Identifying barriers to healthcare to reduce health disparity in Zuni Indians using focus group conducted by community health workers

Vallabh O. Shah, Donica M. Ghahate, Jeanette Bobelu, Phillip Sandy, Sara Newman, Deborah L. Helitzer, Thomas Faber, Philip Zager

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


The Zuni Pueblo is home to an economically disadvantaged population, which faces a public health challenge from the interrelated epidemics of obesity, diabetes and kidney disease. Efforts to decrease the impact of these epidemics have been complicated by historical, economic and cultural barriers, which may limit healthcare utilization. The NIH supported Zuni Health Initiative (ZHI) conducted a study to identify barriers to healthcare in the Zuni Pueblo. Community health representatives (CHRs) led 14 one-hour focus group sessions at which a total of 112 people participated posed unique questions that took into account the Zuni culture to elicit information on perceived barriers to healthcare. Audiotapes were translated and transcribed by bilingual ZHI staff. We reduced the text to thematic categories, constructed a coding dictionary and inserted the text into NVivo 9 program. We identified nine themes emerged regarding the barriers experienced in receiving healthcare and adhering to medical advice. These included distance; transportation; embarrassment; relating to healthcare professionals; navigating the medical system; awareness of available resources; waiting times; adhering to medication; and incentives in health promotion. In conclusion the implementation of culturally appropriate community-based health promotion programs and preventive screening techniques will improve access to healthcare and diminish health disparities.

Original languageEnglish (US)
Pages (from-to)6-11
Number of pages6
JournalClinical and translational science
Issue number1
StatePublished - Feb 2014
Externally publishedYes


  • Access to healthcare
  • American Indians
  • Barriers to healthcare
  • Community health representatives (CHRs)
  • Community-based participatory research (CBPR)
  • Health disparity

ASJC Scopus subject areas

  • General Neuroscience
  • General Biochemistry, Genetics and Molecular Biology
  • Pharmacology, Toxicology and Pharmaceutics(all)


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