1
|
Alsbury-Nealy K, Scodras S, Munce S, Colquhoun H, Jaglal SB, Salbach NM. Models for establishing linkages between healthcare and community: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3904-e3920. [PMID: 36317803 DOI: 10.1111/hsc.14096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/22/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
Community-based programmes can support healthcare systems by delivering preventive services and health promotion. This study aimed to determine the nature, range, and extent of theoretical models that guide the development of linkages between healthcare settings and community programmes. A scoping review guided by the Joanna Briggs Institute methodology and the PRISMA-ScR was conducted. Four databases (MEDLINE, EMBASE, CINAHL and PsycINFO) were searched on August 8, 2020. Two reviewers independently screened articles by title and abstract and divided the remaining articles for full-text screening. Articles that described the development of a theoretical model to guide the establishment of linkages between healthcare settings and community programmes, were peer-reviewed, and in English, were included. Articles that solely applied linkage models were excluded. One reviewer extracted data on study and model characteristics (e.g. model purpose, model components and relationships between components from the included articles). Categorical data were summarised using frequencies and percentages. Conventional content analysis was used for variables that had lengthier descriptions and variable terminology. The search identified 8926 records. Six articles describing six unique models were included in the review. Of the four models that described intended users, three (75%) identified primary care. Healthcare settings were identified in all models, with three (50%) focusing on primary care. Models used two or more linkage strategies: (1) agreeing on sharing resources, staff, and information, (2) coordinating services and referral processes, (3) planning and evaluation, (4) leadership, policies, and funding, (5) boundary spanning and (6) brokering. All models used the linkage strategy of agreeing on sharing resources, staff, and information. Findings provide important considerations for healthcare and community programme providers planning linkages. Future research should investigate the role and characteristics of community programmes in linkages, and linkages with other types of healthcare settings.
Collapse
Affiliation(s)
- Kyla Alsbury-Nealy
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Scodras
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Munce
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Heather Colquhoun
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan B Jaglal
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nancy M Salbach
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Persaud A, Castro I, Simione M, Smith JD, O'Connor G, Sharifi M, Perkins M, Torres S, Taveras EM, Kuhlthau K, Fiechtner L. Multi-sector stakeholder's perceptions of determinants of successful implementation of a pediatric weight management intervention. Front Public Health 2022; 10:954063. [PMID: 36091513 PMCID: PMC9454190 DOI: 10.3389/fpubh.2022.954063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/25/2022] [Indexed: 01/24/2023] Open
Abstract
Background Multi-sector stakeholder engagement is essential in the successful implementation, dissemination, and sustainability of pediatric weight management interventions (PWMI), particularly in low-income settings where sustainability relies on external policies and reimbursement. The objective of this study was to engage stakeholders (1) to inform the creation of the intervention with adaptations needed for a successful PWMI in a primary care and community setting and (2) to identify barriers and facilitators to implementation and dissemination. Methods We sought to examine the perspectives of local, state, and national clinic and community stakeholders during the pre-implementation period of a two-arm, randomized trial of a Health Weight Clinic PWMI conducted in two health centers and a modified-Healthy Weight and Your Child PWMI at two local YMCAs that serve a predominantly lower income, Hispanic community. The Consolidated Framework for Implementation Research interview guide served as a template for the study but was modified to fit the PWMIs and the various professional roles. Interviews were transcribed and analyzed using the framework analysis approach and themes were linked to the CFIR domains and constructs. Results Twenty-six stakeholders perceived the following as needed components of a PWMI: a formal curriculum with illustrative examples, a patient- and family-centered program, group visits, and high-quality multidisciplinary personnel. These findings led to the creation of a group visit curriculum, implementation trainings and cross-site collaborative technical assistance. Additionally, creating partnerships between community and clinical organizations, and addressing patient barriers and unmet social needs (i.e., transportation, food) were identified as facilitators to successful implementation. These results led to the creation of community resource guides, connections to community organizations, and screening and referring for unmet social needs. Perceived facilitators of dissemination included proving cost-effectiveness of the PWMI to inform insurance reimbursement for long-term sustainability. Therefore, we collected cost data and engaged with Medicaid officials to discuss reimbursement. Conclusion Findings highlight the importance of engaging multi-sector stakeholders pre-implementation to ensure the components valued are included, ensuring the program minimizes barriers to participation, considering how staff training can improve implementation and how collected outcomes can inform sustainability and dissemination of PWMIs in clinic and community settings.
Collapse
Affiliation(s)
- Alicia Persaud
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Ines Castro
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Meg Simione
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Justin D. Smith
- Division of Health Systems Innovation and Research, Department of Population Health Sciences, School of Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, United States
| | - Giselle O'Connor
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Mona Sharifi
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Meghan Perkins
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Shioban Torres
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA, United States
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Karen Kuhlthau
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Lauren Fiechtner
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
- Division of Gastroenterology and Nutrition, Massachusetts General Hospital for Children, Boston, MA, United States
| |
Collapse
|
3
|
Bajraktari S, Zingmark M, Pettersson B, Rosendahl E, Lundin-Olsson L, Sandlund M. Reaching Older People With a Digital Fall Prevention Intervention in a Swedish Municipality Context-an Observational Study. Front Public Health 2022; 10:857652. [PMID: 35548075 PMCID: PMC9082637 DOI: 10.3389/fpubh.2022.857652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/21/2022] [Indexed: 11/14/2022] Open
Abstract
Background There is robust evidence that falls in old age can be prevented by exercise programs that include balance training, functional exercises, and strength training. For the interventions to have a population health impact, outreach to the population of focus with suitable interventions is needed. While digital interventions are promising there is limited knowledge on the characteristics of who is reached. The aim of this study was to describe the recruitment process, estimate reach rate at the population level and to describe participants characteristics and representativeness in a digital fall prevention intervention study. Methods In a municipality-based observational study, reach of a digital fall prevention intervention was evaluated. The intervention included a digital exercise programme (Safe Step) and optional supportive strategies, complemented with a range of recruitment strategies to optimize reach. Recruitment during a period of 6 months was open to people 70 years or older who had experienced a fall or a decline in balance the past year. Reach was based on data from the baseline questionnaire including health and demographic characteristics of participants. Representativeness was estimated by comparing participants to a sample of older people from the Swedish National Public Health Survey. Results The recruitment rate was 4.7% (n = 173) in relation to the estimated population of focus (n = 3,706). Most participants signed up within the first month of the intervention (n = 131). The intervention attracted primarily women, older people with high education, individuals who used the internet or digital applications almost every day and those perceiving their balance as fair or poor. Safe step participants lived more commonly alone and had higher education and better walking ability in comparison to the Swedish National Public Health Survey. Conclusions With a range of recruitment strategies most participants were recruited to a digital fall intervention during the first month. The intervention attracted primarily highly educated women who frequently used the internet or smart technologies. In addition to digital fall prevention interventions, a higher diversity of intervention types (digital and non-digital) is more likely to reach a larger group of older people with different needs. Clinical Trial Registration ClinicalTrials.gov, NCT04161625 (Retrospectively registered), https://clinicaltrials.gov/ct2/show/NCT04161625.
Collapse
Affiliation(s)
- Saranda Bajraktari
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Magnus Zingmark
- Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Beatrice Pettersson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Erik Rosendahl
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Lillemor Lundin-Olsson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| |
Collapse
|
4
|
Olmos-Ochoa TT, Miake-Lye IM, Glenn BA, Chuang E, Duru OK, Ganz DA, Bastani R. Sustaining Successful Clinical-community Partnerships in Medically Underserved Urban Areas: A Qualitative Case Study. J Community Health Nurs 2021; 38:1-12. [PMID: 33682552 DOI: 10.1080/07370016.2021.1869423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Clinical-community partnerships can improve access and receipt of preventive health services in community settings. Understanding how to sustain their potential benefits is warranted. Qualitative case-study of the Faith Community Health Partnership (FCHP), a collaboration between faith-community nurses and community organizations sustained over 25 years. We used content analysis principles to report on partnership sustainability themes identified through semi-structured interviews with FCHP partners (n = 18). Factors supporting partnership sustainability: Maintaining partners' commitment over time; strategic resource-sharing; facilitating engagement; and preserving partnership flexibility. Sustaining clinical-community partnerships is a dynamic and continuous process requiring significant time, effort, and resources on behalf of partners.
Collapse
Affiliation(s)
- Tanya T Olmos-Ochoa
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, North Hills, California, USA
| | - Isomi M Miake-Lye
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, North Hills, California, USA
| | - Beth A Glenn
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA.,UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, Los Angeles, California, USA.,Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California, USA
| | - Emmeline Chuang
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA.,UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, Los Angeles, California, USA
| | - O Kenrik Duru
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - David A Ganz
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, North Hills, California, USA.,Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Roshan Bastani
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA.,UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, Los Angeles, California, USA
| |
Collapse
|
5
|
Vanhelst J, Deken V, Boulic G, Raffin S, Duhamel A, Romon M. Trends in prevalence of childhood overweight and obesity in a community-based programme: The VIF Programme. Pediatr Obes 2021; 16:e12761. [PMID: 33333630 DOI: 10.1111/ijpo.12761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/10/2020] [Accepted: 11/25/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Obesity in children is considered the main childhood health problem. OBJECTIVE To assess the impact of 7-year community-based interventions on the trend prevalence of overweight and obesity in French preschool children and primary school children between 2008 and 2015. METHODS Two cross-sectional studies were performed in the last grade of every pre-school and primary schools of 6 cities in 2008 and 2015. In 2008 and 2015, 3387 children and 3415 children (aged 5 and 11 years old) participated in the 2 surveys. Interventions consisted to promote physical activity, healthy diet, sleep habits and well-being. Prevalence of overweight and obesity were defined according to age- and sex-specific BMI cut-off points. Priority education area of the schools was also recorded. RESULTS Prevalence of overweight and obesity decreased significantly between 2008 and 2015 in children from pre-schools (18.1% vs 13.0%) and primary schools (20.9% vs 16.9%) (P < 0.05). No effects of priority education area and sex were found related to the decrease of prevalence in overweight and obesity. CONCLUSIONS Our results show that over 7 years period, the community-based intervention has a positive impact on the overweight and obesity prevalence in childhood. These results are promising and encouraging in addressing obesity and related issues in French young boys and girls.
Collapse
Affiliation(s)
- Jérémy Vanhelst
- Univ. Lille, Inserm, CHU Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
| | - Valérie Deken
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Evaluation des technologies de santé et des pratiques médicales, Lille, France
| | | | | | - Alain Duhamel
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Evaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Monique Romon
- Professeur émérite, Univ. Lille, CHU Lille, ULR 2694-METRICS: Evaluation des technologies de santé et des pratiques médicales, Lille, France
| |
Collapse
|
6
|
Cohen DJ, Sweeney SM, Miller WL, Hall JD, Miech EJ, Springer RJ, Balasubramanian BA, Damschroder L, Marino M. Improving Smoking and Blood Pressure Outcomes: The Interplay Between Operational Changes and Local Context. Ann Fam Med 2021; 19:240-248. [PMID: 34180844 PMCID: PMC8118489 DOI: 10.1370/afm.2668] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 01/25/2023] Open
Abstract
PURPOSE We undertook a study to identify conditions and operational changes linked to improvements in smoking and blood pressure (BP) outcomes in primary care. METHODS We purposively sampled and interviewed practice staff (eg, office managers, clinicians) from a subset of 104 practices participating in EvidenceNOW-a multisite cardiovascular disease prevention initiative. We calculated Clinical Quality Measure improvements, with targets of 10-point or greater absolute improvements in the proportion of patients with smoking screening and, if relevant, counseling and in the proportion of hypertensive patients with adequately controlled BP. We analyzed interview data to identify operational changes, transforming these into numeric data. We used Configurational Comparative Methods to assess the joint effects of multiple factors on outcomes. RESULTS In clinician-owned practices, implementing a workflow to routinely screen, counsel, and connect patients to smoking cessation resources, or implementing a documentation change or a referral to a resource alone led to an improvement of at least 10 points in the smoking outcome with a moderate level of facilitation support. These patterns did not manifest in health- or hospital system-owned practices or in Federally Qualified Health Centers, however. The BP outcome improved by at least 10 points among solo practices after medical assistants were trained to take an accurate BP. Among larger, clinician-owned practices, BP outcomes improved when practices implemented a second BP measurement when the first was elevated, and when staff learned where to document this information in the electronic health record. With 50 hours or more of facilitation, BP outcomes improved among larger and health- and hospital system-owned practices that implemented these operational changes. CONCLUSIONS There was no magic bullet for improving smoking or BP outcomes. Multiple combinations of operational changes led to improvements, but only in specific contexts of practice size and ownership, or dose of external facilitation.
Collapse
Affiliation(s)
- Deborah J Cohen
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Shannon M Sweeney
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | | | - Jennifer D Hall
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Edward J Miech
- Regenstrief Institute, Center for Health Services Research, Indianapolis, Indiana
| | - Rachel J Springer
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Bijal A Balasubramanian
- Department of Epidemiology, Human Genetics, and Environmental Science, UTHealth School of Public Health, Dallas, Texas
| | - Laura Damschroder
- Implementation Pathways, LLC and VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| |
Collapse
|
7
|
Heerschop SN, Biesbroek S, Temme EHM, Ocké MC. Can Healthy and Sustainable Dietary Patterns That Fit within Current Dutch Food Habits Be Identified? Nutrients 2021; 13:nu13041176. [PMID: 33918283 PMCID: PMC8066075 DOI: 10.3390/nu13041176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/18/2022] Open
Abstract
This study investigated major healthy and sustainable dietary patterns in the Dutch population. Two 24-hour dietary recalls were collected in 2078 participants aged 19–79 years in the Dutch National Food Consumption Survey 2012–2016. Dietary patterns were identified using reduced rank regression. Predictor variables were food groups and response variables were Dutch Healthy Diet index 2015 (DHD15-index) score, greenhouse gas emissions (GHGE), and blue water use. Three patterns were discovered, including a “high fruit and vegetable dietary pattern”, a “low meat dietary pattern”, and a “high dairy, low fruit juices dietary pattern”. Diets in the highest quartile of these patterns had higher DHD15-index score than the average population. However, diets of the “high fruit and vegetable dietary pattern” were associated with higher dietary GHGE (14%) and blue water use (69.2%) compared to the average population. Diets of the “low meat dietary pattern” were associated with lower GHGE (19.6%) and higher blue water use (7.7%). Concluding, the “low meat dietary pattern” was the most healthy and sustainable dietary pattern in this population. The addition of blue water use as an environmental impact indicator shows the difficulty of finding existing dietary patterns that have low environmental impact in all determinants.
Collapse
Affiliation(s)
- Samantha N. Heerschop
- Division of Human Nutrition and Health, Wageningen University, P.O. Box 17, 6700 AA Wageningen, The Netherlands; (S.N.H.); (S.B.); (E.H.M.T.)
| | - Sander Biesbroek
- Division of Human Nutrition and Health, Wageningen University, P.O. Box 17, 6700 AA Wageningen, The Netherlands; (S.N.H.); (S.B.); (E.H.M.T.)
| | - Elisabeth H. M. Temme
- Division of Human Nutrition and Health, Wageningen University, P.O. Box 17, 6700 AA Wageningen, The Netherlands; (S.N.H.); (S.B.); (E.H.M.T.)
- National Institute for Public Health and the Environment (RIVM), Postbox 1, Bilthoven, 3720 BA Utrecht, The Netherlands
| | - Marga C. Ocké
- Division of Human Nutrition and Health, Wageningen University, P.O. Box 17, 6700 AA Wageningen, The Netherlands; (S.N.H.); (S.B.); (E.H.M.T.)
- National Institute for Public Health and the Environment (RIVM), Postbox 1, Bilthoven, 3720 BA Utrecht, The Netherlands
- Correspondence: ; Tel.: +31-(0)317-48-0363
| |
Collapse
|
8
|
Sanchez JI, Briant KJ, Wu-Georges S, Gonzalez V, Galvan A, Cole S, Thompson B. Eat Healthy, Be Active Community Workshops implemented with rural Hispanic women. BMC WOMENS HEALTH 2021; 21:24. [PMID: 33435981 PMCID: PMC7805196 DOI: 10.1186/s12905-020-01157-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/20/2020] [Indexed: 12/11/2022]
Abstract
Background In the U.S., obesity disproportionately affects some racial/ethnic groups more than others; 42.5% of Hispanic adults are obese, compared to 32.6% of non-Hispanic whites (NHW). Research also shows that Mexican American women are 40% more likely to be overweight, as compared to NHW women. With high obesity rates among Hispanics, improving healthier lifestyle practices is an important step for reducing health disparities. The Eat Healthy, Be Active (EHBA) community workshops were developed to assist individuals in translating national nutrition and physical activity recommendations into action. Promotora-led EHBA workshops could be used to promote obesity-related health behavior lifestyle changes among Hispanics. Methods Hispanic women from rural communities in Washington state were recruited to participate in a six-week Promotora-led workshop series. This pilot study used a pre- and post-test study design to examine differences in healthy lifestyle knowledge and practices. Results A total of 49 Hispanic women participated in the workshops, of whom 45% were obese. Six-weeks after implementation of EHBA, women had improvements in healthy lifestyle practices, including an increase in nutrition label literacy, decrease in consumption of food eaten in restaurants, and an increase in the number of times a woman performed physical activity long enough to make them sweat. Conclusion The findings from this pilot study indicate that delivering EHBA workshops through promotoras is a feasible culturally relevant approach to promoting healthier lifestyle practices among Hispanic women. Further, focusing on females, who do the food shopping and preparation in their homes, may help increase awareness among whole families.
Collapse
Affiliation(s)
- Janeth I Sanchez
- Department of Health Services, University of Washington School of Public Health, Box 357230, Seattle, WA, 98195, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M3-B232, Seattle, WA, 98166, USA
| | - Katherine J Briant
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M3-B232, Seattle, WA, 98166, USA
| | - Samantha Wu-Georges
- Fred Hutchinson Cancer Research Center - Center for Community Health Promotion, 320 N. 16th Street, Sunnyside, WA, 98944, USA
| | - Virginia Gonzalez
- Fred Hutchinson Cancer Research Center - Center for Community Health Promotion, 320 N. 16th Street, Sunnyside, WA, 98944, USA
| | - Avigail Galvan
- Fred Hutchinson Cancer Research Center - Center for Community Health Promotion, 320 N. 16th Street, Sunnyside, WA, 98944, USA
| | - Sara Cole
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M3-B232, Seattle, WA, 98166, USA.
| | - Beti Thompson
- Department of Health Services, University of Washington School of Public Health, Box 357230, Seattle, WA, 98195, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M3-B232, Seattle, WA, 98166, USA
| |
Collapse
|
9
|
Carr CL, McLeigh J, Roman H, Fults JB, Gonzalez JR, Sanders C, Clutter MO, Tsai R, Jetelina KK. Healthcare Utilization Patterns Among Children With a History of Child Protective Services Investigations. VIOLENCE AND VICTIMS 2020; 35:906-919. [PMID: 33372116 DOI: 10.1891/vv-d-19-00122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Examine whether children with a prior child protective services (CPS) investigation had different healthcare utilization compared to children without a history of CPS investigations. METHODS The Children's Health Assessment and Planning Survey assessed 6,492 primary caregivers of children ages 0-17 years residing in North Texas in 2015. Caregivers reported prior CPS investigations and child healthcare utilization (emergency department [ED] use, unmet medication needs, and unmet medical care needs). PRINCIPLE FINDINGS A total of 408 (5%) caregivers reported their child had a CPS investigation. Children with CPS investigations had greater odds of visiting the ED (OR = 1.9; 95% CI: 1.4, 2.5) and not receiving necessary medical care (OR = 1.9; 95% CI: 1.4, 2.8) compared to children without a CPS investigation. CONCLUSIONS Prior CPS investigation was associated with disparities in receipt of necessary medical care and ED utilization for children.
Collapse
Affiliation(s)
- Christian L Carr
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston, School of Public Health, Dallas, Texas, USA
| | - Jill McLeigh
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | - Corron Sanders
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston, School of Public Health, Dallas, Texas, USA
| | | | - Ray Tsai
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston, School of Public Health, Dallas, Texas, USA
| | | |
Collapse
|
10
|
Persai D, Karan A, Panda R. Incremental Benefits of Multiple Tobacco Control Interventions: A Factorial Randomized Control Trial. Asian Pac J Cancer Prev 2020; 21:1905-1911. [PMID: 32711414 PMCID: PMC7573427 DOI: 10.31557/apjcp.2020.21.7.1905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Indexed: 11/29/2022] Open
Abstract
Tobacco control requires a comprehensive approach. The present study aims to examine the incremental effectiveness of health systems intervention when combined with other interventions in enhancing knowledge and practices of physicians in tobacco cessation.
Collapse
Affiliation(s)
- Divya Persai
- Indian Institute of Public Health, Public Health Foundation of India, Delhi NCR, India
| | - Anup Karan
- Indian Institute of Public Health, Public Health Foundation of India, Delhi NCR, India
| | - Rajmohan Panda
- Indian Institute of Public Health, Public Health Foundation of India, Delhi NCR, India
| |
Collapse
|
11
|
Ramanadhan S, Daly J, Lee RM, Kruse GR, Deutsch C. Network-Based Delivery and Sustainment of Evidence-Based Prevention in Community-Clinical Partnerships Addressing Health Equity: A Qualitative Exploration. Front Public Health 2020; 8:213. [PMID: 32671008 PMCID: PMC7332771 DOI: 10.3389/fpubh.2020.00213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/08/2020] [Indexed: 01/07/2023] Open
Abstract
Background: Increased delivery of evidence-based preventive services can improve population health and increase health equity. Community-clinical partnerships offer particular promise, but delivery and sustainment of preventive services through these systems face several challenges related to service integration and collaboration. We used a social network analysis perspective to explore (a) the range of contributions made by community-clinical partnership network members to support the delivery of evidence-based preventive services and (b) important influences on the ability of these partnerships to sustain service delivery. Methods: Data come from an implementation evaluation of the Prevention and Wellness Trust Fund initiative, which supported nine Massachusetts communities to coordinate delivery of evidence-based prevention and address inequities in hypertension, pediatric asthma, falls among older adults, or tobacco use. In 2016, we conducted semi-structured interviews with (a) leadership teams representing nine community-level partnerships and (b) practitioners from four high-implementation partnerships (n = 23). We managed data using NVivo11 and utilized a framework analysis approach. Results: Key network contributions for delivery of evidence-based preventive services included creating referrals, delivering services, providing links to community members, and administration and leadership. Less emphasized contributions included wraparound services, technical assistance, and venue provision. Implementers from high-implementation partnerships also highlighted contributions such as program adaptation, creating buy-in, and sharing information to improve service delivery. Expected drivers of program sustainability included the ability to develop a business case, ongoing network facilitation, technology support, continued integrated action, and sufficient staffing to maintain programming. Conclusion: The study highlights the need to take a long-term, infrastructure-focused approach when designing community-clinical partnerships. Strategic partnership composition, including identifying sources of necessary network contributions, in conjunction with efforts from the outset to link systems, align effort, and build a long-term funding structure can support the required coordinated action around preventive services needed to improve health equity.
Collapse
Affiliation(s)
- Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - James Daly
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Rebekka M. Lee
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Gina R. Kruse
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Charles Deutsch
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| |
Collapse
|
12
|
Katz IR, Dent KR, Morley SW, Hein TC, Hoff RA, McCarthy JF. Can "deaths of despair" serve as a focus for planning and evaluating clinical and preventive services for Veterans? Psychiatry Res 2020; 285:112841. [PMID: 32050146 DOI: 10.1016/j.psychres.2020.112841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/30/2020] [Accepted: 02/02/2020] [Indexed: 10/25/2022]
Abstract
Deaths of despair, a composite outcome including suicide and drug- and alcohol-related deaths, have been increasing, especially in subpopulations and geographic areas sensitive to economic and social hardships. The Veterans Health Administration (VHA) has begun evaluating the utility of this concept to guide planning and evaluations of clinical and preventive services for Veterans. In this study, mortality rates for middle-aged American men for 2013 to 2017 were from CDC WONDER, and rates for all Veterans, those using VHA healthcare services (VHA-utilizers), and other (non-VHA) Veterans were derived from National Death Index data. Findings demonstrated that rates for the composite were higher in VHA-utilizers and lower in non-VHA Veterans than middle-aged American men, consistent with use of VHA services by Veterans with the greatest needs. State rates in Veteran men were significantly and positively correlated with state rates for American men, and both were correlated with other characteristics of the social environment. The lack of correlation between rates for suicide and drug-related deaths indicates that deaths of despair cannot be modeled by assuming parallel paths from reactions to community-based stressors to the component outcomes; models should allow for an impact of community characteristics on partitioning between outcomes.
Collapse
Affiliation(s)
- Ira R Katz
- VA Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC 20420, United States.
| | - Kallisse R Dent
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI 48109, United States
| | - Sybil W Morley
- VA Center of Excellence for Suicide Prevention, Canandaigua, NY, 14424, United States
| | - Tyler C Hein
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI 48109, United States
| | - Rani A Hoff
- VA Northeast Program Evaluation Center, West Haven, CT, 06516, United States; Department of Psychiatry, Yale University, New Haven, CT, 06520, United States
| | - John F McCarthy
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI 48109, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI, 48109, United States
| |
Collapse
|
13
|
Serious quit attempts and cessation implications for Asian American male smokers. Addict Behav 2020; 100:106129. [PMID: 31627162 PMCID: PMC7354905 DOI: 10.1016/j.addbeh.2019.106129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/03/2019] [Accepted: 09/10/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Smoking prevalence remains high among Asian American immigrant men, particularly those with limited English proficiency. Understanding ways to promote serious quit attempts (defined as a quit attempt lasting at least 24 h) could be crucial for reducing tobacco-related health disparities in this population. This study examines correlates of serious past year quit attempts among Chinese and Vietnamese American male daily smokers. METHODS Baseline survey data were collected between 2015 and 2017 from a lifestyle intervention trial (N = 340 Chinese and Vietnamese male daily smokers). Data analysis was conducted in 2019. Multivariable logistic regression analysis was used to identify factors associated with serious past year quit attempts. RESULTS Less than half (43.2%) of the study participants had at least one serious past year quit attempt. Significant correlates of serious quit attempts included utilizing evidence-based methods (OR = 12.83, 95% CI 5.17-31.84) or other methods (OR = 3.92, 95% CI 3.92-13.73) to facilitate quitting compared to those who did not attempt to quit. Also, participants who had a physician encounter in the past year were more likely to have had a serious quit attempt (OR = 2.25, 95% CI 1.12-4.53). Discussing smoking during a past year doctor's visit, however, was not a significant correlate of serious quit attempts. CONCLUSIONS Our findings underscore the importance of promoting the use of smoking cessation resources, and potentially utilizing healthcare encounters to facilitate cessation. Investigations are warranted to understand better how patient-physician interactions can enhance smoking cessation.
Collapse
|
14
|
Brandt HM, Vanderpool RC, Curry SJ, Farris P, Daniel-Ulloa J, Seegmiller L, Stradtman LR, Vu T, Taylor V, Zubizarreta M. A multi-site case study of community-clinical linkages for promoting HPV vaccination. Hum Vaccin Immunother 2019; 15:1599-1606. [PMID: 31158042 DOI: 10.1080/21645515.2019.1616501] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Human papillomavirus (HPV) vaccination rates in the U.S. are suboptimal, requiring innovative partnerships between community and clinical entities to remedy this issue. A rigorous evaluation of HPV-related community-clinical linkages (CCLs) was conducted to understand their components, processes, and outcomes to increase HPV vaccination. Cancer Prevention and Control Research Network (CPCRN) investigators explored CCLs in their communities employing an iterative, case study approach. Information describing nine CCLs on HPV vaccination was collected from representatives from the community organization and clinical setting. Thematic content analysis was used to analyze and interpret data. Five CCLs included a federally qualified health center as the clinical partner, and five included a non-profit organization as the community partner. Five reflected clinically focused integration wherein engagement occurs in the community but vaccine delivery and follow-up occur in the clinical setting. The main impetus was the need to improve HPV vaccination and a community's strong interest in preventing cancer. Noted critical components were a designated person to support the CCL and funding. Results will guide HPV vaccination promotion, education, and intervention efforts. CCLs provide an opportunity to study the adaption, integration, and enhancement of evidence-based approaches to increase HPV vaccination.
Collapse
Affiliation(s)
- Heather M Brandt
- a Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health , Columbia , SC , USA
| | - Robin C Vanderpool
- b Department of Health, Behavior and Society, University of Kentucky College of Public Health , Lexington , KY , USA
| | - Susan J Curry
- c Department of Health Management and Policy, University of Iowa , Iowa City , USA
| | - Paige Farris
- d Oregon Health and Science University School of Public Health , Portland , QR , USA
| | - Jason Daniel-Ulloa
- e Department of Community & Behavioral Health, University of Iowa College of Public Health , Iowa City , IA , USA
| | - Laura Seegmiller
- e Department of Community & Behavioral Health, University of Iowa College of Public Health , Iowa City , IA , USA
| | - Lindsay R Stradtman
- b Department of Health, Behavior and Society, University of Kentucky College of Public Health , Lexington , KY , USA
| | - Thuy Vu
- f Department of Health Services, University of Washington School of Public Health , Seattle , WA , USA
| | - Victoria Taylor
- f Department of Health Services, University of Washington School of Public Health , Seattle , WA , USA
| | - Maria Zubizarreta
- a Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health , Columbia , SC , USA
| |
Collapse
|
15
|
Butel J, Braun KL. The Role of Collective Efficacy in Reducing Health Disparities: A Systematic Review. FAMILY & COMMUNITY HEALTH 2019; 42:8-19. [PMID: 30431465 PMCID: PMC7012267 DOI: 10.1097/fch.0000000000000206] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Many improvements in health equity are spearheaded by community collaborations working to change policy and social norms. But how can collective efficacy (CE), defined as the willingness and ability of a group to work toward a common good, be increased? Eight articles reporting on interventions aiming to reduce health disparities by improving CE were found for this systematic literature review. All studies showed improvements in CE and most found reduction in disparities, but operationalization of CE varied. Findings support a model of how CE can address health disparities, which can guide standardization of CE interventions and measures.
Collapse
Affiliation(s)
- Jean Butel
- Office of Public Health Studies, University of Hawaii at Manoa, Honolulu
| | | |
Collapse
|
16
|
Tolma EL, Stoner JA, Thomas C, Engelman K, Li J, Dichkov A, Neely N. Conducting a formative evaluation of an intervention promoting mammography screening in an American Indian community: The Native Women's Health Project. AMERICAN JOURNAL OF HEALTH EDUCATION 2018; 50:52-65. [PMID: 31289604 PMCID: PMC6615737 DOI: 10.1080/19325037.2018.1552216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Breast cancer is an important public health issue among American Indian/Alaska Native (AI/AN) women. However, there are very few published studies describing the evaluation of breast health promotion programs among AI/AN women. PURPOSE To describe the formative evaluation of a multi-component intervention to promote mammography screening in an AI community in rural Oklahoma. METHODS A comprehensive process evaluation plan with emphasis on context, reach, dose received, dose delivered, and fidelity was developed. Data collection included mixed research methodology and impact was assessed via one group pre/post research design. Data analysis consisted of descriptive statistical analysis and content analysis. The study utilized a community-based participatory research (CBPR) approach. RESULTS Process evaluation revealed a relatively high reach within the priority population for both components (clinic and community) and a moderate implementation. Focus group research showed that participants were overall satisfied with program implementation. The intervention was feasible to implement in real-world settings. TRANSLATION TO HEALTH EDUCATION PRACTICE Community-based evaluation of breast health promotion programs among AI communities is challenging, as one has to balance methodological rigor with practical constraints. The use of an evaluation plan, mixed methods and a collaborative approach are useful tools in conducting the evaluation.
Collapse
Affiliation(s)
- Eleni L Tolma
- Department of Social and Behavioral Sciences, Faculty of Public Health, Kuwait University Health Sciences Center, P.O. Box 24923, Safat, 13110 Kuwait
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th Street, CHB 309, Oklahoma City, OK 73126, x 49480
| | - Cara Thomas
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73126
| | - Kimberly Engelman
- Preventive Medicine and Public Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66160
| | - Ji Li
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th Street, CHB 203, Oklahoma City, OK 73104, x 30126
| | - Aleksandar Dichkov
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73126
| | - Norma Neely
- American Indian Institute, University of Oklahoma, 1639 Cross Center Drive, Norman, OK 73019
| |
Collapse
|
17
|
Leppin AL, Okamoto JM, Organick PW, Thota AD, Barrera-Flores FJ, Wieland ML, McCoy RG, Bonacci RP, Montori VM. Applying Social Network Analysis to Evaluate Implementation of a Multisector Population Health Collaborative That Uses a Bridging Hub Organization. Front Public Health 2018; 6:315. [PMID: 30450355 PMCID: PMC6224340 DOI: 10.3389/fpubh.2018.00315] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/15/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Multisector collaboratives are increasingly popular strategies for improving population health. To be comprehensive, collaboratives must coordinate the activities of many organizations across a geographic region. Many policy-relevant models encourage creation and use of centralized hub organizations to do this work, yet there is little guidance on how to evaluate implementation of such hubs and track their network reach. We sought to demonstrate how social network analysis (SNA) could be used for this purpose. Methods: Through formative research, we defined and conceptualized key characteristics of a bridging hub network and identified a set of candidate measures—(1) network membership, (2) network interaction, (3) role and reach of the bridging hub, and (4) network collaboration—to evaluate its implementation within a pre-determined geographic region of Southeast Minnesota, USA. We then developed and administered a survey to assess outcomes as part of a SNA. We commented on the feasibility and usefulness of the methods. Results: The initial surveyed network consisted of 50 healthcare organizational sites and 50 community organizations representing sectors of public health, education, research, health promotion, social services, and long-term care and supports. Fifty-three of these organizations responded to the survey. The network's level of collaboration was “Cooperation” (level 2 of 5) and reported levels of collaboration varied by organization. Thirty-eight additional, unsurveyed organizations were identified as collaborators by respondents, pushing the theoretical network denominator up to 138 organizations. These additional organizations included grocery stores, ambulance services, and smaller, independent healthcare and community-based services focused on meeting the needs of underserved populations. The bridging hub organization had the highest betweenness centrality and was in good position to bridge healthcare and the community, although its organizational reach was estimated at only 51%. The SNA methods were feasible and useful for identifying opportunities and guiding implementation. Conclusions: Bridging hub organizations are not likely to link—or even be aware of—all relevant organizations in a geographic region at initial implementation. SNA may be a useful method for evaluating the value and reach of a bridging hub organization and guiding ongoing implementation efforts. Trial registration: http://ClinicalTrials.gov; #NCT03046498
Collapse
Affiliation(s)
- Aaron L Leppin
- Knowledge and Evaluation Research Unit, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, United States
| | - Janet M Okamoto
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ, United States
| | - Paige W Organick
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States
| | - Anjali D Thota
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States
| | | | - Mark L Wieland
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Rozalina G McCoy
- Division of Primary Care Internal Medicine, Division of Health Care Policy and Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Robert P Bonacci
- Department of Family and Community Medicine, Mayo Clinic, Rochester, MN, United States
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
18
|
Nápoles AM, Stewart AL. Transcreation: an implementation science framework for community-engaged behavioral interventions to reduce health disparities. BMC Health Serv Res 2018; 18:710. [PMID: 30208873 PMCID: PMC6134771 DOI: 10.1186/s12913-018-3521-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/04/2018] [Indexed: 12/22/2022] Open
Abstract
Background Methods for translating evidence-based behavioral interventions into real-world settings seldom account for the special issues in reaching health disparity populations. Main text The objective of this article is to describe an innovative “transcreational” framework for designing and delivering interventions in communities to reduce health disparities. We define transcreation as the process of planning, delivering, and evaluating interventions so that they resonate with the community experiencing health disparities, while achieving intended health outcomes. The Transcreation Framework for Community-engaged Behavioral Interventions to Reduce Health Disparities comprises seven steps: 1) identify community infrastructure and engage partners; 2) specify theory; 3) identify multiple inputs for new program; 4) design intervention prototype; 5) design study, methods, and measures for community setting; 6) build community capacity for delivery; and 7) deliver transcreated intervention and evaluate implementation processes. Communities are engaged from the start and interventions are delivered by community-based interventionists and tested in community settings. The framework applies rigorous scientific methods for evaluating program effectiveness and implementation processes. It incorporates training and ongoing technical assistance to assure treatment fidelity and build community capacity. Conclusions This framework expands the types of scientific evidence used and balances fidelity to evidence and fit to the community setting. It can guide researchers and communities in developing and testing behavioral interventions to reduce health disparities that are likely to be sustained because infrastructure development is embedded in the research.
Collapse
Affiliation(s)
- Anna María Nápoles
- National Institute on Minority Health and Health Disparities, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD, 20892, USA.
| | - Anita L Stewart
- University of California San Francisco, 3333 California Street, Suite 350E, San Francisco, CA, 94118, USA
| |
Collapse
|
19
|
Andress L, Scalise D, Wright JG, Moore SE. Fitting a square peg into a round hole: Perceptions of Appalachian physicians on the incorporation of chronic disease prevention into their practice. Prev Med Rep 2018; 11:216-220. [PMID: 30003017 PMCID: PMC6041460 DOI: 10.1016/j.pmedr.2018.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/29/2018] [Accepted: 06/01/2018] [Indexed: 12/14/2022] Open
Abstract
This study used a focus group in August 2017 (n = 9) to explore the perceptions of rural physicians to a state request to incorporate diabetes prevention screening into their West Virginia medical practice. Analysis of the data revealed that the participants did not think private physicians were equipped to incorporate diabetes prevention programming into their practice. Three categories emerged from the data analysis to explain the reasoning of the health practitioners on the incorporation of pre-diabetes screening and management into their practice.The practice of medicine Prevention is a mismatch Social determinants of health
In the end, the study revealed that a request for physicians to identify and refer at risk patients to a diabetes prevention program is problematic due to conceptual and structural issues. Based on the findings it does not appear at this time that private physicians in rural settings can incorporate diabetes prevention into their existing practice. To address conceptual and structural barriers the invitation to rural physicians must: 1) present evidence on how physicians may be effective in a diabetes management team; 2) include a model that demonstrates a limited, specific role and duties for the physician within a team setting; and last, 3) integrate physicians into an existing community-based network of social and human service providers set up to provide diabetes prevention services.
Collapse
Affiliation(s)
- Lauri Andress
- Department of Health Policy, Management & Leadership, West Virginia University Robert C. Byrd Health Sciences Center, School of Public Health, United States
| | - Danny Scalise
- West Virginia Medical State Association, 4307 MacCorkle Avenue, Chaleston, WV 25304, United States
| | - Jessica G Wright
- Division of Health Promotion and Chronic Disease, WV Bureau for Public Health, 350 Capitol Street Room 514, Charleston, WV 25301, United States
| | - Stephanie E Moore
- Division of Health Promotion and Chronic Disease, WV Bureau for Public Health, 350 Capitol Street Room 514, Charleston, WV 25301, United States
| |
Collapse
|
20
|
Primary care provider approaches to preventive health delivery: a qualitative study. Prim Health Care Res Dev 2018; 19:464-474. [PMID: 29307319 DOI: 10.1017/s1463423617000858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AimThe objective of this study was to seek decision-making insights on the provider level to gain understanding of the values that shape how providers deliver preventive health in the primary care setting. BACKGROUND The primary care clinic is a core site for preventive health delivery. While many studies have identified barriers to preventive health, less is known regarding how primary care providers (PCPs) make preventive health decisions such as what services to provide, under what circumstances, and why they might choose one over another. METHODS Qualitative methods were chosen to deeply explore these issues. We conducted semi-structured, one-on-one interviews with 21 PCPs at clinics affiliated with an academic medical center. Interviews with providers were recorded and transcribed. We conducted a qualitative analysis to identify themes and develop a theoretical framework using Grounded Theory methods.FindingsThe following themes were revealed: longitudinal care with an established PCP-patient relationship is perceived as integral to preventive health; conflict and doubt accompany non-preventive visits; PCPs defer preventive health for pragmatic reasons; when preventive health is addressed, providers use multiple contextual factors to decide which interventions are discussed; and PCPs desired team-based preventive health delivery, but wish to maintain their role when shared decision-making is required. We present a conceptual framework called Pragmatic Deferral.
Collapse
|
21
|
Schopp LH, Clark MJ, Lamberson WR, Uhr DJ, Minor MA. A randomized controlled trial to evaluate outcomes of a workplace self-management intervention and an intensive monitoring intervention. HEALTH EDUCATION RESEARCH 2017; 32:219-232. [PMID: 28486643 DOI: 10.1093/her/cyx042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 04/21/2017] [Indexed: 06/07/2023]
Abstract
The purpose of this study was to determine and compare outcomes of two voluntary workplace health management methods: an adapted worksite self-management (WSM) approach and an intensive health monitoring (IM) approach. Research participants were randomly assigned to either the WSM group or the IM group by a computer-generated list (n = 180; 92 WSM and 88 IM). Participants completed baseline, 3 and 12-month follow-up surveys. Individuals receiving workplace WSM and IM improved in self-efficacy and nearly all health behaviors and health status variables after the intervention, compared to before the intervention. Individuals in the WSM group improved in depression symptoms at 3 and 12 months (P < 0.0001, P < 0.0001), and individuals in the IM group did not improve at either time period (P < 0.1488, P < 0.0521). Participants in the WSM group reported more improvement in physical activity and energy, health interfering less with personal life and daily activities and fewer depression symptoms at follow up, compared to participants in the IM group. This study provided additional support for worksite-based health promotion programs to promote healthy lifestyles and improve health status, and documented effectiveness of both methods, with superior performance and greater scalability for the WSM program.
Collapse
Affiliation(s)
- Laura H Schopp
- Department of Health Psychology, University of Missouri, Columbia, MO 65211, USA
| | - Mary J Clark
- Department of Health Psychology, University of Missouri, Columbia, MO 65211, USA
| | | | - David J Uhr
- School of Public Health, University of Missouri, Columbia, MO 65211, USA
- Present address: University of Minnesota, Office of Measurement Services, USA
| | - Marian A Minor
- School of Public Health, University of Missouri, Columbia, MO 65211, USA
| |
Collapse
|
22
|
Rahman R, Pinto RM, Wall MM. HIV Education and Welfare Services in Primary Care: An Empirical Model of Integration in Brazil's Unified Health System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030294. [PMID: 28335444 PMCID: PMC5369130 DOI: 10.3390/ijerph14030294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/06/2017] [Accepted: 03/08/2017] [Indexed: 11/16/2022]
Abstract
Integration of health education and welfare services in primary care systems is a key strategy to solve the multiple determinants of chronic diseases, such as Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS). However, there is a scarcity of conceptual models from which to build integration strategies. We provide a model based on cross-sectional data from 168 Community Health Agents, 62 nurses, and 32 physicians in two municipalities in Brazil’s Unified Health System (UHS). The outcome, service integration, comprised HIV education, community activities (e.g., health walks and workshops), and documentation services (e.g., obtainment of working papers and birth certificates). Predictors included individual factors (provider confidence, knowledge/skills, perseverance, efficacy); job characteristics (interprofessional collaboration, work-autonomy, decision-making autonomy, skill variety); and organizational factors (work conditions and work resources). Structural equation modeling was used to identify factors associated with service integration. Knowledge and skills, skill variety, confidence, and perseverance predicted greater integration of HIV education alongside community activities and documentation services. Job characteristics and organizational factors did not predict integration. Our study offers an explanatory model that can be adapted to examine other variables that may influence integration of different services in global primary healthcare systems. Findings suggest that practitioner trainings to improve integration should focus on cognitive constructs—confidence, perseverance, knowledge, and skills.
Collapse
Affiliation(s)
- Rahbel Rahman
- Department of Social Work, Community of College and Public Affairs, Binghamton University, 67 Washington St, Binghamton, NY 13902, USA.
| | - Rogério M Pinto
- School of Social Work, University of Michigan, 1080 S University Ave, Ann Arbor, MI 48109, USA.
| | - Melanie M Wall
- Department of Biostatistics, Columbia University, 722 West 168th St. New York, NY 10032, USA.
| |
Collapse
|
23
|
Harden SM, Ramalingam NS, Wilson KE, Evans-Hoeker E. Informing the development and uptake of a weight management intervention for preconception: a mixed-methods investigation of patient and provider perceptions. BMC OBESITY 2017; 4:8. [PMID: 28191322 PMCID: PMC5295190 DOI: 10.1186/s40608-017-0144-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/27/2017] [Indexed: 11/19/2022]
Abstract
Background It is recommended for women to have a healthy body mass index before conception. However, there is limited research on appropriate preconception interventions for weight loss. Furthermore, there is a lack of knowledge on providers’ willingness to refer to particular behavioral interventions and the degree to which patients would attend those interventions. Methods A cross-section of 67 patients and 21 providers completed surveys related to their demographics and willingness to refer/attend a number of interventions for weight loss. A case study of three patients from the target audience was used to elicit detailed feedback on preconception weight status and weight loss intervention. Results Overall, patients were willing to attend a variety of interventions, regardless of BMI category. Focus group participants shared that weight loss prior to conception would be beneficial for them and their child, but cited barriers such as time, location, and the way providers encourage weight loss. Providers were willing to refer to a number of behavioral interventions, and were less willing to prescribe weight loss medications than other intervention options. Conclusions A number of intervention strategies may be well received by both patients and providers in preconception care to assist with weight loss prior to conception. Future research is needed on intervention effects and sustainability. Electronic supplementary material The online version of this article (doi:10.1186/s40608-017-0144-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Samantha M Harden
- Department of Human Nutrition, Virginia Tech Foods, and Exercise, 1981 Kraft Dr, Blacksburg, VA USA.,Department of OBGYN, Virginia Tech Carilion School of Medicine, 1231 S. Jefferson St, Roanoke, VA 24013 USA
| | - NithyaPriya S Ramalingam
- Virginia Tech Translational Biology, Medicine, and Health Program, 1981 Kraft Dr, Blacksburg, VA USA
| | - Kathryn E Wilson
- Department of Human Nutrition, Virginia Tech Foods, and Exercise, 1981 Kraft Dr, Blacksburg, VA USA
| | - Emily Evans-Hoeker
- Department of OBGYN, Virginia Tech Carilion School of Medicine, 1231 S. Jefferson St, Roanoke, VA 24013 USA
| |
Collapse
|
24
|
Edshteyn I, Uduhiri KA, Morgan TO, Rhodes KL, Sherin KM. Practice Policy Statement: Integrating Effective Weight Management Into Practice. Am J Prev Med 2016; 51:542-8. [PMID: 27374207 DOI: 10.1016/j.amepre.2016.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/29/2016] [Accepted: 05/13/2016] [Indexed: 01/28/2023]
Abstract
The American College of Preventive Medicine Prevention Practice Committee contributes to policy guidelines and recommendations on preventive health topics for clinicians and public health decision makers. As an update to a previously published statement on weight management counseling of overweight adults, the College is providing a consensus-based recommendation designed to more effectively integrate weight management strategies into clinical practice and to incorporate referrals to effective evidence-based community and commercial weight management programs. The goal is to empower providers to include lifestyle interventions as part of the foundation of clinical practice.
Collapse
Affiliation(s)
- Ingrid Edshteyn
- Yale-Griffin Prevention Research Center, Derby, Connecticut.
| | | | - Toyosi O Morgan
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Katrina L Rhodes
- American Association of Public Health Physicians, Green Cove Springs, Florida
| | - Kevin M Sherin
- Department of Family Medicine, Florida State University College of Medicine, Tallahassee, Florida; University of Central Florida College of Medicine, Orlando, Florida; Florida Department of Health in Orange County, Orlando, Florida
| | | |
Collapse
|
25
|
Cohen DJ, Balasubramanian BA, Gordon L, Marino M, Ono S, Solberg LI, Crabtree BF, Stange KC, Davis M, Miller WL, Damschroder LJ, McConnell KJ, Creswell J. A national evaluation of a dissemination and implementation initiative to enhance primary care practice capacity and improve cardiovascular disease care: the ESCALATES study protocol. Implement Sci 2016; 11:86. [PMID: 27358078 PMCID: PMC4928346 DOI: 10.1186/s13012-016-0449-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/08/2016] [Indexed: 12/15/2022] Open
Abstract
Background The Agency for Healthcare Research and Quality (AHRQ) launched the EvidenceNOW Initiative to rapidly disseminate and implement evidence-based cardiovascular disease (CVD) preventive care in smaller primary care practices. AHRQ funded eight grantees (seven regional Cooperatives and one independent national evaluation) to participate in EvidenceNOW. The national evaluation examines quality improvement efforts and outcomes for more than 1500 small primary care practices (restricted to those with fewer than ten physicians per clinic). Examples of external support include practice facilitation, expert consultation, performance feedback, and educational materials and activities. This paper describes the study protocol for the EvidenceNOW national evaluation, which is called Evaluating System Change to Advance Learning and Take Evidence to Scale (ESCALATES). Methods This prospective observational study will examine the portfolio of EvidenceNOW Cooperatives using both qualitative and quantitative data. Qualitative data include: online implementation diaries, observation and interviews at Cooperatives and practices, and systematic assessment of context from the perspective of Cooperative team members. Quantitative data include: practice-level performance on clinical quality measures (aspirin prescribing, blood pressure and cholesterol control, and smoking cessation; ABCS) collected by Cooperatives from electronic health records (EHRs); practice and practice member surveys to assess practice capacity and other organizational and structural characteristics; and systematic tracking of intervention delivery. Quantitative, qualitative, and mixed methods analyses will be conducted to examine how Cooperatives organize to provide external support to practices, to compare effectiveness of the dissemination and implementation approaches they implement, and to examine how regional variations and other organization and contextual factors influence implementation and effectiveness. Discussion ESCALATES is a national evaluation of an ambitious large-scale dissemination and implementation effort focused on transforming smaller primary care practices. Insights will help to inform the design of national health care practice extension systems aimed at supporting practice transformation efforts in the USA. Clinical Trial Registration NCT02560428 (09/21/15)
Collapse
Affiliation(s)
- Deborah J Cohen
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA. .,Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.
| | - Bijal A Balasubramanian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Dallas Regional Campus, Dallas, TX, USA
| | - Leah Gordon
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Sarah Ono
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.,Department of Veteran Affairs, Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA
| | | | - Benjamin F Crabtree
- Department of Family Medicine and Community Health, Rutgers-Robert Wood, Johnson Medical School, New Brunswick, NJ, USA
| | - Kurt C Stange
- Departments of Family Medicine and Community Health, Epidemiology and Biostatistics, Sociology and the Case Comprehensive Cancer Center, and Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, OH, USA
| | - Melinda Davis
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.,Oregon, Rural Practice-Based Research Network, Portland, OR, USA
| | - William L Miller
- Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Laura J Damschroder
- Center for Clinical Management Research and PROVE QUERI, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - K John McConnell
- Center for Health Systems Effectiveness and Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | - John Creswell
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
26
|
|
27
|
Holden K, Akintobi T, Hopkins J, Belton A, McGregor B, Blanks S, Wrenn G. Community Engaged Leadership to Advance Health Equity and Build Healthier Communities. SOCIAL SCIENCES (BASEL, SWITZERLAND) 2016; 5:2. [PMID: 27713839 PMCID: PMC5048675 DOI: 10.3390/socsci5010002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Health is a human right. Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential and, more pragmatically, that no one should be disadvantaged from achieving this potential. Addressing the multi-faceted health needs of ethnically and culturally diverse individuals in the United States is a complex issue that requires inventive strategies to reduce risk factors and buttress protective factors to promote greater well-being among individuals, families, and communities. With growing diversity concerning various ethnicities and nationalities; and with significant changes in the constellation of multiple of risk factors that can influence health outcomes, it is imperative that we delineate strategic efforts that encourage better access to primary care, focused community-based programs, multi-disciplinary clinical and translational research methodologies, and health policy advocacy initiatives that may improve individuals' longevity and quality of life.
Collapse
Affiliation(s)
- Kisha Holden
- Department of Psychiatry & Behavioral Science, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
- Satcher Health Leadership Institute, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
| | - Tabia Akintobi
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
- Prevention Research Center, Morehouse School of Medicine, 720Westview Drive, Atlanta, GA 30310, USA
| | - Jammie Hopkins
- Satcher Health Leadership Institute, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
| | - Allyson Belton
- Satcher Health Leadership Institute, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
| | - Brian McGregor
- Department of Psychiatry & Behavioral Science, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
- Satcher Health Leadership Institute, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
| | - Starla Blanks
- Satcher Health Leadership Institute, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
| | - Glenda Wrenn
- Department of Psychiatry & Behavioral Science, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
- Satcher Health Leadership Institute, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
| |
Collapse
|
28
|
Challenges to an integrated population health research agenda: Targets, scale, tradeoffs and timing. Soc Sci Med 2016; 150:279-85. [PMID: 26794721 DOI: 10.1016/j.socscimed.2015.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 11/22/2022]
|
29
|
Rogers EA, Fine SC, Handley MA, Davis HB, Kass J, Schillinger D. Engaging Minority Youth in Diabetes Prevention Efforts Through a Participatory, Spoken-Word Social Marketing Campaign. Am J Health Promot 2016; 31:336-339. [PMID: 26730553 DOI: 10.4278/ajhp.141215-arb-624] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine the reach, efficacy, and adoption of The Bigger Picture, a type 2 diabetes (T2DM) social marketing campaign that uses spoken-word public service announcements (PSAs) to teach youth about socioenvironmental conditions influencing T2DM risk. DESIGN A nonexperimental pilot dissemination evaluation through high school assemblies and a Web-based platform were used. SETTING The study took place in San Francisco Bay Area high schools during 2013. SUBJECTS In the study, 885 students were sampled from 13 high schools. INTERVENTION A 1-hour assembly provided data, poet performances, video PSAs, and Web-based platform information. A Web-based platform featured the campaign Web site and social media. MEASURES Student surveys preassembly and postassembly (knowledge, attitudes), assembly observations, school demographics, counts of Web-based utilization, and adoption were measured. ANALYSIS Descriptive statistics, McNemar's χ2 test, and mixed modeling accounting for clustering were used to analyze data. RESULTS The campaign included 23 youth poet-created PSAs. It reached >2400 students (93% self-identified non-white) through school assemblies and has garnered >1,000,000 views of Web-based video PSAs. School participants demonstrated increased short-term knowledge of T2DM as preventable, with risk driven by socioenvironmental factors (34% preassembly identified environmental causes as influencing T2DM risk compared to 83% postassembly), and perceived greater personal salience of T2DM risk reduction (p < .001 for all). The campaign has been adopted by regional public health departments. CONCLUSION The Bigger Picture campaign showed its potential for reaching and engaging diverse youth. Campaign messaging is being adopted by stakeholders.
Collapse
Key Words
- Health focus: prevention and health literacy
- Outcome measure: cognitive, descriptive
- Research purpose: program evaluation
- Setting: Web-based platform, school
- Strategy: education
- Study design: nonexperimental
- Target population age: youth
- Target population circumstances: income level, geographic location, race/ethnicity
- Type 2 Diabetes Mellitus, Prevention, Adolescent, Social Marketing, Health Campaigns, Health Literacy, Prevention Research. Manuscript format: research
Collapse
Affiliation(s)
- Elizabeth A Rogers
- 1 Departments of Internal Medicine and Pediatrics, and the Department of Medicine's Applied Clinical Research Program, University of Minnesota, Minneapolis, Minnesota.,2 Departments of Internal Medicine and Pediatrics, University of California, San Francisco, California
| | - Sarah C Fine
- 3 Division of General Internal Medicine and Center for Vulnerable Populations at San Francisco General Hospital, University of California, San Francisco, California
| | - Margaret A Handley
- 4 Department of Epidemiology and Biostatistics and Center for Vulnerable Populations at San Francisco General Hospital, University of California, San Francisco, San Francisco General Hospital and Trauma Center, San Francisco, California
| | | | - James Kass
- 5 Youth Speaks, San Francisco, California
| | - Dean Schillinger
- 3 Division of General Internal Medicine and Center for Vulnerable Populations at San Francisco General Hospital, University of California, San Francisco, California
| |
Collapse
|
30
|
Persai D, Panda R, Gupta A. Examining Implementation of Tobacco Control Policy at the District Level: A Case Study Analysis from a High Burden State in India. Adv Prev Med 2016; 2016:4018023. [PMID: 26933512 PMCID: PMC4735919 DOI: 10.1155/2016/4018023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/08/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction. While extensive scientific evidence exists on the tobacco epidemic, a lack of understanding of both policies and their appropriate way of implementation continues to hinder effective tobacco control. This is especially so in the developing countries such as India. The present study aims to understand current implementation practices and the challenges faced in mainstreaming tobacco control policy and program. Methods. We chose a qualitative study design to conduct the case analysis. A total of 42 in-depth interviews were undertaken with seven district officials in six districts of Andhra Pradesh. A conceptual framework was developed by applying grounded theory for analysis. Analysis was undertaken using case analysis approach. Results and Discussion. Our study revealed that most program managers were unfamiliar with the comprehensive tobacco control policy. Respondents have an ambiguous opinion regarding integration of tobacco control program into existing health and development programs. Respondents perceive lack of resources, low prioritization of tobacco control, and lack of monitoring and evaluation of smoke-free laws as limiting factors affecting implementation of tobacco control policy. Conclusion. The findings of this study highlighted the need for a systematic, organized action plan for effective implementation of tobacco control policy and program.
Collapse
Affiliation(s)
- Divya Persai
- Public Health Foundation of India, New Delhi 110019, India
| | - Rajmohan Panda
- Public Health Foundation of India, New Delhi 110019, India
| | - Adyya Gupta
- School of Public Health and Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, SA 5005, Australia
| |
Collapse
|
31
|
Grossman DC, Elder RW. Aligning the Work of Two U.S. Task Forces on Behavioral Counseling Recommendations. Am J Prev Med 2015; 49:S174-83. [PMID: 26296552 PMCID: PMC4669683 DOI: 10.1016/j.amepre.2015.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/12/2015] [Accepted: 06/04/2015] [Indexed: 12/12/2022]
Abstract
This paper highlights the collaboration and alignment between topics and recommendations related to behavioral counseling interventions from the U.S. Preventive Services Task Force (USPSTF) and Community Preventive Services Task Force (CPSTF). Although the scope and mandates of the USPSTF and CPSTF differ, there are many similarities in the methods and approaches used to select topics and make recommendations to their key stakeholders. Behavioral counseling recommendations represent an important domain for both Task Forces, given the importance of behavior change in promoting healthful lifestyles. This paper explores opportunities for greater alignment between the two Task Forces and compares and contrasts the groups and their current approaches to making recommendations that involve behavioral counseling interventions. Opportunities to enhance behavioral counseling preventive services through closer coordination when developing and disseminating recommendations as well as future collaboration between the USPSTF and CPSTF are discussed.
Collapse
Affiliation(s)
- David C Grossman
- Group Health Cooperative, Group Health Research Institute, Seattle, Washington;.
| | | |
Collapse
|
32
|
Bhuyan SS, Chandak A, Smith P, Carlton EL, Duncan K, Gentry D. Integration of public health and primary care: A systematic review of the current literature in primary care physician mediated childhood obesity interventions. Obes Res Clin Pract 2015; 9:539-52. [PMID: 26259684 DOI: 10.1016/j.orcp.2015.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 07/06/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Childhood obesity, with its growing prevalence, detrimental effects on population health and economic burden, is an important public health issue in the United States and worldwide. There is need for expansion of the role of primary care physicians in obesity interventions. The primary aim of this review is to explore primary care physician (PCP) mediated interventions targeting childhood obesity and assess the roles played by physicians in the interventions. METHODS A systematic review of the literature published between January 2007 and October 2014 was conducted using a combination of keywords like "childhood obesity", "paediatric obesity", "childhood overweight", "paediatric overweight", "primary care physician", "primary care settings", "healthcare teams", and "community resources" from MEDLINE and CINAHL during November 2014. Author name(s), publication year, sample size, patient's age, study and follow-up duration, intervention components, role of PCP, members of the healthcare team, and outcomes were extracted for this review. RESULTS Nine studies were included in the review. PCP-mediated interventions were composed of behavioural, education and technological interventions or a combination of these. Most interventions led to positive changes in Body Mass Index (BMI), healthier lifestyles and increased satisfaction among parents. PCPs participated in screening and diagnosing, making referrals for intervention, providing nutrition counselling, and promoting physical activity. PCPs, Dietitians and nurses were often part of the healthcare team. CONCLUSION PCP-mediated interventions have the potential to effectively curb childhood obesity. However, there is a further need for training of PCPs, and explain new types of interventions such as the use of technology.
Collapse
Affiliation(s)
- Soumitra S Bhuyan
- School of Public Health, The University of Memphis, Memphis, TN, United States.
| | - Aastha Chandak
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Patti Smith
- School of Public Health, The University of Memphis, Memphis, TN, United States
| | - Erik L Carlton
- School of Public Health, The University of Memphis, Memphis, TN, United States
| | - Kenric Duncan
- School of Public Health, The University of Memphis, Memphis, TN, United States
| | - Daniel Gentry
- School of Public Health, The University of Memphis, Memphis, TN, United States
| |
Collapse
|
33
|
Schopp LH, Bike DH, Clark MJ, Minor MA. Act Healthy: promoting health behaviors and self-efficacy in the workplace. HEALTH EDUCATION RESEARCH 2015; 30:542-553. [PMID: 26141203 DOI: 10.1093/her/cyv024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 05/26/2015] [Indexed: 06/04/2023]
Abstract
Chronic health conditions and multiple health risk factors afflict Americans and burden employers, but effective, affordable, workplace-based health promotion interventions have not been widely implemented. This is the first study to adapt the empirically validated Chronic Disease Self-Management Program for a general employee population in a workplace setting with an emphasis on disease prevention and health promotion. A quasi-experimental, wellness standard of care comparison, prospective cohort design was used among employee participants at a large University employer. Ninety-one individuals participated in the program. Participants reported significantly increased health behavior frequency and self-efficacy after the intervention, compared with their pre-intervention scores, and improvements were sustained at 3-month follow-up [self-rated abilities for health practices scale (SRA): F = 30.89, P < 0.001; health promoting lifestyle profile-II (HPLP-II): F = 36.30 P < 0.001]. Individuals in the intervention group reported improved self-efficacy and health behaviors compared with the wellness standard of care comparison group at post intervention (SRA: F = 12.45, P < 0.001; HPLP-II: F = 25.28, P < 0.001). Adapting lay-facilitated self-management for the workplace offers promise as a replicable, scalable, affordable model for culture change in organizations.
Collapse
Affiliation(s)
| | - Denise H Bike
- Department of Educational, School and Counseling Psychology
| | | | - Marian A Minor
- Department of Physical Therapy, University of Missouri, Columbia, MO 65211, USA
| |
Collapse
|
34
|
Chambers EC, Wong BC, Riley RW, Hollingsworth N, Blank AE, Myers C, Bedell J, Selwyn PA. Combining clinical and population-level data to understand the health of neighborhoods. Am J Public Health 2015; 105:510-2. [PMID: 25602860 DOI: 10.2105/ajph.2014.302326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
From February through December 2012, we examined responses to health behavior questions integrated into the electronic medical record of primary care centers in the Bronx, New York in the context of New York City Community Health Survey data. We saw a higher proportion of unhealthy behaviors among patients than among the neighborhood population. Analyzing clinical data in the neighborhood context can better target at-risk populations.
Collapse
Affiliation(s)
- Earle C Chambers
- Earle C. Chambers, Arthur E. Blank, and Peter A. Selwyn are with the Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York. Barbara C. Wong, Christa Myers, and Jane Bedell are with the Bronx District Public Health Office, Bronx, New York. Rachael W. Riley and Nicole Hollingsworth are with the Department of Family and Social Medicine, Montefiore Medical Center, Bronx, New York
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Harden SM, Fanning JT, Motl RW, McAuley E, Estabrooks PA. Determining the reach of a home-based physical activity program for older adults within the context of a randomized controlled trial. HEALTH EDUCATION RESEARCH 2014; 29:861-869. [PMID: 25122617 PMCID: PMC4165990 DOI: 10.1093/her/cyu049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/15/2014] [Indexed: 06/03/2023]
Abstract
UNLABELLED Determining the reach of physical activity (PA) programs is challenging due to inconsistent reporting across studies. The purpose of this study was to document multiple indicators of program reach for a 6-month, Digital Versatile Disc (DVD)-delivered home-based PA program. Radio, newspaper and direct mailing advertisements were tracked to determine costs as well as the number and representativeness of older adults exposed and responding to recruitment. It was estimated that all older adults in the recruitment area (n = 105 515) may have been exposed to at least one of the recruitment strategies--563 responded and 383 were screened as eligible. Of those that enrolled (n = 307), the DVD reached between 81% and 97% of the participants over each month within the 6 month period. Newspaper advertisements were most effective (n = 222) at a cost of $78 per participant enrolled. CONCLUSION Using multiple indicators of reach supports the accurate calculation and generalizability of recruiting older adults into PA programs.
Collapse
Affiliation(s)
- Samantha M Harden
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24060, USA, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61801, USA and Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA 24016, USA
| | - Jason T Fanning
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24060, USA, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61801, USA and Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA 24016, USA
| | - Robert W Motl
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24060, USA, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61801, USA and Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA 24016, USA
| | - Edward McAuley
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24060, USA, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61801, USA and Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA 24016, USA
| | - Paul A Estabrooks
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24060, USA, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61801, USA and Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA 24016, USA Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24060, USA, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61801, USA and Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA 24016, USA
| |
Collapse
|
36
|
Daniels LM, Dixon KE, Campbell LC. Building Capacity for Behavioral Health Services and Clinical Research in a Rural Primary Care Clinic: A Case Study. AIMS Public Health 2014; 1:60-75. [PMID: 29546076 PMCID: PMC5689795 DOI: 10.3934/publichealth.2014.2.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 03/31/2014] [Indexed: 11/24/2022] Open
Abstract
Integrating sustainable, evidence-based, and collaborative depression screening and follow-up treatment into primary care clinics is a significant challenge in health care. In this article a case study approach is used to describe the process of building capacity for a depression screening program in a rural federally qualified health center (FQHC). A conceptual framework addressing the clinical, operational, and financial perspectives of a primary care setting is applied restrospectively to identify 1) the barriers and facilitating factors associated with integrating a depression screening program into standard practice and 2) how the program was leveraged to conduct clinical research to improve self-management in patients with diabetes and elevated depressive symptoms.
Collapse
Affiliation(s)
- Laura M Daniels
- Department of Psychology, East Carolina University, Greenville, NC 27858, USA858
| | - Kim E Dixon
- Psychology Services, Tuscaloosa VA Medical Center, Tuscaloosa, AL 35404, USA
| | - Lisa C Campbell
- Department of Psychology, East Carolina University, Greenville, NC 27858, USA858
| |
Collapse
|
37
|
Schiavo R, Leung MM, Brown M. Communicating risk and promoting disease mitigation measures in epidemics and emerging disease settings. Pathog Glob Health 2014; 108:76-94. [PMID: 24649867 PMCID: PMC4005587 DOI: 10.1179/2047773214y.0000000127] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This review aims to identify and assess evidence on interventions to communicate risk and promote disease mitigation measures in epidemics and emerging disease outbreak settings. The study focuses on data that are relevant to low and middle-income country (LMIC) settings. METHODS We conducted a comprehensive literature search using five major electronic databases (Pubmed Medline, Biomed Central, EMBASE, Science of Citation Index, and Cochrane Library) and other sources to identify relevant studies published from January 2002 to July 2013. The review was guided by the socio-ecological model/perspective of public health and the ideation theory and focused on interventions at the community, healthcare, and multi-sectoral settings, which also reflect key intervention levels of the Ottawa Charter for Health Promotion. Eligible quantitative studies were selected according to specific study criteria and assessed using the Critical Appraisal Skills Program (CASP) framework. Conversely, qualitative studies, reviews, case studies, and editorials were not included. Studies were selected by two independent reviewers. RESULTS Twenty-nine relevant studies from 16 countries were included. Most studies focused on a single intervention or intervention level, rather than multi-sectoral interventions. The majority of the evidence relates to programs aimed at behavioral and social results (or relevant intermediate steps) within a specific population group. Two studies included implications for improvements in health service delivery, two studies examined the intervention's impact on health systems-related outcomes, and three had also implications for environmental health outcomes. Cost- and health equity-related implications for select evidence were also discussed. CONCLUSIONS The paucity of well-designed quantitative evaluations of interventions to communicate health risk and promote disease control measures in LMICs does not allow for any definitive conclusions. Yet, the review identified several promising interventions and areas for future investigation. Among them, community-based and participatory interventions seemed to be central within epidemic and emerging disease settings, particularly in low-resource settings. Yet, evidence on their effectiveness is not conclusive and needs to be explored by future studies. Other promising areas for future investigation include multi-component and multi-sectoral approaches to intervention design. Major research gaps referred to any evaluation of the impact of these kinds of interventions on health policy adoption and/or implementation, and social determinants of health. Research on cost-effectiveness also needs to be strengthened. This review identified several research gaps and questions, and discusses potential future directions for increasing capacity for future and more rigorous assessments.
Collapse
Key Words
- Behavior change communication,
- Communication preparedness,
- Cost,
- Development communication,
- Emerging diseases,
- Epidemics,
- Global health,
- Health communication,
- Health equity,
- Health promotion,
- Health service delivery,
- Health systems,
- Low and middle-income countries (LMICs),
- Outbreak control,
- Public health,
- Risk communication,
- Social change communication,
- Vulnerable and underserved populations
Collapse
Affiliation(s)
| | - May May Leung
- CUNY School of Public Health, New York, NY, USA
- Hunter College, New York, NY, USA
| | | |
Collapse
|
38
|
Breen C, Shakeshaft A, Sanson-Fisher R, D'Este C, Mattick RP, Gilmour S. Identifying individual- and population-level characteristics that influence rates of risky alcohol consumption in regional communities. Aust N Z J Public Health 2014; 38:60-5. [DOI: 10.1111/1753-6405.12176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/01/2013] [Accepted: 11/01/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- Courtney Breen
- National Drug and Alcohol Research Centre, School of Public Health and Community Medicine, University of New South Wales
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, School of Public Health and Community Medicine, University of New South Wales
| | - Rob Sanson-Fisher
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, New South Wales
| | - Catherine D'Este
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, New South Wales
| | - Richard P. Mattick
- National Drug and Alcohol Research Centre, School of Public Health and Community Medicine, University of New South Wales
| | - Stuart Gilmour
- Department of Global Health Policy, University of Tokyo, Japan
| |
Collapse
|
39
|
Mama SK, Soltero EG, Ledoux TA, Gallagher MR, Lee RE. Solving the obesity epidemic: voices from the community. Nurs Inq 2013; 21:192-201. [PMID: 24372868 DOI: 10.1111/nin.12054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2013] [Indexed: 01/03/2023]
Abstract
"Science and Community: Ending Obesity Improving Health" (S&C) aimed to reduce obesity in Houston by developing community partnerships to identify research priorities and develop a sustainable obesity reduction program. Partnership members were recruited from S&C events and invited to participate in in-depth interviews to gain insight into obesity prevalence, causes, and solutions. Members (n = 22) completed a 60-90-min in-depth interview. The interview guide consisted of 30 questions about pressing health problems in the community, potential solutions to health problems and obesity and how the environment has impacted obesity and health behaviors in the community. Interviewees (n = 12 women and 10 men) were mostly Hispanic/Latino (n = 9) and African American (n = 7). Common problems identified were childhood obesity, balancing a healthy diet and physical inactivity. Interviewees identified obesity as a major problem in their communities and cited access to quality food and physical activity resources as both a problem and a solution. Additional emergent themes focused on solutions, including increasing awareness and education, coordinated efforts among organizations and using an ecologic approach to combat obesity. Community insight gleaned from this study may be used to enhance relevance and sustainability of programs developed to reduce obesity and suggests possible avenues for participatory research and intervention.
Collapse
Affiliation(s)
- Scherezade K Mama
- University of Houston, Houston, TX, USA; The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | |
Collapse
|
40
|
Bergman M. Inadequacies of current approaches to prediabetes and diabetes prevention. Endocrine 2013; 44:623-33. [PMID: 23881341 DOI: 10.1007/s12020-013-0017-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 07/10/2013] [Indexed: 12/20/2022]
Abstract
In view of the global shift from communicable to chronic, non-communicable diseases including obesity, prediabetes, and type 2 diabetes mellitus, the increasing prevalence of the latter creates a considerable challenge to the clinician and public health infrastructure. Despite the substantial research efforts in the last 10-15 years highlighting the considerable benefit of lifestyle modification in thwarting the insidious progression to diabetes and its complications, many individuals will ineluctably progress even when initially responsive. Furthermore, the vast majority of individuals with prediabetes remain undiagnosed and untreated. Therefore, the responsibilities of the medical and public health communities involve identifying new methods for screening and identifying those at risk as well as refining therapeutic approaches availing as many high-risk individuals as possible to novel treatment modalities.
Collapse
Affiliation(s)
- Michael Bergman
- Division of Endocrinology and Metabolism, NYU Diabetes and Endocrine Associates, NYU School of Medicine, 530 First Avenue, Schwartz East, Suite 5E, New York, NY, 10016, USA,
| |
Collapse
|
41
|
Navarro HJ, Shakeshaft A, Doran CM, Petrie DJ. Does increasing community and liquor licensees' awareness, police activity, and feedback reduce alcohol-related violent crime? A benefit-cost analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:5490-506. [PMID: 24169411 PMCID: PMC3863856 DOI: 10.3390/ijerph10115490] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 09/24/2013] [Accepted: 09/29/2013] [Indexed: 11/16/2022]
Abstract
Approximately half of all alcohol-related crime is violent crime associated with heavy episodic drinking. Multi-component interventions are highly acceptable to communities and may be effective in reducing alcohol-related crime generally, but their impact on alcohol-related violent crime has not been examined. This study evaluated the impact and benefit-cost of a multi-component intervention (increasing community and liquor licensees’ awareness, police activity, and feedback) on crimes typically associated with alcohol-related violence. The intervention was tailored to weekends identified as historically problematic in 10 experimental communities in NSW, Australia, relative to 10 control ones. There was no effect on alcohol-related assaults and a small, but statistically significant and cost-beneficial, effect on alcohol-related sexual assaults: a 64% reduction in in the experimental relative to control communities, equivalent to five fewer alcohol-related sexual assaults, with a net social benefit estimated as AUD$3,938,218. The positive benefit-cost ratio was primarily a function of the value that communities placed on reducing alcohol-related harm: the intervention would need to be more than twice as effective for its economic benefits to be comparable to its costs. It is most likely that greater reductions in crimes associated with alcohol-related violence would be achieved by a combination of complementary legislative and community-based interventions.
Collapse
Affiliation(s)
- Héctor José Navarro
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Kensington, NSW 2052, Australia; E-Mail:
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Kensington, NSW 2052, Australia; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +61-2-9385-0333; Fax: +61-2-9385-0222
| | - Christopher M. Doran
- Hunter Medical Research Institute and the University of Newcastle, Room 3016, HMRI Building, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; E-Mail:
| | - Dennis J. Petrie
- Centre for Health Policy, Programs & Economics, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC 3010, Australia; E-Mail:
| |
Collapse
|
42
|
Kenney MK, Wang J, Iannotti R. Residency and racial/ethnic differences in weight status and lifestyle behaviors among US youth. J Rural Health 2013; 30:89-100. [PMID: 24383488 PMCID: PMC4696387 DOI: 10.1111/jrh.12034] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Elevated risk for obesity is found in rural environments and in some minority populations. It is unclear whether living in rural or nonmetropolitan areas and being a minority compound the risk of obesity beyond that of either factor acting alone. Our purpose was to examine adolescent obesity in light of the potential concomitant influences of race/ethnicity, residency, and obesity-related lifestyle behaviors. METHODS We assessed obesity prevalence, physical activity, consumption of fatty snack foods, and screen time in 8,363 US adolescents based on variation in race/ethnicity and residency. Descriptive, bivariate, and multivariate statistics were used to: (1) calculate race- and residency-based rates of obesity and obesity-related lifestyle behaviors and (2) generate race- and residency-based obesity odds ratios as a function of those same behaviors. FINDINGS The results indicated that nonmetropolitan black youth had the highest risk of obesity (26%), rate of consuming fatty snack foods on more than 2 days/week (86%), and rate of spending more than 2 hours/day in screen time (91%) compared to white metropolitan youth. Compared to their metropolitan counterparts, black nonmetropolitan youth had greater odds of being obese if they exercised less than daily (1.71 times), ate fatty snack foods on more than 2 days/week (1.65 times), or spent more than 2 hours/day in screen time (1.64 times). CONCLUSIONS Race/ethnicity and residency may have a compounding effect on the risk of obesity. Prevention and intervention must be viewed in a socioecological framework that recognizes the importance of culture and community on obesity-related behaviors.
Collapse
Affiliation(s)
- Mary Kay Kenney
- US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland
| | - Jing Wang
- US Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland
| | - Ron Iannotti
- US Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland
| |
Collapse
|
43
|
Weaver KE, Palmer N, Lu L, Case LD, Geiger AM. Rural-urban differences in health behaviors and implications for health status among US cancer survivors. Cancer Causes Control 2013; 24:1481-90. [PMID: 23677333 DOI: 10.1007/s10552-013-0225-x] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 05/04/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE Rural US adults have increased risk of poor outcomes after cancer, including increased cancer mortality. Rural-urban differences in health behaviors have been identified in the general population and may contribute to cancer health disparities, but have not yet been examined among US survivors. We examined rural-urban differences in health behaviors among cancer survivors and associations with self-reported health and health-related unemployment. METHODS We identified rural (n = 1,642) and urban (n = 6,162) survivors from the cross-sectional National Health Interview Survey (2006-2010) and calculated the prevalence of smoking, physical activity, overweight/obesity, and alcohol consumption. Multivariable models were used to examine the associations of fair/poor health and health-related unemployment with health behaviors and rural-urban residence. RESULTS The prevalence of fair/poor health (rural 36.7 %, urban 26.6 %), health-related unemployment (rural 18.5 %, urban 10.6 %), smoking (rural 25.3 %, urban 15.8 %), and physical inactivity (rural 50.7 %, urban 38.7 %) was significantly higher in rural survivors (all p < .05); alcohol consumption was lower (rural 46.3 %, urban 58.6 %), and there were no significant differences in overweight/obesity (rural 65.4 %, urban 62.6 %). All health behaviors were significantly associated with fair/poor health and health-related unemployment in both univariate and multivariable models. After adjustment for behaviors, rural survivors remained more likely than urban survivors to report fair/poor health (OR = 1.21, 95 % CI 1.03-1.43) and health-related unemployment (OR = 1.49, 95 % CI 1.18-1.88). CONCLUSIONS Rural survivors may need tailored, accessible health promotion interventions to address health-compromising behaviors and improve outcomes after cancer.
Collapse
Affiliation(s)
- Kathryn E Weaver
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | | | | | | | | |
Collapse
|
44
|
Shenson D, Adams M, Bolen J, Wooten K, Clough J, Giles WH, Anderson L. Developing an integrated strategy to reduce ethnic and racial disparities in the delivery of clinical preventive services for older Americans. Am J Public Health 2012; 102:e44-50. [PMID: 22698041 PMCID: PMC3464841 DOI: 10.2105/ajph.2012.300701] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2012] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the optimum strategy for increasing up-to-date (UTD) levels in older Americans, while reducing disparities between White, Black, and Hispanic adults, aged 65 years and older. METHODS Data were analyzed from the 2008 Behavioral Risk Factor Surveillance System, quantifying the proportion of older Americans UTD with influenza and pneumococcal vaccinations, mammograms, Papanicolaou tests, and colorectal cancer screening. A comparison of projected changes in UTD levels and disparities was ascertained by numerically accounting for UTD adults lacking 1 or more clinical preventive services (CPS). Analyses were performed by gender and race/ethnicity. RESULTS Expanded provision of specific vaccinations and screenings each increased UTD levels. When those needing only vaccinations were immunized, there was a projected decrease in racial/ethnic disparities in UTD levels (2.3%-12.2%). When those needing only colorectal cancer screening, mammography, or Papanicolaou test were screened, there was an increase in UTD disparities (1.6%-4.5%). CONCLUSIONS A primary care and public health focus on adult immunizations, in addition to other CPS, offers an effective strategy to reduce disparities while improving UTD levels.
Collapse
Affiliation(s)
- Douglas Shenson
- Sickness Prevention Achieved through Regional Collaboration (SPARC), Newton, MA 02465, USA.
| | | | | | | | | | | | | |
Collapse
|
45
|
Krist AH, Woolf SH, Rothemich SF, Johnson RE, Peele JE, Cunningham TD, Longo DR, Bello GA, Matzke GR. Interactive preventive health record to enhance delivery of recommended care: a randomized trial. Ann Fam Med 2012; 10:312-9. [PMID: 22778119 PMCID: PMC3392290 DOI: 10.1370/afm.1383] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Americans receive only one-half of recommended preventive services. Information technologies have been advocated to engage patients. We tested the effectiveness of an interactive preventive health record (IPHR) that links patients to their clinician's record, explains information in lay language, displays tailored recommendations and educational resources, and generates reminders. METHODS This randomized controlled trial involved 8 primary care practices. Four thousand five hundred patients were randomly selected to receive a mailed invitation to use the IPHR or usual care. Outcomes were measured using patient surveys and electronic medical record data and included IPHR use and service delivery. Comparisons were made between invited and usual-care patients and between users and nonusers among those invited to use the IPHR. RESULTS At 4 and 16 months, 229 (10.2%) and 378 (16.8%) of invited patients used the IPHR. The proportion of patients up-to-date with all services increased between baseline and 16 months by 3.8% among intervention patients (from 11.4% to 15.2%, P <.001) and by 1.5% among control patients (from 11.1% to 12.6%, P = .07), a difference of 2.3% (P = .05). Greater increases were observed among patients who used the IPHR. At 16 months, 25.1% of users were up-to-date with all services, double the rate among nonusers. At 4 months, delivery of colorectal, breast, and cervical cancer screening increased by 19%, 15%, and 13%, respectively, among users. CONCLUSIONS Information systems that feature patient-centered functionality, such as the IPHR, have potential to increase preventive service delivery. Engaging more patients to use systems could have important public health benefits.
Collapse
Affiliation(s)
- Alex H Krist
- Department of Family Medicine, Virginia Commonwealth University, Richmond, VA 23298-0251, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Schootman M, Deshpande AD, Pruitt S, Aft R, Jeffe DB. Estimated effects of potential interventions to prevent decreases in self-rated health among breast cancer survivors. Ann Epidemiol 2012; 22:79-86. [PMID: 22226030 DOI: 10.1016/j.annepidem.2011.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 10/21/2011] [Accepted: 10/27/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE To estimate the effect of hypothetical changes in modifiable predictors on the incidence of fair-to-poor self-rated health (SRH) in breast cancer survivors. METHODS In 2007-2008, we interviewed 832 breast cancer survivors 1 year after diagnosis (baseline) and 1 year later. First, multivariable logistic regression models estimated the association between the predictors (sociodemographic factors, access to medical care, comorbid conditions, psychosocial factors, perceived neighborhood conditions, cancer-related behaviors, clinical factors) and SRH. Second, we estimated the probabilities of fair-to-poor SRH for values of the predictors for each breast cancer survivor. Third, we estimated the population-wide effect of potential changes in modifiable predictors on the incidence of fair-to-poor SRH. RESULTS A total of 7.6% of participants (92.4% white; mean age, 58.0 years) whose SRH was rated good-to-excellent at baseline reported fair-to-poor SRH 1 year later. The largest potential reduction in incidence of fair-to-poor SRH could be obtained by eliminating surgical side effects (27.8% reduction) and comorbidity (21.8% reduction) and by engaging in any physical activity (19.6% reduction). CONCLUSIONS A significant portion of the decline in SRH can be avoided by reducing surgical side effects, preventing comorbidity, and improving physical activity with the use of evidence-based strategies.
Collapse
Affiliation(s)
- Mario Schootman
- Departments of Medicine and Pediatrics, Division of Health Behavior Research, Washington University School of Medicine, Saint Louis, MO 63108, USA.
| | | | | | | | | |
Collapse
|
47
|
Zhu SH, Lee M, Zhuang YL, Gamst A, Wolfson T. Interventions to increase smoking cessation at the population level: how much progress has been made in the last two decades? Tob Control 2012; 21:110-8. [PMID: 22345233 PMCID: PMC3446870 DOI: 10.1136/tobaccocontrol-2011-050371] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This paper reviews the literature on smoking cessation interventions, with a focus on the last 20 years (1991 to 2010). These two decades witnessed major development in a wide range of cessation interventions, from pharmacotherapy to tobacco price increases. It was expected that these interventions would work conjointly to increase the cessation rate on the population level. This paper examines population data from the USA, from 1991 to 2010, using the National Health Interview Surveys. Results indicate there is no consistent trend of increase in the population cessation rate over the last two decades. Various explanations are presented for this lack of improvement, and the key concept of impact = effectiveness × reach is critically examined. Finally, it suggests that the field of cessation has focused so much on developing and promoting interventions to improve smokers' odds of success that it has largely neglected to investigate how to get more smokers to try to quit and to try more frequently. Future research should examine whether increasing the rate of quit attempts would be key to improving the population cessation rate.
Collapse
Affiliation(s)
- Shu-Hong Zhu
- University of California, San Diego, La Jolla, CA 92093-0905, USA.
| | | | | | | | | |
Collapse
|
48
|
Shakeshaft A, Petrie D, Doran C, Breen C, Sanson-Fisher R. An empirical approach to selecting community-based alcohol interventions: combining research evidence, rural community views and professional opinion. BMC Public Health 2012; 12:25. [PMID: 22233608 PMCID: PMC3305500 DOI: 10.1186/1471-2458-12-25] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 01/10/2012] [Indexed: 11/03/2022] Open
Abstract
Background Given limited research evidence for community-based alcohol interventions, this study examines the intervention preferences of rural communities and alcohol professionals, and factors that influence their choices. Method Community preferences were identified by a survey of randomly selected individuals across 20 regional Australian communities. The preferences of alcohol professionals were identified by a survey of randomly selected members of the Australasian Professional Society on Alcohol and Other Drugs. To identify preferred interventions and the extent of support for them, a budget allocation exercise was embedded in both surveys, asking respondents to allocate a given budget to different interventions. Tobit regression models were estimated to identify the characteristics that explain differences in intervention preferences. Results Community respondents selected school programs most often (88.0%) and allocated it the largest proportion of funds, followed by promotion of safer drinking (71.3%), community programs (61.4%) and police enforcement of alcohol laws (60.4%). Professionals selected GP training most often (61.0%) and allocated it the largest proportion of funds, followed by school programs (36.6%), community programs (33.8%) and promotion of safer drinking (31.7%). Community views were susceptible to response bias. There were no significant predictors of professionals' preferences. Conclusions In the absence of sufficient research evidence for effective community-based alcohol interventions, rural communities and professionals both strongly support school programs, promotion of safer drinking and community programs. Rural communities also supported police enforcement of alcohol laws and professionals supported GP training. The impact of a combination of these strategies needs to be rigorously evaluated.
Collapse
Affiliation(s)
- Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia.
| | | | | | | | | |
Collapse
|
49
|
Shih SC, McCullough CM, Wang JJ, Singer J, Parsons AS. Health information systems in small practices. Improving the delivery of clinical preventive services. Am J Prev Med 2011; 41:603-9. [PMID: 22099237 DOI: 10.1016/j.amepre.2011.07.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 05/25/2011] [Accepted: 07/08/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite strong evidence that clinical preventive services (CPS) reduce morbidity and mortality, CPS performance has not improved in adult primary care. In addition to implementing electronic health records (EHRs), key factors for improving CPS include providing actionable information at the point of care, technical support staff, and quality-improvement assistance. These resources are not typically available in small practices. PURPOSE Estimate the impact on CPS delivery after a software upgrade to embed a clinical decision support system and practice-level quality-improvement support services. METHODS Practices were recruited from the Primary Care Information Project, a citywide initiative assisting practices adopt health information technology. Data were collected in 2009 and 2010, and analyses were conducted in 2010 and 2011. Across two time periods, receipt of CPS was calculated for 56 practices. Period 1 measured CPS delivery 2-37 months following implementation of an EHR. Period 2 measured CPS delivery within the first 6 months after an EHR software upgrade. RESULTS Substantial increases in the delivery of selected CPS were observed after the EHR software upgrades. Blood pressure control for patients with hypertension increased from 46.0% to 54.8%. Breast cancer screening, recorded BMI, and HbA1c testing for patients with diabetes also increased. More than half of the practices increased their patients' blood pressure control, recorded BMI, breast cancer screening, and HbA1c screening by ≥5 percentage points. CONCLUSIONS Delivery of CPS can increase in small primary care practices that implement an EHR that includes comprehensive quality-improvement support.
Collapse
Affiliation(s)
- Sarah C Shih
- Primary Care Information Project, New York City Department of Health and Mental Hygiene, 42-09 28th Street,Queens, NY 11101-4132, USA.
| | | | | | | | | |
Collapse
|
50
|
Ockene JK, Schneider KL, Lemon SC, Ockene IS. Can we improve adherence to preventive therapies for cardiovascular health? Circulation 2011; 124:1276-82. [PMID: 21911795 DOI: 10.1161/circulationaha.110.968479] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Judith K Ockene
- University of Massachusetts Medical School, Worcester, 01655, USA.
| | | | | | | |
Collapse
|