An Assessment of Barriers to Care and Health Literacy: A Cross-Sectional Telephone Survey at a Federally Qualified Health Center Women's Clinic.

INTRODUCTION

Persistent barriers to healthcare disproportionately affect marginalized populations, particularly those served by federally qualified health centers (FQHCs), where patients are more likely to be non-white, low-income, and Medicaid-insured. Women in these settings face additional obstacles; missed appointments both reflect structural inequities and increase the risk of adverse health outcomes.

METHODS

Patients with missed appointments at the University of California, Irvine Family Health Center’s OBGYN clinic, an FQHC in Santa Ana, were identified through EPIC. Using a convenience sample, patients were contacted and consented by phone to complete an IRB-approved survey between May–November 2024. Data were collected in RedCap and analyzed using Excel and SAS 9.4 (SAS Institute, Cary, NC).

RESULTS

In 2023, the clinic recorded 10,805 visits with 2,735 unique patients. Of 257 patients contacted, 100 (38.9%) completed the survey. Most respondents identified as Hispanic or Latin origin (83%), reported Spanish as their primary language (61%), and were insured by Medi-Cal (81%). Reported reasons for missed appointments included forgetting (22%), illness (18%), and scheduling conflicts (18%). Knowledge gaps were notable: only 39% associated Pap smears with cancer, 23% correctly stated that postmenopausal bleeding is abnormal, and 40% identified mammography recommendations as annually or every other year after age 40. Patients with prior abnormal Pap results showed slightly higher knowledge (50%).

CONCLUSION

Most missed appointments were for routine care and stemmed from diverse factors. Findings underscore health literacy gaps among FQHC patients and highlight the need for culturally responsive education to improve adherence, reduce inequities, and enhance outcomes. Further research should identify effective, equity-focused interventions.