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Yegnanarayanan V, Krithicaa Narayanaa Y, Anitha M, Ciurea R, Marceanu LG. Graph theoretical way of understanding protein-protein interaction in ovarian cancer. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2022. [DOI: 10.3233/jifs-219289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cancer is a major research area in the medical field. Precise assessment of non-similar cancer types holds great significance in according to better treatment and reducing the risk of destructiveness in patients’ health. Cancer comprises a ambient that differs in response to therapy, signaling mechanisms, cytology and physiology. Netting theory and graph theory jointly gives a viable way to probe the proteomic specific data of cancer types such as ovarian, colon, breast, oral, cervical, prostate, and lung. We observe that the P2P(protein-protein) interaction Nettings of the cancerous tissues blended with the seven cancers and normal have same structural attributes. But some of these point to desultory changes from the disease Nettings to normal implying the variation in the dealings and bring out the redoing in the complicacy of various cancers. The Netting-based approach has a pertinent role in precision oncology. Cancer can be better dealt with through mutated pathways or Nettings in preference to individual mutations and that the utility value of repositioned drugs can be understood from disease modules in molecular Nettings. In this paper, we demonstrate how the graph theory and neural Nettings act as vital tools for understanding cancer and other types such as ovarian cancer at the zeroth level.
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Affiliation(s)
- V. Yegnanarayanan
- Deapartment of Mathematics, Kalasalingam Academy of Research and Education, Krishnankoil, Tamilnadu, India
| | - Y. Krithicaa Narayanaa
- Department of Biomedical Sciences, Sri Ramachandra Institute for Higher Education and Research (DU), Chennai, Tamil Nadu, India
| | - M. Anitha
- Deapartment of Mathematics, Kalasalingam Academy of Research and Education, Krishnankoil, Tamilnadu, India
| | - Rujita Ciurea
- Faculty of Medicine, Vasile Goldis Western University of Arad, Arad, Romania
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Ercia A, Le N, Wu R. Health insurance enrollment strategies during the Affordable Care Act (ACA): a scoping review on what worked and for whom. Arch Public Health 2021; 79:129. [PMID: 34253258 PMCID: PMC8274016 DOI: 10.1186/s13690-021-00645-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/21/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The Affordable Care Act (ACA) provided an opportunity for millions of people in the U.S. to get coverage from the publicly funded Medicaid program or private insurance from the newly established marketplace. However, enrolling millions of people for health insurance was an enormous task. The aim of this review was to examine the strategies used to enroll people for health insurance and their effectiveness after implementing the ACA's coverage expansion. METHODS The PRISMA Extension for Scoping Review (PRISMA-ScR) guided this review. Included studies were empirical studies that met the inclusion criteria and published between 2010 and 2020. Studies were searched mainly from two scholarly databases, CINAHL Plus and Medline (PubMed) using keyword searches. Hand searches from the references of selected journals were also performed. Content analysis was conducted by two authors in which codes were inductively developed to identify themes. RESULTS There were 2213 potential studies identified from the search, but 10 met the inclusion criteria. The research design of the studies varied. Two studies were randomized trials, one quasi-experimental trial, three mixed-methods, two qualitative and two quantitative. All studies focused on strategies used to inform and help people enroll for either Medicaid or private insurance from the marketplace. This review identified three key strategies used to help enroll people for coverage: 1) individual assistance; 2) community outreach; and 3) health education and promotion (HE&P). CONCLUSION Community-based organizations were likely to use a combination of the three strategies simultaneously to reach uninsured individuals and directly help them enroll for health insurance. Other organizations that aimed to reach a wider segment of the population used single strategies, such as community outreach or HE&P.
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Affiliation(s)
- Angelo Ercia
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK.
| | - Nga Le
- Department of Health & Human Services, County of Marin, Marin, California, USA
| | - Runguo Wu
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
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Viramontes O, Hochman M, Serota ML, Delgado E, Moreno G. New enrollment under the affordable care act: leading the way for community health centers in Southern California. BMC Health Serv Res 2018; 18:729. [PMID: 30241471 PMCID: PMC6151004 DOI: 10.1186/s12913-018-3469-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 08/13/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The Affordable Care Act (ACA) has improved healthcare access in the community health centers that have played a critical role in enrolling low income and minority patients. This study examined the ACA enrollment for one of the largest federally qualified community health centers in the country. METHODS An exploratory sequential mixed method study was used as the main qualitative and quantitative approach for this study. Key stakeholders (n = 6) were interviewed as part of the qualitative component, and information about barriers and best practices were acquired. As part of the quantitative analysis, we examined cross-sectional data among 59,272 AltaMed enrollees in 2013-2015. We analyzed data on age, gender, language, ethnicity, and enrollment periods. The interviews were conducted first and followed by the data analysis. RESULTS AltaMed was the top enroller of patients in ACA insurance plans in California (2013-14 and 2014-15) through the state exchange and Medicaid expansion. Using key stakeholder interviews, 5 main barriers were identified and 5 innovative solutions that allowed AltaMed to enroll people into the state exchange and Medicaid expansion. Barriers to enrollment included training, new workflows, and enrollment of Young Invincibles, and these enrollment barriers were overcome with community health workers. CONCLUSION Enrollment barriers were overcome through AltaMed's community-based approach and long term community partnerships.
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Affiliation(s)
- Omar Viramontes
- UCLA Health and Department of Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA 90024 USA
| | - Michael Hochman
- Gehr Family Center for Implementation Science, Department of Medicine Keck School of Medicine, University of Southern California, 2020 Zonal Ave. IRD 320, Los Angeles, CA 90033 USA
| | | | - Elvia Delgado
- AltaMed, Inc., 2040 Camfield Ave, Los Angeles, CA 90040 USA
| | - Gerardo Moreno
- Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA 90024 USA
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Jones EC, Storksdieck M, Rangel ML. How Social Networks May Influence Cancer Patients' Situated Identity and Illness-Related Behaviors. Front Public Health 2018; 6:240. [PMID: 30234086 PMCID: PMC6131661 DOI: 10.3389/fpubh.2018.00240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/10/2018] [Indexed: 11/13/2022] Open
Abstract
Little research is currently available that captures variation in the degree to which individuals who have, or had cancer in the past (but are in remission) integrate their cancer experience into their sense of self or their cancer-associated identity. Such research should cover how those identities shape personal narratives within existing or new social networks so that, ultimately, we understand the implications for treatment choices and health outcomes. Particularly understudied are the social factors influencing the incorporation of cancer into identity, learning, and behavior. Social network analysis captures specific relationships, what they offer, and the structure or constellation of these relationships around someone who has cancer or has had cancer. Some studies point to potential cultural differences in ethnic or social groups in how social influences on the cancer experience play out in terms of individual coping strategies. In some populations, social cohesion or tight networks are common and of particular importance to individuals and include social institutions like church communities. Social status might also generate social pressures not typically noticed or experienced by other groups. We will discuss how social network analysis can be used to elucidate these factors and, conversely, how the specific context of cancer diagnosis can be used through social network analysis to better understand the role of community in helping individuals address situations of severe adversity.
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Affiliation(s)
- Eric C. Jones
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Martin Storksdieck
- Center for Research on Lifelong STEM Learning, Oregon State University, Corvallis, OR, United States
| | - Maria L. Rangel
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
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Hom JK, Stillson C, Rosin R, Cahill R, Kruger E, Grande D. Effect of Outreach Messages on Medicaid Enrollment. Am J Public Health 2017; 107:S71-S73. [PMID: 28661816 DOI: 10.2105/ajph.2017.303845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To measure the impact of different outreach messages on health insurance enrollment among Medicaid-eligible adults. METHODS Between March 2015 and April 2016, we conducted a series of experiments using mail-based outreach that encouraged individuals to enroll in Pennsylvania's expanded Medicaid program. Recipients were randomized to receive 1 of 4 different messages describing the benefits of health insurance. The primary outcome was the response rate to each letter. RESULTS We mailed outreach letters to 32 993 adults in Philadelphia. Messages that emphasized the dental benefits of insurance were significantly more likely to result in a response than messages emphasizing the health benefits (odds ratio = 1.33; 95% confidence interval = 1.10, 1.61). CONCLUSIONS Medicaid enrollment outreach messages that emphasized the dental benefits of insurance were more effective than those that emphasized the health-related benefits. Public Health Implications. Although the structure and eligibility of the Medicaid program are likely to change, testing and identifying successful outreach and enrollment strategies remains important. Outreach messages that emphasize dental benefits may be more effective at motivating enrollment among individuals of low socioeconomic status.
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Affiliation(s)
- Jeffrey K Hom
- Jeffrey K. Hom is with the Department of Medicine, Crescenz VA Medical Center, Philadelphia, PA. Christian Stillson and David Grande are with the Division of General Internal Medicine, University of Pennsylvania, Philadelphia. Roy Rosin is with the Penn Medicine Center for Health Care Innovation, University of Pennsylvania. Rachel Cahill and Evelyne Kruger are with Benefits Data Trust, Philadelphia
| | - Christian Stillson
- Jeffrey K. Hom is with the Department of Medicine, Crescenz VA Medical Center, Philadelphia, PA. Christian Stillson and David Grande are with the Division of General Internal Medicine, University of Pennsylvania, Philadelphia. Roy Rosin is with the Penn Medicine Center for Health Care Innovation, University of Pennsylvania. Rachel Cahill and Evelyne Kruger are with Benefits Data Trust, Philadelphia
| | - Roy Rosin
- Jeffrey K. Hom is with the Department of Medicine, Crescenz VA Medical Center, Philadelphia, PA. Christian Stillson and David Grande are with the Division of General Internal Medicine, University of Pennsylvania, Philadelphia. Roy Rosin is with the Penn Medicine Center for Health Care Innovation, University of Pennsylvania. Rachel Cahill and Evelyne Kruger are with Benefits Data Trust, Philadelphia
| | - Rachel Cahill
- Jeffrey K. Hom is with the Department of Medicine, Crescenz VA Medical Center, Philadelphia, PA. Christian Stillson and David Grande are with the Division of General Internal Medicine, University of Pennsylvania, Philadelphia. Roy Rosin is with the Penn Medicine Center for Health Care Innovation, University of Pennsylvania. Rachel Cahill and Evelyne Kruger are with Benefits Data Trust, Philadelphia
| | - Evelyne Kruger
- Jeffrey K. Hom is with the Department of Medicine, Crescenz VA Medical Center, Philadelphia, PA. Christian Stillson and David Grande are with the Division of General Internal Medicine, University of Pennsylvania, Philadelphia. Roy Rosin is with the Penn Medicine Center for Health Care Innovation, University of Pennsylvania. Rachel Cahill and Evelyne Kruger are with Benefits Data Trust, Philadelphia
| | - David Grande
- Jeffrey K. Hom is with the Department of Medicine, Crescenz VA Medical Center, Philadelphia, PA. Christian Stillson and David Grande are with the Division of General Internal Medicine, University of Pennsylvania, Philadelphia. Roy Rosin is with the Penn Medicine Center for Health Care Innovation, University of Pennsylvania. Rachel Cahill and Evelyne Kruger are with Benefits Data Trust, Philadelphia
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Petersen S, Do T, Shaw C, Brake K. Developing a model of health behavior change to reduce parasitic disease in Vietnam. HEALTH EDUCATION RESEARCH 2016; 31:716-728. [PMID: 27744354 DOI: 10.1093/her/cyw041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 09/02/2016] [Indexed: 06/06/2023]
Abstract
Worldwide more deaths occur due to conditions that can be ameliorated by behavior change. Changing health behaviors using models popularized in non-western countries has not proven particularly successful. The purpose of this study was to test variables elicited during qualitative interviews and cultural conversations to develop a model of health behavior change from the ground up in Vietnam. Village leaders and women representatives from the Women's Committee were trained as health advocates to facilitate changes in health practices that led to parasitic and infectious diseases. The health advocates visited 156 families to assess household conditions and assist women head-of-households in applying new behaviors to water treatment, personal hygiene, proper latrining and proximity of animals to humans. Predictors that were tested were self-efficacy, social desirability, internal and external control, and outcome expectations. The correlational and regression design resulted in self-efficacy alone predicting both home hygiene and family health with a large effect size. Social desirability appears to play a different role than in western culture studies. Outcome expectations and control were not predictive. A cultural analysis of the results is included.
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Affiliation(s)
- Suni Petersen
- Department of Clinical Psychology, Alliant International University, 2030 W. El Camino Avenue, Sacramento, CA 89533, USA
| | - Trina Do
- Department of Clinical Psychology, Alliant International University, 2030 W. El Camino Avenue, Sacramento, CA 89533, USA
| | - Christy Shaw
- Department of Clinical Psychology, Alliant International University, 2030 W. El Camino Avenue, Sacramento, CA 89533, USA
| | - Kaile Brake
- Department of Clinical Psychology, Alliant International University, 2030 W. El Camino Avenue, Sacramento, CA 89533, USA
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Housten AJ, Furtado K, Kaphingst KA, Kebodeaux C, McBride T, Cusanno B, Politi MC. Stakeholders' perceptions of ways to support decisions about health insurance marketplace enrollment: a qualitative study. BMC Health Serv Res 2016; 16:634. [PMID: 27821121 PMCID: PMC5100320 DOI: 10.1186/s12913-016-1890-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/01/2016] [Indexed: 12/02/2022] Open
Abstract
Background Approximately 29 million individuals are expected to enroll in health insurance using the Patient Protection and Affordable Care Act (ACA) Marketplace by 2022. Those seeking health insurance struggle to understand insurance options and choose a plan that best suits their needs. Methods We interviewed stakeholders to identify the challenges associated with the ACA Marketplace health insurance enrollment and elicited feedback about what to include in health insurance decision support tools. Interviews were transcribed and themes were identified using inductive thematic analysis. Results Stakeholders stated that consumers felt frustrated by unclear terminology, high plan costs, and complex calculations required to assess costs. Consumers felt anxious about making the wrong choice and being unable to change plans within a calendar year. Stakeholders recommended using plain language tables defining complex terms, grouping information, and using engaging graphics to communicate information about health insurance. Stakeholders thought that narratives of how others made decisions about insurance might be helpful to consumers, but recommended that they be tailored to the needs of specific consumers. Conclusion Strategies that clarify health insurance terms using plain language and graphics, acknowledge concern associated with making the wrong choice, calculate and enable cost comparison, and tailor information to consumers’ unique needs could benefit those enrolling in ACA Marketplace plans, Narratives developed should be simple and inclusive enough for diverse populations.
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Affiliation(s)
- A J Housten
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA
| | - K Furtado
- George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130-4899, USA
| | - K A Kaphingst
- Department of Communication, Huntsman Cancer Institute, University of Utah, 255 S Central Campus Dr., Room 2400, Salt Lake City, UT 84112, USA
| | - C Kebodeaux
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA
| | - T McBride
- George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130-4899, USA
| | - B Cusanno
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA
| | - M C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA.
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Abstract
This article reviews available data on the implications of the Affordable Care Act (ACA) for the diagnosis and care of type 2 diabetes. We provide a general overview of the major issues for diabetes diagnosis and care, and describe the policies in the ACA that affect diabetes diagnosis and care. We also estimate that approximately 2.3 million of the 4.6 million people in the USA with undiagnosed diabetes aged 18-64 in 2009-2010 may have gained access to free preventive care under the ACA, which could increase diabetes detection. In addition, we note two factors that may limit the success of the ACA for improving access to diabetes care. First, many states with the highest diabetes prevalence have not expanded Medicaid eligibility, and second, primary care providers may not adequately meet the increase in Medicaid patients because federal funding to increase provider reimbursement for Medicaid visits recently expired. We close by discussing current gaps in the literature and future directions for research on the ACA's impact on diabetes diagnosis, care, and health outcomes.
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Affiliation(s)
- Rebecca Myerson
- Harris School of Public Policy, University of Chicago, 1155 E. 60th St, Chicago, IL, 60637, USA.
| | - Neda Laiteerapong
- Department of Medicine, University of Chicago, 5847 S Maryland Ave, MC 2007, Chicago, IL, 60637, USA.
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Chandrasekar E, Kim KE, Song S, Paintal R, Quinn MT, Vallina H. First Year Open Enrollment Findings: Health Insurance Coverage for Asian Americans and the Role of Navigators. J Racial Ethn Health Disparities 2015; 3:537-45. [PMID: 27294747 PMCID: PMC4999475 DOI: 10.1007/s40615-015-0172-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/16/2015] [Accepted: 09/20/2015] [Indexed: 01/29/2023]
Abstract
The health insurance coverage established by the Patient Protection and Affordable Care Act has created an opportunity to reduce racial/ethnic disparities in healthcare. It is expected that of the 24 million individuals projected to join, nearly one-half will be non-white and one-fourth will speak a language other than English at home. Asian Americans are one of the fastest growing racial/ethnic groups in the USA. The majority are foreign born and experience limited English proficiency. The role of navigators has been shown to increase enrollment rates of public insurance programs. They are trusted for their shared traditions and sense of community. By conducting culturally-targeted outreach, Cambodian, Chinese, Vietnamese, Korean, and Laotian community-based organizations were able to reach individuals for whom the percentage of uninsured is disproportionately high. They enrolled eligible Asians immigrants in coverage despite language barriers and limited health knowledge. Through a collaborative network, a community-level intervention was implemented that was associated with increases in first year marketplace enrollment and greater likelihood of obtaining a primary care physician. Preventable illnesses, lost productivity, and inadequate healthcare are major hardships in immigrant communities that bear similar burdens to society. Bringing primary care to the underserved helps to contain these costs.
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Affiliation(s)
- Edwin Chandrasekar
- Asian Health Coalition, 180 West Washington Street, Suite 1000, Chicago, IL, 60602, USA.
| | - Karen E Kim
- Division of the Biological Sciences and Office of Community Engagement and Cancer Disparities, University of Chicago, 5841 South Maryland Avenue, Room S401 MC4080, Chicago, IL, 60637, USA
| | - Sharon Song
- Asian Health Coalition, 180 West Washington Street, Suite 1000, Chicago, IL, 60602, USA
| | - Ranjana Paintal
- Asian Health Coalition, 180 West Washington Street, Suite 1000, Chicago, IL, 60602, USA
| | - Michael T Quinn
- Division of the Biological Sciences and Office of Community Engagement and Cancer Disparities, University of Chicago, 5841 South Maryland Avenue, Room S401 MC4080, Chicago, IL, 60637, USA
| | - Helen Vallina
- Division of the Biological Sciences and Office of Community Engagement and Cancer Disparities, University of Chicago, 5841 South Maryland Avenue, Room S401 MC4080, Chicago, IL, 60637, USA
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Hall KS, Nadella SP, Zochowski MK, Patel D, Dalton VK. Social, Reproductive, and Attitudinal Factors Associated with U.S. Women's Disagreement with the Passage of the Affordable Care Act. J Womens Health (Larchmt) 2015; 24:730-9. [PMID: 26125483 DOI: 10.1089/jwh.2014.5175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Notably absent from research and public and policy dialogue on the Affordable Care Act (ACA) and reproductive health care are women's perspectives and a broader understanding of factors that shape ACA attitudes. We investigated social, reproductive, and attitudinal factors associated with women's disagreement with the passage of the ACA. METHODS Data were drawn from the Women's Health Care Experiences and Preferences Study, our population-based internet survey of 1,078 randomly sampled United States women ages 18-55 years conducted in September 2013. Items measured ACA attitudes, including disagreement with the ACA's passage. We examined relationships between ACA disagreement, sociodemographic and reproductive characteristics, health service experiences, and reproductive health care and policy attitudes with logistic regression. RESULTS Among women who had heard of the ACA (n=888), 35% disagreed with it and 38% did not know how they felt. Black women (adjusted odds ratio [aOR] 0.12, 95% confidence interval [CI] 0.03-0.55) and women with incomes of >$75k (aOR 0.38, CI 0.17-0.88), Medicare/Medicaid insurance (aOR 0.24, CI 0.10-0.61), and infrequent religious service attendance (aOR 0.57, CI 0.35-0.93) were less likely to disagree with the ACA's passage, compared with their counterparts. Republican party affiliation was the strongest predictor of ACA disagreement (aOR 17.10, CI 9.12-32.09). Negative beliefs about the ACA's ability to improve access to preferred care and regarding employers' and the government's roles in reproductive health care were positively associated with ACA disagreement. CONCLUSIONS Many women who could benefit from the ACA disagree with or do not know how they feel about its passage, which may influence participation in ACA benefits and services.
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Affiliation(s)
- Kelli Stidham Hall
- 1 Department of Obstetrics and Gynecology, Program on Women's Health Care Effectiveness Research; Institute for Social Research, Population Studies Center, University of Michigan , Ann Arbor Michigan
| | - Samantha Paturu Nadella
- 2 L4000 Women's Hospital , Ann Arbor, Michigan.,3 Department of Obstetrics and Gynecology, The Ohio State University , Columbus Ohio
| | - Melissa K Zochowski
- 1 Department of Obstetrics and Gynecology, Program on Women's Health Care Effectiveness Research; Institute for Social Research, Population Studies Center, University of Michigan , Ann Arbor Michigan
| | - Divya Patel
- 1 Department of Obstetrics and Gynecology, Program on Women's Health Care Effectiveness Research; Institute for Social Research, Population Studies Center, University of Michigan , Ann Arbor Michigan
| | - Vanessa K Dalton
- 1 Department of Obstetrics and Gynecology, Program on Women's Health Care Effectiveness Research; Institute for Social Research, Population Studies Center, University of Michigan , Ann Arbor Michigan
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Politi MC, Kaphingst KA, Liu JE, Perkins H, Furtado K, Kreuter MW, Shacham E, McBride T. A Randomized Trial Examining Three Strategies for Supporting Health Insurance Decisions among the Uninsured. Med Decis Making 2015; 36:911-22. [PMID: 25840904 DOI: 10.1177/0272989x15578635] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 03/02/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Affordable Care Act allows uninsured individuals to select health insurance from numerous private plans, a challenging decision-making process. This study examined the effectiveness of strategies to support health insurance decisions among the uninsured. METHODS Participants (N = 343) from urban, suburban, and rural areas were randomized to 1 of 3 conditions: 1) a plain language table; 2) a visual condition where participants chose what information to view and in what order; and 3) a narrative condition. We administered measures assessing knowledge (true/false responses about key features of health insurance), confidence in choices (uncertainty subscale of the Decisional Conflict Scale), satisfaction (items from the Health Information National Trends Survey), preferences for insurance features (measured on a Likert scale from not at all important to very important), and plan choice. RESULTS Although we did not find significant differences in knowledge, confidence in choice, or satisfaction across condition, participants across conditions made value-consistent choices, selecting plans that aligned with their preferences for key insurance features. In addition, those with adequate health literacy skills as measured by the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) had higher knowledge overall ([Formula: see text] = 6.1 v. 4.8, P < 0.001) and preferred the plain language table to the visual (P = 0.04) and visual to narrative (P = 0.0002) conditions, while those with inadequate health literacy skills showed no preference for study condition. A similar pattern was seen for those with higher subjective numeracy skills and higher versus lower education with regard to health insurance knowledge. Individuals with higher income felt less confident in their choices ([Formula: see text] = 28.7 v. 10.0, where higher numbers indicate less confidence/more uncertainty; P = 0.004). CONCLUSIONS Those developing materials about the health insurance marketplace to support health insurance decisions might consider starting with plain language tables, presenting health insurance terminology in context, and organizing information according to ways the uninsured might use and value insurance features. Individuals with limited health literacy and numeracy skills and those with lower education face unique challenges selecting health insurance and weighing tradeoffs between cost and coverage.
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Affiliation(s)
- Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO (MCP, KAK, JEL, HP, KF)
| | - Kimberly A Kaphingst
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO (MCP, KAK, JEL, HP, KF)
| | - Jingxia Esther Liu
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO (MCP, KAK, JEL, HP, KF)
| | - Hannah Perkins
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO (MCP, KAK, JEL, HP, KF)
| | - Karishma Furtado
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO (MCP, KAK, JEL, HP, KF),Washington University in St. Louis, George Warren Brown School of Social Work, St. Louis, MO (KF, MWK, TM)
| | - Matthew W Kreuter
- Washington University in St. Louis, George Warren Brown School of Social Work, St. Louis, MO (KF, MWK, TM)
| | - Enbal Shacham
- Department of Behavioral Science and Health Education, St. Louis University College for Public Health and Social Justice, St. Louis, MO (ES)
| | - Timothy McBride
- Washington University in St. Louis, George Warren Brown School of Social Work, St. Louis, MO (KF, MWK, TM)
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Fernández ME, Melvin CL, Leeman J, Ribisl KM, Allen JD, Kegler MC, Bastani R, Ory MG, Risendal BC, Hannon PA, Kreuter MW, Hebert JR. The cancer prevention and control research network: An interactive systems approach to advancing cancer control implementation research and practice. Cancer Epidemiol Biomarkers Prev 2014; 23:2512-21. [PMID: 25155759 PMCID: PMC6013073 DOI: 10.1158/1055-9965.epi-14-0097] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Although cancer research has advanced at a rapid pace, a gap remains between what is known about how to improve cancer prevention and control (CPC) and what is implemented as best practices within health care systems and communities. The Cancer Prevention and Control Research Network (CPCRN), with more than 10 years of dissemination and implementation research experience, aims to accelerate the uptake and use of evidence-based CPC interventions. METHODS The collective work of the CPCRN has facilitated the analysis and categorization of research and implementation efforts according to the Interactive Systems Framework for Dissemination and Implementation (ISF), providing a useful heuristic for bridging the gap between prevention research and practice. The ISF authors have called for examples of its application as input to help refine the model. RESULTS We provide examples of how the collaborative activities supported by the CPCRN, using community-engaged processes, accelerated the synthesis and translation of evidence, built both general and innovation-specific capacity, and worked with delivery systems to advance cancer control research and practice. CONCLUSIONS The work of the CPCRN has provided real-world examples of the application of the ISF and demonstrated that synthesizing and translating evidence can increase the potential that evidence-based CPC programs will be used and that capacity building for both the support system and the delivery system is crucial for the successful implementation and maintenance of evidence-based cancer control. IMPACT Adoption and implementation of CPC can be enhanced by better understanding ISF systems and intervening to improve them.
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Affiliation(s)
- María E Fernández
- Division of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas.
| | - Cathy L Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Jennifer Leeman
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina. Center for Health Promotion and Disease Prevention and Lineberger Comprehensive Cancer Center, and
| | - Kurt M Ribisl
- Center for Health Promotion and Disease Prevention and Lineberger Comprehensive Cancer Center, and Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer D Allen
- Department of Public Health and Community Medicine, Tufts University, Medford, Massachusetts
| | - Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Roshan Bastani
- UCLA Department of Health Policy and Management, Center for Cancer Prevention and Control Research, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Marcia G Ory
- Texas A&M Health Science Center, School of Public Health, Department of Health Promotion and Community Health Sciences, College Station, Texas
| | - Betsy C Risendal
- University of Colorado School of Public Health, Denver, Colorado
| | - Peggy A Hannon
- Health Promotion Research Center, Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Matthew W Kreuter
- Health Communication Research Laboratory, Brown School, Washington University in St Louis, Missouri
| | - James R Hebert
- Department of Biostatistics and Epidemiology and Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Hall KS, Fendrick AM, Zochowski M, Dalton VK. Women's health and the Affordable Care Act: high hopes versus harsh realities? Am J Public Health 2014; 104:e10-3. [PMID: 24922171 DOI: 10.2105/ajph.2014.302045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Our population-based survey of 1078 randomly sampled US women, aged 18 to 55 years, sought to characterize their understanding of and attitudes toward the Affordable Care Act (ACA). Most women, especially socially disadvantaged groups, had negative or uncertain attitudes toward the ACA and limited understanding of its health benefits, including its relevance for their own health service coverage and utilization. Our findings are important for continued research, policy, and practice, with implications for whether, when, and how improved coverage will translate to improved access and outcomes for US women.
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Affiliation(s)
- Kelli Stidham Hall
- Kelli Stidham Hall is with the Department of Obstetrics and Gynecology and the Institute for Social Research, University of Michigan, Ann Arbor. A. Mark Fendrick is with the Department of Internal Medicine and the Department of Health Management and Policy, University of Michigan. Melissa Zochowski is with the Department of Obstetrics and Gynecology, University of Michigan. Vanessa K. Dalton is with the Department of Obstetrics and Gynecology, Program on Women's Health Care Effectiveness Research and the Institute for Healthcare Policy and Innovation, University of Michigan
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