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Fairman CM, Kava CM, Beima-Sofie K, Sakhuja M, Masud M, Dias E, Sheng J, Gorzelitz J, Morshed A, Green BB, Skiba MB, Madhivanan P, Parthasarathy N, Hirschey R, Vander Weg MW, Hebert J. Addressing differences in cancer: a framework for synergistic programming in cancer prevention and control. Res Sq 2024:rs.3.rs-4046415. [PMID: 38562683 PMCID: PMC10984020 DOI: 10.21203/rs.3.rs-4046415/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background Cancer remains a leading cause of death worldwide and continues to disproportionately impact certain populations. Several frameworks have been developed that illustrate the multiple determinants of cancer. Expanding upon the work of others, we present an applied framework for cancer prevention and control designed to help clinicians, as well as public health practitioners and researchers, better address differences in cancer outcomes. Methods The framework was developed by the Cancer Prevention and Control Research Network's Health Behaviors Workgroup. An initial framework draft was developed based on workgroup discussion, public health theory, and rapid literature review on the determinants of cancer. The framework was refined through interviews and focus groups with Federally Qualified Health Center providers (n=2) and cancer patients (n=2); participants were asked to provide feedback on the framework's causal pathways, completeness, and applicability to their work and personal life. Results The framework provides an overview of the relationships between sociodemographic inequalities, social and structural determinants, and key risk factors associated with cancer diagnosis, survivorship, and cancer morbidity and mortality across the lifespan. The framework emphasizes how health-risk behaviors like cigarette smoking interact with psychological, psychosocial, biological, and psychosocial risk factors, as well as healthcare-related behavior and other chronic diseases. Importantly, the framework emphasizes addressing social and structural determinants that influence health behaviors to reduce the burden of cancer and improve health equity. Aligned with previous theory, our framework underscores the importance of addressing co-occurring risk factors and disease states, understanding the complex relationships between factors that influence cancer, and assessing how multiple forms of inequality or disadvantage intersect to increase cancer risk across the lifespan. Conclusions This paper presents an applied framework for cancer prevention and control to address cancer differences. Because the framework highlights determinants and factors that influence cancer risk at multiple levels, it can be used to inform the development, implementation, and evaluation of interventions to address cancer morbidity and mortality.
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Affiliation(s)
| | | | | | | | | | - E Dias
- UTHealth Houston School of Public Health
| | - J Sheng
- University of Wisconsin-Madison
| | | | | | - B B Green
- Kaiser Permanente Washington Health Research Institute
| | | | | | | | - R Hirschey
- University of North Carolina and Lineberger Comprehensive Cancer Center
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Escoffery C, Petagna CN, Wangen M, Flicker KJ, Noblet SB, Sakhuja M, Thomson CA, Morrato EH, Adams S, Leeman J, Friedman DB. Mixed methods evaluation of the inaugural year of the Cancer Prevention and Control Research Network's (CPCRN) scholars program. Cancer Causes Control 2023; 34:57-73. [PMID: 37106215 PMCID: PMC10139907 DOI: 10.1007/s10552-023-01702-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE A diverse workforce trained in dissemination & implementation (D&I) science is critical for improving cancer outcomes and reducing cancer-related health disparities. This study aims to describe and evaluate impact of the Cancer Prevention and Control Research Network (CPCRN) Scholars Program in preparing scholars for collaborative careers in cancer control and implementation research and practice, and offers evaluation-driven recommendations for program improvements. METHODS The CPCRN Scholars Workgroup conducted a sequential, mixed methods evaluation. We collected baseline and follow-up surveys and invited all 20 scholars and ten mentors to participate in an exit interview. We assessed the experience with the Scholar's program, ratings of D&I competences, progress on their project, feedback about the curriculum, and understanding of implementation science. RESULTS Over 86% partially or fully completed their project within 9 months; 78% of scholars engaged with a CPCRN workgroup. Scholars rated the following program components as valuable: the Putting Public Health Evidence in Action (PPHEIA) training (88.9%), D&I training modules (83.3%), and webinars (kickoff webinar-88.9% and selecting theories/models-88.9%). There was an increase in D&I competencies from baseline to posttest, with the greatest in community engagement topics. About 78% reported that they were satisfied with format of the activities and increased confidence in ability to discuss D&I concepts. From the qualitative interviews, the benefit of the program was becoming more knowledgeable about D&I research and networking. CONCLUSION The inaugural year of the program yielded positive results, particularly related to increasing knowledge about D&I science and cancer control. This program builds the capacity of students, researchers and practitioners in D&I science.
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Affiliation(s)
- Cam Escoffery
- Rollins School of Public Health, Department of Behavioral, Social, and Health Education Sciences, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA.
| | - Courtney N Petagna
- Rollins School of Public Health, Department of Behavioral, Social, and Health Education Sciences, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA
| | - Mary Wangen
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kimberly J Flicker
- The University of South Carolina, Arnold School of Public, Health Health Promotion, Education, and Behavior, Columbia, SC, USA
| | - Samuel B Noblet
- The University of South Carolina, Arnold School of Public, Health Health Promotion, Education, and Behavior, Columbia, SC, USA
| | - Mayank Sakhuja
- The University of South Carolina, Arnold School of Public, Health Health Promotion, Education, and Behavior, Columbia, SC, USA
| | - Cynthia A Thomson
- Health Promotion Sciences Department, University of Arizona, Mel and Enid Zuckerman, Tucson, Arizona, USA
| | - Elaine H Morrato
- Loyola University Chicago, Parkinson School of Health Sciences and Public Health, Chicago, Illinois, USA
| | - Swann Adams
- The University of South Carolina, Arnold School of Public, Health Health Promotion, Education, and Behavior, Columbia, SC, USA
| | - Jennifer Leeman
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniela B Friedman
- The University of South Carolina, Arnold School of Public, Health Health Promotion, Education, and Behavior, Columbia, SC, USA
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Yelton B, Rumthao JR, Sakhuja M, Macauda MM, Donelle L, Arent MA, Yang X, Li X, Noblet S, Friedman DB. Assessment and Documentation of Social Determinants of Health Among Health Care Providers: Qualitative Study. JMIR Form Res 2023; 7:e47461. [PMID: 37399064 PMCID: PMC10365596 DOI: 10.2196/47461] [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: 03/21/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Research clearly demonstrates social determinants of health (SDOH) impact health outcomes. Provider consideration of patient SDOH in prevention and treatment planning is critical for improved health care quality and health equity. Despite awareness of the connections between SDOH and improved population health, research demonstrates few providers document patient SDOH. OBJECTIVE This qualitative study aimed to better understand the barriers and facilitators of SDOH assessment, documentation, and referral in different health care settings and roles. METHODS Individual semistructured interviews were conducted with practicing health care providers in South Carolina between August 25, 2022, and September 2, 2022. Participants were recruited via community partners' web-based newsletters or listservs using a purposive sampling design. An interview guide with 19 questions was used to explore the following research question: How do SDOH impact patient health and what are the facilitators and barriers experienced by multidisciplinary health care providers assessing and documenting patient SDOH? RESULTS Participants (N=5) included a neonatal intensive care unit registered nurse, a nurse practitioner, a certified nurse midwife, a family and preventive medicine physician, and a counselor (licensed clinical social worker) with careers spanning 12 to 32 years. Participant responses are presented according to the following 5 themes: participants' understanding of SDOH for the patient population, assessment and documentation practices, referrals to other providers and community-based resources, barriers and facilitators of SDOH assessment and documentation, and SDOH assessment and documentation training preferences. Overall, participants were aware of the importance of including patient SDOH in assessment and intervention but noted a variety of institutional and interpersonal barriers to assessment and documentation, including time constraints, perceptions of stigma around discussion of SDOH, and limited referral protocols. CONCLUSIONS Incentivizing inclusion of patient SDOH in health care must be facilitated from the top down, so assessment and documentation can be universally implemented in a pragmatic way that works for providers in a variety of roles and settings for the betterment of health care quality, health equity, and improved population health outcomes. Partnering with community organizations can serve to augment health care organizations' resource and referral availability for addressing patients' social needs.
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Affiliation(s)
- Brooks Yelton
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Jancham Rachel Rumthao
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Mayank Sakhuja
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Mark M Macauda
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Center for Applied Research and Evaluation, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Lorie Donelle
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Michelle A Arent
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Xueying Yang
- SC SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Xiaoming Li
- SC SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Samuel Noblet
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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Macauda MM, Arent MA, Sakhuja M, Yelton B, Noblet S, Fedrick D, Zona D, New C, Isenhower WD, Wandersman A, Friedman DB. Elements for successful implementation of a clinic-based health literacy intervention. Front Public Health 2022; 10:977765. [PMID: 36388330 PMCID: PMC9650509 DOI: 10.3389/fpubh.2022.977765] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/07/2022] [Indexed: 01/25/2023] Open
Abstract
Improving health literacy is a national public health priority. Given the context of the COVID-19 pandemic, it is even more critical for health and medical information to be clear and understandable for patients and their families. Clinic-based programs to improve health literacy need to be pragmatic, feasible, and helpful for the implementing clinic and patients. This paper describes the development, implementation, and evaluation of a pragmatic, clinic-based health literacy intervention in a safety-net clinic that serves uninsured and indigent patients. Study methods are guided by a previous pilot study and components recommended for pragmatic interventions. An electronic readiness assessment was distributed to out-patient clinics affiliated with a statewide hospital association. The AskMe3 tool was used for the intervention as it is evidence informed and relatively easy to implement. Implementation included ongoing dialogue between the clinic and the academic research team. Within the implementing clinic, data collected from patients via verbally administered questionnaires was analyzed using descriptive statistics and chi-squares. Interview data collected from the clinic director was analyzed qualitatively for themes. The implementing clinic had some of the lowest average scores of the 34 clinics who participated in the initial readiness assessment. Despite this, they were able to successfully implement the health literacy intervention during a global pandemic. Eighty-eight participants completed patient questionnaires at this clinic. Most patients (96%) agreed the AskMe3 questions helped them talk with the doctor or nurse at their current appointment. Most (99%) also perceived the AskMe3 tool to be very helpful when used in a clinical setting. The clinic director offered that the staff initially thought the intervention would be difficult to implement. However, implementation by clinic volunteers with encouragement and prioritization of health literacy by the clinic director contributed to success. When considering interventions for clinical settings, a pragmatic approach can help with selection and implementation of a program that fits with the realities on the ground. Further, frequent technical assistance can help resolve implementation barriers. Interventions utilizing tools such as AskMe3, because of their simplicity, allow creative solutions to capacity issues for clinics who see a need for health literacy improvements.
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Affiliation(s)
- Mark M. Macauda
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States,Center for Applied Research and Evaluation, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States,*Correspondence: Mark M. Macauda
| | - Michelle A. Arent
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Mayank Sakhuja
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Brooks Yelton
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Samuel Noblet
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States,Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | | | - Diana Zona
- South Carolina Hospital Association, Columbia, SC, United States
| | - Cyndi New
- South Carolina Hospital Association, Columbia, SC, United States
| | | | | | - Daniela B. Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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Yelton B, Friedman DB, Noblet S, Lohman MC, Arent MA, Macauda MM, Sakhuja M, Leith KH. Social Determinants of Health and Depression among African American Adults: A Scoping Review of Current Research. Int J Environ Res Public Health 2022; 19:ijerph19031498. [PMID: 35162519 PMCID: PMC8834771 DOI: 10.3390/ijerph19031498] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 02/04/2023]
Abstract
Depression in the United States (US) is increasing across all races and ethnicities and is attributed to multiple social determinants of health (SDOH). For members of historically marginalized races and ethnicities, depression is often underreported and undertreated, and can present as more severe. Limited research explores multiple SDOH and depression among African American adults in the US. Guided by Healthy People (HP) 2030, and using cross-disciplinary mental health terminology, we conducted a comprehensive search to capture studies specific to African American adults in the US published after 2016. We applied known scoping review methodology and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. From 12,315 initial results, 60 studies were included in our final sample. Most studies explored the HP 2030 Social and Community Context domain, with a heavy focus on discrimination and social support; no studies examined Health Care Access and Quality. Researchers typically utilized cross-sectional, secondary datasets; no qualitative studies were included. We recommend research that comprehensively examines mental health risk and protective factors over the life course within, not just between, populations to inform tailored health promotion and public policy interventions for improving SDOH and reducing racial and ethnic health disparities.
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Affiliation(s)
- Brooks Yelton
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
| | - Daniela B. Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA;
- Correspondence:
| | - Samuel Noblet
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
- Prevention Research Center, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Matthew C. Lohman
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA;
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Michelle A. Arent
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
| | - Mark M. Macauda
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
- Center for Applied Research and Evaluation, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Mayank Sakhuja
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
| | - Katherine H. Leith
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA;
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Friedman DB, Arent MA, Yelton B, Sakhuja M, Haynes VE, Noblet S, Brandt HM, Isenhower WD, Wandersman A, Zona D, New C, Fedrick D, Scaccia J, Bruner L. Development of a Clinical-Academic-Community Collaboration to Improve Health Literacy. J Prim Care Community Health 2021; 11:2150132720957440. [PMID: 32909496 PMCID: PMC7495516 DOI: 10.1177/2150132720957440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Limited health literacy is associated with poor patient health outcomes and
increased hospitalization rates. Patient-provider communication plays an
important role in patient health literacy and the understanding of medical
terminology. This study demonstrates how a collaboration between clinical,
academic, and community partners was instrumental in the design and
implementation of a clinic readiness assessment and a clinic-based pilot
intervention to encourage patient-provider communication and improve patient
health literacy. A state hospital association, academic research team, and
community adult literacy center director collaborated to develop a 60-item
clinic readiness assessment and an evidence-informed pilot intervention. The
clinic readiness assessment captured clinics’ motivation and capacity for pilot
implementation and providers’ current communication strategies. The intervention
centered around AskMe3™ educational materials and involved 2 patient visits
(initial and follow-up visits). Data collection instruments for the intervention
were administered verbally and included questions about patient demographics and
communication needs, and a single-item health literacy measure. Descriptive
statistics (frequencies/percentages) were used to analyze results from the
clinic readiness assessment and pilot intervention. Establishment of the
partnership, and collaborative, iterative development of the clinic readiness
assessment and pilot intervention are described. This pilot project resulted in
important lessons learned which led to critical modifications that will inform
future expansion of the intervention. Collaboration between healthcare leaders,
researchers, and community partners is recommended for developing clinic-based
health literacy initiatives.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Diana Zona
- South Carolina Hospital Association, Columbia, SC, USA
| | - Cyndi New
- South Carolina Hospital Association, Columbia, SC, USA
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