MCHBG Focus Group Report
Table of Contents
Background………………………………………………………………………………3
Overview………………………………………………………………………………….4
Summary of Demographic Data……………………………………….………………..7
Summary of Findings
Use of Health Care Facilities and Access……………………….…………...... 7
Interaction with Health Care Providers……………………….……………….9
Community Experience with Health Plans…………………………………...11
Health Concerns of communities……………………………………………...13
Sensitivity of health care providers to community………………...... 14
Dissemination of Health Information…………………………………………15
Awareness of and Access and experience with programs…………………....16
Impact of September 11, 2001…………………………………………………18
Individual Focus Group Reports
Focus Group Questions…………………………………..…………………….21
Homeless Women………………………………………….…………………... 23
Native American Women………………………………….………………….. 28
Dominican Women ………………………………………..………………….. 33
Far Rockaway Community……………………………….…………………... 37
Middle Eastern Women………………………………….……………………. 42
Nassau County Community.…………………….……………….…………....48
Asian Women……………………………………………………...………….. 52
Participant Focus Group Evaluation ………………………………………………... 55
Appendix
Consent Form
Demographic Survey
Evaluation Questions
The New York State Department of Health’s Division of Family Health and Health Research Incorporated awarded state funds to Northern Manhattan Perinatal Partnership Inc., to conduct focus groups for New York’s Maternal and Child Health Block Grant (MCHBG). The purpose of the focus groups was to obtain information on the health care needs of pregnant and parenting women. These assessments were aimed at assisting the NYSDOH in focusing MCHBG activities on monitoring and evaluating maternal and child health programs and improving the health status for mothers, infants, children and teens in New York State. Accordingly, it has been recommended that a series of focus groups be conducted to examine these issues within seven different population groups.
The Northern Manhattan Perinatal Partnership, Inc. (NMPP) was established in 1991 as part of the New York State Department of Health’s effort to stem the tide of poor birth outcomes in the Harlem community. NMPP has been charged with the task of implementing community-based interventions and mobilizing a consumer driven coalition that could impact the high rates of infant mortality and morbidity in Northern Manhattan. For the past eleven years, NMPP has been serving predominantly African Americans, Latino, new immigrants and low-income populations. Its mission is to improve women’s access to prenatal care through outreach, education, case management, and collaboration with health care providers. Over the last five years NMPP has assembled a strategic agenda to make sure mothers and babies in Central Harlem are healthy and experience normal development.
NMPP’s Social Health Marketing Group’s research history includes an investigative study that assessed community reaction to Child Health Plus among residents of Central and West Harlem. NMPP’s Social Health Marketing Group developed position statements, which were utilized for a major advertising campaign endorsing Child Health Plus.
Northern Manhattan Social Health Marketing Group
The Social Health Marketing Group (SHMG) is composed of administrative, marketing and other program staff organized to develop marketing, outreach and advertising campaigns for social service agencies, health facilities and private businesses. The SHMG is a subsidiary of the Northern Manhattan Perinatal partnership, Inc. The SHMG is a creative team, whose mission is to research, identify, target, motivate and persuade customers to utilize the service of hospitals, clinics, social service agencies and businesses.
OVERVIEW
Northern Manhattan Perinatal Partnership’s Social Health Marketing Group conducted seven focus groups to gather information on health care experiences of pregnant and parenting women throughout the New York City metropolitan area. Seven communities and organizations participated in the focus groups. They were:
· Homeless Women, November 7, 2002, 12 pm
American Red Cross Family Shelter
515 West 41st Street NY, NY 10036
· Native American Women, November 19, 2002, 12 pm
Poospatuck Indian Reservation Community Center
151 Poospatuck Lane, P.O. Box 86, Mastic NY 11950
· Dominican Women, November 22, 2002, 1 pm
Northern Manhattan Perinatal Partnership
127 W 127 Street, NY, NY 10027
· African American Women (Far Rockaway), December 3, 2002, 1 pm
Queens Comprehensive Perinatal Council,
106-46 Guy R. Brewer Blvd Jamaica Queens NY 11433
· Middle Eastern Women, December 17, 2002, 1 pm
Muslim American Society Community Center
1933 Bath Avenue, Brooklyn, NY
· African American Women (Nassau County), December 19, 2002, 1 pm
Nassau County Health Department
26 Main Street, Hempstead NY 11550
· Asian American Women, December 20, 2002, 8 am
Charles B. Wong Community Health Center
268 Canal Street, NY NY 10013
Study Design
Seven (7) focus groups were conducted for this research study. The population surveyed varied in location, ethnicity and demographics. Participants were screened by the host agency as well as by the Focus Group Coordinator. Each participant was screened to have at least one child less than 12 years old and or currently pregnant. Most respondents had children under the age of 5 and many were currently pregnant. All participants represented the population being surveyed.
Participants were recruited through the use of flyers, newspaper advertisements, word of mouth and current participation in a host agency program. Recruitment for the homeless population was conducted at the American Red Cross Family Shelter. These women were recruited on site. The Dominican women were recruited in the Washington Heights community. Flyers were the primary means in recruiting this population group. Native American women were recruited on the Poospatuck Reservation in Suffolk County.
The Poospatuck Community Health Center assisted in screening the women prior to the group. The recruitment process for the Far Rockaway participants was done primarily through the Queens Comprehensive Perinatal Council in collaboration with The Visiting Nurses Services of Far Rockaway. The Middle Eastern women were recruited via word of mouth with the assistance of Aziza Hussein (New York City WIC).
The utilization of a native Middle Eastern woman was instrumental in building trust within this population. Nassau County women were recruited through the efforts of the Nassau County Health Department. Lastly the Asian women were recruited through the Charles B. Wong Community Center located in the heart of China Town. Translation services were utilized for the Dominican, Middle Eastern and Asian focus groups. The Asian focus group was completely facilitated with the use of a translator.
Each focus group was conducted at different times convenient to each population. For example, the Middle Eastern focus group was conducted after Ramadan (a Muslim Religion) per request of that community. Each session lasted approximately an hour and a half to two hours long. The sessions were audio taped with the verbal and written consent of each participant. Confidentially was assured for each group as well.
Participants were reimbursed for their time and transportation. Childcare was provided when needed. Women who utilized private childcare providers were reimbursed for their childcare expenses. Culturally appropriate health foods were provided at each session.
Program Staff
Jodyann Buckle, M.A. and Henry Ampofo, MPH both SHMG members responded to the request for applications from the New York State Department of Health and wrote the proposal that was accepted on behalf of NMPP. As Program Coordinator, Jodyann Buckle solicited the participating maternal and child health agencies and community organizations and assisted them with participant recruitment. Ms. Buckle managed the budget as well as supervised the administrative staff.
Lensa Gelana, M.P.H facilitated six focus groups throughout the metropolitan area and prepared a written report on each focus group facilitated. Ms. Gelana with the assistance of program staff prepared a comprehensive qualitative report on seven focus groups evaluating the trends and findings of each group. A seventh group was facilitated in collaboration with Jodyann Buckle.
Mario Drummonds, MS, CSW provided administrative oversight for the entire project. He guided the project from a methodological perspective and helped determine the policy and practice implications to the research findings.
Limitations of the Research
The focus group interview seeks to develop insight and direction rather than quantitatively precise or absolute measures. Due to the limited number of respondents involved and the special recruitment methods employed, this research must be viewed as exploratory in nature and should be considered in a qualitative frame of reference. Concomitantly, verbatim comments, where they are included, have only been used to convey to the reader the tenor and tonality of response.
Areas of Investigation
Topics covered in each session included questions on the following areas of interest:
· Use of health care facilities
· Interaction with health care providers
· Communities experience with health plans
· Health concerns of communities
· Dissemination of health information
· Awareness, access and experience with government programs
· Impact of September 11, 2001
Group / # of Participants / Demographic informationHomeless Women / N=15 / Most 30-40
All Black, African American,1 Puerto Rican
Most not employed
Native American Women / N=12 / Most 30-40
4 Black,4 American Indian, 2 Tribes (Pospatuck, Ukechaug)
Most were employed
Dominican Women / N=09 / (4) 20-30, (2) 30-40, (3) 40-50
All Dominican
Most not employed
Far Rockaway Community / N=13 / Most 20-30
All Black, African American, 3 Puerto Rican, 1 Mexican American
Most not employed
Middle Eastern Women / N=16 / Most 30-40
7 White, 6 Middle Eastern, 1 North African
Nassau County Women / N=15 / Most 20-30
All Black, African American,1 Puerto Rican
Most not employed
Asian Women / N=14 / Most 20-30
All Chinese
Most not employed
Type of Insurance Parent / Total Number / Percent
None / 13 / 24%
Private / 3 / 5.4%
Medicaid / 50 / 91%
Managed Care / 3 / 5.4%
Social Security Supplemental Income (SSI) / 2 / 3.6%
Social Security Supplemental Disability Income (SSDI) / 2 / 3.6%
Other / 3 / 5.4%
Did not specify
· some participant had more than one form of Health Insurance Plan
None / 7 / 12.7%
Private / 0 / 0
Medicaid / 50 / 90.9%
Managed Care / 8 / 14.5%
Physically handicapped children’s program / 0 / 0
Child Health Plus / 18 / 32.7%
Medicaid wavier / 1 / 1.8%
Other / 1 / 1.8%
Did not specify / 0 / 0
· Some participant had more than one form of Health Insurance Plan
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MCHBG Focus Group Report
Use of Health Care Facilities and Access
When asked about the health facilities they visited, most participants from each group reported visiting a clinic or hospital near their homes. Those who traveled further than their community to access health services did so when they relocated but wanted to keep their provider, or when they needed to see a specialist. A significant number of participants in each group also reported that they visited a different clinic than their children.
The majority of participants reported having difficulty getting to health care services with their children due to the inconveniences of carrying a stroller. Most said that although the clinics were within their communities, it was very difficult to use buses and trains with strollers. The Native American women were the only group who reported having no difficulty getting to health care services adding the clinic they visited was “up the street.”
All recommended that car services be available to pregnant and parenting women to facilitate easier access to health services. Some women from the Nassau group said they liked their health plan especially because it covered car service.
Frequency of Health Care Visits
When asked about the frequency of visits to the doctor, most participants reported that they went to the doctor about twice a month if they had infants and small children and less frequently for themselves. By group, women from the Chinese community reported visiting the doctor the least, followed by the Dominican group and Far Rockaway group. The Native American, Middle Eastern, Homeless and Nassau women had the highest frequency of visits averaging once a month. In each of these groups, women whose children had asthma reported the highest frequency of visits.
Well-Child Checkups
All participants from each group reported that they took their children to well-child check ups and immunizations.
Interaction with Health Care Providers
Communities dissatisfied with health care experiences
Participants from the Homeless, Far Rockaway and Middle Eastern groups said they were dissatisfied with their health care providers and with the services they received.
The main cause of dissatisfaction expressed repeatedly from each group was the amount of attention giving to them by providers. Words like “rushed, not thorough, did not answer questions” were used to express their interaction with providers. Participants said rushed visits made them question the competence of health care providers and they did not trust doctors to give them the right information. In each group, participants said that doctors had misdiagnosed their children’s illnesses, adding to their distrust.
Participants in all the dissatisfied groups said they preferred to address their health concerns at home or within the community, rather than visit the doctor. They said that going to the doctor was their last option and they tried to avoid it as much as possible.
Additional issues listed by community
Participants from Far Rockaway, most of whom were under the age of 21, said that they were discriminated against because of their age. They said that providers did not consult with them about medical decisions that needed to be made for their children because they were young parents. They also said they believed age discrimination was operating when medical students were allowed to visit them or their children without their permission or when providers called Administration for Children’s Services (ACS) without speaking to them.
The majority of participants from the Middle Eastern community expressed great dissatisfaction with Lutheran Hospital, the main hospital used by the community. They said the hospital was overcrowded, did not have enough doctors, and experienced very long waiting time when they arrived for their appointments. They also reported an average waiting period of three or four months to get an appointment. Some said even once they were given an appointment, they were told that their case was not an emergency and were sent home with another appointment.
Communities satisfied with health care experiences
Participants from Poospatuck, Dominican, Nassau and Chinese groups reported being satisfied with their health care experiences. Participants from these groups said they liked their providers because they took time with them, listened to them, explained medication and medical procedures to them and promptly referred them if necessary. They said they felt at home at the doctor’s office because they felt the providers knew and cared about their families. These participants found the staff of clinics they visited friendly and they said the doctors were good. They said they can “get seen” if they walk in which was also a benefit they enjoyed. These respondents said that once they found a provider they liked, they made every effort to stay with that provider.