Field of Work: Reducing sociocultural barriers to access to high quality health care.

Problem Synopsis: Even when health care is available and affordable, certain population sub-groups face nonfinancial obstacles to care (such as culture, language, race, and ethnicity), resulting in poorer access to care and health outcomes among racial and ethnic minority groups in the United States.

Synopsis of the Work: Jointly funded with the Henry J. Kaiser Family Foundation, Opening Doors: A Program to Reduce Sociocultural Barriers to Health Care (July 1992 to August 1999) supported demonstration and research projects with the potential to improve access to maternal, child and reproductive health services by reducing sociocultural barriers to care.

Key Results: According to a report produced by the National Program Office, Opening Doors supported 23 projects in rural and urban areas in 11 states. The funded projects fell into two categories: service projects to reduce sociocultural barriers and research projects to identify the sociocultural barriers to health care and strategies to reduce them.

The key results of the Opening Doors program and its projects include:

• Affecting direct services in rural and urban settings in 11 states across the country by: using community outreach workers, providing interpreter services, and changing policies and practices that created barriers.
• Training health staff through developing cross-cultural curricula for medical students, providing community-based training opportunities for residents and offering cultural competency training for agency staff and board members.
• Improving use patterns, such as reducing unnecessary emergency room visits in a rural immigrant community, and increasing patient enrollment in an urban, hospital-based HMO where interpreters and outreach workers were available for immigrants.
• Developing policy recommendations regarding cultural competency in managed care, HMO compliance with state standards for access to reproductive health care and cultural and linguistic competency in interpreter services.