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Huang Q, Peng W, Han J, Mao B. Characterizing the Perceived Need for CRC Screening among the Elderly Living in Rural Areas in the Pacific Northwest US: Roles of Miscommunication, Experience of Discrimination, and Dependence. Am J Health Promot 2024:8901171241257051. [PMID: 38780489 DOI: 10.1177/08901171241257051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
PURPOSE Increasing the perceived need for CRC screening can facilitate undertaking CRC screening. This study aims to identify factors associated with the need for CRC screening in rural populations. DESIGN A cross-sectional online survey. SETTING The survey was conducted in June - September 2022 in the rural areas of Alaska, Idaho, Oregon, and Washington, US. SUBJECTS The subjects of this study were 250 adults (completion rate: 65%) aged 45-75 residing in rural Alaska, Idaho, Oregon, and Washington. MEASURES Perceived need for CRC screening, internet usage for health purposes, demographics, and intrapersonal, interpersonal, community, and environmental characteristics. RESULTS Perceived need for CRC screening were negatively associated with patient-provider miscommunication (β = -.23, P < .001) and perceived discrimination (β = -.21, P < .001), cancer fatalism (β = -.16, P < .05), individualism (β = -.15, P < .05), and dependence on community (β = -.11, P < .05), but positively with compliance with social norms (β = .16, P < .05), trust in health care providers (β = .16, P < .05), knowledge about colorectal cancer (β = .12, P < .05). CONCLUSIONS Our study showed potential individual and situational characteristics that might help increase colorectal cancer screening. Future efforts might consider addressing discrimination in health care settings, improving patient-provider communication, and tailoring messaging to reflect the rural culture.
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Affiliation(s)
- Qian Huang
- Department of Communication, University of North Dakota, Grand Forks, ND, USA
| | - Wei Peng
- Washington State University, Edward R. Murrow College of Communication, Pullman, WA, USA
| | - Jihae Han
- Washington State University, Edward R. Murrow College of Communication, Pullman, WA, USA
| | - Bingjing Mao
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Snyder SA, Kuan KE, Velasco MG, Saadi A. Order Keepers or Immigration Agents? Latine Immigrant Views of Law Enforcement in Healthcare Settings. J Gen Intern Med 2024:10.1007/s11606-024-08767-x. [PMID: 38698296 DOI: 10.1007/s11606-024-08767-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/10/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Police and security presence in healthcare settings have grown. There are few studies exploring perceptions of these law enforcement agents among US Latine immigrants, who can be vulnerable to immigration enforcement actions due to past and ongoing criminalization and anti-immigrant policies. OBJECTIVE To explore Latine immigrants' perceptions of law enforcement in healthcare settings. DESIGN Exploratory, semi-structured qualitative interviews asked participants about their perspectives of law enforcement in healthcare settings. PARTICIPANTS English- and Spanish-speaking adult patients (n = 19) from a Federally Qualified Health Center (FQHC) in Los Angeles, CA, serving predominantly low-income Latine immigrants. APPROACH We used the framework method for analysis to establish a codebook and inform our thematic interpretation. KEY RESULTS We identified three themes: (1) perceptions of safety offered by police officers are separated from the role of immigration officers; (2) perceptions of police officers are integrated into broader perceptions of the healthcare system; and (3) lived experiences, including immigration status, influenced valence response to officer uniforms and perceptions of officers. Most participants viewed police officers positively as maintaining order and safety, separating them from federal immigration enforcement actions, and reflecting on local, state, and organizational "sanctuary" or immigrant-friendly policies. Individuals with precarious immigration status more often saw officers as intimidating. Immigration enforcement remained a key concern. CONCLUSIONS Differentiating police and security roles from immigration enforcement in healthcare could improve Latine immigrant trust and access. Future studies should explore perspectives of Latine immigrants in localities without sanctuary laws or organizational immigrant-friendly policies.
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Affiliation(s)
- Sara A Snyder
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Krystal E Kuan
- Departments of Biostatistics, Epidemiology, and Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Margarita G Velasco
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Izudi J, Cattamanchi A, Castelnuovo B, King R. Barriers and facilitators to viral load suppression among people living with HIV following intensive adherence counseling in Kampala, Uganda: A qualitative study. Soc Sci Med 2024; 343:116595. [PMID: 38242033 DOI: 10.1016/j.socscimed.2024.116595] [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] [Received: 07/07/2023] [Revised: 12/08/2023] [Accepted: 01/10/2024] [Indexed: 01/21/2024]
Abstract
We explored the barriers and facilitators to viral load (VL) suppression after three or more intensive adherence counseling (IAC) sessions among adolescents and adults living with human immunodeficiency virus (HIV) on a first-line anti-retroviral therapy (ART) with initially unsuppressed VL in Kampala, Uganda. Using a qualitative study, data were collected through in-depth interviews with people living with HIV (PLHIV) with unsuppressed and suppressed VL and caregivers of younger adolescents living with HIV after three or more IAC sessions. We held key informant interviews with health workers involved in IAC implementation, namely ART/HIV focal persons, IAC Team Leaders, and linkage facilitators. Guided by the socioecological model, we performed content analysis and reported the findings using themes along with the participants' quotes. We studied 24 participants and found the individual-level barriers as forgetting to take HIV medications, high pill burden, medication side effects, a lack of food, and HIV-related psychological distress. Undisclosed HIV status and broken families were the barriers at the interpersonal level. Institutional-level barriers included insufficient HIV and ART counseling. Stigma was considered a community-level barrier while nonadherence to HIV treatment guidelines was a policy-level barrier. Facilitators included personal reminders, knowing the importance of taking treatment, and the ability to deal with side effects of HIV medications at the personal level; treatment support, peer support clubs, and incentivized treatment at the interpersonal level; and mental health support club and explaining during counseling that HIV is a chronic disease at the institutional level. We found an unsuppressed VL after completing IAC was due to several barriers at the personal, interpersonal, health systems, community, and policy levels. Achieving ≥95% VL suppression necessitates tackling the barriers to VL suppression and scaling up the facilitators by HIV control programs.
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Affiliation(s)
- Jonathan Izudi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Uganda; University of California Global Health Institute (UCGHI), University of California San Francisco, San Francisco, CA, USA.
| | - Adithya Cattamanchi
- Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Irvine, CA, USA
| | - Barbara Castelnuovo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Uganda
| | - Rachel King
- Institute for Global Health Sciences, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Clifford N, Blanco N, Bang SH, Heitkemper E, Garcia AA. Barriers and facilitators to healthcare for people without documentation status: A systematic integrative literature review. J Adv Nurs 2023; 79:4164-4195. [PMID: 37688364 DOI: 10.1111/jan.15845] [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: 03/05/2023] [Revised: 07/21/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023]
Abstract
AIMS To identify the barriers and facilitators to healthcare for people without documentation status. DESIGN We conducted a systematic integrative literature review following the Whittemore and Knafl methodology. METHODS Literature search was conducted to identify studies addressing barriers or facilitators to healthcare for people without documentation status in the United States between 2012 and 2022. Studies were critiqued for quality, with results analysed thematically using the social-ecological model. DATA SOURCES Searches were conducted in PubMed, PAIS, Web of Science, CINAHL and Psych Info in October 2022. RESULTS The review incorporated 30 studies (19 qualitative and 11 quantitative). People without documentation status encountered numerous healthcare barriers such as intrapersonal (lack of financial resources and health insurance, fear), interpersonal (language and cultural discrepancies, discrimination), community (bureaucratic requirements, anti-immigrant rhetoric) and policy-related barriers. Conversely, linguistically and culturally competent care, empathetic and representative staff, health navigators, safety-net clinics and supportive federal policies emerged as key facilitators. CONCLUSION These findings illuminate the complex healthcare disparities experienced by people without documentation status and underscore facilitators enhancing care accessibility. Future research is needed to explore interventions to increase access to care for this population. IMPACT This paper provides a comprehensive examination of the complex barriers and facilitators to healthcare for people without documentation status in the United States. The findings support the value of universal healthcare access, a priority of the World Health Organization, and can inform healthcare policies and practices worldwide. REPORTING METHOD The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was needed. TRIAL AND PROTOCOL REGISTRATION The study protocol was registered with the PROSPERO database (registration number: CRD42022366289).
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Affiliation(s)
- Namuun Clifford
- The University of Texas at Austin School of Nursing, Austin, Texas, USA
| | - Nancy Blanco
- The University of Texas at Austin School of Nursing, Austin, Texas, USA
| | - So Hyeon Bang
- The University of Texas at Austin School of Nursing, Austin, Texas, USA
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Abudiab S, de Acosta D, Shafaq S, Yun K, Thomas C, Fredkove W, Garcia Y, Hoffman SJ, Karim S, Mann E, Yu K, Smith MK, Coker T, Dawson-Hahn E. "Beyond just the four walls of the clinic": The roles of health systems caring for refugee, immigrant and migrant communities in the United States. Front Public Health 2023; 11:1078980. [PMID: 37064664 PMCID: PMC10097984 DOI: 10.3389/fpubh.2023.1078980] [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: 10/24/2022] [Accepted: 03/06/2023] [Indexed: 04/18/2023] Open
Abstract
This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Introduction Refugee, immigrant and migrant (hereafter referred to as "immigrant") communities have been inequitably affected by the COVID-19 pandemic. There is little data to help us understand the perspectives of health systems on their role, in collaboration with public health and community-based organizations, in addressing inequities for immigrant populations. This study will address that knowledge gap. Methods This qualitative study used semi-structured video interviews of 20 leaders and providers from health systems who cared for immigrant communities during the pandemic. Interviewees were from across the US with interviews conducted between November 2020-March 2021. Data was analyzed using thematic analysis methods. Results Twenty individuals representing health systems participated with 14 (70%) community health centers, three (15%) county hospitals and three (15%) academic systems represented. The majority [16 health systems (80%)] cared specifically for immigrant communities while 14 (70%) partnered with refugee communities, and two (10%) partnered with migrant farm workers. We identified six themes (with subthemes) that represent roles health systems performed with clinical and public health implications. Two foundational themes were the roles health systems had building and maintaining trust and establishing intentionality in working with communities. On the patient-facing side, health systems played a role in developing communication strategies and reducing barriers to care and support. On the organizational side, health systems collaborated with public health and community-based organizations, in optimizing pre-existing systems and adapting roles to evolving needs throughout the pandemic. Conclusion Health systems should focus on building trusting relationships, acting intentionally, and partnering with community-based organizations and public health to handle COVID-19 and future pandemics in effective and impactful ways that center disparately affected communities. These findings have implications to mitigate disparities in current and future infectious disease outbreaks for immigrant communities who remain an essential and growing population in the US.
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Affiliation(s)
- Seja Abudiab
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | | | - Sheeba Shafaq
- Community Leadership Board, National Resource Center for Refugees, Immigrants and Migrants, San Francisco, CA, United States
| | - Katherine Yun
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Christine Thomas
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Windy Fredkove
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, MN, United States
| | - Yesenia Garcia
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Sarah J. Hoffman
- School of Nursing, University of Minnesota, Minneapolis, MN, United States
| | - Sayyeda Karim
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, MN, United States
| | - Erin Mann
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, MN, United States
| | - Kimberly Yu
- Independent Consultant, Seattle, WA, United States
| | - M. Kumi Smith
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Tumaini Coker
- Department of Pediatrics, University of Washington, Seattle, WA, United States
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Kiehne E, Hafen Q. State and local integrationist policies and the physical and psychological health of undocumented immigrants. Curr Opin Psychol 2022; 48:101453. [PMID: 36174328 DOI: 10.1016/j.copsyc.2022.101453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 01/28/2023]
Abstract
Protracted daily preoccupation with the federal immigration policing infrastructure, restrictive policy, and antagonistic rhetoric take a substantial toll on the psychological and physical health of undocumented immigrants and their families. A growing network of states and municipalities are adopting policies to promote immigrant wellbeing through integration. Recent advances in research suggest subfederal healthcare access, sanctuary, and ID policies increase access to healthcare and health resources and decrease fear and stress. However, health impacts of these policies are modulated by national socio-political forces that spur misinformation, distrust, and fear. To help overcome this, states and municipalities should layer integrationist actions. Critically, more policy impact research is needed to support understanding, uptake, and renewal of state and local policymaking promoting immigrant health.
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Obisie-Nmehielle N, Kalule-Sabiti I, Palamuleni M. Factors associated with knowledge about family planning and access to sexual and reproductive health services by sexually active immigrant youths in Hillbrow, South Africa: a cross-sectional study. Reprod Health 2022; 19:169. [PMID: 35907974 PMCID: PMC9338581 DOI: 10.1186/s12978-022-01477-9] [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] [Received: 12/23/2021] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background In South Africa, universal access to health care services, including those relating to sexual and reproductive health (SRH) care, is contained in Section 27 of the Constitution and commits the country to supporting the United Nations 2030 Agenda for the Sustainable Development Goals (SDGs). The objective of this study was to examine the factors associated with knowledge about family planning and access to SRH services among sexually active immigrant youths in Hillbrow, South Africa. Method This cross-sectional study was based on data from a household survey conducted in Hillbrow during December 2019. Interviewer-administered questionnaires were used to collect information from immigrant youths (18–34 years old). Data on 437 sexually active respondents was analysed in STATA 14 using univariate, bivariate, logistic, and multinomial regression models. A p-value of < 0.05 was chosen as the level of significance. Results About half of the respondents had poor knowledge about family planning; about one-third (35%) of the immigrant youths had no access to SRH services, 42% had some access, and 23% had access. The adjusted logistic regression model showed that being a female (AOR = 3.85, CI: 2.34–6.35, belonging to age group 30–34 years (AOR = 3.88, CI: 2.00–7.53); belonging to the rich wealth index (AOR = 2.55 (1.32–4.93); not having received information about family planning (AOR = 0.17, CI = 0.10–0.29) and not using a contraceptive at the time of the survey (AOR = 0.37, CI: 0.19–0.70) were factors associated with having knowledge about family planning. The adjusted multinomial regression shows that the factors associated with not having access to SRH services were secondary or higher level of education (ARRR = 1.89, 95% CI = 1.06–3.36), belonging to the rich wealth quintile (ARRR = 2.25, 95% CI = 1.00–5.07), being undocumented (ARRR = 0.49, 95% CI = 0.27–0.88), having experienced discrimination in Hillbrow (ARRR = 2.06, 95% CI = 1.15–3.67) and having received information about family planning 6 months prior to the survey (ARRR = 0.49, 95% CI = 0.26–0.90, p-value < 0.05). Conclusion To move towards realization of the Constitution of South Africa, achieve the SDGs, and curb associated negative SRH outcomes, there is a need to advocate for the implementation of universal access to SRH services that is inclusive of immigrant youths. Access to SRH services by adolescents and youths has been a serious public health concern globally. In South Africa, universal access to health care including reproductive health care services is contained in Sect. 27 of the Constitution. The country is committed to the 2030 Agenda of the SDGs with the theme “leaving no one behind”. The objective of this study was to examine the factors associated with knowledge about family planning and access to SRH services among sexually active immigrant youths in Hillbrow, South Africa. Interviewer-administered questionnaires were used to collect information on the socio-demographic, migration, and reproductive health characteristics from 439 sexually active immigrant youths in Hillbrow during December 2019. The data were analysed to assess the factors associated with knowledge about family planning and access to SRH services. The findings show that 46% of the immigrant youth had poor knowledge about family planning, while 35% had no access to SRH services, 42% had some access and only 23% had access. The study showed that the factors associated with knowledge about family planning are female respondents, from the rich income group, those in the older age category, those who received information about family planning 6-months prior to the survey and those using a contraceptive at the time of the survey. The factors associated with having no access to SRH services were those respondents having completed secondary education and higher, from the rich income group, undocumented immigrants, those respondents having experienced discrimination in Hillbrow, youths not having received information about family planning prior to the survey, and those not using a contraceptive. It is important to make access to SRH services available to immigrant youths to prevent associated negative SRH outcomes among the youths.
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Affiliation(s)
| | | | - Martin Palamuleni
- Population Studies and Demography, North-West University, Mafikeng, South Africa
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Huang JT, Davies OMT, Siegel DH. Achieving equity and inclusion in pediatric dermatology research: Priorities and considerations. Pediatr Dermatol 2021; 38 Suppl 2:179-182. [PMID: 34399006 DOI: 10.1111/pde.14763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
As we increase our focus and energy on equity, diversity, and inclusion (EDI)-relevant research, we must consider the "what, why, and how" of our work. The goals of this paper are to highlight unique issues pediatric dermatologists face in providing equitable care, pose considerations when reporting data on race and ethnicity, and advocate for standardized classification of race and ethnicity in research.
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Affiliation(s)
- Jennifer T Huang
- Dermatology Program, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
| | - Olivia M T Davies
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dawn H Siegel
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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