Patient-Clinician Interaction and the Perception of Choice: A Qualitative Analysis of Communication and Reproductive Health in Rural Mexico

Analie Fernandes & Kaitlyn Cox, University of Notre Dame

Abstract
The relationship between clinicians and their patients in biomedicine has historically been plagued by miscommunication, power differentials, and ambivalence. In regards to reproductive health, previous research has shown that women’s choices are evidence of the entangled social, cultural, political, and economic structures in which they live (Wurtz 2012). Though much research has been done, the impact of poor communication between the clinician and the patient remains underexplored, especially within low-resource contexts. This study helps to fill this gap by examining how patient-clinician communication affects indigenous women’s perspectives of their reproductive health and autonomy in the context of rural Mexico, specifically the indigenous village of Amatlán (pseudonym) in northern Veracruz, Mexico. This ethnographic study involved analysis of qualitative data from clinicians, midwives, and women using several qualitative analysis methods suggested by Bernard et al. (2018) including Key Word in Context, word repetition, cutting and sorting, word co-occurrence, and semantic network analysis. The data was gathered by Dr. Vania Smith-Oka in 2007 and was collected through analysis of behavior, semi-structured interviews and unstructured interviews with 53 women of reproductive and post-reproductive age, two midwives, and 11 clinicians. This study found that faulty communication surrounding family planning services resulted in confusion, fear, and a lack of autonomy in women’s decision making about their reproductive health. Through analysis of patient and clinician interviews about the clinical encounter, the study found women lacked the autonomy, knowledge, or trust to make family planning decisions and discuss their difficulties with their family planning professional. 

Disparities in Healthcare Access for Undocumented Latino Immigrants in Indiana vs. Illinois

Christian Abraham Arega, University of Notre Dame

Abstract
This project aims to look at the barriers to health care that exist for undocumented immigrants in the states of Indiana and Illinois. There are many factors that contribute to the health and well being of all persons and those factors span beyond physical indicators of illness. Factors such as socioeconomic status, environment, neighborhood, race etc, broadly termed 'social determinants of health', both directly and indirectly affect the health and well-being of all people. This project aims to understand what kinds of social determinants affect the health of undocumented immigrants living in Illinois and Indiana. It will focus attention on the sociopolitical

factors that determine undocumented immigrants' access to healthcare benefits, specifically Medicare and Medicaid. Qualitative and quantitative data on the healthcare programs available to this population in each state will be collected, and ethnographically examined to understand how providers work with these populations to facilitate access to healthcare. The aim of this research is to identify opportunities to leverage existing healthcare services available to migrant populations, in order to overcome structural barriers to health provision. Preliminary investigations suggests that Illinois has a more robust system for providing affordable healthcare to undocumented migrant populations, and so by exploring these services in depth, I aim to provide solutions for improving healthcare for undocumented populations in the state of Indiana, and beyond.

Uncovering the Sugar-Coated Truth: An Examination of the Role of Gender in Health-Seeking Behaviors of Diabetic Men and Women in San Juan, Puerto Rico

Vaishali Nayak, University of Notre Dame

Abstract
Puerto Rico’s population is becoming increasingly diabetic, peaking currently at 17% (International Diabetes Federation, 2017). Just in the last 10 years, death as a result of diabetes has increased by nearly a quarter on the commonwealth (CDC, 2017). Due to interesting trends like women being disproportionately affected by the disease, cultural phenomenons like familialism, where a woman’s primary responsibility has lied in taking care of the family, and of the machismo culture, which expects manly and self-reliant behaviors by men, there are unstudied effects of gender on measures of self-care in diabetes management. Given that self-management is an essential component of treatment for chronic diseases, through this research, I explore the behaviors and barriers faced by men and women in San Juan, Puerto Rico through semi-structured interviews. Specifically, I interviewed a purposive sample 28 men and 28 women in the age range of 30-60 years from the Caño Martín Peña neighborhoods of San Juan in a clinical setting. The insights developed through qualitative analysis about the barriers such as absence of social support systems, inability to self-monitor and perceived hurdles to exercise and behaviors regarding compliance in diet, medical intake and exercise will be shared with the local clinic to improve their health education programs and will contribute towards filling the gap about culturally-sensitive health education for diabetics in Puerto Rico.