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Zoellner J, Porter K, Thatcher E, Kennedy E, Werth JL, Grossman B, Roatsey T, Hamilton H, Anderson R, Cohn W. A Multilevel Approach to Understand the Context and Potential Solutions for Low Colorectal Cancer (CRC) Screening Rates in Rural Appalachia Clinics. J Rural Health 2020; 37:585-601. [PMID: 33026682 DOI: 10.1111/jrh.12522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To explore system/staff- and patient-level opportunities to improve colorectal cancer (CRC) screening within an 11-clinic Federally Qualified Health Center (FQHC) in rural Appalachia with CRC screening rates around 22%-30%. METHODS Using a convergent parallel mixed-methods design, staff (n = 26) and patients (n = 60, age 50-75, 67% female, 83% <college, 47% Medicare, 23% Medicaid) were interviewed about CRC-related screening practices. Staff and patient interviews were guided by the Consolidated Framework for Implementation Research and Health Belief Model, respectively, and analyzed using a hybrid inductive-deductive approach. RESULTS Among staff, inner setting factors that could promote CRC screening included high workplace satisfaction, experiences tracking other cancer screenings, and a highly active Performance Improvement Committee. Inner setting hindering factors included electronic medical record inefficiencies and requiring patients to physically return fecal tests to the clinic. Outer setting CRC screening promoting factors included increased Medicaid access, support from outside organizations, and reporting requirements to external regulators, while hindering factors included poor social determinants of health, inadequate colonoscopy access, and lack of patient compliance. Among patients, perceived screening benefits were rated relatively higher than barriers. Top barriers included cost, no symptoms, fear, and transportation. Patients reported high likelihood of getting a stool-based test and colonoscopy if recommended, yet self-efficacy to prevent CRC was considerably lower. CONCLUSIONS Contextualized perceptions of barriers and practical opportunities to improve CRC screening rates were identified among staff and patients. To optimize multilevel CRC screening interventions in rural Appalachia clinics, future quality improvement, research, and policy efforts are needed to address identified challenges.
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Affiliation(s)
- Jamie Zoellner
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Kathleen Porter
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Esther Thatcher
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Erin Kennedy
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - James L Werth
- Stone Mountain Health Services, Damascus, Virginia.,Tri-Area Community Health, Laurel Fork, Virginia
| | - Betsy Grossman
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | | | | | - Roger Anderson
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Wendy Cohn
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
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Chiang YC, Li X, Lee CY, Rui J, Hu CW, Yang HJ, Chen SC, Chen T, Su Y, Kuo CY, Hsueh SC. Protective equipment and health education program could benefit students from dust pollution. AIR QUALITY, ATMOSPHERE, & HEALTH 2020; 14:371-380. [PMID: 32963632 PMCID: PMC7499415 DOI: 10.1007/s11869-020-00942-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/13/2020] [Indexed: 06/11/2023]
Abstract
In recent years, children living in the downstream of the Choshui River in Taiwan have been exposed to violent dust episodes. For the sake of the health of these children, we aimed to investigate the effectiveness of protective equipment (sand-proof plastic cover and air purifier) installed outside/inside the classrooms on students' pulmonary function and evaluate the health education program for preventing the adverse consequences of exposure to river-dust episodes. Public elementary school students in Yunlin County, which was severely affected by river-dust, were selected as the participants. Study 1 consisted of three-wave follow-up data (801 person-times) in high-/low-dust exposure regions to examine pulmonary function. Study 2 used 147 and 73 students in the high-/low-dust exposure regions, respectively, to establish our health education intervention. Paired t tests, repeated measures ANOVA, and generalized estimating equation were used to analyze the short- and long-term effects. The results showed that the students' pulmonary function in schools that installed protective equipment was improved. The health education (such as the usage of correct masks and our designed PM2.5 full-cover sand-proof clothing) improved the students' cognition and behaviors related to river-dust episodes and yielded both short- and long-term effects. Therefore, we suggest more schools with high-dust exposure to adopt protective equipment and health education program. Our designed PM2.5 full-cover sand-proof clothing can prevent from not only haze but also droplet transmission by infectious diseases such as COVID-19.
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Affiliation(s)
- Yi-Chen Chiang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian People’s Republic of China
| | - Xian Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian People’s Republic of China
| | - Chun-Yang Lee
- School of International Business, Xiamen University Tan Kah Kee College, Zhangzhou, Fujian People’s Republic of China
| | - Jia Rui
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian People’s Republic of China
| | - Chiung-Wen Hu
- Department of Public Health, Chung Shan Medical University, Taichung, Republic of China
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Republic of China
| | - Hao-Jan Yang
- Department of Public Health, Chung Shan Medical University, Taichung, Republic of China
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Republic of China
| | - Szu-Chieh Chen
- Department of Public Health, Chung Shan Medical University, Taichung, Republic of China
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Republic of China
| | - Tianmu Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian People’s Republic of China
| | - Yanhua Su
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian People’s Republic of China
| | - Chung-Yih Kuo
- Department of Public Health, Chung Shan Medical University, Taichung, Republic of China
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Republic of China
| | - Shao-Chieh Hsueh
- Institute of Economics, School of Economics, Wang Yanan Institute for Studies in Economics, Xiamen University, Xiamen, Fujian People’s Republic of China
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Sofija E, Plugge M, Wiseman N, Harris N. 'This is the beginning of the new me': process evaluation of a group fitness intervention to promote wellbeing in formerly homeless individuals. BMC Public Health 2018; 18:290. [PMID: 29482615 PMCID: PMC6389096 DOI: 10.1186/s12889-018-5175-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/14/2018] [Indexed: 11/18/2022] Open
Abstract
Background Homelessness is a persistent social issue with diverse impacts reaching far beyond individuals. Strategies and research concerning homelessness and health have largely focused on the risk factors and weaknesses of individuals. Such preoccupation has meant the potential strengths and resources within individuals, and so-called strength-based approaches have received less attention. Consequently, understanding how to effectively work with and engage this population in such interventions is limited. Methods The current study presents a process evaluation of an 8-week group fitness intervention in a supportive housing facility. The purpose of the intervention was to increase tenants’ physical activity together with opportunities for social interaction and support to, in turn, improve physical and mental wellbeing, and ultimately help individuals re-engage in their community. The evaluation focused on seven key components: context, recruitment, reach/participation, dose delivered, dose received, satisfaction/feedback and fidelity. Data collection methods included observation, attendance records and participant and staff interviews. Results Findings indicate the intervention was appropriate, well delivered, and enjoyed by participants who highlighted the importance of the sessions for their mental wellbeing and social inclusion. The intervention being conducted on site, the trainers’ ability to build good rapport with participants together with the supportive environment they created were central to successful implementation. Conclusion Group fitness sessions represent a promising intervention to improve wellbeing of this population. However, the need for more personalised care when delivering fitness sessions, due to the complexity of health issues prevalent in this population, was identified. This has implications for already limited resources, including staffing. Strategies to address this are required to ensure the continuity of fitness programs. Impact evaluation to quantify changes/improvements in wellbeing would complement this work and add much to understanding the effects of participation.
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Affiliation(s)
- Ernesta Sofija
- School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, Australia. .,Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, Australia.
| | - Melanie Plugge
- School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, Australia
| | - Nicola Wiseman
- School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, Australia
| | - Neil Harris
- School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, Australia
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Dunn SF, Lofters AK, Ginsburg OM, Meaney CA, Ahmad F, Moravac MC, Nguyen CTJ, Arisz AM. Cervical and Breast Cancer Screening After CARES: A Community Program for Immigrant and Marginalized Women. Am J Prev Med 2017; 52:589-597. [PMID: 28094134 DOI: 10.1016/j.amepre.2016.11.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 10/20/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Marginalized populations such as immigrants and refugees are less likely to receive cancer screening. Cancer Awareness: Ready for Education and Screening (CARES), a multifaceted community-based program in Toronto, Canada, aimed to improve breast and cervical screening among marginalized women. This matched cohort study assessed the impact of CARES on cervical and mammography screening among under-screened/never screened (UNS) attendees. METHODS Provincial administrative data collected from 1998 to 2014 and provided in 2015 were used to match CARES participants who were age eligible for screening to three controls matched for age, geography, and pre-education screening status. Dates of post-education Pap and mammography screening up to June 30, 2014 were determined. Analysis in 2016 compared screening uptake and time to screening for UNS participants and controls. RESULTS From May 15, 2012 to October 31, 2013, a total of 1,993 women attended 145 educational sessions provided in 20 languages. Thirty-five percent (118/331) and 48% (99/206) of CARES participants who were age eligible for Pap and mammography, respectively, were UNS on the education date. Subsequently, 26% and 36% had Pap and mammography, respectively, versus 9% and 14% of UNS controls. ORs for screening within 8 months of follow-up among UNS CARES participants versus their matched controls were 5.1 (95% CI=2.4, 10.9) for Pap and 4.2 (95%=CI 2.3, 7.8) for mammography. Hazard ratios for Pap and mammography were 3.6 (95% CI=2.1, 6.1) and 3.2 (95% CI=2.0, 5.3), respectively. CONCLUSIONS CARES' multifaceted intervention was successful in increasing Pap and mammography screening in this multiethnic under-screened population.
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Affiliation(s)
- Sheila F Dunn
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Aisha K Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Research on Inner City Health, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ophira M Ginsburg
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christopher A Meaney
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Farah Ahmad
- School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
| | - M Catherine Moravac
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Angela M Arisz
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Kousoulis AA, Ioakeim-Ioannidou M, Economopoulos KP. Access to health for refugees in Greece: lessons in inequalities. Int J Equity Health 2016; 15:122. [PMID: 27485633 PMCID: PMC4970229 DOI: 10.1186/s12939-016-0409-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/19/2016] [Indexed: 11/13/2022] Open
Abstract
Eastern Greek islands have been direct passageways of (mainly Syrian) refugees to the European continent over the past year. However, basic medical care has been insufficient. Despite calls for reform, the Greek healthcare system has for many years been costly and dysfunctional, lacking universal equity of access. Thus, mainly volunteers look after the refugee camps in the Greek islands under adverse conditions. Communicable diseases, trauma related injuries and mental health problems are the most common issues facing the refugees. The rapid changes in the epidemiology of multiple conditions that are seen in countries with high immigration rates, like Greece, demand pragmatic solutions. Best available knowledge should be used in delivering health interventions. So far, Greece is failed by international aid, and cross-border policies have not effectively tackled underlying reasons for ill-health in this context, like poverty, conflict and equity of access.
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Affiliation(s)
- Antonis A Kousoulis
- Society of Junior Doctors, Athens, Greece. .,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, 10 Norwood Avenue, London, HA0 1LY, UK.
| | | | - Konstantinos P Economopoulos
- Society of Junior Doctors, Athens, Greece.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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