Family & Community Health最新文献

Background and objective: Internet-based patient engagement (PE) can empower rural individuals in essential health services. This study investigated predisposing, need, and enabling factors associated with major online PE activities in the rural populations of the United States Pacific Northwest region.

Method: A cross-sectional survey of 250 adults aged 45 to 75 residing in rural parts of Alaska, Idaho, Oregon, and Washington was conducted. Three domains of predictors (predisposing, need, and enabling factors) were assessed. The outcomes were 3 major online PE activities (online access to care, information seeking and sharing, and self-management support).

Result: Online health engagement was associated with multiple chronic diseases, perceived need for colorectal cancer screening, difficulty finding providers, and lower mistrust. Younger age, higher awareness of colorectal cancer risk, better health status, difficulty finding providers, frequent internet use, and misunderstanding between patients and providers were associated with increased online information seeking and sharing. Female gender, more cancer knowledge, lower income, and higher information search difficulty were associated with increased online self-management support. Health information literacy was associated with all PE activities.

Conclusion: Different factors influence online PE activities among rural populations. Optimizing diverse PE activities should assess different predisposing, need, and enabling factors in rural health care.

Background and objectives: Nearly 24 million adults in the United States identify as LGBTQIA+, facing significant health disparities due to discrimination, structural barriers, and lack of culturally competent health care. This study explores health care disparities, barriers, facilitators, and the association of perceived discrimination on LGBTQIA+ health care.

Methods: Participants were recruited from June 2023 to January 2024 using convenience sampling methods via LGBTQIA+ organizations and social media platforms. A total of 501 participants completed a REDCap survey, with 255 providing complete data. The survey queried demographics, physical and mental health, and health care utilization. Data analysis included descriptive statistics and CHERRIES guidelines.

Results: Participants reported significant barriers to care, including being uninsured (22%), geographic distance (33%), fear of negative reactions (26%), and past trauma (23%). Discrimination in health care settings was reported by 83%, impacting access. High rates of homelessness (26%), food insecurity (73%), and chronic medical conditions (92%) were reported. Approximately 55% reported head trauma, 26% experienced intimate partner violence-related head injuries, and only 44% sought care for head injuries. Moderate depressive and anxiety symptoms were common, and 49% screened positive for possible PTSD.

Conclusions: This study highlights barriers to care reported by LGBTQIA+ individuals, emphasizing the need for culturally informed services. Addressing these disparities requires education, cultural humility, and systemic reforms to reduce disparities in health care for LGBTQIA+ individuals.

Background and objectives: Social determinants of health (SDOH) can have profound impacts on children, though many lack access to SDOH programs. Our objective was to determine feasibility and outcomes of a SDOH program for families of children seen in an emergency department (ED) serving an under-resourced rural population.

Methods: This prospective cohort study assessed for 11 domains of SDOH among families of pediatric ED patients. Families with positive screens were contacted following their ED visit and provided resources. Fisher exact and Chi-square tests were used to identify sociodemographic factors associated with SDOH and resource requests.

Results: Of the 95 surveys administered, 42% were positive for ≥1 SDOH, most frequently food scarcity (27%). Forty percent of families with positive SDOH needs screens requested services, of which remote resource assistance was performed successfully with 75%. Families with an unemployed primary caregiver ( P = .04) and Medicaid insurance ( P < .001) were more likely to screen positive for SDOH needs. Forty percent of respondents were from surrounding rural counties and were less likely to request resources ( P = .01).

Conclusions: SDOH needs are common among families utilizing EDs for their children's health care. EDs serving under-resourced rural communities can be leveraged to address SDOH needs, and further research is needed to evaluate their impacts on rural families.

Background: Some maternity leave practices are associated with postpartum depressive (PPD) symptoms which in turn are linked with increased risk of poor maternal and infant outcomes. Mothers of color disproportionately experience poor maternity leave policies and elevated PPD symptoms.

Methods: This cross-sectional study employed data collected at baseline of the Baby's First Year study. Participants were 153 American mothers living below the poverty line. They were interviewed (2018-2019) in the days following birth regarding their race, maternity leave, and PPD symptoms.

Results: Findings indicated that alone race and maternity leave practices were not associated with PPD symptoms. However, the interaction between the two accounted for significant variability in PPD symptoms. Black/African American mothers who reported that they used unpaid maternity leave (n=41, M=8.146, SD=0.708) and mothers in the "Other" race category who reported not taking maternity leave (n=7, M=8.857, SD=1.715) had higher than expected rates of PPD.

Conclusion: These findings show that on the whole, poor maternity leave practices have a disproportionate impact on mothers of color. When women of color are exposed to either no maternity leave or unpaid maternity leave, they are at elevated risk of developing PPD.

Background: In the United States, 30.7% of children aged 10-17 are overweight/obese, increasing their risk of experiencing negative health outcomes. Clinical guidelines urge for frequent visits for preventative weight management. Limited research examines the intersection of primary care patterns and families' perspectives of pediatric primary care in rural South Carolina (SC).

Objectives: 1) Examine rural/non-rural differences in pediatric primary care patterns among Medicaid-insured children, and 2) contextualize differences from families' perspectives.

Methods: SC Medicaid claims were analyzed among patients who had a weight-related diagnostic code and ≥1 primary care visit in northeastern SC from 2018 to 2022 (N = 22,084). Logistic regression examined associations between patient characteristics and traveling for primary care. Additionally, in-depth interviews (N = 12) were conducted to explore families' perspectives in rural primary care access.

Results: Overall, 40.54% of children were diagnosed as overweight/obese. Children living in rural counties, younger, non-Hispanic white, and had a healthy weight were most likely to travel for primary care. Rurality influenced the relationship between traveling for care, race/ethnicity, and weight status. Families express limited trust and perceive poor healthcare quality in their community, motivating their willingness to travel for healthcare.

Conclusion: Findings may inform tailored public health efforts to optimize child and family health across rural SC.

Background: Research suggests that physical activity policy is emerging as an avenue to target physical activity behaviors. Shared use has been identified as a policy strategy to increase access to physical activity opportunities. Still, few studies have examined the shared use process and the partnerships at the policy and environmental levels within the local context.

Objectives: This study examined the influential factors of shared use initiatives and the community-school partnership.

Methods: A multiple case study method was utilized to investigate shared use policies and procedures. Seven interviews were conducted with nine combined participants from three schools. The qualitative data were analyzed using thematic analysis.

Results: Cross-case analysis revealed three salient themes: (1) the need for coordinated communication, (2) variation in partnership collaboration, and (3) fluctuation in the use of established policy.

Implications for policy: This study revealed gaps in communication from upper-level education administration, and having diverse partners can enhance shared use implementation efforts. Additionally, having a specific shared use policy was a nominal factor in schools participating in shared use.

Conclusion: The findings suggest that policy dissemination and education should be considered for local school administration and the community. Multifaceted partnerships are needed to implement robust shared use initiatives.

Background: Residents of historically Black low-income neighborhoods experience disproportionately poorer health. Public infrastructure redevelopment projects (eg, multi-use trails, parks, and public transportation) may improve quality of life and health outcomes in these neighborhoods.

Objectives: The current study draws from communication infrastructure theory to examine the role of interpersonal discussion and civic engagement (belonging, collective efficacy) in intentions to use newly built trails and parks for physical activity.

Methods: Community-based survey data from 398 randomly selected households in historically Black low-income neighborhoods impacted by health inequities were used to identify factors associated with intention to use multi-use trails being developed in the neighborhoods.

Results: Interpersonal discussion, belonging, and collective efficacy were positively and independently associated with intentions to use parks and trails. Additionally, the civic engagement factors (belonging and collective efficacy) mediate the relationship between interpersonal discussion and intentions to use parks and trails.

Conclusion: Interpersonal discussions and civic engagement can promote new parks and trails in low-income neighborhoods, which in turn may increase physical activity and improve overall health of community members.

Background: Social determinants of health (SDOH) interventions within clinical settings have been proposed to address health-related social needs, but few studies have explored intervention needs and challenges for Latinx families. This sequential mixed-methods study examined the effect of Developmental Understanding and Legal Collaboration for Everyone (DULCE), a 6-month SDOH intervention conducted in pediatric clinics in California and Florida.

Methods: Using survey data collected among Latinx caregivers who participated in the DULCE evaluation (n = 393), we examined changes in caregivers' depression, stress, and resilience, including differences by nativity. Qualitative interviews were conducted with DULCE participants (n = 16) across nativity to elucidate the components of the intervention that impacted caregiver outcomes.

Results: DULCE led to significant increases in resilience among Latinx caregivers, especially immigrants, but no changes in depression or stress. Qualitative interviews illuminated that the following themes contributed to caregivers' resilience through the DULCE program: trusted relationship with family specialist caseworkers, connection to critical resources, addressing postpartum depression and social isolation, building caregivers' capacity to withstand challenges, and bolstering caregivers' confidence to seek resources independently.

Discussion: Pediatric SDOH interventions are a promising strategy to support Latinx families in early childhood. Effective interventions for Latinx families, however, require strategies that pair resource connection with relationship building, address immigrants' and Latinx system avoidance, and incorporate additional supports or boosters for families experiencing extreme stress.

Background: To shift home-based program delivery, public health initiatives seek to increase capacity of community-based organizations (CBOs) to provide such services. Yet, no study measured how a public health initiative used equity principles for capacity-building (EPCB).

Objectives: Study aims were measured at 2 time points 6 months apart and explored how participants rated (1) the Initiative's use of 10 EPCB; (2) their CBO's organizational strengths and conditions; and (3) the relationships among EPCB, CBOs' organizational strengths, and CBOs' organizational conditions.

Design and sample: Community-based participatory research was conducted with 20 multicultural, multilingual participants from 9 CBOs.

Methods: Equity principles were measured in May and November 2019. Demographics, CBOs' organizational strengths, and CBOs' organizational conditions were collected. Descriptive and correlational analysis was employed.

Results: Between May and November, 4 significant findings were observed: (1) There was a significant decrease in transformational principle use, reducing CBOs' power and leadership. (2) Racial equity principle use was significantly associated with CBOs' total organizational strengths and CBOs' clear communication. (3) Participants' confidence significantly decreased. (4) Workloads become manageable with funding.

Conclusion: Power transfer using the transformational principle is vital. Equity principles need repeated measurement.

Background and objectives: California has one of the largest unhoused populations in the United States, a crisis compounded by the prevalence of untreated mental illness among those living on the streets. In this Perspective, we elucidate the critical importance of addressing mental illness within California's and other states' unhoused populations, who often are overlooked and not connected to psychiatric services.

Methods and results: We propose the consultation-liaison (C/L) psychiatrist as a bridge between community outreach teams and psychiatric services, in addition to their traditional roles in inpatient and outpatient psychiatry. Drawing upon clinical experience, literature review, and community insights, we underscore the urgent need for comprehensive mental health interventions to mitigate the profound impact of psychiatric disorders on unhoused individuals and consider the C/L psychiatrist to be particularly skilled in this endeavor.

Discussion: We highlight the safety concerns, improved quality of life, and other benefits of timely recognition and treatment of mental illness in unhoused populations.