This is an application for a competing continuation of an NICHD grant, in which we have been examining family choices about the use of health services and their consequences for children's health in Guatemala. In the continuation period we propose to collect new and considerably more detailed data using both ethnographic and sample survey methods, in rural areas of Guatemala. The objectives of the study are: (10 to describe the process by which families and individuals cope with childhood illness and pregnancy in an environment in which a variety of different forms of treatment are often available; (20 to examine the role of family and community characteristics, including ethnic identity, social support systems, availability of modern and non-modern health services, social class, and financial resources, in families; choices about treatment during pregnancy and childhood illnesses; and (30 to investigate the effects of treatment choices for women's and children's health outcomes. The structure of Guatemalan society provides a unique opportunity to understand the complex associations among ethnic identity, health beliefs, social support, poverty an social class, choices about use of health care and health outcomes, as discussed below. These issues are central to health and social policy in the United States, as well as in other countries. The large scale immigration of Central Americans and mexicans tot he United Stats also makes it important to understand the health care environment from which immigrants come and the ways in which they have been accustomed to making treatment choices before arriving in the U.S.
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