Study protocol for the implementation of Centering Patients with Fibroids, a novel group education and empowerment program for patients with symptomatic uterine fibroids.

BACKGROUND: Black women and people with uteri have utilized collectivistic and relational practices to improve health outcomes in the face of medical racism and discrimination for decades. However, there remains a need for interventions to improve outcomes of uterine fibroids, a condition that disproportionately impacts Black people with uteri. Leveraging personalized approaches alongside evidence that demonstrates the positive impact of social and peer support on health outcomes, we adapted from CenteringPregnancy, an evidence based group prenatal care intervention, for the education and empowerment of patients with uterine fibroids. METHODS: The present report provides  an overview of the study design and planned implementation of CPWF in cohorts at Boston Medical Center and Emory University / Grady Memorial Hospital. After receiving training from the Centering Healthcare Institute (CHI), we adapted the 10-session CenteringPregnancy curriculum to an 8-session hybrid group intervention called Centering Patients with Fibroids (CPWF). The study began in 2022 with planned recruitment of six cohorts of 10-12 participants at each institution. We will conduct a mixed methods evaluation of the program using validated survey tools and qualitative methods, including focus groups and 1:1 interviews. DISCUSSION: To date, we have successfully recruited 4 cohorts at Boston Medical Center and are actively implementing BMC Cohort 5 and the first cohort at Emory University / Grady Memorial Hospital. Evaluation of the program is forthcoming.

Fibroids are non-cancerous smooth muscle tumors that disproportionate impact black women and gender expansive people. Our team adapted CenteringPregnancy, a group based model of prenatal care, to an education and empowerment program for peple with fibroids called Centering Patients with Fibroids (CPWF). This paper describes the development and implemation of the program at two academic hospitals serving diverse patients in Boston, Massachusetts and Atlanta, Georgia. To evaluate the successes and challenges of the program, we ask participants to complete surveys to learn more about their experience with having fibroids and also invite them to group feedback sessions or focus groups. We also interview other healthcare providers, team members, and hospital leadership on their knowledge and thoughts about the program. We hope to use the feedback to improve the program and make it available to more people across the country.

Use of Chemical Hair Straighteners and Fecundability in a North American Preconception Cohort.

Chemical hair straighteners ("relaxers") are used by millions of North Americans, particularly women of color. Hair relaxers may contain endocrine-disrupting compounds, which can harm fertility. We evaluated the association between hair relaxer use and fecundability among 11,274 participants from Pregnancy Study Online (PRESTO), a North American preconception cohort study. During 2014-2022, participants completed a baseline questionnaire in which they reported their history of relaxer use and completed follow-up questionnaires every 8 weeks for 12 months or until pregnancy, whichever came first. We used multivariable-adjusted proportional probabilities regression models to estimate fecundability ratios (FRs) and 95% confidence intervals (CIs). Relative to never use, fecundability was lower among current (FR = 0.81, 95% CI: 0.64, 1.03) and former (FR = 0.89, 95% CI: 0.81, 0.98) users of hair relaxers. FRs for first use of hair relaxers at ages <10, 10-19, and ≥20 years were 0.73 (95% CI: 0.55, 0.96), 0.93 (95% CI: 0.83, 1.04), and 0.85 (95% CI: 0.74, 0.98), respectively. Fecundability was lowest among those with longer durations of use (≥10 years vs. never: FR = 0.71, 95% CI: 0.54, 0.91) and more frequent use (≥5 times/year vs. never: FR = 0.82, 95% CI: 0.60, 1.11), but associations were nonmonotonic. In this preconception cohort study, use of chemical hair straighteners was associated with slightly reduced fecundability.

Sexual dysfunction, distress, and care-seeking among females during the preconception period.

BACKGROUND: Despite the high prevalence of female sexual dysfunction in population-based studies and the importance of sexual functioning for mixed-sex couples attempting conception, little is known about female sexual function in the preconception period. OBJECTIVE: This descriptive study aimed to assess the prevalence of female sexual dysfunction, distress, and pain with intercourse in a preconception population of pregnancy planners. The study also explored the extent to which participants discussed their sex lives with a healthcare provider during a preconception visit. STUDY DESIGN: We used data from Pregnancy Study Online, a web-based preconception cohort study (August 2020-October 2022). Eligible participants identified as female and were aged 21 to 45 years, residents of the United States or Canada, attempting pregnancy, and not using fertility treatments at cohort entry. At enrollment, participants completed a detailed baseline questionnaire. Thirty days after enrollment, participants were invited to complete an optional questionnaire about sexual function. Our study included 1120 participants who responded to the sexual function questionnaire within 1 year of completing their baseline questionnaire. We assessed sexual dysfunction using the 6-item Female Sexual Function Index, and sexual distress using the Female Sexual Distress Scale, which assess sexual function and distress in the previous 4 weeks, respectively. We also asked participants whether they had discussed their plans to conceive with a healthcare provider, and if so, whether they discussed their sex lives. If not, we collected information on perceived barriers. RESULTS: Twenty-five percent of the sample met criteria for female sexual dysfunction, whereas 12.2% met the criteria for sexual distress; 8% of our sample reported both sexual dysfunction and sexual distress. Thirty percent reported at least some pain with intercourse in the past 4 weeks. Although over 80% of the sample reported discussing their conception plans with a healthcare provider, 70% of these participants did not discuss their sex lives. The most commonly reported reasons for not discussing their sex life with a provider was not experiencing a sexual health issue, the provider not asking, feeling nervous/uncomfortable/ashamed, and feeling it was not relevant to becoming pregnant or inappropriate to discuss. The percentage of participants who reported discussing their sex lives varied across provider type, with those seeing midwives having the highest percentage (39%), followed by nurse practitioners (36%) and obstetrician-gynecologists (34%). CONCLUSION: Sexual dysfunction, distress, and painful intercourse are prevalent in the preconception period, but participants frequently did not discuss their sex lives when discussing plans to conceive. The provider not asking was a commonly reported barrier. Providers may consider raising the issue of sexual functioning at the time of a preconception visit to better support patients who may be dealing with a sexual function issue while attempting pregnancy. These findings may not generalize beyond a primarily non-Hispanic White, highly educated, and high-income population.

Learning from community-based HIV prevention to inform control and mitigation of the COVID-19 pandemic.

The current COVID-19 pandemic and the likelihood of future viral pandemics demonstrate a need for strategic prevention campaigns that integrate biomedical, structural, and behavioral interventions within larger scale comprehensive public health initiatives. In Human Immunodeficiency Virus (HIV) prevention, community-based efforts have resulted in reductions in transmission rates, increases in testing, increases in biomedical prevention uptake, and increased engagement in secondary and tertiary prevention efforts. In this paper, we review three community-based strategies (health communication, accessible screening, and accessible prevention resources) that have demonstrated effectiveness in HIV prevention and offer recommendations for utilizing these strategies in the COVID-19 pandemic. For example, health communication strategies have positively influenced HIV testing behavior, sex communication, and condom use among HIV negative individuals and treatment initiation, treatment adherence, and retention in care among people living with HIV. In addition, studies have shown that improving accessibility of HIV screening and prevention resources in community venues such as schools, pharmacies, mobile-testing sites, churches, hair salons, and bars is useful for increasing the uptake of HIV testing, especially among disproportionately affected populations and those deemed hard to reach. Despite differences in modes of transmission, it is plausible that a synergistic multilevel response with emphasis on community-based efforts could lead to similar outcomes for the current COVID-19 pandemic and future viral pandemics. Community-based prevention strategies offer an opportunity to integrate, and bolster disconnected and siloed initiatives that achieve limited impacts independently.

Predictors of Non-Response to a Sexual Health Survey in a North American Preconception Cohort Study.

BACKGROUND: Refusal to participate in studies related to sexual health can compromise the internal and external validity of findings. Research examining non-response to sexual health studies has primarily focused on predictors such as specific sexual attitudes and behaviors. AIM: Evaluate predictors of non-response to a supplemental sexual health survey added to a web-based cohort study, focusing on predictors that may be important in epidemiologic studies of sexual health. METHODS: In March 2021, we added the "Sexual Health and Wellbeing Questionnaire" (SQ), an optional supplemental sexual health survey, to the protocol for Pregnancy Study Online , a web-based North American prospective cohort study. Eligible participants identified as female and were aged 21-45 years, actively trying to conceive, and in a relationship with a male partner. Participants completed a baseline questionnaire at enrollment and follow-up questionnaires every 8 weeks. Participants were invited to complete the SQ 30 days after baseline questionnaire completion. The analytic sample included all Pregnancy Study Online participants who enrolled between March 2021 and December 2021 and was divided into 3 mutually-exclusive groups: (i) those who completed the baseline questionnaire only (ie, did not complete a follow-up questionnaire or the SQ), (ii) those who completed at least 1 follow-up questionnaire but not the SQ, and (iii) participants who completed the SQ (with or without a follow-up questionnaire). We compared sociodemographic, medical, lifestyle, and reproductive factors across these groups. RESULTS: Of the 1,491 enrolled participants, 302 (20.3%) completed the baseline questionnaire only, 259 (17.4%) completed a follow-up questionnaire but not the SQ, and 930 (62.4%) completed the SQ. Strong predictors of non-response (absolute difference in response >10% comparing SQ responders to baseline-only responders) included longer pregnancy attempt time at study entry, a history of infertility, and lower income and education. Compared with response to the follow-up questionnaire only, SQ response was lower among Hispanic/Latina participants and participants aged <25 years. CLINICAL TRANSLATION: The addition of sexual health surveys to established cohort studies may be an effective way to expand epidemiologic sex research efforts. STRENGTHS & LIMITATIONS: Study strengths include the prospective design, geographic heterogeneity of the cohort, and use of online methods. Our findings may not generalize to clinic-based sex research. CONCLUSION: We report that in an established North American cohort study, response to the SQ exceeded 60%. We observed few strong predictors for SQ non-response among engaged participants. Bond JC, Abrams J, Wesselink AK, et al. Predictors of Non-Response to a Sexual Health Survey in a North American Preconception Cohort Study. J Sex Med 2022;19:1707-1715.

Becoming Strong: Sociocultural Experiences, Mental Health, & Black Girls' Strong Black Woman Schema Endorsement.

This study examines the precedents and consequences of Black girls' Strong Black Woman schema (SBW) endorsement. Hierarchical regression analyses revealed that, among Black girls (N= 308), racial discrimination experiences and racial barrier socialization messages were positively associated with SBW endorsement. However, there was no significant interaction between racial discrimination and racial barrier messages in predicting SBW endorsement. Our analyses also revealed that SBW was not directly associated with internalizing symptoms (e.g., anxiety and depression symptoms). Furthermore, there was no significant interaction between racial discrimination and SBW endorsement in predicting internalizing symptoms. Findings provide evidence of and clarity on how sociocultural experiences shape SBW development and highlight a need to better understand how SBW endorsement functions in the mental health of Black girls.

Reframing Sexual Health for Black Girls and Women in HIV/STI Prevention Work: Highlighting the Role of Identity and Interpersonal Relationships.

While Black girls and women are disproportionately impacted by sexual health disparities, there continues to be an overwhelming focus on individual risk behaviors within prevention initiatives, which offers a fragmented narrative of the multidimensional nature of risk and plausibly limits effectiveness of prevention programs and attenuates reductions in disparities. Because sexual health is experienced within an individual's beliefs/values, interpersonal relationships, and behaviors and reflects larger social and cultural systems, it is important to critically examine common theories used to inform HIV/STI prevention interventions for Black women and girls. To fill this gap in the literature, we critique two commonly used theories in HIV/STI prevention interventions, namely the social cognitive theory and the theory of gender and power, by highlighting theoretical and practical strengths and weaknesses. We propose research implications that incorporate key strengths of the two theories while adding new concepts grounded in the intersectionality theory. The overall goal is to introduce a more comprehensive conceptual model that is reflective of and applicable to the multidimensional sexual experiences of Black girls and women within the evolving definition of sexual health and behavior.

A Review of Recent HIV Prevention Interventions and Future Considerations for Nursing Science.

ABSTRACT: As our knowledge of HIV evolved over the decades, so have the approaches taken to prevent its transmission. Public health scholars and practitioners have engaged in four key strategies for HIV prevention: behavioral-, technological-, biomedical-, and structural/community-level interventions. We reviewed recent literature in these areas to provide an overview of current advances in HIV prevention science in the United States. Building on classical approaches, current HIV prevention models leverage intimate partners, families, social media, emerging technologies, medication therapy, and policy modifications to effect change. Although much progress has been made, additional work is needed to achieve the national goal of ending the HIV epidemic by 2030. Nurses are in a prime position to advance HIV prevention science in partnership with transdisciplinary experts from other fields (e.g., psychology, informatics, and social work). Future considerations for nursing science include leveraging transdisciplinary collaborations and consider social and structural challenges for individual-level interventions.

Strategies for increasing impact, engagement, and accessibility in HIV prevention programs: suggestions from women in urban high HIV burden counties in the Eastern United States (HPTN 064).

BACKGROUND: Merely having the tools to end HIV is insufficient. Effectively ending the epidemic necessitates addressing barriers that impede engagement in biomedical and behavioral prevention and wide scale implementation and utilization of existing interventions. This qualitative study identifies suggestions for increasing access to, engagement in, and impact of HIV prevention among women living in cities in high HIV burden counties in the eastern US. METHODS: Data analyzed for the current study were collected via a qualitative sub-study within the HIV Prevention Trials Network Study 064 (HPTN 064), a multisite observational cohort study designed to estimate HIV incidence among women residing in communities with elevated HIV prevalence who also reported personal or partner characteristics associated with increased risk of HIV acquisition. Focus group and interview participants in the qualitative sub-study (N = 288) were from four cities in the eastern US. RESULTS: Thematic analyses revealed four themes describing women's most frequently stated ideas for improving prevention efforts: 1) Promote Multilevel Empowerment, 2) Create Engaging Program Content, 3) Build "Market Demand", and 4) Ensure Accessibility. We conducted additional analyses to identify contradictory patterns in the data, which revealed an additional three themes: 1) Address Structural Risk Factors, 2) Increase Engagement via Pleasure Promotion, 3) Expand Awareness of and Access to Prevention Resources. CONCLUSIONS: Findings may be useful for enhancing women's engagement in and uptake of behavioral and biomedical HIV prevention resources, improving policy, and addressing multilevel risk factors. TRIAL REGISTRATION: Clinicaltrials.gov: NCT00995176 , prospectively registered.

Conocimientos de la hipertensión: Health beliefs about hypertension in an under-resourced community in the Dominican Republic.

Understanding health beliefs is important to facilitate health promotion and disease prevention as they influence health behaviors, outcomes, and disease management. Given the rise of hypertension-related diseases in the Dominican Republic, the purpose of our study was to identify hypertension-related health beliefs of Dominicans in order to inform the development of culturally appropriate interventions for hypertension prevention, care, and treatment. Semi-structured interviews were conducted with 20 Dominicans, 15 of whom were receiving treatment for hypertension. Operating within the interpretative paradigmatic framework, we conducted thematic analyses of interview data to identify hypertension-related health beliefs and practices. Iterative data analysis revealed the following themes: 1) Negative emotions are a primary cause of hypertension, 2) Medication is the best treatment but adherence is challenging, 3) Systemic barriers impede treatment access, 4) Hypertension negatively impacts mental and physical well-being, and 5) Lifestyle changes, relaxation, and social support help manage hypertension. Data gathered from member checking validated these findings. This study enhances understanding of the beliefs and experiences of Dominicans and emphasize the importance of implementing culturally competent health programming and care.

Considerations for employing intersectionality in qualitative health research.

Intersectionality theory has recently emerged in the health sciences as a critical theoretical and methodical approach. Though some scholars have outlined explicit guidelines for applying intersectionality in research using quantitative methods, others have cited epistemological concerns and additive thinking to advocate for the analysis of intersectionality with qualitative methods. Thus, there remains a need for additional guidance and support for utilizing and applying intersectionality theory throughout the qualitative research process. With the goal of demystifying the process of utilizing intersectionality as a methodological approach in qualitative research in the health sciences, this paper provides researchers with recommendations, specific examples, and important considerations for incorporating intersectional approaches into study conceptualization, participant recruitment, data collection, and data analysis. Additionally, this paper reviews challenges that researchers may experience in conducting research using intersectional approaches and offers suggestions for overcoming challenges. This paper offers timely and relevant information that can be used to strengthen the theoretical and methodological rigor of qualitative health research, especially studies that seek to advance health equity.

Sexual Orientation Identity, Race/Ethnicity, and Lifetime HIV Testing in a National Probability Sample of U.S. Women and Men: An Intersectional Approach.

Purpose: We examined differences in lifetime human immunodeficiency virus (HIV) testing in relation to both sexual orientation identity and race/ethnicity among U.S. women and men. Methods: We used 2013-2017 National Health Interview Survey data and multivariable logistic regression to assess the distribution of lifetime HIV testing across and within sexual orientation identity and racial/ethnic groups of U.S. women (n = 60,867) and men (n = 52,201) aged 18-64 years. Results: Among women, Black lesbian (74.1%) and bisexual (74.0%) women had the highest prevalence whereas Asian lesbian women (32.5%) had the lowest prevalence of lifetime HIV testing. Among men, the prevalence of lifetime HIV testing was the highest among Latino gay men (92.6%) and the lowest among Asian heterosexual men (32.0%). In most cases, Black women and Black and Latino men had significantly higher adjusted odds whereas Asian women and men had lower adjusted odds of lifetime HIV testing compared with their White counterparts within sexual orientation identity groups. In many instances, bisexual women and gay men had significantly higher adjusted odds of lifetime HIV testing relative to their heterosexual counterparts within racial/ethnic groups. Compared with White heterosexual individuals, most sexual orientation identity and racial/ethnic subgroups had significantly higher adjusted odds whereas Asian heterosexual, bisexual, and lesbian women and Asian heterosexual and bisexual men may have lower adjusted odds of lifetime HIV testing. Conclusion: Culturally relevant, linguistically appropriate, and structurally competent programs and practices are needed to facilitate lifetime HIV testing among diverse sexual orientation identity and racial/ethnic subgroups of women and men, including multiply marginalized subgroups that are undertested or disproportionately affected by HIV/AIDS.

Underneath the Mask of the Strong Black Woman Schema: Disentangling Influences of Strength and Self-Silencing on Depressive Symptoms among U.S. Black Women.

Recent investigations have elucidated the influence of the Strong Black Woman (SBW) Schema on the mental health and treatment seeking behaviors of Black women in the United States. However, the SBW schematic characteristics that produce depression have yet to be identified. The current study fills this void in the literature through a quantitative examination of how characteristics of the SBW Schema relate to depressive symptomology. Analyses were based on 194 participants, including college students (n = 98) and community members (n = 96), ranging in age from 18 to 82 years-old (M = 37.53, SD = 19.88). As hypothesized, various manifestations of self-silencing were found to significantly mediate the relationship between the perceived obligation to manifest strength (a SBW characteristic) and depressive symptomatology. The present study advances the idea that depressive symptoms are related to endorsement of the SBW Schema and highlights self-silencing as a mechanism by which this relationship occurs. These results offer evidence and clarification of the impact of the SBW Schema on Black women's mental health and identify specific points of intervention for mental health practitioners conducting therapeutic work with Black women. We provide recommendations for future research to avoid pathologizing strength and we discuss the implications and potential benefits of integrating a Womanist theoretical perspective into counseling for Black women, a population that has historically underutilized mental health resources.

Association between hospital community services and county population health in the USA.

OBJECTIVES: Little research has utilized population level data to test the association between community health outcomes and (i) hospital-sponsored community services that facilitate access to care and (ii) hospital-sponsored community building services in the USA. Therefore, the purpose of this study was to examine these relationships. METHODS: A secondary data analysis of the 2016 County Health Rankings and American Hospital Association databases was conducted via zero-truncated negative Binomial regression. RESULTS: Findings indicate a statistically significant difference between the number of community healthcare access services and community building services with county's rank of health behavior. However, no statistically significant differences were found between the number of community healthcare access services and community building services with county rankings of length of life, quality of life or clinical care. CONCLUSIONS: Our findings suggest that quality measures of services may play a more important role in community health improvement and that there is opportunity for hospitals to revamp the way in which community health needs assessments are conducted. Additional federal action is needed to standardize hospital sponsored community health service data reporting so that practitioners, hospital administrators and researchers can more specifically define hospitals' role in public health protection in the USA.

Combining task shifting and community-based care to improve maternal health: Practical approaches and patient perceptions.

Globally, community-based care and task shifting strategies are used to address maternal healthcare shortages in low-income countries. Limited research exists on models that combine these strategies. Using a qualitative approach, we explored Haitian women's perceptions of the Midwives for Haiti model, which unites task shifting and community-based care by training nurses as skilled birth attendants and offering healthcare via rotating, mobile clinics. Eight focus groups (N = 52) were conducted in rural Haiti in March 2017. Thematic analysis of data indicated that perceptions of care were universally positive. Participants cited accessible patient-centred care, affordable services, and health education as primary motivators to attend. Results illustrated the importance of women's perceptions on the future use of mobile clinic sites or other formal care. Future efforts to address maternal healthcare shortages should consider the Midwives for Haiti model, combining task shifting and community-based care to address common social, topographical, or financial barriers to maternal healthcare.

Circumstances Beyond Their Control: Black Women's Perceptions of Black Manhood.

Insufficient empirical attention has been paid to Black women's perceptions of Black male gender roles and associated masculinity. Although constructions of Black masculinity have been speculated about in popular media and literature, no known published studies have specifically investigated Black women's perceptions of Black men or offered a conceptualization of Black masculinity informed by their voices. Because women's perceptions of and beliefs about men affect partnership decisions, quality of relationships, childrearing decisions, health behaviors, and other aspects of personal and psychosocial well-being, the purpose of the present exploratory qualitative study was to fill the noted gap in the literature while highlighting context related to these beliefs. Participants in eight focus groups were 44 Black women, ranging in age from 18 to 91, from the Mid-Atlantic region of the United States. Transcribed focus group data were coded via a qualitative data analysis software program. Thematic analysis of data revealed three main themes: (a) Strong Armed and Strong Minded, (b2) Challenges with Familial and Personal Connections, and (c) Circumstances Beyond Their Control: Impact of the Black Experience. Implications for research and practice related to Black marriage, family, and parenting relationships are discussed.

Condom Use Efficacy and Sexual Communication Skills Among African American College Women.

Despite condom use being the most protective measure against the transmission of human immunodeficiency virus (HIV), little is known about the intermediary relationships between condom negotiation, assertive sexual communication, and condom use efficacy. The purpose of the current study was to examine the relationships between these constructs within the context of an HIV prevention intervention. We examined two samples of African American college women participating in two HIV prevention interventions, one of which was based on social learning theory ( N = 214). Data collected at intervention posttest and 3-month follow-up were analyzed. Findings revealed that condom use efficacy at posttest fully mediated the relationship between intervention effect and assertive sexual communication at 3-month follow-up. In addition, condom use efficacy at posttest fully mediated the relationship between intervention effect and condom negotiation at 3-month follow-up. Implications of the importance of experiential learning, in combination with behavior observance, on the maintenance of condom protective behaviors are discussed. Findings have the potential to inform clinic and community-based HIV prevention interventions conducted among African American women.

Considerations for Implementing Group-Level Prenatal Health Interventions in Low-Resource Communities: Lessons Learned From Haiti.

Haiti's high maternal and infant mortality rates evidence an urgent need for implementation of evidence-based strategies. A potential cost-effective strategy to mitigate high maternal and infant mortality rates is group prenatal care, an innovative model that combines antenatal clinical assessment with pregnancy education. Despite research demonstrating the effectiveness of this model in high-resource settings, less is known about the challenges of implementing it in low-resource settings. The purpose of this article is to provide recommendations for overcoming challenges of implementing group prenatal care in low-resources communities globally. Challenges addressed include language, literacy, space, cultural appropriateness of intervention content, and sociopolitical climate. Using examples from work conducted in Haiti, this information can be used to assist practitioners and researchers with overcoming challenges of implementing models of group care in international low-resource communities.

Addressing Noncommunicable Disease in Dominican Republic: Barriers to Hypertension and Diabetes Care.

INTRODUCTION: Noncommunicable diseases (NCDs) significantly contribute to morbidity and mortality worldwide. During medical brigades in Santo Domingo, the Dominican Aid Society of Virginia (DASV) collects data to help understand the dynamics of NCD management. This study presents findings regarding resources and barriers to NCD treatment. Methods: A cross-sectional survey study was conducted in two communities (Los Mina and Paraiso) during the 2014 DASV summer brigade. Descriptive statistics, associations, correlations as well as qualitative analyses were conducted to better understand resources and barriers to care in relation to health care coverage. RESULTS: More than one third (n = 64) of 165 individuals had hypertension and/or diabetes. Thirty-seven percent (Paraiso) and 46% (Los Mina) of study participants did not have health insurance in the previous year. For those that did have insurance, 77% (P) and 89% (LM) visited a physician in the previous year. In this same group, 65% of individuals from Paraiso reported that their health insurance never covered the cost of medications while only a quarter of individuals from Los Mina indicated this. Health insurance and access to physicians and medication varied depending on the community of residence. Surveys indicated that access to affordable medications was an important issue for participants. Also, even though individuals in Los Mina were less likely to have health insurance than those in Paraiso, they were more likely to visit a physician. CONCLUSION: This study contributes to a greater understanding of health care coverage and access for low-resource communities in the Dominican Republic. Health care access, insurance, and cost sharing differed between these communities, but barriers to care were common. Future investigations could focus on qualitative differences in communities' health insurance coverages and development of interventions to address obstacles to care.