2395 Developing a conceptual model of healthcare access foradolescent Latinas in the US South

• Published in: Journal of clinical and translational science Vol. 2; no. S1; p. 68
• Main Authors: Aleman, Mercedes M M, Ferreti, Gwendolyn, Scarinci, Isabel C
• Format: Journal Article
• Language: English
• Published: Cambridge Cambridge University Press 01.06.2018
• Subjects: Adolescents; Health disparities; HIV; Human immunodeficiency virus; Immigration; Immigration policy; Noncitizens; Population; Population studies; Pregnancy; Womens health; Workers; United States > US; Alabama
• ISSN: 2059-8661
• DOI: 10.1017/cts.2018.248

OBJECTIVES/SPECIFIC AIMS: Alabama (AL) experienced a 145%increase in its Latino population between 2000 and 2010; making itthe state with the second fastest growing Latino population in the United States(US) during that time. Adolescent Latinas in the United States and in AL aredisproportionately affected by sexual health disparities as evidenced by thedisproportionate burden of HIV, STIs and early pregnancy compared with theirnon-Hispanic, White counterparts. In 2011, Alabama passed 1 of the harshestanti-immigration laws in the nation. Following the passing of this law, countyhealth department visits among Latino adults decreased by 25% forSTIs and 13% for family planning. Empirical data with adult Latinasin the Southeast suggest significant barriers to sexual healthcare access.However, to our knowledge, no other researchers have examined barriers andfacilitators to sexual healthcare access for this subpopulation. Therefore, thegoal of this 3-phase study is to: (a) better understand the factors underlyingsexual health disparities and gaps in healthcare access among adolescentLatinas; (b) develop a conceptual model based on these data and the extantliterature summarizing the theorized pathways through which factors at differinglevels of the socioecological model of health (SEMH) impact sexual healthcareaccess for this group; and (c) develop community-driven, theory-based,culturally-relevant, multilevel intervention strategies to reduce sexual healthdisparities and increase sexual healthcare access for adolescent Latinas througha community-engaged, intervention mapping process. Community based participatoryresearch (CBPR), which ensures equitable participation of stakeholder groupsthrough partnerships, and the SEMH, which conceptualizes the individual asnested within a set of social structures, provide the philosophical andtheoretical frameworks for the work. METHODS/STUDY POPULATION: From January of2017 to December of 2017 we completed phase 1 of the study: conducting andanalyzing 20 semi-structured qualitative interviews with adolescents who:self-identified as Latina, were between 15 and 20 years of age, had been in theUnited States for over 5 years, and lived in one of the counties of West AL and15 semi-structured qualitative interviews with key stakeholders (healthcareproviders, parents, policy makers, etc.) who regularly work with Latinaadolescents. Interview participants were recruited throughpurposeful-convenience sampling. Two bilingual (in English and Spanish) codersused an iterative process (between independent coding and consensus building) toanalyze the data using NVivo 11. Phase 2 of the study is currently underway:constructing a conceptual model on sexual healthcare access for young Latinas inAlabama. We have utilized an iterative process between qualitative interviewdata collected in phase 1 and review of the extant literature to draft aconceptual model of healthcare access among adolescent Latinas in the US South.This model will serve as the foundation of future studies including thedevelopment of intervention strategies through a CBPR process (phase 3), tocommence in January 2018. RESULTS/ANTICIPATED RESULTS: PHASE 1: Several barriersand facilitators to sexual healthcare access emerged from the semi-structuredqualitative research interviews with young women. These included: (1) parentalapproval/disapproval and embarrassment(“pena”); (2) structural barriers/facilitatorsto care (e.g., lack of transportation, flexible clinic hours); and (3)negative/positive experiences with providers (e.g., perceiveddiscrimination based on immigrant status). Key stakeholders identified thefollowing barriers and facilitators to sexual healthcare access for adolescentLatinas in their interviews: (1) language barriers/need forinterpreters and outreach workers to work with young Latina women; (2) need forbetter sexual health education across the state; (3) lack of knowledge amongyoung women and their parents about institutions in general and sexualhealthcare, in specific; and (4) perceived lack of“deservingness” and discrimination fromproviders/“not my patients” phenomenon. PHASE2: This presentation will summarize the development of our conceptual model (seedrafts attached). For ease of interpretation, we have created 2 sub-models(centering gender and immigration, respectively) which summarize theorizedpathways through which policy, community, organizational, and family-levelfactors influence young Latina women’s access to sexual healthcareservices. DISCUSSION/SIGNIFICANCE OF IMPACT: The proposed research issignificant because: (1) the state of AL experienced a dramatic increase in itsLatino/a population over the last 15 years and adolescent Latinas in AL aredisproportionately affected by sexual health disparities; (2) to our knowledge,this is the only study to examine the multilevel factors associated with sexualhealthcare access for adolescent Latinas in the South and inform interventionstrategies to promote sexual healthcare access in this population; (3) the workis being conducted under the philosophical lens of CBPR such that communitymembers are involved in every step of the research process, resulting inculturally relevant and youth-specific intervention strategies.