Family & Community Health最新文献

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.

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: 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 (eg, race, gender, residence, socioeconomic status, education level) with the community in which the initiatives aim to serve.

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.

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.

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: 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 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.