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Crittendon DR, Brecher AC, Okere S, Hass R, Frasso R, Brawer R, Zeigler-Johnson C. Perceptions of Smoking Stigma Among African Americans: A Qualitative Study. Nicotine Tob Res 2024:ntae127. [PMID: 39009350 DOI: 10.1093/ntr/ntae127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 04/01/2024] [Accepted: 05/18/2024] [Indexed: 07/17/2024]
Abstract
INTRODUCTION African Americans/Blacks (AAB) are at increased risk for morbidity and mortality from smoking-related diseases including lung cancer (LC). Smoking stigma is believed to be a primary barrier to health care-seeking for people who smoke. Previous studies illustrate that perceptions of smoking vary across populations. However, little is known about the prevalence of smoking stigmas among AAB. The purpose of this study was to increase understanding of the perception of cigarette smoking by AAB. AIMS AND METHODS We conducted free-listing interviews in which individuals listed all-thoughts and feelings regarding smoking and health-related questions with a convenience sample of eligible AAB adults (n = 58) in the Philadelphia region. Additionally, we collected participant self-reported demographic data. Data were cleaned and the salience of each term was computed using Anthropac. Graphical methods were then used to determine salient responses across groups stratified by gender, age, education, and smoking status. RESULTS The sample had a median age of 51 years and was 67.2% female. Most participants had completed college (58.6%) and had never smoked (74.1%). Regarding their perceptions of people who smoke cigarettes, results showed that "smelly," "health hazard," and "judgment" were the most salient terms among all-participants. Overall, "smelly" and "unhealthy" were salient for both males and females. However, "dental," "dirty," "addictive," and "habit" were also salient among males. Phrases such as "unhealthy" and "addictive" were primarily salient for older participants (>51 years) versus "smelly" for younger participants. The term "smelly" was salient among all-education levels. However, "unhealthy" was also salient among those with less than a 4-year college degree. Moreover, the terms "smelly" and "annoying" were most common among people who smoke as opposed to "health hazard" among people who don't smoke. CONCLUSIONS We observed that the most stigmatizing language was primarily associated with perceptions of negative social interactions, social judgment, and health-related concerns. Future studies are needed to explore how smoking-related stigmas impact patient adherence to smoking cessation programs and LC screening protocols. IMPLICATIONS Little is known about the prevalence of smoking stigmas among AAB. This study explores the AAB perspective of cigarette smoking and related stigmas. Among AAB, smoking is represented by stigmatizing language across gender, age groups, and smoking history. It is primarily associated with negative social interactions, social judgement, and health-related concerns indicating that smoking stigma is a concern for AAB individuals who smoke. Further research is warranted.
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Affiliation(s)
- Denine R Crittendon
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Samantha Okere
- Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Richard Hass
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rosemary Frasso
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rickie Brawer
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Charnita Zeigler-Johnson
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
- Fox Chase Cancer Center, Philadelphia, PA, USA
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Ziegler S, Bozorgmehr K. "I don´t put people into boxes, but…" A free-listing exercise exploring social categorisation of asylum seekers by professionals in two German reception centres. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002910. [PMID: 38394055 PMCID: PMC10889701 DOI: 10.1371/journal.pgph.0002910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/22/2024] [Indexed: 02/25/2024]
Abstract
Newly arriving asylum seekers in Germany mostly live in large reception centres, depending on professionals in most aspects of their daily lives. The legal basis for the provision of goods and services allows for discretionary decisions. Given the potential impact of social categorisation on professionals' decisions, and ultimately access to health and social services, we explore the categories used by professionals. We ask of what nature these categorisations are, and weather they align with the public discourse on forced migration. Within an ethnographic study in outpatient clinics of two refugee accommodation centres in Germany, we conducted a modified free-listing with 40 professionals (physicians, nurses, security-personnel, social workers, translators) to explore their categorisation of asylum seekers. Data were qualitatively analysed, and categories were quantitatively mapped using Excel and the Macro "Flame" to show frequencies, ranks, and salience. The four most relevant social categorisations of asylum seekers referred to "demanding and expectant," "polite and friendly" behaviour, "economic refugees," and "integration efforts". In general, sociodemographic variables like gender, age, family status, including countries and regions of origin, were the most significant basis for categorisations (31%), those were often presented combined with other categories. Observations of behaviour and attitudes also influenced categorisations (24%). Professional considerations, e.g., on health, education, adaption or status ranked third (20%). Social categorisation was influenced by public discourses, with evaluations of flight motives, prospects of staying in Germany, and integration potential being thematised in 12% of the categorisations. Professionals therefore might be in danger of being instrumentalised for internal border work. Identifying social categories is important since they structure perception, along their lines deservingness is negotiated, so they potentially influence interaction and decision-making, can trigger empathy and support as well as rejection and discrimination. Larger studies should investigate this further. Free-listing provides a suitable tool for such investigations.
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Affiliation(s)
- Sandra Ziegler
- Section for Health Equity Studies & Migration, Heidelberg University Hospital, Heidelberg, Germany
- Department of Population Medicine and Health Services Research, School of Public Health, University of Bielefeld, Bielefeld, Germany
| | - Kayvan Bozorgmehr
- Section for Health Equity Studies & Migration, Heidelberg University Hospital, Heidelberg, Germany
- Department of Population Medicine and Health Services Research, School of Public Health, University of Bielefeld, Bielefeld, Germany
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Lee NS, Keddem S, Sorrentino AE, Jenkins KA, Long JA. Health Equity in the Veterans Health Administration From Veterans' Perspectives by Race and Sex. JAMA Netw Open 2024; 7:e2356600. [PMID: 38373000 PMCID: PMC10877456 DOI: 10.1001/jamanetworkopen.2023.56600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/27/2023] [Indexed: 02/20/2024] Open
Abstract
Importance Advancing equitable patient-centered care in the Veterans Health Administration (VHA) requires understanding the differential experiences of unique patient groups. Objective To inform a comprehensive strategy for improving VHA health equity through the comparative qualitative analysis of care experiences at the VHA among veterans of Black and White race and male and female sex. Design, Setting, and Participants This qualitative study used a technique termed freelisting, an anthropologic technique eliciting responses in list form, at an urban academic VHA medical center from August 2, 2021, to February 9, 2022. Participants included veterans with chronic hypertension. The length of individual lists, item order in those lists, and item frequency across lists were used to calculate a salience score for each item, allowing comparison of salient words and topics within and across different groups. Participants were asked about current perceptions of VHA care, challenges in the past year, virtual care, suggestions for change, and experiences of racism. Data were analyzed from February 10 through September 30, 2022. Main Outcomes and Measures The Smith salience index, which measures the frequency and rank of each word or phrase, was calculated for each group. Results Responses from 49 veterans (12 Black men, 12 Black women, 12 White men, and 13 White women) were compared by race (24 Black and 25 White) and sex (24 men and 25 women). The mean (SD) age was 64.5 (9.2) years. Some positive items were salient across race and sex, including "good medical care" and telehealth as a "comfortable/great option," as were some negative items, including "long waits/delays in getting care," "transportation/traffic challenges," and "anxiety/stress/fear." Reporting "no impact" of racism on experiences of VHA health care was salient across race and sex; however, reports of race-related unprofessional treatment and active avoidance of race-related conflict differed by race (present among Black and not White participants). Experiences of interpersonal interactions also diverged. "Impersonal/cursory" telehealth experiences and the need for "more personal/attentive" care were salient among women and Black participants, but not men or White participants, who associated VHA care with courtesy and respect. Conclusions and Relevance In this qualitative freelist study of veteran experiences, divergent experiences of interpersonal care by race and sex provided insights for improving equitable, patient-centered VHA care. Future research and interventions could focus on identifying differences across broader categories both within and beyond race and sex and bolstering efforts to improve respect and personalized care to diverse veteran populations.
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Affiliation(s)
- Natalie S. Lee
- Division of General Internal Medicine, The Ohio State University Wexner Medical Center, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, The Ohio State University, Columbus
| | - Shimrit Keddem
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Anneliese E. Sorrentino
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Kevin Ahmaad Jenkins
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Judith A. Long
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Sosanya ME, Freeland-Graves JH, Gbemileke AO, Adesanya OD, Akinyemi OO, Ojezele SO, Samuel FO. Why Acute Undernutrition? A Qualitative Exploration of Food Preferences, Perceptions and Factors Underlying Diet in Adolescent Girls in Rural Communities in Nigeria. Nutrients 2024; 16:204. [PMID: 38257097 PMCID: PMC10819043 DOI: 10.3390/nu16020204] [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: 11/23/2023] [Revised: 12/21/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Adolescent girls are nutritionally vulnerable due to their rapid growth and increased nutrient requirements. Nigeria has the sixth-largest population in the world. This study qualitatively explored the food preferences, perceptions of nutritive value and factors underlying food consumption of adolescent girls in rural communities in Nigeria. METHODS The data were collected via the free listing of foods and focus group sessions conducted in the Hausa language with 48 unmarried adolescent girls. The discussions were audio-recorded, transcribed, translated into English, and analyzed using a deductive thematic framework. RESULTS The mean age of the respondents was 13.0 ± 2.7, and almost half (48%) had a primary school education. A total of 19 and 23 foods were identified as preferred, and perceived as nourishing, respectively. The top 10 foods present on both free lists overlapped considerably in terms of cognitive salience. The focus group themes included nutrition knowledge, food preferences, autonomy, household food allocation, courtship practices, and agricultural landscapes and economic access. The participants had minimal knowledge of nutrients and food groups, and their preferred foods were limited in diversity. The key factors in food preferences were desirable health effects, sensory attributes, and the contribution of foods to a desirable body image for marriage. Household food choices depended on parents. Thus, a desire for independence was an incentive for early marriage, mostly at 13 to 17 years. Gender inequities in household food distribution (quantity) and animal protein intake were reported. The participants believed that boys need more food for strength to impregnate girls. As part of a courtship practice, the girls received gifts of animal source foods from potential suitors. The food options were limited by financial challenges and low agricultural diversity. CONCLUSION To interrupt the cycle of inadequate food consumption and undernutrition in these adolescent girls, policy makers need to promote nutrition education and address the underlying determinants of inequitable access to nutritious foods.
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Affiliation(s)
- Mercy E. Sosanya
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX 78712, USA
- Department of Nutrition and Dietetics, The Federal Polytechnic, Bauchi 740102, Nigeria;
| | | | | | | | - Oluwaseun O. Akinyemi
- Department of Health Policy and Management, College of Medicine, University of Ibadan, Ibadan 200285, Nigeria
| | - Samuel O. Ojezele
- Department of Health Policy and Management, College of Medicine, University of Ibadan, Ibadan 200285, Nigeria
| | - Folake O. Samuel
- Department of Human Nutrition and Dietetics, College of Medicine, University of Ibadan, Ibadan 200132, Nigeria
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Decker-Palmer M, Klodowski D, Thompson T, Lanoue M, Messina A, Schroeder D, Barto S, Oglesby B, Frasso R. Freelisting: A Technique for Enhancing the Community Health Needs Assessment. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:201-208. [PMID: 36513364 DOI: 10.1177/2752535x221146232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
US health systems are required to conduct community health needs assessments (CHNAs). These assessments often rely solely on publicly reported disease prevalence data. The objective of this study was to identify a feasible qualitative method that can be implemented into CHNAs to confirm existing information and enhance them with new data and community narrative. Freelisting interviews were conducted in 2017 throughout a county in Pennsylvania. Individuals listed (1) things that improve health, (2) health problems, and (3) health barriers. Responses were grouped into like terms, Smith's salience index was calculated for each, subgroup variation was assessed. Community-reported health priorities were identified by salient terms juxtaposed with publicly reported disease prevalence data. 98 respondents throughout the county participated in freelisting interviews. Demographics resembled the population: median age 55, 46% female, 88% Caucasian, 9% uninsured. Salient terms that improve health included: "physical activity", "healthy eating", and "health services". Salient terms describing health problems included: "cardiovascular disease" and "spine and joint disease". Centers for Disease Control and Prevention (CDC)-reported chronic disease prevalence in the county included heart disease mortality (22% of deaths) and arthritis (26% of adults). Salient barriers to health included: "weight, physical activity, and dietary concerns", as well as "occupational concerns". This is in line with 2017 County Health Rankings related to obesity (reported 29%), however, while 10% were uninsured in the community, this was not a salient term. Freelisting can augment and inform CHNAs. In this single-county study, freelisting responses supported publicly available disease/mortality prevalence data and provided insight into community perceptions of health issues.
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Affiliation(s)
- Marquita Decker-Palmer
- 1889 Jefferson Center for Population Health, Johnstown, PA, USA
- Jefferson College of Population Health at Thomas Jefferson University, Philadelphia, PA, USA
| | - David Klodowski
- Jefferson College of Population Health at Thomas Jefferson University, Philadelphia, PA, USA
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Trina Thompson
- 1889 Jefferson Center for Population Health, Johnstown, PA, USA
| | - Marianna Lanoue
- Jefferson College of Population Health at Thomas Jefferson University, Philadelphia, PA, USA
| | - Allison Messina
- Center for Health Promotion and Disease Prevention, Johnstown, PA, USA
| | - Diana Schroeder
- Center for Health Promotion and Disease Prevention, Johnstown, PA, USA
| | - Shiryl Barto
- Center for Health Promotion and Disease Prevention, Johnstown, PA, USA
| | - Billy Oglesby
- Jefferson College of Population Health at Thomas Jefferson University, Philadelphia, PA, USA
| | - Rosemary Frasso
- Jefferson College of Population Health at Thomas Jefferson University, Philadelphia, PA, USA
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Mhango P, Malata MP, Chipeta E, Sixpence A, Taylor TE, Wilson ML, Cohee LM, Mangani C, Mathanga DP. Barriers to accessing malaria treatment amongst school-age children in rural Malawi. Malar J 2023; 22:258. [PMID: 37674177 PMCID: PMC10481490 DOI: 10.1186/s12936-023-04695-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: 11/10/2022] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Over the last two decades, many countries have moved from malaria control toward malaria elimination. However, some sub-Saharan African countries, like Malawi, have recently seen a reversal in malaria control progress with reported increases in confirmed malaria cases. This may be the result of inadequate access to effective malaria control interventions by key population groups that perpetuate transmission. This study aimed to assess the barriers to accessing malaria treatment among school-aged children (SAC) in Malawi. METHODS A qualitative study was conducted between September and October 2020, where data were gathered in rural Malawi using free-listing interviews, key-informant interviews, semi-structured interviews and focus group discussions. Purposively sampled participants included SAC, parents of SAC, health workers and key stakeholders at community and district levels. Interviews were digitally recorded and transcribed verbatim. Data were organized using NVivo 12 software and analysed using the thematic method. RESULTS The study recruited 252 participants, with 156 being SAC, equally divided between boys and girls. Health system barriers to malaria treatment included long waiting hours and queues at clinics, frequent stock-outs of medical supplies, and travel time to the facility. Provider barriers included negative attitude and limited service hours. Individual and cultural barriers included fear of malaria tests and beliefs associating witchcraft as the best treatment for malaria. In addition, COVID-19-related barriers included the inability to follow preventive measures, a shift in focus from malaria to COVID-19, and fear of contracting COVID-19 and/or being tested for COVID-19 at the facility. CONCLUSIONS This study shows most of the barriers to accessing malaria treatment among SAC are similar to those experienced by other population groups. Furthermore, COVID-19 adversely affected SAC's access to treatment. Interventions that support SAC access to prompt diagnosis and treatment are urgently needed to improve the effective control of malaria.
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Affiliation(s)
- Patani Mhango
- Centre for Reproductive Health (CRH), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi.
| | - Monica Patricia Malata
- Centre for Reproductive Health (CRH), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Effie Chipeta
- Centre for Reproductive Health (CRH), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
- School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Alick Sixpence
- Malaria Alert Centre (MAC), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Terrie E Taylor
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Mark L Wilson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Lauren M Cohee
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Charles Mangani
- School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Don P Mathanga
- School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
- Malaria Alert Centre (MAC), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
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Britton LE, Arcia A, Kaur G, Sontan O, Marshall CJ, George M. "A patient should not have to ask": Women's experiences of patient education about preconception care for type 2 diabetes. PATIENT EDUCATION AND COUNSELING 2023; 112:107739. [PMID: 37094436 PMCID: PMC10399209 DOI: 10.1016/j.pec.2023.107739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES To characterize perspectives and experiences regarding preconception care (PCC) patient education among women with type 2 diabetes. METHOD Descriptive, qualitative research design. Thirty-two English-speaking women with type 2 diabetes identifying as Black and/or Latina, ages 18-40 years old, participated. We conducted semi-structured interviews about PCC perspectives and experiences which we analyzed with conventional content analysis. To enhance rigor, we collected freelisting data from which we calculated salience scores. We triangulated our qualitative findings with salience scores. RESULTS We identified three themes. Our first theme concerned mismatch between women's desires for PCC counseling to be frequent in contrast with their experiences of its infrequency. Our second theme captured how women felt responsible for initiating care in the clinical encounter but uncertain about what they "should" be asking for. Our third theme characterized women's perspectives on receiving information about PCC and pregnancy planning. CONCLUSIONS Young adult women with type 2 diabetes who are Black and/or Latina welcome more education about how PCC can prevent obstetrical complications associated with diabetes, which disproportionately affect their communities. PRACTICE IMPLICATIONS Our findings provide actionable suggestions for improving acceptability and accessibility of PCC patient education in the United States where PCC awareness and uptake are low.
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Affiliation(s)
| | - Adriana Arcia
- University of San Diego, Hahn School of Nursing and Health Science, USA
| | - Guneet Kaur
- University of California Los Angeles David Geffen School of Medicine, David Geffen School of Medicine, USA
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Naik A, Syvyk S, Tong J, Wirtalla C, Barg FK, Guerra CE, Mehta SJ, Wender R, Merchant RM, Kelz RR. Factors Associated With Primary Care Physician Decision-making When Making Medication Recommendations vs Surgical Referrals. JAMA Netw Open 2023; 6:e2256086. [PMID: 36790807 PMCID: PMC9932841 DOI: 10.1001/jamanetworkopen.2022.56086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
IMPORTANCE Although objective data are used routinely in prescription drug recommendations, it is unclear how referring physicians apply evidence when making surgeon or hospital recommendations for surgery. OBJECTIVE To compare the factors associated with the hospital or surgeon referral decision-making process with that used for prescription medication recommendations. DESIGN, SETTING, AND PARTICIPANTS This qualitative study comprised interviews conducted between April 26 and May 18, 2021, of a purposive sample of 21 primary care physicians from a large primary care network in the Northeast US. MAIN OUTCOMES AND MEASURES Main outcomes were the factors considered when making prescription medication recommendations vs referral recommendations to specific surgeons or hospitals for surgery. RESULTS All 21 participant primary care physicians (14 women [66.7%]) reported use of evidence-based decision support tools and patient attributes for prescription medication recommendations. In contrast, for surgeon and hospital referral recommendations, primary care physicians relied on professional experience and training, personal beliefs about surgical quality, and perceived convenience. Primary care physicians cited perceived limitations of existing data on surgical quality as a barrier to the use of such data in the process of making surgical referrals. CONCLUSIONS AND RELEVANCE As opposed to the widespread use of objective decision support tools for guidance on medication recommendations, primary care physicians relied on subjective factors when making referrals to specific surgeons and hospitals. The findings of this study highlight the potential to improve surgical outcomes by introducing accessible, reliable data as an imperative step in the surgical referral process.
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Affiliation(s)
- Anusha Naik
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Solomiya Syvyk
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
| | - Jason Tong
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Chris Wirtalla
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
| | - Frances K. Barg
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Carmen E. Guerra
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Shivan J. Mehta
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Richard Wender
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Raina M. Merchant
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rachel R. Kelz
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Salles I, Travassos P, Spener-Gomes R, Loch AP, Saraceni V, Lauria L, Cavalcante S, Garcia de Oliveira J, Brito de Souza A, Guimarães Costa A, Sakabe S, Schiavon Nogueira R, Chaisson LH, Cohn S, Jamal LF, Valdez Ramalho Madruga J, Cordeiro-Santos M, Castro B, Portella Ferreira D, Hoffmann CJ, Golub JE, Durovni B, Kerrigan D. Contextualizing and optimizing novel strategies to improve the latent TB continuum of care: Insights from people living with HIV and health care providers in Brazil. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001251. [PMID: 36962892 PMCID: PMC10021802 DOI: 10.1371/journal.pgph.0001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/06/2022] [Indexed: 01/05/2023]
Abstract
Tuberculosis (TB) causes 1 in 3 deaths among people living with HIV (PLHIV). Diagnosing and treating latent tuberculosis infection (LTBI) is critical to reducing TB incidence and mortality. Blood-based screening tests (e.g., QuantiFERON-TB Gold Plus (QFT+)) and shorter-course TB preventive therapy (TPT) regimens such as 3HP (3 months weekly isoniazid-rifapentine) hold significant promise to improve TB outcomes. We qualitatively explored barriers and solutions to optimizing QFT+ and 3HP among PLHIV in three cities in Brazil. We conducted 110 in-depth interviews with PLHIV, health care providers (HCP) and key informants (KI). Content analysis was conducted including the use of case summaries and comparison of themes across populations and contexts. LTBI screening and treatment practices were dependent on HCP's perceptions of whether they were critical to improving TB outcomes. Many HCP lacked a strong understanding of LTBI and perceived the current TPT regimen as complicated. HCP reported that LTBI screening and treatment were constrained by clinic staffing challenges. While PLHIV generally expressed willingness to consider any test or treatment that doctors recommended, they indicated HCP rarely discussed LTBI and TPT. TB testing and treatment requests were constrained by structural factors including financial and food insecurity, difficulties leaving work for appointments, stigma and family responsibilities. QFT+ and 3HP were viewed by all participants as tools that could significantly improve the LTBI cascade by avoiding complexities of TB skin tests and longer LTBI treatment courses. QFT+ and 3HP were perceived to have challenges, including the potential to increase workload on over-burdened health systems if not implemented alongside improved supply chains, staffing, and training, and follow-up initiatives. Multi-level interventions that increase understanding of the importance of LTBI and TPT among HCP, improve patient-provider communication, and streamline clinic-level operations related to QFT+ and 3HP are needed to optimize their impact among PLHIV and reduce TB mortality.
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Affiliation(s)
- Isadora Salles
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | | | - Renata Spener-Gomes
- Gerência de Micobacteriologia, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Universidade Federal do Amazonas, Manaus, Brazil
| | - Ana Paula Loch
- Centro de Referência e Treinamento DST/Aids, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
| | | | - Lilian Lauria
- Secretaria Municipal de Saúde, Rio de Janeiro, Brazil
| | - Solange Cavalcante
- Secretaria Municipal de Saúde, Rio de Janeiro, Brazil
- Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | | | - Alexandra Brito de Souza
- Gerência de Micobacteriologia, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Allyson Guimarães Costa
- Gerência de Micobacteriologia, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola de Enfermagem de Manaus, Universidade Federal do Amazonas, Manaus, Brazil
| | - Sumire Sakabe
- Centro de Referência e Treinamento DST/Aids, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
| | - Roberta Schiavon Nogueira
- Centro de Referência e Treinamento DST/Aids, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
| | - Lelia H. Chaisson
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, Illinos, United States of America
| | - Silvia Cohn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Leda Fatima Jamal
- Centro de Referência e Treinamento DST/Aids, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
| | | | - Marcelo Cordeiro-Santos
- Gerência de Micobacteriologia, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | | | | | - Christopher J. Hoffmann
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Jonathan E. Golub
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Betina Durovni
- Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, District of Columbia, United States of America
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10
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Balis LE, Grocke-Dewey M. Built environment approaches: Extension personnel's preferences, barriers, and facilitators. Front Public Health 2022; 10:960949. [PMID: 36311640 PMCID: PMC9614838 DOI: 10.3389/fpubh.2022.960949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/30/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Interventions that modify the built environment can increase population physical activity levels and prevent chronic disease. The national Cooperative Extension System is poised to implement built environment approaches (i.e., pedestrian/bicycle infrastructure and enhanced access to physical activity spaces), but implementation strategies (i.e., methods or techniques to move research to practice) are needed to improve uptake. Effective implementation strategies address relevant barriers and capitalize on facilitators. The purpose of this study was to understand 1) barriers and facilitators to implementing built environment approaches in two state Extension systems, 2) preferences for built environment approaches, and 3) preferences for implementation strategies. Methods A cross-sectional online survey was used to understand Extension personnel's preferences for and barriers and facilitators to built environment approaches through a mixed-methods study design. This work was informed by anthropological inquiry as the overall research philosophy, and by the Health Impact Pyramid, Leeman et al.'s classification of implementation strategies, and the Consolidated Framework for Implementation Research as the theoretical frameworks. The survey was distributed to eligible Extension personnel (n = 42) in two states. Quantitative data analysis consisted of numbers/proportions and Friedman tests. Qualitative analysis was completed through a rapid deductive approach to quickly produce actionable results. Results Fourteen respondents (33%) completed the survey. Most had not implemented physical activity interventions in their communities or had implemented only individual-level interventions, though were interested in implementing built environment approaches. Benches, playground improvements, and crosswalks were the most desired approaches, while facilitation, assessing community strengths and needs, and technical assistance were desired implementation strategies. The most common barriers were relative priority and available resources; facilitators were external policy and incentives and implementation climate. Discussion Extension personnel are receptive to built environment approaches and engaged with community coalitions. Yet, invested parties prefer individual-level interventions, and agents perceive a lack of resources for implementation. Implementation strategies that build capacity in both the Extension system and community coalitions may address these barriers through increasing relative priority and sharing existing resources. This work is a first step toward compiling implementation strategies to address relevant barriers to built environment approaches in community settings.
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Affiliation(s)
- Laura E. Balis
- Louisville Center, Pacific Institute for Research and Evaluation, Louisville, KY, United States
| | - Michelle Grocke-Dewey
- Department of Health and Human Development, Montana State University, Bozeman, MT, United States
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11
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Stewart JM, Snowden V, Charles CE, Farmer EA, Flanagan CE. Barriers to Discharge Patients With a Tracheostomy: A Qualitative Analysis. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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