My current work is bringing qunatitative data to add to the empirical evidence of a theory that people perceive health different ways and that this influences their health-seeking behavior. The underpinnings of this theory rely on autonomy as a predictor for health-seeking behavior in contrast to standard quantitative measures of wellbeing such as cholesterol, A1c, and blood pressure. Two previous qualitative projects helped build the theory. The first was a pilot study (N=10) of older Mexican immigrants in the California Central Valley found that focused on the conceptualization of health, illness, risk and prevention. The dissertation work continued this conceptualization data gathering and mapped the health seeking process of elder Mexican immigrant men. Through 20 in-depth interviews I found that while active in their own self-defined health regimens, participants rely on women to help them navigate the United States healthcare system.
The principal contribution of this work is that autonomy, rather than wellness or health, drove the decision-making of whether or not they sought medical care or adhered to chronic disease management. They saw themselves as adhering patients, did not have overarching negative sentiment about the healthcare system, and yet did not adhere to screenings, lab work, and avoided seeking healthcare. Abstaining from health care or modifying prescribed health regimes was due to distrust of biomedical risk, and the labeling of sick as being an overall impediment to their autonomy. Their autonomy happened within the constraints of systemic barriers to health, economic stability, and a healthy environment.
Pacheco T. (2014). Autonomy in Health and Health Seeking Behavior among Older Mexican Immigrant Men in California's Central Valley (Doctoral Dissertation).
My early publications document the need to do policy analysis while tracking the impact on the individual. The first publication found that when looking at a policy to reduce violence sought to implement initiatives in a variety of sectors, reduction in violence was only as strong as the funding, level of commitment from leadership, and enforcement codes attached to the initiatives. This was one of the earliest evaluations that attempted evaluated an initiative looking at violence as a public health issue. Later publications trace the policy impact of health insurance access policies and mandates at the individual level for Mexican immigrants, both documented and undocumented. The research demonstrates that restrictive policies on access and funding for facilities that serve the underserved lead to a personal experience of being made to feel less-than, and that the systems are purposefully confusing. This research also demonstrated that using community health workers known as “Promotoras,” participants were able to increase their self-efficacy and effectively navigate the systems to both attain medical insurance and receive care. It also added to the public health knowledge that having access to care goes beyond having medical insurance, and that coverage is not a guarantee of engaging with the medical system.
Pacheco T, Ramirez M, and Capitman J.A. (2012). Policy barriers to healthcare access fuel discriminatory treatment: The role of Promotoras in overcoming malos tratos. Journal of Ambulatory Care Management, 35(1), 1-12. PMCID: 22156951
“Promotoras: Lessons Learned on Improving Healthcare Access to Latinos” with John A. Capitman, Mariana Ramirez, and Alicia Gonzalez. Fresno, CA: Central Valley Health Policy Institute. January 2010
“Undocumented Latinos in the San Joaquin Valley: Health Care Access and Impact on Safety Net Providers” with John A. Capitman and Diana Traje. Sacramento, CA: California Program on Access to Care. August 2009.
“Violent Crimes in Alameda County: A Six Year Trend Report” with Howard Pinderhughes.
Oakland, CA: Alameda County Public Health Violence Prevention Data and Evaluation Subcommittee. July 2007.
For over 10 years, I have been engaged in health research in the California Central Valley. Below are current projects that are published and in the pipeline.
Gender dynamics in health process seeking behavior for men
Neighborhood effects on health outcomes
Preterm birth and stress