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Blackburn CC, Nuzhath T. An exploration of barriers to access to healthcare in Hancock County, Tennessee: A qualitative study. Health Expect 2024; 27:e14074. [PMID: 38769887 PMCID: PMC11106589 DOI: 10.1111/hex.14074] [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: 09/18/2023] [Revised: 03/29/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVE Explore barriers to healthcare access in Hancock County, Tennessee using a conceptual framework for access to healthcare. METHODS We collected data from 30 participants in Hancock County during 1 week in April 2023 using a combination of network and purposive sampling. We analyzed the data using thematic analysis and the conceptual framework of healthcare access. RESULTS All dimensions of the conceptual framework of healthcare access presented barriers to healthcare access for participants of the study. A lack of acceptability of local healthcare among participants manifested in a perceived lack of availability of healthcare. This resulted in participants travelling or considering it necessary to travel long distances for care, even in a life-threatening emergency, despite the local availability of a hospital with an emergency department. CONCLUSIONS A lack of acceptability can create healthcare access barriers similar to a lack of availability of healthcare facilities. PATIENT OR PUBLIC CONTRIBUTION The research team met several times with the leader of a local community organization to discuss this research in Hancock County. These conversations helped to inform the study design and provided necessary background to conduct in-depth interviews. Members of the community organization helped identify individuals to interview and provide access to Remote Area Medical clinic patients. The research team discussed the final themes with the primary community collaborator.
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Affiliation(s)
- Christine Crudo Blackburn
- Department of Health Policy and Management, School of Public HealthTexas A&M UniversityCollege StationTexasUSA
| | - Tasmiah Nuzhath
- Department of Global Health and Population, T.H. Chan School of Public HealthHarvard UniversityCambridgeMassachusettsUSA
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Alon Y, Azriel O, Pine DS, Bar-Haim Y. A randomized controlled trial of supervised remotely-delivered attention bias modification for posttraumatic stress disorder. Psychol Med 2023; 53:3601-3610. [PMID: 35132952 PMCID: PMC10248784 DOI: 10.1017/s003329172200023x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/03/2022] [Accepted: 01/17/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many individuals with posttraumatic stress disorder (PTSD) have limited access to first-line treatments, warranting the development of remotely-delivered treatments. Attention bias modification (ABM), targeting perturbed threat-related attentional patterns, shows promise when delivered in-person. However, previous studies found ABM to be ineffective when delivered remotely. Randomized clinical trials usually applied two variations of ABM: ABM away from threat or attention control training (ACT) balancing attention between threat-related and neutral stimuli. We tested remotely-delivered ACT/ABM with tighter supervision and video-based interactions that resemble in-clinic protocols. We expected to replicate the results of in-clinic trials, in which ACT outperformed ABM for PTSD. METHODS In this double-blinded, parallel-group randomized controlled trial, 60 patients diagnosed with PTSD were randomized (ABM n = 30; ACT n = 30). Patients performed eight bi-weekly remotely-delivered supervised ABM/ACT sessions. Symptoms were assessed pre- and post-treatment with Clinician-Administered PTSD Scale 5 (CAPS-5) severity score and PTSD diagnosis as the primary outcomes. Current depressive episode, current anxiety-related comorbidity, and time elapsed since the trauma were examined as potential moderators of treatment outcome. RESULTS Significant decrease in CAPS-5 severity scores and PTSD diagnosis was observed following both ACT and ABM with no between-group difference. Patients without depression or whose trauma occurred more recently had greater symptom reduction in the ACT than the ABM group. CONCLUSIONS Contrary to our expectation, symptoms decreased similarly following ACT and ABM. Moderator analyses suggest advantage for ACT in non-depressed patients and patients whose trauma occurred more recently. Further refinements in remotely-delivered ABM/ACT may be needed.
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Affiliation(s)
- Yaron Alon
- School of Psychological Sciences, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Omer Azriel
- School of Psychological Sciences, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Daniel S. Pine
- Section on Developmental Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel-Aviv University, Tel Aviv-Yafo, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv-Yafo, Israel
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Zhang H, Yang Z, Wang Y, Ankrah Twumasi M, Chandio AA. Impact of Agricultural Mechanization Level on Farmers' Health Status in Western China: Analysis Based on CHARLS Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4654. [PMID: 36901664 PMCID: PMC10001758 DOI: 10.3390/ijerph20054654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 06/18/2023]
Abstract
Agricultural mechanization is an important component of agricultural modernization, as it contributes to the improvement of agricultural technology and the rapid transformation of agricultural development. However, research on the connection between agricultural mechanization and farmers' health status is scarce. Thus, using the 2018 China Health and Retirement Longitudinal Survey (CHARLS) data, this study explored how agricultural mechanization can affect farmers' health. OLS and 2SLS models were used for the study's analysis. Furthermore, we used a PSM model to check the robustness of our analysis. The findings showed that: (1) the current state of agricultural mechanization in western China harms the health of rural residents; (2) agricultural mechanization can mitigate the adverse effects on health by increasing farmers' living expenditure and improving their living environment; and (3) agricultural mechanization's effects on farmers' health are regionally and income-heterogeneous. Agricultural mechanization has a more significant impact on health in Tibetan areas and high-income regions. It has an almost minimal effect in non-Tibetan and low-income areas. This paper suggests approaches that can be used to encourage the rational development of agricultural mechanization and improve rural populations' health.
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Althouse BM, Baker C, Smits PD, Gratzl S, Lee RH, Goodwin Cartwright BM, Simonov M, Wang MD, Stucky NL. Racial inequality in COVID-treatment and in-hospital length of stay in the US over time. Front Public Health 2023; 10:1074775. [PMID: 36711416 PMCID: PMC9876573 DOI: 10.3389/fpubh.2022.1074775] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Demonstrated health inequalities persist in the United States. SARS-CoV-2 (COVID) has been no exception, with access to treatment and hospitalization differing across race or ethnic groups. Here, we aim to assess differences in treatment with remdesivir and hospital length of stay across the four waves of the pandemic. Materials and methods Using a subset of the Truveta data, we examine the odds ratio (OR) of in-hospital remdesivir treatment and risk ratio (RR) of in-hospital length of stay between Black or African American (Black) to White patients. We adjusted for confounding factors, such as age, sex, and comorbidity status. Results There were statistically significant lower rates of remdesivir treatment and longer in-hospital length of stay comparing Black patients to White patients early in the pandemic (OR for treatment: 0.88, 95% confidence interval [CI]: 0.80, 0.96; RR for length of stay: 1.17, CI: 1.06, 1.21). Rates became close to parity between groups as the pandemic progressed. Conclusion While inpatient remdesivir treatment rates increased and length of stay decreased over the beginning course of the pandemic, there are still inequalities in patient care.
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Affiliation(s)
- Benjamin M. Althouse
- Truveta, Inc., Bellevue, WA, United States
- Information School, University of Washington, Seattle, WA, United States
- Department of Biology, New Mexico State University, Las Cruces, NM, United States
| | | | | | | | | | | | - Michael Simonov
- Truveta, Inc., Bellevue, WA, United States
- Yale School of Medicine, New Haven, CT, United States
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Qiu W, Wu T, Xue P. Can Mobile Payment Increase Household Income and Mitigate the Lower Income Condition Caused by Health Risks? Evidence from Rural China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11739. [PMID: 36142011 PMCID: PMC9517343 DOI: 10.3390/ijerph191811739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
China has moved into a new stage of its fight against poverty, where the further raising of rural household income is of great importance. Health risk is one of the biggest obstacles to the poverty reduction progress. Therefore, how to cope with the negative effects of health risks has attracted the attention of scholars, especially in the background of the global outbreak of COVID-19. In this paper, we try to explore whether mobile payment, a new form of payment, can improve the income of rural households and mitigate the lower income condition caused by health risks in China. Using data from the 2017 China Household Finance Survey, we found: (1) mobile payment can substantially increase rural household income; (2) health risks will lower the income of rural residents, but mobile payment can lessen this negative effect. Mechanism analysis indicates that mobile payment is likely to ease liquidity constraints, increase social interaction, and stimulate entrepreneurship for rural households. We advised the government to promote mobile payment adoption in rural areas and enhance its design. Additionally, better medical resources should also be made available to rural households.
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Affiliation(s)
- Weisong Qiu
- Tailong Finance School, Zhejiang Gongshang University, Hangzhou 310018, China
| | - Tieqi Wu
- The School of Management and Economics, Jingdezhen Ceramic University, Jingdezhen 333403, China
| | - Peng Xue
- The Six Topographic Survey Team of Ministry of Natural Resources, Chengdu 610500, China
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O’Callaghan E, Sullivan S, Gupta C, Belanger HG, Winsberg M. Feasibility and acceptability of a novel telepsychiatry-delivered precision prescribing intervention for anxiety and depression. BMC Psychiatry 2022; 22:483. [PMID: 35854281 PMCID: PMC9297585 DOI: 10.1186/s12888-022-04113-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/05/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Major Depressive Disorder and Generalized Anxiety Disorder are pervasive and debilitating conditions, though treatment is often inaccessible and based on trial-and-error prescribing methods. The present observational study seeks to describe the use of a proprietary precision prescribing algorithm piloted during routine clinical practice as part of Brightside's telepsychiatry services. The primary aim is to determine the feasibility and acceptability of implementing this intervention. Secondary aims include exploring remission and symptom improvement rates. METHODS Participants were adult patients enrolled in Brightside who completed at least 12 weeks of treatment for depression and/or anxiety and received a prescription for at least one psychiatric medication. A prescription recommendation was made by Brightside's algorithm at treatment onset and was utilized for clinical decision support. Participants received baseline screening surveys of the PHQ-9 and GAD-7, and at weeks 2,4,6,8,10 and 12. Intent-to-treat (ITT) sensitivity analyses were conducted. Feasibility of the implementation was measured by the platform's ability to enroll and engage participants in timely psychiatric care, as well as offer high touch-point treatment options. Acceptability was measured by patient responses to a 5-star satisfaction rating. RESULTS Brightside accessed and treated 6248 patients from October 2018 to April 2021, treating a majority of patients within 4-days of enrollment. The average plan cost was $115/month. 89% of participants utilized Brightside's core medication plan at a cost of $95/month. 13.4% of patients in the study rated Brightside's services as highly satisfactory, averaging a 4.6-star rating. Furthermore, 90% of 6248 patients experienced a MCID in PHQ-9 or GAD-7 score. Remission rates were 75% (final PHQ-9 or GAD-7 score < 10) for the study sample and 59% for the ITT sample. 69.3% of Brightside patients were treated with the medication initially prescribed at intake. CONCLUSIONS Results suggest that the present intervention may be feasible and acceptable within the assessed population. Exploratory analyses suggest that Brightside's course of treatment, guided by precision recommendations, improved patients' symptoms of anxiety and depression.
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Affiliation(s)
- Erin O’Callaghan
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA 94607-1703 USA
| | - Scott Sullivan
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA 94607-1703 USA
| | - Carina Gupta
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA, 94607-1703, USA.
| | - Heather G. Belanger
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA 94607-1703 USA ,grid.170693.a0000 0001 2353 285XDepartments of Psychology and Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL USA
| | - Mirène Winsberg
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA 94607-1703 USA
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Cohen SA, Nash CC, Byrne EN, Mitchell LE, Greaney ML. Black/White Disparities in Obesity Widen with Increasing Rurality: Evidence from a National Survey. Health Equity 2022; 6:178-188. [PMID: 35402770 PMCID: PMC8985531 DOI: 10.1089/heq.2021.0149] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Steven A. Cohen
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Caitlin C. Nash
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Erin N. Byrne
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Lauren E. Mitchell
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Mary L. Greaney
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
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Haithcoat T, Liu D, Young T, Shyu CR. Investigating Health Context: Using Geospatial Big Data Ecosystem (Preprint). JMIR Med Inform 2021; 10:e35073. [PMID: 35311683 PMCID: PMC9021952 DOI: 10.2196/35073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/27/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Timothy Haithcoat
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO, United States
| | - Danlu Liu
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO, United States
| | - Tiffany Young
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO, United States
| | - Chi-Ren Shyu
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO, United States
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Staples JN, Nelamangala SL, Morris S, Wells K. Exploring socio-demographic and geospatial variation in human papillomavirus vaccination uptake in Virginia. Vaccine 2021; 39:5385-5390. [PMID: 34384637 DOI: 10.1016/j.vaccine.2021.07.079] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/11/2021] [Accepted: 07/28/2021] [Indexed: 01/20/2023]
Abstract
Significant variation in human papillomavirus (HPV) vaccine coverage exists across the United States. A closer look at state and region-specific coverage is necessary to identify potentially modifiable disparities. Using ArcGIS software, we identify geospatial variation in HPV vaccine coverage in the state of Virginia and examine the relationship between various socio-demographic indicators and HPV vaccination uptake. HPV vaccination rates among adolescents 11 to 17 years as of 07/01/2018 were retrieved at the zip-code level from the Virginia Immunization Information System and chloropleth maps produced. The ArcGIS Hot Spot Analysis tool identified spatial clusters of zip codes with high and low vaccination rates. Population characteristics and socioeconomic indicators were retrieved from the 2010 United States Census and compared between statistically significant clusters of higher or lower than expected vaccination rates. Regions with significantly lower initiation rates were less populated, less educated, and had a lower median household income (MHI) with higher rates of poverty and unemployment. Among male adolescents, these areas had a significantly lower density of primary care providers and smaller African American and Hispanic populations. In contrast, regions with significantly lower series completion were more populated and had a higher MHI, but there was no difference in provider density or minority population. Ultimately, regional socioeconomic indicators are significant predictors of HPV vaccination, but have contrasting implications for series initiation and completion. Targeted interventions and safety net programs have traditionally focused on the socioeconomically disadvantaged, however it is the more affluent communities that may be struggling with series completion.
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Affiliation(s)
- Jeanine N Staples
- Sibley Center for Gynecologic Oncology and Advanced Pelvic Surgery, Sibley Memorial Hospital, Johns Hopkins Medicine, Washington, DC, USA.
| | | | - Sean Morris
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Kristen Wells
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA
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Wang Y, Liu Y, Struthers J, Lian M. Spatiotemporal Characteristics of the COVID-19 Epidemic in the United States. Clin Infect Dis 2021; 72:643-651. [PMID: 32640020 PMCID: PMC7454424 DOI: 10.1093/cid/ciaa934] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/02/2020] [Indexed: 01/25/2023] Open
Abstract
Background A range of near-real-time online/mobile mapping dashboards and applications have been used to track the coronavirus disease 2019 (COVID-19) pandemic worldwide; however, small area-based spatiotemporal patterns of COVID-19 in the United States remain unknown. Methods We obtained county-based counts of COVID-19 cases confirmed in the United States from 22 January to 13 May 2020 (N = 1 386 050). We characterized the dynamics of the COVID-19 epidemic through detecting weekly hotspots of newly confirmed cases using Spatial and Space-Time Scan Statistics and quantifying the trends of incidence of COVID-19 by county characteristics using the Joinpoint analysis. Results Along with the national plateau reached in early April, COVID-19 incidence significantly decreased in the Northeast (estimated weekly percentage change [EWPC]: −16.6%) but continued increasing in the Midwest, South, and West (EWPCs: 13.2%, 5.6%, and 5.7%, respectively). Higher risks of clustering and incidence of COVID-19 were consistently observed in metropolitan versus rural counties, counties closest to core airports, the most populous counties, and counties with the highest proportion of racial/ethnic minorities. However, geographic differences in incidence have shrunk since early April, driven by a significant decrease in the incidence in these counties (EWPC range: −2.0%, −4.2%) and a consistent increase in other areas (EWPC range: 1.5–20.3%). Conclusions To substantially decrease the nationwide incidence of COVID-19, strict social-distancing measures should be continuously implemented, especially in geographic areas with increasing risks, including rural areas. Spatiotemporal characteristics and trends of COVID-19 should be considered in decision making on the timeline of re-opening for states and localities.
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Affiliation(s)
- Yun Wang
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Ying Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA.,Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, Missouri, USA
| | - James Struthers
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Min Lian
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA.,Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, Missouri, USA
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Deng X, Zeng M, Xu D, Wei F, Qi Y. Household Health and Cropland Abandonment in Rural China: Theoretical Mechanism and Empirical Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193588. [PMID: 31557866 PMCID: PMC6801875 DOI: 10.3390/ijerph16193588] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 11/16/2022]
Abstract
Prior studies have fully explored the impacts of rural labor migration on land use forms. In contrast to prior studies, this study focuses on the health status of rural households and its quantitative impacts on cropland abandonment (CA). More specifically, under the guidance of the theoretical mechanism of "household health affects CA by labor supply", this study employs survey data from 8031 households collected in 27 Chinese provinces in 2014 to explore the quantitative impacts of household health on CA. The results are as follows. (1) The higher the level of household health is, the less CA there is. (2) Compared with males, the impact of female health status on CA is more obvious. Thus, the relationship between household health and CA matters, not only because it may help to theoretically enhance the understanding of the importance of health in peasant households, but also because it may help to practically provide references for effective policies of CA from the perspective of rural medical services.
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Affiliation(s)
- Xin Deng
- College of Economics, Sichuan Agricultural University, #211, Huimin Road, Chengdu 611130, China.
| | - Miao Zeng
- School of Economics, Sichuan University, #24, Yihuannan Road, Chengdu 610065, China.
| | - Dingde Xu
- Sichuan Center for Rural Development Research, College of Management, Sichuan Agricultural University; #211, Huimin Road, Chengdu 611130, China.
| | - Feng Wei
- College of Economics, Sichuan Agricultural University, #211, Huimin Road, Chengdu 611130, China.
| | - Yanbin Qi
- College of Economics, Sichuan Agricultural University, #211, Huimin Road, Chengdu 611130, China.
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Blix BH, Hamran T. Assisted living in rural areas: aging in blurred landscapes. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2019. [DOI: 10.4081/qrmh.2019.7826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Here, we explore the experiences and practices of care in the context of assisted living facilities (ALFs) in rural areas from the perspectives of family members, health care professionals, and senior citizen interest group representatives. Specifically, we focus on the potential for ALFs to safeguard and unify the health care policy ambitions of equity, quality, and aging in place. Focus group interviews with health care professionals and interest group representatives and individual interviews with family members were conducted in largely rural Norwegian municipalities. Providing high-quality health care services in people’s homes remains challenging, particularly in rural areas. ALFs have been introduced as a compromise, a home away from home. In rural areas, ALFs are typically localized in community centers. ALFs are neither homes nor nursing homes, and residents possess varying and changing care needs. Several parties experience challenges with respect to safety, evolving care needs, and responsibilities. Moreover, the service allocation and user payment systems may undermine equity. This study indicates that health care authorities should evaluate whether prioritizing assisted living is still suitable for the aging population in rural areas and beyond.
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Khairat S, Haithcoat T, Liu S, Zaman T, Edson B, Gianforcaro R, Shyu CR. Advancing health equity and access using telemedicine: a geospatial assessment. J Am Med Inform Assoc 2019; 26:796-805. [PMID: 31340022 PMCID: PMC6696489 DOI: 10.1093/jamia/ocz108] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/29/2019] [Accepted: 06/01/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Health disparity affects both urban and rural residents, with evidence showing that rural residents have significantly lower health status than urban residents. Health equity is the commitment to reducing disparities in health and in its determinants, including social determinants. OBJECTIVE This article evaluates the reach and context of a virtual urgent care (VUC) program on health equity and accessibility with a focus on the rural underserved population. MATERIALS AND METHODS We studied a total of 5343 patient activation records and 2195 unique encounters collected from a VUC during the first 4 quarters of operation. Zip codes served as the analysis unit and geospatial analysis and informatics quantified the results. RESULTS The reach and context were assessed using a mean accumulated score based on 11 health equity and accessibility determinants calculated for each zip code. Results were compared among VUC users, North Carolina (NC), rural NC, and urban NC averages. CONCLUSIONS The study concluded that patients facing inequities from rural areas were enabled better healthcare access by utilizing the VUC. Through geospatial analysis, recommendations are outlined to help improve healthcare access to rural underserved populations.
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Affiliation(s)
- Saif Khairat
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Timothy Haithcoat
- MU Informatics Institute, University of Missouri, Columbia, Missouri, USA
| | - Songzi Liu
- School of Information and Library Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tanzila Zaman
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Barbara Edson
- Virtual Care Center, UNC Healthcare, Chapel Hill, North Carolina, USA
| | | | - Chi-Ren Shyu
- MU Informatics Institute, University of Missouri, Columbia, Missouri, USA
- Electrical Engineering and Computer Science Department, University of Missouri, Columbia, Missouri, USA
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Brandão D, Ribeiro O, Afonso RM, Paúl C. Regional differences in morbidity profiles and health care use in the oldest old: Findings from two Centenarian Studies in Portugal. Arch Gerontol Geriatr 2019; 82:139-146. [PMID: 30797992 DOI: 10.1016/j.archger.2019.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 10/16/2018] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The worldwide increase of human life expectancy and the rapid aging of the population will contribute to an increasing prevalence of chronic illness. Even so, individuals who reach very advanced ages often postpone or escape age-related diseases that are common causes of death. OBJECTIVE This article aims to examine health-related characteristics of two distinct samples of Portuguese centenarians (one predominantly rural - PR vs. one predominantly urban - PU), and explore potential dissimilarities in their morbidity profiles and use of health care services. METHODS A total of 241 centenarians were considered. Sociodemographic characteristics, health status, and use of health care services were assessed by semi-structured interviews with the centenarians and their proxies (family or formal caregiver). RESULTS A higher average of 4.80 self-reported illnesses (sd = 2.01) were found in the PU sample (vs. 2.96; sd = 1.77 in the PR sample); in overall the PR sample presented a better health condition with lower levels of physical and mental impairments, and a greater number of centenarians who did not succumb to the three most common lethal diseases (heart disease, non-skin cancer and stroke) in the elderly population (85.4% vs. 60% in the PU sample). CONCLUSIONS Portuguese centenarians experienced a substantial number of illnesses, but an overall better health status was found in centenarians from the PR area. By providing distinctive health-related profiles, our findings suggest the importance of contextual factors in shaping how very advanced ages may be achieved.
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Affiliation(s)
- Daniela Brandão
- Center for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal; Faculty of Medicine, University of Porto (FMUP-UP), Porto, Portugal
| | - Oscar Ribeiro
- Center for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal; Department of Education and Psychology, University of Aveiro (DEP.UA), Aveiro, Portugal.
| | - Rosa Marina Afonso
- Center for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal; Department of Psychology and Education, University of Beira Interior (UBI), Covilhã, Portugal
| | - Constança Paúl
- Center for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal; Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
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Reaching 100 in the Countryside: Health Profile and Living Circumstances of Portuguese Centenarians from the Beira Interior Region. Curr Gerontol Geriatr Res 2018; 2018:8450468. [PMID: 30008746 PMCID: PMC6020501 DOI: 10.1155/2018/8450468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/06/2018] [Accepted: 05/03/2018] [Indexed: 01/08/2023] Open
Abstract
The interest in studying a specific population of centenarians who lives in the country's interior region (PT100-BI) emerged during the first Portuguese systematic study about centenarians (PT100 Oporto Centenarian Study). This region of Portugal is predominantly rural and is one of the regions with the largest number of aged people. The aim of this study is to provide information on the centenarians who live in the Beira Interior region, specifically in terms of their health status and the health services they use. A total of 101 centenarians (mean age: 101.1 years; SD = 1.5 years), 14 males and 87 females, were considered. Most centenarians lived in the community, and 47.6% lived in nursing homes. Nearly half (47.5%) presented cognitive functioning without deficits. A noteworthy percentage presented conditioned mobility and sensory problems. The most common self-reported diseases include urinary incontinence (31.7%), high blood pressure (23.8%), and heart conditions (19.8%). Despite these health and functional characteristics, formal support services and technical assistance were found to be scarcely used. Further research is needed to understand how the role of contextual variables and the countryside environment contribute to the centenarians' adaptation to advanced longevity.
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16
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Regional Variations in General Practitioner Visits for Alcohol-Attributed Diseases in British Columbia, Canada. Int J Ment Health Addict 2016. [DOI: 10.1007/s11469-016-9651-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Sanders SR, Erickson LD, Call VRA, McKnight ML. Middle-Aged and Older Adult Health Care Selection. J Appl Gerontol 2016; 36:441-461. [PMID: 26316268 DOI: 10.1177/0733464815602108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study assesses the prevalence of primary-care physician (PCP) bypass among rural middle-aged and older adults. Bypass is a behavior where people travel beyond local providers to obtain health care. This article applies a precise Geographic Information System (GIS)-based measure of bypass and examines the role of community and non-health-care-related characteristics on bypass. Our results indicate that bypass behavior among rural middle-aged and older adults is multifaceted. In addition to the perceived quality of local primary care, dissatisfaction with local services, such as shopping, creates an effect that increases the likelihood of bypass, whereas strong community ties decrease the likelihood of bypass. The results suggest that the "outshopping theory," where respondents select services in larger regional economic centers rather than local "mom and pop" providers, now extends to older adult health care selection.
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Weigel PAM, Ullrich F, Finegan CN, Ward MM. Rural Bypass for Elective Surgeries. J Rural Health 2015; 33:135-145. [PMID: 26625274 DOI: 10.1111/jrh.12163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Rural bypass of Critical Access Hospitals (CAHs) for elective inpatient and outpatient surgical procedures has not been studied. Residents choosing to have their elective surgeries elsewhere, when the local CAH provides those surgical services, erode their rural hospital's financial base. The purpose of this research is to describe the elective surgical bypass rate, the procedures most commonly bypassed by rural residents, the distribution of volume among CAHs that offer elective surgical services, and factors predictive of bypass. METHODS A sample of elective surgery discharges was created from the 2011 Healthcare Cost and Utilization Project State Inpatient Databases and State Ambulatory Surgery Databases for Colorado, North Carolina, Vermont, and Wisconsin. Frequencies of procedures bypassed and CAH volume distribution were performed. Logistic regression was used to model factors associated with rural bypass for elective surgical care. FINDINGS The rural bypass rate for elective surgical procedures is 48.4%. Procedures bypassed most are operations on the musculoskeletal system, eye, and digestive system. Annual volume distribution for elective surgical procedures among CAHs varied widely. Patients who are younger, medically complex, at higher surgical risk, and have private insurance are at higher odds of bypass. Patients are also more likely to bypass low-volume hospitals. CONCLUSION Rural hospitals should consider developing surgical services that are performed electively and on an outpatient basis that are attractive to a broader rural population. CAHs that already offer elective surgical procedures and yet who are still bypassed must examine the mutable factors that drive bypass behavior.
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Affiliation(s)
- Paula A M Weigel
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa
| | - Fred Ullrich
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa
| | - Chance N Finegan
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa
| | - Marcia M Ward
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa
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Young L, Montgomery M, Barnason S, Schmidt C, Do V. A Conceptual Framework for Barriers to the Recruitment and Retention of Rural CVD Participants in Behavior Intervention Trials. ACTA ACUST UNITED AC 2015; 2:19-24. [PMID: 28580381 DOI: 10.5176/2010-4804_2.2.71] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rural residents diagnosed with cardiovascular disease (CVD) or with CVD-related risks are underrepresented in behavioral intervention trials based on an extensive review of published studies. The low participation rate of rural residents weakens both the internal and external validity of published studies. Moreover, compared to urban residents, limited research exists to describe the unique barriers that limit the participation of rural residents in behavioral intervention trials. OBJECTIVE The purpose of this review is to identify a conceptual framework (CF) underpinning common barriers faced by rural CVD patients to enroll in behavioral intervention trials. METHODS We conducted a literature review using several electronic databases to obtain a representative sample of research articles, synthesized the evidence, and developed a CF to explain the barriers that may affect the research participation rate of rural residents with CVD or related risks. RESULTS We found our evidence-based CF well explained the barriers for rural CVD patients to take part in behavioral intervention trials. Besides contextual factors (i.e. patient, community and research levels), other common factors impacting rural patients' intent to enroll are lack of awareness and understanding about behavioral trials, limited support from their healthcare providers and social circles, unfavorable attitudes, and the lack of opportunity to participating research. CONCLUSION AND IMPLICATION OF RESULT The findings demonstrate the evidence-based model consisting of interlinked multi-level factors may help our understanding of the barriers encountered by rural CVD patients participating interventions to promote behavioral change. The implication for researchers is that identifying and developing strategies to overcome the barriers precedes conducting studies in rural communities.
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20
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A closer look at the rural-urban health disparities: Insights from four major diseases in the Commonwealth of Virginia. Soc Sci Med 2015. [DOI: 10.1016/j.socscimed.2015.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Slaunwhite AK, Macdonald S. Alcohol, Isolation, and Access to Treatment: Family Physician Experiences of Alcohol Consumption and Access to Health Care in Rural British Columbia. J Rural Health 2015; 31:335-45. [PMID: 25953523 DOI: 10.1111/jrh.12117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this project was to study the experiences of physicians who treat persons with alcohol-attributed diseases in rural areas of British Columbia, Canada. METHOD A cross-sectional survey was distributed to primary health care physicians that had a family practice in a designated rural community using the Rural Coordination Centre of British Columbia's community isolation rating system. Data were collected through a mail and online survey sent to primary health care physicians. Purposeful sampling was used to select participants that had a primary health care practice in a designated rural community. RESULTS Surveys were returned by 22% of potential participants (N = 67) that had an average of 15.8 years in family practice. The majority of participants (95.4%) reported that alcohol had a negative impact on population health, and physicians expressed particular concern for alcohol consumption in relation to mental health (85.1%) and physical illness (82.1%). Most participants had referred patients out of the community for treatment; however, 76.4% reported difficulty with referrals, including long wait-lists, limited services, and issues related to transportation and leaving the community for substance use treatment. CONCLUSION Rural physicians showed an awareness and concern for alcohol consumption in their community, but they also reported difficulties referring patients for substance use treatment. Additional study is required to understand how to improve the continuity of care provided to persons with alcohol-related issues in rural British Columbia.
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Affiliation(s)
- Amanda K Slaunwhite
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada.,Centre for Addictions Research of British Columbia, Victoria, British Columbia, Canada
| | - Scott Macdonald
- Centre for Addictions Research of British Columbia, Victoria, British Columbia, Canada.,School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
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22
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Remote patient monitoring acceptance trends among older adults residing in a frontier state. COMPUTERS IN HUMAN BEHAVIOR 2015. [DOI: 10.1016/j.chb.2014.11.044] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bacsu J, Jeffery B, Novik N, Abonyi S, Oosman S, Johnson S, Martz D. Policy, Community and Kin: Interventions That Support Rural Healthy Aging. ACTIVITIES, ADAPTATION & AGING 2014. [DOI: 10.1080/01924788.2014.901067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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25
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Andrykowski MA, Steffens RF, Bush HM, Tucker TC. Disparities in mental health outcomes among lung cancer survivors associated with ruralness of residence. Psychooncology 2013; 23:428-36. [DOI: 10.1002/pon.3440] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 09/20/2013] [Accepted: 10/04/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Michael A. Andrykowski
- Department of Behavioral Science; University of Kentucky College of Medicine; Lexington KY USA
| | - Rachel F. Steffens
- Department of Behavioral Science; University of Kentucky College of Medicine; Lexington KY USA
| | - Heather M. Bush
- Department of Biostatistics; University of Kentucky College of Public Health; Lexington KY USA
| | - Thomas C. Tucker
- Department of Epidemiology; University of Kentucky College of Public Health; Lexington KY USA
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26
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Rosie JA, Ruhen S, Hing WA, Lewis GN. Virtual rehabilitation in a school setting: is it feasible for children with cerebral palsy? Disabil Rehabil Assist Technol 2013; 10:19-26. [PMID: 24001213 DOI: 10.3109/17483107.2013.832414] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Juliet A Rosie
- Health and Rehabilitation Research Institute, AUT University , Auckland , New Zealand
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27
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Ryser L, Halseth G. Resolving mobility constraints impeding rural seniors' access to regionalized services. J Aging Soc Policy 2012; 24:328-44. [PMID: 22720890 DOI: 10.1080/08959420.2012.683329] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Rural and small town places in developed economies are aging. While attention has been paid to the local transportation needs of rural seniors, fewer researchers have explored their regional transportation needs. This is important given policies that have reduced and regionalized many services and supports. This article explores mobility constraints impeding rural seniors' access to regionalized services using the example of northern British Columbia. Drawing upon several qualitative studies, we explore geographical, maintenance, organizational, communication, human resources, infrastructure, and financial constraints that affect seniors' regional mobility. Our findings indicate that greater coordination across multiple government agencies and jurisdictions is needed and more supportive policies and resources must be in place to facilitate a comprehensive regional transportation strategy. In addition to discussing the complexities of these geographies, the article identifies innovative solutions that have been deployed in northern British Columbia to support an aging population. This research provides a foundation for developing a comprehensive understanding of the key issues that need to be addressed to inform strategic investments in infrastructure and programs that support the regional mobility and, hence, healthy aging of rural seniors.
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Affiliation(s)
- Laura Ryser
- Rural and Small Town Studies Program, University of Northern British Columbia, Prince George, British Columbia, Canada.
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Miyamoto S, Henderson S, Young H, Ward D, Santillan V. Recruiting rural participants for a telehealth intervention on diabetes self-management. J Rural Health 2012; 29:69-77. [PMID: 23289657 DOI: 10.1111/j.1748-0361.2012.00443.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Recruiting rural and underserved participants in behavioral health interventions is challenging. Community-based recruitment approaches are effective, but they are not always feasible in multisite, diverse community interventions. This study evaluates the feasibility of a rapid, multisite approach that uses rural clinic site coordinators to recruit study participants. The approach allows for rural recruitment in areas where researchers may not have developed long-term collaborative relationships. METHODS Adults with diabetes were recruited from rural Federally Qualified Health Center (FQHC) clinics. Recruitment feasibility was assessed by analyzing field notes by the project manager and health coaches, and 8 in-depth, semistructured interviews with clinic site coordinators and champions, followed by thematic analysis of field notes and interviews. FINDINGS Forty-seven rural sites were contacted to obtain the 6 sites that participated in the study. On average, sites took 14 days to commit to study participation. One hundred and twenty-one participants were acquired from letters mailed to eligible participants and, in some sites, by follow-up phone calls from site coordinators. Facilitators and deterrents affecting study recruitment fell into 4 broad categories--study design, site, site coordinator, and participant factors. CONCLUSION The rapid multisite approach led to quick and efficient recruitment of clinic sites and participants. Recruitment success was achieved in some, but not all, rural sites. The study highlights the opportunities and challenges of recruiting rural clinics and rural, underserved participants in multisite research. Suggestions are provided for improving recruitment for future interventions.
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Affiliation(s)
- Sheridan Miyamoto
- Betty Irene Moore School of Nursing at University of California Davis, Sacramento, CA, USA.
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29
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Neill C, Leipert BD, Garcia AC, Kloseck M. Using photovoice methodology to investigate facilitators and barriers to food acquisition and preparation by rural older women. J Nutr Gerontol Geriatr 2012; 30:225-47. [PMID: 21846240 DOI: 10.1080/21551197.2011.591268] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This research investigates facilitators and barriers that rural women aged 65 to 75 years in Southwestern Ontario experience in acquiring and preparing food through the use of photovoice methodology. Eighteen participants in five rural communities used a camera and log book to document their experiences and perspectives relating to the acquisition and preparation of food, and they each participated in two focus groups to engage in critical dialogue and knowledge sharing regarding the meaning and significance of the pictures they took. Analysis of photographs, log books, and focus group data revealed 13 themes, 3 emerging as facilitators to food acquisition and preparation (availability of food, social networks and values, personal values and resources), 5 as barriers (adjusting to changing family size, winter weather, food labeling issues, grocery shopper resources, limited physical capacity), and 5 as both facilitators and barriers (economics, valuing a healthy diet, technology changes, transportation, location and nature of grocery stores). Data also revealed rurality, age, and gender as foundationally influential factors affecting rural older women's food acquisition and preparation.
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Affiliation(s)
- Carly Neill
- University of Western Ontario, London, Canada.
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30
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Zgibor JC, Gieraltowski LB, Talbott EO, Fabio A, Sharma RK, Hassan K. The association between driving distance and glycemic control in rural areas. J Diabetes Sci Technol 2011; 5:494-500. [PMID: 21722565 PMCID: PMC3192616 DOI: 10.1177/193229681100500304] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In order to optimize care and improve outcomes in people with diabetes, adequate access to health care facilities and resources for self-management is required. METHODS Data on 3369 individuals with type 2 diabetes who received education at 7 diabetes centers were collected prospectively between June 2005 and January 2007. The driving distances of subjects who were in good control [hemoglobin A1c (A1C) ≤7.0%] were compared with the driving distances of those who were not (A1C >7.0%). The association between A1C and improvement in A1C with travel burden was tested. RESULTS The mean distance subjects traveled to visit their center was 13.3 miles. The results indicated that residing more than 10 miles from the diabetes management center [odds ratio (OR) = 1.91, p < .0001], being younger (OR = 0.99, p = .00015), and having a longer duration of diabetes (OR = 1.03, p = .0007) were significant contributors to a A1C >7% adjusted for individual- and community-level factors. In addition, those who lived within 10 miles of their center were 2.5 times more likely to have improved their A1C values between their first and last office visits. CONCLUSION Health care providers should be aware of travel burden as a potential barrier to glycemic control. In the future, it may be useful to minimize driving distance for individuals with diabetes, perhaps by improved public transportation, more diabetes center locations in rural areas, telemedicine, or home visits.
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Affiliation(s)
- Janice C Zgibor
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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31
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Stajduhar K, Funk L, Toye C, Grande G, Aoun S, Todd C. Part 1: Home-based family caregiving at the end of life: a comprehensive review of published quantitative research (1998-2008). Palliat Med 2010; 24:573-93. [PMID: 20562171 DOI: 10.1177/0269216310371412] [Citation(s) in RCA: 205] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The changing context of palliative care over the last decade highlights the importance of recent research on home-based family caregiving at the end of life. This article reports on a comprehensive review of quantitative research (1998-2008) in this area, utilizing a systematic approach targeting studies on family caregivers, home settings, and an identified palliative phase of care (n = 129). Methodological challenges were identified, including: small, non-random, convenience samples; reliance on descriptive and bivariate analyses; and a dearth of longitudinal research. Robust evidence regarding causal relationships between predictor variables and carer outcomes is lacking. Findings suggest the need for knowledge regarding: family caregiving for patients with non-malignant terminal conditions; whether needs and outcomes differ between family caregivers at the end of life and comparison groups; and caregiver outcomes in bereavement. Clear definitions of 'family caregiving', 'end of life', and 'needs' are required as well as greater application and testing of theoretical and conceptual explanations.
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Affiliation(s)
- Ki Stajduhar
- School of Nursing, University of Victoria, British Columbia, Canada, Centre on Aging, University of Victoria, British Columbia, Canada.
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32
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Thorpe JM, Van Houtven CH, Sleath BL, Thorpe CT. Rural-urban differences in preventable hospitalizations among community-dwelling veterans with dementia. J Rural Health 2010; 26:146-55. [PMID: 20447001 DOI: 10.1111/j.1748-0361.2010.00276.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CONTEXT Alzheimer's patients living in rural communities may face significant barriers to effective outpatient medical care. PURPOSE We sought to examine rural-urban differences in risk for ambulatory care sensitive hospitalizations (ACSH), an indicator of access to outpatient care, in community-dwelling veterans with dementia. METHODS Medicare and Veteran Affairs inpatient claims for 1,186 US veterans with dementia were linked to survey data from the 1998 National Longitudinal Caregiver Survey. ACSH were identified in inpatient claims over a 1-year period following collection of independent variables. Urban Influence Codes were used to classify care recipients into 4 categories of increasing county-level rurality: large metropolitan; small metropolitan; micropolitan; and noncore rural counties. We used the Andersen Behavioral Model of Health Services to identify veteran, caregiver, and community factors that may explain urban-rural differences in ACSH. FINDINGS Thirteen percent of care recipients had at least 1 ACSH. The likelihood of an ACSH was greater for patients in noncore rural counties versus large metropolitan areas (22.6% vs 12.8%, unadjusted odds ratio [OR]= 1.99; P < .01). The addition of other Andersen behavioral model variables did not eliminate the disparity (adjusted OR = 1.97; P < .05). CONCLUSIONS We found that dementia patients living in the most rural counties were more likely to have an ACSH; this disparity was not explained by differences in caregiver, care recipient, or community factors. Furthermore, the annual rate of ACSH was higher in community-dwelling dementia patients compared to previous reports on the general older adult population. Dementia patients in rural areas may face particular challenges in receiving timely, effective ambulatory care.
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Affiliation(s)
- Joshua M Thorpe
- Division of Social and Administrative Sciences, University of Wisconsin School of Pharmacy, Madison, Wisconsin 53705-2222, USA.
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33
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Brems C, Johnson ME, Warner TD, Roberts LW. Barriers to healthcare as reported by rural and urban interprofessional providers. J Interprof Care 2009; 20:105-18. [PMID: 16608714 DOI: 10.1080/13561820600622208] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The research literature is replete with reports of barriers to care perceived by rural patients seeking healthcare. Less often reported are barriers perceived by the rural healthcare providers themselves. The current study is an extensive survey of over 1,500 healthcare providers randomly selected from two US states with large rural populations, Alaska and New Mexico. Barriers consistently identified across rural and urban regions by all healthcare professionals were Patient Complexity, Resource Limitations, Service Access, Training Constraints, and Patient Avoidance of Care. Findings confirmed that rural areas, however, struggle more with healthcare barriers than urban and small urban areas, especially as related to Resource Limitations, Confidentiality Limitations, Overlapping Roles, Provider Travel, Service Access, and Training Constraints. Almost consistently, the smaller a provider's practice community, the greater the reports of barriers, with the most severe barriers reported in small rural communities.
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Hartman L, Jarosek SL, Virnig BA, Durham S. Medicare-certified home health care: urban-rural differences in utilization. J Rural Health 2007; 23:254-7. [PMID: 17565526 DOI: 10.1111/j.1748-0361.2007.00098.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Availability of Medicare-certified home health care (HHC) to rural elders can prevent more expensive institutional care. To date, utilization of HHC by rural elders has not been studied in detail. PURPOSE To examine urban-rural differences in Medicare HHC utilization. METHODS The 2002 100% Medicare HHC claims and denominator files were used to estimate use of HHC and to make urban-rural comparisons on the basis of utilization levels within ZIP codes. FINDINGS Overall, the proportion of Medicare beneficiaries living in areas with little HHC utilization is relatively low. Rural elders, however, are more likely than their urban counterparts to live in such areas. Less than 1% of urban beneficiaries live in ZIP codes with no or low use of HHC, but over 17% of the most rural beneficiaries live in such areas. CONCLUSIONS Continued monitoring of rural HHC utilization and access is important, especially as Medicare seeks to evaluate the effectiveness of payment increases to rural home health agencies.
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Affiliation(s)
- Lacey Hartman
- University of Minnesota, School of Public Health, Division of Health Policy and Management, Minneapolis, MN 55455, USA
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35
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Liu LJ, Sun X, Zhang CL, Guo Q. Health-care utilization among empty-nesters in the rural area of a mountainous county in China. Public Health Rep 2007; 122:407-13. [PMID: 17518313 PMCID: PMC1847485 DOI: 10.1177/003335490712200315] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Li-Juan Liu
- Training Department, Second Military Medical University, Shanghai, People's Republic of China
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Abstract
Early psychosis (EP), in which the terms first-episode psychosis or first-break psychosis are also considered, is an area of developing research intensity. Although it is apparent that considerable progress has been made in establishing best practice criteria and protocols for EP in general, the particular issues pertaining to rural areas have not received the same attention. The purpose of the present study was to conduct a systematic review of the literature of early psychosis programmes, initiatives and research in rural areas in order to help establish the best available evidence. The authors conducted a systematic search of major electronic databases, based on the NHMRC hierarchy of evidence, an established scale, for identified early psychosis cross-referenced with multiple rural terms, between the years 1995 and 2005. A total of 637 articles met the initial search criteria; 206 were identified as having primary significance; three dealt specifically with rural areas. There is a paucity of research findings or published literature concerning the specific needs or characteristics of early psychosis practice or service delivery in rural areas. A number of inferences and suggestions for further research, investigations and policy directions are put forward for consideration.
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Affiliation(s)
- Mark Welch
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
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37
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Abstract
OBJECTIVES To determine the acceptance rate of new Medicare patients by all primary care physicians. Among primary care physicians accepting new patients, to determine whether demographic and geographic factors are associated with the likelihood of accepting new Medicare patients. DESIGN Cross-sectional. SETTING Primary care physicians drawn from a national sample. PARTICIPANTS Eight hundred forty-eight primary care physicians. MEASUREMENTS Percentage of physicians accepting, not accepting, or conditionally accepting new Medicare patients. RESULTS Of the 848 primary care physicians contacted, only 58% unconditionally accepted all new Medicare patients; 20% accepted new patients but restricted new Medicare patients using policies of nonacceptance or conditional acceptance. Of the 665 physicians accepting new patients, those in the south and west were more likely not to accept new Medicare patients than those in the northeast, with multivariable odds ratios (ORs) of 2.79 (95% confidence interval (CI)=1.34-5.78) and 3.14 (95% CI=1.35-7.33), respectively. Similarly, family physicians were more likely than internists not to accept new Medicare patients (OR=2.36, 95% CI=1.39-3.99). Primary care physicians in the Midwest were more likely to conditionally accept new Medicare patients than those in the northeast (OR=4.84, 95% CI=1.32-17.76), and primary care physicians in metropolitan areas with a population less than 100,000 were more likely to conditionally accept new Medicare patients than those in areas with a population greater than 100,000 (OR=2.39, 95% CI=1.18-4.84). CONCLUSION Medicare beneficiaries' access to primary care is limited and varies significantly by region, population size, and type of provider.
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Affiliation(s)
- William C Chou
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut 06504, USA.
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38
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Johnson ME, Brems C, Warner TD, Roberts LW. Rural-urban health care provider disparities in Alaska and New Mexico. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2006; 33:504-7. [PMID: 16220242 DOI: 10.1007/s10488-005-0001-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Compared to their urban counterparts, rural residents face numerous disparities in obtaining health care, including limited access to care providers. We assessed disparities in provider availability in rural versus urban Alaska and New Mexico, with emphasis on professionals likely to provide mental health care. Using lists of licenses, we categorized physical and mental health care providers into rural versus urban and calculated rural versus urban disparity ratios. Rural residents had significantly less access to health care providers and discrepancies grew with level of required provider education and specialization. Addressing disparities via creative strategies is crucial to improving rural care delivery.
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Affiliation(s)
- Mark E Johnson
- Behavioral Health Research and Services, University of Alaska Anchorage, Anchorage, Alaska 99508, USA.
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Gunderson A, Menachemi N, Brummel-Smith K, Brooks R. Physicians Who Treat the Elderly in Rural Florida: Trends Indicating Concerns Regarding Access to Care. J Rural Health 2006; 22:224-8. [PMID: 16824166 DOI: 10.1111/j.1748-0361.2006.00036.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Rural elderly patients are faced with numerous challenges in accessing care. Additional strains to access may be occurring given recent market pressures, which would have significant impact on this vulnerable population. PURPOSE This study focused on the practice patterns and future plans of rural Florida physicians who routinely see elderly patients. Additionally, we examine those who provide services to a high volume of Medicare (HVM) patients. METHODS A self-administered mailed survey was sent to rural physicians who identified themselves as practicing family medicine, internal medicine, psychiatry, general surgery, a surgical specialty, or a medical specialty. Questions examined changes in services offered by all rural physicians and among them, the HVM physicians. Impact of the professional liability insurance situation, satisfaction with current practice, and future practice plans on changes in service availability was also examined. RESULTS Overall, 539 physicians responded for a participation rate of 42.7%. Two hundred eighty eight (54.9%) of all physicians in the study indicated a decrease or elimination of patient services in the last year. HVM physicians, compared to low volume of Medicare providers, were significantly more likely to decrease or eliminate services overall (66% vs 45%, P =.001). Mental health services (47% vs 18%, P =.001), vaccine administration (39% vs 16%, P =.008), and Pap smears (41% vs 13%, P =.008) were more likely to be eliminated among the HVM physicians. HVM physicians were also significantly more likely to be somewhat or very dissatisfied (40% vs 23%, P =.012) with their practice. CONCLUSIONS Physicians in rural Florida report dissatisfaction with their practice and are decreasing or eliminating services that are important to the elderly. Given the aging population and increasing need for health care services, these trends raise concern about the ability for these patients to receive necessary care.
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Affiliation(s)
- Anne Gunderson
- Department of Geriatrics, Florida State University College of Medicine, Tallahassee, FL, USA.
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Goins RT, Williams KA, Carter MW, Spencer M, Solovieva T. Perceived barriers to health care access among rural older adults: a qualitative study. J Rural Health 2005; 21:206-13. [PMID: 16092293 DOI: 10.1111/j.1748-0361.2005.tb00084.x] [Citation(s) in RCA: 216] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Many rural elders experience limited access to health care. The majority of what we know about this issue has been based upon quantitative studies, yet qualitative studies might offer additional insight into individual perceptions of health care access. PURPOSE To examine what barriers rural elders report when accessing needed health care, including how they cope with the high cost of prescription medication. METHODS During Spring 2001, thirteen 90-minute focus groups were conducted in 6 rural West Virginia communities. A total of 101 participants, aged 60 years and older, were asked several culminating questions about their perceptions of health care access. FINDINGS Five categories of barriers to health care emerged from the discussions: transportation difficulties, limited health care supply, lack of quality health care, social isolation, and financial constraints. In addition, 6 diverse coping strategies for dealing with the cost of prescription medication were discussed. They included: reducing dosage or doing without, limiting other expenses, relying on family assistance, supplementing with alternative medicine, shopping around for cheapest prices, and using the Veteran's Administration. CONCLUSIONS Overall, rural older adults encounter various barriers to accessing needed health care. Qualitative methodology allows rural elders to have a voice to expound on their experiences. Research can contribute valuable information to shape policy by providing a forum where older adults can express their concerns about the current health care delivery system.
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Affiliation(s)
- R Turner Goins
- Department of Community Medicine, West Virginia University School of Medicine, Morgantown, WV, USA.
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Abstract
The health status of people who live in the rural, coal-producing counties of southwest Virginia remains problematic despite an apparent high primary care provider-to-population threshold. This descriptive exploratory study surveyed 922 households representing 2,188 people, with regard to the availability, need, and access to health care services. Findings indicated a population who had a greater morbidity for chronic illnesses such as heart disease and hypertension than the rest of the state, a large number of people without health and prescription coverage, and an overall perception of fair-to-poor health status. Findings also indicated a substantial proportion of the population who were in need of dental and visual care and general preventive services and those who were dealing with depression at home without outside intervention. One disturbing finding was the large number of people who shared prescriptive medications with family and friends. The Community As Partner Model might be used by community health nurses in this region to help structure interventions. Overall findings suggest a need for interventions aimed at screening for depression, managing prescriptive medications, and identification of low-cost and free preventive, dental, and visual care services.
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Affiliation(s)
- Kathleen Huttlinger
- Center for Nursing Research, College of Nursing, Kent State University, Ohio 44242, USA.
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Goins RT, Tincher A, Spencer SM. Awareness and use of home- and community-based long-term care by rural American Indian and white elderly with co-morbid diabetes. Home Health Care Serv Q 2004; 22:65-81. [PMID: 14629084 DOI: 10.1300/j027v22n03_04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purposes of this study were to determine if there are any differences in awareness and utilization of available home- and community-based long-term care (HCBLTC) between rural American Indian and white elderly with co-morbid diabetes, and to examine how they learned about HCBLTC programs. Survey data were analyzed from 62 American Indians and 64 whites aged 65 years or older living in the community. The American Indian respondents were more likely to be aware of and to have used HCBLTC programs compared to their white counterparts. The most common way that the American Indian participants learned about HCBLTC programs was through health care referrals, while the most common way for whites was through friends.
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Affiliation(s)
- R Turner Goins
- Center on Aging, West Virginia University, PO Box 9127, Morgantown, WV 26506, USA.
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Coleman EA, Lord J, Heard J, Coon S, Cantrell M, Mohrmann C, O'Sullivan P. The Delta project: increasing breast cancer screening among rural minority and older women by targeting rural healthcare providers. Oncol Nurs Forum 2003; 30:669-77. [PMID: 12861326 DOI: 10.1188/03.onf.669-677] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To test a multimethod approach designed for rural healthcare providers to increase breast cancer screening among low-income, African American, and older women. DESIGN Two-year experimental pretest/post-test with random assignment by group. SETTING Primary healthcare providers' offices. SAMPLE 224 nurses, physicians, and mammography technicians. METHODS Standardized patients to observe and record healthcare providers' performances, followed by direct feedback, newsletters, posters, pocket reminder cards, and lay literature about screening to use in clinics. MAIN RESEARCH VARIABLES Healthcare providers' knowledge and attitudes as measured by survey responses, skills as measured by a checklist, and the provision of breast cancer screening as measured by mammography facilities' data. FINDINGS Healthcare providers significantly improved in demonstration of breast cancer screening practice after the intervention. Nurses performed significantly better than physicians on the breast examination during the post-test. More women older than 50 received mammograms in the experimental counties than in the comparison counties. Culturally sensitive lay literature is needed for African American women with low literacy. CONCLUSIONS Successful interventions included use of standardized patients to teach healthcare providers in their office settings, prompts such as posters and pocket reminder cards, and easy-to-read newsletters. IMPLICATIONS FOR NURSING Physicians and nurses play a powerful role in motivating women to have mammograms and clinical breast examinations and to practice breast self-examination. Interventions that help these providers fulfill that role should be implemented.
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Affiliation(s)
- Elizabeth Ann Coleman
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AK, USA.
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