Journal of Appalachian health最新文献

Introduction: Hospital discharge is a complex process plagued with medical errors and poor coordination. Disjointed discharges are detrimental to Appalachian patients with access barriers and multiple chronic diseases. Telehealth is a tool used to improve access within rural Appalachia. To address this high-risk transition period, an interprofessional team deployed telemedicine to improve post-hospital care for Appalachian patients.

Purpose: Patients with uncontrolled chronic medical conditions were enrolled into the Intensive Telemedicine Transition of Care Clinic (I-TTC) with a primary outcome of 30-day Emergency Department (ED) presentations and hospital readmissions. Secondary outcomes included improved control of chronic conditions and patient cost savings.

Methods: Patients with uncontrolled chronic conditions were given home-monitoring devices and enrolled in the I-TTC post-hospitalization. Telehealth visits were conducted with an interprofessional team comprised of graduate health science students under the supervision of I-TTC physicians. Hospital readmissions, emergency department (ED) presentations, and chronic disease specific measurements were analyzed through retrospective review.

Results: Sixteen adult patients participated in the I-TTC pilot study from 2021-2022. At baseline all patients with hypertension were uncontrolled. The average HbA1C of patients with uncontrolled diabetes was 11%. Post-enrollment, 12.5% of patients had a 30-day ED presentation or hospital re-admission. The average HbA1c for those with uncontrolled diabetes was 8.1% after I-TTC intervention. Of the ten patients with uncontrolled blood pressure, six were controlled post-enrollment. The average cohort total cost savings was $3,144.35.

Implications: The I-TTC suggests feasibility for an interprofessional team utilizing telemedicine in achieving control of chronic medical conditions through improved access to ambulatory healthcare.

Introduction: Consequences of alcohol consumption are well-established and compounded by physiological changes of aging (increased sensitivity; medication interactions; etc.). Alcohol screening for all ages is recommended, especially as most Americans believe moderate drinking is acceptable. Screening is important in high alcohol use regions, such as rural areas where isolation is more likely, especially for older adults. The Appalachian Region has a significant rural population of older adults. West Virginia (WV) is representative of Appalachia. It is a rural state, has many older adults, and all counties are Appalachian.

Purpose: The purpose of this cross-sectional study is to determine the likelihood of alcohol screening among older versus younger WV adults.

Methods: Behavioral Risk Factor Surveillance System 2022 WV data were used. Study inclusion was complete data on sex (at birth), age, alcohol use, and alcohol screening responses. Data were analyzed using Rao-Scott Chi square and logistic regression analysis for the association of age on alcohol screening at routine healthcare visits.

Results: Of the entire sample (n=3,297), 30% were ≥65 years; 53% were female; and 35.7% reported moderate drinking. Alcohol screening was 58.4% for individuals ≥65 years, and 89.8% for individuals ages 18 to <40 years>( p<0.0001). Individuals ≥65 years were nearly 5 times more likely than individuals ages 18 to <40 years to not be screened (adjusted odds ratio=4.84 [95% CI: 3.24, 7.23]; p<0.0001).

Implications: There is a need for greater screening for alcohol use in older adults, as older adults are disproportionately less likely to receive an alcohol screening compared to individuals <40 >years.

Introduction: Radon, a radioactive gas, poses significant health risks, including lung cancer, and is prevalent in indoor environments. Understanding radon testing behavior and Environmental Health Literacy (EHL) is crucial for individuals to take appropriate preventive measures.

Purpose: This study assessed radon-related EHL among Health Council participants in seven Northeast Tennessee (NETN) counties and examined associations between sociodemographic factors and EHL levels. Understanding radon knowledge and behaviors within this influential group is critical, as they often serve as trusted public health advocates.

Methods: A cross-sectional survey was conducted from September - November 2023 among Health Council participants across seven counties in NETN, assessing sociodemographic characteristics and radon EHL. Descriptive statistics and linear regression analyses were employed to examine associations between sociodemographic variables and radon EHL scores.

Results: A total of 131 Health Council members participated in the study. Of these total participants, the majority of participants were homeowners (60.3%). While 80.2% of participants had heard of radon, only 12% had tested their homes for it. TV commercials were the primary source of radon information. Younger age (p<0.001), renters (p<0.001), and those of Hispanic ethnicity (p=0.033) were associated with decreased EHL scores.

Implications: Study's findings reveal disparities in radon knowledge, testing behavior, and EHL among Health Council participants in NETN. Tailored risk communication strategies considering demographic factors are essential to bridge the radon EHL gap. Collaborative efforts between public health agencies, policymakers, and community members are crucial to enhancing radon knowledge and testing uptake.

Introduction: Older adults in East Tennessee (TN), the fastest growing demographic, face significant health challenges, with 44% reporting four or more chronic conditions. The state ranks 45th in physical inactivity among older adults, exacerbating chronic disease risks, fall-related injuries, and mental health issues. Urban-rural disparities in East TN further complicate efforts to promote active living, particularly for rural residents.

Purpose: This qualitative study explored socioecological barriers and solutions to increase physical activity (PA).

Methods: In April 2024, two focus group were conducted in East TN, with a total of 11 participants composed of six community partners and five older adults. A semi-structured interview guide explored PA attitudes, beliefs, and behaviors and gathered recommendations for increasing physical activities among older adults. Data were analyzed thematically using a socioecological framework at individual, organizational, and community levels.

Results: Barriers at the individual level included poor physical, psychological, and social health, and low digital literacy skills. Organizational-level barriers included limited capacity to support PA programming (e.g., staffing, facilities, and funding limitations) and overlapping community program efforts. Community level barriers included limited social support networks and inadequately built environmental features for active living. Solutions highlighted the role of relationships (e.g., peer-to-peer, trusted facilitators) at the individual level, tailored programming and marketing efforts at the organizational level, and leveraging local resources and multi-system collaborations at the community level.

Implications: The findings highlight socioecological factors contributing to physical inactivity in East TN older adults and identifies strategies to address them. These findings can inform sustainable, multi-systems interventions to promote PA in the region.

Introduction: The Covid-19 pandemic impacted those within rural Appalachian communities, particularly people with marginalized identities.

Purpose: Through interviewing 44 participants from New River Valley, an Appalachian community in Virginia, this study sought to understand how resilience impacted individuals' experiences during the pandemic.

Methods: Participants belonged to one of the following groups: African American, Hispanic, older adults, or people who use drugs. Participants were required to reside in the New River Valley and be older than 18. Each participant was interviewed either in person, by phone, or over video call. Interviews were recorded, transcribed, then thematically analyzed for themes of resilience. Taguette was used to create tags in the interview transcripts.

Results: Seven themes were identified: pastimes, friends and neighbors, family, employers and employment, faith, community support, and hope. The primary purpose of this analysis was to understand where participants found resilience despite barriers created or perpetuated by the pandemic. The secondary purpose was to apply the themes to address future recommendations and interventions.

Implications: Results of this study inform helpful interventions for these populations including allocation of funding for social supports, development of continued community building, and policy development that supports education and the reduction of health inequities for people of marginalized identities.

Introduction: Person-centered, trauma-informed care (PCTIC) is a combined, holistic service model promoting the well-being and empowerment of trauma survivors.

Purpose: This study examined the PCTIC knowledge, skills, and abilities needed by West Virginia (WV) Medicaid Home and Community-Based Services (HCBS) direct service professionals (DSPs) to serve clients that may have experienced trauma.

Methods: Semi-structured interviews were conducted with diverse stakeholders (n = 32) from 19 organizations that provide HCBS services in all 55 counties. Interviews focused on identifying current training, needs and knowledge gaps, and priority areas for additional PCTIC training. ATLAS.ti software was used to manage and code. Validity was established by using multiple data coders, gathering insights from multiple roles, and theory triangulation. Thematic analysis identified training needs and knowledge gaps for PCTIC approaches.

Results: Stakeholders identified knowledge gaps and training needs to address knowledge and empowerment of trauma, positive behavior reinforcement, and access to mental health services. Knowledge gaps included standardized operational definitions related to trauma and PCTIC and the importance of assuring accessibility for evidence-based training for all staff levels. In addition, tailoring for various educational backgrounds and skills was recommended to achieve new performance levels among DSPs. Areas to strengthen current trainings included facilitation of culture change, self-care, listening skills, setting boundaries, and problem-solving/critical thinking.

Implications: Results confirm PCTIC training needs for DSPs to strengthen the WV Medicaid HCBS workforce. However, HCBS training implementation and competency areas should consider factors such as understanding/balancing the training needs and abilities of clinically and non-clinically trained workforce and organizational responsiveness.

Introduction: Non-metro/rural Appalachian West Virginia (WV) residents have been stigmatized for poor oral health (OH), despite many advances.

Purpose: The aims of this study were to examine current OH in children in WV, as compared to children in the greater United States (U.S.), and secondarily in subgroup non-metro/rural comparisons.

Methods: This observational study involved the U.S. National Survey of Children's Health 2022-2023 data from parents/guardians who were asked about their child's previous 12-month OH. Rao-Scott Chi-square and logistic regression analyses were used.

Results: Nationally, the mean age was 9.7 years; for WV children, it was 9.9 years. Nationally, 12.4% of children lived in non-metro/rural areas; in WV, 36.5% of children lived in non-metro/rural areas. Children from WV were similar or had slightly more positive outcomes of being more likely to see a dentist, have a dental prophylaxis, have a professional fluoride treatment, have sealant placement, and to have both preventive dental and medical care, as compared to children in the rest of the nation. Among non-metro/rural children, WV children were more likely to see a dentist and have ≥1 preventive dental visit(s), dental prophylaxis, oral hygiene instructions, fluoride, sealant(s), and to have both preventive dental and medical care.

Implications: Children living in WV have similar or slightly better OH than children living in the U.S. overall. Similarly, children living in non-metro/rural WV have similar or slightly better OH than children living in non-metro/rural U.S. These positive results are often obscured by the previous health history in rural WV. Overall, there remains a need to continue to improve OH, particularly in improving the number of children who have preventive dental care.

Introduction: The Appalachian Region has a higher prevalence of type 2 diabetes mellitus (T2DM) and associated adverse health outcomes. Although numerous papers report best practices for diabetes care and education, a clinician-friendly, synthesized summary of best practices tailored to Appalachian cultural preferences is lacking.

Purpose: This paper uses the Melnyk & Fineout-Overholt evidence-based framework to identify the best practices for T2DM care and education for Appalachian residents.

Methods: A comprehensive literature search using the databases CINAHL, Academic Search Complete, and PubMed was guided by a PICOT question. Quality appraisals were completed for fifty-two articles; thirty papers were selected to synthesize best practices, delivery methods, lifestyle modifications, and outcomes.

Results: Best practices for T2DM education are recognizing how culture and the social determinants of health (SDOH) influence care, using a multidisciplinary team, and screening for diabetes knowledge and distress. Beneficial education topics are nutrition, weight management, medication management, stress management, health maintenance screenings, and lifestyle modification including exercise. Access to care may be increased by using digital or online formats.

Implications: T2DM is a complex chronic health issue; strategies are needed to address health disparities and SDOH in Appalachia. Future research is needed to determine the best practices for the duration and frequency of diabetes education and to determine ways to engage residents in diabetes care. Partnerships with local organizations may create a support network for diabetes management. Decision-makers can use these best practices to pursue interventions that engage the Appalachian community in better diabetes care.

Introduction: The Southwest Virginia Health Authority (SWVHA) recently commissioned a community health needs assessment (CHNA) to reduce the high rate of preventable health problems in Virginia's (VA) Appalachian Region. The CHNA took place over a two-year period from 2023 - 2025.

Purpose: This iterative, mixed-method CHNA informed the development of a new iteration of the regional Blueprint for Health Improvement and Health-Enabled Prosperity identifying and prioritizing health issues and develop strategic planning to address them in VA's three westernmost regional health districts.

Methods: The CHNA followed a sequential mixed methods design to assess the regional health status, the contextual factors associated with any health disparities identified, and the development of a participatory community health improvement plan to modify those contextual factors. The sequential approach involved three phases: in Phase 1, the study team collected and compiled primarily quantitative secondary data from local and regional sources. These data informed the subsequent collection and analysis of quantitative and qualitative data in Phase 2, and the data from Phase 2 informed development of a collaborative community-based strategic implementation plan in Phase 3.

Results: The all-cause mortality rate for the region is roughly double the state average. Residents are dying at a higher rate, and at younger ages, due to inadequate access to quality health care, educational opportunities, income stability, and treatments for substance use disorder. Community stakeholders recommended interventions to address the combination of access to quality care and rurality, employment/income, trauma, and substance use disorder, and education and nutrition. Based on these priorities, seven local non-profit organizations were selected for implementation funding.

Implications: This iterative effort supported the development of integrated and community-based population health interventions in the region. Future regional community health assessments will apply similar methods to evaluate progress on these projects and recalibrate regional efforts in response to evolving local needs and priorities.

This article examines the role of two Academic Health Departments (AHDs) in Buncombe and Burke Counties, North Carolina in responding to Hurricane Helene in 2024. The partnership between local health departments and the UNC Asheville - UNC Gillings Master of Public Health (MPH) Program fostered a place-based approach to public health. After the hurricane disrupted regional infrastructure, the AHDs integrated students and faculty into recovery efforts. This paper identifies key lessons for strengthening public health preparedness through academic-practice partnerships and highlights the importance of embedding education in local contexts.