The Roles of Education, Socioeconomic Status, Clinic Payment Method and Acculturation in the Health of Latino Primary Care Patients
Regular access to primary care is important for a long and healthy life. Limited access to health services has been shown to partially account for disparities between Whites and Latinos. However, little is known about the factors that predict health status among Latinos who access primary care. A greater understanding of differences in functional status among Latinos can help social workers and other service providers develop culturally tailored measures that more effectively prevent limitations in physical and mental health functioning. This study aims to examine the relationship between social and economic resources, acculturation, and functional health status among Latino primary care patients.
Methods
Participants for this cross-sectional study included Latino patients 18 years of age and older visiting 16 family practice clinics in the San Diego County area over a 7-month period (N=264). Research assistants recruited participants from clinical settings at random intervals. Eligible participants completed a questionnaire which included information on their social and demographic characteristics, including age, sex, marital status, ethnicity, education, household income, method of payment for clinic services, as well as level of acculturation and functional status (using the Medical Outcomes Study Short-Form Health Survey: SF-36). Bivariate and ordinary least squares regression analyses were conducted to determine statistically significant associations between independent and dependent variables.
Results
We found a significant relationship between functional status of Latino primary care patients and socioeconomic status indicators of education, household income, and clinic payment method (p<0.05). A college education was independently related to greater physical, social, and role functioning, and physical health status; household income was a significant independent indicator of general health; and clinic payment method was a significant independent indicator of greater physical functioning, general health, and reduced bodily pain. Consistent with previous research, we found the health status of Medi-Cal patients is generally worse than that of patients with some other form of health insurance. Level of acculturation was also found to be significantly related with social functioning, bodily pain, general health perception, and the physical component score. Patients with a medium level of acculturation reported a significantly greater level of general health than patients with a low level of acculturation.
Conclusions and Implications:
These findings offer clear evidence that socioeconomic status is associated with functional status and that this association is independent of access to care. Furthermore, functional status improves with level of acculturation, but only to a point where the patient is able to successfully maintain a bicultural identity. Latinos are not a homogeneous population with respect to socioeconomic status or functional status; those with low socioeconomic status and low acculturation have the greatest need for care. When designing interventions targeted toward Latino clients, social workers should factor in clients’ socioeconomic status and acculturation levels. More culturally competent social work services that take into account socioeconomic status and acculturation can improve the health and longevity of Latino primary care patients.