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Getrich CM, Umanzor D, Burdette A, Ortez-Rivera A. DACA Recipient Health Care Workers' Barriers to Professionalization and Deployment of Navigational Capital in Pursuit of Health Equity for Immigrants. J Immigr Minor Health 2023; 25:1279-1285. [PMID: 37273118 PMCID: PMC10240124 DOI: 10.1007/s10903-023-01506-0] [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] [Accepted: 05/28/2023] [Indexed: 06/06/2023]
Abstract
The COVID-19 pandemic has laid bare entrenched health inequalities in the U.S. health care system faced by structurally marginalized immigrant communities. Deferred Action for Childhood Arrivals (DACA) recipients are well suited to address these social and political determinants of health due to their large presence in service positions and skill sets. Yet their potential in health-related careers is limited by unique barriers related to uncertainty about their status and training and licensure processes. We report findings from a mixed-method (interview and questionnaire) study of 30 DACA recipients in Maryland. Nearly half of participants (14; 47%) worked in health care and social service fields. The longitudinal design featured three research phases conducted between 2016 and 2021, which enabled us to observe participants' evolving career trajectories and capture their experiences during a tumultuous period (due to the DACA rescission and COVID-19 pandemic). Using a community cultural wealth (CCW) framework, we present three case studies that demonstrate challenges recipients encountered as they embarked on health-related careers, including protracted educational journeys, concerns about program completion/licensure, and uncertainty about future employment. Yet participants' experiences also revealed valuable forms of CCW they deploy, including building on social networks/collective knowledge, forging navigational capital and sharing experiential knowledge, and leveraging identity to devise innovative strategies. Results highlight the critical value of DACA recipients' CCW that renders them particularly apt brokers and advocates in promoting health equity. Yet they also reveal the urgent need for comprehensive immigration and state-licensure reform to promote DACA recipients' inclusion in the health care workforce.
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Affiliation(s)
- Christina M Getrich
- Department of Anthropology, College Park, University of Maryland, 2138 LeFrak Hall, 7251 Preinkert Drive, College Park, MD, 20742, USA.
| | - Delmis Umanzor
- Department of Anthropology, College Park, University of Maryland, 2138 LeFrak Hall, 7251 Preinkert Drive, College Park, MD, 20742, USA
| | - Alaska Burdette
- Department of Anthropology, College Park, University of Maryland, 2138 LeFrak Hall, 7251 Preinkert Drive, College Park, MD, 20742, USA
| | - Ana Ortez-Rivera
- Department of Anthropology, College Park, University of Maryland, 2138 LeFrak Hall, 7251 Preinkert Drive, College Park, MD, 20742, USA
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Salerno JP, Getrich CM, Fish JN, Castillo Y, Edmiston S, Sandoval P, Aparicio EM, Fryer CS, Boekeloo BO. Profiles of psychosocial stressors and buffers among Latinx immigrant youth: Associations with suicidal ideation. Psychiatry Res 2023; 330:115583. [PMID: 37995421 PMCID: PMC10841582 DOI: 10.1016/j.psychres.2023.115583] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/25/2023]
Abstract
This study aimed to examine the associations of latent profile group membership based on post-migration psychosocial stressors (proximal immigrant minority stress) and buffers (family, peer, and school support, and ethnic identity importance), and distal stressors (pre- to post-migration victimization and forced immigration-related family separation) with suicidal ideation among immigrant youth from the Northern Triangle (NT). Surveys were administered in a public high school-based Latinx immigrant youth support program between Spring 2019 and Spring 2022 (N = 172). A three latent profile model was previously identified, characterized by moderate stress/low buffer (weak resources), moderate stress/moderate buffer (average resources), and low stress/high buffer (strong resources) levels of psychosocial stressors and buffers. Associations of profile membership and the previously mentioned distal stressors with suicidal ideation were examined using multivariable logistic regression. Findings revealed that youth in the strong resources group experienced significant protection from suicidal ideation compared to youth in both the average and weak resources groups. Distal stressors were not significantly associated with suicidal ideation in multivariable analysis. Immigrant youth from the NT may require substantial buffering resources (i.e., ethnic identity importance, and school, family, and peer support) and minimization of proximal immigrant minority stress during post-migration to experience protection from suicidal ideation.
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Affiliation(s)
- John P Salerno
- School of Social Work, Columbia University, New York, NY, United States.
| | - Christina M Getrich
- Department of Anthropology, College of Behavioral and Social Sciences, University of Maryland, College Park, MD, United States
| | - Jessica N Fish
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, United States
| | | | | | | | - Elizabeth M Aparicio
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, United States
| | - Craig S Fryer
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, United States
| | - Bradley O Boekeloo
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, United States
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Getrich CM, Ortez-Rivera A, Umanzor D, Burdette A. Manoeuvering through the Multilayered Jurisdictional Policy Patchwork: DACA Recipients' Navigational Capital in the Washington, D.C. Metropolitan Region. Ethn Racial Stud 2022; 46:141-165. [PMID: 36582943 PMCID: PMC9793846 DOI: 10.1080/01419870.2022.2062251] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/29/2022] [Indexed: 06/17/2023]
Abstract
During its almost-decade of existence, Deferred Action for Childhood Arrivals (DACA) has been a focal point of immigration policy debate. Liminally legal DACA recipients have endured a rollercoaster of lawsuits and court decisions, yet are simultaneously incorporating into local communities characterized by distinctive socio-legal contexts. Drawing from a longitudinal qualitative study of 30 DACA recipients in the Washington, D.C. Metropolitan region, we argue that DACA recipients draw from their legal-spatial consciousness and local knowledge to forge navigational capital that allows them to adeptly maneuver between different jurisdictions. Over time, they deploy this navigational capital to strategically access distinct yet interconnected educational, health care, housing, and employment sectors and expand their spatial mobility, underscoring their capacity for adaptation and resilience. As forms of collective knowledge, their navigational capital reverberates through their social networks as they broker on-the-ground forms of inclusion for themselves and their families and communities within these socio-legal contexts.
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Affiliation(s)
| | | | - Delmis Umanzor
- Prince George's County Public Schools, University of Maryland, College Park
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Vasquez Guzman CE, Sussman AL, Kano M, Getrich CM, Williams RL. A Comparative Case Study Analysis of Cultural Competence Training at 15 U.S. Medical Schools. Acad Med 2021; 96:894-899. [PMID: 33637658 DOI: 10.1097/acm.0000000000004015] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Twenty years have passed since the Liaison Committee on Medical Education (LCME) mandated cultural competence training at U.S. medical schools. There remain multiple challenges to implementation of this training, including curricular constraints, varying interpretations of cultural competence, and evidence supporting the efficacy of such training. This study explored how medical schools have worked to implement cultural competence training. METHOD Fifteen regionally diverse public and private U.S. medical schools participated in the study. In 2012-2014, the authors conducted 125 interviews with 52 administrators, 51 faculty or staff members, and 22 third- and fourth-year medical students, along with 29 focus groups with an additional 196 medical students. Interviews were recorded, transcribed, and imported into NVivo 10 software for qualitative data analysis. Queries captured topics related to students' preparedness to work with diverse patients, engagement with sociocultural issues, and general perception of preclinical and clinical curricula. RESULTS Three thematic areas emerged regarding cultural competence training: formal curriculum, conditions of teaching, and institutional commitment. At the formal curricular level, schools offered a range of courses collectively emphasizing communication skills, patient-centered care, and community-based projects. Conditions of teaching emphasized integration of cultural competence into the preclinical years and reflection on the delivery of content. At the institutional level, commitment to institutional diversity, development of programs, and degree of prioritization of cultural competence varied. CONCLUSIONS There is variation in how medical schools approach cultural competence. Among the 15 participating schools, longitudinal and experiential learning emerged as important, highlighting the needs beyond mere integration of cultural competence content into the formal curriculum. To determine efficacy of cultural competence programming, it is critical to conduct systematic assessment to identify and address gaps. While LCME standards have transformed aspects of medical education, further research is needed to clarify evidence-based, effective approaches to this training.
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Affiliation(s)
- Cirila Estela Vasquez Guzman
- C.E. Vasquez Guzman is a family medicine postdoctoral fellow, Oregon Health & Science University, Portland, Oregon
| | - Andrew L Sussman
- A.L. Sussman is associate professor, Comprehensive Cancer Center and Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Miria Kano
- M. Kano is assistant professor, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Christina M Getrich
- C.M. Getrich is associate professor, Department of Anthropology, University of Maryland, College Park, Maryland
| | - Robert L Williams
- R.L. Williams is Distinguished Professor, Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
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Getrich CM. The U.S.‐Mexico Transborder Region: Cultural Dynamics and Historical Interactions. CarlosVélez‐Ibáñez and JosiahHeyman, eds. Tucson: University of Arizona Press, 2017. The Journal of Latin American and Caribbean Anthropology 2020. [DOI: 10.1111/jlca.12504] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Getrich CM, Rapport K, Burdette A, Ortez-Rivera A, Umanzor D. Navigating a fragmented health care landscape: DACA recipients' shifting access to health care. Soc Sci Med 2019; 223:8-15. [PMID: 30685567 DOI: 10.1016/j.socscimed.2019.01.018] [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] [Received: 09/07/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
Deferred Action for Childhood Arrivals (DACA) recipients face an uncertain fate as their future in the United States is being debated. Yet even before the program was introduced in June 2012 and became endangered in September 2017, they encountered challenges in navigating a fragmented health care landscape throughout the United States. This paper focuses on DACA recipients' experiences in accessing health care throughout their lives, both before and after receiving DACA. We conducted semi-structured interviews and questionnaires with 30 DACA recipients living in Maryland between April-December 2016. Participants represented 13 countries of origin and ranged in age between 18 and 28. Results demonstrate that DACA recipients have had punctuated coverage throughout their lives and continue to face constrained access despite temporary gains in status. Health care access is further stratified within their mixed-status families. Participants have also experienced shifts in their health care coverage due to moving between jurisdictions with variable eligibility and changing life circumstances related to family, school, and employment. This article underscores the importance of examining young adult immigrants' access to care over time as they weather changes in the broader policy context and in highly variable contexts of reception nationwide, shaped by state, but also county and city policies and programs. The challenges and gaps in coverage DACA recipients face also underscore the need for both health care and immigration reform.
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Affiliation(s)
- Christina M Getrich
- University of Maryland, College Park, Department of Anthropology, 1111 Woods Halls, 4302 Chapel Lane, College Park, MD, 20742, USA.
| | - Kaelin Rapport
- Northwestern University, Department of Anthropology, 1810 Hinman Avenue, Evanston, IL, 60208, USA.
| | - Alaska Burdette
- University of Maryland, College Park, Department of Anthropology, 1111 Woods Halls, 4302 Chapel Lane, College Park, MD, 20742, USA.
| | - Ana Ortez-Rivera
- University of Maryland, College Park, Department of Anthropology, 1111 Woods Halls, 4302 Chapel Lane, College Park, MD, 20742, USA.
| | - Delmis Umanzor
- University of Maryland, College Park, Department of Anthropology, 1111 Woods Halls, 4302 Chapel Lane, College Park, MD, 20742, USA.
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Williams RL, Vasquez CE, Getrich CM, Kano M, Boursaw B, Krabbenhoft C, Sussman AL. Racial/Gender Biases in Student Clinical Decision-Making: a Mixed-Method Study of Medical School Attributes Associated with Lower Incidence of Biases. J Gen Intern Med 2018; 33:2056-2064. [PMID: 29998436 PMCID: PMC6258638 DOI: 10.1007/s11606-018-4543-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/02/2018] [Accepted: 06/05/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Accumulating evidence suggests that clinician racial/gender decision-making biases in some instances contribute to health disparities. Previous work has produced evidence of such biases in medical students. OBJECTIVE To identify contextual attributes in medical schools associated on average with low levels of racial/gender clinical decision-making biases. DESIGN A mixed-method design using comparison case studies of 15 medical schools selected based on results of a previous survey of student decision-making bias: 7 schools whose students collectively had, and 8 schools whose students had not shown evidence of such biases. PARTICIPANTS Purposively sampled faculty, staff, underrepresented minority medical students, and clinical-level medical students at each school. MAIN MEASURES Quantitative descriptive data and qualitative interview and focus group data assessing 32 school attributes theorized in the literature to be associated with formation of decision-making and biases. We used a mixed-method analytic design with standard qualitative analysis and fuzzy set qualitative comparative analysis. KEY RESULTS Across the 15 schools, a total of 104 faculty, administrators and staff and 21 students participated in individual interviews, and 196 students participated in 29 focus groups. While no single attribute or group of attributes distinguished the two clusters of schools, analysis showed some contextual attributes were seen more commonly in schools whose students had not demonstrated biases: longitudinal reflective small group sessions; non-accusatory approach to training in diversity; longitudinal, integrated diversity curriculum; admissions priorities and action steps toward a diverse student body; and school service orientation to the community. CONCLUSIONS We identified several potentially modifiable elements of the training environment that are more common in schools whose students do not show evidence of racial and gender biases.
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Affiliation(s)
- Robert L Williams
- Department of Family and Community Medicine; MSC09-5060, University of New Mexico, Albuquerque, NM, USA.
| | | | | | - Miria Kano
- Cancer Research and Treatment Center, University of New Mexico, Albuquerque, NM, USA
| | - Blake Boursaw
- College of Nursing, University of New Mexico, Albuquerque, NM, USA
| | - Crystal Krabbenhoft
- Department of Family and Community Medicine; MSC09-5060, University of New Mexico, Albuquerque, NM, USA
| | - Andrew L Sussman
- Department of Family and Community Medicine; MSC09-5060, University of New Mexico, Albuquerque, NM, USA
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Getrich CM, García JM, Solares A, Kano M. Effective Strategies for Affordable Care Act Enrollment in Immigrant-Serving Safety Net Clinics in New Mexico. J Health Care Poor Underserved 2018; 28:626-634. [PMID: 28529213 DOI: 10.1353/hpu.2017.0063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the new Affordable Care Act (ACA) health care environment, safety-net institutions continue to serve as important sources of culturally appropriate care for different groups of immigrant patients. This article reports on a qualitative study examining the early ACA enrollment experiences of a range of health care providers (n = 29) in six immigrant-serving safety-net clinics in New Mexico. The six clinics configured their ACA enrollment strategies differently with regard to operations, staffing, and outreach. Providers reported a generally chaotic rollout overall and expressed frustration with strategies that did not accommodate patients, provided little training for providers, and engaged in minimal outreach. Conversely, providers lauded strategies that flexibly met patient needs, leveraged trust through strategic use of staff, and prioritized outreach. Findings underscore the importance of using and funding concerted strategies for future enrollment of immigrant patients, such as featuring community health workers and leveraging trust for outreach.
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Getrich CM, García JM, Solares A, Kano M. Buffering the Uneven Impact of the Affordable Care Act: Immigrant-serving Safety-net Providers in New Mexico. Med Anthropol Q 2017; 32:233-253. [PMID: 28556358 DOI: 10.1111/maq.12391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 06/04/2015] [Revised: 05/16/2017] [Accepted: 05/17/2017] [Indexed: 11/30/2022]
Abstract
We conducted a study in early 2014 to document how the initial implementation of the Affordable Care Act (ACA) affected health care provision to different categories of immigrants from the perspective of health care providers in New Mexico. Though ACA navigators led enrollment, a range of providers nevertheless became involved by necessity, expressing concern about how immigrants were faring in the newly configured health care environment and taking on advocacy roles. Providers described interpreting shifting eligibility and coverage, attending to vulnerable under/uninsured patients, and negotiating new bureaucratic barriers for insured patients. Findings suggest that, like past efforts, this recent reform to the fragmented health care system has perpetuated a condition in which safety-net clinics and providers are left to buffer a widening gap for immigrant patients. With possible changes to the ACA ahead, safety-net providers' critical buffering roles will likely become more crucial, underscoring the necessity of examining their experiences with past reforms.
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Affiliation(s)
| | | | - Angélica Solares
- Clinical and Translational Science Center, University of New Mexico
| | - Miria Kano
- Comprehensive Cancer Center, University of New Mexico
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Mishra SI, Sussman AL, Murrietta AM, Getrich CM, Rhyne R, Crowell RE, Taylor KL, Reifler EJ, Wescott PH, Saeed AI, Hoffman RM. Patient Perspectives on Low-Dose Computed Tomography for Lung Cancer Screening, New Mexico, 2014. Prev Chronic Dis 2016; 13:E108. [PMID: 27536900 PMCID: PMC4993119 DOI: 10.5888/pcd13.160093] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION National guidelines call for annual lung cancer screening for high-risk smokers using low-dose computed tomography (LDCT). The objective of our study was to characterize patient knowledge and attitudes about lung cancer screening, smoking cessation, and shared decision making by patient and health care provider. METHODS We conducted semistructured qualitative interviews with patients with histories of heavy smoking who received care at a Federally Qualified Health Center (FQHC Clinic) and at a comprehensive cancer center-affiliated chest clinic (Chest Clinic) in Albuquerque, New Mexico. The interviews, conducted from February through September 2014, focused on perceptions about health screening, knowledge and attitudes about LDCT screening, and preferences regarding decision aids. We used a systematic iterative analytic process to identify preliminary and emergent themes and to create a coding structure. RESULTS We reached thematic saturation after 22 interviews (10 at the FQHC Clinic, 12 at the Chest Clinic). Most patients were unaware of LDCT screening for lung cancer but were receptive to the test. Some smokers said they would consider quitting smoking if their screening result were positive. Concerns regarding screening were cost, radiation exposure, and transportation issues. To support decision making, most patients said they preferred one-on-one discussions with a provider. They also valued decision support tools (print materials, videos), but raised concerns about readability and Internet access. CONCLUSION Implementing lung cancer screening in sociodemographically diverse populations poses significant challenges. The value of tobacco cessation counseling cannot be overemphasized. Effective interventions for shared decision making to undergo lung cancer screening will need the active engagement of health care providers and will require the use of accessible decision aids designed for people with low health literacy.
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Affiliation(s)
- Shiraz I Mishra
- Professor, Department of Pediatrics, University of New Mexico School of Medicine, 1 University of New Mexico, MSC 10 5590, Albuquerque, NM 87131.
| | - Andrew L Sussman
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Ambroshia M Murrietta
- Clinical and Translational Science Center, University of New Mexico, Albuquerque, New Mexico
| | | | - Robert Rhyne
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Richard E Crowell
- University of New Mexico Comprehensive Cancer Center, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Kathryn L Taylor
- Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Ellen J Reifler
- Informed Medical Decisions Foundation/Healthwise, Boston, Massachusetts
| | - Pamela H Wescott
- Informed Medical Decisions Foundation/Healthwise, Boston, Massachusetts
| | - Ali I Saeed
- Division of Pulmonary Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Richard M Hoffman
- Department of Medicine, University of Iowa Carver College of Medicine, University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA
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Abstract
Scholars often do not describe in detail the complex process of conducting focus groups, including what happens when they take unexpected turns. A critical incident lens provides a framework for better analyzing and understanding what actually happens during focus group sessions. Using a critical incident approach, we examine our experiences of carrying out focus groups about the human papillomavirus (HPV) vaccine with vaccine-eligible adolescent girls and parents/caregivers of vaccine-eligible adolescent girls in New Mexico. The critical incident lens allowed us to productively explore the context and interactional dynamics of our focus groups and ultimately pushed us to talk through the challenges of conducting and analyzing them. We hope this serves as a call to qualitative researchers to be attentive to the critical incidents in your own research to enrich your analysis and contribute to a broader discussion of the realities of focus group conduct.
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Affiliation(s)
| | | | | | - Angélica Solares
- Environmental Health Department, Bernalillo County, Albuquerque, New Mexico, USA
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Bradley PV, Getrich CM, Hannigan GG. New Mexico practitioners' access to and satisfaction with online clinical information resources: an interview study using qualitative data analysis software. J Med Libr Assoc 2015; 103:31-5. [PMID: 25552942 DOI: 10.3163/1536-5050.103.1.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
QUESTIONS What information resources are available to health care practitioners not affiliated with the University of New Mexico? How satisfied are they with those resources? SETTING The state is rural and medically underserved. METHODS The authors interviewed practitioners, using a nine-item guide. Interview transcripts were coded using QSR NVivo 9 software. MAIN RESULTS Fifty-one practitioners were interviewed. Most use online information resources. Many have access to a point-of-care resource within an electronic health records system. They often expressed dissatisfaction with available patient education resources. CONCLUSION New Mexico practitioners routinely use electronic information resources but indicate they need better patient information.
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Affiliation(s)
- Patricia V Bradley
- , Native and Distance Services Librarian, Health Sciences Library and Informatics Center, University of New Mexico, MSC 09 5100, 1 University of New Mexico, Albuquerque, NM 87131-0001; , Assistant Professor, University of Maryland, College Park, 1111 Woods Hall, College Park, MD 20742; , Research Professor, Health Sciences Library and Informatics Center, University of New Mexico, MSC 09 5100, 1 University of New Mexico, Albuquerque, NM 87131-0001
| | - Christina M Getrich
- , Native and Distance Services Librarian, Health Sciences Library and Informatics Center, University of New Mexico, MSC 09 5100, 1 University of New Mexico, Albuquerque, NM 87131-0001; , Assistant Professor, University of Maryland, College Park, 1111 Woods Hall, College Park, MD 20742; , Research Professor, Health Sciences Library and Informatics Center, University of New Mexico, MSC 09 5100, 1 University of New Mexico, Albuquerque, NM 87131-0001
| | - Gale G Hannigan
- , Native and Distance Services Librarian, Health Sciences Library and Informatics Center, University of New Mexico, MSC 09 5100, 1 University of New Mexico, Albuquerque, NM 87131-0001; , Assistant Professor, University of Maryland, College Park, 1111 Woods Hall, College Park, MD 20742; , Research Professor, Health Sciences Library and Informatics Center, University of New Mexico, MSC 09 5100, 1 University of New Mexico, Albuquerque, NM 87131-0001
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Hoffman RM, Sussman AL, Getrich CM, Rhyne RL, Crowell RE, Taylor KL, Reifler EJ, Wescott PH, Murrietta AM, Saeed AI, Mishra SI. Attitudes and Beliefs of Primary Care Providers in New Mexico About Lung Cancer Screening Using Low-Dose Computed Tomography. Prev Chronic Dis 2015; 12:E108. [PMID: 26160294 PMCID: PMC4509091 DOI: 10.5888/pcd12.150112] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION On the basis of results from the National Lung Screening Trial (NLST), national guidelines now recommend using low-dose computed tomography (LDCT) to screen high-risk smokers for lung cancer. Our study objective was to characterize the knowledge, attitudes, and beliefs of primary care providers about implementing LDCT screening. METHODS We conducted semistructured interviews with primary care providers practicing in New Mexico clinics for underserved minority populations. The interviews, conducted from February through September 2014, focused on providers' tobacco cessation efforts, lung cancer screening practices, perceptions of NLST and screening guidelines, and attitudes about informed decision making for cancer screening. Investigators iteratively reviewed transcripts to create a coding structure. RESULTS We reached thematic saturation after interviewing 10 providers practicing in 6 urban and 4 rural settings; 8 practiced at federally qualified health centers. All 10 providers promoted smoking cessation, some screened with chest x-rays, and none screened with LDCT. Not all were aware of NLST results or current guideline recommendations. Providers viewed study results skeptically, particularly the 95% false-positive rate, the need to screen 320 patients to prevent 1 lung cancer death, and the small proportion of minority participants. Providers were uncertain whether New Mexico had the necessary infrastructure to support high-quality screening, and worried about access barriers and financial burdens for rural, underinsured populations. Providers noted the complexity of discussing benefits and harms of screening and surveillance with their patient population. CONCLUSION Providers have several concerns about the feasibility and appropriateness of implementing LDCT screening. Effective lung cancer screening programs will need to educate providers and patients to support informed decision making and to ensure that high-quality screening can be efficiently delivered in community practice.
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Affiliation(s)
- Richard M Hoffman
- University of New Mexico School of Medicine, University of New Mexico Cancer Center, Albuquerque Veterans Affairs Medical Center, Albuquerque, New Mexico
| | - Andrew L Sussman
- University of New Mexico Cancer Center and Department of Family Medicine and Community Medicine, Albuquerque, New Mexico
| | | | - Robert L Rhyne
- University of New Mexico Cancer Center and Department of Family Medicine and Community Medicine, Albuquerque, New Mexico
| | - Richard E Crowell
- University of New Mexico School of Medicine and University of New Mexico Cancer Center, Albuquerque, New Mexico
| | - Kathryn L Taylor
- Georgetown Lombardi Comprehensive Cancer Center and Georgetown University Medical Center, Washington, DC
| | | | | | - Ambroshia M Murrietta
- Clinical and Translational Science Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Ali I Saeed
- University of New Mexico School of Medicine and University of New Mexico Cancer Center, Albuquerque, New Mexico
| | - Shiraz I Mishra
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM 87131. . Dr Mishra is also affiliated with the University of New Mexico Cancer Center and the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Abstract
PURPOSE Data confirm that high rates of human papillomavirus (HPV) vaccination have not been achieved despite strong clinician endorsement of the vaccine. We conducted a study of primary care clinicians to assess the broad range of health care delivery, health policy, and attitudinal factors influencing vaccination uptake and opportunities for informed decision making. METHODS We implemented a mixed methods study in RIOS Net, a primary care practice-based research network in New Mexico. We first conducted qualitative, in-depth interviews with primary care clinicians, health policy makers, and immunization experts, and followed up with a confirmatory survey distributed to RIOS Net clinician members. RESULTS Health service delivery challenges emerged as the greatest barrier to HPV vaccination, specifically the lack of capacity to track and distribute reminders to eligible patients. Clinicians also reported variations in counseling approaches attributable to both age and emphasis on the cancer prevention benefits of the vaccine. There was no evidence of sociocultural influences on vaccine decision making, nor did concerns about perceived overprotection emerge. CONCLUSIONS Our findings, based on a long-term program of research, suggest that both patients' attributes and health system delivery are most influential in HPV vaccination coverage challenges. Interventions targeting innovative communication techniques, as well as health system changes that build on efforts toward coordinated care and utilization of other venues to promote vaccination, will be necessary to address these challenges.
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Affiliation(s)
- Andrew L Sussman
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Deborah Helitzer
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
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15
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Williams RL, Romney C, Kano M, Wright R, Skipper B, Getrich CM, Sussman AL, Zyzanski SJ. Racial, gender, and socioeconomic status bias in senior medical student clinical decision-making: a national survey. J Gen Intern Med 2015; 30:758-67. [PMID: 25623298 PMCID: PMC4441663 DOI: 10.1007/s11606-014-3168-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 12/01/2014] [Accepted: 12/22/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Research suggests stereotyping by clinicians as one contributor to racial and gender-based health disparities. It is necessary to understand the origins of such biases before interventions can be developed to eliminate them. As a first step toward this understanding, we tested for the presence of bias in senior medical students. OBJECTIVE The purpose of the study was to determine whether bias based on race, gender, or socioeconomic status influenced clinical decision-making among medical students. DESIGN We surveyed seniors at 84 medical schools, who were required to choose between two clinically equivalent management options for a set of cardiac patient vignettes. We examined variations in student recommendations based on patient race, gender, and socioeconomic status. PARTICIPANTS The study included senior medical students. MAIN MEASURES We investigated the percentage of students selecting cardiac procedural options for vignette patients, analyzed by patient race, gender, and socioeconomic status. KEY RESULTS Among 4,603 returned surveys, we found no evidence in the overall sample supporting racial or gender bias in student clinical decision-making. Students were slightly more likely to recommend cardiac procedural options for black (43.9 %) vs. white (42 %, p = .03) patients; there was no difference by patient gender. Patient socioeconomic status was the strongest predictor of student recommendations, with patients described as having the highest socioeconomic status most likely to receive procedural care recommendations (50.3 % vs. 43.2 % for those in the lowest socioeconomic status group, p < .001). Analysis by subgroup, however, showed significant regional geographic variation in the influence of patient race and gender on decision-making. Multilevel analysis showed that white female patients were least likely to receive procedural recommendations. CONCLUSIONS In the sample as a whole, we found no evidence of racial or gender bias in student clinical decision-making. However, we did find evidence of bias with regard to the influence of patient socioeconomic status, geographic variations, and the influence of interactions between patient race and gender on student recommendations.
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Affiliation(s)
- Robert L Williams
- Department of Family and Community Medicine, MSC09 5040, 1 University of New Mexico, Albuquerque, NM, 87131, USA,
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16
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Kano M, Getrich CM, Romney C, Sussman AL, Williams RL. Costs and inconsistencies in US IRB review of low-risk medical education research. Med Educ 2015; 49:634-637. [PMID: 25989411 PMCID: PMC5698906 DOI: 10.1111/medu.12693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 07/29/2014] [Accepted: 10/08/2014] [Indexed: 06/04/2023]
Abstract
CONTEXT Advances in communication technologies over the last two decades have transformed the way medical education research is conducted, creating opportunities for multi-institution national and international studies. Although these studies enable researchers to gain broader understandings of educational processes across institutions, they increase the need for multiple institutional review board (IRB) reviews to ensure the protection of human subjects. OBJECTIVES This study describes the process of obtaining multiple IRB approvals of the same protocol for a multi-site, low-risk, medical education research project in the USA. The burden of obtaining those reviews and their consistency are assessed. The associated time and costs, and implications for the research process are detailed. METHODS Following review by the investigators' parent institution IRB, the project team circulated a uniform protocol for conduct of a low-risk, medical education survey to the IRBs of 89 US medical schools for review. The processes and time required to obtain approvals were recorded to estimate associated research team personnel costs. RESULTS Approval could not be obtained from five IRBs as a result of insurmountable procedural barriers. A total of 67 IRBs eventually deferred to the parent IRB determination. The remaining IRBs required a variety of additional procedural processes before ultimately agreeing with the original determination. The personnel costs associated with obtaining the 84 approvals amounted to US$121,344. CONCLUSIONS Considering the value of multi-site designs to address a range of research questions, enhance participant diversity and develop representative findings, solutions must be found to counter inefficiencies of current IRB review processes for low-risk research, such as that usually conducted in medical education. Although we acknowledge that local review is an essential protective measure for research involving identifiable communities that are uniquely susceptible to social or economic harm, this report suggests that proposals to modernise and streamline IRB review processes for low-risk research are timely and relevant.
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Affiliation(s)
- Miria Kano
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Christina M Getrich
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Crystal Romney
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Andrew L Sussman
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Robert L Williams
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
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Helitzer DL, Sussman AL, Hoffman RM, Getrich CM, Warner TD, Rhyne RL. Along the way to developing a theory of the program: a re-examination of the conceptual framework as an organizing strategy. Eval Program Plann 2014; 45:157-63. [PMID: 24836998 PMCID: PMC8162028 DOI: 10.1016/j.evalprogplan.2014.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 03/03/2014] [Accepted: 04/23/2014] [Indexed: 05/17/2023]
Abstract
PURPOSE Conceptual frameworks (CF) have historically been used to develop program theory. We re-examine the literature about the role of CF in this context, specifically how they can be used to create descriptive and prescriptive theories, as building blocks for a program theory. Using a case example of colorectal cancer screening intervention development, we describe the process of developing our initial CF, the methods used to explore the constructs in the framework and revise the framework for intervention development. METHODS We present seven steps that guided the development of our CF: (1) assemble the "right" research team, (2) incorporate existing literature into the emerging CF, (3) construct the conceptual framework, (4) diagram the framework, (5) operationalize the framework: develop the research design and measures, (6) conduct the research, and (7) revise the framework. RESULTS A revised conceptual framework depicted more complicated inter-relationships of the different predisposing, enabling, reinforcing, and system-based factors. The updated framework led us to generate program theory and serves as the basis for designing future intervention studies and outcome evaluations. CONCLUSIONS A CF can build a foundation for program theory. We provide a set of concrete steps and lessons learned to assist practitioners in developing a CF.
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Affiliation(s)
- Deborah L Helitzer
- Department of Family and Community Medicine, University of New Mexico, United States.
| | - Andrew L Sussman
- Department of Family and Community Medicine, University of New Mexico, United States
| | - Richard M Hoffman
- New Mexico VA Health Care System (Department of Internal Medicine, UNM), United States
| | - Christina M Getrich
- Department of Family and Community Medicine, University of New Mexico, United States
| | - Teddy D Warner
- Department of Family and Community Medicine, University of New Mexico, United States
| | - Robert L Rhyne
- Department of Family and Community Medicine, University of New Mexico, United States
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18
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Brenner AT, Getrich CM, Pignone M, Rhyne RL, Hoffman RM, McWilliams A, de Hernandez BU, Weaver MA, Tapp H, Harbi K, Reuland D. Comparing the effect of a decision aid plus patient navigation with usual care on colorectal cancer screening completion in vulnerable populations: study protocol for a randomized controlled trial. Trials 2014; 15:275. [PMID: 25004983 PMCID: PMC4100055 DOI: 10.1186/1745-6215-15-275] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/23/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Screening can reduce colorectal cancer (CRC) incidence and mortality. However, screening is underutilized in vulnerable patient populations, particularly among Latinos. Patient-directed decision aids can increase CRC screening knowledge, self-efficacy, and intent; however, their effect on actual screening test completion tends to be modest. This is probably because decision aids do not address some of the patient-specific barriers that prevent successful completion of CRC screening in these populations. These individual barriers might be addressed though patient navigation interventions. This study will test a combined decision aid and patient navigator intervention on screening completion in diverse populations of vulnerable primary care patients. METHODS/DESIGN We will conduct a multisite, randomized controlled trial with patient-level randomization. Planned enrollment is 300 patients aged 50 to 75 years at average CRC risk presenting for appointments at two primary clinics in North Carolina and New Mexico. Intervention participants will view a video decision aid immediately before the clinic visit. The 14 to 16 minute video presents information about fecal occult blood tests and colonoscopy and will be viewed on a portable computer tablet in English or Spanish. Clinic-based patient navigators are bilingual and bicultural and will provide both face-to-face and telephone-based navigation. Control participants will view an unrelated food safety video and receive usual care. The primary outcome is completion of a CRC screening test at six months. Planned subgroup analyses include examining intervention effectiveness in Latinos, who will be oversampled. Secondarily, the trial will evaluate the intervention effects on knowledge of CRC screening, self-efficacy, intent, and patient-provider communication. The study will also examine whether patient ethnicity, acculturation, language preference, or health insurance status moderate the intervention effect on CRC screening. DISCUSSION This pragmatic randomized controlled trial will test a combined decision aid and patient navigator intervention targeting CRC screening completion. Findings from this trial may inform future interventions and implementation policies designed to promote CRC screening in vulnerable patient populations and to reduce screening disparities. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT02054598.
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Affiliation(s)
- Alison T Brenner
- Cecil Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Boulevard, Campus Box 7590, Chapel Hill, NC 27599-7590, USA
| | | | - Michael Pignone
- Cecil Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Boulevard, Campus Box 7590, Chapel Hill, NC 27599-7590, USA
- Division of General Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Robert L Rhyne
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Richard M Hoffman
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
- University of New Mexico Cancer Center, Albuquerque, NM, USA
| | - Andrew McWilliams
- Department of Family Medicine, Carolinas HealthCare System, Charlotte, USA
| | | | - Mark A Weaver
- Departments of Medicine and Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hazel Tapp
- Department of Family Medicine, Carolinas HealthCare System, Charlotte, USA
| | - Khalil Harbi
- Cecil Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Boulevard, Campus Box 7590, Chapel Hill, NC 27599-7590, USA
| | - Daniel Reuland
- Cecil Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Boulevard, Campus Box 7590, Chapel Hill, NC 27599-7590, USA
- Division of General Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Getrich CM, Broidy LM, Kleymann E, Helitzer DL, Kong AS, Sussman AL. Different models of HPV vaccine decision-making among adolescent girls, parents, and health-care clinicians in New Mexico. Ethn Health 2014; 19:47-63. [PMID: 24261842 PMCID: PMC4411557 DOI: 10.1080/13557858.2013.857767] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Human papillomavirus (HPV) vaccination rates in the United States have been lower than anticipated since the vaccine became widely available globally in 2006. Of particular concern are data that suggest disparities in vaccine receipt among US ethnic minority and health disparity populations such as Hispanics, who are disproportionately affected by cervical cancer. Given these trends, it is important to examine actual vaccination decision-making processes among clinicians, parents, and adolescents to identify strategies to enhance uptake. DESIGN We conducted a mixed-method study examining HPV vaccine decision-making, utilizing both structured questionnaires of primarily Hispanic mothers and daughters (aged 12-18) and semi-structured interviews with mothers, daughters, and health-care clinicians to more deeply investigate decision-making dynamics. Quantitative analysis was used for descriptive purposes, while qualitative analysis featured an iterative process to examine factors related to decision-making surrounding the HPV vaccine. The study was conducted in two primary care clinics serving predominantly Hispanic patients in an urban New Mexico setting through Research Involving Outpatient Setting Network (RIOS Net), a primary care practice-based research network. RESULTS We administered 22 questionnaires and conducted 30 interviews. We identified three aspects of vaccine delivery that were similar across clinics: availability/supply of the vaccine, favorable clinician attitudes toward the vaccine, and clinicians' competing demands. We also identified three decision-making stages (pre-encounter, encounter, and post-encounter), though we found distinct differences in decision-making processes at the two sites. We describe the differences between an encounter-based and a process-based model of decision-making, and the ways in which explanatory factors might influence the decision-making process. CONCLUSION Our findings suggest that factors other than race and ethnicity, such as education, socioeconomic status, and health-care access, play an important role in HPV vaccination decisions. Further research to elucidate the specific informational needs and communication strategies associated with these factors will be needed to enhance vaccine uptake.
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Affiliation(s)
- Christina M. Getrich
- Department of Family and Community Medicine, MSC 09 5040, University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Lisa M. Broidy
- Department of Sociology, MSC 05 3080, University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Erin Kleymann
- Department of Sociology, MSC 05 3080, University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Deborah L. Helitzer
- Department of Family and Community Medicine, MSC 09 5040, University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Alberta S. Kong
- Department of Pediatrics, Division of Adolescent Medicine, MSC 10 5590, University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Andrew L. Sussman
- Department of Family and Community Medicine, MSC 09 5040, University of New Mexico, Albuquerque, NM 87131-0001, USA
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20
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Getrich CM, Sussman AL, Campbell-Voytal K, Tsoh JY, Williams RL, Brown AE, Potter MB, Spears W, Weller N, Pascoe J, Schwartz K, Neale AV. Cultivating a cycle of trust with diverse communities in practice-based research: a report from PRIME Net. Ann Fam Med 2013; 11:550-8. [PMID: 24218379 PMCID: PMC3823726 DOI: 10.1370/afm.1543] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Practice-based research networks (PBRNs) are increasingly seen as important vehicles to translate research into practice, although less is known about the process of engaging diverse communities in PBRN research. The objective of this study was to identify strategies for successfully recruiting and retaining diverse racial/ethnic communities into PBRN research studies. METHODS This collaborative, multisite study engaged 5 of the 8 networks of the PRImary care MultiEthnic Network (PRIME Net) consortium that conducts research with traditionally underrepresented/underserved populations. We used a sequential, qualitative research design. We first conducted 1 key informant interview with each of 24 researchers experienced in recruiting research participants from 5 racial/ethnic communities (African American, Arab/Chaldean, Chinese, Hispanic, and Native American). Subsequently, we conducted 18 focus groups with 172 persons from these communities. RESULTS Participants' comments indicated that successful recruitment and retention of underrepresented populations in PBRN studies is linked to the overall research process. This process, which we termed the cycle of trust, entailed developing and sustaining relationships of trust during 4 interrelated stages: before the study, during study recruitment, throughout study conduct, and after study completion. Participants identified a set of flexible strategies within each stage and called for close engagement with clinic and community partners. CONCLUSIONS Our participants suggest that approaches to research that lay a foundation of trust, demonstrate respect for community members, and extend beyond the enrollment and data collection phases are essential to enhance the participation of diverse populations in PBRN research. These findings offer the PBRN community a guide toward achieving this important goal.
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Hardy LJ, Getrich CM, Quezada JC, Guay A, Michalowski RJ, Henley E. A call for further research on the impact of state-level immigration policies on public health. Am J Public Health 2012; 102:1250-4. [PMID: 22594736 PMCID: PMC3477996 DOI: 10.2105/ajph.2011.300541] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2011] [Indexed: 11/04/2022]
Abstract
Arizona's Support Our Law Enforcement and Safe Neighborhoods Act, signed into law in April 2010, is already adversely affecting public health in the state. Our findings from a study on childhood obesity in Flagstaff suggest that the law changed health-seeking behaviors of residents of a predominantly Latino neighborhood by increasing fear, limiting residents' mobility, and diminishing trust of officials. These changes could exacerbate barriers to healthy living, limit access to care, and affect the overall safety of the neighborhood. Documentation of the on-the-ground impact of Arizona's law and similar state-level immigration policies is urgently needed. To inform effective policymaking, such research must be community engaged and include safety measures beyond the usual protocols.
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Affiliation(s)
- Lisa J Hardy
- Dept of Anthropology, Fellow, Interdisciplinary Health Policy Institute, Northern Arizona University, Flagstaff, AZ 86011, USA.
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Getrich CM, Sussman AL, Helitzer DL, Hoffman RM, Warner TD, Sánchez V, Solares A, Rhyne RL. Expressions of machismo in colorectal cancer screening among New Mexico Hispanic subpopulations. Qual Health Res 2012; 22:546-59. [PMID: 22138258 PMCID: PMC3636712 DOI: 10.1177/1049732311424509] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [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] [Indexed: 05/04/2023]
Abstract
Although national colorectal cancer (CRC) incidence rates have steadily decreased, the rate for New Mexico Hispanics has been increasing, and screening rates are low. We conducted an exploratory qualitative study to determine barriers to CRC screening for New Mexico Hispanics. We found that machismo served as a dynamic influence on men's health-seeking behaviors; however, it was conceptualized differently by two distinct Hispanic subpopulations, and therefore appeared to play a different role in shaping their screening attitudes and behaviors. Machismo emerged as more of an influence for Mexican men, who expressed concern over colonoscopies being potentially transformative and/or stigmatizing, but was not as salient for Hispanos, who viewed the colonoscopy as "strictly medical," and were more concerned with discomfort and pain. Findings from the study highlight the importance of identifying varying characteristics among subpopulations to better understand screening barriers and provide optimal CRC screening counseling in primary care settings.
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