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

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.

Purpose: To investigate the relationship between selected resource insecurities (i.e., food, housing, and transportation) and abstinence self-efficacy among women with criminal legal system (CLS)-involvement and opioid use disorder (OUD) and examine potential moderating effects of living in a rural or urban area.

Methods: Data were collected as part of the NIDA-funded Kentucky Justice Community Opioid Innovation Network (JCOIN) trial. Women (N = 900) were randomly selected from nine Kentuckyjails, screened for OUD, enrolled, and interviewed. Measures included resource insecurity and a single-item measure of abstinence self-efficacy.

Findings: Results from a multivariable regression analysis examining independent correlates of abstinence self-efficacy demonstrated significant associations with food insecurity (p = .008), controlling for sociodemographic covariates. Rurality moderated the relationship between transportation and abstinence self-efficacy (p = .001).

Conclusions: Resource insecurity, particularly transportation insecurity in rural areas, may reduce abstinence self-efficacy. Addressing resource disadvantages is vital to improving treatment engagement and recovery among women.

Self-rated health (SRH), an indicator of overall health status, has been associated with morbidity and mortality. Yet links between SRH and nutrition are lacking, especially in conjunction with other characteristics affecting SRH. Therefore, the study objective was to identify significant sociodemographic/socioeconomic, chronic disease, dietary habits, and food environment explanatory variables for perceptions of self-rated health (SRH). Data were collected in 2021 and consisted of households at risk of or experiencing food insecurity. Multivariable logistic regression was used to identify significant explanatory variables for SRH. Of the 54% of participants with low SRH, 43% had nutrition insecurity and 66% had one or more chronic disease. For participants with high SRH, 25% had nutrition insecurity and 32% had one or more chronic disease. Household income, fruit and vegetable intake, and scratch-cooked meals consumption were protective against low SRH (5%-16% decrease in odds). Participants with low SRH were 1.8 and 4.3 times as likely to have nutrition insecurity and one or more chronic disease, respectively than participants with high SRH. Perceptions of one's health are positively associated with healthful dietary habits and negatively associated with nutrition insecurity and presence of chronic disease.

Food insecurity and access to healthy nutritious foods are ongoing issues for urban Indigenous communities across the United States. This manuscript describes a qualitative evaluation of a produce box program implemented by the Native American Community Clinic in Minneapolis and provides recommendations for sustainability of the program in the future.

Food pantries are promising community partners in health promotion. This study explored client perspectives in food pantries to inform new approaches to improve client experience, reach, and access. We interviewed 52 adult clients who visited participating food pantries two or more times over 12 months in Cook County, Illinois in English, Spanish, or Cantonese. We analyzed transcripts using the Health Equity Implementation Framework. Participants were 69% female, 48% Black, 29% Asian, and 15% Hispanic/Latino. Participants identified availability of healthy and high-quality foods, client choice models, client-personnel interactions, multilingual services, and wait times as influential to pantry reach and access. Participants felt that client feedback opportunities and client-led community outreach could successfully engage community members who avoided food pantries due to stigma. Creating opportunities for client-centered feedback may improve client experience, reach, and access of food pantries, reduce stigma, and optimize a novel setting for community-based health promotion in diverse populations.

This study examined mental health needs and risk factors associated with service use among Latinx high school students in two cities in the United States. We explored how socioeconomic characteristics, school location, youth and parental nativity, and self-perceived clinical needs were associated with the odds of youths seeing a mental health provider. Data were collected from 306 Latinx youths during the 2018-19 school year. Most youths (78%) self-reported symptoms of anxiety, trauma, or depression above the clinical range. None of these clinical needs predicted service utilization. Youth experiencing less economic hardship and having a mother from South America were almost five times more likely to use services than their counterparts. Similarly, males and older respondents were more likely to be underserved than females and younger respondents. Implications to ensure equitable access to services among older, low-income Latinx youth, particularly those from Central America, the Caribbean, and Mexico, are discussed.

Gender affirmation is standard medical care, and community input is an essential component of patient-centered care. This study shares how our organization assessed patients' perceptions of health care organizations that provide gender-affirming care. Building on qualitative interview data, we distributed an online survey via a lesbian-gaybisexual-transgender-queer research firm. The survey was completed by 314 transgender individuals residing in 37 U.S. states and territories. Most respondents (69%) reported negative experiences seeking health care. Patients would travel long distances for competent providers and were more willing to seek care from an institution actively working to change a formerly negative reputation. Patients described high-quality organizations as prioritizing staff training (95.5%), having inclusive policies (93.3%), and hiring expert staff (86.0%). Programs should ensure cultural competency training for all staff. They should recruit and retain providers skilled in transgender medicine, especially trans-identified providers. Patient experience and reputation in the community influence where patients seek care.