Factors Associated to Health Service Use By Latino Day Laborers

Background: Latino Day Laborers (LDLs) challenging work conditions, compounded by marginalization, have led to disproportionately high rates of on-the-job injuries and fatalities among LDLs when compared with other workers in the U.S. While, it can be assumed that LDLs are not likely to use health services due to their undocumented immigrant status, there has been relatively minimal exploration regarding which factors LDLs themselves indicate to be barriers to their health care utilization. Using Anderson’s Behavioral Model of Health Service Use, the current study sought to examine the impact of predisposing variables (age, education level, income, location of educational training, legal status, and marital status), enabling variables (trust in medical personnel, whether the respondent has someone they consider their personal doctor, and whether their doctor speaks the same language, perceived barriers to care) and need variables (self-rated health, number of chronic conditions) on the use of health services by LDLs.

Method: The current study used cross-sectional data from a purposive sample (N= 150) of LDLs.  To participate in this study, participants had to self-identify as either Hispanic or Latino, be at least 18 years of age, and actively be seeking informal or short-term contingent employment.  Data were collected face-to-face from April 2013 through July 2013 from 4 popular day laborer sites in Dallas and Arlington, TX. Self-report questionnaires were given in English or Spanish. An option of an oral reading of the survey was offered to all participants to ensure that respondents with literacy concerns were not discouraged from participating. The main outcome variable was a sum of three single items asking participants how many times they visited a health clinic, doctor, and emergency room in the last year. Descriptive, bivariate and multivariate regression analyses were computed using the SPSS 22 software program.

Results: LDLs perceived that: lack of health insurance, could not afford to pay for services, being afraid to seek services because of their immigration status, and waiting times at the clinics were too long as reasons for not seeking care for health services. Regression results suggest that legal status (β = .21), the sum of multiple chronic conditions (β = .16), lack of health insurance coverage (β = -.22), could not pay for services (β = -.23), being embarrassed or family not approving (β = .18), and trust in medical providers (β = .41) significantly predicted health care usage. The most prominent factor in the model was trust in medical personnel. The overall regression model was significant (F = 4.843, p = .001) and explained 41% of the variance.

Conclusion: The findings suggest that LDLs are faced with a number of predisposing, enabling, and need factors that significantly predicted health care usage. However, it may be prudent for social workers and other health professionals to pay more attention to enabling variables such as establishing and fostering increased trust between LDLs and health care providers. Doing so may provide a pathway to lessen mistrust and disparities in health care usage among LDLs.