Health Care Access and Utilization for American Indian Elders: A Concept-Mapping Study

Area of Science:

• Public Health
• Health Services Research
• Indigenous Health

Background:

• Inequities in healthcare access and utilization significantly impact the health and quality of life for American Indian elders (AIEs).
• Understanding the specific factors influencing healthcare use in this population is crucial for developing targeted interventions.

Purpose of the Study:

• To explore the importance and perceived prevalence of factors affecting healthcare use among AIEs.
• To assess the changeability of these factors to identify actionable strategies for improving healthcare access and utilization.
• To develop a list of timely and relevant action items for enhancing AIE healthcare.

Main Methods:

• Concept mapping was employed with 65 AIEs and 50 professional stakeholders (tribal leaders, health system administrators, outreach workers, providers).
• Data were analyzed using multidimensional scaling and cluster analyses to identify key themes and relationships.

Main Results:

• Nine thematic clusters emerged, detailing factors affecting elder healthcare: Insurance difficulties, knowledge insecurity, limited service availability, scheduling challenges, provider relationships, family/emotional issues, self-efficacy, transportation barriers, and policy.
• Key barriers include obtaining insurance, navigating services, provider interactions, and accessibility issues.

Conclusions:

• Enhancing AIE healthcare access necessitates actions across multiple domains: health system navigation, workforce development, and tribal, state, and federal policy.
• A multilevel socioecological approach is required to effectively organize and implement these necessary actions.
• Addressing these complex factors is vital for improving the overall health and quality of life for American Indian elders.