Initial Efforts in Community Engagement with Health Care Providers: Perceptions of Barriers to Care for Cancer Patients in Puerto Rico (Report‪)‬

Cancer health disparities are particularly evident among Hispanics. Although the overall incidence and death rates for all cancers are lower in Hispanics than in non-Hispanic Whites, Hispanics are more likely to be diagnosed later in the course of the disease when the cancer has reached a more advanced stage (1). However, the majority of cancer health services research has examined Hispanics as a homogenous group rather than exploring variations by sub-ethnicity. Hispanics are a diverse population with individuals from multiple origins such as the Caribbean, Central or South America, and Spain (2). The majority of the U.S. Hispanic populations are of Mexican, Puerto Rican, and Cuban origin (3). To reduce cancer health disparities, it is important to consider individual cultural and system factors that may impact perceptions of cancer and health seeking behaviors (4). For example, there are differences in cancer rates and access to services between Puerto Ricans living in the United States (mainland) and those living on the island. Island Puerto Ricans appear to have different rates of cancer compared to other Hispanic groups and non-Hispanic whites. Rates of breast, colon/rectum, lung, and prostate cancer are lower in Puerto Rico than in the mainland United States, whereas rates of cervical, liver, and stomach cancers are higher (5). In 2000, the total US Puerto Rican population reached over 7.2 million, with approximately equal numbers living on the island of Puerto Rico or the mainland US (2). Mainland and island Puerto Rican Hispanics differ by several factors that may impact health status, including lifestyles and health behaviors, the environment, and access to health services. With respect to access to health services, in the 1990s the Puerto Rican legislature approved Health Care Reform legislation intended to increase access, lower costs, and improve health outcomes for individuals who had previously been covered under Medicaid and Medicare and whose incomes are below 200% of the poverty level (5). This Reform (known as "the Reforma") shifted the care of these individuals, who comprise nearly half the island's population, from the public sector to the private sector via the creation of the Puerto Rico Health Insurance Administration (in Spanish, ASES). However, there has been little published research on the effectiveness of Reforma or the perceptions of its value among Puerto Ricans. Due to the research emphasis on mainland Puerto Rican populations; additional research is needed to ensure that cancer prevention and control activities are relevant to Puerto Rican populations on the island.