Family & Community Health最新文献

Background and purpose: Chronically ill individuals with cardiovascular diseases (CVDs) have been extensively challenged by the complexities of disease management. Although clinically integrated community health worker (cCHW) support interventions have been increasingly implemented to help manage CVDs, a comprehensive analysis of interventions implemented in real-world settings is lacking. Additionally, the influence of contextual factors (eg, patient/organization characteristics) on such interventions is underexplored. Guided by the PRISM framework, the purpose of this review is to understand cCHW interventions supporting individuals with CVDs in the clinical settings.

Methods: PubMed, CINAHL and APA PsycInfo databases were searched using the following primary keywords: (community health worker), (integrat*), (chronic) and (cardiovascular disease). Studies investigating the integration of CHWs in the care of adults with CVD published from inception to 2023 were included.

Results: A total of 25 studies were included in the review. Majority of studies (n = 23) measured intervention effectiveness and often positively impacted outcomes, including blood pressure and chronic disease control. Compared to effectiveness, the rest of the RE-AIM domains were underexplored.

Conclusion and implications: cCHW programs have demonstrated some evidence in improving health outcomes in individuals with CVD. However, less is known about their impact on other relevant multidimensional RE-AIM outcomes.

Background: Girls' physical activity and healthful eating behaviors decline throughout adolescence. These trajectories may be linked to the underdevelopment of exercise and healthful eater identities. Youth programs might consider prioritizing identity development as an innovative health promotion strategy, especially during the formative preadolescent life stage.

Objectives: This study examines healthful identities and behaviors among a sample of preadolescent girls who participated in SPLASH, a multicomponent youth program consisting of identity development ("I am an exerciser"; "I am a healthy eater"), physical activity, and healthful eating.

Methods: SPLASH was piloted in a community-based recreational facility in the Midwest United States. Participants had differing levels of program access: all girls (N = 32, age = 10.6 ± 0.8) attended a 1-week summer day camp, and a subset (n = 16) received supplementary access to a 10-week eHealth program. Using a feasibility framework, we examined SPLASH's (1) preliminary efficacy, (2) implementation, and (3) acceptability.

Results: Girls' exercise identities and behaviors improved following camp participation. At follow-up, those in the camp-plus-eHealth group reported greater improvements in physical activity enjoyment relative to girls in the camp-only group.

Conclusions: SPLASH is a promising identity-focused health promotion program for preadolescent girls. Community support and family engagement facilitated this pilot study. Programmatic impact should be assessed in additional communities.

The Centers for Disease Control and Prevention created the Social Vulnerability Index (SVI) for the purpose of allocating resources in times of emergency based on social determinants of health (SDOH). The purpose of this systematic review was to evaluate how the SVI tool has been applied in health care literature focused on health in the United States(US). A systematic literature review was conducted in 7 research databases with an 11-year time frame reflecting the launch of SVI, with the last search completed on September 29, 2022. Studies were included that involved humans, health, SVI, and conducted in the US. Articles were excluded if the SVI was used in COVID-19, disaster, pandemic, environment, or hazards. A total of 47 articles were included in the systematic review. The majority of studies analyzed individual/population health outcomes in clinical, surgical, mortality, or health promotion areas. The majority of studies showed a relationship between neighborhood-level SDOH and health outcomes. Study authors reported strengths, limitations, and recommendations of the SVI tool. A potential limitation of the study was the exclusion of studies that used the SVI related to disaster. The SVI represents a powerful tool to assess neighborhood-level SDOH and examine upstream drivers health outcomes with direct implications for research, policy, and practice.

Background and objectives: As telehealth grows in ubiquity, it is important to understand the barriers and facilitators to telehealth utilization in historically marginalized populations. This study utilizes the Theory of Planned Behavior (TPB) to assess correlates of the intention to utilize video consultations among low-income Hispanic patients.

Methods: This cross-sectional observational study included participants (N = 138) recruited from a federally qualified health center affiliated with a large university health system. Components of the TPB were assessed using an in-person survey. Participant survey responses were analyzed using multiple logistic regression to identify correlates of participants' intention to utilize video consultations.

Results: Multiple logistic regression revealed subjective norms (adjusted odds ratio (aOR [95% CI]) = 3.29 [1.66, 6.52], P = .001) as the only significant correlate of participants' intention to utilize video consultations. Attitudes toward video consultations (aOR [95% CI] = 1.32 [0.60, 2.89], P = .49) and perceived behavioral control (1.72 [0.89, 3.32], P = .11) did not independently correlate with behavioral intention.

Conclusions: Ratings of subjective norms were independently correlated with intention to utilize video consultations among low-income, predominantly Spanish-speaking Hispanic adults. These results suggest a potentially central role of relational influences in determining telehealth engagement in this population.

Background and objectives: This qualitative study explored perceived community strengths and health issues among 3 underserved and under-studied populations in the Atlanta, Georgia-older adults, Black or African American persons, and refugees/immigrants/migrants.

Methods: Eight focus groups were conducted with 92 participants who were members of the 3 populations in Atlanta between November 2022 and March 2023.

Results: Although there were variations among groups, all groups emphasized diversity within their community as the foundation of community strength. Elements of the built environment such as parks, convenience stores, the Atlanta Beltline, and food outlets bolstered community strength. Furthermore, community members being able to voice concerns and the responsiveness of governmental institutions helped form strong relationships to build a strong community. Regarding health issues, common physical health concerns included hypertension and obesity, with varied mental health issues. Accessibility and affordability of healthy foods were significant social concerns, alongside challenges in healthcare access such as navigating complex systems and high medical costs.

Conclusion: Tailored interventions recognizing community strengths and addressing specific health issues are crucial for improving outcomes in marginalized communities, necessitating a health-in-all policies approach considering social, cultural, and structural determinants of health.

Background and objectives: Financial resilience describes an actionable financial capability to cope with emergencies and adversities. However, little is known about whether financial resilience patterns impact holistic health outcomes.

Methods: This study conducted a 3-step latent profile analysis using an urban community sample (n = 3710) from a nationally representative database in China. A multinomial logistic regression model and multiple linear regression models were estimated to examine the proposed argument guided by social determinants of health and resilience theory.

Results: Three latent subgroups were identified to differentiate population heterogeneity with high, moderate, and low financial resilience. Younger generations with lower employment participation, education, income, and assets were significantly less likely to be in moderate and high financial resilience subgroups. After controlling demographics and conventional socioeconomic covariates, financial resilience patterns were significantly negatively associated with mental illness, while positively associated with physical health, subjective happiness, and life satisfaction.

Conclusion: Financial resilience could be a strength-based and actionable socioeconomic determinant of health. Research and practical implications are provided for addressing health inequalities. A new target in community health and social welfare is to enhance financial resilience among marginalized populations through family asset-building, financial inclusion policy, financial literacy education, and social capital investment.

Background and objectives: Though preventive measures are available to alleviate the burden of dental caries, there remain racial disparities in the utilization of preventative dental care. Our objectives were to determine whether racial disparities persisted in receiving preventive oral procedures between (1) black children and white children; and (2) Hispanic children and white children.

Methods: We used pooled Medical Expenditure Panel Survey data in the United States from 2018 to 2021. The key outcome variable involved the use of preventive dental services (ie, examination, x-rays, cleaning, dental sealant fitting, and fluoride treatment), while the main predictor variable involved race (ie, whether they were white, black, or Hispanic children).

Results: Controlling for covariates, there was no statistical significance in the odds of Hispanic and white children in receiving x-rays, sealants, and fluoride treatment (P < .001). black children had significantly lower odds of receiving oral examination, x-rays, and fluoride treatment than their white counterparts (P < .01).

Conclusions: This study highlights the massive strides made in the utilization of preventive dental services by Hispanic children in the United States along with the persisting disparities largely present for black children; however, further studies are needed focusing on structural, sociocultural, and factors contributing to these disparities.

Background and objectives: Community-based organizations, such as Food Literacy Project, Inc. (FLP), focused on cultivating food justice through increasing access to healthy foods in under-resourced areas are uniquely positioned to positively affect the nutrition landscape. This article reports on an evaluation of FLP's efforts in implementing food justice programming.

Methods: A single, longitudinal case study evaluation framed within the socioecological model included the collection of survey, interview and focus group, on-site observational and field notes data at multiple points throughout the evaluation period of July 2019 through August 2020.

Results: Research findings lauded FLP's initiatives providing food access, creating youth advocacy programming, and fostering community connections. However, critical need existed to implement initiatives by individuals who reflected the communities in which they served on land that was fully secured for tenure and ownership.

Conclusions: The results from this evaluation suggest a call to action for non-profit organizations to build and maintain trust in under-resourced communities. When applying for grants, partnering with academic institutions and implementing programming, the site team members, as well as evaluation team members, should be intentional to identify (e.g., race, gender, residence, socioeconomic status, education level) with the community in which the initiatives aim to serve.

Background: Nonuse and inconsistent use of contraception in young adults can result in undesired pregnancies. Prior research on contraceptive use has primarily focused on individual influences such as attitudes, beliefs, and skills related to contraceptive use, with little consideration of the social and economic determinants.

Objective: This study explored domains from the Healthy People 2030 Social Determinants of Health (SDH) framework and examined their cross-sectional associations with young adults' self-reported contraceptive use (ie, any use in the past year and consistent use of contraception).

Methods: Eleven measures related to 5 SDH domains were extracted from the Add Health dataset collected from 2001 to 2002 (Wave III). The final sample included 11,172 youth with a mean age of 21.88 years (SD: 1.84) and was 53.8% female.

Results: Measures associated with the past year's use of contraceptives included non-poverty status, employment, housing instability, high school graduation, enrollment in higher education, English language spoken at home, experience of civic participation, and access to primary care. For consistent use of contraception, associated measures were participants' non-poverty status, employment, high school graduation, enrollment in higher education, English language spoken at home, experience of civic participation, incarceration, and access to health care.

Conclusions: Interventions that address social determinants of health can potentially promote contraceptive use.

Older adults from underserved backgrounds experience chronic pain at a rate of 60% to 75%. Pharmacological treatments have limited efficacy and involve considerable risks. Mind-body interventions hold promise to improve pain outcomes but are typically not implemented in community clinics in which they are needed most, thus contributing to health disparities in chronic pain treatment. We conducted qualitative focus groups and interviews with 20 providers (eg, primary care doctors, nurses, administrators). We sought their perspectives on barriers and facilitators to implementing an evidence based mind-body activity program for older adults with chronic pain at an underserved community health clinic in Massachusetts. Subthemes were identified within 2 superordinate domains (barriers and facilitators) using a hybrid inductive-deductive thematic analysis approach following the Framework Method. Providers discussed facilitators (partner with clinic staff to facilitate referrals and buy-in, integrate referrals through the electronic medical record, offer groups in different languages, post and tailor advertisements) and barriers (limited staff bandwidth, scheduling challenges, inconsistent patient participation). These results will directly inform tailoring and subsequent effectiveness testing and implementation of the pain management program for older underserved adults with chronic pain in this community health care setting.