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Newton RL, Zhang D, Johnson WD, Martin CK, Apolzan JW, Denstel KD, Brantley PJ, Davis TC, Arnold C, Sarpong DF, Price-Haywood EG, Lavie CJ, Thethi TK, Katzmarzyk PT. Predictors of racial differences in weight loss: the PROPEL trial. Obesity (Silver Spring) 2024; 32:476-485. [PMID: 38058232 PMCID: PMC10922207 DOI: 10.1002/oby.23936] [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: 06/07/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Studies have consistently shown that African American individuals lose less weight in response to behavioral interventions, but the mechanisms leading to this result have been understudied. METHODS Data were derived from the PROmoting Successful Weight Loss in Primary CarE in Louisiana (PROPEL) study, which was a cluster-randomized, two-arm trial conducted in primary care clinics. In the PROPEL trial, African American individuals lost less weight compared with patients who belonged to other racial groups after 24 months. In the current study, counterfactual mediation analyses among 445 patients in the intervention arm of PROPEL were used to determine which variables mediated the relationship between race and weight loss. The mediators included treatment engagement, psychosocial, and lifestyle factors. RESULTS At 6 months, daily weighing mediated 33% (p = 0.008) of the racial differences in weight loss. At 24 months, session attendance and daily weighing mediated 35% (p = 0.027) and 66% (p = 0.005) of the racial differences in weight loss, respectively. None of the psychosocial or lifestyle variables mediated the race-weight loss association. CONCLUSIONS Strategies specifically targeting engagement, such as improving session attendance and self-weighing behaviors, among African American individuals are needed to support more equitable weight losses over extended time periods.
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Affiliation(s)
| | - Dachaun Zhang
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | | | | | | | | | - Terry C. Davis
- Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Connie Arnold
- Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Daniel F. Sarpong
- Office of Health Equity Research, Yale University School of Medicine, New Haven, CT, USA
| | | | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School- the UQ School of Medicine, New Orleans, LA, USA
| | - Tina K. Thethi
- AdventHealth Translational Research Institute, Orlando, FL, USA
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Craig LS, Sarpong DF, Peacock EM, Roberts S, Theall KP, Williams L, Al-Dahir S, Davis TC, Arnold CL, Williams A, Fields T, Wilson M, Krousel-Wood M. Using Community Feedback to Inform Strategies for Inclusive Participation in Research: Lessons Learned From the Louisiana Community Engagement Alliance (LA-CEAL). Am J Public Health 2024; 114:S29-S32. [PMID: 37944099 PMCID: PMC10785181 DOI: 10.2105/ajph.2023.307457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Leslie S Craig
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Daniel F Sarpong
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Erin M Peacock
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Shearon Roberts
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Katherine P Theall
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - LaKeisha Williams
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Sara Al-Dahir
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Terry C Davis
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Connie L Arnold
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Allie Williams
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Tynesia Fields
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Michelle Wilson
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Marie Krousel-Wood
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
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Craig LS, Sarpong DF, Peacock EM, Theall KP, Williams L, Al-Dahir S, Davis TC, Arnold CL, Williams A, Fields T, Wilson M, Krousel-Wood M. Clinical trial participation among underserved communities: Insights from the Louisiana Community Engagement Alliance. Am J Med Sci 2023; 366:254-262. [PMID: 37517691 PMCID: PMC10962264 DOI: 10.1016/j.amjms.2023.07.011] [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] [Received: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Diverse, equitable and inclusive participation in clinical research is needed to ensure evidence-based clinical practice and lessen disparities in health outcomes. Yet, clinical trial participation remains critically low in minoritized communities, particularly among Blacks. The Louisiana Community Engagement Alliance against COVID-19 Disparities (LA-CEAL) was launched in response to the disproportionate impact of COVID-19 on Black Louisianans to understand community barriers and preferences and increase inclusive participation in research. This study aims to understand perceptions regarding COVID-19 trial participation among underrepresented Louisianans. METHODS A rapid assessment integrating cross-sectional, surveys among federally qualified health center (FQHC) patients and community residents, and focus group discussions (FGDs) from community representatives was conducted in 2020-2021. Factors and perceptions underlying trial participation were identified using logistic regression models and thematic analyses, respectively. RESULTS Quantitative findings (FQHC: N=908, mean age=46.6 years, 66.4% Black; community: N=504, mean age=54.2 years, 93.7% Black) indicated that 0.9% and 3.6%, respectively, ever participated in a COVID-19 trial. Doctors/Healthcare providers were most trusted (FQHC=55.1%; community=59.3%) sources of information about trials. Advancing age was associated with increased odds of being very willing to participate (ORFQHC=1.03, 95% CI 1.02-1.05; ORCommunity=1.02, 95% CI 1.00-1.04). Qualitative data (6 FGDs, 29 attendees) revealed limited awareness, experimentation/exploitation-based fears, and minimal racial/ethnic representation among trialists as barriers to participation. CONCLUSION COVID-19 trial participation rates were low in our sample. Altruism was a key facilitator to participation; fear, mistrust, and low awareness were predominant barriers. Community-centered approaches, engaging informed providers and trusted community members, may facilitate inclusive trial participation.
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Affiliation(s)
- Leslie S Craig
- Tulane University, School of Medicine, New Orleans, LA, USA
| | - Daniel F Sarpong
- Xavier University of Louisiana, College of Pharmacy, New Orleans, LA, USA; Yale School of Medicine, General Internal Medicine, Office of Health Equity Research
| | - Erin M Peacock
- Tulane University, School of Medicine, New Orleans, LA, USA
| | - Katherine P Theall
- Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - LaKeisha Williams
- Xavier University of Louisiana, College of Pharmacy, New Orleans, LA, USA
| | - Sara Al-Dahir
- Xavier University of Louisiana, College of Pharmacy, New Orleans, LA, USA
| | - Terry C Davis
- Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Connie L Arnold
- Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Allie Williams
- Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Tynesia Fields
- Xavier University of Louisiana, College of Pharmacy, New Orleans, LA, USA
| | | | - Marie Krousel-Wood
- Tulane University, School of Medicine, New Orleans, LA, USA; Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA.
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4
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Höchsmann C, Martin CK, Apolzan JW, Dorling JL, Newton RL, Denstel KD, Mire EF, Johnson WD, Zhang D, Arnold CL, Davis TC, Fonseca V, Thethi TK, Lavie CJ, Springgate B, Katzmarzyk PT. Initial weight loss and early intervention adherence predict long-term weight loss during the Promoting Successful Weight Loss in Primary Care in Louisiana lifestyle intervention. Obesity (Silver Spring) 2023; 31:2272-2282. [PMID: 37551762 PMCID: PMC10597572 DOI: 10.1002/oby.23854] [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: 08/23/2022] [Revised: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE This study tested whether initial weight change (WC), self-weighing, and adherence to the expected WC trajectory predict longer-term WC in an underserved primary-care population with obesity. METHODS Data from the intervention group (n = 452; 88% women; 74% Black; BMI 37.3 kg/m2 [SD: 4.6]) of the Promoting Successful Weight Loss in Primary Care in Louisiana trial were analyzed. Initial (2-, 4-, and 8-week) percentage WC was calculated from baseline clinic weights and daily at-home weights. Weights were considered adherent if they were on the expected WC trajectory (10% at 6 months with lower [7.5%] and upper [12.5%] bounds). Linear mixed-effects models tested whether initial WC and the number of daily and adherent weights predicted WC at 6, 12, and 24 months. RESULTS Percentage WC during the initial 2, 4, and 8 weeks predicted percentage WC at 6 (R2 = 0.15, R2 = 0.28, and R2 = 0.50), 12 (R2 = 0.11, R2 = 0.19, and R2 = 0.32), and 24 (R2 = 0.09, R2 = 0.11, and R2 = 0.16) months (all p < 0.01). Initial daily and adherent weights were significantly associated with WC as individual predictors, but they only marginally improved predictions beyond initial weight loss alone in multivariable models. CONCLUSIONS These results highlight the importance of initial WC for predicting long-term WC and show that self-weighing and adherence to the expected WC trajectory can improve WC prediction.
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Affiliation(s)
- Christoph Höchsmann
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - John W Apolzan
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - James L Dorling
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Robert L Newton
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Kara D Denstel
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Emily F Mire
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | | | - Dachuan Zhang
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Connie L Arnold
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Terry C Davis
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Vivian Fonseca
- AdventHealth, Translational Research Institute, Orlando, Florida, USA
| | - Tina K Thethi
- AdventHealth, Translational Research Institute, Orlando, Florida, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, New Orleans, Louisiana, USA
| | - Benjamin Springgate
- Department of Internal Medicine, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
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Apolzan JW, Martin CK, Newton RL, Myers CA, Arnold CL, Davis TC, Johnson WD, Zhang D, Höchsmann C, Fonseca VA, Denstel KD, Mire EF, Springgate BF, Lavie CJ, Katzmarzyk PT. Dietary intake during a pragmatic cluster-randomized weight loss trial in an underserved population in primary care. Nutr J 2023; 22:38. [PMID: 37528391 PMCID: PMC10394871 DOI: 10.1186/s12937-023-00864-7] [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] [Received: 01/17/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Currently there are limited data as to whether dietary intake can be improved during pragmatic weight loss interventions in primary care in underserved individuals. METHODS Patients with obesity were recruited into the PROPEL trial, which randomized 18 clinics to either an intensive lifestyle intervention (ILI) or usual care (UC). At baseline and months 6, 12, and 24, fruit and vegetable (F/V) intake and fat intake was determined. Outcomes were analyzed by repeated-measures linear mixed-effects multilevel models and regression models, which included random cluster (clinic) effects. Secondary analyses examined the effects of race, sex, age, and food security status. RESULTS A total of 803 patients were recruited. 84.4% were female, 67.2% African American, 26.1% received Medicaid, and 65.5% made less than $40,000. No differences in F/V intake were seen between the ILI and UC groups at months 6, 12, or 24. The ILI group reduced percent fat at months 6, 12, and 24 compared to UC. Change in F/V intake was negatively correlated with weight change at month 6 whereas change in fat intake was positively associated with weight change at months 6, 12, and 24 for the ILI group. CONCLUSIONS The pragmatic weight loss intervention in primary care did not increase F/V intake but did reduce fat intake in an underserved population with obesity. F/V intake was negatively associated with weight loss at month 6 whereas percent fat was positively correlated with weight loss throughout the intervention. Future efforts better targeting both increasing F/V intake and reducing fat intake may promote greater weight loss in similar populations. TRIAL REGISTRATION NCT Registration: NCT02561221.
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Affiliation(s)
- John W Apolzan
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA.
| | - Corby K Martin
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA
| | - Robert L Newton
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA
| | - Candice A Myers
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA
| | - Connie L Arnold
- Department of Medicine, Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Terry C Davis
- Department of Medicine, Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - William D Johnson
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA
| | - Dachuan Zhang
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA
| | - Christoph Höchsmann
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Vivian A Fonseca
- Department of Medicine, Division of Endocrinology and Metabolism, Tulane University Health Sciences Center, School of Medicine, Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
| | - Kara D Denstel
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA
| | - Emily F Mire
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA
| | - Benjamin F Springgate
- Department of Internal Medicine, Section of Community and Population Medicine, Louisiana State University School of Medicine, New Orleans, LA, USA
- Program in Health Policy and Systems Management, School of Public Health, Louisiana State University, New Orleans, LA, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Peter T Katzmarzyk
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA
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Bailey SC, Griffith JW, Vuyyuru C, Batio S, Velazquez E, Carpenter DM, Davis TC, Parker RM, Taddeo M, Wolf MS. Development and Validation of the HL6: a Brief, Technology-Based Remote Measure of Health Literacy. J Gen Intern Med 2023; 38:421-427. [PMID: 35879534 PMCID: PMC9311340 DOI: 10.1007/s11606-022-07739-3] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/01/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Most health literacy measures require in-person administration or rely upon self-report. OBJECTIVE We sought to develop and test the feasibility of a brief, objective health literacy measure that could be deployed via text messaging or online survey. DESIGN Participants were recruited from ongoing NIH studies to complete a phone interview and online survey to test candidate items. Psychometric analyses included parallel analysis for dimensionality and item response theory. After 9 months, participants were randomized to receive the final instrument via text messaging or online survey. PARTICIPANTS Three hundred six English and Spanish-speaking adults with ≥ 1 chronic condition MAIN MEASURES: Thirty-three candidate items for the new measure and patient-reported physical function, anxiety, depression, and medication adherence. All participants previously completed the Newest Vital Sign (NVS) in parent NIH studies. KEY RESULTS Participants were older (average 67 years), 69.6% were female, 44.3% were low income, and 22.0% had a high school level of education or less. Candidate items loaded onto a single factor (RMSEA: 0.04, CFI: 0.99, TLI: 0.98, all loadings >.59). Six items were chosen for the final measure, named the HL6. Items demonstrated acceptable internal consistency (α=0.73) and did not display differential item functioning by language. Higher HL6 scores were significantly associated with greater educational attainment (r=0.41), higher NVS scores (r=0.55), greater physical functioning (r=0.26), fewer depressive symptoms (r=-0.20), fewer anxiety symptoms (r=-0.15), and fewer barriers to medication adherence (r=-0.30; all p<.01). In feasibility testing, 75.2% of participants in the text messaging arm completed the HL6 versus 66.2% in the online survey arm (p=0.09). Socioeconomic disparities in completion were more common in the online survey arm. CONCLUSIONS The HL6 demonstrates adequate reliability and validity in both English and Spanish. This performance-based assessment can be administered remotely using commonly available technologies with fewer logistical challenges than assessments requiring in-person administration.
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Affiliation(s)
- Stacy Cooper Bailey
- Center of Applied Health Research on Aging, Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - James W Griffith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Chandana Vuyyuru
- Center of Applied Health Research on Aging, Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Stephanie Batio
- Center of Applied Health Research on Aging, Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Evelyn Velazquez
- Center of Applied Health Research on Aging, Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Terry C Davis
- Department of Medicine, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Ruth M Parker
- Center for Ethics, Emory University, Atlanta, GA, USA
| | - Michelle Taddeo
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael S Wolf
- Center of Applied Health Research on Aging, Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Bhuiyan MAN, Davis TC, Arnold CL, Motayar N, Bhuiyan MS, Smith DG, Murnane KS, Densmore K, van Diest M, Bailey SR, Kevil CG. Using the social vulnerability index to assess COVID-19 vaccine uptake in Louisiana. GeoJournal 2022; 88:3239-3248. [PMID: 36531533 PMCID: PMC9734623 DOI: 10.1007/s10708-022-10802-5] [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] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 06/02/2023]
Abstract
Using data from the Louisiana Department of Public Health, we explored the spatial relationships between the Social Vulnerability Index (SVI) and COVID-19-related vaccination and mortality rates. Publicly available COVID-19 vaccination and mortality data accrued from December 2020 to October 2021 was downloaded from the Louisiana Department of Health website and merged with the SVI data; geospatial analysis was then performed to identify the spatial association between the SVI and vaccine uptake and mortality rate. Bivariate Moran's I analysis revealed significant clustering of high SVI ranking with low COVID-19 vaccination rates (1.00, p < 0.001) and high smoothed mortality rates (0.61, p < 0.001). Regression revealed that for each 10% increase in SVI ranking, COVID-19 vaccination rates decreased by 3.02-fold (95% CI = 3.73-2.30), and mortality rates increased by a factor of 1.19 (95% CI = 0.99-1.43). SVI values are spatially linked and significantly associated with Louisiana's COVID-19-related vaccination and mortality rates. We also found that vaccination uptake was higher in whites than in blacks. These findings can help identify regions with low vaccination rates and high mortality, enabling the necessary steps to increase vaccination rates in disadvantaged neighborhoods.
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Affiliation(s)
| | - Terry C Davis
- Department of Medicine, Department of Pediatrics, and Feist-Weiller Cancer Center, Louisiana State University Health, Shreveport, LA USA
| | - Connie L Arnold
- Department of Medicine, Department of Pediatrics, and Feist-Weiller Cancer Center, Louisiana State University Health, Shreveport, LA USA
| | - Nasim Motayar
- Department of Medicine, Louisiana State University Health, Shreveport, LA USA
| | - Md. Shenuarin Bhuiyan
- Department of Pathology and Translational Pathobiology, Louisiana State University Health, Shreveport, LA USA
| | - Deborah G Smith
- Department of Medicine, Louisiana State University Health, Shreveport, LA USA
| | - Kevin S Murnane
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health, Shreveport, LA USA
| | - Kenneth Densmore
- Center of Excellence for Emerging Viral Threats, Louisiana State University Health, Shreveport, LA USA
| | - Maarten van Diest
- Center of Excellence for Emerging Viral Threats, Louisiana State University Health, Shreveport, LA USA
| | - Steven R Bailey
- Department of Medicine, Louisiana State University Health, Shreveport, LA USA
| | - Christopher G Kevil
- Department of Pathology and Translational Pathobiology, Louisiana State University Health, Shreveport, LA USA
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Davis TC, Vanchiere JA, Sewell MR, Davis AB, Wolf MS, Arnold CL. Influenza and COVID-19 Vaccine Concerns and Uptake Among Patients Cared for in a Safety-Net Health System. J Prim Care Community Health 2022; 13:21501319221136361. [PMID: 36448443 PMCID: PMC9716187 DOI: 10.1177/21501319221136361] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To examine Influenza and COVID-19 vaccine concerns and uptake among adult patients in a Southern safety-net health system. METHODS Trained research assistants conducted a structured telephone interview from April to October 2021. Of 118 participants, mean age was 57.7 years, 63.6% were female, 55.1% were Black, 42.4% white, and 54.2% reported rural residence. RESULTS Among participants, 44.9% had received the influenza vaccine during the 2020 to 2021 season, and 66.1% had received the COVID-19 vaccine. Participants who received the influenza vaccine were more likely to report getting a COVID-19 vaccine compared to those who reported not getting a flu vaccine (81.1% vs 53.8%, P = .002). Black adults were significantly less likely than white adults (29.2% vs 46.0%, P = .048) and bordering on significance, males less likely than females (27.9% vs 41.3%, P = .054) to have reported receiving both vaccines. Of note, 25.4% of participants did not get either vaccine. The most common reasons for not getting the influenza vaccine were not being concerned about getting the flu (13.8%) and belief the vaccine gave them the flu (12.3%). The primary reasons for not getting a COVID-19 vaccine were concern about vaccine safety (22.5%), concern about side effects (20.0%), and belief they were not going to get sick (20.0%). CONCLUSIONS These findings could help direct regional vaccine messaging and clinical communication to improve vaccine uptake among underserved populations.
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Affiliation(s)
- Terry C. Davis
- Louisiana State University Health Shreveport, Shreveport, LA, USA,Terry C. Davis, Department of Medicine, Louisiana State University Health Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130-3932, USA.
| | | | | | | | | | - Connie L. Arnold
- Louisiana State University Health Shreveport, Shreveport, LA, USA
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Davis TC, Beyl R, Bhuiyan MAN, Davis AB, Vanchiere JA, Wolf MS, Arnold CL. COVID-19 Concerns, Vaccine Acceptance and Trusted Sources of Information among Patients Cared for in a Safety-Net Health System. Vaccines (Basel) 2022; 10:vaccines10060928. [PMID: 35746535 PMCID: PMC9227546 DOI: 10.3390/vaccines10060928] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 12/03/2022] Open
Abstract
We examined COVID-19 concerns, vaccine acceptance, and trusted sources of information among patients in a safety-net health system in Louisiana. The participants were surveyed via structured telephone interviews over nine months in 2021. Of 204 adult participants, 65% were female, 52% were Black, 44.6% were White, and 46.5% were rural residents. The mean age was 53 years. The participants viewed COVID-19 as a serious public health threat (8.6 on 10-point scale). Black adults were more likely to perceive the virus as a threat than White adults (9.4 vs. 7.6 p < 0.0001), urban residents more than rural (9.0 vs. 8.2 p = 0.02), females more than males (8.9 vs. 8.1 p = 0.03). The majority (66.7%) had gotten the COVID-19 vaccine, with females being more likely than males (74.7 vs. 54.5% p = 0.02). There was no difference by race or rural residence. Overall, participants reported that physicians were the most trusted source of COVID-19 vaccine information (77.6%); followed by the CDC/FDA (50.5%), State Department of Health (41.4%), pharmacists (37.1%), nurses (36.7%); only 3.8% trusted social media. All sources were more trusted among black adults than White adults except family and social media. These findings could help inform efforts to design trustworthy public health messaging and clinical communication about the virus and vaccines.
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Affiliation(s)
- Terry C. Davis
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA;
- Correspondence: ; Tel.: +1-318-675-8694
| | - Robbie Beyl
- Biostatistics & Analysis, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA 70808, USA;
| | - Mohammad A. N. Bhuiyan
- Department of Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (M.A.N.B.); (A.B.D.)
| | - Adrienne B. Davis
- Department of Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (M.A.N.B.); (A.B.D.)
| | - John A. Vanchiere
- Department of Pediatrics, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA;
| | - Michael S. Wolf
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Chicago, IL 60611, USA;
| | - Connie L. Arnold
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA;
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Davis TC, Curtis LM, Wolf MS, Vanchiere JA, Bhuiyan MAN, Horswell R, Batio S, Arnold CL. COVID-19 Knowledge, Beliefs, and Behavior Among Patients in a Safety-Net Health System. J Community Health 2022; 47:437-445. [PMID: 35118553 PMCID: PMC8812349 DOI: 10.1007/s10900-021-01059-z] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 11/27/2022]
Abstract
Examine COVID-19 knowledge, concerns, behaviors, stress, and sources of information among patients in a safety-net health system in Louisiana. Research assistants surveyed participants via structured telephone interviews from April to October 2020. The data presented in this study were obtained in the pre-vaccine availability period. Of 623 adult participants, 73.5% were female, 54.7% Black, and 44.8% lived in rural small towns; mean age was 48.69. Half (50.5%) had spoken to a healthcare provider about the virus, 25.8% had been tested for COVID-19; 11.4% tested positive. Small town residents were less likely to be tested than those in cities (21.1% vs 29.3%, p = 0.05). Knowledge of COVID-19 symptoms and ways to prevent the disease increased from (87.9% in the spring to 98.9% in the fall, p < 0.001). Participants indicating that the virus had 'changed their daily routine a lot' decreased from 56.9% to 39.3% (p < 0.001). The main source of COVID-19 information was TV, which increased over time, 66.1-83.6% (p < 0.001). Use of websites (34.2%) did not increase. Black adults were more likely than white adults (80.7% vs 65.6%, p < 0.001) to rely on TV for COVID-19 information. Participants under 30 were more likely to get COVID-19 information from websites and social media (58.2% and 35.8% respectively). This study provides information related to the understanding of COVID-19 in rural and underserved communities that can guide clinical and public health strategies.
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Affiliation(s)
- Terry C. Davis
- Department of Medicine, Louisiana State University Health Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130-3932 USA
| | - Laura M. Curtis
- Division of General Internal Medicine and Geriatrics, Northwestern Medicine, Feinberg School of Medicine, Chicago, USA
| | - Michael S. Wolf
- Division of General Internal Medicine and Geriatrics, Northwestern Medicine, Feinberg School of Medicine, Chicago, USA
| | - John A. Vanchiere
- Center for Emerging Viral Threats, Louisiana State University Health Shreveport, Shreveport, USA
| | | | | | - Stephanie Batio
- Division of General Internal Medicine and Geriatrics, Northwestern Medicine, Feinberg School of Medicine, Chicago, USA
| | - Connie L. Arnold
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, USA
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Davis TC, Morris JD, Reed EH, Curtis LM, Wolf MS, Davis AB, Arnold CL. Design of a randomized controlled trial to assess the comparative effectiveness of a multifaceted intervention to improve three-year adherence to colorectal cancer screening among patients cared for in rural community health centers. Contemp Clin Trials 2022; 113:106654. [PMID: 34906745 PMCID: PMC8844093 DOI: 10.1016/j.cct.2021.106654] [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] [Received: 09/20/2021] [Revised: 11/11/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
Colorectal cancer (CRC) screening has been shown to decrease CRC mortality, yet significant disparities persist among those living in rural areas, from minority backgrounds, and those having low income. The purpose of this two-arm randomized controlled trial is to test the effectiveness and fidelity of a stepped care (increasing intensity as needed) approach to promoting 3-year adherence to CRC screening via fecal immunochemical testing (FIT) or colonoscopy in rural community clinics serving high rates of low-income and minority patients. We hypothesize that, compared to enhanced usual care (EUC), patients receiving the multifaceted CRC screening intervention will demonstrate higher rates of CRC screening completion over 3 years. Participants from six federally qualified health centers (FQHCs; N = 1200 patients) serving predominately low-income populations in rural Louisiana will be randomized to the intervention or EUC arm. All participants will receive health literacy-directed CRC counseling, simplified materials about both the FIT and colonoscopy procedures, and motivational interviewing to aid in the determination of test preference. Participants in the intervention arm will also receive motivational reminder messages from their primary care provider (via audio recording or tailored text) for either a scheduled colonoscopy or return of a completed FIT. Participants in the EUC arm will receive the standard follow-up provided by their clinic or colonoscopy facility. The primary outcome will be completion of either colonoscopy or annual FIT over 3 years. Results will provide evidence on the effectiveness of the intervention to decrease disparities in CRC screening completion related to health literacy, race, and gender. Trial registration:Clinicaltrials.gov Identifier NCT04313114.
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Affiliation(s)
- Terry C Davis
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health, 1501 Kings Highway, Shreveport, LA 71130
| | - James D Morris
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health, 1501 Kings Highway, Shreveport, LA 71130
| | - Elise H Reed
- Grambling State University, 403 Main Street, GSU Box 4267, Grambling, LA 71245
| | - Laura M Curtis
- Division of General Internal Medicine and Geriatrics Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor Chicago, IL 60611 USA
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor Chicago, IL 60611 USA
| | - Adrienne B Davis
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health, 1501 Kings Highway, Shreveport, LA 71130
| | - Connie L Arnold
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health, 1501 Kings Highway, Shreveport, LA 71130,Corresponding author at: Professor, Department of Medicine, Chief, Division of Health Disparities, LSU Health Shreveport, Feist-Weiller Cancer Center, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130-3932,
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12
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Davis TC, Arnold CL, Mills G, Lesser GJ, Brown WM, Schulz R, Weaver KE, Pawloski PA. Assessment of Oral Chemotherapy Nonadherence in Chronic Myeloid Leukemia Patients Using Brief Measures in Community Cancer Clinics: A Pilot Study. Int J Environ Res Public Health 2021; 18:ijerph182111045. [PMID: 34769563 PMCID: PMC8582838 DOI: 10.3390/ijerph182111045] [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] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 01/03/2023]
Abstract
The purpose of this pilot study was to assess Chronic Myeloid Leukemia (CML) patients’ adherence to, beliefs about, and barriers to oral anticancer agents (OAC) using brief self-report measures in community-based cancer clinics. Patients completed a structured interview including a health literacy assessment, a Brief Medication Questionnaire, two single-item self-report adherence questions, and the Medications Adherence Reasons Scale. Of the 86 participants, 88.4% were white; 55.8% male; mean age, 58.7 years; and 22.1% had limited health literacy. Nonadherence (missing at least one dose in the last week) was reported by 18.6% of participants and associated (p < 0.003) with less-than-excellent perceived ability to take CML medications (16.3%). Black participants reported more difficulty taking CML medications than white participants (28.6% vs. 8.3%, p = 0.053). Among all participants, 43.0% reported their CML medicine was ineffective and 24.4% that taking CML pills was somewhat to very hard. The most common reasons for missing a dose were simply missed it (24.4%) and side effects (18.6%). Most patients perceived their ability to take CML medication was good to excellent, yet nearly one in five reported missing at least one dose in the last week. Brief, no-cost self-report assessments to screen CML patients’ OAC adherence, barriers, and beliefs could facilitate counseling in busy community cancer clinics.
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Affiliation(s)
- Terry C. Davis
- Department of Medicine, Louisiana State University Health—Shreveport, Shreveport, LA 71130, USA; (C.L.A.); (G.M.)
- Correspondence: ; Tel.: +1-318-675-8694
| | - Connie L. Arnold
- Department of Medicine, Louisiana State University Health—Shreveport, Shreveport, LA 71130, USA; (C.L.A.); (G.M.)
| | - Glenn Mills
- Department of Medicine, Louisiana State University Health—Shreveport, Shreveport, LA 71130, USA; (C.L.A.); (G.M.)
| | - Glenn J. Lesser
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
| | - W. Mark Brown
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
| | - Richard Schulz
- College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA;
| | - Kathryn E. Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
| | - Pamala A. Pawloski
- Metro-Minnesota Community Oncology Research Consortium, St. Louis Park, MN 55416, USA;
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Myers CA, Martin CK, Apolzan JW, Arnold CL, Davis TC, Johnson WD, Katzmarzyk PT. Food Insecurity and Weight Loss in an Underserved Primary Care Population: A Post Hoc Analysis of a Cluster Randomized Trial. Ann Intern Med 2021; 174:1032-1034. [PMID: 33683931 PMCID: PMC8292163 DOI: 10.7326/m20-6326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Candice A Myers
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - John W Apolzan
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Connie L Arnold
- Louisiana State University Health Sciences Center, Shreveport, Louisiana
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Höchsmann C, Dorling JL, Martin CK, Newton RL, Apolzan JW, Myers CA, Denstel KD, Mire EF, Johnson WD, Zhang D, Arnold CL, Davis TC, Fonseca V, Lavie CJ, Price-Haywood EG, Katzmarzyk PT. Effects of a 2-Year Primary Care Lifestyle Intervention on Cardiometabolic Risk Factors: A Cluster-Randomized Trial. Circulation 2021; 143:1202-1214. [PMID: 33557578 DOI: 10.1161/circulationaha.120.051328] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 11/16/2022]
Abstract
BACKGROUND Intensive lifestyle interventions (ILIs) are the first-line approach to effectively treat obesity and manage associated cardiometabolic risk factors. Because few people have access to ILIs in academic health centers, primary care must implement similar approaches for a meaningful effect on obesity and cardiometabolic disease prevalence. To date, however, effective lifestyle-based obesity treatment in primary care is limited. We examined the effectiveness of a pragmatic ILI for weight loss delivered in primary care among a racially diverse, low-income population with obesity for improving cardiometabolic risk factors over 24 months. METHODS The PROPEL trial (Promoting Successful Weight Loss in Primary Care in Louisiana) randomly allocated 18 clinics equally to usual care or an ILI and subsequently enrolled 803 (351 usual care, 452 ILI) adults (67% Black, 84% female) with obesity from participating clinics. The usual care group continued to receive their normal primary care. The ILI group received a 24-month high-intensity lifestyle-based obesity treatment program, embedded in the clinic setting and delivered by health coaches in weekly sessions initially and monthly sessions in months 7 through 24. RESULTS As recently demonstrated, participants receiving the PROPEL ILI lost significantly more weight over 24 months than those receiving usual care (mean difference, -4.51% [95% CI, -5.93 to -3.10]; P<0.01). Fasting glucose decreased more in the ILI group compared with the usual care group at 12 months (mean difference, -7.1 mg/dL [95% CI, -12.0 to -2.1]; P<0.01) but not 24 months (mean difference, -0.8 mg/dL [95% CI, -6.2 to 4.6]; P=0.76). Increases in high-density lipoprotein cholesterol were greater in the ILI than in the usual care group at both time points (mean difference at 24 months, 4.6 mg/dL [95% CI, 2.9-6.3]; P<0.01). Total:high-density lipoprotein cholesterol ratio and metabolic syndrome severity (z score) decreased more in the ILI group than in the usual care group at both time points, with significant mean differences of the change of -0.31 (95% CI, -0.47 to -0.14; P<0.01) and -0.21 (95% CI, -0.36 to -0.06; P=0.01) at 24 months, respectively. Changes in total cholesterol, low-density lipoprotein cholesterol, triglycerides, and blood pressure did not differ significantly between groups at any time point. CONCLUSIONS A pragmatic ILI consistent with national guidelines and delivered by trained health coaches in primary care produced clinically relevant improvements in cardiometabolic health in an underserved population over 24 months. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02561221.
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Affiliation(s)
- Christoph Höchsmann
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
| | - James L Dorling
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
| | - Robert L Newton
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
| | - John W Apolzan
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
| | - Candice A Myers
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
| | - Kara D Denstel
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
| | - Emily F Mire
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
| | - William D Johnson
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
| | - Dachuan Zhang
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
| | - Connie L Arnold
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.)
| | - Terry C Davis
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.)
| | - Vivian Fonseca
- Department of Medicine, Section of Endocrinology, Tulane University Health Sciences Center, New Orleans, LA (V.F.)
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, New Orleans, LA (C.J.L.)
| | - Eboni G Price-Haywood
- Ochsner Clinic Foundation, Center for Outcomes and Health Services Research, New Orleans, LA (E.G.P.-H.)
| | - Peter T Katzmarzyk
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
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Disbrow EA, Arnold CL, Glassy N, Tilly CM, Langdon KM, Gungor D, Davis TC. Alzheimer Disease and Related Dementia Resources: Perspectives of African American and Caucasian Family Caregivers in Northwest Louisiana. J Appl Gerontol 2021; 40:209-219. [PMID: 32046583 PMCID: PMC8637937 DOI: 10.1177/0733464820904568] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We examined knowledge of Alzheimer's disease and related dementias (ADRD), resources, and research opportunities among older African American (AA) and Caucasian caregivers. A mixed methods design integrated qualitative (focus group) and quantitative (survey) data from Northwest Louisiana. Eight focus groups (59 adults, 92% female, 78% AA, 25% rural) revealed limited knowledge. Quantitative findings from 117 ADRD caregivers (83% female, 72% AA, 30% limited heath literacy, 27% low income) indicated participants obtained information from providers (54%), friends and relatives (32%), and the internet (37%). Barriers to care were cost (24%) and lack of family agreement (17%). Few families used adult daycare (8%) or support groups (28%). Concerns about research participation were violation of privacy (30%) and fear of patient distress (27%). Distrust of doctors was minimal (3%). Findings did not vary by race. There is a need for clear, literacy-appropriate information about ADRD, caregiver resources, and clinical trials.
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Affiliation(s)
- Elizabeth A. Disbrow
- Department of Neurology and Center for Brain Health, Louisiana State University Health Sciences Center Shreveport, USA
| | - Connie L. Arnold
- Department of Medicine, and Fiest-Weiller Cancer Center at Louisiana State University Health Sciences Center, USA
| | - Nathaniel Glassy
- Department of Neurology and Center for Brain Health, Louisiana State University Health Sciences Center Shreveport, USA
| | - Collette M. Tilly
- Department of Neurology and Center for Brain Health, Louisiana State University Health Sciences Center Shreveport, USA
| | - Kate M. Langdon
- Department of Medicine, and Fiest-Weiller Cancer Center at Louisiana State University Health Sciences Center, USA
| | - Deniz Gungor
- Department of Medicine, and Fiest-Weiller Cancer Center at Louisiana State University Health Sciences Center, USA
| | - Terry C. Davis
- Department of Medicine, and Fiest-Weiller Cancer Center at Louisiana State University Health Sciences Center, USA
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Chang ME, Baker SJ, Dos Santos Marques IC, Liwo AN, Chung SK, Richman JS, Knight SJ, Fouad MN, Gakumo CA, Davis TC, Chu DI. Health Literacy in Surgery. Health Lit Res Pract 2020; 4:e46-e65. [PMID: 32053207 PMCID: PMC7015264 DOI: 10.3928/24748307-20191121-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/22/2019] [Indexed: 01/11/2023] Open
Abstract
Background: Low health literacy is associated with poor health outcomes in many chronic diseases and may have an important role in determining surgical outcomes. This study aims to comprehensively review the current state of science on adult health literacy in surgery and to identify knowledge gaps for future research. Methods: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic search was conducted to identify all studies from January 2002 through May 2018 that used validated instruments to assess health literacy among adult patients undergoing surgery. Studies were assessed for quality using the Newcastle-Ottawa scale and evaluated on findings by their focus on identifying health literacy levels, understanding associations with surgical outcomes, and/or developing interventions to address low health literacy. Key Results: There were 51 studies on health literacy with data from 22,139 patients included in this review. Low health literacy was present in more than one-third of surgical patients (34%, interquartile range 16%–50%). The most commonly used validated instrument for assessment of health literacy in the surgical population was the Newest Vital Sign. Most studies were focused on identifying the prevalence of low health literacy within a surgery population (84%, n = 43). Few studies focused on understanding the association of health literacy to surgical outcomes (12%, n = 6) and even fewer studies developed interventions to address health literacy (4%, n = 2). Discussion: Low health literacy is common among surgical patients. Important opportunities exist to better understand the role of health literacy in determining surgical outcomes and to develop more health literacy-sensitive models of surgical care. [HLRP: Health Literacy Research and Practice. 2020;4(1):e45–e65.] Plain Language Summary: Health literacy has not been well-studied in surgery but likely plays an important role. In this article, we reviewed all current research on health literacy in surgery to help us understand where we are at and where we need to go. We found that low health literacy is common and we need more ways to address it in surgery.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Daniel I. Chu
- Address correspondence to Daniel I. Chu, MD, Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, KB 428, 1720 2nd Avenue S., Birmingham, AL 35294-0016;
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Dos Santos Marques IC, Theiss LM, Baker SJ, Liwo A, Wood LN, Cannon JA, Morris MS, Kennedy GD, Fouad MN, Davis TC, Chu DI. Low Health Literacy Exists in the Inflammatory Bowel Disease (IBD) Population and Is Disproportionately Prevalent in Older African Americans. Crohns Colitis 360 2020; 2:otaa076. [PMID: 33442671 PMCID: PMC7802758 DOI: 10.1093/crocol/otaa076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Low health literacy is common in general populations, but its prevalence in the inflammatory bowel disease (IBD) population is unclear. The objective of this study was to assess the prevalence of low health literacy in a diverse IBD population and to identify risk factors for low health literacy. METHODS Adult patients with IBD at a single institution from November 2017 to May 2018 were assessed for health literacy using the Newest Vital Sign (NVS). Demographic and socioeconomic data were also collected. Primary outcome was the prevalence of low health literacy. Secondary outcomes were length-of-stay (LOS) and 30-day readmissions after surgical encounters. Bivariate comparisons and multivariable regression were used for analyses. RESULTS Of 175 IBD patients, 59% were women, 23% were African Americans, 91% had Crohn disease, and mean age was 46 years (SD = 16.7). The overall prevalence of low health literacy was 24%. Compared to white IBD patients, African Americans had significantly higher prevalence of low health literacy (47.5% vs 17.0%, P < 0.05). On multivariable analysis, low health literacy was associated with older age and African American race (P < 0.05). Of 83 IBD patients undergoing abdominal surgery, mean postoperative LOS was 5.5 days and readmission rate was 28.9%. There was no significant difference between LOS and readmissions rates by health literacy levels. CONCLUSIONS Low health literacy is present in IBD populations and more common among older African Americans. Opportunities exist for providing more health literacy-sensitive care in IBD to address disparities and to benefit those with low health literacy.
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Affiliation(s)
| | - Lauren M Theiss
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Samantha J Baker
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Amandiy Liwo
- Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lauren N Wood
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jamie A Cannon
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Melanie S Morris
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gregory D Kennedy
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mona N Fouad
- Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Terry C Davis
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA,Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Daniel I Chu
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA,Address correspondence to: Daniel I. Chu, MD, 1720 2nd Avenue South, Birmingham, AL 35294-0016 ()
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Katzmarzyk PT, Martin CK, Newton RL, Apolzan JW, Arnold CL, Davis TC, Price-Haywood EG, Denstel KD, Mire EF, Thethi TK, Brantley PJ, Johnson WD, Fonseca V, Gugel J, Kennedy KB, Lavie CJ, Sarpong DF, Springgate B. Weight Loss in Underserved Patients - A Cluster-Randomized Trial. N Engl J Med 2020; 383:909-918. [PMID: 32877581 PMCID: PMC7493523 DOI: 10.1056/nejmoa2007448] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Evidence of the effectiveness of treatment for obesity delivered in primary care settings in underserved populations is lacking. METHODS We conducted a cluster-randomized trial to test the effectiveness of a high-intensity, lifestyle-based program for obesity treatment delivered in primary care clinics in which a high percentage of the patients were from low-income populations. We randomly assigned 18 clinics to provide patients with either an intensive lifestyle intervention, which focused on reduced caloric intake and increased physical activity, or usual care. Patients in the intensive-lifestyle group participated in a high-intensity program delivered by health coaches embedded in the clinics. The program consisted of weekly sessions for the first 6 months, followed by monthly sessions for the remaining 18 months. Patients in the usual-care group received standard care from their primary care team. The primary outcome was the percent change from baseline in body weight at 24 months. RESULTS All 18 clinics (9 assigned to the intensive program and 9 assigned to usual care) completed 24 months of participation; a median of 40.5 patients were enrolled at each clinic. A total of 803 adults with obesity were enrolled: 452 were assigned to the intensive-lifestyle group, and 351 were assigned to the usual-care group; 67.2% of the patients were Black, and 65.5% had an annual household income of less than $40,000. Of the enrolled patients, 83.4% completed the 24-month trial. The percent weight loss at 24 months was significantly greater in the intensive-lifestyle group (change in body weight, -4.99%; 95% confidence interval [CI], -6.02 to -3.96) than in the usual-care group (-0.48%; 95% CI, -1.57 to 0.61), with a mean between-group difference of -4.51 percentage points (95% CI, -5.93 to -3.10) (P<0.001). There were no significant between-group differences in serious adverse events. CONCLUSIONS A high-intensity, lifestyle-based treatment program for obesity delivered in an underserved primary care population resulted in clinically significant weight loss at 24 months. (Funded by the Patient-Centered Outcomes Research Institute and others; PROPEL ClinicalTrials.gov number, NCT02561221.).
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Affiliation(s)
- Peter T Katzmarzyk
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Corby K Martin
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Robert L Newton
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - John W Apolzan
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Connie L Arnold
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Terry C Davis
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Eboni G Price-Haywood
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Kara D Denstel
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Emily F Mire
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Tina K Thethi
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Phillip J Brantley
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - William D Johnson
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Vivian Fonseca
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Jonathan Gugel
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Kathleen B Kennedy
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Carl J Lavie
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Daniel F Sarpong
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Benjamin Springgate
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
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Dos Santos Marques IC, Herbey II, Theiss LM, Hollis RH, Knight SJ, Davis TC, Fouad M, Chu DI. Understanding the Surgical Experience for African-Americans and Caucasians With Enhanced Recovery. J Surg Res 2020; 250:12-22. [PMID: 32014697 DOI: 10.1016/j.jss.2019.12.034] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/18/2019] [Accepted: 12/27/2019] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Racial/ethnic disparities in surgical outcomes exist. Enhanced recovery programs (ERPs) have reduced some racial/ethnic disparities, but it remains unclear if disparities in experiences are also reduced. The purpose of this study was to use qualitative methods to better understand the surgical experience for African-American and Caucasian patients in the setting of an ERP. METHODS Using purposeful sampling at a minority-serving institution, we recruited African-American and Caucasian patients who had undergone colorectal surgery under an ERP to six focus groups. Participants identified barriers and facilitators to a positive, or negative, surgical experience. Audio recordings were transcribed and analyzed using an indicative thematic approach with NVivo 10 software (QSR International). RESULTS Forty-three patients (15 African-Americans and 28 Caucasians) participated in six focus groups. Six themes were identified by patients to be important in surgery: 1) knowledge about colorectal surgery, 2) obtaining information, 3) quality of information, 4) setting expectations about surgery, 5) following preoperative and postoperative instructions, and 6) confidence in surgery outcomes. For both racial/ethnic groups, patients felt that more information could have been provided, information should be given at their level of understanding, and trust in the physician made them feel confident in a positive outcome. African-American patients described experiences of having incorrect or no expectations on surgical outcomes, being provided inconsistent information, and feeling misled. African-Americans also described following instructions from family members and valued the importance of diet and exercise in recovery. CONCLUSIONS African-American and Caucasian surgical patients have varied surgical experiences even under an ERP. All patients, however, valued the ability to obtain, process, and understand health information during the surgical process. These elements define "health literacy" and suggest the importance of providing health literacy-sensitive care in surgery.
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Affiliation(s)
| | - Ivan I Herbey
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lauren M Theiss
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert H Hollis
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sara J Knight
- Division of Preventative Medicine, University of Utah, Salt Lake City, Utah
| | - Terry C Davis
- Departments of Medicine and Pediatrics, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Mona Fouad
- Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Daniel I Chu
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
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Hadden KB, Arnold CL, Curtis LM, Davis TC, Gan JM, Hur SI, McSweeney JC, Mikesell BL, Wolf MS. Barriers and solutions to implementing a pragmatic diabetes education trial in rural primary care clinics. Contemp Clin Trials Commun 2020; 18:100550. [PMID: 32190781 PMCID: PMC7068634 DOI: 10.1016/j.conctc.2020.100550] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 02/20/2020] [Accepted: 02/23/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The purpose of this report is to describe barriers and solutions to the implementation and optimization of a pragmatic trial that tests an evidence-based, patient-centered, low literacy intervention promoting diabetes self-care in rural primary care clinics. METHODS The two-arm pragmatic trial has been implemented in six rural family medicine clinics in Arkansas. It tests a self-management education and counseling intervention for patients with type 2 diabetes compared to enhanced usual care. Barriers and solutions were identified as issues arose and through interviews with clinic directors and clinic administrators and a focus group, interviews, and tracking reports with clinic health coaches who delivered the intervention. RESULTS Barriers to optimizing enrollment, intervention delivery, and data collection were addressed through targeted education of and relationship building with leadership, changing enrollment oversight, and ongoing training of health coaches. CONCLUSIONS Successful implementation and optimization of this pragmatic clinical trial in rural primary care clinics was achieved through establishing common goals with clinic leadership, minimizing demands on clinic staff and administration, frequent contact and ongoing support of health coaches, and collaborative troubleshooting of issues with delivering the intervention.
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Affiliation(s)
- Kristie B. Hadden
- University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, 72205-7199, USA
| | - Connie L. Arnold
- Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, Shreveport, LA, 71130-3932, USA
| | - Laura M. Curtis
- Northwestern University, Division of General Internal Medicine and Geriatrics, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA
| | - Terry C. Davis
- Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, Shreveport, LA, 71130-3932, USA
| | - Jennifer M. Gan
- University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, 72205-7199, USA
| | - Scott I. Hur
- Northwestern University, Division of General Internal Medicine and Geriatrics, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA
| | - Jean C. McSweeney
- University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, 72205-7199, USA
| | - Brandie L. Mikesell
- University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, 72205-7199, USA
| | - Michael S. Wolf
- Northwestern University, Department of Preventive Medicine, 680 N. Lake Shore Drive, Chicago, IL, 60611, USA
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Arnold CL, Davis TC, Morris J, Murphy P, Mills G. Abstract PR12: CRC screening in rural community clinics using the fecal immunochemical test (FIT): Issues with repeat screening. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-pr12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Introduction: Colorectal cancer (CRC), the second leading cause of cancer death in the United States, can be significantly reduced if it is detected early. Although overall CRC screening rates have increased significantly, disparities persist among low-income individuals, adults with low literacy and those living in rural areas. These groups all have screening completion rates below 50%.
Objectives: To assess patient knowledge, beliefs, and self-efficacy about CRC screening and compare the effectiveness of two health literacy informed telephone follow-up strategies to improve annual screening over a three-year period with fecal immunochemical test (FIT) in rural community clinics.
Methods: A two-arm, randomized controlled trial is being implemented in four community clinics. Clinics reported CRC baseline screening rates of 3% to 5%. Eligible patients, age 50-75, were recruited at the clinic prior to a scheduled appointment. A research assistant (RA) conducted a baseline structured interview measuring CRC screening knowledge, beliefs, and self-efficacy. The RA then recommended screening and gave brief literacy and culturally appropriate education using a pamphlet (4th-grade level), the FIT kit with preaddressed envelope, simplified instructions (3rd-grade level) and a demonstration of how to use it. At four weeks patients who had not returned their kit received either 1) a personal follow-up call (PC) from a central prevention coordinator using motivational interviewing skills and reminding them to complete and mail FIT kits, or 2) an automated follow-up call (AC) using plain language and motivational messages encouraging patients to complete and mail the FIT. Outcomes include FIT completion after intervention, and again at 12 and 24 months.
Results: 620 patients not up-to-date were enrolled: 308/AC and 306/PC; 66% were African American, 55% women; 40% had limited literacy. During Year 1, 69% completed screening in AC arm versus 67% in PC arm. During Year 2, percentage screened decreased: 40% screened in AC arm and 37% in PC arm. Number of patients who needed at least one follow-up call increased: 74% in both arms needed at least 1 reminder call. Among those called, 19% in the AC arm completed their kit versus 15% in the PC arm. To date in Year 3, 32% screened in AC and 34% in PC.
Conclusions: Simplified instructions accompanied by a face-to-face demonstration of FIT, and use of “teach back” to confirm understanding with a follow-up call if needed, facilitated completion rates of all patients, particularly those with limited literacy. Providing FIT + literacy appropriate education at regularly scheduled clinic visit with follow-up call (if needed) increased CRC screening rates of low-income, rural patients. Sustaining annual screening with FIT is challenging. In year 2 < 40% completed FIT. Follow-up calls were essential. Only 1/4 completed FIT without phone prompt. Lower-cost automated call has proven to be just as effective as personal call in both years 1 and 2. FIT is only effective if completed annually.
This abstract is also being presented as Poster B099.
Citation Format: Connie L. Arnold, Terry C. Davis, James Morris, Peggy Murphy, Glenn Mills. CRC screening in rural community clinics using the fecal immunochemical test (FIT): Issues with repeat screening [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr PR12.
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Affiliation(s)
- Connie L. Arnold
- 1Feist-Weiller Cancer Center and LSU Health Sciences Center, Shreveport, LA,
| | - Terry C. Davis
- 1Feist-Weiller Cancer Center and LSU Health Sciences Center, Shreveport, LA,
| | | | | | - Glenn Mills
- 1Feist-Weiller Cancer Center and LSU Health Sciences Center, Shreveport, LA,
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Davis TC, Arnold C, Mills G, Miele L. Abstract IA07: Biobanking and genomic research: Understanding and acceptance of individuals unrepresented in clinical trials. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-ia07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Disparities exists in recruitment in clinical trials and biorepositories among minority groups, rural residents, and low-income individuals. The objective of this study to identify barriers and facilitators to awareness, understanding, and acceptance of clinical trials and biobanking among English- and Spanish-speaking safety-net patients and providers and African American (AA) and Hispanic social and church groups. We conducted 14 focus groups and 7 individual interviews January-May 2017 among English-speaking adults in urban and rural communities in Louisiana. In September 2018 we expanded the study to Hispanic adults. (This study is ongoing.) Sites included safety-net oncology and primary care clinics, social service agencies, Alzheimer support groups, and social and church groups. Themes were identified. The first study included 103 individuals: 78 patient and community participants and 25 providers; 24% lived in rural areas. Patients and community members' age ranged from 45-88; 85% were female, 78% AA. Participants were aware of clinical trials and personalized medicine due to ads on TV. Low-income and minority patients were open to participating in genomic trials and biobanking even if it would not benefit them directly. Cancer patients and Alzheimer family caregivers were highly interested in clinical trials that might benefit them or their family. Community participants were less trusting of clinical trials than patients. All said information about clinical trials would be most effective and actionable if it comes from a trusted physician. Terms such as clinical trials and biobanking were scary to some and not understood—medical studies and a bank to store blood and tissue were clearer. AA participants indicated that a recruitment message needs to be “ALL people are needed for studies to improve treatments” rather than “AA have been under-represented and most treatments based on whites,” which raises suspicion. Some participants were concerned with who would see data and if it would be a barrier to jobs or insurance, despite being told of protections in place for confidentiality. Community providers were interested in being more involved in clinical trials. They lacked time to identify trials and explain them to patients. They wanted brief, plain-language handouts with talking points and a card to give patients to call for more information. Transportation to academic centers is a barrier to patient participation in clinical trials. Very few patients, caregivers, or providers had looked for clinical trials on the Internet or social media. AA and lower-income white adults were interested in clinical trials but not clear how to learn about them. Most were willing to participate but had never been asked. Recommendation to participate in a clinical trial is most effective coming from a trusted physician; however, community physicians lack appropriate information to give patients. Strategies to create understandable and actionable information that can be shared with community providers and the public are urgently needed.
Citation Format: Terry C. Davis, Connie Arnold, Glenn Mills, Lucio Miele. Biobanking and genomic research: Understanding and acceptance of individuals unrepresented in clinical trials [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr IA07.
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Affiliation(s)
| | | | - Glenn Mills
- 1LSU Health Sciences Center-S, Shreveport, LA,
| | - Lucio Miele
- 2LSU Health Sciences Centre-NO, New Orleans, LA
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Swaminathan R, Morris JD, Davis TC. Rural-urban disparities in colorectal cancer screening: An insight from a statewide database. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
69 Background: The Healthy People 2020 initiative aims to increase colorectal cancer (CRC) screening. The common CRC screening options are FIT, FOBT, sigmoidoscopy, and colonoscopy. Colonoscopy allows visualization of the entire colon and offers therapeutic benefit whereas stool tests are less invasive, cost-effective and are easily available. Inequities exist in CRC screening among rural residents which may be contributed to a lower level of education, income, health insurance and access to health care. The purpose of the study is to identify the impact of geographic region on the preference of CRC screening modality among Louisiana adults. Methods: We performed a retrospective cohort study among age-eligible Louisiana adults who had CRC screening either with colonoscopy or stool-based tests using the 2016 Behavioral Risk Factor Surveillance System database (n = 1372). We examined demographic characteristics among participants who had CRC screening with colonoscopy versus who had a stool-based test. Multivariable logistic regression analysis evaluated the association of geographic region and the preference of CRC screening. Results: Participants age 65-75 years old were 36% less likely to have a colonoscopy as compared to age 50-64 years (p = 0.0008). African Americans and Hispanic Americans were 34% (p < 0.006) and 55% (p = 0.057) less likely to have a colonoscopy as compared to Caucasian Americans, respectively. Medicaid and Medicare participants were 82% (p < 0.0001) and 52% (p < 0.0001) less likely to have a colonoscopy compared to participants with private insurance, respectively. After adjusting for age, race/ethnicity, education, income, and insurance the odds of screening colonoscopy was 29% lower for rural residents compared to urban residents of Louisiana (OR 0.71 95% CI 0.53 - 0.94). Conclusions: Individuals residing in rural parishes of Louisiana were more likely to have a stool-based test for CRC screening. Health care providers while considering the reliability and feasibility of CRC screening modality should also incorporate patient’s preferences while offering the screening tests to increase the rate of CRC screening.
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Davis TC, White RR. Breeding animals to feed people: The many roles of animal reproduction in ensuring global food security. Theriogenology 2020; 150:27-33. [PMID: 32088028 DOI: 10.1016/j.theriogenology.2020.01.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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] [Received: 01/17/2020] [Accepted: 01/18/2020] [Indexed: 02/06/2023]
Abstract
As the population grows and shifts demographically, the resulting increase in demand for beef and milk necessitates improvements in the sustainability of ruminant livestock production systems. Ruminant livestock contribute to ensuring global food security because they have the ability to up-cycle non-human-edible products into meat and milk products with notable nutritional value. However, ruminant livestock also pose a challenge to global food sustainability because they are resource-intensive to produce and contribute substantially to agricultural greenhouse gas emissions. As such, improving environmental impacts of ruminant livestock production globally is an essential goal. There are a number of strategies that can be employed to enhance sustainability of ruminant production systems; however, improving reproductive efficiency is among the more efficient, because an increase in reproductive success will reduce the number of cows needed to produce a target quantity of beef. This reduction in the cow herd size helps limit the number of unproductive animals retained in the herd, thereby reducing the environmental maintenance cost of livestock production. Additionally, proper application of reproductive technologies enables faster and more targeted advances in genetic gains, which can be leveraged to produce phenotypes that are resource-use-efficient and well-adapted to their production environment. Optimizing reproductive efficiency can be accomplished through improved genetic selection for fertility and fecundity; applying more effective use of assisted reproductive technologies; and coupling reproductive and nutritional management to optimize likelihood of reproductive success. Collectively, applying these approaches will be essential when working to ensure ruminant livestock's contribution to global food security.
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Affiliation(s)
- T C Davis
- Department of Animal and Poultry Sciences, Virginia Tech, Blacksburg, VA, 24060, USA
| | - R R White
- Department of Animal and Poultry Sciences, Virginia Tech, Blacksburg, VA, 24060, USA.
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25
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Arnold CL, Rademaker AW, Morris JD, Ferguson LA, Wiltz G, Davis TC. Follow-up approaches to a health literacy intervention to increase colorectal cancer screening in rural community clinics: A randomized controlled trial. Cancer 2019; 125:3615-3622. [PMID: 31355924 DOI: 10.1002/cncr.32398] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/09/2018] [Revised: 02/28/2019] [Accepted: 04/05/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Significant disparities exist in colorectal cancer (CRC) screening rates among those of low socioeconomic status, with fewer years of education, lacking health insurance, or living in rural areas. METHODS A randomized controlled trial was conducted to compare the effectiveness of 2 follow-up approaches to a health literacy intervention to improve CRC screening: automated telephone call or personal call. Patients aged 50 to 75 years residing in 4 rural community clinics in Louisiana were given a structured interview that assessed demographic, health literacy and CRC screening barriers, knowledge, and attitudes. All were given health literacy-informed CRC education, a patient-friendly CRC screening pamphlet, simplified fecal immunochemical test (FIT) instructions, and a FIT kit, and a "teach-back" method was used to confirm understanding. Patients were randomized to 1 of 2 telephone follow-up arms. If they did not mail their FIT kit within 4 weeks, they received a reminder call and were called again at 8 weeks if the test still was not received. RESULTS A total of 620 patients were enrolled. Approximately 55% were female, 66% were African American, and 40% had limited literacy. The overall FIT completion rate was 68%: 69.2% in the automated telephone call arm and 67% in the personal call arm. Greater than one-half of the patients (range, 58%-60%) returned the FIT kit without receiving a telephone call. There was no difference noted with regard to the effectiveness of the follow-up calls; each increased the return rate by 9%. CONCLUSIONS Providing FIT kits and literacy-appropriate education at regularly scheduled clinic visits with a follow-up telephone call when needed was found to increase CRC screening among low-income, rural patients. The lower cost automated call was just as effective as the personal call.
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Affiliation(s)
- Connie L Arnold
- Department of Medicine, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana
| | - Alfred W Rademaker
- Department of Preventive Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - James D Morris
- Department of Medicine, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana
| | - Laurie Anne Ferguson
- College of Nursing and Health, Loyola University New Orleans, New Orleans, Louisiana
| | - Gary Wiltz
- Teche Action Clinic, Franklin, Louisiana
| | - Terry C Davis
- Department of Medicine, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana
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Davis TC, Rademaker A, Morris J, Ferguson LA, Wiltz G, Arnold CL. Repeat Annual Colorectal Cancer Screening in Rural Community Clinics: A Randomized Clinical Trial to Evaluate Outreach Strategies to Sustain Screening. J Rural Health 2019; 36:307-315. [PMID: 31523848 DOI: 10.1111/jrh.12399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/23/2019] [Revised: 07/17/2019] [Accepted: 08/19/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE The majority of colorectal cancer (CRC) research using the fecal immunochemical test (FIT) has studied short-term screening results in predominantly urban areas. The purpose of this study was to evaluate the effectiveness of 2 outreach strategies embedded in a health literacy intervention on repeat CRC screening in rural community clinics. METHODS A 2-arm randomized controlled trial was conducted in 4 rural clinics in Louisiana. During a regularly scheduled clinic visit, participants ages 50-75 received a FIT kit and brief educational intervention. Participants were randomized to receive an automated call or a personal call by a prevention counselor after 4 weeks and 8 weeks if FIT kits were not returned. In year 2, materials were mailed, and follow-up calls were conducted as in year 1. The primary outcome was repeat FIT-the return of the FIT kit in both years. PARTICIPANTS Of 568 eligible participants, 55% were female, 67% were African American, and 39% had low health literacy. FINDINGS Repeat FIT rates were 36.5% for those receiving the automated call and 33.6% for those receiving a personal call (P = .30). No annual FITs were returned in 30% of participants, while only 1 FIT was returned by 35% of participants (31% only year 1 and 4% only year 2). CONCLUSION Sustaining CRC screening with FIT is challenging in rural clinics. A lower cost automated call was just as effective as the personal call in promoting repeat annual screening. However, more intensive strategies are needed to improve long-term FIT screening among rural participants.
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Affiliation(s)
- Terry C Davis
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Alfred Rademaker
- Department of Preventive Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - James Morris
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | | | - Gary Wiltz
- Teche Action Clinic, Franklin, Louisiana
| | - Connie L Arnold
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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Myers CA, Martin CK, Newton RL, Apolzan JW, Arnold CL, Davis TC, Price-Haywood EG, Katzmarzyk PT. Cardiovascular Health, Adiposity, and Food Insecurity in an Underserved Population. Nutrients 2019; 11:nu11061376. [PMID: 31248113 PMCID: PMC6628173 DOI: 10.3390/nu11061376] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 11/16/2022] Open
Abstract
This study investigated associations between cardiovascular health (CVH), adiposity, and food insecurity by race, sex, and health literacy in a sample of 800 underserved patients with obesity (body mass index [BMI] ≥ 30 kg/m2). CVH was assessed using American Heart Association Life’s Simple 7 (LS7) and adiposity was estimated using BMI and waist circumference (WC). Mixed models including interaction terms between food insecurity and sex, race, and health literacy were analyzed for LS7, BMI, and WC. Stratified models were analyzed as indicated by significant interactions. Mean BMI and WC were 37.3 kg/m2 (4.6 SD) and 113.5 cm (12.4 SD), respectively. Among patients, 31% were food insecure and 31% had low health literacy. There were significant positive associations between food insecurity and BMI (p = 0.03) and WC (p = 0.03) in the overall sample. In sex-stratified models, women who were food insecure had higher BMI (p = 0.02) and WC (p = 0.007) than their food secure counterparts. Further, food insecure patients with better health literacy had greater BMI (p = 0.004) and WC (p = 0.007) than their food secure counterparts. Results suggest that adiposity is a greater burden in food insecure patients, which may be an important consideration for obesity treatment in underserved populations.
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Affiliation(s)
- Candice A Myers
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
| | - Corby K Martin
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
| | - Robert L Newton
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
| | - John W Apolzan
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
| | - Connie L Arnold
- Department of Medicine, Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71103, USA.
| | - Terry C Davis
- Department of Medicine, Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71103, USA.
| | - Eboni G Price-Haywood
- Ochsner Clinic Foundation, Center for Outcomes and Health Services Research, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
- Ochsner Clinical School, University of Queensland, 1401 Jefferson Highway, New Orleans, LA 70121, USA.
| | - Peter T Katzmarzyk
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
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Davis TC, Arnold CL, Mills G, Miele L. A Qualitative Study Exploring Barriers and Facilitators of Enrolling Underrepresented Populations in Clinical Trials and Biobanking. Front Cell Dev Biol 2019; 7:74. [PMID: 31114788 PMCID: PMC6502895 DOI: 10.3389/fcell.2019.00074] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [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: 01/10/2019] [Accepted: 04/15/2019] [Indexed: 11/24/2022] Open
Abstract
Disparities exist in enrollment in clinical trials and biorepositories among adults with low socioeconomic status, racial and ethnic minority groups and individuals who live in rural areas. Diverse participation is necessary to identify the most effective treatments in different groups. The purpose of this study was to use qualitative methods to identify factors that may affect the likelihood that members of underrepresented groups choose to participate in clinical trials and/or biobanking. We conducted 14 focus groups and seven telephone interviews in urban and rural areas of Louisiana to: (1) identify barriers and facilitators to participation; and (2) elicit input in crafting clear, culturally appropriate language and recruitment strategies. Of 103 participants, 25 were safety-net healthcare providers, 18 were primary care or oncology clinic patients, and 60 were members of social and faith-based groups. Patients and community participants were English-speaking, 79% were African American, 81% were female and 24% lived in rural areas. Barriers to participation identified were lack of knowledge about clinical trials and biobanks; limited specific information and access to participation, trust and privacy concerns about clinical trials and biobanking Facilitators included: altruism, high interest in medical research particularly studies that might benefit them or their families; plain language, culturally appropriate information; convenient access to studies; and input of a trusted provider. In addition, all primary care providers were interested in having clinical trial options available for their patients but did not have time to search for available trials. Results of this study can inform the development of education materials and strategies to increase participation of underrepresented groups in clinical trial and biobanking.
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Affiliation(s)
- Terry C Davis
- Department of Medicine, Feist-Weiller Cancer Center, LSU Health Sciences Center Shreveport, Shreveport, LA, United States
| | - Connie L Arnold
- Department of Medicine, Feist-Weiller Cancer Center, LSU Health Sciences Center Shreveport, Shreveport, LA, United States
| | - Glenn Mills
- Department of Medicine, Feist-Weiller Cancer Center, LSU Health Sciences Center Shreveport, Shreveport, LA, United States
| | - Lucio Miele
- Stanley S. Scott Cancer Center, LSU Health Sciences Center New Orleans, New Orleans, LA, United States
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Mitchell S, Hirschman KB, Laurens V, Martin Howard J, Davis TC, Li J, Williams MV, Jack BW. UNDERSTANDING FACILITATORS AND BARRIERS TO CARE TRANSITIONS: PATIENT AND CAREGIVER PERSPECTIVE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.744] [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: 11/12/2022] Open
Affiliation(s)
- S Mitchell
- Boston University School of Medicine, Boston, Massachusetts, United States
| | - K B Hirschman
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - V Laurens
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
| | - J Martin Howard
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
| | - T C Davis
- Department of Medicine and Pediatrics, Louisiana State University Health Sciences, Shreveport, LA, USA
| | - J Li
- Center for Health Services Research, University of Kentucky, Lexington, KY, USA
| | - M V Williams
- Univeristy of Kentucky, Lexinton, KY, USA; Center for Health Services Research, University of Kentucky, Lexington, LY, USA
| | - B W Jack
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
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Arnold C, Davis TC, Morris J, Mills GM. Annual colorectal cancer screening in rural community clinics using the fecal immunochemical test (FIT): Second and third year screening. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.30_suppl.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
35 Background: Colorectal cancer (CRC), the second leading cause of cancer death in the US, can be significantly reduced if it is detected early. Although overall CRC screening rates have increased significantly, disparities persist among low income individuals, adults with low literacy and those living in rural areas. Methods: Randomized controlled trial to assess the effectiveness of 2 health literacy informed phone follow-up strategies to improve annual screening with Fecal Immunochemical Test (FIT) in 4 rural community clinics. Eligible patients, age 50-75, were recruited. After consenting, a research assistant (RA) recommended screening and gave literacy and culturally appropriate education using a pamphlet, the FIT kit, simplified instructions and a demonstration of how to use it, At 4 weeks patients who had not returned their kit receive either 1) a personal follow-up call (PC) from a central RA using motivational interviewing skills and reminding them to complete FIT kits; or 2) an automated follow-up call (AC) using plain language and motivational messages encourages patients to complete the FIT. During years 2 and 3, FIT kits were mailed to patients. Follow-up call procedures previously used were followed. Results: 620 patients not up-to-date were enrolled: 308/AC & 306/PC; 66% were African American, 55% women; 40% had limited literacy. During Year 1, 69% completed screening in AC arm versus 67% in PC arm. During Year 2, percentage screened decreased: 40% screened in AC arm and 37% in PC arm. Number of patients that needed at least one follow-up called increased: 74% in both arms needed at least 1 reminder call. Among those called, 19% in the AC arm completed their kit versus 15% in the PC arm. To date in Year 3, 32% screened in AC and 34% in PC. Conclusions: Simplified instructions accompanied by a face-to-face demonstration of FIT, use of “teach back” to confirm understanding with a follow-up call if needed, facilitated completion rates of all patients, particularly those with limited literacy. The less costly and time consuming automated call was equally effective as a personal call. Screening rates in years 2 and 3 declined. CRC screening with FIT is only effective when completed annually. Clinical trial information: RSG-13-021-01 - CPPB.
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Affiliation(s)
- Connie Arnold
- LSU Health Sciences Center - Shreveport, Shreveport, LA
| | - Terry C Davis
- LSU Health Sciences Center - Shreveport, Shreveport, LA
| | - James Morris
- LSU Health Sciences Center - Shreveport, Shreveport, LA
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Hadden KB, Arnold CL, Curtis LM, Gan JM, Hur SI, Kwasny MJ, McSweeney JC, Prince LY, Wolf MS, Davis TC. Rationale and development of a randomized pragmatic trial to improve diabetes outcomes in patient-centered medical homes serving rural patients. Contemp Clin Trials 2018; 73:152-157. [PMID: 30243812 PMCID: PMC6179446 DOI: 10.1016/j.cct.2018.09.007] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/10/2018] [Accepted: 09/18/2018] [Indexed: 12/20/2022]
Abstract
Proper diabetes self-care requires patients to have considerable knowledge, a range of skills, and to sustain multiple health behaviors. Self-management interventions are needed that can be readily implemented and sustained in rural clinics with limited resources that disproportionately care for patients with limited literacy. Researchers on our team developed an evidence-based, patient-centered, low literacy intervention promoting diabetes self-care that includes: 1) the American College of Physicians (ACP) Diabetes Guide that uses plain language and descriptive photographs to teach core diabetes concepts and empower patients to initiate behavior change; 2) a brief counseling strategy to assist patients in developing short-term, explicit and attainable goals for behavior change ('action plans'); and 3) a training module for health coaches that prepares them to assume educator/counselor roles with the Diabetes Guide as a teaching tool. While the intervention has previously been field tested and found to significantly improve patient knowledge, self-efficacy, and engagement in related health behaviors, its optimal implementation is not known. This project took advantage of a unique opportunity to modify and disseminate the ACP health literacy intervention among patients with type 2 diabetes cared for at rural clinics in Arkansas that are Patient-Centered Medical Homes (PCMH). These practices all had health coaches that could be leveraged to provide chronic disease self-management mostly via phone, but also at the point-of-care. Hence we conducted a patient-randomized, pragmatic clinical trial in 6 rural PCMHs in Arkansas, targeting individuals with uncontrolled type 2 diabetes.
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Affiliation(s)
- Kristie B Hadden
- University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205-7199, USA.
| | - Connie L Arnold
- Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, Shreveport, LA 71130-3932, USA
| | - Laura M Curtis
- Northwestern University, Division of General Internal Medicine and Geriatrics, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA
| | - Jennifer M Gan
- University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205-7199, USA
| | - Scott I Hur
- Northwestern University, Division of General Internal Medicine and Geriatrics, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA
| | - Mary J Kwasny
- Northwestern University, Department of Preventive Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA
| | - Jean C McSweeney
- University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205-7199, USA
| | - Latrina Y Prince
- University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205-7199, USA
| | - Michael S Wolf
- Northwestern University, Division of General Internal Medicine and Geriatrics, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA
| | - Terry C Davis
- Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, Shreveport, LA 71130-3932, USA
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Arnold CL, Davis TC, Morris J, Rademaker A, Mills G. Abstract 594: Strategies to improve repeat CRC screening in rural community clinics using the fecal immunochemical test (FIT). Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Colorectal cancer (CRC), the second leading cause of cancer death in the United States, can be significantly reduced if it is detected early. Although overall CRC screening rates have increased significantly, disparities persist among low income individuals, adults with low literacy and those living in rural areas.
Objectives: To assess the effectiveness of two health literacy informed telephone follow-up strategies to improve annual repeat screening with Fecal Immunochemical Test (FIT) in rural community clinics.
Methods: A two-arm, randomized controlled trial is being implemented in four community clinics. Clinics reported CRC baseline screening rates of 1% to 3%. Eligible patients, age 50-75, were recruited at the clinic prior to a scheduled appointment. A research assistant (RA) conducted a baseline structured interview. The RA then recommended screening and gave brief literacy and culturally appropriate education using a pamphlet (4th grade level), the FIT kit with pre-addressed envelope, simplified instructions (3rd grade level) and a demonstration of how to use it, At four weeks patients who had not returned their kit receive either 1) a personal follow-up call (PC) from a central prevention coordinator using motivational interviewing skills and reminding them to complete and mail FIT kits; or 2) an automated follow-up call (AC) using plain language and motivational messages encourages patients to complete and mail the FIT. During years 2 and 3, FIT kits were mailed to patients along with previous literacy and culturally appropriate education. Follow-up call procedures previously used at weeks 4 and 8 were followed.
Results: 620 patients not up-to-date with screening were enrolled; 66% were African American, 55% women; 40% had limited literacy.
Screening results:
1st Year Screening: 620 patients enrolled - (6 withdrew before completing test)
AC Arm (n=308)
213 (69%) completed kits [23 (7%) positive]
124 (40%) people needed at least one follow-up call [29 (24%) returned FIT after call]
PC Arm (n=306)
205 (67%) completed kits [21 (7%) positive]
127 (41%) people needed at least one follow-up call [26 (20%) returned FIT after call]
2nd Year Screening: 568 Second kits mailed (4 withdrew and no previous positives included)
AC Arm (n=285)
111 (40%) completed kits [9 (8%) positive]
212 (74%) people needed at least one follow-up call [40 (19%) returned FIT after call]PC Arm (n=283)
104 (37%) completed kits [8 (8%) positive]
209 (74%) people needed at least one follow-up call [31 (15%) returned FIT after call]
Discussion: Simplified instructions accompanied by a face-to-face demonstration of FIT, use of “teach back” to confirm understanding with a follow-up call if needed, facilitated completion rates of all patients, particularly those with limited literacy. The less costly and time consuming automated call was equally effective as a personal call.
Citation Format: Connie L. Arnold, Terry C. Davis, James Morris, Alfred Rademaker, Glenn Mills. Strategies to improve repeat CRC screening in rural community clinics using the fecal immunochemical test (FIT) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 594.
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Affiliation(s)
| | | | | | - Alfred Rademaker
- 3Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Glenn Mills
- 1LSU Feist-Weiller Cancer Ctr., Shreveport, LA
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Davis TC, Arnold C, Dillaha J, Rosof BM. Lessons Learned from Immunization Providers: Strategies for Successful Immunization Efforts Among Medicare Patients. NAM Perspect 2018. [DOI: 10.31478/201806c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mitchell SE, Laurens V, Weigel GM, Hirschman KB, Scott AM, Nguyen HQ, Howard JM, Laird L, Levine C, Davis TC, Gass B, Shaid E, Li J, Williams MV, Jack BW. Care Transitions From Patient and Caregiver Perspectives. Ann Fam Med 2018; 16:225-231. [PMID: 29760026 PMCID: PMC5951251 DOI: 10.1370/afm.2222] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [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: 02/15/2017] [Revised: 10/26/2017] [Accepted: 11/18/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Despite concerted actions to streamline care transitions, the journey from hospital to home remains hazardous for patients and caregivers. Remarkably little is known about the patient and caregiver experience during care transitions, the services they need, or the outcomes they value. The aims of this study were to (1) describe patient and caregiver experiences during care transitions and (2) characterize patient and caregiver desired outcomes of care transitions and the health services associated with them. METHODS We interviewed 138 patients and 110 family caregivers recruited from 6 health networks across the United States. We conducted 34 homogenous focus groups (103 patients, 65 caregivers) and 80 key informant interviews (35 patients, 45 caregivers). Audio recordings were transcribed and analyzed using principles of grounded theory to identify themes and the relationship between them. RESULTS Patients and caregivers identified 3 desired outcomes of care transition services: (1) to feel cared for and cared about by medical providers, (2) to have unambiguous accountability from the health care system, and (3) to feel prepared and capable of implementing care plans. Five care transition services or provider behaviors were linked to achieving these outcomes: (1) using empathic language and gestures, (2) anticipating the patient's needs to support self-care at home, (3) collaborative discharge planning, (4) providing actionable information, and (5) providing uninterrupted care with minimal handoffs. CONCLUSIONS Clear accountability, care continuity, and caring attitudes across the care continuum are important outcomes for patients and caregivers. When these outcomes are achieved, care is perceived as excellent and trustworthy. Otherwise, the care transition is experienced as transactional and unsafe, and leaves patients and caregivers feeling abandoned by the health care system.
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Affiliation(s)
- Suzanne E Mitchell
- Department of Family Medicine, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts (Mitchell, Laurens, Weigel, Howard, Jack); School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania (Hirschman, Shaid); Department of Communication, University of Kentucky, Lexington, Kentucky (Scott); Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, California (Nguyen); Medical Anthropology, Boston University School of Medicine, Boston, Massachusetts (Laird); Families and Health Care Project, United Hospital Fund, New York, New York (Levine); Department of Medicine and Pediatrics, Louisiana State University Health Sciences, New Orleans, Louisiana (Davis); Telligen, Quality Improvement, Des Moines, Iowa (Gass); Center for Health Services Research, University of Kentucky, Lexington, Kentucky (Li, Williams)
| | - Vivian Laurens
- Department of Family Medicine, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts (Mitchell, Laurens, Weigel, Howard, Jack); School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania (Hirschman, Shaid); Department of Communication, University of Kentucky, Lexington, Kentucky (Scott); Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, California (Nguyen); Medical Anthropology, Boston University School of Medicine, Boston, Massachusetts (Laird); Families and Health Care Project, United Hospital Fund, New York, New York (Levine); Department of Medicine and Pediatrics, Louisiana State University Health Sciences, New Orleans, Louisiana (Davis); Telligen, Quality Improvement, Des Moines, Iowa (Gass); Center for Health Services Research, University of Kentucky, Lexington, Kentucky (Li, Williams)
| | - Gabriela M Weigel
- Department of Family Medicine, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts (Mitchell, Laurens, Weigel, Howard, Jack); School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania (Hirschman, Shaid); Department of Communication, University of Kentucky, Lexington, Kentucky (Scott); Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, California (Nguyen); Medical Anthropology, Boston University School of Medicine, Boston, Massachusetts (Laird); Families and Health Care Project, United Hospital Fund, New York, New York (Levine); Department of Medicine and Pediatrics, Louisiana State University Health Sciences, New Orleans, Louisiana (Davis); Telligen, Quality Improvement, Des Moines, Iowa (Gass); Center for Health Services Research, University of Kentucky, Lexington, Kentucky (Li, Williams)
| | - Karen B Hirschman
- Department of Family Medicine, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts (Mitchell, Laurens, Weigel, Howard, Jack); School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania (Hirschman, Shaid); Department of Communication, University of Kentucky, Lexington, Kentucky (Scott); Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, California (Nguyen); Medical Anthropology, Boston University School of Medicine, Boston, Massachusetts (Laird); Families and Health Care Project, United Hospital Fund, New York, New York (Levine); Department of Medicine and Pediatrics, Louisiana State University Health Sciences, New Orleans, Louisiana (Davis); Telligen, Quality Improvement, Des Moines, Iowa (Gass); Center for Health Services Research, University of Kentucky, Lexington, Kentucky (Li, Williams)
| | - Allison M Scott
- Department of Family Medicine, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts (Mitchell, Laurens, Weigel, Howard, Jack); School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania (Hirschman, Shaid); Department of Communication, University of Kentucky, Lexington, Kentucky (Scott); Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, California (Nguyen); Medical Anthropology, Boston University School of Medicine, Boston, Massachusetts (Laird); Families and Health Care Project, United Hospital Fund, New York, New York (Levine); Department of Medicine and Pediatrics, Louisiana State University Health Sciences, New Orleans, Louisiana (Davis); Telligen, Quality Improvement, Des Moines, Iowa (Gass); Center for Health Services Research, University of Kentucky, Lexington, Kentucky (Li, Williams)
| | - Huong Q Nguyen
- Department of Family Medicine, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts (Mitchell, Laurens, Weigel, Howard, Jack); School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania (Hirschman, Shaid); Department of Communication, University of Kentucky, Lexington, Kentucky (Scott); Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, California (Nguyen); Medical Anthropology, Boston University School of Medicine, Boston, Massachusetts (Laird); Families and Health Care Project, United Hospital Fund, New York, New York (Levine); Department of Medicine and Pediatrics, Louisiana State University Health Sciences, New Orleans, Louisiana (Davis); Telligen, Quality Improvement, Des Moines, Iowa (Gass); Center for Health Services Research, University of Kentucky, Lexington, Kentucky (Li, Williams)
| | - Jessica Martin Howard
- Department of Family Medicine, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts (Mitchell, Laurens, Weigel, Howard, Jack); School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania (Hirschman, Shaid); Department of Communication, University of Kentucky, Lexington, Kentucky (Scott); Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, California (Nguyen); Medical Anthropology, Boston University School of Medicine, Boston, Massachusetts (Laird); Families and Health Care Project, United Hospital Fund, New York, New York (Levine); Department of Medicine and Pediatrics, Louisiana State University Health Sciences, New Orleans, Louisiana (Davis); Telligen, Quality Improvement, Des Moines, Iowa (Gass); Center for Health Services Research, University of Kentucky, Lexington, Kentucky (Li, Williams)
| | - Lance Laird
- Department of Family Medicine, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts (Mitchell, Laurens, Weigel, Howard, Jack); School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania (Hirschman, Shaid); Department of Communication, University of Kentucky, Lexington, Kentucky (Scott); Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, California (Nguyen); Medical Anthropology, Boston University School of Medicine, Boston, Massachusetts (Laird); Families and Health Care Project, United Hospital Fund, New York, New York (Levine); Department of Medicine and Pediatrics, Louisiana State University Health Sciences, New Orleans, Louisiana (Davis); Telligen, Quality Improvement, Des Moines, Iowa (Gass); Center for Health Services Research, University of Kentucky, Lexington, Kentucky (Li, Williams)
| | - Carol Levine
- Department of Family Medicine, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts (Mitchell, Laurens, Weigel, Howard, Jack); School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania (Hirschman, Shaid); Department of Communication, University of Kentucky, Lexington, Kentucky (Scott); Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, California (Nguyen); Medical Anthropology, Boston University School of Medicine, Boston, Massachusetts (Laird); Families and Health Care Project, United Hospital Fund, New York, New York (Levine); Department of Medicine and Pediatrics, Louisiana State University Health Sciences, New Orleans, Louisiana (Davis); Telligen, Quality Improvement, Des Moines, Iowa (Gass); Center for Health Services Research, University of Kentucky, Lexington, Kentucky (Li, Williams)
| | - Terry C Davis
- Department of Family Medicine, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts (Mitchell, Laurens, Weigel, Howard, Jack); School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania (Hirschman, Shaid); Department of Communication, University of Kentucky, Lexington, Kentucky (Scott); Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, California (Nguyen); Medical Anthropology, Boston University School of Medicine, Boston, Massachusetts (Laird); Families and Health Care Project, United Hospital Fund, New York, New York (Levine); Department of Medicine and Pediatrics, Louisiana State University Health Sciences, New Orleans, Louisiana (Davis); Telligen, Quality Improvement, Des Moines, Iowa (Gass); Center for Health Services Research, University of Kentucky, Lexington, Kentucky (Li, Williams)
| | - Brianna Gass
- Department of Family Medicine, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts (Mitchell, Laurens, Weigel, Howard, Jack); School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania (Hirschman, Shaid); Department of Communication, University of Kentucky, Lexington, Kentucky (Scott); Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, California (Nguyen); Medical Anthropology, Boston University School of Medicine, Boston, Massachusetts (Laird); Families and Health Care Project, United Hospital Fund, New York, New York (Levine); Department of Medicine and Pediatrics, Louisiana State University Health Sciences, New Orleans, Louisiana (Davis); Telligen, Quality Improvement, Des Moines, Iowa (Gass); Center for Health Services Research, University of Kentucky, Lexington, Kentucky (Li, Williams)
| | - Elizabeth Shaid
- Department of Family Medicine, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts (Mitchell, Laurens, Weigel, Howard, Jack); School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania (Hirschman, Shaid); Department of Communication, University of Kentucky, Lexington, Kentucky (Scott); Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, California (Nguyen); Medical Anthropology, Boston University School of Medicine, Boston, Massachusetts (Laird); Families and Health Care Project, United Hospital Fund, New York, New York (Levine); Department of Medicine and Pediatrics, Louisiana State University Health Sciences, New Orleans, Louisiana (Davis); Telligen, Quality Improvement, Des Moines, Iowa (Gass); Center for Health Services Research, University of Kentucky, Lexington, Kentucky (Li, Williams)
| | - Jing Li
- Department of Family Medicine, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts (Mitchell, Laurens, Weigel, Howard, Jack); School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania (Hirschman, Shaid); Department of Communication, University of Kentucky, Lexington, Kentucky (Scott); Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, California (Nguyen); Medical Anthropology, Boston University School of Medicine, Boston, Massachusetts (Laird); Families and Health Care Project, United Hospital Fund, New York, New York (Levine); Department of Medicine and Pediatrics, Louisiana State University Health Sciences, New Orleans, Louisiana (Davis); Telligen, Quality Improvement, Des Moines, Iowa (Gass); Center for Health Services Research, University of Kentucky, Lexington, Kentucky (Li, Williams)
| | - Mark V Williams
- Department of Family Medicine, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts (Mitchell, Laurens, Weigel, Howard, Jack); School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania (Hirschman, Shaid); Department of Communication, University of Kentucky, Lexington, Kentucky (Scott); Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, California (Nguyen); Medical Anthropology, Boston University School of Medicine, Boston, Massachusetts (Laird); Families and Health Care Project, United Hospital Fund, New York, New York (Levine); Department of Medicine and Pediatrics, Louisiana State University Health Sciences, New Orleans, Louisiana (Davis); Telligen, Quality Improvement, Des Moines, Iowa (Gass); Center for Health Services Research, University of Kentucky, Lexington, Kentucky (Li, Williams)
| | - Brian W Jack
- Department of Family Medicine, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts (Mitchell, Laurens, Weigel, Howard, Jack); School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania (Hirschman, Shaid); Department of Communication, University of Kentucky, Lexington, Kentucky (Scott); Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, California (Nguyen); Medical Anthropology, Boston University School of Medicine, Boston, Massachusetts (Laird); Families and Health Care Project, United Hospital Fund, New York, New York (Levine); Department of Medicine and Pediatrics, Louisiana State University Health Sciences, New Orleans, Louisiana (Davis); Telligen, Quality Improvement, Des Moines, Iowa (Gass); Center for Health Services Research, University of Kentucky, Lexington, Kentucky (Li, Williams)
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Katzmarzyk PT, Martin CK, Newton RL, Apolzan JW, Arnold CL, Davis TC, Denstel KD, Mire EF, Thethi TK, Brantley PJ, Johnson WD, Fonseca V, Gugel J, Kennedy KB, Lavie CJ, Price-Haywood EG, Sarpong DF, Springgate B. Promoting Successful Weight Loss in Primary Care in Louisiana (PROPEL): Rationale, design and baseline characteristics. Contemp Clin Trials 2018; 67:1-10. [PMID: 29408562 PMCID: PMC5965693 DOI: 10.1016/j.cct.2018.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 10/27/2017] [Revised: 01/22/2018] [Accepted: 02/01/2018] [Indexed: 11/18/2022]
Abstract
Underserved and minority populations suffer from a disproportionately high prevalence of obesity and related comorbidities. Effective obesity treatment programs delivered in primary care that produce significant weight loss are currently lacking. The purpose of this trial is to test the effectiveness of a pragmatic, high intensity lifestyle-based obesity treatment program delivered within primary care among an underserved population. We hypothesize that, relative to patients who receive usual care, patients who receive a high-intensity, health literacy- and culturally-appropriate lifestyle intervention will have greater percent reductions in body weight over 24 months. Eighteen clinics (N = 803 patients) serving low income populations with a high proportion of African Americans in Louisiana were randomized to the intervention or usual car. Patients in the intervention participate in a high-intensity lifestyle program delivered by health coaches employed by an academic health center and embedded in the primary care clinics. The program consists of weekly (16 in-person/6 telephone) sessions in the first six months, followed by sessions held at least monthly for the remaining 18 months. Primary care practitioners in usual care receive information on weight management and the current Centers for Medicare and Medicaid Services reimbursement for obesity treatment. The primary outcome is percent weight loss at 24 months. Secondary outcomes include absolute 24-month changes in body weight, waist circumference, blood pressure, fasting glucose and lipids, health-related quality of life, and weight-related quality of life. The results will provide evidence on the effectiveness of implementing high-intensity lifestyle and obesity counseling in primary care settings among underserved populations. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02561221.
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Affiliation(s)
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Robert L Newton
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - John W Apolzan
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Connie L Arnold
- Department of Medicine, Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA, United States
| | - Terry C Davis
- Department of Medicine, Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA, United States
| | - Kara D Denstel
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Emily F Mire
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Tina K Thethi
- Department of Medicine, Division of Endocrinology and Metabolism, Tulane University Health Sciences Center, School of Medicine, New Orleans, LA, United States; Southeast Louisiana Veterans Health Care System, United States
| | | | - William D Johnson
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Vivian Fonseca
- Department of Medicine, Division of Endocrinology and Metabolism, Tulane University Health Sciences Center, School of Medicine, New Orleans, LA, United States; Southeast Louisiana Veterans Health Care System, United States
| | - Jonathan Gugel
- Department of Medicine, Section of General Internal Medicine & Geriatrics, Tulane University Health Sciences Center, School of Medicine, New Orleans, LA, United States
| | - Kathleen B Kennedy
- College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, United States
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA, United States
| | - Eboni G Price-Haywood
- Ochsner Clinic Foundation, Center for Applied Health Services Research, New Orleans, LA, United States; Ochsner Clinical School, University of Queensland, New Orleans, LA, United States
| | - Daniel F Sarpong
- College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, United States
| | - Benjamin Springgate
- Department of Internal Medicine, Louisiana State University School of Medicine, New Orleans, LA, United States; Program in Health Policy and Systems Management, Louisiana State University School of Public Health, New Orleans, LA, United States
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Abstract
Toxic shock syndrome may complicate burns and scalds in young children1,2. However, it can occur in the district general hospital setting, where early recognition of the prodromal features to facilitate early therapy will depend on the knowledge and training of paediatricians and casualty staff.
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Affiliation(s)
- T C Davis
- Child Health Directorate, Northampton General Hospital NHS Trust, Cliftonville, England
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38
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Arnold CL, Rademaker A, Wolf MS, Liu D, Lucas G, Hancock J, Davis TC. Final Results of a 3-Year Literacy-Informed Intervention to Promote Annual Fecal Occult Blood Test Screening. J Community Health 2018; 41:724-31. [PMID: 26769026 DOI: 10.1007/s10900-015-0146-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 12/22/2022]
Abstract
This three arm study was designed to make CRC screening with FOBTs more accessible, understandable and actionable for patients cared for in predominantly rural Federally Qualified Health Centers. Patients in an enhanced version of usual care received an annual CRC recommendation and FOBT kit; those in the education arm additionally received brief literacy and culturally appropriate education and those in the nurse arm received the education by a nurse manager who followed up by telephone. Baseline FOBT rates in this population were 3 %. We evaluated if FOBT rates could be sustained over 3 years. A three-arm, quasi-experimental evaluation was conducted among eight clinics in Louisiana. Screening efforts included: (1) enhanced usual care, (2) literacy-informed education of patients, and (3) education plus nurse support. Overall, 961 average-risk patients, ages 50-85, eligible for routine CRC screenings were recruited. The primary outcome was completing three annual FOBT tests. Of 961 patients enrolled, 381 (39.6 %) participants did not complete a single FOBT, 60.4 % completed at least one FOBT of which 318 (33.1 %) completed only one, 162 (16.9 %) completed two and 100 (10.4 %) completed three FOBTs over the 3-year period (the primary study outcome). The primary outcome, return of three FOBT kits over the 3-year period, was achieved by 4.7 % in enhanced care, 11.4 % in education and 13.6 % in the nurse arm (p = 0.005). Overall 3-year FOBT screening rates were not sustained with any of the three interventions, despite reports of promising interim results at years 1 and 2. New strategies for sustaining FOBT screening over several years must be developed.
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Affiliation(s)
- Connie L Arnold
- Department of Medicine, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA, 71130-3932, USA.
| | - Alfred Rademaker
- Department of Preventive Medicine, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL, USA
| | - Dachao Liu
- Department of Preventive Medicine, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Geoffrey Lucas
- Department of Medicine, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA, 71130-3932, USA
| | - Jill Hancock
- Department of Medicine, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA, 71130-3932, USA
| | - Terry C Davis
- Department of Medicine, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA, 71130-3932, USA
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Davis TC, Morris J, Rademaker A, Ferguson LA, Arnold CL. Barriers and Facilitators to Colorectal Cancer Screening Among Rural Women in Community Clinics by Heath Literacy. J Womens Health Issues Care 2017; 6:1000292. [PMID: 29568788 PMCID: PMC5858715 DOI: 10.4172/2325-9795.1000292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Rural women lag rural men and urban women in colon cancer (CRC) screening completion. OBJECTIVE To identify rural female patients' knowledge, beliefs barriers, self-efficacy, prior recommendation and completion of CRC screening using an FOBT and to compare these factors by health literacy (HL) level. METHODS This descriptive study was conducted between 2015 and 2016 in 4 rural community clinics in south Louisiana. Patients overdue for screening were given a structured interview by a research assistant. RESULTS 339 women were enrolled, mean age 58.5, 32% had limited HL, 66% were African American. Most (91.7%) had heard of CRC, yet only 71% knew of any CRC screening tests. Women with adequate HL had greater knowledge of specific tests than those with limited HL (78.4% vs 56.6%, p<0.001). Only 25.7% had been given information on CRC testing; those with adequate HL were more likely to have received information (30.1% vs 16.8%; p=0.017). Most women (93.2%) indicated they would want to know if they had CRC, while 72.2% reported a provider had recommended CRC screening. Only 24.9% said a healthcare provider had ever given them an FOBT or that they had ever completed an FOBT (22.7%). There were no differences in women's report of recommendation or completion by HL level.Self-efficacy for completing an FOBT was high; over 90% indicated they could get an FOBT, complete it and mail results to the lab. Level of confidence did not vary by literacy. Three of the four barrier items varied by HL with women with low HL being more likely to fear doing an FOBT because they thought FOBT instructions would be confusing (p=0.002), doing the test would be embarrassing (p=0.025) or messy (p=0.057). CONCLUSIONS Rural women are receptive to CRC screening and view FOBTs as effective. Rural community clinics need to provide low cost FOBTs with literacy, gender and culturally appropriate information.
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Affiliation(s)
- Terry C. Davis
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA
| | - James Morris
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Alfred Rademaker
- Department of Preventive Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | | | - Connie L. Arnold
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA
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Arnold CL, Davis TC, Rademaker AW, Morris J, Mills G. Abstract 770: Colorectal cancer screening in rural community health clinics using the fecal immunochemical test (FIT). Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Colorectal cancer (CRC), the second leading cause of cancer death in the United States, can be significantly reduced if it is detected early. Although overall CRC screening rates have increased significantly, disparities persist among low income individuals, adults with low literacy and those living in rural areas. These groups all have screening completion rates below 50%.
Objectives: To assess patient knowledge, beliefs, and self-efficacy about CRC screening and compare the effectiveness of two health literacy informed telephone follow-up strategies to improve initial and annual repeat screening with Fecal Immunochemical Test (FIT) in rural community clinics.
Methods: A two-arm, randomized controlled trial is being implemented in four community clinics. Clinics reported CRC baseline screening rates of 1% to 3%. Eligible patients, age 50-75, are recruited at the clinic prior to a scheduled appointment. A research assistant (RA) conducts a baseline structured interview measuring CRC screening knowledge, beliefs, and self-efficacy. The RA then recommends screening and gives brief literacy and culturally appropriate education using a pamphlet (4th grade level), the FIT kit with pre-addressed envelope, simplified instructions (3rd grade level) and a demonstration of how to use it, At four weeks patients who have not returned their kit receive either 1) a personal follow-up call (PC) from a central prevention coordinator using motivational interviewing skills and reminding them to complete and mail FIT kits; or 2) an automated follow-up call (AC) using plain language and motivational messages encourages patients to complete and mail the FIT. Outcomes include FIT completion after intervention, and again at 12 and 24 months. 650 patients will be enrolled.
Results: To date 599 patients not up-to-date with screening have been enrolled; 64% African American, 56% women; 40% inadequate literacy. Although 90% reported having heard of CRC, only 64% knew a test to check for CRC. 70% reported a provider had recommended CRC screening in the past and 91% reported they would want to know if they have CRC. Self-efficacy was high with over 90% indicating they would return the kit to the lab. Screening results: 599 patients enrolled to date (AC: n=300 / PC: n=299); 412 (69%) completed tests (AC: n=210 (70%) / PC: n=202 (68%)). Follow-up calls for Unreturned Kits - AC: 113 people called - 26 returned FIT (23% of people called completed FIT). PC: 115 people called - 22 returned FIT - (19% of people called completed FIT). 2nd Year Screening: 129 Second kits mailed out to-date. AC (n=61): n=29 (48%) completed kits. PC (n=68): 28 (41%) completed kits.
Discussion: Implementing literacy and culturally appropriate CRC education and screening strategies using the FIT and phone reminders has the potential to increase CRC screening rural community clinics and address public health disparities.
Citation Format: Connie L. Arnold, Terry C. Davis, Alfred W. Rademaker, James Morris, Glenn Mills. Colorectal cancer screening in rural community health clinics using the fecal immunochemical test (FIT) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 770. doi:10.1158/1538-7445.AM2017-770
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Affiliation(s)
| | - Terry C. Davis
- 1LSU Health Sciences Center - Shreveport, Shreveport, LA
| | | | - James Morris
- 1LSU Health Sciences Center - Shreveport, Shreveport, LA
| | - Glenn Mills
- 1LSU Health Sciences Center - Shreveport, Shreveport, LA
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Arnold CL, Rademaker A, Liu D, Davis TC. Changes in Colorectal Cancer Screening Knowledge, Behavior, Beliefs, Self-Efficacy, and Barriers among Community Health Clinic Patients after a Health Literacy Intervention. J Community Med Health Educ 2017; 7:497. [PMID: 28344855 PMCID: PMC5362257 DOI: 10.4172/2161-0711.1000497] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The objective in this pre- and post-survey assessment was to compare the effectiveness of a health literacy-directed intervention designed to increase knowledge, beliefs, barriers, self-efficacy and behavior associated with CRC screening with FOBT among patients cared for in predominantly rural community clinics and the change in these characteristics over the first 15 months after enrolling in a study designed to assess screening strategies. METHODS Between 2008 and 2011, a quasi-experimental intervention was conducted in 8 predominantly rural Federally Qualified Health Centers. Patients were orally administered a 15-minute survey at enrollment by a clinic research assistant (RA) and at 15 months by phone by a central RA. Participants included 428 community clinic patients aged 50-85 (mean 58.5); the majority (79%) were female, 69% were African American, and 54% had limited health literacy. RESULTS There was significant improvement across all groups with the number of patients reporting they had been given information /education on CRC testing (p<.0001), been given an FOBT kit (p<.0001), and completed an FOBT (p<.0001) with significant improvement in having a doctor recommendation in all groups except usual care. Confidence in an FOBT's potential to decrease chances of dying from CRC improved across all groups as well (p<0.002). In addition, patients 'belief that they would get CRC in their lifetime' decreased across all groups post-intervention (p<0.03) as did their worry that they may find out they have CRC (p<0.04). CONCLUSION Overall these low income FQHC patients who were not up-to-date with screening had heard of CRC screening, had positive attitudes toward screening and wanted to know if they had cancer. Results demonstrate the value of giving patients a recommendation and a kit; patients in all groups reported significant increases at 15 months in completing CRC screening (>83%) as confirmed by study records.
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Affiliation(s)
- Connie L. Arnold
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Alfred Rademaker
- Department of Preventive Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Dachao Liu
- Department of Preventive Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Terry C. Davis
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA
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Wolf MS, Davis TC, Curtis LM, Bailey SC, Knox JP, Bergeron A, Abbet M, Shrank WH, Parker RM, Wood AJJ. A Patient-Centered Prescription Drug Label to Promote Appropriate Medication Use and Adherence. J Gen Intern Med 2016; 31:1482-1489. [PMID: 27542666 PMCID: PMC5130952 DOI: 10.1007/s11606-016-3816-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [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: 04/12/2016] [Revised: 05/25/2016] [Accepted: 07/08/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patient misunderstanding of prescription drug label instructions is a common cause of unintentional misuse of medication and adverse health outcomes. Those with limited literacy and English proficiency are at greater risk. OBJECTIVE To test the effectiveness of a patient-centered drug label strategy, including a Universal Medication Schedule (UMS), to improve proper regimen use and adherence compared to a current standard. DESIGN Two-arm, multi-site patient-randomized pragmatic trial. PARTICIPANTS English- and Spanish-speaking patients from eight community health centers in northern Virginia who received prescriptions from a central-fill pharmacy and who were 1) ≥30 years of age, 2) diagnosed with type 2 diabetes and/or hypertension, and 3) taking ≥2 oral medications. INTERVENTION A patient-centered label (PCL) strategy that incorporated evidence-based practices for format and content, including prioritized information, larger font size, and increased white space. Most notably, instructions were conveyed with the UMS, which uses standard intervals for expressing when to take medicine (morning, noon, evening, bedtime). MAIN MEASURES Demonstrated proper use of a multi-drug regimen; medication adherence measured by self-report and pill count at 3 and 9 months. KEY RESULTS A total of 845 patients participated in the study (85.6 % cooperation rate). Patients receiving the PCL demonstrated slightly better proper use of their drug regimens at first exposure (76.9 % vs. 70.1 %, p = 0.06) and at 9 months (85.9 % vs. 77.4 %, p = 0.03). The effect of the PCL was significant for English-speaking patients (OR 2.21, 95 % CI 1.13-4.31) but not for Spanish speakers (OR 1.19, 95 % CI 0.63-2.24). Overall, the intervention did not improve medication adherence. However, significant benefits from the PCL were found among patients with limited literacy (OR 5.08, 95 % CI 1.15-22.37) and for those with medications to be taken ≥2 times a day (OR 2.77, 95 % CI 1.17-6.53). CONCLUSIONS A simple modification to pharmacy-generated labeling, with minimal investment required, can offer modest improvements to regimen use and adherence, mostly among patients with limited literacy and more complex regimens. Trial Registration (ClinicalTrials.gov): NCT00973180, NCT01200849.
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Affiliation(s)
- Michael S Wolf
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA. .,Department of Learning Sciences, School of Education and Social Policy, Northwestern University, Evanston, IL, USA.
| | - Terry C Davis
- Department of Medicine-Pediatrics, Louisiana State University Health Sciences Center - Shreveport, Shreveport, LA, USA
| | - Laura M Curtis
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA
| | - Stacy Cooper Bailey
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | | | - Ashley Bergeron
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA
| | | | | | - Ruth M Parker
- Division of General Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Alastair J J Wood
- Department of Pharmacology, Weill Cornell Medical College, New York, NY, USA
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Davis TC, Arnold CL, Wolf MS, Bennett CL, Liu D, Rademaker A. Joint breast and colorectal cancer screenings in medically underserved women. J Community Support Oncol 2016; 13:47-54. [PMID: 26918252 DOI: 10.12788/jcso.0108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Breast and colon cancer screening in rural community clinics is underused. OBJECTIVE To evaluate the effectiveness and cost-effectiveness of alternative interventions designed to promote simultaneous screening for breast and colon cancer in community clinics. METHODS A 3-arm, quasi-experimental evaluation was conducted during May 2008-August 2011 in 8 federally qualified health clinics in predominately rural Louisiana. Baseline screening rates reported by the clinics was <10% for breast cancer (using mammography) and 1%-2% for colon cancer (using the fecal occult blood test [FOBT]). 744 women aged 50 years or older who were eligible for routine mammography and an FOBT were recruited. The combined screening efforts included: enhanced care; health literacy-informed education (education alone), or health literacy-informed education with nurse support (nurse support). RESULTS Postintervention screening rates for completing both tests were 28.1% with enhanced care, 23.7% with education alone, and 38.7% with nurse support. After adjusting for age, race, and literacy, patients who received nurse support were 2.21 times more likely to complete both screenings than were those who received the education alone (95% confidence interval [CI], 1.12-4.38; P = .023). The incremental cost per additional woman completing both screenings was $3,987 for education with nurse support over education alone, and $5,987 over enhanced care. LIMITATIONS There were differences between the 3 arms in sociodemographic characteristics, literacy, and previous screening history. Not all variables that were significantly different between arms were adjusted for, therefore adjustments for key variables (age, race, literacy) were made in statistical analyses. Other limitations related generalizability of results. CONCLUSIONS Although joint breast and colon cancer screening rates were increased substantially over existing baseline rates in all 3 arms, the completion rate for both tests was modest. Nurse support and telephone follow-up were most effective. However, it is not likely to be cost effective or affordable in clinics with limited resources.
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Affiliation(s)
- Terry C Davis
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
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Abstract
OBJECTIVES Our objective was to determine the effectiveness of 3 approaches to encourage completion of fecal occult blood testing (FOBT) in the third year of the intervention. METHODS Between 2008 and 2011, a quasi-experimental intervention was conducted in 8 predominantly rural Federally Qualified Health Centers. Clinics were randomly assigned to enhanced care (screening recommendation and FOBT kit mailed annually), education (patients additionally received a health literacy appropriate pamphlet and simplified FOBT instructions), or nurse support (same as education but with nurse follow-up). Participants included 206 patients with negative FOBTs in years 1 and 2; ages 50-85, 80% female, 70% African American, and 52% had limited health literacy. The main outcome measure was completion of a third annual FOBT. RESULTS Third-year FOBT rates were 48% overall, 34.2% enhanced care, 59.6% education, and 47.4% nurse support (p = .21), even after adjustment for sex, marital status, and health literacy. CONCLUSION All mailed interventions were similarly effective in sustaining rates of FOBT screening. Post hoc analyses of the results analyzed by health literacy skills found that patients with both limited and adequate health literacy skills were more likely to complete FOBTs when mailed simplified instructions.
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Affiliation(s)
- Connie L Arnold
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
| | - Alfred Rademaker
- Department of Preventive Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Michael S Wolf
- Medicine and Learning Sciences, Associate Chair, Department of Medicine, Associate Division Chief - Research, Department of General Internal Medicine and Geriatrics Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Dachao Liu
- Department of Preventive Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Jill Hancock
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Terry C Davis
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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Abstract
BACKGROUND Health literacy has been found to be a crucial component of successful communication and navigation in health care. Various tools have been developed to measure health literacy skills, but few have been developed specifically for adolescents, and most require in-person administration. This study sought to develop a self-report health literacy scale for adolescents to assess four key health literacy domains: the ability to obtain, communicate, understand, and process health information. METHODS We collected data from 272 youth aged 12-19 recruited from a pediatrics clinic (37%) and the community (63%). We administered the Rapid Estimate of Adolescent Literacy in Medicine-Teen, Newest Vital Sign, and three surveys, and used factor analysis to identify scale items. RESULTS Using multiple health literacy assessments, it was clear that many teens struggle with low health literacy skills. When identifying items that can be used as self-report items in future research, factor analysis identified three subscales; a 5-item communication scale (alpha = 0.77), a 4-item confusion scale (alpha = 0.73), and a 6-item functional health literacy scale (alpha = 0.76). The scales performed reasonably well when compared with validation items. CONCLUSIONS Self-report items can be used to assess health literacy skills for adolescents when in-person administration is not possible or feasible. Such items will allow for greater study of how health literacy impacts communication in not only health care settings, but for all levels of health communication. The tool will also allow researchers to better understand how adolescent health literacy is related to a variety of health outcomes. Further testing of these scales with different populations is warranted.
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Affiliation(s)
- Jennifer A. Manganello
- Department of Health Policy, Management & Behavior, University at Albany School of Public Health, USA
| | - Robert F. DeVellis
- Department of Health Behavior, School of Public Health, University of North Carolina at Chapel Hill, USA
| | - Terry C. Davis
- Department of Medicine, Louisiana State University Health Sciences Center-Shreveport, USA
- Department of Pediatrics, Louisiana State University Health Sciences Center-Shreveport, USA
| | - Carrin Schottler-Thal
- Division of General Pediatrics, The Children’s Hospital at Albany Medical College, USA
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Davis TC, Arnold CL, Bennett CL, Wolf MS, Liu D, Rademaker A. Sustaining mammography screening among the medically underserved: a follow-up evaluation. J Womens Health (Larchmt) 2015; 24:291-8. [PMID: 25692910 DOI: 10.1089/jwh.2014.4967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Our previous three-arm comparative effectiveness intervention in community clinic patients who were not up-to-date with screening resulted in mammography rates over 50% in all arms. OBJECTIVE Our aim was to evaluate the effectiveness and cost-effectiveness of the three interventions on improving biennial screening rates among eligible patients. METHODS A three-arm quasi-experimental evaluation was conducted in eight community clinics from 2008 to 2011. Screening efforts included (1) enhanced care: Participants received an in-person recommendation from a research assistant (RA) in year 1, and clinics followed usual clinic protocol for scheduling screening mammograms; (2) education intervention: Participants received education and in-person recommendation from an RA in year 1, and clinics followed usual clinic protocol for scheduling mammograms; or (3) nurse support: A nurse manager provided in-person education and recommendation, scheduled mammograms, and followed up with phone support. In all arms, mammography was offered at no cost to uninsured patients. RESULTS Of 624 eligible women, biennial mammography within 24-30 months of their previous test was performed for 11.0% of women in the enhanced-care arm, 7.1% in the education- intervention arm, and 48.0% in the nurse-support arm (p<0.0001). The incremental cost was $1,232 per additional woman undergoing screening with nurse support vs. enhanced care and $1,092 with nurse support vs. education. CONCLUSIONS Biennial mammography screening rates were improved by providing nurse support but not with enhanced care or education. However, this approach was not cost-effective.
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Affiliation(s)
- Terry C Davis
- 1 Department of Medicine, Louisiana State University Health Sciences Center , Shreveport, Louisiana
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Wolf MS, Bailey SC, Serper M, Smith M, Davis TC, Russell AL, Manzoor BS, Belter L, Parker RM, Lambert B. Comparative Effectiveness of Patient-centered Strategies to Improve FDA Medication Guides. Med Care 2014; 52:781-9. [DOI: 10.1097/mlr.0000000000000182] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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McCarthy DM, Cameron KA, King JP, Mullen RJ, Bailey SC, Jacobson KL, Di Francesco L, Davis TC, Parker RM, Wolf MS. Patient recall of health care provider counseling for opioid-acetaminophen prescriptions. Pain Med 2014; 15:1750-6. [PMID: 25039586 DOI: 10.1111/pme.12499] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study was to determine the frequency and nature of physician, nurse, and pharmacist verbal counseling at the time of a new prescription for an opioid-acetaminophen containing medication as recalled by patients. DESIGN A mixed methods approach with data from cross sectional, structured interviews was used. SETTING The settings were one academic emergency department in Chicago, IL and one outpatient pharmacy at a public hospital in Atlanta, GA. PATIENTS One hundred forty-nine patients receiving a new prescription for an opioid-acetaminophen medication were enrolled. METHODS Interviews assessed patient recall of counseling they received from their physician, nurse, and pharmacist upon receiving the new prescription. Their responses were unitized and assigned to categories. RESULTS One hundred forty-nine patients were enrolled; 61.1% African American and 58.4% female. Seven major categories of responses were noted; frequencies of patient recall for counseling in these categories were reported. Four categories related to the content of the counseling discussion were (1) details of administration (patient recall counseling from: physician/nurse only 44.3%, pharmacist only 5.4%, both providers 12.8%); (2) activities to avoid and side effects (36.2%, 4.7%, 8.7%); (3) medication indication (32.9%, 4%, 4%); and (4) addictive potential (9.3%, 1.3%, 0%). Three categories describe patients' recall of the interaction in broad terms: (5) being referred to print informational material accompanying the prescription (MD/RN only 7.4%, pharmacist only 20.1%, both providers 2.7%); (6) having questions solicited (0%, 11.4%, 0%); (7) having no interaction relating to medication counseling (3.4%, 32.2%, 1.3%). CONCLUSIONS Patients infrequently recall counseling from providers on topics that are important to prevent harm from opioid-acetaminophen prescriptions. Future patient-centered clinical research should target identifying optimal strategies to convey these critical messages.
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Affiliation(s)
- Danielle M McCarthy
- Health Literacy and Learning Program, Feinberg School of Medicine, Northwestern University, Chicago, USA; Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
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Davis TC, Rademaker A, Bennett CL, Wolf MS, Carias E, Reynolds C, Liu D, Arnold CL. Improving mammography screening among the medically underserved. J Gen Intern Med 2014; 29:628-35. [PMID: 24366401 PMCID: PMC3965756 DOI: 10.1007/s11606-013-2743-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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: 11/15/2012] [Revised: 07/27/2013] [Accepted: 12/02/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND We evaluated the effectiveness and cost-effectiveness of alternative interventions designed to promote mammography in safety-net settings. METHODS A three-arm, quasi-experimental evaluation was conducted among eight federally qualified health clinics in predominately rural Louisiana. Mammography screening efforts included: 1) enhanced care, 2) health literacy-informed education of patients, and 3) education plus nurse support. Outcomes included mammography screening completion within 6 months and incremental cost-effectiveness. RESULTS Overall, 1,181 female patients ages 40 and over who were eligible for routine mammography were recruited. Baseline screening rates were < 10%. Post intervention screening rates were 55.7% with enhanced care, 51.8% with health literacy-informed education and 65.8% with education and nurse support. After adjusting for race, marital status, self-efficacy and literacy, patients receiving health-literacy informed education were not more likely to complete mammographic screening than those receiving enhanced care; those additionally receiving nurse support were 1.37-fold more likely to complete mammographic screening than those receiving the brief education (95% Confidence Interval 1.08-1.74, p = 0.01). The incremental cost per additional women screened was $2,457 for literacy-informed education with nurse support over literacy-informed education alone. CONCLUSIONS Mammography rates were increased substantially over existing baseline rates in all three arms with the educational initiative, with nurse support and follow-up being the most effective option. However, it is not likely to be cost-effective or affordable in resource-limited clinics.
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Affiliation(s)
- Terry C Davis
- Department of Medicine and Pediatrics, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71130, USA,
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