Katherine Ly

Project title: Getting Pediatric Care in Gentrifying King County

Degree: MPH | Program: Environmental and Occupational Health (EOH) | Project type: Thesis/Dissertation
Completed in: 2020 | Faculty advisor: Michele Andrasik


Introduction: Gentrification is a public health crisis and significant environmental injustice. Rapid gentrification of Seattle unequally burdens and displaces families of color further south in King County. Gentrification changes the environment, forcing readjustments that can compromise the continuity of education, healthcare, housing and employment. Displacement removes families from familiar community support and resources such as healthcare and other social services. Telehealth became widely available when the COVID-19 pandemic required care from a distance and may help increase access to healthcare for displaced families. This thesis explores opportunities to support families of an urban children’s community health clinic impacted by gentrification and displacement by identifying their needs, stressors, and perceptions of telehealth. Methods: A web-based survey was developed for this exploratory cross-sectional study. Qualitative and quantitative data from 177 randomly selected caregivers of pediatric patients were descriptively analyzed to assess needs, barriers, attitudes toward telehealth, and stressors related to displacement and gentrification.

Results: Telehealth is a useful tool to minimize risk of exposure during the pandemic and reduce travel stress. However, caregivers report less confidence in diagnosis and suitability of care delivered over telehealth, emphasizing quality is not comparable to in-person visits. Barriers to telehealth include limited internet access, video capability or comfort with technology, and privacy or safety concerns. A chi-square test found no difference in acceptability of telehealth among those who have and have not used telehealth. Housing instability is higher among participants than the rest of the regional area and a significant stressor. Affordability and safety/stability were top drivers of displacement. More support for stressful caregiving situations was desired along with gender-affirming and mental health care.

Conclusion: Mental health care and support for caregivers are essential for children’s wellness. Many needs identified by caregivers of the clinic’s patients are not medical, confirming the clinic’s health home model of healing with culturally responsive care and opportunities outside of exam rooms. Although in-person appointments are preferred, telehealth can offer flexibility to alleviate barriers like transportation and work conflicts. Increasing psychosocial support is crucial to mitigating negative effects of gentrification and the COVID-19 pandemic. An in-depth qualitative assessment of protective factors of health—including community, culture, and resilience—could better determine resources to promote lasting positive mental health such as support groups, information on housing rights, and education.

URI: http://hdl.handle.net/1773/47064