Date of Award

January 2012

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Denise Stevens

Second Advisor

Debbie Humphries

Abstract

Background: Barriers to health care typically exist amongst poor and marginalized communities that are burdened by a number of factors, such as unemployment, lack of insurance, and homeless. These groups also hold a disproportionate disease burden due to increased risk of exposure. Thus, they are likely to go without care for treatable conditions because they are unable to access traditional health care settings. One way of overcoming these barriers to care is through the use of mobile clinics. These clinics are able to offer a variety of services within disadvantaged communities to both prevent the spread of disease and alleviate its burden. An example of one of these clinics is the Community Health Care Van (CHCV) in New Haven, Connecticut.

Purpose: While the CHCV has been operating in New Haven since 1993, it is important to evaluate this system to provide insight into service provision and the success of the program. This evaluation was conducted to provide information on who was coming to the van, what services were being provided, and patient and provider opinions of the services and system. The overarching goal is to determine if the van is operating reaching the clients most in need of its services in New Haven.

Methods: A mixed methods approach was used to evaluate the van, including quantitative, qualitative, and spatial analysis. The qualitative data provides information on client demographics, frequency in visits, and trends by stop and by year of service. Interviews were conducted with both clients and providers to gather qualitative data on regular sources of health care, barriers to care, satisfaction with the CHCV, the strengths and weaknesses of the CHCV, and suggestions for improvements. A spatial analysis was done using US census data to map median household income in New Haven and its surrounding area. This information was compared to information at the zip code level regarding service utilization, HIV client residence, and HIV testing client residence.

Conclusion: The CHCV provides care to a number of high-risk groups within New Haven and many of the clients are low income, uninsured, unemployed, homeless, sex workers, injection drug users (IDU), and/or recently incarcerated. Overall, the van seems to be operating in the areas of greatest need but there is concern that the working poor may be missed due to the CHCV's limited schedule. Clients were very satisfied with the care they received at the CHCV and suggestions by both clients and providers were mainly for expanding access to van services.

Comments

This is an Open Access Thesis.

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