Socio-Ecological Influences on Health-Care Access and Navigation Among Persons of Mexican Descent Living on the US/Mexico Border

Reininger BM, Barroso CS, Mitchell-Bennett L, Chavez M, Fernandez ME, Cantu E, Smith KL, Fisher-Hoch SP
Source: J Immigr Minor Health
Publication Year: 2014
Patient Need Addressed: Behavioral health
Population Focus: Low income
Demographic Group: Adult, Racial and ethnic minority groups
Study Design: Other Study Design
Type of Literature: White

The study reported here examines factors influencing decision-making concerning healthcare access and navigation among persons of Mexican origin living along the U.S./Mexico border. Specifically, the study examined how persons with limited financial resources accessed these two systems. Seven focus groups were held with 52 low income Mexican American people aged 18-65 years. Transcripts were analyzed to identify themes in Atlasti 5.0 software and the theory used included a socio-ecological framework and complemented by constructed from the Social Cognitive Theory. We found that in addition to a lack of insurance and financial resources to pay for healthcare; fear, embarrassment and denial associated with a diagnosis of illness; poor medical personnel interactions, and desire for quality but streamlined healthcare also influenced decision making. This theory-based study raises important issues if healthcare is to improve the health and welfare of disadvantaged populations and points to the need for greater focus on medical homes and prevention and early intervention approaches.

Insights Results

Overview of article

  • This article examines factors influencing decision-making concerning healthcare access and navigation among persons of Mexican origin living along the U.S./Mexico border, specifically assessing how persons with limited financial resources accessed the 2 systems

Methods of article

  • 7 focus groups were held with 52 low income Mexican American people aged 18–65 years. The design of the guide for the focus groups was to emphasize factors contributing to decision-making about accessing and navigating either healthcare system. It was illustrated with brief scenarios about a fictitious local family and their healthcare experiences, used to prompt reactions and provide an opportunity for participants to either react to the hypothetical scenario or speak about themselves if they so chose. For example, in the scenario the mother is ill and the family wants her to see a physician. Questions are asked about the mother’s choices regarding a visit to a physician in Mexico/U.S., what experiences would she have during the visit, and who makes the decisions about healthcare in the family
  • The study used the socio-ecological framework to guide focus group interview guide design and evaluation of results


  • In both systems (Mexican and American), participants sparingly accessed care with most waiting until they were really sick to seek care. The only preventive service mentioned was breast and cervical cancer screening
  • Focus group findings fall into 3 headings: 1) Personal influences; 2) Interpersonal influences; and 3) Systemic
  • Overall, personal influences were offered as a major explanation for why Mexican Americans did not use medical services. Specific explanation includes emotional (e.g., fear, embarrassment), cognitive (e.g., denial, ignorance), and financial (e.g., work)
  • “Confianza” was also a major theme and included issues of cultural competence, listening, understanding, respecting and treating patients
  • Specific explanations for interpersonal influences include poor perceived responsiveness of providers, communication problems related to language and culture, and feelings of being disrespected by providers
  • Participants felt more confident and capable in accessing care in Mexico than in the US. They also expressed having their healthcare needs met more quickly in Mexico. Specific issues that participants faced in the US include lack of access to care (mainly due to cost), problems with not having one doctor or place to go for health concerns, perceived delayed treatment and rushed care, and extreme wait time (short and long)

Key takeaways/implications

  • This study shows that important influences at the personal, interpersonal and systemic levels affect decision-making about healthcare in low SES persons of Mexican descent. Additionally, our results show that influences across the socio-ecological model interact to inform decisions
  • Lack of financial means is a major deterrent to seeking healthcare for uninsured or underinsured Mexican Americans living along the U.S./Mexico border. Moreover, factors that discourage access to and navigation of the U.S. healthcare system by persons of Mexican descent include the systemic influences of lack of insurance, the reliance on specialists for care in the U.S. system, the poor Spanish language skills of most doctors, and misunderstanding of the U.S. healthcare system
  • Limitations to the study include lack of generalizability, small male population size, lack of evaluation of past experiences and background and their potential role in decision making,
  • Future research should explore the male perspective and expand this topic for further generalizability and should assess the role of “confianza”