The Community as the Unit of Healing: Conceptualizing Social Determinants of Health and Well-Being for Older American Indian Adults

被引:7
作者
Jaramillo, Elise T. [1 ]
Haozous, Emily [1 ]
Willging, Cathleen E. [1 ]
机构
[1] Pacific Inst Res & Evaluat, 851 Univ Blvd SE,Suite 101, Albuquerque, NM 87106 USA
基金
美国国家卫生研究院;
关键词
American Indians; Health care utilization; Health equity; Health policy; Well-being; INTERVENTION RESEARCH; ALASKA NATIVES; DISPARITIES; CARE;
D O I
10.1093/geront/gnac018
中图分类号
R4 [临床医学]; R592 [老年病学];
学科分类号
1002 ; 100203 ; 100602 ;
摘要
Background and Objectives Multiple racial and social inequities shape health and access to health care for American Indian Elders, who have a lower life expectancy than all other aging populations in the United States. This qualitative study examines how upstream social determinants of health influence Elders' ability to access and use health care. Research Design and Methods Between June 2016 and March 2017, we conducted individual, semistructured interviews with 96 American Indian Elders, aged 55 and older, and 47 professionals involved in planning or delivering care to Elders in 2 states in the U.S. Southwest. Transcripts were analyzed iteratively using grounded theory approaches, including open and focused coding. A group of American Indian Elders and allies called the Seasons of Care Community Action Board guided interpretation and prioritization of findings. Results Participants described multiple barriers that hindered Elders' ability to access health care services and providers, which were largely tied to funding shortages and bureaucratic complexities associated with health care and insurance systems. Where available, community resources bridged service gaps and helped Elders navigate systems. Discussion and Implications Longstanding structural inequities for American Indians manifest in barriers to health equity, many of which are situated at the community level. These are compounded by additional disparities affecting older adults, rural residents, and marginalized citizens in general. Findings underscore the importance of health and policy initiatives for American Indian Elders that emphasize the community as the focus of intervention.
引用
收藏
页码:732 / 741
页数:10
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