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Schubel L, Mete M, Fong A, Boxley C, Barac A, Gallagher C, Magee MF, Arem H. Understanding Perceptions of Care Coordination and Chronic Illness Management among Black Breast and Prostate Cancer Survivors and Providers: Findings from a Quality Improvement Study. J Ambul Care Manage 2024; 47:228-238. [PMID: 39028275 DOI: 10.1097/jac.0000000000000505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Navigating cancer care is complex and is exacerbated by pre-existing comorbidities managed by multiple providers. In this quality improvement study, we evaluated changes in perceived care coordination, navigation, and chronic illness care with community health worker (CHW) and mHealth support among Black breast cancer and prostate cancer patients with hypertension and/or diabetes. We collected patient and provider surveys on chronic illness care coordination at baseline and six months and found improvements in multiple domains. These findings support engaging CHWs to improve care coordination among cancer patients with comorbidities and demonstrate a use case of importance with emerging navigation reimbursement policies.
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Affiliation(s)
- Laura Schubel
- Author Affiliations: National Center for Human Factors in Healthcare, Healthcare Delivery Research (Ms Schubel), Implementation Science, Healthcare Delivery Research (Ms Schubel and Dr Arem), Center for Biostatistics, Informatics, and Data Science, Healthcare Delivery Research (Dr Mete and Messrs Fong and Boxley), MedStar Health Research Institute, Washington, District of Columbia; Heart and Vascular Institute (Dr Barac), MedStar Washington Hospital Center (Dr Gallagher), Diabetes and Research Institutes (Dr Magee), MedStar Health, Washington, District of Columbia; Department of Psychiatry, School of Medicine (Dr Mete), Department of Medicine, School of Medicine (Drs Barac and Magee), Department of Oncology (Dr Arem), Georgetown University, Washington, District of Columbia; and Heart and Vascular Institute, Inova Health System (Dr Barac), Falls Church, Virginia
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Scroggins JK, Harkins SE, Brown S, St Clair V, LeBron GK, Barcelona V. A systematic review of community-based interventions to address perinatal mental health. Semin Perinatol 2024; 48:151945. [PMID: 39033052 PMCID: PMC11377151 DOI: 10.1016/j.semperi.2024.151945] [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: 07/23/2024]
Abstract
Little is known about the scope and effectiveness of community-based interventions to address maternal perinatal mental health in the US. We searched PubMed, CINAHL, and PsychINFO in January 2024 to conduct a systematic review of studies using community-based interventions for maternal mental health from pregnancy to 1 year postpartum in the US. We reviewed 22 quantitative studies, and assessed methodological quality and effectiveness of interventions. Most were randomized trials (n = 16) with strong or good methodological quality. The majority of the studies included racially and ethnically diverse participants (n = 14), delivered interventions through community health workers, nurses, midwives, and doulas (n = 18), and had mixed effectiveness of interventions (n = 14). Limitations included small sample sizes, interventions not specifically developed for mental health, limited community involvement in designing interventions, and focus on participants with no mental health issues. Community partners augment this review with lived experience and recommendations for research and clinical practice.
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Affiliation(s)
- Jihye Kim Scroggins
- Columbia University School of Nursing, 560W 168th St, New York, NY 10032, USA
| | - Sarah E Harkins
- Columbia University School of Nursing, 560W 168th St, New York, NY 10032, USA
| | - Sevonna Brown
- Black Women's Blueprint, PO Box 24713, Cadman Plaza Park , Brooklyn, NY 11202, USA
| | - Victoria St Clair
- Caribbean Women's Health Association, 3512 Church Avenue, Brooklyn, NY 11203, USA
| | | | - Veronica Barcelona
- Columbia University School of Nursing, 560W 168th St, New York, NY 10032, USA.
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Majercak KR, Gorman EF, Robert NJ, Palmer B, Antwi HA, Mullins CD. Which social determinants of health have the highest impact in community oncology to advance patient care equity and improve health outcomes? A scoping review. Cancer Med 2024; 13:e70160. [PMID: 39240161 DOI: 10.1002/cam4.70160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 08/04/2024] [Accepted: 08/18/2024] [Indexed: 09/07/2024] Open
Abstract
INTRODUCTION To better understand the SDOH-health equity landscape within a community oncology setting to answer the research question, "Which SDOH can have the highest impact in community oncology to advance patient care equity and improve health outcomes?" METHODS Arksey and O'Malley's scoping review framework was used to identify evidence related to SDOH and health equity in community oncology. The study was guided by the "10-Step Framework for Continuous Patient Engagement" and a Community Advisory Board to assure relevance to patients and community providers. Literature was retrieved from literary databases and oncology organizations' websites. Eligible studies included discussion of SDOH and health equity as outlined by the World Health Organization and Centers for Disease Control and Prevention, respectively, and involved community oncology/cancer care in outpatient settings. Studies were excluded if the SDOH-health equity relationship was not discussed. RESULTS The review resulted in 61 exploratory and 17 confirmatory "intervention" studies addressing the impact of SDOH on health equity in community oncology settings. The most frequently SDOH-health equity pairs identified were the SDOH categories, social inclusion and non-discrimination, income and social protection, and structural conflict, all paired with the health equity category, access to care/treatment. Confirmatory studies focused on income and social protection (SDOH) and access to care/treatment (health equity); the SDOH categories, social inclusion and non-discrimination and health/general literacy-patient, paired with the health equity category, and adherence/compliance. CONCLUSIONS Literature highlights the SDOH and health equity relationship within the realm of oncology. Most studies on SDOH/health inequities in the community oncology setting are exploratory. There is the need to shift from documentation of cancer inequities to implementing solutions.
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Affiliation(s)
- Kayleigh R Majercak
- School of Pharmacy, University of Maryland Baltimore, Baltimore, Maryland, USA
- The PATIENTS Program, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Emily F Gorman
- Health Sciences and Human Services Library, University of Maryland Baltimore, Baltimore, Maryland, USA
| | | | - Barbara Palmer
- The PATIENTS Program, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Henry Asante Antwi
- School of Pharmacy, University of Maryland Baltimore, Baltimore, Maryland, USA
- The PATIENTS Program, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - C Daniel Mullins
- School of Pharmacy, University of Maryland Baltimore, Baltimore, Maryland, USA
- The PATIENTS Program, University of Maryland Baltimore, Baltimore, Maryland, USA
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Ahmed K, Presley-Cantrell L, Moeti R, Wong D, Freese KL, Taplin C, Rodrigue J, Spencer TD, Hacker K. The Community-Based Health Workforce in Public Health and Health Care Delivery. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:E264-E269. [PMID: 39041776 DOI: 10.1097/phh.0000000000001911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
CONTEXT The "community-based workforce" is an umbrella term used by a workgroup of U.S. Department of Health and Human Services (HHS) leaders to characterize a variety of job titles and descriptions for positions in the public health, health care delivery, and human service sectors across local communities. APPROACH Definitions, expectations of the scope of work, and funding opportunities for this workforce vary. To address some of these challenges, a workgroup of HHS agencies met to define the roles of this workforce and identify existing opportunities for training, career advancement, and compensation. DISCUSSION The community-based workforce has demonstrated success in improving poor health outcomes and addressing the social determinants of health for decades. However, descriptions of this workforce, expectations of their roles, and funding opportunities vary. The HHS workgroup identified that comprehensive approaches are needed within HHS and via public health sectors to meet these challenges and opportunities. CONCLUSION Using the common term "community-based workforce" across HHS can encourage alignment and collaboration. As the environment for this public health and health care community-based workforce shifts, it will be important to understand the value and opportunities available to ensure long-term sustainability for this workforce to continue to advance health equity.
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Affiliation(s)
- Kaha Ahmed
- Centers for Disease Control and Prevention, Atlanta, Georgia (Mss Ahmed and Moeti, Drs Presley-Cantrell and Hacker); Office of Minority Health, Rockville, Maryland (Dr Wong); Substance Abuse and Mental Health Services Administration, Kansas City, Missouri (Ms Freese); The Assistant Secretary for Planning and Evaluation, Washington, District of Columbia (Ms Taplin); Health Resources & Services Administration, Rockville, Maryland (Mss Rodrigue and Spencer)
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Spadoni N, Baron A, Zavala E, Burns M, Draw K, Hernandez W, Bennett J, Gleason L, Levine S. Community health worker training on older adults: A qualitative needs assessment. J Am Geriatr Soc 2024; 72:2825-2833. [PMID: 39016122 PMCID: PMC11368648 DOI: 10.1111/jgs.19077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/24/2024] [Accepted: 06/14/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Community health workers (CHWs) are frontline public health personnel who serve as liaisons between vulnerable patient populations and the healthcare system. They are instrumental in health promotion and education for urban-dwelling older adults. However, no research exists on training that CHWs receive on age-friendly health care. This article explores CHW education on the 4Ms of an Age-Friendly Health System and identifies areas where additional training may be necessary. METHODS As part of a two-pronged qualitative needs assessment, four focus groups were held with a total of 17 CHWs and semistructured interviews were conducted with 10 clinicians, including both healthcare providers and social workers. Focus group and interview transcripts were then analyzed for major themes in Dedoose, a qualitative coding software. RESULTS Clinicians most often identified Mentation and Mobility as areas where CHWs can have the greatest impact. Correspondingly, CHWs felt under-equipped to assist patients in these areas and expressed strong interest in additional training. In general, CHWs and clinicians agreed that Medications and What Matters do not fall under CHW scope of practice. CONCLUSIONS Our findings confirm the critical role that CHWs can play in promoting the health and well-being of urban-dwelling older adults. However, we also demonstrate that many CHWs lack adequate training in age-friendly care. To meet the social and medical needs of a rapidly aging US population, there is a pertinent need to develop a novel community health worker training curriculum on Mentation and Mobility.
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Affiliation(s)
- Nora Spadoni
- University of Chicago, Pritzker School of Medicine
| | - Aliza Baron
- UChicago Medicine, Section of Geriatrics and Palliative Medicine
| | - Elizabeth Zavala
- UChicago Medicine, Section of Geriatrics and Palliative Medicine
| | | | | | | | - Jenil Bennett
- UChicago Medicine, Section of Geriatrics and Palliative Medicine
| | - Lauren Gleason
- UChicago Medicine, Section of Geriatrics and Palliative Medicine
| | - Stacie Levine
- UChicago Medicine, Section of Geriatrics and Palliative Medicine
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Deaver JE, Uchuya GM, Cohen WR, Foote JA. A retrospective cohort study of a community-based primary care program's effects on pharmacotherapy quality in low-income Peruvians with type 2 diabetes and hypertension. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003512. [PMID: 39173046 PMCID: PMC11341050 DOI: 10.1371/journal.pgph.0003512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 06/30/2024] [Indexed: 08/24/2024]
Abstract
Little is known about the effects of the Chronic Care Model (CCM) and community health workers (CHWs) on pharmacotherapy of type 2 diabetes and hypertension in resource-poor settings. This retrospective cohort implementation study evaluated the effects of a community-based program consisting of CCM, CHWs, guidelines-based treatment protocols, and inexpensive freely accessible medications on type 2 diabetes and hypertension pharmacotherapy quality. A door-to-door household survey identified 856 adults 35 years of age and older living in a low-income Peruvian community, of whom 83% participated in screening for diabetes and hypertension. Patients with confirmed type 2 diabetes and/or hypertension participated in the program's weekly to monthly visits for < = 27 months. The program was implemented as two care periods employed sequentially. During home care, CHWs made weekly home visits and a physician made treatment decisions remotely. During subsequent clinic care, a physician attended patients in a centralized clinic. The study compared the effects of program (pre- versus post-) (N = 262 observations), and home versus clinic care periods (N = 211 observations) on standards of treatment with hypoglycemic and antihypertensive agents, angiotensin converting enzyme inhibitors, and low-dose aspirin. During the program, 80% and 50% achieved hypoglycemic and antihypertensive standards, respectively, compared to 35% and 8% prior to the program, RRs 2.29 (1.72-3.04, p <0.001) and 6.64 (3.17-13.9, p<0.001). Achievement of treatment standards was not improved by clinic compared to home care (RRs 1.0 +/- 0.08). In both care periods, longer retention in care (>50% of allowable time) was associated with achievement of all treatment standards. 85% compared to 56% achieved the hypoglycemic treatment standard with longer and shorter retention, respectively, RR 1.52 (1.13-2.06, p<0.001); 56% compared to 27% achieved the antihypertensive standard, RR 2.11 (1.29-3.45, p<0.001). In a dose-dependent manner, the community-based program was associated with improved guidelines-based pharmacotherapy of type 2 diabetes and hypertension.
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Affiliation(s)
| | | | - Wayne R. Cohen
- College of Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Janet A. Foote
- College of Public Health, University of Arizona, Tucson, Arizona, United States of America
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Basu S, Patel SY, Robinson K, Baum A. Financing Thresholds for Sustainability of Community Health Worker Programs for Patients Receiving Medicaid Across the United States. J Community Health 2024; 49:606-634. [PMID: 38311699 PMCID: PMC11306546 DOI: 10.1007/s10900-023-01290-w] [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] [Accepted: 09/28/2023] [Indexed: 02/06/2024]
Abstract
States have turned to novel Medicaid financing to pay for community health worker (CHW) programs, often through fee-for-service or capitated payments. We sought to estimate Medicaid payment rates to ensure CHW program sustainability. A microsimulation model was constructed to estimate CHW salaries, equipment, transportation, space, and benefits costs across the U.S. Fee-for-service rates per 30-min CHW visit (code 98960) and capitated rates were calculated for financial sustainability. The mean CHW hourly wage was $23.51, varying from $15.90 in Puerto Rico to $31.61 in Rhode Island. Overhead per work hour averaged $43.65 nationwide, and was highest for transportation among other overhead categories (65.1% of overhead). The minimum fee-for-service rate for a 30-min visit was $53.24 (95% CI $24.80, $91.11), varying from $40.44 in South Dakota to $70.89 in Washington D.C. The minimum capitated rate was $140.18 per member per month (95% CI $105.94, $260.90), varying from $113.55 in South Dakota to $176.58 in Washington D.C. Rates varied minimally by metro status but more by panel size. Higher Medicaid fee-for-service and capitated rates than currently used may be needed to support financial viability of CHW programs. A revised payment estimation approach may help state officials, health systems and plans discussing CHW program sustainability.
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Affiliation(s)
- Sanjay Basu
- Clinical Product Development, Waymark Care, San Francisco, USA.
| | - Sadiq Y Patel
- Department of Health Care Policy, Harvard Medical School, Boston, USA
| | - Kiiera Robinson
- Clinical Product Development, Waymark Care, San Francisco, USA
| | - Aaron Baum
- Icahn School of Medicine, Mount Sinai, New York, USA
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Wu J, Chen D, Li C, Wang Y. Effect of community-based public health service on health-related quality of life among middle-aged and older adults with chronic diseases in China. BMC Public Health 2024; 24:2039. [PMID: 39080595 PMCID: PMC11290236 DOI: 10.1186/s12889-024-19556-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The growing prevalence of non-communicable chronic diseases poses a significant public health challenge globally, particularly impacting the well-being of aging populations. This study aims to assess the impact of community-based public health service (PHS) on the health-related quality of life (HRQoL) among middle-aged and older adults with chronic diseases in China. METHODS Utilizing data from the China Health and Retirement Longitudinal Study, we constructed a novel scale based on the 36-Item Short Form Health Survey (SF-36) to measure the HRQoL of middle-aged and older patients with hypertension and/or type-2 diabetes. Multivariate linear regression models with Instrument Variables and Propensity Score Matching techniques were applied to examine the effect of PHS on the HRQoL of identified chronic disease patients. RESULTS Among 8,403 hypertensive and/or diabetic patients, only 10.98% had received PHS. After adjusting for covariates, PHS exhibited a significant association with an elevated overall SF-36 score (β = 3.539, p < 0.001). Similar effects were observed in the physical and mental component summary scores, with increases of 1.982 (p < 0.001) and 5.095 (p < 0.001), respectively. Sensitive analysis affirmed the robustness of these findings. Heterogeneity analysis revealed significant HRQoL improvements among males, females, those aged 70 and older, patients with comorbidities, and urban residents, while the effect was less pronounced in the middle-aged, those without comorbidities, or rural dwellers. CONCLUSION Community-based PHS has exerted a positive impact on both the physiological and psychological aspects of HRQoL among middle-aged and older chronic disease patients, with effects varying among individuals with different characteristics. Our findings advocate for enhancing the delivery and utilization of government-funded PHS, increasing health literacy, and promoting early prevention strategies for chronic diseases. Furthermore, targeted health management initiatives for patients with comorbidities and enhancements in the quality of community healthcare services, particularly in rural areas, are deemed necessary.
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Affiliation(s)
- Jingxian Wu
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China.
| | - Danlei Chen
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China
| | - Cong Li
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China
| | - Yingwen Wang
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China
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Kithulegoda N, Williams C, Senthilmurugan A, Aimola S, Atkinson J, Banerjee AT, Bazeghi F, Bender JL, Flynn S, Ghatage L, Goulbourne E, Grunfeld E, Heisey R, Rao A, Sutcliffe K, Lofters A, Ivers NM. Assessing the effectiveness of "BETTER Women", a community-based, primary care-linked peer health coaching programme for chronic disease prevention: protocol for a pragmatic, wait-list controlled, type 1 hybrid effectiveness-implementation trial. BMJ Open 2024; 14:e085933. [PMID: 39053957 DOI: 10.1136/bmjopen-2024-085933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION The Building on Existing Tools to Improve Cancer and Chronic Disease Prevention and Screening in Primary Care (BETTER) programme trains allied health professionals working in primary care settings to develop personalised chronic disease 'prevention prescriptions' with patients. However, maintenance of health behaviour changes is difficult without ongoing support. Sustainable options to enhance the BETTER programme and ensure accessibility to underserved populations are needed. We designed the BETTER Women programme, which uses a digital app to match patients with a trained peer health coach (PHC) who provides ongoing support for health behaviour change after receipt of a BETTER prevention prescription in primary care. METHODS AND ANALYSIS We will conduct a type 1 hybrid implementation-effectiveness patient-randomised trial. Interested women aged 40-68 years will be recruited from three large, sociodemographically distinct primary care clinics (urban, suburban and rural). Patients will be randomised 1:1 to intervention or wait-list control after receipt of their BETTER prevention prescription. We will aim to recruit 204 patients per group (408 total). Effectiveness will be assessed by the primary outcome of targeted behaviours achieved for each participant at 6 months, consisting of three cancer screening tests (cervical, breast and colorectal) and four behavioural determinants of cancer and chronic disease (diet, smoking, alcohol use and physical activity). Data will be collected through patient survey and clinical chart review, measured at 3, 6 and 12 months. Implementation outcomes will be assessed through patient surveys and interviews with patients, peer health coaches and healthcare providers. An embedded economic evaluation will examine cost per quality-adjusted life-year and per additional health behavioural targets achieved. ETHICS AND DISSEMINATION This study has been approved by Women's College Hospital Research Ethics Board (REB), the Royal Victoria Regional Health Centre REB and the University of Toronto REB. All participants will provide informed consent prior to enrolment. Participation is voluntary and withdrawal will have no impact on the usual care received from their primary care provider. The results of this trial will be published in peer-reviewed journals and shared via conference presentations. Deidentified datasets will be shared on request, after publication of results. TRIAL REGISTRATION NUMBER NCT04746859.
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Affiliation(s)
- Natasha Kithulegoda
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Camille Williams
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Aranee Senthilmurugan
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Sabrina Aimola
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - John Atkinson
- Ontario Public Health Association, Toronto, ON, Canada
| | - Ananya Tina Banerjee
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Farnaz Bazeghi
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Jacqueline L Bender
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Susan Flynn
- Canadian Cancer Society, Toronto, ON, Canada
| | | | - Elaine Goulbourne
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Ruth Heisey
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Anjana Rao
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | | | - Aisha Lofters
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada
| | - Noah M Ivers
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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Foley S, Flowers A, Hall T, Jansen MT, Burcin M. "That Was an Eye Opener for Me": Mixed-Methods Outcomes Educating Texas Community Health Workers on HPV Vaccination Using Project ECHO ®. Vaccines (Basel) 2024; 12:806. [PMID: 39066444 PMCID: PMC11281520 DOI: 10.3390/vaccines12070806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/11/2024] [Accepted: 07/14/2024] [Indexed: 07/28/2024] Open
Abstract
Human papillomavirus (HPV) is known to cause six different types of cancer. HPV vaccination can prevent over 90% of these cancers. Community health workers (CHWs) have the potential to drive HPV vaccination demand through education and navigation by addressing vaccine hesitancy and dis/misinformation and by reaching non-English speaking, vulnerable, or rural populations. Despite their possible reach, there is limited research on HPV vaccination education programs for CHWs. In 2020-2021, the American Cancer Society (ACS) HPV Cancer Free Texas (HPVCFT) Project implemented the eight-session Mission: HPVCFT Vaccination ECHO-CHW Program ten times. This manuscript details the program's implementation processes and outcomes. The program used the Project ECHO model and was offered in both English and Spanish. One hundred and forty-six Texan CHWs completed pre- and post-training surveys. The participants demonstrated significant HPV vaccination knowledge increases and desirable shifts in their foundational HPV vaccination beliefs, including the belief that the HPV vaccine is for cancer prevention. The participants also reported increased confidence in communicating about the HPV vaccine in the community. Improving knowledge, beliefs, and confidence in HPV vaccination is the first step in addressing concerns and increasing uptake. Future research and interventions are needed to better understand how CHWs can be more systematically linked to vaccination opportunities or provided with clearer paths for directing patients to providers that vaccinate.
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Affiliation(s)
- Shaylen Foley
- Interventions and Implementation Department, American Cancer Society, 3380 Chastain Meadows Pkwy NW, Suite 20, Kennesaw, GA 30144, USA; (A.F.); (M.B.)
| | - Ashleigh Flowers
- Interventions and Implementation Department, American Cancer Society, 3380 Chastain Meadows Pkwy NW, Suite 20, Kennesaw, GA 30144, USA; (A.F.); (M.B.)
| | - Tralisa Hall
- Interventions and Implementation Department, American Cancer Society, 3380 Chastain Meadows Pkwy NW, Suite 20, Kennesaw, GA 30144, USA; (A.F.); (M.B.)
| | | | - Michelle Burcin
- Interventions and Implementation Department, American Cancer Society, 3380 Chastain Meadows Pkwy NW, Suite 20, Kennesaw, GA 30144, USA; (A.F.); (M.B.)
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Teehan E, Phord-Toy A, Venkatapuram P, Kan KM. Creating a community advisory board for pediatric bladder health. Front Pediatr 2024; 12:1396003. [PMID: 39081924 PMCID: PMC11287218 DOI: 10.3389/fped.2024.1396003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/14/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Pediatric lower urinary tract symptoms (LUTS) are highly prevalent in neurologically healthy school-aged children. However, no evidence-based programs exist to prevent or treat LUTS in the community setting. To address this, we established the first community advisory board (CAB) that aims to identify individual and societal structures impacting pediatric bladder health in Northern California's Bay Area and co-design culturally relevant bladder health interventions. Methods Probability and non-probability sampling methods were used to recruit community stakeholders to the CAB. Our final CAB comprised of two parents, two community health workers, one educator, one pediatric urology registered nurse, and one pediatrician. The CAB met quarterly during the 1-year study period. Results Bi-directional feedback identified community-level barriers to bladder health, particularly in the school environment, and the need for tailored resources to teach children and families about healthy bladder behaviors. Discussion The CAB co-designed school-based bladder health interventions, including bladder health posters, and provided feedback on three school-based research study proposals. The CAB will continue to guide and inform future community-engaged research efforts.
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Affiliation(s)
| | | | | | - Kathleen M. Kan
- School of Medicine, Stanford University, Stanford, CA, United States
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Rex J, Fifer N, Johnson-Webb KD, Menich M, Horn A, Salamone C, T Renzhofer Pappada H, Arsene C, Martin C, Cunningham M. "She's a Family Member": How Community Health Workers Impact Perinatal Mothers' Stress Through Social-Emotional Support and Connections to Programs and Resources. Health Equity 2024; 8:469-479. [PMID: 39011078 PMCID: PMC11249134 DOI: 10.1089/heq.2024.0038] [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] [Accepted: 05/05/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction This study examines whether being a client in the Northwest Ohio Pathways HUB program reduces stress and improves mental wellbeing for perinatal mothers. The HUB works to improve health by connecting mothers to community health workers (CHWs) who assess mothers' risk factors and connect them to evidence-based care pathways to reduce known risks associated with adverse birth outcomes. Methods A one-time survey of 119 mothers in the program and monthly semi-structured interviews with 41 mothers, totaling 220 interviews. Results Almost all mothers reported significantly reduced stress after joining the program. The majority also reported an improved sense of safety, security, and hope. Interviews show additional moderate reductions in stress over time while being a program client. Interviews also indicate that mothers' relationship with their CHW is key to these improvements: CHW provide social-emotional support, access to tangible goods, and help navigating social service bureaucracies. Discussion The results support the broader literature on the health benefits of community health workers and address identified gaps within the literature, which has infrequently studied CHWs in the perinatal context. Conclusion CHWs may be one way to address racial inequity in birth outcomes linked to infant mortality, given research on the links between inequitable exposure to stressors, the impacts of racism-induced stress, and preterm and low birth weight babies. Further, the findings indicate the need to better support CHWs, and the programs that utilize them, with increased funding, insurance reimbursement, and certification.
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Affiliation(s)
- Justin Rex
- Political Science, Bowling Green State University, Bowling Green, Ohio, USA
| | - Nichole Fifer
- Center for Regional Development, Bowling Green State University, Bowling Green, Ohio, USA
| | - Karen D Johnson-Webb
- School of Earth, Environment, & Society, Bowling Green State University, Bowling Green, Ohio, USA
| | - Maddi Menich
- Center for Regional Development, Bowling Green State University, Bowling Green, Ohio, USA
| | | | | | | | - Camelia Arsene
- ProMedica Health System, University of Toledo School of Population Health, Toledo, Ohio, USA
| | | | - Malcolm Cunningham
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Mayor's Office of Neighborhood Safety and Engagement, City of Toledo, Office of the Mayor, Toledo, Ohio, USA
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McAtee CM, Baker JT, DeWolf BM, Sheridan MN, George EM, Sutton NA. Evaluation of a Cardiovascular Disease/Diabetes Mellitus Expansion Program for Community Health Workers Employed by Rhode Island Community Health Teams. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:S18-S26. [PMID: 38870356 DOI: 10.1097/phh.0000000000001896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
CONTEXT The integration of certified community health workers (CCHWs) with specialty chronic disease training into clinical care teams has demonstrated improvements in chronic disease quality of care, management, and outcomes. PROGRAM Rhode Island Department of Health's Diabetes, Heart Disease, and Stroke Program expanded the roles of CCHWs employed by Community Health Teams for chronic disease with a focus on cardiovascular disease (CVD) and diabetes mellitus (DM) from 2020 to 2023. Rhode Island Department of Health's Diabetes, Heart Disease, and Stroke Program sought to determine whether patient health behaviors and clinical outcomes improved with specialty trained CCHW support. IMPLEMENTATION Community Health Teams identified high-risk or rising-risk patients with hypertension, high cholesterol, and/or diabetes. During an infrastructure phase, patients were assigned a CCHW who had not received CVD/DM specialty training. During a performance phase, a separate cohort of patients was assigned a CVD/DM specialty-trained CCHW. In each phase, patients were seen by the CCHWs at least twice and completed baseline and follow-up health assessments. The trained CCHWs utilized the baseline assessment to offer health coaching specific to the patient's chronic disease-related needs. EVALUATION Improvements in blood pressure readings and cholesterol were observed at an individual level for CVD patients. However, a significant difference was not observed for hypertension or high cholesterol when comparing phases. Individual-level results indicated improved HbA1c values for DM patients; however, the differences in clinical values were not significant. Although there were no significant differences for clinical values between the phases, the proportion of patients who reported confidence in managing their condition(s) increased from baseline to follow-up for both phases. DISCUSSION It cannot be concluded that specialty-trained CCHWs have significant impact on patient behaviors and clinical outcomes. However, overall CCHW intervention did result in improved self-efficacy in patients to manage their chronic conditions. Further evaluation is needed to understand what factors led to improved patient confidence levels.
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Affiliation(s)
- Cali M McAtee
- Author Affiliations: Rhode Island Department of Health, Center for Chronic Care and Disease Management, Providence, Rhode Island (Mss McAtee, DeWolf, Sheridan, and Sutton, and Mr Baker); and JSI Research and Training Institute, Boston, Massachusetts (Ms George)
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14
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Kim SE, Turner BJ, Steinberg J, Solano L, Hoffman E, Saluja S. Partners in vaccination: A community-based intervention to promote COVID-19 vaccination among low-income homebound and disabled adults. Disabil Health J 2024; 17:101589. [PMID: 38341354 DOI: 10.1016/j.dhjo.2024.101589] [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] [Received: 09/30/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Care managers (CM) for low-income disabled clients may address COVID-19 vaccine hesitancy with specific training. OBJECTIVE To assess the Partners in Vaccination (PIV) that trained CMs of a homecare program for disabled adults to promote COVID-19 vaccination. METHODS We randomized 78 CMs to PIV intervention (N = 38) or control (N = 40). PIV featured motivational interviewing (MI) skills and educational materials for unvaccinated clients. The primary outcome was first COVID-19 vaccination between December 1, 2021 and June 30, 2022 for clients of intervention CMs versus control CMs. Mixed method analysis included key informant interviews conducted from 5/24/22 to 7/25/22 with CMs, administrators, and clients about the PIV intervention. RESULTS Among 1939 clients of 78 study CMs, 528 (26.8 %) were unvaccinated by December 1, 2021 (274 clients of intervention CMs; 254 clients of control CMs). These clients' mean age was 62.3 years old (SD = 22.4) and 54 % were Black or Hispanic/Latino. First vaccination rate did not differ for intervention and control groups (6.2 % vs. 5.9 %, p = .89) by 6/30/2022. Barriers to addressing COVID-19 vaccination from interviews with 7 CMs and administrators were competing responsibilities and potentially antagonizing clients. Seven interviewed clients (five vaccinated and two unvaccinated) cited concerns about vaccination they heard from their family/friends and belief that risks of COVID-19 infection may be less than vaccination. Yet, some clients were receptive to physician recommendations. CONCLUSION Training CMs to promote COVID-19 vaccination for disabled clients did not increase first vaccination rates. CMs preferred their usual role of coordinating care and, even after the training, expressed discomfort with this potentially polarizing topic.
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Affiliation(s)
- Sue E Kim
- Keck School of Medicine of University of Southern California, Department of Population and Public Health Sciences, 1845 N. Soto Street, Los Angeles, CA, 90089-9239, USA; Gehr Family Center for Health Systems Science and Innovation, Keck Medicine of University of Southern California, 2250 Alcazar Street, Los Angeles, CA, 90033, USA.
| | - Barbara J Turner
- Gehr Family Center for Health Systems Science and Innovation, Keck Medicine of University of Southern California, 2250 Alcazar Street, Los Angeles, CA, 90033, USA.
| | - Jane Steinberg
- Keck School of Medicine of University of Southern California, Department of Population and Public Health Sciences, 1845 N. Soto Street, Los Angeles, CA, 90089-9239, USA.
| | - Laura Solano
- Gehr Family Center for Health Systems Science and Innovation, Keck Medicine of University of Southern California, 2250 Alcazar Street, Los Angeles, CA, 90033, USA.
| | - Eric Hoffman
- University of Southern California/Los Angeles General Medical Center Internal Medicine Residency Program, 2020 Zonal Avenue, IRD, 620, Los Angeles, CA, 90033, USA.
| | - Sonali Saluja
- Gehr Family Center for Health Systems Science and Innovation, Keck Medicine of University of Southern California, 2250 Alcazar Street, Los Angeles, CA, 90033, USA.
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15
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Keller AO, Ohlendorf JM. Engagement in physical activity among African American women caregivers: a cross-sectional study. J Women Aging 2024; 36:286-298. [PMID: 38441910 DOI: 10.1080/08952841.2024.2325201] [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] [Received: 06/19/2023] [Accepted: 02/26/2024] [Indexed: 06/18/2024]
Abstract
Family caregivers and African Americans often do not achieve the recommended 150 minutes of moderate-intensity aerobic activity per week. Factors associated with engaging in physical activity among African American caregivers have not been systematically examined. This cross-sectional study examined how contextual factors were associated with meeting the recommended amount of physical activity among African American women caregivers. We used a population-based sample of 1,478 African American women caregivers in the U.S. from the 2015, 2017, and 2019 Behavioral Risk Factor Surveillance System. We used survey-weighted multivariate regression analyses to examine associations between condition-specific factors, physical and social environment, and individual and family factors and meeting the national aerobic physical activity guideline (i.e., participating in 150 minutes (or vigorous equivalent minutes) of physical activity per week). Over half (53.9%) of African American women caregivers in the U.S. did not meet the guideline. Being age 65 years or older was associated with decreased odds of meeting the guideline compared to being between the ages of 25-44 years (OR = 0.50, 95% CI[0.26-0.99]). Compared to college graduates, women with partial college education had higher odds of meeting the guideline (OR = 2.08, 95%CI[1.24-3.51]). Having health insurance was associated with increased odds of meeting the guideline (OR = 2.28, 95%CI[1.12-4.63]). Our findings suggest several contextual factors are independently associated with meeting the national guideline. Understanding the relationships between contextual factors and engaging in physical activity among African American women caregivers can inform interventions aimed at protecting and promoting the health of these women.
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Affiliation(s)
- Abiola O Keller
- College of Nursing, Marquette University, Milwaukee, WI, USA
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Stevens ER, Thomas J, Martinez-Lopez N, Fagerlin A, Ciprut S, Shedlin M, Gold HT, Li H, Davis JK, Campagna A, Bhat S, Warren R, Ubel P, Ravenell JE, Makarov DV. Limited Evidence of Shared Decision Making for Prostate Cancer Screening in Audio-Recorded Primary Care Visits Among Black Men and their Healthcare Providers. J Immigr Minor Health 2024:10.1007/s10903-024-01606-5. [PMID: 38822923 DOI: 10.1007/s10903-024-01606-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2024] [Indexed: 06/03/2024]
Abstract
Prostate-specific antigen (PSA)-based prostate cancer screening is a preference-sensitive decision for which experts recommend a shared decision making (SDM) approach. This study aimed to examine PSA screening SDM in primary care. Methods included qualitative analysis of audio-recorded patient-provider interactions supplemented by quantitative description. Participants included 5 clinic providers and 13 patients who were: (1) 40-69 years old, (2) Black, (3) male, and (4) attending clinic for routine primary care. Main measures were SDM element themes and "observing patient involvement in decision making" (OPTION) scoring. Some discussions addressed advantages, disadvantages, and/or scientific uncertainty of screening, however, few patients received all SDM elements. Nearly all providers recommended screening, however, only 3 patients were directly asked about screening preferences. Few patients were asked about prostate cancer knowledge (2), urological symptoms (3), or family history (6). Most providers discussed disadvantages (80%) and advantages (80%) of PSA screening. Average OPTION score was 25/100 (range 0-67) per provider. Our study found limited SDM during PSA screening consultations. The counseling that did take place utilized components of SDM but inconsistently and incompletely. We must improve SDM for PSA screening for diverse patient populations to promote health equity. This study highlights the need to improve SDM for PSA screening.
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Affiliation(s)
- Elizabeth R Stevens
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
| | - Jerry Thomas
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Department of Urology, NYU Langone Health, New York, NY, USA
- VA New York Harbor Healthcare System, New York, NY, USA
| | | | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah Spencer Eccles School of Medicine, Salt Lake City, UT, USA
- VA Salt Lake City Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA
| | - Shannon Ciprut
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Department of Urology, NYU Langone Health, New York, NY, USA
- VA New York Harbor Healthcare System, New York, NY, USA
| | | | - Heather T Gold
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Huilin Li
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - J Kelly Davis
- The Fuqua School of Business, Duke University, Durham, NC, USA
| | - Ada Campagna
- The Fuqua School of Business, Duke University, Durham, NC, USA
| | | | - Rueben Warren
- National Center for Bioethics in Research and Health Care, Tuskegee University, Tuskegee, USA
| | - Peter Ubel
- The Fuqua School of Business, Duke University, Durham, NC, USA
| | - Joseph E Ravenell
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Danil V Makarov
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Department of Urology, NYU Langone Health, New York, NY, USA
- VA New York Harbor Healthcare System, New York, NY, USA
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Nielsen VM, Ursprung WWS, Song G, Hirsch G, Mason T, Santarelli C, Guimaraes E, Marshall E, Allen CG, Lei PP, Brown D, Behl-Chadha B. The Launch of Massachusetts Community Health Worker Certification: Findings From the Massachusetts Community Health Worker Workforce Surveys. Public Health Rep 2024:333549241253419. [PMID: 38807371 DOI: 10.1177/00333549241253419] [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: 05/30/2024] Open
Abstract
OBJECTIVES The launch of state certification for community health workers (CHWs) in Massachusetts in 2018 aimed to promote and champion this critical workforce. However, concerns exist about unintentional adverse effects of certification. Given this, we conducted 2 cross-sectional surveys to evaluate this certification policy. METHODS We conducted surveys of CHW employers and CHWs in 3 sample frames: community health centers and federally qualified health centers, acute-care hospitals, and community-based organizations. We administered the surveys in 2016 (before certification launch) and 2021 (after certification launch) to answer the following questions: Was certification associated with positive outcomes among CHWs after its launch? Did harmful shifts occur among the CHW workforce and employers after certification launch? Was certification associated with disparities among CHWs after its launch? RESULTS Certification was associated with higher pay among certified (vs noncertified) CHWs, better perceptions of CHWs among certified (vs noncertified) CHWs, and better integration of certified (vs noncertified) CHWs into care teams. We found no adverse shifts in CHW workforce by sociodemographic variables or in CHW employer characteristics (most notably CHW employer hiring requirements) after certification launch. After certification launch, certified and uncertified CHWs had similar demographic and educational characteristics. However, certified CHWs more often worked in large, clinical organizations while uncertified CHWs most often worked in medium-sized community-based organizations. CONCLUSIONS Our evaluation of Massachusetts CHW certification suggests that CHW certification was not associated with workforce disparities and was associated with positive outcomes. Our study fills a notable gap in the research literature and can guide CHW research agendas, certification efforts in Massachusetts and other states, and program efforts to champion this critical, grassroots workforce.
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Affiliation(s)
- Victoria M Nielsen
- Office of Population Health, Massachusetts Department of Public Health, Boston, MA, USA
| | - W W Sanouri Ursprung
- Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA, USA
| | - Glory Song
- Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA, USA
| | - Gail Hirsch
- Office of Community Health Workers, Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA, USA
| | - Theresa Mason
- Office of Community Health Workers, Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA, USA
| | - Claire Santarelli
- Bureau of Community Health and Prevention, Division of Health Protection and Promotion, Massachusetts Department of Public Health, Boston, MA, USA
| | - Erica Guimaraes
- ForHealth Consulting, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Erica Marshall
- Bureau of Community Health and Prevention, Division of Community-Based Prevention and Care, Massachusetts Department of Public Health, Boston, MA, USA
| | - Caitlin G Allen
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Pei-Pei Lei
- Office of Survey Research, University of Massachusetts Chan Medical School, Shrewsbury, MA, USA
| | - Diane Brown
- Office of Survey Research, University of Massachusetts Chan Medical School, Shrewsbury, MA, USA
| | - Bittie Behl-Chadha
- Office of Survey Research, University of Massachusetts Chan Medical School, Shrewsbury, MA, USA
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Fritz M, Grimm M, My Hanh HT, Koot JAR, Nguyen GH, Nguyen TPL, Probandari A, Widyaningsih V, Lensink R. Effectiveness of community-based diabetes and hypertension prevention and management programmes in Indonesia and Viet Nam: a quasi-experimental study. BMJ Glob Health 2024; 9:e015053. [PMID: 38777393 PMCID: PMC11116884 DOI: 10.1136/bmjgh-2024-015053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Non-communicable diseases (NCDs) have surpassed infectious diseases as the leading global cause of death, with the Southeast Asian region experiencing a significant rise in NCD prevalence over the past decades. Despite the escalating burden, screening for NCDs remains at very low levels, resulting in undetected cases, premature mortality and high public healthcare costs. We investigate whether community-based NCD prevention and management programmes are an effective solution. METHODS In Indonesia, we compare participants in the community-based NCD screening and management programme Pos Pembinaan Terpadu-Penyakit Tidak Menular with matched non-participants with respect to their uptake of screening activities, health-related behaviour and knowledge and metabolic risk factors. We use statistical matching to redress a possible selection bias (n=1669). In Viet Nam, we compare members of Intergenerational Self-Help Clubs, which were offered similar NCD health services, with members of other community groups, where such services were not offered. We can rely on two waves of data and use a double-difference approach to redress a possible selection bias and to measure the impacts of participation (n=1710). We discuss strengths and weaknesses of the two approaches in Indonesia and Viet Nam. RESULTS In Indonesia, participants have significantly higher uptake of screening for hypertension and diabetes (+13% from a control mean of 88% (95% CI 9% to 17%); +93% from a control mean of 48% (95% CI 79% to 108%)). In both countries, participants show a higher knowledge about risk factors, symptoms and complications of NCDs (Indonesia: +0.29 SD (0.13-0.45), Viet Nam: +0.17 SD (0.03-0.30)). Yet, the improved knowledge is only partly reflected in improved health behaviour (Viet Nam: fruit consumption +0.33 SD (0.15-0.51), vegetable consumption +0.27 SD (0.04-0.50)), body mass index (BMI) (Viet Nam: BMI -0.07 SD (-0.13 to -0.00)) or metabolic risk factors (Indonesia: systolic blood pressure: -0.13 SD (-0.26 to -0.00)). CONCLUSION Community-based NCD programmes are well suited to increase screening and to transmit health knowledge. Due to their extensive outreach within the community, they can serve as a valuable complement to the screening services provided at the primary healthcare level. Yet, limited coverage, insufficient resources and a high staff turnover remain a problem. TRIAL REGISTRATION NUMBER NCT05239572.
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Affiliation(s)
- Manuela Fritz
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, The Netherlands
- School of Business, Economics and Information Systems, University of Passau, Passau, Germany
| | - Michael Grimm
- School of Business, Economics and Information Systems, University of Passau, Passau, Germany
- IZA Institute of Labor Economics, Bonn, Germany
| | | | - Jaap A R Koot
- Department of Health Sciences, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Thi-Phuong-Lan Nguyen
- Faculty of Public Health, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen City, Viet Nam
| | - Ari Probandari
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Central Java, Indonesia
| | - Vitri Widyaningsih
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Central Java, Indonesia
| | - Robert Lensink
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, The Netherlands
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McCarville E, Martin MA, Pratap P, Pinsker E, Seweryn SM, Peters KE. Understanding critical factors associated with integration of community health workers into health and hospital systems. J Interprof Care 2024; 38:507-516. [PMID: 36946323 DOI: 10.1080/13561820.2023.2183183] [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] [Received: 01/15/2021] [Accepted: 01/07/2023] [Indexed: 03/23/2023]
Abstract
Community health worker (CHW) models have been shown to improve health behaviors and health outcomes and reduce cost, particularly among low-income underserved populations. Consequently, health systems are increasingly employing CHWs to provide health services in clinical environments. A growing body of the literature suggests that effective integration of CHWs within the healthcare system is important to achieve the desired outcomes, but the question of how to achieve effective integration is less clear. This study seeks to explore the integration of CHWs within a large state university health system to identify factors critical to the effective integration of CHWs into the clinical care environment. We conducted a qualitative descriptive multiple embedded case study of the University of Illinois at Chicago's Hospital and Health Science System (UI Health). The embedded subunits of analysis were teams within the UI Health System that currently employ CHWs to assist with the provision of clinical care or services to patients. Data were collected via semi-structured interviews and document review. In total, six sub-units were enrolled, and 17 interviews were conducted with CHWs (n = 9), and administrators or healthcare providers (n = 8). Fourteen factors related to effective CHW integration were identified and organized in four categories: individual, team, organization, and community. Findings suggest that in addition to commonly recognized elements of effective CHW models including training, supervision, and the presence of a champion, programs must consider the organizational context in which the program is positioned as well as the ways in which both CHWs and the organization engage with communities served. This research can serve as a roadmap for health systems that seek to integrate CHWs within healthcare services and can be used to promote best practice in CHW integration.
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Affiliation(s)
- Erin McCarville
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Molly A Martin
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Preethi Pratap
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Eve Pinsker
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Steven M Seweryn
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Karen E Peters
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
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Elizabeth AJ, Aruna J, Mercy PJ. Lifestyle Interventions vs. Multi Interventional Therapy on Physiological Parameters of Metabolic Syndrome among Women: A Comparative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2024; 29:373-378. [PMID: 39100403 PMCID: PMC11296594 DOI: 10.4103/ijnmr.ijnmr_417_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 10/21/2023] [Accepted: 11/14/2023] [Indexed: 08/06/2024]
Abstract
Background Metabolic syndrome is one of the emerging health issues in developing countries. It includes diabetes, high Blood Pressure (BP), obesity, and elevated blood cholesterol. Materials and Methods This comparative study was conducted from March 2019 to February 2020 in selected areas of Ernakulam district, Kerala. The study used a quasi-experimental design with a nonequivalent control group. One-way analysis of variance and paired t-tests were used for statistical analysis. Women (aged between 35 and 55 years) with metabolic syndrome were recruited by multistage sampling (N = 220) and randomly assigned into three groups: (a) control, (b) Lifestyle Interventions (LI), and (c) Multi Interventional Therapy (MIT). LI was given to the LI group, and reflexology foot massage along with LI was given to the MIT group for 12 weeks. The control group received routine care. Physiological variables were assessed before and after the intervention. Results Women who received MIT and LI had significantly lower values of weight, Body Mass Index (BMI), and waist circumference after the treatment from baseline and compared with control (F = 12.09, 15.58, 22.37, p < 0.001). A remarkable change in systolic and diastolic BP was found in the MIT group (pretest mean of systolic BP and diastolic BP in control: 142.3 and 90.1, LI: 141.7 and 89.7, MIT: 141.8 and 89.8, p = 0.945, posttest means control: 142.6 and 90.4, LI: 131.5 and 85.5, MIT: 118.5 and 78.3, (F = 54.83, 57.87, p < 0.001). Conclusions Both LI and MIT should be considered as interventions for reducing the physiological parameters of metabolic syndrome, such as body weight, BMI, and obesity. MIT was found to be more effective in reducing blood pressure.
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Affiliation(s)
- A. J. Elizabeth
- Vice Principal, Department of Medical Surgical Nursing, Sree Sudheendra College of Nursing, Ambalamedu, Ernakulam, Kerala, India
| | - J Aruna
- Assistant Professor, Department of Nursing, Jazan University, Saudi Arabia
| | - P. J. Mercy
- Assistant Professor, Academic Staff College, Kerala University of Health Sciences, Thrissur, Kerala, India
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Irvin VL, Kile ML, Lucas-Woodruff C, Cude C, Anderson L, Baylog K, Hovell MF, Choun S, Kaplan RM. An overview of the Be Well Home Health Navigator Program to reduce contaminants in well water: Design and methods. Contemp Clin Trials 2024; 140:107497. [PMID: 38471641 PMCID: PMC11065571 DOI: 10.1016/j.cct.2024.107497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/23/2024] [Accepted: 03/08/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The Be Well Home Health Navigator Program is a prospective, randomized controlled trial (RCT) implemented to compare a community health navigator program to usual care program to reduce contaminants in drinking water. DESIGN AND SETTING This 4-year two-armed RCT will involve well owners in Oregon that have private drinking water wells that contain arsenic, nitrate, or lead above maximum contaminant levels. INTERVENTION The intervention leverages the trusted relationship between Cooperative Extension Service (CES) Community Educators and rural well owners to educate, assist and motivate to make decisions and set actionable steps to mitigate water contamination. In this study, CES will serve as home health navigators to deliver: 1) individualized feedback, 2) positive reinforcement, 3) teach-back moments, 4) decision-making skills, 5) navigation to resources, 6) self-management, and 7) repeated contact for shaping and maintenance of behaviors. Usual care includes information only with no access to individual meetings with CES. MEASURABLE OUTCOMES Pre-specified primary outcomes include 1) adoption of treatment to reduce exposure to arsenic, nitrate, or lead in water which may include switching to bottled water and 2) engagement with well stewardship behaviors assessed at baseline, and post-6 and 12 months follow-up. Water quality will be measured at baseline and 12-month through household water tests. Secondary outcomes include increased health literacy scores and risk perception assessed at baseline and 6-month surveys. IMPLICATIONS The results will demonstrate the efficacy of a domestic well water safety program to disseminate to other CES organizations. TRIAL REGISTRATION NUMBER NCT05395663.
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Affiliation(s)
| | - Molly L Kile
- Oregon State University, College of Health, Corvallis, OR, USA
| | | | | | - Lilly Anderson
- Oregon State University, College of Health, Corvallis, OR, USA
| | - Kara Baylog
- Oregon State University, Extension Service, Southern Oregon Research and Extension Center, OR, USA
| | | | - Soyoung Choun
- Oregon State University, College of Health, Corvallis, OR, USA
| | - Robert M Kaplan
- Clinical Excellence Research Center, Stanford University School of Medicine, Palo Alto, CA, USA
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Ignoffo S, Gu S, Ellyin A, Benjamins MR. A Review of Community Health Worker Integration in Health Departments. J Community Health 2024; 49:366-376. [PMID: 37828419 PMCID: PMC10924716 DOI: 10.1007/s10900-023-01286-6] [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] [Accepted: 09/12/2023] [Indexed: 10/14/2023]
Abstract
Community health workers (CHWs) are frontline public health workers who bridge the gap between historically marginalized communities, healthcare, and social services. Increasingly, states are developing the CHW workforce by implementing training and certification policies. Health departments (HDs) are primarily responsible for community health through policy implementation and provision of public health services. The two objectives of this study are to explore: (1) state progress in establishing CHW training and certification policies, and (2) integration of CHWs in HD workforces. In this scoping review, we searched PubMed, CINAHL, and Google Scholar for articles published between 2012 and 2022. We looked for articles that discussed state-level certification and training for CHWs and those covering CHWs working with and for city, county, state, and federal HDs. We excluded studies set outside of the US or published in a language other than English. Twenty-nine studies were included for review, documenting CHWs working at all levels of HDs. Within the included studies, HDs often partner with organizations that employ CHWs. With HD-sponsored programs, CHWs increased preventative care, decreased healthcare costs, and decreased disease risk in their communities. Almost all states have begun developing CHW training and certification policies and are at various points in the implementation. HD-sponsored CHW programs improved the health of marginalized communities, whether CHWs were employed directly by HDs or by a partner organization. The success of HD-sponsored CHW programs and state efforts around CHW training and certification should encourage increased investment in CHW workforce development within public health.
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Affiliation(s)
| | - Shannon Gu
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Alexander Ellyin
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Maureen R Benjamins
- Sinai Urban Health Institute, Chicago, IL, USA
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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Webber E, Bishop S, Drain PK, Dupuis V, Garza L, Gregor C, Hassell L, Ibarra G, Kessler L, Ko L, Lambert A, Lyon V, Rowe C, Singleton M, Thompson M, Warne T, Westbroek W, Adams A. Critical lessons from a pragmatic randomized trial of home-based COVID-19 testing in rural Native American and Latino communities. J Rural Health 2024. [PMID: 38449317 DOI: 10.1111/jrh.12830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/25/2024] [Accepted: 02/12/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE Native Americans and Latinos have higher COVID-19 infection and mortality rates and may have limited access to diagnostic testing. Home-based testing may improve access to care in rural and underserved populations. This study tests the effect of community health worker (CHW) support on accessibility, feasibility, and completion of COVID-19 home testing among Native American and Latino adults living on the Flathead Reservation in Montana and in Yakima Valley, Washington. METHODS A two-arm, multisite, pragmatic randomized controlled trial was conducted using block randomization stratified by site and participant age. Active arm participants received CHW assistance with online COVID-19 test kit registration and virtual swabbing support. The passive arm participants received standard-of-care support from the kit vendor. Logistic regression modeled the association between study arm and test completion (primary outcome) and between study arm and test completion with return of valid test results (secondary outcome). Responses to posttest surveys and interviews were summarized using deductive thematic analysis. FINDINGS Overall, 63% of participants (n = 268) completed COVID-19 tests, and 50% completed tests yielding a valid result. Active arm participants had higher odds of test completion (odds ratio: 1.66, 95% confidence interval [1.01, 2.75]). Differences were most pronounced among adults ≥60 years. Participants cited ease of use and not having to leave home as positive aspects, and transportation and mailing issues as negative aspects of home-based testing. CONCLUSIONS CHW support led to higher COVID-19 test completion rates, particularly among older adults. Significant testing barriers included language, educational level, rurality, and test kit issues.
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Affiliation(s)
- Eliza Webber
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, Montana, USA
| | - Sonia Bishop
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Paul K Drain
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Virgil Dupuis
- Extension Office, Salish Kootenai College, Pablo, Montana, USA
| | - Lorenzo Garza
- Family and Community Engagement, Sunnyside School District, Sunnyside, Washington, USA
| | - Charlie Gregor
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Laurie Hassell
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Geno Ibarra
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Larry Kessler
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Linda Ko
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Alison Lambert
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
- Providence Medical Research Center, Providence Health Care, Spokane, Washington, USA
| | - Victoria Lyon
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Carly Rowe
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Michael Singleton
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Matthew Thompson
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Teresa Warne
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, Montana, USA
| | - Wendy Westbroek
- Extension Office, Salish Kootenai College, Pablo, Montana, USA
| | - Alexandra Adams
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, Montana, USA
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Carson SL, Cameron F, Lee D, Zúñiga D, Poole K, Jones A, Herman C, Ramirez M, Harlow S, Johnson J, Agonafer EP, Hong CS, Brown AF. A collaboration team to build social service partnerships within a safety-net health system. BMC Public Health 2024; 24:654. [PMID: 38429651 PMCID: PMC10905940 DOI: 10.1186/s12889-024-18155-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 02/19/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND To facilitate safety-net healthcare system partnerships with community social service providers, the Los Angeles County Department of Health Services (LAC DHS) created a new collaboration team to spur cross-agency social and medical referral networks and engage communities affected by health disparities as part of a Sect. 1115 Medicaid waiver in Los Angeles County entitled Whole Person Care-Los Angeles (WPC-LA). METHODS This observational research reviews three years of collaboration team implementation (2018-2020) through Medicaid-reportable engagement reports, a collaboration team qualitative survey on challenges, facilitators, and recommendations for community engagement. Member reflections for survey findings were conducted with the collaboration team and LAC DHS WPC-LA leadership. RESULTS Collaboration team Medicaid engagement reports (n = 144) reported > 2,700 events, reaching > 70,000 individuals through cross-agency and community-partnered meetings. The collaboration team survey (n = 9) and member reflection sessions portrayed engagement processes through outreach, service assessments, and facilitation of service partnerships. The collaboration team facilitated community engagement processes through countywide workgroups on justice-system diversion and African American infant and maternal health. Recommendations for future safety net health system engagement processes included assessing health system readiness for community engagement and identifying strategies to build mutually beneficial social service partnerships. CONCLUSIONS A dedicated collaboration team allowed for bi-directional knowledge exchange between county services, populations with lived experience, and social services, identifying service gaps and recommendations. Engagement with communities affected by health disparities resulted in health system policy recommendations and changes.
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Affiliation(s)
- Savanna L Carson
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, 1100 Glendon Ave, Suite 1100, Los Angeles, CA, 90095, USA.
| | - Francesca Cameron
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, 1100 Glendon Ave, Suite 1100, Los Angeles, CA, 90095, USA
| | - Diamond Lee
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Diana Zúñiga
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
- Tres Lunas Consulting, 1509 Stanley Ave. #302, Long Beach, 90804, USA
| | - Kelli Poole
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Adjoa Jones
- Los Angeles County Department of Health Services, 313 N Figueroa St, Los Angeles, CA, 90012, USA
| | - Cristina Herman
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Mayra Ramirez
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Simone Harlow
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Jeannette Johnson
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Etsemaye P Agonafer
- Department of Health System Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Clemens S Hong
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Arleen F Brown
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, 1100 Glendon Ave, Suite 1100, Los Angeles, CA, 90095, USA
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Schriger SH, Knowles M, Daglieri T, Kangovi S, Beidas RS. Barriers and Facilitators to Implementing an Evidence-Based Community Health Worker Model. JAMA HEALTH FORUM 2024; 5:e240034. [PMID: 38457130 PMCID: PMC10924240 DOI: 10.1001/jamahealthforum.2024.0034] [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: 09/22/2023] [Accepted: 01/05/2024] [Indexed: 03/09/2024] Open
Abstract
Importance Community health worker (CHW) programs may improve health outcomes, increase quality of life, and reduce hospitalizations and cost of care. However, knowledge is limited on the barriers and facilitators associated with scaling evidence-based CHW programs to maximize their public health outcomes. Objective To identify barriers and facilitators to implementing an evidence-based CHW model. Design, Setting, and Participants This qualitative study examined perspectives of Individualized Management of Person-Centered Targets (IMPaCT) program staff (health system leaders, program managers, and community health workers) and patients receiving the intervention between March 9, 2020, and July 22, 2021, at 5 institutionally and geographically diverse health systems across the US. The collected data were analyzed between December 1, 2021, and April 27, 2022. Program staff were recruited via purposive sampling, and patients were recruited via convenience sampling. Intervention The disease-agnostic IMPaCT CHW model includes a standardized implementation approach and a structured set of theory-informed intervention components to create and achieve individualized action plans. Main Outcomes and Measures Interview guides were informed by the Consolidated Framework for Implementation Research. A rapid qualitative analytic technique was used to identify key themes, which were categorized into barriers and facilitators associated with framework ecological domains. Results Of a total 41 individuals invited, 39 agreed to participate (95% response rate; mean [SD] age, 45.0 [12.6] years; 30 women). General barriers included economic and policy constraints, including insufficient funding for CHW programs, clinical integration challenges, and CHW difficulty with maintaining boundaries. Program-specific barriers included insufficiently tailored materials for certain populations and upfront and ongoing program costs. General facilitators included CHWs' interpersonal skills and life experiences. Program-specific facilitators included the model's strong evidence base, supportive implementation team, and program design that enabled relationship building and engagement. Additional themes were cited as both barriers and facilitators, including the COVID-19 pandemic, organizational leadership, IMPaCT training, and program fidelity. Conclusions and Relevance These findings suggest growing recognition of the importance of CHWs to improving health equity and population health. Barriers identified point to important policy and practice implications for CHW programs more broadly, including the need for continued attention to improving clinical integration and the need for sustainable program financing to preserve the longevity of this workforce.
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Affiliation(s)
| | - Molly Knowles
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Penn Center for Community Health Workers, Philadelphia, Pennsylvania
| | - Talia Daglieri
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Penn Center for Community Health Workers, Philadelphia, Pennsylvania
| | - Shreya Kangovi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- IMPaCT Care, Philadelphia, Pennsylvania
| | - Rinad S. Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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26
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Liu Y, Cai C, Wu X, Tang PY, Maggy Coufal M, Chen H, Shen L, Yu W, Qian Y, Luu S, Fisher EB, Jia W. Benefits of 12-month peer support for diabetes self management sustained at 18 months. Diabetes Res Clin Pract 2024; 209:111564. [PMID: 38336218 DOI: 10.1016/j.diabres.2024.111564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/19/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
AIMS To evaluate sustainability of peer support (PS) benefits in diabetes management. METHODS Supporting a Peer Leader program through Community Health Centers (CHCs) included trainings and consultations from baseline to 12 months. Evaluation at baseline, 12-month, and 18-month follow-up included primary outcome, HbA1c, and other outcomes of SBP, DBP, LDLc, PHQ-8, diabetes distress, and EQ-5D. RESULTS 1284 participants with type 2 diabetes mellitus were recruited from 9 CHCs. Mean (SD) for age = 68.00 (7.55) years, 43.07 % male, mean (SD) for diabetes duration = 11.79 (7.34) years. Across 18-months, linear mixed model analyses controlling for confounders found the least square mean (SE) of HbA1c improved significantly from 7.62 % (0.06 %) to 7.53 % (0.06 %) for all, and from 9.25 % (0.09 %) to 8.52 % (0.11 %) among those ≥8 % at baseline. Parallel improvements were found among all for SBP, DBP, PHQ-8, diabetes distress, and, among those elevated at baseline for all outcomes. EQ-5D showed significant but modest increase from baseline to 18 months. No significant reversals between 12 and 18 months were found except for LDLc. Supporting robustness of findings, patterns were similar across age, diabetes duration, and gender. CONCLUSIONS Relative to the fundamentally progressive nature of diabetes, it is striking that improvements associated with PS were generally sustained after program support ended.
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Affiliation(s)
- Yuexing Liu
- Shanghai Diabetes Institute, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Technical Center for Diabetes Prevention and Clinical Care, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Research Center for Endocrine and Metabolic Diseases, Shanghai Municipal Key Clinical Specialty, 200233, China.
| | - Chun Cai
- Shanghai Diabetes Institute, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Technical Center for Diabetes Prevention and Clinical Care, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Research Center for Endocrine and Metabolic Diseases, Shanghai Municipal Key Clinical Specialty, 200233, China.
| | - Xiaoyu Wu
- Department of Health Promotion, Shanghai Municipal Health Commission, Shanghai 200125, China.
| | - Patrick Y Tang
- Peers for Progress, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7440, Chapel Hill, NC 27599-7440, USA.
| | - Muchieh Maggy Coufal
- Asian Center for Health Education, 3916 Gettysburg Circle, Plano, TX 75023, USA.
| | - Hongli Chen
- Shanghai Diabetes Institute, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Technical Center for Diabetes Prevention and Clinical Care, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Research Center for Endocrine and Metabolic Diseases, Shanghai Municipal Key Clinical Specialty, 200233, China.
| | - Li Shen
- Shanghai Diabetes Institute, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Technical Center for Diabetes Prevention and Clinical Care, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Research Center for Endocrine and Metabolic Diseases, Shanghai Municipal Key Clinical Specialty, 200233, China.
| | - Wenya Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China.
| | - Yiqing Qian
- Peers for Progress, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7440, Chapel Hill, NC 27599-7440, USA.
| | - Samantha Luu
- Peers for Progress, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7440, Chapel Hill, NC 27599-7440, USA.
| | - Edwin B Fisher
- Peers for Progress, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7440, Chapel Hill, NC 27599-7440, USA.
| | - Weiping Jia
- Shanghai Diabetes Institute, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Technical Center for Diabetes Prevention and Clinical Care, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Research Center for Endocrine and Metabolic Diseases, Shanghai Municipal Key Clinical Specialty, 200233, China.
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Chebli P, Strayhorn SM, Hanneke R, Muramatsu N, Watson K, Fitzgibbon M, Abboud S, Molina Y. A Scoping Review of Cancer Interventions with Arab Americans. J Immigr Minor Health 2024; 26:200-226. [PMID: 37266829 DOI: 10.1007/s10903-023-01497-y] [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] [Accepted: 05/10/2023] [Indexed: 06/03/2023]
Abstract
This scoping review provides an overview of cancer interventions implemented with Arab Americans across the cancer control continuum, including an examination of outcomes and implementation processes. The search strategy included database searching and reviewing reference lists and forward citations to identify articles describing interventions with Arab adults living in the US, with no restrictions on date of publication or research methodology. The review included 23 papers describing 12 unique cancer interventions. Most interventions focused on individual-level determinants of breast and cervical cancer screening; used non-quasi-experimental research designs to evaluate intervention effectiveness; and demonstrated improvements in short-term cancer screening knowledge. Implementation processes were less commonly described. Most interventions were culturally and linguistically tailored to communities of focus; were delivered in educational sessions in community settings; engaged with the community mostly for recruitment and implementation; and were funded by foundation grants. Suggestions for research and intervention development are discussed.
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Affiliation(s)
- Perla Chebli
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.
- NYU Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10016, USA.
| | - Shaila M Strayhorn
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Rosie Hanneke
- Information Services & Research Department at the Library of the Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Naoko Muramatsu
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Karriem Watson
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Marian Fitzgibbon
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Sarah Abboud
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Yamilé Molina
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
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Porterfield L, Santiago Delgado Z, Patel PG, Goodman ML, Campbell KM, Vaughan EM. Preparing Community Health Workers to Empower Latino(a)s With Diabetes: A Real-World Implementation Study. Sci Diabetes Self Manag Care 2024; 50:56-64. [PMID: 38243754 PMCID: PMC10851650 DOI: 10.1177/26350106231220012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
PURPOSE The purpose of the study was to evaluate the delivery of diabetes self-management education (DSME) to Latino(a) adults by community health workers (CHWs). METHODS Investigators developed an evidence-based, bilingual (Spanish/English) diabetes education curriculum and trained 10 CHWs on its content. CHWs then implemented the curriculum in 6-month diabetes group visit programs for low-income Latino(a)s with type 2 diabetes in nonacademic 501(c)3 community clinics. Investigators evaluated efficacy of the training through successful implementation, measured by participant group visit acceptance and attendance. RESULTS Participants (n = 70) reported high levels of program satisfaction (3.8/4.0), improvement in quality of life (9.7/10), meeting of individual needs (3.8/4.0), and acceptability (9.7/10.0). Content analyses revealed that 87.1% of participants would not change the program or wanted to extend it. Participant attendance was 81.6%. CONCLUSIONS Investigators demonstrated the ability to develop a training that nonmedical personnel (CHWs) successfully implemented in a real-world study. This study provides a curricular framework for CHW-led education that may serve as a template to extend to other diseases and populations.
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Affiliation(s)
- Laura Porterfield
- Department of Family Medicine, University of Texas Medical Branch (UTMB), Galveston, Texas
- Sealy Institute for Vaccine Sciences, UTMB, Galveston, Texas
| | | | | | | | - Kendall M. Campbell
- Department of Family Medicine, University of Texas Medical Branch (UTMB), Galveston, Texas
| | - Elizabeth M. Vaughan
- Department of Internal Medicine, UTMB, Galveston, Texas
- Department of Medicine, Baylor College of Medicine, Houston, Texas
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Ozkan S, Tari Selcuk K, Kan ZE. Is green behaviors of health professionals related to green practices in the workplace? Multicenter study in Turkey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:898-910. [PMID: 36854645 DOI: 10.1080/09603123.2023.2185209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
In this study, it is aimed to examine the relationship between green behaviors of health professionals and green practices in the workplace. The study sample consisted of 174 health professionals from 34 Family Healthcare Centers (FHCs) in Turkey. Number, percent, mean, standard deviation, student's test, Mann - Whitney U test, One Way Anova test, Kruskal-Wallis H test, linear regression analysis were used for statistical analysis. Energy-saving (β: 0.197; 95%CI: 0.040;0.266) and waste reduction practices (β: 0.174; 95%CI: 0.019;0.256) in the workplace were positive associated with environmental sensitivity. Waste reduction practices (β: 0.228; 95%CI: 0.093;0.478) in the workplace were positive associated with environmental participation. Recycling bins (β: 0.181; 95%CI :0.084;0.799) and using solar energy (β: 0.198; 95%CI: 0.030; 0.785) in the workplace were positive associated with technological sensitivity. Health professionals who work in workplaces with energy-saving, waste reduction practices, recycling bins and using solar energy more likely to display green behaviors.
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Affiliation(s)
- Sirin Ozkan
- Department of Medical Services and Techniques, Uludag University, Bursa, Turkey
| | - Kevser Tari Selcuk
- Department of Nutrition and Dietetics, Bandırma Onyedi Eylül University Faculty of Health Science, Bandirma, Turkey
| | - Zeynep Ece Kan
- Department of Healthcare Management, Bandırma Onyedi Eylül University, Bandirma, Turkey
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30
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Kroenke K, Corrigan JD, Ralston RK, Zafonte R, Brunner RC, Giacino JT, Hoffman JM, Esterov D, Cifu DX, Mellick DC, Bell K, Scott SG, Sander AM, Hammond FM. Effectiveness of care models for chronic disease management: A scoping review of systematic reviews. PM R 2024; 16:174-189. [PMID: 37329557 DOI: 10.1002/pmrj.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/14/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To conduct a scoping review of models of care for chronic disease management to identify potentially effective components for management of chronic traumatic brain injury (TBI). METHODS Information sources: Systematic searches of three databases (Ovid MEDLINE, Embase, and Cochrane Database of Systematic Reviews) from January 2010 to May 2021. ELIGIBILITY CRITERIA Systematic reviews and meta-analyses reporting on the effectiveness of the Chronic Care Model (CCM), collaborative/integrated care, and other chronic disease management models. DATA Target diseases, model components used (n = 11), and six outcomes (disease-specific, generic health-related quality of life and functioning, adherence, health knowledge, patient satisfaction, and cost/health care use). SYNTHESIS Narrative synthesis, including proportion of reviews documenting outcome benefits. RESULTS More than half (55%) of the 186 eligible reviews focused on collaborative/integrated care models, with 25% focusing on CCM and 20% focusing on other chronic disease management models. The most common health conditions were diabetes (n = 22), depression (n = 16), heart disease (n = 12), aging (n = 11), and kidney disease (n = 8). Other single medical conditions were the focus of 22 reviews, multiple medical conditions of 59 reviews, and other or mixed mental health/behavioral conditions of 20 reviews. Some type of quality rating for individual studies was conducted in 126 (68%) of the reviews. Of reviews that assessed particular outcomes, 80% reported disease-specific benefits, and 57% to 72% reported benefits for the other five types of outcomes. Outcomes did not differ by the model category, number or type of components, or target disease. CONCLUSIONS Although there is a paucity of evidence for TBI per se, care model components proven effective for other chronic diseases may be adaptable for chronic TBI care.
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Affiliation(s)
- Kurt Kroenke
- Department of Medicine, Indiana School of Medicine and Regenstrief Institute, Indianapolis, Indiana, USA
| | - John D Corrigan
- Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus, Ohio, USA
| | - Rick K Ralston
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Robert C Brunner
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Dmitry Esterov
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | | | - Kathleen Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, Texas, USA
| | - Steven G Scott
- Center of Innovation on Disability & Rehab Research (CINDRR), James A Haley Veterans' Hospital, Tampa, Florida, USA
| | - Angelle M Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, and Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas, USA
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Christensen K, Bauer AG, Burgin T, Williams J, McDowd J, Sutkin G, Bennett K, Bowe Thompson C, Berkley-Patton JY. "Black Women Don't Always Put Our Healthcare First": Facilitators and Barriers to Cervical Cancer Screening and Perceptions of Human Papillomavirus Self-Testing Among Church-Affiliated African American Women. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:137-150. [PMID: 36125430 DOI: 10.1177/0272684x221115494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: African American women are at greater risk for cervical cancer incidence and mortality than White women. Up to 90% of cervical cancers are caused by human papillomavirus (HPVs) infections. The National Institutes of Health (NIH) co-developed HPV self-test kits to increase access to screening, which may be critical for underserved populations. Purpose/Research Design: This mixed methods study used the Theory of Planned Behavior to examine attitudes, barriers, facilitators, and intentions related to receipt of cervical cancer screening and perceptions of HPV self-testing among church-affiliated African American women. Study Sample/Data Collection: Participants (N = 35) aged 25-53 participated in focus groups and completed a survey. Results: Seventy-four percent of participants reported receipt of cervical cancer screening in the past 3 years. Healthcare providers and the church were supportive referents of screening. Past trauma and prioritizing children's healthcare needs were screening barriers. Concerns about HPV self-testing included proper test administration and result accuracy. Conclusions: Strategies to mitigate these concerns (e.g., delivering HPV self-test kits to the health department) are discussed.
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Affiliation(s)
- Kelsey Christensen
- Department of Family and Community Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Alexandria G Bauer
- Center for Alcohol & Substance Use Studies, Rutgers University, Piscataway, NJ, USA
| | - Tacia Burgin
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| | - Joah Williams
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| | - Joan McDowd
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| | - Gary Sutkin
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Kymberly Bennett
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| | - Carole Bowe Thompson
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Jannette Y Berkley-Patton
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
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Wong AKC, Tso WC, Su JJ, Hui VCC, Chow KKS, Wong SM, Wong BB, Wong FKY. Effectiveness of support from community health workers on the sustained use of a wearable monitoring device among community-dwelling older adults: A randomized trial protocol. PLoS One 2023; 18:e0294517. [PMID: 38134126 PMCID: PMC10745171 DOI: 10.1371/journal.pone.0294517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/30/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Wearable monitoring devices, such as smartwatches and fitness bands, are health technologies for enhancing self-care management among community-dwelling older adults. While the evidence suggests that these devices can promote health, older adults often struggle to use them over the long term. Community health workers can effectively motivate older adults to change their health behaviors. This study proposes an intervention involving community health workers as peer supporters to promote sustained daily use of wearable monitoring devices among community-dwelling older adults. METHODS The intervention group in this randomized controlled trial will receive the Live with Wearable Monitoring Device program from trained community health workers with the support of a nurse and social workers through a one-time home visit and regular phone calls. The control group will receive only the wearable monitoring device. Data will be collected at baseline, 1 month, 3 months, and 6 months. DISCUSSION Merely providing older adults with wearable monitoring devices may not lead to the realization of the potential health benefits of these devices, as long-term usage can be challenging. The results of this trial can provide evidence for a new approach to enhancing self-management and community healthcare among community-dwelling older adults, ultimately improving their health outcomes. IMPACT Wearable monitoring devices not only enable real-time monitoring of vital signs, but can also support tailored messaging and facilitate virtual communication between users and healthcare professionals. Despite considerable health benefits, there is evidence showing that older adults largely stop using them after a few months. This study is the first to use a peer support approach to help older adults incorporate a wearable monitoring device in their daily routines in conjunction with goal setting and regular reminders. This will boost the self-care ability of the older adults, allowing them to continue physically functioning in the community. TRIAL REGISTRATION This study was prospectively registered at clinicaltrials.gov (identifier: NCT05269303). Registration date: 24/2/2022.
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Affiliation(s)
| | - Wai Chun Tso
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Jing Jing Su
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | | | - Karen Kit Sum Chow
- Elderly Center Division, Hong Kong Lutheran Social Service, Ho Man Tin, Hong Kong
| | - Siu Man Wong
- Elderly Center Division, Hong Kong Lutheran Social Service, Ho Man Tin, Hong Kong
| | - Bonnie Bo Wong
- Elderly Center Division, Hong Kong Lutheran Social Service, Ho Man Tin, Hong Kong
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ElSayed NA, Bannuru RR, Bakris G, Bardsley J, de Boer IH, Gabbay RA, Gockerman J, McCoy RG, McCracken E, Neumiller JJ, Pilla SJ, Rhee CM. Diabetic Kidney Disease Prevention Care Model Development. Clin Diabetes 2023; 42:274-294. [PMID: 38694240 PMCID: PMC11060626 DOI: 10.2337/cd23-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
More than one-third of people with diabetes develop diabetic kidney disease (DKD), which substantially increases risks of kidney failure, cardiovascular disease (CVD), hypoglycemia, death, and other adverse health outcomes. A multifaceted approach incorporating self-management education, lifestyle optimization, pharmacological intervention, CVD prevention, and psychosocial support is crucial to mitigate the onset and progression of DKD. The American Diabetes Association convened an expert panel to develop the DKD Prevention Model presented herein. This model addresses prevention and treatment, including screening guidelines, diagnostic tools, and management approaches; comprehensive, holistic interventions; well-defined roles for interdisciplinary health care professionals; community engagement; and future directions for research and policy.
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Affiliation(s)
- Nuha A. ElSayed
- American Diabetes Association, Alexandria, VA
- Harvard Medical School, Boston, MA
| | | | - George Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, University of Chicago School of Medicine, Chicago, IL
| | - Joan Bardsley
- MedStar Health Research Institute and MedStar System Nursing, Columbia, MD
| | - Ian H. de Boer
- Division of Nephrology, University of Washington School of Medicine, Seattle, WA
| | | | | | - Rozalina G. McCoy
- Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, University of Maryland Institute for Health Computing, Rockville, MD
| | | | - Joshua J. Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA
- Providence Medical Research Center, Providence Health Care, Spokane, WA
| | - Scott J. Pilla
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Connie M. Rhee
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Irvine, CA
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Kitzman H, Dodgen L, Vargas C, Khan M, Montgomery A, Patel M, Ajoku B, Allison P, Strauss AM, Bowen M. Community health worker navigation to improve allostatic load: The Integrated Population Health (IPOP) study. Contemp Clin Trials Commun 2023; 36:101235. [PMID: 38156244 PMCID: PMC10753173 DOI: 10.1016/j.conctc.2023.101235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/06/2023] [Accepted: 11/12/2023] [Indexed: 12/30/2023] Open
Abstract
Background Social determinants of health (SDOH) and cumulative stress contribute to chronic disease development. The physiological response to repeated stressors typical of lower-income environments can be measured through allostatic load - a composite measure of cardiovascular, metabolic, and immune variables. Healthcare systems have employed patient navigation for social and medical needs to improve SDOH that has demonstrated limited impact on chronic disease outcomes. This study evaluates a novel community health worker navigation intervention developed using behavioral theories to improve access to social and medical services and provide social support for poverty stressed adults. Methods The Integrated Population Health Study (IPOP) study is a randomized, parallel two arm study evaluating community health worker navigation in addition to an existing integrated population health program (IPOP CHW) as compared to Usual Care (population health program only, IPOP) on allostatic load and chronic disease risk factors. IPOP CHW participants receive a 10-month navigation intervention. Results From 381 screened individuals, a total of 202 participants (age 58.15 ± 12.03 years, 74.75 % female, 79.21 % Black/African American, 17.33 % Hispanic) were enrolled and randomized to IPOP CHW (n = 100) or IPOP Only (n = 102). Conclusion This study will evaluate whether CHW navigation, using a structured intervention based on health behavior theories, can effectively guide poverty stressed individuals to address social and medical needs to improve allostatic load-a composite of cumulative stress and physiological responses. Healthcare systems, nonprofit organizations, and governmental entities are interested in addressing SDOH to improve health, thus developing evidence-based interventions could have broad clinical and policy implications.
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Affiliation(s)
- Heather Kitzman
- Peter J. O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Leilani Dodgen
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Cristian Vargas
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Mahbuba Khan
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Aisha Montgomery
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Meera Patel
- Peter J. O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Brittany Ajoku
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Patricia Allison
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | | | - Michael Bowen
- Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
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Zhu W, Liang D, Petersen JD, Zhang W, Huang J, Dong Y. Relationship between diabetic knowledge, attitudes and practices among patients with diabetes in China: a structural equation model. BMJ Open 2023; 13:e076464. [PMID: 37973542 PMCID: PMC10660206 DOI: 10.1136/bmjopen-2023-076464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES Whether the routine delivery of diabetes-related knowledge can change patients' attitudes and hence influence their self-management activities remains unknown in primary healthcare settings in China. Thus, this study aims to explore the complex transformation process between knowledge, attitude and practice (KAP) among patients with diabetes in a city in China. DESIGN A cross-sectional study. SETTING Yuhuan City, Zhejiang Province, China. PARTICIPANTS A total of 803 patients with diabetes were invited to attend a questionnaire survey and 782 patients with type 2 diabetes completed the survey. The average age of participants was 58.47 years old, 48.21% of whom only attended primary school or below. PRIMARY AND SECONDARY OUTCOME MEASURES A questionnaire based on existing scales and expert consultation was applied to assess patients' socio-demographic information (SI), disease progression risk and diabetes-related KAP. A structural equation model was built to analyse the relationships between patients' characteristics and KAP. RESULTS No significant association was found between patients' knowledge and attitude (β=0.01, p=0.43). Better knowledge and attitude were both found to be associated with better diet and physical activities (β=0.58, p<0.001; β=0.46, p=0.01). However, patients with a more positive attitude toward diabetic care showed worse foot care practice (β=-0.13, p=0.02), while better knowledge was associated with better foot care practice (β=0.29, p<0.001). In addition, patients with higher SI (β=0.88, p<0.001) and/or disease progression risk (β=0.42, p<0.001) tended to present higher levels of disease knowledge. CONCLUSIONS While successful KAP transformation has been achieved in practice for diet and physical activities, there is a need to improve foot care practice. Health education should also prioritise the prevention, detection and care of diabetic foot. Also, appropriate methods should be adopted to deliver health education to vulnerable patients, such as the elderly, those living in rural areas, those with minimal education, the unemployed and low-income patients.
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Affiliation(s)
- Wenjun Zhu
- School of Public Health, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People's Republic of China
| | - Di Liang
- School of Public Health, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People's Republic of China
| | - Jindong Ding Petersen
- Research Unit for General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
- International School of Public Health and One Health, Hainan Medical University, Haikou, China
| | - Weijun Zhang
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Jiayan Huang
- School of Public Health, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People's Republic of China
| | - Yin Dong
- People's Hospital of Yuhuan, Taizhou, China
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Tucker K, Ingram M, Doubleday K, Piper R, Sander A, Flores R, Martinez D, Carvajal S. Results From La Vida Buena (The Good Life): A Quasi-Experimental Intervention of a Community Health Worker-Led Family-Based Childhood Obesity Program for Latino Children 5-8 Years of Age on the U.S.-Mexico Border. Health Promot Pract 2023; 24:1196-1205. [PMID: 36468422 DOI: 10.1177/15248399221112691] [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: 10/26/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of the 8-week, community health worker (CHW)-led La Vida Buena childhood obesity program among Latino children 5 to 8 years old in a rural county along the U.S.-Mexico border. METHODS This quasi-experimental study used a community-based participatory research approach to compare the effectiveness of the La Vida Buena (The Good Life) curriculum as compared with a single educational session. We took anthropomorphic measures and administered parent-reported nutrition and physical activity surveys at baseline, 3 months, and 6 months. The study took place between 2017 and 2020 in Santa Cruz County, Arizona. RESULTS Change in body mass index (BMI) z-score was negligible for both groups. The parent-reported behavior indicated a shift toward healthier family behaviors and environment in the intervention group. IMPLICATIONS FOR PRACTICE This study adds to the growing literature of CHW-led childhood obesity interventions. The engagement of the CHWs in all aspects of the intervention helped to facilitate important behavior changes. Future interventions should emphasize health and wellness rather than BMI z-score and include community, socioeconomic, and systems-level interventions to promote healthy environments.
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Affiliation(s)
- Kathryn Tucker
- The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Maia Ingram
- The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Kevin Doubleday
- The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Rosie Piper
- Mariposa Community Health Center, Nogales, AZ, USA
| | | | | | | | - Scott Carvajal
- The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
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Mallaiah J, Leon RD, Williams O, Allegrante JP. Cardiovascular Disease and Stroke-Focused Competency Assessment Tools for Community Health Workers in the United States: A Scoping Review. Health Promot Pract 2023; 24:1183-1195. [PMID: 36062599 DOI: 10.1177/15248399221120809] [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: 11/17/2022]
Abstract
Cardiovascular disease (CVD) and stroke are major contributors to chronic disease burden in the United States. Despite the high prevalence of stroke, 90% of all stroke events are preventable and can be attributed to seven key modifiable risk factors (MRFs)-high blood pressure (BP), high cholesterol, diabetes mellitus (DM), smoking, obesity, unhealthy diet, and physical inactivity. In the United States, stroke prevention interventions led by community health workers (CHWs) have been proven to be highly effective in preventing the onset of MRFs. We conducted a scoping review of the competency assessment methods used in CVD and stroke-focused CHW training programs. We searched six online databases: PubMed, Cochrane, CINAHL, Embase, Web of Science, and HaPI, from all available years until January 2021. Of the 1,774 initial articles found, we identified 30 eligible articles to be included in the review. Nine of these studies used previously validated instruments, whereas the remaining 21 studies used tools from the training curriculum or independently developed instruments. Only five of these validated tools reported psychometric properties; none of them were designed for the CHW population. Our scoping review of literature revealed that CHW-specific competency assessment methods were limited, with few or no domain-referenced tools on CVD or stroke risk factors that complied with established measurement standards. We conclude that there is an urgent need for the development of a comprehensive and valid assessment instrument in CVD and stroke prevention to evaluate CHW performance and optimize their credibility, representing important first steps toward integrating CHWs into health care systems.
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Allen CG, Olstad DL, Kahkoska AR, Guan Y, Ramos PS, Steinberg J, Staras SAS, Lumpkins CY, Milko LV, Turbitt E, Rahm AK, Saylor KW, Best S, Hatch A, Santangelo I, Roberts MC. Extending an Antiracism Lens to the Implementation of Precision Public Health Interventions. Am J Public Health 2023; 113:1210-1218. [PMID: 37651661 PMCID: PMC10568499 DOI: 10.2105/ajph.2023.307386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 09/02/2023]
Abstract
Precision public health holds promise to improve disease prevention and health promotion strategies, allowing the right intervention to be delivered to the right population at the right time. Growing concerns underscore the potential for precision-based approaches to exacerbate health disparities by relying on biased data inputs and recapitulating existing access inequities. To achieve its full potential, precision public health must focus on addressing social and structural drivers of health and prominently incorporate equity-related concerns, particularly with respect to race and ethnicity. In this article, we discuss how an antiracism lens could be applied to reduce health disparities and health inequities through equity-informed research, implementation, and evaluation of precision public health interventions. (Am J Public Health. 2023;113(11):1210-1218. https://doi.org/10.2105/AJPH.2023.307386).
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Affiliation(s)
- Caitlin G Allen
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Dana Lee Olstad
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Anna R Kahkoska
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Yue Guan
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Paula S Ramos
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Julia Steinberg
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Stephanie A S Staras
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Crystal Y Lumpkins
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Laura V Milko
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Erin Turbitt
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Alanna K Rahm
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Katherine W Saylor
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Stephanie Best
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Ashley Hatch
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Isabella Santangelo
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Megan C Roberts
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Vaughan EM, Virani S, Al Rifai M, Cardenas VJ, Johnston CA, Porterfield L, Santiago Delgado Z, Samson SL, Schick V, Naik AD. Determining call-to-entry rate and recruitment barriers in clinical studies for community clinics serving low-income populations: a cohort study. BMJ Open 2023; 13:e077819. [PMID: 37898484 PMCID: PMC10619090 DOI: 10.1136/bmjopen-2023-077819] [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] [Received: 07/15/2023] [Accepted: 10/11/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Recruitment for clinical studies is challenging. To overcome barriers, investigators have previously established call-to-entry rates to assist in planning. However, rates specific to low-income minority populations are needed to account for additional barriers to enrolment these individuals face. OBJECTIVE To obtain a call-to-entry rate in a low-income uninsured Hispanic population with chronic disease. METHODS We used data from four of our randomised clinical studies to determine the call-to-entry rate for individuals (n=1075) with or at risk for type 2 diabetes: participants needed/potential participants contacted=recruitment rate (yield). Research staff contacted potential participants to enrol in a study that evaluated 6 month diabetes programmes at community clinics from 2015 to 2020. We recorded call-to-entry rates, reasons for declining the study, show rates, and attrition. RESULTS The call-to-entry rate was 14.5%. Forty per cent of potential participants could not be contacted, and 30.6%, 19.1%, and 5.4% responded yes, no, and maybe, respectively. No show percentages were 54% for yes and 91.4% for maybe responders. The majority (61.6%) declined due to inability to attend; reasons to decline included work (43%), eligibility (18%), transportation (10%), out of town (9%), did not think they needed the programme (7%) and other/unknown (14%). Being a physician predicted inability to reach participants (adjusted OR 2.91, 95% CI 1.73 to 4.90). Attrition was 6.8%. CONCLUSIONS We described a call-to-entry rate and detailed recruitment data, including reasons to decline the study. This valuable information can assist investigators in study planning and overcoming enrolment barriers in low-income populations. Telehealth-based or strategies that limit transportation needs may increase participant involvement. TRIAL REGISTRATION NUMBER NCT03394456.
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Affiliation(s)
- Elizabeth M Vaughan
- Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Salim Virani
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Houston Center for Quality of Care and Utilization Studies, Center for Innovations in Quality Effectiveness and Safety, Houston, Texas, USA
| | - Mahmoud Al Rifai
- Michael E DeBakey VA Medical Center, Houston, Texas, USA
- Houston Methodist Debakey Heart & Vascular Center, Houston, Texas, USA
| | - Victor J Cardenas
- Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Craig A Johnston
- Health and Human Performance, The University of Houston, Houston, Texas, USA
| | - Laura Porterfield
- Department of Family Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Zuleica Santiago Delgado
- Department of Family Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Susan L Samson
- Department of Internal Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Vanessa Schick
- Deparrtment of Management, Policy, and Community Health, University of Texas School of Public Health, Houston, Texas, USA
| | - Aanand D Naik
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Deparrtment of Management, Policy, and Community Health, University of Texas School of Public Health, Houston, Texas, USA
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Kokorelias KM, Singh HK, Abdelhalim R, Saragosa M, Fat GL, Sheppard C. Exploring the roles and functions of champions within community-based interventions to support older adults with chronic conditions: A scoping review protocol. PLoS One 2023; 18:e0291252. [PMID: 37831680 PMCID: PMC10575514 DOI: 10.1371/journal.pone.0291252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/03/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Health care solutions are needed to meet the need of an ageing population. Health care champions are people who endorse the adoption of new initiatives being implemented within health care settings. Although the role of champions has been cited as key to the success of numerous community-based interventions implemented to improve the care of older adults with chronic conditions, no synthesis of their implementation experiences have been conducted. We report on a scoping review protocol that will be applied to collect evidence on the role of champions within community-based health interventions to support older adults with chronic conditions. Specifically, we will identify how the term 'champion' is used and defined (i.e., conceptualized) and identify the roles (i.e., professional background) and functions of champions (i.e., responsibilities). We will also explore how this role impacts program implementation. METHODS This is a scoping review protocol informed by guidelines for Scoping Reviews (PRISMA-ScR) and a six-stage scoping review methodology. Peer-review literature will be retrieved from Medline, CINAHL, PubMed, PsycInfo, Cochrane JBI and Scopus databases, using a peer-reviewed search strategy developed in collaboration with an Information Specialist. The scoping review will consider all empirical studies published in English. Two reviewers will pilot-test the screening criteria and data abstraction forms, and then independently screen the literature. Extracted data will be analyzed numerically and thematically. Self-identified champions will be consulted to refine the practice recommendations from this work. DISCUSSION This scoping review will broadly and systematically identify, define and expand existing knowledge on champions' impact in implementing community-based interventions to support older adults with chronic conditions. We anticipate that our results will lead to a greater understanding of the characteristics and role champions play within these interventions, which will be relevant to a wide range of knowledge users, including researchers, decision-makers, and health care providers.
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Affiliation(s)
- Kristina M. Kokorelias
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- National Institute on Ageing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Hardeep K. Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Reham Abdelhalim
- Joseph Brant Hospital, Burlington, Canada
- Burlington OHT, Burlington, ON, Canada
| | - Marianne Saragosa
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Guillaume Lim Fat
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada
| | - Christine Sheppard
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
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Ibe C, Hines A, Dominguez Carrero N, Fuller S, Trainor A, Scott T, Hickman D, Cooper LA. Voices, Images, And Experiences Of Community Health Workers: Advancing Antiracist Policy And Practice. Health Aff (Millwood) 2023; 42:1392-1401. [PMID: 37782865 DOI: 10.1377/hlthaff.2023.00584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Community health workers (CHWs) are front-line public health personnel who share common attributes with or have a nuanced understanding of the communities they serve. Their membership in marginalized communities gives them expertise in delivering contextualized interventions that mitigate their clients' social risk factors, but it also places them at greater risk for exposure to various harms. We employed the photovoice method to illuminate how the lived experiences of CHWs working, residing, or both in Baltimore City, Maryland, dovetail with facets of their jobs. In partnership with our sixteen predominantly racial and ethnic minoritized study participants, we surfaced the ways in which CHWs negotiated and subsequently leveraged experiences with social risk factors rooted in structural racism to shape their approach to intervention delivery for structurally vulnerable communities. We also uncovered several occupational hazards that participants faced as a function of their identities. Our findings underscore the need to embed antiracist principles in the fabric of policies and practices that directly affect the CHW workforce.
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Affiliation(s)
- Chidinma Ibe
- Chidinma Ibe , Johns Hopkins University, Baltimore, Maryland
| | - Anika Hines
- Anika Hines, Virginia Commonwealth University, Baltimore, Maryland
| | | | | | | | - Tiffany Scott
- Tiffany Scott, Maryland Community Health Worker Association, Baltimore, Maryland
| | - Debra Hickman
- Debra Hickman, Sisters Together and Reaching, Inc., Baltimore, Maryland
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Ge L, Yip WF, Yan AHH, Seng ECS, Pei CCP, Onn ILY, Yiwen EC, Tham S, Moon-Ho RH, Tan WS. Perceived Roles and Barriers in Delivering Community-Based Care: A Qualitative Study of Health and Social Care Professionals. Int J Integr Care 2023; 23:5. [PMID: 37877112 PMCID: PMC10591202 DOI: 10.5334/ijic.7617] [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: 03/23/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction As healthcare systems increasingly embrace population health management, the integration of health and social care to improve the health and well-being of individuals is crucial. Thus, we conducted a qualitative study in Singapore to understand health and social care professionals' (HCPs and SCPs) perception of the roles they played in delivering community-based care. Methods A descriptive phenomenological research design was adopted. HCPs and SCPs (n = 53) providing services in community settings were recruited purposefully and interviewed through eleven focus group discussions. Each session was recorded and transcribed. Thematic analysis was applied. Results Our results revealed eight themes in three main categories describing the roles played by HCPs and SCPs, including: (1) delivering needs-based care in community settings; (2) activating and empowering clients in health care, and (3) fostering community-based sustainable support networks. Six barriers encountered while performing these roles were also identified. Discussion and Conclusion Our results highlight that the roles of HCPs and SCPs go beyond the provision of direct medical and social care. They were involved in activating and empowering clients to take care of their health, and importantly, fostering community-based sustainable support networks to better empower individuals in coping with health challenges. The identified barriers shed light on areas for potential improvements for integrated community care.
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Affiliation(s)
- Lixia Ge
- Health Services and Outcomes Research, National Healthcare Group Pte Ltd, SG
| | - Wan Fen Yip
- Health Services and Outcomes Research, National Healthcare Group Pte Ltd, SG
| | - Andy Ho Hau Yan
- School of Social Sciences, Nanyang Technological University, SG
- Lee Kong Chian School of Medicine, Nanyang Technological University, SG
| | | | | | | | - Evon Chua Yiwen
- Population Health & Community Transformation, Yishun Health, SG
| | - Sinma Tham
- Office of Community Integration, Woodlands Health Campus, SG
| | | | - Woan Shin Tan
- Health Services and Outcomes Research, National Healthcare Group Pte Ltd, SG
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Lo SHS, Chau JPC, Choi KC, Wong RYM, Kwan JCY, Iu IHL. Health Professional- and Volunteer-partnered Self-management Support (COMBO-KEY) to Promote Self-efficacy and Self-management Behaviors in People with Stroke: A Randomized Controlled Trial. Ann Behav Med 2023; 57:866-876. [PMID: 37260291 PMCID: PMC10498819 DOI: 10.1093/abm/kaad028] [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: 06/02/2023] Open
Abstract
BACKGROUND Multiple systematic reviews have reported that self-management interventions are associated with positive impacts on self-efficacy and health-related quality of life (HRQoL) of people with stroke. PURPOSE This article reports the effects of an enhanced stroke self-management program. METHODS Eligible adults with stroke were recruited from community-based organizations and a support group for a two-arm, assessor-blinded randomized controlled trial. Participants in the control group received usual care, while those in the intervention group also received the 8-week self-management program, Coaching Ongoing Momentum Building On stroKe rEcovery journeY (COMBO-KEY), consisting of four individual home visits and five follow-up phone calls, delivered by healthcare professionals and trained volunteers. Assessments were conducted at baseline and after the intervention, for outcomes of self-efficacy, satisfaction with the performance of self-management behaviors, HRQoL, and community reintegration, which were analyzed using generalized estimating equations (GEEs). RESULTS 134 Participants were recruited [mean age = 64.1 years, standard deviation (SD) = 12.7]. Over 80% of the participants had a first-ever stroke [mean years after first stroke: 4.2 (SD = 5.1)]. The GEE analysis revealed that the intervention group participants showed significantly greater improvements in self-efficacy, satisfaction with their performance of self-management behaviors, HRQoL, and community reintegration at 8-week follow-up with respect to their baseline levels. CONCLUSIONS The COMBO-KEY program showed effective improvements in recovery outcomes of people with stroke. Future research should explore the inclusion of virtual/hybrid sessions, strategies to assess health conditions of people with stroke via online modes, and assessment of goal attainment and actual performance of self-management behaviors.
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Affiliation(s)
- Suzanne H S Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| | - Janita P C Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| | - Kai C Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| | - Rebecca Y M Wong
- New Territories East Cluster, Hospital Authority, Hong Kong SAR (Former)
| | - Jackie C Y Kwan
- The Hong Kong Society for Rehabilitation, Hong Kong SAR (Former)
| | - Issac H L Iu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
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Tang C, Camp P. Supporting the Respiratory Health of Migrants and Refugees. Clin Chest Med 2023; 44:605-612. [PMID: 37517838 DOI: 10.1016/j.ccm.2023.03.013] [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: 08/01/2023]
Abstract
Migrants and refugees are at risk of developing acute and chronic respiratory diseases at their destination countries. Yet, people from these populations are also least likely to access care within the current health care system across the world. Although biological, psychological, and social factors play a role in influencing risk of respiratory diseases among these populations, the influences from cultural differences on health behaviors cannot be ignored. Cultural differences are influential in affecting an individual's level of health literacy. Health professionals can contribute to the provision of equitable care to diverse communities through addressing issues related to linguistic and cultural differences.
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Affiliation(s)
- Clarice Tang
- Physiotherapy, Western Sydney University, Sydney, Australia; Allied Health, South Western Sydney Local Health District, Sydney, Australia.
| | - Pat Camp
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
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Watson ED, Moosa S, Janse Van Rensburg DC, Schwellnus M, Lambert EV, Stoutenberg M. Task-Shifting: Can Community Health Workers Be Part of the Solution to an Inactive Nation? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6675. [PMID: 37681815 PMCID: PMC10487434 DOI: 10.3390/ijerph20176675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/03/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
Background: In low-to-middle income countries (LMICs), there is a growing burden of non-communicable diseases (NCDs) placing strain on the facilities and human resources of healthcare systems. Prevention strategies that include lifestyle behavior counseling have become increasingly important. We propose a potential solution to the growing burden of NCDs through an expansion of the role for community health workers (CHWs) in prescribing and promoting physical activity in public health settings. This discussion paper provides a theoretical model for task-shifting of assessment, screening, counseling, and prescription of physical activity to CHWs. Five proposed tasks are presented within a larger model of service delivery and provide a platform for a structured, standardized, physical activity prevention strategy aimed at NCDs using CHWs as an integral part of reducing the burden of NCDs in LMICs. However, for effective implementation as part of national NCD plans, it is essential that CHWs received standardized, ongoing training and supervision on physical activity and other lifestyle behaviors to optimally impact community health in low resource settings.
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Affiliation(s)
- Estelle D. Watson
- Department of Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa
- Department of Exercise Science, Faculty of Science, University of Auckland, Auckland 1023, New Zealand
| | - Shabir Moosa
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa
| | - Dina C. Janse Van Rensburg
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Martin Schwellnus
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Estelle V. Lambert
- UCT Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Department of Human Biology, Division of Research Unit for Exercise Science and Sports Medicine, Division of Physiological Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, 7700, South Africa
| | - Mark Stoutenberg
- Department of Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa
- College of Public Health, Temple University, Philadelphia, PA 19122, USA
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Martire FG, Piccione E, Exacoustos C, Zupi E. Endometriosis and Adolescence: The Impact of Dysmenorrhea. J Clin Med 2023; 12:5624. [PMID: 37685691 PMCID: PMC10488856 DOI: 10.3390/jcm12175624] [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: 07/28/2023] [Revised: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023] Open
Abstract
Endometriosis affects approximately 10% of premenopausal women worldwide. Despite its impact on quality of life, the delay in diagnosing this chronic disease is well known. Many patients with endometriosis report having suffered from dysmenorrhea and chronic pelvic pain in adolescence or at a young age. However, this painful symptom is often highly underestimated and considered a normal and transient symptom in young women. The real prevalence of endometriosis in adolescence remains uncertain. Some authors recently described at least one ultrasound feature of endometriosis in 13.3% of a general population of adolescent girls, which increased to 35.3% in young girls with severe dysmenorrhea. Dysmenorrhea is classified as primary dysmenorrhea or secondary dysmenorrhea. Primary dysmenorrhea is defined as a menstrual pain without organic disease, while secondary dysmenorrhea is defined as a menstrual pain associated with organic pelvic pathology. Since endometriosis represents the main cause of secondary dysmenorrhea in adolescents and young women, it is important to determine whether the patient has primary dysmenorrhea or additional suggestive symptoms related to endometriosis. Endometriosis in adolescent patients is a challenging problem with clinical and pathological differences compared with its presentation in premenopausal women. Adolescents and young women with dysmenorrhea and painful symptoms that suggest endometriosis should be referred to dedicated endometriosis centers for an early diagnosis and appropriate medical and surgical management. This paper aims to describe the role of dysmenorrhea in adolescents and the management of these young patients to confirm or exclude endometriosis.
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Affiliation(s)
- Francesco G. Martire
- Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, University of Rome “Tor Vergata”, 00133 Rome, Italy;
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy;
| | - Emilio Piccione
- Department of Surgical Sciences, Catholic University “Our Lady of Good Counsel”, 1000 Tirane, Albania
| | - Caterina Exacoustos
- Department of Surgical Sciences, Section of Gynecology and Obstetrics, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy;
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Lazzeri L, Andersson KL, Angioni S, Arena A, Arena S, Bartiromo L, Berlanda N, Bonin C, Candiani M, Centini G, Forno SD, Donati A, Exacoustos C, Fuggetta E, Labanca L, Maiorana A, Maneschi F, Mattei A, Muzii L, Ottolina J, Perandini A, Perelli F, Pino I, Porpora MG, Remorgida V, Scaramuzzino S, Schimberni M, Seracchioli R, Solima E, Vignali M, Zupi E, Martire FG. How to Manage Endometriosis in Adolescence: The Endometriosis Treatment Italian Club Approach. J Minim Invasive Gynecol 2023; 30:616-626. [PMID: 37001691 DOI: 10.1016/j.jmig.2023.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023]
Abstract
The evaluation of endometriosis in an adolescent girl is a challenging topic. The initial stage of the disease and the limited diagnostic instrument appropriate for the youth age and for its typical features can reduce the ability of the gynecologist. At the same time, missing a prompt diagnosis can delay the beginning of specific and punctual management of endometriosis, which could avoid a postponed diagnosis from 6 to 12 years, typical of adolescent girls complaining of dysmenorrhea. This article aimed to answer all the potential questions around the diagnosis and management of endometriosis in adolescents starting from a clinical case looking at the possible solution that is easily reproducible in the clinical practice.
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Affiliation(s)
- Lucia Lazzeri
- Department of Molecular and Developmental Medicine (Drs. Lazzeri, Centini, Martire, and Zupi), Università di Siena, Siena, Italy
| | - Karin Louise Andersson
- Department of Territory Health (Dr. Andersson, Exacoustos), Azienda Sanitaria Toscana Centro, Florence, Italy
| | - Stefano Angioni
- Department of Surgical Sciences (Dr. Angioni), Università di Cagliari, Cittadella Universitaria, Cagliari, Italy
| | - Alessandro Arena
- Department of Medical and Surgical Sciences (Drs. A. Arena, Del Forno, and Seracchioli), DIMEC, Sant'Orsola Hospital, Università di Bologna, Bologna, Italy
| | - Saverio Arena
- Department of Obstetrics and Gynecology (Arena), Santa Maria della Misericordia hospital, Perugia, Italy
| | - Ludovica Bartiromo
- Department of Obstetrics and Gynecology (Drs. Bartiromo, Candiani, Ottolina, and Schimberni), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Berlanda
- Department of Obstetrics and Gynecology (Drs. Berlanda and Donati), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Cecilia Bonin
- Azienda Ospedaliera Universitaria Integrata (Drs. Bonin and Perandini), Università di Verona, Piazzale A. Stefani 1, Verona, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynecology (Drs. Bartiromo, Candiani, Ottolina, and Schimberni), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine (Drs. Lazzeri, Centini, Martire, and Zupi), Università di Siena, Siena, Italy
| | - Simona Del Forno
- Department of Medical and Surgical Sciences (Drs. A. Arena, Del Forno, and Seracchioli), DIMEC, Sant'Orsola Hospital, Università di Bologna, Bologna, Italy
| | - Agnese Donati
- Department of Obstetrics and Gynecology (Drs. Berlanda and Donati), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Caterina Exacoustos
- Department of Territory Health (Dr. Andersson, Exacoustos), Azienda Sanitaria Toscana Centro, Florence, Italy; Department of Surgical Sciences, Gynecologic Unit (Drs. Exacoustos, and Martire), University of Rome "Tor Vergata" Rome, Italy
| | - Eliana Fuggetta
- Department of Obstetrics and Gynecology (Drs. Fuggetta and Maneschi), San Giovanni Addolorata Hospital (Drs. Labanca and Martire), Roma, Italy
| | - Luca Labanca
- Department of Surgical Sciences (Drs. Labanca), Valdarno Hospital, Azienda Toscana Sud Est, Italy
| | - Antonio Maiorana
- Department of Obstetrics and Gynecology (Dr. Maiorana), ARNAS Ospedale Civico Piazza Nicola, Palermo, Italy
| | - Francesco Maneschi
- Department of Obstetrics and Gynecology (Drs. Fuggetta and Maneschi), San Giovanni Addolorata Hospital (Drs. Labanca and Martire), Roma, Italy
| | - Alberto Mattei
- Department of Molecular and Developmental Medicine (Drs. Lazzeri, Centini, Martire, and Zupi), Università di Siena, Siena, Italy; Department of Surgical Sciences, Gynecologic Unit (Drs. Exacoustos, and Martire), University of Rome "Tor Vergata" Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urology (Drs. Muzii, Porpora, and Scaramuzzino), Università di Roma La Sapienza, Policlinico Umberto I, Rome, Italy
| | - Jessica Ottolina
- Department of Obstetrics and Gynecology (Drs. Bartiromo, Candiani, Ottolina, and Schimberni), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessio Perandini
- Azienda Ospedaliera Universitaria Integrata (Drs. Bonin and Perandini), Università di Verona, Piazzale A. Stefani 1, Verona, Italy
| | - Federica Perelli
- Division of Gynecology and Obstetrics (Drs. Mattei and Perelli), Santa Maria Annunziata Hospital, USL Toscana Centro, Florence, Italy
| | - Ida Pino
- Preventive Gynecology Unit (Dr. Pino), European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Grazia Porpora
- Department of Maternal and Child Health and Urology (Drs. Muzii, Porpora, and Scaramuzzino), Università di Roma La Sapienza, Policlinico Umberto I, Rome, Italy
| | - Valentino Remorgida
- Unit of Obstetrics and Gynecology (Dr. Remorgida), University of Eastern Piedmont, Novara, Italy
| | - Sara Scaramuzzino
- Department of Maternal and Child Health and Urology (Drs. Muzii, Porpora, and Scaramuzzino), Università di Roma La Sapienza, Policlinico Umberto I, Rome, Italy
| | - Matteo Schimberni
- Department of Obstetrics and Gynecology (Drs. Bartiromo, Candiani, Ottolina, and Schimberni), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Renato Seracchioli
- Department of Medical and Surgical Sciences (Drs. A. Arena, Del Forno, and Seracchioli), DIMEC, Sant'Orsola Hospital, Università di Bologna, Bologna, Italy; Division of Gynecology and Human Reproduction Phisiopatology (Dr. Seracchioli), IRCCS, Azienda Ospedaliera Universitaria di Bologna, Bologna Italy
| | - Eugenio Solima
- Department of Obstetrics and Gynecology (Drs. Solima and Vignali), Macedonio Melloni Hospital, Milan, Italy
| | - Michele Vignali
- Department of Obstetrics and Gynecology (Drs. Solima and Vignali), Macedonio Melloni Hospital, Milan, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine (Drs. Lazzeri, Centini, Martire, and Zupi), Università di Siena, Siena, Italy.
| | - Francesco Giuseppe Martire
- Division of Gynecology and Obstetrics (Drs. Mattei and Perelli), Santa Maria Annunziata Hospital, USL Toscana Centro, Florence, Italy
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Klinkenberg E, Katende B, Ruperez M, Bresser M, Kangololo B, Bwalya J, Erhardt RM, Schaap A, Kasese N, Gatchie T, Floyd S, 'Mota 'MJ, Ayles H, Shanaube K, Reither K. Creating access to SARS-CoV-2 screening and testing through community-based COVID-19 case-finding, observations from cross-sectional studies in Lesotho and Zambia. BMC Public Health 2023; 23:1414. [PMID: 37488552 PMCID: PMC10364377 DOI: 10.1186/s12889-023-16306-2] [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: 12/16/2022] [Accepted: 07/13/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The health impact of the COVID-19 pandemic largely depends on the ability of the healthcare systems to develop effective and adaptable preparedness and mitigation strategies. A collaborative initiative (BRCCH-EDCTP COVID-19 Initiative) was set up between Lesotho and Zambia early on in the pandemic, to jointly conduct a project to investigate creating access to SARS-CoV-2 screening and testing through community-based COVID-19 case-finding. METHODS Two different community case-finding strategies were deployed. In Lesotho, an approach was implemented whereby a community (village) health worker screened community members at their home or during community gatherings for COVID-19 signs and symptoms. All community members who screened positive were then offered SARS-CoV-2 testing. In Zambia, so-called community hubs, staffed by community health care workers, were set up at different locations in the community for people to walk in and get tested for SARS-CoV-2. Hubs changed location from week-to-week and targeted transmission hotspots. All persons visiting the hubs were offered testing for SARS-CoV-2 irrespective of self-reported signs and symptoms of COVID-19 though information was collected on occurrence of these. Testing in both approaches was done using SARS-CoV-2 rapid antigen tests. RESULTS Setting up testing in the community setting was feasible in both countries. In Lesotho in the village health worker approach, over a period of 46 weeks, 7221 persons were screened, and 49 (11.4%) SARS-COV-2 cases identified among 428 COVID-19 screen positive participants. In the community hubs among 3150 people tested, 166 (5.3%) SARS-CoV-2 cases were identified in a period of 26 weeks. From the community hubs approach, where all seen were offered COVID-19 testing it was learned that people screening positive for COVID-19 signs and symptoms were more likely to test SARS-COV-2 positive, especially those reporting classic COVID-19 symptoms like loss of sense/smell for a short period of time (1-3 days). CONCLUSIONS In conclusion, in this project we learned that implementing COVID-19 screening and testing by lay health workers in the community is possible. Characteristics of the population screened, tested, and identified to have SARS-CoV-2 are described to help guide development of future testing strategies.
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Affiliation(s)
- Eveline Klinkenberg
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK.
- Department of Global Health, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
| | | | - Maria Ruperez
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Moniek Bresser
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Bxyn Kangololo
- Zambart, University of Zambia School of Public Health, Lusaka, Zambia
| | - Justin Bwalya
- Zambart, University of Zambia School of Public Health, Lusaka, Zambia
| | - Rahel M Erhardt
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Ab Schaap
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Nkatya Kasese
- Zambart, University of Zambia School of Public Health, Lusaka, Zambia
| | - Thomas Gatchie
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK
- Zambart, University of Zambia School of Public Health, Lusaka, Zambia
| | - Sian Floyd
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - 'Mota J 'Mota
- SolidarMed, Partnerships for Health, Maseru, Lesotho
| | - Helen Ayles
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Kwame Shanaube
- Zambart, University of Zambia School of Public Health, Lusaka, Zambia
| | - Klaus Reither
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Porterfield L, Warren V, Schick V, Gulliot-Wright S, Temple JR, Vaughan EM. Addressing Training Gaps: A Competency-Based, Telehealth Training Initiative for Community Health Workers. TELEMEDICINE REPORTS 2023; 4:126-134. [PMID: 37351464 PMCID: PMC10282968 DOI: 10.1089/tmr.2023.0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 06/24/2023]
Abstract
Background To overcome vast variations in Community Health Worker (CHW) training, investigators for the CHW Core Consensus Project (CCCP) derived three types of CHW (Category 1, 2, 3) and established competencies for each category. However, studies are needed that implement these competencies in real-world settings. Objective Using the six competency domains of the CCCP as a theoretical backbone, we developed and evaluated a training for Category 1 CHWs, individuals whose focus is on community outreach and advocacy. Methods We developed five telehealth-based, bilingual (Spanish/English) training sessions and implemented them among Category 1 Latino(a) CHWs. We measured the number of CHWs who achieved ≥70% correct on a domain-based posttest, attendance, and qualitative feedback. Results All (18/18) CHWs achieved at least 70% on the posttest (mean: 93.7%; range 73.3-100%). Training attendance was 98.9%. Using a six-point scale, CHWs reported high levels of satisfaction overall (5.72 ± 0.57/6.0), with telehealth (5.72 ± 0.58/6.0), effectiveness of teaching strategies/methods (5.89 ± 0.32/6.0), achieving training objectives (5.96 ± 0.15/6.0), knowledge improvement (5.72 ± 0.57/6.0), and interest (5.78 ± 0.43/6.0). Conclusion We successfully developed and evaluated a bilingual training program for Category 1 CHWs to address core competency gaps. High CHW attendance reinforces the value of telehealth modalities and their potential to increase the reach for CHW training. To overcome gaps in chronic disease training, investigations are needed to address additional CHW trainings. Trial Registration NCT04835493.
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Affiliation(s)
- Laura Porterfield
- Department of Family Medicine, University of Texas Medical Branch (UTMB), Galveston, Texas, USA
- Sealy Institute for Vaccine Sciences, UTMB, Galveston, Texas, USA
| | - Victoria Warren
- Department of Health and Human Performance, University of Houston, Houston, Texas, USA
| | - Vanessa Schick
- Management, Policy, and Community Health, School of Public Health, University of Texas, Houston, Texas, USA
| | - Shannon Gulliot-Wright
- Department of Family Medicine, University of Texas Medical Branch (UTMB), Galveston, Texas, USA
| | | | - Elizabeth M. Vaughan
- Department of Internal Medicine, UTMB, Galveston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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50
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Blebu BE, Liu PY, Harrington M, Nicholas W, Jackson A, Saleeby E. Implementation of cross-sector partnerships: a description of implementation factors related to addressing social determinants to reduce racial disparities in adverse birth outcomes. Front Public Health 2023; 11:1106740. [PMID: 37397779 PMCID: PMC10313205 DOI: 10.3389/fpubh.2023.1106740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 05/12/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Traditional perinatal care alone cannot address the social and structural determinants that drive disparities in adverse birth outcomes. Despite the wide acceptance of partnerships between healthcare systems and social service agencies to address this challenge, there needs to be more research on the implementation factors that facilitate (or hinder) cross-sector partnerships, particularly from the perspective of community-based organizations. This study aimed to integrate the views of healthcare staff and community-based partner organizations to describe the implementation of a cross-sector partnership designed to address social and structural determinants in pregnancy. Methods We used a mixed methods design (in-depth interviews and social network analysis) to integrate the perspectives of healthcare clinicians and staff with those of community-based partner organizations to identify implementation factors related to cross-sector partnerships. Results We identified seven implementation factors related to three overarching themes: relationship-centered care, barriers and facilitators of cross-sector partnerships, and strengths of a network approach to cross-sector collaboration. Findings emphasized establishing relationships between healthcare staff, patients, and community-based partner organizations. Conclusion This study provides practical insights for healthcare organizations, policymakers, and community organizations that aim to improve access to social services among historically marginalized perinatal populations.
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Affiliation(s)
- Bridgette E. Blebu
- The Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, United States
| | - Patrick Y. Liu
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - William Nicholas
- Center for Health Impact Evaluation, Los Angeles Country Department of Public Health, Los Angeles, CA, United States
| | - Ashaki Jackson
- The Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, United States
- Women’s Health Programs and Innovations, Los Angeles County Department of Health Services, Alhambra, CA, United States
| | - Erin Saleeby
- Women’s Health Programs and Innovations, Los Angeles County Department of Health Services, Alhambra, CA, United States
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