Health Care Disparities Among English-Speaking and Spanish-Speaking Women With Pelvic Organ Prolapse at Public and Private Hospitals: What Are the Barriers?

Abstract

Objectives: 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).

Methods: 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.

Results: 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.

Conclusions: 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.

Conflict of interest statement

A.A. is a research investigator for Pfizer. G.D. is a research investigator and speaker for Pelvacon and holds a position on the American Urogynecologic Society educational committee. K.E. is a consultant for American Medical Systems and an investigator for American Medical Systems and Boston Scientific. R.G.R. is editor for the International Urogynecology Journal, special editor for Obstetrics and Gynecology Journal and Female Pelvic Medicine and Reconstructive Surgery Journal, receives royalties from Up to Date and McGraw Hill textbook, American Board of Obstetrics and Gynecology subspecialty board member, and data safety medical board chair for the TOPAS System to Treat Fecal Incontinence trial. J.A. is a research investigator for American Medical Systems and Boston Scientific. The other authors have declared they have no conflicts of interest.