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Strategies to Reduce Health Disparities
Access to Information
Christine Molnar, M.S., Director, Managed Care Education Programs, Community Service Society of New York, New York, NY
Terrie S. Restivo, Project Director, Native American Cancer Survivors' Network/Circles, Native American Cancer Research (NACR), Westminster, CA
Informing consumers on appropriate use of health services is a daunting task. It requires explaining:
- The complexity of the system (e.g., eligibility systems, care delivery systems, and facilitating services).
- The importance of an early link to a provider.
- Ways to empower consumers (e.g., patient/provider communication, using the grievance system without fear of retribution, involvement in policymaking).
Considerations to guide efforts to assist consumers in becoming informed about their choices include:
- How active or passive a role do we want consumers to have?
- What do we expect consumers to know?
- What do we expect them to do with this knowledge?
- Which subgroups are least likely to use information?
- What kind of support do they need? How can messages be tailored for their needs?
Choice of health plan requires an understanding of the basics of managed care. Studies have found Medicaid consumers to have little understanding of how managed care works. A 13-city study found issues with the ways in which MCOs inform consumers, including:
- Overwhelming amount of information.
- Poor readability and translations.
- Lack of effective outreach and education on how to use information to make choices.
- Faulty provider network directories.
- No quality information in enrollment packets
- Emphasis on call centers.
Barriers to effective education as to choice of plan/provider include:
- Skills (e.g., understanding what is read, using comparison charts, researching options, making decisions).
- Low expectations and lack of trust—people need to be convinced that making a choice will benefit their health.
One effective way to inform consumers is through partnerships with community-based organizations. These organizations can serve as:
- Knowledge brokers.
- Cultural and linguistic brokers.
- Skills developers.
- Problem solvers.
- Persons who can help instill trust in the delivery system.
For example, the New York City Managed Care Consumer Assistance Program contracts with 25 community-based organizations to reach people formerly thought to be impossible to reach. The program develops training and serves as an all-payer ombudsman program targeting racial/ethnic minorities, immigrants, and low-income communities. Outreach, education, counseling, and navigation assistance services are provided in 11 languages.
Self-advocacy is a skill that not all consumers possess. AI/ANs often come from cultures that equate assertiveness with rudeness, so they do not push for treatments that they need. They also tend to be "silent sufferers" who avoid pain management out of fear of being perceived as complainers. Educations provided through short- and long-term support groups can promote the development of self-advocacy skills.
Native American Cancer Survivors/Thrivers Talking Circles—a collaborative effort between Native American Cancer Research and University of California Los Angeles—provide support to urban Indians in southern California. Each talking circle has 12 weekly 2-hour sessions. Men and women meet in separate circles. Participants learn about treatments (both Western and traditional) and develop coping and assertiveness skills. Knowledge and skills and their perceived benefits are measured both at the beginning and completion of the 12-week circle and typically increase during the program.
The Native American Cancer Survivors' Support Network—part of Native American Cancer Research—connects approximately 200 people. Services include dissemination of free educational materials, and advocate-support counseling to encourage the improvement of the quality of care. The network collaborates with the University of California Los Angeles in the "Healthy Path Program," which provides cancer-related information on reservations, rancheros, and urban communities.
Other education strategies used by Native American Cancer Research include:
- Beginning where the community is.
- Collaborating on training/education/materials.
- Developing intertribal collaborative networks.
- Providing strong, consistent partnerships between providers and patients.
Molnar C. Informing consumers about health care quality: Implementation of the research and action agenda for consumers with special communication needs. New York (NY): Community Service Society of New York; 2000 Dec.
Molnar C. Policy and practice recommendations for reducing race/ethnic, linguistic, and class disparities in the health care delivery system. New York (NY): Community Service Society of New York and the U.S. Department of Health and Human Services, Office of Minority Health; 2000 Jul.