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Ventres WB, Stone LA, Rowland KT, Streiffer RH, Macechko MD, Roulier JA, Borkan JM, Green LA. Storylines of family medicine I: framing family medicine - history, values and perspectives. Fam Med Community Health 2024; 12:e002788. [PMID: 38609088 PMCID: PMC11029363 DOI: 10.1136/fmch-2024-002788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/20/2024] [Indexed: 04/14/2024] Open
Abstract
Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'I: framing family medicine-history, values, and perspectives', the authors address the following themes: 'Notes on Storylines of Family Medicine', 'Family medicine-the generalist specialty', 'Family medicine's achievements-a glass half full assessment', 'Family medicine's next 50 years-toward filling our glasses', 'Four enduring truths of family medicine', 'Names matter', 'Family medicine at its core' and 'The ecology of medical care.' May readers find much food for thought in these essays.
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Affiliation(s)
- William B Ventres
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Leslie A Stone
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Kathleen T Rowland
- Family and Preventive Medicine, Rush Medical College of Rush University, Chicago, Illinois, USA
| | - Richard H Streiffer
- College of Community Health Sciences, University of Alabama, Tuscaloosa, Alabama, USA
| | - Michael D Macechko
- UAMS Northwest Regional Campus Family Medicine Residency Program, Fayetteville, Arkansas, USA
| | - Julia A Roulier
- UAMS North Central Regional Campus Family Medicine Residency Program, Batesville, Arkansas, USA
| | - Jeffrey M Borkan
- Family Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Larry A Green
- University of Colorado School of Medicine, Aurora, Colorado, USA
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Moore R, Purvis RS, Willis DE, Li J, Langner J, Gurel-Headley M, Kraleti S, Curran GM, Macechko MD, McElfish PA. "Every Time It Comes Time for Another Shot, It's a Re-Evaluation": A Qualitative Study of Intent to Receive COVID-19 Boosters among Parents Who Were Hesitant Adopters of the COVID-19 Vaccine. Vaccines (Basel) 2024; 12:171. [PMID: 38400154 PMCID: PMC10892107 DOI: 10.3390/vaccines12020171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
COVID-19 vaccine coverage remains low for US children, especially among those living in rural areas and the Southern/Southeastern US. As of 12 September 2023, the CDC recommended bivalent booster doses for everyone 6 months and older. Emerging research has shown an individual may be vaccine hesitant and also choose to receive a vaccine for themselves or their child(ren); however, little is known regarding how hesitant adopters evaluate COVID-19 booster vaccinations. We used an exploratory qualitative descriptive study design and conducted individual interviews with COVID-19 vaccine-hesitant adopter parents (n = 20) to explore COVID-19 parental intentions to have children receive COVID-19 boosters. Three primary themes emerged during the analysis: risk, confidence, and intent, with risk assessments from COVID-19 and COVID-19 vaccine confidence often related to an individual parent's intent to vaccinate. We also found links among individuals with persistent concerns about the COVID-19 vaccine and low COVID-19 vaccine confidence with conditional and/or low/no intent and refusal to receive recommended boosters for children. Our findings suggest that healthcare providers and public health officials should continue making strong recommendations for vaccines, continue to address parental concerns, and provide strong evidence for vaccine safety and efficacy even among the vaccinated.
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Affiliation(s)
- Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA; (R.M.); (R.S.P.); (D.E.W.)
| | - Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA; (R.M.); (R.S.P.); (D.E.W.)
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA; (R.M.); (R.S.P.); (D.E.W.)
| | - Ji Li
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Jonathan Langner
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA;
| | - Morgan Gurel-Headley
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA; (M.G.-H.); (S.K.)
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Shashank Kraleti
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA; (M.G.-H.); (S.K.)
| | - Geoffrey M. Curran
- College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA;
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 4300 W. 7th St., North Little Rock, AR 72114, USA
| | - Michael D. Macechko
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA;
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA; (R.M.); (R.S.P.); (D.E.W.)
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McElfish PA, Liston R, Smith V, Norris AK, Weaver J, Dickson SM, Macechko MD, Brimberry RK, Lemdja MR, Middleton TL, Nix MW, Irish-Clardy KA, Meredith-Neve SM, Kennedy JL, James LP. Rural Research Network to engage rural and minority community members in translational research. J Clin Transl Res 2023; 9:115-122. [PMID: 37179792 PMCID: PMC10171320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/30/2023] [Accepted: 03/02/2023] [Indexed: 05/15/2023] Open
Abstract
Background To address the high prevalence of health disparities and lack of research opportunities among rural and minority communities, the University of Arkansas for Medical Sciences (UAMS) developed the Rural Research Network in January 2020. Aim The aim of this report is to describe our process and progress in developing a rural research network. The Rural Research Network provides a platform to expand research participation opportunities to rural Arkansans, many of whom are older adults, low-income individuals, and underrepresented minority populations. Methods The Rural Research Network leverages existing UAMS Regional Programs family medicine residency clinics within an academic medical center. Results Since the inception of the Rural Research Network, research infrastructure and processes have been built within the regional sites. Twelve diverse studies have been implemented with recruitment and data collection from 9248 participants, and 32 manuscripts have been published with residents and faculty from the regional sites. Most studies were able to recruit Black/African American participants at or above a representative sample. Conclusions As the Rural Research Network matures, the types of research will expand in parallel with the health priorities of Arkansas. Relevance to Patients The Rural Research Network demonstrates how Cancer Institutes and sites funded by a Clinical and Translational Science Award can collaborate to expand research capacity and increase opportunities for research among rural and minority communities.
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Affiliation(s)
- Pearl A. McElfish
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States of America
- Corresponding author: Pearl A. McElfish University of Arkansas for Medical Sciences Northwest, 2708 S. 48 St, Springdale, AR 72762, United States of America. Phone: +1 479 713 8680
| | - Robin Liston
- University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Veronica Smith
- University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Amber K. Norris
- University of Arkansas for Medical Sciences East, Helena-West Helena, AR, United States of America
| | - Jordan Weaver
- University of Arkansas for Medical Sciences North Central, Batesville, AR, United States of America
| | - Scott M. Dickson
- University of Arkansas for Medical Sciences Northeast, Jonesboro, AR, United States of America
| | - Michael D. Macechko
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, United States of America
| | - Ronald K. Brimberry
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, United States of America
| | - Mimo R. Lemdja
- University of Arkansas for Medical Sciences South, Magnolia, AR, United States of America
| | - Toni L. Middleton
- University of Arkansas for Medical Sciences South Central, Pine Bluff, AR, United States of America
| | - Matthew W. Nix
- University of Arkansas for Medical Sciences Southwest, Texarkana, AR, United States of America
| | | | | | - Joshua L. Kennedy
- University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Laura P. James
- University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
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McElfish PA, Selig JP, Scott AJ, Rowland B, Willis DE, Reece S, CarlLee S, Macechko MD, Shah SK. Associations Between General Vaccine Hesitancy and Healthcare Access Among Arkansans. J Gen Intern Med 2023; 38:841-847. [PMID: 36323819 PMCID: PMC9629763 DOI: 10.1007/s11606-022-07859-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Vaccines provide protection against numerous diseases that can cause serious illness and death. However, vaccine hesitancy threatens to undermine progress in reducing preventable diseases and illness. Vaccine hesitancy has been shown to vary by sociodemographic characteristics. However, studies examining associations between healthcare access and vaccine hesitancy are lacking. OBJECTIVE Using a statewide random sample of Arkansas adults, we examined the relationship between general vaccine hesitancy and healthcare access. DESIGN From July 12 to 30, 2021, participants were contacted by landlines and cellular phones using random digit dialing. PARTICIPANTS A total of 1500 Arkansas adults were surveyed. Black/African American and Hispanic/Latinx adults were oversampled to ensure adequate representation. The survey had a cooperation rate of 20%. MAIN MEASURES The dependent variable was an ordinal measure of general vaccine hesitancy. Age, gender, race, education, relationship status, and rural/urban residence were included in the model. Healthcare access was measured across four domains: (1) health insurance coverage; (2) having a primary care provider (PCP); (3) forgoing care due to cost; and (4) time since last routine checkup. The relationship between general vaccine hesitancy and healthcare access was modeled using ordinal logistic regression, controlling for sociodemographic characteristics. KEY RESULTS Mean age was 48.5 years, 51.1% were women, 28% reported a race other than White, and 36.3% held a bachelor's degree or higher. Those with a PCP and those with health insurance had approximately two-thirds the odds of being more hesitant ([OR=0.63, CI=0.47, 0.84] and [OR=0.68; CI=0.49, 0.94]) than those without a PCP and those without health insurance. Participants reporting a routine checkup in the last 2 years were almost half as likely to be more hesitant than those reporting a checkup more than 2 years prior (OR=0.58; CI=0.43, 0.79). CONCLUSIONS Results suggest improving access to health insurance, PCPs, and routine preventative care services may be critical to reducing vaccine hesitancy.
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA.
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Michael D Macechko
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Sumit K Shah
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
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McElfish PA, Rowland B, Hall S, CarlLee S, Reece S, Macechko MD, Shah SK, Rojo MO, Riklon S, Richard-Davis G, Marin LP, Laelan M, Maddison BK, Alik E, Selig JP. Comparing community-driven COVID-19 vaccine distribution methods: Faith-based organizations vs. outpatient clinics. J Family Med Prim Care 2022; 11:6081-6086. [PMID: 36618221 PMCID: PMC9810872 DOI: 10.4103/jfmpc.jfmpc_327_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 11/11/2022] Open
Abstract
Background Minority and low socioeconomic communities may face practical barriers to vaccination, including decreased access to health care and less trust in healthcare organizations; however, few studies have focused on these barriers as the cause of differential vaccine uptake. We worked with community partners to implement and evaluate two community-driven approaches to COVID-19 vaccination distribution-through faith-based organizations (FBOs) and outpatient clinics-with a focus on understanding the differences between the populations who accessed each distribution method. Methodology Participants who came to the vaccination locations were approached and asked to complete a survey during their 15 min post-vaccination observation period. Differences between distribution locations were examined using Chi-square tests. Results The survey rendered 1,476 valid responses, with a total of 927 participants recruited at clinical locations and 519 at FBOs during vaccination events. There were significant differences by race/ethnicity, with distribution methods at FBOs reaching a higher proportion of Hispanic/Latino and Marshallese participants. The proportion of uninsured participants who had lower health literacy and had lower educational attainment was higher with the FBO distribution method. FBO participants were more likely to report "completely" trusting the COVID-19 vaccine. There was no significant difference between FBO and clinic participants with regard to the level of vaccine hesitancy. There were no statistically significant differences with regard to access. Conclusion A higher proportion of Hispanic/Latino and Marshallese participants utilized FBOs for vaccination, suggesting collaborations with FBOs can potentially increase vaccination uptake among minority communities and help mitigate vaccination disparities.
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Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA,Address for correspondence: Dr. Pearl A. McElfish, 1125 N. College Ave., Fayetteville, AR 72703, USA. E-mail:
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Spencer Hall
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Michael D. Macechko
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Sumit K. Shah
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Martha O. Rojo
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Gloria Richard-Davis
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Luis Paganelli Marin
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Melisa Laelan
- Arkansas Coalition of Marshallese, Springdale, Arkansas, USA
| | | | - Eldon Alik
- Republic of the Marshall Islands Consulate, Springdale, Arkansas, USA
| | - James P. Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
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McElfish PA, Rowland B, Scott AJ, Andersen JA, CarlLee S, McKinnon JC, Reece S, Meredith‐Neve SM, Macechko MD, Gurel‐Headley M, Willis DE. Hesitant adopters: An examination of hesitancy among adults in Arkansas who have taken the COVID-19 vaccine. Clin Transl Sci 2022; 15:2316-2322. [PMID: 36004689 PMCID: PMC9538052 DOI: 10.1111/cts.13367] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 04/20/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 01/25/2023] Open
Abstract
Recent research suggests people who report vaccine hesitancy may still get vaccinated; however, little is known about hesitancy among those who chose to vaccinate. The current study focused on individuals who received the coronavirus disease 2019 (COVID-19) vaccine despite their hesitancy, whom we refer to as "hesitant adopters." With the understanding that vaccine attitudes and vaccine behaviors may or may not be correlated, we examined the prevalence of COVID-19 vaccine hesitancy among those who have been vaccinated, how COVID-19 vaccine hesitancy varies across sociodemographic groups, and how COVID-19 vaccine hesitancy relates to other factors (prior health care access and influenza vaccination behavior over the past 5 years). Random digit dialing of telephone landlines and cell phones was used to contact potential survey respondents, rendering a sample of 1500 Arkansan adults. Approximately one-third of those who received a COVID-19 vaccine also reported some level of hesitancy. Among hesitant adopters, 5.3% said they were "very hesitant," 8.8% said they were "somewhat hesitant," and 17.1% said they were "a little hesitant." Black/African American and Hispanic/Latinx respondents reported more hesitancy than White respondents, and female respondents reported greater hesitancy compared to male respondents. Greater hesitancy was associated with non-metro/rural residence, forgoing health care due to cost, and lower influenza vaccination rates over the past 5 years. Findings suggest those who are hesitant may get vaccinated despite their hesitancy, illustrating the complexity of vaccination behaviors. Prevalence of hesitancy among the vaccinated has implications for communication strategies in vaccine outreach programs and may help to reduce stigmatization of hesitant adopters.
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Affiliation(s)
- Pearl A. McElfish
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Brett Rowland
- Office of Community Health and ResearchUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Aaron J. Scott
- Office of Community Health and ResearchUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Jennifer A. Andersen
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Sheena CarlLee
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Joshua C. McKinnon
- College of NursingUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Sharon Reece
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Sandra M. Meredith‐Neve
- Integrated Medicine Service LineUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Michael D. Macechko
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Morgan Gurel‐Headley
- College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
- Fay W. Boozman College of Public HealthUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Don E. Willis
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
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