Barriers and Contributors to Health and Social Service Access: Insights from a Family Navigation Proof-of-Concept Study

Background. A sizeable proportion of families with children in the United States experience barriers accessing health and social care. Understanding barriers and contributors to health and social service access can inform policies, programs, and services aimed at reducing health and social inequality and promoting child and family safety and well-being. The aim of the current study was to develop an understanding of the service needs and barriers among families who participated in a family navigation preventive intervention, what services were accessed during the study, how participant characteristics impacted barriers and access, and the relationship between barriers and access to services.

Methods. Data were collected from twenty-nine caregivers who participated in a study of a voluntary, telephone and web-mediated model of family service navigation called Navigate Your Way. Data were collected from participants at two major-wave assessments spaced 12 weeks apart. Family and household characteristics were collected at baseline and included parent/child age, race, and gender, household size, support system size, family community group engagement, religious affiliation, and immigration/tribal membership status. Service barriers were collected using a study-specific 23-item checklist which included family barriers (9-item; alpha=0.69), logistical barriers (6-item; alpha=0.40), provider barriers (6-item; alpha=.65), system barriers (2-item; alpha=.62), and total barriers alpha=0.74). Service access included the number health and social services participants accessed between the two assessments (range=0-3). To identify significant associations among the study variables bivariate correlation matrix and Fisher’s exact tests were computed. Statistically significant associations were then explored in an iterative series of Poisson regression models tailored for small samples to examine the individual and combined contribution of participant and household characteristics and service barriers on service access.

Results. Caregivers reported an average of 10.4(SD=4.1) service barriers across family, logistical, provider, and system domains. Participant age (r=.47, p=.01), child age (r=.36, p=.05), and community group involvement (r=.39, p=.04) were associated with increased provider barriers. Community group engagement was associated within (r=.59, p<.01) system barriers. There were no significant associations from service barrier constructs to service access; however, an analysis of individual items within the constructs revealed provider waitlists were associated with increased service access (r =.43, p=.02) and male child gender was associated with decreased service access (r=-.72, p=0.02). An omnibus test of the Poisson model containing these variables was significant [Likelihood X2(2, N=29)=12.2, p<0.01] with caregivers of male children accessing one fewer service than caregivers of female children (B=-1.1, SE=0.42, p<0.01).

Conclusions. Child gender and provider waitlists were important contextual factors associated with accessing health and social care. The finding of waitlists helping access care may be reflective of caregiver readiness to engage with needed services. Caregivers with male children may need additional supports accessing community services. Replication of the study with a larger sample may uncover additional factors associated with early access and engagement with health and social care.