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Mkuu RS, Staras SA, Chakrabarti C, Hall J, Harvey I, Salloum RG, Barrow S, Ortega S, Woodard J, Seals K, Rawls A, Meduri Y, Donahoo WT, Goede DL, Shenkman EA. Acceptability of HPV self-collection: A qualitative study of Black women living with type II diabetes and social vulnerability. J Clin Transl Endocrinol 2024; 35:100331. [PMID: 38444842 PMCID: PMC10912756 DOI: 10.1016/j.jcte.2024.100331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/26/2024] [Accepted: 02/15/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Human papillomavirus (HPV) causes 99.7% of cervical cancer cases. Cervical cancer is preventable through early detection via HPV testing. However, the number of women screened for cervical cancer has not increased in the last several years. Lower screening rates among women living in high poverty and social vulnerability areas, Black women, and women with chronic co-morbidities (e.g., type 2 diabetes (T2D)) are associated with their higher cervical cancer mortality rates. When screened, Black women are more likely to be diagnosed at later stages and die from cervical cancer. HPV self-collection decreases barriers to cervical cancer screening and can help lessen disparities among underserved women. This study aimed to examine the acceptability of HPV self-collection among Black women with T2D living in socially vulnerable communities. Methods Qualitative semi-structured interviews were conducted with 29 Black women with T2D living in communities with high social vulnerability. The Health Belief Model informed the development of the interview guide to gather data on the acceptability of HPV self-collection. Results Three main themes aligned with the Health Belief Model were identified: (1) HPV self-collection provides a comfortable alternative to in-clinic HPV testing (perceived benefits); (2) HPV self-collection would result in awareness of current HPV status (health motivation); and (3) Women were concerned about collecting their sample accurately (perceived barriers). Discussion/Conclusion Black women with T2D living in communities with high social vulnerability identified multiple benefits of cervical cancer screening through HPV self-collection. Women are concerned about their ability to collect these samples correctly. Our findings call for future studies focusing on increasing self-efficacy and skills to collect HPV samples among Black women with chronic conditions like T2D who reside in underserved communities with high social vulnerability.
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Affiliation(s)
- Rahma S Mkuu
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Stephanie A Staras
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Choeeta Chakrabarti
- Department of Anthropology, Florida State University, 909 Antarctic Way, Tallahassee, FL 32304, USA
| | - Jaclyn Hall
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Idethia Harvey
- College of Health Sciences, University of Missouri, 313 Clark Hall, Columbia, MO 65211, USA
| | - Ramzi G Salloum
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Office of Community Outreach and Engagement, UF Health Cancer Center, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Sable Barrow
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Office of Community Outreach and Engagement, UF Health Cancer Center, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Selena Ortega
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Office of Community Outreach and Engagement, UF Health Cancer Center, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Jennifer Woodard
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Office of Community Outreach and Engagement, UF Health Cancer Center, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Kayla Seals
- Department of Health Science, University of Alabama, 108 Russell Hall, Tuscaloosa, AL 35487, USA
| | - Audrey Rawls
- Department of Health Science, University of Alabama, 108 Russell Hall, Tuscaloosa, AL 35487, USA
| | - Yashaswini Meduri
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - William T Donahoo
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Florida, P.O. Box 100226, Gainesville, FL 32610, USA
| | - Dianne L Goede
- Internal Medicine, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4th Floor, Suite 4592, Gainesville, FL 32610-3008, USA
| | - Elizabeth A Shenkman
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
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Aruma JF, Hearn M, Bernacchi V, Moss JL. Examining the roles of travel distance, medical mistrust, and cancer fatalism in the uptake of clinical cancer prevention among women in rural and urban US communities: A secondary data analysis. Prev Med Rep 2024; 38:102611. [PMID: 38375162 PMCID: PMC10874844 DOI: 10.1016/j.pmedr.2024.102611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction Rural adults are less likely to receive cancer screening than urban adults, likely due to systematic differences in community- and individual-level factors. The purpose of this study was to analyze the relative contributions of rurality, travel time, medical mistrust, and cancer fatalism in explaining uptake of clinical cancer prevention services. Methods We conducted a secondary data analysis of 2019-2020 survey data from women, ages 45-65, in rural and urban counties in central Pennsylvania, examining rurality, travel time to a primary care provider, medical mistrust, and cancer fatalism, as well as uptake of guideline-recommended colorectal cancer screening, cervical cancer screening, and preventive check-up. Final models used multivariable logistic regression to assess the relationships among study variables, controlling for participant demographics. Results Among 474 participants, 48.9 % resided in rural counties. Most participants had received clinical cancer prevention services (colorectal cancer screening: 55.4 %; cervical cancer screening: 82.8 %; preventive check-up in the last year: 75.4 %). Uptake of services was less common among participants with higher medical mistrust (colorectal cancer screening: adjusted odds ratio [aOR] = 0.87, 95 % confidence interval [CI] = 0.76-1.00; cervical cancer screening: aOR = 0.79, 95 % CI = 0.63-1.00; last-year check-up: aOR = 0.74, 95 % CI = 0.63-0.88). Conclusions Patient attitudes, particularly medical mistrust, may contribute to rural/urban disparities in clinical cancer prevention among women. Community- and individual-level interventions are needed to improve cancer outcomes in rural areas.
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Affiliation(s)
- Jane-Frances Aruma
- Penn State College of Medicine, The Pennsylvania State University, State College, PA, USA
| | - Madison Hearn
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Veronica Bernacchi
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Jennifer L. Moss
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
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Cox AB, Jaiswal J, LoSchiavo C, Witte T, Wind S, Griffin M, Halkitis PN. Medical Mistrust Among a Racially and Ethnically Diverse Sample of Sexual Minority Men. LGBT Health 2023; 10:471-479. [PMID: 37418567 PMCID: PMC10623470 DOI: 10.1089/lgbt.2022.0252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023] Open
Abstract
Purpose: Medical mistrust is a barrier to health care utilization and is associated with suboptimal health outcomes. Research on mistrust among sexual minority men (SMM) is limited and largely focuses on Black SMM and HIV, with few studies assessing mistrust among SMM of other race/ethnicities. The purpose of this study was to examine differences in medical mistrust among SMM by race. Methods: From February 2018 to February 2019, a mixed-methods study examined the health-related beliefs and experiences of young SMM in New York City. The Group-Based Medical Mistrust Scale (GBMMS) was used to measure medical mistrust related to race, and a modified version of the scale assessed mistrust related to one's "sexual/gender minority" status (Group-Based Medical Mistrust Scale-Sexual/Gender Minority [GBMMS-SGM]). With an analytic sample of 183 cisgender SMM, a one-way multivariate analysis of variance was used to examine differences in GBMMS and GBMMS-SGM scores by race/ethnicity [Black, Latinx, White, "Another Racial Group(s)"]. Results: There were significantly different GBMMS scores by race, with participants of color reporting higher levels of race-based medical mistrust than White participants. This finding is supported by effect sizes ranging from moderate to large. Differences in GBMMS-SGM scores by race were borderline; however, the effect size for Black and White participants' GBMMS-SGM scores was moderate, indicating that higher GBMMS-SGM scores among Black participants is meaningful. Conclusion: Multilevel strategies should be used to earn the trust of minoritized populations, such as addressing both historical and ongoing discrimination, moving beyond implicit bias trainings, and strengthening the recruitment and retention of minoritized health care professionals.
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Affiliation(s)
- Amanda B. Cox
- Department of Health Science, University of Alabama, Tuscaloosa, Alabama, USA
| | - Jessica Jaiswal
- Department of Health Science, University of Alabama, Tuscaloosa, Alabama, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, USA
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
| | - Caleb LoSchiavo
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, Newark, New Jersey, USA
| | - Tricia Witte
- Department of Human Development and Family Studies, University of Alabama, Tuscaloosa, Alabama, USA
| | - Stefanie Wind
- Department of Educational Studies in Psychology, Research Methodology and Counseling, University of Alabama, Tuscaloosa, Alabama, USA
| | - Marybec Griffin
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, Newark, New Jersey, USA
| | - Perry N. Halkitis
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Urban-Global Public Health, Rutgers School of Public Health, Rutgers University, Newark, New Jersey, USA
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Rutgers University, Newark, New Jersey, USA
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Thomas MK, Amstutz C, Orr-Roderick D, Horter J, Holben DH. Medical Mistrust Among Food Insecure Individuals in Appalachia. FAMILY & COMMUNITY HEALTH 2023; 46:192-202. [PMID: 37079541 PMCID: PMC10179979 DOI: 10.1097/fch.0000000000000362] [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: 05/03/2023]
Abstract
This study focused on the relationship between food insecurity and medical mistrust within Appalachia. Food insecurity has negative consequences on health, while medical mistrust can lead to a decrease in health care use, creating additive consequences to already vulnerable populations. Medical mistrust has been defined in various ways, with measures addressing health care organizations and individual health care providers. To determine whether food insecurity has an additive impact on medical mistrust, a cross-sectional survey was completed by 248 residents in Appalachia Ohio while attending community or mobile clinics, food banks, or the county health department. More than one-quarter of the respondents had high levels of mistrust toward health care organizations. Those with high food insecurity levels were more likely to have higher levels of medical mistrust than those with lower levels of food insecurity. Individuals with higher self-identified health issues and older participants had higher medical mistrust scores. Screening for food insecurity in primary care can reduce the impact of mistrust on patient adherence and health care access by increasing patient-centered communication. These findings present a unique perspective on how to identify and mitigate medical mistrust within Appalachia and call attention to the need for further research on the root causes among food insecure residents.
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Affiliation(s)
- Melissa K. Thomas
- Department of Primary Care (Dr Thomas), Ohio University Heritage College of Osteopathic Medicine (Ms Amstutz), Athens, Ohio; Learning Resource Center, Ohio University Heritage College of Osteopathic Medicine/Medical Education, Athens, Ohio (Ms Orr-Roderick); Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Ms Horter); and Department of Nutrition and Hospitality Management, Office of Food and Nutrition Security, The University of Mississippi, University, Mississippi (Dr Holben)
| | - Ciara Amstutz
- Department of Primary Care (Dr Thomas), Ohio University Heritage College of Osteopathic Medicine (Ms Amstutz), Athens, Ohio; Learning Resource Center, Ohio University Heritage College of Osteopathic Medicine/Medical Education, Athens, Ohio (Ms Orr-Roderick); Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Ms Horter); and Department of Nutrition and Hospitality Management, Office of Food and Nutrition Security, The University of Mississippi, University, Mississippi (Dr Holben)
| | - Debra Orr-Roderick
- Department of Primary Care (Dr Thomas), Ohio University Heritage College of Osteopathic Medicine (Ms Amstutz), Athens, Ohio; Learning Resource Center, Ohio University Heritage College of Osteopathic Medicine/Medical Education, Athens, Ohio (Ms Orr-Roderick); Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Ms Horter); and Department of Nutrition and Hospitality Management, Office of Food and Nutrition Security, The University of Mississippi, University, Mississippi (Dr Holben)
| | - Julia Horter
- Department of Primary Care (Dr Thomas), Ohio University Heritage College of Osteopathic Medicine (Ms Amstutz), Athens, Ohio; Learning Resource Center, Ohio University Heritage College of Osteopathic Medicine/Medical Education, Athens, Ohio (Ms Orr-Roderick); Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Ms Horter); and Department of Nutrition and Hospitality Management, Office of Food and Nutrition Security, The University of Mississippi, University, Mississippi (Dr Holben)
| | - David H. Holben
- Department of Primary Care (Dr Thomas), Ohio University Heritage College of Osteopathic Medicine (Ms Amstutz), Athens, Ohio; Learning Resource Center, Ohio University Heritage College of Osteopathic Medicine/Medical Education, Athens, Ohio (Ms Orr-Roderick); Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Ms Horter); and Department of Nutrition and Hospitality Management, Office of Food and Nutrition Security, The University of Mississippi, University, Mississippi (Dr Holben)
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Mkuu RS, Hall JM, Galochkina Z, Cho HD, Staras SAS, Lee JH, Guo Y, Chakrabarti C, Barrow SB, Ortega S, Avery DM, Higginbotham J, Lockhart J, Shenkman EA. Does the Intersectionality of Race/Ethnicity and Type 2 Diabetes Increase the Odds of a Cervical Cancer Diagnosis? A Nested Case-Control Study of a Florida Statewide Multisite EHR Database. Healthcare (Basel) 2023; 11:1863. [PMID: 37444697 DOI: 10.3390/healthcare11131863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
Cervical cancer and Type 2 Diabetes (T2D) share common demographic risk factors. Despite this, scarce research has examined the relationship between race/ethnicity, having T2D, and cervical cancer incidence. We analyzed statewide electronic health records data between 2012 and 2019 from the OneFlorida+ Data Trust. We created a 1:4 nested case-control dataset. Each case (patient with cervical cancer) was matched with four controls (patients without cervical cancer) without replacement by year of encounter, diagnosis, and age. We used conditional logistic regression to estimate the unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to examine the association between race/ethnicity, T2D, and cervical cancer incidence. A total of 100,739 cases and 402,956 matched controls were identified. After adjusting for sociodemographic characteristics, non-Hispanic Black women with T2D had higher odds of cervical cancer compared with non-Hispanic White women with T2D (OR: 1.58, 95% CI 1.41-1.77). Living in a rural area, having Medicaid/Medicare insurance, and having high social vulnerability were associated with higher odds of having a cervical cancer diagnosis. Our findings imply the need to address the higher burden of cervical cancer diagnosis among non-Hispanic Black women with T2D and in underserved populations.
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Affiliation(s)
- Rahma S Mkuu
- Department of Health Science, The University of Alabama, Tuscaloosa, AL 35487, USA
| | - Jaclyn M Hall
- Department of Health Outcomes and Biomedical Informatics, The University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA
| | - Zhanna Galochkina
- Division of Quantitative Sciences, University of Florida Health Cancer Center, The University of Florida, 2033 Mowry Road, Gainesville, FL 32610, USA
| | - Hee Deok Cho
- Department of Health Outcomes and Biomedical Informatics, The University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA
| | - Stephanie A S Staras
- Department of Health Outcomes and Biomedical Informatics, The University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA
| | - Ji-Hyun Lee
- Department of Biostatistics, The University of Florida, 2004 Mowry Road, Gainesville, FL 32603, USA
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, The University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA
| | - Choeeta Chakrabarti
- Department of Anthropology, Florida State University, 2035 E Paul Dirac Drive Suite 206, Tallahassee, FL 32310, USA
| | - Sable Bowman Barrow
- Department of Health Outcomes and Biomedical Informatics, The University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA
| | - Selena Ortega
- Department of Health Outcomes and Biomedical Informatics, The University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA
| | - Daniel M Avery
- College of Community Health Sciences, The University of Alabama, 211 Peter Bryce Boulevard, Tuscaloosa, AL 35401, USA
| | - John Higginbotham
- College of Community Health Sciences, The University of Alabama, 211 Peter Bryce Boulevard, Tuscaloosa, AL 35401, USA
| | - Jala Lockhart
- Department of Health Science, The University of Alabama, Tuscaloosa, AL 35487, USA
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, The University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA
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Tsui J, Martinez B, Shin MB, Allee-Munoz A, Rodriguez I, Navarro J, Thomas-Barrios KR, Kast WM, Baezconde-Garbanati L. Understanding medical mistrust and HPV vaccine hesitancy among multiethnic parents in Los Angeles. J Behav Med 2023; 46:100-115. [PMID: 35107656 PMCID: PMC8808279 DOI: 10.1007/s10865-022-00283-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/03/2022] [Indexed: 01/26/2023]
Abstract
Determinants of parental HPV vaccine hesitancy, including medical mistrust and exposure to negative vaccine information, are understudied in racial/ethnic minority communities where vaccine uptake is low. We conducted a cross-sectional survey (March 2021) among parents of adolescents, ages 9-17 years, from an academic enrichment program serving low-income, first-generation, underrepresented minority families in Los Angeles to understand determinants of parental HPV vaccine hesitancy. Parents completed self-administered surveys, including a 9-item HPV vaccine hesitancy scale, in either English, Spanish, or Chinese. Logistic regression was used to identify individual and interpersonal factors associated with parental hesitancy and adolescent HPV vaccination. One-fifth of parents (n = 357) reported high HPV vaccine hesitancy and > 50% reported concerns about safety or side effects. High medical mistrust was associated with high parental HPV vaccine hesitancy (adjusted-OR 1.69, 95% CI: 1.13, 2.37). Community-tailored and multilevel strategies to increase vaccine confidence are needed to improve HPV and other adolescent vaccinations.
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Affiliation(s)
- Jennifer Tsui
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Bibiana Martinez
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michelle B Shin
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alec Allee-Munoz
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ivonne Rodriguez
- Leslie and William McMorrow Neighborhood Academic Initiative, University of Southern California, Los Angeles, CA, USA
| | - Jazmin Navarro
- Leslie and William McMorrow Neighborhood Academic Initiative, University of Southern California, Los Angeles, CA, USA
| | - Kim R Thomas-Barrios
- Leslie and William McMorrow Neighborhood Academic Initiative, University of Southern California, Los Angeles, CA, USA
| | - W Martin Kast
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lourdes Baezconde-Garbanati
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Higashi RT, Tiro JA, Winer RL, Ornelas IJ, Bravo P, Quirk L, Kessler LG. Understanding the effect of new U.S. cervical cancer screening guidelines and modalities on patients' comprehension and reporting of their cervical cancer screening behavior. Prev Med Rep 2023; 32:102169. [PMID: 36922960 PMCID: PMC10009194 DOI: 10.1016/j.pmedr.2023.102169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
With recent shifts in guideline-recommended cervical cancer screening in the U.S., it is important to accurately measure screening behavior. Previous studies have indicated the U.S. National Health Interview Survey (NHIS), a resource for measuring self-reported screening adherence, has lower validity among non-White racial/ethnic groups and non-English speakers. Further, measuring diverse population groups' comprehension of items and attitudes toward HPV self-sampling merits investigation as it is a modality likely to be recommended in the U.S. soon. This study cognitively tested NHIS items assessing recency of and reasons for receiving cervical cancer screening and attitudes toward HPV self-sampling. We conducted cognitive interviews between April 2021 - April 2022 in English and Spanish with individuals screened in the past two years by either a medical center in metropolitan Seattle, Washington or a safety-net healthcare system in Dallas, Texas. Interviews probed understanding of reasons for screening, experiences with abnormal results, and interest in HPV self-sampling. We completed 32 interviews in Seattle and 42 interviews in Dallas. A majority of participants were unaware that two different tests for cervical cancer screening exist (Pap and HPV). Many did not know which type(s) of test they received. Dallas participants had more limited and inaccurate knowledge of HPV compared to Seattle participants, and fewer responded favorably toward HPV self-sampling (32% vs. 55%). To improve comprehension and accurate reporting of cervical cancer screening, we suggest specific refinements to currently used survey questions. Attitudes toward self-sampling should be explored further as differences may exist by region and/or sociodemographic factors.
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Affiliation(s)
- Robin T Higashi
- University of Texas Southwestern Medical Center, Peter O'Donnell Jr. School of Public Health, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA.,Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Road, Dallas, TX, 75235, USA
| | - Jasmin A Tiro
- University of Texas Southwestern Medical Center, Peter O'Donnell Jr. School of Public Health, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA.,Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Road, Dallas, TX, 75235, USA
| | - Rachel L Winer
- University of Washington, Department of Epidemiology, Box 351619, 3980 15th Ave NE, Seattle, WA 98195, USA.,Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA
| | - India J Ornelas
- University of Washington, Department of Health Systems and Population Health, School of Public Health, 3980 15th Ave NE, UW Box 351621, Seattle, WA 98195, USA
| | - Perla Bravo
- University of Washington, Department of Health Systems and Population Health, School of Public Health, 3980 15th Ave NE, UW Box 351621, Seattle, WA 98195, USA
| | - Lisa Quirk
- University of Texas Southwestern Medical Center, Peter O'Donnell Jr. School of Public Health, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
| | - Larry G Kessler
- University of Washington, Department of Health Systems and Population Health, School of Public Health, 3980 15th Ave NE, UW Box 351621, Seattle, WA 98195, USA
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Trust Dynamics of Community Health Workers in Frontier Food Banks and Pantries: a Qualitative Study. J Gen Intern Med 2023; 38:18-24. [PMID: 36864268 PMCID: PMC9980865 DOI: 10.1007/s11606-022-07921-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 10/31/2022] [Indexed: 03/04/2023]
Abstract
BACKGROUND Medical mistrust has had devastating consequences during the COVID-19 pandemic, particularly in rural communities. Community Health Workers (CHWs) have been shown to build trust, but there is little research on trust-building by CHWs in rural communities. OBJECTIVE This study aims to understand the strategies that CHWs use to build trust with participants of health screenings in frontier Idaho. DESIGN This is a qualitative study based on in-person, semi-structured interviews. PARTICIPANTS We interviewed CHWs (N=6) and coordinators of food distribution sites (FDSs; e.g., food banks and pantries) where CHWs hosted a health screening (N=15). APPROACH Interviews were conducted with CHWs and FDS coordinators during FDS-based health screenings. Interview guides were initially designed to assess facilitators and barriers to health screenings. Trust and mistrust emerged as dominant themes that determined nearly every aspect of the FDS-CHW collaboration, and thus became the focus of interviews. KEY RESULTS CHWs encountered high levels of interpersonal trust, but low institutional and generalized trust, among the coordinators and clients of rural FDSs. When working to reach FDS clients, CHWs anticipated confronting mistrust due to their association with the healthcare system and government, especially if CHWs were perceived as "outsiders." Hosting health screenings at FDSs, which were trusted community organizations, was important for CHWs to begin building trust with FDS clients. CHWs also volunteered at FDS locations to build interpersonal trust before hosting health screenings. Interviewees agreed that trust building was a time- and resource-intensive process. CONCLUSIONS CHWs build interpersonal trust with high-risk rural residents, and should be integral parts of trust building initiatives in rural areas. FDSs are vital partners in reaching low-trust populations, and may provide an especially promising environment to reach some rural community members. It is unclear whether trust in individual CHWs also extends to the broader healthcare system.
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Ho IK, Sheldon TA, Botelho E. Medical mistrust among women with intersecting marginalized identities: a scoping review. ETHNICITY & HEALTH 2022; 27:1733-1751. [PMID: 34647832 DOI: 10.1080/13557858.2021.1990220] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
The purpose of this scoping review is to synthesize knowledge about medical mistrust and health among women who occupy other marginalized identities; namely women who also belong to one or more of the following social groups: people of color, people of low socioeconomic status, people with disabilities, lesbian and bisexual women, and/or women who have sex with women. This scoping review is based on the methodological framework by Arksey and O'Malley (2005. "Scoping Studies: Towards a Methodological Framework." International Journal of Social Research Methodology 8: 19-32. doi:10.1080/1364557032000119616). Specific search terms were entered into selected databases. Based on a set of inclusion criteria, articles were screened and assessed for eligibility. Data from the selected articles were extracted and summarized. Forty studies were included. Thirty-one studies used quantitative methodology, of which more than half used the Group-Based Medical Mistrust Scale. The majority of studies (84%) investigated the intersection of gender with race and ethnicity. Breast cancer and HIV combined accounted for more than half of the included studies. Of those studies that examined the relationship between medical mistrust and a health outcome or health behavior, almost all reported that medical mistrust had a deleterious impact. Medical mistrust among women with intersecting marginalized identities is worthy of further study, and there is still a dearth of knowledge in the role of medical mistrust among a wide range of subgroups of women and health domains.
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Affiliation(s)
- Ivy K Ho
- Department of Psychology, University of Massachusetts Lowell, Lowell, MA, USA
| | - Taylor A Sheldon
- Department of Psychology, University of Massachusetts Lowell, Lowell, MA, USA
| | - Elliott Botelho
- Department of Psychology, University of Massachusetts Lowell, Lowell, MA, USA
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Farr DE, Battle DA, Hall MB. Using Facebook Advertisements for Women's Health Research: Methodology and Outcomes of an Observational Study. JMIR Form Res 2022; 6:e31759. [PMID: 35019843 PMCID: PMC8792890 DOI: 10.2196/31759] [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: 07/02/2021] [Revised: 10/25/2021] [Accepted: 11/23/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Recruitment of diverse populations for health research studies remains a challenge. The COVID-19 pandemic has exacerbated these challenges by limiting in-person recruitment efforts and placing additional demands on potential participants. Social media, through the use of Facebook advertisements, has the potential to address recruitment challenges. However, existing reports are inconsistent with regard to the success of this strategy. Additionally, limited information is available about processes that can be used to increase the diversity of study participants. OBJECTIVE A Qualtrics survey was fielded to ascertain women's knowledge of and health care experiences related to breast density. This paper describes the process of using Facebook advertisements for recruitment and the effectiveness of various advertisement strategies. METHODS Facebook advertisements were placed in 2 rounds between June and July 2020. During round 1, multiple combinations of headlines and interest terms were tested to determine the most cost-effective advertisement. The best performing advertisement was used in round 2 in combination with various strategies to enhance the diversity of the survey sample. Advertisement performance, cost, and survey respondent data were collected and examined. RESULTS In round 1, a total of 45 advertisements with 5 different headlines were placed, and the average cost per link click for each headline ranged from US $0.12 to US $0.79. Of the 164 women recruited in round 1, in total 91.62% were eligible to complete the survey. Advertisements used during recruitment in round 2 resulted in an average cost per link click of US $0.11. During the second round, 478 women attempted the survey, and 87.44% were eligible to participate. The majority of survey respondents were White (80.41%), over the age of 55 years (63.94%), and highly educated (63.71%). CONCLUSIONS Facebook advertisements can be used to recruit respondents for health research quickly, but this strategy may yield participants who are less racially diverse, more educated, and older than the general population. Researchers should consider recruiting participants through other methods in addition to creating Facebook advertisements targeting underrepresented populations.
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Affiliation(s)
- Deeonna E Farr
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, United States
| | - Darian A Battle
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, United States
| | - Marla B Hall
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, United States
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Duthely LM, Sanchez-Covarrubias AP, Prabhakar V, Brown MR, Thomas TES, Montgomerie EK, Potter JE. Medical Mistrust and Adherence to Care Among a Heterogeneous Cohort of Women Living with HIV, Followed in a Large, U.S. Safety Net Clinic. Health Equity 2021; 5:681-687. [PMID: 34909537 PMCID: PMC8665805 DOI: 10.1089/heq.2020.0105] [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] [Accepted: 07/12/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: To explore the relationship between medical mistrust, as measured by the Group-Based Medical Mistrust (GBMM) scale, and HIV care adherence among a cohort of minority women receiving care in a U.S. safety net clinic. Methods: English-, Spanish-, and Haitian Creole (Creole)-speaking patients with a recent history of nonadherence to care were surveyed. Results: English speakers endorsed the highest level of mistrust, followed by Spanish speakers and Creole speakers. Creole speakers endorsed lower mistrust, lower suspicion of providers, and lower levels of “perceived health care disparities.” Higher mistrust was associated significantly with lower medication adherence, and lower rates of viral suppression (nonsignificant). Conclusion: Understanding perceptions of medical care and the relationship to HIV care adherence is an important step to addressing negative health outcomes for ethnic minority women with HIV. Clinical Trial Registration Number: NCT03738410.
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Affiliation(s)
- Lunthita M Duthely
- Divisions of Research and Special Projects and Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alex P Sanchez-Covarrubias
- Divisions of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Varsha Prabhakar
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Megan R Brown
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Tanya E S Thomas
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Emily K Montgomerie
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - JoNell E Potter
- Divisions of Research and Special Projects and Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
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Morris BB, Rossi B, Fuemmeler B. The role of digital health technology in rural cancer care delivery: A systematic review. J Rural Health 2021; 38:493-511. [PMID: 34480506 DOI: 10.1111/jrh.12619] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Rural residents face higher cancer incidence rates and mortality rates, disparities that could be mitigated with health technology interventions, yet a digital divide is also apparent. This paper systematically and critically examines existing literature to understand how digital technologies have been used to support rural oncology care. METHODS PubMed, CINAHL Complete, PsycINFO, and Embase were searched using Medical Subject Headings terms and keywords. Studies were eligible if they presented empirical data investigating the use of technology in rural oncology and were published in English in a peer-reviewed journal within the last decade. The Mixed Methods Appraisal Tool was used to assess methodological quality. FINDINGS Digital health has been less extensively utilized in rural oncology compared with the general cancer population and other chronic diseases. We identified 54 studies that used technology in rural cancer care delivery, a comparatively small number, representing a significant gap in the literature. Studies were classified into 4 categories: Telemedicine (n = 32), phone calls (n = 11), Internet (n = 9), and mobile phone (n = 2). Of the 54 articles, 12 were RCTs, 17 were quasi-experimental, 3 were descriptive, 12 were mixed methods, and 10 were qualitative. Most of the studies involved patients only (n = 31) and were not specific to a cancer type (n = 41). CONCLUSIONS Further implementation and expansion of telemedicine and phone-based strategies in rural cancer care delivery are warranted. Rural cancer survivors value digital approaches to their care. However, social and behavioral determinants of health and access to technology must be considered.
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Affiliation(s)
- Bonny B Morris
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Brianna Rossi
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Bernard Fuemmeler
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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Statz M, Evers K. Spatial barriers as moral failings: What rural distance can teach us about women's health and medical mistrust author names and affiliations. Health Place 2020; 64:102396. [PMID: 32739783 PMCID: PMC7391386 DOI: 10.1016/j.healthplace.2020.102396] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/01/2020] [Accepted: 07/09/2020] [Indexed: 11/15/2022]
Abstract
Policy attention to growing rural "health care deserts" tends to identify rural distance as a primary spatial barrier to accessing care. This paper brings together geography, health policy, and ethnographic methods to instead theorize distance as an expansive and illuminating concept that highlights place-based expertise. It specifically engages rural women's interpretations of rural distance as a multifaceted dimension of accessing health care, which includes but is not limited to women's health services and maternity care. Presenting qualitative research with 51 women in a rural region of the U.S., thematic findings reveal an interpretation of barriers to rural health care as moral failings rather than as purely spatial or operational challenges, along with wide communication of negative health care experiences owing to spatially-disparate but trusted social networks. Amid or owing to the rural crisis context, medical mistrust here emerges as a meaningful but largely unrecognized barrier to rural women's ability-and willingness-to obtain health care. This underscores how a novel interpretation of distance may inform policy efforts to address rural medical deserts.
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Affiliation(s)
- Michele Statz
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth Campus 1035 University Dr. Duluth, MN, 55812, USA.
| | - Kaylie Evers
- Medical Student University of Minnesota Medical School, Duluth Campus 1035 University Dr. Duluth, MN, 55812, USA.
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