Journal of Primary Care and Community Health最新文献

Background: Collecting patients' social determinants of health data allows primary care providers to identify needed services that can address patients' social needs and improve their overall health. Patients' social needs may also be addressed through collaborations between legal and primary care teams, known as medical-legal partnerships (MLPs). We sought to understand patients' experiences with social needs screening (SNS) and MLPs in primary care.

Methods: In 2024, we conducted a web-based survey with a national sample of 502 U.S. adults who had visited a primary care provider in the prior year. The survey assessed patients' experiences with SNS, preferences of SNS delivery and referrals, and perceptions of MLPs. Analyses used multivariable logistic regression models to assess correlates of willingness to use MLPs.

Results: Thirty-eight percent of participants (n = 194) reported having completed a SNS. Of those who completed a SNS, 51% were offered a referral to address their social needs, including 19% who were referred to legal assistance. Approximately 53% of all participants said they were willing to use MLPs. Participants were more willing to use MLPs if they live in rural communities (Odds Ratio [OR] = 1.79, 95% Confidence Interval [CI]: 1.07-3.01) and were aware of SNS (OR = 1.47, 95% CI: 1.05-2.06) and receive public benefits (OR = 0.67, 95% CI: 0.48-0.93).

Conclusion: MLPs are perceived favorably among patients. Establishing MLPs in rural areas may help address social determinants of health in these communities. Next steps in this research include understanding how to build trust in legal representatives in communities with negative experiences with the justice system.

Introduction: Uncontrolled hypertension is a leading global public health concern, contributing significantly to cardiovascular disease burden and premature mortality. Crucially, insufficient patient health literacy often underlies poor blood pressure management. Enhancing health literacy therefore offers substantial potential to empower patients, foster beneficial health behaviors, and ultimately achieve effective blood pressure control.

Objective: To evaluate the effects of a health literacy promotion program on health behaviors and systolic and diastolic blood pressure levels in patients with uncontrolled hypertension.

Methods: This quasi-experimental study employed a 2-group pretest-posttest design with 50 patients diagnosed with uncontrolled hypertension. It was conducted at a subdistrict health promoting hospital in Phayao Province, Thailand. Participants were randomly assigned to either an experimental or a control group, with 25 individuals in each. The control group received usual care, while the experimental group participated in a 12-week health literacy promotion program. This intervention comprised small-group activities incorporating the Teach-back method, Ask Me 3, and motivational interviewing, supplemented by home-based phone calls. The program aimed to develop 6 key health literacy skills. Data were analyzed using descriptive statistics, chi-square test, Fisher's exact test, Mann-Whitney U test, paired t-test, independent t-test, and ANCOVA.

Results: The experimental group showed a significant increase in health behavior scores by 8.72 points post-program (95% CI: 6.61, 10.82; P < .001). This increase was 9.52 points greater than that observed in the control group (95% CI: 6.46, 12.58; P < .001; Cohen d = 1.77). Systolic blood pressure decreased by 14.00 mmHg post-program (95% CI: -17.82, -10.18; P < .001). The between-group difference in reduction was -6.97 mmHg (95% CI: -13.33, -0.60; P = .033, Partial η² = 0.094), indicating a significantly larger reduction in the experimental group. Although diastolic blood pressure decreased by 10.24 mmHg post-program (95% CI: -13.72, -6.76; P < .001), this change did not significantly differ from the control group (P = .387).

Conclusions: The health literacy promotion program significantly improved health behaviors and reduced systolic blood pressure, suggesting its feasibility for implementation in primary care settings. Future research should employ larger sample sizes and extended follow-up periods to thoroughly examine the program's long-term effectiveness across diverse populations.

Background: Non-medical drivers of Health (NMDOH) (e.g., discrimination, income) influence the health status of individuals and their families. In primary care, where clinicians are trained to provide continuous, comprehensive care to patients, there is increasing recognition of the complexity to treat patients impacted by adverse NMDOH. Addressing complex needs requires coordinated support from both healthcare and social systems to overcome socioeconomic barriers and improve outcomes. The purpose of this project was to identify barriers that clinic team members encounter when referring patients to resources.

Methods: Focus groups were conducted with Primary Care Providers and staff (e.g., Social Workers) regularly tasked with referring patients to community organizations. Interviews were audio-recorded, transcribed, and analyzed.

Results: Participants described 3 themes related to barriers: (1) PCPs Are Unaware of Appropriate Referral Processes and Services/Scope of Services Available Internally, (2) Constant Fluctuation of Community Resources Limit Access, and (3) Cost, Communication, Transportation, and Paperwork Limit Patient Access to Services. A fourth theme included participants' recommendations for Solutions to Improve the Referral Process and Communication.

Conclusion: Understanding the barriers between healthcare providers and community organizations can provide a guide toward improving referral protocols and access to resources, thus ultimately leading toward a more equitable community.

Background: Depression and anxiety affect nearly 1 in 4 Canadians. Traditional patient education materials, such as handouts, are often lengthy and difficult to understand, leading to disengagement. Human-like artificial intelligence (AI) avatars offer a novel way to supplement education by delivering consistent, engaging video content that mimics human interaction and is easily accessible online.

Objective: This pilot study aimed to develop a human-like, non-generative AI avatar educational video to support education on antidepressants for patients living with depression and anxiety. The secondary objectives were to evaluate participants perceptions of the tool across 3 domains: credibility, satisfaction, and understanding.

Methods: The video was developed through 2 Plan-Do-Study-Act (PDSA) cycles, informed by prior research on patient-reported barriers and enablers to antidepressant use. After viewing the video, participants completed a survey assessing the 3 domains. Success was predefined as ≥60% of participants rating each domain ≥4 on a 5-point Likert scale. Open-ended feedback was summarized descriptively to help inform revisions.

Results: Fifteen University Health Network (UHN) Patient Partners participated in PDSA Cycle 1, most with lived experience of depression or anxiety and high digital literacy. Success thresholds were achieved for credibility (75%) and satisfaction (67%) but not for understanding (50%). After revisions, 10 participants from the original group completed PDSA Cycle 2, where all domains exceeded thresholds (credibility 90%, satisfaction 85%, understanding 82%). Participants described the tool as trustworthy, clear, and engaging.

Conclusion: This pilot study demonstrated that human-like, non-generative AI avatars can be an effective supplementary educational tool to deliver education on antidepressants for individuals with depression and anxiety. The tool demonstrated acceptability across credibility, satisfaction, and perceived understanding, highlighting its potential to enhance patient engagement and access to reliable information. As a scalable and adaptable format, avatar-based education may extend beyond mental health to other conditions, languages, and clinical settings. Future studies should examine its impact on knowledge retention, treatment adherence, and integration into clinical practice.

Background: A healthy lifestyle can slow the progression of chronic conditions and improve quality of life. Lifestyle counseling in Dutch general practices can be further optimized, among other factors by improving collaboration with social work services. To achieve this, it is important to map out the system of lifestyle counseling within and between general practices and social work services, as well as to identify opportunities for improvement.

Methods: Semi-structured individual interviews were conducted with 3 general practitioners (GPs) and 6 practice nurses (PNs), as well as 5 group interviews with in total 15 professionals from social work services. Participants were based in the city of Nijmegen, the Netherlands. The interviews were conducted between March and August 2024. A thematic analysis was performed which resulted in themes and subthemes. Hereafter, the interviews were re-read to examine relationships between subthemes. The themes, subthemes, and relationships formed the basis for developing a causal loop diagram (CLD) and identifying areas for improvement. The CLD was subsequently reviewed through a member check with the same professions.

Results: The system of lifestyle counseling within and between general practices and social work services consists of the following main themes; addressing lifestyle within general practices, referral to social work services from general practices, GP/PNs' overview and knowledge about social work services, contact between GP/PNs and social work services, and patient status exchange between GP/PNs and social work services. These main themes include interrelated variables which facilitate or impede referrals from general practices to social work services, which is illustrated by the CLD. For example, the more patient status information is shared, the better the GP/PNs' understanding of the available social work services.

Conclusion: The CLD illustrates multiple factors that influence the system of lifestyle counseling in and between general practices and social work services. The CLD, together with the improvement points identified in the interviews, leads to actionable strategies to enhance collaboration between general practices and social work services. These strategies include increasing GP/PNs' understanding of the role and activities of social work services, exchange information, as well as strengthening mutual familiarity and facilitating personal contact between professionals in both domains.

Introduction: E-cigarette use has become increasingly prevalent among adolescents and young adults.

Objective: This study aimed to identify determinants associated with successful e-cigarette cessation among secondary school students.

Setting: Study was conducted at the secondary schools in northern Thailand.

Methods: A cross-sectional study was conducted among 277 secondary school students in Thailand, aged 12 to 25 years. Participants completed a self-administered electronic questionnaire assessing sociodemographic characteristics, academic performance, age of initiation, exposure to e-cigarette use in the environment (defined as having 1 or more e-cigarette users among family, relatives, or friends), perceived risks, and attitudes toward e-cigarettes (the higher score indicates risky attitudes toward e-cigarettes). The outcome was successful cessation, defined as being a former e-cigarette user (no use in the past 12 months among ever-users). Multiple logistic regression analyses were used to explore the factors associated with successful e-cigarette quitting. The gender subgroup analysis was performed.

Results: Of 277 participants, 114 (41.2%) were former users and 163 (58.8%) were current users. The absence of e-cigarette users in the environment (aOR 0.38, 95% CI 0.22-0.67, P = .001) and risky attitudes toward e-cigarettes (aOR 0.79, 95% CI 0.72-0.88, P < .001) were independently associated with cessation. Subgroup analysis confirmed the importance of attitudes for both males and females, while environmental exposure was significant among females.

Conclusion: Successful cessation among secondary school students was strongly associated with less risky attitudes toward e-cigarettes and the absence of e-cigarette users in the peer and family environment. Interventions should target both individual attitude and environmental factors to improve quit rates. Therefore, interventions should focus on correcting attitudes regarding the social image, stress relief, and socialization aspects of e-cigarettes, while simultaneously engaging families and peers to create a vape-free environment.

Introduction: To combat persistent health and social disparities, the VA Greater Los Angeles and its community partners piloted a novel vocational rehabilitation program that employed persons who have experienced homelessness (PEHs) as app-based food deliverers. The program focused on removing barriers to employment, providing subsidized electronic bicycles for deliveries and personal use; "priority status" as deliverers; and access to financial literacy coaching. We aimed to characterize program experiences, with a lens toward program scale-up.

Methods: We conducted semi-structured interviews with a convenience sample of 6 participants and 5 vocational rehabilitation staff. Interviews explored motivations to participate (among participants), and program strengths/challenges. Data were analyzed using rapid qualitative methods.

Results: PEHs reported high motivation to participate due to the e-bike and flexible scheduling of work duties. Interviewees reported positive program impacts including: financial relief; reduced transportation barriers; and improved mental health. Suggesting for improvement included enhanced technical support (with the app and e-bike); improved communication among program partners; and more individualized employment opportunities.

Conclusions: These data suggest the value of this novel vocational rehabilitation model for PEHs. Specific recommendations for program scale-up include a centralized platform for participant technical support requests; and regular communication and data sharing agreements between implementation partners.

Introduction/objectives: Despite the efficacy of vaccines in preventing disease and disability and their cost-effectiveness, a proportion of the population remains reluctant to vaccination. Vaccination literacy is one of the main determinants of vaccine decision-making. The aims of this study were to assess the measurement properties of the Hungarian version of a vaccination literacy instrument and describe the level and determinants of vaccination literacy among the Hungarian adult population.

Methods: A cross-sectional study was conducted on a sample of 1205 Hungarian adult respondents within the European Health Literacy Population Survey 2019-2021. The data were collected by computer-assisted telephone survey in December 2020. The questionnaire covered the following topics: sociodemographic data, self-perceived health, social support, and general and vaccination literacy. The instrument's internal consistency was measured using Cronbach's alpha, its reliability was assessed based on the Spearman-Brown correlation coefficient. The construct validity of the questionnaire was examined using principal component analysis based on a polychoric correlation matrix. Multivariate ordered logistic regression analyses investigated the relationship between vaccination literacy and other relevant variables.

Results: The Cronbach's alpha was 0.78, while the Spearman-Brown correlation coefficient was 0.725. The principal component analysis extracted 1 significant factor that explained 69% of the total variance. The Hungarian adult population had a good level of vaccination literacy (mean score: 82.4, 95% CI 74.9-89.8). We found that social support (OR for the moderate support: 1.93, OR for the strong support: 2.19; P < .001 for both), lack of financial deprivation (OR: 2.05, P < .001), and secondary education level (OR: 1.50, P: .024) are positively correlated with vaccination literacy.

Conclusion: We recommend using the vaccination literacy instrument to identify individuals with inadequate vaccination literacy. Interventions focusing on social support and education to promote vaccine-related information would contribute to enhancing vaccination literacy.

First Contact Physiotherapy Practitioners (FCPPs) are working across the UK to deliver musculoskeletal services to patients within general practice. Little is known about the impact of the model and how variation in delivery may lead to different experiences and outcomes of the service amongst patients and general practice staff. This study explored staff and patient experiences of First Contact Physiotherapy in general practice to determine what works, for whom, under what circumstances, and how. Qualitative interviews were conducted in general practice sites across Great Britain. Interviews were based on initial programme theories identified in an earlier realist review and consensus event. We conducted 80 remote interviews with practice staff and patients, and a further 3 interviews with respondents with other roles related to First Contact Physiotherapy provision. All interviews were analysed using a realist approach. Seven overarching theory areas were identified: 1. Awareness of FCPPs; 2. Communication and integration into practice; 3. FCPP approach in primary care; 4. FCPP additional qualifications; 5. Practice workload; 6. FCPP personal development; and 7. Employment models of FCPP. Three key areas were identified as integral to successful service delivery and implementation: FCPP integration; skillset and impact on resource use; and employment model. Findings from this study strengthen the evidence by providing a robust piece of empirical work about the key issues and contexts impacting successful implementation of the FCPP role into general practice, which will aid decision makers when developing First Contact Physiotherapy services.