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

In this paper, we describe the Project Extension for Community Healthcare Outcomes+ (ECHO+) model and evaluation plan for incorporating changes to primary care delivery, improving patient and clinician outcomes, and making long-term system improvements.

People with schizophrenia are at increased risk for contracting HIV and face higher mortality rates compared with the general population. Viral suppression is key to HIV care, yet little is known about this metric among people with HIV and schizophrenia. A chart review was conducted among people with HIV/AIDS and schizophrenia living in San Francisco who had received inpatient mental health services between 2010 and 2016. Demographic, laboratory, medication, encounter, and discharge data were collected, and were compared with all people living with HIV in San Francisco (PLWH-SF). Among 153 people living with HIV and comorbid schizophrenia, 77% were virally suppressed, compared to 67% for all PLWH-SF. Viral suppression for people with comorbid HIV and schizophrenia living in San Francisco appears higher than PLWH-SF. Further research is needed to confirm the association and mechanisms behind better treatment outcomes for people living with HIV and comorbid schizophrenia.

Purpose: Food insecurity threatens veterans' health, yet little is known about their experiences seeking food assistance. Thus, we studied veterans' experiences as they navigated from food insecurity to food assistance.

Methods: We built a journey map using thematic analysis of interviews with 30 veterans experiencing food insecurity.

Findings: The map focuses on: (1) identifying contributing circumstances, (2) recognizing food insecurity, (3) finding help, and (4) obtaining assistance. Contributing circumstances included unemployment/under-employment, mental health challenges, and interpersonal violence. Veterans did not recall being screened for food insecurity. Military training also inhibited some veterans from recognizing their own food insecurity. Locating and accessing food assistance was a struggle. While many veterans applied for the Supplemental Nutrition Assistance Program, few qualified. Food pantries were a last resort.

Conclusions: Opportunities to help veterans include (1) addressing contributing circumstances, (2) improving identification, (3) sharing knowledge of resources, and (4) reexamining sufficiency of food assistance programs.

The COVID-19 pandemic placed demands on community-based organizations (CBOs) to address human needs to promote the health and well-being of diverse communities experiencing high rates of disparities. To enhance the capacity of CBOs in engaging with their communities, we developed webinars on health literacy and cultural humility. The concept that drove the training was wraparound services, with the objective to increase CBOs' skills and knowledge for addressing the needs of the whole person.

Justice-involved young adult (JIYA) men are at high risk for HIV, yet frequently do not access HIV services. A better understanding of testing behaviors and motivation, as well as facilitators and barriers to testing is necessary for treatment-as-prevention approaches to be implemented among JIYA. Seventeen JIYA men and nine staff were recruited from three alternative sentencing programs (ASPs). In-depth interviews and a staff focus group explored HIV risk and testing uptake behaviors. Narratives from JIYA demonstrated a lack of connection among HIV risk and behavior, views on testing, and knowledge of PreP. Youth and staff also disclosed various youth and environmental/structural barriers to HIV testing. The justice system may be a crucial point of intervention to reduce HIV risk and promote HIV testing with interventions targeted to the needs of JIYA.

Addressing housing insecurity contributes to health care programs as stable housing has positive health benefits. Home environmental hazards may reduce these potential health benefits and could increase morbidity for conditions such as asthma. This study examined housing and indoor air quality among urban low-income households in Colorado to inform housing-insecurity interventions. We conducted a community-engaged study among residents of motels, mobile homes, apartments, and single-family homes that included a survey on the home environment, health, and sociodemographic factors, spirometry, and indoor air quality measurement. We enrolled 60 households: 50% single-family homes, 37% apartments, and 13% residential motels. Perceived stress and depression were higher among motel residents compared with other housing types. We did not find differences in lung function by housing type. Indoor fine particulate matter (PM2.5) and black carbon concentrations were higher in motels than in other housing types. The differential health impacts of housing type support housing programs that jointly address security and quality.

Objectives: This study evaluated how high versus low-intensity community wellness coaching and health behaviors were associated with changes in depression screen results over one year.

Methods: This was an analysis of secondary data collected in a 12-month obesity-related community health worker (CHW) program for 485 Utah women of color. Depression screen (Patient Health Questionnaire-2 score ³3) and self-reported fruit/vegetable consumption and physical activity (FV/PA) were recorded quarterly. Associations between FV/PA and changes in depression screen over time were evaluated in multivariable models.

Results: Positive depression screen prevalence declined over 12 months (21.7% to 9.5%) with no difference between study arms. Overall, FV ³5 times/day (AOR=1.5; 95% CI 1.0-2.2), any PA (AOR=3.1; 95% CI 1.5-6.4), and muscle strengthening activities (AOR=1.13; 95% CI 1.01-1.26) were associated with improved depression screen results over time.

Conclusion: These results indicate value in addressing and evaluating depression in obesity-related interventions in underserved communities.

Introduction: Hunger Vital SignTM (HVS) and Food Insufficiency Tool (FIT) are two screeners of food insecurity that have not been extensively researched against the well-known 10-item Household Food Security Survey (HFSS-10) Module in large population settings such as New York City (NYC).

Methods: We calculated sensitivity and specificity of the HVS compared with the HFSS-10-based food-insecurity measure and of the FIT compared with the very low food security category of the HFSS-10 using data from the June 2022 New York City Health Panel food access survey.

Results: Overall, the HVS had a sensitivity of 98.1% and a specificity of 72.1%. The FIT had a sensitivity of 53.8% and a specificity of 94.5%. Specificity varied for the HVS while sensitivity varied for the FIT when stratified by sociodemographic subgroups.

Conclusion: The HVS captured people experiencing or at risk of experiencing food insecurity. The FIT underestimated the prevalence of people experiencing very low food security. These screeners may be measuring different constructs of food insecurity.

Children in immigrant families (CIF) constitute 25% of all children in the United States. Known barriers to accessing and navigating the health care system for immigrants (i.e., poverty, fear, limited English proficiency, lack of insurance) lead to decreased medical home establishment among CIF, although the ways in which these obstacles affect medical home access are less studied. With a focus on Congolese, Afghan, Syrian/Iraqi, and Central American immigrants, key informant interviews and focus groups were conducted to identify mothers' perceptions of and experiences with pediatric primary health care. Five common themes emerged: mothers' critical role in children's health, uniqueness of the U.S. health care system, logistical challenges, influence of prior clinical experiences, and importance of culturally appropriate communication. Few, but distinct, differences among the groups revealed specific obstacles for individual populations. Improving rates of medical home use among CIF requires targeted, immigrant-informed approaches that involve population outreach as well as systems-level changes.