NAU publications by CHER
Faculty & staff publications
NAU faculty and staff have the opportunity to publish their findings and knowledge as authors. CHER has many researchers that have been cited multiple times in major publications for their great work. The Center for Health Equity Research has accumulated all faculty publications into one, easy to navigate database.
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Wohl, David A; Panter, A T; Kirby, Christine; Magnus, Brokke E; Hudgens, Michael G; Allmon, Andrew G; Mollan, Katie R Estimating HIV medication adherence and persistence: Two instruments for clinical and research use Journal Article AIDS and Behavior, 22 (3), pp. 948-960, 2018. @article{Wohl2018, title = {Estimating HIV medication adherence and persistence: Two instruments for clinical and research use}, author = {David A Wohl and A T Panter and Christine Kirby and Brokke E Magnus and Michael G Hudgens and Andrew G Allmon and Katie R Mollan}, url = {https://link.springer.com/article/10.1007/s10461-017-1772-z}, doi = {10.1007/s10461-017-1772-z}, year = {2018}, date = {2018-03-01}, journal = {AIDS and Behavior}, volume = {22}, number = {3}, pages = {948-960}, abstract = {Antiretroviral therapy (ART) requires lifelong daily oral therapy. While patient characteristics associated with suboptimal ART adherence and persistence have been described in cohorts of HIV-infected persons, these factors are poor predictors of individual medication taking behaviors. We aimed to create and test instruments for the estimation of future ART adherence and persistence for clinical and research applications. Following formative work, a battery of 148 items broadly related to HIV infection and treatment was developed and administered to 181 HIV-infected patients. ART adherence and persistence were assessed using electronic monitoring for 3 months. Perceived confidence in medication taking and self-reported barriers to adherence were strongest in predicting non-adherence over time. Barriers to adherence (e.g., affordability, scheduling) were the strongest predictors of non-adherence, as well as 3- and 7-day non-persistence. A ten-item battery for prediction of these outcomes (www.med.unc.edu/ncaidstraining/adherence/for-providers) and a 30-item battery reflective of underlying psychological constructs can help identify and study individuals at risk for suboptimal ART adherence and persistence.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Antiretroviral therapy (ART) requires lifelong daily oral therapy. While patient characteristics associated with suboptimal ART adherence and persistence have been described in cohorts of HIV-infected persons, these factors are poor predictors of individual medication taking behaviors. We aimed to create and test instruments for the estimation of future ART adherence and persistence for clinical and research applications. Following formative work, a battery of 148 items broadly related to HIV infection and treatment was developed and administered to 181 HIV-infected patients. ART adherence and persistence were assessed using electronic monitoring for 3 months. Perceived confidence in medication taking and self-reported barriers to adherence were strongest in predicting non-adherence over time. Barriers to adherence (e.g., affordability, scheduling) were the strongest predictors of non-adherence, as well as 3- and 7-day non-persistence. A ten-item battery for prediction of these outcomes (www.med.unc.edu/ncaidstraining/adherence/for-providers) and a 30-item battery reflective of underlying psychological constructs can help identify and study individuals at risk for suboptimal ART adherence and persistence. |
Sabo, Samantha; Allen, Caitlin G; Sutkowi, Katherine; Wennerstrom, Ashley Community health workers in the United States: Challenges in identifying, surveying, and supporting the workforce Journal Article American Journal of Public Health, 107 (12), pp. 1964-1969, 2017. @article{Sabo2017, title = {Community health workers in the United States: Challenges in identifying, surveying, and supporting the workforce}, author = {Samantha Sabo and Caitlin G Allen and Katherine Sutkowi and Ashley Wennerstrom}, url = {https://ajph.aphapublications.org/doi/10.2105/AJPH.2017.304096}, year = {2017}, date = {2017-11-08}, journal = {American Journal of Public Health}, volume = {107}, number = {12}, pages = {1964-1969}, abstract = {Community health workers (CHWs) are members of a growing profession in the United States. Studying this dynamic labor force is challenging, in part because its members have more than 100 different job titles. The demand for timely, accurate information about CHWs is increasing as the profession gains recognition for its ability to improve health outcomes and reduce costs. Although numerous surveys of CHWs have been conducted, the field lacks well-delineated methods for gaining access to this hard-to-identify workforce. We outline methods for surveying CHWs and promising approaches to engage the workforce and other stakeholders in conducting local, state, and national studies. We also highlight successful strategies to overcome challenges in CHW surveys and future directions for surveying the field.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Community health workers (CHWs) are members of a growing profession in the United States. Studying this dynamic labor force is challenging, in part because its members have more than 100 different job titles. The demand for timely, accurate information about CHWs is increasing as the profession gains recognition for its ability to improve health outcomes and reduce costs. Although numerous surveys of CHWs have been conducted, the field lacks well-delineated methods for gaining access to this hard-to-identify workforce. We outline methods for surveying CHWs and promising approaches to engage the workforce and other stakeholders in conducting local, state, and national studies. We also highlight successful strategies to overcome challenges in CHW surveys and future directions for surveying the field. |
Henson, Michele; Sabo, Samantha; Trujillo, Aurora; Teufel-Shone, Nicolette Identifying protective factors to promote health in American Indian and Alaska Native adolescents: A literature review Journal Article Journal of Primary Prevention, 38 (1-2), pp. 5-26, 2017. @article{Henson2017, title = {Identifying protective factors to promote health in American Indian and Alaska Native adolescents: A literature review}, author = {Michele Henson and Samantha Sabo and Aurora Trujillo and Nicolette Teufel-Shone}, url = {https://link.springer.com/article/10.1007/s10935-016-0455-2}, year = {2017}, date = {2017-11-08}, journal = {Journal of Primary Prevention}, volume = {38}, number = {1-2}, pages = {5-26}, abstract = {Exposure to protective factors, conditions that protect against the occurrence of an undesirable outcome or promote the occurrence of a desirable outcome within an adolescent’s environment, can foster healthy adolescent behaviors and reduce adult morbidity and mortality. Yet, little is known about the nature and effect of protective factors on the positive social and health outcomes among American Indian and Alaska Native (AIAN) adolescents. We conducted a review of the literature to identify the protective factors associated with positive health outcomes among AIAN adolescents. We consulted Elsevier Science Direct, ERIC EBSCOhost, PubMed, and the Web of Science databases. A total of 3421 articles were encountered. Excluded publications were those that did not focus on AIAN adolescents (n = 3341), did not identify protective factors (n = 56), were not original research studies (n = 8), or were not written in the English language. We identified nine categories of protective factors positively associated with health and social outcomes, including: current and/or future aspirations, personal wellness, positive self-image, self-efficacy, non-familial connectedness, family connectedness, positive opportunities, positive social norms, and cultural connectedness. Such factors positively influenced adolescent alcohol, tobacco, and substance use; delinquent and violent behavior; emotional health including depression, suicide attempt; resilience; and academic success. Protective factors spanned multiple domains of the socio-ecological model. Strengths-based health promotion efforts that leverage local, innate protective factors and work with AIANs to create environments rich in protective factors are key to improving the health and wellbeing of AIAN adolescents.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Exposure to protective factors, conditions that protect against the occurrence of an undesirable outcome or promote the occurrence of a desirable outcome within an adolescent’s environment, can foster healthy adolescent behaviors and reduce adult morbidity and mortality. Yet, little is known about the nature and effect of protective factors on the positive social and health outcomes among American Indian and Alaska Native (AIAN) adolescents. We conducted a review of the literature to identify the protective factors associated with positive health outcomes among AIAN adolescents. We consulted Elsevier Science Direct, ERIC EBSCOhost, PubMed, and the Web of Science databases. A total of 3421 articles were encountered. Excluded publications were those that did not focus on AIAN adolescents (n = 3341), did not identify protective factors (n = 56), were not original research studies (n = 8), or were not written in the English language. We identified nine categories of protective factors positively associated with health and social outcomes, including: current and/or future aspirations, personal wellness, positive self-image, self-efficacy, non-familial connectedness, family connectedness, positive opportunities, positive social norms, and cultural connectedness. Such factors positively influenced adolescent alcohol, tobacco, and substance use; delinquent and violent behavior; emotional health including depression, suicide attempt; resilience; and academic success. Protective factors spanned multiple domains of the socio-ecological model. Strengths-based health promotion efforts that leverage local, innate protective factors and work with AIANs to create environments rich in protective factors are key to improving the health and wellbeing of AIAN adolescents. |
Camplain, Ricky; Kucharska-Newton, Anna; Loehr, Laura; Keyserling, Thomas C; Layton, Bradley J; Wruck, Lisa; Folsom, Aaron R; Bertoni, Alain G; Heiss, Gerardo Accuracy of Self-Reported Heart Failure. The Atherosclerosis Risk in Communities (ARIC) Study Journal Article Journal of Cardiac Failure, 23 (11), pp. 802-808, 2017. @article{Camplain2017b, title = {Accuracy of Self-Reported Heart Failure. The Atherosclerosis Risk in Communities (ARIC) Study}, author = {Ricky Camplain and Anna Kucharska-Newton and Laura Loehr and Thomas C Keyserling and Bradley J Layton and Lisa Wruck and Aaron R Folsom and Alain G Bertoni and Gerardo Heiss}, url = {https://www.ncbi.nlm.nih.gov/pubmed/28893677}, year = {2017}, date = {2017-11-01}, journal = {Journal of Cardiac Failure}, volume = {23}, number = {11}, pages = {802-808}, abstract = {Objective The aim of this work was to estimate agreement of self-reported heart failure (HF) with physician-diagnosed HF and compare the prevalence of HF according to method of ascertainment. Methods and Results ARIC cohort members (60–83 years of age) were asked annually whether a physician indicated that they have HF. For those self-reporting HF, physicians were asked to confirm their patients' HF status. Physician-diagnosed HF included surveillance of hospitalized HF and hospitalized and outpatient HF identified in administrative claims databases. We estimated sensitivity, specificity, positive predicted value, kappa, prevalence and bias–adjusted kappa (PABAK), and prevalence. Compared with physician-diagnosed HF, sensitivity of self-report was low (28%–38%) and specificity was high (96%–97%). Agreement was poor (kappa 0.32–0.39) and increased when adjusted for prevalence and bias (PABAK 0.73–0.83). Prevalence of HF measured by self-report (9.0%), ARIC-classified hospitalizations (11.2%), and administrative hospitalization claims (12.7%) were similar. When outpatient HF claims were included, prevalence of HF increased to 18.6%. Conclusions For accurate estimates HF burden, self-reports of HF are best confirmed by means of appropriate diagnostic tests or medical records. Our results highlight the need for improved awareness and understanding of HF by patients, because accurate patient awareness of the diagnosis may enhance management of this common condition.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objective The aim of this work was to estimate agreement of self-reported heart failure (HF) with physician-diagnosed HF and compare the prevalence of HF according to method of ascertainment. Methods and Results ARIC cohort members (60–83 years of age) were asked annually whether a physician indicated that they have HF. For those self-reporting HF, physicians were asked to confirm their patients' HF status. Physician-diagnosed HF included surveillance of hospitalized HF and hospitalized and outpatient HF identified in administrative claims databases. We estimated sensitivity, specificity, positive predicted value, kappa, prevalence and bias–adjusted kappa (PABAK), and prevalence. Compared with physician-diagnosed HF, sensitivity of self-report was low (28%–38%) and specificity was high (96%–97%). Agreement was poor (kappa 0.32–0.39) and increased when adjusted for prevalence and bias (PABAK 0.73–0.83). Prevalence of HF measured by self-report (9.0%), ARIC-classified hospitalizations (11.2%), and administrative hospitalization claims (12.7%) were similar. When outpatient HF claims were included, prevalence of HF increased to 18.6%. Conclusions For accurate estimates HF burden, self-reports of HF are best confirmed by means of appropriate diagnostic tests or medical records. Our results highlight the need for improved awareness and understanding of HF by patients, because accurate patient awareness of the diagnosis may enhance management of this common condition. |
Mayer, Alyssa B; McDermott, Robert J; Bryant, Carol A; Baldwin, Julie A; Kromrey, Jeffrey Sustainability of community-based health promotion coalitions: Putting theory into practice Journal Article Health Behavior and Policy Review, 4 (6), pp. 511-520, 2017. @article{Mayer2017, title = {Sustainability of community-based health promotion coalitions: Putting theory into practice}, author = {Alyssa B Mayer and Robert J McDermott and Carol A Bryant and Julie A Baldwin and Jeffrey Kromrey}, url = {http://ingentaconnect.com/contentone/psp/hbpr/2017/00000004/00000006/art00001;jsessionid=22whnsckp4hwq.x-ic-live-03}, year = {2017}, date = {2017-11-01}, journal = {Health Behavior and Policy Review}, volume = {4}, number = {6}, pages = {511-520}, abstract = {Objective: Despite their rich potential, community coalitions enjoy mixed success in effecting long-term population health improvement. A need exists for strategies that augment and sustain their functional success. We undertook a study to enhance definition of the elements of coalition success and sustainability that, in turn, may foster better achievement in community-based participatory research (CBPR) and concomitant health-related outcomes. Methods: We conducted in-depth, semi-structured interviews (N = 42) with academic researchers and their community coalition partners about the effectiveness of their collaborative endeavors. A grounded theory analysis of interview data informed the identification of domains and thematic elements influencing coalition effectiveness. Results: Seven domains emerged: (1) Characteristics related to coalition structure and processes; (2) Partner characteristics, eg, diversity, patience, flexibility, expertise; (3) Community characteristics, eg, capacity, ownership; (4) Partnership dynamics and synergy; (5) Tangible benefits; (6) Available resources, and; (7) Project characteristics. In all, 70 elements representing these domains influenced coalition effectiveness over time. Conclusions: These results extend our knowledge of factors contributing to coalition effectiveness and the sustainability of academic-community partnerships. Attention to these domains during key operational stages of CBPR initiatives is likely to have broad stakeholder benefits.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objective: Despite their rich potential, community coalitions enjoy mixed success in effecting long-term population health improvement. A need exists for strategies that augment and sustain their functional success. We undertook a study to enhance definition of the elements of coalition success and sustainability that, in turn, may foster better achievement in community-based participatory research (CBPR) and concomitant health-related outcomes. Methods: We conducted in-depth, semi-structured interviews (N = 42) with academic researchers and their community coalition partners about the effectiveness of their collaborative endeavors. A grounded theory analysis of interview data informed the identification of domains and thematic elements influencing coalition effectiveness. Results: Seven domains emerged: (1) Characteristics related to coalition structure and processes; (2) Partner characteristics, eg, diversity, patience, flexibility, expertise; (3) Community characteristics, eg, capacity, ownership; (4) Partnership dynamics and synergy; (5) Tangible benefits; (6) Available resources, and; (7) Project characteristics. In all, 70 elements representing these domains influenced coalition effectiveness over time. Conclusions: These results extend our knowledge of factors contributing to coalition effectiveness and the sustainability of academic-community partnerships. Attention to these domains during key operational stages of CBPR initiatives is likely to have broad stakeholder benefits. |
Camplain, Ricky; Kucharska-Newton, Anna; Loehr, Laura; Keyserling, Thomas C; Layton, Bradley J; Wruck, Lisa; Folsom, Aaron R; Bertoni, Alain G; Heiss, Gerardo Accuracy of self-reported heart failure. The atherosclerosis risk in communities (ARIC) study Journal Article Journal of Cardiac Failure, 23 (11), pp. 802-808, 2017. @article{Camplain2017c, title = {Accuracy of self-reported heart failure. The atherosclerosis risk in communities (ARIC) study}, author = {Ricky Camplain and Anna Kucharska-Newton and Laura Loehr and Thomas C Keyserling and Bradley J Layton and Lisa Wruck and Aaron R Folsom and Alain G Bertoni and Gerardo Heiss}, url = {https://www.sciencedirect.com/science/article/pii/S1071916417311673?via%3Dihub}, year = {2017}, date = {2017-11-01}, journal = {Journal of Cardiac Failure}, volume = {23}, number = {11}, pages = {802-808}, abstract = {Objective The aim of this work was to estimate agreement of self-reported heart failure (HF) with physician-diagnosed HF and compare the prevalence of HF according to method of ascertainment. Methods and Results ARIC cohort members (60–83 years of age) were asked annually whether a physician indicated that they have HF. For those self-reporting HF, physicians were asked to confirm their patients' HF status. Physician-diagnosed HF included surveillance of hospitalized HF and hospitalized and outpatient HF identified in administrative claims databases. We estimated sensitivity, specificity, positive predicted value, kappa, prevalence and bias–adjusted kappa (PABAK), and prevalence. Compared with physician-diagnosed HF, sensitivity of self-report was low (28%–38%) and specificity was high (96%–97%). Agreement was poor (kappa 0.32–0.39) and increased when adjusted for prevalence and bias (PABAK 0.73–0.83). Prevalence of HF measured by self-report (9.0%), ARIC-classified hospitalizations (11.2%), and administrative hospitalization claims (12.7%) were similar. When outpatient HF claims were included, prevalence of HF increased to 18.6%. Conclusions For accurate estimates HF burden, self-reports of HF are best confirmed by means of appropriate diagnostic tests or medical records. Our results highlight the need for improved awareness and understanding of HF by patients, because accurate patient awareness of the diagnosis may enhance management of this common condition.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objective The aim of this work was to estimate agreement of self-reported heart failure (HF) with physician-diagnosed HF and compare the prevalence of HF according to method of ascertainment. Methods and Results ARIC cohort members (60–83 years of age) were asked annually whether a physician indicated that they have HF. For those self-reporting HF, physicians were asked to confirm their patients' HF status. Physician-diagnosed HF included surveillance of hospitalized HF and hospitalized and outpatient HF identified in administrative claims databases. We estimated sensitivity, specificity, positive predicted value, kappa, prevalence and bias–adjusted kappa (PABAK), and prevalence. Compared with physician-diagnosed HF, sensitivity of self-report was low (28%–38%) and specificity was high (96%–97%). Agreement was poor (kappa 0.32–0.39) and increased when adjusted for prevalence and bias (PABAK 0.73–0.83). Prevalence of HF measured by self-report (9.0%), ARIC-classified hospitalizations (11.2%), and administrative hospitalization claims (12.7%) were similar. When outpatient HF claims were included, prevalence of HF increased to 18.6%. Conclusions For accurate estimates HF burden, self-reports of HF are best confirmed by means of appropriate diagnostic tests or medical records. Our results highlight the need for improved awareness and understanding of HF by patients, because accurate patient awareness of the diagnosis may enhance management of this common condition. |
Pohl, David A; Kuwahara, Rita K; Javadi, Kamran; Kirby, Christine; Rosen, David L; Napravnik, Sonia; Farel, Claire Financial barriers and lapses in treatment and care of HIV-infected adults in a southern state in the United States Journal Article AIDS Patient Care and STDs, 31 (11), pp. 463-469, 2017. @article{Pohl2017, title = {Financial barriers and lapses in treatment and care of HIV-infected adults in a southern state in the United States}, author = {David A Pohl and Rita K Kuwahara and Kamran Javadi and Christine Kirby and David L Rosen and Sonia Napravnik and Claire Farel}, url = {https://www.liebertpub.com/doi/abs/10.1089/apc.2017.0125}, year = {2017}, date = {2017-11-01}, journal = {AIDS Patient Care and STDs}, volume = {31}, number = {11}, pages = {463-469}, abstract = {Antiretroviral (ARV) adherence has largely been considered from the perspective of an individual's behavior with less attention given to potential structural causes for lapses in treatment, such as the cost of medications and care. HIV medication expense is typically covered by third party payers. However, private insurance premiums and deductibles may rise, or policies terminated such as with a change in employment. Likewise, a patient's eligibility for publicly funded coverage like state AIDS Drug Assistance Programs (ADAP) or Medicaid can also be lost. We conducted a one-time survey of a sample of 300 patients receiving HIV care at a single large academic center in the south of United States to examine lapses in HIV therapy due to financial reasons. We found that during the prior year, financial issues including medication cost or coverage led to a lapse in ARVs in 10% (n = 31) of participants. However, of …}, keywords = {}, pubstate = {published}, tppubtype = {article} } Antiretroviral (ARV) adherence has largely been considered from the perspective of an individual's behavior with less attention given to potential structural causes for lapses in treatment, such as the cost of medications and care. HIV medication expense is typically covered by third party payers. However, private insurance premiums and deductibles may rise, or policies terminated such as with a change in employment. Likewise, a patient's eligibility for publicly funded coverage like state AIDS Drug Assistance Programs (ADAP) or Medicaid can also be lost. We conducted a one-time survey of a sample of 300 patients receiving HIV care at a single large academic center in the south of United States to examine lapses in HIV therapy due to financial reasons. We found that during the prior year, financial issues including medication cost or coverage led to a lapse in ARVs in 10% (n = 31) of participants. However, of … |
Reinschmidt, Kerstin M; Ingram, Maia; Morales, Stephanie; Sabo, Samantha; Blackburn, John; Murrieta, Lucy; David, Cassalyn; Carvajal, Scott C Documenting community health worker roles in primary care: Contributions to evidence-based integration into health care teams, 2015 Journal Article Journal of Ambulatory Care Management, 40 (4), pp. 305-315, 2017. @article{Reinschmidt2017, title = {Documenting community health worker roles in primary care: Contributions to evidence-based integration into health care teams, 2015}, author = {Kerstin M Reinschmidt and Maia Ingram and Stephanie Morales and Samantha Sabo and John Blackburn and Lucy Murrieta and Cassalyn David and Scott C Carvajal}, url = {https://journals.lww.com/ambulatorycaremanagement/Fulltext/2017/10000/Documenting_Community_Health_Worker_Roles_in.11.aspx}, doi = {10.1097/JAC.0000000000000178}, year = {2017}, date = {2017-10-01}, journal = {Journal of Ambulatory Care Management}, volume = {40}, number = {4}, pages = {305-315}, abstract = {The Patient Protection and Affordable Care Act provided community health workers (CHWs) with new opportunities, and current efforts develop evidence-based guidelines for CHW integration into clinical teams. This qualitative study documents CHW roles and activities in 3 federally qualified health care centers in southern Arizona. Community health worker clinical roles, activities, and integration varied by health center and were in flux. Integration included complementary roles, scheduled and everyday communications with team members, and documentation in the electronic health records. These findings contribute to evidence-based guidelines for CHW integration into clinical teams that are critical to maximizing CHW contributions to patient health improvements.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The Patient Protection and Affordable Care Act provided community health workers (CHWs) with new opportunities, and current efforts develop evidence-based guidelines for CHW integration into clinical teams. This qualitative study documents CHW roles and activities in 3 federally qualified health care centers in southern Arizona. Community health worker clinical roles, activities, and integration varied by health center and were in flux. Integration included complementary roles, scheduled and everyday communications with team members, and documentation in the electronic health records. These findings contribute to evidence-based guidelines for CHW integration into clinical teams that are critical to maximizing CHW contributions to patient health improvements. |
Arora, Nonie S; Davis, Kelly J; Kirby, Christine; McGuire, Amy L; Green, Robert C; Blumenthal-Barby, J S; Ubel, Peter A Communication challenges for non geneticist physicians relaying clinical genomic results Journal Article Personalized Medicine, 14 (5), pp. 423-431, 2017. @article{Arora2017, title = {Communication challenges for non geneticist physicians relaying clinical genomic results}, author = {Nonie S Arora and Kelly J Davis and Christine Kirby and Amy L McGuire and Robert C Green and J S Blumenthal-Barby and Peter A Ubel}, url = {https://www.futuremedicine.com/doi/abs/10.2217/pme-2017-0008}, year = {2017}, date = {2017-09-15}, journal = {Personalized Medicine}, volume = {14}, number = {5}, pages = {423-431}, abstract = {Aim: Identify the behavioral challenges to the use of genome sequencing (GS) in a clinical setting. Materials & methods: We observed how general internists and nongenetic specialists delivered GS results to patients enrolled in the MedSeq Project. Using transcripts of such disclosure interactions, we made qualitative observations of communication behaviors that could limit the usefulness of GS results until reaching the point of thematic saturation. Results: Findings included confusion regarding genomic terminology, difficulty with the volume or complexity of information and difficulties communicating complex risk information to patients. We observed a broad dismissal of clinical value of GS by some physicians and sometimes ineffective communication regarding health behavior change. Conclusion: Overcoming these behavioral challenges is necessary to make full use of clinical GS results.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Aim: Identify the behavioral challenges to the use of genome sequencing (GS) in a clinical setting. Materials & methods: We observed how general internists and nongenetic specialists delivered GS results to patients enrolled in the MedSeq Project. Using transcripts of such disclosure interactions, we made qualitative observations of communication behaviors that could limit the usefulness of GS results until reaching the point of thematic saturation. Results: Findings included confusion regarding genomic terminology, difficulty with the volume or complexity of information and difficulties communicating complex risk information to patients. We observed a broad dismissal of clinical value of GS by some physicians and sometimes ineffective communication regarding health behavior change. Conclusion: Overcoming these behavioral challenges is necessary to make full use of clinical GS results. |
Ingram, Maia; Doubleday, Kevin; Bell, Melanie L; Lohr, Abby; Murrieta, Lucy; Velasco, Maria; Blackburn, John; Sabo, Samantha; de Zapien, Jill Guernsey; Carvajal, Scott C Community health worker impact on chronic disease outcomes within primary care examined using electronic health records Journal Article American Journal of Public health, 107 (10), pp. 1668-1674, 2017. @article{Ingram2017b, title = {Community health worker impact on chronic disease outcomes within primary care examined using electronic health records}, author = {Maia Ingram and Kevin Doubleday and Melanie L Bell and Abby Lohr and Lucy Murrieta and Maria Velasco and John Blackburn and Samantha Sabo and Jill Guernsey de Zapien and Scott C Carvajal}, url = {https://www.ncbi.nlm.nih.gov/pubmed/28817321}, doi = {10.2105/AJPH.2017.303934}, year = {2017}, date = {2017-09-13}, journal = {American Journal of Public health}, volume = {107}, number = {10}, pages = {1668-1674}, abstract = {Objectives. To investigate community health worker (CHW) effects on chronic disease outcomes using electronic health records (EHRs). Methods. We examined EHRs of 32 147 patients at risk for chronic disease during 2012 to 2015. Variables included contact with clinic-based CHWs, vitals, and laboratory tests. We estimated a mixed model for all outcomes. Results. Within-group findings showed statistically significant improvements in chronic disease indicators after exposure to CHWs. In health center 1, HbA1c (glycated hemoglobin) decreased 0.15 millimoles per mole (95% confidence interval [CI] = −0.24, −0.06), body mass index decreased 0.29 kilograms per meter squared (CI = –0.39, −0.20), and total cholesterol decreased 11.9 milligrams per deciliter (CI = −13.5, −10.2). In health center 2, HbA1c decreased 0.43 millimoles per mole (CI = –0.7, −0.17), body mass index decreased by 0.08 kilograms per meter squared (CI = −0.14, −0.02), and triglycerides decreased by 22.50 milligrams per deciliter (CI = −39.0, −6.0). Total cholesterol of 3.62 milligrams per deciliter (CI = −6.6, −0.6) in health center 1 was the only improvement tied to CHW contact. Conclusions. Although patients’ chronic disease indicators consistently improved, between-group models provided no additional evidence of impact. EHRs’ evolution may elucidate CHW contributions moving forward.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objectives. To investigate community health worker (CHW) effects on chronic disease outcomes using electronic health records (EHRs). Methods. We examined EHRs of 32 147 patients at risk for chronic disease during 2012 to 2015. Variables included contact with clinic-based CHWs, vitals, and laboratory tests. We estimated a mixed model for all outcomes. Results. Within-group findings showed statistically significant improvements in chronic disease indicators after exposure to CHWs. In health center 1, HbA1c (glycated hemoglobin) decreased 0.15 millimoles per mole (95% confidence interval [CI] = −0.24, −0.06), body mass index decreased 0.29 kilograms per meter squared (CI = –0.39, −0.20), and total cholesterol decreased 11.9 milligrams per deciliter (CI = −13.5, −10.2). In health center 2, HbA1c decreased 0.43 millimoles per mole (CI = –0.7, −0.17), body mass index decreased by 0.08 kilograms per meter squared (CI = −0.14, −0.02), and triglycerides decreased by 22.50 milligrams per deciliter (CI = −39.0, −6.0). Total cholesterol of 3.62 milligrams per deciliter (CI = −6.6, −0.6) in health center 1 was the only improvement tied to CHW contact. Conclusions. Although patients’ chronic disease indicators consistently improved, between-group models provided no additional evidence of impact. EHRs’ evolution may elucidate CHW contributions moving forward. |
MacFarlan, Shane J; Remiker, Mark Cultural multi-level selection and biological market theory explain the coupled dynamics of labor exchange cooperation and social support Journal Article Sustainability Science, 13 (1), pp. 59-70, 2017. @article{MacFarlan2017, title = {Cultural multi-level selection and biological market theory explain the coupled dynamics of labor exchange cooperation and social support}, author = {Shane J MacFarlan and Mark Remiker}, url = {https://link.springer.com/article/10.1007/s11625-017-0481-x}, year = {2017}, date = {2017-09-13}, journal = {Sustainability Science}, volume = {13}, number = {1}, pages = {59-70}, abstract = {Smallholders rely on labor exchange and social support networks; however, little is known about the cooperative dynamics of these interlinked systems. Whereas cultural multi-level selection (CLMS) predicts group membership and changes in the dominant level of selection modulates cooperation, biological market theory (BMT) posits market size fluctuations affect cooperation. We assess these predictions by examining two dimensions of labor exchange, competitive helping and labor reciprocity, and their downstream impacts on social support in a Dominican community between 2007 and 2010. First, we analyze within-community labor organization. Next, we analyze how international regulatory change and the 2008–2009 World Trade Collapse affected local labor organization and its impacts on competitive helping and labor reciprocity. Finally, we show how labor dynamics affected social support. Analyses reveal that (1) village labor initially involved two levels (labor contracting and labor exchange) and the presence of a structured group who maintained higher rates of reciprocal labor relative to non-group members; (2) changes in the international commodities market reduced labor contracting, the size of the labor exchange market, and the dominant level of selection, resulting in less competitive helping, lower rates of reciprocity for group members, and more cliquish social support; and (3) as the global market for bay oil ameliorated, labor organization shifted back to a pre-recession structure, resulting in a larger labor market with more competitive helping and higher rates of reciprocity amongst group members. We highlight the utility of an integrated CMLS and BMT framework for analyzing cooperative dynamics and socio-economic systems sustainability.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Smallholders rely on labor exchange and social support networks; however, little is known about the cooperative dynamics of these interlinked systems. Whereas cultural multi-level selection (CLMS) predicts group membership and changes in the dominant level of selection modulates cooperation, biological market theory (BMT) posits market size fluctuations affect cooperation. We assess these predictions by examining two dimensions of labor exchange, competitive helping and labor reciprocity, and their downstream impacts on social support in a Dominican community between 2007 and 2010. First, we analyze within-community labor organization. Next, we analyze how international regulatory change and the 2008–2009 World Trade Collapse affected local labor organization and its impacts on competitive helping and labor reciprocity. Finally, we show how labor dynamics affected social support. Analyses reveal that (1) village labor initially involved two levels (labor contracting and labor exchange) and the presence of a structured group who maintained higher rates of reciprocal labor relative to non-group members; (2) changes in the international commodities market reduced labor contracting, the size of the labor exchange market, and the dominant level of selection, resulting in less competitive helping, lower rates of reciprocity for group members, and more cliquish social support; and (3) as the global market for bay oil ameliorated, labor organization shifted back to a pre-recession structure, resulting in a larger labor market with more competitive helping and higher rates of reciprocity amongst group members. We highlight the utility of an integrated CMLS and BMT framework for analyzing cooperative dynamics and socio-economic systems sustainability. |
Hunter, Wynn G; Zafar, Yousuf S; Hesson, Ashley; Davis, Kelly J; Kirby, Christine; Barnett, Jamison A; Ubel, Peter A Discussing health care expenses in the oncology clinic: Analysis of cost conversations in outpatient encounters Journal Article Journal of Oncology Practice, 12 (11), pp. e944-e956, 2017. @article{Hunter2017, title = {Discussing health care expenses in the oncology clinic: Analysis of cost conversations in outpatient encounters}, author = {Wynn G Hunter and Yousuf S Zafar and Ashley Hesson and Kelly J Davis and Christine Kirby and Jamison A Barnett and Peter A Ubel}, url = {http://ascopubs.org/doi/abs/10.1200/JOP.2017.022855}, year = {2017}, date = {2017-08-23}, journal = {Journal of Oncology Practice}, volume = {12}, number = {11}, pages = {e944-e956}, abstract = {Purpose: ASCO identified oncologist-patient conversations about cancer costs as an important component of high-quality care. However, limited data exist characterizing the content of these conversations. We sought to provide novel insight into oncologist-patient cost conversations by determining the content of cost conversations in breast cancer clinic visits. Methods: We performed content analysis of transcribed dialogue from 677 outpatient appointments for breast cancer management. Encounters featured 677 patients with breast cancer visiting 56 oncologists nationwide from 2010 to 2013. Results: Cost conversations were identified in 22% of visits (95% CI, 19 to 25) and had a median duration of 33 seconds (interquartile range, 19 to 62). Fifty-nine percent of cost conversations were initiated by oncologists (95% CI, 51 to 67), who most commonly brought up costs for antineoplastic agents. By contrast, patients …}, keywords = {}, pubstate = {published}, tppubtype = {article} } Purpose: ASCO identified oncologist-patient conversations about cancer costs as an important component of high-quality care. However, limited data exist characterizing the content of these conversations. We sought to provide novel insight into oncologist-patient cost conversations by determining the content of cost conversations in breast cancer clinic visits. Methods: We performed content analysis of transcribed dialogue from 677 outpatient appointments for breast cancer management. Encounters featured 677 patients with breast cancer visiting 56 oncologists nationwide from 2010 to 2013. Results: Cost conversations were identified in 22% of visits (95% CI, 19 to 25) and had a median duration of 33 seconds (interquartile range, 19 to 62). Fifty-nine percent of cost conversations were initiated by oncologists (95% CI, 51 to 67), who most commonly brought up costs for antineoplastic agents. By contrast, patients … |
Baldwin, Julie A; Williamson, Heather J; Eaves, Emery R; Levin, Bruce L; Burton, Donna L; Massey, Oliver T Broadening measures of success: Results of a behavioral health translational research training program Journal Article Implementation Science, 12 (92), 2017. @article{Baldwin2017b, title = {Broadening measures of success: Results of a behavioral health translational research training program}, author = {Julie A Baldwin and Heather J Williamson and Emery R Eaves and Bruce L Levin and Donna L Burton and Oliver T Massey}, url = {https://implementationscience.biomedcentral.com/articles/10.1186/s13012-017-0621-9}, year = {2017}, date = {2017-07-24}, journal = {Implementation Science}, volume = {12}, number = {92}, abstract = {Background While some research training programs have considered the importance of mentoring in inspiring professionals to engage in translational research, most evaluations emphasize outcomes specific to academic productivity as primary measures of training program success. The impact of such training or mentoring programs on stakeholders and local community organizations engaged in translational research efforts has received little attention. The purpose of this evaluation is to explore outcomes other than traditional academic productivity in a translational research graduate certificate program designed to pair graduate students and behavioral health professionals in collaborative service-learning projects. Methods Semi-structured qualitative interviews with scholars, community mentors, and academic mentors were conducted regarding a translational research program to identify programmatic impacts. Interviews were transcribed and coded by the research team to identify salient themes related to programmatic outcomes. Results Results are framed using the Translational Research Impact Scale which is organized into three overarching domains of potential impact: (1) research-related impacts, (2) translational impacts, and (3) societal impacts. This evaluation demonstrates the program’s impact in all three domains of the TRIS evaluation framework. Graduate certificate participants (scholars) reported that gaining experience in applied behavioral health settings added useful skills and expertise to their present careers and increased their interest in pursuing translational research. Scholars also described benefits resulting from networks gained through participation in the program, including valuable ties between the university and community behavioral health organizations. Conclusions This evaluation of the outcomes of a graduate certificate program providing training in translational research highlights the need for more community-oriented and practice-based measures of success. Encouraging practitioner involvement in translational research is vital to translate knowledge into practice and to enable practice-based needs to inform research and policy. A more flexible approach to measuring programmatic success in research training programs can help bridge the knowledge translation gap.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background While some research training programs have considered the importance of mentoring in inspiring professionals to engage in translational research, most evaluations emphasize outcomes specific to academic productivity as primary measures of training program success. The impact of such training or mentoring programs on stakeholders and local community organizations engaged in translational research efforts has received little attention. The purpose of this evaluation is to explore outcomes other than traditional academic productivity in a translational research graduate certificate program designed to pair graduate students and behavioral health professionals in collaborative service-learning projects. Methods Semi-structured qualitative interviews with scholars, community mentors, and academic mentors were conducted regarding a translational research program to identify programmatic impacts. Interviews were transcribed and coded by the research team to identify salient themes related to programmatic outcomes. Results Results are framed using the Translational Research Impact Scale which is organized into three overarching domains of potential impact: (1) research-related impacts, (2) translational impacts, and (3) societal impacts. This evaluation demonstrates the program’s impact in all three domains of the TRIS evaluation framework. Graduate certificate participants (scholars) reported that gaining experience in applied behavioral health settings added useful skills and expertise to their present careers and increased their interest in pursuing translational research. Scholars also described benefits resulting from networks gained through participation in the program, including valuable ties between the university and community behavioral health organizations. Conclusions This evaluation of the outcomes of a graduate certificate program providing training in translational research highlights the need for more community-oriented and practice-based measures of success. Encouraging practitioner involvement in translational research is vital to translate knowledge into practice and to enable practice-based needs to inform research and policy. A more flexible approach to measuring programmatic success in research training programs can help bridge the knowledge translation gap. |
Williamson, Heather J; Contreras, Graciela M; Rodriguez, Erica S; Smith, Jennifer M; Perkins, Elizabeth A Health Care Access for Adults With Intellectual and Developmental Disabilities: A Scoping Review Journal Article OTJR: Occupation, Participation and Health, 37 (4), pp. 227-236, 2017. @article{Williamson2017b, title = {Health Care Access for Adults With Intellectual and Developmental Disabilities: A Scoping Review}, author = {Heather J Williamson and Graciela M Contreras and Erica S Rodriguez and Jennifer M Smith and Elizabeth A Perkins}, url = {http://journals.sagepub.com/doi/abs/10.1177/1539449217714148}, year = {2017}, date = {2017-07-13}, journal = {OTJR: Occupation, Participation and Health}, volume = {37}, number = {4}, pages = {227-236}, abstract = {Adults with intellectual and/or developmental disabilities (IDD) often experience health disparities. To address disparities, Healthy People 2020 includes specific disability and health goals focused on improving health care access. The study’s purpose was to review the literature exploring health care access for adults with IDD to identify opportunities for occupational therapy research and practice. A scoping review was completed of articles discussing health care access among adults with IDD in the United States. Thirty-seven articles met the inclusion criteria. Results are framed using the ecology of human performance theory identifying person and environmental issues affecting health care access of adults with IDD. Opportunities exist for occupational therapy to improve participation and health of adults with IDD through engaging in research and practice efforts addressing health care access. Occupational therapy could develop interventions to establish skills and abilities and recommend changes to the health care environment.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Adults with intellectual and/or developmental disabilities (IDD) often experience health disparities. To address disparities, Healthy People 2020 includes specific disability and health goals focused on improving health care access. The study’s purpose was to review the literature exploring health care access for adults with IDD to identify opportunities for occupational therapy research and practice. A scoping review was completed of articles discussing health care access among adults with IDD in the United States. Thirty-seven articles met the inclusion criteria. Results are framed using the ecology of human performance theory identifying person and environmental issues affecting health care access of adults with IDD. Opportunities exist for occupational therapy to improve participation and health of adults with IDD through engaging in research and practice efforts addressing health care access. Occupational therapy could develop interventions to establish skills and abilities and recommend changes to the health care environment. |
Baldwin, Julie A; Williamson, Heather J; Eaves, Emery R; Levin, Bruce L; Burton, Donna L; Massey, Oliver T Broadening measures of success: results of a behavioral health translational research training program Journal Article Implementation Science, 12 (92), 2017. @article{Baldwin2017b, title = {Broadening measures of success: results of a behavioral health translational research training program}, author = {Julie A Baldwin and Heather J Williamson and Emery R Eaves and Bruce L Levin and Donna L Burton and Oliver T Massey}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5525239/}, year = {2017}, date = {2017-07-04}, journal = {Implementation Science}, volume = {12}, number = {92}, abstract = {Background: While some research training programs have considered the importance of mentoring in inspiring professionals to engage in translational research, most evaluations emphasize outcomes specific to academic productivity as primary measures of training program success. The impact of such training or mentoring programs on stakeholders and local community organizations engaged in translational research efforts has received little attention. The purpose of this evaluation is to explore outcomes other than traditional academic productivity in a translational research graduate certificate program designed to pair graduate students and behavioral health professionals in collaborative service-learning projects. Methods: Semi-structured qualitative interviews with scholars, community mentors, and academic mentors were conducted regarding a translational research program to identify programmatic impacts. Interviews were transcribed and coded by the research team to identify salient themes related to programmatic outcomes. Results: Results are framed using the Translational Research Impact Scale which is organized into three overarching domains of potential impact: (1) research-related impacts, (2) translational impacts, and (3) societal impacts. This evaluation demonstrates the program’s impact in all three domains of the TRIS evaluation framework. Graduate certificate participants (scholars) reported that gaining experience in applied behavioral health settings added useful skills and expertise to their present careers and increased their interest in pursuing translational research. Scholars also described benefits resulting from networks gained through participation in the program, including valuable ties between the university and community behavioral health organizations. Conclusions: This evaluation of the outcomes of a graduate certificate program providing training in translational research highlights the need for more community-oriented and practice-based measures of success. Encouraging practitioner involvement in translational research is vital to translate knowledge into practice and to enable practice-based needs to inform research and policy. A more flexible approach to measuring programmatic success in research training programs can help bridge the knowledge translation gap}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background: While some research training programs have considered the importance of mentoring in inspiring professionals to engage in translational research, most evaluations emphasize outcomes specific to academic productivity as primary measures of training program success. The impact of such training or mentoring programs on stakeholders and local community organizations engaged in translational research efforts has received little attention. The purpose of this evaluation is to explore outcomes other than traditional academic productivity in a translational research graduate certificate program designed to pair graduate students and behavioral health professionals in collaborative service-learning projects. Methods: Semi-structured qualitative interviews with scholars, community mentors, and academic mentors were conducted regarding a translational research program to identify programmatic impacts. Interviews were transcribed and coded by the research team to identify salient themes related to programmatic outcomes. Results: Results are framed using the Translational Research Impact Scale which is organized into three overarching domains of potential impact: (1) research-related impacts, (2) translational impacts, and (3) societal impacts. This evaluation demonstrates the program’s impact in all three domains of the TRIS evaluation framework. Graduate certificate participants (scholars) reported that gaining experience in applied behavioral health settings added useful skills and expertise to their present careers and increased their interest in pursuing translational research. Scholars also described benefits resulting from networks gained through participation in the program, including valuable ties between the university and community behavioral health organizations. Conclusions: This evaluation of the outcomes of a graduate certificate program providing training in translational research highlights the need for more community-oriented and practice-based measures of success. Encouraging practitioner involvement in translational research is vital to translate knowledge into practice and to enable practice-based needs to inform research and policy. A more flexible approach to measuring programmatic success in research training programs can help bridge the knowledge translation gap |
Sabo, Samantha; Flores, Melissa; Wennerström, Ashley; Bell, Melanie L; Verdugo, Lorena; Carvajal, Scott; Ingram, Maia Community health workers promote civic engagement and organizational capacity to impact policy Journal Article Journal of Community Health, 42 (6), pp. 1197-1203, 2017. @article{Sabo2017b, title = {Community health workers promote civic engagement and organizational capacity to impact policy}, author = {Samantha Sabo and Melissa Flores and Ashley Wennerström and Melanie L Bell and Lorena Verdugo and Scott Carvajal and Maia Ingram}, url = {https://link.springer.com/article/10.1007/s10900-017-0370-3}, year = {2017}, date = {2017-06-06}, journal = {Journal of Community Health}, volume = {42}, number = {6}, pages = {1197-1203}, abstract = {Community health workers (CHW) have historically served to link structurally vulnerable populations to broad support systems. Emerging evidence suggests that CHWs engage in various forms of advocacy to promote policy and systems change. We assessed the impact of CHW community advocacy on community change, defined as civic engagement, organizational capacity and policy and systems change. Data are drawn from the 2014 National Community Health Worker Advocacy Survey (N = 1776) aimed to identify the state of the CHW profession, and their impact on health disparities through community advocacy and policy engagement. Our primary analysis used multiple linear regression to assess the association between CHW advocacy and community change. As predicted, there was a significant, positive association between CHW advocacy and change in community conditions. Additionally, both adjusted and sensitivity models had similar standardized beta estimates for advocacy, and adjusted R 2 statistics. CHW advocacy predicts positive change in community conditions and further advances the CHW Community Advocacy Framework designed to support and monitor CHW community advocacy to reduce health disparities through advocacy and policy change.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Community health workers (CHW) have historically served to link structurally vulnerable populations to broad support systems. Emerging evidence suggests that CHWs engage in various forms of advocacy to promote policy and systems change. We assessed the impact of CHW community advocacy on community change, defined as civic engagement, organizational capacity and policy and systems change. Data are drawn from the 2014 National Community Health Worker Advocacy Survey (N = 1776) aimed to identify the state of the CHW profession, and their impact on health disparities through community advocacy and policy engagement. Our primary analysis used multiple linear regression to assess the association between CHW advocacy and community change. As predicted, there was a significant, positive association between CHW advocacy and change in community conditions. Additionally, both adjusted and sensitivity models had similar standardized beta estimates for advocacy, and adjusted R 2 statistics. CHW advocacy predicts positive change in community conditions and further advances the CHW Community Advocacy Framework designed to support and monitor CHW community advocacy to reduce health disparities through advocacy and policy change. |
Brown, Gregory D; Hunter, Wynn G; Hesson, Ashley; Davis, Kelly J; Kirby, Christine; Barnett, Jamison A; Byelmac, Dmytro; Ubel, Peter A Discussing out-of-pocket expenses during clinical appointments: An observational study of patient-psychiatrist interactions Journal Article Psychiatric Services, 68 (6), pp. 610-617, 2017. @article{Brown2017, title = {Discussing out-of-pocket expenses during clinical appointments: An observational study of patient-psychiatrist interactions}, author = {Gregory D Brown and Wynn G Hunter and Ashley Hesson and Kelly J Davis and Christine Kirby and Jamison A Barnett and Dmytro Byelmac and Peter A Ubel}, url = {https://ps.psychiatryonline.org/doi/abs/10.1176/appi.ps.201600275}, year = {2017}, date = {2017-05-19}, journal = {Psychiatric Services}, volume = {68}, number = {6}, pages = {610-617}, abstract = {Objective: High out-of-pocket expenses for medical treatment have been associated with worse quality of life, decreased treatment adherence, and increased risk of adverse health outcomes. Treatment of depression potentially has high out-of-pocket expenses. Limited data characterize psychiatrist-patient conversations about health care costs. Methods: The authors conducted content analysis from 422 outpatient psychiatrist-patient visits for medication management of major depressive disorder in community-based private practices nationwide from 2010 to 2014. Results: Patients’ health care expenses were discussed in 38% of clinic visits (95% confidence interval [CI]= 33%–43%). Uninsured patients were significantly more likely to discuss expenses than were patients enrolled in private or public plans (64%, 44%, and 30%, respectively; p<.001). Sixty-nine percent of cost conversations lasted less than one minute …}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objective: High out-of-pocket expenses for medical treatment have been associated with worse quality of life, decreased treatment adherence, and increased risk of adverse health outcomes. Treatment of depression potentially has high out-of-pocket expenses. Limited data characterize psychiatrist-patient conversations about health care costs. Methods: The authors conducted content analysis from 422 outpatient psychiatrist-patient visits for medication management of major depressive disorder in community-based private practices nationwide from 2010 to 2014. Results: Patients’ health care expenses were discussed in 38% of clinic visits (95% confidence interval [CI]= 33%–43%). Uninsured patients were significantly more likely to discuss expenses than were patients enrolled in private or public plans (64%, 44%, and 30%, respectively; p<.001). Sixty-nine percent of cost conversations lasted less than one minute … |
Salinas-Miranda, Abraham; King, Lindsey M; Salihu, Hamisu M; Berry, Estrellita; Austin, Deborah; Nash, Susan; Scarborough, Kenneth; Best, Evangeline; Cox, Lillian; King, Georgette; Hepburn, Carrie; Burpee, Conchita; Richardson, Eugene; Ducket, Marlo; Briscoe, Richard; Baldwin, Julie A Exploring the life course perspective in maternal and child health through community-based participatory focus groups: Social risk assessment Journal Article Journal of Health Disparities Research and Practice, 10 (1), pp. 143-166, 2017. @article{Salinas-Miranda2017, title = {Exploring the life course perspective in maternal and child health through community-based participatory focus groups: Social risk assessment}, author = {Abraham Salinas-Miranda and Lindsey M King and Hamisu M Salihu and Estrellita Berry and Deborah Austin and Susan Nash and Kenneth Scarborough and Evangeline Best and Lillian Cox and Georgette King and Carrie Hepburn and Conchita Burpee and Eugene Richardson and Marlo Ducket and Richard Briscoe and Julie A Baldwin}, url = {https://digitalscholarship.unlv.edu/jhdrp/vol10/iss1/9/}, year = {2017}, date = {2017-04-20}, journal = {Journal of Health Disparities Research and Practice}, volume = {10}, number = {1}, pages = {143-166}, abstract = {Little is known about the patterns of risk factors experienced by communities of color and how diverse community contexts shape the health trajectory of women from the early childhood period to the time of their pregnancies. Thus, we conducted a focus group study to identify social risks over the life course that contribute to maternal and child health from the perspective of community members residing in low income urban areas. Ten community-based participatory focus groups were conducted with residents from selected communities in Tampa, Florida, from September to November 2013. We used the life course perspective to illuminate and explain the experiences reported by the interviewees. A total of 78 residents participated in the focus groups. Children and adolescents’ health risks were childhood obesity, lack of physical activity, and low self-esteem. Women’s health risks were low self-esteem, low educational level, low health literacy, inadequate parenting skills, and financial problems. Risks during pregnancy included stress, low self-esteem, inadequate eating patterns, lack of physical activity, healthcare issues, lack of social support, and lack of father involvement during pregnancy. Multiple risk factors contribute to maternal and child health in low income communities in Tampa Bay. The intersection of risk factors in different life periods suggest possible pathways, cumulative, and latent effects, which must be considered in future longitudinal studies and when developing effective maternal and child health programs and policies.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Little is known about the patterns of risk factors experienced by communities of color and how diverse community contexts shape the health trajectory of women from the early childhood period to the time of their pregnancies. Thus, we conducted a focus group study to identify social risks over the life course that contribute to maternal and child health from the perspective of community members residing in low income urban areas. Ten community-based participatory focus groups were conducted with residents from selected communities in Tampa, Florida, from September to November 2013. We used the life course perspective to illuminate and explain the experiences reported by the interviewees. A total of 78 residents participated in the focus groups. Children and adolescents’ health risks were childhood obesity, lack of physical activity, and low self-esteem. Women’s health risks were low self-esteem, low educational level, low health literacy, inadequate parenting skills, and financial problems. Risks during pregnancy included stress, low self-esteem, inadequate eating patterns, lack of physical activity, healthcare issues, lack of social support, and lack of father involvement during pregnancy. Multiple risk factors contribute to maternal and child health in low income communities in Tampa Bay. The intersection of risk factors in different life periods suggest possible pathways, cumulative, and latent effects, which must be considered in future longitudinal studies and when developing effective maternal and child health programs and policies. |
Williamson, Heather J; Perkins, Elizabeth A; Levin, Bruce L; Baldwin, Julie A; Lulinski, Amie; Armstrong, Mary I; Massey, Oliver T Implementation of Medicaid managed long-term services and supports for adults with intellectual and/or developmental disabilities in Kansas Journal Article Intellectual and Developmental Disabilities, 55 (2), pp. 84-96, 2017. @article{Williamson2017b, title = {Implementation of Medicaid managed long-term services and supports for adults with intellectual and/or developmental disabilities in Kansas}, author = {Heather J Williamson and Elizabeth A Perkins and Bruce L Levin and Julie A Baldwin and Amie Lulinski and Mary I Armstrong and Oliver T Massey}, url = {http://www.aaiddjournals.org/doi/10.1352/1934-9556-55.2.84}, year = {2017}, date = {2017-04-01}, journal = {Intellectual and Developmental Disabilities}, volume = {55}, number = {2}, pages = {84-96}, abstract = {Many adults with intellectual and/or developmental disabilities (IDD) can access health and long-term services and supports (LTSS) through Medicaid. States are reforming their Medicaid LTSS programs from a fee-for-service model to a Medicaid managed LTSS (MLTSS) approach, anticipating improved quality of care and reduced costs, although there is limited evidence of MLTSS effectiveness. This study's objective was to contribute to the growing MLTSS research literature by describing MLTSS implementation in Kansas for adults with IDD. Thirty-one stakeholders completed in-depth semi-structured interviews, representing state or regional groups, service coordination providers, and family caregivers. Findings identify key aspects of the Centers for Medicare and Medicaid Services' new MLTSS regulations in the design and implementation of MLTSS programs.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Many adults with intellectual and/or developmental disabilities (IDD) can access health and long-term services and supports (LTSS) through Medicaid. States are reforming their Medicaid LTSS programs from a fee-for-service model to a Medicaid managed LTSS (MLTSS) approach, anticipating improved quality of care and reduced costs, although there is limited evidence of MLTSS effectiveness. This study's objective was to contribute to the growing MLTSS research literature by describing MLTSS implementation in Kansas for adults with IDD. Thirty-one stakeholders completed in-depth semi-structured interviews, representing state or regional groups, service coordination providers, and family caregivers. Findings identify key aspects of the Centers for Medicare and Medicaid Services' new MLTSS regulations in the design and implementation of MLTSS programs. |
Martinez-Hume, Anna C; Baker, Allison M; Bell, Hannah S; Montemayor, Isabel; Elwell, Kristan; Hunt, Linda M "They Treat you a Different Way:" Public Insurance, Stigma, and the Challenge to Quality Health Care Journal Article Culture, Medicine, and Psychiatry, 41 (1), pp. 161-180, 2017. @article{Martinez-Hume2017, title = {"They Treat you a Different Way:" Public Insurance, Stigma, and the Challenge to Quality Health Care}, author = {Anna C Martinez-Hume and Allison M Baker and Hannah S Bell and Isabel Montemayor and Kristan Elwell and Linda M Hunt}, url = {https://www.ncbi.nlm.nih.gov/pubmed/28025774}, year = {2017}, date = {2017-03-01}, journal = {Culture, Medicine, and Psychiatry}, volume = {41}, number = {1}, pages = {161-180}, abstract = {Under the Affordable Care Act, Medicaid Expansion programs are extending Medicaid eligibility and increasing access to care. However, stigma associated with public insurance coverage may importantly affect the nature and content of the health care beneficiaries receive. In this paper, we examine the health care stigma experiences described by a group of low-income public insurance beneficiaries. They perceive stigma as manifest in poor quality care and negative interpersonal interactions in the health care setting. Using an intersectional approach, we found that the stigma of public insurance was compounded with other sources of stigma including socioeconomic status, race, gender, and illness status. Experiences of stigma had important implications for how subjects evaluated the quality of care, their decisions impacting continuity of care, and their reported ability to access health care. We argue that stigma challenges the quality of care provided under public insurance and is thus a public health issue that should be addressed in Medicaid policy.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Under the Affordable Care Act, Medicaid Expansion programs are extending Medicaid eligibility and increasing access to care. However, stigma associated with public insurance coverage may importantly affect the nature and content of the health care beneficiaries receive. In this paper, we examine the health care stigma experiences described by a group of low-income public insurance beneficiaries. They perceive stigma as manifest in poor quality care and negative interpersonal interactions in the health care setting. Using an intersectional approach, we found that the stigma of public insurance was compounded with other sources of stigma including socioeconomic status, race, gender, and illness status. Experiences of stigma had important implications for how subjects evaluated the quality of care, their decisions impacting continuity of care, and their reported ability to access health care. We argue that stigma challenges the quality of care provided under public insurance and is thus a public health issue that should be addressed in Medicaid policy. |
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