1
|
Obi ON, Sharp M, Harper L. Progress for all: addressing disparities in sarcoidosis. Curr Opin Pulm Med 2024; 30:551-560. [PMID: 38989780 PMCID: PMC11309889 DOI: 10.1097/mcp.0000000000001104] [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] [Indexed: 07/12/2024]
Abstract
PURPOSE OF REVIEW The impact of healthcare disparities in the treatment, care, and outcomes of patients with sarcoidosis has been described. There is paucity of literature on ways to address these disparities with a goal to improving health outcomes for patients with sarcoidosis. RECENT FINDINGS Recent findings in other respiratory and systemic diseases suggest that multifaceted interventions directed at improving care at various levels including individual, family, and larger societal levels have been successful in dismantling some of the social and structural barriers to care and consequently have resulted in a reduction in disparate disease outcomes. We explore what some of these interventions would look like in sarcoidosis. SUMMARY The impact of healthcare disparities in the treatment, care, and outcomes of patients with sarcoidosis has been described. We outline various steps and approaches aimed at addressing these health disparities with a goal to improving outcomes for those most impacted by disease.
Collapse
Affiliation(s)
- Ogugua Ndili Obi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Michelle Sharp
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, Maryland
| | - Logan Harper
- Department of Pulmonary and Critical Care Medicine, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
2
|
Niebur H, Rookwood A, Karki B, Abresch C. Toward a new model of childhood asthma care: community needs assessment in an underserved urban population. J Asthma 2023; 60:2064-2073. [PMID: 37171134 DOI: 10.1080/02770903.2023.2213351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES The objective of this study was to utilize a community-engaged research approach to better understand gaps and opportunities for improving asthma care from the perspectives of patients, caregivers, community organization representatives, and healthcare providers in a predominantly minority community. METHODS Forty-one participants from four groups (patients, caregivers, community organization representatives, healthcare providers) participated in interviews or focus groups. A phenomenological approach to this qualitative research allowed the research team to better understand the lived experiences of families seeking asthma care in this community. RESULTS Five gaps and five corresponding opportunities were identified. The gaps identified were unequal healthcare resource distribution; underrepresentation of health professionals from diverse backgrounds; experiences of environmental racism; mistrust, bias, and discrimination in healthcare encounters; and systemic marginalization of communities. The opportunities identified include increasing healthcare infrastructure and accessibility; increasing racially, culturally, and linguistically congruent healthcare; implementing equitable improvements to the built environment; building relationships with communities and individuals; and acknowledging communities' strengths and resilience. CONCLUSION This study identified systemic gaps to asthma care that are of prominent concern to the community.
Collapse
Affiliation(s)
- Hana Niebur
- Department of Pediatrics, University of NE Medical Center, Omaha, USA
| | - Aislinn Rookwood
- Department of Pediatrics, University of NE Medical Center, Omaha, USA
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, USA
| | - Bibhusha Karki
- Division of Nursing, Midwifery and Social work, University of Manchester, Manchester, UK
| | - Chad Abresch
- Department of Pediatrics, University of NE Medical Center, Omaha, USA
| |
Collapse
|
3
|
Everhart RS, Haley AD, Regan GG, Romo S, Dempster KW, Barsell DJ, Corona R, Mazzeo SE, Schechter MS. Engaging with the Richmond Community to Reduce Pediatric Asthma Disparities: Findings from a Community-engaged Needs Assessment. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 66:222-231. [PMID: 32578886 DOI: 10.1002/ajcp.12439] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Childhood asthma disparities persist, with children living in low-income areas experiencing worse morbidity. We partnered with a community-academic research team and stakeholders to conduct a needs assessment to understand barriers and supports to asthma treatment. We convened a community advisory board, comprised of parents of children with asthma, youth with asthma, and members of key community organizations. Two focus groups with parents of children with asthma and four focus groups with youth with asthma were conducted, and a survey was administered to 100 parents. A visual mapping process was used to gather qualitative data about barriers, strategies, and outcomes, and allowed advisory board members to interpret focus group and survey data within the lived experiences of families. Focus group themes included parent stress/anxiety, concerns about school nurses, and lack of trust in providers. Findings from focus groups and surveys suggested that emergency department visits were not perceived negatively by families, although health providers and researchers generally view them as such. Public health implications include systemic changes that allow the healthcare system to address families' acute needs and worry. A community program focused on education and coordination among families, schools, and medical homes might improve asthma outcomes at the population level.
Collapse
|
4
|
Foronda CL, Kelley CN, Nadeau C, Prather SL, Lewis-Pierre L, Sarik DA, Muheriwa SR. Psychological and Socioeconomic Burdens Faced by Family Caregivers of Children With Asthma: An Integrative Review. J Pediatr Health Care 2020; 34:366-376. [PMID: 32299726 DOI: 10.1016/j.pedhc.2020.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/11/2020] [Accepted: 02/18/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Asthma affects nearly 1 in every 12 children in the United States. Caring for a child with asthma poses significant challenges for the parent or caregiver. The purpose of this integrative review was to identify the psychological and socioeconomic burdens faced by family caregivers of children with asthma. METHOD An integrative review was conducted to review and appraise 80 studies. RESULTS Psychosocial burdens included decreased mental health, quality of life, sleep, family stress, educational deficits, cultural and health disparities, and health care communication challenges. Socioeconomic burdens included poor access to care, as well as work and financial challenges. Studies demonstrated a link between family caregiver health and child health outcomes. Facilitators included education and empowerment, social support, and use of technology. DISCUSSION As the family caregiver's health directly affects the asthmatic child's health, addressing the burdens of family caregivers should be a key consideration in pediatric asthma care.
Collapse
|
5
|
Haldane V, Chuah FLH, Srivastava A, Singh SR, Koh GCH, Seng CK, Legido-Quigley H. Community participation in health services development, implementation, and evaluation: A systematic review of empowerment, health, community, and process outcomes. PLoS One 2019; 14:e0216112. [PMID: 31075120 PMCID: PMC6510456 DOI: 10.1371/journal.pone.0216112] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 04/15/2019] [Indexed: 11/23/2022] Open
Abstract
Background Community participation is widely believed to be beneficial to the development, implementation and evaluation of health services. However, many challenges to successful and sustainable community involvement remain. Importantly, there is little evidence on the effect of community participation in terms of outcomes at both the community and individual level. Our systematic review seeks to examine the evidence on outcomes of community participation in high and upper-middle income countries. Methods and findings This review was developed according to PRISMA guidelines. Eligible studies included those that involved the community, service users, consumers, households, patients, public and their representatives in the development, implementation, and evaluation of health services, policy or interventions. We searched the following databases from January 2000 to September 2016: Medline, Embase, Global Health, Scopus, and LILACs. We independently screened articles for inclusion, conducted data extraction, and assessed studies for risk of bias. No language restrictions were made. 27,232 records were identified, with 23,468 after removal of duplicates. Following titles and abstracts screening, 49 met the inclusion criteria for this review. A narrative synthesis of the findings was conducted. Outcomes were categorised as process outcomes, community outcomes, health outcomes, empowerment and stakeholder perspectives. Our review reports a breadth of evidence that community involvement has a positive impact on health, particularly when substantiated by strong organisational and community processes. This is in line with the notion that participatory approaches and positive outcomes including community empowerment and health improvements do not occur in a linear progression, but instead consists of complex processes influenced by an array of social and cultural factors. Conclusion This review adds to the evidence base supporting the effectiveness of community participation in yielding positive outcomes at the organizational, community and individual level. Trial registration Prospero record number:CRD42016048244.
Collapse
Affiliation(s)
- Victoria Haldane
- Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Fiona L. H. Chuah
- Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Aastha Srivastava
- Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Shweta R. Singh
- Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Gerald C. H. Koh
- Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Chia Kee Seng
- Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Helena Legido-Quigley
- Swee Hock School of Public Health, National University of Singapore, Singapore
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| |
Collapse
|
6
|
Chilenski SM, Welsh J, Olson J, Hoffman L, Perkins DF, Feinberg ME. Examining the Highs and Lows of the Collaborative Relationship Between Technical Assistance Providers and Prevention Implementers. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 19:250-259. [PMID: 28677088 DOI: 10.1007/s11121-017-0812-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The PROSPER model uses a three-tiered community partnership, university researcher, and Cooperative Extension-based technical assistance system to support the delivery of evidence-based interventions in communities. This study examines the trajectory and predictors of the collaborative relationship between technical assistance providers and community teams across the three phases of organization, implementation, and sustainability. Members of 14 PROmoting School-university-community Partnerships to Enhance Resilience (PROSPER) community teams and directors of local agencies rated communities' levels of readiness and adolescent substance use norms. Technical assistance providers rated their collaborative relationship with their teams at 14 occasions across 4.5 years. Results from mixed models show that levels of collaboration were stable until the sustainability phase, when they increased significantly. Team differences in change were significant during the implementation phase. Community readiness predicted levels of the collaborative relationship over time: high community readiness was associated with a high level of collaboration during organization, but a decline in collaboration during implementation. These results provide a more nuanced understanding of the relationship between technical assistance provision and community prevention teams and lead to recommendations to improve dissemination models to achieve a greater public health impact.
Collapse
Affiliation(s)
- Sarah M Chilenski
- Prevention Research Center, The Pennsylvania State University, University Park, PA, USA.
- The Clearinghouse for Military Family Readiness, The Pennsylvania State University, University Park, PA, USA.
| | - Janet Welsh
- Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
- The Clearinghouse for Military Family Readiness, The Pennsylvania State University, University Park, PA, USA
| | | | - Lesa Hoffman
- Schiefelbusch Institute for Life Span Studies, University of Kansas, Lawrence, KS, USA
| | - Daniel F Perkins
- The Clearinghouse for Military Family Readiness, The Pennsylvania State University, University Park, PA, USA
- The Department of Agricultural Economics, Sociology, and Education, The Pennsylvania State University, University Park, PA, USA
| | - Mark E Feinberg
- Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| |
Collapse
|
7
|
Evans-Agnew RA. Asthma Disparity Photovoice: The Discourses of Black Adolescent and Public Health Policymakers. Health Promot Pract 2017; 19:213-221. [PMID: 29161900 DOI: 10.1177/1524839917691039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Policies in U.S. public schools that address asthma management for Black adolescents may not sufficiently transform sociocultural determinants of disparities. A critical analysis of public health policy maker and adolescent discourses on asthma management using an ecological framework could inform policy development. This study describes the discourses of asthma management disparities of school and other public health policymakers and Black adolescents with asthma during a statewide asthma planning activity. METHOD I conducted a qualitative critical discourse analysis on transcripts and phototexts from a photovoice project with Black adolescents with asthma (n = 19), an asthma-planning meeting with school and public health policymakers (n = 12), and an observation of a photovoice dissemination event that included the same adolescents and policymakers. RESULTS Policymakers did not discuss sociocultural discourses concerning asthma management disparities such as racism and discrimination, but the adolescents did. The only shared discourses between adolescents and policymakers were on the management of indoor environments, health care quality, inadequate housing, and outdoor air pollution. CONCLUSIONS Including Black adolescents in policymaking activities concerning asthma management disparities furthers the identification of differing and shared discourses. School policies should include multilevel strategies that address structural inequities. Photovoice presents an opportunity for including the voice of marginalized youth in policy-planning processes.
Collapse
|
8
|
Golden SD, McLeroy KR, Green LW, Earp JAL, Lieberman LD. Upending the social ecological model to guide health promotion efforts toward policy and environmental change. HEALTH EDUCATION & BEHAVIOR 2016; 42:8S-14S. [PMID: 25829123 DOI: 10.1177/1090198115575098] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Efforts to change policies and the environments in which people live, work, and play have gained increasing attention over the past several decades. Yet health promotion frameworks that illustrate the complex processes that produce health-enhancing structural changes are limited. Building on the experiences of health educators, community activists, and community-based researchers described in this supplement and elsewhere, as well as several political, social, and behavioral science theories, we propose a new framework to organize our thinking about producing policy, environmental, and other structural changes. We build on the social ecological model, a framework widely employed in public health research and practice, by turning it inside out, placing health-related and other social policies and environments at the center, and conceptualizing the ways in which individuals, their social networks, and organized groups produce a community context that fosters healthy policy and environmental development. We conclude by describing how health promotion practitioners and researchers can foster structural change by (1) conveying the health and social relevance of policy and environmental change initiatives, (2) building partnerships to support them, and (3) promoting more equitable distributions of the resources necessary for people to meet their daily needs, control their lives, and freely participate in the public sphere.
Collapse
Affiliation(s)
- Shelley D Golden
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Jo Anne L Earp
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | |
Collapse
|
9
|
Stempski S, Liu L, Grow HM, Pomietto M, Chung C, Shumann A, Bennett E. Everyone Swims. HEALTH EDUCATION & BEHAVIOR 2015; 42:106S-114S. [DOI: 10.1177/1090198115570047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Well-known disparities exist in rates of obesity and drowning, two public health priorities. Addressing these disparities by increasing access to safe swimming and water recreation may yield benefits for both obesity and injury prevention. Everyone Swims, a community partnership, brought community health clinics and water recreation organizations together to improve policies and systems that facilitated learning to swim and access to swimming and water recreation for low-income, diverse communities. Based in King County, Washington, Everyone Swims launched with Centers for Disease Control and Prevention grant funding from 2010 to 2012. This partnership led to multiple improvements in policies and systems: higher numbers of clinics screening for swimming ability, referrals from clinics to pools, more scholarship accessibility, and expansion of special swim programs. In building partnerships between community health/public health and community recreation organizations to develop systems that address user needs in low-income and culturally diverse communities, Everyone Swims represents a promising model of a structured partnership for systems and policy change to promote health and physical activity.
Collapse
Affiliation(s)
| | - Lenna Liu
- Seattle Children’s Hospital, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
- Odessa Brown Children’s Clinic, Seattle, WA, USA
| | - H. Mollie Grow
- University of Washington, Seattle, WA, USA
- Seattle Children’s Research Institute, Seattle, WA, USA
- Harborview Pediatric Clinic, Seattle, WA, USA
| | | | | | - Amy Shumann
- Environmental Health Services Division, Public Health, Seattle & King County, Seattle, WA, USA
| | | |
Collapse
|