modules introduce critical concepts– Two universities partner with local community

health center – Promotoras, local providers, students, and faculty

are members of the interdisciplinary team (IDT)– Client caseload maintained by promotoras– Weekly case management seminars

Model cont’d

• Process– Students have weekly client / promotora

encounters (home visits) – Students / promotoras present clients to the IDT in

weekly seminar– Problem solutions identified in an interdisciplinary

context• Disciplinary knowledge and skills shared• Cultural knowledge shared

– Social support for students

Interdisciplinary Case Management Model - Outcomes

• Client– Receives interventions that increase access to care:

• Teaching / Counseling / Guidance• Case Management / Surveillance

– Increased knowledge and skills for accessing community resources

– Increased knowledge of diabetes and increased self-care abilities related to diabetes

– Increased self-efficacy related to self and family health issues

Outcomes cont’d

• Student– Knowledge of an interdisciplinary case

management model– Knowledge of rural / border health issues– Knowledge of cultural self-efficacy / cultural values

and beliefs– Knowledge of relationship between immigration

and immigrant health policy and access– Increased Spanish language skills

Outcomes cont’d

• Promotora– Knowledge of an interdisciplinary case

management model – Increased knowledge of client health care needs– Increased knowledge of health professions

disciplines– Increased English language skills

Outcomes cont’d

• Provider– Increased knowledge of community health care

systems and resources– Increased awareness of cultural barriers– Formalized knowledge of immigration issues– Increased expertise in using interdisciplinary

models– Increased knowledge of other disciplines

Conclusions• Decreasing barriers to accessing care requires a

multidimensional approach that must address health professions education, education of local providers, and the health care delivery system.

• We maintain an interdisciplinary approach for health professions education and an interdisciplinary case management delivery model facilitates decreasing barriers to accessing care along the U.S. - Mexico border.

• Nuestra Comunidad, Nuestra Salud Project (Spanish for “Our Community, Our Health”) is funded by HRSA Grant No. 2D36 HP 10033-08.