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Gallo Marin B, Oliva R, Anandarajah G. Exploring the Beliefs, Values, and Understanding of Quality End-of-Life Care in the Latino Community: A Spanish-Language Qualitative Study. Am J Hosp Palliat Care 2024; 41:508-515. [PMID: 37408485 DOI: 10.1177/10499091231188693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Context: Hospice services are underutilized by the Latino community in the United States. Previous research has identified that language is a key barrier contributing to disparities. However, very few studies have been conducted in Spanish to specifically explore other barriers to hospice enrollment or values related to end-of-life (EOL) care in this community. Here, we remove the language barrier in order to gain an in-depth understanding of what members of the diverse Latino community in one state in the USA considers high quality EOL and barriers to hospice. Methods: This exploratory semi-structured individual interview study of Latino community members was conducted in Spanish. Interviews were audio-recorded, transcribed verbatim and translated to English. Transcripts were analyzed by three researchers, using a grounded-theory approach to identify themes and sub-themes. Main Findings: Six major themes emerged: (1) concept of "a good death"-spiritual peace, family/community connection, no burdens left behind; (2) centrality of family; (3) lack of knowledge about hospice/palliative care; (4) Spanish language as critical; (5) communication style differences; and (6) necessity for cultural understanding. The central theme of "a good death" was closely linked to having the entire family physically and emotionally present. The four other themes represent interrelated, compounding barriers to achieving this "good death." Principal Conclusions: Healthcare providers and the Latino community can work together to decrease hospice utilization disparities by: actively involving family at every step; addressing misconceptions regarding hospice; conducting important conversations in Spanish; and improving provider skills in culturally sensitive care, including communication style.
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Affiliation(s)
| | - Rocío Oliva
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Gowri Anandarajah
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Hope Hospice and Palliative Care Rhode Island, Providence, RI, USA
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Sawalha R, Hosseinzadeh H, Bajorek B. Culturally and linguistically diverse patients' perspectives and experiences on medicines management in Australia: a systematic review. Int J Clin Pharm 2023:10.1007/s11096-023-01560-6. [PMID: 37020057 DOI: 10.1007/s11096-023-01560-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 02/15/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Within the quality use of medicines (QUM)-which entails timely access to, and the rational use of, medicines-medicine safety is a global health priority. In multicultural countries, such as Australia, national medicines policies are focused on achieving QUM, although this is more challenging among their Culturally and Linguistically Diverse (CALD) patients (i.e., those from ethnic minority groups). AIM This review aimed to identify and explore the specific challenges to achieving QUM, as experienced by CALD patients living in Australia. METHOD A systematic literature search was conducted using Web of Science, Scopus, Academic search complete, CINHAL, PubMed and Medline. Qualitative studies describing any aspects of QUM among CALD patients in Australia were included. RESULTS Major challenges in facilitating QUM among CALD patients in Australia were identified, particularly in relation to the following medicines management pathway steps: difficulties around participation in treatment decision-making alongside deficiencies in information provision about medicines. Furthermore, medication non-adherence was commonly observed and reported. When mapped against the bio-psycho-socio-systems model, the main contributors to the medicine management challenges identified related to "social" and "system" factors, reflecting the current health-system's lack of capacity and resourcing to respond to patients' low health literacy levels, communication and language barriers, and cultural and religious perceptions about medicines. CONCLUSION QUM challenges were different among different ethnic groups. This review suggests a need to engage with CALD patients in co-designing culturally appropriate resources and/or interventions to enable the health-system to address the identified barriers to QUM.
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Affiliation(s)
- Rawan Sawalha
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia.
| | - Hassan Hosseinzadeh
- School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Beata Bajorek
- Heart and Stroke Program, Hunter Medical Research Institute, NSW, Australia
- Hunter New England Local Health District, New Lambton, NSW, Australia
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Pham CN, Cunningham SD, Humphries DL. Action learning and public health pedagogy: Student reflections from an experiential public health course. Front Public Health 2023; 11:1128705. [PMID: 37056658 PMCID: PMC10086179 DOI: 10.3389/fpubh.2023.1128705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/08/2023] [Indexed: 03/30/2023] Open
Abstract
IntroductionApplied practice experiences are essential components of the Masters of Public Health (MPH) curriculum. The objective of this study was to examine students’ perspectives on the skills and expertise they developed in an MPH course offering applied practice opportunities.MethodsOf 236 students who took the course from 2008 to 2018, email addresses were obtained for 212 and 104 completed the consent form. Following consent, reflection essays were de-identified and analyzed using a rapid qualitative analysis approach. The essays addressed students’ learning experiences and application of the competencies for MPH programs set by the Council for Education in Public Health (CEPH). Deductive and inductive analytical lenses were used to identify the key lessons learned by each cohort of students. Semi-structured guides and matrixes for essay analysis were created using assignment instructions and CEPH competencies.ResultsAlthough the reflection paper assignment varied across the years, commonalities were observed in the student reflections. Key themes included turning theory into practice, navigating the complex environment of public health practice, skill building, critical self-reflection, challenges encountered, and elements that facilitated project success. Students reported developing practical skills, such as planning for independent research (e.g., preparing for institutional review board (IRB) submission, consulting with faculty and other experts), identifying realistic approaches for data extraction during chart reviews and analyses of electronic medical records, and disseminating findings for diverse stakeholders and audiences. Students also reported strengthening cross-cutting skills such as communication, teamwork, and problem-solving that were useful for navigating power dynamics and balancing competing interests and expectations. Students explored their identity as public health professionals as they navigated the dynamics of public health practice.ConclusionThe applied practice experience served as a valuable tool for knowledge and skills acquisition. Moreover, it served as an opportunity for students to engage with the unique organizational cultures of their respective community partners and to deepen their understanding the complexities of conducting meaningful community-engaged research.ImplicationsThis study demonstrates the utility of analyzing students’ critical self-reflections as a tool for exploring learning experiences when training future public health professionals. The findings can help educators design future applied practice experiences.
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Affiliation(s)
- Christine N. Pham
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
| | - Shayna D. Cunningham
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
- Department of Public Health Sciences, UConn Health, Farmington, CT, United States
| | - Debbie L. Humphries
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
- *Correspondence: Debbie L. Humphries,
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Mavragani A, Leon-Thomas M, Smith SL, Silverman L, Perez-Torres C, Hall WC, Iadarola S. COVID-19 Vaccine Equity and Access: Case Study for Health Care Chatbots. JMIR Form Res 2023; 7:e39045. [PMID: 36630649 PMCID: PMC9879317 DOI: 10.2196/39045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/07/2022] [Accepted: 11/29/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Disparities in COVID-19 information and vaccine access have emerged during the pandemic. Individuals from historically excluded communities (eg, Black and Latin American) experience disproportionately negative health outcomes related to COVID-19. Community gaps in COVID-19 education, social, and health care services (including vaccines) should be prioritized as a critical effort to end the pandemic. Misinformation created by the politicization of COVID-19 and related public health measures has magnified the pandemic's challenges, including access to health care, vaccination and testing efforts, as well as personal protective equipment. Information and Communication Technology (ICT) has been demonstrated to reduce the gaps of marginalization in education and access among communities. Chatbots are an increasingly present example of ICTs, particularly in health care and in relation to the COVID-19 pandemic. OBJECTIVE This project aimed to (1) follow an inclusive and theoretically driven design process to develop and test a COVID-19 information ICT bilingual (English and Spanish) chatbot tool named "Ana" and (2) characterize and evaluate user experiences of these innovative technologies. METHODS Ana was developed following a multitheoretical framework, and the project team was comprised of public health experts, behavioral scientists, community members, and medical team. A total of 7 iterations of ß chatbots were tested, and a total of 22 ß testers participated in this process. Content was curated primarily to provide users with factual answers to common questions about COVID-19. To ensure relevance of the content, topics were driven by community concerns and questions, as ascertained through research. Ana's repository of educational content was based on national and international organizations as well as interdisciplinary experts. In the context of this development and pilot project, we identified an evaluation framework to explore reach, engagement, and satisfaction. RESULTS A total of 626 community members used Ana from August 2021 to March 2022. Among those participants, 346 used the English version, with an average of 43 users per month; and 280 participants used the Spanish version, with an average of 40 users monthly. Across all users, 63.87% (n=221) of English users and 22.14% (n=62) of Spanish users returned to use Ana at least once; 18.49% (n=64) among the English version users and 18.57% (n=52) among the Spanish version users reported their ranking. Positive ranking comprised the "smiley" and "loved" emojis, and negative ranking comprised the "neutral," "sad," and "mad" emojis. When comparing negative and positive experiences, the latter was higher across Ana's platforms (English: n=41, 64.06%; Spanish: n=41, 77.35%) versus the former (English: n=23, 35.93%; Spanish: n=12, 22.64%). CONCLUSIONS This pilot project demonstrated the feasibility and capacity of an innovative ICT to share COVID-19 information within diverse communities. Creating a chatbot like Ana with bilingual content contributed to an equitable approach to address the lack of accessible COVID-19-related information.
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Affiliation(s)
| | - Mariela Leon-Thomas
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
| | - Sabrina L Smith
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
| | - Laura Silverman
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
| | - Claudia Perez-Torres
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
| | - Wyatte C Hall
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
| | - Suzannah Iadarola
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
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Pitchalard K, Moonpanane K, Wimolphan P, Singkhorn O, Wongsuraprakit S. Implementation and evaluation of the peer-training program for village health volunteers to improve chronic disease management among older adults in rural Thailand. Int J Nurs Sci 2022; 9:328-333. [PMID: 35891909 PMCID: PMC9305007 DOI: 10.1016/j.ijnss.2022.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/23/2022] [Accepted: 06/12/2022] [Indexed: 10/24/2022] Open
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Eissa A, Rowe R, Pinto A, Okoli GN, Campbell KM, Washington JC, Rodríguez JE. Implementing High-Quality Primary Care Through a Health Equity Lens. Ann Fam Med 2022; 20:164-169. [PMID: 35165087 PMCID: PMC8959728 DOI: 10.1370/afm.2785] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/13/2021] [Accepted: 12/01/2021] [Indexed: 11/09/2022] Open
Abstract
The COVID-19 pandemic highlighted the importance of centering health equity in future health system and primary care reforms. Strengthening primary care will be needed to correct the longstanding history of mistreatment of First Nations/Indigenous and racialized people, exclusion of health care workers of color, and health care access and outcome inequities further magnified by the COVID-19 pandemic. The National Academies of Sciences, Engineering, and Medicine (NASEM) released a report on Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, that provided a framework for defining high-quality primary care and proposed 5 recommendations for implementing that definition. Using the report's framework, we identified health equity challenges and opportunities with examples from primary care systems in the United States and Canada. We are poised to reinvigorate primary care because the recent pandemic and the attention to continued racialized police violence sparked renewed conversations and collaborations around equity, diversity, inclusion, and health equity that have been long overdue. The time to transition those conversations to actionable items to improve the health of patients, families, and communities is now.Appeared as Annals "Online First" article.
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Affiliation(s)
- Azza Eissa
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada
| | - Robyn Rowe
- ICES Central, Strategic Partnerships & Digital Services, Indigenous Data Team, Kingston, Ontario, Canada.,Health Data Research Network Canada, Indigenous Data Team, Vancouver, British Columbia, Canada
| | - Andrew Pinto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada
| | - George N Okoli
- George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kendall M Campbell
- Department of Family Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Judy C Washington
- Atlantic Medical Group, Overlook Family Medicine Residency Program, Summit, New Jersey
| | - José E Rodríguez
- Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah .,Office of Health Equity, Diversity & Inclusion, University of Utah Health, Salt Lake City, Utah
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Culhane-Pera KA, Pergament SL, Kasouaher MY, Pattock AM, Dhore N, Kaigama CN, Alison M, Scandrett M, Thao MS, Satin DJ. Correction to: Diverse community leaders' perspectives about quality primary healthcare and healthcare measurement: qualitative community-based participatory research. Int J Equity Health 2021; 20:264. [PMID: 34961520 PMCID: PMC8714433 DOI: 10.1186/s12939-021-01586-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Kathleen A Culhane-Pera
- SoLaHmo Partnership for Health and Wellness, Minnesota Community Care, Inc., 895 E 7th, MN, 55106, St. Paul, USA.
| | - Shannon L Pergament
- SoLaHmo Partnership for Health and Wellness, Minnesota Community Care, Inc., 895 E 7th, MN, 55106, St. Paul, USA
| | - Maiyia Y Kasouaher
- Program in Health Disparities Research, University of Minnesota, 717 Delaware St. SE, Minneapolis, MN, 55414, USA
| | - Andrew M Pattock
- Department of Family and Community Medicine, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Naima Dhore
- SoLaHmo Partnership for Health and Wellness, Minnesota Community Care, Inc., 895 E 7th, MN, 55106, St. Paul, USA
| | - Cindy N Kaigama
- SoLaHmo Partnership for Health and Wellness, Minnesota Community Care, Inc., 895 E 7th, MN, 55106, St. Paul, USA
| | - Marcela Alison
- SoLaHmo Partnership for Health and Wellness, Minnesota Community Care, Inc., 895 E 7th, MN, 55106, St. Paul, USA
| | - Michael Scandrett
- Minnesota Health Care Safety Net Coalition, 1113 East Franklin Ave #202B, Minneapolis, MN, 55404, USA
| | - Mai See Thao
- Department of Anthropology, Global Religions and Cultures, University of Wisconsin-Oshkosh, 800 Algoma Blvd, Oshkosh, WI, 54901, USA
| | - David J Satin
- Department of Family and Community Medicine, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
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