Introduction: Patient-provider trust is essential for effective healthcare delivery, influencing care engagement, disclosure, and adherence. Mistrust can delay diagnoses, reduce care utilization, and worsen outcomes. While cultural competence trainings aim to improve provider awareness, few studies examine how community health workers (CHWs) perceive and support trust-building in clinical care.
Purpose: To explore strategies for building and maintaining patient-provider trust from the perspectives of CHWs.
Methods: Using a Community-Based Participatory Research approach, 39 CHWs from 3 rural-serving health centers in California participated in semi-structured focus groups. English and Spanish sessions were co-led by University researchers and trained CHW partners. Deductive thematic analysis was conducted in Dedoose, and descriptive statistics were generated using Stata 17.
Results: CHWs identified 3 factors that shape patient-provider trust: (1) Power dynamics, such as provider-dominated conversations and time constraints, limit trust-building; (2) Communication that fosters emotional safety, including provider attentiveness and respectful verbal and nonverbal behaviors; and (3) Cultural respect and competence, emphasizing the importance of recognizing patients' beliefs and providing language-concordant care.
Discussion: CHWs offer community-informed insights on trust-building that can inform culturally responsive and equity-oriented interventions, particularly in rural and underserved regions. Future efforts should explore co-developing training modules with CHWs to strengthen patient-provider trust.
Introduction: Unmet health-related social needs (HRSNs) contribute to higher health care spending. Health systems and governments are increasingly addressing these needs to improve outcomes and reduce costs.
Objective: This study examined differences in health care costs and utilization among patients who screened positive versus negative for HRSNs within a large urban health system.
Methods: This retrospective, cross-sectional study included adult Medicaid patients (ages 21-65) who completed a 10-item HRSN screening between April 2018 and December 2019. Each patient's first screening was linked to insurance claims for the following 12 months. Cost and utilization outcomes were analyzed using linear regressions adjusted for sociodemographic covariates.
Results: Of 4432 patients, 1194 (26.9%) screened positive for at least 1 HRSN. Their mean annual health care cost was $8169.72, compared with $4393.22 among those without HRSNs, a difference of $3776.50 (P < .005). Patients with HRSNs also had higher utilization: 3.65 more specialty visits, 1.08 more mental health visits, 0.86 more emergency visits, and 0.40 additional inpatient days annually (P < .005).
Conclusions: Unmet HRSNs were linked to significantly higher costs and utilization, highlighting the potential of addressing social needs to improve outcomes and reduce health care spending.
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.
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.
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: Food insecurity (FI) affects health outcomes, yet screening in primary care remains limited and little is known about how patients view the physician's role. This study examined patient comfort and expectations with FI-related care.
Methods: A cross-sectional survey of adult patients was conducted at family medicine clinics in New Jersey. The survey assessed patient comfort and expectations regarding FI discussions. Associations were analyzed using ANOVA and probit regression.
Results: Among 250 respondents, 17.2% screened positive for FI. Few participants reported previous FI screening (1.2%), discussions with their primary care provider (1.2%), or referrals to FI resources (1.6%). Most respondents felt comfortable discussing FI. Patients identified roles for physicians in screening (24%) and providing referrals (37%).
Conclusions: FI was common, yet screening, discussion, and referral rates were low despite patient comfort with physician involvement. Integrating patient perspectives into screening may improve FI identification and support within family medicine settings.
Background: Cervical cancer (CC) remains a leading cause of death among women worldwide despite the availability of effective preventive strategies. In Ecuador, CC is the second most prevalent cancer among women. However, many women in rural areas remain inadequately screened, resulting in both underscreening and overscreening patterns.
Objective: To identify the determinants associated with under- and overscreening for CC among women in rural areas of Cuenca, Ecuador.
Methods: A cross-sectional, door-to-door survey was conducted between September and December 2023 in the rural parishes of Nulti and Chiquintad. A total of 1692 women aged 18 years and older were included. Participants were categorized as under-, optimally, or overscreened based on self-reported Pap test frequency according to the World Health Organization (WHO) recommended 3-to-5-year screening intervals. Odds ratio (OR) with 95% confidence intervals (CI) were calculated to identify associated factors.
Results: Among the participants, 42.7% were underscreened, 19.3% optimally screened, and 37.9% overscreened. Underscreening was associated with being older than 45 years, having a low educational level, being single, experiencing embarrassment during genital examination, and lack of time. Overscreening was associated with being younger than 45 years, having higher education, and a strong willingness to undergo screening.
Conclusions: Targeted interventions should address informational and emotional barriers contributing to underscreening while discouraging unnecessary overscreening. Strengthened counseling, public education, and standardized guidelines could improve the efficiency and equity of CC screening programs.
Objective: This current study aims to explore the associations and the longitudinal effects of childhood intimate violent exposure (IPV) on bullying and cyberbullying perpetrations and the trajectory of bullying and cyberbullying perpetrations during adolescence.
Methods: This study used data from the Bullying, Sexual, and Dating Violence Trajectories from Early to Late Adolescence in the Midwestern United States, 2007 to 2013. One thousand one hundred sixty-two participants were recruited from 4 Midwestern middle schools (mean age = 11.81; SD = 1.09) and followed into high schools. A 2-part mixed-effects model, the logit submodel and the continuous submodel, was used for statistical analyses.
Results: Bullying perpetration declined as adolescents aged (β = -.03, P < 0.01), while cyberbullying perpetration increased (β = .05, P < .01). Adolescents who have childhood IPV exposure were more likely to engage in bully perpetration (β = .27, P < .01) and cyberbullying perpetration (β = .17, P < .05).
Conclusions: Cyberbullying perpetration has increased as ages, while bullying perpetration decreased. Childhood IPV exposure significantly increased the levels of bullying and cyberbullying perpetrations. Parents need to avoid violent behaviors in front of children; in addition, parents and teachers should pay attention to children's online experiences and educate children about emotion control and proper tools for dealing with negative experiences.
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.
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