Valuing diversityIdentifying and addressing barriers to healthcare and their connection to breastfeeding through culturally sensitive practices

Purpose• This tutorial is designed to

• Identify the barriers minorities in Louisiana, Mississippi and Arkansas face when accessing healthcare services

• Identify avenues for public health agencies to promote breastfeeding with minorities while keeping in mind the barriers they face while accessing healthcare

• These ideas are presented to spark the thought processes. Theories, practices and ideas can be adapted to fit many different situations

Outline

• Disparities in Healthcare Access for minorities

• Addressing the Gap• Breastfeeding Among Minorities

• Barriers• Trends• Practices that work

• WIC 3

Disparities in the Target Area

The following slides show some of the

disparities in the target region.

These challenges are specifically relevant for

Maternal and Child Public Health workers

• In Louisiana, Mississippi, and Arkansas:• poor quality of healthcare• High minority population • Rate of low birth weight

high among minorities

THECOMMONWEALTH

FUND

5States with the largest percentage of white residentshave the highest Medicare quality rankings.

0

20

40

60

80

100

NH VT ME ND UT IA CO WI CT MN OR NE FL AL NJ CA OK IL GA AR TX MS LA PR

1 2 3 4 5 6 7 8 9 10 11 12 41 42 43 44 45 46 47 48 49 50 51 52

Note: Medicare rankings are shown for the top 12 and the bottom 12 states only.

Sources: S. F. Jencks et al., “Change in the Quality of Care Delivered to Medicare Beneficiaries,1998–1999 to 2000–2001,” Journal of the American Medical Association, Jan. 15, 2003 289(3):305–12; United States Census Bureau, Census 2000. Chart 6-3

Percentage of population that is non-Hispanic white according to2000 census by Medicare Quality Ranking for 2000–2001

The target area has the lowest quality ranking and lower percentage

of white residents

Low birth weight percentage in the target area for minority populations

March of Dimes Peristats

Disparities in US Healthcare

These factors limit minority populations from accessing care.

Evidence shows that these factors cause some Hispanic populations to

not even seek care.

• Transportation • Childcare• Language• Cultural Barriers• Financial barriers• Lack of social supports• Lack of Insurance

The Commonwealth Fund Chartbook March 2008

Addressing the Gap

• Insurance coverage for vulnerable minority populations

• Interpreter services for those with English as a second language

• Providing more permanent solutions to racial and ethnic disparities is key

The Commonwealth Fund Chartbook March 2008

Addressing the Gap

Culturally Competent Training

• Training for Healthcare workers

• Educational materials for minorities that are culturally competent• Language• Respectful of beliefs and

practices

Providing a Medical Home

• Developing a relationship with a primary care provider is associated with better overall healthcare

• Regular source of care gives the patient access to more services and resources• (see next slide)

The Commonwealth Fund Chartbook March 2008

THECOMMONWEALTH

FUND

10

Racial and ethnic differences in getting neededmedical care are minimal for adults with medical homes;

disparities decline substantially compared with adults withno regular source of care.

Percentage of adults ages 18 to 64 reportingalways getting care they need when they need it

Note: Having a medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone, or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.

Source: The Commonwealth Fund. Health Care Quality Survey. 2006. Chart 7-4

74767474

50525352

343138

44

0

20

40

60

80

100

Total White Black Hispanic

Medical home

Regular source of care, not a medical home

No regular source of care/ER

BREASTFEEDING AMONG MINORITIES

Barriers TrendsPractices that Work

Breastfeeding Rates in the target area

http://www.cdc.gov/breastfeeding/data/reportcard.htm

Barriers to BreastfeedingRural Populations

• Lower income populations• Higher rates of poverty

• Lack of resources that promote breastfeeding

• Lack of specialized services in hospitals or clinics to support Maternal and Child Health (Sparks 2010)

African American Populations

• Lack of individual and generational education about breastfeeding

• Lack of social support• Lack of support from the

work environment• Cultural norms that

support formula feeding and early feedings with solid foods (Chin, Myers, Magnus 2008)

Barriers to Breastfeeding

Latin American Populations• Lack of support from extended

family• Lack of support services that

understand Latin American culture or traditions

• US cultural norms that support formula feeding through availability and marketing of formula

• Lack of communication with providers • Language barriers

(Denman-Vitale & Murillo, 1999)

PRACTICES THAT WORK

WIC• Incentives for breastfeeding mothers• Loving Support Project• Other Initiatives

Women, Infants and Children• Although research by Chin, Myers and Magnus (2008)

associated participation in WIC with lower rates of breastfeeding; WIC has initiated a strong campaign to promote breastfeeding

• The following highlight the practices WIC uses to promote breast feeing among minority populations. Their methods include : incentives, peer support, and targeted cultural campaigning

WIC Incentives

By using incentives, WIC promotes

breastfeeding and offers support for mothers who face

financial challenges or work related

barriers

• WIC mothers choosing to breastfeed are provided information through counseling and breastfeeding educational materials.

• Breastfeeding mothers receive follow-up support through peer counselors.

• Breastfeeding mothers are eligible to participate in WIC longer than non-breastfeeding mothers.

• Mothers who exclusively breastfeed their infants receive an enhanced food package.

• Breastfeeding mothers can receive breast pumps, breast shells or nursing supplements to help support the initiation and continuation of breastfeeding

http://www.fns.usda.gov/wic/Breastfeeding/breastfeedingmainpage.HTM

WIC “Loving Support Makes Breastfeeding

Work” Campaign

Campaign sponsored by WIC and Best Start Social Marketing

Used to promote breastfeeding in States

Provides information on how other states have successfully implemented or expanded peer support breast feeding programs

Provides information about training workers .

• This document created by WIC shares the successes of several States WIC supported breastfeeding peer counseling programs

• Use the above link to access the document

Breastfeeding Peer Support – Implementation and Expansion Resource

Also see the presentation on Peer Counseling

http://www.nal.usda.gov/wicworks/Learning_Center/bfshowcase.pdf

Breastfeeding a Magical Bond of Love

WIC initiative specifically designed to promote breastfeeding in Hispanic families.

Created from a study that looked at the perceptions that Hispanic women have of breastfeeding in the United States

Provides educational materials for mothers, fathers, and grandmothers in English and Spanish

http://www.nal.usda.gov/wicworks/Learning_Center/support_bond.html

Promotional videos• Video by Mississippi WIC

is highly representative of minority populations in the State

• Highlight minorities populations breastfeeding• Teenage mothers• Single mothers• Black, Hispanic and Asian

mothers

http://vimeo.com/13649529

Conclusions• Using a diverse approach to addressing health disparities is an

effective way to target programing• Culturally competent training and practices help provide services

that are sustainable and effective• Barriers to Breastfeeding among minority populations may be

seeded in cultural norms, lack of resources or lack of support services.

• WIC provides various services that could be replicated or improved upon to promote breastfeeding among diverse populations• Key programs provides education, support and incentives