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Killough CM, Madaras A, Phillips C, Hettema J, Ceballos V, Fuentes JE, Rishel Brakey H, Wagner K, Page K. Community health worker insights on promoting research engagement with diverse populations. Front Public Health 2023; 10:959504. [PMID: 36711331 PMCID: PMC9874150 DOI: 10.3389/fpubh.2022.959504] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023] Open
Abstract
Representation of diverse populations in health research enhances our ability to understand the factors that impact health, generalize results, implement findings, and promote social justice. The primary objective of the study was to understand the unique perspectives of frontline community health workers (CHWs) to identify actionable barriers and facilitators that may impact representation of diverse groups in health research. Focus groups with CHWs were conducted followed by thematic analysis. Results revealed five main themes: barriers/risks to research participation, facilitation of research, CHW roles, recommendations, and transparency. A novel finding was that some CHWs see themselves as both facilitators and gatekeepers. As facilitators, CHWs ensure their patient populations receive resources and benefit from being involved in research; as gatekeepers CHWs feel that they protect patient populations from experiencing further trauma, especially when engaging in research. Recognizing that in many communities there is a high reliance and trust with CHWs, can promote genuine and informed participation at all stages of research.
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Affiliation(s)
- Cynthia M. Killough
- Clinical and Translational Science Center, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States,*Correspondence: Cynthia M. Killough ✉
| | - Annemarie Madaras
- Department of Family and Community Medicine, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Christina Phillips
- Department of Family and Community Medicine, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | | | - Venice Ceballos
- Community Health Worker Initiatives, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Jesus E. Fuentes
- Clinical and Translational Science Center, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Heidi Rishel Brakey
- Clinical and Translational Science Center, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Katherine Wagner
- Department of General Internal Medicine, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Kimberly Page
- Department of General Internal Medicine, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
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Teufel-Shone NI, Goldtooth-Begay C, Begay AB, Lazaro A, Yellowhair J, Todecheenie R, Begay D, Singer D, Briscoe C. Maintaining the Partnership Between a Tribal Breast and Cervical Cancer Program and a University-Based Cancer Prevention Center During COVID-19 Lock-Down Restrictions-A Case Study. Front Public Health 2022; 10:902253. [PMID: 35910901 PMCID: PMC9326352 DOI: 10.3389/fpubh.2022.902253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
To inform women of the Navajo Nation of safety measures implemented to minimize COVID-19 virus exposure during screening and treatment procedures at Navajo Nation based health care facilities, the Navajo Nation Breast and Cervical Cancer Prevention Program (NNBCCPP) and the University-based Partnership for Native American Cancer Prevention Program (NACP) collaborated to develop a podcast to describe the continued availability of services. During the COVID-19 pandemic, women of all ages and ethnicities in the US needing breast and cervical cancer prevention screenings and treatment, have been hesitant to seek services given the advice to avoid crowded spaces and maintain physical distancing. Epidemiological trends indicate that proactive, intensive strategies are needed in Native American communities for early detection and treatment to support early cancer diagnosis and improve cancer survival. The NNBCCPP and Northern Arizona University (NAU) through the National Institute of Health's National Cancer Institute funded NACP had a nascent partnership prior to the onset of COVID-19 pandemic. This partnership relied on face-to-face interaction to allow for informal social interaction, facilitate clear communication and support continued trust building. To adhere to federal, state and tribal recommendations to minimize gatherings and to stay in-place to minimize the spread of the virus, the Navajo Nation and NAU restricted, and in most cases would not approve employee travel for partnership meetings. The plans to develop a podcast necessitated bringing additional members into the collaboration who were unfamiliar to the original partners and due to travel restrictions, required all interactions to be remote. This expanded group met virtually to develop a script, record and edit the podcast. More importantly, group members had to build and maintain trust over months of communicating via a teleconference video platform. This collaborative addressed challenges related to unstable Internet connections and periodic stay-at-home policies; thus, these emerging partners had to modify social and professional communication to respect and accommodate the stress and uncertain circumstances created by the pandemic on the citizens and employees of Navajo Nation. This case study describes strategies used to maintain and respect all members of the partnership.
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Affiliation(s)
- Nicolette I. Teufel-Shone
- Center for Health Equity Research, Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, United States
| | - Carol Goldtooth-Begay
- Center for Health Equity Research, Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, United States
| | - Andria B. Begay
- School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, United States
| | - Ashley Lazaro
- Center for Health Equity Research, Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, United States
| | - Janet Yellowhair
- Center for Health Equity Research, Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, United States
| | - Rolanda Todecheenie
- Navajo Nation Breast and Cervical Cancer Prevention Program, Navajo Nation Department of Health, Window Rock, AZ, United States
| | - Delila Begay
- Navajo Nation Breast and Cervical Cancer Prevention Program, Navajo Nation Department of Health, Window Rock, AZ, United States
| | - Darlene Singer
- Navajo Nation Breast and Cervical Cancer Prevention Program, Navajo Nation Department of Health, Window Rock, AZ, United States
| | - Curtis Briscoe
- Navajo Nation Breast and Cervical Cancer Prevention Program, Navajo Nation Department of Health, Window Rock, AZ, United States
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Rankin A, Baumann A, Downey B, Valaitis R, Montour A, Mandy P. The Role of the Indigenous Patient Navigator: A Scoping Review. Can J Nurs Res 2022; 54:199-210. [PMID: 35014886 PMCID: PMC9109580 DOI: 10.1177/08445621211066765] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Healthcare systems are complex and as a result patients may experience fragmentation of services. Indigenous populations experience increasingly disproportionate health disparities compared to non-Indigenous populations. Patient navigation is known as a patient-centered approach to empower individuals to connect with appropriate services. Literature surrounding the Indigenous Patient Navigator (IPN) remains sparse necessitating this scoping review. Purpose: To map the current state of the role of the IPN internationally within Canada, United States, Australia and New Zealand. METHODS Estalished methodological framework by Arksey and O'Malley and the PRISMA extension for scoping reviews was used. RESULTS A total of 820 articles were reviewed from four databases, yielding sixteen articles. CONCLUSIONS The absence of published literature surrounding the IPN role in Australia and New Zealand was surprising considering similar histories of colonization. The term navigator was used most often and was typically used when describing lay/peer roles. Professional roles were described using specific role descriptions. Six IPN roles were identified including: (1) social service navigation, (2) wholistic support of Indigenous people, (3) advocacy/building capacity, (4) health assessment, (5) administrative navigation, and (6) outreach. Additionally, barriers and enablers IPNs address are identified. This scoping review will assist to promote and reinforce the IPN role.
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Affiliation(s)
| | | | | | | | | | - Pat Mandy
- McMaster University, Hamilton, Canada
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Kruse G, Lopez-Carmen VA, Jensen A, Hardie L, Sequist TD. The Indian Health Service and American Indian/Alaska Native Health Outcomes. Annu Rev Public Health 2022; 43:559-576. [PMID: 35081315 DOI: 10.1146/annurev-publhealth-052620-103633] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Indian Health Service (IHS) has made huge strides in narrowing health disparities between American Indian and Alaska Native (AI/AN) populations and other racial and ethnic groups. Yet, health disparities experienced by AI/AN people persist, with deep historical roots combined with present-day challenges. Here we review the history of the IHS from colonization to the present-day system, highlight persistent disparities in AI/AN health and health care, and discuss six key present-day challenges: inadequate funding, limited human resources, challenges associated with transitioning services from federal to Tribal control through contracting and compacting, evolving federal and state programs, the need for culturally sensitive services, and the promise and challenges of health technology.
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Affiliation(s)
- Gina Kruse
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA;
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Anpotowin Jensen
- School of Engineering, Stanford University, Stanford, California, USA
| | - Lakotah Hardie
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA;
| | - Thomas D Sequist
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Quality and Patient Experience, Massachusetts General Brigham, Somerville, Massachusetts, USA
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Fitzpatrick K, Sehgal A, Montesanti S, Pianarosa E, Barnabe C, Heyd A, Kleissen T, Crowshoe L. Examining the role of Indigenous primary healthcare across the globe in supporting populations during public health crises. Glob Public Health 2022; 18:2049845. [PMID: 35343868 DOI: 10.1080/17441692.2022.2049845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
When health systems are overwhelmed during a public health crisis regular care is often delayed and deaths result from lapses in routine care. Indigenous primary healthcare (PHC) can include a range of programmes that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health (SDoH) and a focus on redressing health inequities. We examined how Indigenous PHC mobilises and innovates during a public health crisis to address patient needs and the broader SDoH. A rapid review methodology conducted from January 2021 - March 2021 was purposefully chosen given the urgency with COVID-19, to understand the role of Indigenous PHC during a public health crisis. Our review identified five main themes that highlight the role of Indigenous PHC during a public health crisis: (1) development of culturally appropriate communication and education materials about vaccinations, infection prevention, and safety; (2) Indigenous-led approaches for the prevention of infection and promotion of health; (3) strengthening intergovernmental and interagency collaboration; (4) maintaining care continuity; and (5) addressing the SDoH. The findings highlight important considerations for mobilising Indigenous PHC services to meet the needs of Indigenous patients during a public health crisis such as the COVID-19 pandemic.
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Affiliation(s)
- Kayla Fitzpatrick
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Anika Sehgal
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Emilie Pianarosa
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amber Heyd
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tessa Kleissen
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lynden Crowshoe
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Sisson N, Starke J. Promotores de Salud in Montana: An Analysis of a Rural Health Care Intervention Rooted in Catholic Social Teaching and its Place in Medical Curricula. Linacre Q 2022; 89:21-35. [PMID: 35321492 PMCID: PMC8935425 DOI: 10.1177/00243639211059346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The Latino population in the United States faces significant health disparities compared to their White counterparts. Community-based processes in Gallatin County, Montana, through academic-community partnerships have identified strategies to overcome these barriers. One such strategy includes the utilization of community health workers (CHWs) in the Latino population-in Spanish, "Promotores de Salud." CHWs are often selected to target community health problems because they share the cultural, social, and demographic features of the population they serve. This paper explores the inherent ties between Catholic Social Teaching and the CHW health care model while focusing on a community-academic partnership in Montana that is implementing a CHW program. Catholic health care providers are called to apply CST principles to their health care systems and communities in order to achieve health equity for their patients. This paper proposes that community organizing and advocacy should be taught in medical school curricula across the country in order to promote physician involvement in solving public health disparities. Additionally, the authors suggest that practicing Catholic health care providers immediately incorporate community organizing through the use of CHWs to attain health equity for their patient panels.
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Affiliation(s)
- Nathaniel Sisson
- School of Medicine, University of Washington, Seattle, WA, USA,Nathaniel Sisson, School of Medicine, University of Washington, 1959 NE Pacific St, A-300 Health Sciences Center, Box 356340, Seattle, WA 98195-0005, USA.
| | - Jenna Starke
- School of Medicine, University of Washington, Seattle, WA, USA
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O'Keefe VM, Cwik MF, Haroz EE, Barlow A. Increasing culturally responsive care and mental health equity with indigenous community mental health workers. Psychol Serv 2021; 18:84-92. [PMID: 31045405 PMCID: PMC6824928 DOI: 10.1037/ser0000358] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There are 600 diverse American Indian/Alaska Native communities that represent strong and resilient nations throughout Indian Country. However, a history of genocidal practices, cultural assaults, and continuing oppression contribute to high rates of mental health and substance use disorders. Underresourced mental health care and numerous barriers to services maintain these disparities. Indigenous community mental health workers hold local understandings of history, culture, and traditional views of health and wellness and may reduce barriers to care while promoting tribal health and economic self-determination and sovereignty. The combination of Native community mental health workers alongside a growing workforce of Indigenous mental health professionals may create an ideal system in which tribal communities are empowered to restore balance and overall wellness, aligning with Native worldviews and healing traditions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Brown C, Lalla A, Curley C, King C, Muskett O, Salt S, Ray K, Begay MG, Nelson AK, Shin S. Community-clinic linkages: qualitative provider perspectives on partnering with community health representatives in Navajo Nation. BMJ Open 2020; 10:e031794. [PMID: 32054623 PMCID: PMC7044898 DOI: 10.1136/bmjopen-2019-031794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To understand providers' opinions about the Community Outreach and Patient Empowerment (COPE) Project designed to strengthen Navajo Community Health Representative (CHR) outreach to individuals living with diabetes. DESIGN This was a qualitative study nested within a larger evaluation of a programme intervention. SETTING The study took place in Navajo Nation and evaluated a programme initiative designed to strengthen collaboration between CHRs and clinic-based healthcare providers and provide structured outreach to individuals living with diabetes in Navajo Nation. The CHR Programme is a formal community health worker programme that exists in most tribal healthcare systems across the USA. PARTICIPANTS Healthcare providers involved in the programme took part in one-on-one interviews. ANALYSIS We used thematic analysis for this study. A team of three study staff used open-coding to create a codebook. Coded material were summarised and patterns were identified and tied into a narrative using concept mapping. The study design and instrument construction were guided by a Community Health Advisory Panel. RESULTS A total of 13 interviews were completed. Providers acknowledged CHRs as an asset to the clinical team and were enthusiastic about the COPE coaching materials, mentioning they provided a consistent message to CHRs and the community. Providers that led COPE trainings with CHRs valued the face-to-face time and opportunity to build relationships. Providers (n=4) supported CHRs' access to electronic health record to record patient visits and streamline referrals. Among their requests were having designated personnel to manage referrals with CHRs and a formal system to record modules CHRs have completed. CONCLUSION Providers participating in COPE activities valued the work of CHRs and endorsed further strengthening relationships and communication with CHRs. Healthcare programmes should consider systems changes to integrate community health workers into clinic-based teams. TRIAL REGISTRATION NUMBER NCT03326206; Results.
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Affiliation(s)
- Christian Brown
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Amber Lalla
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Cameron Curley
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Caroline King
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Olivia Muskett
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Shine Salt
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kathy Ray
- Navajo Area Indian Health Service, Saint Michael, Arizona, USA
| | - Mae-Gilene Begay
- Community Health Representative Outreach Program, Navajo Nation Department of Health, Window Rock, Arizona, USA
| | - Adrianne Katrina Nelson
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Sonya Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
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Lalla A, Salt S, Schrier E, Brown C, Curley C, Muskett O, Begay MG, Shirley L, Clark C, Singer J, Shin S, Nelson AK. Qualitative evaluation of a community health representative program on patient experiences in Navajo Nation. BMC Health Serv Res 2020; 20:24. [PMID: 31914997 PMCID: PMC6950858 DOI: 10.1186/s12913-019-4839-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/16/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Community Health Representatives (CHRs) overcome health disparities in Native communities by delivering home care, health education, and community health promotion. The Navajo CHR Program partners with the non-profit Community Outreach and Patient Empowerment (COPE), to provide home-based outreach to Navajo clients living with diabetes. COPE has created an intervention (COPE intervention) focusing on multiple levels of improved care including trainings for CHRs on Motivational Interviewing and providing CHRs with culturally-appropriate education materials. The objective of this research is to understand the participant perspective of the CHR-COPE collaborative outreach through exploring patient-reported outcomes (PROs) of clients who consent to receiving the COPE intervention (COPE clients) using a qualitative methods evaluation. METHODS Seven COPE clients were selected to participate in semi-structured interviews one year after finishing COPE to explore their perspective and experiences. Qualitative interviews were recorded, transcribed, and coded to identify themes. RESULTS Clients revealed that health education delivered by CHRs facilitated lifestyle changes by helping them understand key health indicators and setting achievable goals through the use of accessible material and encouragement. Clients felt comfortable with CHRs who respected traditional practices and made regular visits. Clients also appreciated when CHRs educated their family members, who in turn were better able to support the client in their health management. Finally, CHRs who implemented the COPE intervention helped patients who were unable to regularly see a primary care doctor for critical care and support in their disease management. CONCLUSION The COPE-CHR collaboration facilitated trusting client-CHR relationships and allowed clients to better understand their diagnoses. Further investment in materials that respect traditional practices and aim to educate clients' families may foster these relationships and improve health outcomes. TRIAL REGISTRATION clinicaltrials.gov: NCT03326206. Registered 9/26/2017 (retrospectively registered).
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Affiliation(s)
- Amber Lalla
- University of New Mexico, 2425 Camino de Salud, Albuquerque, NM 87106 USA
| | - Shine Salt
- Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | | | - Christian Brown
- Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Cameron Curley
- Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Olivia Muskett
- Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Mae-Gilene Begay
- Navajo Nation Community Health Representative & Outreach Program, Navajo Nation Department of Health, Hwy 264 and St. Michael Road, St Michael, AZ 86511 USA
| | - Lenora Shirley
- Navajo Nation Community Health Representative & Outreach Program, Navajo Nation Department of Health, Hwy 264 and St. Michael Road, St Michael, AZ 86511 USA
| | - Clarina Clark
- Community Outreach and Patient Empowerment (COPE), 210 East Aztec Avenue, Gallup, NM 87301 USA
| | - Judy Singer
- Community Outreach and Patient Empowerment (COPE), 210 East Aztec Avenue, Gallup, NM 87301 USA
| | - Sonya Shin
- Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Adrianne Katrina Nelson
- Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112 USA
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Utilizing Telemedicine for Group Visit Provider Encounters: A Feasibility and Acceptability Study. INTERNATIONAL JOURNAL OF DIABETES & METABOLIC SYNDROME 2020; 1:1-6. [PMID: 32984864 PMCID: PMC7514109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
BACKGROUND The value of telemedicine has been underscored during the coronavirus pandemic. Utilizing telemedicine could markedly enhance group visit scalability and sustainability. However, there are limited data demonstrating telemedicine use for group visits. OBJECTIVE To evaluate the feasibility and acceptability of provider encounters conducted via telemedicine in group visits. MATERIALS AND METHODS We conducted a 6-month diabetes group visit program and compared in-person (months 1-3) versus telemedicine (videoconferencing) (months 4-6) patient-provider encounters. Participants completed the Telehealth Usability Questionnaire (TUQ) at 6-months (primary outcome). To ensure telemedicine did not negatively affect clinical outcomes, we compared in-person versus telemedicine differences in HbA1c, blood pressure, body mass index (BMI), and attendance. RESULTS The TUQ revealed that participants (N=19) found telemedicine useful and easy to use (4.9/5.0, 4.4/5.0, respectively) and with excellent interface (4.3/5.0), interaction (4.6/5.0), reliability (4.2/5.0), and satisfaction (4.4/5.0). There were no significant differences in clinical outcomes between arms: HbA1c (in-person: -0.60%, telemedicine: -0.52%, p=0.86), blood pressure (systolic: p=0.475, diastolic: p=0.683), weight (p=0.982), BMI (p=0.981), attendance (in-person: 75.44%, telemedicine: 70.12%, p=0.551). CONCLUSION Provider telemedicine encounters in group visits are feasible and acceptable. This is a promising model to address provider limitations in group visits and increase access to care. Larger studies are needed to further evaluate these findings.
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Lee NR, Noonan CJ, Nelson L, Umans JG. HPV Knowledge and Attitudes Among American Indian and Alaska Native Health and STEM Conference Attendees. INTERNATIONAL JOURNAL OF INDIGENOUS HEALTH 2019; 14:205-221. [PMID: 32373556 PMCID: PMC7199482 DOI: 10.32799/ijih.v14i2.31920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
American Indian and Alaska Native women had approximately twice the incidence of cervical cancer as white women. Preventive measures for cervical cancer rely on screening and HPV vaccination. However, vaccine series completion and catch-up vaccinations for eligible adults are low across all racial/ethnic groups. Therefore, the aim of this study was to identify gaps in knowledge and evaluate the attitudes toward HPV and the vaccine among AIANs with various levels of training in the STEM and health-related fields. A survey was used to collect data from audience members at two national conferences geared towards American Indian and Alaska Natives in health and STEM fields in September 2017. A vignette study was administered via a live electronic poll to test knowledge (true/false questions), attitudes, and to collect demographic information. Respondents self-identified as primarily American Indian and Alaska Native (74%), pursuing or completed a graduate degree (67%), and female (85%). Most respondents (86%) were aware of HPV-associated cancer in men. However, most (48-90%) answered incorrectly to detailed true/false statements about HPV and available vaccines. After educational information was provided, opinions collected via vignettes highlighted mainly positive attitudes toward vaccination; specifically, that vaccines are safe and all eligible community members should be vaccinated (75% and 84%, respectively). We observed that our respondents with higher educational attainment still lacked accurate knowledge pertaining to HPV and the vaccine. Overall, continued education about HPV and the vaccine is needed across all levels of education including American Indian and Alaska Native community members and health professionals.
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Affiliation(s)
- Naomi R Lee
- Department of Molecular Genetics and Microbiology, University of New Mexico, Albuquerque, NM, USA. Department of Chemistry and Biochemistry, Northern Arizona University, Flagstaff, AZ, USA
| | - Carolyn J Noonan
- Partnerships for Native Health, Initiative for Research and Education to Advance Community Health, College of Nursing, Washington State University, Seattle, WA, USA
| | - Lonnie Nelson
- Partnerships for Native Health, Initiative for Research and Education to Advance Community Health, College of Nursing, Washington State University, Seattle, WA, USA
| | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, MD, USA. Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA
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McCalman J, Campbell S, Jongen C, Langham E, Pearson K, Fagan R, Martin-Sardesai A, Bainbridge R. Working well: a systematic scoping review of the Indigenous primary healthcare workforce development literature. BMC Health Serv Res 2019; 19:767. [PMID: 31665011 PMCID: PMC6819619 DOI: 10.1186/s12913-019-4580-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Strong and effective workforce models are essential for improving comprehensive Indigenous primary healthcare service (PHC) provision to Indigenous peoples in Canada, Australia, New Zealand and the USA (CANZUS nations). This review systematically scoped the literature for studies that described or evaluated models and systems that support the sustainability, capacity or growth of the Indigenous PHC workforce to provide effective PHC provision. METHODS Eleven databases, 10 websites and clearinghouses, and the reference lists of 5 review articles were searched for relevant studies from CANZUS nations published in English from 2000 to 2017. A process of thematic analysis was utilised to identify key conditions, strategies and outcomes of Indigenous PHC workforce development reported in the literature. RESULTS Overall, 28 studies were found. Studies reported enabling conditions for workforce development as government funding and appropriate regulation, support and advocacy by professional organisations; community engagement; PHC leadership, supervision and support; and practitioner Indigeneity, motivation, power equality and wellbeing. Strategies focused on enhancing recruitment and retention; strengthening roles, capacity and teamwork; and improving supervision, mentoring and support. Only 12/28 studies were evaluations, and these studies were generally of weak quality. These studies reported impacts of improved workforce sustainability, workforce capacity, resourcing/growth and healthcare performance improvements. CONCLUSIONS PHCs can strengthen their workforce models by bringing together healthcare providers to consider how these strategies and enabling conditions can be improved to meet the healthcare and health needs of the local community. Improvement is also needed in the quality of evidence relating to particular strategies to guide practice.
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Affiliation(s)
| | | | | | - Erika Langham
- Central Queensland University, QLD, Cairns, Australia
| | | | - Ruth Fagan
- Central Queensland University, QLD, Cairns, Australia
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Wallace C, Farmer J, McCosker A. Community boundary spanners as an addition to the health workforce to reach marginalised people: a scoping review of the literature. HUMAN RESOURCES FOR HEALTH 2018; 16:46. [PMID: 30200968 PMCID: PMC6131945 DOI: 10.1186/s12960-018-0310-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 08/26/2018] [Indexed: 06/01/2023]
Abstract
BACKGROUND Health services in high-income countries increasingly recognise the challenge of effectively serving and engaging with marginalised people. Effective engagement with marginalised people is essential to reduce health disparities these populations face. One solution is by tapping into the phenomenon of boundary-spanning people in the community-those who facilitate the flow of ideas, information, activities and relationships across organisation and socio-cultural boundaries. METHODS A scoping review methodology was applied to peer-reviewed articles to answer the question: "How do health services identify, recruit and use boundary spanners and what are the outcomes?" The review was conducted in seven databases with search terms based on community-based boundary spanning, marginalised people and health services. FINDINGS We identified 422 articles with the screening process resulting in a final set of 30 articles. We identified five types of community-based boundary spanning: navigators, community health workers, lay workers, peer supporters and community entities. These range from strong alignment to the organisation through to those embedded in the community. We found success in four domains for the organisation, the boundary spanner, the marginalised individuals and the broader community. Quantifiable outcomes related to cost-savings, improved disease management and high levels of clinical care. Outcomes for marginalised individuals related to improved health knowledge and behaviours, improved health, social benefits, reduced barriers to accessing services and increased participation in services. We identified potential organisational barriers to using boundary spanners based on organisational culture and staff beliefs. CONCLUSIONS Community boundary spanners are a valuable adjunct to the health workforce. They enable access to hard to reach populations with beneficial health outcomes. Maintaining the balance of organisational and community alignment is key to ongoing success and diffusion of this approach.
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Affiliation(s)
- Carolyn Wallace
- Swinburne University of Technology, Hawthorn, Victoria Australia
| | - Jane Farmer
- Swinburne University of Technology, Hawthorn, Victoria Australia
| | - Anthony McCosker
- Swinburne University of Technology, Hawthorn, Victoria Australia
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Identifying risk factors for 30-day readmission events among American Indian patients with diabetes in the Four Corners region of the southwest from 2009 to 2016. PLoS One 2018; 13:e0195476. [PMID: 30070989 PMCID: PMC6071952 DOI: 10.1371/journal.pone.0195476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/24/2018] [Indexed: 11/21/2022] Open
Abstract
Objective The objective of this study was to identify risk factors for 30-day readmission events for American Indian patients with diabetes in the southwest. Research design and methods Data from patients with diabetes admitted to Gallup Indian Medical Center between 2009 and 2016 were analyzed using logistic regression analyses. Results Of 2,660 patients, 394 (14.8%) patients had at least one readmission within 30 days of discharge. Older age (OR (95% CI) = 1.26, (1.17, 1.36)), longer length of stay (OR (95% CI) = 1.01, (1.0001, 1.0342)), and a history of substance use disorder (OR (95% CI) = 1.80, (1.25, 2.60)) were risk factors for 30-day readmission. An American Indian language preference was protective against readmission. Conclusions Readmission events are complex and may reflect broad and interwoven disparities in community systems. Future research should work to support community-defined interventions to address both in hospital and external factors that impact risk factors for readmission.
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Sequist TD. Urgent action needed on health inequities among American Indians and Alaska Natives. Lancet 2017; 389:1378-1379. [PMID: 28402807 DOI: 10.1016/s0140-6736(17)30883-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 03/24/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Thomas D Sequist
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA; Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Partners Healthcare System, Boston, MA 02199, USA.
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