Community Input

A number of participants recognized the need of leadership and better coordination among organizations and services in order to address the increasingly complex issues affecting the health and well-being of Dallas County residents. While it was acknowledged that improving the health of the county and eliminating disparities will require a community-wide effort beyond what the health provider entities can achieve on their own, several participants expressed the opinion that the county health agencies (Parkland and DCHHS) are best positioned to organize such efforts. 14% of the respondents offered responses that identified Parkland as an anchor organization in the community. A number of participants urged Parkland, in particular, to help support and enable the efforts of other allied organizations within the community who serve a population common to the health system.

Focus group participants identified several barriers that prevent the patient population most commonly served by Parkland and DCHHS from improving their health status. The team developing the CHNA collected this feedback and, as described in the methodology section of this assessment, coded responses based on the CDC's HealthyPeople 2020 Social Determinants of Health (SDOH) Framework. Once the data from the focus group responses was analyzed and coded, the SDOH were ranked by the number of participant references to each topic (see Figure 131).

The graphic above shows that after categorizing all focus group responses (N=820) by SDOH according to the HealthyPeople 2020 framework, the top three SDOH that participants perceived as having the most influence over the health of the community are: Health and Healthcare (61%), Social Impact and Community Context (19%) and Education (10%).

The HealthyPeople 2020 category, which received the most focus group participant responses, was Health and Healthcare.

Of the responses that fall within the Health and Healthcare domain, Access to Care was the most prominent. Factors categorized under Access to Care create situations in which it is difficult physically, financially or in terms of navigating a complicated healthcare system, for patients to access care through available resources. It also includes health literacy which, apart from being a factor that impacts an individual's ability to navigate the healthcare landscape, impacts one's ability to understand and manage chronic disease.

Responses within the Access to Care category include the following:

• Lack of insurance coverage
• Poor Health Literacy
• Other
• Increase in Patient Volumes
• Access to Medication
• Access to Behavioral Health Services
• Care Coordination

"Health literacy is a major barrier. A patient might bring in a bag with meds and have no idea what they take them for. Sometimes we find they have different meds for the same thing."

"Along with our mental health patients, we're also seeing two distinct groups - geriatric and adolescent. With both groups, they may end up in the Psych ED for four days because there's no place for them to go in the community."

The category with the second highest number of responses was Social Impact and Community Context. The factors within the Social Impact & Community Context category include responses that deal with social cohesion (the willingness of members of a society to cooperate with each other in order to prosper), discrimination (real, perceived and/or anticipated) and cultural competency. Responses within this category reflected a level of fear and/or anxiety on the part of patients when dealing with the healthcare industry and health providers (ranging from fear of being unnecessarily charged to not being treated well by staff to "not wanting to know" if they have health issues). In addition, a level of fear and/or anxiety was expressed by frontline healthcare providers who have experienced, witnessed or been made aware of increased patient on staff violence over the past two years.

Responses within the Social Impact & Community Context domain included the following:

• Social cohesion
• Discrimination
• Cultural competency
• Other

"Patients have a fear of going to doctors and a distrust of the system. They may feel that 'they don't want to know' health issues."

"Patients are afraid the employer won't fill out the paperwork (to access financial assistance)."

The category with the third largest number of responses was Education. While health literacy was discussed often over the course of our focus groups, a number of participants raise the issue of reading literacy and the challenges patients have when they are unable to read treatment plans and prescriptions. These responses were closely correlated with health literacy and discussion tended to drift between reading literacy and health literacy.

Discussion topics within the Neighborhood and Built Environment domain included SDOH, such as access to health facilities, access to fresh foods and access to adequate child care. Among patients, transportation issues were important.

• Access to transportation
• Reliance on family members or others for transportation (scheduling rides)
• Cost of transportation
• Elderly people's difficulty in dealing with the public transportation system