IDENTIFYING POTENTIAL BARRIERS TO OBTAIN PREVENTIVE SCREENINGS FOR WOMEN WITH DISABILITIES IN GENESEE COUNTY, MICHIGAN

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1 IDENTIFYING POTENTIAL BARRIERS TO OBTAIN PREVENTIVE SCREENINGS FOR WOMEN WITH DISABILITIES IN GENESEE COUNTY, MICHIGAN Linda Jackson Faculty Co-Author and Sponsor: Rie Suzuki Department of Health Sciences and Administration, University of Michigan-Flint

2 Abstracts Primary health care screening services is the first step in treatment for some diseases to reduce their impact on a person s health and prevent an early death. Studies show, however, that people with disabilities are less likely to get some preventive screenings at the recommended times than people without disabilities. The dual purpose of this study is to identify screening services available to women with disabilities living in Genesee County, and to create health promotion brochures of these findings. There were numerous calls and visits to the Disability Network, Health Access, Michigan Health Department, and Genesee community health services in Flint to find access information (e.g., transportation, health insurance coverage) for women with disabilities to obtain preventive health services. Identifying accurate information produces barriers requiring persistence. For example, in order to verify what services are or are not covered by Medicaid proved to be challenging due to unfamiliarity of the specific preventive screening information for women with disabilities. 2

3 Background Women with disabilities are less likely to get some preventive screenings at the recommended times than those without disabilities. There are several barriers when using health care which include physical, emotional and social. Transportation and lack of information about available programs can be seen as common physical barriers to access preventive health care. Types of insurance and insurance coverage also interfere with health care promotion (Becker and Stuifbergen). Additionally, people with disabilities think that how providers treat themselves has an impact on the use of preventive services. For example, health care providers do not know the needs of primary health care among women with disabilities, or have perceptions that certain screenings are not needed. They are also insensitive to disabilities (Smeltzer). Therefore, the purpose of this study was to identify potential barriers to obtain preventive screenings for women with disabilities in Genesee County in Michigan. In order to assess community capacity to support women with disabilities in receiving appropriate preventive screenings, the asset mapping approach was utilized to understand this community. Asset based community development efforts start from understanding what resources and phenomena exist in a community, such as the abilities of associations and institutions. Assets assessment focuses on effectiveness, builds interdependences among resources, and identifies the means that people provide their talents in a targeted community (Kretzmann and McKnight). Hence, we targeted the availability of preventive screening services and the public transportation coverage to them, and the development of health promotion 3

4 brochures regarding these findings. This study serves as the initial step to conduct the assets assessment in Genesee County. Methods This study was operated between September, 2008 and March, In order to understand screening availability covered by the Medicaid, Department of Human Services, Genesee County Health Department, Disability Network, three major hospitals, and four clinics in Genesee County, and a physician were reached by phone calls or office visits. Additionally, to obtain transportation accessibility, we visited the Mass Transit Authority and Disability Network and called Greyhound and Amtrak. Since the research assistant who did not know Medicaid conducted this asset assessment, it was expected that the findings from this study would partially portray as the similar obstacles and experiences if family members for people with disabilities who moved in this community would look for such information. Results Explore whether or not Medicaid covers preventive screenings in the major hospitals and clinics. Our initial question was How does a person with disabilities go about applying for Medicaid, and would the following screenings be covered such as Mammogram, Pap smear, Cholesterol, Weight check, and Bone density? In the Department of Human Services, the program analyst explained that eligibility and the availability of the Medicaid programs in Genesee County. For instance, most persons with disabilities may be eligible for Medicaid; however, there are two types of Medicaid (A and B); which covers specific services. There are also the Medicaid programs for low-income pregnant women or women with families and the HMO s for persons with disabilities such as Health Plus Partners and BlueCaid of Michigan. 4

5 Unfortunately, screening availability was not provided in Genesee County. At the Genesee County Health Department, accurate health coverage information was difficult to obtain. Questions regarding eligibility and coverage were never directly answered by them. Health Access or a health information provider in Genesee County serves as a link to health care services. However, they did not disseminate information for preventive screenings for Medicaid. In the Disability Network or the Social Service Organization for people with disabilities, there was little information about preventive health services. However, they helped to narrow the list of Medicaid hospitals and clinics where persons with disabilities typically visit in Genesee County. For three hospitals (Genesys Regional Medical Center, McLaren Regional Medical Center, Hurley Medical Center) and four clinics (Genesys West Flint Campus, Genesee County Free Medical Clinic, McLaren Family Practice residency Program, and Hamilton Clinic), we asked Do you accept Medicaid to obtain preventive screenings such as Mammogram, Pap Smear, Cholesterol, Weight check, and Bone density?. The results of all hospitals and clinics showed that it was difficult to obtain the direct information regarding their acceptance of Medicaid patients. It also took a long time to receive these answers and whether Medicaid covered screenings at each hospital and clinic. We also talked to a physician in Flint. Interestingly, she could provide accurate Medicaid acceptance information obtaining preventive screenings in these hospitals and clinics. For instance, one free clinic only accepted persons without insurance. She, however, did not know whether or not these institutions provided some screenings on site while other referred patients to other facilities. In addition to these findings, we experienced several obstacles to obtain information regarding preventive screening for women with disabilities. First of all, it took several 5

6 connections to several departments before getting an infinitive answer from personnel in patient. Moreover, it was difficult to obtain the Medicaid related information because the clinics and hospitals did not release Medicaid services information to non-member of Medicaid. For instance, case workers and other health care workers repeatedly told us call the number on the back of the Medicaid card for coverage information, as a result, many facilities could not release information unless one has Medicaid Insurance. Furthermore, very few personnel could provide information related to Medicaid coverage and information regarding which hospitals and/or clinics is equipped to give preventive screening for women with disabilities. services. Identify the linkage between the major hospitals and clinics and public transportation In order to examine the available public transportation services, we visited the Mass Transportation Authority (MTA), and called Greyhound and Amtrak to identify availability of transportation routes and fare prices for women with disabilities. The results indicated that the MTA has had disability accessible buses as well the Your Ride transportation which provides door-to-door services for those with disabilities. The MTA also has offered the reduced fares for people with disabilities. To qualify for this reduced fare one must meet medical disability eligibility requirements. Greyhound and Amtrak in Genesee County, however, did not have access to the clinics and hospitals. Discussion This study represents the first major stride to consider the community assets of preventive screening services for women with disabilities in Genesee County. While this study took the qualitative approach, our findings showed the layout of availability as well as weaknesses of 6

7 physical and human resources to support preventive screenings. The potential for bias toward individuals without disability and ultimately our approach from non clinical people is an inherent limitation of the study methods. Given the qualitative approach of this study and analyses, the causal relationship between community assets and preventive screening practices among women with disabilities is limited. Our interviews toward the Medicaid reveal that the personnel who received our calls were not familiar with the insurance coverage of patients. In our analysis, the hospitals and clinics also could not navigate the correct answer of the Medicaid covered preventive screening availability within their own institutions. Our experiences from these interviews may support several conclusions. First, there is a lack of information for women with disabilities needing preventive services; second, there is a lack of Medicaid information for women with disabilities, especially specific information about Medicaid, without visiting and calling various organizations; finally, it could be a lack of knowledge about the need of preventive healthcare among women with disabilities. Another interview of the public transportation also identified that the MTA website information was unorganized, not clear and difficult for people with disabilities to navigate services and fees. Fees also could be expensive. For example, as of March 2009, the MTA charges $22.50 per month for the reduced fair, and $ per month for the Your Ride bus pass. It would be a barrier to getting adequate preventive health care for the fixed income family. Implications in Practice Since Medicaid information is complex and there are many different questions concerning patient health care screening, there needs to be educational opportunities geared 7

8 towards patients for example that would teach patients how to talk to providers in order to get accurate information. In addition, if health care providers and the general public believe it is not necessary for women with disabilities to obtain regular preventive screenings, there needs to be more education in treating women with disabilities the same as women without disabilities. Also, due to lack of information about providers and coverage, there needs to be an increase of effective communication tools such as that created by our research team (See Figure 2) to increase the use of preventive health care. Moreover, unless one is a Medicaid recipient, it is difficult to access Medicaid information. Medicaid patients should be self-motivated to obtain screening information. Hence, educational opportunities (e.g., how to talk to the providers to get the accurate screening information in time allotted during visits) for them are very important in promoting health. Finally, since transportation cost can be quite expensive for someone on a fixed budget, health educators should create social networks to volunteer transportation services for persons with disabilities in order to reduce barriers to seeking preventive health care. Next Step After completing interviews, we developed the brochures to summarize the Medicaid covered preventive screening services in Genesee County and its available public transportation (Figure 1 and 2). We assessed the readability, accuracy and usability of these materials through health education experts, hospital clerks, health care workers and the disability expert at the Disability Network. They provided tremendous beneficial feedback to improve the quality of these brochures (e.g., whether or not the materials covered sufficient services in Genesee County). Formatting the materials (e.g. font, color, pictures) through the formative evaluation is an on-going process. 8

9 Work Sited Becker, H., and A. Stuifbergen. "What Makes It So Hard? Barriers to Health Promotion Experienced by People with Multiple Sclerosis and Polio." Fam Community Health 27.1 (2004): Kretzmann, John P, and John L. McKnight. Building Communities Form the inside Out: A Path toward Finding and Mobilizing a Community's Assets. Chicago, IL: ACTA Publication, Smeltzer, S. C. "Preventive Health Screening for Breast and Cervical Cancer and Osteoporosis in Women with Physical Disabilities." Fam Community Health 29.1 Suppl (2006): 35S-43S. 9

10 (Front) (Inside) Figure 1. Health Promotion Brochure 1: What preventive services does Medicaid provide for women with disabilities? 2

11 (Front) 3 (Inside) Figure 2. Health Promotion Brochure 1: Available transportation forwomen with Disabilities in Genesee County.