Showing papers in "Journal of Health Care for the Poor and Underserved in 2016"
TL;DR: While health care providers are serving this patient population, they do not consistently identify them as victims of human trafficking.
Abstract: Objectives. This study aimed to build the evidence base around human trafficking (HT) and health in the U.S. by employing a quantitative approach to exploring the notion that health care providers encounter this population. Furthermore, this study sought to describe the health care settings most frequented by victims of human trafficking. Methods. This was an anonymous, retrospective study of survivors of U.S.-based human trafficking. Results. One hundred and seventy-three participants who endured U.S.-based human trafficking were surveyed. The majority (68%, n=117) of participants were seen by a health care provider while being trafficked. Respondents most frequently reported visiting emergency/urgent care practitioners (56%), followed by primary care providers, dentists, and obstetricians/gynecologists (OB/GYNs). Conclusions. While health care providers are serving this patient population, they do not consistently identify them as victims of human trafficking.
116 citations
TL;DR: In adjusted analyses, education and health literacy each significantly reduced racial differences in patient activation, especially important when considering emerging data on the significance of patient activation and new strategies to increase patient engagement.
Abstract: The Patient Activation Measure (PAM) assesses facets of patient engagement to identify proactive health behaviors and is an important predictor of health outcomes. Health literacy and education are also important for patient participation and successful navigation of the health care system. Because health literacy, education, and patient activation are associated with racial disparities, we sought to investigate whether health literacy and education would mediate racial differences in patient activation. Participants were 265 older adults who participated in a computer-based exercise interventional study. Health literacy was assessed using the Test of Functional Health Literacy in Adults (TOFHLA). Of 210 eligible participants, 72% self-identified as Black and 28% as White. In adjusted analyses, education and health literacy each significantly reduced racial differences in patient activation. These findings are especially important when considering emerging data on the significance of patient activation and new strategies to increase patient engagement.
42 citations
TL;DR: The objective of this brief report is to estimate the numbers of millions of Americans 60 years or older with untreated hearing loss stratified by income level, and the high cost of hearing aids makes hearing treatment particularly inaccessible for this vulnerable population.
Abstract: Age-related hearing loss is highly prevalent and only 20% of adults with hearing loss report using hearing aids. A major barrier to increased hearing aid use is the high out-of-pocket costs associated with hearing aids. The objective of this brief report is to estimate the numbers of millions of Americans 60 years or older with untreated hearing loss stratified by income level. Using multiple cycles from the National Health and Nutrition Examination Survey (NHANES; 1999-2006 and 2009-2010), the prevalence of untreated hearing loss is reported based on audiometric hearing tests and self-reported hearing aid use from a cross-sectional, nationally representative sample. Overall, approximately 20 million Americans 60 years or older have an untreated clinically significant hearing loss. Importantly for the nearly six million low-income older adults with untreated hearing loss, the high cost of hearing aids makes hearing treatment particularly inaccessible for this vulnerable population.
41 citations
TL;DR: It is suggested that the dearth of established social support networks and health care infrastructure in new Latino growth areas exacerbate the health care obstacles experienced by Latino immigrants throughout the country.
Abstract: Unlike regions with larger Latino populations, the health care infrastructure in Cincinnati does not include linguistically and culturally appropriate services to meet the need of the growing Latino immigrant community. In order to guide development of appropriate health care services, a team of academic and community researchers collaborated on a community-based participatory research project to understand health care use, barriers to health care, perceptions of health care, and health care needs of Latino immigrants. Co-researchers administered 518 surveys and conducted focus groups with 34 Latino immigrants. Participants relied on community clinics for care more often than is seen in nationwide Hispanic samples. Results revealed significant health care barriers, which Latino immigrants attribute to language, lack of quality interpreters, documentation status, and discrimination. Results suggest that the dearth of established social support networks and health care infrastructure in new Latino growth areas exacerbate the health care obstacles experienced by Latino immigrants throughout the country.
40 citations
TL;DR: Interventions that target patient attitudes/beliefs and health care disparities might be more productive if they focus on mistrust or suspicion specific to health care providers/systems and their correlates identified in this study.
Abstract: This research concerned relationships among Black cancer patients' health care attitudes and behaviors (e.g., adherence, decisional control preferences,) and their race-related attitudes and beliefs shaped by (a) general life experiences (i.e., perceived discrimination, racial identity) and (b) experiences interacting with health care systems (i.e., physician mistrust, suspicion about medical care). Perceived discrimination, racial identity, and medical suspicion correlated weakly with one another; mistrust and suspicion correlated only moderately. Race-related attitudes and beliefs were associated with health care attitudes and behavior, but patterns of association varied. Physician mistrust and medical suspicion each independently correlated with adherence and decisional control preferences, but discrimination only correlated with control preferences. Associations among patients' different racial attitudes/beliefs are more complex than previously assumed. Interventions that target patient attitudes/beliefs and health care disparities might be more productive if they focus on mistrust or suspicion specific to health care providers/systems and their correlates identified in this study.
38 citations
TL;DR: In the context of dental care, racism experienced by Aboriginal women can be a barrier to accessing services and programs and policies should address racism's insidious effects on both mothers’ and children’s oral health outcomes.
Abstract: This study assessed links between racism and oral health outcomes among pregnant Canadian Aboriginal women. Baseline data were analyzed for 541 First Nations (94.6%) and Metis (5.4%) women in an early childhood caries preventive trial conducted in urban and on-reserve communities in Ontario and Manitoba. One-third of participants experienced racism in the past year determined by the Measure of Indigenous Racism Experience. In logistic regressions, outcomes significantly associated with incidents of racism included: wearing dentures, off-reserve dental care, asked to pay for dental services, perceived need for preventive care, flossing more than once daily, having fewer than 21 natural teeth, fear of going to dentist, never received orthodontic treatment and perceived impact of oral conditions on quality of life. In the context of dental care, racism experienced by Aboriginal women can be a barrier to accessing services. Programs and policies should address racism's insidious effects on both mothers' and children's oral health outcomes.
36 citations
TL;DR: A need to integrate programs to reduce abuse, depression, and economic hardship with those that address sexual health risks among women living in low-income, high-HIV-prevalence neighborhoods is suggested.
Abstract: Women living in poverty suffer more post-traumatic stress disorder (PTSD) symptoms than do members of the general population; however we know little about factors associated with changes in their PTSD symptoms over time. Using data from HPTN 064, a cohort of women from low-income, high-HIV-prevalence communities across six eastern states (n=1,860), we assessed the prevalence of and changes in PTSD symptoms over 12 months and the effect of potential predictors on symptom acquisition and remission (via the Primary Care-PTSD symptoms scale). Forty-three percent screened positive for PTSD symptoms. Those reporting food insecurity, ongoing abuse, depressive symptoms, or binge drinking were more likely to acquire PTSD symptoms. Those with ongoing abuse or depressive symptoms were less likely to experience PTSD symptom remission. Findings suggest a need to integrate programs to reduce abuse, depression, and economic hardship with those that address sexual health risks among women living in low-income, high-HIV-prevalence neighborhoods.
34 citations
TL;DR: Stable housing may improve viral suppression and access to cART, and drug use was associated with viral suppression, likely because of patient engagement with on-site addiction services.
Abstract: Background . The importance of HIV viral suppression is widely known, however few studies have examined the effects of homelessness on HIV viral suppression. Methods . The study included HIV-seropositive patients in a health care for the homeless program (HCH). Electronic medical record data for 138 patients were analyzed to compare demographic characteristics, health characteristics, and utilization by housing status. For the 95 individuals with available HIV viral loads, multivariable logistic analysis was performed to examine factors associated with incomplete viral suppression. Results . The adjusted odds ratio of incomplete HIV viral load suppression was 3.84 times higher in homeless compared with housed (95% CI 1.36–10.36) individuals. Illicit drug use and combined antiretrovirals (cART) were associated with HIV viral suppression. Conclusions . Homelessness predicted incomplete HIV viral suppression. Stable housing may improve viral suppression and access to cART. Drug use was associated with viral suppression, likely because of patient engagement with on-site addiction services.
32 citations
TL;DR: Closed rural hospitals had a smaller market share despite being in areas with higher population density, were located nearer to another hospital, and were located in markets that had a higher rate of unemployment and a higher percentage of Black and Hispanic residents.
Abstract: From January 2005 through December 2015, 105 rural hospitals closed. This study examined associations between community characteristics and rural hospital closure. Compared with other rural hospitals that were at high risk of financial distress but remained open over the same time period, closed rural hospitals had a smaller market share (p < .0001) despite being in areas with higher population density (p < .05), were located nearer to another hospital (p < .0001), and were located in markets that had a higher rate of unemployment (p < .05) and a higher percentage of Black (p < .05) and Hispanic (p < .01) residents. These results have three implications for rural health policy: rural hospital closures may disproportionately affect racial and ethnic minorities, community characteristics in combination with other factors make it likely that rural hospital closures will continue, and rural hospital closures illuminate the need for new models of reimbursement and health care delivery to meet the needs of rural communities.
32 citations
TL;DR: The complex health histories and frequent health care contacts of homeless drug overdose decedents suggest that clinical facilities may be an important frontline venue for overdose education, naloxone distribution, and integrated substance use treatment programming.
Abstract: Drug overdose is a major cause of death among homeless people, but little is known about the characteristics of homeless overdose decedents. We conducted a retrospective record review of 219 adult patients of Boston Health Care for the Homeless Program (BHCHP) who died of drug overdose in 2003-2008. We assessed the substances implicated in overdose and the health and service use characteristics of decedents prior to death. Eighty-one percent of overdose deaths involved opioids and 40% involved multiple drugs. Problem substance use (85%), psychiatric illness (61%), and chronic pain (45%) were common, and 32% had documentation of all three. Half were well-connected to BHCHP, and 35% had a clinic visit within 90 days of death. The complex health histories and frequent health care contacts of homeless drug overdose decedents suggest that clinical facilities may be an important frontline venue for overdose education, naloxone distribution, and integrated substance use treatment programming.
31 citations
TL;DR: Adjusting applicant academic metrics using socioeconomic information on medical school applications may be a race-neutral means of increasing the socioeconomic and racial/ethnic diversity of the physician workforce.
Abstract: A diverse physician workforce is needed to increase access to care for underserved populations, particularly as the Affordable Care Act expands insurance coverage. Yet legal restrictions constrain the extent to which medical schools may use race/ethnicity in admissions decisions. We conducted simulations using academic metrics and socioeconomic data from applicants to a California public medical school from 2011 to 2013. The simulations systematically adjusted medical school applicants' academic metrics for socioeconomic disadvantage. We found that socioeconomic and under-represented minority disparities in admissions could be eliminated while maintaining academic readiness. Adjusting applicant academic metrics using socioeconomic information on medical school applications may be a race-neutral means of increasing the socioeconomic and racial/ethnic diversity of the physician workforce.
TL;DR: Examination of the literature on the effect of geographical location variation on breast cancer stage at diagnosis, race/ethnicity, and socioeconomic status found cancer patients residing in rural and disadvantaged areas were more likely to be diagnosed with distant breast metastasis.
Abstract: Objective: To examine systematically the literature on the effect of geographical location variation on breast cancer stage at diagnosis, race/ethnicity, and socioeconomic status. Methods. Eight electronic databases were searched using combination of key words. Of the 312 articles retrieved from the search, 36 studies from 12 countries were considered eligible for inclusion. Results. This review identified 17 (47%) of 36 studies in which breast cancer patients residing in geographically remote/rural areas had more late-stage diagnosis than urban women. Ten (28%) studies reported higher proportions of women diagnosed with breast cancer resided in urban than rural counties. Nine (25%) studies reported no statistically significant association between place of residence and stage at diagnosis for breast cancer patients residing in rural and urban areas. Conclusions. Cancer patients residing in rural and disadvantaged areas were more likely to be diagnosed with distant breast metastasis. Efforts to reduce these inequalities and subsequent mortality are needed.
TL;DR: Adverse childhood experiences are strong predictors of adult cancer risk behaviors, particularly increased likelihood of smoking, and among women, lower mammography and Pap screening rates.
Abstract: Objectives . Adverse childhood experiences (ACE) can affect health in adulthood. We investigate the relationship between childhood experiences and adult cancer risk and screening behaviors in a racially diverse, low income population. Methods . Nearly 22,000 adults 40 years and older in the Southern Community Cohort Study were administered the ACE questionnaire. We estimated odds ratios (OR) for the prevalence of smoking, alcohol consumption, BMI and five cancer screening methods in relation to the ACE score. Results . Over half reported at least one ACE, with percentages higher for women (61%) than men (53%). Higher ACE scores were related to increased prevalence of smoking (ORs 1.25 (1.05–1.50) to 2.33 (1.96–2.77). Little association was seen between rising ACE score and alcohol consumption or BMI, except for a modest trend in morbid obesity (BMI ≥ 40 kg/m2 ). Mammography and cervical cancer screening decreased with rising ACE scores, but no trends were seen with prostate or colorectal cancer screening. Conclusions . Adverse childhood experiences are strong predictors of adult cancer risk behaviors, particularly increased likelihood of smoking, and among women, lower mammography and Pap screening rates.
TL;DR: There is an urgent need to improve support systems for early testing and linkage to care and to expand employment opportunities to reduce fear of diagnosis and improve access to care.
Abstract: Men who have sex with men (MSM) and transgender women are disproportionately affected by HIV in Guatemala, yet little is known about their experiences with diagnosis, linkage to care, and retention. We conducted qualitative in-depth interviews with 26 MSM and transgender women living with HIV in Guatemala City. HIV diagnosis experiences changed over time with increasing asymptomatic testing at non-governmental organizations. Fear of the physical and social impacts of HIV delayed testing, acceptance of diagnosis, and linkage to HIV care. These fears were driven by layered stigma and discrimination due to non-normative gender expressions and / or sexual orientation. Retention-specific determinants included HIV clinic dynamics and limited employment opportunities. There is an urgent need to improve support systems for early testing and linkage to care and to expand employment opportunities. Stigma and discrimination must be addressed at the family, clinic and contextual levels to reduce fear of diagnosis and improve access to care.
TL;DR: This pilot study evaluated the Ho‘ouna Pono curriculum, which is a culturally grounded, school-based, drug prevention curriculum tailored to rural Native Hawaiian youth, and suggested areas for curricular improvement, including more emphasis on normative drug education.
Abstract: This pilot study evaluated the Ho'ouna Pono curriculum, which is a culturally grounded, school-based, drug prevention curriculum tailored to rural Native Hawaiian youth The curriculum focuses on culturally relevant drug resistance skills training and is aligned with the State of Hawai'i academic standards Six Hawai'i Island public middle/intermediate schools randomly assigned to intervention or treatment-as-usual comparison conditions (N = 213) were evaluated in this study Paired sample t-tests separating intervention and comparison groups were conducted, as well as mixed models that adjusted for random effects (nesting) at the school level Findings suggested that the curriculum was effective in maintaining youths' use of culturally relevant drug resistance skills, as well as decreasing girls' aggressive behaviors, at six-month follow-up Unanticipated findings also suggested areas for curricular improvement, including more emphasis on normative drug education Implications for future research and development of the curriculum are discussed
TL;DR: This paper highlights and provides recommendations regarding the importance of disaggregating HIV surveillance data on Blacks by country of birth and under-estimation of HIV prevalence in the African immigrant population, making it difficult to allocate resources appropriately for HIV prevention and treatment.
Abstract: The goals of the United States' National HIV/AIDS Strategy are reducing HIV infections, increasing linkage to care, and reducing health disparities. To accomplish these, it is imperative to have accurate data about HIV prevalence, especially in high-burden populations, including immigrants, ethnic/racial minorities and other minority populations. However, recent increases in HIV prevalence among Black migrants from sub-Saharan Africa has drawn attention to the need to examine the epidemiological diversity of the Black population, and accurately account for HIV prevalence within it. In most HIV surveillance data, a single category, Black/African American, is used to combine data for U.S.-born and foreign-born Blacks, including migrants from sub-Saharan Africa. Such categorizations result in under-estimation of HIV prevalence in the African immigrant population, making it difficult to allocate resources appropriately for HIV prevention and treatment. This paper highlights and provides recommendations regarding the importance of disaggregating HIV surveillance data on Blacks by country of birth.
TL;DR: This is the first known study to use the Gelberg-Andersen Behavioral Model for Vulnerable Populations to predict African American women’s use of three types of health services in the 18 months after release from prison.
Abstract: This is the first known study to use the Gelberg-Andersen Behavioral Model for Vulnerable Populations to predict African American women's use of three types of health services (alternative, hospitalization, and ambulatory) in the 18 months after release from prison. In the multivariate models, the most robust predictors of all three types of service utilization were in the vulnerable theoretical domains. Alternative health services were predicted by ethnic community membership, higher religiosity, and HIV/HCV. Hospitalizations were predicted by the lack of barriers to health care and disability. Ambulatory office visits were predicted by more experiences of gendered racism, a greater number of physical health problems, and HIV/HCV. Findings highlight the importance of cultural factors and HIV/HCV in obtaining both alternative and formal health care during community re-entry. Clinicians and policymakers should consider the salient role that the vulnerable domain plays in offender's accessing health services.
TL;DR: Large practices and community health centers were more likely to Go Live (>80% EHR adoption) than rural health clinics and other underserved settings and had a 47% higher risk of not achieving Go Live status than private insurance predominant practices.
Abstract: This study evaluates electronic health record (EHR) adoption by primary care providers in Georgia to assess adoption disparities according to practice size and type, payer mix, and community characteristics. Frequency variances of EHR “Go Live” status were estimated. Odds ratios were calculated by univariate and multivariate logistic regression models. Large practices and community health centers (CHCs) were more likely to Go Live (80% EHR adoption) than rural health clinics and other underserved settings (53%). A significantly lower proportion (68.9%) of Medicaid predominant providers had achieved Go Live status and had a 47% higher risk of not achieving Go Live status than private insurance predominant practices. Disparities in EHR adoption rates may exacerbate existing disparities in health outcomes of patients served by these practices. Targeted support such as that provided to CHCs would level the playing field for practices now at a disadvantage.
TL;DR: Higher educational attainment and cash-transfers may have a positive influence on reducing food insecurity, and depression and functional limitations may increase the likelihood of food insecurity among older adults.
Abstract: Purpose. To examine factors associated with food insecurity among urban older adults (65 years and older). Methods. Three hundred and fifty two older adults attending community centers in a neighborhood of Mexico City were surveyed for food insecurity, functional impairments, health and mental health status, cash-transfer assistance, socio-demographic characteristics, social isolation, and the built food environment. Results. Having at least primary education and receiving cash-transfers were significantly associated with a lower probability of being moderately-severely food insecure (OR=0.478 and 0.597, respectively). The probability of moderate-severe food insecurity was significantly higher among elderly at risk of depression (OR=2.843), those with at least one activity of daily living impaired (OR=2.177) and those with at least one instrumental activity of daily living impaired (OR=1.785). Conclusions. Higher educational attainment and cash-transfers may have a positive influence on reducing food insecurity. Depression and functional limitations may increase the likelihood of food insecurity among older adults.
TL;DR: The opportunities and challenges of training medical students for rural practice are illustrated and lessons learned are provided to inform newly-established and long standing rural medical education programs.
Abstract: The Association of American Medical Colleges projects an increasing shortage of physicians in rural areas. Medical schools have developed specialty track programs to improve the recruitment and retention of physicians who can serve rural populations. One such program in California includes a variety of unique elements including outreach, admissions, rural clinical experiences, focused mentorship, scholarly and leadership opportunities, and engagement with rural communities. Preliminary outcomes demonstrate that this rural track program has achieved some success in the recruitment, retention, and training of students interested in future rural practice and in the placement of students in primary care residencies. Long-term outcomes, such as graduates entering rural practice, are still unknown, but will be monitored to assess the impact and sustainability of the rural program. This article illustrates the opportunities and challenges of training medical students for rural practice and provides lessons learned to inform newly-established and long standing rural medical education programs.
TL;DR: Low-income Latino seniors in Oregon community health centers were immunized against pneumococcus more frequently than insured non-Hispanic Whites, although this finding was mitigated in Latinos without insurance.
Abstract: Background. In cross-sectional studies, Latino and Spanish-speaking U.S. residents age 65 and over are less likely to receive pneumococcal vaccination than non-Hispanic Whites. Methods. We performed a time-to-event, cohort analysis, in 23 Oregon community health centers of low-income patients who turned 65 in the study period (2009–2013; n = 1,248). The outcome measure was receipt of PPSV-23 in the study period by race / ethnicity, preferred language, and insurance status. Results. Insured Latino patients were more likely to receive PPSV-23 than insured non-Hispanic Whites (HR = 2.05, p Conclusions. Low-income Latino seniors in Oregon community health centers were immunized against pneumococcus more frequently than insured non-Hispanic Whites, although this finding was mitigated in Latinos without insurance. This finding needs further research in order to reduce adult immunization disparities in the society at large.
TL;DR: Rural-serving CP programs provided services to shift costs to less expensive settings and provide appropriate care where vulnerable patients live, but more evidence is needed that care is safe, effective, and economical.
Abstract: Community paramedicine (CP) uses emergency medical services (EMS) providers to help rural communities increase access to primary care and public health services. This study examined goals, activities, and outcomes of 31 rural-serving CP programs through structured interviews of program leaders and document review. Common goals included managing chronic disease (90.3%); and reducing emergency department visits (83.9%), hospital admissions/readmissions (83.9%), and costs (83.9%). Target populations included the chronically ill (90.3%), post-hospital discharge patients (80.6%), and frequent EMS users (64.5%). Community paramedicine programs engaged in bi-directional referrals most often with primary care facilities (67.7%), hospitals (54.8%), and home health (38.7%). Programs provided assessment, testing, preventive care, and post-discharge services. Reported outcomes were promising, but few programs used rigorous evaluation methods. Rural-serving CP programs provided services to shift costs to less expensive settings and provide appropriate care where vulnerable patients live, but more evidence is needed that care is safe, effective, and economical.
TL;DR: The proposed framework expands the preoperative assessment to include a psychosocial assessment and care navigation, and can be used to guide both health systems and insurance providers in the development of transgender medicine programs.
Abstract: Transgender people have a gender identity different from their birth-assigned sex. Transgender people may seek gender-affirming surgeries to align their body with their identified gender. With increasing visibility of transgender identities, and recognition of the importance of gender-affirming care, has come a policy shift toward mandated coverage or provision of blanket exclusions of these procedures by insurance companies and Medicaid. The World Professional Association for Transgender Health provides guidance to mental health professionals evaluating patients for gender-affirming surgeries, including making a diagnosis and assessing for capacity to consent. However the expansion of covered gender-affirming surgeries to safety-net populations has highlighted the need for an expanded presurgical process which includes a psychosocial assessment and care navigation. The proposed framework expands the preoperative assessment to include these components, and can be used to guide both health systems and insurance providers in the development of transgender medicine programs.
TL;DR: Patients who received text message reminders demonstrated improved attendance to their appointments and might be an effective supplemental appointment reminder method in a subpopulation of CHC patients and it should be explored in future research.
Abstract: We explored whether text message (TM) reminders could be used at a community health center (CHC) to improve primary care appointment attendance in adult patients. Over six months, we allocated 8,425 appointments to intervention and 2,679 to control. The proportion of no-shows in the intervention was 18.0% vs. 19.8% in control (p = .106). Among intervention appointments, 1,431 did not have a cell phone, 4,955 did not respond to the consent TM, and 231 declined TMs. The proportion of no-shows for the 1,309 appointments who received TM was 13.7% compared with 20.2% in a matched control group (p = .001). However, of 81 surveyed patients who did not respond to the consent TM, 64 (93%) wished to receive TMs. In conclusion, patients who received TM demonstrated improved attendance to their appointments. TM might be an effective supplemental appointment reminder method in a subpopulation of CHC patients and it should be explored in future research.
TL;DR: The high rate of ED visits for dental problems by people who are homeless suggests that access to dental care is inadequate and the large number of repeat visits indicates that ED settings are ineffective for treatment of dental problems.
Abstract: Objectives To evaluate emergency department (ED) visits for dental problems among Toronto’s homeless population (Ontario, Canada) Methods A random sample of 1,189 homeless was recruited from shelters and meal programs Emergency department visits for non-traumatic dental problems (ICD-10-CA codes K00-K14) were identified using participants’ health insurance number, during 2005–2009 Age- and sex-matched controls were selected from low-income neighborhoods Results Homeless and matched controls had 182 and 10 ED visits for dental problems, respectively Homeless people were more significantly more likely (OR=227, p=007) to make ED visit for dental problems compared with controls Over 80% of the ED visits by homeless people were for odontogenic infections, and 46% of homeless people had more than one such visit Conclusion The high rate of ED visits for dental problems by people who are homeless suggests that access to dental care is inadequate The large number of repeat visits indicates that ED settings are ineffective for treatment of dental problems
TL;DR: The fidelity of an early childhood caries MI intervention among Aboriginal mothers in South Australia was assessed and Beginner to expert competency in fidelity to the MI model was observed.
Abstract: Objectives . This paper assessed the fidelity of an early childhood caries MI intervention among Aboriginal mothers in South Australia. Methods . Four MI-trained staff delivered the intervention and all interviews were recorded. A randomly selected subset (n = 164, 41.2%) were tested for MI fidelity using the Motivational Interviewing Treatment Integrity (MITI) code 3.1.1. A further randomly selected 20 taped sessions were additionally scored by an external expert to assess external reliability. Results . Mean scores for evocation, collaboration, autonomy/support, direction and empathy ranged from 3.5 (95% CI 3.4–3.7) to 4.1 (95% CI 4.0–4.2). The mean global score was 3.8 (95% 3.7–3.9). The Reflection:Question ratio was 0.9 (95% CI 0.8–1.0), % Open-ended Questions was 54.9 (95% CI 50.0–59.8), % Complex Reflections was 54.0 (95% CI 50.5–57.5) and % MI-adherent statements was 95.0 (95% CI 92.0–98.0). Inter-assessor reliability was high. Conclusions . Beginner to expert competency in fidelity to the MI model was observed.
TL;DR: This supplement spotlights methods that rural stakeholders have employed to address the health concerns and disease burden in communities that lack adequate access to care and features promising and evidencebased solutions to longstanding rural health care delivery and quality issues.
Abstract: A Acting Administrator for the Health Resources and Services Administration (HRSA) and Associate Administrator of the Federal Office of Rural Health Policy (FORHP) of the U.S. Department of Health and Human Services, we welcome you to this special theme issue that features promising and evidencebased solutions to longstanding rural health care delivery and quality issues. This supplement spotlights methods that rural stakeholders have employed to address the health concerns and disease burden in communities that lack adequate access to care. As the home of ruralspecific grant programs, research, and policy within the Department of Health and Human Services, FORHP plays an integral role in rural health care delivery and improving the health of rural communities. Today, FORHP continues to build a programmatic evidence base for its rural grant programs to ensure that programs are informed by past investments and incorporate lessons learned to inform current and future grantees. The FORHP also engages providers that lack experience in quality measure reporting and valuebased incentives. For example, FORHP collaborated with a geographically diverse sample of Rural Health Clinics (RHCs) to pilottest the use and reporting of quality measures relevant to primary care. This effort developed a foundation for supporting RHC efforts to respond to the changing health care environment. The featured research and stories within this issue highlight promising practice models that inform our counsel to the Secretary on the impact of Medicare and Medicaid regulations on rural providers and communities. While HRSA’s work to build rural health care capacity at the state and community level is centered in FORHP, every part of HRSA has a role in this effort. For example, at least 40% of community health centers are either physically located in or serve rural patients. The Maternal, Infant, and Early Childhood Home Visiting Program has facilitated the provision of evidencebased home visiting services to expectant mothers and parents of prekindergarten children in over 400 rural counties. AddiFOREWORD
TL;DR: Using videoconferencing technology to augment in-person training, ECHO creates a community of practice for case-based learning and ongoing support.
Abstract: ECHO is a movement to build capacity to provide best practice care for rural and underserved people all over the world. Community health workers are an integral part of this movement. Using videoconferencing technology to augment in-person training, ECHO creates a community of practice for case-based learning and ongoing support.
TL;DR: A needs assessment describes the characteristics of men most at risk of weight gain and elevated disease risk associated with their weight status in order to build the groundwork for a collaborative health intervention.
Abstract: In the context of the ever increasing incarcerated population in the U.S. and a lack of data documenting weight status of this population, we document the weight status of male inmates in a unified correctional facility in Rhode Island using BMI and waist circumference. This needs assessment describes the characteristics of men most at risk of weight gain and elevated disease risk associated with their weight status in order to build the groundwork for a collaborative health intervention.
TL;DR: Opportunities for building a more robust rural health evidence base include investments to incentivize evidence-based programming in rural settings; rural-specific research and theory-building; translation of existing evidence using a rural lens; technical assistance to support rural innovation; and prioritization of evaluation locally.
Abstract: Objective. This paper explores how communities translate evidence-based and promising health practices to rural contexts. Methods. A descriptive, qualitative analysis was conducted using data from 70 grantees funded by the Federal Office of Rural Health Policy to implement evidence-based health practices in rural settings. Findings were organized using The Interactive Systems Framework for Dissemination and Implementation. Results. Grantees broadly interpreted evidence-based and promising practices, resulting in the implementation of a patchwork of health-related interventions that fell along a spectrum of evidentiary rigor. The cohort faced common challenges translating recognized practices into rural community settings and reported making deliberate modifications to original models as a result. Conclusion. Opportunities for building a more robust rural health evidence base include investments to incentivize evidence-based programming in rural settings; rural-specific research and theory-building; translation of existing evidence using a rural lens; technical assistance to support rural innovation; and prioritization of evaluation locally.