At a July 29 meeting, Healthy Archuleta representatives presented the results of its recently completed nutrition security and community health access survey.
Healthy Archuleta staff member Mozhdeh Bruss opened the meeting by explaining the goals of Healthy Archuleta’s nutrition security and health access work, indicating that the organization was interested in understanding access to and utilization of health care in the community, as well as the connections between food and health.
She indicated that Healthy Archuleta took an “iterative” approach to its community health assessment work, which began in 2021 with the organization gathering community members to formulate questions.
That was followed by 2.5 years of surveying the community to answer these questions using a variety of data sources and iteratively implementing interventions to assess the impact of different approaches.
Bruss stated that the assessment used 22 “convenient samples” such as health care professionals or food pantry clients in addition to random samples.
In an interview, Healthy Archuleta staff member Vanessa Skean explained that the iterative process involved initial outreach and data gathering with a wide range of community groups and stakeholders, such as health care institutions or food pantries.
As this data was collected, the organization would work with partners to make suggestions or improvements at these organizations based on patterns in the data as well as refining the questions asked for future data gathering, Skean explained.
She added that these processes helped refine the questions used in a later randomized survey of the community.
At the meeting, Bruss explained that the results that Healthy Archuleta would be presenting at the meeting were primarily from a recent countywide survey that provided a “representative sample” of the community.
A representative sample can be used to make statements about an issue in a community overall due to representing community composition and being randomized, Bruss stated, adding that this survey is the first time that such a sampling had been done in the county.
She then noted several overarching issues in health, including the importance of consistent access and affordability of nutritious foods, the difficulties experienced by marginalized or minority communities in accessing food and medical resources, and the prevalence of chronic diseases in the U.S.
She noted that, according to data from San Juan Basin Public Health, Archuleta County has notable issues with excessive weight and poor cardiac health, both of which can be addressed with consumption of healthy foods.
However, she commented that such foods tend to be more expensive in the area, limiting access, particularly among low-income or non-English speaking populations.
Bruss indicated that Archuleta County has a higher rate of food insecurity compared to the state of Colorado, according to various data sources, in addition to having a lower rate of enrollment in the Supplemental Nutrition Access Program (SNAP) than the state average.
She introduced David Metz from Fairbank, Maslin, Maullin, Metz and Associates (FM3), who she explained is involved with the Colorado Health Foundation and performed — along with his firm — the representative survey for the community health assessment with guidance and assistance from Healthy Archuleta.
Demographics
Metz then presented the key findings of the survey, beginning by explaining its methodology.
He stated that the survey worked to obtain a representative sample of the community using a random sampling methodology combined with population quotas based on census data intended to ensure that the population interviewed was representative of the county as a whole.
A total of 417 residents were interviewed for the survey, he indicated, adding that this led to a margin of error on the survey of 4.9 percent.
Metz stated that the demographics of Archuleta County and those interviewed for the survey skew older than many communities and that 14 percent of the population identifies as Latino or Hispanic.
According to the survey, 91 percent of respondents indicated that they had health insurance, although those below 40 years old were “significantly less likely” to be insured and all those over 65 interviewed had insurance.
He stated that, among those who had insurance, about a third stated they had Medicare, a third were on employer-provided health insurance, and the remaining third stated they were on Medicaid, had purchased their own insurance plan or were insured through another means.
Metz noted that one in five of the respondents stated that they speak a language other than English at home and that the distribution of how long respondents had lived in Archuleta County was “pretty broad,” with only a small portion being born and raised in the county.
Fifty-two percent of respondents lived in a two-person household, he stated, adding that a third lived in a household with three or more people.
He added that households with four or more residents were disproportionately likely be Latino and that larger households were typically younger, which Metz commented is not surprising due to younger households often containing children.
Survey results
Metz then reported on the results of the survey, starting with indicating that respondents had varied responses to what items make a community healthy.
He stated that low levels of crime and violence; affordable healthy food options; easy access to affordable physical health care; and treating people of varied ethnic, racial and income groups with respect were rated the most important.
He added that the food and health care availability were investigated in depth in the survey.
However, he noted that the diversity of responses was notable and included items not traditionally associated with health care, such as transportation.
Metz explained that respondents were asked about their financial circumstances, with more than one-quarter stating that they were just getting by financially or struggling, and 47 percent stating that they were living comfortably but not able to save money.
He commented that these responses reflect general economic conditions in the U.S., with many having difficulties with high costs of living.
Financial security strongly correlated with income, Metz stated, with lower-income households being more likely to be struggling and higher-income households being more secure.
He indicated that college-educated men were the most financially secure, while non-college-educated women were the most financially insecure.
Seventy-three percent of respondents stated they got a physical checkup in the past year, while 57 stated they received dental care and 13 percent received mental healthcare, Metz stated.
He added that 13 percent stated they visited a food pantry in the county.
Metz commented that the question only concerned accessing these services within Archuleta County and that it is possible some respondents obtained these services outside the county, although he added that the responses are important since access to providers was a significant issue in later survey questions.
Metz stated that the survey showed a strong correlation between income and the use of dental and mental health care and food pantries, with households with incomes below $50,000 having a lower likelihood of using either type of health care and a higher likelihood of using food pantries.
He added that white residents were more likely to use dental health care than residents of color.
Metz explained that younger respondents, who are more likely to be uninsured and healthier, were less likely to have gotten a physical checkup in the past year.
The survey also asked respondents if they postponed accessing medical services or skipped meals due to a lack of food, Metz stated.
He indicated that a minority of residents stated they had these experiences, although, in some cases, this was a “fairly sizable minority,” particularly among lower-income respondents and residents of color.
He explained that those who had skipped meals or some form of health care tended to skew younger, were more female than male, were more likely to be lower income, were more likely to have children at home and were disproportionately Latino.
Metz explained that the remainder of the survey focused on a “deeper dive” into food and health care availability.
He indicated that the majority of respondents stated that they were able to purchase the food they wanted most of the time, although a significantly lower percentage stated that they could always purchase the food their household needs and wants.
More than a third of respondents were concerned about if they will be able to feed their family, Metz stated, with those concerned being younger, more likely to be female, lower income, often having children and being more likely to respond to the survey in Spanish.
He stated that the most common source of food was from stores, although a majority stated they also shop at a farmers market and a significant number grew their own food or obtained it through hunting or fishing.
He commented that the highest use of farmers markets was among the most affluent county residents.
Metz explained that respondents were asked to identify the issues preventing them from accessing the food they need.
He stated that the largest obstacle survey participants identified was food costs, with difficulty growing food, extreme heat or rainfall and a lack of stores near where they live also being cited as less-significant issues.
Metz explained that lower-income households were more likely to report barriers to food access, particularly food costs.
He added that a larger portion of Latino or respondents of color cited a lack of available food from their cultural background as a challenge compared to white respondents.
The survey also asked respondents what supports would be most helpful to them in obtaining the food they need, Metz stated, with respondents rating lowering the cost of food as the most helpful and a majority stating that increased access to locally grown food products would be useful.
He added that a larger number of respondents stated that making it easier to get benefits like SNAP would be useful compared to those who stated that making it easier to use these benefits would be useful.
Those with household incomes between $50,000 and $100,000 per year were most likely to say that getting SNAP benefits would be helpful, Metz noted.
He added that this is a typical pattern that those just outside the income range for a public benefit like SNAP feel it would be most helpful to have it expanded.
Metz stated that the survey asked respondents about what actions they could take or already taking to improve their food access, with responses focusing on purchasing food from farmers markets and from local growers.
He then moved on to discuss the responses to questions about access to health care.
Metz indicated that about 85 percent stated they are receiving the physical health care they need to maintain their health, with those who have health insurance being more likely to say they were receiving the care they needed compared to those without insurance.
He noted that a lower number of Latino residents stated that they were very likely to get a physical checkup in the next year compared to white residents.
The survey asked residents what barriers exist to them receiving care, Metz explained, with a lack of appointments, doctors in the community not accepting new patients, difficulty finding a provider who will accept your insurance and wait times being too long being the largest challenges identified, although no barrier was identified as an issue by the majority of respondents.
He commented that cost of health care was rated behind these concerns, which Metz stated is a common pattern in rural communities.
Metz indicated that lower-income households were more likely to face barriers in terms of access to health care and affording it.
He added that difficulties in finding a doctor that accepts a respondent’s insurance was more prevalent in the middle income range, which might indicate that those in this range are more likely to be uninsured or have more narrow health insurance coverage than those above or below them in income.
Those respondents who were insured or uninsured expressed equal levels of concern about affording health care, Metz stated, commenting that even those who are insured still can face significant health care costs.
He indicated that those respondents who stated that they postponed receiving health care reported facing a wider range of barriers to seeking health care, although they ranked those barriers similarly to the general population.
Metz stated that those who answered the survey in Spanish stated more frequently that they could not find a doctor or clinic whose staff spoke the same language as them or a family member.
Two-thirds of respondents stated they could obtain the mental health care they needed, Metz explained, adding that this was lower than approximately 90 percent who indicated they could get the physical health care they needed.
He added that a “counterintuitive” finding was that those who are uninsured were more likely to state that they had access to the mental health care they needed than those who were insured.
He added that one of reported barriers to receiving mental health care was that insurance would not cover it and speculated that those who have insurance may seek mental health care at a higher rate and be denied coverage, while those without insurance have not tried to seek out such care and thus do not experience the barriers.
“That’s something that might merit a little further explanation,” Metz said.
He stated that a relatively low number of respondents rated any barrier to mental health care as significant, although he commented that this was more likely due to many respondents not trying to access such care rather than because they were accessing such care successfully.
He indicated that cost of care, difficulty finding a provider who will accept your insurance and difficulty making appointments were the largest barriers to accessing mental health care identified, followed by issues related to social stigma around such care.
Difficulties paying for mental health care was strongly correlated with lower incomes, Metz stated, and many barriers were more prominent among residents of color than among white residents, including much higher barriers related to social stigma, such as discomfort speaking about personal problems with another and concerns about being judged by family or friends.
Among those who postponed seeking mental health care, the ranking of the barriers were similar to the general population, Metz stated.
He noted that there were a greater variety of potential solutions to improving mental health care access that survey respondents stated would be significant compared to physical health care, with increasing access and affordability being top-rated solutions.
He added that lower-income households were more likely to be interested in these supports, although the solutions rated as effective were similar across income levels.
Latino residents had a higher likelihood of stating that access to more health resources in Spanish would be helpful, Metz indicated.
He explained that, if the supports related to accessing physical health care were implemented, there was a 5 percent increase in the number of respondents who indicated that they would be very likely to get a physical checkup in the next year.
Metz commented that the overall survey results showed a broad recognition that a wide range of factors feed into community health beyond health care and that residents in the area are facing financial challenges.
He added that, while most are comfortable with their access to physical health care, most are not comfortable with their access to mental health care and point to lack of access and cost of care as barriers to accessing both.
He stated that most residents can access the food their families need and want, although many are concerned about their ability to do so in the future.
Metz also noted that there is a strong interest in accessing food from farmers markets and local producers.
“The main help that I think most county residents want, both when it comes to food and health care, is lower costs,” Metz said. “Just at bottom line — affordability to afford it.”
At several meetings, the Archuleta County Board of Health has indicated that the data from this survey will be a valuable tool in its planning processes for the five-year Public Health Improvement Plan the board is working on finalizing.
In an interview, Skean and Healthy Archuleta staff member Drew Brown added that the data will be used to shape Healthy Archuleta’s future priorities and grant funding applications, such as an upcoming grant-funded effort to investigate the local mental health care system and develop interventions to improve access to mental health care in the community.
josh@pagosasun.com
