Increasing Access to Medical Care for Hispanic Women Without Insurance: A Mobile Clinic Approach.

The purpose of this study was to describe the health status and barriers of people who sought care on a free mobile health clinic for women without insurance in California. Participants were 221 women who attended the Salud para Mujeres (Women's Health) mobile medical clinic between 2019 and 2021. Medical chart abstractions provided data on sociodemographic factors, medical history, barriers to care, depressive symptoms, and dietary factors. Anthropometric measure, blood pressure, and biomarkers of cardiometabolic disease risk were also abstracted. Participants were young adult (29.1 [SD 9.3] years), Hispanic (97.6%), farm-working (62.2%) women from Mexico (87.0%). Prevalent barriers to accessing (non-mobile) medical care included high cost (74.5%), language (47.6%), hours of operation (36.2%), and transportation (31.4%). The majority (89.5%) of patients had overweight (34.0%) or obesity (55.5%), and 27% had hypertension. Among those (n = 127) receiving a lipid panel, 60.3% had higher than recommended levels of low-density lipoprotein and 89% had lower than recommended levels of high-density lipoprotein. Point-of-care HbA1c tests (n = 133) indicated that 9.0% had diabetes and 24.8% had prediabetes. Over half (53.1%) of patients reported prevalent occupational exposure to pesticides and 19% had moderate to severe depressive symptoms. Weekly or more frequent consumption of sugar sweetened beverages (70.9%) and fast food (43.5%) were also prevalent. Mobile health units have potential for reaching women who face several barriers to care and experience major risk factors for cardometabolic disease. Findings suggest a compelling need to assure that Hispanic and Indigenous women and farmworkers have access to healthcare.

Mi Gente, Nuestra Salud: Protocol for a People's Movement for Health Ownership.

BACKGROUND: Community-based participatory research (CBPR) is an increasingly recognized approach to address health inequities. Although in CBPR all processes occur within the community context, its diagrammatic model places the intervention/research outside of the community rather than conceptualizing it as an event in a complex web of system components. OBJECTIVES: We sought to 1) introduce a systems-oriented community ownership conceptual framework that integrates a systems perspective with CBPR and 2) to describe an application of this framework in the form of the Mi Gente, Nuestra Salud initiative, a research-based, action-oriented collaboration between Cal Poly investigators and community partners in Santa Maria and Guadalupe, California. METHODS: We conducted a stocktake of community assets and partnerships in Santa Maria and Guadalupe, among California's poorest and most medically underserved cities; created marketing materials; launched the initiative in December 2020; and collected survey and interview data on community health concerns. An advisory board guides direction of the work. Activities are intended to affect partnerships (who is involved in actions and decisions) and processes (what actions will be taken), as well as resources (e.g., building human and social capital by changing narratives of local, historically rooted power dynamics and offering peer learning opportunities on advocacy and health care interactions). Implementation challenges within this framework are also discussed. CONCLUSIONS: By de-centering specific interventions and conceptualizing them as single events in a complex web, our system-oriented community ownership model brings the focus back to the system itself, and to system-based processes and solutions, while still guided by CBPR principles.