Factors Affecting Hispanics' Access to Healthcare During the COVID-19 Pandemic

An Integrative Review

MaryAnn Perez-Brescia, PhD, RN

Disclosures

Online J Issues Nurs. 2022;27(3) 

In This Article

Abstract and Introduction

Abstract

Hispanics comprise more than one third of U.S. COVID-19 cases. This higher prevalence is associated with determinants to access that existed long before the pandemic. Using the Preferred Report Items for Systematic Review and Metanalysis (PRISMA) guidelines, this review examined 20 studies that addressed barriers faced specifically by Hispanics in the United States, Sampling methods are described and the synthesized research findings are organized using the Theoretical Framework of Access, which classified barriers as either structural or personal. Results suggested that Hispanics had lower COVID-19 knowledge than other groups. The article discussion considers possible causes, such as low health literacy levels, an inability to reach or pay for services, a mistrust of healthcare providers, or a lack of access to information. To increase U.S. Hispanics' COVID-19 knowledge and encourage safer behaviors, culturally sensitive and linguistically appropriate information is needed.

Introduction

The COVID-19 virus, caused by a coronavirus and named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was initially reported to the World Health Organization on December 31, 2019 (Cennimo, Bergman, & Olsen, 2021). As it spread worldwide and into the United States, an ethnic disparity became visible: Latinx or Hispanics (henceforth referred to as Hispanics) were more likely to contract COVID-19 than non-Hispanic whites [NHWs] (Centers for Disease Control and Prevention [CDC], 2022). Hispanics comprise over one third of national cases (Moyce et al., 2021), with a mortality 1.9 times higher than cases in NHWs (Gross et al., 2020).

Increased cases in minority populations such as Hispanics have been associated with disparities such as overcrowded living spaces, an inability to shelter in place due to work, and status as essential workers (Pflugeisen & Mou, 2021). Further putting Hispanics at risk are disparities in healthcare, which are well documented (Manuel, 2018; Sharma et al., 2018; Singh & Wilk, 2019; Yue, Rasmussen, & Ponce, 2018). For one, they are less likely to have health insurance, making it difficult to receive care (Berchick, Barnett, & Upton, 2019). Due to this lack of insurance, Hispanics also tend to have more preexisting conditions, such as obesity, diabetes, and hypertension, all of which increase morbidity and mortality (Aguayo-Mazzucato et al., 2019; Garg, 2020; Hales, Carroll, Fryar, & Ogden, 2020; Williams et al., 2020).

Hispanics also tend to have a higher prevalence of specific chronic diseases such as diabetes (Baquero et al., 2020). In a study that evaluated prevalence data (n = 56,290), 29% of Hispanics reported having diabetes, compared to 17% of NHWs. However, NHWs had a higher prevalence of multimorbidities excluding diabetes, but Hispanics still suffered greater rates of infection by COVID-19. This is due, in part, to limited or no insurance, which has caused further delays in testing for and treatment of COVID-19 (Williams et al., 2020). Access to healthcare is critical during a pandemic, but a full understanding of the barriers to access is needed to lower COVID-19 case rates and improve general health for Hispanics.

Although the expansion of healthcare coverage as a result of the Affordable Care Act (2010) has provided opportunities to access healthcare, coverage alone is not enough (Pflugeisen & Mou, 2021; Yue et al., 2018). A person must also be able to navigate the healthcare system. However, Hispanics often have lower health literacy levels than NHWs, as well as language barriers that limit their ability to navigate the system (Edward et al., 2018; Villagra, Bhuva, Coman, Smith, & Fifield, 2019). Determining barriers to access for Hispanics during the COVID-19 pandemic is complex; the objective of this review is to examine how Hispanics access care, as well as the potential barriers to accessing that care during the COVID-19 pandemic.

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