Journal of Health Care for the Poor and Underserved

Brief communication 125 UTILIZATION OF ROUTINE MEDICAL SERVICES AMONG IMMIGRANTS FROM EL SALVADOR Latinos represent the second largest minority group in the United States, comprising 10 percent (27 million) of the U.S. population.1 While the U.S. population grew by only 6 percent between 1990 and 1994, the Latino population increased by 28 percent during the same period, and projections suggest that Latinos will be the largest minority group by the year 2050.2 By then, Latinos will account for more than 25 percent of the U.S. population.3 The Latino community in the United States consists of various subgroups: Mexicans, Puerto Ricans, Cubans, Central Americans, South Americans, and other Caribbean groups. Frequently, no distinction is made between the subgroups that comprise the Latino population; therefore, extrapolation of data from one group to another may not be appropriate because each Latino subgroup has come to the United States for different reasons. Furthermore, their ethnic and racial backgrounds may differ. The 1982-1984 Hispanic Health and Nutrition Examination Survey (HHANES) produced national data on Mexicans, Puerto Ricans, and Cubans indicating that the use of preventive services varies by Latino subgroup.4 Data from the 1982-1984 HHANES indicate that Cubans and Puerto Ricans tend to use routine medical checkups, blood pressure screenings, eye examinations, and dental checkups more often than Mexicans, although no differences were found for receiving Pap smears and breast examinations.4 Furthermore, objectives in Healthy People 2000 include increasing the proportion of people receiving routine checkups in the past three years and having a specific source of medical care. The target for the year 2000 of adults 18 to 64 years of age receiving a routine checkup is 91 percent. The target for the year 2000 for having a specific source of ongoing primary care is 95 percent.5 Most information in the literature deals with Mexican Americans, Puerto Ricans, and Cubans. Because of ongoing political turmoil in their countries, Latino groups from Central America migrated to the United States during the 1980s. Immigrants from El Salvador, who presently constitute the fourth largest group of Latinos in the United States, are one example.6 The 1990 census showed that there were 10,513 documented Salvadoreans living in Washington, D.C., representing more than one-third of the Latino population of the city.3 Limited information is available on the utilization of medical services among immigrants from El Salvador. The purpose of this study is to determine the Journal of Health Care for the Poor and Underserved · Vol. 11, No. 2 · 2000 126 Utilization of Medical Services factors that are associated with utilization of routine medical checkups in a sample of Salvadorian men and women living in the Washington, D.C., metropolitan area. Methods Data were collected between October 1993 and May 1994 using a survey instrument consisting of 115 items. The survey instrument collected information on perception of community health problems, practice of cancer-screening behaviors, use of cigarettes and alcohol, nutrition intake, beliefs about cancer , perception of early detection, access to medical care, exposure to health education, and sociodemographics.6 The survey instrument was subjected to a test-retest for reliability and validity and pretested in a sample (n = 20) of the population under study. Use of a routine medical checkup was the outcome of interest for the analysis presented in this article. The interviews were conducted in homes or health care facilities in the Washington, D.C., metropolitan area by trained bilingual interviewers from El Salvador. Interviewers going into the community and health clinics (30 percent) recruited participants, since no population base existed for randomization. The selection criteria were to include individuals 18 years of age or older born in El Salvador and residing in the Washington, D.C., metropolitan area. The survey had a very low refusal rate (2 percent). Before starting any interview, oral consent was obtained from the participants. No remuneration was provided for their participation. The development of the survey instrument, sampling, and interviewers' training has been described previously.6'7 One of the most frequently used frameworks for analyzing patient utilization of health care services is the behavioral model developed by Andersen and colleagues in 1968;8 a...