1
|
Jaramillo ET. Place-based strengths and vulnerabilities for mental wellness among rural minority older adults: an intervention development study protocol. BMJ Open 2024; 14:e088348. [PMID: 38844399 PMCID: PMC11163646 DOI: 10.1136/bmjopen-2024-088348] [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: 05/03/2024] [Accepted: 05/24/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION Severe inequities in depression and its diagnosis and treatment among rural-dwelling, racial-minority and ethnic-minority older adults compared with their urban white counterparts result in cognitive impairment, comorbidities and increased mortality, presenting a growing public health concern as the United States (US) population ages. These inequities are often attributable to social and environmental factors, including economic insecurity, histories of trauma, gaps in transportation and safety-net services, and disparities in access to policy-making processes rooted in colonialism. This constellation of factors renders racial-minority and ethnic-minority older adults 'structurally vulnerable' to mental ill health. Fewer data exist on protective factors associated with social and environmental contexts, such as social support, community attachment and a meaningful sense of place. Scholarship on the social determinants of health widely recognises the importance of such place-based factors. However, little research has examined how they shape disparities in depression and treatment specifically, limiting the development of practical approaches addressing these factors and their effects on mental well-being for rural minority populations. METHODS AND ANALYSIS This community-driven mixed-method study uses quantitative surveys, qualitative interviews and ecological network research with 125 rural American Indian and Latinx older adults in New Mexico and 28 professional and non-professional social supporters to elucidate how place-based vulnerabilities and protective factors shape experiences of depression among older adults. Data will serve as the foundation of a community-driven plan for a multisystem intervention focused on the place-based causes of disparities in depression. Intervention Mapping will guide the intervention development process. ETHICS AND DISSEMINATION This study has been reviewed and approved by the University of New Mexico Health Sciences Center Institutional Review Board. All participants will provide informed consent. Study results will be disseminated within the community of study through community meetings and presentations, as well as broadly via peer-reviewed journals, conference presentations and social media.
Collapse
Affiliation(s)
- Elise Trott Jaramillo
- College of Population Health, University of New Mexico, Albuquerque, New Mexico, USA
| |
Collapse
|
2
|
Garcia AN, Venegas-Murrillo A, Martinez-Hollingsworth A, Smith LV, Wells K, Heilemann MV, Fischbach L, Cummings PL, Kuo T. Patterns of Health Care Access and Use in an Urban American Indian and Alaska Native Population. J Racial Ethn Health Disparities 2024; 11:1478-1488. [PMID: 37202652 PMCID: PMC10195651 DOI: 10.1007/s40615-023-01624-3] [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: 12/08/2022] [Revised: 01/29/2023] [Accepted: 04/26/2023] [Indexed: 05/20/2023]
Abstract
Studies of health care access and use among historically resilient populations, while common, often field a limited sample size and rarely ask the groups most impacted by health inequities to weigh in. This is especially so for research and programs that focus on the American Indian and Alaska Native (AIAN) population. The present study addresses this gap by examining data from a cross-sectional survey of AIANs in Los Angeles County. To better interpret project findings and generate culturally relevant contexts, qualitative feedback was gathered at a community forum held in Spring 2018. Because recruitment of AIANs has historically been challenging, purposive sampling was employed to strategically identify a larger eligible pool. Among those who were eligible, 94% completed the survey (n = 496). AIANs who were enrolled in a tribe were 32% more likely to use the Indian Health Service (IHS), compared with those who were not enrolled (95% CI: 20.4%, 43.2%; p < .0001). In multivariable modeling, the strongest factors influencing IHS access and use were: tribal enrollment, preference for culturally-specific health care, proximity of the services to home or work, having Medicaid, and having less than a high school education. Feedback from the community forum indicated cost and trust (of a provider) were important considerations for most AIANs. Study findings reveal heterogeneous patterns of health care access and use in this population, suggesting a need to further improve the continuity, stability, and the image of AIANs' usual sources of care (e.g., IHS, community clinics).
Collapse
Affiliation(s)
- Andrea N. Garcia
- Los Angeles County Department of Mental Health, 510 S. Vermont Street, Los Angeles, CA 90020 USA
- County Department of Mental Health, National Clinician Scholars Program at the University of California, (UCLA); Los Angeles CA, Los Angeles, USA
| | - Angela Venegas-Murrillo
- National Clinician Scholars Program at UCLA, Charles R. Drew University of Medicine and Science, Los Angeles, CA USA
| | | | - Lisa V. Smith
- Rapid Assessment, Training and Evaluation Unit – Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA USA
| | - Kenneth Wells
- Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine; Department of Health Policy and Management, UCLA Fielding School of Public Health, Center for Health Services and Society of the Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA
| | - MarySue V. Heilemann
- UCLA School of Nursing, National Clinician Scholars Program at UCLA, Los Angeles, CA USA
| | - Lori Fischbach
- Quality Assurance Team, COVID-19 Outbreak Management Branch, Los Angeles County Department of Public Health, Los Angeles, CA USA
| | - Patricia L. Cummings
- Epidemiology Research & Evaluation, Eisenhower Medical Center, Rancho Mirage, CA USA
| | - Tony Kuo
- Department of Family Medicine, UCLA David Geffen School of Medicine; Department of Epidemiology, UCLA Fielding School of Public Health, Population Health Program, UCLA Clinical and Translational Science Institute, Los Angeles, CA USA
| |
Collapse
|
3
|
Carlini BH, Garrett SB, Matos P, Nims LN, Kestens Y. Identifying policy options to regulate high potency cannabis: A multiple stakeholder concept mapping study in Washington State, USA. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104270. [PMID: 38043404 DOI: 10.1016/j.drugpo.2023.104270] [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: 06/22/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Cannabis legalization in some U.S.A. states has catapulted the mass production of concentrates, with tetrahydrocannabinol (THC) concentrations ranging from 50-90%. A major public health concern is that these products will increase cannabis-related harms such as use disorders, psychotic symptoms, and accidental poisonings. This paper describes and contextualizes the results of a study requested by the WA State Legislature to understand perspectives of WA stakeholders on the topic. METHODS Concept Mapping (CM), a mixed-methods research approach that supports people-centered policy decisions was utilized. The goal of the study was to explore stakeholders' concern levels and support of policies to address the availability of high THC cannabis products. For analysis purposes, stakeholders were categorized into three groups: community, professionals, and cannabis advocates. RESULTS CM generated an inventory of policy ideas for regulating high-potency cannabis from a variety of stakeholders. Notably, stakeholders from community and professional groups supported environmental policy changes such as such as taxation, increasing minimum age for high concentration cannabis products, and advertising prohibition. Meanwhile, cannabis advocates (mostly industry actors) opposed taxation per THC content, proposed lowering taxes, and supported policies with low population impact such as educating parents, teachers, and youth. CONCLUSION Support for regulating high concentration THC products varied by stakeholder group. Consistent with how other health compromising industries have historically acted, cannabis industry stakeholders rejected regulation of their products. Future studies should explore non-cannabis industry stakeholders' willingness to work towards minimizing the influence of the cannabis industry in policy development processes to assure public health regulations prevail.
Collapse
Affiliation(s)
- Beatriz H Carlini
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences at the University of Washington, Seattle, WA, United States of America.
| | - Sharon B Garrett
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences at the University of Washington, Seattle, WA, United States of America
| | | | - Lexi N Nims
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences at the University of Washington, Seattle, WA, United States of America
| | - Yan Kestens
- École de santé publique de l'Université de Montréal, Montréal, Canada; Centre de Recherche en Santé Publique, Montréal, Canada
| |
Collapse
|
4
|
Liddell JL. "Treat Me like Your Family": Positive Factors that Influence Patient-Provider Relationships for Native American Women. SOCIAL WORK IN PUBLIC HEALTH 2023; 38:221-234. [PMID: 36135975 PMCID: PMC11104767 DOI: 10.1080/19371918.2022.2127434] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Although extensive documentation of the health disparities experienced by Native American peoples exists, little research explores experiences of members of non-federally recognized tribes who receive health care outside of the Indian Health Services (IHS) system. Additionally, positive factors that influence relationships between health care providers and tribal members are understudied and are needed to promote health care access. A qualitative descriptive methodologic approach was used to conduct semi structured life history interviews with 31 women who identified as members of a state-recognized, Gulf South Native American tribe. Results identified the following important themes: Do Participants Have a Regular Provider, Personal Relationship With Provider, Feel Provider Cares, Provider Addresses Concern, and Respect for Traditional or Holistic Medicine. These findings suggest health care providers play an important role in impacting the health care experiences of Native American tribal members. Implications for trainings for health care providers are discussed.
Collapse
|
5
|
Jaramillo ET, Sommerfeld DH, Haozous EA, Brunner A, Willging CE. Causes and Consequences of Not Having a Personal Healthcare Provider Among American Indian Elders: A Mixed-Method Study. Front Public Health 2022; 10:832626. [PMID: 35309185 PMCID: PMC8926165 DOI: 10.3389/fpubh.2022.832626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/07/2022] [Indexed: 11/22/2022] Open
Abstract
Having a regular relationship with a healthcare provider contributes to better health outcomes and greater satisfaction with care for older adults. Although members of federally recognized American Indian tribes have a legal right to healthcare, American Indian Elders experience inequities in healthcare access that may compromise their ability to establish a relationship with a healthcare provider. This multi-year, community-driven, mixed-method study examines the potential causes and consequences of not having a personal healthcare provider among American Indian Elders. Quantitative surveys and qualitative interviews were conducted with 96 American Indian Elders (age 55 and over) in two states in the Southwestern United States. Quantitative and qualitative data were analyzed separately and then triangulated to identify convergences and divergences in data. Findings confirmed that having a consistent healthcare provider correlated significantly with self-rated measures of health, confidence in getting needed care, access to overall healthcare, and satisfaction with care. Lack of a regular healthcare provider was related to interconnected experiences of self-reliance, bureaucratic and contextual barriers to care, and sentiments of fear and mistrust based in previous interactions with medical care. Increasing health equity for American Indian Elders will thus require tailored outreach and system change efforts to increase continuity of care and provider longevity within health systems and build Elders' trust and confidence in healthcare providers.
Collapse
Affiliation(s)
- Elise Trott Jaramillo
- Southwest Center, Pacific Institute for Research and Evaluation, Albuquerque, NM, United States
| | - David H Sommerfeld
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Emily A Haozous
- Southwest Center, Pacific Institute for Research and Evaluation, Albuquerque, NM, United States
| | - Amy Brunner
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Cathleen E Willging
- Southwest Center, Pacific Institute for Research and Evaluation, Albuquerque, NM, United States
| |
Collapse
|
6
|
Jaramillo ET, Haozous E, Willging CE. The Community as the Unit of Healing: Conceptualizing Social Determinants of Health and Well-Being for Older American Indian Adults. THE GERONTOLOGIST 2022; 62:732-741. [PMID: 35092427 PMCID: PMC9154240 DOI: 10.1093/geront/gnac018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives Multiple racial and social inequities shape health and access to health care for American Indian Elders, who have a lower life expectancy than all other aging populations in the United States. This qualitative study examines how upstream social determinants of health influence Elders’ ability to access and use health care. Research Design and Methods Between June 2016 and March 2017, we conducted individual, semistructured interviews with 96 American Indian Elders, aged 55 and older, and 47 professionals involved in planning or delivering care to Elders in 2 states in the U.S. Southwest. Transcripts were analyzed iteratively using grounded theory approaches, including open and focused coding. A group of American Indian Elders and allies called the Seasons of Care Community Action Board guided interpretation and prioritization of findings. Results Participants described multiple barriers that hindered Elders’ ability to access health care services and providers, which were largely tied to funding shortages and bureaucratic complexities associated with health care and insurance systems. Where available, community resources bridged service gaps and helped Elders navigate systems. Discussion and Implications Longstanding structural inequities for American Indians manifest in barriers to health equity, many of which are situated at the community level. These are compounded by additional disparities affecting older adults, rural residents, and marginalized citizens in general. Findings underscore the importance of health and policy initiatives for American Indian Elders that emphasize the community as the focus of intervention.
Collapse
Affiliation(s)
| | - Emily Haozous
- Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | | |
Collapse
|
7
|
Carroll C, Sworn K, Booth A, Tsuchiya A, Maden M, Rosenberg M. Equity in healthcare access and service coverage for older people: a scoping review of the conceptual literature. INTEGRATED HEALTHCARE JOURNAL 2022; 4:e000092. [PMID: 37440846 PMCID: PMC10327458 DOI: 10.1136/ihj-2021-000092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/07/2021] [Indexed: 11/04/2022] Open
Abstract
There is currently no global review of the conceptual literature on the equity of healthcare coverage (including access) for older people. It is important to understand the factors affecting access to health and social care for this group, so that policy and service actions can be taken to reduce potential inequities. A scoping review of published and grey literature was conducted with the aim of summarising how health and social care service access and coverage for older people has been conceptualised. PubMed, MEDLINE, PsycINFO, CINAHL, Web of Science, SciELO, LILACS, BIREME and Global Index Medicus were searched. Selection of sources and data charting were conducted independently by two reviewers. The database searches retrieved 10 517 citations; 32 relevant articles were identified for inclusion from a global evidence base. Data were summarised and a meta-framework and model produced listing concepts specific to equitable health and social care service coverage relating to older people. The meta-framework identified the following relevant factors: acceptability, affordability, appropriateness, availability and resources, awareness, capacity for decision-making, need, personal social and cultural circumstances, physical accessibility. This scoping review is relevant to the development and specification of policy for older people. It conceptualises those factors, such as acceptability and affordability, that affect an older person's ability and capacity to access integrated, person-centred health and social care services in a meaningful way. These factors should be taken into account when seeking to determine whether equity in service use or access is being achieved for older people.
Collapse
Affiliation(s)
- Christopher Carroll
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Katie Sworn
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Aki Tsuchiya
- Department of Economics, The University of Sheffield, Sheffield, UK
| | - Michelle Maden
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Megumi Rosenberg
- Centre for Health Development, World Health Organization, Kobe, Hyogo, Japan
| |
Collapse
|
8
|
Davison CM, Bartels SA, Purkey E, Neely AH, Bisung E, Collier A, Dutton S, Aldersey HM, Hoyt K, Kivland CL, Carpenter J, Talbot EA, Adams LV. Last mile research: a conceptual map. Glob Health Action 2021; 14:1893026. [PMID: 33736574 PMCID: PMC8288767 DOI: 10.1080/16549716.2021.1893026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: The term 'last mile' has been used across disciplines to refer to populations who are farthest away, most difficult to reach, or last to benefit from a program or service. However, last mile research lacks a shared understanding around its conceptualization.Objectives: This project used a concept mapping process to answer the questions: what is last mile research in global health and, how can it be used to make positive change for health equity in the last mile?Methods: Between July and December 2019, a five-stage concept mapping exercise was undertaken using online concept mapping software and an in-person consensus meeting. The stages were: establishment of an expert group and focus prompt; idea generation; sorting and rating; initial analysis and final consensus meeting.Results: A group of 15 health researchers with experience working with populations in last mile contexts and who were based at the Matariki Network institutions of Queen's University, CAN and Dartmouth College, USA took part. The resulting concept map had 64 unique idea statements and the process resulted in a map with five clusters. These included: (1) Last mile populations; (2) Research methods and approaches; (3) Structural and systemic factors; (4) Health system factors, and (5) Broader environmental factors. Central to the map were the ideas of equity, human rights, health systems, and contextual sensitivity.Conclusion: This is the first time 'last mile research' has been the focus of a formal concept mapping exercise. The resulting map showed consensus about who last mile populations are, how research should be undertaken in the last mile and why last mile health disparities exist. The map can be used to inform research training programs, however, repeating this process with researchers and members from different last mile populations would also add further insight.
Collapse
Affiliation(s)
- Colleen M Davison
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Susan A Bartels
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.,Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Eva Purkey
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Abigail H Neely
- Department of Geography, Dartmouth College, Hanover, New Hampshire, USA
| | - Elijah Bisung
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Amanda Collier
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Sherri Dutton
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Heather M Aldersey
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Kendall Hoyt
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Chelsey L Kivland
- Department of Anthropology, Dartmouth College, Hanover, New Hampshire, USA
| | - Jennifer Carpenter
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Elizabeth A Talbot
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Lisa V Adams
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.,Center for Global Health Equity, Dartmouth College, Hanover, New Hampshire, USA
| |
Collapse
|
9
|
Lewis JP, Manson SM, Jernigan VB, Noonan C. "Making Sense of a Disease That Makes No Sense": Understanding Alzheimer's Disease and Related Disorders Among Caregivers and Providers Within Alaska Native Communities. THE GERONTOLOGIST 2021; 61:363-373. [PMID: 32789474 PMCID: PMC8023374 DOI: 10.1093/geront/gnaa102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES With the rate of Alzheimer's disease and related dementias (ADRD) increasing among Alaska Indian/Alaska Native (AI/AN) people, the Alaska Native Health system is ill-prepared to meet the challenges associated with the growing population at risk of ADRD. The high cost of care, inadequate training of health care providers, and lack of supportive services for caregivers are especially concerning. RESEARCH DESIGN AND METHODS Interviews were conducted with 22 AN caregivers for ANs with ADRD and 12 ANs and non-Native health care providers in communities across Alaska. Interviews lasted approximately 60 min and were transcribed verbatim. We employed directed content analysis to examine the major agreements and disagreements between the participants' understandings of ADRD in each of the domains of Kleinman's Explanatory Model of Illness. RESULTS Caregivers and health care providers expressed concerns about the lack of understanding, resources, and awareness of ADRD among ANs in rural and urban communities. Both caregivers and providers recognized the need to obtain an early diagnosis, blend Western and traditional medicines, promote lifestyle and dietary changes, and foster training for caregivers. Health care providers acknowledged their limited exposure to AN understanding of ADRD and wish to receive culturally relevant training to better serve AN. DISCUSSION AND IMPLICATIONS As the older AN adult population grows, the need for culturally responsive training and support services will continue to increase. We recommend establishing rural outreach and support groups for caregivers, developing an understanding of how ANs view ADRD to train and educate health care providers, and implement screening early for memory loss during routine medical examinations.
Collapse
Affiliation(s)
- Jordan P Lewis
- Memory Keepers Medical Discovery Team, University of Minnesota Medical School, Duluth Campus, Aurora
| | - Spero M Manson
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Valarie B Jernigan
- Center for Indigenous Health Research and Policy, Oklahoma State University, Tulsa
| | - Carolyn Noonan
- Institute for Research and Education to Advance Community Health, Washington State University, Pullman
- Elson S. Floyd College of Medicine, Washington State University, Pullman
| |
Collapse
|