Journal of Health Care for the Poor and Underserved最新文献

Despite facing many social and structural challenges inside and outside of health systems, transgender and gender diverse (TGD) Brazilian immigrants in the U.S. are understudied, and their barriers to care are largely unnamed. In this commentary, we build on existing literature and our experiences at a safety-net community health system that sees a high volume of Brazilian patients to discuss challenges facing TGD Brazilian immigrant populations. We highlight that while Brazilian TGD populations face discrimination in Brazil, major challenges persist upon immigrating to the U.S., and include: difficulty updating identity documents and changing immigration status, barriers seeking general and specialized health care (including finding bilingual and bicultural providers), challenges navigating complex health and insurance systems, and a lack of community supports. We end by recommending more coordinated efforts between health care and community organizations to help ensure the health and wellness of TGD Brazilian immigrants in the United States.

Sexual minority women (SMW) experience worse health than their heterosexual counterparts but have largely been omitted from health services research. To address this gap, we conducted 25 semi-structured, in-depth interviews with SMW. Transcripts were analyzed using thematic analysis, and findings were organized using a modified socioecological framework. Key themes at each socioecological level include (1) structural: stigma, sociocultural norms, health infrastructure; (2) organizational: stigma, patient-provider relationship, hours and location, linkage to care and co-location of services; (3) interpersonal: stigma and social support; (4) individual: internalized stigma, self-efficacy, socioeconomic status, health literacy, and intersecting identities. Stigma is the central theme affecting vulnerabilized SMW's experiences accessing care. Anti-stigma initiatives and factors that lead to personal resilience and can mitigate care access barriers were identified at each level. Interventions should focus on building inclusive policies/infrastructure and using SMW's unique social networks to empower and improve care access and health outcomes among vulnerabilized SMW.

The COVID-19 pandemic disproportionately affected populations that were already facing socioeconomic disadvantages and limited access to health care services. The livelihood of millions was further compromised when strict shelter-in-place measures forced them out of their jobs. The way that individuals accessed food during the early stages of the COVID-19 pandemic drastically changed as a result of declines in household income, food chain supply disruptions, and social distance measures. This qualitative study examined the food access experiences of participants enrolled in a safety-net health care system-based, free, monthly fruit and vegetable market in the Metro Boston area during the first six months of the COVID-19 pandemic. The findings offer rich qualitative information to understand the financial repercussions of the pandemic on food access.

Background: Asian Americans (AA) face cultural and linguistic barriers to health care access, resulting in poor health outcomes. This study investigates the experiences of AAs using language interpretation services (LIS) in health care settings.

Methods: Using a mixed-methods approach, we conducted a community survey (N=401) and seven focus groups between April and September 2023. We use the Andersen model to understand the experience around LIS for AAs and calculated descriptive statistics for predisposing (i.e., sociodemographic factors and attitudes toward LIS), enabling (i.e., perceived barriers), and need factors (i.e., perceived need for LIS). Focus groups were analyzed using a modified template approach to text analysis.

Results: Quantitative and qualitative analyses found that although AAs recognize the benefits and need for LIS, various barriers (e.g., lack of interpreters when booking an appointment) preclude these communities from accessing these services.

Conclusions: Results from this study will help inform interventions that seek to improve LIS within health care systems.

With the aim of achieving higher, equitable hypertension control rates, 350 nationwide federally qualified health centers implemented self-measured blood pressure programs (SMBP) over a three-year grant initiative. Various SMBP program designs with systematic processes, team-based care models, and culturally sensitive approaches with improved BP control are highlighted.

Meeting best-practice guidelines can significantly enhance quality of life and longevity for those with sickle cell disease (SCD). However, many clinical settings lack the necessary resources for optimal care. We present an integrated suite of tools and collaborative actions designed to enhance SCD care.

The purpose of this study was to understand the barriers and facilitators among diverse health care and community organization stakeholders implementing a populationbased social determinants of health (SDOH) intervention. The SDOH intervention included three core programs: SDOH screening, a community health worker program, and a digital referral platform. After one year of implementation, we conducted semi-structured qualitative interviews with clinical and community-based organization stakeholders about (1) the three SDOH programs, (2) organizational implementation strategies, (3) interactions with partner organizations, and (4) perceived target population needs. Findings from the first year of implementation highlighted several factors to consider when designing and implementing SDOH programming, including (1) the successful features of the three SDOH programs, (2) the local implementation strategies and challenges across organizations, (3) the impact of broader community needs and resource availability on implementation, and (4) the importance of intentionally fostering relationships and collaboration among partner organizations.

Background: For transition-aged youth experiencing homelessness (TAYEH) moving to transitional housing, a motivational network intervention (MNI) may help modify high-risk networks, thereby reducing substance use and strengthening prosocial connections.

Methods: Thirty-six TAYEH received a four-session MNI integrated into usual housing case management or usual case management. Intervention acceptability, feasibility, and motivational interviewing fidelity were evaluated.

Results: Nearly all participants would recommend the MNI to others, formed goals, and believed the program improved their lives. Case managers delivered the program with fidelity. However, sample size and number of sessions delivered fell short of targets due to COVID-19 disruptions and other factors and limited our ability to examine preliminary effects on substance use and network outcomes in a fully powered trial.

Conclusion: Case managers can successfully deliver the MNI, but its use may not be feasible unless adaptations are made to accommodate the instability this population faces when they enter housing.