Applying a socioecological framework to chronic disease management: implications for social informatics interventions in safety-net healthcare settings

Caregiver and Provider Perceptions of Health Disparities in the Neonatal Intensive Care Unit: A Qualitative Study

OBJECTIVES

1) To describe the experience of caregivers and their perceptions of disparate care in the neonatal intensive care unit (NICU) and 2) explore interprofessional NICU provider perspectives on potential biases and perceptions of disparate care.

METHODS

This qualitative study was conducted in 1 southeastern level IV NICU. Semistructured interviews assessed caregiver and provider perspectives on NICU care. Purposive sampling ensured ≥50% of caregivers self-identified as racial and/or ethnic minorities. Interviews were recorded, transcribed verbatim, and audio verified. A coding scheme was developed, raw data were systematically coded, and emerging themes were identified using thematic analyses.

RESULTS

Twenty-three caregivers and 14 providers were interviewed, including 5 neonatologists, 6 nurses, and 3 residents. Caregivers were predominantly English-speaking (85%); 96% were mothers with a mean age of 32 years. Neonates were predominantly racial and ethnic minorities (62%). Providers were predominantly White (71%) and female (71%). Five themes emerged 1) ineffective, biased communication between caregivers, providers, and health care team may contribute to disparities; 2) language barriers and lack of interpreter access play a significant role in perceived negative care; 3) lack of caregiver involvement and role in decision-making may negatively influence NICU outcomes, especially for those not able to be present at the bedside; and 4) multiple biases may affect neonatal health disparities.

CONCLUSIONS

Our study highlights the importance of considering both provider and racial and/or ethnic minority caregiver perceptions disparities in NICU care delivery. It adds to the literature as one of the few qualitative studies comparing perceptions of disparate NICU care among both caregivers and providers.

Parental Binge Eating and Child Binge Eating and Weight-Control Behaviors: Cross-Sectional and Longitudinal Findings From the EAT 2010-2018 Study

OBJECTIVE

In cross-sectional and retrospective research, parental binge eating is associated with their children's eating psychopathology. The current study extended the evidence by cross-sectionally and longitudinally examining the relation between parental binge eating and binge eating and weight-control behaviors in the next generation of their adolescent children and young adult children in a population-based sample.

METHODS

Adolescents (Time 1: M = 14.5, SD = 2.0 years) (n = 2367), followed into adulthood (Time 2: M = 22.1, SD = 2.0 years), and their parents (n = 3664) were enrolled in EAT 2010-2018 and Project F-EAT 2010. The current study examined parental binge eating, and child binge eating and weight-control behaviors. Adjusted models covaried for child gender, age, and race/ethnicity.

RESULTS

Approximately 7% of adolescents at Time 1 had at least one parent who reported binge eating with no differences by child's age, gender, or race/ethnicity. Having at least one parent experiencing binge eating at Time 1 (vs. not) was associated cross-sectionally with adolescent children's use of extreme weight-control behaviors (9.6% vs. 4.8%; Risk Difference [RD] = 4.9%) and associated longitudinally with binge eating during young adulthood (21.1% vs. 11.6%; RD = 9.5%). Other associations did not reach statistical significance.

CONCLUSIONS

Children of parents with binge eating appear to have elevated risk of extreme weight-control behaviors during adolescence and binge eating in young adulthood. Clinicians should assess whether eating psychopathology extends to other family members, and offer additional support to parents with binge eating. Further research is needed to identify risk factors in the children of parents with binge eating and to assess strategies for prevention.

A Culturally Adapted Perioperative Mental Health Intervention for Older Black Surgical Patients

OBJECTIVES

Perioperative mental health of older Black surgical patients is associated with poor surgical outcomes; however, evidence-based perioperative interventions are lacking. Our two study objectives included: first, examine factors affecting perioperative care experiences of older Black surgical patients with mental health problems, and second, ascertain design and implementation requirements for a culturally-adapted perioperative mental health intervention.

DESIGN SETTING AND PARTICIPANTS

We conducted six focus groups with older Black patients (n = 15; ≥50 years; surgery within the past 5 years and/or interest in mental health research; history of distress, anxiety, or depression coping with surgery/hospitalization/) from a large academic medical center. We engaged study partners, including interventionists and community members, to gather insights on intervention and implementation needs. We followed a hybrid inductive-deductive thematic approach using open coding and the National Institute on Minority Health and Health Disparities Research Framework.

RESULTS

Patients reported that their psychological well-being and long-term mental health outcomes were not appropriately considered during perioperative care. Perceived stressors included interpersonal and structural barriers to using mental healthcare services, clinician treatment biases and ageism in care, and lack of healthcare professional connections/resources. Patients utilized various coping strategies, including talk therapy, faith/spirituality, and family and friends.

CONCLUSION

This study offers valuable insights into the experiences of older Black surgical patients and the critical elements for developing a personalized perioperative mental health intervention to support their well-being before, during, and after surgery. Our findings demonstrated a need for a patient-centered and culturally adapted intervention targeting the individual/behavioral and interpersonal levels. Informed by the cultural adaptation framework, we propose a multi-component intervention that integrates psychological and pharmacological components.

Social Marketing Perspective on Participant Recruitment in Informatics-Based Intervention Studies

Effective recruitment strategies are pivotal for informatics-based intervention trials success, particularly for people living with HIV (PLWH), where engagement can be challenging. Although informatics interventions are recognized for improving health outcomes, the effectiveness of their recruitment strategies remains unclear. We investigated the application of a social marketing framework in navigating the nuances of recruitment for informatics-based intervention trials for PLWH by examining participant experiences and perceptions. We used qualitative descriptive methodology to conduct semi-structured interviews with 90 research participants from four informatics-based intervention trials. Directed inductive and deductive content analyses were guided by Howcutt et al.'s social marketing framework on applying the decision-making process to research recruitment. The majority were male (86.7%), living in the Northeast United States (56%), and identified as Black (32%) or White (32%). Most participants (60%) completed the interview remotely. Sixteen subthemes emerged from five themes: motivation, perception, attitude formation, integration, and learning. Findings from our interview data suggest that concepts from Howcutt et al.'s framework informed participants' decisions to participate in an informatics-based intervention trial. We found that the participants' perceptions of trust in the research process were integral to the participants across the four trials. However, the recruitment approach and communication medium preferences varied between older and younger age groups. Social marketing framework can provide insight into improving the research recruitment process. Future work should delve into the complex interplay between the type of informatics-based interventions, trust in the research process, and communication preferences, and how these factors collectively influence participants' willingness to engage.

Building a Client Resource and Communication Platform for Community-Based Organizations to Address Health and Social Needs: Co-Design Study

Background

Connecting individuals to existing community resources is critical to addressing social needs and improving population health. While there is much ongoing informatics work embedding social needs screening and referrals into health care systems and their electronic health records, there has been less focus on the digital ecosystem and needs of community-based organizations (CBOs) providing or connecting individuals to these resources.

Objective

We used human-centered design to develop a digital platform for CBOs, focused on identification of health and social resources and communication with their clients.

Methods

Centered in the Develop phase of the design process, we conducted in-depth interviews in 2 phases with community-based organizational leadership and staff to create and iterate on the platform. We elicited and mapped participant feedback to theory-informed domains from the Technology Acceptance Model, such as Usefulness and Ease of Use, to build the final product and summarized all major design decisions as the platform development proceeded.

Results

Overall, we completed 22 interviews with 18 community-based organizational leadership and staff in 2 consecutive Develop phases. After coding of the interview transcripts, there were 4 major themes related to usability, relevance, and external factors impacting use. Specifically, CBOs expressed an interest in a customer relationship management software to manage their client interactions and communications, and they needed specific additional features to address the scope of their everyday work, namely (1) digital and SMS text messaging communication with clients and (2) easy ways to identify relevant community resources based on diverse client needs and various program eligibility criteria. Finally, clear implementation needs emerged, such as digital training and support for staff using new platforms. The final platform, titled "Mapping to Enhance the Vitality of Engaged Neighborhoods (MAVEN)," was completed in the Salesforce environment in 2022, and it included features and functions directly mapped to the design process.

Conclusions

Engaging community organizations in user-centered design of a health and social resource platform was essential to tapping into their deep expertise in serving local communities and neighborhoods. Design methods informed by behavioral theory can be similarly employed in other informatics research. Moving forward, much more work will be necessary to support the implementation of platforms specific to CBOs' needs, especially given the resources, training, and customization needed in these settings.

Application of Digital Informatics in Precision Prevention, Epidemiology, and Clinicogenomics Research to Advance Precision Healthcare

OBJECTIVES

To summarize recent public health informatics and precision epidemiology developments impacting the healthcare ecosystem. The influence of new technologies and precision approaches in surveillance and management of chronic diseases is high-lighted as areas of clinical practice where digital informatics can markedly improve pop-ulation health.

METHODS

In this narrative review, we summarized the main themes from research and practice to define disease prevention and public health trends. Publications on public health informatics and precision epidemiology were searched using Google Scholar us-ing the following keywords: "digital informatics", "precision in prevention", "precision epi-demiology", "public health surveillance", "clinicogenomics" and combinations thereof. In addition, we introduced the principles of a clinicogenomics registry as a case study to empower underrepresented communities and to reduce health disparities.

RESULTS

Technology applications such as telehealth and digital information tools fre-quently intertwine with public health informatics and precision epidemiology in efforts to identify and target individuals and populations at risk of disease. There is an urgent need for more investigations and evaluation of the validity and utility of digital platforms, including artificial intelligence (AI) and predictive analytics to advance precision preven-tion and epidemiology. The major precision-based opportunities identified included: (1) the utilization of digital tools, (2) a public health strategic framework, (3) tele-health/telemonitoring tools, (4) digital twins to simulate and optimize care models, (5) clinicogenomics registries, (6) biomarker analyses and omics panels, and (7) mobile health.

CONCLUSIONS

Successful implementation of precision prevention and epidemiology ini-tiatives requires development of a researcher and practitioner workforce that is well-versed in informatics and public health. The positive impact of precision healthcare ap-proaches depends on solutions and technologies that connect digital patient information with wearable devices, mobile apps, telehealth, and digital analytics using AI. The vital components required to successfully integrate public health informatics, precision pre-vention and epidemiology are people, data, and tool systems, albeit within legal and ethical constraints. Together, these applications can significantly improve actionability of public health surveillance and societal trends in the preservation of health and disease prevention.