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J Ambul Care Manage. 2012 Jan-Mar;35(1):2-14. doi: 10.1097/JAC.0b013e31822c8d66.

Policy barriers to health care access fuel discriminatory treatment: the role of Promotoras in overcoming malos tratos.

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  • 1Central Valley Health Policy Institute at California State University, Fresno, California 93710, USA.


This article demonstrates that policy barriers resulting in access to health care inequities were significantly decreased by 2 Promotora interventions for 416 legal and undocumented Latino immigrants in the California Central Valley. Promotoras conducted baseline/follow-up assessments and referrals/phone-calls/visits during a 3-month period. In-depth interviews with Promotoras and a policy analysis on policy-driven access programs were carried out. Access to care was significantly increased between legal and undocumented immigrant from baseline to follow-up. Systemic barriers to access (malos tratos) reflected on personal barriers such as affordability of care. Promotoras help participants overcome barriers but do not change the policies determining access and procedures.

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