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Pérez‐Aronsson A, Inge E, Alanbari H, Alsalamah I, Ghannoum M, Mohammad ZA, Metso FJ, Holmqvist F, Belachew J, Filén T, Hennoks FP, Sarkadi A, Warner G. Co-Design Workshops to Develop a Psychosocial Support Service Model for Refugees in Sweden Affected by Gender-Based Violence. Health Expect 2024; 27:e14177. [PMID: 39129706 PMCID: PMC11317807 DOI: 10.1111/hex.14177] [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: 04/10/2024] [Revised: 07/26/2024] [Accepted: 07/27/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Experiencing gender-based violence (GBV) is common among refugees. Intersecting systems of oppression can increase the risk of GBV and of suffering detrimental consequences, while concurrently creating barriers to meaningful support. Despite this, refugees with lived experience of GBV are rarely involved in the development, planning and adaptation of services and policies. METHODS This article reports on a formative research process that aimed to involve public contributors (refugee victim-survivors of GBV) and relevant stakeholders in co-designing a service model aimed at improving psychosocial support in Sweden. Led by a partnership of public contributors and academic researchers, the research process consisted of iterative cycles of co-design workshops, complemented by scoping of existing literature. RESULTS The co-design process resulted in a characterisation of the psychosocial service system needs, as perceived by the survivor co-researchers and stakeholders, and a two-level empowerment and support service model. The model included (i) a community-based intervention to promote help-seeking and (ii) psychosocial group support delivered in specialist clinics. Outcomes of the project included perceived benefits for those involved, service-led direct changes and acquisition of funding for continued research on the co-designed model. CONCLUSION Improving psychosocial support for refugees in Sweden affected by GBV requires safe spaces to connect with peers and familiarise with available services, laws and rights in the society. Further, strengthened collaborations across sectors are necessary to meet the variety of needs. Co-design workshops were an effective way to initiate changes in the service delivery model for psychosocial support for refugees in Sweden affected by GBV. PATIENT OR PUBLIC CONTRIBUTIONS This is a participatory reflection on a participatory process. The survivor co-researchers contributed to designing and carrying out the PPI process and have co-authored this manuscript.
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Affiliation(s)
- Anna Pérez‐Aronsson
- Child Health and Parenting (CHAP), Department of Public Health and Caring ScienceUppsala UniversityUppsalaSweden
- Centre for Women's Mental Health During the Reproductive Lifespan—WOMHERUppsala UniversityUppsalaSweden
| | - Elin Inge
- Child Health and Parenting (CHAP), Department of Public Health and Caring ScienceUppsala UniversityUppsalaSweden
| | - Heba Alanbari
- Child Health and Parenting (CHAP), Department of Public Health and Caring ScienceUppsala UniversityUppsalaSweden
| | - Iman Alsalamah
- Child Health and Parenting (CHAP), Department of Public Health and Caring ScienceUppsala UniversityUppsalaSweden
| | - Miras Ghannoum
- Child Health and Parenting (CHAP), Department of Public Health and Caring ScienceUppsala UniversityUppsalaSweden
| | - Zozan Abu Mohammad
- Child Health and Parenting (CHAP), Department of Public Health and Caring ScienceUppsala UniversityUppsalaSweden
| | - Frida Johansson Metso
- Swedish Red Cross Competence Centre for Rehabilitation of Torture and War TraumaStockholmSweden
| | - Frida Holmqvist
- Information SwedenCounty Administrative Boards of Västra GötalandGothenburgSweden
| | - Johanna Belachew
- Kvinnofridsmottagningen (Outpatient Clinic for Women Subjected to Violence), Uppsala University Hospital, Region Uppsala, and National Centre for Knowledge on Men's Violence Against Women (NCK)Uppsala UniversityUppsalaSweden
| | - Tove Filén
- Kvinnofridsmottagningen (Outpatient Clinic for Women Subjected to Violence), Uppsala University Hospital, Region Uppsala, and National Centre for Knowledge on Men's Violence Against Women (NCK)Uppsala UniversityUppsalaSweden
| | - Frida Pålsson Hennoks
- Kvinnofridsmottagningen (Outpatient Clinic for Women Subjected to Violence), Uppsala University Hospital, Region Uppsala, and National Centre for Knowledge on Men's Violence Against Women (NCK)Uppsala UniversityUppsalaSweden
| | - Anna Sarkadi
- Child Health and Parenting (CHAP), Department of Public Health and Caring ScienceUppsala UniversityUppsalaSweden
| | - Georgina Warner
- Child Health and Parenting (CHAP), Department of Public Health and Caring ScienceUppsala UniversityUppsalaSweden
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Kaul A, Saboor L, Ahmad A, Mannell J, Paphitis SA, Devakumar D. What are the experiences and psychosocial needs of female survivors of domestic violence in Afghanistan? A qualitative interview study in three Afghan provinces. BMJ Open 2024; 14:e079615. [PMID: 38839389 PMCID: PMC11163623 DOI: 10.1136/bmjopen-2023-079615] [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: 09/06/2023] [Accepted: 05/20/2024] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVES This study aimed to qualitatively explore (1) the experiences of female survivors of domestic abuse and mental health problems in Afghanistan; (2) how female survivors of violence and abuse, male members of the community and service providers perceive and respond to mental health and domestic violence in Afghanistan and (3) the provision of mental health services for female survivors of violence and abuse in Afghanistan, including the barriers and challenges faced around accessing mental health services. DESIGN Qualitative interviews and framework thematic analysis. SETTING Kabul, Bamyan and Nangarhar in Afghanistan. PARTICIPANTS 60 female survivors of domestic abuse, 60 male community members and 30 service providers who work with female survivors of domestic abuse. RESULTS Experiences of multiple and compounding traumatic experiences of violence, armed conflict, and complex and competing psychosocial concerns were common among the female survivor participants. All female survivor participants reported experiencing negative mental health outcomes in relation to their experiences of violence and abuse, which were further precipitated by widespread social stigma and gender norms. Support and service provision for female survivors was deemed by participants to be insufficient in comparison to the amount of people who need to access them. CONCLUSIONS There are many risks and barriers women face to disclosing their experiences of violence and mental health problems which restrict women's access to psychological support. Culturally relevant services and trauma-informed interventions are necessary to respond to these issues. Service providers should be trained to effectively recognise and respond to survivors' mental health needs.
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Affiliation(s)
- Anjuli Kaul
- Section of Women's Mental Health, King's College London, London, UK
| | - Lamba Saboor
- Institute for Global Health, University College London, London, UK
| | | | | | | | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
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Blumrich L, Masiero Silva L, Dias Barreto V, Rohde LA, Polanczyk GV, Miguel EC, Grisi SJFE, Fleitlich-Bilyk B, Ferraro AA. Causal Pathways Between the Acute Experience of Violence During Pregnancy and Fetal Intrauterine Growth Restriction: A Cohort Study. J Womens Health (Larchmt) 2024; 33:765-773. [PMID: 38551182 DOI: 10.1089/jwh.2023.0645] [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: 06/18/2024] Open
Abstract
Introduction: Violence during pregnancy (VDP) is a prevalent global issue with dire consequences for the mother and the developing fetus. These consequences include prematurity, low birthweight, and intrauterine growth restriction (IUGR), but its pathways remain elusive. This study investigated the causal pathways between VDP and IUGR using mediation analysis. Methods: A prospective population-based birth cohort was followed from the beginning of the third gestational trimester to the second year of life. IUGR was defined by the Kramer index, and information on VDP was collected using the WHO-Violence Against Women (WHO VAW) questionnaire. Cases were considered positive only when no other life episodes were reported. Ten different mediators were analyzed as possible pathways based on previous research. Path analysis was conducted to evaluate these relationships. Results: The path analysis model included 755 dyads and presented an adequate fit. Violence during pregnancy showed a direct effect (β = -0.195, p = 0.041) and a total effect (β = -0.276, p = 0.003) on IUGR. Violence was associated with gestational depression or anxiety, tobacco and alcohol consumption, changes in blood pressure, and the need for emergency care, but these did not constitute mediators of its effect on IUGR. The sum of the indirect effects, however, showed a significant association with IUGR (β = -0.081, p = 0.011). Conclusion: The acute experience of violence during pregnancy was associated with IUGR, primarily via a direct pathway. An indirect effect was also present but not mediated through the variables analyzed in this study. The robust strength of these associations underscores the negative health consequences of violence against women for the succeeding generation.
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Affiliation(s)
- Lukas Blumrich
- Department of Pediatrics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | | | - Luis Augusto Rohde
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul; Medical Council UniEduK; National Institute of Developmental Psychiatry & National Center for Innovation and Research in Mental Health, São Paulo, Brazil
| | | | | | | | - Bacy Fleitlich-Bilyk
- Department of Psychiatry, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
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Henriksen L, Kisa S, Lukasse M, Flaathen EM, Mortensen B, Karlsen E, Garnweidner-Holme L. Cultural Sensitivity in Interventions Aiming to Reduce or Prevent Intimate Partner Violence During Pregnancy: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:97-109. [PMID: 34109872 PMCID: PMC9660282 DOI: 10.1177/15248380211021788] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Intimate partner violence (IPV) around the time of pregnancy is a recognized global health problem. Ethnic minorities and immigrant pregnant women experiencing IPV require culturally responsive health services. The aim of this scoping review was to identify aspects of cultural sensitivity in interventions to prevent or reduce IPV among ethnic minorities and immigrant pregnant women in high-income countries. Eight databases were searched in November 2019. Any type of scientific research, quantitative, qualitative, or mixed methods studies regarding interventions against IPV among pregnant women were considered for inclusion. Resnicow et al.'s definition of cultural sensitivity was used to identify aspects of cultural sensitivity. Ten papers relating to nine interventions/studies met our inclusion criteria. These studies, which included randomized controlled trials, a mixed methods study, a program evaluation, and a longitudinal study, were conducted in Australia, Belgium, Norway, and the United States. Aspects of surface cultural sensitivity, including the translation of intervention content into the language of the target group(s) and the involvement of bilingual staff to recruit participants, were identified in eight studies. Deep structure aspects of cultural sensitivity were identified in one study, where the intervention content was pretested among the target group(s). Results that could be related to the culture-sensitive adaptions included successful recruitment of the target population. Three studies were planning to investigate women's experiences of interventions, but no publications were yet available. This scoping review provides evidence that culturally sensitive interventions to reduce or prevent IPV among immigrant pregnant women are limited in number and detail.
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Affiliation(s)
- Lena Henriksen
- Department of Nursing and Health Promotion, Oslo Metropolitan
University, Norway
- Division of General Gynaecology and Obstetrics, Oslo University
Hospital, Norway
| | - Sezer Kisa
- Department of Nursing and Health Promotion, Oslo Metropolitan
University, Norway
| | - Mirjam Lukasse
- Department of Nursing and Health Promotion, Oslo Metropolitan
University, Norway
- Department of Nursing and Health Sciences, University of
South-Eastern Norway, Kongsberg, Norway
| | - Eva Marie Flaathen
- Department of Nursing and Health Promotion, Oslo Metropolitan
University, Norway
| | - Berit Mortensen
- Department of Nursing and Health Promotion, Oslo Metropolitan
University, Norway
| | - Elisabeth Karlsen
- Department of Nursing and Health Promotion, Oslo Metropolitan
University, Norway
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Intimate Partner Violence in the Sub-Saharan African Immigrant Community in Chicago: A Changing Landscape. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2022; 3:337-352. [PMID: 36417242 PMCID: PMC9620894 DOI: 10.3390/epidemiologia3030026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/23/2022] [Accepted: 07/01/2022] [Indexed: 12/14/2022]
Abstract
The challenges of conducting research on intimate partner violence (IPV) in immigrant communities means little is known about the occurrence of various forms of IPV, making it difficult to address in these populations. This research draws on data gathered in Chicago's large and varied African immigrant communities. This research used a mixed methods approach: collection of quantitative survey data on occurrence, followed by qualitative interviews to explain the results. Missing quantitative data and contradicting qualitative responses made it difficult to draw definite conclusions on physical IPV; however, verbal abuse and controlling behaviours appear to be relatively widespread and normalised, and not always viewed as violence. Particularly with the probability of future pandemics and natural disasters, which are known to increase prevalence, it is important to raise awareness of less visible controlling behaviours and verbal abuse as forms of violence, and to implement appropriate prevention programs to minimise a concomitant rise in IPV within African immigrant communities.
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Paphitis SA, Bentley A, Asher L, Osrin D, Oram S. Improving the mental health of women intimate partner violence survivors: Findings from a realist review of psychosocial interventions. PLoS One 2022; 17:e0264845. [PMID: 35299229 PMCID: PMC8929660 DOI: 10.1371/journal.pone.0264845] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/17/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is highly prevalent and is associated with a range of mental health problems. A broad range of psychosocial interventions have been developed to support the recovery of women survivors of IPV, but their mechanisms of action remain unclear. METHODS Realist review following a prospectively published protocol in PROSPERO (CRD42018114207) and reported using the Realist and Meta-narrative Evidence Synthesis: Evolving Standards (RAMSES) guidelines. RESULTS Evidence was extracted from 60 reviews and triangulated in expert consultations. Mechanisms of action were categorised as either associated with intervention design and delivery or with specific intervention components (access to resources and services; safety, control and support; increased knowledge; alterations to affective states and cognitions; improved self-management; improved family and social relations). CONCLUSIONS Findings suggest that psychosocial interventions to improve the mental health of women survivors of IPV have the greatest impact when they take a holistic view of the problem and provide individualised and trauma-informed support.
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Affiliation(s)
- Sharli Anne Paphitis
- Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
- * E-mail:
| | - Abigail Bentley
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laura Asher
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - David Osrin
- Institute for Global Health, University College London, London, United Kingdom
| | - Sian Oram
- Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
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Safe Pregnancy intervention for intimate partner violence: a randomised controlled trial in Norway among culturally diverse pregnant women. BMC Pregnancy Childbirth 2022; 22:144. [PMID: 35189843 PMCID: PMC8862262 DOI: 10.1186/s12884-022-04400-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/10/2022] [Indexed: 01/10/2023] Open
Abstract
Background Intimate partner violence (IPV) during pregnancy is a global health problem with adverse consequences for mothers, infants and families. We hypothesise that information about IPV and safety behaviours during pregnancy has the potential to increase quality of life and the use of safety behaviours and prevent IPV. Methods A multicentre randomised controlled trial among culturally diverse pregnant women in Norway, to test the effect of a tablet-based video intervention about IPV and safety behaviours. Women attending routine antenatal check-ups alone (baseline) were screened for violence (Abuse Assessment Screen) by responding to questions on a tablet, and randomised (1:1) by computer to receive an intervention or a control video. The intervention video presented information about IPV and safety behaviours. The controls viewed a video promoting healthy pregnancy in general. Outcome measures were assessed three months post-partum: The World Health Organization Quality of Life-BREF, the Composite Abuse Scale on violence during the last 12 months and use of safety behaviours based on a 15-item checklist. A general linear model for repeated measures was used to examine the intervention’s effect. The analyses were conducted by intention to treat. Results Among 1818 eligible women, 317 reported IPV and were randomised to an intervention (157) or a control group (160). A total of 251 (79.2%) women completed the follow-up questionnaire: 120 (76.4%) in the intervention group and 131 (81.9%) in the control group. At follow-up, 115 (45.8%) women reported a history of IPV. Few women (n = 39) reported IPV during the last 12 months. No differences in quality-of-life domains and overall quality of life and health were found between the intervention and the control groups. We detected no differences between the use of safety behaviours or IPV frequency and severity during the last 12 months. Conclusion Our intervention did not improve women’s quality of life, use of safety behaviours or exposure to violence. Nevertheless, a tablet-based tool may motivate women experiencing IPV to seek help and support. More research is needed regarding tablet-based interventions for women experiencing IPV, particularly culturally sensitive interventions. Trial registration NCT03397277 registered in clinicaltrials.gov on 11/01/2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04400-z.
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Kozina RM, Lear MK, Stacy S, Kern S, Ripley A, Clapp J. Moderating effects of brooding on the link between functional impairment and interpersonal needs in survivors of serious trauma. J Clin Psychol 2022; 78:1839-1850. [PMID: 35150129 DOI: 10.1002/jclp.23327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 12/12/2021] [Accepted: 01/22/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Trauma and resulting functional limitations demonstrate associations with perceived burdensomeness and thwarted belongingness, factors contributing to elevated risk for suicidal ideation. However, survivors display differential risk in response to impairment, highlighting the need for research on exacerbating factors. The current study examined the impact of brooding on the association of functional impairment with burdensomeness and belongingness among trauma-exposed undergraduates (N = 262). METHOD Trauma was assessed via clinical interview with questionnaires for study variables. Regression models examined the unique and interactive effects of physical impairment, emotional impairment, and brooding on burdensomeness and thwarted belongingness. RESULTS An interaction of brooding and impairment due to emotional difficulties was observed for burdensomeness with impairment linked to elevated burdensomeness at high (β = -0.46; p < 0.001), but not low (β = -0.07; p = 0.476) brooding. Impairment due to emotional difficulties (β = -0.38; p < 0.001) and brooding (β = 0.25; p < 0.001) were associated with belongingness. CONCLUSIONS Findings identify brooding as a potential target for assessment and intervention in trauma-exposed individuals.
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Affiliation(s)
- Ryan M Kozina
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| | - M Kati Lear
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| | - Stephanie Stacy
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| | - Shira Kern
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| | - Adam Ripley
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| | - Joshua Clapp
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
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Li X, Wang J. Continuity and change: Violations of private patriarchal practices and domestic violence against rural wives in China. Health Care Women Int 2021; 43:898-913. [PMID: 34586956 DOI: 10.1080/07399332.2021.1963967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We investigated how violations of private patriarchal practices affect physical, psychological, and sexual violence against rural wives. The sample was drawn from nationally representative data from the third wave survey on the Social Status of Women in China. We found that (1) women making a similar income or more than their husbands were more likely to experience psychological and physical violence, respectively; (2) the wife's migration experience increased her risk of psychological and sexual violence; (3) husband doing more housework decreased the odds of psychological violence, and equal distribution of housework reduced the likelihood of physical and psychological violence; (4) infertility or having given birth to only daughters was not associated with any form of violence; and (5) equal marital power decreased the wife's likelihood to suffer three forms of violence. A balanced conjugal power structure may effectively prevent domestic violence against wives in societies with traditional and modern influences.
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Affiliation(s)
- Xiangmei Li
- School of Politics and Public Administration, Guangxi Normal University, Guilin, China
| | - Jun Wang
- College of Humanities and Social Sciences, Harbin Engineering University, Harbin, China
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De Marchis EH, Hessler D, Fichtenberg C, Fleegler EW, Huebschmann AG, Clark CR, Cohen AJ, Byhoff E, Ommerborn MJ, Adler N, Gottlieb LM. Assessment of Social Risk Factors and Interest in Receiving Health Care-Based Social Assistance Among Adult Patients and Adult Caregivers of Pediatric Patients. JAMA Netw Open 2020; 3:e2021201. [PMID: 33064137 PMCID: PMC7568201 DOI: 10.1001/jamanetworkopen.2020.21201] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Health care organizations are increasingly incorporating social risk screening into patient care. Studies have reported wide variations in patients' interest in receiving health care-based assistance for identified social risks. However, no study to date has examined the factors associated with patients' interest in receiving assistance, including whether interest in receiving assistance varies based on specific patient demographic characteristics. Targeted research on this topic could improve the success of health care-based programs that offer social care services. OBJECTIVE To identify participant characteristics associated with interest in receiving health care-based social risk assistance. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted in 7 primary care clinics and 4 emergency departments in 9 US states between July 2, 2018, and February 13, 2019. A convenience sample of adult patients and adult caregivers of pediatric patients completed a screening survey that measured social risk factors and participants' interest in receiving assistance for identified social risks. Participants were randomly selected to receive 1 of 2 versions of the survey, which differed based on the order in which questions about social risks and interest in receiving assistance were presented. Multivariable logistic regression analyses were used to evaluate the associations between covariates and participants' interest in receiving assistance, stratified by social risk screening results. Data were analyzed from September 8, 2019, to July 30, 2020. EXPOSURES Social risk screening questions assessed risk factors comprising housing, food, transportation, utilities, and exposure to interpersonal violence. Additional questions assessed participants' interest in receiving assistance and their perspectives on health care-based social risk screening. MAIN OUTCOMES AND MEASURES Participant interest in receiving health care-based social risk assistance. RESULTS A total of 1021 adult participants with complete survey responses were included in the analysis. Of those, 709 of 1004 participants (70.6%) were female, and 544 of 1007 participants (54.0%) were aged 18 to 44 years. Overall, 353 of 662 participants (53.3%) with positive screening results for 1 or more social risk factors were interested in receiving assistance, whereas 31 of 359 participants (8.6%) with negative screening results for all social risks were interested in receiving assistance. Participants with positive screening results for 1 or more social risk factors had a higher likelihood of being interested in receiving assistance if they answered the question about interest in receiving assistance before they answered the questions about social risk factors (adjusted odds ratio [aOR], 1.48; 95% CI, 1.05-2.07), had positive screening results for a higher number of social risk factors (aOR, 2.40; 95% CI, 1.68-3.42), reported lower household income levels (aOR, 7.78; 95% CI, 2.96-20.44), or self-identified as having non-Hispanic Black ancestry (aOR, 2.22; 95% CI, 1.37-3.60). Among those with negative screening results for all social risk factors, the interest in receiving assistance was higher if the participants reported lower household income levels (aOR, 12.38; 95% CI, 2.94-52.15), previous exposure to health care-based social risk screening (aOR, 2.35; 95% CI, 1.47-3.74), higher perceived appropriateness of social risk screening (aOR, 3.69; 95% CI, 1.08-12.55), or worse health status (aOR, 4.22; 95% CI, 1.09-16.31). CONCLUSIONS AND RELEVANCE In this study, multiple factors were associated with participants' interest in receiving social risk assistance. These findings may have implications for how and when social risk assistance is offered to patients. As the health care system's role in addressing social risk factors evolves, an understanding of patients' perspectives regarding screening and their interest in receiving assistance may be important to implementing patient-centered interventions.
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Affiliation(s)
- Emilia H. De Marchis
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco
| | - Caroline Fichtenberg
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco
| | - Eric W. Fleegler
- Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amy G. Huebschmann
- Division of General Internal Medicine and Center for Women’s Health Research, University of Colorado School of Medicine, Aurora
| | - Cheryl R. Clark
- Division of General Internal Medicine and Primary Care, Center for Community Health and Health Equity, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alicia J. Cohen
- Providence VA Medical Center, Departments of Family Medicine and Health Services, Policy, and Practice, Brown University, Providence, Rhode Island
| | - Elena Byhoff
- Department of Medicine and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Mark J. Ommerborn
- Center for Community Health and Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Nancy Adler
- Department of Psychiatry, University of California, San Francisco, San Francisco
| | - Laura M. Gottlieb
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco
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Lele Mookerjee A, Fischer BD, Cavanaugh S, Rajput V. Innovative curriculum: Integrating the bio-behavioral and social science principles across the LifeStages in basic science years. MEDICAL TEACHER 2019; 41:167-171. [PMID: 29781379 DOI: 10.1080/0142159x.2018.1457214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Behavioral and social science integration in clinical practice improves health outcomes across the life stages. The medical school curriculum requires an integration of the behavioral and social science principles in early medical education. We developed and delivered a four-week course entitled "LifeStages" to the first year medical students. The learning objectives of the bio-behavioral and social science principles along with the cultural, economic, political, and ethical parameters were integrated across the lifespan in the curriculum matrix. We focused on the following major domains: Growth and Brain Development; Sexuality, Hormones and Gender; Sleep; Cognitive and Emotional Development; Mobility, Exercise, Injury and Safety; Nutrition, Diet and Lifestyle; Stress and coping skills, Domestic Violence; Substance Use Disorders; Pain, Illness and Suffering; End of Life, Ethics and Death along with Intergenerational issues and Family Dynamics. Collaboration from the clinical and biomedical science departments led to the dynamic delivery of the course learning objectives and content. The faculty developed and led a scholarly discussion, using the case of a multi-racial, multi-generational family during Active Learning Group (ALG) sessions. The assessment in the LifeStages course involved multiple assessment tools: including the holistic assessment by the faculty facilitator inside ALGs, a Team-Based Learning (TBL) exercise, multiple choice questions and Team Work Assessment during which the students had to create a clinical case on a LifeStages domain along with the facilitators guide and learning objectives.
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Affiliation(s)
| | | | - Susan Cavanaugh
- a Cooper Medical School of Rowan University , Camden , NJ , USA
| | - Vijay Rajput
- b Ross University School of Medicine , Miramar , FL , USA
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