Unlike regions with larger Latino populations, the health care infrastructure in Cincinnati does not include linguistically and culturally appropriate services to meet the need of the growing Latino immigrant community. In order to guide development of appropriate health care services, a team of academic and community researchers collaborated on a community-based participatory research project to understand health care use, barriers to health care, perceptions of health care, and health care needs of Latino immigrants. Co-researchers administered 518 surveys and conducted focus groups with 34 Latino immigrants. Participants relied on community clinics for care more often than is seen in nationwide Hispanic samples. Results revealed significant health care barriers, which Latino immigrants attribute to language, lack of quality interpreters, documentation status, and discrimination. Results suggest that the dearth of established social support networks and health care infrastructure in new Latino growth areas exacerbate the health care obstacles experienced by Latino immigrants throughout the country.

This paper identifies differences in adult Latino immigrant barriers to healthcare in the Cincinnati area in Hamilton County, OH on three levels: by region, by neighborhood, and by community health center. Secondary data analysis was performed on 439 surveys. Respondents were aggregated by the geographic regions and neighborhoods where they live and by two community health centers where they receive care. Outcome measures included pragmatic and skill barrier indices adapted from the Barriers to Care Questionnaire (BCQ); the pragmatics index consists logistical barriers, including transportation and cost; the skills index is made up of items related to navigating the healthcare system, including communicating with physicians and completing paperwork. The results indicate that immigrant Latinos living in western Cincinnati and northern Hamilton County face significantly higher pragmatic barriers to care, while Latino immigrants going to a community health center in western Cincinnati have significantly fewer pragmatic and skill barriers than immigrants utilizing a nearby community health center. Because healthcare options for undocumented immigrants do not improve with the Affordable Care Act, community health centers will continue to serve as their primary source of care. This is particularly true in non-traditional migration areas, where immigrants tend to be isolated and lack resources. Efforts to improve access to healthcare for immigrant Latinos require place-based approaches that allow for targeted resources to improve care in these locations. This study helps to fill that need by identifying variation in barriers to care on multiple levels and offering strategies to alleviate these barriers.

The tremendous Latino growth combined with the challenges of living in a nontraditional migration area make Latinos, particularly those who are undocumented, a "difficult-to-reach" and understudied population in research. We describe the development and practice of an immigrant community research team created to investigate and improve research quality regarding health-related needs, beliefs, and behaviors of recent Latino immigrants living in Cincinnati, Ohio. Our community research team, Latinos Unidos por la Salud (LU-Salud), is composed of Latino immigrant community members and academic researchers working in a health research partnership. The community team members are considered "co-researchers" since LU-Salud was designed within a community-based participatory research framework where we engaged in shared decision making at each phase of the research process from design, data collection, and interpretation of findings to dissemination. The co-researcher approach promoted shared decision-making and community empowerment throughout the research process with our community members providing expertise about the "what" (Latino immigrant health-related beliefs and behaviors, questionnaire content, interpretation of data) and the "why" (to obtain perspectives from Latino immigrants who typically don't engage with academics) and our academic members bringing expertise about the "how" (research design and methods, grant funding).

Equitable partnership processes and group dynamics, including individual, relational, and structural factors, have been identified as key ingredients to successful community-based participatory research partnerships. The purpose of this qualitative study was to investigate the key aspects of group dynamics and partnership from the perspectives of community members serving as co-researchers. Semistructured, in-depth interviews were conducted with 15 Latino immigrant co-researchers from an intervention project with Latinos Unidos por la Salud (LU-Salud), a community research team composed of Latino immigrant community members and academic investigators working in a health research partnership. A deductive framework approach guided the interview process and qualitative data analysis. The LU-Salud co-researchers described relationships, personal growth, beliefs/identity motivation (individual dynamics), coexistence (relational dynamics), diversity, and power/resource sharing (structural dynamics) as key foundational aspects of the community-academic partnership. Building on existing CBPR and team science frameworks, these findings demonstrate that group dynamics and partnership processes are fundamental drivers of individual-level motivation and meaning making, which ultimately sustain efforts of community partners to engage with the research team and also contribute to the achievement of intended research outcomes.

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