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Ngo VK, Vu TT, Punter MA, Levine D, Borrell LN, Mateu-Gelabert P. Mental Health Service Use, Barriers, and Service Preferences During COVID-19 among Low-Income Housing and Market-Rate Housing Residents of Harlem in New York City. J Community Health 2024; 49:439-447. [PMID: 38066218 PMCID: PMC10981563 DOI: 10.1007/s10900-023-01301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 03/27/2024]
Abstract
This study examined the differences in mental health service use, barriers, and service preferences among 393 low-income housing (LIH) and market-rate housing (MRH) Harlem residents in New York City. One-third (34.6%) endorsed the need for professional support for psychological issues, 27.2% and 15.8% reported using counseling services and psychotropic medication, with no differences between housing types. LIH residents (21.6-38.8%) reported significantly higher use of all types of mental health resources (e.g., websites, anonymous hotlines, self-help tools) compared with MRH residents (16.1-26.4%). Eighty-six percent reported barriers to mental health access, with LIH residents reporting more than double the barriers. Particularly, LIH residents reported greater difficulty getting time off work (34.1% vs. 14%), lack of health insurance (18.7% vs. 9.8%), lack of trust in mental health providers (14.6% vs. 4.7%), and stigma (12.2% vs. 5.1%) compared with MRH residents. Residents most preferred places of services were health clinics and houses of worship; provided by healthcare and mental health providers; and services delivered in-person and phone-based counseling. In contrast, residents least preferred getting support at mental health clinics; from family/friends; and by the Internet. No differences were found between service preferences by housing type. LIH residents reported higher use of mental health services and resources, but they face significantly more barriers to mental health care, suggesting a need to address specific barriers. Preferences for mental health services suggest a need for expanding mental health services to different settings given the low preference for services to be delivered at mental health clinics.
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Affiliation(s)
- Victoria K Ngo
- Center for Innovation in Mental Health, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA
- Department of Community Health and Social Sciences, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA
| | - Thinh T Vu
- Center for Innovation in Mental Health, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA.
- Department of Community Health and Social Sciences, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA.
| | - Malcolm A Punter
- Harlem Congregations for Community Improvement, Inc, New York, NY, USA
| | - Deborah Levine
- Harlem Health Initiative, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA
| | - Luisa N Borrell
- Department of Epidemiology and Biostatistics, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA
| | - Pedro Mateu-Gelabert
- Department of Community Health and Social Sciences, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA
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Mirzaian CB, Deavenport-Saman A, Hudson SM, Betz CL. Barriers to Mental Health Care Transition for Youth and Young Adults with Intellectual and Developmental Disabilities and Co-occurring Mental Health Conditions: Stakeholders' Perspectives. Community Ment Health J 2024:10.1007/s10597-024-01262-x. [PMID: 38619698 DOI: 10.1007/s10597-024-01262-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/25/2024] [Indexed: 04/16/2024]
Abstract
Youth and young adults (YYA) with intellectual and developmental disabilities (IDD) have high rates of co-occurring mental health (MH) conditions. The time during transition from pediatric to adult health and mental health care can be a very challenging, with risk of loss of services leading to poor outcomes. This study aimed to explore barriers to transition from pediatric to adult health and mental health care and services for individuals with IDD and co-occurring MH conditions, by eliciting the view of stakeholders, including disability advocates. Qualitative analysis was conducted using grounded theory, and themes were coded based upon the social-ecological model (SEM). We generated themes into multiple levels: the individual level, the family level, the provider level, the systems of care level, and the societal level. Stakeholders expressed a critical need to improve coordination between systems, and to increase provider availability to care for YYA with IDD and co-occurring MH conditions.
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Affiliation(s)
- Christine B Mirzaian
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #76, Los Angeles, CA, 90027, USA.
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | - Alexis Deavenport-Saman
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #76, Los Angeles, CA, 90027, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Sharon M Hudson
- AltaMed Institute for Health Equity, AltaMed Health Services, Los Angeles, CA, USA
| | - Cecily L Betz
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #76, Los Angeles, CA, 90027, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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3
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Norton A, Homayra F, Defriend C, Barker B, Meilleur L, Hayashi K, Nosyk B. Perceptions of provider awareness of traditional and cultural treatments among Indigenous people who use unregulated drugs in Vancouver, Canada. BMC Health Serv Res 2024; 24:266. [PMID: 38429744 PMCID: PMC10908172 DOI: 10.1186/s12913-024-10672-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 02/01/2024] [Indexed: 03/03/2024] Open
Abstract
INTRODUCTION Indigenous people who use unregulated drugs (IPWUD) face significant barriers to care, including sparse availability of culturally safe health services. Integrating Indigenous traditional and cultural treatments (TCT) into health service delivery is one way to enhance culturally safe care. In a Canadian setting that implemented cultural safety reforms, we sought to examine the prevalence and correlates of client perceptions of primary care provider awareness of TCT among IPWUD. METHODS Data were derived from two prospective cohort studies of PWUD in Vancouver, Canada between December 2017 and March 2020. A generalized linear mixed model with logit-link function was used to identify longitudinal factors associated with perceived provider awareness of TCT. RESULTS Among a sample of 507 IPWUD who provided 1200 survey responses, a majority (n = 285, 56%) reported their primary care provider was aware of TCT. In multiple regression analyses, involvement in treatment decisions always (Adjusted Odds Ratio [AOR] = 3.6; 95% confidence interval [CI]: 1.6-7.8), involvement in treatment decisions most or some of the time (AOR = 3.3; 95% CI: 1.4-7.7), comfort with provider or clinic (AOR = 2.7; 95% CI: 1.5-5.0), and receiving care from a social support worker (AOR = 1.5; 95% CI: 1.0-2.1) were positively associated with provider awareness of TCT. CONCLUSION We found high levels of perceived provider awareness of TCT and other domains of culturally safe care within a cohort of urban IPWUD. However, targeted initiatives that advance culturally safe care are required to improve healthcare and health outcomes for IPWUD, who continue to bear a disproportionate burden of substance use harms.
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Affiliation(s)
- Alexa Norton
- BC Centre on Substance Use, Vancouver, BC, Canada
- First Nations Health Authority, West Vancouver, BC, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | - Kanna Hayashi
- BC Centre on Substance Use, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Bohdan Nosyk
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Kobylski LA, Arakelian MH, Freeman MP, Gaw ML, Cohen LS, Vanderkruik R. Barriers to care and treatment experiences among individuals with postpartum psychosis. Arch Womens Ment Health 2024:10.1007/s00737-024-01447-z. [PMID: 38396143 DOI: 10.1007/s00737-024-01447-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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE Postpartum psychosis (PP) is a severe psychiatric disorder affecting 1-2 per 1,000 deliveries. Prompt access to healthcare and timely initiation of treatment are crucial to minimizing harm and improving outcomes. This analysis seeks to fill gaps in knowledge surrounding barriers to care and treatment experiences among this population. METHODS Participants were individuals with histories of PP who enrolled in the Massachusetts General Hospital Postpartum Psychosis Project (MGHP3). The MGHP3 Healthcare Access Survey, a cross-sectional questionnaire, assesses barriers to care, treatment-seeking behaviors, and experiences with treatment. Descriptive statistics were utilized to describe sample characteristics. RESULTS 139 participants provided 146 episode-specific survey responses. Lack of available services was cited as the greatest barrier to care for PP. Among those who sought treatment, obstetric providers (34.5%) and emergency medical professionals (29.4%) were the most common initial points of contact. 82.2% of the respondents went to an emergency room or crisis center during their episode(s). Most (61.8%) reported being given insufficient information to manage their PP. Approximately half of participants were hospitalized (55.5%), the majority of whom had no access to their infant during hospitalization (70.4%). Of those breastfeeding or pumping at admission, 31.3% were not given access to a breast pump. 44.4% dealt with delivery-related medical issues during their hospitalization. CONCLUSION This report is the first of its kind to assess key public health domains among individuals with PP. Findings point to several directions for future research and clinical practice to improve treatment timeliness and quality, potentially improving long-term outcomes related to this serious illness.
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Affiliation(s)
- Lauren A Kobylski
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA.
- Department of Psychological & Brain Sciences, George Washington University, Washington, DC, USA.
| | - Miranda H Arakelian
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Marlene P Freeman
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
| | - Margaret L Gaw
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
| | - Lee S Cohen
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
| | - Rachel Vanderkruik
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
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Fleury MJ, Imboua A, Grenier G. Barriers and Facilitators to High Emergency Department Use Among Patients with Mental Disorders: A Qualitative Investigation. Community Ment Health J 2024:10.1007/s10597-024-01239-w. [PMID: 38383882 DOI: 10.1007/s10597-024-01239-w] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
This qualitative study explored reasons for high emergency department (ED) use (3 + visits/year) among 299 patients with mental disorders (MD) recruited in four ED in Quebec, Canada. A conceptual framework including healthcare system and ED organizational features, patient profiles, and professional practice guided the content analysis. Results highlighted insufficient access to and inadequacy of outpatient care. While some patients were quite satisfied with ED care, most criticized the lack of referrals or follow-up care. Patient profiles justifying high ED use were strongly associated with health and social issues perceived as needing immediate care. The main barriers in professional practice involved lack of MD expertise among primary care clinicians, and insufficient follow-up by psychiatrists in response to patient needs. Collaboration with outpatient care may be prioritized to reduce high ED use and improve ED interventions by strengthening the discharge process, and increasing access to outpatient care.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
| | - Armelle Imboua
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
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O'Connell G, Shih S, Shui M, Krikhely A, Bessler M, Rohde CH. The financial toxicity of postbariatric body contouring surgery: a survey study of an urban tertiary care center's patients. Surg Obes Relat Dis 2024:S1550-7289(24)00075-3. [PMID: 38519294 DOI: 10.1016/j.soard.2024.02.003] [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: 05/30/2023] [Revised: 10/17/2023] [Accepted: 02/10/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Patients with obesity who undergo bariatric surgery achieve sustained weight loss but are often left with excess skin folds that cause functional and psychological deficits. To remove excess skin, patients can undergo postbariatric BCS; however, cost and lack of insurance coverage present a significant barrier for many patients. OBJECTIVES This study aimed to characterize the financial impact of treatment on all patients who received bariatric surgery and to compare between those receiving only bariatric surgery and those with postbariatric BCS. SETTING Email-based survey study at an urban tertiary care center. METHODS Surveys that included the COST-FACIT were sent to patients with a history of bariatric surgery and/or post-bariatric BCS. RESULTS One hundred and five respondents completed the survey, of which 19 reported having postbariatric BCS. Patients with postbariatric BCS had slightly higher COST scores than those receiving bariatric surgery only, but this difference was not significant (15.6 versus 17.8, P = .23). Most patients (76%) did not have an awareness of BCS or BCS cost prior to bariatric surgery, and many (68%) had more loose skin than anticipated. CONCLUSIONS Financial toxicity was similar across all postbariatric surgery patients surveyed regardless of history of BCS. However, survey respondents noted a gap between patient education and expectations around loose skin and body contouring that can be addressed through improved presurgical counseling.
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Affiliation(s)
- Gillian O'Connell
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Sabrina Shih
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Michelle Shui
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Abraham Krikhely
- Division of Bariatric Surgery, Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Marc Bessler
- Division of Bariatric Surgery, Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Christine H Rohde
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York.
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7
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Li H, Kilgour H, Leung B, Cho M, Pollock J, Culbertson S, Hedges P, Mariano C, Haase KR. Caring for older adults with cancer in Canada: Views from healthcare providers and cancer care allies in the community. Support Care Cancer 2024; 32:157. [PMID: 38358430 DOI: 10.1007/s00520-023-08303-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 12/29/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Cancer is common and disproportionately impacts older adults. Moreover, cancer care of older adults is complex, and the current Canadian cancer care system struggles to address all of the dimensions. In this project, our goal was to understand the barriers and facilitators to caring for older adults with cancer from perspectives of healthcare professionals and cancer care allies, which included community groups, seniors' centers, and other community-based supports. METHODS In collaboration with a patient advisory board, we conducted focus groups and interviews with multiple local healthcare professionals and cancer care allies in British Columbia, Canada. We used a descriptive qualitative approach and conducted a thematic analysis using NVivo software. RESULTS A total of 71 participants of various disciplines and cancer care allies participated. They identified both individual and system-level barriers. Priority system-level barriers for older adults included space and staffing constraints and disconnections within healthcare systems, and between healthcare practitioners and cancer care allies. Individual-level barriers relate to the complex health states of older adults, caregiver/support person needs, and the needs of an increasingly diverse population where English may not be a first or preferable language. CONCLUSIONS This study identified key barriers and facilitators that demonstrate aligned priorities among a diverse group of healthcare practitioners and cancer care allies. In conjunction with perspectives from patients and caregivers, these findings will inform future improvements in cancer care. Namely, we emphasize the importance of connections among health systems and community networks, given the outpatient nature of cancer care and the needs of older adults.
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Affiliation(s)
- Hong Li
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Heather Kilgour
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Bonnie Leung
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
- BC Cancer, Vancouver, BC, Canada
| | - Michelle Cho
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | - Kristen R Haase
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.
- BC Cancer Research Institute, Vancouver, BC, Canada.
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Born J, Liu A, Sudom K, Michaud K, Xi M, Fikretoglu D. Role of modifiable organisational factors in decreasing barriers to mental healthcare: a longitudinal study of mission meaningfulness, team relatedness and leadership trust among Canadian military personnel deployed on Operation LASER. BMJ Open 2024; 14:e076625. [PMID: 38331861 PMCID: PMC10860073 DOI: 10.1136/bmjopen-2023-076625] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/18/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES The literature presents complex inter-relationships among individual-factors and organisational-factors and barriers to seeking mental health support after deployment. This study aims to quantify longitudinal associations between such factors and barriers to mental health support. DESIGN A longitudinal online survey of Canadian Armed Forces (CAF) personnel collected data at 3 months post-deployment (T1), 6 months post-deployment (T2) and 1 year post-deployment (T3). SETTING In 2020, as part of Canada's response to the COVID-19 pandemic, 2595 CAF personnel deployed on Operation LASER to support civilian long-term care facilities in Québec and Ontario. PARTICIPANTS All Operation LASER personnel were invited to participate: 1088, 582 and 497 responded at T1, T2 and T3, respectively. Most respondents were young, male, non-commissioned members. MAIN OUTCOME MEASURES Barriers to mental health support were measured using 25 self-reported items and grouped into theory-based factors, including eight factors exploring care-seeking capabilities, opportunities and motivations; and two factors exploring moral issues. Logistic regressions estimated the crude and adjusted associations of individual and organisational characteristics (T1) with barriers (T2 and T3). RESULTS When adjusting for sex, military rank and mental health status, increased meaningfulness of deployment was associated with lower probability of endorsing barriers related to conflicts with career goals and moral discomfort in accessing support at T2. Higher scores in trust in leadership were associated with lower probability of endorsing four barriers at T2, and five barriers at T3. CONCLUSIONS We identified several modifiable organisational-level characteristics that may help reduce perceived barriers to mental health support in military and other high-risk occupational populations. Results suggest that promoting individuals' sense of purpose, instilling trust in leadership and promoting relatedness among team members may improve perceptions of access to mental health supports in the months following a domestic deployment or comparable occupational exposure.
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Affiliation(s)
- Jennifer Born
- Director General Military Personnel Research and Analysis, Department of National Defence and the Canadian Armed Forces, Ottawa, Ontario, Canada
| | - Aihua Liu
- Douglas Mental Health University Institute, Montreal, Québec, Canada
| | - Kerry Sudom
- Director General Military Personnel Research and Analysis, Department of National Defence and the Canadian Armed Forces, Ottawa, Ontario, Canada
| | - Kathy Michaud
- Director General Military Personnel Research and Analysis, Department of National Defence and the Canadian Armed Forces, Ottawa, Ontario, Canada
| | - Min Xi
- Director General Military Personnel Research and Analysis, Department of National Defence and the Canadian Armed Forces, Ottawa, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Deniz Fikretoglu
- Defence Research and Development Canada Toronto Research Centre, Toronto, Ontario, Canada
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Blom S, Lindh F, Lundin A, Burström B, Hensing G, Löve J. How gender and low mental health literacy are related to unmet need for mental healthcare: a cross-sectional population-based study in Sweden. Arch Public Health 2024; 82:12. [PMID: 38273389 PMCID: PMC10809616 DOI: 10.1186/s13690-023-01228-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/08/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Men are more likely to have unmet need for mental healthcare than women. However, an under-investigated aspect of the gender difference is the role of mental health literacy. This study investigated how combinations of gender and mental health literacy were related to two indicators of unmet need: not perceiving a need for mental healthcare despite poor mental health, and refraining from seeking mental healthcare. METHODS This cross-sectional study was based on a questionnaire sent to a general population sample, aged 16-84 years, in Stockholm County, Sweden, in 2019. Of the 1863 respondents (38%), 1563 were included (≥18 years). The sample was stratified into four groups, men and women with low or high mental health literacy, using the third quartile of the Mental Health Knowledge Schedule. The likelihood of not perceiving a need for mental healthcare and refraining from seeking mental healthcare, at any time in life, were investigated by calculating odds ratios with 95% confidence intervals. RESULTS Men with low mental health literacy were most likely to not perceive a need for mental healthcare, also when adjusting for age, education, and poor mental health (OR 5.3, 95% CI 3.6-7.7), and to refrain from seeking mental healthcare, also when adjusting for age and education (OR 3.3, 95% CI 1.7-6.4), followed by men with high mental health literacy (OR 1.9, 95% CI 1.5-2.4, and OR 1.5, 95% CI 1.0-2.2) and women with low mental health literacy (OR 1.9, 95% CI 1.2-2.9, and OR 2.1, 95% CI 1.1-3.9). Women with high mental health literacy were least likely (reference group). CONCLUSION The results show differences in the likelihood of unmet need for mental healthcare based on combinations of gender and mental health literacy level, with men having low mental health literacy being most at risk, and women with high mental health literacy being least at risk. This challenges generalisations of a gender difference in unmet need by showing heterogeneity among men and women based on mental health literacy. Men with low mental health literacy may be particularly in need of targeted interventions to reduce potential individual and societal consequences of their unmet need.
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Affiliation(s)
- Sara Blom
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 453, 405 30, Gothenburg, Sweden.
| | - Frida Lindh
- Centre for Epidemiology and Community Medicine, Region Stockholm, Solnavägen 1E, 104 31, Stockholm, Sweden
| | - Andreas Lundin
- Centre for Epidemiology and Community Medicine, Region Stockholm, Solnavägen 1E, 104 31, Stockholm, Sweden
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Gunnel Hensing
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 453, 405 30, Gothenburg, Sweden
| | - Jesper Löve
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 453, 405 30, Gothenburg, Sweden
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Walsh K, Melnik J, Birkett A, Kidd G, Bujan G, Mehta AHP, Meyer N. "I'm not going to do it alone": A qualitative study of barriers to sexual assault service-seeking among college students. J Am Coll Health 2024:1-12. [PMID: 38227911 DOI: 10.1080/07448481.2023.2283732] [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] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/03/2023] [Indexed: 01/18/2024]
Abstract
Objective: To understand barriers to seeking post-sexual assault services for students of color and lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) students. Methods: Qualitative interviews about campus and community resources for sexual and relationship violence were conducted with 29 undergraduate and graduate students who held diverse sexual, gender, and racial identities (n = 15 disclosed violence-related service-seeking). Results: Organized within trauma-informed care pillars, thematic coding revealed aspects of campus environment/culture that prevent students from accessing support including challenges identifying experiences as violence; limited cultural and identity-affirming care; limited clarity about resources; confidentiality concerns; difficulty accessing resources; and navigating resources alone. Suggestions to address concerns included regular prevention training; better coordinated care and systems with increased accountability, increased survivor support and peer support, and heightened transparency on websites/trainings about processes and confidentiality. Conclusions: Findings suggest promising avenues to improve support, particularly for minoritized survivors of violence, at this campus.
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Affiliation(s)
- Kate Walsh
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Woman and Gender Studies, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jessica Melnik
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Alexis Birkett
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Grace Kidd
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Mount Mary University, Milwaukee, Wisconsin, USA
| | - Grace Bujan
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Anuj H P Mehta
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nicole Meyer
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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11
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Woldetsadik MA, Yoseph Y, Degu M. Exploring barriers to using modern contraceptives and accessing safe abortion care in women who terminated unintended pregnancies in Southern Ethiopia. BMC Womens Health 2024; 24:46. [PMID: 38229066 PMCID: PMC10792934 DOI: 10.1186/s12905-023-02793-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 11/20/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Unsafe abortion is a major medical and public health problem in Ethiopia and contributes significantly to abortion-related morbidity and mortality in the country. We explored women's experiences with modern contraceptives and identified barriers to accessing safe abortion care and other sexual and reproductive health services. METHODS We recruited participants from six health clinics and a public hospital in southern Ethiopia. We conducted one-on-one interviews with 34 women aged 18-49 years who sought abortion care within the past twelve months of the study. Interviews were recorded, transcribed verbatim, translated to English, and imported into Dedoose software. We analysed the data using a directed content analysis. RESULTS Our findings show prevailing belief among participants that contraceptives caused infertility, abnormalities in subsequent pregnancies, and other side effects. Some of the women suggested that medical or unsafe abortions were a better alternative to using modern contraceptives for terminating unplanned pregnancies. Barriers to accessing safe abortion care included costs of services, lack of privacy, and fear of judgment from providers. Women who had negative experiences with providers were more likely to seek unsafe abortion the second time around. CONCLUSION Providers need to address women's concerns about using modern contraceptives, educate their clients about the best ways to prevent unwanted pregnancies, and provide non-judgemental services. In addition, comprehensive counselling services that include contraceptive counselling should be made available to women before, during, and after abortion care. Finally, providers should strive to be facilitators of, not barriers to, safe abortion care.
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Affiliation(s)
| | | | - Mekonnen Degu
- Family Guidance Association of Ethiopia, Hawassa, Ethiopia
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12
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Choi A, Nawash BS, Du K, Ong J, Chhablani J. Barriers to care in neovascular age-related macular degeneration: Current understanding, developments, and future directions. Surv Ophthalmol 2024; 69:160-164. [PMID: 37716480 DOI: 10.1016/j.survophthal.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/22/2023] [Accepted: 09/06/2023] [Indexed: 09/18/2023]
Abstract
Neovascular age-related macular degeneration is the advanced and irreversible stage of age-related macular degeneration, the leading cause of severe vision loss in older adults. While anti-vascular endothelial growth factor injections have been shown to preserve or improve vision quality in eyes with neovascular age-related macular degeneration, the treatment regimen can be demanding of patients and caregivers, leading to lower rates of adherence. Therefore, it is crucial that disparities and obstacles in neovascular age-related macular degeneration care are identified to improve access to treatment. Review of the current literature revealed 7 major categories of barriers: travel burden, psychological barriers, financial burden and socioeconomic status, treatment regimen, other comorbidities, provider-level barriers, and system-level barriers. We provide an overview of the major barriers to neovascular age-related macular degeneration care that have been reported, as well as gaps in research that need to be investigated further.
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Affiliation(s)
- Alison Choi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Baraa S Nawash
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Katherine Du
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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13
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Kamke K, Mullin TM, Goodman KL. Barriers to Seeking Medical Care Among Youth Victims of Sexual Violence. J Adolesc Health 2023; 73:1077-1082. [PMID: 37676193 DOI: 10.1016/j.jadohealth.2023.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Youth victims of sexual violence often experience physical health problems but are unlikely to receive medical care. However, victims' reasons for not accessing medical care have been understudied. We examined barriers to seeking medical care among youth victims who contacted the National Sexual Assault Online Hotline. METHODS We used archival data about one-on-one chat sessions with youth victims between June 2018 and February 2020. Hotline staff described victims' reasons for not accessing medical care via an online assessment. We coded and qualitatively examined these reasons using data about 520 victims with physical health concerns who had not received medical care. RESULTS Victims' barriers were rooted in individual beliefs and contextual realities reflected in three categories: (1) perception that medical care was not needed, (2) anticipated consequences of seeking medical care, and (3) inability to physically access medical care. Victims who perceived care as unnecessary did not understand the health implications of abuse or minimized their need for care. Anticipated consequences included privacy and control over disclosure, stigmatization, retaliation from the perpetrator, family disruptions, and retraumatizing medical treatment. Victims unable to physically access care were uncertain how to access care independently, lacked social support, or were prevented from care by the perpetrator. DISCUSSION Medical treatment can ameliorate acute health concerns and increase safety, but youth victims perceived numerous barriers to care. Several barriers implied unintended consequences of child maltreatment policies, including mandatory reporting. Trauma-informed policy and practice are critical for improving victims' access to medical care and other support services.
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Affiliation(s)
- Kristyn Kamke
- Research & Evaluation Team, Department of Victim Services, Rape, Abuse & Incest National Network (RAINN), Washington, D.C..
| | - Tara M Mullin
- Research & Evaluation Team, Department of Victim Services, Rape, Abuse & Incest National Network (RAINN), Washington, D.C
| | - Kimberly L Goodman
- Research & Evaluation Team, Department of Victim Services, Rape, Abuse & Incest National Network (RAINN), Washington, D.C
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Schmachtenberg T, Königs G, Dragaqina A, Roder S, Müller F, Müllenmeister C, Schröder D, Dopfer-Jablonka A, Vieth K, El-Sayed I. "There is no one who helps you with it": experiences of people with long COVID regarding medical care, therapeutic measures, and barriers in the German healthcare system: results of a qualitative study with four focus groups. BMC Health Serv Res 2023; 23:1160. [PMID: 37884993 PMCID: PMC10601213 DOI: 10.1186/s12913-023-10170-x] [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: 05/22/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Many people experience long-term symptoms such as fatigue, cognitive problems, or shortness of breath after an acute infection with COVID-19. This emerging syndrome, known as long COVID, is new and complex in many aspects. This study aims to collect the experiences of people with long COVID with ambulatory healthcare structures. METHODS Four focus groups were conducted with a total of 23 adults with long COVID in June and July 2022. These discussions were audio-recorded, subsequently transcribed, and analyzed using the qualitative content analysis of Mayring and Kuckartz. RESULTS Fourteen out of 19 participants who had a primary care encounter regarding their long COVID symptoms did not perceive it as helpful. Many respondents reported that their general practitioners did not take their long COVID symptoms seriously and did not refer them to specialists or made therapeutic recommendations. However, some participants reported that they were prescribed non-pharmaceutical therapies (e.g., group meetings supported by psychotherapists, occupational therapy, etc.) that improved their condition. 14 of 23 respondents perceived care barriers such as providers' lack of awareness of long COVID, poor access to specialists, a lack of specialized care (e.g., long COVID clinics), or high bureaucratic hurdles for specific healthcare services. To improve medical care, participants suggested campaigns to raise awareness of long COVID among healthcare providers and the general population, increase research and government investments regarding the development of treatment structures for long COVID, expanding existing therapeutic services, and establishing one-stop shops for integrated specialist healthcare for people with long COVID. CONCLUSIONS Several implications for healthcare professionals and policymakers can be derived from this study: (1) general practitioners should take the symptoms of long COVID seriously, assume a care coordinating role, make referrals, and establish contact with long COVID clinics; (2) care planners should focus on developing interprofessional evidence-based care and treatment approaches for long COVID; (3) existing care structures such as long COVID outpatient clinics should be expanded. The overarching goal must be to develop consistent guidelines for long COVID diagnosis, care, and treatment. TRIAL REGISTRATION The study is registered in the German register for clinical trials (DRKS00026007, first registration on 09/09/2021).
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Affiliation(s)
- Tim Schmachtenberg
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany.
- Department of Rheumatology and Immunology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Gloria Königs
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Anita Dragaqina
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Sascha Roder
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Frank Müller
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
- Department of Family Medicine, College of Human Medicine, Michigan State University, 15 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Christina Müllenmeister
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Dominik Schröder
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Alexandra Dopfer-Jablonka
- Department of Rheumatology and Immunology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- German Center for Infection Research, Partner Site Hannover-Braunschweig, Feodor-Lynen- Str. 26, 30625, Hannover, Germany
| | - Katharina Vieth
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Iman El-Sayed
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
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Trompeter N, Rafferty L, Dyball D, McKenzie A, Greenberg N, Fear NT, Stevelink SAM. Gender differences in structural and attitudinal barriers to mental healthcare in UK Armed Forces personnel and veterans with self-reported mental health problems. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02567-0. [PMID: 37855900 DOI: 10.1007/s00127-023-02567-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/28/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE Structural and attitudinal barriers often hinder treatment-seeking for mental health problems among members of the Armed Forces. However, little is known about potential gender differences in structural and attitudinal barriers among members of the UK Armed Forces. The current study aimed to explore how men and women differ in terms of these barriers to care among a sample of UK Armed Forces personnel and veterans with self-reported mental health problems. METHODS Currently serving and ex-serving members of the UK Armed Forces who self-reported a mental health problem were invited to participate in a semi-structured phone interview on mental health and treatment-seeking. The final sample included 1448 participants (1229 men and 219 women). All participants reported on their current mental health, public stigma, self-stigma, and barriers to mental healthcare. RESULTS Overall, men and women reported similar levels of both structural and attitudinal barriers, with no significant differences detected. The highest scores for both men and women were observed in attitudinal barriers relating to self-stigma domains, which encapsulate internalised attitudes and beliefs about mental illness and treatment. CONCLUSIONS Findings suggest that anti-stigma campaigns can be targeted simultaneously at both men and women within the Armed Forces. In particular, targeting self-stigma may be beneficial for health promotion campaigns.
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Affiliation(s)
- Nora Trompeter
- Institute of Psychiatry, Psychology and Neuroscience, King's Centre for Military Health Research, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK.
| | - Laura Rafferty
- Institute of Psychiatry, Psychology and Neuroscience, King's Centre for Military Health Research, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Daniel Dyball
- Institute of Psychiatry, Psychology and Neuroscience, King's Centre for Military Health Research, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Amber McKenzie
- Institute of Psychiatry, Psychology and Neuroscience, King's Centre for Military Health Research, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Neil Greenberg
- Institute of Psychiatry, Psychology and Neuroscience, King's Centre for Military Health Research, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Nicola T Fear
- Institute of Psychiatry, Psychology and Neuroscience, King's Centre for Military Health Research, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK
- Academic Department of Military Mental Health, King's College London, London, UK
| | - Sharon A M Stevelink
- Institute of Psychiatry, Psychology and Neuroscience, King's Centre for Military Health Research, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK
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Ong H, Ong J, Cheng R, Wang C, Lin M, Ong D. GPT Technology to Help Address Longstanding Barriers to Care in Free Medical Clinics. Ann Biomed Eng 2023; 51:1906-1909. [PMID: 37355478 DOI: 10.1007/s10439-023-03256-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/26/2023]
Abstract
The implementation of technology in healthcare has revolutionized patient-centered decision making by providing contextualized information about a patient's healthcare journey, leading to increased efficiency (Keyworth et al. in BMC Med Inform Decis Mak 18:93, 2018, https://doi.org/10.1186/s12911-018-0661-3 ). Artificial intelligence has been integrated within Electronic Health Records (EHR) to prompt screenings or diagnostic tests based on a patient's holistic health profile. While larger hospitals have already widely adopted these technologies, free clinics hold lower utilization of these advanced capability EHRs. The patient population at a free clinic faces a multitude of factors that limits their access to comprehensive care, thus requiring necessary efforts and measures to close the gap in healthcare disparities. Emerging Artificial Intelligence (AI) technology, such as OpenAI's ChatGPT, GPT-4, and other large language models (LLMs) have remarkable potential to improve patient care outcomes, promote health equity, and enhance comprehensive and holistic care in resource-limited settings. This paper aims to identify areas in which integrating these LLM AI advancements into free clinics operations can optimize and streamline healthcare delivery to underserved patient populations. This paper also identifies areas of improvements in GPT that are necessary to deliver those services.
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Affiliation(s)
- Hannah Ong
- College of Medicine, The Ohio State University, Columbus, OH, 43210, USA.
| | - Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rebekah Cheng
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA, USA
| | - Calvin Wang
- College of Medicine - Robert Wood Johnson, Rutgers University, New Brunswick, NJ, USA
| | - Murong Lin
- Distinguished Engineer, Verizon, San Jose, CA, USA
| | - Dennis Ong
- Amazon Web Services, Amazon, Seattle, WA, USA
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Link A, Okwir M, Iribarren S, Meya D, Bohjanen PR, Kasprzyk D. Lack of education, knowledge, and supplies are barriers to cryptococcal meningitis care among nurses and other healthcare providers in rural Uganda: A mixed methods study. Nurse Educ Today 2023; 128:105873. [PMID: 37390523 DOI: 10.1016/j.nedt.2023.105873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 05/09/2023] [Accepted: 06/05/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Cryptococcal meningitis (CM) is one of the deadliest opportunistic infections related to HIV/AIDS. A research gap exists surrounding the barriers to CM diagnosis, treatment delivery, and care from the healthcare provider's perspective. OBJECTIVES The purpose of this study was to elucidate provider's behaviors, to identify barriers and facilitators to diagnose and treat CM, and to assess their knowledge of CM, cryptococcal screening, and treatment. DESIGN, SETTING, AND PARTICIPANTS A convergent mixed-methods study among twenty healthcare providers who provided CM patient referrals to Lira Regional Referral Hospital in Lira, Uganda. METHODS Surveys and interviews were conducted to obtain information from healthcare providers who referred CM patients to Lira Regional Referral Hospital from 2017 to 2019. Questions related to provider education, knowledge, barriers to CM care, and patient education were inquired to understand the providers' perspectives. RESULTS Nurses had the least amount of CM knowledge with half knowing the cause of CM. Approximately half the participants knew about CM transmission, but only 15 % knew the duration of CM maintenance therapy. Most participants (74 %) last had education regarding CM during didactic training. In addition, 25 % disclosed they never educate patients due to time constraints (30 %) and lack of knowledge (30 %). Nurses (75 %) were least likely to provide patient education. Most participants acknowledged their lack of CM knowledge and attributed it to a lack of education and perceived inexperience with CM. CONCLUSIONS Providers' gaps in knowledge due to the lack of education and experience contributes to decreased patient education, and the lack of access to appropriate supplies affects their provision for CM diagnosis, treatment, and care. These results can guide evidence-based interventions to improve health providers' knowledge. Recommendations for standardized CM education should be developed for both providers and patients in collaboration with professional boards and the Uganda Ministry of Health.
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Affiliation(s)
- Abigail Link
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, MN, USA; Department of Medicine, Infectious Diseases, University of Rochester, Rochester, NY, USA.
| | - Mark Okwir
- Department of Internal Medicine, Lira Regional Referral Hospital, Faculty of Health Sciences, Lira University, Lira, Uganda
| | - Sarah Iribarren
- School of Nursing, University of Washington, Seattle, WA, USA.
| | - David Meya
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Paul R Bohjanen
- Division of Infectious Disease and International Medicine, University of Minnesota, Minneapolis, MN, USA; Department of Medicine, Infectious Diseases, University of Rochester, Rochester, NY, USA.
| | - Danuta Kasprzyk
- School of Nursing, University of Washington, Seattle, WA, USA.
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Harrop EN, Hutcheson R, Harner V, Mensinger JL, Lindhorst T. "You Don't Look Anorexic": Atypical anorexia patient experiences of weight stigma in medical care. Body Image 2023; 46:48-61. [PMID: 37236121 PMCID: PMC10524894 DOI: 10.1016/j.bodyim.2023.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 09/29/2022] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023]
Abstract
Eating disorders (ED) and weight stigma pose significant healthcare challenges. Patients at higher weights, like some with atypical anorexia (AAN), may face increased challenges due to weight stigma. This study analyzed patients' lived experiences with weight stigma in healthcare. Thirty-eight adult patients with AAN completed in-depth, semi-structured interviews regarding healthcare experiences. Guided by narrative inquiry approaches, transcripts were thematically coded. Across the illness trajectory (ED development, pre-treatment, treatment, post-treatment), patients reported that weight stigma in healthcare contributed to initiation and persistence of ED behaviors. Themes included "providers pathologizing patient weight," which patients reported triggered ED behaviors and relapse, "provider minimization and denial" of patients' EDs, which contributed to delays in screening and care, and "overt forms of weight discrimination," leading to healthcare avoidance. Participants reported that weight stigma prolonged ED behaviors, delayed care, created suboptimal treatment environments, deterred help-seeking, and lowered healthcare utilization. This suggests that many providers (pediatricians, primary care providers, ED treatment specialists, other healthcare specialists) may inadvertently reinforce patients' EDs. Increasing training, screening for EDs across the weight spectrum, and targeting health behavior promotion rather than universal weight loss, could enhance quality of care and improve healthcare engagement for patients with EDs, particularly those at higher weights.
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Affiliation(s)
- Erin N Harrop
- University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA 98105, USA; University of Denver Graduate School of Social Work, 2148 South High Street, Denver, CO 80208, USA.
| | - Rebecca Hutcheson
- University of Washington School of Public Health, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle, WA 98195, USA
| | - Vern Harner
- University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA 98105, USA
| | - Janell L Mensinger
- M. Louise Fitzpatrick College of Nursing at Villanova University, 800 E. Lancaster Ave., Villanova, PA 19085, USA; Nova Southeastern University, 3301 College Ave, Fort Lauderdale, FL 33314, USA
| | - Taryn Lindhorst
- University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA 98105, USA
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Allen LP, Ellis L, Engleton C, Valerio VL, Hatala AR. Voices of those living with type 2 diabetes in Belize: barriers to care before and during the COVID-19 pandemic. Int J Equity Health 2023; 22:163. [PMID: 37620814 PMCID: PMC10463824 DOI: 10.1186/s12939-023-01987-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
Belize has the highest national prevalence of type 2 diabetes (T2D) of Central and South America, and fifth direst in the world. T2D is the leading cause of death in Belize, a country facing burdens of increasing prevalence with few resources. Since March of 2020, the COVID-19 pandemic has exacerbated the difficulties of those living with T2D in Belize. To address T2D issues in Belize, our interdisciplinary research team explored the barriers to care and self-management for adult patients with T2D in Belize prior to and during the COVID-19 pandemic.Research relationships between Canadian (ARH) and Belizean (LE) authors have been ongoing since 2016. Together we used a qualitative Constructivist Grounded Theory design generating knowledge through 35 semi-structured patient interviews, 25 key informant discussions, and participant observation with field notes between February 2020 to September 2021. We used Dedoose analysis software for a systematized thematic coding process, as well as iterative verification activities. Findings revealed several barriers to care and self-management, including: 1) the tiered health and social care system with major gaps in coverage; 2) the unfulfilled demand for accurate health information and innovative dissemination methods; and 3) the compounding of loss of community supports, physical exercise, and health services due to COVID-19 restrictions. In the post-pandemic period, it is necessary to invest in physical, nutritional, economic, and psychosocial health through organized activities adaptable to changeable public health restrictions. Recommendations for activities include sending patients informational and motivational text messages, providing recipes with accessibly sourced T2D foods, televising educational workshops, making online tools more accessible, and mobilising community and peer support networks.
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Affiliation(s)
- Lindsay P Allen
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, 221 Human Ecology Bldg, Winnipeg, MB, R3T 2N2, Canada
| | - Lucia Ellis
- Belize Diabetes Association, Belize City, Belize
| | | | | | - Andrew R Hatala
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, 221 Human Ecology Bldg, Winnipeg, MB, R3T 2N2, Canada.
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Naanyu V, Njuguna B, Koros H, Andesia J, Kamano J, Mercer T, Bloomfield G, Pastakia S, Vedanthan R, Akwanalo C. Community engagement to inform development of strategies to improve referral for hypertension: perspectives of patients, providers and local community members in western Kenya. BMC Health Serv Res 2023; 23:854. [PMID: 37568172 PMCID: PMC10422762 DOI: 10.1186/s12913-023-09847-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Hypertension is the leading cause of death and disability. Clinical care for patients with hypertension in Kenya leverages referral networks to provide basic and specialized healthcare services. However, referrals are characterized by non-adherence and delays in completion. An integrated health information technology (HIT) and peer-based support strategy to improve adherence to referrals and blood pressure control was proposed. A formative assessment gathered perspectives on barriers to referral completion and garnered thoughts on the proposed intervention. METHODS We conducted a qualitative study in Kitale, Webuye, Kocholya, Turbo, Mosoriot and Burnt Forest areas of Western Kenya. We utilized the PRECEDE-PROCEED framework to understand the behavioral, environmental and ecological factors that would influence uptake and success of our intervention. We conducted four mabaraza (customary heterogenous community assemblies), eighteen key informant interviews, and twelve focus group discussions among clinicians, patients and community members. The data obtained was audio recorded alongside field note taking. Audio recordings were transcribed and translated for onward coding and thematic analysis using NVivo 12. RESULTS Specific supply-side and demand-side barriers influenced completion of referral for hypertension. Key demand-side barriers included lack of money for care and inadequate referral knowledge. On the supply-side, long distance to health facilities, low availability of services, unaffordable services, and poor referral management were reported. All participants felt that the proposed strategies could improve delivery of care and expressed much enthusiasm for them. Participants appreciated benefits of the peer component, saying it would motivate positive patient behavior, and provide health education, psychosocial support, and assistance in navigating care. The HIT component was seen as reducing paper work, easing communication between providers, and facilitating tracking of patient information. Participants also shared concerns that could influence implementation of the two strategies including consent, confidentiality, and reduction in patient-provider interaction. CONCLUSIONS Appreciation of local realities and patients' experiences is critical to development and implementation of sustainable strategies to improve effectiveness of hypertension referral networks. Incorporating concerns from patients, health care workers, and local leaders facilitates adaptation of interventions to respond to real needs. This approach is ethical and also allows research teams to harness benefits of participatory community-involved research. TRIAL REGISTRATION Clinicaltrials.gov, NCT03543787, Registered June 1, 2018. https://clinicaltrials.gov/ct2/show/NCT03543787.
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Affiliation(s)
- Violet Naanyu
- Department of Sociology Psychology and Anthropology, School of Arts and Social Sciences, Moi University, Nairobi, Kenya.
| | - Benson Njuguna
- Department of Clinical Pharmacy & Practice, Moi Teaching and Referral Hospital, Nairobi, Kenya
| | - Hillary Koros
- Academic Model Providing Access to Healthcare (AMPATH), Nairobi, Kenya
| | - Josephine Andesia
- Academic Model Providing Access to Healthcare (AMPATH), Nairobi, Kenya
| | - Jemima Kamano
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Nairobi, Kenya
| | - Tim Mercer
- Department of Population Health & Department of Medicine, University of Texas at Austin, Austin, USA
| | - Gerald Bloomfield
- Department of Medicine, Duke University School of Medicine &, Duke Global Health Institute, Durham, USA
| | - Sonak Pastakia
- Department of Pharmacy Practice & Center for Health Equity & Innovation, Purdue University College of Pharmacy, West Lafayette, USA
| | - Rajesh Vedanthan
- Department of Population Health & Department of Medicine, New York University Grossman School of Medicine, New York, USA
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Jungbauer WN, Zhang K, Melvin CL, Nietert PJ, Ford ME, Pecha PP. Identifying barriers to obstructive sleep-disordered breathing care: Parental perspectives. Int J Pediatr Otorhinolaryngol 2023; 171:111621. [PMID: 37300964 PMCID: PMC10526645 DOI: 10.1016/j.ijporl.2023.111621] [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: 11/07/2022] [Revised: 05/11/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Despite established clinical practice guidelines for pediatric obstructive sleep-disordered breathing (SDB), disparities persist for this common condition. Few studies have investigated parental experiences about challenges faced in obtaining SDB evaluation and tonsillectomy for their children. To better understand parent-perceived barriers to treatment of childhood SDB, we administered a survey to assess parental knowledge of this condition. MATERIALS & METHODS A cross-sectional survey was designed to be completed by parents of children diagnosed with SDB. Two validated surveys were administered: 1) Barriers to Care Questionnaire and 2) Obstructive Sleep-Disordered Breathing and Adenotonsillectomy Knowledge Scale for Parents. Logistic regression modeling was performed to assess for predictors of parental barriers to SDB care and knowledge. RESULTS Eighty parents completed the survey. Mean patient age was 7.4 ± 4.6 years, and 48 (60%) patients were male. The survey response rate was 51%. Patient racial/ethnic categories included 48 (60.0%) non-Hispanic White, 18 (22.5%) non-Hispanic Black, and 14 (17.5%) Other. Parents reported challenges in the 'Pragmatic' domain, including appointment availability and cost of healthcare, as the most frequently described barrier to care. Adjusting for age, sex, race, and education, parents in the middle-income bracket ($26,500 - $79,500) had higher odds of reporting greater barriers to care than parents in the highest (>$79,500) income tier (OR 5.536, 95% CI 1.312-23.359, P = 0.020) and lowest income tier (<$26,500) (OR 3.920, 95% CI 1.096-14.020). Parents whose children had tonsillectomy (n = 40) answered only a mean 55.7% ± 13.3% of questions correctly on the knowledge scale. CONCLUSION Pragmatic challenges were the most encountered barrier that parents reported in accessing SDB care. Families in the middle-income tier experienced the greatest barriers to SDB care compared to lower and higher income families. In general, parental knowledge of SDB and tonsillectomy was relatively low. These findings represent potential areas of improvement to target interventions to promote equitable care for SDB.
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Affiliation(s)
- W Nicholas Jungbauer
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Kathy Zhang
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Cathy L Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Marvella E Ford
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Phayvanh P Pecha
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
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22
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Jung HH, Kim HJ, Fredriksen-Goldsen K. Identifying Latent Patterns and Predictors of Health Behaviors and Healthcare Barriers Among LGBT Older Adults. Prev Sci 2023; 24:1115-1127. [PMID: 36763229 PMCID: PMC10412727 DOI: 10.1007/s11121-023-01494-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/11/2023]
Abstract
Heightened risk of adverse health behaviors is of major concern among lesbian, gay, bisexual, and transgender (LGBT) older adults. Yet, no previous research has investigated heterogeneity of LGBT older adults on a set of health behaviors in conjunction with healthcare barriers. We aim to identify latent classes of the behavior and barrier patterns and examine differences in physical and psychological health-related quality of life (HRQOL) by the specified latent classes while exploring predictors of the class membership. Three-step latent class analysis applying survey weights was conducted with 14 indicators of health-risk behavior, health-promoting behavior, preventive care use, and healthcare barriers from baseline data of the Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS, N = 2450). The best empirical and substantive fit was determined with four classes consisting of (1) healthy behaviors and minimal barriers (C1, 39%), (2) less healthy behaviors and high barriers (C2, 31%), (3) healthy behaviors and healthcare system barriers (C3, 19%), and (4) optimal health behaviors with risks of limited healthcare access (C4, 11%). Compared to C1, C2 and C3 had lower physical HRQOL and C2 also had lower psychological HRQOL. C4 did not differ in HRQOL from C1. C2 was associated with more day-to-day discrimination, lower mastery, and lower social support. Efforts to lower healthcare barriers are warranted in addition to interventions to strengthen social support and reduce marginalization. Positive relationships between LGBT older adults and healthcare need to be established via trust-building and cultural competency.
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Affiliation(s)
- Hailey H Jung
- School of Social Work, University of Washington, 4101 15th Ave NE, Seattle, WA, 98105, USA.
| | - Hyun-Jun Kim
- School of Social Work, University of Washington, 4101 15th Ave NE, Seattle, WA, 98105, USA
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23
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Li ZHJ, MacDonald K, Preston K, Giuliani M, Leung B, Melosky B, Simmons C, Hamilton S, Tinker A, Ingledew PA. Evaluating the childcare needs of cancer patients undergoing radiation therapy. Support Care Cancer 2023; 31:463. [PMID: 37439947 DOI: 10.1007/s00520-023-07923-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE About one-fifth of newly diagnosed cancer patients are parents to young children. These patients are at higher risk of psychosocial stress and inability to attend treatment due to having to balance their own healthcare needs with childcare duties. This study aims to explore the impact of childcare on cancer parents and elicit their perspectives on potential supports. The results could help inform the implementation of suitable childcare programs to remove this barrier in accessing care. METHODS Patients at a large Canadian cancer treatment center were screened by oncologists for having minor children at home. Secure electronic surveys were then distributed to consenting participants. Domains surveyed included patient demographics, childcare burden, impact on treatment, and preference for childcare supports. RESULTS The mean age of correspondents was 43.9 (range 33-54), 46 patients (92%) were female, and breast cancer was the most common primary tumor. The median number of children per correspondent was two, and their mean age was 8.4. Balancing childcare with cancer treatment had a significant impact on self-reported stress levels for most correspondents. Twenty (40%) participants had to reschedule and 7 (14%) participants missed at least one appointment due to childcare conflicts. During the COVID-19 pandemic, access to childcare resources decreased while childcare responsibilities increased. Three-quarters of correspondents reported that a flexible childcare would make it easier for them to adhere to appointment schedules. CONCLUSION Childcare is a significant psychosocial barrier for patients accessing cancer care. Our results indicate that most parents undergoing treatment may benefit from hospital-based childcare services.
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Affiliation(s)
- Zhang Hao Jim Li
- Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, British Columbia, Canada
| | - Kenzie MacDonald
- Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Preston
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meredith Giuliani
- Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Bonnie Leung
- BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Barbara Melosky
- BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christine Simmons
- BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Hamilton
- Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, British Columbia, Canada
| | - Anna Tinker
- BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paris-Ann Ingledew
- Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, British Columbia, Canada.
- BC Cancer, Vancouver, British Columbia, Canada.
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Hicks PM, Kang L, Armstrong ML, Pongrac JR, Stagg BC, Saylor KM, Newman-Casey PA, Woodward MA. A scoping review of patients' barriers to eye care for glaucoma and keratitis. Surv Ophthalmol 2023; 68:567-577. [PMID: 37004793 PMCID: PMC10875963 DOI: 10.1016/j.survophthal.2023.03.005] [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: 07/19/2022] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
In this scoping review, we examine underlying causes of loss to follow-up for chronic (glaucoma) and acute (corneal ulcers) eye conditions using the Penchansky and Thomas access to care framework. We explore barriers by World Health Organization income levels and by studying geographical location. We identified 6,363 abstracts, with 75 articles retrieved and 16 meeting inclusion criteria. One article discussed barriers to follow-up care for people with corneal ulcers, and the other 15 were for people with glaucoma. The most frequent barriers to care were affordability, awareness, and accessibility. The international studies had a greater percentage of studies report acceptability as a barrier to loss to follow-up. Countries with universal healthcare included affordability as a loss to follow-up barrier, emphasizing that cost goes beyond the ability to pay for direct treatment costs. Understanding and addressing barriers to follow-up care can aid the goal of continued care and decrease the risk of poor outcomes and vision loss.
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Affiliation(s)
- Patrice M Hicks
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Linda Kang
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | | | - Joseph R Pongrac
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Brian C Stagg
- John Moran Eye Center, University of Utah, Salt Lake City, UT, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Kate M Saylor
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
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25
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Tang GH, Thachil J, Bowman M, Bekdache C, James PD, Sholzberg M. Patient-centered care in von Willebrand disease: are we there yet? Expert Rev Hematol 2023; 16:641-649. [PMID: 37581602 DOI: 10.1080/17474086.2023.2243386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Von Willebrand Disease is the most common inherited bleeding disorder. Paradoxically, affected individuals are often misdiagnosed and experience substantial diagnostic delay. There are sex-specific health disparities in VWD rooted in the stigmatization of vaginal bleeding, which leads to symptom dismissal, lack of timely access to care and lower health-related quality of life. AREAS COVERED Following the core elements of patient-centered care - respect for patient preferences, values, and needs, we describe the current state of VWD care. Challenges of diagnostic delay, serial misrecognition of abnormal bleeding, and symptom dismissal are barriers that disproportionately affect women with VWD. These negative effects are further amplified in individuals living in low- and middle-income countries. We describe the importance of coordinated multidisciplinary care, as well as the need for patient education and empowered self-advocacy. EXPERT OPINION While tremendous work has been done to improve the diagnosis and management of VWD, timely and high-quality research is urgently needed to address care gaps. Systemic changes such as resource investment, dedicated research funding for novel treatment modalities, and effective knowledge translation strategies to address structural barriers are needed to facilitate effective patient-centered care for VWD.
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Affiliation(s)
- Grace H Tang
- Hematology-Oncology Clinical Research Group, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jecko Thachil
- Department of Hematology, Manchester University Hospitals, Manchester, UK
| | - Mackenzie Bowman
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Carine Bekdache
- Hematology-Oncology Clinical Research Group, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Paula D James
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Michelle Sholzberg
- Department of Medicine and Laboratory Medicine & Pathobiology, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Moshtagh M, Mirlashari J, Brown H. Experiences of women with cancer living in the rural areas of Iran during the COVID-19 pandemic: a qualitative study. Support Care Cancer 2023; 31:376. [PMID: 37273068 DOI: 10.1007/s00520-023-07847-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/27/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE This study aimed to explore the challenges of access to treatment and quality of life in female cancer survivors living in rural areas of Iran within the global pandemic context (COVID-19). METHODS We conducted a qualitative exploratory study where we recruited nine female-identifying individuals diagnosed with cancer, 23 family members, and five healthcare providers from a hospital affiliated with the Birjand University of Medical Sciences in Iran. Data was collected using semi-structured interviews and analyzed using Braun and Clarke's reflective thematic analysis. RESULTS The three themes constructed were lack of strength from fighting on two fronts (subthemes: (i) fear related to longevity and life span, (ii) disruption of emotional relationships and family functioning, (iii) loneliness and fear of the future, (iv) village culture and double whammy, and (v) isolation and rejection in a rural community); changes during treatment (subthemes: (i) confusion related to treatment and (ii) the hope found during treatment "bottlenecks"); and spiritual growth and clarifying values (subthemes: (i) patience and resilience and (ii) clarifying life values and opportunities when facing uncertainty about the future). CONCLUSION This study highlights the importance of further evaluating interventions to mitigate barriers to supportive care for female cancer survivors living in rural areas with low-resource contexts during the COVID-19 pandemic.
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Affiliation(s)
- Mozhgan Moshtagh
- Social Determinants of Health Research Center, Faculty of Health, Birjand University of Medical Sciences, Birjand, Iran.
| | | | - Helen Brown
- University of British Columbia, School of Nursing, Vancouver, Canada
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27
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Collins C, Pichan C, McGee L, Siden JY, Brower K. Assessing Student Burnout, Treatment Acquisition, and Barriers to Care to Prompt Changes in a Student Mental Healthcare Program. Acad Psychiatry 2023; 47:164-168. [PMID: 35879597 PMCID: PMC9311347 DOI: 10.1007/s40596-022-01685-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/05/2022] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Medical students demonstrate disproportionately higher levels of burnout and depression than their non-medical age-matched peers. Few studies have been conducted about rates of treatment acquisition and the barriers to care among students with mental health concerns. This study further characterizes rates of burnout, obstacles to treatment, and program preference for medical students at The University of Michigan. METHODS In June 2020, a 31-question survey eliciting information regarding student burnout, well-being, barriers to care, and improvements to overcome such barriers was sent to 588 current and recently graduated medical students at The University of Michigan. Participation was anonymous and voluntary, with optional response to each question. RESULTS Ultimately, 312 (53%) students responded. Pre-clinical and core clinical students were significantly more burned out than clinical elective students, with pre-clinical students' odds ratio (OR) of 2.45 and core clinical students' OR of 2.48. Most participants (81%) reported concerns regarding their emotional well-being. Two-thirds (66%) indicated a new or previously diagnosed mental health concern, with 37% of these students never having sought treatment. Commonly reported barriers to care and suggested improvement to mental health services are outlined. Commonly reported barriers to care were financial concerns, time constraints, and stigma-related fear of career-ending consequences. CONCLUSIONS This study showed stratification of the high levels of burnout among medical students. Student-driven feedback and survey results can help prompt medical schools to develop more robust mental healthcare models and drive much-needed structural changes.
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Affiliation(s)
- Claire Collins
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Cayla Pichan
- University of Michigan Medical School, Ann Arbor, Michigan, USA.
| | - Lauren McGee
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Kirk Brower
- University of Michigan Medical School, Ann Arbor, Michigan, USA
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28
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Bei E, Morrison V, Zarzycki M, Vilchinsky N. Barriers, facilitators, and motives to provide distance care, and the consequences for distance caregivers: A mixed-methods systematic review. Soc Sci Med 2023; 321:115782. [PMID: 36801750 DOI: 10.1016/j.socscimed.2023.115782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 01/25/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
RATIONALE Distance caregivers (DCGs) are a growing population with substantial contributions to informal care. While much is known about the provision of local informal care, evidence from the distance caregiving population is lacking. OBJECTIVE This mixed-method systematic review examines barriers and facilitators of distance caregiving, determinants of motivations and willingness to provide distance care, and the impact on caregiver outcomes. METHODS A comprehensive search strategy was conducted in four electronic databases and grey literature to minimise potential publication bias. Thirty-four studies, including 15 quantitative, 15 qualitative, and 4 mixed-method studies were identified. Data synthesis involved a convergent integrated approach to integrate quantitative with qualitative findings, followed by thematic synthesis to identify key themes and subthemes. RESULTS Barriers and facilitators of providing distance care included contextual and socioeconomic aspects of geographic distance, communication and information resources, and local support networks that shaped the distance caregiver role and caregiver involvement. The main motives for caregiving given by DCGs were cultural values and beliefs, societal norms, and perceived expectations of caregiving encompassing the sociocultural context of the caregiving role. Interpersonal relationships and individual characteristics further shaped DCGs' motivations and willingness to care from a geographic distance. DCGs experienced both positive and negative outcomes as a result of their distance caretaking responsibilities including feelings of satisfaction, personal growth, and enhanced relationship with the care recipient but also high levels of caregiver burden, social isolation, emotional distress, and anxiety. CONCLUSIONS The reviewed evidence contributes toward novel understandings about the unique nature of distance care and have important implications for research, policy, healthcare, and social practice.
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Affiliation(s)
- Eva Bei
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan, 5290002, Israel.
| | - Val Morrison
- School of Human and Behavioural Sciences, Bangor University, Bangor, Gwynedd, UK.
| | - Mikołaj Zarzycki
- Department of Psychology, Liverpool Hope University, Liverpool, L16 9JD, England, United Kingdom.
| | - Noa Vilchinsky
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan, 5290002, Israel.
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Holt NR, Hope DA, Mocarski R, Woodruff N. The Often-Circuitous Path to Affirming Mental Health Care for Transgender and Gender-Diverse Adults. Curr Psychiatry Rep 2023; 25:105-111. [PMID: 36773177 PMCID: PMC9918830 DOI: 10.1007/s11920-023-01410-2] [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] [Accepted: 01/09/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE OF REVIEW We describe recent research regarding access to affirming mental health services for transgender and gender-diverse (TGD) adults and explore new resources available for therapists to inform evidence-based practice with TGD clients. RECENT FINDINGS Barriers and facilitators at all socioecological levels impact TGD adults' mental health help-seeking. TGD adults often interface with mental health providers while accessing gender-affirming medical care, though new standards of care are likely to alter this typically common path to mental health services. Efforts to improve therapist education, such as therapy manuals, are increasingly available and a necessary step to increase the number of competent, affirming therapists. More work-both advocacy and research-is needed to fully expand accessible, affirming mental health services for TGD adults. Better understanding factors impacting different steps of the mental health help-seeking process and conducting randomized controlled trials of affirming mental health services are important next steps.
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Affiliation(s)
- Natalie R Holt
- Geriatric Research, Education, and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN, USA.
| | - Debra A Hope
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Richard Mocarski
- Office of Research, San Jose State University, San Jose, CA, USA
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Do TP, Dømgaard M, Stefansen S, Steiner TJ, Ashina M. Characterizing healthcare utilization patterns in a Danish population with headache: results from the nationwide headache in Denmark (HINDER) panel. J Headache Pain 2023; 24:18. [PMID: 36829124 PMCID: PMC9951480 DOI: 10.1186/s10194-023-01553-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/15/2023] [Indexed: 02/26/2023] Open
Abstract
INTRODUCTION Worldwide, far from all of those who would benefit make use of headache services, largely because of clinical, social, and political barriers to access. Identifying the factors contributing to low healthcare utilization can generate evidence to guide health policy. Our purpose here is better to characterize healthcare utilization patterns in Denmark. METHODS The Headache in Denmark (HINDER) study is a nationwide cross-sectional survey of people with headache, conducted using SurveyXact (Rambøll Group A/S, Copenhagen). Healthcare utilization was assessed in a study sample generated by population screening and recruitment. Data collection occurred over two weeks, from September 23rd until October 4th, 2021. The questions enquired into disease characteristics, management, burden, medication intake and healthcare utilization. RESULTS The number of participants included in the HINDER panel was 4,431, with 2,990 (67.5%: 2,522 [84.3%] female, 468 [15.7%] male; mean age 40.9 ± 11.6 years) completing the survey. One quarter of participants (27.7%) disagreed or strongly disagreed that they were able to manage their headache attacks. Most participants (81.7%) agreed or strongly agreed that their headache was a burden in their everyday lives. The most reported acute medications, by 87.2% of participants, were simple analgesics; of note, 8.6% reported using opioids for their headache. One quarter of participants (24.4%) had never consulted a medical doctor for their headache; one in six (16.5%: more than two thirds of the 24.4%) had never done so despite agreeing or strongly agreeing that their headache was a burden in their everyday lives. Two thirds (65.3%) of participants overall, and almost three quarters (72.4%) of those with weekly headache, had tried one or more complementary or alternative therapies outside conventional medical care. CONCLUSIONS Our findings are indicative of inadequate delivery of headache care in a country that provides free and universal coverage for all its residents. The implications are twofold. First, it is not sufficient merely to make services available: public education and increased awareness are necessary to encourage uptake by those who would benefit. Second, educational interventions in both pre- and postgraduate settings are necessary, but a prerequisite for these is a resetting of policy priorities, properly to reflect the very high population ill-health burden of headache.
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Affiliation(s)
- Thien Phu Do
- grid.475435.4Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark ,Danish Knowledge Center On Headache Disorders, Glostrup, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikala Dømgaard
- Danish Knowledge Center On Headache Disorders, Glostrup, Denmark
| | - Simon Stefansen
- Danish Knowledge Center On Headache Disorders, Glostrup, Denmark
| | - Timothy J. Steiner
- grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark ,grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway ,grid.7445.20000 0001 2113 8111Division of Brain Sciences, Imperial College London, London, UK
| | - Messoud Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. .,Danish Knowledge Center On Headache Disorders, Glostrup, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Nicholson TP, Blazer EC, Hymes AS, Ginley MK. A Qualitative Investigation into the Trauma Exhibited by First Responders Impacted by the Opioid Epidemic. Int J Ment Health Addict 2023:1-22. [PMID: 36619000 PMCID: PMC9810250 DOI: 10.1007/s11469-022-00993-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Accepted: 12/13/2022] [Indexed: 01/04/2023] Open
Abstract
This qualitative study aimed to capture the lived experiences of first responders (FRs) combatting the opioid epidemic in an effort to better understand how the increase in opioids, opioid-related harm, and opioid-related death has affected the FR profession. FRs (N = 30) from Tennessee partook in semi-structured interviews investigating the impact of responding to opioid-related incidents. Using a phenomenological approach, three response themes emerged including (1) opioid epidemic burden on FR mental health, (2) variable availability and effectiveness of resources, and (3) identified roles of FRs in reducing the impact of the epidemic. The findings indicate that FRs are experiencing posttraumatic stress and secondary traumatic stress symptoms due to a shift in their duties, as well as repeated exposures to the adverse impacts of opioid use. This study finds a deficit in resources and support to combat the mental health repercussions FRs have experienced due to the epidemic. Given that FRs are often directly involved in preventing opioid-related deaths, ensuring that they are well resourced is an essential component of harm reduction and will ultimately augment care for individuals experiencing opioid-related harm.
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Affiliation(s)
- Thalia P. Nicholson
- Department of Psychology, East Tennessee State University, 420 Rogers Stout-Hall, P.O. Box 70649, Johnson City, TN 37614 USA
| | - Erin C. Blazer
- Department of Counseling, Carson Newman, 1646 Russell Avenue, Jefferson City, TN 37760 USA
| | - Aaron S. Hymes
- Department of Counseling, Milligan University, P.O. Box 22, Milligan, TN 37682 USA
| | - Meredith K. Ginley
- Department of Psychology, East Tennessee State University, 420 Rogers Stout-Hall, P.O. Box 70649, Johnson City, TN 37614 USA
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Decker MJ, Zárate CG, Atyam TV, Saphir M. Improving Adolescent Perceptions of Barriers and Facilitators to Sexual and Reproductive Health Services Through Sexual Health Education. J Adolesc Health 2023; 72:138-46. [PMID: 36289042 DOI: 10.1016/j.jadohealth.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/21/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE This study examines whether comprehensive sexual health education that provides information on clinical services can change adolescents' perceptions of barriers, facilitators, and intention to use services and whether changes in perceptions differ by participant characteristics. METHODS Adolescent participants in a statewide sexual health education program in California were surveyed at baseline and at exit about their perceptions of barriers, facilitators, and intention to use clinical services. Linked baseline and exit surveys (n = 7,460) assessed change in perceptions after program completion. Logistic regression analyses that accounted for the clustered data structure assessed associations between participant characteristics and improvement in perceptions. RESULTS After the program, there were significant reductions in two perceived barriers (worry about cost and judgment by staff), but there were also small but significant increases in perceptions of two barriers (worry about confidentiality of services and test results). There were significant increases in all three perceived facilitators and intention to use sexual and reproductive health services, which rose from 90.6% at baseline to 96.2% at exit. Younger youth were more likely than older youth to show improvement in all perceived facilitators and intentions. Girls and Black youth were more likely than boys and Hispanic youth to show improvement in two facilitators (knowing what to expect and access). No sociodemographic characteristics were consistently associated with reductions in perceived barriers. DISCUSSION Comprehensive sexual health education that addresses adolescents' questions and concerns regarding clinical services can help to reduce perceived barriers, increase facilitators, and increase intention to use services if needed.
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Mac Quene T, Smith L, Odland ML, Levine S, D'Ambruoso L, Davies J, Chu K. Prioritising and mapping barriers to achieve equitable surgical care in South Africa: a multi-disciplinary stakeholder workshop. Glob Health Action 2022; 15:2067395. [PMID: 35730572 PMCID: PMC9225684 DOI: 10.1080/16549716.2022.2067395] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Surgical healthcare in South Africa is inequitable with a considerable lack of resources in the public health sector. Identifying barriers to care and creating research priorities to mitigate these barriers can contribute to strategic interventions to improve equitable access to quality surgical care. OBJECTIVE To use the Four Delays Framework to map barriers to surgical care and identify priorities to achieve equitable and timely access to quality surgical care in South Africa. METHODS A multi-disciplinary stakeholder workshop was held in Cape Town, South Africa in January 2020. A Four Delays Framework (delays in seeking care, reaching care, receiving care, and remaining in care) was used to identify barriers that occur at each delay and the top 10 priorities for intervention. Barriers were categorised into overarching themes and schematically mapped. RESULTS Thirty-four stakeholders including health service users, health service providers, and community members participated in this exercise. In total, 34 barriers were identified with 73 connections to various delays. Specifically, 14 barriers were related to delays in seeking care, 11 were related to delays in reaching care, 20 were related to delays in receiving care, and 28 were related to delays in remaining in care. The highest priority barriers across the delays were Lack of service provider's knowledge, training and experience, and Limited surgical outreach. The barrier Lack of decentralised services was related to all four delays. Barriers were interconnected and potentially reinforcing. CONCLUSIONS This workshop is the first of its kind to generate evidence on the delays to surgical care in South Africa. Mapping crucial interconnected, potentially reinforcing barriers, and priority interventions demonstrated how a multifaceted approach may be required to address delays to access. Further research focused on the identified priorities will contribute to efforts to promote equitable access to quality surgical care in South Africa.
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Affiliation(s)
- Tamlyn Mac Quene
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Luné Smith
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Maria Lisa Odland
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Susan Levine
- Department of Anthropology, Humanities Faculty, University of Cape Town, Cape Town, South Africa
| | - Lucia D'Ambruoso
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
| | - Justine Davies
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Institute for Applied Health Research, University of Birmingham, Birmingham, UK.,Faculty of Health Sciences, Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - Kathryn Chu
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Sonawane K, Castellano T, Washington C, Ting J, Surinach A, Kirshner C, Chhatwal J, Ayer T, Moore K. Factors associated with receipt of second-line recurrent or metastatic cervical cancer treatment in the United States: A retrospective administrative claims analysis. Gynecol Oncol Rep 2022; 44:101121. [PMID: 36589508 PMCID: PMC9797608 DOI: 10.1016/j.gore.2022.101121] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose Contemporary, real-world data on eligible patients receiving treatment following progression on first-line (1L) recurrent or metastatic cervical cancer (r/mCC) therapy are needed to inform treatment algorithms and identify potential gaps in the r/mCC care continuum. Methods This study estimated the prevalence and predictors of second-line (2L) r/mCC therapy among 1L-treated patients using the 2015-2020 IBM MarketScan® commercial claims database. Women ≥ 18 years diagnosed with cervical cancer and treated with first-line systemic therapies were identified and followed for 12 months from their 1L therapy end date. Women with claims for a new therapy after 60 days but no later than 365 days from the end of 1L treatment were identified as those who progressed and received 2L therapy for r/mCC. Descriptive statistics examined baseline cohort characteristics and multivariable logistic regression model examined the factors associated with receiving 2L treatment. Results We identified 384 1L-treated patients with r/mCC with ≥ 12 months of follow-up post-1L treatment. During follow-up, over half (51.0 %) of the 1L-treated r/mCC patients received 2L treatment. Patients from the South and Midwest had a lower likelihood of receiving 2L treatment compared with those living in the Northeast (adjusted odds ratio [aOR] = 0.43; 0.23-0.84) and (aOR = 0.52; 0.28-0.95, respectively). Patients not treated with bevacizumab in 1L were also less likely to receive 2L therapy (aOR = 0.65; 0.43-0.99). Conclusion Additional research and targeted outreach efforts are needed to understand geography-, population-, or practice-specific barriers impacting access to 2L therapy among patients with r/mCC.
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Affiliation(s)
- Kalyani Sonawane
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Tara Castellano
- Louisiana State University, Department of Gynecologic Oncology, New Orleans, LA, USA
| | - Christina Washington
- Stephenson Cancer Center at the University of Oklahoma HSC, Oklahoma, City, OK, USA
| | | | | | | | - Jagpreet Chhatwal
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Turgay Ayer
- Georgia Institute of Technology, Department of Industrial and Systems Engineering, Atlanta, GA, USA,Emory School of Medicine, Atlanta, GA, USA
| | - Kathleen Moore
- Stephenson Cancer Center at the University of Oklahoma HSC, Oklahoma, City, OK, USA,Corresponding author at: Stephenson Cancer Center at the University of Oklahoma HSC, Oklahoma, City, OK, USA. Tel.: +405 271 8707.
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Sonawane K, Castellano T, Washington C, Ting J, Surinach A, Kirshner C, Chhatwal J, Ayer T, Moore K. Factors associated with receipt of second-line recurrent or metastatic cervical cancer treatment in the United States: A retrospective administrative claims analysis. Gynecol Oncol Rep 2022; 44:101101. [PMID: 36506039 DOI: 10.1016/j.gore.2022.101101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/08/2022] Open
Abstract
Purpose Contemporary, real-world data on eligible patients receiving treatment following progression on first-line (1L) recurrent or metastatic cervical cancer (r/mCC) therapy are needed to inform treatment algorithms and identify potential gaps in the r/mCC care continuum. Methods This study estimated the prevalence and predictors of second-line (2L) r/mCC therapy among 1L-treated patients using the 2015-2020 IBM MarketScan® commercial claims database. Women ≥ 18 years diagnosed with cervical cancer and treated with first-line systemic therapies were identified and followed for 12 months from their 1L therapy end date. Women with claims for a new therapy after 60 days but no later than 365 days from the end of 1L treatment were identified as those who progressed and received 2L therapy for r/mCC. Descriptive statistics examined baseline cohort characteristics and multivariable logistic regression model examined the factors associated with receiving 2L treatment. Results We identified 384 1L-treated patients with r/mCC with ≥ 12 months of follow-up post-1L treatment. During follow-up, over half (51.0 %) of the 1L-treated r/mCC patients received 2L treatment. Patients from the South and Midwest had a lower likelihood of receiving 2L treatment compared with those living in the Northeast (adjusted odds ratio [aOR] = 0.43; 0.23-0.84) and (aOR = 0.52; 0.28-0.95, respectively). Patients not treated with bevacizumab in 1L were also less likely to receive 2L therapy (aOR = 0.65; 0.43-0.99). Conclusion Additional research and targeted outreach efforts are needed to understand geography-, population-, or practice-specific barriers impacting access to 2L therapy among patients with r/mCC.
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Cramer RJ, Montanaro E, VanSickle M, Cacace S, Zabelski S, Smith EL, Franks M, Grover S, Cunningham CA. A psychometric assessment of the Military Suicide Attitudes Questionnaire (MSAQ). Psychiatry Res 2022; 317:114849. [PMID: 36166945 DOI: 10.1016/j.psychres.2022.114849] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 01/04/2023]
Abstract
Suicide rates remain high among military populations. Stigmatizing beliefs about suicide contribute to the problem of heightened suicide risk as a deterrent for help-seeking. Measurement of military suicide stigma is therefore an important gap in the literature as a necessity toward the development of military suicide prevention programming. This paper assessed the factor structure, reliability, and validity of the Military Suicide Attitudes Questionnaire (MSAQ). Study 1 featured secondary analysis of a suicide risk dataset from active duty treatment-seeking military personnel (N = 200). Study 2 was a secondary analysis of a statewide assessment of Army National Guard service members' beliefs about mental health and suicide (N =1116). Factor analyses results collectively supported a four-factor Military Suicide Attitudes Questionnaire (MSAQ) structure: discomfort, unacceptability, support, and empathic views. Subscale reliabilities ranged from 0.77 to 0.83 across samples. Unacceptability and support displayed significant negative correlations with psychological distress. Men displayed more negative suicide-related beliefs compared to women counterparts. Discomfort and unacceptability beliefs displayed significant positive associations with perceived barriers to care. The final short version of the MSAQ is an efficient, multi-dimensional measure of military suicide-related beliefs. The instrument can be used for public health assessment and program evaluation in military settings.
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Affiliation(s)
- Robert J Cramer
- Department of Public Health Sciences, Associate Professor & Irwin Belk Distinguished Scholar in Health Research, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA.
| | - Erika Montanaro
- Department of Psychological Sciences, University of North Carolina Charlotte; Charlotte, NC, USA
| | - Marcus VanSickle
- Center for Behavioral Forensic Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Sam Cacace
- Department of Public Health Sciences, Associate Professor & Irwin Belk Distinguished Scholar in Health Research, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA
| | - Sasha Zabelski
- Department of Public Health Sciences, Associate Professor & Irwin Belk Distinguished Scholar in Health Research, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA
| | - Emily L Smith
- Center for Family and Community Engagement, North Carolina State University; Raleigh, NC, USA
| | - Michael Franks
- Psychology Training Programs, Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, USA
| | - Shawna Grover
- Nursing Research and Consultation Services, Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, USA
| | - Craig A Cunningham
- Nursing Research and Consultation Services, Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, USA
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Sheron VA, Shanmugathas S, Gooden TE, Guruparan M, Kumarendran B, Lip GYH, Manaseki-Holland S, Nirantharakumar K, Shribavan K, Subaschandren K, Haniffa R, Surenthirakumaran R, Thomas GN, Uruthirakumar P, Greenfield S, Lane DA, Beane A. Healthcare provider and patient perspectives on access to and management of atrial fibrillation in the Northern Province, Sri Lanka: a rapid evaluation of barriers and facilitators to care. BMC Health Serv Res 2022; 22:1078. [PMID: 35999563 PMCID: PMC9400248 DOI: 10.1186/s12913-022-08440-1] [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] [Received: 04/08/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most common cardiac arrhythmia that affects 60 million people worldwide. Limited evidence on AF management exists from low- and middle-income countries and none from Sri Lanka. We aimed to investigate the existing AF care pathway and patients’ perception on AF management to identify barriers and enablers for optimal AF care in Northern Province, Sri Lanka. Methods A rapid evaluation was undertaken with use of qualitative methods. Local healthcare providers (HCPs) mapped the intended pathway of care for AF patients which was then explored and annotated through 12 iterative sessions with additional HCPs. Topics of inefficiencies identified from the finalised map were used to guide focus group discussions (FGDs) with AF patients. AF patients who were attending the anticoagulation clinic at the only tertiary hospital in Northern Province were recruited and invited to participate using purposive sampling. The topic guide was developed in collaboration with local clinicians and qualitative experts. FGDs were conducted in the native Tamil language and all sessions were recorded, transcribed verbatim and thematically analysed using a deductive approach. Results The mapped pathway revealed inefficiencies in referral, diagnosis and ongoing management. These were explored through three FGDs conducted with 25 AF patients aged 25 to 70 years. Two key themes that contributed to and resulted in delays in accessing care and ongoing management were health seeking behaviours and atomistic healthcare structures. Four cross-cutting sub-themes identified were decision making, paternalistic approach to care, cost impacts and lifestyle impacts. These are discussed across 10 unique categories with consideration of the local context. Conclusions Strengthening primary healthcare services, improving public health literacy regarding AF and building patient autonomy whilst understanding the importance of their daily life and family involvement may be advantageous in tackling the inefficiencies in the current AF care pathway in Sri Lanka. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08440-1.
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Affiliation(s)
- Vethanayagam Antony Sheron
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Shivany Shanmugathas
- Department of Marketing, Faculty of Management Studies and Commerce, University of Jaffna, Jaffna, Sri Lanka
| | - Tiffany E Gooden
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Balachandran Kumarendran
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka.
| | - Gregory Y H Lip
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | - Kaneshamoorthy Shribavan
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Kumaran Subaschandren
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Rashan Haniffa
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Rajendra Surenthirakumaran
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Powsiga Uruthirakumar
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Abi Beane
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
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Thomas AS, Sharma RK, Kwon W, Sugahara KN, Chabot JA, Schrope BA, Kluger MD. Socioeconomic Predictors of Access to Care for Patients with Operatively Managed Pancreatic Cancer in New York State. J Gastrointest Surg 2022; 26:1647-1662. [PMID: 35501551 DOI: 10.1007/s11605-022-05320-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/26/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE We evaluated how race and socioeconomic factors impact access to high-volume surgical centers, treatment initiation, and postoperative care for pancreatic cancer in a state with robust safety net insurance coverage and healthcare infrastructure. METHODS The New York Statewide Planning and Research Cooperative System was analyzed. Patients with pancreatic cancer resected from 2007 to 2017 were identified by ICD and CPT codes. Primary outcomes included surgery at low-volume facilities (< 20 pancreatectomies/year), time to therapy initiation, and time to postoperative surveillance imaging (within 60-180 days after surgery). RESULTS In total, 3312 patients underwent pancreatectomy across 124 facilities. Median age was 67 years (IQR 59, 75) and 55% of patients were male. Most (72.7%) had surgery at high-volume centers. On multivariable analysis, odds ratios for surgery at low-volume centers were increased for Black race (2.21 (95% CI 1.69-2.88)), Asian race (1.64 (95% CI 1.09-2.43)), Hispanic ethnicity (1.68 (95% CI 1.24-2.28)), Medicaid insurance (2.52 (95% CI 1.79-3.56)), no insurance (2.24 (95% CI 1.38-3.61)), lowest income quartile (3.31 (95% CI 2.14-5.32)), and rural zip code (2.49 (95% CI 1.69-3.65)). Patients treated at low-volume centers waited longer to initiate treatment (hazard ratio (HR) 0.91 (95% CI 0.81-1.01)). Black patients underwent the least surveillance imaging (50.4%; p < 0.0001), while Asian (HR 2.04, 95% CI 1.40-2.98)) and Hispanic patients (HR 1.36 (95% CI 1.00-1.84)) were more likely to have surveillance imaging. CONCLUSIONS Race independently affected access to high-volume facilities and surveillance imaging. When considered in light of other accumulating evidence, future efforts might investigate the perceptions and logistical considerations noted by providers and patients alike to identify the etiology of these disparities and then institute corrective measures.
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Affiliation(s)
- Alexander S Thomas
- Division of GI/Endocrine Surgery, Department of Surgery, Columbia University Irving Medical Center: Herbert Irving Pavilion, 177 Fort Washington Ave, New York, NY, 10032, USA.
| | - Rahul K Sharma
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Wooil Kwon
- Division of GI/Endocrine Surgery, Department of Surgery, Columbia University Irving Medical Center: Herbert Irving Pavilion, 177 Fort Washington Ave, New York, NY, 10032, USA
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Kazuki N Sugahara
- Division of GI/Endocrine Surgery, Department of Surgery, Columbia University Irving Medical Center: Herbert Irving Pavilion, 177 Fort Washington Ave, New York, NY, 10032, USA
| | - John A Chabot
- Division of GI/Endocrine Surgery, Department of Surgery, Columbia University Irving Medical Center: Herbert Irving Pavilion, 177 Fort Washington Ave, New York, NY, 10032, USA
| | - Beth A Schrope
- Division of GI/Endocrine Surgery, Department of Surgery, Columbia University Irving Medical Center: Herbert Irving Pavilion, 177 Fort Washington Ave, New York, NY, 10032, USA
| | - Michael D Kluger
- Division of GI/Endocrine Surgery, Department of Surgery, Columbia University Irving Medical Center: Herbert Irving Pavilion, 177 Fort Washington Ave, New York, NY, 10032, USA
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Do TP, Stefansen S, Dømgaard M, Steiner TJ, Ashina M. One-quarter of individuals with weekly headache have never consulted a medical doctor: a Danish nationwide cross-sectional survey. J Headache Pain 2022; 23:84. [PMID: 35850614 PMCID: PMC9295511 DOI: 10.1186/s10194-022-01460-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Large numbers of people with headache who would benefit are not reached by headache services. Among the causes are poor or disorganized provision of headache services, but reluctance to seek healthcare has frequently been identified as a significant barrier. We conducted a national survey of people with headache to assess the extent of this problem in Denmark, a country with well organized, highly resourced, and readily accessible services. METHODS We conducted a nationwide cross-sectional survey of adults ≥ 18 years old in Denmark reporting at least one headache day in the last year. We used social media (Facebook) to publicize and drive a recruitment campaign. The survey investigated five items: (1) disease burden, (2) social life, (3) presenteeism, (4) social support, and (5) healthcare utilization. RESULTS We included 6,567 respondents from May 2021 to June 2021; 70.2% were female, 39.8% male, and mean age was 43.2 ± 13.4 years. Of the respondents, 54.2% reported headache at least once a week, 33.4% reported headache a couple of times a month, and 12.4% reported headache a couple of times a year. Two-thirds of respondents (66.6%) reported that headache limited their social lives occasionally or frequently. Most respondents (86.8%) reported going to work or attending educational activities occasionally or more frequently even though they had headache. Half of the respondents (49.5%) experienced lack of understanding of their headaches from people occasionally or more frequently. Almost half of respondents (43.7%) had never consulted a medical doctor for their headache; even of those with weekly headache, more than a quarter (28.3%) had never done so in their lifetimes. CONCLUSIONS Headache disorders continue to be a problem, even in a high-income country with free and easily accessible headache services. Further studies are needed to investigate and clarify why even people with the highest burden are hesitant to seek and make use of widely available headache services.
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Affiliation(s)
- Thien Phu Do
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Danish Knowledge Center On Headache Disorders, Rigshospitalet Glostrup, Valdemar Hansens Vej 2, 2600, Glostrup, Denmark
| | - Simon Stefansen
- Danish Knowledge Center On Headache Disorders, Rigshospitalet Glostrup, Valdemar Hansens Vej 2, 2600, Glostrup, Denmark
| | - Mikala Dømgaard
- Danish Knowledge Center On Headache Disorders, Rigshospitalet Glostrup, Valdemar Hansens Vej 2, 2600, Glostrup, Denmark
| | - Timothy J Steiner
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Brain Sciences, Imperial College London, London, UK
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. .,Danish Knowledge Center On Headache Disorders, Rigshospitalet Glostrup, Valdemar Hansens Vej 2, 2600, Glostrup, Denmark.
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Gödde K, Fügemann H, Desch A, Stumm J, Schindel D, Rieckmann N, Meisel A, Müller-Nordhorn J, Goerling U, Holmberg C. Development of a patient-oriented navigation model for patients with lung cancer and stroke in Germany. BMC Health Serv Res 2022; 22:785. [PMID: 35710375 DOI: 10.1186/s12913-022-08063-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background The concept of patient navigation was first established in the USA to support vulnerable patient groups in receiving timely and comprehensive access to cancer care. It has recently gained increasing interest in Germany to support patients with chronic diseases in a fragmented healthcare system. The aim of this paper is to present the development of such a model adapted to the German context based on the results of mixed-methods studies investigating the need for and barriers to patient-oriented care. Methods In a process adapted from Delphi rounds, we conducted regular structured workshops with investigators of the project to discuss results of their studies and identify content and structure of the model based on the data. Workshop discussions were structured along seven core components of a navigation model including target patient groups, navigator tasks, occupational background and education of navigators, and patient-navigator interaction mode. Results Using an approach based on empirical data of current care practices with special focus on patients’ perspectives, we developed a patient-oriented navigation model for patients who have experienced stroke and lung cancer in the German healthcare context. Patients without personal social support were viewed as struggling most with the healthcare system, as well as multimorbid and elderly patients. Navigators should serve as a longer-term contact person with a flexible contact mode and timing based on the individual situation and preferences of patients. Navigator tasks include the provision of administrative and organizational support as well as referral and guidance to available resources and beneficial health programs with special forms of knowledge. Implementation of the navigator should be flexibly located to ensure a reliable outreach to vulnerable patients for first contact in settings like specialized in-patient and out-patient settings, while navigation itself focuses on care coordination in the out-patient setting. Conclusion Flexibility of navigator tasks needed to be a core characteristic of a navigation model to be perceived as supportive from patients’ perspectives. In a subsequent feasibility study, an intervention based on the model will be evaluated according to its acceptance, demand, and practicality.
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Dang RR, Brar B, Pasco JM, Rebhun C, Sohn W, Salama A. Dental Practice Patterns for Oral Care in Medical Oncology Patients-a Survey-Based Assessment of Massachusetts Dentists. J Cancer Educ 2022; 37:555-560. [PMID: 32761443 DOI: 10.1007/s13187-020-01845-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Oral complications associated with cancer therapy lead to a significant deterioration of oral health and overall quality of life. The primary aim of this study was to assess dental practice patterns followed by dentists for oral care of medical oncology patients and to identify potential barriers to recommended care. A questionnaire-based survey was developed using the Qualtrics online platform. It was electronically distributed to all dentists within the Massachusetts Dental Society (MDS). Descriptive statistics were automatically computed by Qualtrics. A total of 363 responses (10.7%) were received. Dentists reported minimal correspondence from the oncology team during referrals. Most dentists communicate treatment recommendations to the oncology team with regard to extractions (74.6%), restorations (66.7%), periodontal health (68.8%), and other urgent needs (73.5%). Potential obstacles to providing care included insufficient time for dental care before start of therapy (61%), lack of patient education on oral complications associated with therapy (56%), and lack of dental insurance (31%). Only 50% of the dentists felt adequately trained to treat oncology patients, and 46% of dentists infrequently followed the recommendations set by the National Institute of Dental and Craniofacial research (NIDCR). The findings of this study indicate significant variability in the referral patterns and practice protocols for medically necessary oral care in oncology patients. The major barriers to following established guidelines for care may be attributed to the lack of correspondence between provider teams, inadequate training of professionals, and financial or insurance factors associated with increased cost of supportive care.
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Affiliation(s)
- Rushil R Dang
- Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dentistry, 635 Albany St, Boston, MA, 02118, USA
| | - Branden Brar
- Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dentistry, 635 Albany St, Boston, MA, 02118, USA
| | | | - Chad Rebhun
- Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dentistry, 635 Albany St, Boston, MA, 02118, USA
| | - Woosung Sohn
- Population Oral Health, School of Dentistry, University of Sydney, Sydney, Australia
| | - Andrew Salama
- Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dentistry, 635 Albany St, Boston, MA, 02118, USA.
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Mitchell KS, Sienkiewicz M, Smith BN, Vogt D, Kehle-Forbes S, Cooper Z. Associations between probable eating disorders and healthcare use among post-9/11 veteran men and women. J Psychosom Res 2022; 157:110811. [PMID: 35413512 DOI: 10.1016/j.jpsychores.2022.110811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Healthcare use is elevated among individuals with eating disorders (EDs); however, most people with EDs do not receive ED-specific care, likely due to factors such as the cost and availability of treatment as well as stigma. U.S. military veterans historically have been understudied in ED research. We investigated healthcare use and barriers to care among recently separated veteran men and women. METHOD In this cross-sectional study, 1494 participants completed an online or paper survey assessing ED symptoms, healthcare use, and logistical and attitudinal barriers to care. We estimated logistic regression models to investigate the association of ED status with healthcare use variables and examined gender similarities and differences in barriers to care. RESULTS Men and women with probable EDs reported low rates of ED treatment but greater healthcare use, during military service and since separating from service, compared to veterans without probable EDs (odds ratios = 1.57-7.05). Large proportions of participants reported that they did not know where to get help for EDs and that treatment is too costly. There were few gender differences in barriers to care (Cramer's V = 0.02-0.32). CONCLUSION Veterans reported high healthcare use but low rates of ED treatment. Findings underscore the need to increase the reach and accessibility of ED treatment in potentially vulnerable groups.
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Gordon SA, Waltzman SB, Friedmann DR. Delayed cochlear implantation in congenitally deaf children-identifying barriers for targeted interventions. Int J Pediatr Otorhinolaryngol 2022; 155:111086. [PMID: 35219037 DOI: 10.1016/j.ijporl.2022.111086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/01/2022] [Accepted: 02/15/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Age of cochlear implantation (CI) is an important predictor of language development in those with congenital sensorineural hearing loss. Despite universal newborn hearing screening initiatives and the known benefits of early CI, a subset of congenitally deaf children continue to be evaluated for cochlear implants later in childhood. This study aims to identify the barriers to early cochlear implantation in these children. METHODS A retrospective review was conducted for all pediatric cochlear implants aged 3 years or older performed at a single academic institution between 2013 and 2017. Children implanted before the age three, those with a prior unilateral cochlear implant, and those with progressive or sudden hearing loss were excluded. Variables included newborn hearing screen results, age at hearing loss diagnosis, time of initiation and documented benefit of hearing aids, age of implantation, pre/post-implantation evaluation scores, and reason for delayed referral for cochlear implantation. RESULTS Thirty-one patients were identified meeting these inclusion criteria. Twenty-one children were subject to UNBS in the U.S. Fourteen of those children failed their newborn hearing screening. Average age at implantation was 6.2 years. Four reasons were identified for increased age at cochlear implantation. Two categories represent delays related to (1) Amplification continually prescribed even though the range of hearing loss and speech development assessment suggests CI may have been more appropriate well before referral (N = 13) (2) Patients were not subject to newborn hearing screening and/or timely diagnosis of their hearing loss (N = 8). In other cases, patients were appropriately fit with hearing aids until evidence that they derived limited benefit and then referred for CI (N = 8). Lastly, in a few cases, records were indeterminate with regards to the timing and appropriate diagnosis of their hearing loss (N = 2). CONCLUSION Understanding the reasons for delayed cochlear implantation in congenitally deaf children might allow the development of targeted interventions to improve outcomes. Specifically, those children who were not referred before age 3 despite use of amplification with limited benefit offer one potential target population for earlier CI.
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Affiliation(s)
- Steven A Gordon
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, USA
| | - Susan B Waltzman
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, USA
| | - David R Friedmann
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, USA.
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Acquah I, Hagan K, Valero-Elizondo J, Javed Z, Butt SA, Mahajan S, Taha MB, Hyder AA, Mossialos E, Cainzos-Achirica M, Nasir K. Delayed medical care due to transportation barriers among adults with atherosclerotic cardiovascular disease. Am Heart J 2022; 245:60-69. [PMID: 34902312 DOI: 10.1016/j.ahj.2021.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/06/2021] [Accepted: 11/19/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND In patients with atherosclerotic cardiovascular disease (ASCVD), barriers related to transportation may impair access to care, with potential implications for prognosis. Although few studies have explored transportation barriers among patients with ASCVD, the correlates of delayed care due to transportation barriers have not been examined in this population. We aimed to examine this in U.S. patients with ASCVD using nationally representative data. METHODS Using data from the 2009-2018 National Health Interview Survey, we estimated the self-reported prevalence of delayed medical care due to transportation barriers among adults with ASCVD, overall and by sociodemographic characteristics. Logistic regression was used to examine the association between various sociodemographic characteristics and delayed care due to transportation barriers. RESULTS Among adults with ASCVD, 4.5% (95% CI; 4.2, 4.8) or ∼876,000 annually reported delayed care due to transportation barriers. Income (low-income: odds ratio [OR] 4.43, 95% CI [3.04, 6.46]; lowest-income: OR 6.35, 95% CI [4.36, 9.23]) and Medicaid insurance (OR 4.53; 95% CI [3.27, 6.29]) were strongly associated with delayed care due to transportation barriers. Additionally, younger individuals, women, non-Hispanic Black adults, and those from the U.S. South or Midwest, had higher odds of reporting delayed care due to transportation barriers. CONCLUSIONS Approximately 5% of adults with ASCVD experience delayed care due to transportation barriers. Vulnerable groups include young adults, women, low-income people, and those with public/no insurance. Future studies should analyze the feasibility and potential benefits of interventions such as use of telehealth, mobile clinics, and provision of transportation among patients with ASCVD in the U.S.
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Affiliation(s)
- Isaac Acquah
- Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Kobina Hagan
- Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Javier Valero-Elizondo
- Center for Outcomes Research, Houston Methodist, Houston, TX; Division for Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
| | | | - Sara Ayaz Butt
- Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Shiwani Mahajan
- The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Mohamad Badie Taha
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL
| | - Adnan A Hyder
- Center on Commercial Determinants of Health, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research, Houston Methodist, Houston, TX; Division for Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist, Houston, TX; Division for Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX.
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Marshall AD, Rance J, Grebely J, Treloar C. 'Not just one box that you tick off' - Deconstructing the hepatitis C care cascade in the interferon-free direct acting antiviral era from the client perspective. Int J Drug Policy 2022; 102:103610. [PMID: 35151085 DOI: 10.1016/j.drugpo.2022.103610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND To achieve hepatitis C viral (HCV) elimination targets set by the World Health Organisation, pillars of the HCV care cascade are often referenced to track progress. The aim of this qualitative study was to explore the limitations of the care cascade framework through the real-world accounts of 'HCV journeys' among people who inject drugs (PWID), with particular attention to the intersection of PWID agency and structural determinants in the healthcare system. METHODS An in-depth analysis was conducted on five case studies to better understand participant experiences 'behind the cascade pillars'. The five case studies were drawn from the ETHOS Engage cohort as exemplars of the real-world complexities of people's HCV cascade journeys. Inclusion criteria for the qualitative study were participant has voluntarily signed the informed consent form, aged ≥18 years, HCV antibody positive by self-report, clients of selected sites participating in the ETHOS Engage cohort, and sufficiently proficient in English to participate in an interview. Thirty-four semi-structured interviews were conducted with participants who had received or had not received HCV treatment to identify barriers and facilitators to HCV care. RESULTS Participants 'housed' at the 'HCV RNA diagnosed pillar' (n = 2; Will; Julie) reported withholding their HCV serostatus in certain healthcare settings for fear that disclosure would lead to discriminatory decision-making from their treating physician. among participants who had completed treatment (n = 3; Corey; John; Nora) two reported still being unsure of their HCV status >6 months post-treatment. Ongoing feelings of frustration and shame were expressed in this 'post-cure care pillar' due to a perceived lack of quality care from clinic services and continued uneasiness when discussing drug use and reinfection while receiving opioid agonist treatment (OAT). Both case 'categories' described often tenuous therapeutic relationships with their physicians and recommended task-shifting to nurses and trusted case workers for ongoing care. CONCLUSION The care cascade provides a linear, two dimensional snapshot of clinical targets. Our findings illuminate structural barriers not visible behind its 'static' pillars, presenting insights into experiences among PWID otherwise dismissed as 'disengaged' or 'lost to follow-up'.
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Affiliation(s)
- A D Marshall
- The Kirby Institute, UNSW Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Australia.
| | - J Rance
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - J Grebely
- The Kirby Institute, UNSW Sydney, Australia
| | - C Treloar
- Centre for Social Research in Health, UNSW Sydney, Australia
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Byrne JJ, Smith EM, Saucedo AM, Doody KA, Holcomb D, Spong CY. Accessibility to Postpartum Tubal Ligation After A Vaginal Delivery: When The Medicaid Policy Is Not A Limiting Factor. Contraception 2021; 109:52-56. [PMID: 34971610 DOI: 10.1016/j.contraception.2021.11.007] [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: 08/18/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe rates of postpartum sterilization and indications for unfulfilled requests when Medicaid policy is not a limiting factor. MATERIALS AND METHODS We conducted a single-institution, retrospective review. Women who requested postpartum tubal ligation after vaginal delivery from August 2015 to March 2019 were studied. Select demographic characteristics were compared between those who did and did not undergo the procedure. Reasons for why the procedure was cancelled, alternate contraceptive plans, and subsequent pregnancies were collected. Statistical analysis included the t test and chi-squared test, with P<0.05 considered significant. RESULTS 4,103 patients requested postpartum tubal ligation following vaginal delivery. 3670 (89.4%) procedures were performed and 433 (10.6%) were canceled. Of the 433, 423 (98%) were not performed at patient request; 10 (2 %) were cancelled based on physician recommendation. Of these, 3 were due to significant maternal anemia in the setting of refusal of blood products, 1 due to anesthesia concerns, 1 for increased body mass index, and 1 due to delivery events. Alternative contraception methods were offered; 72 (28% of patients not receiving a tubal ligation) received Depo Provera prior to discharge. One-fourth (n = 110, 25.4%) did not keep the postpartum follow-up appointment. 83 (19.2%) of the 433 patients had at least one subsequent pregnancy. Although over half expressed interest at the time of discharge in long-acting reversible contraceptives, only 20% obtained this method at the postpartum visit. CONCLUSIONS Postpartum sterilization was predominantly achieved, among women whose requests were unfulfilled, the majority (98%) were at patient request with a minority by physician recommendation.
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Affiliation(s)
- John J Byrne
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Parkland Health and Hospital System, Dallas, Texas.
| | - Emma M Smith
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Parkland Health and Hospital System, Dallas, Texas
| | - Alexander M Saucedo
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Parkland Health and Hospital System, Dallas, Texas
| | - Kaitlin A Doody
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Parkland Health and Hospital System, Dallas, Texas
| | - Denisse Holcomb
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Parkland Health and Hospital System, Dallas, Texas
| | - Catherine Y Spong
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Parkland Health and Hospital System, Dallas, Texas
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Buige A, Nguyen M, Harris SC. Barriers to mental health care and stigma perception in doctor of pharmacy students across the United States. Curr Pharm Teach Learn 2021; 13:1634-1645. [PMID: 34895673 DOI: 10.1016/j.cptl.2021.09.041] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 07/21/2021] [Accepted: 09/15/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Pharmacy students are significantly less likely than medical students to seek on-campus mental health services, though barriers are not well known. This study's objective is to expand on perceived barriers to seeking care for mental health concerns among doctor of pharmacy students in the United States. METHODS An institutional review board-exempt, online survey was disseminated to eight pharmacy programs' students assessing mental health barriers to care, resource interest, attitudes towards treatment, and stigma. Quantitative data were analyzed aggregately and by gender, program type, employment status, and education year. Free-text response analysis used thematic coding. RESULTS Common barriers to care included lack of time (20.2%), financial support or resources (13.2%), and preferring to solve the issue independently (13.2%). About half agreed their programs had sufficient resources to support mental health (58.4%). Suggested resources included on-site counselors (14.5%), pet therapy (13.4%), and wellness activities (12.3%). Students reported high rates of perceived internal stigma, yet low rates of stigma towards others. No significant differences were found among employment status or program type, but first-year students had more positive attitudes towards mental health treatment. Females were significantly more likely to agree mental health treatment was effective and less likely to view someone differently who received treatment. CONCLUSIONS Common barriers to care included lack of time, finances or resources, and concerns of being viewed differently. Additionally, substantial stigma exists, particularly public perception and concern for negative impact on future opportunities. Programs should take initiative to understand students' needs and interest in support services.
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Affiliation(s)
- Ashley Buige
- Virginia Commonwealth University Health System, 401 North 12th Street, Richmond, VA 23298, United States.
| | - Mimi Nguyen
- University of North Carolina Eshelman School of Pharmacy, 301 Pharmacy Lane, Chapel Hill, NC 27599, United States.
| | - Suzanne C Harris
- University of North Carolina Eshelman School of Pharmacy, 301 Pharmacy Lane, Chapel Hill, NC 27599, United States.
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Decker MJ, Atyam TV, Zárate CG, Bayer AM, Bautista C, Saphir M. Adolescents' perceived barriers to accessing sexual and reproductive health services in California: a cross-sectional survey. BMC Health Serv Res 2021; 21:1263. [PMID: 34809640 PMCID: PMC8609799 DOI: 10.1186/s12913-021-07278-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Received: 06/22/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background Adolescents may forego needed sexual and reproductive health (SRH) services due to a variety of concerns and barriers. The purpose of this study is to compare adolescents’ perceptions of these barriers by participant characteristics including race/ethnicity, gender, sexual orientation, housing situation, and sexual experience. Methods Adolescents in a California-wide sexual health education program completed an anonymous survey at baseline (N = 10,015) about perceived barriers to using SRH services. Logistic regression analyses that accounted for the clustered data structure assessed differences by gender, age, sexual orientation, race/ethnicity, living situation, and sexual experience. Results The majority of participants were Hispanic/Latino (76.4%) with an average age of 14.9 years, and 28.8% had sexual experience. Half of the youth reported concerns about test results (52.7%), cost of services (52.0%), and confidentiality of services (49.8%). When controlling for other characteristics, youth identifying as transgender/non-binary/multiple genders had the highest odds of perceiving cost (odds ratio (OR) 1.89) and confidentiality (OR 1.51) as barriers. Increasing age was associated with decreasing odds of all barriers. Sexual orientation was a consistent predictor, with LGBQ+ youth having higher odds of perceiving test results (OR 1.21), cost (OR 1.36), and confidentiality (OR 1.24) as barriers. Asian or Pacific Islander/Native Hawaiian youth had higher odds of perceiving test results (OR 1.68) and cost (OR 1.37) as barriers. In contrast, Black youth had lower odds of reporting cost (OR 0.65) and confidentiality (OR 0.77) as barriers. Younger respondents and youth who identified as female, transgender/non-binary/multiple genders, LGBQ+, and Asian or Pacific Islander/Native Hawaiian had higher odds of reporting five or more barriers compared to reference groups. Conclusions The majority of adolescents face barriers to accessing appropriate SRH services, with females, gender-minority youth, younger adolescents, LGBQ+ youth, and Asian and Pacific Islander/Native Hawaiian youth more likely than others to report barriers. Access to SRH services can be improved through strengthening linkages between clinics and SRH education programs, providing youth-friendly clinical services, and ensuring youth have sufficient information, skills, and support to access care. Trial registration Approved by California Health and Human Services Agency’s Committee for the Protection of Human Subjects [12-08-0658, 11/30/2017]. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07278-3.
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Affiliation(s)
- Martha J Decker
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA. .,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois St, San Francisco, CA, 94107, USA. .,Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA.
| | - Tara V Atyam
- California Department of Public Health, Maternal, Child and Adolescent Health Division, 1615 Capitol Ave, MS 8300, P.O. Box 997420, Sacramento, CA, 95899-7420, USA
| | - Catherine Gilmore Zárate
- California Department of Public Health, Maternal, Child and Adolescent Health Division, 1615 Capitol Ave, MS 8300, P.O. Box 997420, Sacramento, CA, 95899-7420, USA
| | - Angela M Bayer
- California Department of Public Health, Maternal, Child and Adolescent Health Division, 1615 Capitol Ave, MS 8300, P.O. Box 997420, Sacramento, CA, 95899-7420, USA
| | - Consuelo Bautista
- California Department of Public Health, Maternal, Child and Adolescent Health Division, 1615 Capitol Ave, MS 8300, P.O. Box 997420, Sacramento, CA, 95899-7420, USA
| | - Melissa Saphir
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois St, San Francisco, CA, 94107, USA
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Ralph LJ, Foster DG, Barar R, Rocca CH. Home pregnancy test use and timing of pregnancy confirmation among people seeking health care. Contraception 2021; 107:10-16. [PMID: 34748750 DOI: 10.1016/j.contraception.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/13/2021] [Accepted: 10/20/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Understanding the timing of pregnancy suspicion and confirmation, including the role of home pregnancy tests, can facilitate earlier entry into pregnancy-related care and identify individuals likely to be impacted by gestation-based abortion restrictions. STUDY DESIGN We use data from 259 pregnant individuals participating in a cross-sectional survey at 8 primary and reproductive health care clinics in 6 U.S. states (2016-2017). We use regression models to identify differences in utilization of HPTs, barriers to use, and to compare gestational duration at pregnancy confirmation. RESULTS Three-quarters (74%) of respondents took a home pregnancy test as the first step in confirming pregnancy; this figure was lower among adolescents versus young adults (65 vs 81%, p = 0.01). Two-thirds (64%) reported delays in home testing, higher among adolescents (85%). People taking a test at home confirmed pregnancy 10 days earlier than those first testing at a clinic (41.3 vs 51.8 days gestation, p = 0.02). Those that did not test at home cited concerns about test accuracy (42%) and difficulties accessing one (26%). While overall 21% confirmed pregnancy at ≥7 weeks gestation, and 35% at ≥6 weeks, confirmation at ≥7 weeks was higher among adolescents versus young adults (47 vs 13%, p = 0.001), Latina versus white women (28 vs 11%, p = 0.02), food insecure versus secure women (28 vs 17%, p = 0.06), and people with unplanned versus planned/mistimed pregnancies (25 vs 13%, p = 0.07). CONCLUSIONS Home pregnancy testing is common and associated with earlier pregnancy confirmation. Still, barriers to at-home testing are evident, particularly among adolescents. Efforts to expand access to home pregnancy tests and increase knowledge about their accuracy may be impactful in increasing utilization. IMPLICATIONS While at home pregnancy testing is common and facilitates earlier confirmation of pregnancy, one in 5 confirm pregnancy at 7 weeks gestation or later (and one in 3 do so at 6 weeks or later). Gestational bans in the first trimester will disproportionately prevent young people, people of color, and those living with food insecurity from being able to access abortion.
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Affiliation(s)
- Lauren J Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, CA, USA.
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, CA, USA
| | - Rana Barar
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, CA, USA
| | - Corinne H Rocca
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, CA, USA
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Lacombe-Duncan A, Logie CH, Persad Y, Leblanc G, Nation K, Kia H, Scheim AI, Lyons T, Horemans C, Olawale R, Loutfy M. Implementation and evaluation of the 'Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)' provider education pilot. BMC Med Educ 2021; 21:561. [PMID: 34732178 PMCID: PMC8566115 DOI: 10.1186/s12909-021-02991-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/21/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUND Transgender (trans) women face constrained access to gender-affirming HIV prevention and care. This is fueled in part by the convergence of limited trans knowledge and competency with anti-trans and HIV-related stigmas among social and healthcare providers. To advance gender-affirming HIV service delivery we implemented and evaluated 'Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)'. This theoretically-informed community-developed intervention aimed to increase providers' gender-affirming HIV prevention and care knowledge and competency and reduce negative attitudes and biases among providers towards trans women living with and/or affected by HIV. METHODS Healthcare and social service providers and providers in-training (e.g., physicians, nurses, social workers) working with trans women living with and/or affected by HIV (n = 78) participated in a non-randomized multi-site pilot study evaluating TEACHH with a pre-post-test design. Pre- and post-intervention surveys assessed participant characteristics, intervention feasibility (e.g., workshop completion rate) and acceptability (e.g., willingness to attend another training). Paired sample t-tests were conducted to assess pre-post intervention differences in perceived competency, attitudes/biases, and knowledge to provide gender-affirming HIV care to trans women living with HIV and trans persons. RESULTS The intervention was feasible (100% workshop completion) and acceptable (91.9% indicated interest in future gender-affirming HIV care trainings). Post-intervention scores indicated significant improvement in: 1) knowledge, attitudes/biases and perceived competency in gender-affirming HIV care (score mean difference (MD) 8.49 (95% CI of MD: 6.12-10.86, p < 0.001, possible score range: 16-96), and 2) knowledge, attitudes/biases and perceived competency in gender-affirming healthcare (MD = 3.21; 95% CI of MD: 1.90-4.90, p < 0.001, possible score range: 9-63). Greater change in outcome measures from pre- to post-intervention was experienced by those with fewer trans and transfeminine clients served in the past year, in indirect service roles, and having received less prior training. CONCLUSIONS This brief healthcare and social service provider intervention showed promise in improving gender-affirming provider knowledge, perceived competency, and attitudes/biases, particularly among those with less trans and HIV experience. Scale-up of TEACHH may increase access to gender-affirming health services and HIV prevention and care, increase healthcare access, and reduce HIV disparities among trans women. TRIAL REGISTRATION ClinicalTrials.gov ( NCT04096053 ).
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Affiliation(s)
- Ashley Lacombe-Duncan
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109-1106, USA.
- Center for Sexuality and Health Disparities, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI, 48109-5482, USA.
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5G 1N8, Canada.
| | - Carmen H Logie
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5G 1N8, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, M5S 1V4, Canada
- Center for Gender & Sexual Health Equity (CGSHE), 1190 Hornby Street, Vancouver, V6Z 2K5, Canada
| | - Yasmeen Persad
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5G 1N8, Canada
| | - Gabrielle Leblanc
- Action Santé Travesti(e)s & Transsexuel(le)s du Québec (ASTT(E)Q), 1300 Sanguinet, Montréal, H2X 3E7, Canada
| | - Kelendria Nation
- Prism Education Series, Vancouver Coastal Health, 1128 Hornby Street, Vancouver, V6Z 2L4, Canada
| | - Hannah Kia
- School of Social Work, University of British Columbia, 2080 West Mall, Vancouver, V6T 1Z2, Canada
| | - Ayden I Scheim
- Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Tara Lyons
- Center for Gender & Sexual Health Equity (CGSHE), 1190 Hornby Street, Vancouver, V6Z 2K5, Canada
- Department of Criminology, Kwantlen Polytechnic University, 12666 72 Avenue, Surrey, V3W 2M8, Canada
| | - Chavisa Horemans
- CIHR Canadian HIV Trials Network, 588-1081 Burrard Street, Vancouver, V6Z 1Y6, Canada
| | - Ronke Olawale
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109-1106, USA
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5G 1N8, Canada
- Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada
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