title: Health Care Disparities Among English-Speaking and Spanish-Speaking Women With Pelvic Organ Prolapse at Public and Private Hospitals: What Are the Barriers?
abstract: The objective of this study was to compare perceptions and barriers between Spanish-speaking and English-speaking women in public and private hospitals being treated for pelvic organ prolapse (POP).
  
  
  
  Eight focus groups, 4 in English and 4 in Spanish, were conducted at 3 institutions with care in female pelvic medicine and reconstructive surgery. Standardized questions were asked regarding patients' emotions to when they initially noticed the POP, if they sought family support, and their response to the diagnosis and treatment. Transcripts were analyzed using grounded theory qualitative methods.
  
  
  
  Thirty-three women were Spanish-speaking and 25 were English-speaking. Spanish speakers were younger (P = 0.0469) and less likely to have a high school diploma (P < 0.0001) than English speakers. Spanish-speaking women had more concerns that the bulge or treatments could lead to cancer, were more resistant to treatment options, and were less likely to be offered surgery. Women in the private hospital desired more information, were less embarrassed, and were more likely to be offered surgery as first-line treatment. The concept emerged that patient care for POP varied based on socioeconomic status and language and suggested the presence of disparities in care for underserved women with POP.
  
  
  
  The discrepancies in care for Spanish-speaking women and women being treated at public hospitals suggest that there are disparities in care for POP treatment for underserved women. These differences may be secondary to profit-driven pressures from private hospitals or language barriers, low socioeconomic status, low health literacy, and barriers to health care.
authors.affiliation: From the *Department of Gynecology, Cleveland Clinic Florida, Weston, FL; †Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM; ‡Department of Obstetrics and Gynecology, Olive View Medical Center; §Department of Urology, UCLA David Geffen School of Medicine; ∥Department of Urology, Cedars-Sinai Medical Center; and ¶Department of Nursing, UCLA School of Nursing, Los Angeles, CA.
authors.forename: Alexandriah N
authors.initials: AN
authors.lastname: Alas
authors.forename: Gena C
authors.initials: GC
authors.lastname: Dunivan
authors.forename: Cecelia K
authors.initials: CK
authors.lastname: Wieslander
authors.forename: Claudia
authors.initials: C
authors.lastname: Sevilla
authors.forename: Biatris
authors.initials: B
authors.lastname: Barrera
authors.forename: Rezoana
authors.initials: R
authors.lastname: Rashid
authors.forename: Sally
authors.initials: S
authors.lastname: Maliski
authors.forename: Karen
authors.initials: K
authors.lastname: Eilber
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Rogers
authors.forename: Jennifer Tash
authors.initials: JT
authors.lastname: Anger
mesh_terms: D003144:Communication Barriers; D030881:Disclosure; D005081:Exercise Therapy / Q000706:statistics & numerical data; D005239:Fear; D005260:Female; D017144:Focus Groups; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D015141:Los Angeles / Q000208:ethnology; D008800:Mexico / Q000208:ethnology; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology; D009516:New Mexico / Q000208:ethnology; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D056887:Pelvic Organ Prolapse / Q000208:ethnology / Q000628:therapy*; D010570:Pessaries / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D012189:Retrospective Studies; D016312:Treatment Refusal / Q000208:ethnology