Showing papers in "Journal of Health Care for the Poor and Underserved in 2006"
TL;DR: The findings revealed no difference in self-reported willingness to participate in biomedical research, as measured by the LOP Scale, between Blacks, Hispanics, and Whites, despite Blacks being 1.8 times as likely as Whites to have a higher fear of participation in biomedicalResearch on the GPFF Scale.
Abstract: The broad goal of the Tuskegee Legacy Project (TLP) study was to address, and understand, a range of issues related to the recruitment and retention of Blacks and other minorities in biomedical research studies. The specific aim of this analysis was to compare the self-reported willingness of Blacks, Hispanics, and Whites to participate as research subjects in biomedical studies, as measured by the Likelihood of Participation (LOP) Scale and the Guinea Pig Fear Factor (GPFF) Scale. The Tuskegee Legacy Project Questionnaire, a 60 item instrument, was administered to 1,133 adult Blacks, Hispanics, and non-Hispanic Whites in 4 U.S. cities. The findings revealed no difference in self-reported willingness to participate in biomedical research, as measured by the LOP Scale, between Blacks, Hispanics, and Whites, despite Blacks being 1.8 times as likely as Whites to have a higher fear of participation in biomedical research on the GPFF Scale.
192 citations
TL;DR: Evidence of a significant U-shaped relationship between discrimination and systolic blood pressure for all three cohorts is found and factors associated with acculturation or cumulative exposure to discriminatory stressors may affect the protective resources of immigrants.
Abstract: The relationship between perceived racial discrimination and both blood pressure and perceived physical health has been documented among African Americans. However, this association has not been well-studied for Black or Latino immigrants. We used multiple regression analysis with a cross-sectional sample of 666 African Americans, Black immigrants, and Latino immigrants from the New Hampshire Racial and Ethnic Approaches to Community Health 2010 Initiative to assess the relationship between discrimination and measures of physical health and blood pressure. The study found evidence of a significant U-shaped relationship between discrimination and systolic blood pressure for all three cohorts. Evidence was also found supporting a negative linear relationship between discrimination and physical health. In addition, the association between discrimination and physical health was attenuated for Latinos compared with the other groups. Future research should evaluate how factors associated with acculturation or cumulative exposure to discriminatory stressors may affect the protective resources of immigrants.
164 citations
TL;DR: Clients appreciated the promotora's socio-cultural characteristics, as well as her personal skills and qualities, and described her as a trained, natural helper whose personalized support removed barriers to health care and helped women to take care of themselves.
Abstract: The purpose of this qualitative study was to elicit information on why a promotora (or, community health worker (CHW)) increased adherence to chronic disease screening among women along the U.S.-Mexico border. After completion of the intervention, women and clinic staff who participated in the promotora phase of a randomized, controlled study answered structured, open-ended questionnaires. Clinicians from two non-participating clinics were also interviewed. Content analysis found that the promotora's roles included health education and the facilitation of routine and follow-up care. Clients appreciated the promotora's socio-cultural characteristics, as well as her personal skills and qualities, and described her as a trained, natural helper whose personalized support removed barriers to health care and helped women to take care of themselves. Most clinicians recommended working with a CHW to increase adherence to chronic disease prevention practices. A CHW can play a crucial role on a health care team and interventions should tap into this resource.
116 citations
TL;DR: Using community-based participatory research methods, a community-research coalition in Santa Clara County, California conducted a quasi-experimental, controlled trial to increase Pap test receipt and to build community capacity among Vietnamese-American women.
Abstract: Using community-based participatory research methods, a community-research coalition in Santa Clara County, California (SCC) conducted a quasi-experimental, controlled trial to increase Pap test receipt and to build community capacity among Vietnamese-American women. From 1999 to 2004, the Coalition planned and implemented an Action Plan with six components: multimedia campaign, lay health worker outreach, Vietnamese Pap clinic with patient navigation, registry and reminder system, continuing medical education for Vietnamese physicians, and restoring a Breast and Cervical Cancer Control Program site. Components were evaluated individually. Community-wide, cross-sectional telephone surveys of Vietnamese women in SCC (intervention community) and Harris County, Texas (comparison community) measured overall project impact. Receipt and currency of Pap tests increased significantly in the intervention compared with the comparison community. Community involvement, system changes, community and research capacity building, dissemination of results, and program sustainability were also demonstrated. Community-based participatory research is feasible and effective in Vietnamese-American communities.
95 citations
TL;DR: The authors analyzed data from The National Survey of Child and Adolescent Well-Being (NSCAW), Wave 1, the first national dataset of children in the child welfare system to identify factors significantly associated with having a chronic condition.
Abstract: The population of children in foster care is rapidly growing. Previous local and state-level analyses have measured the prevalence of chronic conditions among such children to be from 44%-82%. The study objective was to identify factors associated with chronic conditions among a nationally representative sample of children in foster care for one year. The authors analyzed data from The National Survey of Child and Adolescent Well-Being (NSCAW), Wave 1, the first national dataset of children in the child welfare system. In regression analysis, factors significantly associated with having a chronic condition included: child age under 2 years, caregiver race/ethnicity other than Hispanic, and relatively few household members. Discussion includes consideration of chronic conditions in this high-risk population.
91 citations
TL;DR: In addition to awareness and knowledge of the USPHS Syphilis Study at Tuskegee, published studies suggest that a broad array of structural and sociocultural factors influence minorities' willingness to participate in biomedical studies.
Abstract: The purpose of this review was to collect and interpret the findings of all published qualitative or quantitative research that assessed African Americans' 1) general awareness and/or specific knowledge of the U.S. Public Health Service (USPHS) Syphilis Study at Tuskegee, and 2) attitudes towards and/or willingness to participate in biomedical research. An exhaustive review of the literature produced eight articles that fit the aforementioned selection criteria. All articles that assessed both awareness and knowledge found that familiarity with the USPHS Syphilis Study at Tuskegee did not necessarily ensure accurate knowledge of it. Four studies also found that awareness of the USPHS Syphilis Study at Tuskegee did not relate to willingness to participate in biomedical research. In addition to awareness and knowledge of the USPHS Syphilis Study at Tuskegee, published studies suggest that a broad array of structural and sociocultural factors influence minorities' willingness to participate in biomedical studies.
90 citations
TL;DR: A longitudinal repeated measures design was used to assess the return on investment of outreach by CHWs employed by Denver Health Community Voices, and data provide evidence of economic contributions that CHWs make to a public safety net system and inform policy making regarding program sustainability.
Abstract: Community health workers (CHWs) are effective in improving access to health care, promoting client knowledge and behavior change, and contributing to improved health status of individuals. However, few outreach programs have evaluated the financial impact of CHWs on health care systems and policies. A longitudinal repeated measures design was used to assess the return on investment (ROI) of outreach by CHWs employed by Denver Health Community Voices. Service utilization, charges and reimbursements for 590 underserved men were analyzed 9 months before and after interaction with a CHW. Primary and specialty care visits increased and urgent care, inpatient, and outpatient behavioral health care utilization decreased, resulting in a reduction of monthly uncompensated costs by $14,244. Program costs were $6,229 per month and the ROI was 2.28:1.00, a savings of $95,941 annually. These data provide evidence of economic contributions that CHWs make to a public safety net system and inform policy making regarding program sustainability.
86 citations
TL;DR: By valuing faculty time dedicated to this work and actively supporting clinic organizers' applications for external funding, medical school administrators can facilitate high quality care and education at student-run clinics.
Abstract: At medical schools across the United States, students operate free clinics that have the potential to provide health benefits to patients while furnishing unique educational opportunities for students. While they provide the energy necessary to make these clinics successful, students must, due to their inexperience, collaborate with faculty, clinic preceptors, community members and medical school administrators to ensure that their clinics attain high standards in health care and education. Medical school faculty and clinic preceptors must make certain that appropriate health care is provided and that desirable educational messages regarding physician professionalism and altruism are conveyed effectively. As faculty availability in such clinics is limited, it is important that the pursuit of educational goals not compromise clinics' patient care. By valuing faculty time dedicated to this work and actively supporting clinic organizers' applications for external funding, medical school administrators can facilitate high quality care and education at student-run clinics.
82 citations
TL;DR: Investigation of the impact of transportation problems on a family's ability to keep an appointment found caregivers with the following characteristics were more likely not toKeep an appointment: not using a car to the last kept appointment, not keeping an appointment in the past due to transportation problems, having more than two people in the household.
Abstract: The Texas Children's Hospital Residents' Primary Care Group Clinic provides primary care to urban low-income children. The objective of this cross-sectional study was to investigate the impact of transportation problems on a family's ability to keep an appointment. One hundred eighty-three caregivers of children with an appointment were interviewed. Caregivers who kept their appointment were compared with those who did not with respect to demographic and transportation-related characteristics. Logistic regression modeling predicted caregivers with the following characteristics were more likely not to keep an appointment: not using a car to the last kept appointment, not keeping an appointment in the past due to transportation problems, having more than two people in the household, and not keeping an appointment in the past due to reasons other than transportation problems. Future research should focus on developing interventions to help low-income urban families overcome non-financial access barriers, including transportation problems.
80 citations
TL;DR: Understanding the personal, family and community context of living with diabetes and conducting interventions that provide support and coping strategies for self-management have important implications for reducing health disparities among disadvantaged racial and ethnic groups.
Abstract: This study examines baseline levels and correlates of diabetes-related emotional distress among inner-city African Americans and Hispanics with type 2 diabetes. The Problem Areas in Diabetes (PAID) scale, which measures diabetes-related emotional distress, was administered to 180 African American and Hispanic adults participating in the REACH Detroit Partnership. We examined bivariate and multivariate associations between emotional distress and biological, psychosocial, and quality of health care variables for African Americans and Hispanics. Scores were significantly higher among Hispanics than African Americans. Demographic factors were stronger predictors of emotional distress for Hispanics than for African Americans. Daily hassles, physician support, and perceived seriousness and understanding of diabetes were significant for African Americans. Understanding the personal, family and community context of living with diabetes and conducting interventions that provide support and coping strategies for self-management have important implications for reducing health disparities among disadvantaged racial and ethnic groups.
79 citations
TL;DR: Active involvement of mothers in the Mother/Daughter HIV Risk Reduction intervention is cost-effective and should be integrated into HIV intervention programs.
Abstract: Low-income African American inner city adolescent females continue to be at disproportionately high risk for contracting HIV. Though it has been speculated that mothers' involvement in HIV risk reduction may be helpful in the fight against HIV, very few interventions involve mothers. The Mother/Daughter HIV Risk Reduction intervention (MDRR), an innovative community-based intervention, trains mothers to be their daughters' primary HIV educators. A split-plot repeated measures design was used to test the effectiveness of the MDRR in decreasing daughters' sexual activity over a 2-month period. The mediating variables were daughters' HIV transmission knowledge, self-efficacy and intention to refuse sex. The sample consisted of 262 daughters with a mean age of 12.4 years. The results revealed that mothers were effective in increasing the mediating variables and in reducing their daughters' level of sexual activity. Active involvement of mothers is cost-effective and should be integrated into HIV intervention programs.
TL;DR: Primary care-related emergency department visits were found to be weakly correlation with the IMU and strongly correlated with the rate of uninsurance and poverty, and the combination of this indicator with other measures of access could be used to monitor and evaluate local initiatives designed to expand care and coverage to the medically underserved.
Abstract: To cope with the rising number of uninsured, communities around the country are pursuing a variety of strategies to expand local health care safety nets. One measure that has been suggested to evaluate what is working is primary care-related emergency depart- ment (ED) visits. In this paper, we evaluate the applicability of this measure as an access indicator by examining its correlation with other indicators of medical under-service. We obtained ED visit data from safety net hospitals in Houston, Texas and applied the New York University ED Algorithm to estimate the rate of visits that were primary care- related. We then examined at the ZIP code level the correlation of primary care-related ED visits per 1,000 population with the federal government's Index of Medical Underservice (IMU), the poverty rate, and the uninsurance rate. Primary care-related ED visits were found to be weakly correlated with the IMU and strongly correlated with the rate of uninsurance and poverty. These findings suggest that the combination of this indicator with other measures of access could be used to moni- tor and evaluate local initiatives designed to expand care and coverage to the medically underserved.
TL;DR: A conceptual framework is presented to aid in understanding the links between Black ethnicity and birthplace, health outcomes, health- related knowledge and behaviors, and health-related psychological and social factors and the potential to improve the understanding of health disparities in the U.S.
Abstract: Important differences between Blacks of different ethnicities in the U.S. in chronic disease morbidity and mortality have been reported. Blacks in the U.S. constitute a heterogeneous group, including immigrants from Africa, Caribbean nations, Central and South America, as well as people now known as African Americans. Ethnicity among Blacks is seldom examined in health research, although in-depth examination of the ethnicity and culture-related pathways through which psychosocial factors may act to influence health have the potential to improve our understanding of health disparities. This improved understanding could in turn lead to the development of new, innovative, culturally based interventions that may reduce health disparities in the U.S. We briefly review the literature that examines Black ethnicity and birthplace, health outcomes, health-related knowledge and behaviors, and health-related psychological and social factors. We present a conceptual framework to aid in understanding the links between these factors and health. Suggestions are offered for conducting research in the future.
TL;DR: Key findings include the importance of pre-existing relationships within the community and the prominent agenda-setting role played by key pastors, and the strength of the Coalition's dual focus on health behaviors and health disparities.
Abstract: Although many public health initiatives have been implemented through collaborations with faith-based institutions, little is known about best practices for developing such programs. Using a community-based participatory approach, this case study examines the implementation of an initiative in the Bronx, New York, that is designed to educate community members about health promotion and disease management and to mobilize church members to seek equal access to health care services. The study used qualitative methods, including the collaborative development of a logic model for the initiative, focus groups, interviews, analysis of program reports, and participant observation. The paper examines three key aspects of the initiative's implementation: (1) the engagement of the church leadership; (2) the use of church structures as venues for education and intervention; and (3) changes in church policies. Key findings include the importance of pre-existing relationships within the community and the prominent agenda-setting role played by key pastors, and the strength of the Coalition's dual focus on health behaviors and health disparities. Given the churches' demonstrated ability to pull people together, to motivate and to inspire, there is great potential for faith-based interventions, and models developed through such interventions, to address health disparities.
TL;DR: The Northern Manhattan Community Voices Collaborative as discussed by the authors developed a program to train and integrate community health workers (CHWs) into ongoing programs at partner community organizations, which facilitated health insurance enrollment for about 30,000 individuals, assisted 8,000 children to become completely immunized, and supported 4,000 families improving asthma management.
Abstract: The Northern Manhattan Community Voices Collaborative is committed to improving health care in Harlem, Washington Heights, Inwood, and low-income communities in New York City, large parts of which are home to many immigrants to the U.S. The collaborative developed a program to train and integrate community health workers (CHWs) into ongoing programs at partner community organizations. We report on our 2000-2005 experiences with CHWs for health insurance, child immunizations, and asthma management. A total of 1,504 CHWs were trained, with 16%-200% increase in CHW competency for selected skills. The CHWs facilitated health insurance enrollment for about 30,000 individuals, assisted 8,000 children to become completely immunized, and supported 4,000 families improving asthma management. Integration of CHW training into community programs is effective for empowering health promotion in underserved communities.
TL;DR: This article found that perceptions of racial barriers were associated with lower likelihood of being satisfied with care, but not with use of preventive services, and the consequences of this perception may include mistrust and dissatisfaction with medical care.
Abstract: We assessed how commonly people in the rural South perceive racial barriers to care, the characteristics of the people among whom this perception is most common and whether this perception is associated with satisfaction with and use of health services. We analyzed telephone survey data collected in 2002–3, using weighted statistical techniques and multivariate logistic regression in analyses stratified by race. Fifty-four percent of African Americans and 23% of Whites reported that they perceive racial barriers to care in their communities. African Americans who were middle-aged or older, male, or who report being in good-to-excellent health were more likely to perceive racial barriers. Whites who were younger, less educated, and uninsured were more likely than other Whites to perceive racial barriers. For African Americans, perceptions of racial barriers were associated with lower likelihood of being satisfied with care, but not with use of preventive services. The perception of racial barriers to health care is prevalent in the rural South, especially among African Americans. The consequences of this perception may include mistrust and dissatisfaction with medical care.
TL;DR: It is demonstrated that a majority of women leaving jail, including those with chronic diseases, lack primary care, and that this can be facilitated with provision of health benefits and social support.
Abstract: Factors associated with primary care utilization and health insurance coverage were examined among 511 women leaving jail in New York City from 1997-2001. One year after release, roughly half of the sample reported primary care utilization (47%) and health insurance coverage (56%). Neither outcome was more likely among those reporting diabetes, asthma, or depression. Primary care utilization was more likely among those reporting receipt of public benefits, health insurance coverage, moderate social support, avoidance of illegal activity, and HIV seropositivity. Health insurance coverage was associated with receipt of public benefits, hospitalization, primary care, and avoiding re-arrest. This study demonstrated that a majority of women leaving jail, including those with chronic diseases, lack primary care. These data highlight the need to plan for continuity of care from corrections to the community and suggest further that this can be facilitated with provision of health benefits and social support.
TL;DR: It is hoped that the novel training program in health equity for internal medical residents developed at Brigham and Women's Hospital can serve as a model for other teaching hospitals based in the United States.
Abstract: Health disparities are increasingly common and many U.S. practitioners have informal experience working in resource-poor settings. There are, however, few graduate medical education programs that focus on health equity. A graduate medical education program in health equity was developed at Brigham and Women's Hospital based on a review of existing literature and on a survey of junior faculty who have had informal health disparities experience. The Howard Hiatt Residency in Global Health Equity and Internal Medicine was developed as a four-year program to provide intensive training in internal medicine and health disparities. Participating residents are matched with a mentor who has clinical and research experience in the field of global health. In addition to a series of didactic teaching sessions and longitudinal seminars that focus on issues of global health equity, residents take graduate level courses in epidemiology, health policy, ethics, and medical anthropology. Residents also carry out an independent research project in a geographic area that suffers from health disparities. Two residents are selected for training per year. Participating faculty are multidisciplinary and come from diverse Harvard-affiliated institutions. Graduate medical education in the United States with a focus on health equity is lacking. It is hoped that the novel training program in health equity for internal medical residents developed at Brigham and Women's Hospital can serve as a model for other teaching hospitals based in the United States.
TL;DR: It is argued that although progress has been made at improving the accessibility and confidentiality of health department electronic resources, there remains much work to be done to ensure quality access for all Americans in the area of public e health.
Abstract: State health departments have placed a tremendous amount of information, data, and services online in recent years. With the significant increase in online resources at official health sites, though, have come questions concerning equity of access and the confidential - ity of electronic medical materials. This paper reports on an examination of public health department websites maintained by the 50 state governments. Using a content analysis of health department sites undertaken each year from 2000 to 2005, we investigate several dimensions of accessibility and privacy: readability levels, disability access, non-English accessibility, and the presence of privacy and security statements. We argue that although progress has been made at improving the accessibility and confidentiality of health depart - ment electronic resources, there remains much work to be done to ensure quality access for all Americans in the area of public e-health.
TL;DR: Findings from this community-based participatory research project suggest that while location is an important variable in evaluating nutritional and physical activity resources, quality and price considerations are at least as useful.
Abstract: The recent emphasis in public health and medicine on the environmental deter- minants of chronic illness has created the need for a more comprehensive way to assess barriers and facilitators of healthy living. This paper reports on the approach taken by a Centers for Disease Control and Prevention (CDC)-funded project whose goal is to reduce disparities in diabetes and cardiovascular disease in Los Angeles' African American communi- ties. Findings from this community-based participatory research project suggest that while location is an important variable in evaluating nutritional and physical activity resources, quality and price considerations are at least as useful. We argue that every community or neighborhood is located within a resource environment for medical care, recreation, food, and other health-promoting or health-compromising goods and services that affect the lives and health of its residents.
TL;DR: Examination of data collected from an emergency department (ED) diversion program between January 2003 and December 2004 and the effects of interventions by HPSs and CHWs in relationship to ED usage among 711 patients are examined.
Abstract: Accessing comprehensive and timely health care services in the U.S. continues to be a significant problem, particularly for low-income and socially marginalized groups in urban environments. To begin to address these problems, the Northern Manhattan Community Voices partners have turned to health priority specialists (HPSs) and community health workers (CHWs) to help reduce emergency department visits for care that would better be delivered in clinics or provider offices. This paper examines data collected from an emergency department (ED) diversion program between January 2003 and December 2004 and examines the effects of interventions by HPSs and CHWs in relationship to ED usage among 711 patients. At 6-month assessment, 3 interventions were significantly correlated with decreased ED usage: providing health education (pearson correlation = .299; p = .000; N = 177; mean = .02), teaching patients how to use the health care system (pearson correlation = .259; p = .001; N = 177; mean = .01), and providing counseling on social/emotional issues (pearson correlation = .408; p = .000; N = 177; mean = .01). This paper presents data that reflect the operations in a real-life clinical setting working with economically, socially, and linguistically marginalized populations.
TL;DR: A deep and pervasive distrust of the health care system and a sense of being disrespected are revealed, exacerbated by difficulties that patients experience in communicating with their providers.
Abstract: This study seeks to understand the perspective of Black and Hispanic/Latino residents of the South Bronx, New York, on the causes of persistent racial and ethnic disparities in health outcomes. In particular, it focuses on how people who live in this community perceive and interact with the health care system. Findings from 9 focus groups with 110 participants revealed a deep and pervasive distrust of the health care system and a sense of being disrespected, exacerbated by difficulties that patients experience in communicating with their providers. The paper suggests how health care institutions might respond to these perceptions.
TL;DR: A 78 year old woman struggles to read the label on her prescription bottle, and a 50 year old Mung patient wonders why the doctor keeps asking her questions about her medical history when all she wants is medicine for her chronic stomach pain.
Abstract: A 78 year old woman struggles to read the label on her prescription bottle. She knows she needs to take her blood pressure medication, but cannot read the label on the bottle to determine which one is her blood pressure medicine, nor how many she should take, so she picks one. She remembers the doctor told her to take the medicine twice a day so she takes two pills at one time. In an exam room, a 45 year old Hispanic male nods and agrees to what his doctor is telling him in English about diabetes when he came in for knee pain. He leaves unsure of what has happened. His knee still hurts and he doesn’t know what diabetes is or why he is discussing it with him. English is not his primary language. In another exam room, a 50 year old Mung patient wonders why the doctor keeps asking her questions about her medical history when all she wants is medicine for her chronic stomach pain. She is not comfortable talking to the doctor and thinks he must not be very good if he has to ask her so many questions.* *The examples above are based on conversations with primary care providers about their patients with low health literacy.
TL;DR: The objectives of this systematic review were to quantify the data sources for VHA racial/ethnic disparity studies; how missing race/ethnicity data were handled; and the extent ofMissing race/ Ethnicity data.
Abstract: Many studies evaluating racial disparities in health come from the Veterans Health Administration (VHA) and are based on secondary and administrative data. Often race/ethnicity data are missing in these sources. Knowing how investigators treat missing data is critical in evaluating potential biases. The objectives of this systematic review were to quantify: (1) the data sources for VHA racial/ethnic disparity studies; (2) how missing race/ethnicity data were handled; and (3) the extent of missing race/ethnicity data. Two trained reviewers independently abstracted 114 articles. The Patient Treatment File was the most common source of race/ethnicity data (n=49). For just over half of the articles we were unable to determine if there were missing race/ethnicity data (n=58). When missing race/ethnicity data were quantified, the proportion of instances for which the data were missing ranged from 0% to 48%. Missing race/ethnicity data are frequently present in VHA secondary and administrative data sources, but, the proportion of instances for which such data are missing is explicitly discussed or quantified in only about 50% of all articles using these sources.
TL;DR: This formative research illustrates the complexity and interrelatedness of health priorities and barriers created by social issues such as employment, legal status, and related stressors in Baltimore city.
Abstract: Introduction. Major health issues and barriers to health services for Latino immi- grants were identified through community-based participatory research in Baltimore city. Methods. In collaboration with community partners, five focus groups were conducted among Latino adults from 10 countries and health service providers. Findings. Priorities across groups included chronic diseases, HIV/AIDS and STDs, mental health, and the need for ancillary services. Community members and providers did not always agree on what health matters were of primary concern. Participants expected to receive health information at the point of service. Barriers to receiving health services and information span linguis- tic, financial, logistical, legal, and cultural matters. Conclusions. This formative research illustrates the complexity and interrelatedness of health priorities and barriers created by social issues such as employment, legal status, and related stressors.
TL;DR: A mixed-method research design to review an ADHD quality improvement effort in community clinics and private offices in San Diego County revealed a need for tailoring of implementation strategies to more closely fit the needs of children and families cared for in public sector settings.
Abstract: To determine if the American Academy of Pediatrics Attention-Deficit/Hyperactivity Disorder (ADHD) guidelines require tailoring for different settings, the researchers used a mixed-method research design to review an ADHD quality improvement effort in community clinics and private offices in San Diego County. Clinically, no differences were noted in rates of ADHD in the two settings. Children in community clinics (58.3%) were more likely to report public insurance (p<.001), diverse ethnic backgrounds (p=.003), low household incomes (p<.001), single parent households (p=.009), and to screen positive for Oppositional Defiant Disorder/Conduct Disorder (p=.027). They were also more likely to have experienced socio-environmental stressors (p<.001) including foster care, homelessness, parental drug use, and domestic violence. No differences were noted by treatment received at 12 months post-evaluation by office type. Open-ended interviews with clinicians confirmed these findings and revealed a need for tailoring of implementation strategies to more closely fit the needs of children and families cared for in public sector settings.
TL;DR: (12.3%), Hispanics (12.5%) and American Indians/Alaska Natives (0.9%) together represent over 25% of the total U.S. population.
Abstract: (12.3%), Hispanics (12.5%) and American Indians/Alaska Natives (0.9%) together represent over 25% of the total U.S. population. Over the last decade, the Hispanic population alone increased by a notable 57.9%. 2 It appears that populations that historically have been called minorities are on their way to becoming majorities. This demographic transformation has already occurred in 19 Census-designated areas in California, Texas, and Florida and to a lesser extent in New Jersey. 2
TL;DR: The PITCH initiative helps community members work together to unleash the enormous power for change that emerges when people connect to one another, thereby tapping the knowledge, skills, and resources of community members and institutions alike.
Abstract: People Improving the Community's Health (PITCH) uses teams of community health workers to provide targeted outreach, to enroll those eligible in health coverage plans, to provide information and linkages to health and social support services, and to engage community members in community improvement activities. The initiative is based on the assumption that communities must work on the determinants of health and effectively mobilize all their assets to improve not only individual health, but also community health. Developed with support from the Kellogg Foundation's Community Voices Initiative, PITCH addresses intertwined public health concerns about access to health care and community health improvement. Outcomes of PITCH include increased enrollment in health coverage plans as well as increased participation in community improvement activities. The PITCH initiative helps community members work together to unleash the enormous power for change that emerges when people connect to one another, thereby tapping the knowledge, skills, and resources of community members and institutions alike.
TL;DR: Poor health status, non-White race, and fewer supportive relationships were significantly associated with frequent emergency department visits and women with higher rates of ongoing outpatient medical care visits were more likely to have fewer social supports and more bodily pain.
Abstract: Little is known about the relationship of demographic, health, and psychosocial factors with health services utilization over time among low-income female heads of household In a case-control study conducted between 1991 and 1997, 273 homeless and low-income housed mothers living in Worcester, Massachusetts were interviewed at baseline and at a two-year follow-up The use of outpatient and emergency department care in this study sample was examined High usage patterns were found at baseline At the two-year follow-up, poor health status, non-White race, and fewer supportive relationships were significantly associated with frequent emergency department visits Women with higher rates of ongoing outpatient medical care visits were more likely to have fewer social supports and more bodily pain than women with lower rates of ambulatory care usage Mental health and victimization were not associated with service use patterns In order to address poor women's needs in a more effective and potentially less costly way, health programs must understand their need for social support and culturally responsive services
TL;DR: Findings from an evaluation of the Bridges Project indicate that the capacity to address multiple API languages and cultures is essential in providing culturally competent care to APIs living with HIV.
Abstract: This paper reports on findings from an evaluation of the Bridges Project, a community-based intervention implemented at the Asian and Pacific Islander Coalition on HIV/AIDS (APICHA), to reduce disparities in care for Asians and Pacific Islanders (APIs) living with HIV/AIDS in New York. Comparisons of participants by primary language (Asian language vs. English) and immigration status (undocumented vs. documented/citizen) show that Asian-primary-language and undocumented participants at baseline had a significantly lower rate of receipt of primary care services and experienced significantly more barriers per service than English-primary-language and documented participants. At follow-up, however, differences by primary language and immigration status disappeared, indicating that the Bridges Project was effective in improving service utilization and reducing barri- ers for the Asian-primary-language and undocumented participants. Barriers to services reported most frequently by participants were language and cost barriers, not knowing where to go for services, and confidentiality concerns. Study findings indicate that the capacity to address multiple API languages and cultures is essential in providing culturally competent care to APIs living with HIV.