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Shokeen D, Wang N, Nguyen NP, Bakal E, Tripathi O, Palaniappan LP, Huang RJ. The association between local area immigrant fraction and prevalence of cardiovascular diseases in the United States: an observational study. LANCET REGIONAL HEALTH. AMERICAS 2023; 27:100613. [PMID: 37860751 PMCID: PMC10582736 DOI: 10.1016/j.lana.2023.100613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023]
Abstract
Background Local area immigrant fraction is strongly and positively correlated with local life expectancy in the United States. The aim of the study was to determine the relationship between local area immigrant fraction and local prevalence of coronary heart disease (CHD) and stroke. Methods Cross-sectional study design, with ZIP code as the unit of observation. Demographic data was obtained from the American Community Survey, and linked to indicators of health access (e.g., insurance, annual check-ups, cholesterol screening), obesity, behavior (smoking, exercise), and cardiovascular outcomes data from the 2020 Population Level Analysis and Community Estimates. Multivariable regression and path analyses were used to assess both direct and indirect relationships among variables. Findings CHD prevalence was lower in the second (3.9% relative difference, 95% CI: 3.1-4.5%), third (6.5%, 95% CI: 5.8-7.1%), and fourth (14.8%, 95% CI: 14.1-15.8%) quartiles of immigrant fraction compared to the lowest (p-trend <0.001). These effects remained robust in multivariable analysis following adjustment for indicators of access, obesity, and behavioral variables (p-trend <0.0001). For stroke, only the highest quartile demonstrated a significant difference in prevalence (2.1%, 95% CI: 1.2-3.0% with full adjustment). In CHD path analysis, ∼45% of the association of immigrant fraction was direct, and ∼55% was mediated through lower prevalence of deleterious behaviors (e.g., smoking). In stroke path analysis, the effect was entirely mediated through indirect effects. Interpretation In the United States, ZIP codes with higher immigrant fractions have lower prevalence of cardiovascular diseases. These associations are partially mediated through differences in health behaviors at the community level. Funding NIH (K08CA252635, P30AG0059304, K24HL150476), Stanford University, Rutgers University.
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Affiliation(s)
- Deepa Shokeen
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Natalie Wang
- University of California Los Angeles, Los Angeles, CA, USA
| | - Ngan P. Nguyen
- Department of Psychology, Fulbright University Vietnam, Vietnam
| | - Ethan Bakal
- New York University College of Arts and Sciences, New York, USA
| | - Osika Tripathi
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
- San Diego State University School of Public Health, San Diego, CA, USA
| | - Latha P. Palaniappan
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Robert J. Huang
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
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Miranda Quezada IP, Pérez-Salgado D, Dorantes Pineda CM, Ortiz-Hernández L. [Evaluation of a program led by community workers to promote cardiometabolic health in adults in a highly marginalized Mexican municipality]. NUTR HOSP 2023. [PMID: 37154072 DOI: 10.20960/nh.04289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE to evaluate the impact of a group program of nutrition education implemented by community workers on food consumption, physical activity and cardiometabolic risk. MATERIAL AND METHODS a randomized trial by conglomerates was performed. The intervention group (n = 246) participated in a program of nine group sessions of nutrition education delivered by community workers and focused on giving healthy habits options and evocation of motivations. The control group (n = 183) received printed information on healthy eating and physical activity. At the beginning of the study and after one year of follow-up, anthropometric measurements of blood pressure, heart rate, lipid profile and glucose were assessed. A questionnaire was applied to collect sociodemographic data, food consumption and physical activity. RESULTS in multilevel regression models it was observed that the intervention group reported an increase in the frequency of consumption of fruits, vegetables and legumes, increased body mass index and its probability of increasing recreational physical activity was higher; in addition, it reduced its consumption of sweetened cereals, and decreased the probability of hyperglycemia compared to the control group. Resting heart rate increased in both groups, but the increase was lower in the intervention group. CONCLUSIONS nutrition education guided by community workers can have positive effects on cardiometabolic risk, so it would be an alternative to traditional education focused on providing information.
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Estrada LV, Solano J, Reading Turchioe M, Cortes YI, Caceres BA. Comparative Effectiveness of Behavioral Interventions for Cardiovascular Risk Reduction in Latinos: A Systematic Review. J Cardiovasc Nurs 2022; 37:324-340. [PMID: 37707966 PMCID: PMC8556412 DOI: 10.1097/jcn.0000000000000806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Latinos, the fastest growing ethnic minority group in the United States, are at a high risk for cardiovascular disease (CVD). However, little is known about effective strategies to reduce CVD risk in this population. OBJECTIVE The aim of this study was to systematically review and synthesize evidence from randomized controlled trials that examined the effectiveness of behavioral interventions to reduce CVD risk in Latinos living in the United States. METHODS Four electronic databases were searched for relevant peer-reviewed English- and Spanish-language articles published between January 1, 2000, and December 31, 2019. Four reviewers independently completed article screening, data abstraction, and quality appraisal. At least 2 reviewers completed data abstraction and quality appraisal for each article, and a third reviewer was assigned to settle disagreements. Data on study characteristics and outcomes were abstracted. RESULTS We retrieved 1939 articles. After applying inclusion/exclusion criteria, 17 articles were included. Most interventions were led by community health workers (n = 10); 2 family-based interventions were identified. None of the included studies was nurse led. Behavioral factors were assessed across all included studies, whereas only 4 studies reported on psychosocial outcomes. Improvements were observed in dietary habits and psychosocial outcomes. Findings for physical activity and biological outcomes were mixed. We identified no differences in outcomes based on intervention modalities used or the role of those who led the interventions. CONCLUSION Existing evidence is mixed. Future research should assess the effectiveness of understudied treatment modalities (including nurse-led, mobile health, and family-based interventions) in reducing CVD risk in Latinos.
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Carvalho ECAD, Vissoci JRN, Andrade LD, Machado WDL, Paraiso EC, Nievola JC. BNPA: An R package to learn path analysis input models from a data set semi-automatically using Bayesian networks. Knowl Based Syst 2021. [DOI: 10.1016/j.knosys.2021.107042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Chen SH, Chen SC, Lai YP, Chen PH, Huang TY, Lin CC, Yeh KY. Correlates Between Health Beliefs and Health-Promoting Lifestyle Profiles in the Development of Metabolic Syndrome in Taiwan. Asia Pac J Public Health 2018; 31:30-38. [PMID: 30525917 DOI: 10.1177/1010539518816245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Differences in sociodemographic variables, health beliefs, and a healthy lifestyle all contribute to the varied prevalence of metabolic syndrome (MetS). We investigated the associations among MetS-related risk factors and performed a cross-sectional study, recruiting 1741 Taiwanese residents aged ≥30 years, between August 2014 and August 2015. Data were obtained on sociodemographic factors, health beliefs, and health-promoting lifestyle profiles using questionnaires. Multivariate analysis revealed that age ≥65 years (odds ratio [OR] = 2.17), low educational level (OR = 1.46), body mass index ≥24 kg/m2 (OR = 9.00), more health responsibility (OR = 1.08), and less exercise (OR = 0.924) were independent risk factors for MetS development. A correlation existed between health beliefs and health-promoting lifestyle profiles, suggesting that the establishment of an effective health-promoting program should consider participants' health beliefs.
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Affiliation(s)
- Sue-Hsien Chen
- 1 Chang Gung Memorial Hospital, Keelung.,2 Chang Gung University, Taoyuan.,3 Chang Gung University of Science and Technology, Taoyuan
| | - Shu-Ching Chen
- 4 National Taiwan University Hospital, Taipei.,5 National Taiwan University, Taipei
| | - Yo-Ping Lai
- 4 National Taiwan University Hospital, Taipei
| | | | | | | | - Kun-Yun Yeh
- 1 Chang Gung Memorial Hospital, Keelung.,2 Chang Gung University, Taoyuan
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Approaches to decision-making among late-stage melanoma patients: a multifactorial investigation. Support Care Cancer 2018; 27:1059-1070. [PMID: 30136025 PMCID: PMC6373271 DOI: 10.1007/s00520-018-4395-7] [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: 11/29/2017] [Accepted: 08/01/2018] [Indexed: 11/23/2022]
Abstract
Purpose The treatment decisions of melanoma patients are poorly understood. Most research on cancer patient decision-making focuses on limited components of specific treatment decisions. This study aimed to holistically characterize late-stage melanoma patients’ approaches to treatment decision-making in order to advance understanding of patient influences and supports. Methods (1) Exploratory analysis of longitudinal qualitative data to identify themes that characterize patient decision-making. (2) Pattern analysis of decision-making themes using an innovative method for visualizing qualitative data: a hierarchically-clustered heatmap. Participants were 13 advanced melanoma patients at a large academic medical center. Results Exploratory analysis revealed eight themes. Heatmap analysis indicated two broad types of patient decision-makers. “Reliant outsiders” relied on providers for medical information, demonstrated low involvement in decision-making, showed a low or later-in-care interest in clinical trials, and expressed altruistic motives. “Active insiders” accessed substantial medical information and expertise in their networks, consulted with other doctors, showed early and substantial interest in trials, demonstrated high involvement in decision-making, and employed multiple decision-making strategies. Conclusion We identified and characterized two distinct approaches to decision-making among patients with late-stage melanoma. These differences spanned a wide range of factors (e.g., behaviors, resources, motivations). Enhanced understanding of patients as decision-makers and the factors that shape their decision-making may help providers to better support patient understanding, improve patient-provider communication, and support shared decision-making.
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Singer RH, Stoutenberg M, Feaster DJ, Cai J, Hlaing WM, Metsch LR, Salazar CR, Beaver SM, Finlayson TL, Talavera G, Gellman MD, Schneiderman N. The association of periodontal disease and cardiovascular disease risk: Results from the Hispanic Community Health Study/Study of Latinos. J Periodontol 2018. [PMID: 29542123 DOI: 10.1002/jper.17-0549] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Current evidence suggests that periodontal disease (PD) is associated with a significant increased risk of atherosclerotic cardiovascular disease (CVD) independent of known confounders. PD is a chronic oral disease with significant variation in prevalence demonstrated among Hispanic/Latino subgroups. The purpose of this study was to investigate the associations between PD and CVD risk and variations with sex, age, and Hispanic/Latino background. METHODS The sample included 7379 participants aged 30 to 74 years, from the Hispanic Community Health Study/Study of Latinos (2008 to 2011). We assessed CVD risk by the Framingham 10-year general CVD risk score (FGRS). PD severity classification was based on calibrated measurements of gingival recession and probing depth. Multivariable sequential linear models for complex sample design assessed FGRS by PD severity, Hispanic/Latino background, and covariates. RESULTS The prevalence of moderate and severe PD combined was 46%. For women and men with severe PD, the combined prevalence of moderate and high CVD risk was 44% and 85%, respectively. The FGRS observed for women (5.1% [95% CI: 4.1%, 6.0%], p < 0.001) and men 10.8% (95% CI [9.2%, 12.3%], p < 0.001) with severe PD were 56% and 134% greater than those without PD, respectively. Dominican women and men with moderate or severe PD, aged 60 to 69 years, exhibited the greatest CVD risks (FGRS = 15.1%, 95% CI [7.8%, 22.5%]) and (FGRS = 40.2%, 95% CI [30.2%, 50.3%]), respectively. CONCLUSIONS Moderate and severe PD were associated with significant CVD risk with marked sex disparity and heterogeneity by Hispanic/Latino background.
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Affiliation(s)
- Richard H Singer
- University of Miami, Miller School of Medicine, Department of Public Health Sciences, Miami, FL.,Nova Southeastern University, College of Dental Medicine, Ft. Lauderdale, FL
| | - Mark Stoutenberg
- University of Miami, Miller School of Medicine, Department of Public Health Sciences, Miami, FL
| | - Daniel J Feaster
- University of Miami, Miller School of Medicine, Department of Public Health Sciences, Miami, FL
| | - Jianwen Cai
- University of North Carolina, Gillings School of Global Public Health, Collaborate Studies Coordinating Center, Department of Biostatistics, Chapel Hill, NC
| | - WayWay M Hlaing
- University of Miami, Miller School of Medicine, Department of Public Health Sciences, Miami, FL
| | - Lisa R Metsch
- Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences, New York, NY
| | - Christian R Salazar
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, New York, NY
| | - Shirley M Beaver
- University of Illinois at Chicago College of Dentistry, Chicago, IL
| | - Tracy L Finlayson
- San Diego State University, Graduate School of Public Health, San Diego, CA
| | - Gregory Talavera
- San Diego State University, Graduate School of Public Health, San Diego, CA
| | - Marc D Gellman
- University of Miami, Department of Psychology, Miami, FL
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SOUSA MARIADOCARMOVILASBOAS, SANTOS CYNTHIAPIMENTADOS, MENDONÇA SIMONEDEARAÚJOMEDINA. COMPLEXIDADES DO TRABALHO DO AGENTE COMUNITÁRIO DE SAÚDE COM PACIENTES EM USO DE MEDICAMENTOS. TRABALHO, EDUCAÇÃO E SAÚDE 2018. [DOI: 10.1590/1981-7746-sol00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Os agentes comunitários de saúde representam importante elemento na gestão de informações sobre o uso de medicamentos na atenção primária, melhorando a interação da equipe de saúde com a comunidade. O objetivo do estudo foi revelar como o uso de medicamentos está presente na rotina deles e compreender as relações que se estabelecem entre agentes, usuários e equipe. Tratou-se de um estudo qualiquantitativo, com utilização de observação participante, entrevista semiestruturada e grupo focal. Foi desenvolvido em três unidades básicas de saúde em um município de Minas Gerais no período de março de 2013 a fevereiro de 2015. Os resultados revelaram que os agentes se relacionam constantemente com usuários que vivenciam problemas com o uso de medicamentos e apresentam dúvidas sobre suas indicações, efeitos esperados, reações adversas, entre outras. Eles realizam algumas intervenções diretamente com o usuário, porém preferem encaminhar os casos à equipe de saúde. Alguns agentes referiram-se ao farmacêutico como profissional de referência no tocante ao uso de medicamentos, mas a procura por esse profissional mostrou-se baixa pelos sujeitos do estudo. Ressalta-se a importância da formação do agente sobre utilização de medicamentos para instrumentalizá-los no reconhecimento de situações inadequadas, no desenvolvimento de intervenções com a equipe de saúde e no acompanhamento dos usuários.
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Perales J, Reininger BM, Lee M, Linder SH. Participants' perceptions of interactions with community health workers who promote behavior change: a qualitative characterization from participants with normal, depressive and anxious mood states. Int J Equity Health 2018; 17:19. [PMID: 29402278 PMCID: PMC5800056 DOI: 10.1186/s12939-018-0729-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 01/16/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Interventions that promote healthier lifestyles among Latinos often involve community health workers (CHWs). CHWs can effectively advocate for healthier lifestyles and may be pivotal in addressing such mental health conditions as depression and anxiety. The goal of this study was to characterize the relationship dynamics between Latino participants and CHWs, from the participant's perspective. We aimed to determine if CHW-delivered community interventions effected behavior change, especially among participants who reported anxiety and depression. METHODS Semi-structured interviews were conducted with a purposive sample of 28 Latino participants that was based on a mental health scoring strata. Participants completed a lifestyle intervention that included multiple home visits from CHWs to promote physical activity and healthful food choice. Interviews were conducted in the participant's preferred language (English or Spanish). Transcribed interviews were analyzed using a grounded theory approach until concept saturation was achieved. RESULTS The sample was primarily female (82%), lower socioeconomic status (64%), and mean age of 50 years. Participants discussed the rapport building and professionalism of CHWs as a feature that facilitated strong, positive relationships and lifestyle behavior changes. Participants described how CHWs patterned their change approaches, which were similar to commonly used therapeutic techniques in the treatment of anxiety and depression. While anxiety and depression were described as having an impact on behavior change, most, but not all, participants who reported negative mood states said that the CHW relationship helped in changing that state to some extent. CONCLUSIONS Participants' perceptions indicated that positive personal changes were influenced by CHWs. Only participants who reported consistently poor scores for depression, anxiety or both reported negative or neutral experiences with the CHWs. This study lends qualitative support to the use of CHWs as extenders of care, particularly in areas that have a shortage of primary and mental health care providers.
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Affiliation(s)
- Joseph Perales
- La Clínica - Casa del Sol, 1501 Fruitvale Ave, Oakland, California, 94601, USA
| | - Belinda M Reininger
- UT Health School of Public Health in Brownsville, Division of Health Promotion & Behavioral Sciences and Hispanic Health Research Center, One West University Blvd, Brownsville, TX, 78520, USA. .,Michael & Susan Dell Center for Healthy Living, UT School of Public Health, Austin Regional Campus, University of Texas Administration Building (UTA), 1616 Guadalupe Street, Suite 6.300, Austin, Texas, 78701, USA. .,University of Texas Health Science Center at Houston, Center for Clinical and Translational Sciences, 7000 Fannin, Suite 1800, Houston, Texas, 77030, USA.
| | - MinJae Lee
- University of Texas Health Science Center at Houston, Center for Clinical and Translational Sciences, 7000 Fannin, Suite 1800, Houston, Texas, 77030, USA.,University of Texas Health Science Center at Houston, Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences, 7000 Fannin, Suite 1800, Houston, Texas, 77030, USA
| | - Stephen H Linder
- UT Health School of Public Health, Institute for Health Policy, Division of Management, Policy and Community Health, 6410 Fannin, Houston, TX, 77030, USA
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Nguyen N, Nguyen T, Chapman J, Nguyen L, Kumar P, VanDevanter N, Shelley D. Tobacco cessation in Vietnam: Exploring the role of village health workers. Glob Public Health 2017; 13:1265-1275. [PMID: 28776481 DOI: 10.1080/17441692.2017.1360376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to explore current tobacco use treatment (TUT) practice patterns, and attitudes and beliefs among Village Health Workers (VHWs) about expanding their role to include delivering smoking cessation interventions and the perceived barriers. We conducted a survey of 449 VHWs from 26 communes in Thai Nguyen province, Vietnam. We assessed TUT practice patterns including asking about tobacco use, advising smokers to quit, offering assistance (3As) and attitudes, self-efficacy, and norms related to TUT. Seventy two per cent of VHWs reported asking patients if they use tobacco, 78.6% offered advice to quit, and 41.4% offered cessation assistance to few or more patients in the past month. Self-efficacy was low, with 53.2% agreeing that they did not have the skills to counsel patients about smoking cessation. The most commonly reported barriers to offering TUT were a lack of training and perceived lack of patient interest. Greater awareness of their commune health centre's smoke-free policy and higher levels of self-efficacy were associated with screening and offering cessation assistance. VHWs support an expanded role in tobacco cessation, but require additional resources and training to increase their self-efficacy and skills to provide effective treatment.
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Affiliation(s)
- Nam Nguyen
- a Institute of Social and Medical Studies , Ha Noi , Vietnam
| | - Trang Nguyen
- a Institute of Social and Medical Studies , Ha Noi , Vietnam
| | - Jessica Chapman
- a Institute of Social and Medical Studies , Ha Noi , Vietnam
| | - Linh Nguyen
- a Institute of Social and Medical Studies , Ha Noi , Vietnam
| | - Pritika Kumar
- b Department of Population Health , New York University School of Medicine , New York , NY , USA
| | - Nancy VanDevanter
- c New York University Rory Meyers College of Nursing , New York , NY , USA
| | - Donna Shelley
- b Department of Population Health , New York University School of Medicine , New York , NY , USA
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Olaniran A, Smith H, Unkels R, Bar-Zeev S, van den Broek N. Who is a community health worker? - a systematic review of definitions. Glob Health Action 2017; 10:1272223. [PMID: 28222653 PMCID: PMC5328349 DOI: 10.1080/16549716.2017.1272223] [Citation(s) in RCA: 177] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/22/2016] [Accepted: 12/08/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Community health workers (CHWs) can play vital roles in increasing coverage of basic health services. However, there is a need for a systematic categorisation of CHWs that will aid common understanding among policy makers, programme planners, and researchers. OBJECTIVE To identify the common themes in the definitions and descriptions of CHWs that will aid delineation within this cadre and distinguish CHWs from other healthcare providers. DESIGN A systematic review of peer-reviewed papers and grey literature. RESULTS We identified 119 papers that provided definitions of CHWs in 25 countries across 7 regions. The review shows CHWs as paraprofessionals or lay individuals with an in-depth understanding of the community culture and language, have received standardised job-related training of a shorter duration than health professionals, and their primary goal is to provide culturally appropriate health services to the community. CHWs can be categorised into three groups by education and pre-service training. These are lay health workers (individuals with little or no formal education who undergo a few days to a few weeks of informal training), level 1 paraprofessionals (individuals with some form of secondary education and subsequent informal training), and level 2 paraprofessionals (individuals with some form of secondary education and subsequent formal training lasting a few months to more than a year). Lay health workers tend to provide basic health services as unpaid volunteers while level 1 paraprofessionals often receive an allowance and level 2 paraprofessionals tend to be salaried. CONCLUSIONS This review provides a categorisation of CHWs that may be useful for health policy formulation, programme planning, and research.
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Affiliation(s)
- Abimbola Olaniran
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Helen Smith
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Regine Unkels
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sarah Bar-Zeev
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Plasencia J, Hoerr S, Carolan M, Weatherspoon L. Acculturation and Self-Management Perceptions Among Mexican American Adults With Type 2 Diabetes. FAMILY & COMMUNITY HEALTH 2017; 40:121-131. [PMID: 28207675 DOI: 10.1097/fch.0000000000000139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Because type 2 diabetes (T2DM) is disproportionately high among Mexican Americans in the United States, this study examined how acculturation influences T2DM self-management, a critical component for disease outcome. Qualitative interviews of 24 low-income Mexican American patients with T2DM were matched to their biomedical and dietary data and degree of acculturation. Greater acculturation to the United States was associated with less favorable diabetes control, fiber density, leisure-time physical activity, and more physical disability. Health care professionals can improve their cultural competence by learning culturally appropriate foods and fostering a warm, caring manner with Mexican Americans to enhance their sense of well-being and compliance with T2DM recommendations.
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Affiliation(s)
- Julie Plasencia
- Department of Food Science and Human Nutrition (Ms Plasencia, and Drs Hoerr, and Weatherspoon) and Human Development and Family Studies (Dr Carolan), Michigan State University, East Lansing
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Schwingel A, Wiley AR, Teran-Garcia M, McCaffrey J, Gálvez P, Vizcarra M. Promotoras and the Semantic Gap Between Latino Community Health Researchers and Latino Communities. Health Promot Pract 2016; 18:444-453. [PMID: 27760810 DOI: 10.1177/1524839916670576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Promotoras are identified as a unique group of community health workers adept at reducing health disparities. This qualitative study was conducted to better understand perceptions of the term promotora, broadly used in research but not well documented in everyday Latina vocabulary. Six focus groups to better understand perceptions of the term promotora were conducted with 36 Latina women living in three nonmetropolitan areas in Illinois. Results suggest that Latina participants in the study do not understand the meaning of "promotora" in the same way as it is used in the literature. Latina participants understood "promotoras" as referring to people who sell or deliver information, or organize events in the community that are not necessarily related to health events or community health work. Furthermore, they usually understood the term to refer to paid work rather than volunteering. Results underscore the importance of being sensitive to Latinas' perceptions of community health terminology by assessing their context, needs, and expectations. These findings call researchers' attention to the need to educate certain Latino communities about the concept of promotoras, with implications for the implementation and dissemination of promotora-led community health programs, as the semantic discrepancy could affect the recruitment of promotoras as well as community participation in the programs they deliver.
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Affiliation(s)
| | - Angela R Wiley
- 1 University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | | | | | - Patricia Gálvez
- 1 University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Marcela Vizcarra
- 1 University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Shommu NS, Ahmed S, Rumana N, Barron GRS, McBrien KA, Turin TC. What is the scope of improving immigrant and ethnic minority healthcare using community navigators: A systematic scoping review. Int J Equity Health 2016; 15:6. [PMID: 26768130 PMCID: PMC4714538 DOI: 10.1186/s12939-016-0298-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 01/07/2016] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Immigrants are among the most vulnerable population groups in North America; they face multidimensional hurdles to obtain proper healthcare. Such barriers result in increased risk of developing acute and chronic conditions. Subsequently a great deal of burden is placed on the healthcare system. Community navigator programs are designed to provide culturally sensitive guidance to vulnerable populations in order to overcome barriers to accessing healthcare. Navigators are healthcare workers who support patients to obtain appropriate healthcare. This scoping review systematically searches and summarizes the literature on community navigators to help immigrant and ethnic minority groups in Canada and the United States overcome barriers to healthcare. METHODS We systematically searched electronic databases for primary articles and grey literature. Study selection was performed following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Articles were selected based on four criteria: (1) the study population was comprised of immigrants or ethnic minorities living in Canada or the United States; (2) study outcomes were related to chronic disease management or primary care access; (3) the study reported effects of community navigator intervention; (4) the study was published in English. Relevant information from the articles was extracted and reported in the review. RESULT Only one study was found in the literature that focused on navigators for immigrants in Canada. In contrast, 29 articles were found that reported navigator intervention programs for immigrant minorities in the United States. In these studies navigators trained and guided members of several ethnic communities for chronic disease prevention and management, to undertake cancer screening as well as accessing primary healthcare. The studies reported substantial improvement in the immigrant and ethnic minority health outcomes in the United States. The single Canadian study also reported positive outcome of navigators among immigrant women. CONCLUSION Navigator interventions have not been fully explored in Canada, where as, there have been many studies in the United States and these demonstrated significant improvements in immigrant health outcomes. With many immigrants arriving in Canada each year, community navigators may provide a solution to reduce the existing healthcare barriers and support better health outcomes for new comers.
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Affiliation(s)
- Nusrat Sharmeen Shommu
- Department of Family Medicine, Room G012F, Health Sciences Center, University of Calgary, 3330 Hospital Drive Northwest, Calgary, AB, T2N 4N1, Canada.
| | - Salim Ahmed
- Department of Family Medicine, Room G012F, Health Sciences Center, University of Calgary, 3330 Hospital Drive Northwest, Calgary, AB, T2N 4N1, Canada.
| | - Nahid Rumana
- Sleep Center, Foothills Medical Center, University of Calgary, 1403 29 Street NW, Calgary, AB, Canada.
| | - Gary R S Barron
- Department of Family Medicine, Room G012F, Health Sciences Center, University of Calgary, 3330 Hospital Drive Northwest, Calgary, AB, T2N 4N1, Canada.
| | - Kerry Alison McBrien
- Department of Family Medicine, Room G012F, Health Sciences Center, University of Calgary, 3330 Hospital Drive Northwest, Calgary, AB, T2N 4N1, Canada. .,Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive Northwest, Calgary, AB, T2N 4Z6, Canada.
| | - Tanvir Chowdhury Turin
- Department of Family Medicine, Room G012F, Health Sciences Center, University of Calgary, 3330 Hospital Drive Northwest, Calgary, AB, T2N 4N1, Canada. .,Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive Northwest, Calgary, AB, T2N 4Z6, Canada.
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Balcázar HG, de Heer HD, Wise Thomas S, Redelfs A, Rosenthal EL, Burgos X, Duarte MO. Promotoras Can Facilitate Use of Recreational Community Resources: The Mi Corazón Mi Comunidad Cohort Study. Health Promot Pract 2015; 17:343-52. [PMID: 26542302 DOI: 10.1177/1524839915609060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Limited research has documented interventions aimed at promoting use of existing recreational community resources among underserved populations. This study (HEART [Health Education Awareness Research Team] Phase 2) reports findings of an intervention (Mi Corazón Mi Comunidad) where community health workers facilitated use of diet and exercise programming at local recreational facilities among Mexican American border residents. The aim was to evaluate overall attendance rates and to assess which factors predicted higher attendance. METHOD The design was a cohort study. From 2009 to 2013, a total of 753 participants were recruited across 5 consecutive cohorts. The intervention consisted of organized physical activity and nutrition programming at parks and recreational facilities and a free YWCA membership. Attendance at all activities was objectively recorded. Regression analyses were used to evaluate whether demographic factors, health status, and health beliefs were associated with attendance. Results Participants included mostly females at high risk for cardiovascular disease (72.4% were overweight/obese and 64% were [pre-]hypertensive). A total of 83.6% of participants attended at least one session. On average, total attendance was 21.6 sessions (range: 19.1-25.2 sessions between the different cohorts), including 16.4 physical activity and 5.2 nutrition sessions. Females (p = .003) and older participants (p < .001) attended more sessions. Participants low in acculturation (vs. high) attended on average seven more sessions (p = .003). Greater self-efficacy (p < .001), perceived benefits (p = .038), and healthy intentions (p = .024) were associated with higher attendance. Conclusions The intervention was successful in promoting use of recreational facilities among border residents at high risk for cardiovascular disease. Findings were similar across five different cohorts.
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Affiliation(s)
- Héctor G Balcázar
- University of Texas at Houston Health Science Center, El Paso, TX, USA
| | | | | | - Alisha Redelfs
- Paso del Norte Institute for Healthy Living, El Paso, TX, USA
| | - E Lee Rosenthal
- University of Texas at Houston Health Science Center, El Paso, TX, USA
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16
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Critical reflections on the role of CBPR within an RCT community health worker prevention intervention. J Ambul Care Manage 2015; 37:241-9. [PMID: 24887525 DOI: 10.1097/jac.0000000000000010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Coalescence of culturally relevant and community-based research with traditional scientific inquiry is necessary for the translation of science into practice. One methodology that has been identified as an important missing link in achieving the goal of combining science and community practice is the community-based participatory research approach, or CBPR. To demonstrate how CBPR has been successfully blended with randomized control trial (RCT) methodology, we showcase a randomized community trial that has shown efficacy in reducing cardiovascular risk factors integrating community health workers. The purpose of this article is 2-fold. First, it describes the process of merging the CBPR approach within an RCT framework and, second, it describes lessons learned in conducting CBPR-RCT research initiatives.
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17
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Balcazar HG, Wise S, Redelfs A, Rosenthal EL, de Heer HD, Burgos X, Duarte-Gardea M. Perceptions of Community Health Workers (CHWs/PS) in the U.S.-Mexico border HEART CVD study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:1873-84. [PMID: 24518646 PMCID: PMC3945574 DOI: 10.3390/ijerph110201873] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/30/2014] [Accepted: 01/30/2014] [Indexed: 11/16/2022]
Abstract
Although prior research has shown that Community Health Workers/Promotores de Salud (CHW/PS) can facilitate access to care, little is known about how CHW/PS are perceived in their community. The current study reports the findings of a randomized telephone survey conducted in a high-risk urban community environment along the U.S.-Mexico border. In preparation for a community-based CHW/PS intervention called the HEART ecological study, the survey aimed to assess perceptions of CHW/PS, availability and utilization of community resources (recreational and nutrition related) and health behaviors and intentions. A total of 7,155 calls were placed to complete 444 surveys in three zip codes in El Paso, Texas. Results showed that participants felt that healthful community resources were available, but utilization was low and variable: 35% reported going to a park, 20% reported having taken a health class, few reported using a gym (12%), recreation center (8%), or YMCA/YWCA (0.9%). Awareness and utilization of CHW/PS services were low: 20% of respondents had heard of CHW/PS, with 8% reporting previous exposure to CHW/PS services. Upon review of a definition of CHW/PS, respondents expressed positive views of CHW/PS and their value in the healthcare system. Respondents who had previous contact with a CHW/PS reported a significantly more positive perception of the usefulness of CHW/PS (p = 0.006), were more likely to see CHW/PS as an important link between providers and patients (p = 0.008), and were more likely to ask a CHW/PS for help (p = 0.009). Participants who utilized CHW/PS services also had significantly healthier intentions to reduce fast food intake. Future research is needed to evaluate if CHW/PS can facilitate utilization of available community resources such as recreational facilities among Hispanic border residents at risk for CVD.
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Affiliation(s)
- Hector G Balcazar
- School of Public Health, University of Texas Health Science Center, Houston, El Paso Regional Campus, 1101 N. Campbell CH 410, El Paso, TX 79902, USA.
| | - Sherrie Wise
- School of Public Health, University of Texas Health Science Center, Houston, El Paso Regional Campus, 1101 N. Campbell CH 410, El Paso, TX 79902, USA.
| | - Alisha Redelfs
- School of Public Health, University of Texas Health Science Center, Houston, El Paso Regional Campus, 1101 N. Campbell CH 410, El Paso, TX 79902, USA.
| | - E Lee Rosenthal
- Project on Community Health Worker Policy and Practice, Institute for Health Policy, University of Texas School of Public Health, c/o El Paso Regional Campus, 1101 N. Campbell, CHS 410, El Paso, TX 79902, USA.
| | - Hendrik D de Heer
- Department of Physical Therapy and Athletic Training, Northern Arizona University, P.O. Box 15105, 208 E Pine Knoll Dr., Flagstaff, AZ 86004, USA.
| | - Ximena Burgos
- Department of Public Health Sciences, The University of Texas at El Paso, 500 W. University Ave., El Paso, TX 79968, USA.
| | - Maria Duarte-Gardea
- Department of Public Health Sciences, The University of Texas at El Paso, 500 W. University Ave., El Paso, TX 79968, USA.
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Johnson CM, Sharkey JR, Dean WR, St John JA, Castillo M. Promotoras as research partners to engage health disparity communities. J Acad Nutr Diet 2013; 113:638-42. [PMID: 23375463 DOI: 10.1016/j.jand.2012.11.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 11/20/2012] [Indexed: 11/24/2022]
Affiliation(s)
- Cassandra M Johnson
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, NC, USA
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Salinas JJ, Abdelbary B, Wilson J, Hossain M, Fisher-Hoch S, McCormick J. Using the Framingham Risk Score to evaluate immigrant effect on cardiovascular disease risk in Mexican Americans. J Health Care Poor Underserved 2012; 23:666-77. [PMID: 22643615 DOI: 10.1353/hpu.2012.0058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This study uses the Framingham Risk Score (FRS) for 10-year cardiovascular disease (CVD) to evaluate differences between Mexican American immigrants and the U.S.-born population. METHODS AND RESULTS Data from the Cameron County Hispanic Cohort (N=1,559). Average total risk scores were generated by age group for each gender. Regression analysis was conducted adjusting for covariates and interaction effects. Both women and men in the CCHC sample who were long-term immigrant residents (mean FRS scores women 4.2 with p<.001 vs. men 4.0 with p<.001) or born in the U.S. (mean FRS scores women 4.6 with p<.001 vs. men 3.3 with p<.001) had significantly higher risk scores than immigrants who had only been in this country for less than 10 years. The interaction model indicates that differences between immigrant and native-born Mexican Americans are most greatly felt at lowest levels of socioeconomic status for men in the CCHC. CONCLUSIONS This study suggests that in terms of immigrant advantage in CVD risk, on whom, where, and how the comparisons are being made have important implications for the degree of difference observed.
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Affiliation(s)
- Jennifer J Salinas
- Division of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Brownsville Campus, Brownsville, TX 78520, USA.
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Salud Para Su Corazon (health for your heart) community health worker model: community and clinical approaches for addressing cardiovascular disease risk reduction in Hispanics/Latinos. J Ambul Care Manage 2012; 34:362-72. [PMID: 21914992 DOI: 10.1097/jac.0b013e31822cbd0b] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article describes 6 Salud Para Su Corazon (SPSC) family of programs that have addressed cardiovascular disease risk reduction in Hispanic communities facilitated by community health workers (CHWs) or Promotores de Salud (PS). A synopsis of the programs illustrates the designs and methodological approaches that combine community-based participatory research for 2 types of settings: community and clinical. Examples are provided as to how CHWs can serve as agents of change in these settings. A description is presented of a sustainability framework for the SPSC family of programs. Finally, implications are summarized for utilizing the SPSC CHW/PS model to inform ambulatory care management and policy.
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