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Laverty L, Gandrup J, Sharp CA, Ercia A, Sanders C, Dowding D, Dixon WG, van der Veer SN. Using patient-generated health data in clinical practice: How timing influences its function in rheumatology outpatient consultations. Patient Educ Couns 2022; 105:625-631. [PMID: 34238651 DOI: 10.1016/j.pec.2021.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Utilizing patient-generated health data (PGHD) in clinical consultations and informing clinical and shared decision-making processes has the potential to improve clinical practice but has proven challenging to implement. Looking at consultations between people with rheumatoid arthritis (RA) and rheumatologists, this study examines when and how daily PGHD was discussed in outpatient consultations. METHODS We conducted a secondary qualitative analysis of 17 audio-recorded research outpatient consultations using thematic and interactional approaches. RESULTS Clinicians decided when to look at the PGHD and what symptoms to prioritise during the consultation. When PGHD was introduced early in consultations, it was usually used to invite patients to collaborate (elicit new information). When introduced later, PGHD was used to corroborate patient accounts and to convince the patient about proposed actions and treatments. Clinicians occasionally disregarded PGHD if it did not fit into their clinical assessment. CONCLUSION The time that PGHD is introduced may influence how PGHD is used in consultations. Further research is needed to understand how best to empower patients to discuss PGHD. PRACTICE IMPLICATIONS Educating patients and clinicians about the importance of timing and strategies when using PGHD in consultations may help promote shared decision-making.
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Affiliation(s)
- Louise Laverty
- Centre for Health Informatics, University of Manchester, Manchester, UK.
| | - Julie Gandrup
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - Charlotte A Sharp
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK; National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK; The Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Angelo Ercia
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Caroline Sanders
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - William G Dixon
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK; Rheumatology Department, Salford Royal NHS Foundation Trust, Salford, UK; NIHR Greater Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
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Wu R, Ercia A. Analysing the impact of private health insurance on inequities in health care utilization: a longitudinal study from China. Health Policy Plan 2021; 36:1593-1604. [PMID: 34417798 DOI: 10.1093/heapol/czab107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 07/25/2021] [Accepted: 08/20/2021] [Indexed: 11/14/2022] Open
Abstract
Since the early 2000s, Chinese government has sought to encourage the growth of private health insurance (PHI) while simultaneously expanding the breadth of coverage in its social health insurance (SHI) system. This paper examines how the prevalence of PHI has changed during this period and the extent to which PHI contributed to the growth of horizontal and geographical inequities with a focus on healthcare utilization. National data from China Health and Nutrition Survey between 2000 and 2015 were analysed using a multilevel modelling approach. The analysis investigated the impact of SHI membership as related to PHI uptake, PHI enrolees' utilization of health services and out-of-pocket (OOP) expenses. This study found being covered by an SHI scheme reduced the uptake of PHI between 2004 and 2015. Having PHI caused an increase in utilizing outpatient care but did not affect OOP expenses. Coverage prevalence of PHI in a residential community was positively associated with the average level of healthcare utilization. Coverage prevalence of PHI and its effects on healthcare utilization varied geographically. The findings suggest that expanding the role of PHI was not effective without clear support from government policy. Furthermore, the expansion of PHI may cause an increase in horizontal and geographical inequities in healthcare utilization.
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Affiliation(s)
- Runguo Wu
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, Whitechapel, London E1 2AB, UK.,Global Health Policy Unit, School of Social and Political Science, the University of Edinburgh, 15a George Square, Edinburgh EH8 9LD, UK
| | - Angelo Ercia
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK.,Cievert, an Evergreen Life Company, Evergreen Business Centre, Clowes Street, Manchester M3 5NA, UK
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Ercia A. The impact of the Affordable Care Act on patient coverage and access to care: perspectives from FQHC administrators in Arizona, California and Texas. BMC Health Serv Res 2021; 21:920. [PMID: 34488758 PMCID: PMC8420058 DOI: 10.1186/s12913-021-06961-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 08/30/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The Affordable Care Act (ACA) enabled millions of people to gain coverage that was expected to improve access to healthcare services. However, it is unclear the extent of the policy's impact on Federally Qualified Health Centers (FQHC) and the patients they served. This study sought to understand FQHC administrators' views on the ACA's impact on their patient population and organization. It specifically explores FQHC administrators' perspective on 1) patients' experience with gaining coverage 2) their ability to meet patients' healthcare needs. METHODS Twenty-two semi-structured interviews were conducted with administrators from FQHCs in urban counties in 2 Medicaid-expanded states (Arizona and California) and 1 non-expanded state (Texas). An inductive thematic analysis approach was used to analyze the interview data. RESULTS All FQHC administrators reported uninsured patients were more likely to gain coverage from Medicaid than from private health insurance. Insured patients generally experienced an improvement in accessing healthcare services but depended on their plan's covered services, FQHCs' capacity to meet demand, and specialist providers' willingness to accept their coverage type. CONCLUSION Gaining coverage helped improved newly insured patients' access to care, but limitations remained. Additional policies are required to better address the gaps in the depth of covered services in Medicaid and the most affordable PHI plans and capacity of providers to meet demand to ensure beneficiaries can fully access the health care services they need.
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Affiliation(s)
- Angelo Ercia
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PT, UK.
- Cievert, an Evergreen Life Company, Evergreen Business Centre, Clowes St, Manchester, M3 5NA, UK.
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Knowles SE, Ercia A, Caskey F, Rees M, Farrington K, Van der Veer SN. Participatory co-design and normalisation process theory with staff and patients to implement digital ways of working into routine care: the example of electronic patient-reported outcomes in UK renal services. BMC Health Serv Res 2021; 21:706. [PMID: 34273978 PMCID: PMC8286572 DOI: 10.1186/s12913-021-06702-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/31/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Successful implementation of digital health systems requires contextually sensitive solutions. Working directly with system users and drawing on implementation science frameworks are both recommended. We sought to combine Normalisation Process Theory (NPT) with participatory co-design methods, to work with healthcare stakeholders to generate implementation support recommendations for a new electronic patient reported outcome measure (ePRO) in renal services. ePROs collect data on patient-reported symptom burden and illness experience overtime, requiring sustained engagement and integration into existing systems. METHODS We identified co-design methods that could be mapped to NPT constructs to generate relevant qualitative data. Patients and staff from three renal units in England participated in empathy and process mapping activities to understand 'coherence' (why the ePRO should be completed) and 'cognitive participation' (who would be involved in collecting the ePRO). Observation of routine unit activity was completed to understand 'collective action' (how the collection of ePRO could integrate with service routines). RESULTS The mapping activities and observation enabled the research team to become more aware of the key needs of both staff and patients. Working within sites enabled us to consider local resources and barriers. This produced 'core and custom' recommendations specifying core needs that could be met with customised local solutions. We identified two over-arching themes which need to be considered when introducing new digital systems (1) That data collection is physical (electronic systems need to fit into physical spaces and routines), and (2) That data collection is intentional (system users must be convinced of the value of collecting the data). CONCLUSIONS We demonstrate that NPT constructs can be operationalised through participatory co-design to work with stakeholders and within settings to collaboratively produce implementation support recommendations. This enables production of contextually sensitive implementation recommendations, informed by qualitative evidence, theory, and stakeholder input. Further longitudinal evaluation is necessary to determine how successful the recommendations are in practice.
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Affiliation(s)
- S E Knowles
- Centre for Reviews & Dissemination, University of York, York, UK.
| | - A Ercia
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - F Caskey
- Population Health Science Institute, Bristol Medical School, University of Bristol, Bristol, UK
| | - M Rees
- School of Social, Historical and Political Studies, University of Wolverhampton, Farrington, UK
| | - K Farrington
- Renal Unit, East & North Hertfordshire NHS Trust, Stevenage, UK
| | - S N Van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Ercia A, Le N, Wu R. Health insurance enrollment strategies during the Affordable Care Act (ACA): a scoping review on what worked and for whom. Arch Public Health 2021; 79:129. [PMID: 34253258 PMCID: PMC8274016 DOI: 10.1186/s13690-021-00645-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/21/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The Affordable Care Act (ACA) provided an opportunity for millions of people in the U.S. to get coverage from the publicly funded Medicaid program or private insurance from the newly established marketplace. However, enrolling millions of people for health insurance was an enormous task. The aim of this review was to examine the strategies used to enroll people for health insurance and their effectiveness after implementing the ACA's coverage expansion. METHODS The PRISMA Extension for Scoping Review (PRISMA-ScR) guided this review. Included studies were empirical studies that met the inclusion criteria and published between 2010 and 2020. Studies were searched mainly from two scholarly databases, CINAHL Plus and Medline (PubMed) using keyword searches. Hand searches from the references of selected journals were also performed. Content analysis was conducted by two authors in which codes were inductively developed to identify themes. RESULTS There were 2213 potential studies identified from the search, but 10 met the inclusion criteria. The research design of the studies varied. Two studies were randomized trials, one quasi-experimental trial, three mixed-methods, two qualitative and two quantitative. All studies focused on strategies used to inform and help people enroll for either Medicaid or private insurance from the marketplace. This review identified three key strategies used to help enroll people for coverage: 1) individual assistance; 2) community outreach; and 3) health education and promotion (HE&P). CONCLUSION Community-based organizations were likely to use a combination of the three strategies simultaneously to reach uninsured individuals and directly help them enroll for health insurance. Other organizations that aimed to reach a wider segment of the population used single strategies, such as community outreach or HE&P.
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Affiliation(s)
- Angelo Ercia
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK.
| | - Nga Le
- Department of Health & Human Services, County of Marin, Marin, California, USA
| | - Runguo Wu
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
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Greer SL, Stewart E, Ercia A, Donnelly P. Changing health care with, for, or against the public: an empirical investigation into the place of the public in health service reconfiguration. J Health Serv Res Policy 2021; 26:12-19. [PMID: 32686515 PMCID: PMC7809440 DOI: 10.1177/1355819620935148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study sought to understand the different approaches taken to involving the public in service reconfiguration in the four United Kingdom health systems. METHODS This was a multi-method study involving policy document analysis and qualitative semi-structured interviews in England, Northern Ireland, Scotland and Wales. RESULTS Despite the diversity of local situations, interview participants tended to use three frames within which they understood the politics of service reconfigurations: an adversarial approach which assumed conflict over scarce resources (change against the public); a communications approach which defined the problem as educating the public on the desirability of change (change for the public); and a collaborative approach which attempted to integrate the public early into discussions about the shape and nature of desirable services (change with the public). These three framings involved different levels of managerial time, energy, and resources and called on different skill sets, most notably marketing and communications for the communications approach and community engagement for the collaborative approach. CONCLUSIONS We argue that these framings of public involvement co-exist within organisations. Health system leaders, in framing service reconfiguration as adversarial, communicative or collaborative, are deciding between conceptions of the relationship between health care organisations and their publics in ways that shape the nature of the debates that follow. Understanding the reasons why organisations adopt these frames would be a fruitful way to advance both theory and practice.
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Affiliation(s)
- Scott L Greer
- Professor of Health Management and Policy, Global Public Health and Political Science, University of Michigan, USA
- Senior Expert Advisor on Health Governance, European Observatory on Health Systems and Policies, Brussels
| | - Ellen Stewart
- Chancellor's Fellow, Usher Institute, University of Edinburgh, UK
- College of Medicine and Veterinary Science, University of Edinburgh, UK
| | - Angelo Ercia
- Research Associate, Division of Informatics, Imaging & Data Sciences, University of Manchester,UK
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Van Der Veer SN, Ercia A, Caskey FJ, Farrington K, Jury F, Rees M, Whitlock T, Knowles S. Developing an Intervention to Implement Electronic Patient-Reported Outcomes in Renal Services in the UK. Stud Health Technol Inform 2020; 270:936-940. [PMID: 32570519 DOI: 10.3233/shti200299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Routinely collecting and using electronic patient-reported outcome (ePRO) data in clinical practice can improve patients' experience and outcomes, but implementing this at scale has proved challenging. As part of the Optimising routine collection of electronic patient-reported outcomes (OPT-ePRO) study, we therefore developed an intervention that aimed to facilitate the implementation of ePROs. We are conducting OPT-ePRO in the context of secondary care for people with chronic kidney disease in the UK, with three renal units participating as our study sites. Intervention design was guided by Normalisation Process Theory, and informed by published literature and qualitative research. The intervention consisted of a national infrastructure to securely collect, transfer and display ePRO data, complemented with materials and procedures to support kidney patients and renal unit staff with embedding ePROs in usual care pathways. The next step will be to bring the OPT-ePRO intervention into practice and iteratively refine it.
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Affiliation(s)
| | - Angelo Ercia
- Centre for Health Informatics, University of Manchester, UK
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Ken Farrington
- Renal Unit. East & North Hertfordshire NHS Trust, Stevenage, UK
| | - Francine Jury
- Centre for Health Informatics, University of Manchester, UK
| | - Michael Rees
- School of Social, Historical and Political Studies, University of Wolverhampton, UK
| | - Tim Whitlock
- UK Renal Registry, The Renal Association, Bristol, UK
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Stewart E, Greer SL, Ercia A, Donnelly PD. Transforming health care: the policy and politics of service reconfiguration in the UK's four health systems. Health Econ Policy Law 2020; 15:289-307. [PMID: 30975243 PMCID: PMC7525102 DOI: 10.1017/s1744133119000148] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/23/2018] [Accepted: 11/29/2018] [Indexed: 11/24/2022]
Abstract
Public involvement in service change has been identified as a key facilitator of health care transformation (Foley et al., 2017) but little is known about how health policy influences whether and how organisations involve the public in change processes. This qualitative study compares policy and practice for involving the public in major service changes across the UK's four health systems (England, Northern Ireland, Wales and Scotland). We analysed policy documents, and conducted interviews with officials, stakeholders, NHS staff and public campaigners (total number of interviewees = 47). Involving the public in major service change was acknowledged as a policy challenge in all four systems. Despite ostensible similarities, there were some clear differences between the four health systems' processes for involving patients and the public in major changes to health services. The extent of central Government oversight, the prescriptiveness of Government guidance, the role for intermediary bodies and arrangements for independent scrutiny of contentious decisions all vary. We analyse how health policy in the four systems has used 'sticks' and 'sermons' to promote particular approaches, and conclude that both policy and the wider system context within which health care organisations try to effect change are significant, and understudied aspect of contemporary practice.
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Affiliation(s)
- Ellen Stewart
- Centre for Biomedicine, Self & Society, Usher Institute, Old Medical School, University of Edinburgh, Teviot Place, EdinburghEH8 9AG, UK
| | - Scott L. Greer
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, Michigan48109-2029, USA
| | - Angelo Ercia
- Centre for Health Informatics, The University of Manchester, Vaughan House, Portsmouth Street, ManchesterM13 9GB, UK
| | - Peter D. Donnelly
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Wu R, Li N, Ercia A. The Effects of Private Health Insurance on Universal Health Coverage Objectives in China: A Systematic Literature Review. Int J Environ Res Public Health 2020; 17:E2049. [PMID: 32204527 PMCID: PMC7142974 DOI: 10.3390/ijerph17062049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND We conducted a systematic review on the role of private health insurance to complement the social health insurance system towards achieving universal health coverage in China. This review presents the impacts of private health insurance on expanding coverage, increasing access to healthcare, and financial protection. METHODS A systematic review was conducted by searching peer-reviewed articles published between January 2000 and March 2018 in Web of Science, PubMed, and China Knowledge Resource Integrated Database. The search terms included coverage prevalence, access and financial protection related to private health insurance in China. A total of 31 studies were selected. RESULTS Coverage prevalence of private health insurance gradually increased but it was unequally distributed across regions and populations. The expansion of social health insurance has enhanced the total aggregate premium of private health insurance but has had a mixed impact on the take-up of private health insurance. Private insurance beneficiaries were found to limit their utilisation of healthcare services and there was no evidence that it ensured financial protection. CONCLUSION The role of private health insurance (PHI) in extending universal health coverage in China was limited and therefore should not be overstated.
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Affiliation(s)
- Runguo Wu
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh EH8 9LD, UK
| | - Niying Li
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Angelo Ercia
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, the University of Manchester, M13 9PL Manchester, UK;
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Ercia A, Stewart E, Greer S, Donnelly P. Transforming care, engaging communities: conversation with the public on service change across UK. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw174.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ercia A. Meeting the rise in demand for care: U.S.A.'s primary care community clinics use of care teams. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw175.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lee JP, Kirkpatrick S, Rojas-Cheatham A, Sin T, Moore RS, Tan S, Godoy S, Ercia A. Improving the Health of Cambodian Americans: Grassroots Approaches and Root Causes. Prog Community Health Partnersh 2016; 10:113-21. [PMID: 27018360 DOI: 10.1353/cpr.2016.0018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cambodian Americans experience great disparities in health compared to other Americans, yet may be underserved by conventional healthcare systems. Community-based participatory research (CBPR) is a means to engage underserved communities in health research and programming. We describe results of our efforts to engage the Cambodian grassroots members as well as formal leaders in Oakland, California. OBJECTIVES In addition to a community advisory group, we convened a Community Work Group (CWG), composed of 10 grassroots community women of varying ages and backgrounds. The project aimed to leverage the lived experiences of these women and their understandings of health and wellness in identifying specific health issues and developing culturally resonant strategies. METHODS The CWG met weekly with staff facilitators using methods for collective analysis including theater, body mapping, and other expressive arts. RESULTS The approach proved logistically challenging, but resulted in novel analyses and strategies. The group identified trauma, along with poor access to education, unemployment and underemployment, social isolation, and generation gap, together with community violence, as root causes of key behavioral health issues, namely, alcohol abuse, gambling, prescription drug misuse, and domestic violence. Strategies proposed and implemented by the group and project staff were a community garden, Cambodian New Year's celebrations, and a museum exhibit on the Cambodian refugee experiences. CONCLUSIONS Grassroots community engagement can support projects in identifying social determinants of health and developing the capacities of community members to conduct research and actions to improve health.
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Ercia A. The USA’s effort to reduce the uninsurance rate through the Affordable Care Act: Is it working? Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv172.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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