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Gutierrez-Wu JC, Ritter V, McMahon EL, Heerman WJ, Rothman RL, Perrin EM, Shonna Yin H, Sanders LM, Delamater AM, Flower KB. Language Disparities in Caregiver Satisfaction with Physician Communication at Well Visits from 0-2 Years. Acad Pediatr 2024; 24:930-939. [PMID: 38458488 PMCID: PMC11283991 DOI: 10.1016/j.acap.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE This study aimed to describe caregiver satisfaction with physician communication over the first two years of life and examine differences by preferred language and the relationship to physician continuity. METHODS Longitudinal data were collected at well visits (2 months to 2 years) from participants in a randomized controlled trial to prevent childhood obesity. Satisfaction with communication was assessed using the validated Communication Assessment Tool (CAT) questionnaire. Changes in the odds of optimal scores were estimated in mixed-effects logistic regression models to evaluate the associations between satisfaction over time and language, interpreter use, and physician continuity. RESULTS Of 865 caregivers, 35% were Spanish-speaking. Spanish-speaking caregivers without interpreters had lower odds of an optimal satisfaction score compared with English speakers during the first 2 years, beginning at 2 months [OR 0.64 (95% CI: 0.43, 0.95)]. There was no significant difference in satisfaction between English-speaking caregivers and Spanish-speaking caregivers with an interpreter. The odds of optimal satisfaction scores increased over time for both language groups. For both language groups, odds of an optimal satisfaction score decreased each time a new physician was seen for a visit [OR 0.82 (95% CI: 0.69, 0.97)]. CONCLUSION Caregiver satisfaction with physician communication improves over the first two years of well-child visits for both English- and Spanish-speakers. A loss of physician continuity over time was also associated with lower satisfaction. Future interventions to ameliorate communication disparities should ensure adequate interpreter use for primarily Spanish-speaking patients and address continuity issues to improve communication satisfaction.
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Affiliation(s)
- Jennifer C Gutierrez-Wu
- Division of General Pediatrics and Adolescent Medicine (JC Gutierrez-Wu, V Ritter, and KB Flower), Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research (JC Gutierrez-Wu), University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Victor Ritter
- Division of General Pediatrics and Adolescent Medicine (JC Gutierrez-Wu, V Ritter, and KB Flower), Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Division of General Pediatrics (V Ritter and LM Sanders), Stanford University School of Medicine, Palo Alto, Calif
| | - Ellen L McMahon
- Division of General Pediatrics (EL McMahon, WJ Heerman, and RL Rothman), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn
| | - William J Heerman
- Division of General Pediatrics (EL McMahon, WJ Heerman, and RL Rothman), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Russell L Rothman
- Division of General Pediatrics (EL McMahon, WJ Heerman, and RL Rothman), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Eliana M Perrin
- Division of General Pediatrics (EM Perrin), Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md; Johns Hopkins University School of Nursing (EM Perrin), Baltimore, Md; Department of Population, Family, and Reproductive Health (EM Perrin), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - H Shonna Yin
- Departments of Pediatrics and Population Health (H Shonna Yin), New York University School of Medicine, New York City, NY
| | - Lee M Sanders
- Division of General Pediatrics (V Ritter and LM Sanders), Stanford University School of Medicine, Palo Alto, Calif
| | - Alan M Delamater
- Department of Pediatrics (AM Delamater), University of Miami Miller School of Medicine, Miami, Fla
| | - Kori B Flower
- Division of General Pediatrics and Adolescent Medicine (JC Gutierrez-Wu, V Ritter, and KB Flower), Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Fortmann AL, Soriano EC, Gallo LC, Clark TL, Spierling Bagsic SR, Sandoval H, Jones JA, Roesch S, Gilmer T, Schultz J, Bodenheimer T, Philis-Tsimikas A. Medical Assistant Health Coaching for Type 2 Diabetes in Primary Care: Results From a Pragmatic Cluster Randomized Controlled Trial. Diabetes Care 2024; 47:1171-1180. [PMID: 38752923 PMCID: PMC11208755 DOI: 10.2337/dc23-2487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/07/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE This cluster (clinic-level) randomized controlled trial (RCT) compared medical assistant (MA) health coaching (MAC) with usual care (UC) among at-risk adults with type 2 diabetes in two diverse real-world primary care environments: a federally qualified health center (FQHC; Neighborhood Healthcare) and a large nonprofit private insurance-based health system (Scripps Health). RESEARCH DESIGN AND METHODS A total of 600 adults with type 2 diabetes who met one or more of the following criteria in the last 90 days were enrolled: HbA1c ≥8% and/or LDL cholesterol ≥100 mg/dL and/or systolic blood pressure (SBP) ≥140 mmHg. Participants at MAC clinics received in-person and telephone self-management support from a specially trained MA health coach for 12 months. Electronic medical records were used to examine clinical outcomes in the overall sample. Behavioral and psychosocial outcomes were evaluated in a subsample (n = 300). RESULTS All clinical outcomes improved significantly over 1 year in the overall sample (P < 0.001). The reduction in HbA1c was significantly greater in the MAC versus UC group (unstandardized Binteraction = -0.06; P = 0.002). A significant time by group by site interaction also showed that MAC resulted in greater improvements in LDL cholesterol than UC at Neighborhood Healthcare relative to Scripps Health (Binteraction = -1.78 vs. 1.49; P < 0.05). No other statistically significant effects were observed. CONCLUSIONS This was the first large-scale pragmatic RCT supporting the real-world effectiveness of MAC for type 2 diabetes in U.S. primary care settings. Findings suggest that this team-based approach may be particularly effective in improving diabetes outcomes in FQHC settings.
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Affiliation(s)
| | | | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, CA
| | - Taylor L. Clark
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA
| | | | | | | | - Scott Roesch
- Department of Psychology, San Diego State University, San Diego, CA
| | - Todd Gilmer
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA
| | | | - Thomas Bodenheimer
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, CA
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Martinez A, Warner A, Powe NR, Fernandez A, Tuot DS. Association between English Proficiency and Kidney Disease Knowledge and Communication Quality among Patients with ESKD. KIDNEY360 2024; 5:560-568. [PMID: 38356152 PMCID: PMC11093550 DOI: 10.34067/kid.0000000000000398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
Key Points In one hospital-based safety-net dialysis unit, only one half of patients with ESKD knew their cause of kidney failure, which did not differ by English proficiency status. Patients with limited English proficiency (versus English-proficient patients) reported poorer communication with the dialysis care team (less listening, fewer clear explanations, less time spent). We highlight the need for tailored, patient-centered communication between limited English-proficient patients and dialysis care team members. Background ESKD is a chronic health condition for which communication between health care teams and patients is important to guide patient self-management activities. Yet, little is known about the quality of communication among patients with ESKD and their care team members. We examined the influence of patient's limited English proficiency (LEP) status on communication experiences at one dialysis center. Methods A survey was administered to adults receiving ESKD care at a dialysis unit within a public health care delivery system between July 2022 and February 2023, to ascertain kidney disease knowledge and perceptions of communication quality with the dialysis care team. Multivariable logistic and ordinal logistic regression models adjusted for age and sex were used to determine associations between LEP status and CKD knowledge. Results Among 93 eligible patients, 88.2% (n =82) completed the survey. Approximately 37.8% (n =31) had LEP, mean age was 58.8 years, 68.3% were men, mean dialysis vintage was 3.9 years, and 25% had a positive depression screen (LEP 30%; English-proficient 22%). A higher proportion of English-proficient patients screened positive for limited health literacy compared to those with LEP (74.5% versus 38.7%, P = 0.002). Overall, knowledge of assigned cause of ESKD (53.4%) and CKD/transplant knowledge (57.3%) was suboptimal. After adjustment, LEP status was not significantly associated with knowing the correct cause of kidney failure (odds ratio, 0.49; 95% confidence interval, 0.19 to 1.27) but was significantly associated with having a higher score on a CKD/transplant knowledge scale (odds ratio, 3.99; 95% confidence interval, 1.66 to 9.58). Patients with LEP reported poorer communication quality with dialysis providers and staff (less listening, fewer clear explanations, less time spent with patients) compared with English-proficient patients, although differences were not statistically significant. Conclusions Overall communication between patients with ESKD and members of the dialysis care team was suboptimal, regardless of English proficiency. Interventions to enhance communication for ESKD patients are needed.
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Affiliation(s)
- Ashley Martinez
- Division of Nephrology, Stanford University School of Medicine, Stanford, California
| | - Austin Warner
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Neil R. Powe
- Department of Medicine, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- Center for Vulnerable Populations, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
| | - Alicia Fernandez
- Department of Medicine, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- Center for Vulnerable Populations, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
| | - Delphine S. Tuot
- Department of Medicine, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- Center for Vulnerable Populations, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
- Division of Nephrology, University of California, San Francisco, San Francisco, California
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Litvak AL, Lin NA, Hynes KK, Strelzow JA, Conti Mica MA, Stepan JG. Are Social Deprivation and Low Traditional Health Literacy Associated With Higher PROMIS CAT Completion in Orthopaedic Surgery? Clin Orthop Relat Res 2024; 482:442-454. [PMID: 37732819 PMCID: PMC10871763 DOI: 10.1097/corr.0000000000002861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/18/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND The Patient-Reported Outcomes Measurement Information System® (PROMIS®) may be used to assess an individual patient's perspective of their physical, mental, and social health through either standard or computer adaptive testing (CAT) patient questionnaires. These questionnaires are used across disciplines; however, they have seen considerable application in orthopaedic surgery. Patient characteristics associated with PROMIS CAT completion have not been examined within the context of social determinants of health, such as social deprivation or health literacy, nor has patient understanding of the content of PROMIS CAT been assessed. QUESTIONS/PURPOSES (1) What patient demographics, including social deprivation, are associated with completion of PROMIS CAT questionnaires? (2) Is health literacy level associated with completion of PROMIS CAT questionnaires? (3) Do patients with lower health literacy have a higher odds of completing PROMIS CAT without fully understanding the content? METHODS Between June 2022 and August 2022, a cross-sectional study was performed via a paper survey administered to patients at a single, urban, quaternary academic medical center in orthopaedic subspecialty clinics of foot and ankle, trauma, and hand/upper extremity surgeons. We considered all English-speaking patients aged 18 or older, including those with limited reading and/or writing abilities, as eligible provided they received an iPad in clinic to complete the PROMIS CAT questionnaire as part of their routine standard clinical care or they completed the questionnaire via a patient portal before the visit. In all, 946 patients were considered eligible during the study period and a convenience sample of 36% (339 of 946) of patients was approached for inclusion due to clinic time constraints. Fifteen percent (52 of 339) declined to participate, leaving 85% (287 of 339) of patients for analysis here. Median (range) age of study participants was 49 years (35 to 64). Fifty-eight percent (167 of 287) of study participants self-identified as non-Hispanic Black or African American and 26% (75 of 287) as non-Hispanic White. Even proportions were observed across education levels (high school graduate or less, 29% [82 of 287]; some college, 25% [73 of 287]; college graduate, 25% [71 of 287]; advanced degree, 20% [58 of 287]). Eighteen percent (52 of 287) of patients reported an annual income bracket of USD 0 to 13,000, and 17% (48 of 287) reported more than USD 120,000. Forty-six percent (132 of 287) of patients worked full-time, 21% (59 of 287) were retired, and 23% (66 of 287) were unemployed or on disability. The primary outcome of interest was self-reported PROMIS CAT questionnaire completion grouped as: fully completed, partially completed, or no part completed. Overall, self-reported PROMIS CAT questionnaire completion proportions were: 80% (229 of 287) full completion, 13% (37 of 287) partial completion, and 7% (21 of 287) no part completed. We collected the National Area Deprivation Index (ADI) score and the Brief Health Literacy Screening Tool (BRIEF) as part of the study survey to associate with level of completion. Additionally, patient understanding of PROMIS CAT was assessed through Likert-scaled responses to a study survey question that directly asked whether the patient understood all of the questions on the PROMIS CAT questionnaire. Responses to this question may have been limited by social desirability bias, and hence may overestimate how many individuals genuinely understood the questionnaire content. However, the benefit of this approach was it efficiently allowed us to estimate the ceiling effect of patient comprehension of PROMIS CAT and likely had a high degree of specificity for detecting lack of comprehension. RESULTS ADI score adjusted for age was not associated with PROMIS CAT completion (partial completion OR 1.00 [95% CI 0.98 to 1.01]; p = 0.72, no part completed OR 1.01 [95% CI 0.99 to 1.03]; p = 0.45). Patients with lower health literacy scores, however, were more likely to not complete any part of their assigned questionnaires than patients with higher scores (no part completed OR 0.85 [95% CI 0.75 to 0.97]; p = 0.02). Additionally, 74% (26 of 35) of patients who did not fully understand all of the PROMIS CAT questionnaire questions still fully completed them-hence, 11% (26 of 229) of all patients who fully completed PROMIS CAT did not fully understand the content. Among patients self-reporting full completion of PROMIS CAT with health literacy data (99% [227 of 229]), patients with inadequate/marginal health literacy were more likely than patients with adequate health literacy to not fully understand all of the questions (21% [14 of 67] versus 8% [12 of 160], OR 3.26 [95% CI 1.42 to 7.49]; p = 0.005). CONCLUSION Within an urban, socioeconomically diverse, orthopaedic patient population, health literacy was associated with PROMIS CAT questionnaire completion. Lower health literacy levels increased the likelihood of not completing any part of the assigned PROMIS CAT questionnaires. Additionally, patients completed PROMIS CAT without fully understanding the questions. This indicates that patient completion does not guarantee comprehension of the questions nor validity of their scores, even more so among patients with low health literacy. This is a substantive concern for fidelity of data gathered from PROMIS CAT. CLINICAL RELEVANCE Clinical implementation of the PROMIS CAT in orthopaedic populations will benefit from further research into health literacy to increase questionnaire completion and to ensure that patients understand the content of the questions they are answering, which will increase the internal validity of the outcome measure.
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Affiliation(s)
- Audrey L. Litvak
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Nicholas A. Lin
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Kelly K. Hynes
- Department of Orthopaedic Surgery and Rehabilitation Services Duchossois Center for Advanced Medicine, The University of Chicago, Chicago, IL, USA
| | - Jason A. Strelzow
- Department of Orthopaedic Surgery and Rehabilitation Services Duchossois Center for Advanced Medicine, The University of Chicago, Chicago, IL, USA
| | - Megan A. Conti Mica
- Department of Orthopaedic Surgery and Rehabilitation Services Duchossois Center for Advanced Medicine, The University of Chicago, Chicago, IL, USA
| | - Jeffrey G. Stepan
- Department of Orthopaedic Surgery and Rehabilitation Services Duchossois Center for Advanced Medicine, The University of Chicago, Chicago, IL, USA
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Naamneh-Abuelhija B, Yogev-Seligmann G, Kafri M. Does affiliation with a minority group affect patient activation? PATIENT EDUCATION AND COUNSELING 2024; 118:108011. [PMID: 37866072 DOI: 10.1016/j.pec.2023.108011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 09/04/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE To systematically review published studies assessing associations between ethnicity and patient activation (PA) among people with chronic conditions. METHODS A systematic review (PROSPERO-CRD42022320793) was performed by searching in PubMed, CINAHL, Scopus, and Google Scholar. Studies were included according to the following criteria: age > 18, diagnosis of at least one chronic condition, assessment of PA, report of ethnic minority group, and statistical analyses of PA scores include between-group comparisons or correlation or regression with ethnic group affiliation. Two reviewers conducted independent screening of records and full-text articles published until July 2021. Quality was evaluated using the National Institutes of Health study quality assessment tool. RESULTS From 197 records identified, 12 studies were included. The majority of studies focused on participants of White, Black and Hispanic ethnicity. Seven studies establish a significant association between ethnicity and PA, while the remainder of the studies found no association or inconclusive results. CONCLUSIONS The findings indicate that ethnicity is related to PA although additional, multiple explanatory variables other than ethnicity to PA were identified. Practice implications Programs to promote PA should be adjusted to participants' ethnic affiliation but consider differences in the barriers to PA and their magnitude that may differ across different ethnicities.
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Affiliation(s)
- Badera Naamneh-Abuelhija
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 3498838, Israel
| | - Galit Yogev-Seligmann
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 3498838, Israel
| | - Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 3498838, Israel.
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Maras AF, Penedo FJ, Ramirez AG, Worch SM, Ortiz MS, Yanez B, Munoz E, Lad T, Hollowell C, Medina HN, Moreno PI. Cardiometabolic comorbidities in Hispanic/Latino cancer survivors: prevalence and impact on health-related quality of life and supportive care needs. Support Care Cancer 2023; 31:711. [PMID: 37982906 PMCID: PMC11302055 DOI: 10.1007/s00520-023-08181-9] [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: 03/28/2023] [Accepted: 11/10/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE The aim of this study was to characterize the prevalence of cardiometabolic comorbidities (i.e., diabetes, peripheral vascular disease, myocardial infarction, congestive heart failure, cerebrovascular disease) among Hispanic/Latino cancer survivors and examine the impact of cardiometabolic comorbidities on health-related quality of life (HRQoL), unmet supportive care needs, patient-provider communication self-efficacy, satisfaction with cancer care, and increases in healthy behaviors. METHODS Hispanics/Latinos diagnosed with breast, prostate, or colorectal cancer (N = 288) were assessed within 15 months of primary treatment completion. RESULTS One-quarter (24.7%) of survivors were diagnosed with diabetes and one-fifth (20.8%) were diagnosed with peripheral vascular disease. Survivors with at least one cardiometabolic comoribidity were older (t(278) = -.3.622, p < .001) and more likely to have a household income of less than $25,000 (X2 = 8.369, p = .004). When adjusting for sociodemographic and medical covariates, survivors with cardiometabolic comorbidities demonstrated worse overall HRQoL (B = -4.792, p = .050), emotional (B = -1.479, p = .018) and physical (B = -2.228, p = .005) wellbeing, a higher odds of unmet psychological (OR = 2.095, p = .027) and sexuality (OR = 2.898, p = .004) needs, and greater patient-provider communication self-efficacy (B = .179, p = .045). There were no differences in healthy behavior changes or satisfaction with cancer care. CONCLUSIONS Cardiometabolic comorbidities may be highly prevalent among Hispanic/Latino cancer survivors and increase the risk of worse HRQoL and unmet supportive care needs. Targeted interventions are needed to optimize health among Hispanic/Latino cancer survivors with cardiometabolic comorbidities.
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Affiliation(s)
- Ashley F Maras
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, Miami, FL, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Cancer Control Research Program, University of Miami, Miami, FL, USA
| | - Amelie G Ramirez
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, TX, USA
- Department of Population Health Sciences, UT Health San Antonio Long School of Medicine, San Antonio, TX, USA
| | - Sarah M Worch
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Manuel S Ortiz
- Department of Psychology, Universidad de La Frontera, Temuco, Chile
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Edgar Munoz
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, TX, USA
| | - Thomas Lad
- Division of Hematology/Oncology, Cook County Health, Chicago, IL, USA
| | | | - Heidy N Medina
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Patricia I Moreno
- Sylvester Comprehensive Cancer Center, Cancer Control Research Program, University of Miami, Miami, FL, USA.
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
- University of Miami Don Soffer Clinical Research Center, 1120 NW 14Th Street, Miami, FL, 33136, USA.
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Phillips Z, Wong L, Crotty K, Horlick M, Johnston R, Altshuler L, Zabar S, Jay M, Dembitzer A. Implementing an Experiential Telehealth Training and Needs Assessment for Residents and Faculty at a Veterans Affairs Primary Care Clinic. J Grad Med Educ 2023; 15:456-462. [PMID: 37637347 PMCID: PMC10449358 DOI: 10.4300/jgme-d-22-00868.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/03/2023] [Accepted: 04/18/2023] [Indexed: 08/29/2023] Open
Abstract
Background The transition to telehealth during the COVID-19 pandemic revealed a lack of preexisting telehealth training for clinicians. As a workplace-based simulation methodology designed to improve virtual clinical skills, announced standardized patients (ASPs) may help meet evolving educational needs to sustain quality telehealth care. Objective We describe the development and implementation of an ASP program to assess and provide feedback to resident and faculty clinicians in virtual practice, and report on performance, feasibility, and acceptability. Methods From June 2021 to April 2022, resident and faculty clinicians at a VA primary care clinic participated in a video visit in which an ASP portrayed either a 70-year-old man with hearing loss and hypertension or a 60-year-old man with hypertension and financial stress. Following the visit, ASPs provided verbal feedback and completed a behaviorally anchored checklist to rate telehealth and communication skills, chronic disease management, and use of resources. Domain summary scores were calculated as the mean percentage of "well done" items. Participants completed a feedback survey on their experience. Results Seventy-six televisits (60 primary care residents [postgraduate year 1-3], 16 internal medicine faculty) were conducted from August 2021 to April 2022. Clinicians performed well in communication skills: information gathering (79%, 60 of 76, well done), relationship development (67%, 51 of 76), education and counseling (71%, 54 of 76), and patient satisfaction (86%, 65 of 76). They performed less well in telemedicine skills (38%, 29 of 76). Participants agreed that the experience was a good use of their time (88%, 67 of 76). Conclusions An ASP-facilitated training for resident and faculty clinicians assessed telehealth skills and clinical practice and identified areas for intervention. Clinicians responded well to the training and feedback.
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Affiliation(s)
- Zoe Phillips
- Zoe Phillips, BA, is Research Data Associate, New York University Grossman School of Medicine
| | - Laura Wong
- Laura Wong, BA, is Program Manager, New York Harbor Veterans Health Affairs, and New York University Grossman School of Medicine
| | - Kelly Crotty
- Kelly Crotty, MD, is Assistant Professor of Medicine, New York Harbor Veterans Health Affairs and New York University Grossman School of Medicine
| | - Margaret Horlick
- Margaret Horlick, MD, is Associate Professor of Medicine, New York Harbor Veterans Health Affairs and New York University Grossman School of Medicine
| | - Rhonda Johnston
- Rhonda Johnston, PhD, is Director, Veterans Health Administration Office of Connected Care
| | - Lisa Altshuler
- Lisa Altshuler, PhD, is Assistant Professor, New York University Grossman School of Medicine
| | - Sondra Zabar
- Sondra Zabar, MD, is Professor of Medicine, New York University Grossman School of Medicine
| | - Melanie Jay
- Melanie Jay, MD, is Clinician Investigator and Staff Physician, New York Harbor Veterans Health Affairs, and Associate Professor of Medicine and Population Health, New York University Grossman School of Medicine; and
| | - Anne Dembitzer
- Anne Dembitzer, MD, is Staff Physician, New York Harbor Veterans Health Affairs, and Assistant Professor, New York University Grossman School of Medicine
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Zakeri MA, Esmaeili Nadimi A, Bazmandegan G, Zakeri M, Dehghan M. Psychometric Evaluation of Chronic Patients Using the Persian Version of Patient Activation Measure (PAM). Eval Health Prof 2023; 46:115-126. [PMID: 35506588 DOI: 10.1177/01632787221096904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The Patient Activation Measure (PAM) is a 13-item questionnaire that assesses patients' knowledge, skills, and confidence in self-management. The current study aimed to translate the American version of the PAM-13 into Persian and test the psychometric properties of the Persian version among chronic patients. This cross-sectional study was conducted on 438 chronically ill patients in Rafsanjan, Iran from May to November 2019. The American version of the PAM-13 was translated into Persian using a standardized forward-backward translation method. Internal consistency, test-retest reliability, face and content validity, as well as construct validity (structural and convergent validity) were all assessed. The content validity index of the Patient Activation Measure-13 Persian (PAM-13-P) was 0.91. Exploratory and confirmatory factor analyses showed that the PAM-13-P had a meaningful structural validity. The PAM-13-P scores were negatively correlated with the Partner in Health Measure (PIH) (r = -0.29, p < 0.001). In addition, the PAM13-P scores were positively correlated with the Satisfaction with Life Scale (SWLS) (r = 0.31, p < 0.001). The internal consistency was 0.88, and the repeatability was excellent [Intraclass Correlation Coefficient (ICC):0.96 and confidence interval (CI): 0.94-0.98]. This study demonstrates that the PAM-13-P is a reliable and valid measure for assessing activation among chronically ill patients. The PAM-13-P scale assesses the level of self-management of chronic patients and identifies appropriate care strategies to meet their needs.
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Affiliation(s)
- Mohammad Ali Zakeri
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Social Determinants of Health Research Centre, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Ali Esmaeili Nadimi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Golamreza Bazmandegan
- Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Family Medicine, Ali-Ibn Abi-Talib Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Maryam Zakeri
- Physiology-Pharmacology Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Mahlagha Dehghan
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
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Edelman DS, Palmer DM, Romero EK, Chang BP, Kronish IM. Impact of Native Language, English Proficiency, and Language Concordance on Interpersonal Care During Evaluation of Acute Coronary Syndrome. J Gen Intern Med 2023; 38:946-953. [PMID: 36127540 PMCID: PMC10039209 DOI: 10.1007/s11606-022-07794-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/07/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND High-quality interpersonal interactions between clinicians and patients can improve communication and reduce health disparities among patients with novice English proficiency (NEP). Yet, little is known about the impact of native language, NEP, and native language concordance on patient on perceptions of interpersonal care in the emergency department (ED). OBJECTIVE To determine the associations of native language, NEP, and native language concordance with patient perceptions of interpersonal care among patients undergoing evaluation for suspected acute coronary syndrome (ACS) in the ED. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 1000 patients undergoing evaluation for suspected ACS at an urban ED from 2013 to 2016. MAIN MEASURES English- and Spanish-speaking patients were surveyed to identify native language, English proficiency (classified as advanced, intermediate, or novice), and perceived language of the treating ED clinician. Patient perceptions of interpersonal care were assessed using the Interpersonal Processes of Care (IPC) survey, a validated 18-item tool for assessing social-psychological domains of patient-clinician interactions. IPC scores ≤ 4 were categorized as sub-optimal (range, 1-5). The associations between native language, English proficiency, and native language concordance with sub-optimal communication were assessed using hierarchical logistic regression adjusted for all three language variables, sociodemographic characteristics, and depression. KEY RESULTS Nine hundred thirty-three patients (48.0% native non-English-speaking, 55.7% Hispanic) completed the IPC; 522 (57.4%) perceived native language concordance. In unadjusted analyses, non-English native language (OR 1.38, 95% CI 1.04-1.82) and NEP (OR 1.45, 95% CI 1.06-1.98) were associated with sub-optimal communication, whereas language concordance was protective (OR 0.61, 95% CI 0.46-0.81). In fully adjusted analyses, only language concordance remained significantly associated with sub-optimal communication (AOR 0.62, 95% CI 0.42-0.93). CONCLUSIONS This study suggests that perceived native language concordance acts as a protective factor for patient-clinician interpersonal care in the acute setting, regardless of native language or English proficiency.
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Affiliation(s)
- David S Edelman
- Primary Care/Social Internal Medicine Residency Program, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Dana M Palmer
- Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Emily K Romero
- Teachers College, Columbia University, New York, NY, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, PH9-311, New York, NY, 10032, USA.
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10
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Parente VM, Reid HW, Robles J, Johnson KS, Svetkey LP, Sanders LL, Olsen MK, Pollak KI. Racial and Ethnic Differences in Communication Quality During Family-Centered Rounds. Pediatrics 2022; 150:e2021055227. [PMID: 36345704 PMCID: PMC9724176 DOI: 10.1542/peds.2021-055227] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To evaluate racial and ethnic differences in communication quality during family centered rounds. METHODS We conducted an observational study of family-centered rounds on hospital day 1. All enrolled caregivers completed a survey following rounds and a subset consented to audio record their encounter with the medical team. We applied a priori defined codes to transcriptions of the audio-recorded encounters to assess objective communication quality, including medical team behaviors, caregiver participatory behaviors, and global communication scores. The surveys were designed to measure subjective communication quality. Incident Rate Ratios (IRR) were calculated with regression models to compare the relative mean number of behaviors per encounter time minute by race and ethnicity. RESULTS Overall, 202 of 341 eligible caregivers completed the survey, and 59 had accompanying audio- recorded rounds. We found racial and ethnic differences in participatory behaviors: English-speaking Latinx (IRR 0.5; 95% confidence interval [CI] 0.3-0.8) Black (IRR 0.6; 95% CI 0.4-0.8), and Spanish-speaking Latinx caregivers (IRR 0.3; 95% CI 0.2-0.5) participated less than white caregivers. Coder-rated global ratings of medical team respect and partnership were lower for Black and Spanish-speaking Latinx caregivers than white caregivers (respect 3.1 and 2.9 vs 3.6, P values .03 and .04, respectively: partnership 2.4 and 2.3 vs 3.1, P values .03 and .04 respectively). In surveys, Spanish-speaking caregivers reported lower subjective communication quality in several domains. CONCLUSIONS In this study, Black and Latinx caregivers were treated with less partnership and respect than white caregivers.
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Affiliation(s)
| | - Hadley W. Reid
- Duke University School of Medicine, Durham, North Carolina
| | - Joanna Robles
- Hematology/Oncology, Department of Pediatrics
- Cancer Prevention and Control, Duke Cancer Institute, Durham, North Carolina
| | - Kimberly S. Johnson
- Division of Geriatrics, Department of Medicine
- Center for Aging and Human Development
- Geriatrics Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | | | | | - Maren K. Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
- Departments of Biostatistics and Bioinformatics
| | - Kathryn I. Pollak
- Population Health Sciences, Duke University, Durham, North Carolina
- Cancer Prevention and Control, Duke Cancer Institute, Durham, North Carolina
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11
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Chang JE, Lindenfeld Z, Chang VW. Obesity and Patient Activation: Confidence, Communication, and Information Seeking Behavior. J Prim Care Community Health 2022; 13:21501319221129731. [PMID: 36222682 PMCID: PMC9561656 DOI: 10.1177/21501319221129731] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION/OBJECTIVES Patient activation describes the knowledge, skills, and confidence that allow patients to actively engage in managing their health. Prior studies have found a strong relationship between patient activation and clinical outcomes, costs of care, and patient experience. Patients who are obese or overweight may be less engaged than normal weight patients due to lower confidence or stigma associated with their weight. The objective of this study is to examine whether weight status is associated with patient activation and its sub-domains (confidence, communication, information-seeking behavior). METHODS This repeated cross-sectional study of the 2011 to 2013 Medicare Current Beneficiary Survey (MCBS) included a nationally representative sample of 13,721 Medicare beneficiaries. Weight categories (normal, overweight, obese) were based on body mass index. Patient activation (high, medium, low) was based on responses to the MCBS Patient Activation Supplement. RESULTS We found no differences in overall patient activation by weight categories. However, compared to those with normal weight, people with obesity had a higher relative risk (RRR 1.24; CI 1.09-1.42) of "low" rather than "high" confidence. Respondents with obesity had a lower relative risk (RRR 0.82; CI 0.73-0.92) of "low" rather than "high" ratings of communication with their doctor. DISCUSSION AND CONCLUSIONS Though patients with obesity may be less confident in their ability to manage their health, they are more likely to view their communication with physicians as conducive to self-care management. Given the high receptivity among patients with obesity toward physician communication, physicians may be uniquely situated to guide and support patients in gaining the confidence they need to reach weight loss goals.
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Affiliation(s)
- Ji Eun Chang
- New York University, New York, NY,
USA,Ji Eun Chang, College of Global Public
Health, New York University, 708 Broadway, New York, NY 10003, USA.
| | | | - Virginia W. Chang
- New York University, New York, NY,
USA,NYU Grossman School of Medicine, New
York, NY, USA
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12
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Tong CE, Lopez KJ, Chowdhury D, Arya N, Elliott J, Sims-Gould J, Grindrod K, Stolee P. Understanding racialised older adults' experiences of the Canadian healthcare system, and codesigning solutions: protocol for a qualitative study in nine languages. BMJ Open 2022; 12:e068013. [PMID: 36216419 PMCID: PMC9557314 DOI: 10.1136/bmjopen-2022-068013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Racialised immigrant older adults (RIOAs) in Canada have poorer self-rated health and are more likely to report chronic conditions, while they concurrently experience well-documented challenges in navigating and accessing the healthcare system. There is strong evidence that patient and caregiver engagement in their healthcare leads to improved management of chronic disease and better health outcomes. International research suggests that engagement has the potential to reduce health disparities and improve quality of care. We aim to (1) describe what role(s) RIOAs are/are not taking in their own healthcare, from the perspectives of participant groups (RIOAs, caregivers and healthcare providers (HCPs)); and (2) develop a codesign process with these participants, creating linguistically aligned and culturally aligned tools, resources or solutions to support patient engagement with RIOAs. METHODS AND ANALYSIS Using a cross-cultural participatory action research approach, our work will consist of three phases: phase 1, strengthen existing partnerships with RIOAs and appropriate agencies and cultural associations; phase 2, on receipt of informed consent, in-depth interviews with RIOAs and caregivers (n=~45) and HCPs (n=~10), professionally interpreted as needed. Phase 3, work with participants, in multiple interpreted sessions, to codesign culturally sensitive and linguistically sensitive/aligned patient engagement tools. We will conduct this research in the Waterloo-Wellington region of Ontario, in Arabic, Bangla, Cantonese, Hindi, Mandarin, Punjabi, Tamil and Urdu, plus English. Data will be transcribed, cleaned and entered into NVivo V.12, the software that will support team-based analysis. Analysis will include coding, theming and interpreting the data, and, preparing narrative descriptions that summarise each language group and each participant group (older adults, caregivers and HCPs), and illustrate themes. ETHICS AND DISSEMINATION Ethics clearance was obtained through the University of Waterloo Office of Research Ethics (ORE #43297). Findings will be disseminated through peer-reviewed publications, presentations and translated summary reports for our partners and participants.
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Affiliation(s)
- Catherine E Tong
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Kimberly J Lopez
- Department of Recreation and Leisure Studies, University of Waterloo, Waterloo, Ontario, Canada
| | - Diya Chowdhury
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Neil Arya
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jacobi Elliott
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Joanie Sims-Gould
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul Stolee
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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13
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Sungur H, van den Muijsenbergh METC, van Weert JCM, Schouten BC. Caring for older culturally and linguistically diverse patients with Cancer: Healthcare Providers' perceived barriers to communication. J Geriatr Oncol 2022; 13:862-870. [PMID: 35589543 DOI: 10.1016/j.jgo.2022.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 02/16/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Due to various socio-cultural and language related factors, healthcare providers experience barriers when communicating with older culturally and linguistically diverse (CALD) patients with cancer, which can lower the quality of care received by patients and negatively impact healthcare providers. Studies focusing on communication barriers of older CALD patients with cancer and a systematic comparison of those barriers between different healthcare providers have been largely missing. OBJECTIVES In order to lay out the healthcare providers' perceived barriers to communication, the present study identified and compared communication barriers among different healthcare providers when caring for older CALD patients with cancer. METHODS An online survey was conducted among healthcare providers in the Netherlands who identified as being involved in the care of CALD patients with cancer (N = 191), specifically; GPs (NGPs = 54), specialists (Nspecialists = 29), oncology nurses (Nnurses = 77), and pharmacists (Npharmacists = 31). Providers assessed twelve pre-specified factors on (i) importance and (ii) frequency of these factors as barriers to communication. A composite score by employing the QUOTE (Quality Of care Through the patients' Eyes) methodology was used to rank, and classify factors as either potential or influential barriers. RESULTS AND CONCLUSION Overall, low Dutch language proficiency of older CALD patients with cancer, family interpreters providing inadequate translations, not knowing the extent of patients' informational needs, cultural differences in views about healthcare (i.e., illnesses and treatments) and family members blocking communication were found to be influential communication barriers. Healthcare providers showed several differences in what they perceived to be a potential or an influential barrier: Cultural differences in views about healthcare and patients getting treatment in their home countries were important barriers for GPs, while not knowing the patient's contact person was for pharmacists. Nurses perceived the highest number of influential barriers, while specialists perceived the least. We conclude that specific interventions that address differences in perceived barriers among providers are needed, and we highlight potential interventions that involve digital communication tools, such as the Conversation Starter.
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Affiliation(s)
- Hande Sungur
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands.
| | - Maria E T C van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands; Prevention and care Programme, Pharos, National Centre of Expertise on Health Disparities, Utrecht, the Netherlands.
| | - Julia C M van Weert
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands.
| | - Barbara C Schouten
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands.
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14
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Velez T, Gati S, Batista CA, Nino de Rivera J, Banker SL. Facilitating Engagement on Family-Centered Rounds for Families With Limited Comfort With English. Hosp Pediatr 2022; 12:439-447. [PMID: 35411375 DOI: 10.1542/hpeds.2021-006403] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Conducting family-centered rounds (FCR) for families with limited comfort with English (LCE) presents communication challenges. The objective of this study was to characterize the preferences of Spanish-speaking parents with LCE around interpretation and communication with the medical team during FCR to promote family engagement during rounds. METHODS This qualitative study was conducted at a tertiary care children's hospital in New York, New York. Eighteen Spanish-speaking parents of patients admitted to the hospital medicine service participated. Bilingual investigators conducted semistructured interviews over a secure virtual platform. Interview transcriptions were coded and analyzed by using a grounded theory approach and constant comparative method. Parents were recruited until thematic saturation was achieved. RESULTS Most participants were mothers (72%) from the Dominican Republic (61%). Responses from participants yielded a conceptual model depicting parents' perspectives on family engagement and bidirectional communication during FCR. Three major themes emerged: (1) importance of interpreter use, (2) understanding of medical information, and (3) participation in FCR. Within each theme, factors that facilitate or impede engagement in FCR were identified. Interpreters facilitated information sharing and parent understanding of medical care, increasing parent appreciation of FCR. Lack of language-concordant care and parents' perceived responsibility for the language barrier limited engagement. CONCLUSIONS Families with LCE value involvement during FCR, but face difficulties due to language barriers. Providers can support these families by empowering families' participation and by consistently using an interpreter. Understanding the preferences of families with LCE for participation in FCR will help providers deliver more equitable family-centered care.
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Affiliation(s)
- Teresitta Velez
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York.,Department of Pediatrics, Children's National Medical Center, Washington, District of Columbia
| | - Stephanie Gati
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.,Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chelsea A Batista
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York.,Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York, New York
| | | | - Sumeet L Banker
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York.,Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
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15
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Blanchard BE, Mata-Greve F, Johnson M, Fortney JC. Knowledge about Treatment (KaT) in Mental Health Services. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2022; 56:81-98. [PMID: 37378000 PMCID: PMC10292725 DOI: 10.1080/07481756.2022.2041439] [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: 12/22/2022]
Abstract
This study developed and psychometrically evaluated a brief measure of mental health treatment knowledge (N = 726). Scores from Knowledge about Treatment (KaT) demonstrated a unidimensional measure with good model fit, internal consistency reliability, convergent and predictive validity, test-retest reliability, and measurement invariance across gender, ethnicity, education, and poverty status.
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Affiliation(s)
- Brittany E. Blanchard
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Felicia Mata-Greve
- Department of Veterans Affairs, Mental Health Service Line, Puget Sound VA Healthcare System, Seattle, WA, USA
| | - Morgan Johnson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - John C. Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Department of Veterans Affairs, Center of Innovation for Veteran-Centered and Value-Driven Care, Puget Sound VA Healthcare System, Seattle, WA, USA
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16
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Tabaac AR, Sutter ME, Haneuse S, Agénor M, Bryn Austin S, Guss CE, Charlton BM. The interaction of sexual orientation and provider-patient communication on sexual and reproductive health in a sample of U.S. women of diverse sexual orientations. PATIENT EDUCATION AND COUNSELING 2022; 105:466-473. [PMID: 34023174 PMCID: PMC8594287 DOI: 10.1016/j.pec.2021.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Our goal was to examine associations among provider-patient communication, past-year contraceptive use and lifetime sexually transmitted infection. METHODS Data were analyzed cross-sectionally from 22,554 women in the Growing Up Today Study and Nurses' Health Study 3 between the follow-up period of 1996-2020. We used multivariable Poisson regression models adjusted for race/ethnicity, age in years, study cohort, and region of residence to obtain risk ratio (RR) associations and 95% confidence intervals (CI). RESULTS Provider-patient communication was associated with higher likelihood of using all methods of past-year contraceptive use (RRs ranging from 1.11 to 1.63) and lifetime STI diagnosis (RRs ranging from 1.18 to 1.96). Completely heterosexual women with no same-sex partners (referent) were 13% more likely than lesbians and 4% less likely than other groups to report a provider ever discussed their SRH. Significant interactions emerged between sexual minority status and provider-patient communication. Sexual minority women whose providers discussed their SRH were less likely to report contraceptive non-use in the past year (p < .0001). CONCLUSION Provider-patient communication may benefit sexual minority women's contraceptive practices and engagement with STI testing. PRACTICE IMPLICATIONS Differences in provider-patient SRH discussion by sexual orientation indicate lesbian women are not receiving the same attention in clinical encounters.
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Affiliation(s)
- Ariella R Tabaac
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Center for Gender Surgery, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Megan E Sutter
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA; Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY, USA.
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Madina Agénor
- Department of Community Health, Tufts University, Medford, MA, USA; Department of Obstetrics/Gynecology, Tufts University School of Medicine, Boston, MA, USA.
| | - S Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Carly E Guss
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Brittany M Charlton
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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17
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Perez Jolles M, Rivera D, Jacobs G, Thomas KC, Schneiderman JU, Wenzel S. Views on health activation and support services among formerly homeless adults living in Permanent Supportive Housing in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:154-164. [PMID: 33894078 DOI: 10.1111/hsc.13384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 03/01/2021] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
Individuals who have experienced chronic homelessness often have unmet physical and mental health needs and experiences of trauma and stigma. This study aimed to measure, for the first time, health activation (self-advocacy and empowerment) levels among formerly homeless adults living in Permanent Supportive Housing or PSH (referred to hereafter as residents). In addition, residents' experiences accessing health services, and their sense of health activation and efforts to manage their health within PSH settings, were explored. A mixed-methods study was conducted in Southern California (October 2018-June 2019) using a validated survey and interviews with a randomly selected group of residents (n = 61) from three PSH agencies. Activation levels were measured using the Patient Activation Measure. Descriptive and univariate survey analyses were conducted. Interview data was analysed using NVivo. Two coders coded all transcripts, and team meetings were held to reach consensus. Results showed most residents were female (64%), racial and ethnic minorities (66%), on average 54-year-olds, with 37 months of PSH residency, and 43% were taking some action to manage their health (intermediate activation level). Challenges accessing care were due to breakdowns in care, unpleasant experiences with providers, low health literacy and feeling overwhelmed by co-occurring chronic conditions. Health activation related to knowing when to take care of their health on their own and when to seek care. Unique challenges emerged related to PSH, such as lack of resident control within the housing setting and limited personnel responding to health emergencies. These challenges were magnified because residents live alone, per PSH requirements.
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Affiliation(s)
- Monica Perez Jolles
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Dean Rivera
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Gabrielle Jacobs
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Kathleen C Thomas
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Asheville, NC, USA
- Division of Research, UNC Health Sciences at MAHEC, Asheville, NC, USA
| | - Janet U Schneiderman
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Suzanne Wenzel
- Richard M. and Ann L. Thor Professor in Urban Social Development, USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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18
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Matthias MS, Hirsh AT, Ofner S, Daggy J. Exploring the relationships among social support, patient activation, and pain-related outcomes. PAIN MEDICINE 2021; 23:676-685. [PMID: 34718764 DOI: 10.1093/pm/pnab306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/28/2021] [Accepted: 09/25/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Social support has been linked to more effective pain adaptation. The relationship between social support and other relevant constructs is less well-understood. Chief among these is patient activation, which has robust links to effective self-management, yet has not been well-studied in chronic pain. We sought to better understand these relationships in an effort to inform future intervention strategies for patients with chronic pain. METHODS Using baseline data from a clinical trial with patients with chronic pain (N = 213), we analyzed the relationships among perceived social support and patient activation, depression, anxiety, general health perceptions, pain centrality, pain catastrophizing, and pain intensity and interference. Multiple linear regression was used to examine the effect of social support on outcomes. Patient activation was explored as a mediator of the effect of social support on outcomes. RESULTS Social support was significantly associated with all outcomes except pain. Social support explained the greatest variance in patient activation (squared semi-partial correlation =0.081), followed by depression (0.073) and general health perceptions (0.072). Patient activation was not found to be a significant mediator of the effect of social support on pain-related outcomes. CONCLUSIONS Findings provide insight into the roles of patient activation and social support in chronic pain management. Although patient activation did not mediate the relationship between social support and outcomes, this study is an important step toward gaining a more complete understanding of constructs thought to be related to pain self-management and points to the need to advance theory in this area to guide future research. Such work is needed to optimize interventions for patients with chronic pain.
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Affiliation(s)
- Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN.,Regenstrief Institute, Indianapolis, IN.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, IN
| | - Susan Ofner
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Joanne Daggy
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
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19
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White A, Faith TD, Ba A, Loftley A, Ramakrishnan V, Johnson H, Rose J, Dismuke-Greer CL, Oates JC, Egede LE, Williams EM. Support Methodologies for African American Women With Lupus - Comparing Three Methods' Effects on Patient Activation and Coping. Front Psychol 2021; 12:734390. [PMID: 34675844 PMCID: PMC8523887 DOI: 10.3389/fpsyg.2021.734390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/10/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease in which the immune system attacks healthy tissues. While pharmaceutical therapies are an important part of disease management, behavioral interventions have been implemented to increase patients' disease self-management skills, provide social support, and encourage patients to take a more active role in their care. Methods: Three interventions are considered in this study; peer-to-peer methodology, patient support group, and a patient navigator program that were implemented among largely African American women with SLE at the Medical University of South Carolina (MUSC). Outcomes of interest were patient activation and lupus self-efficacy. We used a Least Squares Means model to analyze change in total patient activation and lupus self-efficacy independently in each cohort. We adjusted for demographic variables of age, education, income, employment, and insurance. Results: In both unadjusted and adjusted models for patient activation, there were no statistically significant differences among the three intervention methodologies when comparing changes from baseline to post intervention. Differences in total coping score from baseline to post intervention in the patient navigator group (-101.23, p-value 0.04) and differences in scores comparing the patient navigator with the support group were statistically significant (116.96, p-value 0.038). However, only the difference in total coping from baseline to post intervention for the patient navigator program remained statistically significant (-98.78, p-value 0.04) in the adjusted model. Conclusion: Tailored interventions are a critical pathway toward improving disease self-management among SLE patients. Interventions should consider including patient navigation because this method was shown to be superior in improving self-efficacy (coping scores).
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Affiliation(s)
- Ashley White
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Trevor D. Faith
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, United States
| | - Aissatou Ba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Aundrea Loftley
- Division of Endocrinology and Diabetes, Medical University of South Carolina, Charleston, SC, United States
| | - Viswanathan Ramakrishnan
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | | | - Jillian Rose
- Community Engagement, Diversity and Research, Department of Social Work Programs, Hospital for Special Surgery, New York, NY, United States
| | - Clara L. Dismuke-Greer
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA, United States
| | - Jim C. Oates
- Division of Rheumatology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Leonard E. Egede
- Division of General Internal Medicine, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Edith M. Williams
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
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20
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Noel SE, Santos MP, Wright NC. Racial and Ethnic Disparities in Bone Health and Outcomes in the United States. J Bone Miner Res 2021; 36:1881-1905. [PMID: 34338355 PMCID: PMC8607440 DOI: 10.1002/jbmr.4417] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/12/2021] [Accepted: 07/21/2021] [Indexed: 11/10/2022]
Abstract
Osteoporosis is a bone disease classified by deterioration of bone microarchitecture and decreased bone strength, thereby increasing subsequent risk of fracture. In the United States, approximately 54 million adults aged 50 years and older have osteoporosis or are at risk due to low bone mass. Osteoporosis has long been viewed as a chronic health condition affecting primarily non-Hispanic white (NHW) women; however, emerging evidence indicates racial and ethnic disparities in bone outcomes and osteoporosis management. The primary objective of this review is to describe disparities in bone mineral density (BMD), prevalence of osteoporosis and fracture, as well as in screening and treatment of osteoporosis among non-Hispanic black (NHB), Hispanic, and Asian adults compared with NHW adults living on the US mainland. The following areas were reviewed: BMD, osteoporosis prevalence, fracture prevalence and incidence, postfracture outcomes, DXA screening, and osteoporosis treatments. Although there are limited studies on bone and fracture outcomes within Asian and Hispanic populations, findings suggest that there are differences in bone outcomes across NHW, NHB, Asian, and Hispanic populations. Further, NHB, Asian, and Hispanic populations may experience suboptimal osteoporosis management and postfracture care, although additional population-based studies are needed. There is also evidence that variation in BMD and osteoporosis exists within major racial and ethnic groups, highlighting the need for research in individual groups by origin or background. Although there is a clear need to prioritize future quantitative and qualitative research in these populations, initial strategies for addressing bone health disparities are discussed. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Sabrina E Noel
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA.,Center for Population Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Michelly P Santos
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA.,Center for Population Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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21
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Cuevas H, Heitkemper E, Huang YC, Jang DE, García AA, Zuñiga JA. A systematic review and meta-analysis of patient activation in people living with chronic conditions. PATIENT EDUCATION AND COUNSELING 2021; 104:2200-2212. [PMID: 33610334 DOI: 10.1016/j.pec.2021.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The objectives of this review are to (1) describe the state of the science of patient activation interventions for the self-management of chronic conditions; (2) identify effective intervention elements for improving patient activation; and (3) compare intervention effectiveness across chronic conditions. METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). PubMed, CINAHL, and Web of Science databases were searched. RESULTS Thirty-two articles published between 2005 and 2019 were identified with intervention elements of self-management, disease management, and education. Meta-analysis of a subset of seven randomized controlled trials (n = 7) that used the 13-item version of the Patient Activation Measure with data collection points at 6 months demonstrated that patient activation did not change significantly in comparison with controls (MD = 0.25, 95 % CI = 0.02-0.47). CONCLUSION Most interventions reported significant improvement in patient activation and were linked to tasks such as regular exercise and monitoring glucose. However, the meta-analysis of RCTs did not confirm these findings. PRACTICE IMPLICATIONS Patient activation can be assessed and addressed uniformly across all chronic conditions to improve patient engagement in care.
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Affiliation(s)
- Heather Cuevas
- The University of Texas at Austin, School of Nursing, USA.
| | | | - Ya-Ching Huang
- Texas State University, St. David's School of Nursing, USA
| | - Dong Eun Jang
- The University of Texas at Austin, School of Nursing, USA
| | | | - Julie A Zuñiga
- The University of Texas at Austin, School of Nursing, USA
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22
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Novick TK, Diaz S, Barrios F, Cubas D, Choudhary K, Nader P, ElKhoury R, Cervantes L, Jacobs EA. Perspectives on Kidney Disease Education and Recommendations for Improvement Among Latinx Patients Receiving Emergency-Only Hemodialysis. JAMA Netw Open 2021; 4:e2124658. [PMID: 34499133 PMCID: PMC8430451 DOI: 10.1001/jamanetworkopen.2021.24658] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE In most states, undocumented Latinx immigrants with kidney failure receive dialysis in acute care settings on an emergency-only basis. How much kidney disease education Latinx immigrants receive and how to improve kidney disease education and outreach among Latinx populations are unknown. OBJECTIVE To understand the kidney disease educational gaps of Latinx individuals who need but lack access to scheduled outpatient dialysis. DESIGN, SETTING, AND PARTICIPANTS This qualitative study used semistructured interviews in a Texas hospital system from March 2020 to January 2021 with 15 individuals who received emergency-only dialysis when they were first diagnosed with kidney failure. Demographic information was collected, and a thematic analysis was performed using the constant comparative method on interviews after they were audio-recorded, translated, and transcribed verbatim. Data analysis was performed from April 2020 to February 2021. MAIN OUTCOMES AND MEASURES Subthemes and themes from semistructured interviews. RESULTS All 15 persons interviewed (9 male individuals [60%]; mean [SD] age, 51 [17] years) identified as Hispanic, 11 (73%) were born in Mexico, and none reported knowing about their kidney disease more than 6 months before starting dialysis. The themes identified were (1) lack of kidney disease awareness, (2) education provided was incomplete and poor quality, (3) lack of culturally concordant communication and care, (4) elements that Latinx patients receiving emergency-only dialysis want in their education, (5) facilitators of patient activation and coping, and (6) Latinx patient recommendations to improve community outreach. CONCLUSIONS AND RELEVANCE Latinx adults receiving emergency-only dialysis are usually unaware of their kidney disease until shortly before or after they start dialysis, and the education they receive is poor quality and often not culturally tailored. Participants made feasible recommendations on how to improve education and outreach among Latinx communities.
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Affiliation(s)
- Tessa K. Novick
- Division of Nephrology, University of Texas at Austin, Dell Medical School, Austin
- Department of Internal Medicine, University of Texas at Austin, Dell Medical School, Austin
| | - Santiago Diaz
- Department of Internal Medicine, University of Texas at Austin, Dell Medical School, Austin
| | - Francisco Barrios
- Department of Internal Medicine, University of Texas at Austin, Dell Medical School, Austin
| | - Doris Cubas
- Department of Internal Medicine, University of Texas at Austin, Dell Medical School, Austin
| | | | - Paul Nader
- Division of Nephrology, University of Texas at Austin, Dell Medical School, Austin
- Department of Internal Medicine, University of Texas at Austin, Dell Medical School, Austin
| | - Raymonda ElKhoury
- Division of Nephrology, University of Texas at Austin, Dell Medical School, Austin
- Department of Internal Medicine, University of Texas at Austin, Dell Medical School, Austin
| | - Lilia Cervantes
- Division of General Internal Medicine and Hospital Medicine, University of Colorado, Boulder
| | - Elizabeth A. Jacobs
- Department of Internal Medicine, University of Texas at Austin, Dell Medical School, Austin
- Maine Medical Center Research Institute, Scarborough
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23
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Seibel LF, Peth-Pierce R, Hoagwood KE. Revisiting caregiver satisfaction with children's mental health services in the United States. Int J Ment Health Syst 2021; 15:71. [PMID: 34454565 PMCID: PMC8403344 DOI: 10.1186/s13033-021-00493-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/05/2021] [Indexed: 11/18/2022] Open
Abstract
Nearly four decades ago, Unclaimed Children documented the gaps in the United States between mental health programs and caregivers’ perspectives about those services for their children. This absence of attention to parent or caregiver perspectives, including their satisfaction with these services, was a key finding of the report, which detailed system failure in caring for youth with mental health needs. Since then, the focus on caregiver satisfaction with children’s mental health services has been largely overlooked in research, and when examined has been mostly included as an indicator of the feasibility of program implementation. In striking contrast, overall healthcare system reforms have highlighted the importance of improving consumer’s direct experience of care. However, caregiver satisfaction remains largely disconnected to these overall health system reforms, even as reforms focus increasingly on value-based, coordinated and integrated care. In this paper, we review literature from 2010 to 2020, revisit the measurement of caregiver satisfaction, identify how and when it is being measured, and delineate a research agenda to both realign it with health system improvements, refine its focus on expectancies and appropriateness, and root it more firmly in the principles of user experience (UX) and human-centered design (HCD).
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Affiliation(s)
- Lauren F Seibel
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, 1 Park Ave, 7th Floor, New York, NY, 10016, USA.
| | - Robin Peth-Pierce
- Public Health Communications Consulting, LLC, 16678 State Rd., North Royalton, OH, 44133, USA
| | - Kimberly E Hoagwood
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, 1 Park Ave, 7th Floor, New York, NY, 10016, USA
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24
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Yağar F. Why Does Patient-Physician Communication Matter? More Active Patients, Decreased Healthcare Use and Costs. J Patient Exp 2021; 8:23743735211036524. [PMID: 34395852 PMCID: PMC8361511 DOI: 10.1177/23743735211036524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Today, the increase in the use of emergency health services is one of the most discussed issues. Solutions are sought to reduce the use of unnecessary resources. One of these solutions can be patient–physician communication. Along with this approach, the relationships between patient–physician communication, use of emergency health services, and length of hospital stay was evaluated in this study. In addition, the effect of communication with the physician on the patient activity level was also examined. A total of 724 patients (F/M 397/327, mean age 33.36 ± 15.22 years) were included in this cross-sectional study. “Pearson Correlation Test” and “Simple Linear Regression Test” were used to analyze the data. High communication between physician and patient were associated with higher levels of patient activation (r = 0.632; P < .01). Likewise, a negative correlation was found between patient–physician communication and emergency healthcare use (r = −0.712, P < .01) and length of hospital stay (r = −0.317, P < .01). We think that the positive development of patient–physician communication may be an important way to reduce the use of emergency health services. The findings obtained regarding the length of hospital stay support this result. In addition, it was concluded that good communication with the physician may be an important factor in patients taking a more active role in healthcare. Further research is suggested to examine whether the observed associations are causal.
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Affiliation(s)
- Fedayi Yağar
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Kahramanmaras Sütcü Imam University, Kahramanmaras, Turkey
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25
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Kramer J, Yinusa-Nyahkoon L, Olafsson S, Penti B, Woodhams E, Bickmore T, Jack BW. Black Men's Experiences With Health care: Individuals' Accounts of Challenges, Suggestions for Change, and the Potential Utility of Virtual Agent Technology to Assist Black Men With Health Management. QUALITATIVE HEALTH RESEARCH 2021; 31:1772-1785. [PMID: 34092141 DOI: 10.1177/10497323211013323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Black men have the highest age-adjusted death rate of any major race-gender group in America. Understanding their perceived barriers to accessing health care may benefit future interventions working to increase Black men's health care engagement. Data collected from focus groups of Black men(N = 67), key informant interviews(N = 12), and interviews(N = 5) with participants who pilot tested an online health education system (called "Gabe") were analyzed to explore their health care experiences and how computer-based health programs might better assist Black men. Concerns pertaining to health care systems' failure to recognize the diversity among Black men, and physicians' lack of sociocultural awareness about the challenges they regularly face, were most salient. Building trust with providers was cited as being central to engagement, with Gabe users perceiving the system to be both trustworthy and accessible. Participants reported an openness to technology assisting with health management and provided suggestions of how online systems can meet the needs of Black men.
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Affiliation(s)
- Justin Kramer
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Leanne Yinusa-Nyahkoon
- Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University, Boston, Massachusetts, USA
| | | | - Brian Penti
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | | | | | - Brian W Jack
- Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University, Boston, Massachusetts, USA
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26
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Pinchas-Mizrachi R, Solnica A, Daoud N. Religiosity Level and Mammography Performance Among Arab and Jewish Women in Israel. JOURNAL OF RELIGION AND HEALTH 2021; 60:1877-1894. [PMID: 33123970 DOI: 10.1007/s10943-020-01097-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/26/2020] [Indexed: 06/11/2023]
Abstract
This study compared mammography performance by religiosity level among Arab (weighted n = 103,347) and Jewish women (weighted n = 757,956) in Israel aged 50-74, using data from the 2017 National Social Survey of the Central Bureau of Statistics. In the Survey, women were asked regarding mammogram performance in the 2 years prior. Mammography performance was 78.2% among Jewish women and 64.8% among Arab women. Among Jewish women, self-identifying as "Very religious" and "Somewhat religious" was associated with lower mammography performance compared to being 'non-religious.' The association was in the opposite direction among Arab women. When tailoring interventions to increase mammography performance among ethnically diverse groups, planners should consider women's religiosity.
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Affiliation(s)
- Ronit Pinchas-Mizrachi
- School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Ramat-Gan Academic College Israel, Jacob Arnon 5/8, 9371705, Jerusalem, Israel.
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84015, Beer Sheva, Israel.
| | - Amy Solnica
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nihaya Daoud
- School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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27
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Yao F, Zheng M, Wang X, Ji S, Li S, Xu G, Zheng Z. Patient activation level and its associated factors in adults with chronic pain: A cross-sectional survey. Medicine (Baltimore) 2021; 100:e25929. [PMID: 34106661 PMCID: PMC8133271 DOI: 10.1097/md.0000000000025929] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 04/18/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND: Patients’ capacity to manage their own health can be graded by levels of activation. Highly activated patients tend to have better health outcomes. However, little is known about the activation levels of chronic pain patients in China. This study aimed to identify: (1).. the activation levels within this population; and (2).. demographic and pain factors associated with the level of activation. METHODS: In this cross-sectional survey, patients completed a sociodemographic questionnaire, Brief Pain Inventory and Patient Activation Measure (PAM) 13. Patient activation was measured and categorized into Levels 1–4. Its associations with sociodemographic, patient-reported diseases and pain variables were explored using Wilcoxon rank sum test and Kruskal-Wallis H test. RESULTS: Of 338 patients, 84 were excluded. Of the 254 remaining, 51.6% of patients were at lower activation levels (PAM Levels 1 and 2). Higher activation levels (PAM Levels 3 and 4) were recorded in patients with younger age (P = .00005), higher education (P = .0018), non-laboring occupations (P = .0239), and fewer co-morbidities (P = .00615). Intensities of the worst pain (P = .000627), average pain (P = .0213), and current pain (P = .0353), as well as the impact of pain on relationships with others (P = 0.00529), mood (P = .00391), sleep (P = .0132), and interest in life (P = .0248), were negatively correlated with activation levels. CONCLUSION: Half of the chronic pain patients in this population displayed lower activation levels. Older age, less education, manual labor, more co-morbidities, more intense pain and greater impact of pain on life were associated with lower activation levels. Pain education programs need to target the individual's PAM level. REGISTRATION: This trial was registered in Chinese Clinical Trial Registry. Number: ChiECRCT-20180170
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Affiliation(s)
- Fengzhen Yao
- Department of Anesthesiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Man Zheng
- Department of Anesthesiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Xiaoqing Wang
- Department of Anesthesiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Shujuan Ji
- Department of Anesthesiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Sha Li
- Department of Anesthesiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Gang Xu
- Department of Anesthesiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
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28
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Wallace DD, Karmali RN, Kim C, White AM, Stange KC, Lich KH. Identifying Patient Strengths Instruments and Examining Their Relevance for Chronic Disease Management: A Systematic Review. Prev Chronic Dis 2021; 18:E41. [PMID: 33914678 PMCID: PMC8091945 DOI: 10.5888/pcd18.200323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Most health care focuses on patients' deficits to encourage behavior change. A strengths-based approach, which relies on identifying patient strengths, has great potential to facilitate behavior change for chronic disease management. Little is known about instruments used to assess patient strengths. We conducted a systematic review to identify validated instruments that assess personal strengths by using a theory elaboration approach. METHODS We searched 8 databases including Web of Science, Cumulative Index of Nursing and Allied Health (CINAHL), and PsycINFO (through July 2019) to identify peer reviewed, English-language studies that described strength-based instruments. Thereafter, we evaluated the validity and reliability of the instruments according to 18 Scientific Advisory Committee of the Medical Outcome Trust (SACMOT) criteria, and used an inductive, iterative editing process to identify constructs measured by the instruments. RESULTS We identified 26 instruments that met our inclusion criteria. The instruments were validated in various clinical and nonclinical populations. Only 4 instruments met most of the SACMOT criteria for validation. We extracted 91 unique constructs that fell into 3 domains: inner strengths (49), external strengths (13), and personality constructs (29). CONCLUSION A limited number of reliable and valid instruments are available to assess strengths for the adult population, particularly for clinical populations. Internal strengths can be leveraged to improve patient health; however, the development and validation of additional instruments to capture personal strengths is necessary to examine the multilevel influence of external strengths on individual behaviors and well-being.
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Affiliation(s)
- Deshira D Wallace
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Health Behavior, University of North Carolina at Chapel Hill, 302 Rosenau Hall, 135 Dauer Dr, CB7440, Chapel Hill, NC 27599.
| | - Ruchir N Karmali
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Northern California Kaiser Permanente Division of Research, Oakland, California
| | - Christine Kim
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ann Marie White
- University of Rochester Medical Center, Rochester, New York.,Children's Institute, Rochester, New York
| | - Kurt C Stange
- Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio
| | - Kristen Hassmiller Lich
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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29
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La Flair LN, Christensen AL, Brown JD, Wissow LS. Application of the Spanish-Language Consultation and Relational Empathy (CARE) Measure to Assess Patient-Centered Care Among Latino Populations. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:4-9. [PMID: 33882734 DOI: 10.1177/15404153211010674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Reliable and valid measures are needed to assess the patient-centeredness of clinical care among Latino populations. METHODS We translated the Consultation and Relational Empathy (CARE) measure from English to Spanish and assessed its psychometric properties using data from 349 Latino parents/guardians visiting a pediatric clinic. Using confirmatory factor analysis, we examined the psychometric properties of the Spanish CARE measure. RESULTS Internal reliability of the Spanish CARE measure was high (Omega coefficient = 0.95). Similar to the English-language CARE measure, factor analysis of the Spanish CARE measure yielded a single domain of patient-centeredness with high item loadings (factor loadings range from 0.79 to 0.96). CONCLUSION This preliminary analysis supports the reliability and validity of the Spanish version of the CARE measure among Latinos in pediatric care settings. With further testing, the Spanish CARE measure may be a useful tool for tracking and improving the health care delivered to Latino populations.
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30
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Wilkinson TJ, Memory K, Lightfoot CJ, Palmer J, Smith AC. Determinants of patient activation and its association with cardiovascular disease risk in chronic kidney disease: A cross-sectional study. Health Expect 2021; 24:843-852. [PMID: 33835670 PMCID: PMC8235879 DOI: 10.1111/hex.13225] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/06/2021] [Accepted: 02/10/2021] [Indexed: 12/16/2022] Open
Abstract
Background Patient activation describes the knowledge, skills and confidence in managing one's own health. Promoting patient activation is being prioritized to reduce costs and adverse outcomes such as cardiovascular disease (CVD). The increasing prevalence of chronic kidney disease (CKD) presents a need to understand the characteristics that influence patient activation and the effect on health outcomes. Design Cross‐sectional study. Setting and participants Patients with non‐dialysis CKD recruited from 14 sites (general nephrology and primary care) in England, UK. Outcome measures Patient activation was measured using the PAM‐13. Demographic and health‐related variables, self‐reported symptom burden, health‐related quality of life (HRQOL), socioeconomic status (SES), were assessed as determinants of patient activation. Major CVD risk factors included hypertension, dyslipidaemia, obesity and hyperkalaemia. Results 743 patients were included (eGFR: 32.3 (SD17.1) mL/min/1.73 m2, age 67.8 (SD13.9) years, 68% male). The mean PAM score was 55.1 (SD14.4)/100. Most patients (60%) had low activation. Those with low activation were older (P<.001), had lower eGFR (P = .004), greater number of comorbidities (P = .026) and lower haemoglobin (P = .025). Patients with low activation had a 17% greater number of CVD risk factors (P < .001). Risk factors in those with low activation were being older (P < .001) and having diabetes (P < .001). Conclusion This study showed that only a minority of CKD patients are activated for self‐management. Our findings help better understand the level of activation in these patients, particularly older individuals with multimorbidity, and further the knowledge regarding the characteristics that influence activation. Patient or Public Contribution Patients were involved in the design of main study.
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Affiliation(s)
- Thomas J Wilkinson
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Katherine Memory
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Courtney J Lightfoot
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Jared Palmer
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
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31
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Bonilla J, Escalera C, Santoyo-Olsson J, Samayoa C, Ortiz C, Stewart AL, Nápoles AM. The importance of patient engagement to quality of breast cancer care and health-related quality of life: a cross-sectional study among Latina breast cancer survivors in rural and urban communities. BMC WOMENS HEALTH 2021; 21:59. [PMID: 33563263 PMCID: PMC7871405 DOI: 10.1186/s12905-021-01200-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022]
Abstract
Background Compared to their white counterparts, Latina breast cancer survivors experience poorer quality of care and worse health-related quality of life. Limited English proficiency (LEP) and patient engagement in cancer care could help explain these disparities. We assessed associations between LEP status and difficulty engaging with physicians, with self-reported quality of breast cancer care and health-related quality of life (physical and emotional well-being) among rural and urban Latina breast cancer survivors. Methods Analyses used cross-sectional baseline survey data from two studies that tested a stress management program among rural and urban Latina breast cancer survivors in California. Medical information was collected through medical records review. Linear regression models examined bivariate and multivariable associations of LEP status (yes or no), difficulty engaging with doctors (asking questions and participating in treatment decisions) (1–4; higher score = greater difficulty), and rural versus urban site, with three outcomes: (1) quality of breast cancer care and information; (2) physical well-being; and (3) and emotional well-being, controlling for demographic and medical factors. Results The total sample included 304 women (151 from urban and 153 from rural sites). Mean age was 52.7 years (SD 10.9). Most were limited English proficient (84.5%) and had less than a high school education (67.8%). Difficulty engaging with doctors was inversely associated with patient ratings of quality of breast cancer care and information (B = − 0.190, p = 0.014), emotional well-being (B = − 1.866, p < 0.001), and physical well-being (B = − 1.272, p = 0.002), controlling for demographic and treatment factors. LEP (vs. not; B = 1.987, p = 0.040) was independently associated with physical well-being only. Rural/urban status was not related independently to any outcome. Conclusions Rural and urban Latina breast cancer survivors who report greater difficulty engaging with physicians experienced worse quality of breast cancer care and health-related quality of life. Promoting greater engagement of Latina breast cancer survivors in cancer care and providing medical interpreters when needed could improve patient outcomes among this vulnerable group. Trial registration: http://www.ClinicalTrials.gov identifier NCT02931552 and NCT01383174.
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Affiliation(s)
- Jackie Bonilla
- National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, MD, 20892, Bethesda, USA
| | - Cristian Escalera
- National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, MD, 20892, Bethesda, USA
| | - Jasmine Santoyo-Olsson
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, 3333 California St., Suite 335, San Francisco, CA, 94143-0856, USA
| | - Cathy Samayoa
- Health Equity Research Lab, Department of Biology, San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Carmen Ortiz
- Círculo de Vida Cancer Support and Resource Center, 2601 Mission St, Suite 702, San Francisco, CA, 94110, USA
| | - Anita L Stewart
- Institute for Health & Aging, University of California San Francisco, 3333 California St., Suite 340, San Francisco, CA, 94118, USA
| | - Anna María Nápoles
- National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, MD, 20892, Bethesda, USA.
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Stuart BC, Timmons V, Loh FHE, Dai M, Xu J. Can one or two simple questions predict poor medication adherence? J Eval Clin Pract 2021; 27:75-83. [PMID: 32212235 PMCID: PMC9829406 DOI: 10.1111/jep.13389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/03/2020] [Accepted: 03/06/2020] [Indexed: 01/12/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Poor adherence to evidence-based medications is a major problem in conventional clinical practise. Better prognostic tools are needed to identify those with the highest likelihood of being non-adherent. The objective of this study is to determine if a 2-item patient activation status (PAS) measure identifies Medicare beneficiaries at risk of poor adherence to drugs typically recommended in treating type 2 diabetes. METHODS PAS and medication adherence were assessed for respondents to the 2009 Medicare Current Beneficiary Survey and then compared using bivariate and multivariate tests. Participants' PAS was classified as "active," "high effort," "complacent," or "passive" based on how confident they were in identifying needed medical care and whether they brought medication lists to their doctors' visits. Adherence with oral antidiabetic drugs, angiotensin-converting enzyme-inhibitors/angiotensin receptor blockers, and statins was assessed using proportion of days covered (PDC). RESULTS A total of 940 Medicare beneficiaries with diabetes enrolled in Part D plans in 2009. The overall effect of PAS on medication adherence was small (3% lower PDC for complacent/passive vs active/high effort beneficiaries, P < 0.10). However, interactions of complacent/passive PAS with other characteristics associated with poor adherence identified certain subgroups as especially prone to problematic adherence: age < 65 (PDC -11%, P < 0.05), non-Hispanic black (PDC -13%, P < 0.05), and morbidly obese (-9%, P < 0.10). CONCLUSION A single question relating to taking medication lists to doctor visits may help identify patient subgroups prone to poor adherence in conventional practise, but larger samples are necessary to validate and extend these findings.
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Affiliation(s)
- Bruce C Stuart
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Veronica Timmons
- Department of Pharmacy Practice and Sciences, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Feng-Hua E Loh
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Mingliang Dai
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jing Xu
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Digital Health Information Disparities in Older Adults: a Mixed Methods Study. J Racial Ethn Health Disparities 2021; 9:82-92. [PMID: 33415705 PMCID: PMC7790471 DOI: 10.1007/s40615-020-00931-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 11/10/2022]
Abstract
Important health information including disease prevention and chronic disease self-management is increasingly packaged for digital use. The purpose of this sequential explanatory mixed methods study was to describe the extent of computer ownership, Internet access, and digital health information use in an ethnically diverse sample of older adults, comparing ownership, access, and use of digital health information (DHI) across ethnic groups and identifying the factors associated with them quantitatively. Significant differences in computer ownership, Internet access, and DHI use were found across ethnic groups (African American, Afro-Caribbean, Hispanic American, and European American). Logistic regression identified older age, less education, lower income, and minority group membership as significant predictors of limited DHI use. Older African Americans were one-fifth as likely to own a computer than were European Americans; Hispanic Americans were one-half as likely to have access to the Internet. We then conducted a series of focus groups which highlighted differences across ethnic groups. Participants in the African American/Afro-Caribbean group expressed frustration with lack of access to DHI but appreciation for alternative sources of information. Hispanic Americans critiqued information received from providers and drug inserts, some suggesting that a positive attitude and trust in God also contributed to getting well. European American participants evaluated various DHI websites, looking to providers for help in applying information to their personal situation. As the development and use of DHI continue, parallel efforts to increase access to DHI among economically disadvantaged and minority older adults are critical to prevent further disfranchisement.
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Cultural competence in pediatric radiology: Hispanic culture. Pediatr Radiol 2021; 51:11-13. [PMID: 32949249 DOI: 10.1007/s00247-020-04836-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 07/20/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
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Fortmann AL, Philis-Tsimikas A, Euyoque JA, Clark TL, Vital DG, Sandoval H, Bravin JI, Savin KL, Jones JA, Roesch S, Gilmer T, Bodenheimer T, Schultz J, Gallo LC. Medical assistant health coaching ("MAC") for type 2 diabetes in diverse primary care settings: A pragmatic, cluster-randomized controlled trial protocol. Contemp Clin Trials 2020; 100:106164. [PMID: 33053431 DOI: 10.1016/j.cct.2020.106164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/28/2020] [Accepted: 08/06/2020] [Indexed: 01/30/2023]
Abstract
In the US, nearly 11% of adults were living with diagnosed diabetes in 2017, and significant type 2 diabetes (T2D) disparities are experienced by socioeconomically disadvantaged, racial/ethnic minority populations, including Hispanics. The standard 15-min primary care visit does not allow for the ongoing self-management support that is needed to meet the complex needs of individuals with diabetes. "Team-based" chronic care delivery is an alternative approach that supplements physician care with contact from allied health personnel in the primary care setting (e.g., medical assistants; MAs) who are specially trained to provide ongoing self-management support or "health coaching." While rigorous trials have shown MA health coaching to improve diabetes outcomes, less is known about if and how such a model can be integrated within real world, primary care clinic workflows. Medical Assistant Health Coaching for Type 2 Diabetes in Diverse Primary Care Settings - A Pragmatic, Cluster-Randomized Controlled Trial will address this gap. Specifically, this study compares MA health coaching versus usual care in improving diabetes clinical control among N = 600 at-risk adults with T2D, and is being conducted at four primary care clinics that are part of two health systems that serve large, ethnically/racially, and socioeconomically diverse populations in Southern California. Electronic medical records are used to identify eligible patients at both health systems, and to examine change in clinical control over one year in the overall sample. Changes in behavioral and psychosocial outcomes are being evaluated by telephone assessment in a subset (n = 300) of participants, and rigorous process and cost evaluations will assess potential for sustainability and scalability.
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Affiliation(s)
- Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, 10140 Campus Point Drive, Suite 200, San Diego, CA 92121, USA.
| | - Athena Philis-Tsimikas
- Scripps Whittier Diabetes Institute, Scripps Health, 10140 Campus Point Drive, Suite 200, San Diego, CA 92121, USA.
| | - Johanna A Euyoque
- Scripps Whittier Diabetes Institute, Scripps Health, 10140 Campus Point Drive, Suite 200, San Diego, CA 92121, USA.
| | - Taylor L Clark
- San Diego State University/ University of California, San Diego Joint Doctoral Program in Clinical Psychology, 5500 Campanile Dr, San Diego, CA 92182 / 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Daniela G Vital
- San Diego State University Research Foundation, 5500 Campanile Dr, San Diego, CA 92182, USA.
| | - Haley Sandoval
- Scripps Whittier Diabetes Institute, Scripps Health, 10140 Campus Point Drive, Suite 200, San Diego, CA 92121, USA.
| | - Julia I Bravin
- San Diego State University/ University of California, San Diego Joint Doctoral Program in Clinical Psychology, 5500 Campanile Dr, San Diego, CA 92182 / 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Kimberly L Savin
- San Diego State University/ University of California, San Diego Joint Doctoral Program in Clinical Psychology, 5500 Campanile Dr, San Diego, CA 92182 / 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Jennifer A Jones
- Scripps Whittier Diabetes Institute, Scripps Health, 10140 Campus Point Drive, Suite 200, San Diego, CA 92121, USA.
| | - Scott Roesch
- Department of Psychology, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA.
| | - Todd Gilmer
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Thomas Bodenheimer
- Department of Family and Community Medicine, University of California at San Francisco School of Medicine, 533 Parnassus Ave, San Francisco, CA 94143, USA
| | - James Schultz
- Neighborhood Healthcare, 460 N Elm St, Escondido, CA 92025, USA.
| | - Linda C Gallo
- Department of Psychology, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA.
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Lor M, Martinez GA. Scoping review: Definitions and outcomes of patient-provider language concordance in healthcare. PATIENT EDUCATION AND COUNSELING 2020; 103:1883-1901. [PMID: 32507590 DOI: 10.1016/j.pec.2020.05.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/17/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To conduct a scoping literature review to understand the conceptualization and nature of the research on patient-provider language concordance (LC) in health care. METHODS We searched PubMed, EMBASE, CINAHL, PsycINFO, and Scopus to identify peer-reviewed articles between January 1961 and August 2018. We extracted study characteristics, content, definitions, and findings. RESULTS Fifty studies were included. Forty studies were quantitative, seven were qualitative, and three were mixed methods. Overall, the studies revealed inconsistent definitions and measures of patient-provider LC. Outcomes studied in connection to LC included: (1) interpersonal relationships, (2) access to health information, (3) access to care, (4) satisfaction and health-care experience, and (5) patient-related health outcomes. While four studies found that LC care had a negative or no impact on health outcomes, 46 studies reported positive outcomes associated with LC care. CONCLUSIONS The study findings highlight the need for more research on LC care and a consistent definition of LC using multiple measures of LC to capture the complex and multidimensional nature of language in social interaction. PRACTICAL IMPLICATIONS The study findings highlight the importance of how ideologies of language shape the perceptions of language and LC, thereby influence resource allocation and priorities.
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Affiliation(s)
- Maichou Lor
- School of Nursing, University of Wisconsin-Madison, Madison, WI, United States.
| | - Glenn A Martinez
- Department of Spanish and Portuguese, Ohio State University, OH, United States.
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Turin TC, Rashid R, Ferdous M, Naeem I, Rumana N, Rahman A, Rahman N, Lasker M. Perceived barriers and primary care access experiences among immigrant Bangladeshi men in Canada. Fam Med Community Health 2020; 8:e000453. [PMID: 32994217 PMCID: PMC7526305 DOI: 10.1136/fmch-2020-000453] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The study aimed to explore the experience of male members of a rapidly grown community of Bangladeshi immigrants while accessing primary healthcare (PHC) services in Canada. DESIGN A qualitative research was conducted among a sample of Bangladeshi immigrant men through a community-based participatory research approach. Focus group discussions were conducted to collect the qualitative data where thematic analysis was applied. SETTING The focus group discussions were held in various community centres such as individual meeting rooms at public libraries, community halls and so on arranged in collaboration with community organisations while ensuring complete privacy. PARTICIPANT Thirty-eight adults, Bangladeshi immigrant men, living in Calgary were selected for this study and participated in six different focus groups. The sample represents mostly married, educated, Muslim, Bangla speaking, aged over 25 years, full-time or self-employed and living in an urban centre in Canada >5 years. RESULT The focus groups have highlighted long wait time as an important barrier. Long wait at the emergency room, difficulties to get access to general physicians when feeling sick, slow referral process and long wait at the clinic even after making an appointment impact their daily chores, work and access to care. Language is another important barrier that impedes effective communication between physicians and immigrant patients, thus the quality of care. Unfamiliarity with the healthcare system and lack of resources were also voiced that hinder access to healthcare for immigrant Bangladeshi men in Canada. However, no gender-specific barriers unique to men have been identified in this study. CONCLUSION The barriers to accessing PHC services for Bangladeshi immigrant men are similar to that of other visible minority immigrants. It is important to recognise the extent of barriers across various immigrant groups to effectively shape public policy and improve access to PHC.
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Affiliation(s)
- Tanvir C Turin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ruksana Rashid
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mahzabin Ferdous
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Iffat Naeem
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nahid Rumana
- Sleep Center, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Afsana Rahman
- Community Based Citizen Researcher, Calgary, Alberta, Canada
| | - Nafiza Rahman
- Community Based Citizen Researcher, Calgary, Alberta, Canada
| | - Mohammad Lasker
- Community Based Citizen Researcher, Calgary, Alberta, Canada
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Cunha CM, da Cunha DCPT, Manzato RDO, Nepomuceno E, da Silva D, Dantas RAS. Validation of the Brazilian Version of the Patient Activation Measure 13. J Nurs Meas 2020; 27:97-113. [PMID: 31068494 DOI: 10.1891/1061-3749.27.1.97] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE To assess the psychometric properties of the PAM13 Brazilian-Portuguese (PAM13-B) among outpatients with chronic diseases. METHODS 513 adults participated, diagnosed with a chronic disease for more than 6 months, under outpatient monitoring. Reliability was tested using internal consistency and test-retest reliability. Construct validity was verified through different techniques (correlation between activation and self-esteem measures, anxiety, depression and health status), known-groups validity and dimensionality by means of confirmatory factor analysis. Significance was set at 0.05. RESULTS The PAM13-B presented appropriate results for internal consistency (α = 0.83) and test-retest reliability (intraclass correlation coefficient [ICC] = 0.81). A moderate correlation was found between activation and self-esteem only (r = 0.43, p < 0.001). The one-dimensional structure was not confirmed in the sample analyzed. CONCLUSIONS In the study sample, the version PAM13-B demonstrated its reliability and validity, but with a two-factor structure.
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Affiliation(s)
| | | | | | - Eliane Nepomuceno
- University of São Paulo at Ribeirão Preto College of Nursing-São Paulo State, Brazil
| | - Dirceu da Silva
- University of Campinas, Faculty of Education, Campinas-São Paulo State, Brazil
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The RICH LIFE Project: A cluster randomized pragmatic trial comparing the effectiveness of health system only vs. health system Plus a collaborative/stepped care intervention to reduce hypertension disparities. Am Heart J 2020; 226:94-113. [PMID: 32526534 DOI: 10.1016/j.ahj.2020.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/04/2020] [Indexed: 01/08/2023]
Abstract
Disparities in the control of hypertension and other cardiovascular disease risk factors are well-documented in the United States, even among patients seen regularly in the healthcare system. Few existing approaches explicitly address disparities in hypertension care and control. This paper describes the RICH LIFE Project (Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone) design. METHODS RICH LIFE is a two-arm, cluster-randomized trial, comparing the effectiveness of enhanced standard of care, "Standard of Care Plus" (SCP), to a multi-level intervention, "Collaborative Care/Stepped Care" (CC/SC), for improving blood pressure (BP) control and patient activation and reducing disparities in BP control among 1890 adults with uncontrolled hypertension and at least one other cardiovascular disease risk factor treated at 30 primary care practices in Maryland and Pennsylvania. Fifteen practices randomized to the SCP arm receive standardized BP measurement training; race/ethnicity-specific audit and feedback of BP control rates; and quarterly webinars in management practices, quality improvement and disparities reduction. Fifteen practices in the CC/SC arm receive the SCP interventions plus implementation of the collaborative care model with stepped-care components (community health worker referrals and virtual specialist-panel consults). The primary clinical outcome is BP control (<140/90 mm Hg) at 12 months. The primary patient-reported outcome is change from baseline in self-reported patient activation at 12 months. DISCUSSION This study will provide knowledge about the feasibility of leveraging existing resources in routine primary care and potential benefits of adding supportive community-facing roles to improve hypertension care and reduce disparities. TRIAL REGISTRATION Clinicaltrials.govNCT02674464.
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Gallo LC, Fortmann AL, Bravin JI, Clark TL, Savin KL, Ledesma DL, Euyoque J, Sandoval H, Roesch SC, Gilmer T, Talavera GA, Philis-Tsimikas A. My Bridge (Mi Puente), a care transitions intervention for Hispanics/Latinos with multimorbidity and behavioral health concerns: protocol for a randomized controlled trial. Trials 2020; 21:174. [PMID: 32051005 PMCID: PMC7014646 DOI: 10.1186/s13063-019-3722-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background Multimorbidity affects four of ten US adults and eight of ten adults ages 65 years and older, and frequently includes both cardiometabolic conditions and behavioral health concerns. Hispanics/Latinos (hereafter, Latinos) and other ethnic minorities are more vulnerable to these conditions, and face structural, social, and cultural barriers to obtaining quality physical and behavioral healthcare. We report the protocol for a randomized controlled trial that will compare Mi Puente (My Bridge), a cost-efficient care transitions intervention conducted by a specially trained Behavioral Health Nurse and Volunteer Community Mentor team, to usual care or best-practice discharge approaches, in reducing hospital utilization and improving patient reported outcomes in Latino adults with multiple cardiometabolic conditions and behavioral health concerns. The study will examine the degree to which Mi Puente produces superior reductions in hospital utilization at 30 and 180 days (primary aim) and better patient-reported outcomes (quality of life/physical health; barriers to healthcare; engagement with outpatient care; patient activation; resources for chronic disease management), and will examine the cost effectiveness of the Mi Puente intervention relative to usual care. Methods Participants are enrolled as inpatients at a South San Diego safety net hospital, using information from electronic medical records and in-person screenings. After providing written informed consent and completing self-report assessments, participants randomized to usual care receive best-practice discharge processes, which include educational materials, assistance with outpatient appointments, referrals to community-based providers, and other assistance (e.g., with billing, insurance) as required. Those randomized to Mi Puente receive usual-care materials and processes, along with inpatient visits and up to 4 weeks of follow-up phone calls from the intervention team to address their integrated physical-behavioral health needs and support the transition to outpatient care. Discussion The Mi Puente Behavioral Health Nurse and Volunteer Community Mentor team intervention is proposed as a cost-effective and culturally appropriate care transitions intervention for Latinos with multimorbidity and behavioral health concerns. If shown to be effective, close linkages with outpatient healthcare and community organizations will help maximize uptake, dissemination, and scaling of the Mi Puente intervention. Trial registration ClinicalTrials.gov: NCT02723019. Registered on 30 March 2016.
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Affiliation(s)
- Linda C Gallo
- Department of Psychology, San Diego State University, San Diego CA, USA.
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla CA, USA
| | - Julia I Bravin
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
| | - Taylor L Clark
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
| | - Kimberly L Savin
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
| | | | - Johanna Euyoque
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla CA, USA
| | - Haley Sandoval
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla CA, USA
| | - Scott C Roesch
- Department of Psychology, San Diego State University, San Diego CA, USA
| | - Todd Gilmer
- Department of Family Medicine and Public Health, University of California, San Diego, USA
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Muiruri C, Sico IP, Schexnayder J, Webel AR, Okeke NL, Longenecker CT, Gonzalez JM, Jones KA, Gonzales SE, Bosworth HB. Why Do People Living with HIV Adhere to Antiretroviral Therapy and Not Comorbid Cardiovascular Disease Medications? A Qualitative Inquiry. Patient Prefer Adherence 2020; 14:985-994. [PMID: 32669837 PMCID: PMC7337208 DOI: 10.2147/ppa.s254882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/19/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND After achieving viral suppression, it is critical for persons living with HIV (PLWH) to focus on prevention of non-AIDS comorbidities such as cardiovascular disease (CVD) in order to enhance their quality of life and longevity of life. Despite PLWH elevated risk of developing CVD compared to individuals without HIV, PLWH do not often meet evidence-based treatment goals for CVD prevention; the reasons for PLWH not meeting guideline recommendations are poorly understood. The objective of this study was to identify the factors associated with adherence to CVD medications for PLWH who have achieved viral suppression. METHODS Qualitative data were obtained from formative research conducted to inform the adaptation of a nurse-led intervention trial to improve cardiovascular health at three large academic medical centers in the United States. Transcripts were analyzed using content analysis guided by principles drawn from grounded theory. RESULTS Fifty-one individuals who had achieved viral suppression (<200 copies/mL) participated: 37 in 6 focus groups and 14 in individual semi-structured interviews. Mean age was 57 years (SD: 7.8); most were African Americans (n=31) and majority were male (n=34). Three main themes were observed. First, participants reported discordance between their healthcare providers' recommendations and their own preferred strategies to reduce CVD risk. Second, participants intentionally modified frequency of CVD medication taking which appeared to be related to low CVD risk perception and perceived or experienced side effects with treatment. Finally, participants discussed the impact of long-term experience with HIV care on adherence to CVD medication and motivational factors that enhanced adherence to heart healthy behaviors. CONCLUSION Findings suggest that future research should focus on developing interventions to enhance patient-provider communication in order to elicit beliefs, concerns and preferences for CVD prevention strategies. Future research should seek to leverage and adapt established evidence-based practices in HIV care to support CVD medication adherence.
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Affiliation(s)
- Charles Muiruri
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Correspondence: Charles Muiruri Email
| | - Isabelle P Sico
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Julie Schexnayder
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Juan Marcos Gonzalez
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Sarah E Gonzales
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Hayden B Bosworth
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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DeCamp LR, Showell N, Godage SK, Leifheit KM, Valenzuela-Araujo D, Shah H, Polk S. Parent activation and pediatric primary care outcomes for vulnerable children: A mixed methods study. PATIENT EDUCATION AND COUNSELING 2019; 102:2254-2262. [PMID: 31288957 PMCID: PMC7266441 DOI: 10.1016/j.pec.2019.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 06/25/2019] [Accepted: 07/01/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Among children in low-income families 1) examine associations between parent activation and pediatric primary care outcomes and 2) explore parent perspectives on Parent-Patient Activation Measure (P-PAM) questions in relation to pediatric primary care experiences. METHODS We examined associations between P-PAM score via Spanish- or English-language survey and healthcare outcomes abstracted from electronic medical records for parent/child dyads at an urban general pediatrics clinic. Parent perspectives were elicited via qualitative interviews with a subsample of parents who "thought aloud" during P-PAM completion. RESULTS Among 316 Spanish (68%) and English-language parent/child dyads, we found associations between parent activation and primary care outcomes only among Spanish-language dyads and only for weight and health status. Findings from 21 interviews provided possible explanations for quantitative findings including question limitations in assessing knowledge, skills, and confidence in pediatric primary care and P-PAM cultural and linguistic appropriateness for low-income Latino populations. CONCLUSIONS Pairing quantitative and qualitative methods provided insight on P-PAM measurement limitations and raised questions about its use in patient engagement interventions to reduce health disparities. PRACTICE IMPLICATIONS Practices serving vulnerable children and families should consider the limitations of the P-PAM for measuring parent healthcare engagement before utilizing the P-PAM in patient engagement interventions.
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Affiliation(s)
- Lisa Ross DeCamp
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
| | - Nakiya Showell
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Sashini K Godage
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | | | | | - Harita Shah
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Sarah Polk
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD USA
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Implementation of a Stress Intervention with Latino Immigrants in a Non-traditional Migration City. J Immigr Minor Health 2019; 21:372-382. [PMID: 29623527 DOI: 10.1007/s10903-018-0732-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Stress negatively impacts health outcomes across all racial and ethnic groups, but the health disparities experienced by Latino immigrants in nontraditional migration cities are exacerbated by undeveloped infrastructure and weak social support networks. Immigrants in new migration cities can be difficult to engage in health interventions and are therefore underrepresented in the very research where their inclusion is most crucial. To effectively engage Latino immigrants, a team of academic and community researchers collaborated on a community-based participatory research project to design and implement a stress and coping intervention. Top stressors reported were family, children, and work, but health was most commonly identified as the primary stressor. Participants overwhelmingly chose physical activity goals for stress reduction. Pre- to post- intervention results revealed significant improvements in social support and stress management. Results demonstrate the effectiveness of a peer-led, community-partnered approach to implementing a stress intervention with Latino immigrants in a nontraditional migration city.
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Quarells RC, Spruill TM, Escoffery C, Shallcross A, Montesdeoca J, Diaz L, Payano L, Thompson NJ. Depression self-management in people with epilepsy: Adapting project UPLIFT for underserved populations. Epilepsy Behav 2019; 99:106422. [PMID: 31371202 PMCID: PMC7432961 DOI: 10.1016/j.yebeh.2019.07.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/05/2019] [Indexed: 01/27/2023]
Abstract
Data from the 2015 National Health Interview Survey found that the prevalence of active epilepsy has increased to three million adults. Although findings have been mixed, some research indicates that Blacks and Hispanics share a higher burden of epilepsy prevalence compared with non-Hispanic whites. Moreover, depression is a common comorbid condition among people with epilepsy (PWE), affecting up to 55% of the epilepsy population. Widespread use and increased public health impact of evidence-based self-management interventions is critical to reducing disease burden and may require adapting original interventions into more culturally relevant versions for racial and ethnic minority groups. Project UPLIFT provides access to mental health self-management skills training that is distance-delivered, does not interfere with medication management, and has been shown to be effective in reducing depressive symptoms. This paper presents the process of exploring the adaptation of Project UPLIFT for Black and Hispanic PWE and herein suggests that evidence-based interventions can be successfully adapted for new populations or cultural settings through a careful and systematic process. Additional key lessons learned include the importance of community engagement and that language matters. Ultimately, if the adapted Project UPLIFT intervention produces positive outcomes for diverse populations of PWE, it will extend the strategies available to reduce the burden of depression. Implementing evidence-based interventions such as Project UPLIFT is critical to reducing disease burden; however, their delivery may need to be tailored to the needs and culture of the populations of interest.
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Affiliation(s)
- Rakale C Quarells
- Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310, United States.
| | - Tanya M Spruill
- NYU School of Medicine, Department of Population Health, 180 Madison Ave, 7th Floor, New York, NY 10016, United States
| | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, United States
| | - Amanda Shallcross
- NYU School of Medicine, Department of Population Health, 180 Madison Ave, 7th Floor, New York, NY 10016, United States
| | - Jacqueline Montesdeoca
- NYU School of Medicine, Department of Population Health, 180 Madison Ave, 7th Floor, New York, NY 10016, United States
| | - Laura Diaz
- NYU School of Medicine, Department of Population Health, 180 Madison Ave, 7th Floor, New York, NY 10016, United States
| | - Leydi Payano
- NYU School of Medicine, Department of Population Health, 180 Madison Ave, 7th Floor, New York, NY 10016, United States
| | - Nancy J Thompson
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, United States
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Torres DX, Lu WY, Uratsu CS, Sterling SA, Grant RW. Knowing How to Ask Good Questions: Comparing Latinos and Non-Latino Whites Enrolled in a Cardiovascular Disease Prevention Study. Perm J 2019; 23:18-258. [PMID: 30939290 DOI: 10.7812/tpp/18-258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Latinos face unique challenges engaging with their health care providers for risk management of cardiovascular disease (CVD). OBJECTIVE To better understand differences in how Latinos and non-Latino whites (NLWs) experience CVD care. METHODS We examined self-reported activation, engagement, confidence, and communication comparing Latinos (n = 194) and NLWs (n = 208). Data were taken from baseline survey assessments of participants in the CREATE Wellness Study (NCT02302612), designed to help patients with poorly controlled CVD risk factors more actively engage in their care. The groups were compared using χ2 tests and separate logistic regression models adjusting for age, age and income, and age and educational attainment. RESULTS Latinos in this cohort were younger, were less educated, and had lower incomes than did NLWs. In age-adjusted models, Latinos were significantly less likely to report knowing how to ask good questions about their health (71.1% vs 83.7% for NLW, p < 0.01; adjusted odds ratio = 0.49, 95% confidence interval = 0.29-0.83). Further adjustment by educational attainment or income did not attenuate this association. Latinos were also significantly more likely to report positive experiences and confidence with several measures of chronic illness care (adjusted odds ratio range = 1.57-2.01). Further adjustment by educational attainment eliminated these associations. CONCLUSION We found notable differences between Latinos and NLWs in their experience of health care. These results provide insights into how CVD risk management programs can be tailored for Latinos. Interventions to improve patient activation and engagement for Latinos with CVD should emphasize question-asking skills.
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Chiang M, Chang J, Nakash O, Cruz-Gonzalez M, Fillbrunn MK, Alegría M. Change in Patient Activation and Mental Illness Symptoms After Communication Training: A Multisite Study With a Diverse Patient Sample. Psychiatr Serv 2019; 70:696-702. [PMID: 31084292 PMCID: PMC6675648 DOI: 10.1176/appi.ps.201800216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Patient activation involves patients' ability and motivation to communicate about their health and health care. Research has demonstrated that clinician or patient interventions may improve patient activation. This study explored the degree to which clinician and patient interventions affected both patient activation and symptoms of depression and anxiety in a racially and ethnically diverse clinical sample. METHODS Data were from a randomized clinical trial that included 312 patients and 74 clinicians from 13 Massachusetts community- and hospital-based outpatient behavioral health clinics. Patients completed measures of patient activation and depression and anxiety symptoms. Secondary data analyses were conducted to examine the effect of patient and clinician interventions (DECIDE-PA and DECIDE-PC, respectively) on depression and anxiety symptoms and patient activation. A multilevel, mixed-effects simultaneous-equation model was estimated to assess the relationship between the interventions, changes in patients' symptoms, and patient activation. RESULTS Clinicians' greater intervention dosage (i.e., more completed DECIDE-PC training sessions) was associated with patients' decreased anxiety symptoms, but associations with patient activation or depression symptoms were not significant. The effect of clinician training dosage on anxiety symptoms was stronger when patients and clinicians were not of the same race-ethnicity. The reduction in patients' anxiety symptoms appeared to increase patient activation. CONCLUSIONS Clinician interventions designed to boost patient-clinician communication and the therapeutic alliance may serve to lessen patients' anxiety and may ultimately improve patient activation.
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Affiliation(s)
- Mengchun Chiang
- Counseling and Psychological Services, Carnegie Mellon University, Pittsburgh (Chiang); Department of Psychology, West Chester University, West Chester, Pennsylvania (Chang); School for Social Work, Smith College, Northampton, Massachusetts (Nakash); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston (Cruz-Gonzalez, Fillbrunn, Alegría); Department of Medicine and Psychiatry, Harvard Medical School, Boston (Alegría)
| | - Janet Chang
- Counseling and Psychological Services, Carnegie Mellon University, Pittsburgh (Chiang); Department of Psychology, West Chester University, West Chester, Pennsylvania (Chang); School for Social Work, Smith College, Northampton, Massachusetts (Nakash); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston (Cruz-Gonzalez, Fillbrunn, Alegría); Department of Medicine and Psychiatry, Harvard Medical School, Boston (Alegría)
| | - Ora Nakash
- Counseling and Psychological Services, Carnegie Mellon University, Pittsburgh (Chiang); Department of Psychology, West Chester University, West Chester, Pennsylvania (Chang); School for Social Work, Smith College, Northampton, Massachusetts (Nakash); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston (Cruz-Gonzalez, Fillbrunn, Alegría); Department of Medicine and Psychiatry, Harvard Medical School, Boston (Alegría)
| | - Mario Cruz-Gonzalez
- Counseling and Psychological Services, Carnegie Mellon University, Pittsburgh (Chiang); Department of Psychology, West Chester University, West Chester, Pennsylvania (Chang); School for Social Work, Smith College, Northampton, Massachusetts (Nakash); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston (Cruz-Gonzalez, Fillbrunn, Alegría); Department of Medicine and Psychiatry, Harvard Medical School, Boston (Alegría)
| | - Mirko K Fillbrunn
- Counseling and Psychological Services, Carnegie Mellon University, Pittsburgh (Chiang); Department of Psychology, West Chester University, West Chester, Pennsylvania (Chang); School for Social Work, Smith College, Northampton, Massachusetts (Nakash); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston (Cruz-Gonzalez, Fillbrunn, Alegría); Department of Medicine and Psychiatry, Harvard Medical School, Boston (Alegría)
| | - Margarita Alegría
- Counseling and Psychological Services, Carnegie Mellon University, Pittsburgh (Chiang); Department of Psychology, West Chester University, West Chester, Pennsylvania (Chang); School for Social Work, Smith College, Northampton, Massachusetts (Nakash); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston (Cruz-Gonzalez, Fillbrunn, Alegría); Department of Medicine and Psychiatry, Harvard Medical School, Boston (Alegría)
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Alvarez C, Perrin N, Lameiras-Fernandez M, Rodriguez R, Glass N. Adverse childhood experiences among Latina women and its association with mastery of stress and health. CHILD ABUSE & NEGLECT 2019; 93:139-148. [PMID: 31103836 DOI: 10.1016/j.chiabu.2019.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/11/2019] [Accepted: 05/05/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Adverse childhood experience (ACE) and intimate partner violence (IPV) have sustained, deleterious effects on physical and mental health. Few studies have examined how to help Latina survivors of ACEs and/or IPV regain control of their health. OBJECTIVE To inform interventions for this population, we examined whether mastery of stress and patient activation mediate the relationship between a history of ACE and/or IPV and mental and physical health. PARTICIPANTS AND SETTING We recruited 235 Latina women (M age = 29.6, SD = 5.75) from primary care clinics. METHOD For this cross-sectional study, we used linear regressions to examine the association between ACEs, history of IPV, and health, and the sobel's test to determine whether patient activation and mastery of stress mediated the relationships between ACEs, IPV, and health. RESULTS Most women reported at least one ACE (61.7%, n = 137) and 22.2% (n = 55) reported a history of IPV. Mastery of stress mediated the relationship between ACE and physical health (b= -3.16 p = .002) and mental health (b= -3.83, p < .001). Mastery of stress also mediated the relationship between history of IPV and physical health (b= -2.62, p = .008) and mental health (b= -2.74, p = .006). Patient activation was not associated with a history of trauma or mental health. CONCLUSION While past experiences of trauma cannot be changed, results from this study suggest that improving an individual's mastery of stress may be a point of intervention for improving mental and physical health among survivors of ACEs and IPV.
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Affiliation(s)
- Carmen Alvarez
- Johns Hopkins University School of Nursing, 525 N. Wolfe St, Baltimore, MD, 21205, United States.
| | - Nancy Perrin
- Johns Hopkins University School of Nursing, 525 N. Wolfe St, Baltimore, MD, 21205, United States
| | | | - Rebecca Rodriguez
- Casa de Esperanza: National Latin@ Network, P.O. Box 40115, St. Paul, MN, 55104, United States
| | - Nancy Glass
- Johns Hopkins University School of Nursing, 525 N. Wolfe St, Baltimore, MD, 21205, United States
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Tabaac AR, Benotsch EG, Barnes AJ. Mediation Models of Perceived Medical Heterosexism, Provider–Patient Relationship Quality, and Cervical Cancer Screening in a Community Sample of Sexual Minority Women and Gender Nonbinary Adults. LGBT Health 2019; 6:77-86. [DOI: 10.1089/lgbt.2018.0203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Ariella R. Tabaac
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Psychology and Virginia Commonwealth University, Richmond, Virginia
| | - Eric G. Benotsch
- Department of Psychology and Virginia Commonwealth University, Richmond, Virginia
| | - Andrew J. Barnes
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia
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Noel SE, Arevalo SP, Mena NZ, Mangano K, Velez M, Dawson-Hughes B, Tucker KL. Knowledge, attitudes, beliefs, and health behaviors of bone health among Caribbean Hispanic/Latino adults. Arch Osteoporos 2019; 14:14. [PMID: 30719597 PMCID: PMC6448586 DOI: 10.1007/s11657-019-0566-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/20/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED Few studies have examined knowledge and perceptions of osteoporosis among Caribbean Latino adults. Confusion regarding the term osteoporosis was noted. Doctors were viewed as trusted sources of health information, although descriptions of a paradoxical relationship emerged. This study can be used to inform culturally tailored interventions for osteoporosis prevention. PURPOSE The overall goal of this study was to assess knowledge, attitudes, and beliefs of bone health and osteoporosis among Caribbean Latino adults aged > 50 years. METHODS This triangulated mixed methods study included completion of a quantitative questionnaire and participation in one of four focus groups to obtain information on (1) general health, (2) knowledge about bone health and osteoporosis, (3) sources of information about bone health, and (4) prevention knowledge and personal responsibility. Quantitative data were analyzed using SAS, and qualitative data were analyzed using descriptive and structural coding by two independent research members. RESULTS The majority of participants were female (73%), Dominican (84%), and low income (82% < $20,000) with a mean age of 68.4 (± 8.5) years. Most participants had heard of osteoporosis (90%); however, the majority were not able to accurately describe this chronic condition. Health care providers were viewed as most trusted sources of health information, despite feelings of being rushed during their visits, with limited communication about preventative care. Most participants felt that nutrition and exercise were important for overall health. CONCLUSIONS Caribbean Hispanic adults in this study reported knowledge of osteoporosis and nutritional factors associated with prevention of this chronic condition. However, qualitatively, there was confusion between osteoporosis and other bone and joint conditions. Culturally specific interventions to promote prevention of osteoporosis are urgently needed for this underserved, high-risk population.
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Affiliation(s)
- Sabrina E. Noel
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, 3 Solomont Way, Suite 4, Lowell, MA 01854, USA
| | - Sandra P. Arevalo
- Department of Human Development, California State University, Long Beach, Long Beach, CA, USA
| | - Noereem Z. Mena
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Kelsey Mangano
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, 3 Solomont Way, Suite 4, Lowell, MA 01854, USA
| | - Martha Velez
- City of Lawrence Multipurpose Senior Center, Lawrence, MA, USA
| | - Bess Dawson-Hughes
- Bone Metabolism Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Katherine L. Tucker
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, 3 Solomont Way, Suite 4, Lowell, MA 01854, USA
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Levison JH, Levinson JK, Alegría M. A Critical Review and Commentary on the Challenges in Engaging HIV-Infected Latinos in the Continuum of HIV Care. AIDS Behav 2018; 22:2500-2512. [PMID: 29948334 DOI: 10.1007/s10461-018-2187-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Antiretroviral therapy for treatment of HIV infection has become increasingly effective. Persistent poor HIV outcomes in racial and ethnic minority populations in the US call for a closer examination into why Latinos are at significant risk for acquiring and dying from HIV. To improve clinical outcomes and achieve an AIDS-free generation, HIV research must address disparities in HIV outcomes in Latinos, the largest ethnic/racial minority population in the US. Immigrant status as well as cultural factors influence HIV care utilization and are essential to highlight for effective intervention development in Latinos. A better understanding of these individual and contextual factors is critical to developing tailored approaches to engaging Latinos in HIV care. Based on a comprehensive literature review, we offer a framework for understanding what is needed from clinical practice and research to improve engagement in HIV care for US-based Latinos. These findings may have implications for other minority populations.
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