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Vestal E, Newman S, Phillips S. Barriers and facilitators to accessing pediatric specialty care for rural-dwelling children with complex chronic conditions: An integrative review. J Pediatr Nurs 2024:S0882-5963(24)00185-4. [PMID: 38777676 DOI: 10.1016/j.pedn.2024.05.001] [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: 10/26/2023] [Revised: 05/01/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024]
Abstract
PROBLEM Pediatric specialty services are often geographically concentrated in urban areas, leaving up to 1 in 5 rural-dwelling children in the United States without access to advanced care. The purpose of this review was to identify and review extant literature related to barriers and facilitators to accessing specialty care for rural-dwelling children with complex chronic conditions. ELIGIBILITY CRITERIA The Whittemore and Knafl (2005) integrative review method guided the review which included a critical appraisal and analysis of relevant articles published between 2012 and 2023. SAMPLE Twenty-three studies were identified for inclusion in the integrative review. RESULTS Using the domains of the Levesque et al. (2013) conceptual framework, findings were categorized according to the access to care continuum. Barriers included broadband access, transportation, and inadequate care coordination. Facilitators included telehealth, social support, and outreach clinics. CONCLUSIONS To improve access to pediatric specialty care for rural-dwelling children, nurses, physicians, and policymakers will need to consider how the social determinants of health impact the healthcare access continuum from diagnosis to continuing healthcare. IMPLICATIONS The findings of this integrative review will aid researchers in developing interventions to improve access to pediatric specialty care for rural-dwelling children.
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Affiliation(s)
- Elisabeth Vestal
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160 Charleston, SC 29425 United States.
| | - Susan Newman
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160 Charleston, SC 29425 United States
| | - Shannon Phillips
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160 Charleston, SC 29425 United States
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Maldonado-Puebla M, Akenroye A, Busby J, Cardet JC, Louisias M. Pharmacoequity in Allergy-Immunology: Disparities in Access to Medications for Allergic Diseases and Proposed Solutions in the United States and Globally. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:272-280. [PMID: 37951413 PMCID: PMC10922722 DOI: 10.1016/j.jaip.2023.11.005] [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: 08/14/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023]
Abstract
Pharmacoequity is the principle that individuals should have access to high-quality medications regardless of race and ethnicity, socioeconomic status, or availability of resources. In this review, we summarize access to therapeutics for allergic diseases in the United States and other selected countries. We focus on domains of health care access (health insurance coverage, medication availability, and specialist access) as well as system-level factors and clinician- and patient-level factors such as interpersonal racism and cultural beliefs, and how they can affect timely access to appropriate therapy for allergic diseases. Finally, we propose how pharmacoequity in allergy-immunology can be achieved by highlighting solutions to factors limiting access to medications for allergic diseases, and identify potential future research directions.
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Affiliation(s)
- Martin Maldonado-Puebla
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Ayobami Akenroye
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - John Busby
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom, (f)Department of Immunology, Boston Children's Hospital, Boston, Mass
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Margee Louisias
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass.
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Ladha R, Neiterman E. Shades of care: Understanding the needs of racially and ethnically
diverse paediatric patients, their families, and health care providers in North
America. J Child Health Care 2023; 27:18-34. [PMID: 34461757 PMCID: PMC9932619 DOI: 10.1177/13674935211041863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While race and ethnicity have been acknowledged as determinants of health, there remain gaps regarding their effects on experiences of paediatric care. This scoping review examines empirical literature regarding the state and experience of paediatric care provided to racially and ethnically diverse families in North America. We seek to clarify the needs of care administrators and recipients, as well as to conceptualize what paediatric care must look like to enable equitable practices and optimal health outcomes. Utilizing Arksey and O'Malley's framework, we reviewed literature published between 2005 and 2020, most of which was written within an American context. The literature reviewed featured quantitative, qualitative and mixed methods studies. Paediatric care administrators and recipients collectively identified the following as domains requiring an increased focus: (1) knowledge (awareness or training), (2) alignment of views and values, (3) resources and (4) communication. Findings suggest overall that despite there being merit in the cultural competency efforts underway, more patient-centric approaches are vital. This review concludes by encouraging the sustained development of cultural safety initiatives in paediatric care to ultimately promote patient comfort and provider-patient collaboration.
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Affiliation(s)
- Raisa Ladha
- School of Public Health and Health
Systems, Faculty of Applied Health Sciences, University of
Waterloo, Waterloo, ON, Canada,Raisa Ladha, School of Public Health and
Health Systems, Faculty of Applied Health Sciences, University of Waterloo, 200
University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - Elena Neiterman
- School of Public Health and Health
Systems, Faculty of Applied Health Sciences, University of
Waterloo, Waterloo, ON, Canada
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Stone GA, Fernandez M, DeSantiago A. Rural Latino health and the built environment: a systematic review. ETHNICITY & HEALTH 2022; 27:1-26. [PMID: 30999761 DOI: 10.1080/13557858.2019.1606899] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 04/08/2019] [Indexed: 05/21/2023]
Abstract
Objective: This study systematically reviewed literature examining the influence of the rural built environment on Latinos' health outcomes and behaviour in the United States. A secondary aim of the study was to identify strategies developed to address challenges in the rural built environment affecting Latinos' health.Design: This study followed the reporting guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles included in the final analysis clearly linked Latino health outcomes to characteristics of the rural built environment.Results: Of the nearly 2,500 articles identified in the initial search, the final review included approximately 146 full-text sources. The majority of the articles focused on aspects of Latinos' physical (n = 68), behavioural (n = 43), and mental health (n = 23).Conclusions: Rural Latino neighbourhoods in the United States possess limited access to health care, internet, transportation, and recreation infrastructure, which negatively impacts health outcomes and behaviours. Strategies developed to mitigate these issues include but are not limited to: the use of telecommunications to distribute health information; the use of community health workers and mobile clinics to increase awareness and availability of select health services; the use of worksite trainings and adaptations to the workplace; and the promotion of safety net programmes, such as the Supplemental Nutrition Programme for Women, Infants and Children (WIC). This review supports the need for a more robust research agenda documenting the health experiences of rural Latinos of various nationalities, age groups, and genders.
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Affiliation(s)
- Garrett A Stone
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, USA
| | - Mariela Fernandez
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, USA
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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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Alzayer R, Chaar B, Basheti I, Saini B. Asthma management experiences of Australians who are native Arabic speakers. J Asthma 2017; 55:801-810. [PMID: 28800268 DOI: 10.1080/02770903.2017.1362702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to explore the asthma management experiences of people with asthma within the Arabic-speaking community in Australia. METHODS Semi-structured interviews guided by a schedule of questions were conducted with 25 Arabic-speaking women with asthma\carer of a child with asthma, recruited from medical practices and community centers in Melbourne, Australia. RESULTS Twenty-five Arabic-speaking participants with asthma or caring for those with asthma were interviewed. Interviews lasted on average 25 minutes. Most participants or those they were caring for did not have well-controlled asthma. Thematic analyses of the interview transcripts highlighted five key emergent themes: stigma, health literacy, non-adherence, expectations, and coping styles. Findings indicated that many participants were not conversant about local information avenues or healthcare or facilities such as the Asthma Foundation or availability of Arabic translators during general practitioner (GP) consults. Many recent migrants were generally non-adherent with treatment; preferring to follow traditional folk medicine rather than consulting a GP or pharmacist. Some unrealistic expectations from doctors/treatment goals were expressed by a few participants. Some parents of children with asthma reported disappointment with the fact that their children did not grow out of asthma. CONCLUSION Low health literacy and in particular knowledge about asthma, cultural beliefs, language, and migration-related issues may all be affecting the level of asthma control in the Arabic-speaking population in Australia. Measures to enhance asthma and health system literacy designed to be culturally concordant with the beliefs, expectations, and experiences of such populations may be key to improving asthma management.
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Affiliation(s)
- Reem Alzayer
- a Faculty of Pharmacy , The University of Sydney , Camperdown , New South Wales , Australia
| | - Betty Chaar
- a Faculty of Pharmacy , The University of Sydney , Camperdown , New South Wales , Australia
| | - Iman Basheti
- b Pharmacy School , Applied Science Private University , Amman , Jordan
| | - Bandana Saini
- a Faculty of Pharmacy , The University of Sydney , Camperdown , New South Wales , Australia.,c Woolcock Institute of Medical Research Glebe , NSW , Australia
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Estrada RD, Ownby DR. Rural Asthma: Current Understanding of Prevalence, Patterns, and Interventions for Children and Adolescents. Curr Allergy Asthma Rep 2017; 17:37. [PMID: 28484946 PMCID: PMC6533905 DOI: 10.1007/s11882-017-0704-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Asthma is the most common chronic illness of children and adolescents in the USA. While asthma has been understood to disproportionately affect urban dwellers, recent investigations have revealed rural pediatric asthma prevalence to be very similar to urban and to be more closely correlated with socioeconomic and environmental factors than geographic location or population density. RECENT FINDINGS Rural children experience factors unique to location that impact asthma development and outcomes, including housing quality, cigarette smoke exposure, and small/large-scale farming. Additionally, there are challenging barriers to appropriate asthma care that frequently are more severe for those living in rural areas, including insurance status, lack of primary care providers and pulmonary specialists, knowledge deficits (both patient and provider), and a lack of culturally tailored asthma interventions. Interventions designed to address rural pediatric asthma disparities are more likely to be successful when targeted to specific challenges, such as the use of school-based services or telemedicine to mitigate asthma care access issues. Continued research on understanding the complex interaction of specific rural environmental factors with host factors can inform future interventions designed to mitigate asthma disparities.
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Affiliation(s)
| | - Dennis R Ownby
- Allergy & Immunology, Augusta University, Augusta, GA, USA
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Lee K, Pond D. The Impact of Head Start Enrollment Duration on Migrant Children's Health Outcomes. SOCIAL WORK IN HEALTH CARE 2015; 54:869-891. [PMID: 26671242 DOI: 10.1080/00981389.2015.1061087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of this study is to examine whether family characteristics and the length of children's enrollment in Migrant Head Start affects children's health treatment. Children in the Michigan Migrant Head Start were classified depending on years of enrollments: One year (n = 638), two years (n = 293), and three or more years (n = 426). Logistic regression analyses were conducted to examine whether the probability of children receiving health treatment differed depending on years of enrollment. There is a higher health treatment rate among children who attended Head Start for multiple years than for those who attended for one year. Children's special needs status, of siblings, ethnicity, parental educational level, and marital status were related to preventative dental and physical health treatment outcomes. Although the primary goal of Head Start is school readiness rather than health improvement, migrant and seasonal farmworker children are likely to receive more health treatment if they attend more years of comprehensive intervention, such as Head Start, for positive physical and dental health.
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Affiliation(s)
- Kyunghee Lee
- a School of Social Work , Michigan State University , East Lansing , Michigan , USA
| | - Debora Pond
- a School of Social Work , Michigan State University , East Lansing , Michigan , USA
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