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Dang JHT, Chen S, Hall S, Campbell JE, Chen MS, Doescher MP. Association Between COVID-19 and Planned and Postponed Cancer Screenings Among American Indian Adults Residing in California and Oklahoma, March-December 2020. Public Health Rep 2024:333549241254226. [PMID: 38832678 DOI: 10.1177/00333549241254226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE Little is known about how the COVID-19 pandemic affected cancer screenings among American Indian people residing in California and Oklahoma, 2 states with the largest American Indian populations. We assessed rates and factors associated with cancer screenings among American Indian adults during the pandemic. METHODS From October 2020 through January 2021, we surveyed 767 American Indian adults residing in California and Oklahoma. We asked participants whether they had planned to obtain screenings for breast cancer, cervical cancer, and colorectal cancer (CRC) from March through December 2020 and whether screening was postponed because of COVID-19. We calculated adjusted odds ratios (AORs) for factors associated with reasons for planned and postponed cancer screening. RESULTS Among 395 participants eligible for breast cancer screening, 234 (59.2%) planned to obtain the screening, 127 (54.3%) of whom postponed it. Among 517 participants eligible for cervical cancer screening, 357 (69.1%) planned to obtain the screening, 115 (32.2%) of whom postponed it. Among 454 participants eligible for CRC screening, 282 (62.1%) planned to obtain CRC screening, 80 of whom (28.4%) postponed it. In multivariate analyses, women who lived with a child (vs did not) had lower odds of planning to obtain a breast cancer screening (AOR = 0.6; 95% CI, 0.3-1.0). Adherence to social distancing recommendations was associated with planning to have and postponement of cervical cancer screening (AOR = 7.3; 95% CI, 0.9-58.9). Participants who received (vs did not receive) social or financial support had higher odds of planning to have CRC screening (AOR = 2.0; 95% CI, 1.1-3.9). CONCLUSION The COVID-19 pandemic impeded completion of cancer screenings among American Indian adults. Interventions are needed to increase the intent to receive evidence-based cancer screenings among eligible American Indian adults.
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Affiliation(s)
- Julie H T Dang
- Department of Public Health Sciences, Division of Health Policy and Management, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Spencer Hall
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Moon S Chen
- Department of Internal Medicine, Division of Hematology and Oncology, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Mark P Doescher
- Stephenson Cancer Center, College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma College of Health Science Center, Oklahoma City, OK, USA
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Loganathan T, Rui D, Pocock NS. Healthcare for migrant workers in destination countries: a comparative qualitative study of China and Malaysia. BMJ Open 2020; 10:e039800. [PMID: 33268413 PMCID: PMC7713184 DOI: 10.1136/bmjopen-2020-039800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/01/2020] [Accepted: 11/09/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES This paper explores policies addressing migrant worker's health and barriers to healthcare access in two middle-income, destination countries in Asia with cross-border migration to Yunnan province, China and international migration to Malaysia. DESIGN Qualitative interviews were conducted in Rui Li City and Tenchong County in Yunnan Province, China (n=23) and Kuala Lumpur, Malaysia (n=44), along with review of policy documents. Data were thematically analysed. PARTICIPANTS Participants were migrant workers and key stakeholders with expertise in migrant issues including representatives from international organisations, local civil society organisations, government agencies, medical professionals, academia and trade unions. RESULTS Migrant health policies at destination countries were predominantly protectionist, concerned with preventing transmission of communicable disease and the excessive burden on health systems. In China, foreign wives were entitled to state-provided maternal health services while female migrant workers had to pay out-of-pocket and often returned to Myanmar for deliveries. In Malaysia, immigration policies prohibit migrant workers from pregnancy, however, women do deliver at healthcare facilities. Mandatory HIV testing was imposed on migrants in both countries, where it was unclear whether and how informed consent was obtained from migrants. Migrants who did not pass mandatory health screenings in Malaysia would runaway rather than be deported and become undocumented in the process. Excessive attention on migrant workers with communicable disease control campaigns in China resulted in inadvertent stigmatisation. Language and financial barriers frustrated access to care in both countries. Reported conditions of overcrowding and inadequate healthcare access at immigration detention centres raise public health concern. CONCLUSIONS This study's findings inform suggestions to mainstream the protection of migrant workers' health within national health policies in two middle-income destination countries, to ensure that health systems are responsive to migrants' needs as well as to strengthen bilateral and regional cooperation towards ensuring better migration management.
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Affiliation(s)
- Tharani Loganathan
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Deng Rui
- School of Public Health, Kunming Medical University, Kunming, China
| | - Nicola Suyin Pocock
- Gender Violence & Health Centre, London School of Hygiene & Tropical Medicine, London, UK
- United Nations University - International Institute for Global Health (UNU-IIGH), Kuala Lumpur, Malaysia
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Adunlin G, Cyrus JW, Asare M, Sabik LM. Barriers and Facilitators to Breast and Cervical Cancer Screening Among Immigrants in the United States. J Immigr Minor Health 2019; 21:606-658. [PMID: 30117005 DOI: 10.1007/s10903-018-0794-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
To summarize the literature on barriers and facilitators to breast and cervical cancer screening among immigrants to the US. A literature review was conducted for studies on breast and cervical cancer screening among immigrant populations. A thematic analysis of 180 studies identified a variety of barriers and facilitators to screening at the personal and system levels. Personal barriers included lack of knowledge and insurance coverage, high cost of care, and immigration status. System barriers included poor access to services, lack of interpreter services, and insensitivity to patient needs. Facilitators to screening included knowledge of disease, access to information sources, physician recommendation, and social networks. Cultural norms and resource availability at the individual and system levels influence screening among immigrants. Health insurance coverage was found to be an important predictor of preventative screening use. Future research should seek to identify the best way to address this and other barriers to cancer screening among immigrants groups.
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Affiliation(s)
- Georges Adunlin
- McWhorter School of Pharmacy, Samford University, 2100 Lakeshore Dr, Homewood, AL, 35229, USA.
| | - John W Cyrus
- Tompkins-McCaw Library, Virginia Commonwealth University, 509 N 12th St, Richmond, VA, 23298-0430, USA
| | - Matthew Asare
- Department of Public Health, Baylor University, One Bear Place #97313, Waco, TX, 76798-7313, USA
| | - Lindsay M Sabik
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, 130 De Soto St., Pittsburgh, PA, 15261, USA
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Kung TPH, Gordon JR, Abdullahi A, Barve A, Chaudhari V, Kosambiya JK, Kumar A, Gamit S, Wells KJ. "My husband says this: If you are alive, you can be someone…": Facilitators and barriers to cervical cancer screening among women living with HIV in India. Cancer Causes Control 2019; 30:365-374. [PMID: 30809741 DOI: 10.1007/s10552-019-01145-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Women living with human immunodeficiency virus (WLWH) have a higher risk of cervical cancer than women without HIV. In addition, women in India experience a high burden of death from cervical cancer. This qualitative study evaluated individual and interpersonal factors influencing cervical cancer screening among WLWH in Surat, India. METHODS In-depth interviews were conducted with 25 WLWH and 15 stakeholders in Surat, India. Data were analyzed using directed content analysis to identify individual and intrapersonal barriers and facilitators. RESULTS WLWH lacked knowledge and reported being afraid of cervical cancer and cervical cancer screening but were interested in learning more about it. Interpersonal factors influencing cervical cancer screening included receipt or lack of instrumental and emotional family support, interactions with healthcare providers, and receipt or lack of information about cervical cancer and the Pap test from healthcare providers. CONCLUSION Widespread public education is necessary to increase awareness of cervical cancer and cervical cancer screening and to encourage family members to support women who wish to obtain screening. Patient- and provider-focused interventions may facilitate the process of providing cervical cancer care to WLWH who are obtaining care in busy public healthcare systems in India.
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Affiliation(s)
- Timothy-Paul H Kung
- San Diego State University, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
| | - Janna R Gordon
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
| | - Asha Abdullahi
- San Diego State University, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
| | - Apurva Barve
- Fielding School of Public Health, University of California, Los Angeles, 650 Charles E. Young Dr. South, 16-035 Center for Health Sciences, Los Angeles, CA, 90095-1772, USA
| | - Vipul Chaudhari
- Government Medical College, Surat, Majuragate, Surat, Gujarat, 395001, India
| | | | - Ambuj Kumar
- University of South Florida Morsani College of Medicine, 3515 East Fletcher Avenue, MDC 27, Tampa, FL, 33612, USA
| | - Sukesha Gamit
- Government Medical College, Surat, Majuragate, Surat, Gujarat, 395001, India
| | - Kristen J Wells
- San Diego State University, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA. .,San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA. .,Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92037, USA.
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Le D, Holt CL. CervixCheck: A Spiritually-Based Text Messaging Intervention to Promote Cervical Cancer Awareness and Pap Test Screening Intention among African-American Women. JOURNAL OF HEALTH COMMUNICATION 2018; 23:842-853. [PMID: 30300091 PMCID: PMC9159894 DOI: 10.1080/10810730.2018.1528317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND/PURPOSE On a national level, African-American women have a 34% higher incidence of cervical cancer and are twice as likely to die of the disease when compared to White women. In response to the need to improve cervical cancer prevention and Pap test screening knowledge and utilization, we developed and pilot tested a 16-day SMS text message-based intervention. The CervixCheck study was designed to develop, pilot test, and evaluate the feasibility, acceptability, and initial efficacy of a spiritually-based SMS text messaging intervention aimed at increasing cervical cancer awareness and Pap test screening intention in church-attending African-American women ages 21-65. Methods/Approach: The Theory of Planned Behavior guided the development of the CervixCheck intervention. This intervention utilized a non-experimental one-group pretest-posttest design. In this article, we present findings from the pilot testing phase. Of the 52 participants at baseline, 46 completed the post-program survey. RESULTS/FINDINGS The current study provides evidence for the early feasibility, high acceptability, and some initial efficacy of the CervixCheck intervention. There was a significant pre-post increase observed for knowledge about cervical cancer and the Pap test (p = .001) and subjective norms (p = .006). Findings post-intervention also revealed that 83% of participants reported being either "satisfied" or "very satisfied" with the CervixCheck intervention and 85% found the SMS text messages either "useful" or "very useful". CONCLUSIONS/SIGNIFICANCE A spiritually-based SMS text messaging intervention could be a culturally-appropriate and cost-effective method of promoting cervical cancer early detection information to church-attending African-American women.
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Affiliation(s)
- Daisy Le
- a Department of Behavioral and Community Health (DL, CH) , University of Maryland, School of Public Health , College Park , MD , USA
| | - Cheryl L Holt
- a Department of Behavioral and Community Health (DL, CH) , University of Maryland, School of Public Health , College Park , MD , USA
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Khazaee-Pool M, Yargholi F, Jafari F, Ponnet K. Exploring Iranian women's perceptions and experiences regarding cervical cancer-preventive behaviors. BMC Womens Health 2018; 18:145. [PMID: 30170632 PMCID: PMC6119270 DOI: 10.1186/s12905-018-0635-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/20/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Preventive behaviors regarding cervical cancer are essential for women's health. Even though many studies have addressed women's knowledge and attitudes toward cervical cancer, little information is available about their experiences of cervical cancer-preventive behaviors. Thus, the aim of this study is to explore the perceptions and experiences of Iranian women regarding cervical cancer-preventive behaviors. METHODS This study used a qualitative approach and was conducted in Zanjan, Iran. Participants included 27 women, aged 20-60 years, with no previous history of cervical cancer symptoms or diagnosis. Data were obtained through semi-structured in-depth interviews and focus group discussions. Inductive qualitative content analysis was employed to converge and compare themes through participant data. RESULTS The following six main themes emerged from the analysis: attitudes toward cervical cancer and preventive behaviors, preventive behaviors' concept, self-care, religion and culture, perceived social support, and awareness about cervical cancer and preventive behavior. The findings revealed that several women had misconceptions about cervical cancer and were even superstitious about the causes of it. Fear, shame, and embarrassment were reasons for not undertaking cervical cancer screening. Cervical cancer was also linked to worries about decreased marital satisfaction, sexuality, and femininity. However, religion was considered a positive factor to conducting cancer-preventive behaviors. CONCLUSIONS This study showed that improving knowledge about the causes of cervical cancer, increasing awareness of the potential consequences of it, and creating positive attitudes toward screening behavior might encourage Iranian women to perform cervical cancer-preventive behaviors.
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Affiliation(s)
- Maryam Khazaee-Pool
- Department of Health Education and Promotion, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Fatemeh Yargholi
- Department of Health Education and Promotion, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Fatemeh Jafari
- Department of Public Health, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Koen Ponnet
- Department of Communication Sciences, imec-mict-Ghent University, Ghent, Belgium
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McDonough AM, Vargas M, Nguyen-Rodriguez S, Garcia M, Galvez G, Rios-Ellis B. Mujer Sana, Familia Fuerte: The Effects of a Culturally-Relevant, Community-Based, <i>Promotores</i> Program to Increase Cervical Cancer Screening among Latinas. J Health Care Poor Underserved 2018; 27:568-79. [PMID: 27180696 DOI: 10.1353/hpu.2016.0094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Although cervical cancer can be prevented through screening and follow-up, Latinas' rate of Pap tests remains low due to knowledge gaps and cultural and attitudinal factors. METHODS This study used a single-group pre-/post-test design to evaluate the effectiveness of Mujer Sana, Familia Fuerte (Healthy Woman, Strong Family), an intervention intended to improve Latinas' cervical cancer prevention knowledge, attitudes, self-efficacy to obtain a Pap test, and intention to get tested. The intervention is delivered through a single session by promotores de salud, who use a culturally competent, linguistically appropriate toolkit. A total of 5,211 Latinas participated in the study. RESULTS The evaluation indicated that participants had increases in knowledge, positive attitudes, self-efficacy, and intention to test. CONCLUSION Latinas have a low rate of cervical cancer screening but a high rate of cervical cancer, and Mujer Sana, Familia Fuerte shows promise as a public health practice for use with this population.
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Macia L, Ruiz HC, Boyzo R, Documet PI. Promotores' perspectives on a male-to-male peer network. HEALTH EDUCATION RESEARCH 2016; 31:314-327. [PMID: 27102810 PMCID: PMC4872593 DOI: 10.1093/her/cyw016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 03/17/2016] [Indexed: 06/05/2023]
Abstract
Little documentation exists about male community health workers (promotores) networks. The experiences of promotores can provide input on how to attract, train, supervise and maintain male promotores in CHW programs. We present the experience and perspectives of promotores who participated in a male promotores network assisting Latino immigrant men in an emerging Latino community. All promotores in this community-based participatory study received payment for work 10 hours a week. We conducted qualitative interviews with all promotores starting the program, after 5 and 13 months. Three main themes emerged: 1) Men decided to become promotores to help others, yet appreciated being paid. 2) Promotores' learning experience was ongoing and was facilitated by a cooperative dynamic among them. Learning how to listen was crucial for promotores 3) Promotores experienced difficulty separating their personal lives form their role as a promotor We conclude that paying promotores facilitates the fulfillment of their drive to serve the community. Enhancing listening abilities needs to be part of promotores' training curricula. Finally, it is advisable to build a project with many opportunities for promotores and project staff to share professional and non-professional time and discuss their challenges.
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Affiliation(s)
- Laura Macia
- Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, 15261 PA, USA
| | - Hector Camilo Ruiz
- Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, 15261 PA, USA Anthropology, University of Pittsburgh, Pittsburgh, 15261 PA, USA
| | - Roberto Boyzo
- Latino Engagement Group for Salud (LEGS), Pittsburgh, 15261 PA, USA
| | - Patricia Isabel Documet
- Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, 15261 PA, USA
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Genoff MC, Zaballa A, Gany F, Gonzalez J, Ramirez J, Jewell ST, Diamond LC. Navigating Language Barriers: A Systematic Review of Patient Navigators' Impact on Cancer Screening for Limited English Proficient Patients. J Gen Intern Med 2016; 31:426-34. [PMID: 26786875 PMCID: PMC4803699 DOI: 10.1007/s11606-015-3572-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 06/18/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To systematically review the literature on the impact of patient navigators on cancer screening for limited English proficient (LEP) patients. DATA SOURCES Electronic databases (PubMed, PsycINFO via OVID, Web of Science, Cochrane, EMBASE, and Scopus) through 8 May 2015. ELIGIBILITY CRITERIA Articles in this review had: (1) a study population of LEP patients eligible for breast, cervical or colorectal cancer screenings, (2) a patient navigator intervention to provide services prior to or during cancer screening, (3) a comparison of the patient navigator intervention to either a control group or another intervention, and (4) language-specific outcomes related to the patient navigator intervention. STUDY APPRAISAL We assessed the quality of the articles using the Downs and Black Scale. RESULTS Fifteen studies met the inclusion criteria and evaluated the screening rates for breast, colorectal, and cervical cancer in 15 language populations. Fourteen studies resulted in improved screening rates for LEP patients between 7 and 60%. There was great variability in the patient navigation interventions evaluated. Training received by navigators was not reported in nine of the studies and no studies assessed the language skills of the patient navigators in English or the target language. LIMITATIONS This study is limited by the variability in study designs and limited reporting on patient navigator interventions, which reduces the ability to draw conclusions on the full effect of patient navigators. CONCLUSIONS Overall, we found evidence that navigators improved screening rates for breast, cervical and colorectal cancer screening for LEP patients. Future studies should systematically collect data on the training curricula for navigators and assess their English and non-English language skills in order to identify ways to reduce disparities for LEP patients.
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Affiliation(s)
- Margaux C Genoff
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan-Kettering Cancer Center, New York City, NY, USA
- Department of Psychology, New School for Social Research, New York, NY, USA
| | | | - Francesca Gany
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan-Kettering Cancer Center, New York City, NY, USA
| | - Javier Gonzalez
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan-Kettering Cancer Center, New York City, NY, USA
| | - Julia Ramirez
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan-Kettering Cancer Center, New York City, NY, USA
| | - Sarah T Jewell
- Medical Library, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Lisa C Diamond
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan-Kettering Cancer Center, New York City, NY, USA.
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Fisher EB, Coufal MM, Parada H, Robinette JB, Tang PY, Urlaub DM, Castillo C, Guzman-Corrales LM, Hino S, Hunter J, Katz AW, Symes YR, Worley HP, Xu C. Peer support in health care and prevention: cultural, organizational, and dissemination issues. Annu Rev Public Health 2014; 35:363-83. [PMID: 24387085 DOI: 10.1146/annurev-publhealth-032013-182450] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
As reviewed in the article by Perry and colleagues (2014) in this volume, ample evidence has documented the contributions of peer support (PS) to health, health care, and prevention. Building on that foundation, this article discusses characteristics, contexts, and dissemination of PS, including (a) fundamental aspects of the social support that is often central to it; (b) cultural influences and ways PS can be tailored to specific groups; (c) key features of PS and the importance of ongoing support and backup of peer supporters and other factors related to its success; (d) directions in which PS can be expanded beyond prevention and chronic disease management, such as in mental health or interventions to prevent rehospitalization; (e) other opportunities through the US Affordable Care Act, such as through patient-centered medical homes and chronic health homes; and (f) organizational and policy issues that will govern its dissemination. All these demonstrate the extent to which PS needs to reflect its contexts--intended audience, health problems, organizational and cultural settings--and, thus, the importance of dissemination policies that lead to flexible response to contexts rather than constraint by overly prescriptive guidelines.
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Affiliation(s)
- Edwin B Fisher
- Peers for Progress, American Academy of Family Physicians Foundation
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Cacari-Stone L, Avila M. Rethinking Research Ethics for Latinos: The Policy Paradox of Health Reform and the Role of Social Justice. ETHICS & BEHAVIOR 2012; 22:445-460. [PMID: 33935475 PMCID: PMC8086703 DOI: 10.1080/10508422.2012.729995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This article discusses the paradox of exclusion/inclusion: U.S. health policy prohibits Latinos who fall under certain classifications from accessing health services and insurance yet permits them to be "human subjects" in health research. We aim to advance the discussion of health research ethics post the Tuskegee syphilis experiment in Latinos by (a) tracing the impacts of policy exclusion and the social context of anti-Latino sentiment on Latinos' low participation rates in health research and inequitable access to treatment modalities; (b) challenging researchers to address social sources of vulnerabilities; and (c) offering recommendations on adapting a social justice ethical stance to address these challenges, which are part of the Tuskegee Study legacy.
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Affiliation(s)
- Lisa Cacari-Stone
- Department of Family & Community Medicine Robert Wood Johnson Foundation Center for Health Policy U.S.-Mexico Border Center of Excellence Consortium University of New Mexico Health Sciences Center
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Sirilak S, Okanurak K, Wattanagoon Y, Chatchaiyalerk S, Tornee S, Siri S. Community participation of cross-border migrants for primary health care in Thailand. Health Policy Plan 2012; 28:658-64. [PMID: 23132916 DOI: 10.1093/heapol/czs105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This is the first report of the large-scale utilization of migrants as health volunteers in a migrant primary-healthcare program. The program recruited migrants who volunteered to serve their communities. This study explores the identities of these volunteers, their relationship with program management, and their attitudes. The study also investigates the impact of the volunteers, from the migrants' and healthcare workers' perspective. The study was conducted in two provinces, Tak (northern Thailand) and Samut Sakhon (central Thailand). Primary and secondary information was collected. Mixed methods, comprising in-depth interviews, observation and questionnaires, were used to gather primary data from three groups of participants-migrant volunteers, migrants and healthcare workers. Secondary data, and in-depth interviews with healthcare workers, showed that migrant volunteers made a significant contribution to the provision of both preventive and curative services. The quantitative study covered 260 migrant volunteers and 446 migrants. The results found that <5% of volunteers were selected by the community. Almost all attended a training course. Most were assigned to be health communicators; four stated they did nothing. Volunteers' attitudes were very positive. Most migrants reported that the volunteers' work was useful. It was concluded that the migrant health-volunteer program did help deal with migrant health problems. However, management of the program should be closely considered for more effective outcomes.
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Affiliation(s)
- Supakit Sirilak
- Bureau of Policy and Strategy, Ministry of Public Health, Nonthaburi, Thailand
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Koskan AM, Friedman DB, Brandt HM, Walsemann KM, Messias DKH. Preparing promotoras to deliver health programs for Hispanic communities: training processes and curricula. Health Promot Pract 2012; 14:390-9. [PMID: 22982761 DOI: 10.1177/1524839912457176] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Training is an essential component of health programs that incorporate promotoras de salud (the Spanish term for community health workers) in the delivery of health education and behavioral interventions to Hispanics. During training sessions, promotoras are exposed to information and skill-building activities they need to implement the health programs. This analysis was one component of a broader study which explored program planners' approaches to recruiting and training promotoras to deliver and sustain health promotion programs for Hispanic women. The purpose of this study was to examine promotora-curriculum and training processes used to prepare promotoras to deliver health programs. The authors examined transcripts of 12 in-depth interviews with program planners and conducted a content analysis of seven different training materials used in their respective promotora programs. Interview themes and narratives included program planners' varying conceptualizations of promotora-training, including their personal definitions of "training the trainer," the practice of training a cadre of promotoras before selecting those best fit for the program, and the importance of providing goal-directed, in-depth training and supervision for promotoras. The content analysis revealed a variety of strategies used to make the training materials interactive and culturally competent. Study implications describe the importance of planners' provision of ongoing, goal-directed, and supervised training using both appropriate language and interactive methods to engage and teach promotoras.
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Abstract
To provide students with an unforgettable introduction to community-engaged scholarship, students partnered with the local health promoter of a marginalized community in northeastern Mexico to plan and conduct diabetes education classes with individualized follow-up. The author describes how students and faculty, inspired by this vision, integrated service, scholarship, and community engagement. The experience strengthened the health promoter's role, empowered patients with type 2 diabetes to improve self-care management, and provided students the opportunity to measure the impact of their interventions.
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McElmurry BJ, McCreary LL, Park CG, Ramos L, Martinez E, Parikh R, Kozik K, Fogelfeld L. Implementation, outcomes, and lessons learned from a collaborative primary health care program to improve diabetes care among urban Latino populations. Health Promot Pract 2008; 10:293-302. [PMID: 18344318 DOI: 10.1177/1524839907306406] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A collaborative primary health care service demonstration program was conducted to improve diabetes care among limited English-proficient (LEP) Latino patients. The intervention provided a multilevel approach aimed at patients and health care providers: Community health workers (CHWs) were mobilized to offer diabetes education in Spanish to LEP Latino diabetes patients, and health professions students and providers were offered intensive Spanish language training and cultural competency workshops. Positive outcomes for patients included a significant decrease in HbA1c. Health care providers reported improved patient communication and greater appreciation for cultural influences on health. Collaborating institutions realized ongoing benefits from expansion of CHWs' role and incorporation of cultural and language classes into health professions students' and house officers' training programs. Lessons learned included the importance of working together at every stage to identify and provide for the CHWs' training and support needs and to link the program's intervention with evaluation of multilevel outcomes.
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Affiliation(s)
- Beverly J McElmurry
- Global Health Leadership Office, University of Illinois at Chicago College of Nursing, in Chicago, Illinois 60612-7350, USA
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Viladrich A. From "shrinks" to "urban shamans": Argentine immigrants' therapeutic eclecticism in New York City. Cult Med Psychiatry 2007; 31:307-28. [PMID: 17879006 DOI: 10.1007/s11013-007-9058-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article examines Argentine immigrants' reliance on informal networks of care that enable their access to a variety of health providers in New York City (NYC). These providers range from health brokers (doctors known on a personal basis) to urban shamans, including folk healers and fortunetellers of various disciplines. A conceptual framework, based on analysis of social capital categories, is proposed for the examination of immigrants' access to valuable health resources, which are based on relationships of reciprocity and trust among parties. Results revealed immigrants' diverse patterns of health-seeking practices, most importantly their reliance on health brokers, epitomized by Argentine and Latino doctors who provide informal health assistance on the basis of sharing immigrants' social fields and ethnic interests. While mental health providers constitute a health resource shared by Argentines' social webs, urban shamans represent a trigger for the activation of women's emotional support webs. Contrary to the familiar assumption that dense and homogenous networks are more beneficial to their members, this article underscores the advantages of heterogeneous and fluid social webs that connect immigrants to a variety of resources, including referrals to diverse health practitioners.
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Affiliation(s)
- Anahí Viladrich
- Urban Public Health Program, The School of Health Sciences, Hunter College of the City University of New York, New York, NY 10010-2590, USA.
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