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Ibe C, Hines A, Dominguez Carrero N, Fuller S, Trainor A, Scott T, Hickman D, Cooper LA. Voices, Images, And Experiences Of Community Health Workers: Advancing Antiracist Policy And Practice. Health Aff (Millwood) 2023; 42:1392-1401. [PMID: 37782865 DOI: 10.1377/hlthaff.2023.00584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Community health workers (CHWs) are front-line public health personnel who share common attributes with or have a nuanced understanding of the communities they serve. Their membership in marginalized communities gives them expertise in delivering contextualized interventions that mitigate their clients' social risk factors, but it also places them at greater risk for exposure to various harms. We employed the photovoice method to illuminate how the lived experiences of CHWs working, residing, or both in Baltimore City, Maryland, dovetail with facets of their jobs. In partnership with our sixteen predominantly racial and ethnic minoritized study participants, we surfaced the ways in which CHWs negotiated and subsequently leveraged experiences with social risk factors rooted in structural racism to shape their approach to intervention delivery for structurally vulnerable communities. We also uncovered several occupational hazards that participants faced as a function of their identities. Our findings underscore the need to embed antiracist principles in the fabric of policies and practices that directly affect the CHW workforce.
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Affiliation(s)
- Chidinma Ibe
- Chidinma Ibe , Johns Hopkins University, Baltimore, Maryland
| | - Anika Hines
- Anika Hines, Virginia Commonwealth University, Baltimore, Maryland
| | | | | | | | - Tiffany Scott
- Tiffany Scott, Maryland Community Health Worker Association, Baltimore, Maryland
| | - Debra Hickman
- Debra Hickman, Sisters Together and Reaching, Inc., Baltimore, Maryland
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Gholami M, Abdoli Talaei A, Tarrahi MJ, Mirzaei Taqi F, Galehdar N, Pirinezhad P. The effect of self-management support program on patient activation and inner strength in patients with cardiovascular disease. PATIENT EDUCATION AND COUNSELING 2021; 104:2979-2988. [PMID: 33972129 DOI: 10.1016/j.pec.2021.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 04/08/2021] [Accepted: 04/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The aim of the present study was to evaluate the effect of a self-management program on activation and inner strength in patients with cardiovascular diseases (CVDs). METHODS This study assigned 86 patients with CVDs to an experimental and a comparison group utilizing alternate allocation based on a quasi-experimental design. The experimental group participated in a self-management program based on a theoretical framework in three stages, i.e. orientation-recognition, reinforcing-engaging and monitoring-follow-up; whereas the comparison group received routine care. The supportive program was administered through holding five individual face-to-face sessions, providing educational booklets and performing four phone-call follow-ups during three months after discharge. The outcomes were measured using the patient activation measure (PAM) and the inner strength scale (ISS). RESULTS The between group analysis indicated a statistically-significant difference in the mean score of patient activation (P < 0.001) in the two groups. Nevertheless, there was not a statistically-insignificant difference in the mean score of inner strength between the two groups (P < 0.104). CONCLUSION Although a three-month nurse-led self-management support program was found to improve patient activation levels, it was ineffective in promoting inner strength. PRACTICE IMPLICATIONS Psychosocial dynamics should be integrated in providing self-management program by nurses. To promote patient activation, tailored consultations is recommended.
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Affiliation(s)
- Mohammad Gholami
- School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad 6814993165, Iran.
| | - Arefeh Abdoli Talaei
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Mohammad Javad Tarrahi
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
| | | | - Nasrin Galehdar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Pezhman Pirinezhad
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran.
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Ibe CA, Hickman D, Cooper LA. To Advance Health Equity During COVID-19 and Beyond, Elevate and Support Community Health Workers. JAMA HEALTH FORUM 2021; 2:e212724. [DOI: 10.1001/jamahealthforum.2021.2724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Chidinma A. Ibe
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Baltimore, Maryland
| | - Debra Hickman
- Johns Hopkins Center for Health Equity, Baltimore, Maryland
- Sisters Together and Reaching, Baltimore, Maryland
| | - Lisa A. Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Baltimore, Maryland
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Ibe CA, Bowie J, Carson KA, Bone L, Monroe D, Roter D, Cooper LA. Patient-level Predictors of Extent of Exposure to a Community Health Worker Intervention in a Randomized Controlled Trial. Ethn Dis 2019; 29:261-266. [PMID: 31057311 DOI: 10.18865/ed.29.2.261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Community health worker (CHW) interventions have been cited as a best practice for reducing health disparities, but patient-level attributes may contribute to differential uptake. We examined patient characteristics associated with the extent of exposure to a CHW coaching intervention among a predominantly low-income, African American population participating in a randomized controlled trial of hypertension interventions. Design We conducted a within-group longitudinal analysis of those receiving a CHW intervention from a study conducted between September 2003 and August 2005. We employed mixed effects models to ascertain relationships between patients' characteristics, length of time spent with the CHW, and the number of topics discussed during the intervention. Setting Baltimore, MD. Participants 140 patients with a diagnosis of hypertension in the CHW intervention arm. Results Marital status, stress, depression symptomology, and having multiple comorbid conditions were each independently and positively related to the length of time patients spent with CHWs. An indirect relationship between higher perceived physical health and time spent with the CHW was observed. Patients with multiple comorbid conditions discussed more intervention-related topics, while patients who perceived themselves as being healthier discussed fewer topics. Marital status and extreme poverty were the strongest predictors of the length of time spent with the CHW, while having multiple comorbid conditions was the strongest predictor of the number of coaching topics discussed. Conclusions Differential exposure to a CHW intervention is influenced by patients' physical, psychosocial, and sociodemographic characteristics.
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Affiliation(s)
- Chidinma A Ibe
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Janice Bowie
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kathryn A Carson
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lee Bone
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Dwyan Monroe
- Institute for Public Health Innovation, Washington, DC
| | - Debra Roter
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lisa A Cooper
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Koester KA, Johnson MO, Wood T, Fredericksen R, Neilands TB, Sauceda J, Crane HM, Mugavero MJ, Christopoulos KA. The influence of the 'good' patient ideal on engagement in HIV care. PLoS One 2019; 14:e0214636. [PMID: 30921440 PMCID: PMC6438522 DOI: 10.1371/journal.pone.0214636] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 03/19/2019] [Indexed: 11/18/2022] Open
Abstract
Research on patient engagement in health care shows that better health outcomes and lower healthcare costs are observed among highly engaged patients. Similar to other illnesses, high levels of patient engagement in HIV care are considered essential to maintaining optimal health, and patients who are on treatment and retained in HIV care are known to have better health outcomes. In this article, we draw on focus group discussion data with patients living with HIV in order to explain tacit expectations associated with engagement in care. The main objective of our research was to elicit an explanatory model of engagement in HIV care from the patients’ perspective. We conducted focus group discussions with a sample of two distinct types of patients: those who regularly attended medical appointments and those who did not. In total, we conducted six focus group discussions (n = 43) across in three cities in the US; these included two focus group discussions with a well-engaged and less-well-engaged group in each location. Both types of patients assigned a moral dimension to engagement in care, in that well-engaged patients were considered to be ‘good’ patients. Aspiring to become a ‘good’ patient provided a meaningful goal for some and deepened vulnerabilities among patients that struggled to achieve this status. More vulnerable patients may feel less secure in health care interactions and these feelings may be amplified if patients have an unreasonable impression of what constitutes a ‘good’ patient; thereby leading to disengagement in care. Our findings can inform the development of patient-centered, tailored messages to better serve patients struggling to stay engaged in HIV care.
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Affiliation(s)
- Kimberly A. Koester
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, California, United States of America
- * E-mail:
| | - Mallory O. Johnson
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, California, United States of America
| | - Troy Wood
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, California, United States of America
| | - Rob Fredericksen
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Torsten B. Neilands
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, California, United States of America
| | - John Sauceda
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, California, United States of America
| | - Heidi M. Crane
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Michael J. Mugavero
- Department of Medicine, University of Alabama, Birmingham, Alabama, United States of America
| | - Katerina A. Christopoulos
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, California, United States of America
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Jiang S, Hong YA. Mobile-based patient-provider communication in cancer survivors: The roles of health literacy and patient activation. Psychooncology 2017; 27:886-891. [DOI: 10.1002/pon.4598] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/14/2017] [Accepted: 11/16/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Shaohai Jiang
- Department of Communications and New Media; National University of Singapore; Singapore
| | - Y. Alicia Hong
- School of Public Health; Texas A&M University; College Station TX USA
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Finset A. Patient Participation, Engagement and Activation: Increased emphasis on the role of patients in healthcare. PATIENT EDUCATION AND COUNSELING 2017; 100:1245-1246. [PMID: 28595771 DOI: 10.1016/j.pec.2017.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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