title: Barriers to care among American Indians in public health care programs.
abstract: OBJECTIVE
  We sought to examine the extent to which reported barriers to health care services differ between American Indians (AIs) and non-Hispanic Whites (Whites).
  
  
  METHODS
  A statewide stratified random sample of Minnesota health care program enrollees was surveyed. Responses from AI and White adult enrollees (n=1281) and parents of child enrollees (n=572) were analyzed using logistic regression models that account for the complex sample design. Barriers examined include: financial, access, and cultural barriers, confidence/trust in providers, and discrimination.
  
  
  RESULTS
  Both AIs and Whites report barriers to health care access. However, a greater proportion of AIs report barriers in most categories. Among adults, AIs are more likely to report racial discrimination, cultural misunderstandings, family/work responsibilities, and transportation difficulties, whereas Whites are more likely to report being unable to see their preferred doctor. A higher proportion of adult enrollees compared with parents of child enrollees report barriers in most categories; however, differences between parents of AIs and White children are more substantial. In addition to racial discrimination and cultural misunderstandings, parents of AI children are more likely than parents of White enrollees to report limited clinic hours, lack of respect for religious beliefs, and mistrust of their child's provider as barriers.
  
  
  CONCLUSIONS
  Although individuals have enrolled in health care programs and have access to care, barriers to using these services remain. Significant differences between AIs and Whites involve issues of trust, respect, and discrimination. Providers must address barriers experienced by AIs to improve accessibility, acceptability, and quality of care for AI health care consumers.
authors.affiliation: School of Public Health, University of Minnesota, Minneapolis 55455, and Mayo Clinic, Rochester, USA. callx001@umn.edu
authors.forename: Kathleen Thiede
authors.initials: KT
authors.lastname: Call
authors.forename: Donna D
authors.initials: DD
authors.lastname: McAlpine
authors.forename: Pamela Jo
authors.initials: PJ
authors.lastname: Johnson
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Beebe
authors.forename: James A
authors.initials: JA
authors.lastname: McRae
authors.forename: Yunjie
authors.initials: Y
authors.lastname: Song
mesh_terms: D000328:Adult; D003466:Cultural Characteristics; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D011203:Poverty; D011287:Prejudice; D015980:Public Health Practice / Q000706:statistics & numerical data*; D035502:Trust