Four-County Community Health Needs Assessment 2004

Summary of Findings

WashingtonCounty Demographic Profile

A demographic profile of WashingtonCounty residents who participated in the Four-County Community Health Needs Assessment was compared to the county's 2002 Census Bureau data. The survey's demographic profile was designed to assess whether respondents who participated in the survey were representative of the larger Washington County population. Demographic factors that were assessed included: gender, age, ethnicity, SES status, educational attainment, and employment status.

Results of the demographic profile analysis suggested that survey respondents were disproportionately female, over representative of middle aged adults and Marshall Islanders, under representative of Caucasian, and demonstrated an estimated higher percentage of households which were 200% of the poverty level and below for a family of 4. Survey participants also exhibited a higher percentage of individuals with college degrees and advanced education, and a higher percentage of adults in the workforce, as compared to the 2002 Census Bureau data for Washington County.

Survey Findings

Medical Care Costs

respondents rated the costs associated with medical care services as a significant area of concern. Money needed for prescriptions was the top rated item of concern for survey participants as 57.66% of respondents cited this issue as a major problem. Money for ongoing medical care and money for emergency medical care were also considered to be major issues by survey participants.

   

Several demographic factors affected Washington County resident's perceptions in regard to the costs of medical care services. The gender, age, ethnicity, educational level, household composition and insurance status of the survey participant were significant variables which impacted Washington County resident's opinions in terms of medical care costs.

Women cited significantly greater concern than men in regard to the following medical care costs: money for prescriptions, money for emergency medical care, money for ongoing medical care, and money for ongoing dental care.

The cost of medical care services appeared to be of significantly greater concern for middle-aged adults (45-64 years of age), as compared to younger adults and senior citizens. Adults 45 - 64 years of age reported significantly greater concerns than did younger and older adults in regard to money for prescriptions, money for emergency medical care, money for ongoing dental care, and dentists who will accept my insurance. Dentists who will accept my insurance was identified as a significant problem by younger adults as compared to older adults. Not surprisingly, senior citizens were more likely than younger adults to report finding a doctor who accepts Medicare as a significant problem.

The ethnicity of the survey respondents emerged as a significant factor, primarily affecting participants' opinions in regard to the cost of prescriptions. Marshall Islanders, Caucasians, and African Americans, all expressed significantly greater concern about the costs of prescriptions, as compared to Hispanic respondents. Marshall Islanders also identified money needed for emergency medical care, as a significantly greater problem than did Hispanic respondents.

Survey participants' level of education, affected their perception about medical care costs, in an intriguing manner. Survey participants with "some college", appeared to view medical care costs as more of a significant problem than did respondents with a high school degree or less education and individuals with bachelor's degree or advanced education. Survey respondents with some college cited significantly greater concern for the following issues, as compared to individuals with less and/or more education than themselves: money for prescriptions, money for emergency medical care, money for ongoing medical care, money for ongoing dental care, finding a doctor who accepts ARKids First insurance, a medical doctor who will not accept my insurance, and a dentist who will not accept my insurance. Survey participants with a high school degree or less education were significantly more concerned about finding a doctor who accepts ARKids First insurance, than did respondents with some college.

Households with dependents expressed significantly greater concerns in regard to finding a doctor who accepts Medicaid and ARKids First insurance, and a dentist who will not accept ARKids First insurance, than did households with no dependents.

Washington County residents with health insurance cited the following medical care costs as being a significantly greater problem than did uninsured adults: money for prescriptions and medical doctors who will not accept my insurance. Uninsured adults had significantly greater concern, than did survey respondents with health insurance, in regard to dentists who will not accept ARKids First insurance.


Access to Health Care Services

Adequate and timely access to a physician, access to health care services, and access to dental care were most frequently rated by survey respondents as the most significant issues associated with accessing medical health care services. Over 40% of individuals' surveyed expressed significant concern about the adequate and timely access to a physician. Access to health care services, and access to dental care, was identified as a significant problem by over one third of survey participants.


The age, ethnicity, employment status, educational level, household composition and insurance status affected Washington County residents' opinions about health care

access issues. Middle aged adults cited problems with access to prenatal care, public transportation, health care services, health care clinics, access to affordable and available assisted living for the elderly, adequate and timely access to a physician, access to tests and diagnostic services, access to hospital services, pharmacy services, and dental care, significantly more frequently as compared to younger and or older adults. Younger adults (18-44 years of age) were significantly more concerned than senior citizens about access to hospital services and access to dental care.

In terms of survey participants stated ethnicity, Marshall Islanders cited concerns about accessing health care services, more frequently than any other ethnic group. Marshall Islander's appear to view difficulties with successfully accessing health care insurance as a significant barrier that diminishes their ability to receive needed health care services. Marshall Islanders also expressed significantly greater concern about accessing prenatal services as compared to Caucasian respondents. Caucasians cited access to affordable and available assisted living for the elderly as a significantly greater problem than did Marshall Islanders. In addition, Hispanic/Latino respondents identified this issue as being more problematic than did Marshall Islanders.

In general, survey respondents with some college or with a college degree or advanced education were significantly more likely to identify access to health care services as being a major problem as compared to surveyed individuals with a high school diploma or less education. Access to prenatal care, health care services, health care clinics and adequate and timely access to a physician was of significantly greater concern to survey respondents with some college or greater education, as compared to adults with a high school diploma or less education. Survey respondents with some college expressed greater concern in regard to access to private transportation, than did college graduates and advanced degree respondents, and individuals with the least education.

Households with dependents noted that access to prenatal care, health care clinics, and access to tests and diagnostics were a significantly greater problem, as compared to survey respondents without dependents.

Uninsured adults expressed significantly greater concern about their ability to access dental care, than did insured adults.

 

Physical Health Care Issues

The physical health care issues most frequently cited by survey respondents were:

However, considerable caution needs to be offered in interpreting the results of this section. While the Health Needs Assessment survey was being conducted, a referendum was on the ballot in Fayetteville, Arkansas, involving the ban on public smoking in local restaurants. Due to the highly publicized nature of this issue, any interpretation in regard to the significance of smoking and/or cigarette smoking emerging as the most highly rated physical health care issues in the survey must be reviewed judiciously. Cancer was cited by 54.7% of respondents, and weight problems were identified by 54.55% of individuals surveyed, as the other top rated physical health concerns.


The gender, age, ethnicity, educational level, household composition, and insurance status exerted differential effects on respondents' perceptions about physical health care issues. Women reported significantly greater concern in regard to heart disease than did male survey participants. The age of survey respondents did not appear to exert any consistent effect upon survey participants' opinions about physical health care issues. Middle-aged adults appeared to express the greatest relative concern about asthma and other lung diseases, diabetes, heart disease, weight problems, osteoporosis, STD's, HIV, smokeless tobacco, stroke, Alzheimer's disease, and cancer, as compared to younger and/or older adults. Younger adults, aged 18-44, cited the following issues as being of significantly greater concern as compared to older adults: STD's, smokeless tobacco, and HIV. Older adults reported that osteoporosis, stroke, and Alzheimer's disease were significantly greater problems than did younger adults.

Caucasians identified the following physical health care issues as being of significantly greater concern, as compared to Marshall Islanders and Hispanic/Latino respondents: cigarette smoking and/or second hand smoke, heart disease, osteoporosis, stroke, Alzheimer's disease, and cancer. Weight problems were cited as a comparatively greater issue for Caucasians and Hispanics as compared to Marshall Islanders who participated in this survey. Hispanic/Latino respondents reported STD's as a significantly greater problem as compared to Marshall Islanders.

Washington County residents who were employed, were significantly more likely to cite smokeless tobacco and STD's as major concerns as compared to unemployed survey respondents.

Higher educational level attained (some college, college degree, advanced degree) was positively related with a greater concern about a variety of physical health care issues, as compared to survey respondents with a high school degree or less education. Notable physical health care issues identified as being problematic by survey participants with some college education or greater included; weight problems, osteoporosis, STD's, smokeless tobacco, stroke, Alzheimer's disease and cancer.

Survey participants who resided in households with no dependents expressed significantly greater concern about the following health care issues as compared to households with dependents: osteoporosis, stroke, and Alzheimer's. As all of these physical afflictions are more commonly observed with the advent of the aging process, it is reasonable to surmise that an overrepresentation of elderly households in the "no dependent" status contributed to this finding.

Washington County residents with health insurance demonstrated relatively greater concern about osteoporosis, Alzheimer's disease, and cancer than did survey participants without health insurance.

 

Mental Health Issues

Similar to the results obtained from the other counties surveyed in Northwest Arkansas, WashingtonCounty residents identified substance abuse and alcoholism as the most important mental health issues affecting their community. Nearly 50% of surveyed respondents cited substance abuse as a significant problem and 41.5% of survey participants signified that alcoholism was a major issue. In addition, a little over 40% of WashingtonCounty residents indicated that depression is a major problem.

The gender, age, ethnicity, employment status, and educational level of Washington County survey participants differently affected their perceptions in regard to mental health care issues. Women were significantly more likely than men to identify mental health care issues as being a significant problem. Women cited available and affordable psychiatric services, available and affordable counseling services, emergency mental health services, anxiety disorders, depression, and suicide as representing relatively more significant mental health problems, than did male respondents.

Middle aged survey participants (45-64 years of age), as compared to younger and older adults, identified the following mental health issues as being of significant concern: available and affordable psychiatric and counseling services, emergency mental health services, housing or residential services for the severely and persistently mentally ill, available and affordable substance abuse and alcohol services, and suicide. Older adults (65 years of age or greater) were significantly more likely to identify available and affordable substance abuse services as a major problem, as compared to younger adults.

The stigma and lack of awareness of available and affordable mental health, substance abuse, and alcohol services have contributed to the under utilization of needed and effective mental health services. While some of the reluctance in accessing mental health services has diminished in recent years, multicultural populations in the United Statesare less likely to utilize mental health services than are Caucasians or second and third generation immigrant populations. (U.S. Department of Health and Human Services2001).  These trends were clearly observed when analyzing the results obtained from the Washington County portion of the Four-County Community Health Needs Assessment.

Caucasian respondents were significantly more likely than Hispanic/Latino citizens or Marshall Islanders to cite mental health care issues as being of significant concern. Caucasian survey participants identified the following mental health care issues as representing significant problems: available and affordable psychiatric and counseling services, housing or residential services for the severely and persistently mentally ill, depression, substance abuse, and suicide.

In terms of employment status of the survey respondents, employed adults were significantly more likely to endorse anxiety and suicide as significant problems as compared to unemployed adults.

Educational level attained was positively related to concerns about mental health care issues. Washington County survey participants with some college education or greater identified significantly greater concerns compared to respondents with the least amount of education, in terms of the following mental health issues: available and affordable psychiatric and counseling services, emergency mental health services, housing and residential services for the severely and persistently mentally ill, alcoholism, available and affordable alcohol treatment, depression, substance abuse, available and affordable substance abuse services, and suicide.

 

Multicultural Health Concerns

Cultural and/or language barriers which diminish access to health care services and access to affordable and available health care services were rated by survey respondents as the most significant multicultural health care challenges in Washington County. Nearly 52% of survey participants cited cultural and/or language barriers as a major issue affecting multicultural resident's ability to successfully access health care services. A little over 46% of respondents identified difficulties associated with the access to affordable and available health care services, as a significant problem for the multicultural population residing within Washington County.


Several discrete demographic variables affected survey respondents' perceptions, in regard to multicultural health care concerns. The gender, age, ethnicity, and educational level of the survey participants emerged as significant demographic variables. Women were significantly more likely, as compared to men, to acknowledge multicultural health care issues as being a significant problem. Female survey respondents reported that access to available and affordable health care services, the adequacy of health care services, and awareness of health care services, are a major problem for multicultural populations.

Middle-aged adults appeared to view multicultural health care concerns as a significantly greater area of concern as compared to younger and older adults. Adults 45-64 years of age, identified the following health care issues as being a significant problem: access to affordable and available health care services, adequacy of health care services, awareness of health care services, and cultural and/or language barriers to accessing health care services. Younger adults (18-44 years of age) specified greater concern about cultural and/or language barriers in accessing health care services, as compared to older adults.

Marshall Islanders identified cultural and/or language barriers as a significant impediment to accessing health care services, as compared to Caucasian survey respondents.

Survey participants with the greatest amount of education (college degree or greater) cited significantly greater concern about multicultural health care issues as compared to individuals with some college or less education.

 

washington county Qualitative Summary

Washington County survey respondents were asked to identify the top 3 health care concerns which affect their community. Out of 795 completed surveys in WashingtonCounty, survey respondents identified the following 3 health care issues as the most important health care concerns which impact their community:

 
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