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Irie WC, Croston MA, Mahone A. The Impact of Providers as Health Discussants on Black Women's Interest in PrEP for HIV Prevention. J Int Assoc Provid AIDS Care 2024; 23:23259582231225278. [PMID: 38173234 PMCID: PMC10768609 DOI: 10.1177/23259582231225278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/27/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
This study sought to examine the role of providers as health discussants (HD) on interest in preexposure prophylaxis for HIV prevention in a national sample of adult Black cisgender women (N = 315). Health discussant networks, a type of social network, may be influential in HIV prevention efforts. These networks, often composed of individuals' families, have improved health utilization outcomes in other disciplines. However, health discussants in HIV prevention are understudied, especially when considering providers as network members. We conducted a cross-sectional online survey and collected socio-demographic information, sexual history, HIV concerns, PrEP attitudes, healthcare utilization, mistrust, social support, and HD information. We used descriptive statistics and logistic regression to analyze data. Associations between PrEP interest and variables were examined. We found that older, partnered, who had recent healthcare visits or health insurance were more likely to involve healthcare providers as discussants. Anticipated PrEP stigma decreased provider involvement. Among participants listing providers as discussants, there was a greater likelihood of interest in using PrEP. Our findings indicate that healthcare provider support and social factors are crucial in promoting PrEP engagement among Black women. Integrating social dynamics and positive provider-patient interactions is essential for successful PrEP implementation.
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Affiliation(s)
- Whitney C. Irie
- Social Work, Boston College School of Social Work, Chestnut Hill, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Merriah A. Croston
- School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Anais Mahone
- School of Social Work, Rutgers, The State University of New Jersey,
New Brunswick, NJ, USA
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Towfighi A, Cheng EM, Ayala-Rivera M, Barry F, McCreath H, Ganz DA, Lee ML, Sanossian N, Mehta B, Dutta T, Razmara A, Bryg R, Song SS, Willis P, Wu S, Ramirez M, Richards A, Jackson N, Wacksman J, Mittman B, Tran J, Johnson RR, Ediss C, Sivers-Teixeira T, Shaby B, Montoya AL, Corrales M, Mojarro-Huang E, Castro M, Gomez P, Muñoz C, Garcia D, Moreno L, Fernandez M, Lopez E, Valdez S, Haber HR, Hill VA, Rao NM, Martinez B, Hudson L, Valle NP, Vickrey BG. Effect of a Coordinated Community and Chronic Care Model Team Intervention vs Usual Care on Systolic Blood Pressure in Patients With Stroke or Transient Ischemic Attack: The SUCCEED Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2036227. [PMID: 33587132 PMCID: PMC7885035 DOI: 10.1001/jamanetworkopen.2020.36227] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
IMPORTANCE Few stroke survivors meet recommended cardiovascular goals, particularly among racial/ethnic minority populations, such as Black or Hispanic individuals, or socioeconomically disadvantaged populations. OBJECTIVE To determine if a chronic care model-based, community health worker (CHW), advanced practice clinician (APC; including nurse practitioners or physician assistants), and physician team intervention improves risk factor control after stroke in a safety-net setting (ie, health care setting where all individuals receive care, regardless of health insurance status or ability to pay). DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial included participants recruited from 5 hospitals serving low-income populations in Los Angeles County, California, as part of the Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities (SUCCEED) clinical trial. Inclusion criteria were age 40 years or older; experience of ischemic or hemorrhagic stroke or transient ischemic attack (TIA) no more than 90 days prior; systolic blood pressure (BP) of 130 mm Hg or greater or 120 to 130 mm Hg with history of hypertension or using hypertensive medications; and English or Spanish language proficiency. The exclusion criterion was inability to consent. Among 887 individuals screened for eligibility, 542 individuals were eligible, and 487 individuals were enrolled and randomized, stratified by stroke type (ischemic or TIA vs hemorrhagic), language (English vs Spanish), and site to usual care vs intervention in a 1:1 fashion. The study was conducted from February 2014 to September 2018, and data were analyzed from October 2018 to November 2020. INTERVENTIONS Participants randomized to intervention were offered a multimodal coordinated care intervention, including hypothesized core components (ie, ≥3 APC clinic visits, ≥3 CHW home visits, and Chronic Disease Self-Management Program workshops), and additional telephone visits, protocol-driven risk factor management, culturally and linguistically tailored education materials, and self-management tools. Participants randomized to the control group received usual care, which varied by site but frequently included a free BP monitor, self-management tools, and linguistically tailored information materials. MAIN OUTCOMES AND MEASURES The primary outcome was change in systolic BP at 12 months. Secondary outcomes were non-high density lipoprotein cholesterol, hemoglobin A1c, and C-reactive protein (CRP) levels, body mass index, antithrombotic adherence, physical activity level, diet, and smoking status at 12 months. Potential mediators assessed included access to care, health and stroke literacy, self-efficacy, perceptions of care, and BP monitor use. RESULTS Among 487 participants included, the mean (SD) age was 57.1 (8.9) years; 317 (65.1%) were men, and 347 participants (71.3%) were Hispanic, 87 participants (18.3%) were Black, and 30 participants (6.3%) were Asian. A total of 246 participants were randomized to usual care, and 241 participants were randomized to the intervention. Mean (SD) systolic BP improved from 143 (17) mm Hg at baseline to 133 (20) mm Hg at 12 months in the intervention group and from 146 (19) mm Hg at baseline to 137 (22) mm Hg at 12 months in the usual care group, with no significant differences in the change between groups. Compared with the control group, participants in the intervention group had greater improvements in self-reported salt intake (difference, 15.4 [95% CI, 4.4 to 26.0]; P = .004) and serum CRP level (difference in log CRP, -0.4 [95% CI, -0.7 to -0.1] mg/dL; P = .003); there were no differences in other secondary outcomes. Although 216 participants (89.6%) in the intervention group received some of the 3 core components, only 35 participants (14.5%) received the intended full dose. CONCLUSIONS AND RELEVANCE This randomized clinical trial of a complex multilevel, multimodal intervention did not find vascular risk factor improvements beyond that of usual care; however, further studies may consider testing the SUCCEED intervention with modifications to enhance implementation and participant engagement. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01763203.
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Affiliation(s)
- Amytis Towfighi
- University of Southern California, Los Angeles
- Los Angeles County Department of Health Services, Los Angeles, California
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- LAC+USC Medical Center, Los Angeles, California
| | | | - Monica Ayala-Rivera
- University of Southern California, Los Angeles
- Los Angeles County Department of Health Services, Los Angeles, California
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- LAC+USC Medical Center, Los Angeles, California
| | | | | | - David A. Ganz
- University of California, Los Angeles
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Martin L. Lee
- University of California, Los Angeles
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Nerses Sanossian
- University of Southern California, Los Angeles
- LAC+USC Medical Center, Los Angeles, California
| | - Bijal Mehta
- University of California, Los Angeles
- Harbor-UCLA Medical Center, Torrance, California
| | - Tara Dutta
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- University of Maryland, Baltimore
| | - Ali Razmara
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- Kaiser Permanente, Irvine, California
| | - Robert Bryg
- University of California, Los Angeles
- Olive View-UCLA Medical Center, Sylmar, California
| | - Shlee S. Song
- Cedars Sinai Medical Center, Los Angeles, California
| | - Phyllis Willis
- Watts Labor Community Action Committee, Los Angeles, California
| | - Shinyi Wu
- University of Southern California, Los Angeles
| | - Magaly Ramirez
- University of Washington School of Public Health, Seattle
| | - Adam Richards
- Community Partners International, San Francisco, California
| | | | | | - Brian Mittman
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Kaiser Permanente, Los Angeles, California
| | - Jamie Tran
- Harbor-UCLA Medical Center, Torrance, California
| | - Renee R. Johnson
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- LAC+USC Medical Center, Los Angeles, California
- California State University, Los Angeles
| | - Chris Ediss
- Rancho Los Amigos National Rehabilitation Center, Downey, California
| | - Theresa Sivers-Teixeira
- University of Southern California, Los Angeles
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- LAC+USC Medical Center, Los Angeles, California
| | - Betty Shaby
- Olive View-UCLA Medical Center, Sylmar, California
| | - Ana L. Montoya
- Harbor-UCLA Medical Center, Torrance, California
- Olive View-UCLA Medical Center, Sylmar, California
| | - Marilyn Corrales
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- LAC+USC Medical Center, Los Angeles, California
- University of California, Riverside
| | - Elizabeth Mojarro-Huang
- University of Southern California, Los Angeles
- LAC+USC Medical Center, Los Angeles, California
| | - Marissa Castro
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- Cedars Sinai Medical Center, Los Angeles, California
| | - Patricia Gomez
- Rancho Los Amigos National Rehabilitation Center, Downey, California
| | - Cynthia Muñoz
- University of Southern California, Los Angeles
- Rancho Los Amigos National Rehabilitation Center, Downey, California
| | - Diamond Garcia
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- Harbor-UCLA Medical Center, Torrance, California
| | - Lilian Moreno
- Rancho Los Amigos National Rehabilitation Center, Downey, California
| | - Maura Fernandez
- University of Southern California, Los Angeles
- LAC+USC Medical Center, Los Angeles, California
| | - Enrique Lopez
- Rancho Los Amigos National Rehabilitation Center, Downey, California
| | - Sarah Valdez
- Harbor-UCLA Medical Center, Torrance, California
| | - Hilary R. Haber
- Dimagi, Cambridge, Massachusetts
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Neal M. Rao
- University of California, Los Angeles
- Olive View-UCLA Medical Center, Sylmar, California
| | - Beatrice Martinez
- University of Southern California, Los Angeles
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- LAC+USC Medical Center, Los Angeles, California
- Harbor-UCLA Medical Center, Torrance, California
| | - Lillie Hudson
- University of Southern California, Los Angeles
- Rancho Los Amigos National Rehabilitation Center, Downey, California
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Lin AM, Vickrey BG, Barry F, Lee ML, Ayala-Rivera M, Cheng E, Montoya AV, Mojarro-Huang E, Gomez P, Castro M, Corrales M, Sivers-Teixeira T, Tran JL, Johnson R, Ediss C, Shaby B, Willis P, Sanossian N, Mehta B, Dutta T, Razmara A, Bryg R, Song S, Towfighi A. Factors Associated With Participation in the Chronic Disease Self-Management Program: Findings From the SUCCEED Trial. Stroke 2020; 51:2910-2917. [PMID: 32912091 PMCID: PMC8269960 DOI: 10.1161/strokeaha.119.028022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 08/07/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Self-management programs may improve quality of life and self-efficacy for stroke survivors, but participation is low. In a randomized controlled trial of a complex, multidisciplinary, team-based secondary stroke prevention intervention, we offered participants Chronic Disease Self-Management Program (CDSMP) workshops in addition to clinic visits and home visits. To enhance participation, workshops were facilitated by community health workers who were culturally and linguistically concordant with most participants and scheduled CDSMP sessions at convenient venues and times. Over time, we implemented additional strategies such as free transportation and financial incentives. In this study, we aimed to determine factors associated with CDSMP participation and attendance. METHODS From 2014 to 2018, 18 CDSMP workshop series were offered to 241 English and Spanish-speaking individuals (age ≥40 years) with recent stroke or transient ischemic attack. Zero-inflated Poisson regression was used to identify factors associated with participation and attendance (ie, number of sessions attended) in CDSMP. Missing values were imputed using multiple imputation methods. RESULTS Nearly one-third (29%) of intervention subjects participated in CDSMP. Moderate disability and more clinic/home visits were associated with participation. Participants with higher numbers of clinic and home visits (incidence rate ratio [IRR], 1.06 [95% CI, 1.01-1.12]), severe (IRR, 2.34 [95% CI, 1.65-3.31]), and moderately severe disability (IRR, 1.55 [95% CI, 1.07-2.23]), and who enrolled later in the study (IRR, 1.12 [95% CI, 1.08-1.16]) attended more sessions. Individuals with higher chaos scores attended fewer sessions (IRR, 0.97 [95% CI, 0.95-0.99]). CONCLUSIONS Less than one-third of subjects enrolled in the SUCCEED (Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities) intervention participated in CDSMP; however, participation improved as transportation and financial barriers were addressed. Strategies to address social determinants of health contributing to chaos and engage individuals in healthcare may facilitate attendance. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01763203.
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Affiliation(s)
- Amy M. Lin
- Department of Neurology, University of Southern California, Los Angeles, CA
- Department of Neurology, Washington University in St. Louis, St. Louis, MO
| | - Barbara G. Vickrey
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Frances Barry
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA
| | - Martin L. Lee
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Monica Ayala-Rivera
- Department of Neurology, University of Southern California, Los Angeles, CA
- Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA
- Department of Neurology, Los Angeles County-University of Southern California Medical Center, Los Angeles, CA
| | - Eric Cheng
- VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Ana V. Montoya
- Department of Neurology, Harbor-UCLA Medical Center, Torrance, CA
| | - Elizabeth Mojarro-Huang
- Department of Neurology, Los Angeles County-University of Southern California Medical Center, Los Angeles, CA
| | - Patricia Gomez
- Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA
| | - Marissa Castro
- Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA
| | - Marilyn Corrales
- Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA
- Department of Neurology, Los Angeles County-University of Southern California Medical Center, Los Angeles, CA
| | - Theresa Sivers-Teixeira
- Department of Neurology, University of Southern California, Los Angeles, CA
- Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA
| | - Jamie L. Tran
- Department of Neurology, Harbor-UCLA Medical Center, Torrance, CA
| | - Renee Johnson
- Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA
| | - Chris Ediss
- Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA
| | - Betty Shaby
- Department of Neurology, Olive View-UCLA Medical Center, Sylmar, CA
| | | | - Nerses Sanossian
- Department of Neurology, University of Southern California, Los Angeles, CA
- Department of Neurology, Los Angeles County-University of Southern California Medical Center, Los Angeles, CA
| | - Bijal Mehta
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA
- Department of Neurology, Harbor-UCLA Medical Center, Torrance, CA
| | - Tara Dutta
- VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Neurology, University of Maryland, Baltimore, MD
| | - Ali Razmara
- VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Neurology, Kaiser Permanente, Irvine, CA
| | - Robert Bryg
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA
- Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA
| | - Shlee Song
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Amytis Towfighi
- Department of Neurology, University of Southern California, Los Angeles, CA
- Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA
- Department of Neurology, Los Angeles County-University of Southern California Medical Center, Los Angeles, CA
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Perceived Functional Social Support and Self-Rated Health: The Health Promoting Effects of Instrumental Support for the Irish Community in London. J Immigr Minor Health 2020; 21:1004-1011. [PMID: 30382487 DOI: 10.1007/s10903-018-0831-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Despite an increasing volume of research on Irish migrants to the UK, limited scientific data exists on the main effects of social support on the health of this community. METHODS A sample of Irish migrants in London was purposefully recruited (n = 790). Linear regression was used to predict social support. Logistic regression examined the independent association between functional social support and self-rated health (SRH) controlling for low risk covariates. RESULTS Older age, economic factors and better SRH precited stronger social support. Irish migrants who reported being able to rely on at least three people in times of crisis and those who perceived stronger emotional support were more likely to report good SRH when adjusted for demography and socio-economic factors. As risks increased only perceived support in times of crisis predicted SRH. DISCUSSION Interventions which build reliable and trusted social networks may have a direct effect on migrant health.
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Menkin JA, Guan SSA, Araiza D, Reyes CE, Trejo L, Choi SE, Willis P, Kotick J, Jimenez E, Ma S, McCreath HE, Chang E, Witarama T, Sarkisian CA. Racial/Ethnic Differences in Expectations Regarding Aging Among Older Adults. THE GERONTOLOGIST 2018; 57:S138-S148. [PMID: 28854613 DOI: 10.1093/geront/gnx078] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 05/03/2017] [Indexed: 11/14/2022] Open
Abstract
Purpose of the Study The study identifies differences in age-expectations between older adults from Korean, Chinese, Latino, and African American backgrounds living in the United States. Design and Methods This study uses baseline demographic, age-expectation, social, and health data from 229 racial/ethnic minority seniors in a stroke-prevention intervention trial. Unadjusted regression models and pair-wise comparisons tested for racial/ethnic differences in age-expectations, overall, and across domain subscales (e.g., physical-health expectations). Adjusted regression models tested whether age-expectations differed across racial/ethnic groups after controlling for demographic, social, and health variables. Regression and negative binomial models tested whether age-expectations were consistently associated with health and well-being across racial/ethnic groups. Results Age-expectations differed by race/ethnicity, overall and for each subscale. African American participants expected the least age-related functional decline and Chinese American participants expected the most decline. Although African American participants expected less decline than Latino participants in unadjusted models, they had comparable expectations adjusting for education. Latino and African American participants consistently expected less decline than Korean and Chinese Americans. Acculturation was not consistently related to age-expectations among immigrant participants over and above ethnicity. Although some previously observed links between expectations and health replicated across racial/ethnic groups, in adjusted models age-expectations were only related to depression for Latino participants. Implications With a growing racial/ethnic minority older population in the United States, it is important to note older adults' age-expectations differ by race/ethnicity. Moreover, expectation-health associations may not always generalize across diverse samples.
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Affiliation(s)
- Josephine A Menkin
- Department of Psychology, University of California, Los Angeles.,David Geffen School of Medicine at University of California, Los Angeles
| | - Shu-Sha Angie Guan
- Child and Adolescent Development, California State University, Northridge
| | - Daniel Araiza
- Graduate School of Public Health, San Diego State University, California
| | - Carmen E Reyes
- Community Relations/Outreach, University of California Los Angeles.,Los Angeles Community Academic Partnership for Research in Aging
| | | | - Sarah E Choi
- School of Nursing, University of California Los Angeles
| | | | | | | | | | - Heather E McCreath
- David Geffen School of Medicine at University of California, Los Angeles
| | - Emiley Chang
- David Geffen School of Medicine at University of California, Los Angeles
| | - Tuff Witarama
- David Geffen School of Medicine at University of California, Los Angeles
| | - Catherine A Sarkisian
- David Geffen School of Medicine at University of California, Los Angeles.,VA Greater Los Angeles Healthcare System Geriatric Research Education and Clinical Center
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Towfighi A, Cheng EM, Ayala-Rivera M, McCreath H, Sanossian N, Dutta T, Mehta B, Bryg R, Rao N, Song S, Razmara A, Ramirez M, Sivers-Teixeira T, Tran J, Mojarro-Huang E, Montoya A, Corrales M, Martinez B, Willis P, Macias M, Ibrahim N, Wu S, Wacksman J, Haber H, Richards A, Barry F, Hill V, Mittman B, Cunningham W, Liu H, Ganz DA, Factor D, Vickrey BG. Randomized controlled trial of a coordinated care intervention to improve risk factor control after stroke or transient ischemic attack in the safety net: Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED). BMC Neurol 2017; 17:24. [PMID: 28166784 PMCID: PMC5294765 DOI: 10.1186/s12883-017-0792-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 01/09/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Recurrent strokes are preventable through awareness and control of risk factors such as hypertension, and through lifestyle changes such as healthier diets, greater physical activity, and smoking cessation. However, vascular risk factor control is frequently poor among stroke survivors, particularly among socio-economically disadvantaged blacks, Latinos and other people of color. The Chronic Care Model (CCM) is an effective framework for multi-component interventions aimed at improving care processes and outcomes for individuals with chronic disease. In addition, community health workers (CHWs) have played an integral role in reducing health disparities; however, their effectiveness in reducing vascular risk among stroke survivors remains unknown. Our objectives are to develop, test, and assess the economic value of a CCM-based intervention using an Advanced Practice Clinician (APC)-CHW team to improve risk factor control after stroke in an under-resourced, racially/ethnically diverse population. METHODS/DESIGN In this single-blind randomized controlled trial, 516 adults (≥40 years) with an ischemic stroke, transient ischemic attack or intracerebral hemorrhage within the prior 90 days are being enrolled at five sites within the Los Angeles County safety-net setting and randomized 1:1 to intervention vs usual care. Participants are excluded if they do not speak English, Spanish, Cantonese, Mandarin, or Korean or if they are unable to consent. The intervention includes a minimum of three clinic visits in the healthcare setting, three home visits, and Chronic Disease Self-Management Program group workshops in community venues. The primary outcome is blood pressure (BP) control (systolic BP <130 mmHg) at 1 year. Secondary outcomes include: (1) mean change in systolic BP; (2) control of other vascular risk factors including lipids and hemoglobin A1c, (3) inflammation (C reactive protein [CRP]), (4) medication adherence, (5) lifestyle factors (smoking, diet, and physical activity), (6) estimated relative reduction in risk for recurrent stroke or myocardial infarction (MI), and (7) cost-effectiveness of the intervention versus usual care. DISCUSSION If this multi-component interdisciplinary intervention is shown to be effective in improving risk factor control after stroke, it may serve as a model that can be used internationally to reduce race/ethnic and socioeconomic disparities in stroke in resource-constrained settings. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01763203 .
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Affiliation(s)
- Amytis Towfighi
- Los Angeles County Department of Health Services, Los Angeles, California USA
- University of Southern California, Los Angeles, California USA
- Rancho Los Amigos National Rehabilitation Center, Downey, California USA
| | - Eric M. Cheng
- University of California, Los Angeles (UCLA), Los Angeles, California USA
| | - Monica Ayala-Rivera
- Rancho Los Amigos National Rehabilitation Center, Downey, California USA
- University of California, Los Angeles (UCLA), Los Angeles, California USA
| | - Heather McCreath
- University of California, Los Angeles (UCLA), Los Angeles, California USA
| | - Nerses Sanossian
- University of Southern California, Los Angeles, California USA
- Los Angeles County-University of Southern California (USC) Medical Center, Los Angeles, California USA
| | - Tara Dutta
- Rancho Los Amigos National Rehabilitation Center, Downey, California USA
- Kaiser Permanente, Sacramento, California USA
| | - Bijal Mehta
- University of California, Los Angeles (UCLA), Los Angeles, California USA
- Harbor-UCLA Medical Center, Torrance, California USA
| | - Robert Bryg
- University of California, Los Angeles (UCLA), Los Angeles, California USA
- Olive View-UCLA Medical Center, Sylmar, California USA
| | - Neal Rao
- University of California, Los Angeles (UCLA), Los Angeles, California USA
- Olive View-UCLA Medical Center, Sylmar, California USA
| | - Shlee Song
- Cedars Sinai Medical Center, Los Angeles, California USA
| | - Ali Razmara
- Rancho Los Amigos National Rehabilitation Center, Downey, California USA
- Kaiser Permanente, Irvine, California USA
| | - Magaly Ramirez
- Fielding School of Public Health, Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, California USA
| | - Theresa Sivers-Teixeira
- University of Southern California, Los Angeles, California USA
- Rancho Los Amigos National Rehabilitation Center, Downey, California USA
| | - Jamie Tran
- Harbor-UCLA Medical Center, Torrance, California USA
| | - Elizabeth Mojarro-Huang
- Rancho Los Amigos National Rehabilitation Center, Downey, California USA
- Los Angeles County-University of Southern California (USC) Medical Center, Los Angeles, California USA
| | - Ana Montoya
- Rancho Los Amigos National Rehabilitation Center, Downey, California USA
- Harbor-UCLA Medical Center, Torrance, California USA
- Olive View-UCLA Medical Center, Sylmar, California USA
| | - Marilyn Corrales
- Los Angeles County Department of Health Services, Los Angeles, California USA
- Rancho Los Amigos National Rehabilitation Center, Downey, California USA
| | - Beatrice Martinez
- Rancho Los Amigos National Rehabilitation Center, Downey, California USA
- Harbor-UCLA Medical Center, Torrance, California USA
| | - Phyllis Willis
- Watts Labor Community Action Committee, Watts, California USA
| | - Mireya Macias
- Worker Education and Resource Center, Los Angeles, California USA
| | - Nancy Ibrahim
- Esperanza Community Housing, Los Angeles, California USA
| | - Shinyi Wu
- School of Social Work, Edward R. Roybal Institute on Aging, and Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, California USA
- RAND Corporation, Santa Monica, California USA
| | | | | | - Adam Richards
- University of California, Los Angeles (UCLA), Los Angeles, California USA
| | - Frances Barry
- University of California, Los Angeles (UCLA), Los Angeles, California USA
| | - Valerie Hill
- Rancho Los Amigos National Rehabilitation Center, Downey, California USA
| | - Brian Mittman
- Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California USA
| | - William Cunningham
- University of California, Los Angeles (UCLA), Los Angeles, California USA
| | - Honghu Liu
- University of California, Los Angeles (UCLA), Los Angeles, California USA
| | - David A. Ganz
- University of California, Los Angeles (UCLA), Los Angeles, California USA
- RAND Corporation, Santa Monica, California USA
- Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California USA
| | - Diane Factor
- Worker Education and Resource Center, Los Angeles, California USA
| | - Barbara G. Vickrey
- University of California, Los Angeles (UCLA), Los Angeles, California USA
- Icahn School of Medicine at Mount Sinai, New York, New York USA
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7
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Liou CL, Shenk D. A Case Study of Exploring Older Chinese Immigrants' Social Support within a Chinese Church Community in the United States. J Cross Cult Gerontol 2016; 31:293-309. [PMID: 27294347 DOI: 10.1007/s10823-016-9292-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The number of older Chinese immigrants living in the United States is increasing steadily. They are faced with challenges to meet their needs for social support and are unlikely to turn to formal services. This case study utilizes an ecological framework to analyze social support among Chinese immigrants age 65 year and older within a Christian Chinese church community, and to explore the ways in which a Chinese church functions as the source of social support for older Chinese immigrants. Seven months of participant observation and ten face-to-face, in-depth interviews were conducted with 65+ Chinese adults who attended one Chinese church in the Southern United State and included questions concerning patterns of support and personal relationships within the church. Findings revealed that gender, living arrangements, working experiences, ability to drive, and English language skills were related to support the older Chinese immigrants sought, received, and provided. Although the Chinese church can be a viable source of supplementary support, some participants in this study felt the support they received from the church was insufficient, particularly in terms of emotional support. Therefore, suggestions are outlined that may assist Chinese churches to be more proactive in better understanding and providing services that meet the different needs and desires of older Chinese immigrants.
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Affiliation(s)
- Chih-Ling Liou
- Department of Human Development and Family Studies, Kent State University at Stark, 6000 Frank Ave. N.W, North Canton, OH, 44720, USA.
| | - Dena Shenk
- Department of Anthropology, University of North Carolina at Charlotte, Charlotte, NC, USA
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Ko Y, Chee W, Im EO. Factors Associated With Perceived Health Status of Multiracial/Ethnic Midlife Women in the United States. J Obstet Gynecol Neonatal Nurs 2016; 45:378-90. [DOI: 10.1016/j.jogn.2016.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 11/29/2022] Open
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Abstract
The current study used grounded theory methods to analyze trans men’s positive emotions. The sample included 11 participants who were assigned a female sex at birth and currently identify with a binary male identity. Results yielded eight positive emotion themes emerging for trans men, which included the following: confidence, comfort, connection, feeling alive, amazement, pride, happiness, and interpersonal reactionary emotions. Participants reported specific gender experiences within these themes, including a sense of brotherhood, excitement related to taking testosterone, authentic pride in identifying as a man, and happiness connected to others using correct gender language (e.g., pronouns, family labels, greetings). A theoretical model from the eight themes and 39 higher order categories emerged, indicating the importance of initial internal emotions, confidence related to trans men’s identity processes, and the ways in which positive interpersonal interactions affect positive emotions. Implications include using emotion-focused therapy and including more positivity into trans individuals’ experiences and emotions.
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Schuler M, Musekamp G, Bengel J, Nolte S, Osborne RH, Faller H. Measurement invariance across chronic conditions: a systematic review and an empirical investigation of the Health Education Impact Questionnaire (heiQ™). Health Qual Life Outcomes 2014. [PMID: 24758346 DOI: 10.1186/1477-7525-12-56.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To examine whether lack of measurement invariance (MI) influences mean comparisons among different disease groups, this paper provides (1) a systematic review of MI in generic constructs across chronic conditions and (2) an empirical analysis of MI in the Health Education Impact Questionnaire (heiQ™). METHODS (1) We searched for studies of MI among different chronic conditions in online databases. (2) Multigroup confirmatory factor analyses were used to study MI among five chronic conditions (orthopedic condition, rheumatism, asthma, COPD, cancer) in the heiQ™ with N = 1404 rehabilitation inpatients. Impact on latent and composite mean differences was examined. RESULTS (1) A total of 30 relevant studies suggested that about one in three items lacked MI. However, only four studies examined impact on latent mean differences. Scale means were only affected in one of these three studies. (2) Across the eight heiQ™ scales, seven scales had items with lack of MI in at least one disease group. However, in only two heiQ™ scales were some latent or composite mean differences affected. CONCLUSIONS Lack of MI among disease groups is common and may have a relevant influence on mean comparisons when using generic instruments. Therefore, when comparing disease groups, tests of MI should be implemented. More studies of MI and according impact on mean differences in generic questionnaires are needed.
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Affiliation(s)
- Michael Schuler
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences Section, University of Würzburg, Klinikstr, 3, D-97070 Wuerzburg, Germany.
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Schuler M, Musekamp G, Bengel J, Nolte S, Osborne RH, Faller H. Measurement invariance across chronic conditions: a systematic review and an empirical investigation of the Health Education Impact Questionnaire (heiQ™). Health Qual Life Outcomes 2014; 12:56. [PMID: 24758346 PMCID: PMC4021509 DOI: 10.1186/1477-7525-12-56] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 04/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To examine whether lack of measurement invariance (MI) influences mean comparisons among different disease groups, this paper provides (1) a systematic review of MI in generic constructs across chronic conditions and (2) an empirical analysis of MI in the Health Education Impact Questionnaire (heiQ™). METHODS (1) We searched for studies of MI among different chronic conditions in online databases. (2) Multigroup confirmatory factor analyses were used to study MI among five chronic conditions (orthopedic condition, rheumatism, asthma, COPD, cancer) in the heiQ™ with N = 1404 rehabilitation inpatients. Impact on latent and composite mean differences was examined. RESULTS (1) A total of 30 relevant studies suggested that about one in three items lacked MI. However, only four studies examined impact on latent mean differences. Scale means were only affected in one of these three studies. (2) Across the eight heiQ™ scales, seven scales had items with lack of MI in at least one disease group. However, in only two heiQ™ scales were some latent or composite mean differences affected. CONCLUSIONS Lack of MI among disease groups is common and may have a relevant influence on mean comparisons when using generic instruments. Therefore, when comparing disease groups, tests of MI should be implemented. More studies of MI and according impact on mean differences in generic questionnaires are needed.
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Affiliation(s)
- Michael Schuler
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences Section, University of Würzburg, Klinikstr, 3, D-97070 Wuerzburg, Germany.
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12
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Wong ST, Wu A, Gregorich S, Pérez-Stable EJ. What Type of Social Support Influences Self-Reported Physical and Mental Health Among Older Women? J Aging Health 2014; 26:663-678. [PMID: 24733751 DOI: 10.1177/0898264314527478] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We examined which types of social support were associated with older women's self-report of physical and mental health and whether the effects of social support were moderated by race/ethnicity. METHOD Women completed a health behavior survey that included the Medical Outcomes Study-Short Form-12 (MOS SF-12). Single race/ethnic group regressions examined whether different types of social support were related to health. We also examined Pratt's relative importance measures. RESULTS Emotional support had the strongest effect on both physical and mental health, explaining the highest amount of variation, except among African Americans. Race/ethnicity moderated the association of informational support for Asian women's reports of their mental health. DISCUSSION For clinicians, assessing individuals' emotional support is important for maintaining or increasing physical and mental health. Clinicians can also assess Asian women's stress, providing informational support accordingly as too much information could be detrimental to their health. For researchers, the inclusion of emotional support items is the most important.
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Affiliation(s)
- Sabrina T Wong
- University of British Columbia, School of Nursing and Centre for Health Services and Policy Research, Vancouver, Canada University of California, San Francisco, USA
| | - Amery Wu
- University of British Columbia, School of Nursing and Centre for Health Services and Policy Research, Vancouver, Canada
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Greene MC, Zhang J, Li J, Desai M, Kershaw T. Mental health and social support among HIV-positive injection drug users and their caregivers in China. AIDS Behav 2013; 17:1775-84. [PMID: 23283579 DOI: 10.1007/s10461-012-0396-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The burden of HIV/AIDS in China is due to injection drug use. Non-clinical caregivers provide much of the care for HIV patients but are often not included in HIV care or research. The objective of this study is to examine the relationships between the caregiver context and mental health of HIV-positive injection drug users and their caregivers. We interviewed 96 patient-caregiver dyads using quantitative methods. A conceptual model was developed as a framework for multivariate linear regression modeling. The strongest predictor of poor patient mental health was lack of social support, which was largely determined by the caregiver's stigma towards HIV/AIDS and caregiver burden. Patient disability and caregiver burden were the primary predictors of poor caregiver mental health. The interrelated nature of caregiver and patient mental health supports the inclusion of caregiver health into the patient's HIV/AIDS treatment to maximize support provision and health for the patient and caregiver.
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Rodebaugh TL, Fernandez KC, Levinson CA. Testing the effects of social anxiety disorder on friendship quality across gender and ethnicity. Cogn Behav Ther 2012; 41:130-9. [PMID: 22428540 PMCID: PMC3836437 DOI: 10.1080/16506073.2012.661451] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Previous research suggests that social anxiety disorder (SAD) has a specific relationship with impairment in friendship quality; however, potential moderators of this relationship have not been tested. The current study examines whether the specific effect of SAD on friendship quality is stable or varies across gender and ethnicity in a large epidemiological dataset. Results indicate that the underlying construct of friendship quality differed slightly but significantly between men and women; as a result, effects of SAD were tested in men and women separately. After partially constraining friendship quality across ethnic groups, our results indicated that the relationship between SAD and friendship quality remained robust in all groups. In addition to replicating the finding that SAD specifically relates to perceived friendship quality, the current study highlights the need to test whether underlying constructs such as friendship quality are consistent across the groups that make up heterogeneous samples.
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Affiliation(s)
- Thomas L Rodebaugh
- Department of Psychology, Washington University in St Louis, St Louis , MO 63130, USA.
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Webb JR, Robinson EAR, Brower KJ. Mental health, not social support, mediates the forgiveness-alcohol outcome relationship. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2012; 25:462-73. [PMID: 21443306 DOI: 10.1037/a0022502] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Religiousness and spirituality are important to most Americans, and evidence suggests that they may contribute to both addiction and recovery. Forgiveness is a specific dimension of religiousness and spirituality that may enhance recovery, but the mechanism(s) through which it operates is unknown. We hypothesized that higher levels of forgiveness would be associated with higher levels of mental health and social support, which, in turn, would be associated with improved alcohol-related outcomes. Baseline and 6-month longitudinal data from a sample of 149 individuals with alcohol use disorders seeking outpatient substance abuse treatment were analyzed through multiple-mediation statistical techniques. While previous research has shown direct associations among forgiveness, alcohol-related outcomes, mental health, and social support, this study found that the direct associations between forgiveness and alcohol-related outcomes were no longer significant when mental health and social support were analyzed as mediator variables. At baseline, for each alcohol-related outcome measured (alcohol-related problems, percent heavy drinking days, percent days abstinent, and drinks per drinking day), mental health individually played a role in the relationship with both forgiveness of self and forgiveness of others, fully mediating or operating through an indirect-only pathway. For alcohol-related problems only, mental health fully mediated the relationship with forgiveness of self at follow-up and operated through an indirect-only pathway with forgiveness of others longitudinally. Social support and feeling forgiven by God were nonsignificant variables at baseline, follow-up, and longitudinally.
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Affiliation(s)
- Jon R Webb
- Department of Psychology, East Tennessee State University, Box 70649, Johnson City, TN 37614-1702, USA.
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