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Pyne JM, Kelly PA, Fischer EP, Owen RR, Cucciare MA, Miller CJ, Connolly SL, Zamora KA, Koenig CJ, Seal KH, Fortney JC. Trust and perceived mental health access: Exploring the relationship between perceived access barriers and veteran-reported trust. Psychol Serv 2024; 21:102-109. [PMID: 38127502 PMCID: PMC11006371 DOI: 10.1037/ser0000829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
The importance of patients' trust in health care is well known. However, identifying actionable access barriers to trust is challenging. The goal of these exploratory analyses is to identify actionable access barriers that correlate with and predict patients' lack of trust in providers and in the health care system. This article combines existing data from three studies regarding perceived access to mental health services to explore the relationship between provider and system trust and other access barriers. Data from the Perceived Access Inventory (PAI) were analyzed from three studies that together enrolled a total of 353 veterans who screened positive for a mental health problem and had a VA mental health encounter in the previous 12 months. The PAI includes actionable barriers to accessing VA mental health services. The data are cross-sectional, and analyses include Spearman rank correlations of PAI access barriers and provider and system trust, and linear regressions examining the effect of demographic, clinical, and PAI barriers on lack of trust in VA mental health providers and in the VA health care system. Age, depression, and anxiety symptoms and PAI items demonstrated statistically significant bivariate correlations with provider and system trust. However, in multivariate linear regressions, only PAI items remained statistically significant. The PAI items that predicted provider and system trust could be addressed in interventions to improve provider- and system-level trust. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Jeffrey M Pyne
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System
| | - P Adam Kelly
- South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System
| | - Ellen P Fischer
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System
| | - Richard R Owen
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System
| | - Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System
| | - Christopher J Miller
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System
| | - Samantha L Connolly
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System
| | | | | | | | - John C Fortney
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System
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Makaryus AN, Rosen SE, Kang L, Shaw LJ, Nash B, Gajer R, Coppolino W, Mieres JH. Racial and Ethnic Differences in Awareness and Prevalence of Unidentified Cardiovascular Risk Factors Among Health System Employees. Am J Health Promot 2023; 37:1091-1099. [PMID: 37492930 DOI: 10.1177/08901171231192484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
PURPOSE To evaluate awareness about cardiovascular (CVD) risk among a racially and ethnically diverse cohort of health system employees. DESIGN Cross-sectional study. SETTING Voluntary survey of health system employees during an annual CVD awareness and screening event. SUBJECTS 759 health system employees. MEASURES We performed initial CVD screening measurements (blood pressure, body mass index) and collected patient-reported answers to questions about their own CVD risk factors (hypertension, high cholesterol, diabetes, overweight, smoking, physical inactivity and family history of CVD) and whether or not they believed that CVD is preventable. Subjects were offered in-depth follow-up CVD screening (lipid panel, hs-CRP, hemoglobin A1c), if interested. ANALYSIS Continuous measures were compared across sex and racial/ethnic subsets using a t test and analysis of variance technique. Univariable and multivariable logistic regression models were used to estimate the employee's willingness to undergo further comprehensive screening. RESULTS African American, Hispanic, and Asian employees were younger than white employees (P < .0001). More than one-quarter of African Americans reported a history of hypertension, a higher rate than for other subgroups (P = .001). The rate of self-reported diabetes was highest in African American and Asian employees (P = .001). African Americans had a 54% reduced odds of electing to pursue follow-up CVD screening (odds ratio: .46, 95% confidence interval = .24-.91, P = .025). CONCLUSION Presence of CVD risk factors and knowledge of their importance differ among racial and ethnic groups of health system employees in our cohort as does interest in pursuing follow-up screening once risk factors are identified. Development of evidence-based customization strategies by racial and ethnic group may improve understanding of and interest in CVD risk factors and advance prevention. The data from this study will inform future research and strategies for employee health promotion.
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Affiliation(s)
- Amgad N Makaryus
- Department of Cardiology, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, NY, USA
- Department of Cardiology, NuHealth, Nassau University Medical Center, East Meadow, NY, USA
| | - Stacey E Rosen
- Department of Cardiology, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, NY, USA
- Katz Institute for Women's Health at Northwell Health, Lake Success, NY, USA
| | - Leslie Kang
- Katz Institute for Women's Health at Northwell Health, Lake Success, NY, USA
| | - Leslee J Shaw
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Beth Nash
- Katz Institute for Women's Health at Northwell Health, Lake Success, NY, USA
| | - Reva Gajer
- Katz Institute for Women's Health at Northwell Health, Lake Success, NY, USA
| | | | - Jennifer H Mieres
- Department of Cardiology, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, NY, USA
- Katz Institute for Women's Health at Northwell Health, Lake Success, NY, USA
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Blum JD, Ng JJ, Craig J, Smith R, Kota A, Moura SP, Ford AD, Kalluri MH, Garland C, Cho DY. Sociodemographic Disparities in Craniosynostosis: A Systematic Review. Cleft Palate Craniofac J 2023:10556656231199832. [PMID: 37691284 DOI: 10.1177/10556656231199832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
OBJECTIVE Given the consequences of delayed treatment and diagnosis of craniosynostosis, this study reviews the literature on sociodemographic risk factors and disparities associated with delayed craniosynostosis treatment. DESIGN A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search of PubMed/Medline and Embase was performed by two independent reviewers. Included studies discussed craniosynostosis health disparities. Demographic characteristics and outcomes were analyzed. SETTING Not applicable. PATIENTS Patients with craniosynostosis. INTERVENTIONS Standard surgical intervention for craniosynostosis. RESULTS Our literature search yielded 273 studies, of which 18 were included for analysis. Included studies represented data from 31 256 U.S. patients with craniosynostosis. Sixty percent of patients (n = 16 510) were White, 13.8% were Hispanic/Latino, 6.2% were Black/African American, 1.3% were Asian, 0.3% were American Indian or Alaska Native, and 0.1% were Native Hawaiian or Pacific Islander. Average age at surgery was 6.36 months for White patients, 10.63 months for Black patients, and 9.18 months for Hispanic patients. Minority racial and/or ethnic status was a risk factor for delayed presentation, and increased incidence of open surgery, complication rates, hospital charges, operative time, anesthesia duration, and hospital length of stay. Government-funded health insurance was associated with delayed intervention and increased complications. CONCLUSIONS Minority craniosynostosis patients experience delays in intervention and increased complication rates. Our findings highlight the importance of expedited and equitable referrals, screenings, and treatment, and the need for a standardized approach to investigating longitudinal demographic and outcomes data in this population.
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Affiliation(s)
- Jessica D Blum
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jinggang J Ng
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jasmine Craig
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rachel Smith
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Anchith Kota
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven P Moura
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Avery D Ford
- Georgetown University School of Medicine, Washington, DC, USA
| | - Manasa H Kalluri
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Catharine Garland
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel Y Cho
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Rovner B, Casten R, Nightingale G, Leiby BE, Kelley M, Rising K. Emergency Department Use in Black Individuals With Diabetes. Diabetes Spectr 2023; 36:391-397. [PMID: 37982058 PMCID: PMC10654115 DOI: 10.2337/ds22-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Objective The prevalence of diabetes is higher in Black than in White individuals, and Blacks seek emergency department (ED) care for diabetes more often than Whites. This randomized controlled trial compared the efficacy of a novel intervention called the Diabetes Interprofessional Team to Enhance Adherence to Medical Care (DM I-TEAM) to usual medical care (UMC) to prevent return diabetes-related ED visits and hospitalizations over 12 months in 200 Black individuals with diabetes after an ED visit. The trial also identified baseline variables associated with return ED visits and hospitalizations. Methods The DM I-TEAM provided diabetes education and behavioral activation services delivered by race-concordant research assistants, telehealth visits with a diabetes care and education specialist and primary care physicians, and clinical pharmacist recommendations. Results Participants had a mean age of 64.9 years, and 73.0% were women. There was no treatment group difference in return diabetes-related ED visits or hospitalizations over 12 months (DM I-TEAM n = 39 [45.3%] vs. UMC n = 37 [38.5%], χ2 = 0.864, P = 0.353). Baseline variables that were associated with return diabetes-related ED visits or hospitalizations were longer duration of diabetes, higher number of chronic health conditions, higher number of previous ED visits or hospitalizations, greater anticholinergic medication burden, lower satisfaction with primary care physicians, and lower trust in physicians (all P ≤0.05). Conclusion Among Black individuals with diabetes, the DM I-TEAM interprofessional intervention was no better than UMC at preventing return diabetes-related ED visits or hospitalizations. High medical morbidity, greater anticholinergic medication burden, low satisfaction with primary care physicians, and physician mistrust were associated with diabetes-related ED visits or hospitalizations independent of treatment. Before clinical interventions such as the DM I-TEAM can be effective, reducing system-level barriers to health, improving physician-patient relationships and medication prescribing, and building community health care capacity will be necessary.
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Affiliation(s)
- Barry Rovner
- Departments of Neurology, Psychiatry, and Ophthalmology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Robin Casten
- Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Ginah Nightingale
- Jefferson College of Pharmacy at Thomas Jefferson University, Philadelphia, PA
| | - Benjamin E. Leiby
- Division of Biostatistics, Department of Pharmacology, Physiology, and Cancer Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Megan Kelley
- Department of Neurology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Kristin Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
- Center for Connected Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Turner NR, Freitag C, Johnson I, Parsey CM, Ramirez M, Berridge C. The Role of Trust in Older Adult Service Provision at the Onset of the COVID-19 Pandemic. J Gerontol Soc Work 2023; 66:739-762. [PMID: 36617864 PMCID: PMC10329095 DOI: 10.1080/01634372.2022.2164821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic caused near immediate service delivery adaptation among social service and healthcare sectors. Findings from in-depth interviews with 45 senior leaders of social services and healthcare organizations serving older adults in Washington State elucidate the role of trust in service provision at the onset of the pandemic. First, a history of trust facilitated service adaptation. Intentional outreach, programs, and culturally responsive services sustained trust with service recipients. Providing services and information in an older adult's preferred language built trust. Community networks facilitated and reflected trust between organizations and older adults. Finally, mistrust was prevalent for clients who perceived a high risk of experiencing negative consequences from accessing services. Our findings support the need for culturally and linguistically diverse services. To improve trust, the aging network should strengthen and expand partnerships with community-based organizations who have established trust through history, intentionality, and relevance to their service populations..
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Affiliation(s)
- Natalie R. Turner
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Callie Freitag
- Evans School of Public Policy & Governance, University of Washington, Seattle, Washington, USA
| | - Ian Johnson
- College of Social Work, University of Tennessee Knoxville, Tennessee, USA
| | - Carolyn M. Parsey
- School of Medicine, Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Magaly Ramirez
- School of Public Health, Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Clara Berridge
- School of Social Work, University of Washington, Seattle, Washington, USA
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Dauria EF, Clemenzi-Allen A, Nowotny K, Brinkley-Rubinstein L, Williams B, Wurcel A. Increasing availability of COVID-19 vaccine to older adults under community supervision. Int J Prison Health 2022; ahead-of-print:10.1108/IJPH-06-2022-0035. [PMID: 36367307 PMCID: PMC10114607 DOI: 10.1108/ijph-06-2022-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Vaccinating adults who are involved with the carceral system, particularly those aged 55 or older, is crucial to containing the COVID-19 pandemic in the USA, particularly as variants continue to emerge and spread. In this Viewpoint, the authors discuss the reasons why improving access to COVID-19 vaccine and boosters among community supervised adults, especially the aging population, is critical to mitigating the public health consequences of the COVID-19 pandemic. This study concludes by providing recommendations to enhance vaccine and booster uptake in this population, as the pandemic continues. DESIGN/METHODOLOGY/APPROACH This is a Viewpoint paper regarding mitigating the spread of COVID-19 by improving access to vaccine and boosters among community supervised adults, especially the aging population. FINDINGS A key population that has been overlooked in vaccination efforts are older adults involved in the carceral system who are living in the community (i.e. "community supervised" or people on probation or parole). Older adults on probation and parole are at high risk for SARS-CoV-2 transmission and severe disease due to numerous factors at the individual, community, social and structural levels. ORIGINALITY/VALUE Implementation of recommendations presented in this Viewpoint will mitigate COVID-19 risk among a population that has been marginalized and overlooked, yet has been the epicenter of the COVID-19 pandemic.
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Affiliation(s)
- Emily F. Dauria
- University of Pittsburgh, Graduate School of Public Health, Department of Behavioral and Community Health Sciences, Pittsburgh, PA, USA
| | - Angelo Clemenzi-Allen
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Kathryn Nowotny
- Department of Sociology, University of Miami, Coral Gables, Florida, USA
| | - Lauren Brinkley-Rubinstein
- University of North Carolina, Chapel Hill, Department of Social Medicine, Center for Health Equity Research, Chapel Hill, NC, USA
| | - Brie Williams
- Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Alysse Wurcel
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
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Choi EPH, Hui BPH, Wan EYF, Kwok JYY, Lok KYW, Lee JJ. Using the Revised Health Care System Distrust Scale to evaluate healthcare distrust among Chinese men in Hong Kong: An analysis from a prostate cancer screening behaviours survey. Health Soc Care Community 2022; 30:e4694-e4704. [PMID: 35698821 DOI: 10.1111/hsc.13875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 04/14/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
Information about the level of distrust in healthcare systems is very limited in Chinese populations, and no validated instrument has been developed to measure this distrust. Therefore, to begin addressing this research gap, this study evaluated the psychometric properties of a traditional Chinese version of the Revised Health Care System Distrust Scale and used it to assess the level of distrust in a healthcare system. The study involved a community-based personal interview survey of individuals in Hong Kong. A total of 340 men were randomly recruited. In addition to the distrust instrument, the two-item Trust in Physician Scale and the Patient Health Questionnaire-9 were used. The two-factor structure of the distrust scale was confirmed. The item-total correlations corrected for overlap were >0.4 for both the Competence and Values Distrust subscales, confirming the internal construct validity of the scale. The Cronbach's alpha coefficient was 0.77 for both subscales. The scores of both the Competence and Values subscales were moderately negatively correlated with the total score of the Trust in Physician Scale, providing support for convergent validity. Regarding known-group validity, the scale could differentiate people according to marital status, monthly personal income and severity of depressive symptoms. Moreover, we found that men who had previously undergone prostate cancer screening had higher Values Distrust scores than those who had not. The descriptive analysis showed that only about half of the participants reported that they received high-quality medical care and that the healthcare system provided excellent medical care, suggesting that more effort is needed to improve the quality of care and people's satisfaction with healthcare in Hong Kong. In summary, the translated traditional Chinese version of the Revised Health Care System Distrust Scale used in this study is a valid and reliable scale for assessing the level of distrust in a healthcare system.
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Affiliation(s)
- Edmond P H Choi
- School of Nursing, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Bryant P H Hui
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Eric Y F Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Jojo Y Y Kwok
- School of Nursing, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Kris Y W Lok
- School of Nursing, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Jung Jae Lee
- School of Nursing, The University of Hong Kong, Pok Fu Lam, Hong Kong
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Ezell JM, Alsmadi I, Gosnell N, Kaur A. The racial and cultural ecology of home and community-based services for diverse older adults. J Aging Stud 2022; 61:101023. [DOI: 10.1016/j.jaging.2022.101023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 11/19/2022]
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Beller J, Schäfers J, Haier J, Geyer S, Epping J. Trust in Healthcare during COVID-19 in Europe: vulnerable groups trust the least. Z Gesundh Wiss 2022; 31:1-10. [PMID: 35345647 PMCID: PMC8944407 DOI: 10.1007/s10389-022-01705-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/06/2022] [Indexed: 12/30/2022]
Abstract
Aim We examined predictors of trust in the healthcare system during the COVID-19 pandemic in 27 European countries. Subjects and methods We used population-based data drawn from the Living, working and COVID-19 survey (N = 21,884, 52% female, ages 18 to 92 years) covering 27 European countries dated June and July 2020. Multilevel linear regression, linear regression, and regression-tree analyses were conducted. Results We found that most participants tended to trust the healthcare system, although a substantial part could still be classified as distrusting (approx. 21%). Multiple variables, including being middle-aged or of older age, being female, lower levels of education, unemployment, worse general health status, having income difficulties, having unmet needs for healthcare, no healthcare contact during the COVID-19 pandemic, higher mental distress, and loneliness, were significantly associated with lower levels of trust. Among these variables mental distress, income difficulties, and unmet needs for healthcare emerged as especially important and, across European regions and countries, consistent predictors for lower trust in the healthcare system during the COVID-19 pandemic. Conclusions Medically vulnerable subgroups, such as individuals with unmet healthcare needs, higher levels of mental distress, and older age, as well as people living in socially and economically vulnerable situations, such as higher levels of loneliness and financial difficulties, were the least trusting of the healthcare system during the COVID-19 pandemic. As these vulnerable subgroups are also at highest risk for contracting COVID-19 and experiencing negative COVID-19-related outcomes, more targeted prevention and intervention efforts should be implemented in these groups. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-022-01705-3.
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Affiliation(s)
- Johannes Beller
- Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jürgen Schäfers
- Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jörg Haier
- Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Siegfried Geyer
- Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jelena Epping
- Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Dellafiore F, Arrigoni C, Nania T, Caruso R, Baroni I, Vangone I, Russo S, Barello S. The impact of COVID-19 pandemic on family caregivers' mental health: a rapid systematic review of the current evidence. Acta Biomed 2022; 93:e2022154. [PMID: 35545977 PMCID: PMC9534216 DOI: 10.23750/abm.v93is2.12979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Older adults, especially in isolation and with cognitive decline/dementia, can become more anxious and stressed during the quarantine. All these symptoms negatively affect the psycho-physical health of their caregivers. This study aimed to synthesize the current evidence on the impact of the COVID-19 pandemic on caregivers' mental health. METHODS A rapid systematic review was conducted using the following databases: Pubmed/Medline, CINAHL, Scopus, and PsycInfo (PROSPERO registration number: CRD42020215485). The 'PRISMA' flow chart guided the selection of articles. The search was entirely performed up to September 15th, 2021. RESULTS The narrative synthesis has brought out two main themes that represent the current debate in literature: "Family caregivers COVID-19 related stress", and "(Mal)adaptive strategies to the "new" normality". CONCLUSIONS This study provides an evidence synthesis of the negative mental health impact experienced by caregivers of older adults during the COVID-19 pandemic.
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Affiliation(s)
- Federica Dellafiore
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Tiziana Nania
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato (MI), Department of Psychology, EngageMinds HUB – Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato (MI)
| | - Irene Baroni
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato (MI)
| | - Ida Vangone
- Department of Oncology and Hematology-Oncology, IEO IEO-European Institute of Oncology, Milan, Italy
| | - Sara Russo
- Nursing degree course, University of Pavia, section Istituti Clinici di Pavia e Vigevano S.p.A., Pavia, Italy
| | - Serena Barello
- Department of Psychology, EngageMinds HUB – Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
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Jones AL, Fine MJ, Taber PA, Hausmann LR, Burkitt KH, Stone RA, Zickmund SL. National Media Coverage of the Veterans Affairs Waitlist Scandal: Effects on Veterans' Distrust of the VA Health Care System. Med Care 2021; 59:S322-S326. [PMID: 33976083 PMCID: PMC8121177 DOI: 10.1097/mlr.0000000000001551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND On April 23, 2014, US media outlets broadcast reports of excessive wait times and "secret" waitlists at some Veterans Affairs (VA) hospitals, precipitating legislation to increase Veterans' access to private sector health care. OBJECTIVE The aims were to assess changes in Veterans' distrust in the VA health care system before and after the media coverage and explore sex and racial/ethnic differences in the temporal patterns. METHODS Veterans completed semistructured interviews on health care satisfaction from June 2013 to January 2015, including a validated scale of health system distrust (range: 1-5). We used linear splines with knots at 90-day intervals to assess changes in distrust before and after April 23, 2014 ("day 0") in linear mixed models. To explore sex and racial/ethnic differences in temporal patterns, we stratified models by sex and tested for interactions of race/ethnicity with time. RESULTS For women (n=600), distrust scores (mean=2.09) increased by 0.45 in days 0-90 (P<0.01), then decreased by 0.45 in days 90-180 (P<0.01). Among men (n=575), distrust scores (mean=2.05) increased by 0.18 in days 0-90 (P=0.059). Distrust levels were significantly higher for Black versus White women (time adjusted mean difference=0.21) and for Black and Hispanic versus White men (differences=0.26 and 0.18). However, the temporal patterns did not vary by race/ethnicity for women or men (interaction P=0.85 and 0.21, respectively). CONCLUSIONS Health system distrust increased in women following media coverage of VA access problems and was higher in Black/Hispanic versus White Veterans at all time periods. Such perceptions could influence Veteran decisions to seek health care in the community rather than VA.
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Affiliation(s)
- Audrey L. Jones
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT
| | - Michael J. Fine
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion
- Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Peter A. Taber
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT
| | - Leslie R.M. Hausmann
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion
- Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kelly H. Burkitt
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion
| | - Roslyn A. Stone
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion
| | - Susan L. Zickmund
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT
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12
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Wang M, Li M, Dong X. The Associations Between Sociodemographic Characteristics and Trust in Physician With Immunization Service Use in U.S. Chinese Older Adults. Res Aging 2021; 44:164-173. [PMID: 33938299 DOI: 10.1177/01640275211011048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study investigated sociodemographic factors for immunization care use and the relationship between trust in physician (TIP) and immunization service use in older Chinese Americans. Data were collected through the Population Study of Chinese Elderly, including survey information of 3,157 older adults in the Greater Chicago area. Regression results showed that the odds of getting vaccinated were higher for those who were older, female, and had higher education and income. After adjusting for the covariates, higher TIP was associated with greater immunization service use. The highest tertile of TIP was associated with higher odds of using immunization service (OR 2.19, 95% CI [1.76, 2.72]), especially for flu and pneumonia vaccines. Findings suggests that immunization service use may be increased by improving TIP and promoting targeted health care management plans for racial/ethnic minorities, which is highly relevant to increase the vaccination rate and contain the pandemic as the COVID-19 vaccine is available.
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Affiliation(s)
- Mengxiao Wang
- School of Public Administration, 12603Southwestern University of Finance and Economics, Chengdu, China
| | - Mengting Li
- Institute for Health, Health Care Policy and Aging Research, 242612Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.,School of Nursing, 242612Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - XinQi Dong
- Institute for Health, Health Care Policy and Aging Research, 242612Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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13
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Thomas KS, Corneau E, H Van Houtven C, Cornell P, Aron D, M Dosa D, M Allen S. Inequities in access to VA'S aid and attendance enhanced pension benefit to help Veterans pay for long-term care. Health Serv Res 2021; 56:389-399. [PMID: 33634467 DOI: 10.1111/1475-6773.13636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine characteristics that are associated with receipt of Aid and Attendance (A&A), an enhanced pension benefit for Veterans who qualify on the basis of needing daily assistance, among Veterans who receive pensions. DATA SOURCES Secondary data analysis of 2016-2017 national VA administrative data linked with Medicare claims. STUDY DESIGN Observational study examining sociodemographic, medical, and healthcare utilization characteristics associated with receipt of A&A among Veterans receiving pension. PRINCIPAL FINDINGS In 2017, 9.7% of Veterans with pension newly received the A&A benefit. The probability of receiving A&A among black and Hispanic pensioners was 4.6 percentage points lower than for white pensioners (95%CI = -0.051, -0.042). Married Veterans receiving pension had a 4.4-percentage point higher probability of receiving A&A (95%CI = 0.039, 0.048). Most indicators of need for assistance (eg, home health utilization, dementia, stroke) were associated with significantly higher probabilities of receiving A&A, with notable exceptions: pensioners with a diagnosis of Post-Traumatic Stress Disorder (marginal effect = -0.029 95%CI = -0.037, -0.021) or enrolled in Medicaid (marginal effect = -0.053, 95%CI = -0.057, -0.050) had lower probabilities of receiving A&A. Unadjusted and adjusted rates of receiving A&A among Veterans receiving pension varied by VA medical center. CONCLUSIONS This study identified potential inequities in receipt of the A&A enhanced pension among a sample of Veterans receiving pension. Increased Veteran outreach, provider education, and VA office coordination can potentially reduce inequities in access to this benefit.
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Affiliation(s)
- Kali S Thomas
- Providence VA Medical Center, Providence, Rhode Island, USA.,School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Emily Corneau
- Providence VA Medical Center, Providence, Rhode Island, USA
| | - Courtney H Van Houtven
- Durham VA Medical Center, Durham, North Carolina, USA.,Duke University School of Medicine, Durham, North Carolina, USA
| | - Portia Cornell
- Providence VA Medical Center, Providence, Rhode Island, USA.,School of Public Health, Brown University, Providence, Rhode Island, USA
| | - David Aron
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA.,School of Medicine, Case Western Reserve, Cleveland, Ohio, USA
| | - David M Dosa
- Providence VA Medical Center, Providence, Rhode Island, USA.,School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Susan M Allen
- School of Public Health, Brown University, Providence, Rhode Island, USA
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14
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Estrada LV, Agarwal M, Stone PW. Racial/Ethnic Disparities in Nursing Home End-of-Life Care: A Systematic Review. J Am Med Dir Assoc 2021; 22:279-290.e1. [PMID: 33428892 DOI: 10.1016/j.jamda.2020.12.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Health disparities are pervasive in nursing homes (NHs), but disparities in NH end-of-life (EOL) care (ie, hospital transfers, place of death, hospice use, palliative care, advance care planning) have not been comprehensively synthesized. We aim to identify differences in NH EOL care for racial/ethnic minority residents. DESIGN A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and registered in PROSPERO (CRD42020181792). SETTING AND PARTICIPANTS Older NH residents who were terminally ill or approaching the EOL, including racial/ethnic minority NH residents. METHODS Three electronic databases were searched from 2010 to May 2020. Quality was assessed using the Newcastle-Ottawa Scale. RESULTS Eighteen articles were included, most (n = 16) were good quality and most (n = 15) used data through 2010. Studies varied in definitions and grouping of racial/ethnic minority residents. Four outcomes were identified: advance care planning (n = 10), hospice (n = 8), EOL hospitalizations (n = 6), and pain management (n = 1). Differences in EOL care were most apparent among NHs with higher proportions of Black residents. Racial/ethnic minority residents were less likely to complete advance directives. Although hospice use was mixed, Black residents were consistently less likely to use hospice before death. Hispanic and Black residents were more likely to experience an EOL hospitalization compared with non-Hispanic White residents. Racial/ethnic minority residents experienced worse pain and symptom management at the EOL; however, no articles studied specifics of palliative care (eg, spiritual care). CONCLUSIONS AND IMPLICATIONS This review identified NH health disparities in advance care planning, EOL hospitalizations, and pain management for racial/ethnic minority residents. Research is needed that uses recent data, reflective of current NH demographic trends. To help reduce EOL disparities, language services and cultural competency training for staff should be available in NHs with higher proportions of racial/ethnic minorities.
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Affiliation(s)
- Leah V Estrada
- Columbia University School of Nursing, New York, NY, USA.
| | - Mansi Agarwal
- Columbia University School of Nursing, New York, NY, USA
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15
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Stanley SJ, Chatham AP, Trivedi N, Aldoory L. Communication and Control: Hearing the Voices of Low-Income African American Adults to Improve Relationships with Healthcare Providers. Health Commun 2020; 35:1633-1642. [PMID: 31418297 DOI: 10.1080/10410236.2019.1654177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Patient-provider relationships can either impede or encourage patient utilization of healthcare services and adherence to treatment. Given the significant health disparities found among low-income African Americans, it is imperative to understand this population's experiences with healthcare providers and how to improve their patient-provider relationships in order to increase successful treatment outcomes. Relationship management is a well-tested theory that examines factors that improve outcomes between organizations and their publics. This exploratory study uses relationship management theory to understand how African Americans who are medically underserved perceive the quality of their relationships with healthcare providers. Focus groups were held with low-income African American adults. Findings reveal that communication is key to improving trust, but other characteristics needed for a quality relationship were lacking, particularly perceived commitment, which impedes better healthcare. The low-income, medically underserved context influenced participant perceptions of factors such as commitment, but participants also expressed efficacy in feeling in control of healthcare situations, which may help them maintain quality relationships. This study offers theoretical elaboration as well as practical suggestions for how providers may wish to address an important population of patients through communication.
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Affiliation(s)
| | | | - Neha Trivedi
- Department of Behavioral & Community Health, University of Maryland
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16
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Ferguson E, Hill A, Lam M, Reynolds C, Davison K, Lawrence C, Brailsford SR. A typology of blood donor motivations. Transfusion 2020; 60:2010-2020. [PMID: 32618010 DOI: 10.1111/trf.15913] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Although the need for whole blood is declining, so too are the number of first-time and repeat blood donors. To develop new recruitment and retention strategies, therefore, we need to draw on as wide a variation in blood donor motivations as possible. The primary aim of this study is to draw on a large survey of donors to develop a broad, theoretically instantiated typology of donor motivations to identify new and less common, yet practically important, motivations that have not been previously reported. STUDY DESIGN AND METHODS Using data from the UK Blood Donor Survey run by NHS Blood and Transplant/Public Health England Epidemiology Unit (N = 61 123 donors), we analyze fixed (N = 52 225) and free (N = 8867) responses to develop a more comprehensive typology of blood donor motivations based on theories from the biology, psychology, philosophy, economics, and sociology of altruism. RESULTS We identified 54 motivations, including a number of newly identified motivations, for blood donations which we organized into 12 superordinate categories (eg, "inspiration via moral elevation," "perceived social closeness," and "fungibility of donations"). These are linked to intervention suggestions such as donating blood in memoriam or donating blood as an alternative to other charitable acts. CONCLUSION We present the most comprehensive account of blood donor motivations to-date. This work also offers a structure for coding free-text responses, developing motivational measures, and identifying tangible interventions. Thus, we feel that this is a valuable resource for blood donor researchers, marketers, and policy makers.
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Affiliation(s)
- Eamonn Ferguson
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Alexandra Hill
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Michael Lam
- School of Psychology, University of Nottingham, Nottingham, UK.,School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Claire Reynolds
- NHS Blood and Transplant/Public Health England Epidemiology Unit, NHS Blood and Transplant, London, UK
| | - Katy Davison
- NHS Blood and Transplant/Public Health England Epidemiology Unit, Public Health England, London, UK
| | - Claire Lawrence
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Susan R Brailsford
- NHS Blood and Transplant/Public Health England Epidemiology Unit, NHS Blood and Transplant, London, UK
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17
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Casten R, Rovner B, Chang AM, Hollander JE, Kelley M, Leiby B, Nightingale G, Pizzi L, White N, Rising K. A randomized clinical trial of a collaborative home-based diabetes intervention to reduce emergency department visits and hospitalizations in black individuals with diabetes. Contemp Clin Trials 2020; 95:106069. [PMID: 32561466 DOI: 10.1016/j.cct.2020.106069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/29/2020] [Accepted: 06/12/2020] [Indexed: 01/22/2023]
Abstract
The prevalence of diabetes mellitus (DM) in black individuals (blacks) is twice that of white individuals (whites), and blacks are more likely to have worse glycemic control, less optimal medication regimens, and higher levels of mistrust in the medical system. These three factors account for higher rates of acute medical care use in blacks with DM. To address this disparity, we developed DM I-TEAM (Diabetes Interprofessional Team to Enhance Adherence to Medical Care), a home-based multidisciplinary behavioral intervention that integrates care from a community health worker (CHW), the participant's primary care physician (PCP), a DM nurse educator, and a clinical pharmacist. Treatment is delivered during 9 sessions over 1 year, and includes diabetes education and goal setting, telehealth visits with participants' PCP and a DM nurse educator, and comprehensive medication reviews by a pharmacist. We describe the rationale and methods for a randomized controlled trial to test the efficacy of DM I-TEAM to reduce emergency department (ED) visits and hospitalizations. We are enrolling 200 blacks with DM during an ED visit. Participants are randomized to DM I-TEAM or Usual Medical Care (UMC). Follow-up assessments are conducted at 6 and 12 months. The primary outcome is the number of ED visits and hospitalizations over 12 months, and is measured by participant self-report and medical record review. Secondary outcomes include hemoglobin A1c (HbA1c), number of potentially inappropriate medications (PIMs), and trust in health care.
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Affiliation(s)
- Robin Casten
- Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College at Thomas, Jefferson University, United States of America.
| | - Barry Rovner
- Departments of Neurology, Psychiatry, and Ophthalmology, Sidney Kimmel Medical College at Thomas Jefferson University, United States of America
| | - Anna Marie Chang
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, United States of America
| | - Judd E Hollander
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, United States of America
| | - Megan Kelley
- Department of Neurology, Sidney Kimmel Medical College at Thomas Jefferson University, United States of America
| | - Benjamin Leiby
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College at Thomas Jefferson University, United States of America
| | - Ginah Nightingale
- Jefferson College of Pharmacy at Thomas Jefferson University, United States of America
| | - Laura Pizzi
- Center for Health Outcomes, Policy, and Economics, Ernest Mario School of Pharmacy, Rutgers University, United States of America
| | - Neva White
- Center for Urban Health, Thomas Jefferson University Hospital, United States of America
| | - Kristin Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, United States of America
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18
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Sadeghi Bazargani H, Saadati M, Tabrizi JS, Farahbakhsh M, Golestani M. Forty years after Alma-Ata: how people trust primary health care? BMC Public Health 2020; 20:942. [PMID: 32539779 PMCID: PMC7296754 DOI: 10.1186/s12889-020-09082-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/10/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Primary Health Care (PHC) was introduced as the first level of health services delivery after Alma-Ata declaration. However, after forty years, it needs to be more trustful to achieve its predefined objectives. Public trust in PHC is one of the neglected issues in the context. The aim of this study is to evaluate public trust in PHC in Iran. METHODS The present investigation is a household survey conducted in East Azerbaijan Province, Iran. Two-stage cluster sampling method with Probability Proportional to Size (PPS) approach was used. Totally, 1178 households were enrolled in the study. PHC trust questionnaire and Ultra-short version of Socio-Economic Status assessment questionnaire (SES-Iran) was used for data collection. Data were analyzed using STATA software (version 15) through descriptive statistics and linear regression. RESULTS The mean ± SD age of the participants was 41.2 ± 15.1 and most (53.7%) were female. Mean score of PHC trust was 56.9 ± 24.7 (out of 100). It was significantly different between residents of Tabriz (the capital of province) and other cities in the province (p < 0.001). Linear regression showed that younger age, gender, insurance type, being married, and households higher socio-economic status had a significant positive effect on PHC trust level with R2 = 0.14383. CONCLUSIONS Public trust in PHC system in Iran needs to be improved. Individual variables had a small but key role in trust level. PHC trust cannot be only affected by individual's variables and experiences but also by health system and health providers' characteristics and public context in which PHC system exists. PHC trust level could be used as a public indicator in health systems especially in Low and Middle Income Countries (LMIC) to contribute in system strengthening policies at the national and international levels.
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Affiliation(s)
| | - Mohammad Saadati
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Jafar Sadegh Tabrizi
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mostafa Farahbakhsh
- Psychiatrics Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mina Golestani
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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19
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Affiliation(s)
- Mary D. Naylor
- Marian S. Ware Professor in Gerontology, Director of the NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Karen B. Hirschman
- Research Associate Professor, NewCourtland Term Chair in Health Transitions Research, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Kathleen McCauley
- Professor of Cardiovascular Nursing, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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20
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Pinchas-mizrachi R, Zalcman BG, Daoud N. Trust in the Israeli Healthcare System Among Arabs, Jewish Immigrants, and Non-immigrants. Int J Behav Med 2020; 27:647-59. [DOI: 10.1007/s12529-020-09902-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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21
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Abstract
OBJECTIVE Older African Americans may underutilize mental health services, although they experience mental health problems at rates comparable with those of whites. Untreated mental disorders contribute to increased risk of morbidity and mortality and decreased quality of life, and therefore, understanding the factors that influence racial disparities in service use is critical. This study examined whether county characteristics were associated with mental health service use by older African Americans after the analyses adjusted for individual characteristics. METHODS This study combined individual-level data from the 2008-2012 Medical Expenditure Panel Survey with county-level data for 2008-2012 from the 2013-2014 Area Health Resources Files and county-level data from the 2008-2012 Chronic Conditions Report of the Chronic Conditions Data Warehouse for 1,567 community-dwelling African Americans ages 60 and older. Multilevel logistic regressions were used to examine the role of county characteristics on mental health services use with adjustment for individual-level risk factors. RESULTS At the county level, individuals living in a county with a higher proportion of African Americans were less likely to use mental health services. At the individual level, higher income and mental health status were associated with mental health service utilization. CONCLUSIONS Among older African Americans, the racial composition of one's county of residence played a role in mental health service use, indicating the need for future research focusing on the relationship between an area's racial composition and mental health service use. Programs may be able to ameliorate racial disparities in mental health care by targeting areas with a higher percentage of African Americans.
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Affiliation(s)
- Kyeongmo Kim
- Virginia Commonwealth University School of Social Work, Richmond (Kim); University of Maryland School of Social Work, Baltimore (Lehning, Sacco)
| | - Amanda J Lehning
- Virginia Commonwealth University School of Social Work, Richmond (Kim); University of Maryland School of Social Work, Baltimore (Lehning, Sacco)
| | - Paul Sacco
- Virginia Commonwealth University School of Social Work, Richmond (Kim); University of Maryland School of Social Work, Baltimore (Lehning, Sacco)
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22
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Webb Hooper M, Mitchell C, Marshall VJ, Cheatham C, Austin K, Sanders K, Krishnamurthi S, Grafton LL. Understanding Multilevel Factors Related to Urban Community Trust in Healthcare and Research. Int J Environ Res Public Health 2019; 16:ijerph16183280. [PMID: 31500126 PMCID: PMC6765868 DOI: 10.3390/ijerph16183280] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/31/2019] [Accepted: 09/02/2019] [Indexed: 12/19/2022]
Abstract
Background: Community and patient engagement in the healthcare system and biomedical research are prerequisites for eliminating health disparities. We conducted a “listening tour” to enhance our understanding of multilevel factors associated with community trust. Methods: Using community-based participatory research (CBPR) methods, we conducted a phenomenological qualitative study. “Town-hall” style discussions were held at nine sites across an urban, Midwestern city. We recruited adults (N = 130) via community networks, social media, flyers, and word-of-mouth. Demographic assessments were self-administered and listening tour sessions were conducted by trained moderators. Themes were framed within the social ecological model (SEM; intrapersonal, interpersonal, institutional, community, and policy levels). Results: Participants were mostly female (68%), African American (80%), had health coverage (97%) and were diagnosed with a chronic health condition (71%). The overarching theme was sociodemographic differences in distrust, such that African Americans and deaf/hearing impaired participants perceived disparities in healthcare, a lower quality of care, and skepticism about biomedical research, relative to Whites. Conclusions: The depth of distrust for healthcare providers, systems, and researchers in underserved communities remains strong and complex. Findings highlight the need to understand the lived experiences of community members, and how distrust is maintained. Multilevel interventions to increase trust and the accrual of underrepresented populations into clinical trials are needed.
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Affiliation(s)
- Monica Webb Hooper
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA.
| | - Charlene Mitchell
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Vanessa J Marshall
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA
- University Hospitals Cleveland Medical Center, Seidman Cancer Center, Cleveland, OH 44106, USA
| | - Chesley Cheatham
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA
- University Hospitals Cleveland Medical Center, Seidman Cancer Center, Cleveland, OH 44106, USA
| | | | - Kimberly Sanders
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195, USA
| | - Smitha Krishnamurthi
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195, USA
| | - Lena L Grafton
- NEOMED-CSU Partnership for Urban Health, Cleveland State University, Cleveland, OH 44115, USA
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23
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Mullins MA, Peres LC, Alberg AJ, Bandera EV, Barnholtz-Sloan JS, Bondy ML, Funkhouser E, Moorman PG, Peters ES, Terry PD, Schwartz AG, Lawson AB, Schildkraut JM, Cote ML. Perceived discrimination, trust in physicians, and prolonged symptom duration before ovarian cancer diagnosis in the African American Cancer Epidemiology Study. Cancer 2019; 125:4442-4451. [PMID: 31415710 DOI: 10.1002/cncr.32451] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Discrimination and trust are known barriers to accessing health care. Despite well-documented racial disparities in the ovarian cancer care continuum, the role of these barriers has not been examined. This study evaluated the association of everyday discrimination and trust in physicians with a prolonged interval between symptom onset and ovarian cancer diagnosis (hereafter referred to as prolonged symptom duration). METHODS Subjects included cases enrolled in the African American Cancer Epidemiology Study, a multisite case-control study of epithelial ovarian cancer among black women. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for associations of everyday discrimination and trust in physicians with a prolonged symptom duration (1 or more symptoms lasting longer than the median symptom-specific duration), and it controlled for access-to-care covariates and potential confounders. RESULTS Among the 486 cases in this analysis, 302 women had prolonged symptom duration. In the fully adjusted model, a 1-unit increase in the frequency of everyday discrimination increased the odds of prolonged symptom duration 74% (OR, 1.74; 95% CI, 1.22-2.49), but trust in physicians was not associated with prolonged symptom duration (OR, 0.86; 95% CI, 0.66-1.11). CONCLUSIONS Perceived everyday discrimination was associated with prolonged symptom duration, whereas more commonly evaluated determinants of access to care and trust in physicians were not. These results suggest that more research on the effects of interpersonal barriers affecting ovarian cancer care is warranted.
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Affiliation(s)
- Megan A Mullins
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Lauren C Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Anthony J Alberg
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Elisa V Bandera
- Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Melissa L Bondy
- Cancer Prevention and Population Sciences Program, Baylor College of Medicine, Houston, Texas
| | - Ellen Funkhouser
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Patricia G Moorman
- Cancer Control and Population Sciences, Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Edward S Peters
- Epidemiology Program, Louisiana State University Health Sciences Center School of Public Health, New Orleans, Louisiana
| | - Paul D Terry
- Department of Medicine, Graduate School of Medicine, University of Tennessee, Knoxville, Tennessee
| | - Ann G Schwartz
- Population Studies and Disparities Research Program, Department of Oncology, Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, Michigan
| | - Andrew B Lawson
- Hollings Cancer Center and Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Joellen M Schildkraut
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Michele L Cote
- Population Studies and Disparities Research Program, Department of Oncology, Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, Michigan
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24
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Cockroft JD, Adams SM, Matlock D, Dietrich MS. Reliability and construct validity of 3 psychometric trust scales for women seeking substance abuse treatment in a community setting. Subst Abus 2019; 41:391-399. [PMID: 31368857 DOI: 10.1080/08897077.2019.1635967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: Women with a history of substance use disorder (SUD) constitute a unique population with gender-specific needs in treatment. Most notable is high rates of prior trauma and the need for a trauma-informed care framework. Given theoretical links between trauma and interpersonal trust, understanding quantitatively how trust may impact outcomes for women in this population requires confirmation of validity of existing psychometric instruments. Objective: This study sought to confirm reliability and construct validity of the Rotter Interpersonal Trust Scale, Wake Forest Trust in Physician Scale, and the Revised Health Care System Distrust Scale (RHCSDS) for use in women with a history of SUD seeking treatment in a community-based setting. Methods: A total of 301 participants were enrolled between August 2017 and March 2018 at an urban, community-based residential substance abuse treatment program in the mid-South. Participants were given an electronic survey containing questions about demographics/clinical characteristics, the Rotter, Wake Forest, and RHCSDS scales, Socially Desirable Response Five-Item Survey (SDRS-5), and the Adverse Childhood Experiences (ACEs) questionnaire. All participants also completed a modified protocol of the "Trust Game." Statistical analysis was completed for each trust scale in regard to scale means and distribution, internal consistency, interscale correlation, and scale correlation to the ACE score. Results: Results confirm statistically significant (P < .001) differences in global trust and trust of health care providers compared with general population samples in prior studies. Internal consistency of scales is comparable to reliability testing in prior studies (α > .70 for all scales). Interscale correlation between individual scales is statistically significant, with the strongest relationship between the 2 health care-specific scales (r = -.740, P < .001). There was a weak, negative correlation between the ACE score and interpersonal trust (r = -.135, P = .019). Individual scales do not have statistically significant correlation with "Trust Game" scores. Discussion: Findings suggest reliability and construct validity of scales for use in this population.
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Affiliation(s)
| | - Susie M Adams
- Vanderbilt University School of Nursing, Nashville, Tennessee, USA
| | | | - Mary S Dietrich
- Vanderbilt University School of Nursing, Nashville, Tennessee, USA
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25
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Affiliation(s)
- Eamonn Ferguson
- School of Psychology, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Catherine Murray
- Division of Psychology, University of Stirling, Stirling, Scotland
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Chan B, Goldman LE, Sarkar U, Guzman D, Critchfield J, Saha S, Kushel M. High perceived social support and hospital readmissions in an older multi-ethnic, limited English proficiency, safety-net population. BMC Health Serv Res 2019; 19:334. [PMID: 31126336 PMCID: PMC6534878 DOI: 10.1186/s12913-019-4162-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 05/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early readmission amongst older safety-net hospitalized adults is costly. Interventions to prevent early readmission have had mixed success. The role of perceived social support is unclear. We examined the association of perceived social support in 30-day readmission or death in older adults admitted to a safety-net hospital. METHODS This is an observational cohort study derived from the Support From Hospital to Home for Elders (SHHE) trial. Participants were community-dwelling English, Spanish and Chinese speaking older adults admitted to medicine wards at an urban safety-net hospital in San Francisco. We assessed perceived social support using the Multidimensional Scale of Perceived Social Support (MSPSS). We defined high social support as the highest quartile of MSPSS. We ascertained 30-day readmission and mortality based on a combination of participant self-report, hospital and death records. We used multiple/multivariable logistic regression to adjust for patient demographics, health status, and health behaviors. We tested for whether race/ethnicity modified the effect high social support had on 30-day readmission or death by including a race-social support interaction term. RESULTS Participants (n = 674) had mean age of 66.2 (SD 9.0), with 18.8% White, 24.8% Black, 31.9% Asian, and 19.3% Latino. The 30-day readmission or death rate was 15.0%. Those with high social support had half the odds of readmission or death than those with low social support (OR = 0.47, 95% CI 0.26-0.88). Interaction analyses revealed race modified this association; higher social support was protective against readmission or death among minorities (AOR = 0.35, 95% CI 0.16-0.76) but increased likelihood of readmission or death among Whites (AOR = 3.7, 95% CI 1.07-12.9). CONCLUSION In older safety-net patients nearing discharge, high perceived social support may protect against 30-day readmission or death among minorities. Assessing patients' social support may aid targeting of transitional care resources and intervention design. How perceived social support functions across racial/ethnic groups in health outcomes warrants further study. TRIAL REGISTRATION NIH trials registry number ClinicalTrials.gov: NCT01221532 .
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Affiliation(s)
- Brian Chan
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road L475, Portland, OR 97239-3098 USA
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA USA
- Central City Concern, Portland, OR USA
| | - L. Elizabeth Goldman
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA USA
| | - Urmimala Sarkar
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA USA
| | - David Guzman
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA USA
| | - Jeff Critchfield
- Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA USA
| | - Somnath Saha
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road L475, Portland, OR 97239-3098 USA
- VA Portland Health Care System, Portland, OR USA
| | - Margot Kushel
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA USA
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Abstract
Diabetic retinopathy (DR) is more prevalent in blacks than whites because, compared to whites, blacks on average have worse glycemic control. Both of these racial disparities reflect differences in sociocultural determinants of health, including physician mistrust. This randomized, controlled 6-month pilot trial compared the efficacy of a culturally tailored behavioral health/ophthalmologic intervention called Collaborative Care for Depression and Diabetic Retinopathy (CC-DDR) to enhanced usual care (EUC) for improving glycemic control in black patients with DR (n = 33). The mean age of participants was 68 years (SD 6.1 years), 76% were women, and the mean A1C was 8.7% (SD 1.5%). At baseline, 14 participants (42%) expressed mistrust about ophthalmologic diagnoses. After 6 months, CC-DDR participants had a clinically meaningful decline in A1C of 0.6% (SD 2.1%), whereas EUC participants had an increase of 0.2% (SD 1.1%) (f[1, 28] = 1.9; P = 0.176). Within CC-DDR, participants with trust had a reduction in A1C (1.4% [SD 2.5%]), whereas participants with mistrust had an increase in A1C (0.44% [SD 0.7%]) (f[1, 11] = 2.11; P = 0.177). EUC participants with trust had a reduction in A1C (0.1% [SD 1.1%]), whereas those with mistrust had an increase in A1C (0.70% [SD 1.1%]) (f[1, 16] = 2.01; P = 0.172). Mistrust adversely affected glycemic control independent of treatment. This finding, coupled with the high rate of mistrust, highlights the need to target mistrust in new interventions to improve glycemic control in black patients with DR.
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Affiliation(s)
- Barry W Rovner
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Robin J Casten
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
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Park L, Schwei RJ, Xiong P, Jacobs EA. Addressing Cultural Determinants of Health for Latino and Hmong Patients with Limited English Proficiency: Practical Strategies to Reduce Health Disparities. J Racial Ethn Health Disparities 2018; 5:536-544. [PMID: 28791616 PMCID: PMC5803465 DOI: 10.1007/s40615-017-0396-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/31/2017] [Accepted: 06/05/2017] [Indexed: 01/08/2023]
Abstract
We explored how addressing culture may improve patient-provider relationships and reduce health disparities for racial and ethnic individuals with limited English proficiency (LEP). We analyzed qualitative data collected to explore health disparities in preventive cancer screenings for Hmong and Spanish-speaking LEP patients in a large Midwest healthcare system. We interviewed 20 participants (10 from each group) and the audiotaped interviews were transcribed verbatim, then back translated focusing on meaning. Data was analyzed using content analysis. Two themes are: conversation is relational and quality time is valued. Good communication skills involve the amount of conversation, clear explanations, and engaging with the patient. Quality of time meant physical time spent with patient and the task-oriented nature of the encounter. Cultural literacy in healthcare practice helps to understand the whole patient rather than focusing on the symptoms of illness. Patients should not be treated in isolation of their culture. A patient-centered approach to care means physicians should not remain culturally neutral but be more culturally sensitive. We propose steps to reduce disparities by increasing the awareness of cultural literacy for physicians to improve patient-provider relationship.
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Affiliation(s)
- Linda Park
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, 53705, USA.
| | - R J Schwei
- Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - P Xiong
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - E A Jacobs
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, 53705, USA
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
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Hollar D. Epigenetic Significance of Chromatin Organization During Cellular Aging and Organismal Lifespan. Epigenetics, the Environment, and Children’s Health Across Lifespans 2016. [PMCID: PMC7153164 DOI: 10.1007/978-3-319-25325-1_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- David Hollar
- Pfeiffer University, Morrisville, North Carolina USA
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