75 FR 79330 - Negotiated Rulemaking Committee on Designation of Medically Underserved Populations and Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-20

... more information, please contact Nicole Patterson, Office of Shortage Designation, Bureau of Health... written comments to the Committee should be sent to Nicole Patterson at the contact address above at least...

76 FR 31546 - Negotiated Rulemaking Committee on Designation of Medically Underserved Populations and Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-01

... information, please contact Nicole Patterson, Office of Shortage Designation, Bureau of Health Professions... comments or to provide written comments to the Committee should be sent to Nicole Patterson at the contact...

76 FR 12307 - Negotiated Rulemaking Committee on Designation of Medically Underserved Populations and Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-07

... information, please contact Nicole Patterson, Office of Shortage Designation, Bureau of Health Professions... comments or to provide written comments to the Committee should be sent to Nicole Patterson at the contact...

Primary care physicians in underserved areas. Family physicians dominate.

PubMed Central

Burnett, W H; Mark, D H; Midtling, J E; Zellner, B B

1995-01-01

Using the definitions of "medically underserved areas" developed by the California Health Manpower Policy Commission and data on physician location derived from a survey of California physicians applying for licensure or relicensure between 1984 and 1986, we examined the extent to which different kinds of primary care physicians located in underserved areas. Among physicians completing postgraduate medical education after 1974, board-certified family physicians were 3 times more likely to locate in medically underserved rural communities than were other primary care physicians. Non-board-certified family and general physicians were 1.6 times more likely than other non-board-certified primary care physicians to locate in rural underserved areas. Family and general practice physicians also showed a slightly greater likelihood than other primary care physicians of being located in urban underserved areas. PMID:8553635

75 FR 67303 - Negotiated Rulemaking Committee on Designation of Medically Underserved Populations and Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-02

..., please contact Nicole Patterson, Office of Shortage Designation, Bureau of Health Professions, Health... should be sent to Nicole Patterson at the contact address above at least 10 days prior to the meeting...

75 FR 59674 - Negotiated Rulemaking Committee on Designation of Medically Underserved Populations and Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-28

... CONTACT: For more information, please contact Nicole Patterson, Office of Shortage Designation, Bureau of... written comments to the Committee should be sent to Nicole Patterson at the contact address above at least...

75 FR 79329 - Negotiated Rulemaking Committee on Designation of Medically Underserved Populations and Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-20

... CONTACT: For more information, please contact Nicole Patterson, Office of Shortage Designation, Bureau of... Patterson at the contact address above at least 10 days prior to the meeting. The meetings will be open to...

Clinical medical education in rural and underserved areas and eventual practice outcomes: A systematic review and meta-analysis.

PubMed

Raymond Guilbault, Ryan William; Vinson, Joseph Alexander

2017-01-01

Undergraduate medical students are enrolled in clinical education programs in rural and underserved urban areas to increase the likelihood that they will eventually practice in those areas and train in a primary care specialty to best serve those patient populations. MEDLINE and Cochrane Library online databases were searched to identify articles that provide a detailed description of the exposure and outcome of interest. A qualitative review of articles reporting outcome data without comparison or control groups was completed using the Medical Education Research Study Quality Instrument (MERSQI). A meta-analysis of articles reporting outcome data with comparison or control groups was completed with statistical and graphical summary estimates. Seven hundred and nine articles were retrieved from the initial search and reviewed based on inclusion and exclusion criteria. Of those, ten articles were identified for qualitative analysis and five articles included control groups and thus were included in the quantitative analysis. Results indicated that medical students with clinical training in underserved areas are almost three times as likely to practice in underserved areas than students who do not train in those areas (relative risk [RR] = 2.94; 95% confidence interval [CI]: 2.17, 4.00). Furthermore, medical students training in underserved areas are about four times as likely to practice primary care in underserved areas than students who do not train in those locations (RR = 4.35; 95% CI: 1.56, 12.10). These estimates may help guide medical school administrators and policymakers to expand underserved clinical training programs to help relieve some of the problems associated with access to medical care among underserved populations.

75 FR 32972 - Federal Employees Health Benefits Program; Medically Underserved Areas for 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-10

... OFFICE OF PERSONNEL MANAGEMENT Federal Employees Health Benefits Program; Medically Underserved Areas for 2011 AGENCY: Office of Personnel Management. ACTION: Notice. SUMMARY: The U.S. Office of... Underserved Areas under the Federal Employees Health Benefits (FEHB) Program for calendar year 2011. This is...

76 FR 31998 - Federal Employees Health Benefits Program: Medically Underserved Areas for 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-02

... OFFICE OF PERSONNEL MANAGEMENT Federal Employees Health Benefits Program: Medically Underserved Areas for 2012 AGENCY: U.S. Office of Personnel Management. ACTION: Notice. SUMMARY: The U.S. Office of... Underserved Areas under the Federal Employees Health Benefits (FEHB) Program for calendar year 2012. This is...

Medical students' attitudes toward underserved populations: changing associations with choice of primary care versus non-primary care residency.

PubMed

Wayne, Sharon; Timm, Craig; Serna, Lisa; Solan, Brian; Kalishman, Summers

2010-05-01

The number of medical students entering primary care residencies continues to decrease. The association between student attitudes toward underserved populations and residency choice has received little attention even though primary care physicians see a larger proportion of underserved patients than most other specialists. We evaluated attitudes toward underserved populations in 826 medical students using a standardized survey, and used logistic regression to assess the effect of attitudes, along with other variables, on selection of a primary care residency. We compared results between two groups defined by year of entry to medical school (1993-99 and 2000-05) to determine whether associations differed by time period. Students' attitudes regarding professional responsibility toward underserved populations remained high over the study period; however, there was a statistically. significant association between positive attitudes and primary care residency in the early cohort only. This association was not found in the more recent group.

Psychosocial Determinants of Mammography Follow-up after Receipt of Abnormal Mammography Results in Medically Underserved Women

PubMed Central

Fair, Alecia Malin; Wujcik, Debra; Lin, Jin-Mann Sally; Zheng, Wei; Egan, Kathleen M.; Grau, Ana M.; Champion, Victoria L.; Wallston, Kenneth A.

2010-01-01

This article targets the relationship between psychosocial determinants and abnormal screening mammography follow-up in a medically underserved population. Health belief scales were modified to refer to diagnostic follow-up versus annual screening. A retrospective cohort study design was used. Statistical analyses were performed examining relationships among sociodemographic factors, psychosocial determinants, and abnormal mammography follow-up. Women with lower mean internal health locus of control scores (3.14) were two times more likely than women with higher mean internal health locus of control scores (3.98) to have inadequate follow-up (OR = 2.53, 95% CI = 1.12–5.36). Women with less than a high school education had lower cancer fatalism scores than women who had completed high school (47.5 vs. 55.2, p-value = .02) and lower mean external health locus of control scores (3.0 vs. 5.3) (p-value<.01). These constructs have implications for understanding mammography follow-up among minority and medically underserved women. Further comprehensive study of these concepts is warranted. PMID:20173286

Psychosocial determinants of mammography follow-up after receipt of abnormal mammography results in medically underserved women.

PubMed

Fair, Alecia Malin; Wujcik, Debra; Lin, Jin-Mann Sally; Zheng, Wei; Egan, Kathleen M; Grau, Ana M; Champion, Victoria L; Wallston, Kenneth A

2010-02-01

This article targets the relationship between psychosocial determinants and abnormal screening mammography follow-up in a medically underserved population. Health belief scales were modified to refer to diagnostic follow-up versus annual screening. A retrospective cohort study design was used. Statistical analyses were performed examining relationships among sociodemographic factors, psychosocial determinants, and abnormal mammography follow-up. Women with lower mean internal health locus of control scores (3.14) were two times more likely than women with higher mean internal health locus of control scores (3.98) to have inadequate follow-up (OR=2.53, 95% CI=1.12-5.36). Women with less than a high school education had lower cancer fatalism scores than women who had completed high school (47.5 vs. 55.2, p-value=.02) and lower mean external health locus of control scores (3.0 vs. 5.3) (p-value<.01). These constructs have implications for understanding mammography follow-up among minority and medically underserved women. Further comprehensive study of these concepts is warranted.

Medical School Outcomes, Primary Care Specialty Choice, and Practice in Medically Underserved Areas by Physician Alumni of MEDPREP, a Postbaccalaureate Premedical Program for Underrepresented and Disadvantaged Students.

PubMed

Metz, Anneke M

2017-01-01

Minorities continue to be underrepresented as physicians in medicine, and the United States currently has a number of medically underserved communities. MEDPREP, a postbaccalaureate medical school preparatory program for socioeconomically disadvantaged or underrepresented in medicine students, has a stated mission to increase the numbers of physicians from minority or disadvantaged backgrounds and physicians working with underserved populations. This study aims to determine how MEDPREP enhances U.S. physician diversity and practice within underserved communities. MEDPREP recruits disadvantaged and underrepresented in medicine students to complete a 2-year academic enhancement program that includes science coursework, standardized test preparation, study/time management training, and emphasis on professional development. Five hundred twenty-five disadvantaged or underrepresented students over 15 years completed MEDPREP and were tracked through entry into medical practice. MEDPREP accepts up to 36 students per year, with two thirds coming from the Midwest region and another 20% from nearby states in the South. Students complete science, test preparation, academic enhancement, and professionalism coursework taught predominantly by MEDPREP faculty on the Southern Illinois University Carbondale campus. Students apply broadly to medical schools in the region and nation but are also offered direct entry into our School of Medicine upon meeting articulation program requirements. Seventy-nine percent of students completing MEDPREP became practicing physicians. Fifty-eight percent attended public medical schools, and 62% attended medical schools in the Midwest. Fifty-three percent of program alumni chose primary care specialties compared to 34% of U.S. physicians, and MEDPREP alumni were 2.7 times more likely to work in medically underserved areas than physicians nationally. MEDPREP increases the number of disadvantaged and underrepresented students entering and graduating from medical school, choosing primary care specialties, and working in medically underserved areas. MEDPREP may therefore serve as a model for increasing physician diversity and addressing the needs of medically underserved communities.

Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions.

PubMed

Bärnighausen, Till; Bloom, David E

2009-06-26

In many countries worldwide, health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload. We draw on studies of financial-incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial-incentive programmes: financing (programmes may benefit from innovative donor financing schemes, such as endowment funds, international financing facilities or compensation payments); promotion (programmes should use tested communication channels in order to reach secondary school graduates and health workers); selection (programmes may use selection criteria to ensure programme success and to achieve supplementary policy goals); placement (programmes should match participants to areas in order to maximize participant satisfaction and retention); support (programmes should prepare participants for the time in an underserved area, stay in close contact with participants throughout the different phases of enrolment and help participants by assigning them mentors, establishing peer support systems or financing education courses relevant to work in underserved areas); enforcement (programmes may use community-based monitoring or outsource enforcement to existing institutions); and evaluation (in order to broaden the evidence on the effectiveness of financial incentives in increasing the health workforce in underserved areas, programmes in developing countries should evaluate their performance; in order to improve the strength of the evidence on the effectiveness of financial incentives, controlled experiments should be conducted where feasible). In comparison to other interventions to increase the supply of health workers to medically underserved areas, financial-incentive programmes have advantages--unlike initiatives using non-financial incentives, they establish legally enforceable commitments to work in underserved areas and, unlike compulsory service policies, they will not be opposed by health workers--as well as disadvantages--unlike initiatives using non-financial incentives, they may not improve the working and living conditions in underserved areas (which are important determinants of health workers' long-term retention) and, unlike compulsory service policies, they cannot guarantee that they will supply health workers to underserved areas who would not have worked in such areas without financial incentives. Financial incentives, non-financial incentives, and compulsory service are not mutually exclusive and may positively affect each other's performance.

Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions

PubMed Central

Bärnighausen, Till; Bloom, David E

2009-01-01

In many countries worldwide, health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload. We draw on studies of financial-incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial-incentive programmes: financing (programmes may benefit from innovative donor financing schemes, such as endowment funds, international financing facilities or compensation payments); promotion (programmes should use tested communication channels in order to reach secondary school graduates and health workers); selection (programmes may use selection criteria to ensure programme success and to achieve supplementary policy goals); placement (programmes should match participants to areas in order to maximize participant satisfaction and retention); support (programmes should prepare participants for the time in an underserved area, stay in close contact with participants throughout the different phases of enrolment and help participants by assigning them mentors, establishing peer support systems or financing education courses relevant to work in underserved areas); enforcement (programmes may use community-based monitoring or outsource enforcement to existing institutions); and evaluation (in order to broaden the evidence on the effectiveness of financial incentives in increasing the health workforce in underserved areas, programmes in developing countries should evaluate their performance; in order to improve the strength of the evidence on the effectiveness of financial incentives, controlled experiments should be conducted where feasible). In comparison to other interventions to increase the supply of health workers to medically underserved areas, financial-incentive programmes have advantages – unlike initiatives using non-financial incentives, they establish legally enforceable commitments to work in underserved areas and, unlike compulsory service policies, they will not be opposed by health workers – as well as disadvantages – unlike initiatives using non-financial incentives, they may not improve the working and living conditions in underserved areas (which are important determinants of health workers' long-term retention) and, unlike compulsory service policies, they cannot guarantee that they will supply health workers to underserved areas who would not have worked in such areas without financial incentives. Financial incentives, non-financial incentives, and compulsory service are not mutually exclusive and may positively affect each other's performance. PMID:19558682

The Impact of Disasters on Populations With Health and Health Care Disparities

PubMed Central

Davis, Jennifer R.; Wilson, Sacoby; Brock-Martin, Amy; Glover, Saundra; Svendsen, Erik R.

2010-01-01

Context A disaster is indiscriminate in whom it affects. Limited research has shown that the poor and medically underserved, especially in rural areas, bear an inequitable amount of the burden. Objective To review the literature on the combined effects of a disaster and living in an area with existing health or health care disparities on a community’s health, access to health resources, and quality of life. Methods We performed a systematic literature review using the following search terms: disaster, health disparities, health care disparities, medically underserved, and rural. Our inclusion criteria were peer-reviewed, US studies that discussed the delayed or persistent health effects of disasters in medically underserved areas. Results There has been extensive research published on disasters, health disparities, health care disparities, and medically underserved populations individually, but not collectively. Conclusions The current literature does not capture the strain of health and health care disparities before and after a disaster in medically underserved communities. Future disaster studies and policies should account for differences in health profiles and access to care before and after a disaster. PMID:20389193

Cancer screening promotion among medically underserved Asian American women: integration of research and practice.

PubMed

Yu, Mei-yu; Seetoo, Amy D; Hong, Oi Saeng; Song, Lixin; Raizade, Rekha; Weller, Adelwisa L Agas

2002-01-01

Mammography and Pap smear tests are known to be effective early detection measures for breast and cervical cancers, respectively, but Asian Americans are reluctant to make visits for routine preventive care. Quantitative and qualitative research conducted by the Healthy Asian Americans Project (HAAP) between 1996 and 1999 indicated that Asian residents in southeastern Michigan, like the general Asian population in the US, underutilized early cancer screening programs due to cultural, psychosocial, linguistic, and economic barriers. This article reports how the HAAP's research findings guided the Michigan Breast and Cervical Cancer Control Program (BCCCP) promotion (conducted from 2000 to 2001 among medically underserved Asian women residing in southeastern Michigan), and how evaluation of the HAAP's BCCCP promotion will direct future research and health promotion programs. The article presents strategies used to improve access to cancer screening programs for diverse Asian sub-groups as well as outcomes of the 2-year HAAP's BCCCP promotion among the target population. Discussion regarding lessons and experiences gained from integration of research and practice has implications on design and implementation of the cancer screening promotion for the rapidly increasing Asian American population as well as other medically underserved minority populations in the US.

75 FR 26167 - Designation of Medically Underserved Populations and Health Professions Shortage Areas; Intent To...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-11

... groups and/or organizations as negotiation participants. (1) Up to 3 State Primary Care Offices (PCOs... requested to consult with their fellow PCOs between meetings. (2) National Organization of State Offices of...

Impact of selection strategies on representation of underserved populations and intention to practise: international findings.

PubMed

Larkins, Sarah; Michielsen, Kristien; Iputo, Jehu; Elsanousi, Salwa; Mammen, Marykutty; Graves, Lisa; Willems, Sara; Cristobal, Fortunato L; Samson, Rex; Ellaway, Rachel; Ross, Simone; Johnston, Karen; Derese, Anselme; Neusy, André-Jacques

2015-01-01

Socially accountable medical schools aim to reduce health inequalities by training workforces responsive to the priority health needs of underserved communities. One key strategy involves recruiting students from underserved and unequally represented communities on the basis that they may be more likely to return and address local health priorities. This study describes the impacts of different selection strategies of medical schools that aspire to social accountability on the presence of students from underserved communities in their medical education programmes and on student practice intentions. A cross-sectional questionnaire was administered to students starting medical education in five institutions with a social accountability mandate in five different countries. The questionnaire assessed students' background characteristics, rurality of background, and practice intentions (location, discipline of practice and population to be served). The results were compared with the characteristics of students entering medical education in schools with standard selection procedures, and with publicly available socio-economic data. The selection processes of all five schools included strategies that extended beyond the assessment of academic achievement. Four distinct strategies were identified: the quota system; selection based on personal attributes; community involvement, and school marketing strategies. Questionnaire data from 944 students showed that students at the five schools were more likely to be of non-urban origin, of lower socio-economic status and to come from underserved groups. A total of 407 of 810 (50.2%) students indicated an intention to practise in a non-urban area after graduation and the likelihood of this increased with increasing rurality of primary schooling (p = 0.000). Those of rural origin were statistically less likely to express an intention to work abroad (p = 0.003). Selection strategies to ensure that members of underserved communities can pursue medical careers can be effective in achieving a fair and equitable representation of underserved communities within the student body. Such strategies may contribute to a diverse medical student body with strong intentions to work with underserved populations. © 2014 John Wiley & Sons Ltd.

A Five-Year Evolution of a Student-led Elective on Health Disparities at The Alpert Medical School.

PubMed

Leung, Lucinda B; Simmons, James E; Ho, Julius; Anselin, Emma; Yalamanchili, Rian; Rabatin, Joseph S

2016-10-04

Medical students are often unprepared for social challenges in caring for safety net patients. We aim to evaluate and chronicle the evolution of a pre-clinical elective alongside medical disparities curriculum. Medical students designed the course to supplement clinical training on care of vulnerable patients. From 2011-2015, there have been 80 first-year medical student participants, five cohorts of second-year course leaders, and two supporting faculty advisors for this 10-12 session evening elective. Students (n=67) rated the course extremely highly (ranging from 4.4-4.6 on a five-point Likert scale). Medical students reported having significantly more knowledge of underserved populations after taking the course (difference=0.72, SE=0.16, P <0.001). Career interests and attitudes toward health disparities remained strong after taking the course. This student-created elective equipped participants with improved knowledge in caring for underserved patients and contributed to the incorporation of health disparities in medical curriculum. [Full article available at http://rimed.org/rimedicaljournal-2016-10.asp].

Psychology in patient-centered medical homes: Reducing health disparities and promoting health equity.

PubMed

Farber, Eugene W; Ali, Mana K; Van Sickle, Kristi S; Kaslow, Nadine J

2017-01-01

With persisting health disparities contributing to a disproportionate impact on the health and well-being of socially disenfranchised and medically underserved populations, the emerging patient-centered medical home (PCMH) model offers promise in bridging the health disparities divide. Because behavioral health care is an important component of the PCMH, psychologists have significant opportunity to contribute to the development and implementation of PCMH services in settings that primarily serve medically underserved communities. In this article, after briefly defining the PCMH model and its role in clinical settings for medically underserved populations for whom health disparities are present, roles of psychologists as interprofessional collaborators on PCMH medical care teams are explored. Next, the constellation of competencies that position psychologists as behavioral health specialists to contribute to PCMH care teams for medically underserved groups are characterized. The article concludes with reflections on the prospects for psychologists to make tangible contributions as health care team members toward reducing health disparities and promoting health equity in patients served in the PCMH. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Use of clinical placements as a means of recruiting health care students to underserviced areas in Southeastern Ontario: part 1 - student perspectives.

PubMed

MacRae, Michelle; van Diepen, Kelly; Paterson, Margo

2007-02-01

This two-part study examines the present gap between financial and educational incentives required and the recruitment strategies used to draw health science students to underserviced areas in Southeastern Ontario. Part 1 explores the impact of offering travel stipends, rent-free accommodation and interprofessional educational opportunities to health science students on their willingness to participate in clinical placements in underserviced areas. Mixed-method two-part study using a self-administered questionnaire. Canadian university campus. Four hundred and sixty-eight senior level medical, nursing, occupational therapy, physical therapy and X-ray technology students from a Canadian university and affiliated professional school. The influence of currently established incentives on student willingness to complete a clinical placement in designated underserviced communities in Southeastern Ontario. Based on a 75% response rate, the results demonstrate that, in general, students agree that they are more willing to complete a clinical placement in an underserviced community if provided travel stipends (75%), rent-free housing (92%) and interprofessional educational opportunities (65%). Students also identified 15 additional factors influencing willingness. Students are more willing to complete clinical placements in underserviced communities if provided incentives. The findings of this study support an interprofessional clinical education and recruitment enhancement program in Southeastern Ontario.

Evaluation of the Program in Medical Education for the Urban Underserved (PRIME-US) at the UC Berkeley-UCSF Joint Medical Program (JMP): The First 4 Years.

PubMed

Sokal-Gutierrez, Karen; Ivey, Susan L; Garcia, Roxanna M; Azzam, Amin

2015-01-01

Medical educators, clinicians, and health policy experts widely acknowledge the need to increase the diversity of our healthcare workforce and build our capacity to care for medically underserved populations and reduce health disparities. The Program in Medical Education for the Urban Underserved (PRIME-US) is part of a family of programs across the University of California (UC) medical schools aiming to recruit and train physicians to care for underserved populations, expand the healthcare workforce to serve diverse populations, and promote health equity. PRIME-US selects medical students from diverse backgrounds who are committed to caring for underserved populations and provides a 5-year curriculum including a summer orientation, a longitudinal seminar series with community engagement and leadership-development activities, preclerkship clinical immersion in an underserved setting, a master's degree, and a capstone rotation in the final year of medical school. This is a mixed-methods evaluation of the first 4 years of the PRIME-US at the UC Berkeley-UC San Francisco Joint Medical Program (JMP). From 2006 to 2010, focus groups were conducted each year with classes of JMP PRIME-US students, for a total of 11 focus groups; major themes were identified using content analysis. In addition, 4 yearly anonymous, online surveys of all JMP students, faculty and staff were conducted and analyzed. Most PRIME-US students came from socioeconomically disadvantaged backgrounds and ethnic backgrounds underrepresented in medicine, and all were committed to caring for underserved populations. The PRIME-US students experienced many program benefits including peer support, professional role models and mentorship, and curricular enrichment activities that developed their knowledge, skills, and sustained commitment to care for underserved populations. Non-PRIME students, faculty, and staff also benefited from participating in PRIME-sponsored seminars and community-based activities. Challenges noted by PRIME-US students and non-PRIME students, faculty, and staff included the stress of additional workload, perceived inequities in student educational opportunities, and some negative comments from physicians in other specialties regarding primary care careers. Over the first 4 years of the program, PRIME-US students and non-PRIME students, faculty, and staff experienced educational benefits consistent with the intended program goals. Long-term evaluation is needed to examine the participants' medical careers and impacts on California's healthcare workforce and patient outcomes. Attention should also be paid to the challenges of implementing new medical education enrichment programs.

Federal Employees Health Benefits Program miscellaneous changes: Medically Underserved Areas. Direct final rule.

PubMed

2014-12-17

The U.S. Office of Personnel Management (OPM) is issuing a direct final rule to discontinue the annual determination of the Medically Underserved Areas (MUAs) for the Federal Employees Health Benefits (FEHB) Program.

Development of a Design for Evaluation of the Podiatric Medicine Training Grant Program. Final Report and Executive Summary.

ERIC Educational Resources Information Center

American Association of Colleges of Podiatric Medicine, Washington, DC.

Information is presented on an evaluation design for a federal program, the Podiatric Medicine Training Grant Program. The program supports the clinical training of third- and fourth-year podiatric medical students in underserved areas. Background information is provided on: the supply and distribution of health professionals and podiatrists in…

Self-efficacy of Osteopathic Medical Students in a Rural-Urban Underserved Pathway Program.

PubMed

Casapulla, Sharon L

2017-09-01

Self-efficacy has been shown to play a role in medical students' choice of practice location. More physicians are needed in rural and urban underserved communities. Ohio University Heritage College of Osteopathic Medicine has a co-curricular training program in rural and urban underserved practice to address this shortage. To assess whether participation in the co-curricular program in rural and urban underserved practice affects self-efficacy related to rural and underserved urban practice. This cross-sectional study explored self-efficacy using Bandura's 5 sources of self-efficacy (vicarious learning, verbal persuasion, positive emotional arousal, negative emotional arousal, and performance accomplishments). A validated scale on self-efficacy for rural practice was expanded to include self-efficacy for urban underserved practice and e-mailed to all 707 medical students across 4 years of medical school. Composite rural and urban underserved self-efficacy scores were calculated. Scores from participants in the rural and urban underserved training program were compared with those who were not in the program. Data were obtained from 277 students. In the overall sample, students who indicated that they grew up in a rural community reported significantly higher rural self-efficacy scores than those who did not grow up in a rural community (F1,250=27.56, P<.001). Conversely, students who indicated that they grew up in a nonrural community reported significantly higher urban underserved self-efficacy scores than those who grew up in a rural community (F1,237=7.50, P=.007). The participants who stated primary care as their career interest (n=122) had higher rural self-efficacy scores than the participants who reported a preference for generalist specialties (general surgery, general psychiatry, and general obstetrics and gynecology) or other specialties (n=155) (F2,249=7.16, P=.001). Students who participated in the rural and urban underserved training program (n=49) reported higher rural self-efficacy scores (mean [SD], 21.06 [5.06]) than those who were not in the program (19.22 [4.22]) (t65=2.36; P=.022; equal variances not assumed). The weakest source of self-efficacy for rural practice in participants was vicarious experience. The weakest source of urban underserved self-efficacy was verbal persuasion. Opportunities exist for strengthening weaker sources of self-efficacy for rural practice, including vicarious experience and verbal persuasion. The findings suggest a need for longitudinal research into self-efficacy and practice type interest in osteopathic medical students.

Do health information technology self-management interventions improve glycemic control in medically underserved adults with diabetes? A systematic review and meta-analysis.

PubMed

Heitkemper, Elizabeth M; Mamykina, Lena; Travers, Jasmine; Smaldone, Arlene

2017-09-01

The purpose of this systematic review and meta-analysis was to examine the effect of health information technology (HIT) diabetes self-management education (DSME) interventions on glycemic control in medically underserved patients. Following an a priori protocol, 5 databases were searched. Studies were appraised for quality using the Cochrane Risk of Bias assessment. Studies reporting either hemoglobin A1c pre- and post-intervention or its change at 6 or 12 months were eligible for inclusion in the meta-analysis using random effects models. Thirteen studies met the criteria for the systematic review and 10 for the meta-analysis and represent data from 3257 adults with diabetes (mean age 55 years; 66% female; 74% racial/ethnic minorities). Most studies ( n  = 10) reflected an unclear risk of bias. Interventions varied by HIT type: computer software without Internet ( n  = 2), cellular/automated telephone ( n  = 4), Internet-based ( n  = 4), and telemedicine/telehealth ( n  = 3). Pooled A1c decreases were found at 6 months (-0.36 (95% CI, -0.53 and -0.19]; I 2  = 35.1%, Q  = 5.0), with diminishing effect at 12 months (-0.27 [95% CI, -0.49 and -0.04]; I 2  = 42.4%, Q  = 10.4). Findings suggest that medically underserved patients with diabetes achieve glycemic benefit following HIT DSME interventions, with dissipating but significant effects at 12 months. Telemedicine/telehealth interventions were the most successful HIT type because they incorporated interaction with educators similar to in-person DSME. These results are similar to in-person DSME in medically underserved patients, showing that well-designed HIT DSME has the potential to increase access and improve outcomes for this vulnerable group. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Patient Navigation in Medically Underserved Areas study design: A trial with implications for efficacy, effect modification, and full continuum assessment.

PubMed

Molina, Yamile; Glassgow, Anne E; Kim, Sage J; Berrios, Nerida M; Pauls, Heather; Watson, Karriem S; Darnell, Julie S; Calhoun, Elizabeth A

2017-02-01

The Patient Navigation in Medically Underserved Areas study objectives are to assess if navigation improves: 1) care uptake and time to diagnosis; and 2) outcomes depending on patients' residential medically underserved area (MUA) status. Secondary objectives include the efficacy of navigation across 1) different points of the care continuum among patients diagnosed with breast cancer; and 2) multiple regular screening episodes among patients who did not obtain breast cancer diagnoses. Our randomized controlled trial was implemented in three community hospitals in South Chicago. Eligible participants were: 1) female, 2) 18+years old, 3) not pregnant, 4) referred from a primary care provider for a screening or diagnostic mammogram based on an abnormal clinical breast exam. Participants were randomized to 1) control care or 2) receive longitudinal navigation, through treatment if diagnosed with cancer or across multiple years if asymptomatic, by a lay health worker. Participants' residential areas were identified as: 1) established MUA (before 1998), 2) new MUA (after 1998), 3) eligible/but not designated as MUA, and 4) affluent/ineligible for MUA. Primary outcomes include days to initially recommended care after randomization and days to diagnosis for women with abnormal results. Secondary outcomes concern days to treatment initiation following a diagnosis and receipt of subsequent screening following normal/benign results. This intervention aims to assess the efficacy of patient navigation on breast cancer care uptake across the continuum. If effective, the program may improve rates of early cancer detection and breast cancer morbidity. Copyright © 2016 Elsevier Inc. All rights reserved.

75 FR 42755 - The Negotiated Rulemaking Committee on the Designation of Medically Underserved Populations and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-22

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration The... Secretary of Health and Human Services, through the Administrator, Health Resources and Services... Professions Shortage Areas AGENCY: Health Resources and Services Administration (HRSA), HHS. ACTION: Notice of...

A Qualitative Inquiry Into the Challenges of Medical Education for Retention of General Practitioners in Rural and Underserved Areas of Iran

PubMed Central

2016-01-01

Objectives General practitioners (GPs) retention in rural and underserved areas highly effects on accessibility of healthcare facilities across the country. Education seems to be a critical factor that affects GPs retention. Thus, the present study aimed at inquiry into medical education challenges that limit their retention in rural and underserved areas. Methods A qualitative approach was applied for the aim of this study. Data were gathered via 28 semi-structured interviews with experts at different levels of Iran’s health system as well as GPs who retained and refused to retain working in rural settings. Interviews mainly were performed face-to-face and in some cases via telephone during 2015 and then coded and analyzed using content analysis approach. Results Iran’s medical education is faced with several challenges that were categorized in four main themes including student selection, medical students’ perception about their field of study, education setting and approach, curriculum of medical education. According to experts this challenges could results in making GP graduates disinterested for practicing in rural and underserved areas. Conclusions Challenges that were found could have negative effects on retention. Modification in student’s perception about rural practice could be done via changing education setting and approach and curriculum. These modifications could improve GPs retention in rural and underserved areas. PMID:27951631

The Physician Pipeline to Rural and Underserved Areas in Pennsylvania

ERIC Educational Resources Information Center

Schwartz, Myron R.

2008-01-01

Context: An implicit objective of a state's investments in medical education is to promote in-state practice of state educated physicians. Purpose: To present a tool for evaluating this objective by analyzing the "pipeline" from medical education to patient care, primary care, rural areas, and underserved areas in Pennsylvania. Methods:…

78 FR 50119 - Federal Employees Health Benefits Program: Medically Underserved Areas for 2014

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-16

... Areas for 2014 AGENCY: U.S. Office of Personnel Management. ACTION: Notice of Medically Underserved Areas for 2014. SUMMARY: The U.S. Office of Personnel Management (OPM) has completed its annual... Benefits (FEHB) Program for calendar year 2014. This is necessary to comply with a provision of the FEHB...

The excess burden of breast carcinoma in minority and medically underserved communities: application, research, and redressing institutional racism.

PubMed

Shinagawa, S M

2000-03-01

In 1998, the American Cancer Society, the National Cancer Institute, and the Centers for Disease Control and Prevention reported an overall downward trend in cancer incidence and mortality between 1990 and 1995 for all cancers combined. Many minority and medically underserved populations, however, did not share equally in these improvements. A review of surveillance and other reports and recent literature on disparities in cancer incidence and mortality in minority and medically underserved communities was conducted 1) to ascertain the extent to which these communities bear an excess cancer burden, and 2) to explore the macrosocietal and microinstitutional barriers to equitable benefits in cancer health care delivery. Tragic disparities in cancer incidence and mortality in minority and medically underserved communities continue to be inadequately addressed. Overall improvements in U.S. cancer incidence and mortality rates are not shared equally by all segments of our society. While numerous individual and cultural barriers to optimal cancer control and care exist in minority and medically underserved communities, a major factor precluding these populations from sharing equally in advances in cancer research is prevailing societal and institutional racism. Immediate and equitable application of existing cancer control interventions and quality treatment options will significantly decrease cancer incidence and mortality. Enhanced surveillance efforts and a greater investment in targeted cancer research in those communities with the greatest disparities must be employed immediately if we are to achieve the goal of the president of the United States of eliminating racial and ethnic disparities in cancer and other diseases by 2010. Unless we acknowledge and redress institutionalized racism, the miscarriage of health justice will be perpetuated while celebrated advances in cancer research leading to declining incidence and mortality rates continue to evade our nation's minority and medically underserved communities. Copyright 2000 American Cancer Society.

Precommitting to Serve the Underserved

PubMed Central

Eyal, Nir; Bärnighausen, Till

2014-01-01

In many countries worldwide, especially in Sub-Saharan Africa, a shortage of physicians limits the provision of lifesaving interventions. One existing strategy to increase the number of physicians in areas of critical shortage is conditioning medical school scholarships on a precommitment to work in medically underserved areas later. Current practice is usually to demand only one year of service for each year of funded studies. We show the effectiveness of scholarships conditional on such precommitment for increasing physician supplies in underserved areas. Then we defend these scholarships against ethical worries that they constitute slavery contracts; rely on involuntary, biased, or unauthorized early consent by a young signatory; put excessive strains on signed commitments; give rise to domination; and raise suspicion of slavery contracts. Importantly, we find that scholarships involving far longer commitment than current practice allows would also withstand these worries. Policymakers should consider introducing conditional scholarships, including long-term versions, as a means to increasing the supply of physicians to medically underserved areas. PMID:22548519

Precommitting to serve the underserved.

PubMed

Eyal, Nir; Bärnighausen, Till

2012-01-01

In many countries worldwide, especially in sub-Saharan Africa, a shortage of physicians limits the provision of lifesaving interventions. One existing strategy to increase the number of physicians in areas of critical shortage is conditioning medical school scholarships on a precommitment to work in medically underserved areas later. Current practice is usually to demand only one year of service for each year of funded studies. We show the effectiveness of scholarships conditional on such precommitment for increasing physician supplies in underserved areas. Then we defend these scholarships against ethical worries that they constitute slavery contracts; rely on involuntary, biased, or unauthorized early consent by a young signatory; put excessive strains on signed commitments; give rise to domination; and raise suspicion of slavery contracts. Importantly, we find that scholarships involving far longer commitment than current practice allows would also withstand these worries. Policymakers should consider introducing conditional scholarships, including long-term versions, as a means to increasing the supply of physicians to medically underserved areas.

Lack of a close confidant: prevalence and correlates in a medically underserved primary care sample.

PubMed

Newton, Tamara; Buckley, Amy; Zurlage, Megan; Mitchell, Charlene; Shaw, Ann; Woodruff-Borden, Janet

2008-03-01

The present study examined prevalence of lack of a close confidant in a medically underserved primary care sample, and evaluated demographic, medical, and psychological correlates of patients' deficits in close, personal contact. Adult patients (n = 413) reported on confidant status and symptoms of depression and anxiety. Sociodemographic and medical information were obtained through chart review. One-quarter of patients endorsed lack of a close confidant. Past month anxiety and depression symptoms, but not medical status, were associated with unmet socioemotional needs. Implications for primary healthcare interventions are discussed.

Underserved Areas and Pediatric Resident Characteristics: Is There Reason for Optimism?

PubMed

Laraque-Arena, Danielle; Frintner, Mary Pat; Cull, William L

2016-01-01

To examine whether resident characteristics and experiences are related to practice in underserved areas. Cross-sectional survey of a national random sample of pediatric residents (n = 1000) and additional sample of minority residents (n = 223) who were graduating in 2009 was conducted. Using weighted logistic regression, we examined relationships between resident characteristics (background, values, residency experiences, and practice goals) and reported 1) expectation to practice in underserved area and 2) postresidency position in underserved area. Response rate was 57%. Forty-one percent of the residents reported that they had an expectation of practicing in an underserved area. Of those who had already accepted postresidency positions, 38% reported positions in underserved areas. Service obligation in exchange for loans/scholarships and primary care/academic pediatrics practice goals were the strongest predictors of expectation of practicing in underserved areas (respectively, adjusted odds ratio 4.74, 95% confidence interval 1.87-12.01; adjusted odds ratio 3.48, 95% confidence interval 1.99-6.10). Other significant predictors include hospitalist practice goals, primary care practice goals, importance of racial/ethnic diversity of patient population in residency selection, early plan (before medical school) to care for underserved families, mother with a graduate or medical degree, and higher score on the Universalism value scale. Service obligation and primary care/academic pediatrics practice goal were also the strongest predictors for taking a postresidency job in underserved area. Trainee characteristics such as service obligations, values of humanism, and desire to serve underserved populations offer the hope that policies and public funding can be directed to support physicians with these characteristics to redress the maldistribution of physicians caring for children. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Diet and Exercise Adherence and Practices among Medically Underserved Patients with Chronic Disease: Variation across Four Ethnic Groups

ERIC Educational Resources Information Center

Orzech, Kathryn M.; Vivian, James; Huebner Torres, Cristina; Armin, Julie; Shaw, Susan J.

2013-01-01

Many factors interact to create barriers to dietary and exercise plan adherence among medically underserved patients with chronic disease, but aspects related to culture and ethnicity are underexamined in the literature. Using both qualitative ("n" = 71) and quantitative ("n" = 297) data collected in a 4-year, multimethod study…

Development of a community-based participatory colorectal cancer screening intervention to address disparities, Arkansas, 2008-2009.

PubMed

Yeary, Karen; Flowers, Eric; Ford, Gemessia; Burroughs, Desiree; Burton, Jackie; Woods, Delores; Stewart, Chara; Mehta, Paulette; Greene, Paul; Henry-Tillman, Ronda

2011-03-01

The death rate from colorectal cancer is high and affects poor and medically underserved populations disproportionately. In the United States, health disparities are particularly acute in the Lower Mississippi River Delta region. Because many in the region have limited access to basic health care resources, they are not screened for cancer, even though screening is one of the most effective strategies to prevent colorectal cancer. Community-based participatory research is a promising approach to prevent colorectal cancer in this population. The Empowering Communities for Life program was implemented in 2 underserved counties in the Arkansas Lower Mississippi River Delta. The program arose from a 9-year partnership between the University of Arkansas for Medical Sciences and 9 cancer councils across Arkansas. Empowering Communities for Life is a community-based participatory intervention designed to increase colorectal cancer screening in rural, underserved communities through fecal occult blood testing. Community and academic partners collaborated to develop research infrastructure, intervention materials and methods, and the assessment instrument. Project outcomes were strengthened community-academic partnerships, certification of community partners in conducting human subjects research, development of a randomized controlled design to test the intervention's efficacy, an interactive PowerPoint presentation, an informational pamphlet, the certification of 6 lay health advisors and 22 role models to provide the intervention, and an assessment tool using an audience response system. Lessons learned in working collaboratively with diverse groups include the importance of meeting face to face and listening.

8 CFR 245.18 - How can physicians (with approved Forms I-140) that are serving in medically underserved areas or...

Code of Federal Regulations, 2011 CFR

2011-01-01

... period following Service approval of a second preference employment-based immigrant visa petition. (b) Do... with Form I-485. The medical examination report shall be submitted with the documentary evidence noting... Form I-140 with a national interest waiver based upon full-time clinical practice in an underserved...

8 CFR 245.18 - How can physicians (with approved Forms I-140) that are serving in medically underserved areas or...

Code of Federal Regulations, 2010 CFR

2010-01-01

... period following Service approval of a second preference employment-based immigrant visa petition. (b) Do... with Form I-485. The medical examination report shall be submitted with the documentary evidence noting... Form I-140 with a national interest waiver based upon full-time clinical practice in an underserved...

Who Do You Think You Are? Medical Student Socioeconomic Status and Intention to Work in Underserved Areas

ERIC Educational Resources Information Center

Griffin, Barbara; Porfeli, Erik; Hu, Wendy

2017-01-01

A frequently cited rationale for increasing the participation of students from low socioeconomic status (SES) backgrounds is that it will create a workforce who will choose to work in low SES and medically underserviced communities. Two theoretical arguments, one that supports and one that contradicts this assumption, are proposed to explain the…

Impact of Patient Empathy Modeling on Pharmacy Students Caring for the Underserved

PubMed Central

Chen, Judy T.; LaLopa, Joseph

2008-01-01

Objective To determine the impact of the Patient Empathy Modeling pedagogy on students' empathy towards caring for the underserved during an advanced pharmacy practice experience (APPE). Design Pharmacy students completing an APPE at 2 primary care clinics participated in a Patient Empathy Modeling assignment for 10 days. Each student “became the patient,” simulating the life of an actual patient with multiple chronic diseases who was coping with an economic, cultural, or communication barrier to optimal healthcare. Students completed the Jefferson Scale of Physician Empathy (JSPE) before and after completing the assignment, and wrote daily journal entries and a reflection paper. Assessment Twenty-six students completed the PEM exercises from 2005-2006. Scores on the JSPE improved. Students' comments in journals and reflection papers revealed 3 major themes: greater appreciation of the difficulty patients have with adherence to medication and treatment regimens, increased empathy for patients from different backgrounds and patients with medical and psychosocial challenges, and improved ability to apply the lessons learned in the course to their patient care roles. Conclusion A Patient Empathy Modeling assignment improved pharmacy students' empathy toward underserved populations. Integrating the assignment within an APPE allowed students to immediately begin applying the knowledge and insight gained from the exercise. PMID:18483606

Rural Health, Center of Excellence for Remote and Medically Under-Served Areas (CERMUSA). Addendum

DTIC Science & Technology

2010-07-01

questions. Table 1: Advanced Airway Management Item Analysis Question Pretest Posttest Difference N % N % N % Question 1 5 42% 4 33% -1 -8...those of the author (s) and should not be construed as an official Department of the Army position, policy or decision unless so designated by other...solutions. Three departments, namely Telehealth, Distance Learning, and Information Technology, work hand-in-hand to design and execute the research

Dentist shortage: an analysis of dentists, practices, and populations in the underserved areas.

PubMed

Voinea-Griffin, Andreea; Solomon, Eric S

2016-09-01

The objectives of this study are to identify and describe the characteristics of dental underserved geographic areas. Understanding these characteristics is an important step in addressing access to dental care barriers. Dental underserved areas were identified from the Health Resources and Services Administration (HRSA) database and converted to census tracts for analysis. Characteristics of dental underserved geographic areas were compared with areas not designated as underserved. Dental practices included in the Dun & Bradstreet Business information database were geocoded and analyzed according to the underserved designation of their location and census demographic data. Thus, the relationships between dental underserved status, practice, and population characteristics were evaluated. Dental underserved areas are more likely to comprise individuals with lower socio-economic status (income and education levels), higher levels of underrepresented population groups, and have lower population densities than non-underserved areas. The populations living in dental underserved areas are more likely to experience geographic, financial, and educational barriers to dental care. The study identifies the geographic and financial barriers to dental care access. These findings suggest that the likelihood of a market-driven solution to dental underserved geographic areas is low and support public sector interventions to improve the status quo. © 2016 American Association of Public Health Dentistry.

Reasons for HCV non-treatment in underserved African Americans: implications for treatment with new therapeutics.

PubMed

Schaeffer, Sarah; Khalili, Mandana

2015-01-01

African Americans are disproportionately affected by hepatitis C (HCV) and are less likely to undergo HCV treatment. Underserved populations are especially at risk for experiencing health disparity. Aim. To identify reasons for HCV non-treatment among underserved African Americans in a large safetynet system. Medical records of HCV-infected African Americans evaluated at San Francisco General Hospital liver specialty clinic from 2006-2011 who did not receive HCV treatment were reviewed. Treatment eligibility and reasons for non-treatment were assessed. Factors associated with treatment ineligibility were assessed using logistic regression modeling. Among 118 patients, 42% were treatment ineligible, 18% treatment eligible, and 40% were undergoing work-up to determine eligibility. Reasons for treatment ineligibility were medical (54%), non-medical (14%), psychiatric (4%), or combined (28%). When controlling for age and sex, active/recent substance abuse (OR 6.65, p = 0.001) and having two or more medical comorbidities (OR 3.39, p = 0.005) predicted treatment ineligibility. Excluding those ineligible for treatment, 72% of all other patients were lost to follow-up; they were older (55 vs. 48 years, p = 0.01) and more likely to be undergoing work up to determine treatment eligibility (86 vs. 21%, p < 0.0001) than those not lost to follow-up. Medical comorbidities and substance abuse predicted HCV treatment ineligibility in underserved African Americans. Importantly, the majority of those undergoing work-up to determine HCV treatment eligibility were lost to follow-up. While newer anti-HCV agents may increase treatment eligibility, culturally appropriate interventions to increase compliance with evaluation and care remain critical to HCV management in underserved African Americans.

An Analysis of Oppression and Health Education for Underserved Populations in the United States: The Issues of Acculturation, Patient-Provider Communication, and Health Education

ERIC Educational Resources Information Center

Weaver, Shannon; Gull, Bethany; Ashby, Jeanie; Kamimura, Akiko

2017-01-01

The oppression of underserved populations is pervasive throughout the history of the United States (U.S.), especially in health care. Brazilian educator Paulo Freire's controversial ideas about systems of power can be aptly applied to health care. This paper focuses specifically on arguably the most medically underserved group in the U.S.…

Healthy eating for life: rationale and development of an English as a second language (ESL) curriculum for promoting healthy nutrition.

PubMed

Martinez, Josefa L; Rivers, Susan E; Duncan, Lindsay R; Bertoli, Michelle; Domingo, Samantha; Latimer-Cheung, Amy E; Salovey, Peter

2013-12-01

Low health literacy contributes significantly to cancer health disparities disadvantaging minorities and the medically underserved. Immigrants to the United States constitute a particularly vulnerable subgroup of the medically underserved, and because many are non-native English speakers, they are pre-disposed to encounter language and literacy barriers across the cancer continuum. Healthy Eating for Life (HE4L) is an English as a second language (ESL) curriculum designed to teach English language and health literacy while promoting fruit and vegetable consumption for cancer prevention. This article describes the rationale, design, and content of HE4L. HE4L is a content-based adult ESL curriculum grounded in the health action process approach to behavior change. The curriculum package includes a soap opera-like storyline, an interactive student workbook, a teacher's manual, and audio files. HE4L is the first teacher-administered, multimedia nutrition-education curriculum designed to reduce cancer risk among beginning-level ESL students. HE4L is unique because it combines adult ESL principles, health education content, and behavioral theory. HE4L provides a case study of how evidence-based, health promotion practices can be implemented into real-life settings and serves as a timely, useful, and accessible nutrition-education resource for health educators.

DS-MAC: differential service medium access control design for wireless medical information systems.

PubMed

Yuan, Xiaojing; Bagga, Sumegha; Shen, Jian; Balakrishnan, M; Benhaddou, D

2008-01-01

The integration of wireless networking technologies with medical information systems (telemedicine) have a significant impact on healthcare services provided to our society. Applications of telemedicine range from personalized medicine to affordable healthcare for underserved population. Though wireless technologies and medical informatics are individually progressing rapidly, wireless networking for healthcare systems is still at a very premature stage. In this paper we first present our open architecture for medical information systems that integrates both wired and wireless networked data acquisition systems. We then present the implementation at the physical layer and differential service MAC design that adapts channel provisioning based on the information criticality. Performance evaluation using analytical modeling and simulation shows that our DS-MAC provides differentiated services for emergency, warning, and normal traffic.

Mammographic Breast Density in a Cohort of Medically Underserved Women

DTIC Science & Technology

2015-12-01

Health Center, a public facility serving medically indigent and underserved women. Dietary and total ( dietary plus supplements ) vitamin D and calcium...Cancer Study Questionnaire [18] were used to categorize dietary intake and supplement use of vitamin D and calcium into tertiles. The Harvard African...Byrne C, Evers KA, Daly MB. Dietary intake and breast density in high- risk women: a cross-sectional study. Breast Cancer Res 2007;9:R72. [4] Yaghjyan L

Chronic disease management: teaching medical students to incorporate community.

PubMed

Dent, M Marie; Mathis, Mary W; Outland, Monita; Thomas, McKinley; Industrious, DeShawn

2010-01-01

As a response to the growing prevalence of chronic disease, models of chronic care have emerged as salient approaches to address dynamic health care changes and to manage the burden of suffering of these diseases. Concurrently, there has been a growing call to address chronic disease management within medical school curricula. This article describes the development and evaluation of a curricular intervention designed to prepare students to integrate patient-centered care with an understanding of the patients' community, provide care within rural settings, and experience clinical education specific to chronic disease management. Second-year medical students completed a chronic disease management project as part of a 4-week community visit in rural and/or medically underserved sites. Paired pre- and post-survey data were collected using the Community Oriented Health Care Competency Scale to assess the student's knowledge, intent to practice, and attitudes toward incorporating community-oriented primary care into future practice. Matched pre- and post-project surveys were identified for 170 respondents out of 219 students (77.6% response rate). Post-assessment items were found to be statistically different from measures collected prior to the students' entrance into the community: all knowledge questions indicated significant advancements toward community responsiveness, as did one question related to attitude and three of the intent to practice community-oriented health care questions. Community-based rotations can play a positive role in developing the competencies needed for future practice. The development of curricular opportunities designed to train future physicians on the value of incorporating models of chronic care within rural and underserved communities should remain at the forefront of medical education.

How underserviced rural communities approach physician recruitment: changes following the opening of a socially accountable medical school in northern Ontario.

PubMed

Mian, Oxana; Hogenbirk, John C; Warry, Wayne; Strasser, Roger P

2017-01-01

The Northern Ontario School of Medicine (NOSM) opened in 2005 with a social accountability mandate to address a long history of physician shortages in northern Ontario. The objective of this qualitative study was to understand the school's effect on recruitment of family physicians into medically underserviced rural communities of northern Ontario. We conducted a multiple case study of 8 small rural communities in northern Ontario that were considered medically underserviced by the provincial ministry of health and had successfully recruited NOSM-trained physicians. We interviewed 10 people responsible for physician recruitment in these communities. Interview transcripts were analyzed by means of an inductive and iterative thematic method. All 8 communities were NOSM medical education sites with populations of 1600-16 000. Positive changes, linked to collaboration with NOSM, included achieving a full complement of physicians in 5 communities with previous chronic shortages of 30%-50% of the physician supply, substantial reduction in recruitment expenditures, decreased reliance on locums and a shift from crisis management to long-term planning in recruitment activities. The magnitude of positive changes varied across communities, with individual leadership and communities' active engagement being key factors in successful physician recruitment. Locating medical education sites in underserviced rural communities in northern Ontario and engaging these communities in training rural physicians showed great potential to improve the ability of small rural communities to recruit family physicians and alleviate physician shortages in the region.

Factors Associated With Medical School Graduates' Intention to Work With Underserved Populations: Policy Implications for Advancing Workforce Diversity.

PubMed

Garcia, Andrea N; Kuo, Tony; Arangua, Lisa; Pérez-Stable, Eliseo J

2018-01-01

Given projected U.S. physician shortages across all specialties that will likely impact underserved areas disproportionately, the authors sought to explore factors most correlated with medical school graduates' intention to work with underserved populations (IWUP). Data from the 2010-2012 Association of American Medical Colleges Medical School Graduation Questionnaire (n = 40,846) were analyzed. Variables (demographics, career preference, debt burden, intention to enter loan forgiveness programs) were examined using chi-square tests and logistic regression models. Respondents included 49.5% (20,228/40,846) women, 16.6% (6,771/40,837) underrepresented minorities (URMs), and 32.4% (13,034/37,342) with primary care intent. The median educational debt was $160,000. Respondents who were women (adjusted odds ratio [aOR] 1.59, 95% confidence interval [CI] 1.49, 1.70), URMs (aOR 2.50, 95% CI 2.30, 2.72), intended to enter loan forgiveness programs (aOR 2.44, 95% CI 2.26, 2.63), intended to practice primary care (aOR 1.65, 95% CI 1.54, 1.76), and intended to emphasize nonclinical careers (aOR 1.23, 95% CI 1.11, 1.37) had greater odds of reporting IWUP. Among those who chose specialties and careers with a nonclinical emphasis, and among those with greater burdens of educational and consumer debt, URMs were nearly twice as likely as other minorities and whites to report IWUP. Findings suggest physician characteristics that may be associated with filling workforce gaps in underserved areas. Restructuring financial incentive programs to support physician leaders and specialists with characteristics associated with IWUP may complement similar policies in primary care and could have key impacts on health equity in underserved areas.

Nurse Education, Center of Excellence for Remote and Medically Under-Served Areas (CERMUSA)

DTIC Science & Technology

2013-10-01

humanitarian assistance and disaster response missions throughout the world . To prepare for future military humanitarian missions, nurses turn to...disaster response education modules that include real- world scenarios were designed to inform and create learning opportunities to enhance disaster...preparedness and response. According to the American Public Health Association (2008), “In a rapidly changing world facing natural and man-made

Diet self-management and readiness to change in underserved adults with type 2 diabetes.

PubMed

Knight, Holly; Stetson, Barbara; Krishnasamy, Sathya; Mokshagundam, Sri Prakash

2015-06-01

Dietary assessment in diabetes may be enhanced by considering patient-centered perspectives and barriers to change within IDF guidelines. Consideration of readiness to change (RTC) diet in underserved samples may guide future interventions in high risk populations. This study assesses the utility of a rapid assessment of RTC diet in a medically underserved sample. Participants were 253 Black (43.7%) and White (55.1%) American adults with type 2 diabetes [M age=57.93 (11.52); 60.5% female; 19% below the US poverty threshold]. Participants were recruited at medical clinics and completed validated self-report measures assessing diabetes knowledge, self-efficacy and dietary behaviors and barriers by RTC. Stage-based comparisons identified significant differences in diabetes and dietary domains: participants in the Action stage endorsed fewer behavioral dietary barriers (p<.001), more frequent dietary problem-solving (p<.001), and greater diabetes self-efficacy (p<.001) than participants in the Contemplation and Preparation stages. Women were more likely to be in the Preparation stage and beyond (p<.05). Findings highlight the clinical utility of a brief measure of RTC in understanding patient perspectives toward dietary behaviors in a medically underserved sample. The impact of gender on RTC diet warrants further exploration. Copyright © 2014 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Educational and individual factors associated with positive change in and reaffirmation of medical students' intention to practice in underserved areas.

PubMed

Boscardin, Christy K; Grbic, Douglas; Grumbach, Kevin; O'Sullivan, Patricia

2014-11-01

The projected U.S. physician shortage will disproportionately affect underserved areas. This study examined the impact of medical school educational experiences on positive changes in and reaffirmation of students' intention to practice in underserved areas (practice intention). Medical students (n = 7,361) from 113 U.S. MD-granting medical schools who graduated in 2009-2010 and responded to both the Association of American Medical Colleges' 2006 Matriculating Student Questionnaire and 2010 Graduation Questionnaire were included. Multilevel logistic regression analyses were conducted to determine factors associated with change in and reaffirmation of practice intention. After controlling for individual characteristics, community health field experience (adjusted odds ratio [OR]: 1.36; 95% CI: 1.18, 1.57), learning another language (OR: 1.41; 95% CI: 1.22, 1.63), cultural competence/awareness experience (OR: 1.38; 95% CI: 1.21, 1.58), becoming more aware of perspectives of individuals from different backgrounds (OR: 1.24; 95% CI: 1.04, 1.48), and attending schools with higher social mission scores (OR: 1.66; 95% CI: 1.28, 2.16) were all significantly associated with positive changes in practice intention from matriculation to graduation. Field experience in community health (OR: 1.24; 95% CI: 0.99, 1.53), learning another language (OR: 1.29; 95% CI: 1.01, 1.65), and attending schools with higher social mission scores (OR: 1.62; 95% CI: 1.09, 2.43) were all significantly associated with reaffirmation of practice intention at graduation. Multifaceted factors are associated with practice intention. This study suggests medical schools can play active roles in alleviating the physician shortage in underserved areas through targeted curricular interventions and recruitment.

Access to Digital Communication Technology and Perceptions of Telemedicine for Patient Education among American Indian Patients with Diabetes.

PubMed

Mathieson, Kathleen; Leafman, Joan S; Horton, Mark B

2017-01-01

Health care access for medically underserved patients managing chronic conditions is challenging. While telemedicine can support patient education and engagement, the "digital divide" may be particularly problematic among the medically underserved. This study evaluated physical access to digital devices, use of e-mail and social media tools, and perceptions of telemedicine among American Indian (AI) patients with diabetes mellitus (DM). Survey data were collected from AI patients with DM during teleophthalmology exams. Eighty-eight percent of patients had access to digital device(s), 70% used e-mail, and 56% used social media. Younger age and greater education were positively associated with e-mail and social media use (p < .05). Most (60%) considered telemedicine an excellent medium for health-related patient education. American Indian patients with DM had access enabling patient education via telemedicine. Future work should examine patient technology preferences and effectiveness of technology-based education in improving outcomes among medically underserved populations.

Increasing participation in cancer research: insights from Native Hawaiian women in medically underserved communities.

PubMed

Ka'opua, Lana Sue; Mitschke, Diane; Lono, Joelene

2004-09-01

The cancer burden falls heavily on Native Hawaiian women, and of particular concern are those living in medically underserved communities where participation in potentially helpful clinical studies may be limited. Difficulty in accrual of Native Hawaiian women to a culturally-grounded intervention led researchers to conduct focus groups aimed at exploring attitudes towards research, use of a traditional Hawaiian practice for family discussion, and study promotion. Social marketing theory guided the development of discussion questions and a survey. Through purposive sampling, 30 women from medically underserved communities were recruited. Content analysis was used to identify major discussion themes. Findings indicate that lack of informational access may be a major barrier to participation. Study information disseminated through community channels with targeted outreach to social and religious organizations, promotion through face-to-face contact with researchers, and culturally tailored messages directed to families were preferred. Community oriented strategies based on linkages with organizational networks may increase participation.

A medical student leadership course led to teamwork, advocacy, and mindfulness.

PubMed

Warde, Carole M; Vermillion, Michelle; Uijtdehaage, Sebastian

2014-06-01

Many medical trainees seek work among underserved communities but may be unprepared to cope with the challenges. Relationship-centered qualities have been shown to promote physician resilience and prevent burnout. The UCLA-PRIME program aims to prepare medical students to work among vulnerable groups and begins with a 3-week leadership course. We describe this course and share lessons with those seeking to foster leadership, advocacy, and resiliency in our future physician workforce. Twenty students participated in our curriculum that emphasized five competencies: leadership, advocacy, teamwork, mindfulness, and self-care. Course activities complemented the students' work as they developed a community outreach project. They assessed and reflected on their leadership, relationship, and team behaviors, were coached to improve these, learned mindfulness meditation, and participated in community forums. Our evaluation assessed course quality, project completion, leadership, mindfulness, and team relational coordination. Students were very satisfied with all aspects of the course. They designed a medical student elective addressing the health challenges of an incarcerated and formerly incarcerated population. While we found no change in leadership practices scores, students had high team relational coordination scores and improved mindfulness scores upon course completion. Our course to develop medical students as resilient leaders, team members, and advocates for medically underserved groups consisted of a community-based service project, coupled with a facilitated relationship-centered curriculum. It promoted qualities in students that characterize effective and resilient physician leaders; they were more mindful, related to each other effectively, and coordinated their activities well with one another.

A Health Information System for Scalable and Comprehensive Assessment of Well-Being: A Multidisciplinary Team Solution.

PubMed

Zhou, Leming; Watzlaf, Valerie; Abernathy, Paul; Abdelhak, Mervat

2017-01-01

To improve the health and well-being of the medically underserved in a free clinic in Pittsburgh, Pennsylvania, a multidisciplinary team representing several health information management and information technology (IT) professionals, including faculty, students, researchers, and clinicians, created a novel IT system called imHealthy. The imHealthy system includes four critical components: a multidomain well-being questionnaire, a mobile app for data collection and tracking, a customization of an open-source electronic health record (EHR), and a data integration and well-being evaluation program leading to recommendations for personalized interventions to caregivers serving the medically underserved. This multidisciplinary team has worked closely on this project and finished critical components of the imHealthy system. Evaluations of these components will be conducted, and factors facilitating the design and adoption of the imHealthy system will be presented. The results from this research can serve as a model for free clinics with similar needs that identified by the research team in Cleveland, Indianapolis, Minnesota, Motor City, Orange County, San Diego, and St. Louis.

The association between global health training and underserved care: early findings from two longstanding tracks.

PubMed

Liaw, Winston; Bazemore, Andrew; Xierali, Imam; Walden, John; Diller, Phillip; Morikawa, Masahiro J

2013-04-01

Global health tracks (GHTs) improve knowledge and skills, but their impact on career plans is unclear. The objective of this analysis was to determine whether GHT participants are more likely to practice in underserved areas than nonparticipants. In this retrospective cohort study, using the 2009 American Medical Association Masterfile, we assessed the practice location of the 480 graduates from 1980--2008 of two family medicine residencies-Residency 1 and Residency 2. The outcomes of interest were the percentage of graduates in health professional shortage areas (HPSAs), medically underserved areas (MUAs), rural areas, areas of dense poverty, or any area of underservice. Thirty-seven percent of Residency 1 participants and 20% of nonparticipants practiced in HPSAs; 69% of Residency 2 participants and 55.5% of nonparticipants practiced in areas of dense poverty. All other combined and within-residency differences were not statistically significant. These findings neither confirm nor refute the results of prior surveys suggesting that global health training is associated with increased interest in underserved care. Studies involving more GHTs and complimentary methods are needed to more precisely elucidate the impact of this training.

With Educational Benefits for All: Campus Inclusion through Learning Communities Designed for Underserved Student Populations

ERIC Educational Resources Information Center

Fink, John E.; Hummel, Mary L.

2015-01-01

This chapter explores the practices of learning communities designed for specific, underserved student populations, highlighting on-campus examples and culminating with a synthesized list of core practices from these "inclusive" learning communities.

Teachers' Preferences to Teach Underserved Students

ERIC Educational Resources Information Center

Ronfeldt, Matthew; Kwok, Andrew; Reininger, Michelle

2016-01-01

To increase the supply of teachers into underserved schools, teacher educators and policymakers commonly use two approaches: (a) recruit individuals who already report strong preferences to work in underserved schools or (b) design pre-service preparation to increase preferences. Using survey and administrative data on more than 1,000 teachers in…

Patient-centered medical homes: will health care reform provide new options for rural communities and providers?

PubMed

Bolin, Jane N; Gamm, Larry; Vest, Joshua R; Edwardson, Nick; Miller, Thomas R

2011-01-01

Many are calling for the expansion of the patient-centered medical home model into rural and underserved populations as a transformative strategy to address issues of access, efficiency, quality, and sustainability in the delivery of health care. Patient-centered medical homes have been touted as a promising cost-saving model for comprehensive management of persons with chronic diseases and disabilities, but it is unclear how rural practitioners in medically underserved areas will implement the patient-centered medical home. This article examines how the Patient Protection & Affordable Care Act of 2010 will enhance rural providers' ability to provide patient-centered care and services contemplated under the Act in a comprehensive, coordinated, cost-effective way despite leaner budgets and health workforce shortages.

Medical specialists' choice of location: the role of geographical attachment in Norway.

PubMed

Kristiansen, I S; Førde, O H

1992-01-01

The relation between current place of work (area of the country) and factors that might possibly represent doctors geographical attachments was studied in a sample of 322 Norwegian medical specialists. Location of hospital residency, age and geographical origin of spouse were associated with current location. Geographical attachment seems to influence doctors' locational choices from start of medical school until the end of their residency. The probability that a doctor shall locate in peripheral areas may increase from less than 10% to more than 50% if the doctor has the residency training in the periphery. Hence, favoring entrance to medical schools of students from the underserved areas, and location of graduate and postgraduate medical training in the underserved areas, as far as it is feasible while still maintaining medical standards, is suggested by the study.

Report on a seminar on financing and service delivery issues in caring for the medically underserved.

PubMed Central

Tavani, C

1991-01-01

Current national activities directed toward improving access to health care and assessing the potential effectiveness of various financing and service delivery strategies were reviewed by an invited group of 39 public and private sector health policy experts. Health care access problems of the medically underserved population were defined and a range of strategies for addressing them were presented. The seminar was held at Columbia, MD, July 6-7, 1988, sponsored jointly by the Robert Wood Johnson Foundation and the Health Resources and Services Administration, PHS. PMID:1899935

The Effect of Volunteering at a Student-Run Free Healthcare Clinic on Medical Students' Self-Efficacy, Comfortableness, Attitude, and Interest in Working with the Underserved Population and Interest in Primary Care.

PubMed

Tran, Kelvin; Kovalskiy, Aleksandr; Desai, Anand; Imran, Amna; Ismail, Rahim; Hernandez, Caridad

2017-02-23

The number of primary care physicians in the United States continues to lag behind the number of uninsured people. There has been a growing demand for medical students to improve their self-efficacy, comfortableness, attitude, and interest in working with the underserved and in primary care. This study aims to discern whether volunteering at a student-run, free healthcare clinic has a positive impact on these five variables of interest or not. A 95-item survey was distributed through Qualtrics Survey Software (Qualtrics, Provo, UT, USA) to medical students from the Class of 2018 and Class of 2019 at the University of Central Florida College of Medicine. They were recruited via emails, Facebook, and in-classroom announcements. Mean responses on a Likert-like scale to different survey items were collected and compared between two study cohorts: Keeping Neighbors In Good Health Through Service (KNIGHTS) Clinic volunteers and non-volunteers. Results from 128 students showed no significant differences in the means between the two cohorts (p-values were not significant). When volunteers were asked the survey item, "KNIGHTS Clinic positively influenced my attitude towards working with underserved patients," 62% strongly agreed, 26% agreed, 10% were neutral, and 2% disagreed. Based on the results, volunteering at KNIGHTS Clinic may not have a positive impact on the five variables of interest. However, the lack of significance may also be due to certain limitations of this study addressed elsewhere in this paper. With the majority of KNIGHTS Clinic volunteers agreeing that "KNIGHTS Clinic positively influenced […their] attitude towards working with underserved patients," there may be a positive impact of volunteering on volunteers' attitude towards working with the underserved.

Timing is everything: methodologic issues locating and recruiting medically underserved women for abnormal mammography follow-up research

PubMed Central

Fair, Alecia Malin; Wujcik, Debra; Lin, Jin-Mann S.; Egan, Kathleen M.; Grau, Ana M.; Zheng, Wei

2008-01-01

Objectives Recruiting underserved women in breast cancer research studies remains a significant challenge. We present our experience attempting to locate and recruit minority and medically underserved women identified in a Nashville, Tennessee public hospital for a mammography follow-up study. Study Design The study design was a retrospective hospital based case-control study. Methods We identified 227 women (88 African American, 65 Caucasian, 36 other minority, 38 race undocumented in the medical record) who had undergone screening mammography and received an abnormal result during 2003–2004. Of the 227 women identified, 159 women were successfully located with implementation of a tracking protocol and more rigorous attempts to locate the women using online directory assistance and public record search engines. Women eligible for the study were invited to participate in a telephone research survey. Study completion was defined as fully finishing the telephone survey. Results An average of 4.6 telephone calls (range 1–19) and 2.7 months (range 1–490 days) were required to reach the 159 women contacted. Within three contact attempts, more cases were located than controls (61% cases vs. 49% controls, p=0.03). African-American women cases were four times likely to be recruited than African-American controls, (OR, 4.07; 95% CI, 1.59–10.30) (p=0.003). After three months of effort, we located 67% of African-American women, 63% of Caucasian women, and 56% of other minorities. Ultimately, after a maximum of 12 attempts to contact women, 77% of African-American women and 71% of Caucasian women were eventually found. Of these, 59% of African-American women, 69% Caucasian women, and 50% other minorities were located and completed the study survey for an overall response rate of 59%, 71%, and 47% respectively. Conclusions Data collection and study recruitment efforts were more challenging in racial and ethnic minorities. Continuing attempts to contact women may increase minority group study participation but does not guarantee retention or study completion. PMID:18289943

8 CFR 204.12 - How can second-preference immigrant physicians be granted a national interest waiver based on...

Code of Federal Regulations, 2012 CFR

2012-01-01

... will be based on the evidence the physician submits pursuant to the requirements of § 245.18(d) of this... an underserved area. This calculation will be based on the evidence the physician submits pursuant to... physicians be granted a national interest waiver based on service in a medically underserved area or VA...

8 CFR 204.12 - How can second-preference immigrant physicians be granted a national interest waiver based on...

Code of Federal Regulations, 2011 CFR

2011-01-01

... will be based on the evidence the physician submits pursuant to the requirements of § 245.18(d) of this... an underserved area. This calculation will be based on the evidence the physician submits pursuant to... physicians be granted a national interest waiver based on service in a medically underserved area or VA...

8 CFR 204.12 - How can second-preference immigrant physicians be granted a national interest waiver based on...

Code of Federal Regulations, 2014 CFR

2014-01-01

... will be based on the evidence the physician submits pursuant to the requirements of § 245.18(d) of this... an underserved area. This calculation will be based on the evidence the physician submits pursuant to... physicians be granted a national interest waiver based on service in a medically underserved area or VA...

8 CFR 204.12 - How can second-preference immigrant physicians be granted a national interest waiver based on...

Code of Federal Regulations, 2013 CFR

2013-01-01

... will be based on the evidence the physician submits pursuant to the requirements of § 245.18(d) of this... an underserved area. This calculation will be based on the evidence the physician submits pursuant to... physicians be granted a national interest waiver based on service in a medically underserved area or VA...

Web usability testing with a Hispanic medically underserved population.

PubMed

Moore, Mary; Bias, Randolph G; Prentice, Katherine; Fletcher, Robin; Vaughn, Terry

2009-04-01

Skilled website developers value usability testing to assure user needs are met. When the target audience differs substantially from the developers, it becomes essential to tailor both design and evaluation methods. In this study, researchers carried out a multifaceted usability evaluation of a website (Healthy Texas) designed for Hispanic audiences with lower computer literacy and lower health literacy. METHODS INCLUDED: (1) heuristic evaluation by a usability engineer, (2) remote end-user testing using WebEx software; and (3) face-to-face testing in a community center where use of the website was likely. Researchers found standard usability testing methods needed to be modified to provide interpreters, increased flexibility for time on task, presence of a trusted intermediary such as a librarian, and accommodation for family members who accompanied participants. Participants offered recommendations for website redesign, including simplified language, engaging and relevant graphics, culturally relevant examples, and clear navigation. User-centered design is especially important when website developers are not representative of the target audience. Failure to conduct appropriate usability testing with a representative audience can substantially reduce use and value of the website. This thorough course of usability testing identified improvements that benefit all users but become crucial when trying to reach an underserved audience.

Exploring the workforce implications of a decade of medical school expansion: variations in medical school growth and changes in student characteristics and career plans.

PubMed

Shipman, Scott A; Jones, Karen C; Erikson, Clese E; Sandberg, Shana F

2013-12-01

To explore whether medical school enrollment growth may help address workforce priorities, including diversity, primary care, care for underserved populations, and academic faculty. The authors compared U.S. MD-granting medical schools, applicants, and matriculants immediately before expansion (1999-2001) and 10 years later (2009-2011). Using data from the American Medical Association Physician Masterfile and the Association of American Medical Colleges, they examined medical schools' past production of physicians and changes in matriculant characteristics and practice intentions. Among the 124 schools existing in 1999-2001, growth varied substantially. Additionally, 11 new schools enrolled students by 2009-2011. Aggregate enrollment increased by 16.6%. Increases in applicants led to a lower likelihood of matriculation for all but those with rural backgrounds, racial/ethnic minorities, applicants >24 years old, and those with Medical College Admission Test scores > 33. The existing schools that expanded most had a history of producing the highest percentages of physicians practicing in primary care and in underserved and rural areas; those that expanded least had produced the greatest percentage of faculty. Compared with existing schools, new schools enrolled higher percentages of racial/ethnic minorities and of students with limited parental education or lower income. Matriculants' interest in primary care careers showed no decline; interest in practicing with underserved populations increased, while interest in rural practice declined. Despite expansion, the characteristics of matriculating medical students changed little, except at new schools. Further expansion may benefit from targeted consideration of workforce needs.

Action Research Approach on Mobile Learning Design for the Underserved

ERIC Educational Resources Information Center

Kim, Paul H.

2009-01-01

This paper discusses an action research study focused on developing a mobile learning model of literacy development for underserved migrant indigenous children in Latin America. The research study incorporated a cyclical action model with four distinctive stages (Strategize, Apply, Evaluate, and Reflect) designed to guide constituencies involved…

Recruiting and Retaining Primary Care Physicians in Urban Underserved Communities: The Importance of Having a Mission to Serve

PubMed Central

Ryan, Gery; Ramey, Robin; Nunez, Felix L.; Beltran, Robert; Splawn, Robert G.; Brown, Arleen F.

2010-01-01

Objectives. We examined factors influencing physician practice decisions that may increase primary care supply in underserved areas. Methods. We conducted in-depth interviews with 42 primary care physicians from Los Angeles County, California, stratified by race/ethnicity (African American, Latino, and non-Latino White) and practice location (underserved vs nonunderserved area). We reviewed transcriptions and coded them into themes by using standard qualitative methods. Results. Three major themes emerged in relation to selecting geographic- and population-based practice decisions: (1) personal motivators, (2) career motivators, and (3) clinic support. We found that subthemes describing personal motivators (e.g., personal mission and self-identity) for choosing a practice were more common in responses among physicians who worked in underserved areas than among those who did not. By contrast, physicians in nonunderserved areas were more likely to cite work hours and lifestyle as reasons for selecting their current practice location or for leaving an underserved area. Conclusions. Medical schools and shortage-area clinical practices may enhance strategies for recruiting primary care physicians to underserved areas by identifying key personal motivators and may promote long-term retention through work–life balance. PMID:20935263

Recruiting and retaining primary care physicians in urban underserved communities: the importance of having a mission to serve.

PubMed

Odom Walker, Kara; Ryan, Gery; Ramey, Robin; Nunez, Felix L; Beltran, Robert; Splawn, Robert G; Brown, Arleen F

2010-11-01

We examined factors influencing physician practice decisions that may increase primary care supply in underserved areas. We conducted in-depth interviews with 42 primary care physicians from Los Angeles County, California, stratified by race/ethnicity (African American, Latino, and non-Latino White) and practice location (underserved vs nonunderserved area). We reviewed transcriptions and coded them into themes by using standard qualitative methods. Three major themes emerged in relation to selecting geographic- and population-based practice decisions: (1) personal motivators, (2) career motivators, and (3) clinic support. We found that subthemes describing personal motivators (e.g., personal mission and self-identity) for choosing a practice were more common in responses among physicians who worked in underserved areas than among those who did not. By contrast, physicians in nonunderserved areas were more likely to cite work hours and lifestyle as reasons for selecting their current practice location or for leaving an underserved area. Medical schools and shortage-area clinical practices may enhance strategies for recruiting primary care physicians to underserved areas by identifying key personal motivators and may promote long-term retention through work-life balance.

Big Pharma on the Farm: Students Are Exposed to Pharmaceutical Marketing More Often in Rural Clinics.

PubMed

Evans, David V; Keys, Toby; Desnick, Laurel; A Andrilla, C Holly; Bienz, Danielle; Rosenblatt, Roger

2016-07-01

Pharmaceutical marketing techniques are effective in changing the behavior of health care providers in ways that deviate from evidence-based practices. To mitigate the influence of pharmaceutical marketing on learners, academic medical centers (AMCs) have adopted policies to limit student/industry interaction. Many clinical experiences occur outside of the AMC. The purpose of this study was to compare medical students' exposure to pharmaceutical marketing in off-campus rural and urban underserved clinical sites. The University of Washington School of Medicine Rural and Underserved Opportunities Program (RUOP) places rising second-year medical students in underserved clinical sites in five northwestern states. We surveyed RUOP students to evaluate their exposure to pharmaceutical marketing. Of 120 students, 86 (72%) completed surveys. Sixty-five (76%) did their RUOP rotation in rural areas. Students in rural locations were more likely to report exposure to pharmaceutical marketing. Distribution of free drug samples was reportedly three times higher in rural than urban sites (54% versus 15%). Doctors meeting with sales representatives were reported as four times higher in rural clinics (40% versus 10%). Students at rural sites reported exposure to pharmaceutical marketing more than those in urban settings. Rural medical educators should provide faculty development for community clinicians on the influences of pharmaceutical marketing on learners. Medical schools must review local clinic and institution-wide policies to limit pharmaceutical marketing exposure to learners in the rural learning environment.

Giving Voice to the Medically Under-Served: A Qualitative Co-Production Approach to Explore Patient Medicine Experiences and Improve Services to Marginalized Communities.

PubMed

Latif, Asam; Tariq, Sana; Abbasi, Nasa; Mandane, Baguiasri

2018-01-27

With an aging population, the appropriate, effective and safe use of medicines is a global health priority. However, "'medically under-served" patients continue to experience significant inequalities around access to healthcare services. This study forms part of a wider project to co-develop and evaluate a digital educational intervention for community pharmacy. The aim of this paper is to explore the medicine needs of patients from marginalized communities and suggest practical way on how services could be better tailored to their requirements. Following ethical approval, qualitative data was gathered from: (1) workshops with patients and professionals ( n = 57 attendees); and (2) qualitative semi-structured interviews (10 patients and 10 pharmacists). Our findings revealed that patients from marginalized communities reported poor management of their medical conditions and significant problems with adherence to prescribed medicines. Their experience of pharmacy services was found to be variable with many experiencing discrimination or disadvantage as a result of their status. This study highlights the plight of medically under-served communities and the need for policy makers to tailor services to an individual's needs and circumstances. Furthermore, patients and professionals can work in collaboration using a co-production approach to develop educational interventions for pharmacy service improvements.

Demonopolizing medical knowledge.

PubMed

Arora, Sanjeev; Thornton, Karla; Komaromy, Miriam; Kalishman, Summers; Katzman, Joanna; Duhigg, Daniel

2014-01-01

In the past 100 years, there has been an explosion of medical knowledge-and in the next 50 years, more medical knowledge will be available than ever before. Regrettably, current medical practice has been unable to keep pace with this explosion of medical knowledge. Specialized medical knowledge has been confined largely to academic medical centers (i.e., teaching hospitals) and to specialists in major cities; it has been disconnected from primary care clinicians on the front lines of patient care. To bridge this disconnect, medical knowledge must be demonopolized, and a platform for collaborative practice amongst all clinicians needs to be created. A new model of health care and education delivery called Project ECHO (Extension for Community Healthcare Outcomes), developed by the first author, does just this. Using videoconferencing technology and case-based learning, ECHO's medical specialists provide training and mentoring to primary care clinicians working in rural and urban underserved areas so that the latter can deliver the best evidence-based care to patients with complex health conditions in their own communities. The ECHO model increases access to care in rural and underserved areas, and it demonopolizes specialized medical knowledge and expertise.

Title VII funding is associated with more family physicians and more physicians serving the underserved.

PubMed

Meyers, D; Fryer, G E; Krol, D; Phillips, R L; Green, L A; Dovey, S M

2002-08-15

Title VII funding of departments of family medicine at U.S. medical schools is significantly associated with expansion of the primary care physician workforce and increased accessibility to physicians for the residents of rural and underserved areas. Title VII has been successful in achieving its stated goals and has had an important role in addressing U.S. physician workforce policy issues.

Service, training, mentorship: first report of an innovative education-support program to revitalize primary care social service in Chiapas, Mexico.

PubMed

Van Wieren, Andrew; Palazuelos, Lindsay; Elliott, Patrick F; Arrieta, Jafet; Flores, Hugo; Palazuelos, Daniel

2014-01-01

The Mexican mandatory year of social service following medical school, or pasantía, is designed to provide a safety net for the underserved. However, social service physicians (pasantes) are typically unpracticed, unsupervised, and unsupported. Significant demotivation, absenteeism, and underperformance typically plague the social service year. Compañeros en Salud (CES) aimed to create an education-support package to turn the pasantía into a transformative learning experience. CES recruited pasantes to complete their pasantía in CES-supported Ministry of Health clinics in rural Chiapas. The program aims to: 1) train pasantes to more effectively deliver primary care, 2) expose pasantes to central concepts of global health and social medicine, and 3) foster career development of pasantes. Program components include supportive supervision, on-site mentorship, clinical information resources, monthly interactive seminars, and improved clinic function. We report quantitative and qualitative pasante survey data collected from February 2012 to August 2013 to discuss strengths and weaknesses of this program and its implications for the pasante workforce in Mexico. Pasantes reported that their medical knowledge, and clinical and leadership skills all improved during the CES education-support program. Most pasantes felt the program had an overall positive effect on their career goals and plans, although their self-report of preparedness for the Mexican residency entrance exam (ENARM) decreased during the social service year. One hundred percent reported they were satisfied with the CES-supported pasantía experience and wished to help the poor and underserved in their careers. Education-support programs similar to the CES program may encourage graduating medical students to complete their social service in underserved areas, improve the quality of care provided by pasantes, and address many of the known shortcomings of the pasantía. Additional efforts should focus on developing a strategy to expand this education-support model so that more pasantes throughout Mexico can experience a transformative, career-building, social service year.

Effect of Health Literacy on Decision-Making Preferences among Medically Underserved Patients.

PubMed

Seo, Joann; Goodman, Melody S; Politi, Mary; Blanchard, Melvin; Kaphingst, Kimberly A

2016-05-01

Participation in the decision-making process and health literacy may both affect health outcomes; data on how these factors are related among diverse groups are limited. This study examined the relationship between health literacy and decision-making preferences in a medically underserved population. We analyzed a sample of 576 primary care patients. Multivariable logistic regression was used to examine the independent association of health literacy (measured by the Rapid Estimate of Adult Literacy in Medicine-Revised) and patients' decision-making preferences (physician directed or patient involved), controlling for age, race/ethnicity, and gender. We tested whether having a regular doctor modified this association. Adequate health literacy (odds ratio [OR] = 1.7;P= 0.009) was significantly associated with preferring patient-involved decision making, controlling for age, race/ethnicity, and gender. Having a regular doctor did not modify this relationship. Males were significantly less likely to prefer patient-involved decision making (OR = 0.65;P= 0.024). Findings suggest health literacy affects decision-making preferences in medically underserved patients. More research is needed on how factors, such as patient knowledge or confidence, may influence decision-making preferences, particularly for those with limited health literacy. © The Author(s) 2016.

Using Health Information Technology to Reach Patients in Underserved Communities: A Pilot Study to Help Close the Gap with Health Disparities

PubMed Central

Ryan, Mark H.; Yoder, Jonathan; Flores, Sharon K.; Soh, Jason; Vanderbilt, Allison A.

2016-01-01

Introduction: In the current era of medical education and curriculum reform, medical schools across the United States are launching innovative approaches to teaching students in order to improve patient outcomes and increase patient safety. One such innovation is the use information technology (IT) that can be used to disseminate health information, especially for patients with limited access to care. Strategies for using health IT to enhance communication between providers and patients in low-income communities can be incorporated into undergraduate medical education (UME) curriculum. Methods: A pilot study was conducted to determine if IT could serve as an effective means of communication with patients at a free clinic where 100% of the patients are uninsured; the clinic is located in an urban setting and primarily serves Latinos, the working poor, and the homeless. An anonymous survey was administered to patients to assess rates of IT ownership, general IT use, and IT use for health and medical information. Results: The majority of study participants owned a cell phone (92%); one-third used their cell phone to access health or medical information (38%). Most study participants reported using the Internet (72%), and two-thirds had used the Internet to obtain health and medical information (64%). Conclusion: Given the difficulties faced by low income and medically underserved communities in accessing healthcare services, the use of IT tools may improve their’ access to health information in ways that could enhance patient knowledge and self-management, and perhaps positively impact health outcomes. Therefore, it is essential to incorporate use of IT tools in training for medical students and residents to enhance communication with patients in underserved communities. PMID:26755484

Using Health Information Technology to Reach Patients in Underserved Communities: A Pilot Study to Help Close the Gap With Health Disparities.

PubMed

Ryan, Mark H; Yoder, Jonathan; Flores, Sharon K; Soh, Jason; Vanderbilt, Allison A

2015-10-20

In the current era of medical education and curriculum reform, medical schools across the United States are launching innovative approaches to teaching students in order to improve patient outcomes and increase patient safety. One such innovation is the use information technology (IT) that can be used to disseminate health information, especially for patients with limited access to care. Strategies for using health IT to enhance communication between providers and patients in low-income communities can be incorporated into undergraduate medical education (UME) curriculum. A pilot study was conducted to determine if IT could serve as an effective means of communication with patients at a free clinic where 100% of the patients are uninsured; the clinic is located in an urban setting and primarily serves Latinos, the working poor, and the homeless. An anonymous survey was administered to patients to assess rates of IT ownership, general IT use, and IT use for health and medical information. The majority of study participants owned a cell phone (92%); one-third used their cell phone to access health or medical information (38%). Most study participants reported using the Internet (72%), and two-thirds had used the Internet to obtain health and medical information (64%). Given the difficulties faced by low income and medically underserved communities in accessing healthcare services, the use of IT tools may improve their' access to health information in ways that could enhance patient knowledge and self-management, and perhaps positively impact health outcomes. Therefore, it is essential to incorporate use of IT tools in training for medical students and residents to enhance communication with patients in underserved communities.

Satisfaction with cancer care among underserved racial-ethnic minorities and lower-income patients receiving patient navigation.

PubMed

Jean-Pierre, Pascal; Cheng, Ying; Wells, Kristen J; Freund, Karen M; Snyder, Frederick R; Fiscella, Kevin; Holden, Alan E; Paskett, Electra D; Dudley, Donald J; Simon, Melissa A; Valverde, Patricia A

2016-04-01

Patient navigation is a barrier-focused program of care coordination designed to achieve timely and high-quality cancer-related care for medically underserved racial-ethnic minorities and the poor. However, to the authors' knowledge, few studies to date have examined the relationship between satisfaction with navigators and cancer-related care. The authors included data from 1345 patients with abnormal cancer screening tests or a definitive cancer diagnosis who participated in the Patient Navigation Research Program to test the efficacy of patient navigation. Participants completed demographic questionnaires and measures of patient satisfaction with cancer-related care (PSCC) and patient satisfaction with interpersonal relationship with navigator (PSN-I). The authors obtained descriptive statistics to characterize the sample and conducted regression analyses to assess the degree of association between PSN-I and PSCC, controlling for demographic and clinical factors. Analyses of variance were conducted to examine group differences controlling for statistically significant covariates. Statistically significant relationships were found between the PSCC and PSN-I for patients with abnormal cancer screening tests (1040 patients; correlation coefficient (r), 0.4 [P<.001]) and those with a definitive cancer diagnosis (305 patients; correlation coefficient, 0.4 [P<.001]). The regression analysis indicated that having an abnormal colorectal cancer screening test in the abnormal screening test group and increased age and minority race-ethnicity status in the cancer diagnosis group were associated with a higher satisfaction with cancer care (P<.01). Satisfaction with navigators appears to be significantly associated with satisfaction with cancer-related care. Information regarding the patient-navigator relationship should be integrated into patient navigation programs to maximize the likelihood of reducing caner disparities and mortality for medically underserved racial-ethnic minorities and the poor. © 2016 American Cancer Society.

Satisfaction with Cancer Care Among Underserved Racial-Ethnic Minorities And Lower Income Patients Receiving Patient Navigation

PubMed Central

Jean-Pierre, Pascal; Cheng, Ying; Wells, Kristen J.; Freund, Karen M.; Snyder, Frederick R.; Fiscella, Kevin; Holden, Alan E.; Paskett, Electra; Dudley, Donald; Simon, Melissa A.; Valverde, Patricia

2016-01-01

BACKGROUND Patient navigation is a barrier-focused program of care coordination designed to achieve timely and high quality cancer-related care for medically underserved racial-ethnic minorities and the poor. However, few studies have examined the relationship between satisfaction with navigators and cancer-related care. METHODS We included data from 1,345 patients with abnormal cancer screening or definitive cancer diagnosis who participated in the Patient Navigation Research Program to test the efficacy of patient navigation. Participants completed demographic questionnaires and measures of Patient Satisfaction with Cancer-related Care (PSCC) and Patient Satisfaction with Interpersonal Characteristics of Navigators (PSN-I). We obtained descriptive statistics to characterize the sample, and conducted regression analyses to assess the degree of association between PSN-I and PSCC, controlling for demographic and clinical factors. We conducted analysis of variance to examine group differences controlling for statistically significant covariates. RESULTS We found statistically significant relationships between the PSCC and PSN-I for patients with abnormal cancer screening (N=1040, r=0.4, p<0.001) and definitive cancer diagnosis (N=305, r=0.4, p<0.001). The regression analysis showed that having abnormal colorectal cancer screening in the abnormal screening group and increased age and minority race-ethnicity status in the cancer diagnosis group were associated with higher satisfaction with cancer care (p<0.01). CONCLUSION Satisfaction with navigators is significantly associated with satisfaction with cancer-related care. Information about the patient-navigator relationship should be integrated in patient navigation programs to maximize the likelihood of reducing caner disparities and mortality for medically underserved racial-ethnic minorities and the poor. PMID:26849163

Improving child and adolescent psychiatry education for medical students: an inter-organizational collaborative action plan.

PubMed

Fox, Geraldine S; Stock, Saundra; Briscoe, Gregory W; Beck, Gary L; Horton, Rita; Hunt, Jeffrey I; Liu, Howard Y; Partner Rutter, Ashley; Sexson, Sandra; Schlozman, Steven C; Stubbe, Dorothy E; Stuber, Margaret L

2012-11-01

A new Child and Adolescent Psychiatry in Medical Education (CAPME) Task Force, sponsored by the Association for Directors of Medical Student Education in Psychiatry (ADMSEP), has created an inter-organizational partnership between child and adolescent psychiatry (CAP) educators and medical student educators in psychiatry. This paper outlines the task force design and strategic plan to address the long-standing dearth of CAP training for medical students. The CAPME ADMSEP Task Force, formed in 2010, identified common challenges to teaching CAP among ADMSEP's CAPME Task Force members, utilizing focus-group discussions and a needs-assessment survey. The Task Force was organized into five major sections, with inter-organizational action plans to address identified areas of need, such as portable modules and development of benchmark CAP competencies. The authors predict that all new physicians, regardless of specialty, will be better trained in CAP. Increased exposure may also improve recruitment into this underserved area.

"We can see a future here": Place attachment, professional identity, and forms of capital mobilized to deliver medical education in an underserviced area.

PubMed

Hanlon, Neil; Halseth, Greg; Snadden, David

2010-09-01

Community-integrated undergraduate medical education is becoming a more common option for students predisposed to practice in rural and small town places. One such initiative, the Northern Medical Program, has been operating since 2004 in the northern interior of British Columbia, Canada. The NMP's curriculum relies heavily on the involvement of practicing physicians in its host community, Prince George. Drawing on Bourdieu's conceptualization of capital in its different forms, the commitment of the local physician community is understood as social capital derived from cultural capital centred on a collective sense of professional identity forged by conditions of practice in an underserviced area. The findings of this study are discussed with respect to the long-term operation and success of community-integrated medical education programs. Copyright 2010 Elsevier Ltd. All rights reserved.

Pediatric and Adolescent Issues in Underserved Populations.

PubMed

Desai, Neerav; Romano, Mary Elizabeth

2017-03-01

Children and adolescents in underserved populations have health care risks that are different from those of the adult population. Providers need to be aware of these needs and the available resources. Providers should work with school and community organizations to provide timely and appropriate preventive health care and screen for medical and mental health problems that occur more commonly in these high-risk patient populations. Copyright © 2016 Elsevier Inc. All rights reserved.

A study protocol: using demand-side financing to meet the birth spacing needs of the underserved in Punjab Province in Pakistan

PubMed Central

2014-01-01

Background High fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women’s health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas. This paper presents a study protocol that describes an evaluation of a demand-side financing (DSF) voucher approach which aims to increase the uptake of modern contraception among women of the lowest two wealth quintiles in Punjab Province, Pakistan. Methods/Design This study will use quasi-experimental design with control arm and be implemented in: six government clinics from the Population Welfare Department; 24 social franchise facilities branded as ‘Suraj’ (Sun), led by Marie Stopes Society (a local non-governmental organization); and 12 private sector clinics in Chakwal, Mianwali and Bhakkar districts. The study respondents will be interviewed at baseline and endline subject to voluntary acceptance and medical eligibility. In addition, health service data will record each client visit during the study period. Discussion The study will examine the impact of vouchers in terms of increasing the uptake of modern contraception by engaging private and public sector service providers (mid-level and medical doctors). If found effective, this approach can be a viable solution to satisfying the current demand and meeting the unmet need for contraception, particularly among the poorest socio-economic group. PMID:24885657

Using simulation pedagogy to enhance teamwork and communication in the care of older adults: the ELDER project.

PubMed

Mager, Diana R; Lange, Jean W; Greiner, Philip A; Saracino, Katherine H

2012-08-01

The Expanded Learning and Dedication to Elders in the Region (ELDER) project addressed the needs of under-served older adults by educating health care providers in home health and long-term care facilities. Four agencies in a health professional shortage/medically underserved area participated. Focus groups were held to determine agency-specific educational needs. Curricula from the John A. Hartford Foundation were adapted to design unique curricula for each agency and level of personnel during the first 2 years. The focus of this report is the case-based simulation learning approach used in year 3 to validate application of knowledge and facilitate teamwork and interprofessional communication. Three simulation sessions on varying topics were conducted at each site. Postsimulation surveys and qualitative interviews with hired evaluators showed that participants found simulations helpful to their practice. Tailored on-site education incorporating mid-fidelity simulation was an effective model for translating gerontological knowledge into practice and encouraging communication and teamwork in these settings. Copyright 2012, SLACK Incorporated.

Why Aren't Our Digital Solutions Working for Everyone?

PubMed

Winkle, Brian Van; Carpenter, Neil; Moscucci, Mauro

2017-11-01

The article explores a digital injustice that is occurring across the country: that digital solutions intended to increase health care access and quality often neglect those that need them most. It further shows that when it comes to digital innovation, health care professionals and technology companies rarely have any incentives to focus on underserved populations. Nevertheless, we argue that the technologies that are leaving these communities behind are the same ones that can best support them. The key is in leveraging these technologies with: (a) design features that accommodate various levels of technological proficiency (e-literacy), (b) tech-enabled community health workers and navigators who can function as liaisons between patients and clinicians, and (c) analytics and customer relationship management tools that enable health care professionals and support networks to provide the right interventions to the right patients. Finally, we argue that community health care workers will need to be incentivized to play a larger role in building and adopting innovations targeting the underserved. © 2017 American Medical Association. All Rights Reserved.

Perspectives of Mobile Versus Fixed Mammography in Santa Clara County, California: A Focus Group Study.

PubMed

Chen, Yi-Ren; Chang-Halpenny, Christine; Kumarasamy, Narmadan A; Venegas, Angela; Braddock Iii, Clarence H

2016-02-12

Our aim was to examine underserved women's perceptions on mobile versus fixed mammography in Santa Clara, California through a focus group study.  Research has shown that medically underserved women have higher breast cancer mortality rates correlated with under-screening and a disproportional rate of late-stage diagnosis. The Community Health Partnership in Santa Clara County, California runs the Community Mammography Access Project (CMAP) that targets nearly 20,000 medically underserved women over the age of 40 in the county through the collaborative effort of an existing safety net of healthcare providers. However, little data exists on the advantages or disadvantages of mobile mammography units from the patient perspective.   We assessed underserved women's perspectives on mammography services in Santa Clara County through two focus groups from women screened at mobile or fixed site programs. Patients were recruited from both CMAP clinics and a county hospital, and focus group data were analyzed using content analysis.  We found that women from both the mobile and fixed sites shared similar motivating factors for getting a mammogram. Both groups recognized that screening was uncomfortable but necessary for good health and had positive feedback about their personal physicians. However, mobile participants, in particular, appreciated the atmosphere of mobile screening, reported shorter wait times, and remarked on the good communication from the clinic staff and empathetic treatment they received. However, mobile participants also expressed concern about the quality of films at mobile sites due to delayed initial reading of the films.   Mobile mammography offers a unique opportunity for women of underserved populations to access high satisfaction screenings, and it encourages a model similar to CMAP in other underserved areas. However, emphasis should be placed on providing a warm and welcoming environment for patients and ensuring the quality of mammography images.

Utilizing international medical graduates in health care delivery: brain drain, brain gain, or brain waste? A win-win approach at University of California, Los Angeles.

PubMed

Dowling, Patrick T; Bholat, Michelle Anne

2012-12-01

After identifying many unlicensed Hispanic international medical graduates (IMGs) legally residing in southern California, University of California, Los Angeles developed an innovative program to prepare these sidelined physicians to enter family medicine residency programs and become licensed physicians. On completion of a 3-year family medicine residency-training program, these IMGs have an obligation to practice in a federally designated underserved community in the state for 2 to 3 years. As the US health care system moves from physician-centered practices to patient-focused teams, with primary care serving as the foundation for building patient-centered medical homes, attention to educating IMGs in these concepts is crucial. Copyright © 2012 Elsevier Inc. All rights reserved.

Designing a community-based lay health advisor training curriculum to address cancer health disparities.

PubMed

Gwede, Clement K; Ashley, Atalie A; McGinnis, Kara; Montiel-Ishino, F Alejandro; Standifer, Maisha; Baldwin, Julie; Williams, Coni; Sneed, Kevin B; Wathington, Deanna; Dash-Pitts, Lolita; Green, B Lee

2013-05-01

Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. APPROACH AND STRATEGIES: Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic-community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program. Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research.

Engaging Community Stakeholders to Evaluate the Design, Usability, and Acceptability of a Chronic Obstructive Pulmonary Disease Social Media Resource Center

PubMed Central

Chaney, Beth; Chaney, Don; Paige, Samantha; Payne-Purvis, Caroline; Tennant, Bethany; Walsh-Childers, Kim; Sriram, PS; Alber, Julia

2015-01-01

Background Patients with chronic obstructive pulmonary disease (COPD) often report inadequate access to comprehensive patient education resources. Objective The purpose of this study was to incorporate community-engagement principles within a mixed-method research design to evaluate the usability and acceptability of a self-tailored social media resource center for medically underserved patients with COPD. Methods A multiphase sequential design (qual → QUANT → quant + QUAL) was incorporated into the current study, whereby a small-scale qualitative (qual) study informed the design of a social media website prototype that was tested with patients during a computer-based usability study (QUANT). To identify usability violations and determine whether or not patients found the website prototype acceptable for use, each patient was asked to complete an 18-item website usability and acceptability questionnaire, as well as a retrospective, in-depth, semistructured interview (quant + QUAL). Results The majority of medically underserved patients with COPD (n=8, mean 56 years, SD 7) found the social media website prototype to be easy to navigate and relevant to their self-management information needs. Mean responses on the 18-item website usability and acceptability questionnaire were very high on a scale of 1 (strongly disagree) to 5 (strongly agree) (mean 4.72, SD 0.33). However, the majority of patients identified several usability violations related to the prototype’s information design, interactive capabilities, and navigational structure. Specifically, 6 out of 8 (75%) patients struggled to create a log-in account to access the prototype, and 7 out of 8 patients (88%) experienced difficulty posting and replying to comments on an interactive discussion forum. Conclusions Patient perceptions of most social media website prototype features (eg, clickable picture-based screenshots of videos, comment tools) were largely positive. Mixed-method stakeholder feedback was used to make design recommendations, categorize usability violations, and prioritize potential solutions for improving the usability of a social media resource center for COPD patient education. PMID:25630449

HRSA's collaborative efforts with national organizations to expand primary care for the medically underserved.

PubMed Central

Crane, A B

1991-01-01

As the Federal agency that provides leadership in expanding access to primary health care, the Health Resources and Services Administration (HRSA) manages some 50 programs directed toward the delivery of services and strengthening the base of national health resources. An enabling element of the agency's strategy is the expansion of partnerships with national associations, private foundations, and other entities that share a concern for the health care of the medically underserved. Cooperative efforts with national organizations are intended to promote the integration of public and private resources and encourage adoption of efficient approaches to organizing and financing health care. Medical education in the primary care specialties, State programs for women and children, involvement of managed care organizations with low-income populations, and programs concerning the uninsured are the foci of some of these collaborative relationships. PMID:1899932

Personal values of family physicians, practice satisfaction, and service to the underserved.

PubMed

Eliason, B C; Guse, C; Gottlieb, M S

2000-03-01

Personal values are defined as "desirable goals varying in importance that serve as guiding principles in people's lives," and have been shown to influence specialty choice and relate to practice satisfaction. We wished to examine further the relationship of personal values to practice satisfaction and also to a physician's willingness to care for the underserved. We also wished to study associations that might exist among personal values, practice satisfaction, and a variety of practice characteristics. We randomly surveyed a stratified probability sample of 1224 practicing family physicians about their personal values (using the Schwartz values questionnaire), practice satisfaction, practice location, breadth of practice, demographics, board certification status, teaching involvement, and the payor mix of the practice. Family physicians rated the benevolence (motivation to help those close to you) value type highest, and the ratings of the benevolence value type were positively associated with practice satisfaction (correlation coefficient = 0.14, P = .002). Those involved in teaching medical trainees were more satisfied than those who were not involved (P = .009). Some value-type ratings were found to be positively associated with caring for the underserved. Those whose practices consisted of more than 40% underserved (underserved defined as Medicare, Medicaid, and indigent populations) rated the tradition (motivation to maintain customs of traditional culture and religion) value type significantly higher (P = .02). Those whose practices consisted of more than 30% indigent care rated the universalism (motivation to enhance and protect the well-being of all people) value type significantly higher (P = .03). Family physicians who viewed benevolence as a guiding principle in their lives reported a higher level of professional satisfaction. Likewise, physicians involved in the teaching of medical trainees were more satisfied with their profession. Family physicians who rate the universalism values highly are more likely to provide care to the indigent.

Unequal cancer survivorship care: addressing cultural and sociodemographic disparities in the clinic.

PubMed

Surbone, Antonella; Halpern, Michael T

2016-12-01

The number of individuals diagnosed with cancer is growing worldwide. Cancer patients from underserved populations have widely documented disparities through the continuum of cancer care. As the number of cancer survivors (i.e., individuals who have completed cancer treatment) from underserved populations also continue to grow, these individuals may continue to experience barriers to survivorship care, resulting in persistent long-term negative impacts on health and quality of life. In addition, there is limited participation of survivors from underserved populations in clinical trials and other research studies. To address disparities and change practices in survivorship care, a better understanding of the roles of both socioeconomic status (SES) and of culture in cancer care disparities and the relevance of these to providing high-quality care is needed. SES and culture often overlap but are not identical; understanding the impact of each is especially relevant to survivorship care. To enhance health equity among cancer survivors, clinicians need to practice culturally competent care, address cultural beliefs and practices that may influence survivors' beliefs and activities, gain awareness of historical patterns of medical care in the survivor's community, and consider how barriers to cross-cultural communications may hinder communication in clinical settings. While the design and implementation of survivorship care programs emphasizing effectiveness and equity is complex and potentially time consuming, it is critical for providing optimal care for all survivors, including those from the most vulnerable populations.

A day of immersive physiology experiments increases knowledge and excitement towards physiology and scientific careers in Native American students.

PubMed

Becker, Bryan K; Schiller, Alicia M; Zucker, Irving H; Eager, Eric A; Bronner, Liliana P; Godfrey, Maurice

2017-03-01

Underserved minority groups are disproportionately absent from the pursuit of careers in science, technology, engineering, and mathematics (STEM) fields. One such underserved population, Native Americans, are particularly underrepresented in STEM fields. Although recent advocacy and outreach designed toward increasing minority involvement in health care-related occupations have been mostly successful, little is known about the efficacy of outreach programs in increasing minority enthusiasm toward careers in traditional scientific professions. Furthermore, very little is known about outreach among Native American schools toward increasing involvement in STEM. We collaborated with tribal middle and high schools in South Dakota and Nebraska through a National Institutes of Health Science Education Partnership Award to hold a day-long physiology, activity-based event to increase both understanding of physiology and enthusiasm to scientific careers. We recruited volunteer biomedical scientists and trainees from the University of Nebraska Medical Center, Nebraska Wesleyan University, and University of South Dakota. To evaluate the effectiveness of the day of activities, 224 of the ~275-300 participating students completed both a pre- and postevent evaluation assessment. We observed increases in both students self-perceived knowledge of physiology and enthusiasm toward scientific career opportunities after the day of outreach activities. We conclude that activity-based learning opportunities in underserved populations are effective in increasing both knowledge of science and interest in scientific careers. Copyright © 2017 the American Physiological Society.

Healthcare provider perceptions of the role of interprofessional care in access to and outcomes of primary care in an underserved area.

PubMed

Wan, Shaowei; Teichman, Peter G; Latif, David; Boyd, Jennifer; Gupta, Rahul

2018-03-01

To meet the needs of an aging population who often have multiple chronic conditions, interprofessional care is increasingly adopted by patient-centred medical homes and Accountable Care Organisations to improve patient care coordination and decrease costs in the United States, especially in underserved areas with primary care workforce shortages. In this cross-sectional survey across multiple clinical settings in an underserved area, healthcare providers perceived overall outcomes associated with interprofessional care teams as positive. This included healthcare providers' beliefs that interprofessional care teams improved patient outcomes, increased clinic efficiency, and enhanced care coordination and patient follow-up. Teams with primary care physician available each day were perceived as better able to coordinate care and follow up with patients (p = .031), while teams that included clinical pharmacists were perceived as preventing medication-associated problems (p < .0001). Healthcare providers perceived the interprofessional care model as a useful strategy to improve various outcomes across different clinical settings in the context of a shortage of primary care physicians.

Feasibility of a psychosocial and patient navigation intervention to improve access to treatment among underserved breast cancer patients.

PubMed

Madore, Shannon; Kilbourn, Kristin; Valverde, Patricia; Borrayo, Evelinn; Raich, Peter

2014-08-01

Medically underserved women with recently diagnosed breast cancer face a number of significant obstacles that impact the timeliness and quality of their care. The Breast CARES (Cancer Advocacy, Resources Education and Support) intervention combined patient navigation with telephone counseling to guide newly diagnosed breast cancer patients in overcoming treatment barriers. The study aimed to learn more about the types of barriers encountered by the participants. The study also sought to understand the relationship between patient-reported barriers and patient-reported psychosocial distress in underserved women recently diagnosed with breast cancer. Data were analyzed using a mixed-methods approach. Participants were assessed pre- and post-intervention. Psychosocial measures included cancer-related distress, depression, anxiety, social support, and quality of life. Case notes and responses to process evaluation questions were used to determine whether the CARES intervention adequately addressed the needs of the participants. The mean age of participants (N = 20) was 54 years (SD = 12.5), 40% were Hispanic, 70% were unemployed, 50% were uninsured, and 20% were mono-lingual in Spanish. Qualitative analysis revealed four categories of barriers: psychosocial, medical, logistical, and communication. Similarities and differences existed between the PN and TC regarding how barriers were addressed. Post-intervention psychosocial scores indicate a decrease in depression and cancer-related distress and an increase in social support. The participants reported that participation in the Breast CARES program helped them overcome financial barriers (73%), transportation problems (60%), and communication barriers with medical staff (73%). This study demonstrates the unique and complementary roles for PNs and TCs in overcoming barriers to treatment adherence faced by underserved breast cancer patients.

Sustaining Family Physicians in Urban Underserved Settings.

PubMed

Getzin, Anne; Bobot, Bonnie L; Simpson, Deborah

2016-11-01

Our objective was to identify factors that sustain family physicians practicing in Milwaukee's underserved urban areas. Family physicians with clinical careers in Milwaukee's urban, underserved communities were identified and invited to participate in a 45-60 minute interview using a literature-based semi-structured protocol. Each interview was transcribed and de-identified prior to independent analysis using a grounded theory qualitative approach by two authors to yield sustaining themes. The project was determined not human subjects research per Aurora Health Care IRB. Sixteen family physicians were identified; six of 11 who met inclusion criteria agreed to interview. Four general domains central to sustaining family physicians working with underserved populations were identified: (1) cognitive traits and qualities (trouble shooting, resilience, flexibility), (2) core values (medicine as mechanism to address social justice), (3) skills (self-care, communication, clinical management), and (4) support systems (supportive family/employer, job flexibility, leadership opportunities, staff function as team). The formation of these personal attributes and skills was partly shaped by experiences (from childhood to medical training to work experience) and by personal drivers that varied by individual. Common was that the challenges of providing care in urban underserved settings was seen as rewarding in and of itself and aligned with these physicians' values and skills. Family physicians working with underserved populations described possessing a combination of values, cognitive qualities, skill sets, and support systems. While family physicians face complex challenges in quality care goals in urban underserved settings, training in the personal and professional skill sets identified by participants may improve physician retention in such communities.

Impact of a regional distributed medical education program on an underserved community: perceptions of community leaders.

PubMed

Toomey, Patricia; Lovato, Chris Y; Hanlon, Neil; Poole, Gary; Bates, Joanna

2013-06-01

To describe community leaders' perceptions regarding the impact of a fully distributed undergraduate medical education program on a small, medically underserved host community. The authors conducted semistructured interviews in 2007 with 23 community leaders representing, collectively, the education, health, economic, media, and political sectors. They reinterviewed six participants from a pilot study (2005) and recruited new participants using purposeful and snowball sampling. The authors employed analytic induction to organize content thematically, using the sectors as a framework, and they used open coding to identify new themes. The authors reanalyzed transcripts to identify program outcomes (e.g., increased research capacity) and construct a list of quantifiable indicators (e.g., number of grants and publications). Participants reported their perspectives on the current and anticipated impact of the program on education, health services, the economy, media, and politics. Perceptions of impact were overwhelmingly positive (e.g., increased physician recruitment), though some were negative (e.g., strains on health resources). The authors identified new outcomes and confirmed outcomes described in 2005. They identified 16 quantifiable indicators of impact, which they judged to be plausible and measureable. Participants perceive that the regional undergraduate medical education program in their community has broad, local impacts. Findings suggest that early observed outcomes have been maintained and may be expanding. Results may be applicable to medical education programs with distributed or regional sites in similar rural, remote, and/or underserved regions. The areas of impact, outcomes, and quantifiable indicators identified will be of interest to future researchers and evaluators.

Patient-centered health care using pharmacist-delivered medication therapy management in rural Mississippi.

PubMed

Ross, Leigh Ann; Bloodworth, Lauren S

2012-01-01

To describe and provide preliminary clinical and economic outcomes from a pharmacist-delivered patient-centered health care (PCHC) model implemented in the Mississippi Delta. Mississippi between July 2008 and June 2010. 13 community pharmacies in nine Mississippi Delta counties. This PCHC model implements a comprehensive medication therapy management (MTM) program with pharmacist training, individualized patient encounters and group education, provider outreach, integration of pharmacists into health information technology, and on-site support in community pharmacies in a medically underserved region with a large burden of chronic disease and health disparities. The program also expands on traditional MTM services through initiatives in health literacy/cultural competency and efforts to increase the provider network and improve access to care. Criteria-based clinical outcomes, quality indicator reports, cost avoidance. PCHC services have been implemented in 13 pharmacies in nine counties in this underserved region, and 78 pharmacists and 177 students have completed the American Pharmacists Association's MTM Certificate Training Program. Preliminary data from 468 patients showed 681 encounters in which 1,471 drug therapy problems were identified and resolved. Preliminary data for clinical indicators and economic outcome measures are trending in a positive direction. Preliminary data analyses suggest that pharmacist-provided PCHC is beneficial and has the potential to be replicated in similar rural communities that are plagued with chronic disease and traditional primary care provider shortages. This effort aligns with national priorities to reduce medication errors, improve health outcomes, and reduce health care costs in underserved communities.

Competency-Based Objectives in Global Underserved Women's Health for Medical Trainees.

PubMed

Chen, Chi Chiung Grace; Dougherty, Anne; Whetstone, Sara; Mama, Saifuddin T; Larkins-Pettigrew, Margaret; Raine, Susan P; Autry, Amy M

2017-10-01

The Association of Professors of Gynecology and Obstetrics Committee on Global Health developed an inclusive definition of global women's health and competency-based objectives that reflected work internationally, as well as with U.S. vulnerable and underserved populations, such as refugee and immigrant populations or those who would otherwise have compromised access to health care. The knowledge, skill, and attitude-based competencies required to fulfill each learning objective were mapped to the Accreditation Council for Graduate Medical Education Outcomes Project's educational domains and the Consortium of Universities for Global Health competency domains. The proposed global women's health definition and competency-based learning objective framework is a first step in ensuring quality standards for educating trainees to address global women's health needs. By proposing these objectives, we hope to guide future program development and spark a broader conversation that will improve health for vulnerable women and shape educational, ethical, and equitable global health experiences for medical trainees.

Recruiting Underserved Mothers to Medical Research: Findings from North Carolina

PubMed Central

Spears, Chaya R.; Sandberg, Joanne C.; O’Neill, Jenna L.; Grzywacz, Joseph G.; Howard, Timothy D.; Feldman, Steven R.; Arcury, Thomas A.

2014-01-01

Representative samples are required for ethical, valid, and useful health research. Yet, recruiting participants, especially from historically underserved communities, can be challenging. This paper presents findings from in-depth interviews with 40 mothers about factors that might influence their willingness to participate or allow their children to participate in medical research. Saliency analysis organizes the findings. Frequent and important salient themes about research participation included concerns that it might cause participants harm, hope that participants might gain a health benefit, and recognition that time and transportation resources could limit participation. Ultimately, we propose that a theoretical model, such as the Theory of Planned Behavior (TPB), will facilitate more systematic evaluation of effective methods for recruitment and retention of participants in medical research. Future research should explore the utility of such a model for development of effective recruitment and retention strategies. PMID:24185171

Urban Health Project: A Sustainable and Successful Community Internship Program for Medical Students.

PubMed

Roberts, Kasey; Park, Thomas; Elder, Nancy C; Regan, Saundra; Theodore, Sarah N; Mitchell, Monica J; Johnson, Yolanda N

2015-11-01

Urban Health Project (UHP) is a mission and vision-driven summer internship at the University of Cincinnati College of Medicine that places first-year medical students at local community agencies that work with underserved populations. At the completion of their internship, students write Final Intern Reflections (FIRs). Final Intern Reflections written from 1987 to 2012 were read and coded to both predetermined categories derived from the UHP mission and vision statements and new categories created from the data themselves. Comments relating to UHP's mission and vision were found in 47% and 36% of FIRs, respectively. Positive experiences outweighed negative by a factor of eight. Interns reported the following benefits: educational (53%), valuable (25%), rewarding (25%), new (10%), unique (6%), and life-changing (5%). Urban Health Project is successful in providing medical students with enriching experiences with underserved populations that have the potential to change their understanding of vulnerable populations.

Design of a pulse oximeter for price sensitive emerging markets.

PubMed

Jones, Z; Woods, E; Nielson, D; Mahadevan, S V

2010-01-01

While the global market for medical devices is located primarily in developed countries, price sensitive emerging markets comprise an attractive, underserved segment in which products need a unique set of value propositions to be competitive. A pulse oximeter was designed expressly for emerging markets, and a novel feature set was implemented to reduce the cost of ownership and improve the usability of the device. Innovations included the ability of the device to generate its own electricity, a built in sensor which cuts down on operating costs, and a graphical, symbolic user interface. These features yield an average reduction of over 75% in the device cost of ownership versus comparable pulse oximeters already on the market.

Promoting Teen Contraceptive Use by Intervention With Their Mothers.

PubMed

Crosby, Richard A; Collins, Tom; Stradtman, Lindsay R

2017-03-01

The purpose of this pilot study was to test a community outreach model designed to help mothers in a rural, medically underserved area navigate their teen daughters to health department services for long-acting reversible contraception (LARC) or alternative contraception. The pilot study used a single-group, post-test only design. Mothers of teen daughters (N=142) received a 1-hour, one-to-one intervention session (in outreach settings) from Community Liaisons. Mothers received training on how to communicate with their daughters about LARC and other contraceptive methods. Data were collected from June through October 2014, and analyzed in September 2015. The authors re-contacted 104 of 142 mothers enrolled in the study, achieving a 73.2% retention rate. Of these, 12.5% had daughters receiving LARC. An additional 11.0% had daughters with health department-verified initiation of birth control pills. Only one correlate-whether a mother believed her daughter was having sex-was associated with receiving either LARC or birth control pills. Among those indicating they knew their daughters were having sex, 31.7% of the daughters received LARC/birth control pills. By contrast, among mothers not indicating they knew their daughters were having sex, only 2.9% had daughters receiving LARC or birth control pills. Findings suggest that an outreach-based program delivered directly to mothers of teen daughters may be a highly effective method for enhancing service utilization of LARC and the initiation of birth control pill use in a rural, medically underserved area. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Pop Up/Drill Down: A Traveling Exhibit Designed to Reach Underserved Communities through Art and Geosciences

NASA Astrophysics Data System (ADS)

Kurtz, N.

2017-12-01

Scientists observe the world around them in an attempt to understand it. Artists observe the world around them in an attempt to create a reflection or response to the environment. It is critical for the two fields to work together in order to engage and inform the general population. The Consortium for Ocean Leadership, the International Ocean Discovery Program and a series of collaborators are designing a traveling exhibit that will inspire underserved communities in the excitement of exploration, the process of science, and the people and tools required to get there. The project aims to learn more about how to increase access to and awareness of ocean/earth science by bringing a pop-up style museum exhibit to local libraries and public events. As an artist with a science and education background and the graphic designer for this exhibit, this author will highlight the ways this project utilizes art and design to educate underserved populations in ocean and geosciences.

OCCUPATIONAL SAFETY AND HEALTH EDUCATION AND TRAINING FOR UNDERSERVED POPULATIONS

PubMed Central

O’CONNOR, TOM; FLYNN, MICHAEL; WEINSTOCK, DEBORAH; ZANONI, JOSEPH

2015-01-01

This article presents an analysis of the essential elements of effective occupational safety and health education and training programs targeting under-served communities. While not an exhaustive review of the literature on occupational safety and health training, the paper provides a guide for practitioners and researchers to the key factors they should consider in the design and implementation of training programs for underserved communities. It also addresses issues of evaluation of such programs, with specific emphasis on considerations for programs involving low-literacy and limited-English-speaking workers. PMID:25053607

Occupational safety and health education and training for underserved populations.

PubMed

O'Connor, Tom; Flynn, Michael; Weinstock, Deborah; Zanoni, Joseph

2014-01-01

This article presents an analysis of the essential elements of effective occupational safety and health education and training programs targeting underserved communities. While not an exhaustive review of the literature on occupational safety and health training, the paper provides a guide for practitioners and researchers to the key factors they should consider in the design and implementation of training programs for underserved communities. It also addresses issues of evaluation of such programs, with specific emphasis on considerations for programs involving low-literacy and limited-English-speaking workers.

Diversification of U.S. medical schools via affirmative action implementation

PubMed Central

Lakhan, Shaheen Emmanuel

2003-01-01

Background The diversification of medical school student and faculty bodies via race-conscious affirmative action policy is a societal and legal option for the U.S. Supreme Court has recently ruled its use constitutional. This paper investigates the implications of affirmative action, particularly race-conscious compared to race-blind admissions policy; explains how alternative programs are generally impractical; and provides a brief review of the history and legality of affirmative action in the United States. Discussion Selection based solely on academic qualifications such as GPA and MCAT scores does not achieve racial and ethnic diversity in medical school, nor does it adequately predict success as practicing physicians. However, race-conscious preference yields greater practice in underserved and often minority populations, furthers our biomedical research progression, augments health care for minority patients, and fosters an exceptional medical school environment where students are better able to serve an increasingly multicultural society. Summary The implementation of race-conscious affirmative action results in diversity in medicine. Such diversity has shown increased medical practice in underserved areas, thereby providing better health care for the American people. PMID:13678423

Final Report. [Training of Physicians for Rural Areas

DOE Office of Scientific and Technical Information (OSTI.GOV)

McLaughlin, Max, MD

2004-07-23

The purpose of the Southwest Alabama Medical Education Consortium (SAMEC) is to create an organization to operate a medical residency program focused on rural physician training. If successful, this program would also serve as a national model to address physician placement in other rural and underserved areas.

Navigating the digital divide: A systematic review of eHealth literacy in underserved populations in the United States.

PubMed

Chesser, Amy; Burke, Anne; Reyes, Jared; Rohrberg, Tessa

2016-01-01

eHealth provides an important mechanism to connect medically underserved populations with health information, but little is known about gaps in eHealth literacy research in underserved adult populations within the U.S. Between June and July 2013, three systematic literature reviews of five databases were conducted and a subsequent hand search was completed. Identified literature was screened and studies meeting exclusion and inclusion criteria were synthesized and analyzed for common themes. Of the 221 articles critically appraised, 15 met these criteria. Thirty-five of these studies were excluded due to international origin. Of the articles meeting the inclusion criteria, underserved populations assessed included immigrant women, the elderly, low-income, the un- and underemployed, and African-American and Hispanic populations. eHealth literacy assessments utilized included one or two item screeners, the eHEALS scale, health information competence and cognitive task analysis. Factors examined in relation to eHealth literacy included age, experience, overall health literacy, education, income and culture. The majority did not assess the impact of locality and those that did were predominately urban. These data suggest that there is a gap in the literature regarding eHealth literacy knowledge for underserved populations, and specifically those in rural locations, within the U.S.

Placement, support, and retention of health professionals: national, cross-sectional findings from medical and dental community service officers in South Africa.

PubMed

Hatcher, Abigail M; Onah, Michael; Kornik, Saul; Peacocke, Julia; Reid, Stephen

2014-02-26

In South Africa, community service following medical training serves as a mechanism for equitable distribution of health professionals and their professional development. Community service officers are required to contribute a year towards serving in a public health facility while receiving supervision and remuneration. Although the South African community service programme has been in effect since 1998, little is known about how placement and practical support occur, or how community service may impact future retention of health professionals. National, cross-sectional data were collected from community service officers who served during 2009 using a structured self-report questionnaire. A Supervision Satisfaction Scale (SSS) was created by summing scores of five questions rated on a three-point Likert scale (orientation, clinical advising, ongoing mentorship, accessibility of clinic leadership, and handling of community service officers' concerns). Research endpoints were guided by community service programmatic goals and analysed as dichotomous outcomes. Bivariate and multivariate logistical regressions were conducted using Stata 12. The sample population comprised 685 doctors and dentists (response rate 44%). Rural placement was more likely among unmarried, male, and black practitioners. Rates of self-reported professional development were high (470 out of 539 responses; 87%). Participants with higher scores on the SSS were more likely to report professional development. Although few participants planned to continue work in rural, underserved communities (n = 171 out of 657 responses, 25%), those serving in a rural facility during the community service year had higher intentions of continuing rural work. Those reporting professional development during the community service year were twice as likely to report intentions to remain in rural, underserved communities. Despite challenges in equitable distribution of practitioners, participant satisfaction with the compulsory community service programme appears to be high among those who responded to a 2009 questionnaire. These data offer a starting point for designing programmes and policies that better meet the health needs of the South African population through more appropriate human resource management. An emphasis on professional development and supervision is crucial if South Africa is to build practitioner skills, equitably distribute health professionals, and retain the medical workforce in rural, underserved areas.

Designing a Community-Based Lay Health Advisor Training Curriculum to Address Cancer Health Disparities

PubMed Central

Gwede, Clement K.; Ashley, Atalie A.; McGinnis, Kara; Montiel-Ishino, F. Alejandro; Standifer, Maisha; Baldwin, Julie; Williams, Coni; Sneed, Kevin B.; Wathington, Deanna; Dash-Pitts, Lolita; Green, B. Lee

2012-01-01

Introduction Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. Approach and Strategies Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic–community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program. Discussion and Conclusions Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research. PMID:22982709

Impact of Title VII Training Programs on Community Health Center Staffing and National Health Service Corps Participation

PubMed Central

Rittenhouse, Diane R.; Fryer, George E.; Phillips, Robert L.; Miyoshi, Thomas; Nielsen, Christine; Goodman, David C.; Grumbach, Kevin

2008-01-01

PURPOSE Community health centers (CHCs) are a critical component of the health care safety net. President Bush’s recent effort to expand CHC capacity coincides with difficulty recruiting primary care physicians and substantial cuts in federal grant programs designed to prepare and motivate physicians to practice in underserved settings. This article examines the association between physicians’ attendance in training programs funded by Health Resources and Services Administration (HRSA) Title VII Section 747 Primary Care Training Grants and 2 outcome variables: work in a CHC and participation in the National Health Service Corps Loan Repayment Program (NHSC LRP). METHODS We linked the 2004 American Medical Association Physician Master-file to HRSA Title VII grants files, Medicare claims data, and data from the NHSC. We then conducted retrospective analyses to compare the proportions of physicians working in CHCs among physicians who either had or had not attended Title VII–funded medical schools or residency programs and to determine the association between having attended Title VII–funded residency programs and subsequent NHSC LRP participation. RESULTS Three percent (5,934) of physicians who had attended Title VII–funded medical schools worked in CHCs in 2001–2003, compared with 1.9% of physicians who attended medical schools without Title VII funding (P<.001). We found a similar association between Title VII funding during residency and subsequent work in CHCs. These associations remained significant (P<.001) in logistic regression models controlling for NHSC participation, public vs private medical school, residency completion date, and physician sex. A strong association was also found between attending Title VII–funded residency programs and participation in the NHSC LRP, controlling for year completed training, physician sex, and private vs public medical school. CONCLUSIONS Continued federal support of Title VII training grant programs is consistent with federal efforts to increase participation in the NHSC and improve access to quality health care for underserved populations through expanded CHC capacity. PMID:18779543

Si, Se Puede! Preparing Teachers to Build Leadership among Underserved Students

ERIC Educational Resources Information Center

Duffy, Helen M.

2005-01-01

The High School Puente Project, one of several outreach efforts of the University of California, is an innovative program that is designed to assist traditionally underserved students. Puente builds on community and the idea of "familia" and features a strong component of professional developments for teachers as well as structural…

Building Interest in Math and Science for Rural and Underserved Elementary School Children Using Robots

ERIC Educational Resources Information Center

Matson, Eric; DeLoach, Scott; Pauly, Robyn

2004-01-01

The "Robot Roadshow Program" is designed to increase the interest of elementary school children in technical disciplines, specifically math and science. The program focuses on children from schools categorized as rural or underserved, which often have limited access to advanced technical resources. We developed the program using robots…

Attracting qualified physicians to underserved areas. Part 2. Pay physicians more to practice in underserved areas.

PubMed

Weil, T P

1999-01-01

With health networks searching for additional market share and with a projected 30.2 million to be enrolled in Medicaid HMOs by 2000, more health executives will be weighing various strategies of how to attract qualified physicians to practice in poor inner-city and rural areas. Most frequently cited as solutions are supplying more physicians, encouraging more medical school graduates to pursue primary care residencies, and modifying the number of international medical graduates entering U.S. residency programs. Part I of this article, which appeared in the November/December issue of The Physician Executive, reviewed the efficacy of these approaches. The second part explores a more pragmatic option: to simply improve the working conditions and pay substantially more to physicians who practice in "less desirable" locations. Although this idea is consistent with economic principles, drawbacks must be considered, such as: (1) the American taxpayers' reluctance to finance a more costly health care delivery system for the poor; (2) the inherent conceptual difficulties of a capitated Medicaid HMO serving as the linchpin for organizing, financing, and delivering care for the underserved; and, (3) many providers being expected to react in a fairly litigious manner to such an approach.

A study protocol: using demand-side financing to meet the birth spacing needs of the underserved in Punjab Province in Pakistan.

PubMed

Azmat, Syed Khurram; Ali, Moazzam; Hameed, Waqas; Mustafa, Ghulam; Abbas, Ghazanfer; Ishaque, Muhammad; Bilgrami, Mohsina; Temmerman, Marleen

2014-05-30

High fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women's health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas. This paper presents a study protocol that describes an evaluation of a demand-side financing (DSF) voucher approach which aims to increase the uptake of modern contraception among women of the lowest two wealth quintiles in Punjab Province, Pakistan. This study will use quasi-experimental design with control arm and be implemented in: six government clinics from the Population Welfare Department; 24 social franchise facilities branded as 'Suraj' (Sun), led by Marie Stopes Society (a local non-governmental organization); and 12 private sector clinics in Chakwal, Mianwali and Bhakkar districts. The study respondents will be interviewed at baseline and endline subject to voluntary acceptance and medical eligibility. In addition, health service data will record each client visit during the study period. The study will examine the impact of vouchers in terms of increasing the uptake of modern contraception by engaging private and public sector service providers (mid-level and medical doctors). If found effective, this approach can be a viable solution to satisfying the current demand and meeting the unmet need for contraception, particularly among the poorest socio-economic group.

Effect of Computer Support on Younger Women with Breast Cancer

PubMed Central

Gustafson, David H; Hawkins, Robert; Pingree, Suzanne; McTavish, Fiona; Arora, Neeraj K; Mendenhall, John; Cella, David F; Serlin, Ronald C; Apantaku, Funmi M; Stewart, James; Salner, Andrew

2001-01-01

OBJECTIVE Assess impact of a computer-based patient support system on quality of life in younger women with breast cancer, with particular emphasis on assisting the underserved. DESIGN Randomized controlled trial conducted between 1995 and 1998. SETTING Five sites: two teaching hospitals (Madison, Wis, and Chicago, Ill), two nonteaching hospitals (Chicago), and a cancer resource center (Indianapolis, Ill). The latter three sites treat many underserved patients. PARTICIPANTS Newly diagnosed breast cancer patients (N = 246) under age 60. INTERVENTIONS Experimental group received Comprehensive Health Enhancement Support System (CHESS), a home-based computer system providing information, decision-making, and emotional support. MEASUREMENTS AND MAIN RESULTS Pretest and two post-test surveys (at two- and five-month follow-up) measured aspects of participation in care, social/information support, and quality of life. At two-month follow-up, the CHESS group was significantly more competent at seeking information, more comfortable participating in care, and had greater confidence in doctor(s). At five-month follow-up, the CHESS group had significantly better social support and also greater information competence. In addition, experimental assignment interacted with several indicators of medical underservice (race, education, and lack of insurance), such that CHESS benefits were greater for the disadvantaged than the advantaged group. CONCLUSIONS Computer-based patient support systems such as CHESS may benefit patients by providing information and social support, and increasing their participation in health care. These benefits may be largest for currently underserved populations. PMID:11520380

Exploring the relationship between work environment, job satisfaction, and intent to stay of Jordanian nurses in underserved areas.

PubMed

AbuAlRub, Raeda; El-Jardali, Fadi; Jamal, Diana; Abu Al-Rub, Nawzat

2016-08-01

The aims of this study are to (1) examine the relationships between work environment, job satisfaction and intention to stay at work; and (2) explore the predicting factors of intention to stay at work among nurses in underserved areas. Developing and fostering creative work environment are paramount especially in underserved areas, where the work conditions present many challenges. A descriptive correlational design was utilized to collect data from 330 hospital nurses who worked in two underserved governorates in Jordan. A set of instruments were used to measure the variables of the study. The results showed a strong positive association between job satisfaction and work environment. The results of logistic regression indicated receiving housing, job satisfaction, and work environment were the predicting variables of the level of intention to stay at work. It is critical to improve work conditions and create a culture of supportive work environment in underserved area. Copyright © 2015 Elsevier Inc. All rights reserved.

T@lemed: Ehealth applications applied to underserved areas in Latin America

NASA Astrophysics Data System (ADS)

Sachpazidis, Ilias; Ohl, Roland; Binotto, Alécio Pedro Delazari; Torres, Márcio Soares; Messina, Luiz Ary; Sales, Alexandre; Gomes, Ricardo; Sakas, Georgios

2006-12-01

Access to medical care is sometimes very difficult to be reached from people living in rural and underserved areas. This problem is very well known in rural areas in Brazil. Citizens have no access to health care. They have to travel hundreds of kilometres to receive medical care. In this paper, we will propose a medical network based on state-of-the-art medical imaging application that addresses the problems of providing health care from a distance. Additionally, we are going to show preliminarily results of the first year of the system deployment and utilization in undeserved regions in Brazil. The total number of patients submitted to ultrasound examinations, during the 10 months of projects' medical trials, is 321. The exams have begun with the elderly people (hypertension and diabetes cases) with 90% above 50-years-old. Fifty-four percent were male and 46% were female. From those exams, 67 exams (21%) needed a second medical opinion and were transmitted to Santa Casa hospital in Porto Alegre, Brazil, one of the referral medical centres. From those second opinions of Santa Casa, 12 exams had to be repeated since the acquired images were not sufficient to give a correct diagnosis. The Lagoa Tres Cantos medical doctor performed also preventive exams with patients who had not presented any symptoms (70%).

Complementary and Alternative Medicine Use in Minority and Medically Underserved Oncology Patients: Assessment and Implications.

PubMed

Jones, Desiree; Cohen, Lorenzo; Rieber, Alyssa G; Urbauer, Diana; Fellman, Bryan; Fisch, Michael J; Nazario, Arlene

2018-06-01

Complementary and alternative medicine (CAM) use in minority and medically underserved oncology patients is not well documented. We assessed knowledge and utilization of CAM in a sample of these patients receiving treatment at an urban community hospital. Patients with cancer were interviewed using an electronic application that depicted specific CAM therapies. Patients were questioned on their knowledge and utilization of therapies, deterrents to use, and interest in using these therapies if they were made available. Patients (n = 165) reported a high awareness and use of CAM therapies. CAM use was highest for prayer (85%), relaxation (54%), special diet (29%), meditation (19%), and massage (18%). Patients' interest in using CAM was high for nearly all therapies. Lack of adequate knowledge and cost of use were reported as deterrents to use. Female patients reported higher use of aromatherapy relative to males (37.1% vs 19.4%, P = .02); those with higher education reported greater use of relaxation (60.8% vs 28.6%, P = .02); non-Hispanics reported higher use of relaxation relative to Hispanics (63.5% vs 44.2%, P = .03), and African American patients reported higher use of relaxation relative to White patients (69.2% vs 50%, P = .03). CAM use in minority and medically underserved cancer patients is common, but not professionally guided; thus, concerns remain regarding its safe use. Our data underscore the importance of patient-physician dialogue regarding CAM use in this patient population, and interest in access to the medically guided integration of evidence-based CAM therapies.

See, Test & Treat: A 5-Year Experience of Pathologists Driving Cervical and Breast Cancer Screening to Underserved and Underinsured Populations.

PubMed

Magnani, Barbarajean; Harubin, Beth; Katz, Judith F; Zuckerman, Andrea L; Strohsnitter, William C

2016-12-01

- See, Test & Treat is a pathologist-driven program to provide cervical and breast cancer screening to underserved and underinsured patient populations. This program is largely funded by the CAP Foundation (College of American Pathologists, Northfield, Illinois) and is a collaborative effort among several medical specialties united to address gaps in the current health care system. - To provide an outline for administering a See, Test & Treat program, using an academic medical center as a model for providing care and collating the results of 5 years of data on the See, Test & Treat program's findings. - Sources include data from patients seen at Tufts Medical Center (Boston, Massachusetts) who presented to the See, Test & Treat program and institutional data between 2010 and 2014 detailing the outline of how to organize and operationalize a volunteer cancer-screening program. - During the 5-year course of the program, 203 women were provided free cervical and breast cancer screening. Of the 169 patients who obtained Papanicolaou screening, 36 (21.3%) had abnormal Papanicolaou tests. In addition, 16 of 130 patients (12.3%) who underwent mammography had abnormal findings. - In general, women from ethnic populations have barriers that prevent them from participating in cancer screening. However, the CAP Foundation's See, Test & Treat program is designed to reduce those barriers for these women by providing care that addresses cultural, financial, and practical issues. Although screening programs are helpful in identifying those who need further treatment, obtaining further treatment for these patients continues to be a challenge.

The challenges of working in underserved areas: a qualitative exploratory study of views of policy makers and professionals.

PubMed

AbuAlRub, Raeda F; El-Jardali, Fadi; Jamal, Diana; Iblasi, Abdulkareem S; Murray, Susan F

2013-01-01

The inadequate number of health care providers, particularly nurses, in underserved areas is one of the biggest challenges for health policymakers. There is a scarcity of research in Jordan about factors that affect nurse staffing and retention in underserved areas. To elucidate the views of staff nurses working in underserved areas, directors of health facilities in underserved areas and key informants from the policy and education arena on issues of staffing and retention of nurses in underserved areas. An exploratory study using a qualitative approach with semi-structured interviews was utilized to elucidate the views of 22 key informants from the policy and education arena, 11 directors of health centers, and 19 staff nurses on issues that contribute to low staffing and retention of nurses in underserved areas. The five stage 'framework approach' proposed by Bryman et al. (1993) was utilized for data analysis. Nursing shortage in underserved areas in Jordan are exacerbated by a lack of financial incentives, poor transportation and remoteness of these areas, bad working conditions, and lack of health education institutions in these areas, as well as by opportunities for internal and external migration. Young Jordanian male nurses usually grab any opportunity to migrate and work outside the country to improve their financial conditions; whereas, female nurses are more restricted and not encouraged to travel abroad to work. Several strategies are suggested to enhance retention in these areas, such as promoting financial incentives for staff to work there, enhancing the transportation system, and promoting continuous and academic education. Nurses' administrators and health care policy makers could utilize the findings of the present study to design and implement comprehensive interventions to enhance retention of staff in underserved areas. Copyright © 2012 Elsevier Ltd. All rights reserved.

Application of Human Augmentics: A Persuasive Asthma Inhaler.

PubMed

Grossman, Brent; Conner, Steve; Mosnaim, Giselle; Albers, Joshua; Leigh, Jason; Jones, Steve; Kenyon, Robert

2017-03-01

This article describes a tailored health intervention delivered on a mobile phone platform, integrating low-literacy design strategies and basic principles of behavior change, to promote increased adherence and asthma control among underserved minority adolescents. We based the intervention and design principles on theories of Human Augmentics and the Elaboration Likelihood Model. We tested the efficacy of using electronic monitoring devices that incorporate informative and persuasive elements to improve adherence to a prescribed daily medication regimen intended to reduce use of asthma rescue medications. We describe the theoretical framework, hardware and software systems, and results of user testing for design purposes and a clinical pilot study incorporating use of the device and software by the targeted population. The results of the clinical pilot study showed an 83% completion rate for the treatment as well as improved adherence. Of note, 8% and 58% of participants achieved clinically significant adherence targets at baseline and last week of the study, respectively. Rescue asthma medication use decreased from a median of 3 puffs per week at baseline to 0 puffs per week during the last week of the study. Copyright © 2017 Elsevier Inc. All rights reserved.

42 CFR 417.124 - Administration and management.

Code of Federal Regulations, 2010 CFR

2010-10-01

... to organize, plan, control and evaluate the financial, marketing, health services, quality assurance... various age, social, and income groups within its service area. (2) If an HMO has a medically underserved...

Rural Medical Service Funding: Issues and Alternatives. Rural Information Center Publication Series, No. 7.

ERIC Educational Resources Information Center

Kane, John D. H., III, Comp.; Leuci, Mary Simon, Comp.

By almost any definition, rural America has been medically underserved. This bibliography includes materials available from the National Agricultural Library's (NAL) Rural Information Center. The listed materials include approximately 36 books and monographs, 106 articles, and the names and addresses of 17 related associations. Certain local…

A "Medical Mission" at Home: The Needs of Rural America in Terms of Otolaryngology Care

ERIC Educational Resources Information Center

Winters, Ryan; Pou, Anna; Friedlander, Paul

2011-01-01

Objectives: Describe the population, Medicaid, uninsured, and otolaryngology practice demographics for 7 representative rural Southeastern states, and propose academic-affiliated outreach clinics as a service to help meet the specialty care needs of an underserved rural population, based on the "medical mission" model employed in…

Non-physician communities in Japan: are they still disadvantaged?

PubMed

Kashima, S; Inoue, K; Matsumoto, M; Takeuchi, K

2014-01-01

Non-physician community' (NPC) is a policy term that indicates a medically underserved area in Japan. Designated NPCs are politically targeted as the foci of medical resource allocation. NPC is defined as a specified district where 50 or more persons dwell within a geographic diameter of 4 km and medical care is not easily accessible. The definition of NPC was first introduced in 1960 and has been unchanged for more than half a century despite radical social changes in rural Japan. This study examines whether designated NPCs are still more disadvantaged in terms of geographical access to healthcare in comparison to other communities. Hiroshima prefecture, which has the largest number of NPCs in terms of tertiary healthcare areas of Japan, was used as the study area. Targeted communities were all the NPCs in the prefecture, and, as controls, two community groups were selected: non-NPC adjacent to NPC, and municipal center. We measured driving time from NPCs and control communities to the nearest healthcare facilities, which were classified into the following two types: primary or secondary care facilities (n=2636) and tertiary care facilities (equal to tertiary emergency care centers; n=6). We further calculated the driving time to the nearest facilities for secondary emergency care (n=246) extracted from the 2636 primary or secondary care facilities. The median driving times to the nearest primary or secondary healthcare facility for NPC, non-NPC, and municipal center were 11 minutes, 11 minutes, and 1 minute, respectively; the times to a tertiary healthcare facility (equal to an accident and emergency care center) were 80 minutes, 84 minutes, and 68 minutes, respectively; and the times to a secondary emergency care facility were 24 minutes, 18 minutes, and 15 minutes, respectively. Although a municipal center was significantly more advantageous in driving time compared to a primary or secondary care facility, the disadvantage of a NPC in access was no more obvious than an adjacent non-NPC for any type of healthcare facility. NPCs had a disadvantage in access time to primary, secondary and tertiary medical care compared with a municipal center. NPCs, however, did not have a greater access disadvantage in comparison to adjacent rural communities for any type of medical facility. As such, future resource allocation policies in Japan need to redefine medically underserved communities.

Colorectal cancer screening among the medically underserved.

PubMed

Wolf, Michael S; Satterlee, Melissa; Calhoun, Elizabeth A; Skripkauskas, Silvia; Fulwiler, Daniel; Diamond-Shapiro, Linda; Alvarez, Hugo; Eder, Mickey; Mukundan, Padmanabhan

2006-02-01

Prevalence of physician recommendation and patient completion of colorectal cancer screening was investigated among Federally Qualified Health Centers (FQHC) serving low-income neighborhoods in Chicago. Medical records of 3,416 patients receiving primary care services at 1 of 31 FQHCs were randomly chosen for review. In all, 642 patients were identified by age and family history as eligible for colorectal cancer screening and included in this study. Patient demographic information and colorectal cancer screening history were collected. The physician screening recommendation rate was 9.2% (n=59); 7.0% (n=45) of patients were determined to have been appropriately screened for colorectal cancer, primarily by Fecal Occult Blood Test (94.1%, n=43). Among patients who received a recommendation from their physician, 76.2% had completed a screening test. Older patients were more likely than their younger counterparts to have received a recommendation from their physician (p<.05) and to have been screened (p<.01). Organizational interventions are needed to support physicians in medically underserved areas and to promote recommended screening practices.

Disseminating relevant health information to underserved audiences: implications of the Digital Divide Pilot Projects*

PubMed Central

Kreps, Gary L.

2005-01-01

Objective: This paper examines the influence of the digital divide on disparities in health outcomes for vulnerable populations, identifying implications for medical and public libraries. Method: The paper describes the results of the Digital Divide Pilot Projects demonstration research programs funded by the National Cancer Institute to test new strategies for disseminating relevant health information to underserved and at-risk audiences. Results: The Digital Divide Pilot Projects field-tested innovative systemic strategies for helping underserved populations access and utilize relevant health information to make informed health-related decisions about seeking appropriate health care and support, resisting avoidable and significant health risks, and promoting their own health. Implications: The paper builds on the Digital Divide Pilot Projects by identifying implications for developing health communication strategies that libraries can adopt to provide digital health information to vulnerable populations. PMID:16239960

Grantee Spotlight: Elisa Rodriguez, Ph.D., M.S.

Cancer.gov

Dr. Elisa M. Rodriguez tests the feasibility of community-based participatory research approaches to engaging Hispanics, African Americans, and the medically underserved in the Buffalo, NY area in biospecimen donation for cancer research.

Physical activity promotion among underserved adolescents: "make it fun, easy, and popular".

PubMed

Louise Bush, Paula; Laberge, Suzanne; Laforest, Sophie

2010-05-01

There is a paucity of studies regarding noncurricular physical activity promotion interventions among adolescents, and even less such research pertaining to underserved youth. This article describes the development and implementation of a noncurricular, school-based physical activity promotion program designed for a multiethnic, underserved population of adolescents. The program's impact on leisure-time physical activity (LTPA) and on physical activity enjoyment (PAE) is also presented. The 16-week program, named FunAction, utilizes social marketing principles. Control (n = 90) and intervention (n = 131) students are assessed pre- and postintervention for levels of LTPA and PAE. Results indicate that although the program did not contribute to an increase in LTPA or PAE among intervention group students, participation in the program was elevated. This study offers preliminary evidence that noncurricular physical activity promotion programs that apply social marketing principles can be effective in engaging multiethnic, underserved adolescents in physical activity.

77 FR 2734 - Health Information Technology Implementation

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-19

... Information Technology Implementation AGENCY: Health Resources and Services Administration, HHS. ACTION... Technology Implementation for Health Center Controlled Networks (HCCN) funds originally awarded to Community... advance information technology resources of the Tennessee's medically underserved communities, TPCA has...

Streptococcal Infections, Rheumatic Fever and School Health Services.

ERIC Educational Resources Information Center

Markowitz, Milton

1979-01-01

Because rheumatic fever is a potentially serious complication of a streptococcal sore throat which can lead to permanent heart disease, this article advocates the expansion of school health services in medically underserved areas. (JMF)

Preparing Medical Students to Undertake a Cultural Immersion Experience: Introducing Frameworks for Preparatory and Post-Immersion Activities

ERIC Educational Resources Information Center

Mak, Donna B.; Watson, Rashmi; Hadden, John

2011-01-01

Recruiting and retaining practitioners to rural and remote locations is a challenge for many industries including health and education. The medical, nursing and teaching professions have utilized immersion experiences for trainees and students to better prepare them and to address workforce shortages in crosscultural and underserved areas. This…

The utility of rural and underserved designations in geospatial assessments of distance traveled to healthcare services: implications for public health research and practice.

PubMed

Smith, Matthew Lee; Dickerson, Justin B; Wendel, Monica L; Ahn, Sangnam; Pulczinski, Jairus C; Drake, Kelly N; Ory, Marcia G

2013-01-01

Health disparities research in rural populations is based on several common taxonomies identified by geography and population density. However, little is known about the implications of different rurality definitions on public health outcomes. To help illuminate the meaning of different rural designations often used in research, service delivery, or policy reports, this study will (1) review the different definitions of rurality and their purposes; (2) identify the overlap of various rural designations in an eight-county Brazos Valley region in Central Texas; (3) describe participant characteristic profiles based on distances traveled to obtain healthcare services; and (4) examine common profile characteristics associated with each designation. Data were analyzed from a random sample from 1,958 Texas adults participating in a community assessment. K-means cluster analysis was used to identify natural groupings of individuals based on distance traveled to obtain three healthcare services: medical care, dental care, and prescription medication pick-up. Significant variation in cluster representation and resident characteristics was observed by rural designation. Given widely used taxonomies for designating areas as rural (or provider shortage) in health-related research, this study highlights differences that could influence research results and subsequent program and policy development based on rural designation.

Psychosocial needs of ethnic minority, inner-city, pediatric cancer patients.

PubMed

Moody, Karen; Mannix, Margaret M; Furnari, Nicole; Fischer, Judith; Kim, Mimi; Moadel, Alyson

2011-09-01

Limited data are available regarding the psychosocial impact of cancer on families of culturally diverse backgrounds living in medically underserved communities. The unique psychosocial needs of families of children with cancer from an ethnically diverse inner-city population is the focus of this study. The prevalence of psychosocial needs among a multi-cultural, inner-city sample of children and adolescents with cancer and their parents was assessed using a modified version of the Psychosocial Needs Assessment Survey. All patients were recruited from the Children's Hospital at Montefiore located in Bronx, NY, a designated medically underserved community. Seventy-eight percent of parents reported unmet informational needs. The three most commonly endorsed informational needs by parents and children were regarding dietary management of acute side effects, late effects of having cancer and secondary cancer prevention. Less educated parents reported greater unmet supportive, practical, and spiritual needs than those with more education. Fathers had greater informational and practical needs than mothers and younger parents had more practical needs than older parents. Endorsement of spiritual needs was lower for both children and parents compared with supportive, informational, or practical needs. Given the high prevalence of reported unmet informational needs, efforts should be made to provide patients and families with education tailored to their informational needs and level of education. This population may benefit from psychoeducational interventions, including community-based informational and peer support groups. Such interventions may augment efforts to lessen health gaps experienced in this population.

Pioneering and Interprofessional Pediatric Dentistry Programs Aimed at Reducing Oral Health Disparities.

PubMed

Ramos-Gomez, Francisco; Askaryar, Hamida; Garell, Cambria; Ogren, Jennifer

2017-01-01

Early Childhood Caries (ECC) is the most chronic childhood disease and more predominant in low-income and underserved children. Although easily transmitted, ECC is entirely preventable. Dr. Ramos-Gomez and his team at the University of California, Los Angeles put together an interprofessional curriculum where both medical and dental knowledge and practice is integrated to prepare dentists and primary care providers to more cost effectively address ECC and thereby reduce disparities in oral health. The curriculum, known as the Strategic Partnership for Interprofessional Collaborative Education in Pediatric Dentistry (SPICE-PD), consists of nine evidence-based training modules: applied statistics and research, community partners, interprofessional education/training, quality improvement, policy and advocacy, disease management/risk assessment, ethics/professionalism, cultural competency and children with special heath-care needs. SPICE aims to prepare pediatric dental residents and primary care providers to provide preventive, culturally competent, and minimally invasive oral care for underserved, low income, and special needs children. Additionally, the Infant Oral Care Program (IOCP), located at a local community health clinic, provides culturally sensitive preventive oral health care for children aged 0-5 years. The medical-dental integration model utilized at IOCP helps reduce oral health disparities by providing a systems-based and cost-effective approach to combat the burden of ECC. To track the progress of SPICE, a comprehensive evaluation framework has been designed, which aligns goals and objectives with program activities, desired outcomes, and measured indicators.

Lessons learned from a successful MEDRETE in El Salvador.

PubMed

Post, James C; Melendez, Manuel E; Hershey, Donna N; Hakim, Abdul

2003-04-01

Medical readiness education and training exercises are short-term exercises designed to provide health care and preventive medicine education to underserved civilian populations overseas. These high profile missions provide superb training opportunities, build democracies, and can be a powerful incentive to retain soldiers in the Reserves. Despite this, the literature offers little guidance in terms of how to best conduct a MEDRETE, particularly with a unit that has not been recently deployed. A U.S. Army Reserve unit was deployed to El Salvador following two devastating earthquakes and treated 20,890 patients in 10 days. This patient volume was achieved by a close cooperative effort among an experienced Mission Coordinator and Reservists and superb host nation support. Lessons learned regarding predeployment, deployment, patient management, and safety issues are presented to assist future units in conducting successful medical readiness education and training exercises.

Community as client: reaching an underserved urban community and meeting unmet primary health care needs.

PubMed

Aponte, Judith; Nickitas, Donna M

2007-01-01

In a collaborative effort to address the health disparities within 1 urban underserved community, the Hunter-Bellevue School of Nursing, Hunter College, and the Mount Sinai Medical Center organized a health fair. Nursing faculty worked side by side with undergraduate nursing students to offer several health promotion activities, screening, and educational sessions for residents of East Harlem, New York. In addition, nursing students provided individual patient education on nutrition, hand washing hygiene, medication review, and glucometer usage. Educational materials on lifestyle issues (sample meals, maintaining normal blood glucose, blood pressure, cholesterol levels, and smoking cessation) were provided. To help bridge the gap between health education and health promotion activities, nursing students, many of whom were bilingual, served as translators for non-English speaking Spanish and Chinese residents. In addition to the new professional partnerships developed, new clinical placements for nursing students were established.

A national patient navigator training program.

PubMed

Calhoun, Elizabeth A; Whitley, Elizabeth M; Esparza, Angelina; Ness, Elizabeth; Greene, Amanda; Garcia, Roland; Valverde, Patricia A

2010-03-01

Patient Navigation is an intervention aimed at addressing cancer health disparities by eliminating barriers to diagnosis, treatment, and services. Three major patient navigation (PN) programs (The National Cancer Institute, The American Cancer Society &The Center for Medicare and Medicaid Services) are underway to address the needs of medically underserved cancer patients. There has not been national training with a defined curriculum for patient navigators (PNs). Curriculum for training the PNs was created by experts from the three programs. The efficacy of training was evaluated using a pre- and posttest. The data show that overall the posttest scores improved from the pretest. In addition, having a high school education or greater or having more years of work experience were significantly related to improvements on the posttest. The first successful standardized national training program was attended by 116 PNs representing 85 cities with the goal to reduce health disparities for medically underserved.

Exploring the financial impact of breast cancer for African American medically underserved women: a qualitative study.

PubMed

Darby, Kathleen; Davis, Cindy; Likes, Wendy; Bell, John

2009-08-01

In addition to the physical suffering experienced by cancer survivors, there are considerable financial hardships and access barriers to quality health care. The current study explored the financial burden of breast cancer on African American medically underserved women. Four focus groups were conducted in three major cities across Tennessee. Research participants (N=36) were recruited by the staff of cancer support and treatment programs in the area. Findings revealed that participants' lack of insurance or inadequate insurance resulted in missed, delayed, or fewer treatment opportunities. The financial burden of cancer was not limited to the acute treatment phase. The women in the current study reported extreme economic hardship resulting from this disease into long-term survivorship. This exploratory study confirms the importance of providing care across the continuum to address the complex needs of low-income cancer survivors.

The Philadelphia Glaucoma Detection and Treatment Project

PubMed Central

Waisbourd, Michael; Pruzan, Noelle L.; Johnson, Deiana; Ugorets, Angela; Crews, John E.; Saaddine, Jinan B.; Henderer, Jeffery D.; Hark, Lisa A.; Katz, L. Jay

2016-01-01

Purpose To evaluate the detection rates of glaucoma-related diagnoses and the initial treatments received in the Philadelphia Glaucoma Detection and Treatment Project, a community-based initiative aimed at improving the detection, treatment, and follow-up care of individuals at risk for glaucoma. Design Retrospective analysis. Participants A total of 1649 individuals at risk for glaucoma who were examined and treated in 43 community centers located in underserved communities of Philadelphia. Methods Individuals were enrolled if they were African American aged ≥50 years, were any other adult aged ≥60 years, or had a family history of glaucoma. After attending an informational glaucoma workshop, participants underwent a targeted glaucoma examination including an ocular, medical, and family history; visual acuity testing, intraocular pressure (IOP) measurement, and corneal pachymetry; slit-lamp and optic nerve examination; automated visual field testing; and fundus color photography. If indicated, treatments included selective laser trabeculoplasty (SLT), laser peripheral iridotomy (LPI), or IOP-lowering medications. Follow-up examinations were scheduled at the community sites after 4 to 6 weeks or 4 to 6 months, depending on the clinical scenario. Main Outcome Measures Detection rates of glaucoma-related diagnoses and types of treatments administered. Results Of the 1649 individuals enrolled, 645 (39.1%) received a glaucoma-related diagnosis; 20.0% (n = 330) were identified as open-angle glaucoma (OAG) suspects, 9.2% (n = 151) were identified as having narrow angles (or as a primary angle closure/suspect), and 10.0% (n = 164) were diagnosed with glaucoma, including 9.0% (n = 148) with OAG and 1.0% (n = 16) with angle-closure glaucoma. Overall, 39.0% (n = 64 of 164) of those diagnosed with glaucoma were unaware of their diagnosis. A total of 196 patients (11.9%) received glaucoma-related treatment, including 84 (5.1%) who underwent LPI, 13 (0.8%) who underwent SLT, and 103 (6.2%) who were prescribed IOP-lowering medication. Conclusions Targeting individuals at risk for glaucoma in underserved communities in Philadelphia yielded a high detection rate (39.1%) of glaucoma-related diagnoses. Providing examinations and offering treatment, including first-line laser procedures, at community-based sites providing services to older adults are effective to improve access to eye care by underserved populations. PMID:27221736

Guidelines for research recruitment of underserved populations (EERC).

PubMed

Matsuda, Yui; Brooks, Jada L; Beeber, Linda S

2016-11-01

Despite concerted efforts to establish health equity, significant disparities persist. One roadblock to eliminating health disparities is the inadequate recruitment of underserved populations, which prevents researchers from creating culturally-tailored interventions. To further develop the science of recruitment, we argue that a systematic approach should be applied to research participant recruitment. Given the lack of practical and comprehensive recruitment conceptual frameworks or guidelines in the literature, the authors propose newly synthesized guidelines for research recruitment of underserved populations: EERC (evaluate, engage, reflect, and carefully match). The EERC guidelines are delineated, and the application of these guidelines is illustrated through a study recently conducted by the authors. The guidelines consist of the following four components: 1. Evaluate the composition of the research team; 2. Engage fully with the community by working with key informants and cultural insiders; 3. Reflect the unique cultural characteristics of the community in the research conduct; and 4. Carefully use a matching technique. The application component of the article demonstrates concrete examples of how the guidelines can enhance research recruitment for an underserved population. The authors intend these guidelines to be broadly applicable for research teams regardless of research design or characteristics of the underserved population. Application of these guidelines in nursing and health science will contribute to increasing research recruitment of underserved populations, with the goal of reducing health disparities and achieving health equity for all persons. Copyright © 2016 Elsevier Inc. All rights reserved.

Factors associated with differential uptake of seasonal influenza immunizations among underserved communities during the 2009-2010 influenza season.

PubMed

Vlahov, David; Bond, Keosha T; Jones, Kandice C; Ompad, Danielle C

2012-04-01

Influenza vaccination coverage remains low and disparities persist. In New York City, a community-based participatory research project (Project VIVA) worked to address this issue in Harlem and the South Bronx by supplementing existing vaccination programs with non-traditional venues (i.e., community-based organizations). We conducted a 10 min survey to assess access to influenza vaccine as well as attitudes and beliefs towards influenza vaccination that could inform intervention development for subsequent seasons. Among 991 participants recruited using street intercept techniques, 63% received seasonal vaccine only, 11% seasonal and H1N1, and 26% neither; 89% reported seeing a health care provider (HCP) during the influenza season. Correlates of immunization among those with provider visits during the influenza season included being US-born, interest in getting the vaccine, concern about self or family getting influenza, an HCP's recommendation and comfort with government. Among those without an HCP visit, factors associated with immunization included being US born, married, interest in getting the vaccine, understanding influenza information, and concern about getting influenza. Factors associated with lack of interest in influenza vaccine included being born outside the US, Black and uncomfortable with government. In medically underserved areas, having access to routine medical care and understanding the medical implications of influenza play an important role in enhancing uptake of seasonal influenza vaccination. Strategies to improve vaccination rates among Blacks and foreign-born residents need to be addressed. The use of non-traditional venues to provide influenza vaccinations in underserved communities has the potential to reduce health disparities.

Enhancing student perspectives of humanism in medicine: reflections from the Kalaupapa service learning project.

PubMed

Lee, Winona K; Harris, Chessa C D; Mortensen, Kawika A; Long, Linsey M; Sugimoto-Matsuda, Jeanelle

2016-05-09

Service learning is endorsed by the Liaison Committee on Medical Education (LCME) as an integral part of U.S. medical school curricula for future physicians. Service learning has been shown to help physicians in training rediscover the altruistic reasons for pursuing medicine and has the potential to enhance students' perspectives of humanism in medicine. The Kalaupapa service learning project is a unique collaboration between disadvantaged post-baccalaureate students with an underserved rural community. This study was conducted to determine whether the Kalaupapa service learning curricula enhanced student perspectives of humanism in medicine at an early stage of their medical training. Program participants between 2008 and 2014 (n = 41) completed written reflections following the conclusion of the service learning project. Four prompts guided student responses. Reflections were thematically analyzed. Once all essays were read, team members compared their findings to condense or expand themes and assess levels of agreement. Emerging themes of resilience and unity were prominent throughout the student reflections. Students expressed respect and empathy for the patients' struggles and strengths, as well as those of their peers. The experience also reinforced students' commitment to service, particularly to populations in rural and underserved communities. Students also gained a deeper understanding of the patient experience and also of themselves as future physicians. To identify and address underserved and rural patients' health care needs, training programs must prepare an altruistic health care workforce that embraces the humanistic element of medicine. The Kalaupapa service learning project is a potential curricular model that can be used to enhance students' awareness and perspectives of humanism in medicine.

Leveraging Behavioral Health Expertise: Practices and Potential of the Project ECHO Approach to Virtually Integrating Care in Underserved Areas.

PubMed

Hager, Brant; Hasselberg, Michael; Arzubi, Eric; Betlinski, Jonathan; Duncan, Mark; Richman, Jennifer; Raney, Lori E

2018-04-01

This column describes Project ECHO (Extension for Community Healthcare Outcomes), a teleconsultation, tele-education, telementoring model for enhancing primary care treatment of underserved patients with complex medical conditions. Numerous centers have adapted ECHO to support primary care treatment of behavioral health disorders. Preliminary evidence for behavioral health ECHO programs suggests positive impacts on providers, treatment planning, and emergency department costs. ECHO has the potential to improve access to effective and cost-effective behavioral health care by virtually integrating behavioral health knowledge and support in sites where specialty providers are not available. Patient-level outcomes research is critical.

Chronic disease management in rural and underserved populations: innovation and system improvement help lead to success.

PubMed

Bolin, Jane; Gamm, Larry; Kash, Bita; Peck, Mitchell

2005-03-01

Successful implementation of disease management (DM) is based on the ability of an organization to overcome a variety of barriers to deliver timely, appropriate care of chronic illnesses. Such programs initiate DM services to patient populations while initiating self-management education among medication-resistant patients who are chronically ill. Despite formidable challenges, rural health care providers have been successful in initiating DM programs and have discovered several ways in which these programs benefit their organizations. This research reports on six DM programs that serve large rural and underserved populations and have demonstrated that DM can be successfully implemented in such areas.

Preparing Historically Underserved Students for STEM Careers: The Role of an Inquiry-based High School Science Sequence Beginning with Physics

NASA Astrophysics Data System (ADS)

Bridges, Jon P.

Improving the STEM readiness of students from historically underserved groups is a moral and economic imperative requiring greater attention and effort than has been shown to date. The current literature suggests a high school science sequence beginning with physics and centered on developing conceptual understanding, using inquiry labs and modeling to allow students to explore new ideas, and addressing and correcting student misconceptions can increase student interest in and preparation for STEM careers. The purpose of this study was to determine if the science college readiness of historically underserved students can be improved by implementing an inquiry-based high school science sequence comprised of coursework in physics, chemistry, and biology for every student. The study used a retrospective cohort observational design to address the primary research question: are there differences between historically underserved students completing a Physics First science sequence and their peers completing a traditional science sequence in 1) science college-readiness test scores, 2) rates of science college-and career-readiness, and 3) interest in STEM? Small positive effects were found for all three outcomes for historically underserved students in the Physics First sequence.

Social responsibility and the academic medical center: building community-based systems for the nation's health.

PubMed

Foreman, S

1994-02-01

Academic medical centers have fulfilled several of their missions with immense success but have failed to fulfill others. They have responded only modestly to the needs of the nation's underserved rural and urban communities. The author calls on academic medical centers to take an aggressively active role in building the medical infrastructure now missing in these communities and outlines a multi-part agenda for institutional commitment. It includes developing community-based systems of primary care, outreach programs, and social supports; training professionals committed to serving isolated and poor communities; and performing research that will extend the knowledge base to include the health and social issues of the disadvantaged. (Examples are given of institutions that have pioneered these kinds of community-based activities.) To build the new infrastructure, financing must be secured (various sources are discussed), a community-based faculty must be developed, and each institution's leadership--the medical school dean, the hospital executive, and the department chairmen--must come together around a new agenda and support it materially and psychologically, making whatever changes are needed in the corporate culture. The author warns that if centers do not undertake this responsibility for the health of the underserved, a critical job will go undone, a huge opportunity will have been missed, and American society will be the poorer.

12 CFR 563e.12 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... moderate-income geographies; (ii) Designated disaster areas; or (iii) Distressed or underserved, nonmetropolitan middle-income geographies designated by OTS based on— (A) Rates of poverty, unemployment, and...

Evaluating distributed medical education: what are the community's expectations?

PubMed

Lovato, Chris; Bates, Joanna; Hanlon, Neil; Snadden, David

2009-05-01

This study aimed to explore community members' perceptions of present and future impacts of the implementation of an undergraduate medical education programme in an underserved community. We conducted semi-structured interviews with eight key informants representing the health, education, business, economy, media and political sectors. A two-stage approach was used. In the first stage, the interviews were analysed to identify sector-specific impacts informants perceived as already occurring or which they hoped to see in the future. The transcripts were then re-analysed to determine any underlying themes that crossed sectors. Community leaders described impacts that were already occurring in all sectors and also described changes in the community itself. Four underlying themes emerged: an increase in pride and status; partnership development; community self-efficacy, and community development. These underlying themes appear to characterise the development of social capital in the community. The implementation of distributed undergraduate medical education programmes in rural and underserved communities may impact their host communities in ways other than the production of a rural doctor workforce. Further studies to quantify impacts in diverse sectors and to explore possible links with social capital are needed.

Academic Health Centers and Medicaid: Advance or Retreat?

PubMed

Henderson, Mark C; Kizer, Kenneth W; Kravitz, Richard L

2018-05-22

The expansion of Medicaid under the Affordable Care Act has strained the capacity of many academic health centers (AHCs) to deliver primary and specialty care to this traditionally underserved population. The authors, longtime faculty members in the University of California Davis Health (UCDH) system, discuss the challenges of UCDH's participation in Medi-Cal, the nation's largest Medicaid program, and their institution's controversial decision in 2015 to withdraw from all Medi-Cal primary care contracts, which has had untoward effects on UCDH's social and educational missions. The authors conclude by suggesting an alternate approach for engaging with Medi-Cal. They call on AHCs to leverage their considerable intellectual and human capital as well as their focus on education and research to aggressively pursue innovative models of high-value primary care for underserved populations in their local communities, highlighting several recent successful examples of such programs. The UCDH experience has implications for other AHCs grappling with the financial realities of an increasingly competitive, value-based health care marketplace and the inherent difficulty in balancing educational, research, patient care, and social or community service missions.

Examining the Influence of Cost Concern and Awareness of Low-cost Health Care on Cancer Screening among the Medically Underserved.

PubMed

Best, Alicia L; Strane, Alcha; Christie, Omari; Bynum, Shalanda; Wiltshire, Jaqueline

2017-01-01

African Americans suffer a greater burden of mortality from breast, cervical, and colorectal cancers than other groups in the United States. Early detection through timely screening can improve survival outcomes; however, cost is frequently reported as a barrier to screening. Federally qualified health centers (FQHCs) provide preventive and primary care to underserved populations regardless of ability to pay, positioning them to improve cancer screening rates. The purpose of this study was to examine the influence of concern about health care cost (cost concern) and awareness of low-cost health care (awareness) on cancer screening among 236 African Americans within an FQHC service area using self-report surveys. Multiple logistic regression indicated that awareness was positively associated with cervical and colorectal cancer screening, while cost concern was negatively associated with mammography screening. Results indicate that improving awareness and understanding of low-cost health care could increase cancer screening among underserved African Americans.

Community-campus partnership in action: lessons learned from the DuPage County Patient Navigation Collaborative.

PubMed

Samaras, Athena T; Murphy, Kara; Nonzee, Narissa J; Endress, Richard; Taylor, Shaneah; Hajjar, Nadia; Bularzik, Rosario; Frankovich, Carmi; Dong, XinQi; Simon, Melissa A

2014-01-01

Using community-based participatory research (CBPR), the DuPage County Patient Navigation Collaborative (DPNC) developed an academic campus-community research partnership aimed at increasing access to care for underserved breast and cervical cancer patients within DuPage County, a collar county of Chicago. Given rapidly shifting demographics, targeting CBPR initiatives among underserved suburban communities is essential. To discuss the facilitating factors and lessons learned in forging the DPNC. A patient navigation collaborative was formed to guide medically underserved women through diagnostic resolution and if necessary, treatment, after an abnormal breast or cervical cancer screening. Facilitating factors included (1) fostering and maintaining collaborations within a suburban context, (2) a systems-based participatory research approach, (3) a truly equitable community-academic partnership, (4) funding adaptability, (5) culturally relevant navigation, and (6) emphasis on co-learning and capacity building. By highlighting the strategies that contributed to DPNC success, we envision the DPNC to serve as a feasible model for future health interventions.

Adherence in the Cancer Care Setting: a Systematic Review of Patient Navigation to Traverse Barriers.

PubMed

Bush, Matthew L; Kaufman, Michael R; Shackleford, Taylor

2017-06-01

Patient navigation is an evidence-based intervention involving trained healthcare workers who assist patients in assessing and mitigating personal and environmental factors to promote healthy behaviors. The purpose of this research is to systematically assess the efficacy of patient navigation and similar programs to improve diagnosis and treatment of diseases affecting medically underserved populations. A systematic review was performed by searching PubMed, MEDLINE, PsychINFO, and CINAHL to identify potential studies. Eligible studies were those containing original peer-reviewed research reports in English on patient navigation, community health workers, vulnerable and underserved populations, and healthcare disparity. Specific outcomes regarding patient navigator including the effect of the intervention on definitive diagnosis and effect on initiation of treatment were extracted from each study. The search produced 1428 articles, and 16 were included for review. All studies involved patient navigation in the field of oncology in underserved populations. Timing of initial contact with a patient navigator after diagnostic or screening testing is correlated to the effectiveness of the navigator intervention. The majority of the studies reported significantly shorter time intervals to diagnosis and to treatment with patient navigation. Patient navigation expedites oncologic diagnosis and treatment of patients in underserved populations. This intervention is more efficacious when utilized shortly after screening or diagnostic testing.

Temporal Trends and Predictors for Cancer Clinical Trial Availability for Medically Underserved Populations

PubMed Central

Lakoduk, Ashley M.; Priddy, Laurin L.; Yan, Jingsheng; Xie, Xian-Jin

2015-01-01

Background. Lack of access to available cancer clinical trials has been cited as a key factor limiting trial accrual, particularly among medically underserved populations. We examined the trends and factors in clinical trial availability within a major U.S. safety-net hospital system. Materials and Methods. We identified cancer clinical trials activated at the Harold C. Simmons Cancer from 1991 to 2014 and recorded the characteristics of the trials that were and were not activated at the Parkland Health and Hospital System satellite site. We used univariate and multivariate logistic regression to determine the association between trial characteristics and nonactivation status, and chi-square analysis to determine the association between the trial characteristics and the reasons for nonactivation. Results. A total of 773 trials were identified, of which 152 (20%) were not activated at Parkland. In multivariable analysis, nonactivation at Parkland was associated with trial year, sponsor, and phase. Compared with the 1991–2006 period, clinical trials in the 2007–2014 period were almost eightfold more likely not to be activated at Parkland. The most common reasons for nonactivation at Parkland were an inability to perform the study procedures (27%) and the startup costs (15%). Conclusion. Over time, in this single-center setting, a decreasing proportion of cancer clinical trials were available to underserved populations. Trial complexity and costs appeared to account for much of this trend. Efforts to overcome these barriers will be key to equitable access to clinical trials, efficient accrual, and the generalizability of the results. Implications for Practice: Despite numerous calls to increase and diversify cancer clinical trial accrual, the present study found that cancer clinical trial activation rates in a safety-net setting for medically underserved populations have decreased substantially in recent years. The principal reasons for study nonactivation were expenses and an inability to perform the study-related procedures, reflecting the increasing costs and complexity of cancer clinical trials. Future efforts need to focus on strategies to mitigate the increasing disparity in access to clinical research and cutting-edge therapies, which also threatens to hinder study accrual, completion rates, and generalizability. PMID:26018661

Attending to Communication and Patterns of Interaction: Culturally Sensitive Mental Health Care for Groups of Urban, Ethnically Diverse, Impoverished, and Underserved Women.

PubMed

Molewyk Doornbos, Mary; Zandee, Gail Landheer; DeGroot, Joleen

2014-07-01

The United States is ethnically diverse. This diversity presents challenges to nurses, who, without empirical evidence to design culturally congruent interventions, may contribute to mental health care disparities. Using Leininger's theory of culture care diversity and universality, this study documented communication and interaction patterns of ethnically diverse, urban, impoverished, and underserved women. Using a community-based participatory research framework, 61 Black, Hispanic, and White women participated in focus groups around their experiences with anxiety/depression. Researchers recorded verbal communication, nonverbal behavior, and patterns of interaction. The women's communication and interaction patterns gave evidence of three themes that were evident across all focus groups and five subthemes that emerged along ethnic lines. The results suggest cultural universalities and cultural uniquenesses relative to the communication and interaction patterns of urban, ethnically diverse, impoverished, and underserved women that may assist in the design of culturally sensitive mental health care. © The Author(s) 2014.

Leadership Opportunities with Communities, the Medically Underserved, and Special Populations (LOCUS).

PubMed

Haq, Cynthia; Grosch, Michelle; Carufel-Wert, Donald

2002-07-01

The Leadership Opportunities with Communities, the Underserved, and Special Populations (LOCUS) Program aims to improve medical students' leadership knowledge and skills, to improve self-awareness and motivation for community service, and to provide models for students to integrate community service into their medical careers. The LOCUS program was established as a longitudinal, extracurricular student opportunity at the University of Wisconsin Medical School in the fall of 1998. Up to 15 new students each year are selected for the program through an application and interview process during their first or second year of medical school. Students remain in the program from acceptance until graduation from medical school. Nearly 50 students have enrolled in the program to date. LOCUS fellows are matched with a physician mentor, participate in core curriculum activities, and complete a longitudinal community service project. Mentors are community generalist physicians who have integrated community service into their own careers. Students participate in their mentors' clinical practices one afternoon a month during the first two years, and mentors serve as role models and provide guidance for students' projects and career development. The program administration and staff are supported through federal predoctoral training and Area Health Education Centers (AHEC) grants. The LOCUS core curriculum is delivered through a series of retreats, workshops, and seminars that emphasize active learning methods and include approximately 20 hours of scheduled activities per academic year. The curriculum addresses concepts of leadership in relation to one's self and in relation to others. Students are introduced to methods of self-reflection and develop their own vision and mission statements. Students also discuss the importance of compassion, self-care, striving for balance, avoiding burnout, and being realistic about what they can accomplish. Students practice strategies for working with teams, organizing meetings, working with media, taking political action, and resolving conflicts. They acquire community health skills such as assessing the health needs of a defined population; engaging community members' participation in health program development; and selecting priorities, designing interventions, and measuring the progress of community health care. Working in small teams, LOCUS fellows apply and refine their leadership skills through design and completion of a community health service project. Students can design their own projects or work on projects designed by community partners. The projects have addressed a variety of community health needs, such as parenting support for teen mothers, teaching health education for residents of group homes, and providing free sports physical exams for uninsured youth. This pilot program demonstrates that motivated students can develop leadership skills and address unmet community health needs while they progress through medical school. LOCUS students, staff, and physicians provide a social network that includes opportunities, encouragement, reflection, and problem solving. Student and mentor satisfaction with the program has been high. Future challenges include securing long-term funding, refining the core curriculum, assessing the impact of the program on participants, and improving the quality of projects through community partnerships. LOCUS strives to kindle the fires of altruism and community service so they are not extinguished as students progress through medical training.

Using Concept Mapping to Develop a Strategy for Self-Management Support for Underserved Populations Living With Chronic Conditions, British Columbia, August 2013-June 2014.

PubMed

Mills, Susan L; Bergeron, Kim; Pérez, Guillermina

2015-10-08

Self-management support (SMS) is an essential component of public health approaches to chronic conditions. Given increasing concerns about health equity, the needs of diverse populations must be considered. This study examined potential solutions for addressing the gaps in self-management support initiatives for underserved populations. Stakeholders representing government, nongovernment organizations, Aboriginal communities, health authorities, medical practices, and research institutions generated, sorted, and rated ideas on what could be done to improve self-management support for underserved populations. Concept mapping was used to facilitate the collection and organization of the data and to generate conceptual maps. Participants generated 92 ideas that were sorted into 11 clusters (foster partnerships, promote integrated community care, enhance health care provider training, shift government policy, support community development, increase community education, enable client engagement, incorporate client support systems, recognize client capacity, tailor self-management support programs, and develop client skills, training, and tools) and grouped into system, community, and individual levels within a partnership framework. The strategy can stimulate public health dialogue and be a roadmap for developing SMS initiatives. It has the potential to address SMS and chronic condition inequities in underserved populations in several ways: 1) by targeting populations that have greater inequities, 2) by advocating for shifts in government policies that create and perpetuate inequities, 3) by promoting partnerships that may increase the number of SMS initiatives for underserved groups, and 4) by promoting training and engagement that increase the relevance, uptake, and overall effectiveness of SMS.

Health and Wellness Technology Use by Historically Underserved Health Consumers: Systematic Review

PubMed Central

Perchonok, Jennifer

2012-01-01

Background The implementation of health technology is a national priority in the United States and widely discussed in the literature. However, literature about the use of this technology by historically underserved populations is limited. Information on culturally informed health and wellness technology and the use of these technologies to reduce health disparities facing historically underserved populations in the United States is sparse in the literature. Objective To examine ways in which technology is being used by historically underserved populations to decrease health disparities through facilitating or improving health care access and health and wellness outcomes. Methods We conducted a systematic review in four library databases (PubMed, PsycINFO, Web of Science, and Engineering Village) to investigate the use of technology by historically underserved populations. Search strings consisted of three topics (eg, technology, historically underserved populations, and health). Results A total of 424 search phrases applied in the four databases returned 16,108 papers. After review, 125 papers met the selection criteria. Within the selected papers, 30 types of technology, 19 historically underserved groups, and 23 health issues were discussed. Further, almost half of the papers (62 papers) examined the use of technology to create effective and culturally informed interventions or educational tools. Finally, 12 evaluation techniques were used to assess the technology. Conclusions While the reviewed studies show how technology can be used to positively affect the health of historically underserved populations, the technology must be tailored toward the intended population, as personally relevant and contextually situated health technology is more likely than broader technology to create behavior changes. Social media, cell phones, and videotapes are types of technology that should be used more often in the future. Further, culturally informed health information technology should be used more for chronic diseases and disease management, as it is an innovative way to provide holistic care and reminders to otherwise underserved populations. Additionally, design processes should be stated regularly so that best practices can be created. Finally, the evaluation process should be standardized to create a benchmark for culturally informed health information technology. PMID:22652979

Modeling Teacher Professional Development Through a Telescope Making Workshop

NASA Astrophysics Data System (ADS)

Meredith, J. T.; Schleigh, S. P.; Lee, T. D.

2010-08-01

The International Year of Astronomy (IYA2009) provides a springboard to develop innovative enduring educational programming directed toward astronomy education. We examine current professional development models focusing on astronomy and discuss the need for improvement. We propose a professional development design that follows the medical field philosophy using a low cost telescope making workshop as a vehicle to test and modify the model. The workshop promotes teacher content knowledge, pedagogical content knowledge and develops skills and confidence in an inquiry, integrative lesson. This model can be shared with professional development leaders, coordinators and teachers in any topic or level of education. Professional development designs such as the proposed promote excitement and interest in astronomy and makes it possible for underserved and economically depressed regions to have opportunities to promote the values of scientific investigation, STEM education, and public awareness of astronomy.

Loss of international medical experiences: knowledge, attitudes and skills at risk.

PubMed

Grudzen, Corita R; Legome, Eric

2007-11-28

Despite the great influence International Medical Experiences (IMs) can have on young physicians and their impact on patients and communities, they are not offered in all training programs and are at risk of being reduced in some due to stringent guidelines for funding of graduate medical education. IMs provide unique experiences in clinical, epidemiologic, cultural, and political arenas. From an educational perspective, they broaden a physician's differential diagnostic skills and introduce clinical entities rarely seen in the U.S. Time spent in developing countries emphasizes the importance of community health and increases cultural and linguistic competence. Experience working with the underserved during an IM has been shown to increase interest in volunteerism, humanitarian efforts, and work with underserved populations both in the US and abroad. IMs also afford physicians the opportunity to learn about the delivery of health care abroad and are associated with an increase in primary care specialty choice. It is time for the leaders in graduate medical education to prioritize international health opportunities. Leaders in academic medicine can press for changes in reimbursement patterns at the national level or special funds for international electives. Hospitals can set up separate accounts to help finance resident salaries and benefits while abroad. Individual departments must be flexible with resident schedules to allow elective time. Medical students and housestaff can organize and lobby larger organizations such as the American Medical Association (AMA), the American Association of Medical Colleges (AAMC), and specialty groups to make IMs universally accessible.

The safety net medical home initiative: transforming care for vulnerable populations.

PubMed

Sugarman, Jonathan R; Phillips, Kathryn E; Wagner, Edward H; Coleman, Katie; Abrams, Melinda K

2014-11-01

Despite findings that medical homes may reduce or eliminate health care disparities among underserved and minority populations, most previous medical home pilot and demonstration projects have focused on health care delivery systems serving commercially insured patients and Medicare beneficiaries. To develop a replicable approach to support medical home transformation among diverse practices serving vulnerable and underserved populations. Facilitated by a national program team, convening organizations in 5 states provided coaching and learning community support to safety net practices over a 4-year period. To guide transformation, we developed a framework of change concepts aligned with supporting tools including implementation guides, activity checklists, and measurement instruments. Sixty-five health centers, homeless clinics, private practices, residency training centers, and other safety net practices in Colorado, Idaho, Massachusetts, Oregon, and Pennsylvania. We evaluated implementation of the change concepts using the Patient-Centered Medical Home-Assessment, and conducted a survey of participating practices to assess perceptions of the impact of the technical assistance. All practices implemented key features of the medical home model, and nearly half (47.6%) implemented the 33 identified key changes to a substantial degree as evidenced by level A Patient-Centered Medical Home-Assessment scores. Two thirds of practices that achieved substantial implementation did so only after participating in the initiative for >2 years. By the end of the initiative, 83.1% of sites achieved external recognition as medical homes. Despite resource constraints and high-need populations, safety net clinics made considerable progress toward medical home implementation when provided robust, multimodal support over a 4-year period.

Past, Present, and Future of Pharmacologic Therapy in Obesity.

PubMed

Rodríguez, José E; Campbell, Kendall M

2016-03-01

Medications for obesity management can be divided into 4 groups: antidepressants (naltrexone/bupropion), stimulants (phentermine, phendimetrazine, diethylpropion, phentermine/topiramate), fat blockers (orlistat), and diabetes medications (liraglutide). Each group has specific therapeutic effects, adverse effects, and costs. Two medications are indicated for long-term use in obesity: lorcaserin and orlistat. Other available medications are for short-term use. High cost makes many of these medications inaccessible for underserved and poor patients. Because of misuse potential, many obesity medications are also classified as controlled substances. There are no medications currently approved for use in pregnant or lactating women. Copyright © 2016 Elsevier Inc. All rights reserved.

A psychosocial approach to dentistry for the underserved: incorporating theory into practice.

PubMed

Flaer, Paul J; Younis, Mustafa Z; Benjamin, Paul L; Al Hajeri, Maha

2010-01-01

Dentistry for the underserved is more than an egalitarian social issue--it is a key factor in the health and social progress of our nation. The first signs or manifestations of several diseases such as varicella (i.e., chicken pox and shingles), STDs, and influenza become apparent in the oral cavity. The value of access to quality dentistry is an immeasurable factor in maintaining general medical health of people and fulfilling their psychosocial needs of pain reduction and enhanced cosmetics. In the United States, for the most part, only the middle and upper classes receive non-extraction, restorative, and prosthetic dentistry that is economically within their ability to pay. In addition, uninsured and poverty-level individuals often must face overwhelming long waiting lists, unnecessary referrals, lack of choice, and bureaucratic hurdles when seeking primary dental care. Therefore, it seems pertinent to put forth the question: What are the critical values and beliefs of psychosocial theory that can underscore the practice of dentistry for underserved populations in the United States? The widely employed public health theory, the health belief model (HBM), is applied to evaluate psychosocial factors in dental care for the underserved. The HBM is used to predict and explain behavioral changes in dental health and associated belief patterns. The HBM as applied to dentistry for the underserved predicts self-perceptions of susceptibility and seriousness of dental disease, health status, cues to action, and self-efficacy. Furthermore, patients can make judgments about benefits, costs, and risks of dental treatment. A theoretical approach to dentistry employing the HBM, mediated by values and culture, can provide significant insights into patient thinking, beliefs, and perceptions. These insights can mediate access to and use of primary care dental services by underserved populations. Evidence-based practice (i.e., based on research using the scientific method) has been put forth as the future of modern dentistry. However, the practice of dentistry need not just be evidence-based, but have its roots clearly grounded in theory.

Involving American Indians and medically underserved rural populations in cancer clinical trials.

PubMed

Guadagnolo, B Ashleigh; Petereit, Daniel G; Helbig, Petra; Koop, David; Kussman, Patricia; Fox Dunn, Emily; Patnaik, Asha

2009-12-01

To assess cancer clinical trial recruitment and reasons for nonaccrual among a rural, medically underserved population served by a community-based cancer care center. We prospectively tracked clinical trial enrollment incidence among all new patients presenting at the Rapid City Regional Cancer Care Institute. Evaluating physicians completed questionnaires for each patient regarding clinical trial enrollment status and primary reasons for nonenrollment. Patients who identified as American Indian were referred to a program where patients were assisted in navigating the medical system by trained, culturally competent staff. Between September 2006 and January 2008, 891 new cancer patients were evaluated. Seventy-eight patients (9%; 95% confidence intervals, 7-11%) were enrolled on a clinical treatment trial. For 73% (95% confidence intervals, 69-75%) of patients (646 of 891) lack of relevant protocol availability or protocol inclusion criteria restrictiveness was the reason for nonenrollment. Only 45 (5%; 95% confidence intervals, 4-7%) patients refused enrollment on a trial. Of the 78 enrolled on a trial, 6 (8%; 95% confidence intervals, 3-16%) were American Indian. Three additional American Indian patients were enrolled under a nontreatment cancer control trial, bringing the total percentage enrolled of the 94 American Indians who presented to the clinic to 10% (95% confidence intervals, 5-17%). Eligibility rates were unable to be calculated and cross validation of the number in the cohort via registries or ICD-9 codes was not performed. Clinical trial participation in this medically underserved population was low overall, but approximately 3-fold higher than reported national accrual rates. Lack of availability of protocols for common cancer sites as well as stringent protocol inclusion criteria were the primary obstacles to clinical trial enrollment. Targeted interventions using a Patient Navigation program were used to engage AI patients and may have resulted in higher clinical trial enrollment among this racial/ethnic group.

Involving American Indians and medically underserved rural populations in cancer clinical trials

PubMed Central

Guadagnolo, B Ashleigh; Petereit, Daniel G; Helbig, Petra; Koop, David; Kussman, Patricia; Dunn, Emily Fox; Patnaik, Asha

2010-01-01

Purpose To assess cancer clinical trial recruitment and reasons for nonaccrual among a rural, medically underserved population served by a community-based cancer care center. Methods We prospectively tracked clinical trial enrollment incidence among all new patients presenting at the Rapid City Regional Cancer Care Institute. Evaluating physicians completed questionnaires for each patient regarding clinical trial enrollment status and primary reasons for nonenrollment. Patients who identified as American Indian were referred to a program where patients were assisted in navigating the medical system by trained, culturally competent staff. Results Between September 2006 and January 2008, 891 new cancer patients were evaluated. Seventy-eight patients (9%; 95% confidence intervals, 7–11%) were enrolled on a clinical treatment trial. For 73% (95% confidence intervals, 69–75%) of patients (646 of 891) lack of relevant protocol availability or protocol inclusion criteria restrictiveness was the reason for nonenrollment. Only 45 (5%; 95% confidence intervals, 4–7%) patients refused enrollment on a trial. Of the 78 enrolled on a trial, 6 (8%; 95% confidence intervals, 3–16%) were American Indian. Three additional American Indian patients were enrolled under a nontreatment cancer control trial, bringing the total percentage enrolled of the 94 American Indians who presented to the clinic to 10% (95% confidence intervals, 5–17%). Limitations Eligibility rates were unable to be calculated and cross validation of the number in the cohort via registries or ICD-9 codes was not performed. Conclusion Clinical trial participation in this medically underserved population was low overall, but approximately 3-fold higher than reported national accrual rates. Lack of availability of protocols for common cancer sites as well as stringent protocol inclusion criteria were the primary obstacles to clinical trial enrollment. Targeted interventions using a Patient Navigation program were used to engage AI patients and may have resulted in higher clinical trial enrollment among this racial/ethnic group. PMID:19933720

5 CFR 890.702 - Payment to any licensed practitioner.

Code of Federal Regulations, 2011 CFR

2011-01-01

... REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Benefits in Medically Underserved Areas..., if a contract between the Office of Personnel Management and a group health insurance carrier offering a health benefits plan subject to this subpart provides for payment or reimbursement of the cost...

5 CFR 890.702 - Payment to any licensed practitioner.

Code of Federal Regulations, 2014 CFR

2014-01-01

... REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Benefits in Medically Underserved Areas..., if a contract between the Office of Personnel Management and a group health insurance carrier offering a health benefits plan subject to this subpart provides for payment or reimbursement of the cost...

5 CFR 890.702 - Payment to any licensed practitioner.

Code of Federal Regulations, 2010 CFR

2010-01-01

... REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Benefits in Medically Underserved Areas..., if a contract between the Office of Personnel Management and a group health insurance carrier offering a health benefits plan subject to this subpart provides for payment or reimbursement of the cost...

5 CFR 890.702 - Payment to any licensed practitioner.

Code of Federal Regulations, 2013 CFR

2013-01-01

... REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Benefits in Medically Underserved Areas..., if a contract between the Office of Personnel Management and a group health insurance carrier offering a health benefits plan subject to this subpart provides for payment or reimbursement of the cost...

Mammographic Breast Density in a Cohort of Medically Underserved Women

DTIC Science & Technology

2014-10-01

chronic diseases, adult weight history, diet , and health literacy. A trained radiologic technician completed full- field digital screening mammograms on... Mediterranean population. Int J Cancer 118:1782-1789 12. El-Bastawissi AY, White E, Mandelson MT, Taplin S (2001) Variation in mammographic breast

Advancing Health Equity Through Student Empowerment and Professional Success: A Statewide Approach.

PubMed

Noone, Joanne; Wros, Peggy; Cortez, David; Najjar, Rana; Magdaleno, Leela

2016-06-01

A lack of diversity in the nursing workforce nationally has been identified by Oregon state leaders as a factor contributing to health inequity. The goal of Advancing Health Equity Through Student Empowerment and Professional Success (HealthE STEPS) is to graduate nursing students from disadvantaged backgrounds to improve health equity within their communities. A comprehensive plan of evidence-based strategies was developed based on social determinants of health and addresses academic socialization, learning support, financial resources, networking, curriculum development, and campus culture. Ninety undergraduate nursing students participated in the program during a 2-year period. Retention of participants was 97% with graduation rates of 94%. First-time licensure pass rates were 82% and 96% of participating graduates employed in a medically underserved community. This comprehensive innovative program of evidence-based strategies addresses health equity by developing a diverse nursing workforce to practice in medically underserved communities. [J Nurs Educ. 2016;55(6):316-322.]. Copyright 2016, SLACK Incorporated.

The dental safety net in Connecticut.

PubMed

Beazoglou, Tryfon; Heffley, Dennis; Lepowsky, Steven; Douglass, Joanna; Lopez, Monica; Bailit, Howard

2005-10-01

Many poor, medically disabled and geographically isolated populations have difficulty accessing private-sector dental care and are considered underserved. To address this problem, public- and voluntary-sector organizations have established clinics and provide care to the underserved. Collectively, these clinics are known as "the dental safety net." The authors describe the dental safety net in Connecticut and examine the capacity and efficiency of this system to provide care to the noninstitutionalized underserved population of the state. The authors describe Connecticut's dental safety net in terms of dentists, allied health staff members, operatories, patient visits and patients treated per dentist per year. The authors compare the productivity of safety-net dentists with that of private practitioners. They also estimate the capacity of the safety net to treat people enrolled in Medicaid and the State Children's Health Insurance Program. The safety net is made up of dental clinics in community health centers, hospitals, the dental school and public schools. One hundred eleven dentists, 38 hygienists and 95 dental assistants staff the clinics. Safety-net dentists have fewer patient visits and patients than do private practitioners. The Connecticut safety-net system has the capacity to treat about 28.2 percent of publicly insured patients. The dental safety net is an important community resource, and greater use of allied dental personnel could substantially improve the capacity of the system to care for the poor and other underserved populations.

Eroding students' rural motivation: first do no harm?

PubMed

Hurst, Samia

2014-01-01

Migration of health professionals is one of the drivers of vast inequalities in access to healthcare, as medical graduates tend to move away from both poorer countries and rural areas. One of the central ethical problems raised in attempting to alleviate these inequalities is the tension between the healthcare needs of under-served patients and the rights of medical graduates to choose their place of work and specialty. If medical graduates had greater motivation to work in under-served rural areas, this tension would decrease accordingly. Medical schools have a duty to avoid eroding existing motivation for such training and practice. This duty has practical implications. Medical students' motivation regarding their choice of specialty changes during medical training, turning them away from choices such as primary care and rural practice towards more highly specialised, more hospital based specialties. Although students may be victims of a number of biases in the initial assessment, this is unlikely to be the whole story. Students' priorities are likely to change based on their admiration for specialist role models and the visibility of the financial and non-financial rewards attached to these specialties. Students may also have a false expectation upon admission that they will be proficient in rural medicine on graduation, and change their mind once they realise the limits of their skills in that area. Although the measures required to reverse this effect currently lack a solid evidence base, they are plausible and supported by the available data.

The central city site: an urban underserved family medicine training track.

PubMed

Bade, Elizabeth; Baumgardner, Dennis; Brill, John

2009-01-01

We describe the development of an urban track in family medicine residency designed to recruit a high percentage of minority students and promote their future practice in urban, underserved areas of Milwaukee. We report here on the residents and their first practice location and compared this information to what occurred in our original "main" residency program. Information about the program's development was obtained through testimonials from faculty and residency graduates and review of the original accreditation application to the Residency Review Committee. Information about the residents and their practice locations was obtained from the National Resident Matching Program and graduate placement data. The goal of training more minority doctors in Milwaukee was met, with eight of 16 (50%) residents at our urban-track site from minority groups. This compared to only 12% at our main program. Thirty-eight percent of graduates stayed to practice in an underserved area, compared to only 21% in our main program. Development of an urban track for our family medicine residency increased the number of minority physicians trained and the number of physicians practicing in underserved areas after graduation.

Breast care screening for underserved African American women: Community-based participatory approach.

PubMed

Davis, Cindy; Darby, Kathleen; Moore, Matthew; Cadet, Tamara; Brown, Gwendolynn

2017-01-01

Traditional health promotion models often do not take into account the importance of shared cultural backgrounds, beliefs, and experiences unique to underserved African American women when designing community-based cancer screening and prevention programs. Thus, the purpose of this study was the development, implementation, and evaluation of a community-based participatory research (CBPR) program designed to increase breast cancer screening awareness in an underserved African American population by providing culturally appropriate social support and information. The study includes 357 African American women who participated in the program and completed the 6-month follow-up questionnaire. The program consisted of a 45-minute play, using community members and storytelling to honor and incorporate five different cultural experiences (skits) with breast care and cancer. Overall, findings indicate that the educational intervention was effective. In addition, these findings are consistent with the literature that suggests that educational interventions that include knowledge to alleviate concerns, dispel myths, and create awareness can increase breast cancer screening participation rates. Furthermore, these findings confirm the importance of CBPR in health promotion activities in reducing health and cancer disparities.

Nurse Education, Center of Excellence for Remote and Medically Under-Served Areas (CERMUSA)

DTIC Science & Technology

2012-10-01

Support Humanitarian Assistance and Disaster Preparedness Competencies – Phase 1 Pretest / Posttest Stanhope: Foundations of Nursing in the...them gain a better understanding of their role, as well as to enhance the value of the mission. Based on the data generated from this study, CERMUSA...military has long been aware of the critical importance of training medical personnel for mass casualty events that occur on the battlefield; and

Fulfilling the Mission of Academic Medicine: Training Residents in the Health Needs of Prisoners

PubMed Central

Wakeman, Sarah E.

2010-01-01

The single mission of academic medicine is the pursuit of health for all. This mandate serves as a reminder to focus care on vulnerable and underserved populations. The 12 million Americans who cycle through correctional facilities each year are arguably among the most vulnerable populations in this country; predominantly black, with a high burden of disease and many barriers to care after release. Medical training programs should provide exposure to the health needs of prisoners. Residents could establish care with inmates prior to release and arrange follow-up in the community. This addition to training would not only provide care to this underserved group, but also would train residents in the myriad problems prisoners face, and foster social responsibility. PMID:20352517

Physical Examination Reporting System

PubMed Central

Rowley, B.A.; Cameron, J.M.; Anderson, D.E.; Nicholas, T.A.; Hogue, R.L.; Hutcheson, J.L.; Peralta, V.H.; Johansen, B.; Walston, D.

1978-01-01

The following is a description of a Physical Examination Reporting System which was developed in cooperation with physicians from the Department of Family Practice and the Department of Preventive Medicine, Texas Tech University School of Medicine, Lubbock, Texas. This system was designed to evaluate what effect such a report would have on the practice of medicine in underserved areas with regard to health benefit, medical impact, and economic impact. The set of observations was assembled over a three month period by utilizing techniques previously developed in this area as well as the expertise of the TTUSM faculty. This system was developed for impact evaluation purposes. Its actual daily use may require changes in the form, in method of entry, and in format of the report.

HPV Vaccination Practices Among Juvenile Justice Facilities in the United States

PubMed Central

Henderson, Courtney E.; Rich, Josiah D.; Lally, Michelle A.

2010-01-01

The juvenile justice setting provides a unique opportunity to administer the human papillomavirus (HPV) vaccine to a high-risk, medically underserved population. We examined current HPV vaccination practices in the United States. Most states (39) offer the HPV vaccine to females committed to juvenile justice facilities. PMID:20413087

Cancer Risk Assessment by Rural and Appalachian Family Medicine Physicians

ERIC Educational Resources Information Center

Kelly, Kimberly M.; Love, Margaret M.; Pearce, Kevin A.; Porter, Kyle; Barron, Mary A.; Andrykowski, Michael

2009-01-01

Context: Challenges to the identification of hereditary cancer in primary care may be more pronounced in rural Appalachia, a medically underserved region. Purpose: To examine primary care physicians' identification of hereditary cancers. Methods: A cross-sectional survey was mailed to family physicians in the midwestern and southeastern United…

42 CFR 62.52 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Definitions. 62.52 Section 62.52 Public Health... Programs § 62.52 Definitions. In addition to the definitions in § 62.2 of this part, the following... for purposes of this subpart. Medically underserved area means health manpower shortage area or an...

42 CFR 62.52 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Definitions. 62.52 Section 62.52 Public Health... Programs § 62.52 Definitions. In addition to the definitions in § 62.2 of this part, the following... for purposes of this subpart. Medically underserved area means health manpower shortage area or an...

42 CFR 62.52 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Definitions. 62.52 Section 62.52 Public Health... Programs § 62.52 Definitions. In addition to the definitions in § 62.2 of this part, the following... for purposes of this subpart. Medically underserved area means health manpower shortage area or an...

Developing a Culturally Responsive Breast Cancer Screening Promotion with Native Hawaiian Women in Churches

ERIC Educational Resources Information Center

Kaopua, Lana Sue

2008-01-01

This article presents findings from research to develop the promotional component of a breast cancer screening program for Native Hawaiian women associated with historically Hawaiian churches in medically underserved communities. The literature on adherence to health recommendations and health promotions marketing guided inquiry on screening…

42 CFR 62.54 - What must applications for the State Loan Repayment Program contain?

Code of Federal Regulations, 2014 CFR

2014-10-01

... area population without health insurance, and the health status of the population as measured by the... will accord special consideration to medically underserved areas with large minority populations; and... additional conditions of the grant. (Approved by the Office of Management and Budget under control number...

42 CFR 62.54 - What must applications for the State Loan Repayment Program contain?

Code of Federal Regulations, 2012 CFR

2012-10-01

... area population without health insurance, and the health status of the population as measured by the... will accord special consideration to medically underserved areas with large minority populations; and... additional conditions of the grant. (Approved by the Office of Management and Budget under control number...

42 CFR 62.54 - What must applications for the State Loan Repayment Program contain?

Code of Federal Regulations, 2013 CFR

2013-10-01

... area population without health insurance, and the health status of the population as measured by the... will accord special consideration to medically underserved areas with large minority populations; and... additional conditions of the grant. (Approved by the Office of Management and Budget under control number...

42 CFR 62.51 - What is the scope and purpose of the State Loan Repayment Program?

Code of Federal Regulations, 2011 CFR

2011-10-01

... Repayment Program? 62.51 Section 62.51 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN... PROGRAMS Grants for State Loan Repayment Programs § 62.51 What is the scope and purpose of the State Loan... health services in medically underserved areas. ...

42 CFR 62.51 - What is the scope and purpose of the State Loan Repayment Program?

Code of Federal Regulations, 2010 CFR

2010-10-01

... Repayment Program? 62.51 Section 62.51 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN... PROGRAMS Grants for State Loan Repayment Programs § 62.51 What is the scope and purpose of the State Loan... health services in medically underserved areas. ...

National High Blood Pressure 12-Month Kit. May 1988.

ERIC Educational Resources Information Center

National Heart and Lung Inst. (DHHS/NIH), Bethesda, MD. National High Blood Pressure Education Program.

Part I of this kit provides information for program planners and health professionals on ways to overcome barriers to health care among the medically underserved, promote high blood pressure control through the media and other community channels, and improve adherence to treatment among hypertensive patients. It lists additional resources for…

Understanding Disadvantage among Medical School Applicants

ERIC Educational Resources Information Center

Espinoza-Shanahan, Crystal C.

2016-01-01

The United States is a nation of peoples with highly stratified degrees of healthcare access and coverage, including many individuals with none at all. Exacerbating the problem of widespread health disparities is a persistent shortage of physicians over recent decades. Of most urgency is the need for doctors within already underserved minority…

Factors that Influence Physicians to Practice in Rural Locations: A Review and Commentary

ERIC Educational Resources Information Center

Ballance, Darra; Kornegay, Denise; Evans, Paul

2009-01-01

Rural populations remain underserved by physicians, despite various efforts by medical schools and other institutions/organizations to correct this disparity. We examined the literature on factors that influence rural practice location decisions by physicians to determine what opportunities exist along the entire educational pipeline to entice…

Participatory design of ehealth solutions for women from vulnerable populations with perinatal depression.

PubMed

Gordon, Mara; Henderson, Rebecca; Holmes, John H; Wolters, Maria K; Bennett, Ian M

2016-01-01

Cultural and health service obstacles affect the quality of pregnancy care that women from vulnerable populations receive. Using a participatory design approach, the Stress in Pregnancy: Improving Results with Interactive Technology group developed specifications for a suite of eHealth applications to improve the quality of perinatal mental health care. We established a longitudinal participatory design group consisting of low-income women with a history of antenatal depression, their prenatal providers, mental health specialists, an app developer, and researchers. The group met 20 times over 24 months. Applications were designed using rapid prototyping. Meetings were documented using field notes. The group achieved high levels of continuity and engagement. Three apps were developed by the group: an app to support high-risk women after discharge from hospital, a screening tool for depression, and a patient decision aid for supporting treatment choice. Longitudinal participatory design groups are a promising, highly feasible approach to developing technology for underserved populations. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The Lifestyle Intervention for the Treatment of Diabetes study (LIFT Diabetes): Design and baseline characteristics for a randomized translational trial to improve control of cardiovascular disease risk factors.

PubMed

Katula, Jeffrey A; Kirk, Julienne K; Pedley, Carolyn F; Savoca, Margaret R; Effoe, Valery S; Bell, Ronny A; Bertoni, Alain G

2017-02-01

The prevalence of type 2 diabetes continues to increase in minority and underserved patients, who are also more likely to have poorer control of diabetes and related risk factors for complications. Although the Look AHEAD trial has demonstrated improved risk factor control among overweight or obese diabetes patients who received an intensive lifestyle intervention, translating such findings into accessible programs is a major public health challenge. The purpose of this paper is to report the design and baseline characteristics of the Lifestyle Interventions for the Treatment of Diabetes study (LIFT Diabetes). The overall goal is to test the impact of a community-based lifestyle weight loss (LWL) intervention adapted from Look AHEAD on cardiovascular disease risk at 12-months and 24-months among minority and lower income diabetes patients. Secondary outcomes include body weight, physical activity, medication use, cost, resource utilization, and safety. The primary hypothesis being tested is that the LWL will result in 10% relative reduction in CVD risk compared to the DSM. We have randomized 260 overweight or obese adults with diabetes one of two 12-month interventions: a LWL condition delivered by community health workers or a diabetes self-management (DSM) education condition. The baseline demographic characteristics indicate that our sample is predominantly female, obese, low income, and ethnic minority. Translating evidence-based, lifestyle strategies, and targeting minority and underserved patients, will yield, if successful, a model for addressing the burden of diabetes and may favorably impact health disparities. Copyright © 2016 Elsevier Inc. All rights reserved.

Effects of racial and ethnic group and health literacy on responses to genomic risk information in a medically underserved population.

PubMed

Kaphingst, Kimberly A; Stafford, Jewel D; McGowan, Lucy D'Agostino; Seo, Joann; Lachance, Christina R; Goodman, Melody S

2015-02-01

Few studies have examined how individuals respond to genomic risk information for common, chronic diseases. This randomized study examined differences in responses by type of genomic information (genetic test/family history) and disease condition (diabetes/heart disease), and by race/ethnicity in a medically underserved population. 1,057 English-speaking adults completed a survey containing 1 of 4 vignettes (2-by-2 randomized design). Differences in dependent variables (i.e., interest in receiving genomic assessment, discussing with doctor or family, changing health habits) by experimental condition and race/ethnicity were examined using chi-squared tests and multivariable regression analysis. No significant differences were found in dependent variables by type of genomic information or disease condition. In multivariable models, Hispanics were more interested in receiving a genomic assessment than Whites (OR = 1.93; p < .0001); respondents with marginal (OR = 1.54; p = .005) or limited (OR = 1.85; p = .009) health literacy had greater interest than those with adequate health literacy. Blacks (OR = 1.78; p = .001) and Hispanics (OR = 1.85; p = .001) had greater interest in discussing information with family than Whites. Non-Hispanic Blacks (OR = 1.45; p = .04) had greater interest in discussing genomic information with a doctor than Whites. Blacks (β = -0.41; p < .001) and Hispanics (β = -0.25; p = .033) intended to change fewer health habits than Whites; health literacy was negatively associated with number of health habits participants intended to change. Findings suggest that race/ethnicity may affect responses to genomic risk information. Additional research could examine how cognitive representations of this information differ across racial/ethnic groups. Health literacy is also critical to consider in developing approaches to communicating genomic information.

Comparison of small-area deprivation measures as predictors of chronic disease burden in a low-income population.

PubMed

Lòpez-De Fede, Ana; Stewart, John E; Hardin, James W; Mayfield-Smith, Kathy

2016-06-10

Measures of small-area deprivation may be valuable in geographically targeting limited resources to prevent, diagnose, and effectively manage chronic conditions in vulnerable populations. We developed a census-based small-area socioeconomic deprivation index specifically to predict chronic disease burden among publically insured Medicaid recipients in South Carolina, a relatively poor state in the southern United States. We compared the predictive ability of the new index with that of four other small-area deprivation indicators. To derive the ZIP Code Tabulation Area-Level Palmetto Small-Area Deprivation Index (Palmetto SADI), we evaluated ten census variables across five socioeconomic deprivation domains, identifying the combination of census indicators most highly correlated with a set of five chronic disease conditions among South Carolina Medicaid enrollees. In separate validation studies, we used both logistic and spatial regression methods to assess the ability of Palmetto SADI to predict chronic disease burden among state Medicaid recipients relative to four alternative small-area socioeconomic deprivation measures: the Townsend index of material deprivation; a single-variable poverty indicator; and two small-area designations of health care resource deprivation, Primary Care Health Professional Shortage Area and Medically Underserved Area/Medically Underserved Population. Palmetto SADI was the best predictor of chronic disease burden (presence of at least one condition and presence of two or more conditions) among state Medicaid recipients compared to all alternative deprivation measures tested. A low-cost, regionally optimized socioeconomic deprivation index, Palmetto SADI can be used to identify areas in South Carolina at high risk for chronic disease burden among Medicaid recipients and other low-income Medicaid-eligible populations for targeted prevention, screening, diagnosis, disease self-management, and care coordination activities.

12 CFR 25.12 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... moderate-income geographies; (ii) Designated disaster areas; or (iii) Distressed or underserved..., Federal Deposit Insurance Corporation, and OCC, based on— (A) Rates of poverty, unemployment, and...

A mobile monitoring system of blood pressure for underserved in China by information and communication technology service.

PubMed

Jiang, Jiehui; Yan, Zhuangzhi; Kandachar, Prabhu; Freudenthal, Adinda

2010-05-01

High blood pressure (BP, hypertension) is a leading chronic condition in China and has become the main risk factor for many high-risk diseases, such as heart attacks. However, the platform for chronic disease measurement and management is still lacking, especially for underserved Chinese. To achieve the early diagnosis of hypertension, one BP monitoring system has been designed. The proposed design consists of three main parts: user domain, server domain, and channel domain. All three units and their materialization, validation tests on reliability, and usability are described in this paper, and the conclusion is that the current design concept is feasible and the system can be developed toward sufficient reliability and affordability with further optimization. This idea might also be extended into one platform for other physiological signals, such as blood sugar and ECG.

Giving Voice to the Medically Under-Served: A Qualitative Co-Production Approach to Explore Patient Medicine Experiences and Improve Services to Marginalized Communities

PubMed Central

Latif, Asam; Tariq, Sana; Abbasi, Nasa; Mandane, Baguiasri

2018-01-01

Background: With an aging population, the appropriate, effective and safe use of medicines is a global health priority. However, “‘medically under-served” patients continue to experience significant inequalities around access to healthcare services. Aim: This study forms part of a wider project to co-develop and evaluate a digital educational intervention for community pharmacy. The aim of this paper is to explore the medicine needs of patients from marginalized communities and suggest practical way on how services could be better tailored to their requirements. Method: Following ethical approval, qualitative data was gathered from: (1) workshops with patients and professionals (n = 57 attendees); and (2) qualitative semi-structured interviews (10 patients and 10 pharmacists). Results: Our findings revealed that patients from marginalized communities reported poor management of their medical conditions and significant problems with adherence to prescribed medicines. Their experience of pharmacy services was found to be variable with many experiencing discrimination or disadvantage as a result of their status. Discussion: This study highlights the plight of medically under-served communities and the need for policy makers to tailor services to an individual’s needs and circumstances. Furthermore, patients and professionals can work in collaboration using a co-production approach to develop educational interventions for pharmacy service improvements. PMID:29382062

Evaluation of Healthy Living Wellness Program With Minority Underserved Economically Disadvantaged Older Adults.

PubMed

Tallier, Peggy C; Reineke, Patricia R; Frederickson, Keville

2017-04-01

The purpose of this Roy adaptation model-guided study was to test the effectiveness of a student registered nurse intern-led nursing intervention entitled the Healthy Living Wellness Program. A one-group pretest/posttest preexperimental design was used. The intervention was imparted to minority, underserved, economically disadvantaged older adults ( N = 30). Significant findings pre- and postintervention were reported for body mass index, waist circumference, self-reported blood glucose, and weight. The findings supported the effectiveness of the nursing intervention, the Healthy Living Wellness Program, guided by the Roy adaptation model.

The Impact of a Signalized Crosswalk on Traffic Speed and Street-Crossing Behaviors of Residents in an Underserved Neighborhood.

PubMed

Schultz, Courtney L; Sayers, Stephen P; Wilhelm Stanis, Sonja A; Thombs, Lori A; Thomas, Ian M; Canfield, Shannon M

2015-10-01

Infrastructure improvements such as pedestrian crosswalks that calm traffic and increase access to physical activity opportunities could alleviate important barriers to active living in underserved communities with outdated built environments. The purpose of this study was to explore how the built environment influences street-crossing behaviors and traffic speeds in a low-income neighborhood with barriers to active living in Columbia, Missouri. In 2013, a signalized pedestrian crosswalk and 400-ft-long median was constructed along a busy 5-lane, high-speed arterial highway linking low-income housing with a park and downtown areas. Data collection occurred prior to June 2012, and after June 2013, completion of the project at the intervention site and control site. Direct observation of street-crossing behaviors was performed at designated intersections/crosswalks or non-designated crossing points. Traffic volume and speed were captured using embedded magnetic traffic detectors. At the intervention site, designated crossings increased at the new crosswalk (p < 0.001), but not at non-designated crossings (p = 0.52) or designated crossings at intersections (p = 0.41). At the control site, there was no change in designated crossings (p = 0.94) or non-designated crossings (p = 0.79). Motor vehicles traveling above the speed limit of 35 mph decreased from 62,056 (46 %) to 46,256 (35 %) (p < 0.001) at the intervention site and increased from 57,891 (49 %) to 65,725 (59 %) (p < 0.001) at the control site. The installation of a signalized crosswalk facilitated an increase in safe street crossings and calmed traffic volume and speed in an underserved neighborhood. We believe these findings have significant public health implications that could be critical to advocacy efforts to improve infrastructure projects in similar communities.

The Health Sciences and Technology Academy: an educational pipeline to address health care disparities in West Virginia.

PubMed

McKendall, Sherron Benson; Kasten, Kasandra; Hanks, Sara; Chester, Ann

2014-01-01

Health and educational disparities are national issues in the United States. Research has shown that health care professionals from underserved backgrounds are more likely than others to work in underserved areas. The Association of American Medical Colleges' Project 3000 by 2000, to increase the number of underrepresented minorities in medical schools, spurred the West Virginia School of Medicine to start the Health Sciences and Technology Academy (HSTA) in 1994 with the goal of supporting interested underrepresented high school students in pursuing college and health professions careers. The program was based on three beliefs: (1) if underrepresented high school students have potential and the desire to pursue a health professions career and are given the support, they can reach their goals, including obtaining a health professions degree; (2) underserved high school students are able to predict their own success if given the right resources; and (3) community engagement would be key to the program's success.In this Perspective, the authors describe the HSTA and its framework and philosophy, including the underlying theories and pedagogy from research in the fields of education and the behavioral/social sciences. They then offer evidence of the program's success, specifically for African American students, including graduates' high college-going rate and overwhelming intention to choose a health professions major. Finally, the authors describe the benefits of the HSTA's community partnerships, including providing mentors to students, adding legislative language providing tuition waivers and a budgetary line item devoted to the program, and securing program funding from outside sources.

Why Women Living in an Obstetric Care Underserved Area Do Not Utilize Their Local Hospital Supported by Korean Government for Childbirth.

PubMed

Kim, Jung-Eun; Na, Baeg Ju; Kim, Hyun Joo; Lee, Jin Yong

2016-09-01

This study aimed to understand why mothers do not utilize the prenatal care and delivery services at their local hospital supported by the government program, the Supporting Program for Obstetric Care Underserved Area (SPOU). We conducted a focus group interview by recruiting four mothers who delivered in the hospital in their community (a rural underserved obstetric care area) and another four mothers who delivered in the hospital outside of the community. From the finding, the mothers were not satisfied with the quality of services that the community hospital provided, in terms of professionalism of the obstetric care team, and the outdated medical device and facilities. Also, the mothers believed that the hospital in the metropolitan city is better for their health as well as that of their babies. The mothers who delivered in the outside community hospital considered geographical closeness less than they did the quality of obstetric care. The mothers who delivered in the community hospital gave the reason why they chose the hospital, which was convenience and emergency preparedness due to its geographical closeness. However, they were not satisfied with the quality of services provided by the community hospital like the other mothers who delivered in the hospital outside of the community. Therefore, in order to successfully deliver the SPOU program, the Korean government should make an effort in increasing the quality of maternity service provided in the community hospital and improving the physical factors of a community hospital such as outdated medical equipment and facilities. Copyright © 2016. Published by Elsevier B.V.

Patient navigation improves cancer diagnostic resolution: an individually randomized clinical trial in an underserved population.

PubMed

Raich, Peter C; Whitley, Elizabeth M; Thorland, William; Valverde, Patricia; Fairclough, Diane

2012-10-01

Barriers to timely resolution of abnormal cancer screening tests add to cancer health disparities among low-income, uninsured, and minority populations. We conducted a randomized trial to evaluate the impact of lay patient navigators on time to resolution and completion of follow-up testing among patients with abnormal screening tests in a medically underserved patient population. Denver Health, the safety-net health care system serving Denver, is one of 10 performance sites participating in the Patient Navigation Research Program. Of 993 eligible subjects with abnormal screening tests randomized to navigation and no-navigation (control) arms and analyzed, 628 had abnormal breast screens (66 abnormal clinical breast examinations, 304 BIRADS 0, 200 BIRADS 3, 58 BIRADS 4 or 5) whereas 235 had abnormal colorectal and 130 had abnormal prostate screens. Time to resolution was significantly shorter in the navigated group (stratified log rank test, P < 0.001). Patient navigation improved diagnostic resolution for patients presenting with mammographic BIRADS 3 (P = 0.0003) and BIRADS 0 (P = 0.09), but not BIRADS 4/5 or abnormal breast examinations. Navigation shortened the time for both colorectal (P = 0.0017) and prostate screening resolution (P = 0.06). Participant demographics included 72% minority, 49% with annual household income less than $10,000, and 36% uninsured. Patient navigation positively impacts time to resolution of abnormal screening tests for breast, colorectal, and prostate cancers in a medically underserved population. By shortening the time to and increasing the proportion of patients with diagnostic resolution patient navigation could reduce disparities in stage at diagnosis and improve cancer outcomes. 2012 AACR

An Assessment of Six School-Based Clinics: Services, Impact and Potential.

ERIC Educational Resources Information Center

Kirby, Douglas; And Others

For two decades, school-based clinics have been providing basic health care to medically underserved teenagers and addressing the increasingly complex health and social problems facing young people, particularly unintended pregnancy. Today there are 150 school-based clinics operating in most major cities and many rural areas. In 1984, the Center…

Integrating Education on Addressing Health Disparities into the Graduate Social Work Curriculum

ERIC Educational Resources Information Center

Mitchell, Jamie Ann

2012-01-01

The purpose of this article is to propose an elective social work course as a means of better preparing social workers entering practice in healthcare to meet the challenges of promoting health and reducing health disparities in minority and underserved communities. Course offerings specifically targeting health or medical social work training…

Building the Wireless Campus

ERIC Educational Resources Information Center

Gerraughty, James F.; Shanafelt, Michael E.

2005-01-01

This prototype is a continuation of a series of wireless prototypes which began in August 2001 and was reported on again in August 2002. This is the final year of this prototype. This continuation allowed Saint Francis University's Center of Excellence for Remote and Medically Under-Served Areas (CERMUSA) to refine the existing WLAN for the Saint…

Nursing and Nursing Education: Public Policies and Private Actions.

ERIC Educational Resources Information Center

Institute of Medicine (NAS), Washington, DC.

Results are presented of a study of nursing and nursing education that focused on the need for continued federal support of nursing education, ways to attract nurses to medically underserved areas, and approaches to encourage nurses to stay in the profession. Findings are presented on whether the aggregate supply of generalist nurses will be…

Streaming Media Seminar--Effective Development and Distribution of Streaming Multimedia in Education

ERIC Educational Resources Information Center

Mainhart, Robert; Gerraughty, James; Anderson, Kristine M.

2004-01-01

Concisely defined, "streaming media" is moving video and/or audio transmitted over the Internet for immediate viewing/listening by an end user. However, at Saint Francis University's Center of Excellence for Remote and Medically Under-Served Areas (CERMUSA), streaming media is approached from a broader perspective. The working definition includes…

Nursing as a Career Choice by Hispanic/Latino College Students

ERIC Educational Resources Information Center

Stroup, Linda M.

2013-01-01

A culturally competent healthcare workforce is essential to meet the needs of an increasingly diverse society. Greater diversity in the healthcare workforce is expected have many benefits, including improved access to care for the medically underserved and the promotion of research in areas of societal need (Cohen, Gabriel, & Terrell, 2002).…

Dental Disease in Infants and Toddlers: A Transdisciplinary Health Concern and Approach

ERIC Educational Resources Information Center

Finn, Emanuel; Wolpin, Scott

2005-01-01

This article describes the consequences of dental disease among children under age 3. "Early childhood carries" (ECC) is preventable but is still a major public health problem--especially in poor and medically underserved communities--due to lack of awareness about prevention. The authors explain that in transdisciplinary care, practitioners work…

Dental Services for Migrant and Seasonal Farmworkers in US Community/Migrant Health Centers

ERIC Educational Resources Information Center

Lukes, Sherri M.; Simon, Bret

2006-01-01

Context: Migrant and seasonal farmworkers are recognized as a medically underserved population, yet little information on need, access, and services is available--particularly with regard to oral health care. Purpose: This study describes the facilities, services, staffing, and patient characteristics of US dental clinics serving migrant and…

Burnout Syndrome: Global Medicine Volunteering as a Possible Treatment Strategy.

PubMed

Iserson, Kenneth V

2018-04-01

In the last few decades, "burnout syndrome" has become more common among clinicians, or at least more frequently recognized. Methods to prevent and treat burnout have had inconsistent results. Simultaneously, clinicians' interest in global medicine has increased dramatically, offering a possible intervention strategy for burnout while providing help to underserved areas. Caused by a variety of stressors, burnout syndrome ultimately results in physicians feeling that their work no longer embodies why they entered the medical field. This attitude harms clinicians, their patients and colleagues, and society. Few consistently successful interventions exist. At the same time, clinicians' interest in global medicine has risen exponentially. This paper reviews the basics of both phenomena and posits that global medicine experiences, although greatly assisting target populations, also may offer a strategy for combating burnout by reconnecting physicians with their love of the profession. Because studies have shown that regular volunteering improves mental health, short-term global medicine experiences may reinvigorate and reengage clinicians on the verge of, or suffering from, persistent burnout syndrome. Fortuitously, this intervention often will greatly benefit medically underserved populations. Copyright © 2018 Elsevier Inc. All rights reserved.

A Statewide Approach to Health Care Personnel Maldistribution—The California Area Health Education Center System

PubMed Central

Crowder, John E.; Schnepper, James E.; Gessert, Charles

1984-01-01

An Area Health Education Center (AHEC) system has been established in California to address the maldistribution of physicians and other health care professionals. The AHEC program uses educational incentives to recruit and retain health care personnel in underserved areas by linking the academic resources of university health science centers with local educational and clinical facilities. The medical schools, working in partnership with urban or rural AHECs throughout the state, are implementing educational programs to attract trainees and licensed professionals to work in underserved communities. The California AHEC project entered its fifth year in October of 1983 with the participation of all eight medical schools and the Charles Drew Postgraduate School of Medicine, 35 other health professions schools, 17 independent AHECs and more than 400 clinical training sites. Educational programs are reaching more than 22,000 students and practicing health professionals throughout California. We review the current status of the California AHEC system and use the AHEC programs at Loma Linda University to illustrate the effect this intervention is having. PMID:6730500

Diet and Exercise Adherence and Practices Among Medically Underserved Patients With Chronic Disease: Variation Across Four Ethnic Groups

PubMed Central

Orzech, Kathryn M.; Vivian, James; Torres, Cristina Huebner; Armin, Julie; Shaw, Susan J.

2013-01-01

Many factors interact to create barriers to dietary and exercise plan adherence among medically underserved patients with chronic disease, but aspects related to culture and ethnicity are underexamined in the literature. Using both qualitative (n = 71) and quantitative (n = 297) data collected in a 4-year, multimethod study among patients with hypertension and/ or diabetes, the authors explored differences in self-reported adherence to diet and exercise plans and self-reported daily diet and exercise practices across four ethnic groups—Whites, Blacks, Vietnamese, and Latinos—at a primary health care center in Massachusetts. Adherence to diet and exercise plans differed across ethnic groups even after controlling for key sociodemographic variables, with Vietnamese participants reporting the highest adherence. Food and exercise options were shaped by economic constraints as well as ethnic and cultural familiarity with certain foods and types of activity. These findings indicate that health care providers should consider ethnicity and economic status together to increase effectiveness in encouraging diverse populations with chronic disease to make healthy lifestyle changes. PMID:22505574

Diet and exercise adherence and practices among medically underserved patients with chronic disease: variation across four ethnic groups.

PubMed

Orzech, Kathryn M; Vivian, James; Huebner Torres, Cristina; Armin, Julie; Shaw, Susan J

2013-02-01

Many factors interact to create barriers to dietary and exercise plan adherence among medically underserved patients with chronic disease, but aspects related to culture and ethnicity are underexamined in the literature. Using both qualitative (n = 71) and quantitative (n = 297) data collected in a 4-year, multimethod study among patients with hypertension and/or diabetes, the authors explored differences in self-reported adherence to diet and exercise plans and self-reported daily diet and exercise practices across four ethnic groups-Whites, Blacks, Vietnamese, and Latinos-at a primary health care center in Massachusetts. Adherence to diet and exercise plans differed across ethnic groups even after controlling for key sociodemographic variables, with Vietnamese participants reporting the highest adherence. Food and exercise options were shaped by economic constraints as well as ethnic and cultural familiarity with certain foods and types of activity. These findings indicate that health care providers should consider ethnicity and economic status together to increase effectiveness in encouraging diverse populations with chronic disease to make healthy lifestyle changes.

Evaluation of a campaign to improve immunization in a rural headstart program.

PubMed

Mayer, J P; Housemann, R; Piepenbrok, B

1999-02-01

This study evaluated an intervention to improve immunization rates in a high poverty, medically underserved rural area employing a pretest-posttest design. The intervention expanded immunization availability, established walk-in appointment policies, and introduced intensified parent education. Formative evaluation indicated specific messages with high salience to parents. As a result, the susceptibility and severity of childhood infectious disease, the outcome efficacy of vaccines, and methods to reduce barriers to immunization were emphasized in communications with parents. Data on DTP1-4, OPV1-3, and MMR were obtained from preschools, local health departments and private medical practices before (n = 567) and after the intervention (n = 331). Following adjustment for birth order and demographics, at post-intervention a significantly greater proportion of children received 6 of 8 vaccines on time. Effect sizes were large. For example, post MMR rates were at least 2X greater than pre rates. Time-series analysis of trend data on local newspaper coverage of child health topics suggested history was not a major threat to the internal validity of this pre-post only design. The findings indicate that comprehensive intervention, targeting improvements in the availability of pediatric care, health system policies and parent behavior, can improve immunization.

Last resort or roll of the die? Exploring the role of metaphors in cancer clinical trials education among medically underserved populations.

PubMed

Krieger, Janice L

2014-01-01

Improving communication about cancer clinical trials may help increase patients' understanding of medical research and their interest in participating. It is unfortunate that there is little empirical research to provide guidance on how to adapt clinical trial messages to maximize cultural sensitivity. This study examines (a) how medically underserved women conceptualize clinical trials by examining the language they use to describe them and (b) how this audience interprets metaphorical language used to explain randomization in the context of Phase III cancer clinical trials. The author conducted in-depth interviews and focus groups with 41 rural, low-income older women who either had been diagnosed with cancer or were caregivers for a person with cancer. The most commonly used lay metaphors for clinical trials had strong negative connotations and included treatment by trial and error, patients are guinea pigs, and treatment of last resort. Participants also expressed strong, unfavorable responses to conventional metaphors that equate randomization with the roll of a die or use other gambling language. Low-literacy definition approaches were unexpectedly problematic, suggesting the potential effectiveness of culturally grounded metaphors for communicating about clinical trials. Ethical implications of these findings for cancer communication are discussed.

An early stage evaluation of the Supporting Program for Obstetric Care Underserved Areas in Korea.

PubMed

Na, Baeg Ju; Kim, Hyun Joo; Lee, Jin Yong

2014-06-01

"The Supporting Program for Obstetric Care Underserved Areas (SPOU)" provides financial aids to rural community (or district) hospitals to reopen prenatal care and delivery services for regions without obstetrics and gynecology clinics or hospitals. The purpose of this study was to evaluate the early stage effect of the SPOU program. The proportion of the number of birth through SPOU was calculated by each region. Also survey was conducted to investigate the extent of overall satisfaction, elements of dissatisfaction, and suggestions for improvement of the program; 209 subjects participated from 7 to 12 December, 2012. Overall, 20% of pregnant women in Youngdong (71 cases) and Gangjin (106 cases) used their community (or district) hospitals through the SPOU whereas Yecheon (23 cases) was 8%; their satisfaction rates were high. Short distance and easy accessibility was the main reason among women choosing community (or district) hospital whereas the reasons of not selecting the community (or district) hospital were favor of the outside hospital's facility, system, and trust in the medical staffs. The SPOU seems to be currently effective at an early stage. However, to successfully implement this program, the government should make continuous efforts to recruit highly qualified medical staffs and improve medical facility and equipment.

Program evaluation of remote heart failure monitoring: healthcare utilization analysis in a rural regional medical center.

PubMed

Riley, William T; Keberlein, Pamela; Sorenson, Gigi; Mohler, Sailor; Tye, Blake; Ramirez, A Susana; Carroll, Mark

2015-03-01

Remote monitoring for heart failure (HF) has had mixed and heterogeneous effects across studies, necessitating further evaluation of remote monitoring systems within specific healthcare systems and their patient populations. "Care Beyond Walls and Wires," a wireless remote monitoring program to facilitate patient and care team co-management of HF patients, served by a rural regional medical center, provided the opportunity to evaluate the effects of this program on healthcare utilization. Fifty HF patients admitted to Flagstaff Medical Center (Flagstaff, AZ) participated in the project. Many of these patients lived in underserved and rural communities, including Native American reservations. Enrolled patients received mobile, broadband-enabled remote monitoring devices. A matched cohort was identified for comparison. HF patients enrolled in this program showed substantial and statistically significant reductions in healthcare utilization during the 6 months following enrollment, and these reductions were significantly greater compared with those who declined to participate but not when compared with a matched cohort. The findings from this project indicate that a remote HF monitoring program can be successfully implemented in a rural, underserved area. Reductions in healthcare utilization were observed among program participants, but reductions were also observed among a matched cohort, illustrating the need for rigorous assessment of the effects of HF remote monitoring programs in healthcare systems.

Jackson Park Hospital Green Building Medical Center

DOE Office of Scientific and Technical Information (OSTI.GOV)

William Dorsey; Nelson Vasquez

2010-03-31

Jackson Park Hospital completed the construction of a new Medical Office Building on its campus this spring. The new building construction has adopted the City of Chicago's recent focus on protecting the environment, and conserving energy and resources, with the introduction of green building codes. Located in a poor, inner city neighborhood on the South side of Chicago, Jackson Park Hospital has chosen green building strategies to help make the area a better place to live and work. The new green building houses the hospital's Family Medicine Residency Program and Specialty Medical Offices. The residency program has been vital inmore » attracting new, young physicians to this medically underserved area. The new outpatient center will also help to allure needed medical providers to the community. The facility also has areas designated to women's health and community education. The Community Education Conference Room will provide learning opportunities to area residents. Emphasis will be placed on conserving resources and protecting our environment, as well as providing information on healthcare access and preventive medicine. The new Medical Office Building was constructed with numerous energy saving features. The exterior cladding of the building is an innovative, locally-manufactured precast concrete panel system with integral insulation that achieves an R-value in excess of building code requirements. The roof is a 'green roof' covered by native plantings, lessening the impact solar heat gain on the building, and reducing air conditioning requirements. The windows are low-E, tinted, and insulated to reduce cooling requirements in summer and heating requirements in winter. The main entrance has an air lock to prevent unconditioned air from entering the building and impacting interior air temperatures. Since much of the traffic in and out of the office building comes from the adjacent Jackson Park Hospital, a pedestrian bridge connects the two buildings, further decreasing the amount of unconditioned air that enters the office building. The HVAC system has an Energy Efficiency Rating 29% greater than required. No CFC based refrigerants were used in the HVAC system, thus reducing the emission of compounds that contribute to ozone depletion and global warming. In addition, interior light fixtures employ the latest energy-efficient lamp and ballast technology. Interior lighting throughout the building is operated by sensors that will automatically turn off lights inside a room when the room is unoccupied. The electrical traction elevators use less energy than typical elevators, and they are made of 95% recycled material. Further, locally manufactured products were used throughout, minimizing the amount of energy required to construct this building. The primary objective was to construct a 30,000 square foot medical office building on the Jackson Park Hospital campus that would comply with newly adopted City of Chicago green building codes focusing on protecting the environment and conserving energy and resources. The energy saving systems demonstrate a state of the-art whole-building approach to energy efficient design and construction. The energy efficiency and green aspects of the building contribute to the community by emphasizing the environmental and economic benefits of conserving resources. The building highlights the integration of Chicago's new green building codes into a poor, inner city neighborhood project and it is designed to attract medical providers and physicians to a medically underserved area.« less

12 CFR 345.12 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... geographies; (ii) Designated disaster areas; or (iii) Distressed or underserved nonmetropolitan middle-income... Comptroller of the Currency, based on— (A) Rates of poverty, unemployment, and population loss; or (B...

Rural Status, Suicide Ideation, and Telemental Health: Risk Assessment in a Clinical Sample.

PubMed

Tarlow, Kevin R; Johnson, Tina A; McCord, Carly E

2018-06-25

Individuals living in rural areas die by suicide at higher rates than those living in metropolitan areas. Telemental health interventions provide rural residing individuals with access to needed care. Identifying telemental health clients at risk for suicide is an important task for clinicians and policymakers. This study evaluated to what degree rural status and other demographic variables predicted suicide ideation in clients seeking services at a telemental health clinic. Study participants included 457 low-income clients residing in the medically underserved, geographically diverse Brazos Valley region of Texas. Clients completed the patient health questionnaire during their initial counseling appointment, which assessed depression severity and suicide ideation in the 2 weeks prior to assessment. Suicide ideation was common among telemental health clients, with approximately 40% of clients in all demographic groups reporting some recent thoughts of suicide. Rates of suicide ideation did not significantly differ by geographic designation (ie, rural/metropolitan status), gender, or race/ethnicity. However, depression was a strong predictor of recent suicide ideation. Telemental health programs can effectively connect clinicians with rural residing clients who are otherwise isolated from health care services. However, clinicians working in high-need, historically underserved areas should be prepared to encounter a high prevalence of suicide ideation and depression. In these regions, clinical and diagnostic features may be better indicators of suicide ideation than demographic variables. © 2018 National Rural Health Association.

HOPE clinic: a place to care.

PubMed

Westra, Ruth; Skube, Steve; Zant, Melissa

2011-11-01

The University of Minnesota Medical School and College of Pharmacy in Duluth worked with a local drop-in center in 2008 to start a free clinic. The HOPE (Health of People Everywhere) Clinic is a student-run, faculty-organized effort that offers students an opportunity to develop their clinical skills and learn how to work in interprofessional teams while providing needed care to people who are underserved or uninsured. This article describes how this initiative came about and the impact it is having on medical students.

How sequestration cuts affect primary care physicians and graduate medical education.

PubMed

Chauhan, Bindiya; Coffin, Janis

2013-01-01

On April 1, 2013, sequestration cuts went into effect impacting Medicare physician payments, graduate medical education, and many other healthcare agencies. The cuts range from 2% to 5%, affecting various departments and organizations. There is already a shortage of primary care physicians in general, not including rural or underserved areas, with limited grants for advanced training. The sequestration cuts negatively impact the future of many primary care physicians and hinder the care many Americans will receive over time.

Increasing the Capacity of College Counseling through Video Game Design

ERIC Educational Resources Information Center

Mathis, Jonathan D.

2010-01-01

This article discusses game design concepts suggested to foster engagement while considering the needs of underserved high school students preparing for the college admission process. The contextual nature of college counseling efforts in urban secondary school settings provides a backdrop for consideration of the manner in which game design and…

Design of the integrative medical group visits randomized control trial for underserved patients with chronic pain and depression.

PubMed

Gardiner, Paula; Lestoquoy, Anna Sophia; Gergen-Barnett, Katherine; Penti, Brian; White, Laura F; Saper, Robert; Fredman, Lisa; Stillman, Sarah; Lily Negash, N; Adelstein, Pamela; Brackup, Ivy; Farrell-Riley, Christine; Kabbara, Karim; Laird, Lance; Mitchell, Suzanne; Bickmore, Timothy; Shamekhi, Ameneh; Liebschutz, Jane M

2017-03-01

Given the public health crisis of opioid overprescribing for pain, there is a need for evidence-based non pharmacological treatment options that effectively reduce pain and depression. We aim to examine the effectiveness of the Integrative Medical Group Visits (IMGV) model in reducing chronic pain and depressive symptoms, as well as increasing pain self-management. This paper details the study design and implementation of an ongoing randomized controlled trial of the IMGV model as compared to primary care visits. The research aims to determine if the IMGV model is effective in achieving: a) a reduction in self-reported pain and depressive symptoms and 2) an improvement in the self-management of pain, through increasing pain self-efficacy and reducing use of self-reported pain medication. We intend to recruit 154 participants to be randomized in our intervention, the IMGV model (n=77) and to usual care (n=77). Usual care of chronic pain through pharmacological treatment has mixed evidence of efficacy and may not improve quality of life or functional status. We aim to conduct a randomized controlled trial to evaluate the effectiveness of the IMGV model as compared to usual care in reducing self-reported pain and depressive symptoms as well as increasing pain management skills. Copyright © 2016 Elsevier Inc. All rights reserved.

8 CFR 245.18 - Physicians with approved employment-based petitions serving in a medically underserved area or a...

Code of Federal Regulations, 2014 CFR

2014-01-01

... 8 Aliens and Nationality 1 2014-01-01 2014-01-01 false Physicians with approved employment-based... THAT OF PERSON ADMITTED FOR PERMANENT RESIDENCE § 245.18 Physicians with approved employment-based... second preference employment-based immigrant visa petition. (b) Do alien physicians have special time...

8 CFR 245.18 - Physicians with approved employment-based petitions serving in a medically underserved area or a...

Code of Federal Regulations, 2012 CFR

2012-01-01

... 8 Aliens and Nationality 1 2012-01-01 2012-01-01 false Physicians with approved employment-based... THAT OF PERSON ADMITTED FOR PERMANENT RESIDENCE § 245.18 Physicians with approved employment-based... second preference employment-based immigrant visa petition. (b) Do alien physicians have special time...

8 CFR 245.18 - Physicians with approved employment-based petitions serving in a medically underserved area or a...

Code of Federal Regulations, 2013 CFR

2013-01-01

... 8 Aliens and Nationality 1 2013-01-01 2013-01-01 false Physicians with approved employment-based... THAT OF PERSON ADMITTED FOR PERMANENT RESIDENCE § 245.18 Physicians with approved employment-based... second preference employment-based immigrant visa petition. (b) Do alien physicians have special time...

8 CFR 1245.18 - How can physicians (with approved Forms I-140) that are serving in medically underserved areas or...

Code of Federal Regulations, 2013 CFR

2013-01-01

... employment-based immigrant visa petition. (b) Do alien physicians have special time-related requirements for... shall be submitted with the documentary evidence noting the physician's completion of the required years...) Once the Service has approved an alien physician's Form I-140 with a national interest waiver based...

8 CFR 1245.18 - How can physicians (with approved Forms I-140) that are serving in medically underserved areas or...

Code of Federal Regulations, 2014 CFR

2014-01-01

... employment-based immigrant visa petition. (b) Do alien physicians have special time-related requirements for... shall be submitted with the documentary evidence noting the physician's completion of the required years...) Once the Service has approved an alien physician's Form I-140 with a national interest waiver based...

8 CFR 1245.18 - How can physicians (with approved Forms I-140) that are serving in medically underserved areas or...

Code of Federal Regulations, 2012 CFR

2012-01-01

... employment-based immigrant visa petition. (b) Do alien physicians have special time-related requirements for... shall be submitted with the documentary evidence noting the physician's completion of the required years...) Once the Service has approved an alien physician's Form I-140 with a national interest waiver based...

8 CFR 1245.18 - How can physicians (with approved Forms I-140) that are serving in medically underserved areas or...

Code of Federal Regulations, 2010 CFR

2010-01-01

... employment-based immigrant visa petition. (b) Do alien physicians have special time-related requirements for... shall be submitted with the documentary evidence noting the physician's completion of the required years...) Once the Service has approved an alien physician's Form I-140 with a national interest waiver based...

8 CFR 1245.18 - How can physicians (with approved Forms I-140) that are serving in medically underserved areas or...

Code of Federal Regulations, 2011 CFR

2011-01-01

... employment-based immigrant visa petition. (b) Do alien physicians have special time-related requirements for... shall be submitted with the documentary evidence noting the physician's completion of the required years...) Once the Service has approved an alien physician's Form I-140 with a national interest waiver based...

Addressing Disparities in Parent Education: Examining the Effects of Learn the Signs/Act Early Parent Education Materials on Parent Outcomes

ERIC Educational Resources Information Center

Graybill, Emily; Self-Brown, Shannon; Lai, Betty; Vinoski, Erin; McGill, Tia; Crimmins, Daniel

2016-01-01

Early intervention is critical for improved prognosis and quality of life for young children with developmental delays and disabilities. Yet, disparities persist among underserved families with young children. These disparities include knowledge of child development, use of medical providers as referral sources, and later diagnosis. The current…

42 CFR 417.124 - Administration and management.

Code of Federal Regulations, 2011 CFR

2011-10-01

... various age, social, and income groups within its service area. (2) If an HMO has a medically underserved... easily understood by the average person who might enroll in the HMO. (ii) The description of benefits and... meaning it is given in the Employment Retirement Income Security Act of 1974 (ERISA) at 29 U.S.C. 1002(16...

When "Promotoras" and Technology Meet: A Qualitative Analysis of "Promotoras'" Use of Small Media to Increase Cancer Screening among South Texas Latinos

ERIC Educational Resources Information Center

Arvey, Sarah R.; Fernandez, Maria E.; LaRue, Denise M.; Bartholomew, L. Kay

2012-01-01

Computer-based multimedia technologies can be used to tailor health messages, but "promotoras" (Spanish-speaking community health workers) rarely use these tools. "Promotoras" delivered health messages about colorectal cancer screening to medically underserved Latinos in South Texas using two small media formats: a…

Spiritually Based Intervention to Increase Colorectal Cancer Screening among African Americans: Screening and Theory-Based Outcomes from a Randomized Trial

ERIC Educational Resources Information Center

Holt, Cheryl L.; Litaker, Mark S.; Scarinci, Isabel C.; Debnam, Katrina J.; McDavid, Chastity; McNeal, Sandre F.; Eloubeidi, Mohamad A.; Crowther, Martha; Bolland, John; Martin, Michelle Y.

2013-01-01

Colorectal cancer screening has clear benefits in terms of mortality reduction; however, it is still underutilized and especially among medically underserved populations, including African Americans, who also suffer a disproportionate colorectal cancer burden. This study consisted of a theory-driven (health belief model) spiritually based…

Mammographic Breast Density in a Cohort of Medically Underserved Women

DTIC Science & Technology

2013-10-01

94http : / / www.elsev ier .com/ locate / jeghPerinatal factors and breast cancer risk among HispanicsMaureen Sanderson a,b,*, Adriana Pérez c,d, Mirabel...risk of breast cancer: a systematic review and meta-analysis of current evidence. Lancet Oncol 2007;8:1088–100. [3] Park SK, Kang D, McGlynn KA

Approaching the Affective Factors of Information Seeking: The Viewpoint of the Information Search Process Model

ERIC Educational Resources Information Center

Savolainen, Reijo

2015-01-01

Introduction: The article contributes to the conceptual studies of affective factors in information seeking by examining Kuhlthau's information search process model. Method: This random-digit dial telephone survey of 253 people (75% female) living in a rural, medically under-serviced area of Ontario, Canada, follows-up a previous interview study…

What Pennsylvania Health Care Students Would Want for Participating in Loan Forgiveness Programs.

ERIC Educational Resources Information Center

Redd, Kenneth E.

The results of a survey of students majoring in health care fields regarding a proposed program in which educational loans would be forgiven in exchange for serving medically underserved Pennsylvanians are discussed in this report. The survey sought to discover whether students would be interested in participating in a "loan forgiveness"…

The transformation of osteopathic medical education.

PubMed

Gevitz, Norman

2009-06-01

Osteopathic medical schools and hospital-based postgraduate programs have long constituted small but important sources of physicians and surgeons, particularly for traditionally underserved areas of the United States. Though frequently marginalized in or even left out of standard histories and studies of U.S. medical education, these institutions have become much more difficult to ignore, given the rapid expansion of the number of osteopathic medical students in new and existing colleges and the size of their classes. By 2019, upwards of 25% of all U.S. medical school graduates produced annually will be doctors of osteopathic medicine. The author examines the process through which osteopathy was transformed into osteopathic medicine, how osteopathic medical schools achieved their present status as a significant source of U.S. graduates for residency training, and what challenges osteopathic medical education now faces.

Medical students as health educators at a student-run free clinic: improving the clinical outcomes of diabetic patients.

PubMed

Gorrindo, Phillip; Peltz, Alon; Ladner, Travis R; Reddy, India; Miller, Bonnie M; Miller, Robert F; Fowler, Michael J

2014-04-01

Student-run free clinics (SRFCs) provide service-learning opportunities for medical students and care to underserved patients. Few published studies, however, support that they provide high-quality care. In this study, the authors examined the clinical impact of a medical student health educator program for diabetic patients at an SRFC. In 2012, the authors retrospectively reviewed the electronic medical records of diabetic patients who established care at Shade Tree Clinic in Nashville, Tennessee, between 2008 and 2011. They compared clinical outcomes at initial presentation to the clinic and 12 months later. They analyzed the relationship between the number of patient-student interactions (touchpoints) and change in hemoglobin A1c values between these two time points and compared the quality of care provided to best-practice benchmarks (process and outcomes measures). The authors studied data from 45 patients. Mean hemoglobin A1c values improved significantly from 9.6 to 7.9, after a mean of 12.5 ± 1.5 months (P < .0001). A trend emerged between increased number of touchpoints and improvement in A1c values (r = 0.06, P = .10). A high percentage of patients were screened during clinic visits, whereas a low to moderate percentage met benchmarks for A1c, LDL, and blood pressure levels. These findings demonstrate that a medical student health educator program at an SRFC can provide high-quality diabetes care and facilitate clinical improvement one year after enrollment, despite inherent difficulties in caring for underserved patients. Future studies should examine the educational and clinical value of care provided at SRFCs.

STRUCTURAL AND HIDDEN BARRIERS TO A LOCAL PRIMARY HEALTH CARE INFRASTRUCTURE: AUTONOMY, DECISIONS ABOUT PRIMARY HEALTH CARE, AND THE CENTRALITY AND SIGNIFICANCE OF POWER.

PubMed

Freed, Christopher R; Hansberry, Shantisha T; Arrieta, Martha I

2013-09-01

To examine a local primary health care infrastructure and the reality of primary health care from the perspective of residents of a small, urban community in the southern United States. Data derive from 13 semi-structured focus groups, plus three semi-structured interviews, and were analyzed inductively consistent with a grounded theory approach. Structural barriers to the local primary health care infrastructure include transportation, clinic and appointment wait time, and co-payments and health insurance. Hidden barriers consist of knowledge about local health care services, non-physician gatekeepers, and fear of medical care. Community residents have used home remedies and the emergency department at the local academic medical center to manage these structural and hidden barriers. Findings might not generalize to primary health care infrastructures in other communities, respondent perspectives can be biased, and the data are subject to various interpretations and conceptual and thematic frameworks. Nevertheless, the structural and hidden barriers to the local primary health care infrastructure have considerably diminished the autonomy community residents have been able to exercise over their decisions about primary health care, ultimately suggesting that efforts concerned with increasing the access of medically underserved groups to primary health care in local communities should recognize the centrality and significance of power. This study addresses a gap in the sociological literature regarding the impact of specific barriers to primary health care among medically underserved groups.

Enhancing an introductory Pharmacy Practice Experience at free medical clinics.

PubMed

Morello, Candis M; Singh, Renu F; Chen, Karen J; Best, Brookie M

2010-02-01

The aim of the study was to assess and improve first-year student pharmacists' satisfaction and learning experience in a Student-Run Free Medical Clinic Project (SFMCP) providing medical care to an underserved population. Two consecutive classes of first-year student pharmacists at the University of California San Diego (UCSD) Skaggs School of Pharmacy and Pharmaceutical Sciences participated in an Introductory Pharmacy Practice Experience (IPPE) at the UCSD SFMCP. This IPPE involved two inter-professional evening free clinics which provide medical care to an underserved population and opportunities for healthcare professional training and service. Year 1 students completed a self-assessment survey instrument and year 2 students completed the survey instrument plus a new competency checklist tool. Average scores from the self-assessment survey instrument were compared between years 1 and 2. Initial survey results showed that students felt the SFMCP was worthwhile; however, they did not experience enough involvement in the patient assistance programme or non-pharmacy-related clinic activities. After the competency checklist tool implementation, overall student pharmacist satisfaction of the SFMCP IPPE remained high (88%), participation in identified weak areas improved and students agreed that the tool helped focus their clinic experience. Areas of improvement were identified with the survey instrument and the competency checklist tool increased achievement of learning objectives. Overall, student pharmacists felt the SFMCP IPPE was a good learning experience. Practising pharmacists can employ these or similar tools in specific practice settings, to evaluate and help ensure that student pharmacists or interns are achieving applicable learning objectives.

Meeting the needs of regional minority groups: the University of Washington's programs to increase the American Indian and Alaskan native physician workforce.

PubMed

Acosta, David; Olsen, Polly

2006-10-01

Minority populations in the United States are growing rapidly, but physician workforce diversity has not kept pace with the needs of underserved communities. Minorities comprised 26.4% of the population in 1995; by 2050, these groups will comprise nearly half. Medical schools must enlist greater numbers of minority physicians and train all physicians to provide culturally responsive care. The University of Washington School of Medicine (UWSOM) is the nation's only medical school that serves a five-state region (Washington, Wyoming, Alaska, Montana, and Idaho). Its mission addresses the need to serve the region, rectify primary care shortages, and meet increasing regional demands for underserved populations. The UWSOM Native American Center of Excellence (NACOE) was established as one important way to respond to this charge. The authors describe pipeline and minority recruitment programs at UWSOM, focusing on the NACOE and other activities to recruit American Indian/Alaskan Native (AI/AN) applicants to medical schools. These programs have increased the numbers of AI/AN medical students; developed the Indian Health Pathway; worked to prepare students to provide culturally responsive care for AI/AN communities; researched health disparities specific to AI/AN populations; provided retention programs and services to ensure successful completion of medical training; developed mentorship networks; and provided faculty-development programs to increase entry of AI/AN physicians into academia. Challenges lie ahead. Barriers to the pipeline will continue to plague students, and inadequate federal funding will have a significant and negative impact on achieving needed physician-workforce diversity. Medical schools must play a larger role in resolving these, and continue to provide pipeline programs, retention programs, and minority faculty development that can make a difference.

Mano a Mano: Improving health in impoverished Bolivian communities through community-based participatory research.

PubMed

Velasquez, Joan; Knatterud-Hubinger, Nate; Narr, Dan; Mendenhall, Tai; Solheim, Catherine

2011-12-01

Mano a Mano (Spanish translation: "Hand to Hand") is a nonprofit organization that is working in partnership with underserved Bolivian communities to cocreate medical infrastructures and to improve health. Using community-based participatory research (CBPR) methods, Mano a Mano engages local government and community leaders, health care providers, educators, and ordinary citizens in a manner that taps local strengths and resources to allow all participants to work together to realize this mission. After describing Bolivia's call for improved access to high quality care in its poor and underserved rural areas, we outline the Mano a Mano's CBPR approach and sequence to answer this call, the culmination of its efforts to date (including the establishment of 119 health care facilities), lessons learned, and next steps in the formal evaluation and extension of this collaborative work.

Disparities in Underserved White Populations: The Case of Cancer-Related Disparities in Appalachia

PubMed Central

Paskett, Electra D.; Lengerich, Eugene J.; Schoenberg, Nancy E.; Kennedy, Stephenie K.; Conn, Mary Ellen; Roberto, Karen A.; Dwyer, Sharon K.; Fickle, Darla; Dignan, Mark

2011-01-01

There are meaningful cancer-related disparities in the Appalachian region of the U.S. To address these disparities, the Appalachia Community Cancer Network (ACCN), a collaboration of investigators and community partners in five states (Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia), is involved in increasing cancer education and awareness, conducting community-based participatory research (CBPR), and creating mentorship and training opportunities. The primary objective of this paper is to describe cancer-related disparities in the Appalachian region of the U.S. as an example of the disparities experienced by underserved, predominantly white, rural populations, and to describe ACCN activities designed to intervene regarding these disparities. An ACCN overview/history and the diverse activities of ACCN-participating states are presented in an effort to suggest potential useful strategies for working to reduce health-related disparities in underserved white populations. Strengths that have emerged from the ACCN approach (e.g., innovative collaborations, long-standing established networks) and remaining challenges (e.g., difficulties with continually changing communities, scarce resources) are described. Important recommendations that have emerged from the ACCN are also presented, including the value of allowing communities to lead CBPR efforts. Characteristics of the community-based work of the ACCN provide a framework for reducing health-related disparities in Appalachia and in other underserved white and rural populations. PMID:21873582

Maintenance of Certification Part 4 Credit and recruitment for practice-based research.

PubMed

Gorzkowski, Julie A; Klein, Jonathan D; Harris, Donna L; Kaseeska, Kristen R; Whitmore Shaefer, Regina M; Bocian, Alison B; Davis, James B; Gotlieb, Edward M; Wasserman, Richard C

2014-10-01

Competing priorities in pediatric practice have created challenges for practice-based research. To increase recruitment success, researchers must design studies that provide added value to participants. This study evaluates recruitment of pediatricians into a study, before and after the development and addition of a quality improvement (QI) curriculum approved for American Board of Pediatrics Maintenance of Certification (MOC) Part 4 Credit as an enrollment incentive. Researchers implemented multiple outreach methods to enroll pediatric practices over 28 months. Field note review revealed that many physicians declined enrollment, stating that they prioritized MOC Part 4 projects over research studies. A QI curriculum meeting standards for MOC Part 4 Credit was developed and added to the study protocol as an enrollment incentive. Enrollment rates and characteristics of practitioners enrolled pre- and post-MOC were compared. Pre-MOC enrollment contributed 48% of practices in 22 months; post-MOC enrollment contributed 49% of practices in 6 months. An average of 3.5 practices enrolled per month pre-MOC, compared with 13.1 per month post-MOC (P < .001). Clinicians in pre- and post-MOC groups were similar in age, gender, race, and time spent on patient care; practices enrolled post-MOC were more likely to be located in federally designated Medically Underserved Areas than those enrolled pre-MOC (28.6% vs 12%, P = .03). Addition of MOC Part 4 Credit increased recruitment success and increased enrollment of pediatricians working in underserved areas. Including QI initiatives meeting MOC Part 4 criteria in practice-based research protocols may enhance participation and aid in recruiting diverse practice and patient populations. Copyright © 2014 by the American Academy of Pediatrics.

Beyond Blackboards: Engaging Underserved Middle School Students in Engineering

ERIC Educational Resources Information Center

Blanchard, Sarah; Judy, Justina; Muller, Chandra; Crawford, Richard H.; Petrosino, Anthony J.; Christina K. White,; Lin, Fu-An; Wood, Kristin L.

2015-01-01

"Beyond Blackboards" is an inquiry-centered, after-school program designed to enhance middle school students' engagement with engineering through design-based experiences focused on the 21st Century Engineering Challenges. Set within a predominantly lowincome, majority-minority community, our study aims to investigate the impact of…

The Global Spine Care Initiative: a systematic review of individual and community-based burden of spinal disorders in rural populations in low- and middle-income communities.

PubMed

Hurwitz, Eric L; Randhawa, Kristi; Torres, Paola; Yu, Hainan; Verville, Leslie; Hartvigsen, Jan; Côté, Pierre; Haldeman, Scott

2017-12-27

The purpose of this review was to synthesize literature on the burden of spinal disorders in rural communities to inform the Global Spine Care Initiative care pathway and model of care for their application in medically underserved areas and low- and middle-income countries. A systematic review was conducted. Inclusion criteria included all age groups with nonspecific low back pain, neck pain, and associated disorders, nonspecific thoracic spinal pain, musculoskeletal chest pain, radiculopathy, or spinal stenosis. Study designs included observational study design (case-control, cross-sectional, cohort, ecologic, qualitative) or review or meta-analysis. After study selection, studies with low or moderate risk of bias were qualitatively synthesized. Of 1150 potentially relevant articles, 43 were eligible and included in the review. All 10 low and 18 moderate risk of bias studies were cross-sectional, 14 of which included rural residents only. All studies included estimates of low back pain prevalence, one included neck pain and one reported estimates for spinal disorders other than back or neck pain. The prevalence of low back pain appears greater among females and in those with less education, psychological factors (stress, anxiety, depression), and alcohol consumers. The literature is inconsistent as to whether back pain is more common in rural or urban areas. High risk of bias in many studies, lack of data on disability and other burden measures and few studies on conditions other than back and neck pain preclude a more comprehensive assessment of the individual and community-based burden of spinal disorders in less-developed communities. We identified few high-quality studies that may inform patients, providers, policymakers, and other stakeholders about spinal disorders and their burden on individuals and communities in most rural places of the developing world. These findings should be a call to action to devote resources for high-quality research to fill these knowledge gaps in medically underserved areas and low and middle-income countries. These slides can be retrieved under Electronic Supplementary Material.

Expanding Access to HCV Treatment - Extension for Community Healthcare Outcomes (ECHO) Project: Disruptive Innovation in Specialty Care

PubMed Central

Arora, Sanjeev; Kalishman, Summers; Thornton, Karla; Dion, Denise; Murata, Glen; Deming, Paulina; Parish, Brooke; Brown, John; Komaromy, Miriam; Colleran, Kathleen; Bankhurst, Arthur; Katzman, Joanna; Harkins, Michelle; Curet, Luis; Cosgrove, Ellen; Pak, Wesley

2013-01-01

The Extension for Community Healthcare Outcomes (ECHO) Model was developed by the University of New Mexico Health Sciences Center (UNMHSC) as a platform to deliver complex specialty medical care to underserved populations through an innovative educational model of team-based inter-disciplinary development. Using state-of-the-art telehealth technology, best practice protocols, and case based learning, ECHO trains and supports primary care providers to develop knowledge and self-efficacy on a variety of diseases. As a result, they can deliver best practice care for complex health conditions in communities where specialty care is unavailable. ECHO was first developed for the management of hepatitis C virus (HCV), optimal management of which requires consultation with multi-disciplinary experts in medical specialties, mental health and substance abuse. Few practitioners, particularly in rural and underserved areas, have the knowledge to manage its emerging treatment options, side effects, drug toxicities and treatment-induced depression. In addition data was obtained from observation of ECHO weekly clinics and database of ECHO clinic participation and patient presentations by clinical provider, evaluation of the ECHO program incorporates annual survey integrated into the ECHO annual meeting and routine surveys of community providers about workplace learning, personal and professional experiences, systems and environmental factors associated with professional practice, self-efficacy, facilitators and barriers to ECHO. The initial survey data show a significant improvement in provider knowledge, self-efficacy and professional satisfaction through participation in ECHO HCV clinics. Clinicians reported a moderate to major benefit from participation. We conclude that ECHO expands access to best practice care for underserved populations, builds communities of practice to enhance professional development and satisfaction of primary care clinicians, and expands sustainable capacity for care by building local centers of excellence. PMID:20607688

Leveraging CyVerse Resources for De Novo Comparative Transcriptomics of Underserved (Non-model) Organisms

PubMed Central

Joyce, Blake L.; Haug-Baltzell, Asher K.; Hulvey, Jonathan P.; McCarthy, Fiona; Devisetty, Upendra Kumar; Lyons, Eric

2017-01-01

This workflow allows novice researchers to leverage advanced computational resources such as cloud computing to carry out pairwise comparative transcriptomics. It also serves as a primer for biologists to develop data scientist computational skills, e.g. executing bash commands, visualization and management of large data sets. All command line code and further explanations of each command or step can be found on the wiki (https://wiki.cyverse.org/wiki/x/dgGtAQ). The Discovery Environment and Atmosphere platforms are connected together through the CyVerse Data Store. As such, once the initial raw sequencing data has been uploaded there is no more need to transfer large data files over an Internet connection, minimizing the amount of time needed to conduct analyses. This protocol is designed to analyze only two experimental treatments or conditions. Differential gene expression analysis is conducted through pairwise comparisons, and will not be suitable to test multiple factors. This workflow is also designed to be manual rather than automated. Each step must be executed and investigated by the user, yielding a better understanding of data and analytical outputs, and therefore better results for the user. Once complete, this protocol will yield de novo assembled transcriptome(s) for underserved (non-model) organisms without the need to map to previously assembled reference genomes (which are usually not available in underserved organism). These de novo transcriptomes are further used in pairwise differential gene expression analysis to investigate genes differing between two experimental conditions. Differentially expressed genes are then functionally annotated to understand the genetic response organisms have to experimental conditions. In total, the data derived from this protocol is used to test hypotheses about biological responses of underserved organisms. PMID:28518075

A community engagement process identifies environmental priorities to prevent early childhood obesity: the Children's Healthy Living (CHL) program for remote underserved populations in the US Affiliated Pacific Islands, Hawaii and Alaska.

PubMed

Fialkowski, Marie Kainoa; DeBaryshe, Barbara; Bersamin, Andrea; Nigg, Claudio; Leon Guerrero, Rachael; Rojas, Gena; Areta, Aufa'i Apulu Ropeti; Vargo, Agnes; Belyeu-Camacho, Tayna; Castro, Rose; Luick, Bret; Novotny, Rachel

2014-12-01

Underserved minority populations in the US Affiliated Pacific Islands (USAPI), Hawaii, and Alaska display disproportionate rates of childhood obesity. The region's unique circumstance should be taken into account when designing obesity prevention interventions. The purpose of this paper is to (a), describe the community engagement process (CEP) used by the Children's Healthy Living (CHL) Program for remote underserved minority populations in the USAPI, Hawaii, and Alaska (b) report community-identified priorities for an environmental intervention addressing early childhood (ages 2-8 years) obesity, and (c) share lessons learned in the CEP. Four communities in each of five CHL jurisdictions (Alaska, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, Hawai'i) were selected to participate in the community-randomized matched-pair trial. Over 900 community members including parents, teachers, and community leaders participated in the CEP over a 14 month period. The CEP was used to identify environmental intervention priorities to address six behavioral outcomes: increasing fruit/vegetable consumption, water intake, physical activity and sleep; and decreasing screen time and intake of sugar sweetened beverages. Community members were engaged through Local Advisory Committees, key informant interviews and participatory community meetings. Community-identified priorities centered on policy development; role modeling; enhancing access to healthy food, clean water, and physical activity venues; and healthy living education. Through the CEP, CHL identified culturally appropriate priorities for intervention that were also consistent with the literature on effective obesity prevention practices. Results of the CEP will guide the CHL intervention design and implementation. The CHL CEP may serve as a model for other underserved minority island populations.

An Action Research Project on Preparing Teachers to Meet the Needs of Underserved Student Populations

NASA Astrophysics Data System (ADS)

Buck, Gayle A.; Cordes, Jeanene G.

2005-02-01

The focus of this action research study was on the initial stage in reforming our teacher preparation programs. We designed, conducted, evaluated, and revised the components of our teacher preparation programs that were aimed at providing preservice teachers with the confidence and knowledge needed to meet the needs of youth populations underserved in science education. The conceptual framework of this study predicted that providing preservice teachers with experiences in teaching science to at-risk youth in a nonformal educational setting and that exploring these experiences in a seminar setting will increase the teachers confidence and knowledge in regard to teaching science to children from underserved populations. The community-based experience allowed for an experience in which 20 preservice teachers taught in a situation in which at-risk youth were the majority, thus spotlighting their needs in a manner traditionally not experienced by these prospective teachers. A two-phase methodological design (J. Creswell, 1994) was utilized to answer the questions: (a) Did the plan lead to the desired outcomes? and (b) What strategies fostered or hindered progress toward the desired outcomes? The findings of this study were utilized to develop our next action step in preparing teachers to foster science literacy for All Americans.

The Engineering 4 Health Challenge - an interdisciplinary and intercultural initiative to foster student engagement in B.C. and improve health care for children in under-serviced communities.

PubMed

Price, Morgan; Weber-Jahnke, Jens H

2009-01-01

This paper describes the Engineering 4 Health (E4H) Challenge, an interdisciplinary and intercultural initiative that, on the one hand, seeks to improve health education of children in under-serviced communities and, on the other, seeks to attract students in British Columbia to professions in engineering and health. The E4H Challenge engages high school and university students in BC to cooperatively design and develop health information and communication technology (ICT) to educate children living in under-serviced communities. The E4H Challenge works with the One Laptop Per Child (OLPC) program to integrate applications for health awareness into the school programs of communities in developing countries. Although applications developed by the E4H Challenge use the low-cost, innovative XO laptop (the "$100 laptop" developed by the OLPC foundation) the software can also be used with other inexpensive hardware.

Teaching the content in context: Preparing "highly qualified" and "high quality" teachers for instruction in underserved secondary science classrooms

NASA Astrophysics Data System (ADS)

Tolbert, Sara E.

2011-12-01

This dissertation research project presents the results of a longitudinal study that investigates the knowledge, beliefs, and practices of 13 preservice secondary science teachers participating in a science teacher credentialing/Masters program designed to integrate issues of equity and diversity throughout coursework and seminars. Results are presented in the form of three papers: The first paper describes changes in preservice teacher knowledge about contextualization in science instruction, where contextualization is defined as facilitating authentic connections between science learning and relevant personal, social, cultural, ecological, and political contexts of students in diverse secondary classrooms; the second paper relates changes in the self-efficacy and content-specific beliefs about science, science teaching, diversity, and diversity in science instruction; and the final paper communicates the experiences and abilities of four "social justice advocates" learning to contextualize science instruction in underserved secondary placement classrooms. Results indicate that secondary student teachers developed more sophisticated understandings of how to contextualize science instruction with a focus on promoting community engagement and social/environmental activism in underserved classrooms and how to integrate science content and diversity instruction through student-centered inquiry activities. Although most of the science teacher candidates developed more positive beliefs about teaching science in underrepresented classrooms, many teacher candidates still attributed their minority students' underperformance and a (perceived) lack of interest in school to family and cultural values. The "social justice advocates" in this study were able to successfully contextualize science instruction to varying degrees in underserved placement classrooms, though the most significant limitations on their practice were the contextual factors of their student teaching placements---in particular, the extent to which their cooperating teachers gave them the autonomy and planning time to design and implement their own activities and lessons. While the "integrated approach" to diversity and equity in science teacher education was, overall, successful in helping preservice teachers' move closer toward developing the beliefs, knowledge, and practices necessary for effective instruction in underserved classrooms, suggestions are given for increasing the effectiveness of the "integrated approach," particularly in the context of a one-year credentialing program.

34 CFR 303.128 - Traditionally underserved groups.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 2 2011-07-01 2010-07-01 true Traditionally underserved groups. 303.128 Section 303... underserved groups. The statement must include an assurance satisfactory to the Secretary that policies and practices have been adopted to ensure— (a) That traditionally underserved groups, including minority, low...

34 CFR 303.128 - Traditionally underserved groups.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 2 2010-07-01 2010-07-01 false Traditionally underserved groups. 303.128 Section 303... underserved groups. The statement must include an assurance satisfactory to the Secretary that policies and practices have been adopted to ensure— (a) That traditionally underserved groups, including minority, low...

76 FR 63846 - Substantially Underserved Trust Areas (SUTA)

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-14

... CFR Part 1700 RIN 0572-AC23 Substantially Underserved Trust Areas (SUTA) AGENCY: Rural Utilities... of infrastructure projects in Substantially Underserved Trust Areas (SUTA). The intent is to..., Washington, DC 20250-1522. Title: Substantially Underserved Trust Areas. Type of Request: Approval of a new...

Questionnaire design from a cross-cultural perspective: an empirical investigation of Koreans and non-Koreans.

PubMed

Willis, Gordon; Zahnd, Elaine

2007-11-01

A persistent challenge to self-report data across racial, ethnic, or cultural groups is the inherent difficulty of attaining cross-cultural comparability of key measures. The current research study investigated the cross-cultural functioning of health-survey questions presented to four groups: (1) Koreans who were monolingual in Korean; (2) non-Korean native speakers of English; (3) bilingual Koreans interviewed in English, and (4) bilingual Koreans interviewed in Korean. This design allowed us to include those likely to be medically underserved, and to assess both linguistic and cultural barriers to collecting health survey data. A total of 36 cognitive interviews were conducted to identify (a) translation problems; (b) problems of cultural adaptation that impede cross-cultural comparability; and (c) generic problems of questionnaire design that affect all groups. An important category of problems was identified that appeared to result from the interaction of respondent and question characteristics. Such problems can best be assessed through explicit consideration of the socio-cultural backgrounds of survey respondents, as opposed to the more usual focus on details of item translation and wording.

Primary Care and Regular Breast Cancer Screening Among Under-Served Minority Women

DTIC Science & Technology

1999-08-01

PAP SMEAR A pap smear is a test in which you lie on a table with your feet in the stirrups, and the doctor or nurse examines the female internal...exam is when the breast is felt for lumps by a doctor or nurse . 33. Have vou ever had a breast physical exam by a doctor, nurse or medical assistant...IN TO QUESTION #39) 3 DON’T KNOW 4 REF 34. When was vour most recent breast physical exam by a doctor, nurse or medical assistant? NHIS 1 1 year

Mammographic Breast Density in a Cohort of Medically Underserved Women

DTIC Science & Technology

2011-10-01

1.08 relative to ញ years) or birth order (2+ OR 0.99, 95% CI 0.67-1.46 relative to 1) and breast cancer. However, there was a significant...increase in breast cancer risk among women whose mothers smoked during pregnancy (OR 1.73, 95% CI 1.04-2.88). With the exception of birth order , our

Comparison of Program Costs for Parent-Only and Family-Based Interventions for Pediatric Obesity in Medically Underserved Rural Settings

ERIC Educational Resources Information Center

Janicke, David M.; Sallinen, Bethany J.; Perri, Michael G.; Lutes, Lesley D.; Silverstein, Janet H.; Brumback, Babette

2009-01-01

Purpose: To compare the costs of parent-only and family-based group interventions for childhood obesity delivered through Cooperative Extension Services in rural communities. Methods: Ninety-three overweight or obese children (aged 8 to 14 years) and their parent(s) participated in this randomized controlled trial, which included a 4-month…

Continuing Interprofessional Education in Geriatrics and Gerontology in Medically Underserved Areas

ERIC Educational Resources Information Center

Toner, John A.; Ferguson, K. Della; Sokal, Regina Davis

2009-01-01

There is a widening gap between the health care needs of older persons and the treatment skills of the health care professionals who serve them. This gap is especially severe in rural areas, where there is a shortage of and inadequate collaboration between health care professionals and poor access to services for older persons. There is also a…

Advancing Understanding of the Characteristics and Capacity of African American Women Who Serve as Lay Health Advisors in Community-Based Settings

ERIC Educational Resources Information Center

Shelton, Rachel C.; Dunston, Sheba King; Leoce, Nicole; Jandorf, Lina; Thompson, Hayley S.; Erwin, Deborah O.

2017-01-01

Lay Health Advisor (LHA) programs hold tremendous promise for reducing health disparities and addressing social determinants of health in medically underserved communities, including African American populations. Very little is understood about the capacity of LHAs in these roles and the broader contributions they make to their communities. This…

Taking Their Show on the Road: Becky Hebert & Siobhan Champ-Blackwell--National Network of Libraries of Medicine

ERIC Educational Resources Information Center

Library Journal, 2005

2005-01-01

They're two very different women with the same mission: outreach to medically underserved populations. Both work for the National Network of Libraries of Medicine. Becky Hebert (left) covers the Southeast/Atlantic region, and Siobhan Champ-Blackwell, the mid-continental region. They spend much of their lives on the road, exhibiting at minority…

Mission-driven marketing: a rural example.

PubMed

Rohrer, J E; Vaughn, T; Westermann, J

1999-01-01

Marketing receives little attention in the academic healthcare management literature, possibly because it is associated with pursuit of profit rather than community benefit. However, a marketing perspective can be applied to the pursuit of the traditional missions of healthcare delivery organizations. Mission-oriented market selection criteria could include characteristics such as relevance to mission, underserved or vulnerable population status, resistance to care, limited resources, and low accessibility. A survey conducted in a rural county is used to demonstrate ways that underserved market segments can be identified and targeted. In the market surveyed, men used less medical care than women; depressed people and those with low levels of education used less medical care than people without these characteristics. Consumers were more likely to defer care because of cost if they lacked health insurance coverage, were female, were under age 55, had fair health status, were depressed, and were chronically ill. Marketing strategies worthy of consideration relate to price (e.g., free care, coupons and sales for eligible individuals), distribution (e.g., visiting nurses, malls and fairs, occupational medicine programs), product (e.g., satisfaction, waiting time, attractiveness, assertive follow-up), and promotion (education about insurance benefits, facilitating development of regular sources of care, health education).

The Role of Patient Navigation on Colorectal Cancer Screening Completion and Education: a Review of the Literature.

PubMed

Sunny, Ajeesh; Rustveld, Luis

2018-04-01

Although the general assumption is that patient navigation helps patients adhere to CRC screening recommendations, concrete evidence for its effectiveness is still currently under investigation. The present literature review was conducted to explore effectiveness of patient navigation and education on colorectal cancer (CRC) screening completion in medically underserved populations. Data collection included PubMed, Google Scholar, and Cochrane reviews searches. Study inclusion criteria included randomized controlled trials and prospective investigations that included an intervention and control group. Case series, brief communications, commentaries, case reports, and uncontrolled studies were excluded. Twenty-seven of the 36 studies screened for relevance were selected for inclusion. Most studies explored the utility of lay and clinic-based patient navigation. Others implemented interventions that included tailored messaging, and culturally and linguistically appropriate outreach and education efforts to meet CRC screening needs of medically underserved individuals. More recent studies have begun to conduct cost-effectiveness analyses of patient navigation programs that impacted CRC screening and completion. Peer-reviewed publications consistently indicate a positive impact of patient navigation programs on CRC screening completion, as well have provided preliminary evidence for their cost-effectiveness.

International efforts in plastic surgery: the Hartford Hospital, Connecticut Children's Medical Center and University of Connecticut experience in Ecuador.

PubMed

Hughes, Christopher; Wong, Anselm; McCormack, Susan; Castiglione, Charles; Pap, Stephen A; Silverman, Richard; Babigian, Alan

2012-01-01

Plastic and reconstructive surgery provide a necessary and essential service to public health efforts in resource-poor regions around the world. Disease processes amenable to plastic surgical treatment significantly contribute to worldwide disability, and it is the poor and underserved who are disproportionately affected. We conducted a week-long plastic and reconstructive surgical trip to Latacunga, Ecuador to provide reconstructive surgical services for the underserved in this region. Over the course of a week, 97 patients received surgery. Most patients were young (mean age = 21.8 years) and 50.5% were female. Burns and burn scar contractures were the most common diagnoses requiring surgery(21.6%), but cleft lip and palate deformities, scars, nevi, and congenital ear deformities comprised a significant proportion of the case load as well (17.5%, 11.3%, 12.4%, and 10.3%, respectively). There was one postoperative complication requiring reoperation. This short-term surgical trip successfully delivered essential reconstructive surgical care to an underserved population in rural Ecuador. Although this is most certainly only a fraction of the true surgical disease burden within this population, our experience provides a testament to the need for essential reconstructive surgical services in developing nations around the world.

A Cognitive Framework for Understanding Barriers to the Productive Use of a Diabetes Home Telemedicine System

PubMed Central

Kaufman, David R.; Starren, Justin; Patel, Vimla L.; Morin, Philip C.; Hilliman, Charlyn; Pevzner, Jenia; Weinstock, Ruth S.; Goland, Robin; Shea, Steven

2003-01-01

Telemedicine has the potential to transcend geographic and socio-cultural barriers to the delivery of high quality health care to the medically underserved populations. However, there are significant cognitive and usability barriers. This paper presents a multifaceted cognitive evaluation of the IDEATel diabetes education and telemedicine program. The evaluation included a cognitive walkthrough analysis to characterize task complexity and identify potential problems as well as field usability testing in patients’ homes. The study revealed dimensions of the interface that impeded optimal access to system resources. In addition, we found significant obstacles corresponding to perceptual-motoric skills, mental models of the system, and health literacy. The objective of this work is to contribute to a design framework so that participants with a wide range of skills can better manage their chronic illnesses. PMID:14728194

“I Felt Like It Was God's Hands Putting the Needles In”: A Qualitative Analysis of the Experience of Acupuncture for Chronic Pain in a Low-Income, Ethnically Diverse, and Medically Underserved Patient Population

PubMed Central

Buonora, Michele; Gabison, Jonathan; Jacobs, Emilie; Karasz, Alison; McKee, M. Diane

2015-01-01

Abstract Objectives: To examine the experience of patients from a low-income, ethnically diverse medically underserved population receiving acupuncture for chronic pain. Design: Qualitative analysis using inductive thematic analysis of interviews with participants from an acupuncture trial. Settings/Location: Four community health centers in the Bronx, New York. Participants: Thirty-seven adults with chronic neck or back pain or osteoarthritis who participated in a previous acupuncture trial. Interventions: Up to 14 weekly acupuncture treatments. Outcome measures: Pain and quality of life were examined in the original trial; this study examines qualitative outcomes. Results: The themes grouped naturally into three domains of the acupuncture experience: the decision-making process, the treatment experience, and the effect of acupuncture on health. Regarding decision-making, important factors were a willingness to try something new even if you do not necessary “believe” in it or have specifically positive expectations; a sense that medications were not working for their pain, that they also caused significant adverse effects, and that natural strategies might be preferable; and a feeling of desperation. Cost and access were significant barriers to acupuncture treatment. Regarding the process of acupuncture, the open and personal communication with the acupuncturist was an important factor, as were the sense that the process of acupuncture related to a natural process of healing or correction within the body and that part of making acupuncture successful required being open to the power of the mind to generate a positive outcome. Regarding the effect of treatment, notable aspects were the deep sense of rest and relaxation participants reported during treatment as well as the benefit they experienced for conditions other than pain. Conclusions: The themes that emerged in this ethnically diverse, low-income population were very similar to those that have emerged over the past decade of qualitative research on the acupuncture experience in other patient populations. PMID:26247238

The ELDER Project: educational model and three-year outcomes of a community-based geriatric education initiative.

PubMed

Lange, Jean W; Mager, Diana; Greiner, Philip A; Saracino, Katherine

2011-01-01

The purpose of the ELDER (Expanded Learning and Dedication to Elders in the Region) Project was to address the needs of underserved older adults by providing worksite education to individuals who provide nursing care to older adults in community health centers, home health agencies, and long-term care facilities. Four agencies located in a Health Professional Shortage and Medically Underserved Area participated. Project staff conducted separate focus groups with administrators and staff at each agency to determine educational needs and preferences. Curricula from the Hartford Institute, End-of-Life Nursing Education Consortium, and Geriatric Education Centers were adapted to design unique curricula for each agency and level of personnel (licensed nurse or unlicensed caregiver). Activities included focus group meetings to tailor content to the needs of each agency, on-site educational sessions, and identification of an agency champion to sustain the program after the funding ended. A case-based simulation-learning approach was used in the final year to validate application of knowledge and to facilitate teamwork and interprofessional communication. Over 100 nurses and nursing assistants and eight administrators and allied health professionals participated over the three-year period of the project. Retention over this period, independent evaluations, and simulations demonstrated participants' ability to integrate best practices into typical clinical scenarios and revealed improved communication among care providers. Tailored on-site education incorporating simulation was an effective model for translating gerontological knowledge into practice and improving the care of older adults in these multiple settings.

Medical Students as Health Educators at a Student-Run Free Clinic: Improving the Clinical Outcomes of Diabetic Patients

PubMed Central

Peltz, Alon; Ladner, Travis R.; Reddy, India; Miller, Bonnie M.; Miller, Robert F.; Fowler, Michael J.

2014-01-01

Purpose Student-run free clinics (SRFCs) provide service–learning opportunities for medical students and care to underserved patients. Few published studies, however, support that they provide high-quality care. In this study, the authors examined the clinical impact of a medical student health educator program for diabetic patients at an SRFC. Method In 2012, the authors retrospectively reviewed the electronic medical records of diabetic patients who established care at Shade Tree Clinic in Nashville, Tennessee, between 2008 and 2011. They compared clinical outcomes at initial presentation to the clinic and 12 months later. They analyzed the relationship between the number of patient–student interactions (touchpoints) and change in hemoglobin A1c values between these two time points and compared the quality of care provided to best-practice benchmarks (process and outcomes measures). Results The authors studied data from 45 patients. Mean hemoglobin A1c values improved significantly from 9.6 to 7.9, after a mean of 12.5 ± 1.5 months (P < .0001). A trend emerged between increased number of touchpoints and improvement in A1c values (r2 = 0.06, P = .10). A high percentage of patients were screened during clinic visits, whereas a low to moderate percentage met benchmarks for A1c, LDL, and blood pressure levels. Conclusions These findings demonstrate that a medical student health educator program at an SRFC can provide high-quality diabetes care and facilitate clinical improvement one year after enrollment, despite inherent difficulties in caring for underserved patients. Future studies should examine the educational and clinical value of care provided at SRFCs. PMID:24556762

Educational Intervention in a Medically Underserved Area.

PubMed

Atance, Joel; Mickalis, Morgan; Kincade, Brianna

2018-04-01

Medical students from rural and medically underserved areas (MUAs) are more likely than their peers to practice medicine in rural areas and MUAs. However, students from MUAs are also more likely to face socioeconomic barriers to a career in medicine. To determine whether a week-long summer enrichment experience (SEE) at Edward Via College of Osteopathic Medicine-Carolinas could successfully teach high school students from MUAs basic biomedical concepts and foster an interest in medicine and the health sciences. The SEE program is open to high school students in the Spartanburg, South Carolina, area. The program includes interactive lectures, laboratories, demonstrations on gross anatomy prosections, demonstrations on medical simulation models, tours of emergency vehicles, an introduction to osteopathic manipulative medicine, and student-led research projects. Participants were asked to complete a 15-question quiz that assessed their knowledge of basic biomedical concepts and a 10-question survey that assessed their attitudes toward careers in medicine and health sciences. Both the quiz and the survey were completed on both the first and final days of the program. The data were analyzed using paired t tests. Participant knowledge of basic biomedical concepts, as determined by the quiz scores, increased after completion of the program (9.1 average correct answers vs 12.6 average correct answers) (P<.001). Participant attitude toward medicine and the health sciences improved in 9 of the 10 items surveyed after completion of the program (P<.05). Participant knowledge of basic biomedical concepts and their knowledge of and interest in careers in the health sciences improved after completing the SEE program. These findings suggest that educational interventions for high school students could help to develop primary care physicians for rural areas and MUAs and that there is a role for osteopathic medical schools to nurture these students as early as possible.

The Children’s Attention-deficit Hyperactivity Disorder (ADHD) Telemental Health Treatment Study: Methodology for Conducting a Trial of Telemental Health in Multiple Underserved Communities

PubMed Central

Stoep, Ann Vander; Myers, Kathleen

2013-01-01

Background Children who live in non-metropolitan communities are underserved by evidence-based mental health care and underrepresented in clinical trials of mental health services. Telemental Health (TMH), the use of videoteleconferencing (VTC) to provide care that is usually delivered in person, shows promise for helping to rectify these service disparities. Purpose The Children’s ADHD Telemental Health Treatment Study (CATTS) is a randomized controlled trial designed to test the effectiveness of TMH in providing treatment to children diagnosed with attention-deficit hyperactivity disorder (ADHD) who are living in underserved communities. In this paper we describe the methodologies we developed for the trial and lessons learned. Methods Children ages 5.5-12 years of age with ADHD were referred to CATTS by their primary care physicians (PCP’s). The test intervention group (Group A) received six telepsychiatry sessions followed by in-person caregiver behavioral training delivered by a local therapist who was trained and supervised remotely. A secure website was used to support decision-making by the telepsychiatrists, to facilitate real-time collaboration between the telepsychiatrists and community therapists, and communication with the PCP’s. The control group (Group B) received a single telepsychiatry consultation followed by treatment with their PCP’s who implemented the telepsychiatrists’ recommendations at their discretion. Caregivers completed five sets of questionnaires about children’s symptoms and functioning and their own levels of distress. Older children (aged 10-12 years) completed questionnaires about their symptoms and functioning. Teachers completed ADHD rating scales. Questionnaires were completed online through a secure portal from personal computers. Results Eighty-eight PCP’s in seven communities referred the 223 children who participated in the trial. Attrition was low (3%). Children in Group A completed an average of 5.3 of 6 scheduled sessions; 96% of children in Group B completed their telepsychiatry consultation. Parents in both groups completed an average of 4.8 of 5 assessments. Telepsychiatrists and therapists showed high adherence to treatment protocols. Lessons Learned TMH proved to be a viable means of providing evidence-based pharmacological services to children and of training local therapists in evidence-based caregiver behavioral management. Recruitment was enhanced by offering the control group a telepsychiatry consultation. To meet recruitment targets across multiple dispersed sites, we developed community-specific strategies. A dedicated scheduler was a critical staff role to coordinate the multiple sites, sessions, and clinicians. Trial implementation was easier with sites that shared an electronic medical record system with our research hub. Conclusions The CATTS study used methods and procedures to optimize inclusion of children living in multiple dispersed and underserved areas. These experiences should advance the development of technologies needed to recruit underserved populations into research projects with the goal of reducing disparities in access to quality mental health care. PMID:23897950

5 CFR 894.801 - Will benefits be available in underserved areas?

Code of Federal Regulations, 2011 CFR

2011-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Benefits in Underserved Areas § 894.801 Will benefits be available in underserved areas? (a) Dental and vision plans under... underserved areas. (b) In any area where a FEDVIP dental or vision plan does not meet OPM access standards...

5 CFR 894.801 - Will benefits be available in underserved areas?

Code of Federal Regulations, 2010 CFR

2010-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Benefits in Underserved Areas § 894.801 Will benefits be available in underserved areas? (a) Dental and vision plans under... underserved areas. (b) In any area where a FEDVIP dental or vision plan does not meet OPM access standards...

Ecologies, outreach, and the evolution of medical libraries.

PubMed

Shen, Bern

2005-10-01

What are some of the forces shaping the evolution of medical libraries, and where might they lead? Published literature in the fields of library and information sciences, technology, health services research, and business was consulted. Medical libraries currently have a modest footprint in most consumers' personal health ecologies, the network of resources and activities they use to improve their health. They also occupy a relatively small space in the health care, information, and business ecologies of which they are a part. Several trends in knowledge discovery, technology, and social organizations point to ways in which the roles of medical libraries might grow and become more complex. As medical libraries evolve and reach out to previously underserved communities, an ecological approach can serve as a useful organizing framework for the forces shaping this evolution.

Evaluation of the North Country on the Job Network: a model of facilitated care for injured workers in rural upstate New York.

PubMed

Lipscomb, Hester J; Moon, Samuel D; Li, Leiming; Pompeii, Lisa; Kennedy, Margaret Q

2002-03-01

We describe the evaluation of a community-based program designed to facilitate access to care and return to work for injured workers in a rural, medically underserved area in upstate New York. Providers are recruited to provide easily accessible care and are oriented to concepts of transitional duty and rapid return to work as medically appropriate; companies are recruited with the agreement to provide transitional work for injured employees. Registered nurses, hired by the local hospital, serve as case coordinators to facilitate care and coordinate communications among all parties. Over 3000 injured workers received care through the program in the first 56 months, with a decline in the number of transitional days over time. The number of days that the cases remain open has steadily declined, and the number of return-to-work cases has increased. The success of this initiative provides an excellent background for continued improvement in delivery of care to injured workers and proactive efforts at improving workplace safety and health in a rural area.

Healthy Eating for Life English as a second language curriculum: applying the RE-AIM framework to evaluate a nutrition education intervention targeting cancer risk reduction.

PubMed

Martinez, J L; Duncan, L R; Rivers, S E; Bertoli, M C; Latimer-Cheung, A E; Salovey, P

2017-12-01

Medically underserved US immigrants are at an increased risk for death from preventable or curable cancers due to economic, cultural, and/or linguistic barriers to medical care. The purpose of this study was to describe the evaluation of the pilot study of the Healthy Eating for Life (HE4L) English as a second language curriculum. The Reach, Effectiveness Adoption, Implementation, Maintenance (RE-AIM) model was used to design a mixed-methods approach to the evaluation of the HE4L curriculum. Successful implementation was dependent upon enthusiastic teacher and manager support of the curriculum, teachers' ability to flexibly apply the curriculum to meet student needs, and researcher provision of curriculum workbooks. HE4L can be implemented successfully in various adult education settings to teach healthy eating behaviors and English language principles. Scale-up of HE4L may depend on the development of an online version of the curriculum to avoid the costs associated with printing and distributing curriculum materials.

Mobile Health Application and e-Health Literacy: Opportunities and Concerns for Cancer Patients and Caregivers.

PubMed

Kim, Hyunmin; Goldsmith, Joy V; Sengupta, Soham; Mahmood, Asos; Powell, M Paige; Bhatt, Jay; Chang, Cyril F; Bhuyan, Soumitra S

2017-11-14

Health literacy is critical for cancer patients as they must understand complex procedures or treatment options. Caregivers' health literacy also plays a crucial role in caring for cancer patients. Low health literacy is associated with low adherence to medications, poor health status, and increased health care costs. There is a growing interest in the use of mobile health applications (apps) to improve health literacy. Mobile health apps can empower underserved cancer patients and their caregivers by providing features or functionalities to enhance interactive patient-provider communication and to understand medical information more readily. Despite the potentiality of improving health literacy through mobile health apps, there exist several related concerns: no equal access to mobile technology, no familiarity or knowledge of using mobile health apps, and privacy and security concerns. These elements should be taken into account for health policy making and mobile apps design and development. Importantly, mobile apps should be developed with the goal of achieving a high range of user access by considering all health literacy level and various cultural and linguistic needs.

Establishing a binational student-run free-clinic in Tijuana, Mexico: a model for US-Mexico border states.

PubMed

Ojeda, Victoria D; Eppstein, Amy; Lozada, Remedios; Vargas-Ojeda, Adriana C; Strathdee, Steffanie A; Goodman, David; Burgos, Jose L

2014-06-01

In 2011, a bi-national student-run free clinic for the underserved, known as "Health Frontiers in Tijuana" (HFiT), was created in Tijuana, Mexico. Students and faculty from one Mexican and one US medical school staff the clinic and attend patients on Saturdays. Students from both medical schools enroll in a didactic course during the quarter/semester that they attend the free clinic. The course addresses clinical, ethical, cultural, population-specific issues and the structure, financing and delivery of medical care in Mexico. The clinic implements an electronic medical record and is developing telemedicine for consulting on complex cases. Despite challenges related to sustaining adequate funding, this program may be replicated in other border communities.

Evaluation of the Effectiveness of a Problem-Solving Intervention Addressing Barriers to Cardiovascular Disease Prevention Behaviors in 3 Underserved Populations: Colorado, North Carolina, West Virginia, 2009

PubMed Central

Bryant, Lucinda L.; Leary, Janie M.; Vu, Maihan B.; Hill-Briggs, Felicia; Samuel-Hodge, Carmen D.; McMilin, Colleen R.; Keyserling, Thomas C.

2014-01-01

Introduction In low-income and underserved populations, financial hardship and multiple competing roles and responsibilities lead to difficulties in lifestyle change for cardiovascular disease (CVD) prevention. To improve CVD prevention behaviors, we adapted, pilot-tested, and evaluated a problem-solving intervention designed to address barriers to lifestyle change. Methods The sample consisted of 81 participants from 3 underserved populations, including 28 Hispanic or non-Hispanic white women in a western community (site 1), 31 African-American women in a semirural southern community (site 2), and 22 adults in an Appalachian community (site 3). Incorporating focus group findings, we assessed a standardized intervention involving 6-to-8 week group sessions devoted to problem-solving in the fall of 2009. Results Most sessions were attended by 76.5% of participants, demonstrating participant adoption and engagement. The intervention resulted in significant improvement in problem-solving skills (P < .001) and perceived stress (P < .05). Diet, physical activity, and weight remained stable, although 72% of individuals reported maintenance or increase in daily fruit and vegetable intake, and 67% reported maintenance or increase in daily physical activity. Conclusion Study results suggest the intervention was acceptable to rural, underserved populations and effective in training them in problem-solving skills and stress management for CVD risk reduction. PMID:24602586

Calmer Life: A Hybrid Effectiveness-implementation Trial for Late-life Anxiety Conducted in Low-income, Mental Health-Underserved Communities.

PubMed

Shrestha, Srijana; Wilson, Nancy; Kunik, Mark E; Wagener, Paula; Amspoker, Amber B; Barrera, Terri; Freshour, Jessica; Kraus-Schuman, Cynthia; Bavineau, Jane; Turner, Maria; Stanley, Melinda A

2017-05-01

Anxiety is common among older adults and is associated with multiple negative outcomes. Late-life anxiety is usually unrecognized by providers and undertreated, although evidence supports the effectiveness of psychosocial treatment. Access to mental health care is especially poor among African American seniors. New treatment models are needed to expand the reach of mental health care to minority elders. Our article outlines a study designed to test the effectiveness and implementation potential of Calmer Life (CL), a community-based, person-centered, flexible and culturally tailored intervention for late-life anxiety and worry, offered in low-income, mental health-underserved and predominantly African American communities. CL is skills-based, but also includes resource counseling and an option to integrate religion/spirituality. The study population includes individuals 50 years of age and older who are experiencing high levels of worry. The program was developed in the context of a community-academic partnership with organizations that provide services for seniors in underserved communities, and it trains nontraditional community providers to deliver the intervention. Study progress to date, challenges, and lessons learned are discussed. Data collection is ongoing, and study findings will be available in late 2017. CL will offer valuable information to help expand the reach of anxiety treatment among minority seniors living in underserved neighborhoods.

Students Designing Video Games about Immunology: Insights for Science Learning

ERIC Educational Resources Information Center

Khalili, Neda; Sheridan, Kimberly; Williams, Asia; Clark, Kevin; Stegman, Melanie

2011-01-01

Exposing American K-12 students to science, technology, engineering, and math (STEM) content is a national initiative. Game Design Through Mentoring and Collaboration targets students from underserved communities and uses their interest in video games as a way to introduce science, technology, engineering, and math topics. This article describes a…

Exploration of Global Health Careers Across the Medical Fields.

PubMed

Barthélemy, Ernest; Mallol, Vanessa; Hannaford, Alisse; Pean, Christian; Kutua, Rehema; de Haydu, Christopher; Anandaraja, Natasha; Asgary, Ramin; Elahi, Ebrahim; Hexom, Braden; Landrigan, Philip; Shirazian, Taraneh; Katz, Craig

Despite expansion of interest among American medical students in global health (GH), academic medical centers face multiple obstacles to the development of structured GH curricula and career guidance. To meet these demands we sought to provide a systematic analysis of the accounts of GH experts. We developed a collaborative, interview-based, qualitative analysis of GH experiences across six career-related themes that are relevant to medical students interested in GH: justification, medical education, economics, research prospects, law and ethics, and work-life balance. Seven GH faculty members were interviewed for 30-90 minutes using sample questions as guidelines. We applied a grounded theory approach to analyze the interview transcripts to discover an emerging theory pertinent to GH trainees. Regarding justification, 4 respondents defined GH as work with the underserved irrespective of geographic location; 5 respondents found sustainability imperative; and all respondents believe GH creates better physicians. Respondents identified many physician competencies developed through GH medical education, with 5 respondents agreeing that work with underserved populations has transformative potential. Concerning economics, 3 respondents acknowledged GH's popularity among trainees, resulting in increased training opportunities, and 2 respondents emphasized an associated deficiency in program quality. All respondents described career models across specialties. Four respondents noted funding challenges when discussing research prospects. Within the theme of laws and ethics, 4 respondents perceived inadequate accountability, and 6 respondents identified ways to create accountability. Finally, 6 respondents recognized family demands can compromise one's GH career and thus work-life balance. Despite diverse perspectives on the meaning and sustainability of GH work, this analysis provides a nascent framework that may inform curricular development for GH trainees. Suggestions are offered for elaborating this framework to fully exploit the transformative potential of GH training in medical education. Copyright © 2017 Icahn School of Medicine at Mount Sinai. Published by Elsevier Inc. All rights reserved.

Physician Migration to and from Canada: The Challenge of Finding the Ethical and Political Balance between the Individual's Right to Mobility and Recruitment to Underserved Communities

ERIC Educational Resources Information Center

Dauphinee, W. Dale

2005-01-01

Physician migration to and from countries results from many local causes and international influences. These factors operate in the context of an increasingly globalized economy. From an ethical point of view, selective and targeted "raiding" of developing countries' medical workforce by wealthier countries is not acceptable. However,…

Mammographic Breast Density in a Cohort of Medically Underserved Women

DTIC Science & Technology

2012-10-01

training, faculty from MMC and VUMC will conduct a case-control study of mammographic breast density to investigate its’ association with obesity and...hormones and growth factors, 4) to perform statistical analyses to determine the associations between obesity and insulin resistance and mammographic...on obesity and insulin resistance as they relate to mammographic breast density. We hypothesize that: 1) obesity and insulin resistance, defined

42 CFR 5a.3 - Definition of Underserved Rural Community.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 3 that are larger than 400 square miles and have population density of less than 30 people per square mile; and (b) Located in a current: (1) Federally-designated Primary Health Care Geographic Health...

Challenges and possible solutions to colorectal cancer screening for the underserved.

PubMed

Gupta, Samir; Sussman, Daniel A; Doubeni, Chyke A; Anderson, Daniel S; Day, Lukejohn; Deshpande, Amar R; Elmunzer, B Joseph; Laiyemo, Adeyinka O; Mendez, Jeanette; Somsouk, Ma; Allison, James; Bhuket, Taft; Geng, Zhuo; Green, Beverly B; Itzkowitz, Steven H; Martinez, Maria Elena

2014-04-01

Colorectal cancer (CRC) is a leading cause of cancer mortality worldwide. CRC incidence and mortality can be reduced through screening. However, in the United States, screening participation remains suboptimal, particularly among underserved populations such as the uninsured, recent immigrants, and racial/ethnic minority groups. Increasing screening rates among underserved populations will reduce the US burden of CRC. In this commentary focusing on underserved populations, we highlight the public health impact of CRC screening, list key challenges to screening the underserved, and review promising approaches to boost screening rates. We identify four key policy and research priorities to increase screening among underserved populations: 1) actively promote the message, "the best test is the one that gets done"; 2) develop and implement methods to identify unscreened individuals within underserved population groups for screening interventions; 3) develop and implement approaches for organized screening delivery; and 4) fund and enhance programs and policies that provide access to screening, diagnostic follow-up, and CRC treatment for underserved populations. This commentary represents the consensus of a diverse group of experts in cancer control and prevention, epidemiology, gastroenterology, and primary care from across the country who formed the Coalition to Boost Screening among the Underserved in the United States. The group was organized and held its first annual working group meeting in conjunction with the World Endoscopy Organization's annual Colorectal Cancer Screening Committee meeting during Digestive Disease Week 2012 in San Diego, California.

Factors influencing participation in worksite wellness programs among minority and underserved populations.

PubMed

Thompson, Sharon E; Smith, Brenda A; Bybee, Ronald F

2005-01-01

In the United States, employers and employees are increasingly paying a larger portion of the nation's healthcare bill. Preventive measures are being employed by businesses in an effort to contain the escalating costs of employee healthcare. The work site is an ideal setting for health promotion because 130 million Americans are employed and spend one third of their time at work. However, unhealthy workers tend to be the least likely to participate in health promotion activities. Worksite Wellness Programs must be designed to engage segments of the work force with the greatest health needs. Culturally sensitive and appropriate programs must be developed to engage economically challenged minority and other underserved populations.

Designing, Implementing, and Evaluating a Group Therapy for Underserved Populations

ERIC Educational Resources Information Center

Waltman, Scott H.; Hetrick, Holly; Tasker, Tamara E.

2012-01-01

This article presents the case of a mindfulness-based group therapy that was implemented in a residential treatment facility. The case presented comprised a group of adolescent males with disruptive behavior disorders. The group was designed to be appropriate for the unique demographics of the clients, with the intent to help the clients enhance…

Outcomes of a Structured Education Intervention for Latinas Concerning Breast Cancer and Mammography

ERIC Educational Resources Information Center

Laughman, Anna Bawtinhimer; Boselli, Danielle; Love, Magbis; Steuerwald, Nury; Symanowski, James; Blackley, Kris; Wheeler, Mellisa; Arevalo, Gustavo; Carrizosa, Daniel; Raghavan, Derek

2017-01-01

Objective: This study examined the utility of living room and church-based small group educational sessions on breast cancer and mammography, for under-served Latinas in North Carolina, USA. Design: Non-randomised, single arm design. Setting: A total of 329 self-selected Latinas participated in 31 small group educational classes in church and home…

Giving curriculum planners an edge

PubMed Central

Oandasan, Ivy F.; Archibald, Douglas; Authier, Louise; Lawrence, Kathrine; McEwen, Laura April; Palacios, Maria; Parkkari, Marie; Plant, Heidi; Slade, Steve; Ross, Shelley

2015-01-01

Abstract Objective To pilot a survey of family medicine residents entering residency, describing their exposure to family medicine and their perspectives related to their future intentions to practise family medicine, in order to inform curriculum planners; and to test the methodology, feasibility, and utility of delivering a longitudinal survey to multiple residency programs. Design Pilot study using surveys. Setting Five Canadian residency programs. Participants A total of 454 first-year family medicine residents were surveyed. Main outcome measures Residents’ previous exposure to family medicine, perspectives on family medicine, and future practice intentions. Results Overall, 70% of first-year residents surveyed responded (n = 317). Although only 5 residency programs participated, respondents included graduates from each of the medical schools in Canada, as well as international medical graduates. Among respondents, 92% felt positive or strongly positive about their choice to be family physicians. Most (73%) indicated they had strong or very strong exposure to family medicine in medical school, yet more than 40% had no or minimal exposure to key clinical domains of family medicine like palliative care, home care, and care of underserved groups. Similar responses were found about residents’ lack of intention to practise in these domains. Conclusion Exposure to clinical domains in family medicine could influence future practice intentions. Surveys at entrance to residency can help medical school and family medicine residency planners consider important learning experiences to include in training. PMID:26052601

Evaluating Comparative Effectiveness Research Priorities for Care Coordination in Chronic Obstructive Pulmonary Disease: A Community-Based eDelphi Study

PubMed Central

Alber, Julia; Paige, Samantha; Castro, Daniela; Singh, Briana

2015-01-01

Background Despite research supporting the use of care coordination in chronic obstructive pulmonary disease (COPD), there is relatively little known about the comparative effectiveness of different strategies used to organize care for patients. To investigate the most important COPD care coordination strategies, community-based stakeholder input is needed, especially from medically underserved populations. Web-based platforms are electronic tools now being used to bring together individuals from underrepresented populations to share input and obtain clarification on comparative effectiveness research (CER) ideas, questions, and hypotheses. Objective Use low computer-literate, collaborative survey technology to evaluate stakeholder priorities for CER in COPD care coordination. Methods A mixed-method, concurrent triangulation design was used to collect survey data from a virtual advisory board of community-based stakeholders including medically underserved patients with COPD, informal caregivers, clinicians, and research scientists. The eDelphi method was used to conduct 3 iterative rounds of Web-based surveys. In the first 2 survey rounds, panelists viewed a series of “mini research prospectus” YouTube video presentations and rated their level of agreement with the importance of 10 COPD care coordination topics using 7-point Likert scales. In the final third-round survey, panelists ranked (1=most important, 8=least important) and commented on 8 remaining topics that panelists favored most throughout the first 2 survey rounds. Following the third-round survey, panelists were asked to provide feedback on the potential impact of a Web-based stakeholder engagement network dedicated to improving CER in COPD. Results Thirty-seven panelists rated the following care coordination topics as most important (lower means indicate greater importance): (1) measurement of quality of care (mean 2.73, SD 1.95); (2) management of COPD with other chronic health issues (mean 2.92, SD 1.67); (3) pulmonary rehabilitation as a model for care (mean 3.72; SD 1.93); (4) quality of care coordination (mean 4.12, SD 2.41); and (5) comprehensive COPD patient education (mean 4.27, SD 2.38). Stakeholder comments on the relative importance of these care coordination topics primarily addressed the importance of comparing strategies for COPD symptom management and evaluating new methods for patient-provider communication. Approximately one half of the virtual panel assembled indicated that a Web-based stakeholder engagement network could enable more online community meetings (n=19/37, 51%) and facilitate more opportunities to suggest, comment on, and vote for new CER ideas in COPD (n=18/37, 49%). Conclusions Members of this unique virtual advisory board engaged in a structured Web-based communication process that identified the most important community-specific COPD care coordination research topics and questions. Findings from this study support the need for more CER that evaluates quality of care measures used to assess the delivery of treatments and interventions among medically underserved patients with COPD. PMID:26268741

Digital Partnerships for Health: Steps to develop a community-specific health portal aimed at promoting health and well-being

PubMed Central

Kukafka, Rita; Khan, Sharib A.; Hutchinson, Carly; McFarlane, Delano J.; Li, Jianhua; Ancker, Jessica S.; Cohall, Alwyn

2007-01-01

We describe the steps taken by the Harlem Health Promotion Center to develop a community-specific health web portal aimed at promoting health and well-being in Harlem. Methods and results that begin with data collection and move onto elucidating requirements for the web portal are discussed. Sentiments of distrust in medical institutions, and the desire for community specific content and resources were among the needs emanating from our data analysis. These findings guided our decision to customize social software designed to foster connections, collaborations, flexibility, and interactivity; an “architecture of participation”. While we maintain that the leveraging of social software may indeed be the way to build healthy communities and support learning and engagement in underserved communities, our conclusion calls for careful thinking, testing and evaluation research to establish best practice models for leveraging these emerging technologies to support health improvements in the community. PMID:18693872

Center of Excellence for Remote and Medically Under-Served Areas

DTIC Science & Technology

2008-04-11

was an experimental, quantitative , qualitative, descriptive research study related to audio, data and video transmission from the ambulance to the... posttest score. Both the pretest and posttest questions were generated randomly from a bank of XXX course-related test questions. The analysis below...shows the mean for the pretest , posttest , and difference scores for the classroom group, the virtual group, and the total group. (Note: Two of the

The Health Frontiers in Tijuana Undergraduate Internship Program: A Novel Global Health Experience in Mexico for Pre-medical/Pre-health Undergraduates.

PubMed

Burgos, Jose L; Yee, Daniel C; Vargas-Ojeda, Adriana Carolina; Ojeda, Victoria D

2016-01-01

We describe the creation of the Health Frontiers in Tijuana (HFiT) Undergraduate Internship Program (UIP), a novel global health experience for U.S. and Mexican undergraduate students based at the binational HFiT student-run free clinic. The UIP introduces students to a diverse underserved patient population, and U.S.-Mexico border public health.

Practice Characteristics of Graduates of East Tennessee State University Quillen College of Medicine: Factors Related to Career Choices in Primary Care

ERIC Educational Resources Information Center

Click, Ivy A.

2013-01-01

The nation is facing a physician shortage, specifically in relation to primary care and in rural underserved areas. The most basic function of a medical school is to educate physicians to care for the national population. The purpose of this study was to examine the physician practicing characteristics of the graduates of East Tennessee State…

Assessing internet access and use in a medically underserved population: implications for providing enhanced health information services.

PubMed

Zach, Lisl; Dalrymple, Prudence W; Rogers, Michelle L; Williver-Farr, Heather

2012-03-01

The relationship between health information seeking, patient engagement and health literacy is not well understood. This is especially true in medically underserved populations, which are often viewed as having limited access to health information. To improve communication between an urban health centre and the community it serves, a team of library and information science researchers undertook an assessment of patients' level and methods of access to and use of the Internet. Data were collected in 53 face-to-face anonymous interviews with patients at the centre. Interviews were tape-recorded for referential accuracy, and data were analysed to identify patterns of access and use. Seventy-two percentage of study participants reported having access to the Internet through either computers or cell phones. Barriers to Internet access were predominantly lack of equipment or training rather than lack of interest. Only 21% of those with Internet access reported using the Internet to look for health information. The findings suggest that lack of access to the Internet in itself is not the primary barrier to seeking health information in this population and that the digital divide exists not at the level of information access but rather at the level of information use. © 2011 The authors. Health Information and Libraries Journal © 2011 Health Libraries Group.

Appalachian and Non-Appalachian Pediatricians’ Encouragement of the Human Papillomavirus Vaccine: Implications for Health Disparities

PubMed Central

Krieger, Janice L.; Katz, Mira L.; Kam, Jennifer A.; Roberto, Anthony

2013-01-01

Background In medically underserved regions such as Appalachia, cervical cancer incidence and mortality are higher than the general U.S. population; therefore, it is important for pediatricians to encourage parents to have their daughters vaccinated against the human papillomavirus (HPV). Unfortunately, little is known about the predictors of pediatricians’ encouragement of the HPV vaccine among medically underserved populations. The current study compared attitudes and behaviors of pediatricians with practices in Appalachia with those in non-Appalachia to identify potential strategies for reducing health disparities. Methods A survey was conducted with 334 pediatricians located in Appalachia and non-Appalachia counties to examine how prior behavior, perceived susceptibility, severity, self-efficacy, response-efficacy, and behavioral intentions are related to self-reported vaccine encouragement. Results Pediatricians in Appalachia perceived their patients to be less susceptible to HPV and reported lower rates of HPV encouragement than pediatricians in non-Appalachia. In addition, self-efficacy had a significant indirect association with vaccine encouragement for pediatricians in non-Appalachia. Conclusion This study’s findings emphasize the importance of increasing Appalachian pediatricians’ awareness of their patients’ susceptibility to HPV. Broader efforts to increase encouragement of the HPV vaccine among pediatricians should focus on promoting self-efficacy to encourage the HPV vaccine to parents of young females. PMID:21907591

Acceptance of a community-based navigator program for cancer control among urban African Americans.

PubMed

Halbert, Chanita Hughes; Briggs, Vanessa; Bowman, Marjorie; Bryant, Brenda; Bryant, Debbie Chatman; Delmoor, Ernestine; Ferguson, Monica; Ford, Marvella E; Johnson, Jerry C; Purnell, Joseph; Rogers, Rodney; Weathers, Benita

2014-02-01

Patient navigation is now a standard component of cancer care in many oncology facilities, but a fundamental question for navigator programs, especially in medically underserved populations, is whether or not individuals will use this service. In this study, we evaluated acceptance of a community-based navigator program for cancer control and identified factors having significant independent associations with navigation acceptance in an urban sample of African Americans. Participants were African American men and women ages 50-75 who were residents in an urban metropolitan city who were referred for navigation. Of 240 participants, 76% completed navigation. Age and perceived risk of developing cancer had a significant independent association with navigation acceptance. Participants who believed that they were at high risk for developing cancer had a lower likelihood of completing navigation compared with those who believed that they had a low risk for developing this disease. The likelihood of completing navigation increased with increases in age. None of the socioeconomic factors or health care variables had a significant association with navigation acceptance. There are few barriers to using community-based navigation for cancer control among urban African Americans. Continued efforts are needed to develop and implement community-based programs for cancer control that are easy to use and address the needs of medically underserved populations.

State-of-the-science of patient navigation as a strategy for enhancing minority clinical trial accrual.

PubMed

Ghebre, Rahel G; Jones, Lovell A; Wenzel, Jennifer A; Martin, Michelle Y; Durant, Raegan W; Ford, Jean G

2014-04-01

Patient navigation programs are emerging that aim to address disparities in clinical trial participation among medically underserved populations, including racial/ethnic minorities. However, there is a lack of consensus on the role of patient navigators within the clinical trial process as well as outcome measures to evaluate program effectiveness. A review of the literature was conducted of PubMed, Medline, CINHAL, and other sources to identify qualitative and quantitative studies on patient navigation in clinical trials. The search yielded 212 studies, of which only 12 were eligible for this review. The eligible studies reported on the development of programs for patient navigation in cancer clinical trials, including training and implementation among African Americans, American Indians, and Native Hawaiians. A low rate of clinical trial refusal (range, 4%-6%) was reported among patients enrolled in patient navigation programs. However, few studies reported on the efficacy of patient navigation in increasing clinical treatment trial enrollment. Outcome measures are proposed to assist in developing and evaluating the efficacy and/or effectiveness of patient navigation programs that aim to increase participation in cancer clinical trials. Future research is needed to evaluate the efficacy of patient navigators in addressing barriers to clinical trial participation and increasing enrollment among medically underserved cancer patients. © 2014 American Cancer Society.

Acceptance of a community-based navigator program for cancer control among urban African Americans

PubMed Central

Halbert, Chanita Hughes; Briggs, Vanessa; Bowman, Marjorie; Bryant, Brenda; Bryant, Debbie Chatman; Delmoor, Ernestine; Ferguson, Monica; Ford, Marvella E.; Johnson, Jerry C.; Purnell, Joseph; Rogers, Rodney; Weathers, Benita

2014-01-01

Patient navigation is now a standard component of cancer care in many oncology facilities, but a fundamental question for navigator programs, especially in medically underserved populations, is whether or not individuals will use this service. In this study, we evaluated acceptance of a community-based navigator program for cancer control and identified factors having significant independent associations with navigation acceptance in an urban sample of African Americans. Participants were African American men and women ages 50–75 who were residents in an urban metropolitan city who were referred for navigation. Of 240 participants, 76% completed navigation. Age and perceived risk of developing cancer had a significant independent association with navigation acceptance. Participants who believed that they were at high risk for developing cancer had a lower likelihood of completing navigation compared with those who believed that they had a low risk for developing this disease. The likelihood of completing navigation increased with increases in age. None of the socioeconomic factors or health care variables had a significant association with navigation acceptance. There are few barriers to using community-based navigation for cancer control among urban African Americans. Continued efforts are needed to develop and implement community-based programs for cancer control that are easy to use and address the needs of medically underserved populations. PMID:24173501

State-of-the-Science of Patient Navigation as a Strategy for Enhancing Minority Clinical Trial Accrual

PubMed Central

Ghebre, Rahel G.; Jones, Lovell A.; Wenzel, Jennifer; Martin, Michelle Y.; Durant, Raegan; Ford, Jean G.

2014-01-01

Background Patient navigation programs are emerging, that aim to address disparities in clinical trial participation among medically underserved populations, including racial/ethnic minorities. However, there is a lack of consensus on the role of patient navigators within the clinical trial process, as well as outcome measures to evaluate program effectiveness. Methods A review of the literature was conducted of PubMed, Medline, CINHAL, and other sources to identify qualitative and quantitative studies on patient navigation in clinical trials. The search yielded 212 studies, of which only 12 were eligible for this review. Results The eligible studies reported on development of programs for patient navigation in cancer clinical trials, including training and implementation among African American, American Indian and Native Hawaiians. Low clinical trial refusal, 4% to 6%, was reported among patients enrolled in patient navigation program. However, few studies reported on the efficacy of patient navigation on increasing clinical treatment trial enrollment. Conclusion Outcome measures are proposed to assist in developing and evaluating the efficacy and/or effectiveness of patient navigation programs that aim to increase participation in cancer clinical trials. Future research is needed to evaluate the efficacy of patient navigators in addressing barriers to clinical trial participation and increasing enrollment among medically underserved cancer patients. PMID:24643650

Infectious and Non-infectious Etiologies of Cardiovascular Disease in Human Immunodeficiency Virus Infection.

PubMed

Chastain, Daniel B; King, Travis S; Stover, Kayla R

2016-01-01

Increasing rates of HIV have been observed in women, African Americans, and Hispanics, particularly those residing in rural areas of the United States. Although cardiovascular (CV) complications in patients infected with human immunodeficiency virus (HIV) have significantly decreased following the introduction of antiretroviral therapy on a global scale, in many rural areas, residents face geographic, social, and cultural barriers that result in decreased access to care. Despite the advancements to combat the disease, many patients in these medically underserved areas are not linked to care, and fewer than half achieve viral suppression. Databases were systematically searched for peer-reviewed publications reporting infectious and non-infectious etiologies of cardiovascular disease in HIV-infected patients. Relevant articles cited in the retrieved publications were also reviewed for inclusion. A variety of outcomes studies and literature reviews were included in the analysis. Relevant literature discussed the manifestations, diagnosis, treatment, and outcomes of infectious and non-infectious etiologies of cardiovascular disease in HIV-infected patients. In these medically underserved areas, it is vital that clinicians are knowledgeable in the manifestations, diagnosis, and treatment of CV complications in patients with untreated HIV. This review summarizes the epidemiology and causes of CV complications associated with untreated HIV and provide recommendations for management of these complications.

Training Medical Students for Rural, Underserved Areas: A Rural Medical Education Program in California.

PubMed

Eidson-Ton, W Suzanne; Rainwater, Julie; Hilty, Donald; Henderson, Stuart; Hancock, Christine; Nation, Cathryn L; Nesbitt, Thomas

2016-01-01

The Association of American Medical Colleges projects an increasing shortage of physicians in rural areas. Medical schools have developed specialty track programs to improve the recruitment and retention of physicians who can serve rural populations. One such program in California includes a variety of unique elements including outreach, admissions, rural clinical experiences, focused mentorship, scholarly and leadership opportunities, and engagement with rural communities. Preliminary outcomes demonstrate that this rural track program has achieved some success in the recruitment, retention, and training of students interested in future rural practice and in the placement of students in primary care residencies. Long-term outcomes, such as graduates entering rural practice, are still unknown, but will be monitored to assess the impact and sustainability of the rural program. This article illustrates the opportunities and challenges of training medical students for rural practice and provides lessons learned to inform newly-established and long standing rural medical education programs.

Establishing A Binational Student-Run Free-Clinic In Tijuana, Mexico: A Model for U.S.-Mexico Border States

PubMed Central

Ojeda, Victoria D.; Eppstein, Amy; Lozada, Remedios; Vargas-Ojeda, Adriana C.; Strathdee, Steffanie A.; Goodman, David; Burgos, Jose L.

2013-01-01

In 2011, a bi-national student-run free clinic for the underserved, known as “Health Frontiers in Tijuana” (HFiT), was created in Tijuana, Mexico. Students and faculty from one Mexican and one U.S. medical school staff the clinic and attend patients on Saturdays. Students from both medical schools enroll in a didactic course during the quarter/semester that they attend the free clinic. The course addresses clinical, ethical, cultural, population-specific issues and the structure, financing and delivery of medical care in Mexico. The clinic implements an electronic medical record and is developing telemedicine for consulting on complex cases. Despite challenges related to sustaining adequate funding, this program may be replicated in other border communities. PMID:23371839

Financial incentives for return of service in underserved areas: a systematic review

PubMed Central

Bärnighausen, Till; Bloom, David E

2009-01-01

Background In many geographic regions, both in developing and in developed countries, the number of health workers is insufficient to achieve population health goals. Financial incentives for return of service are intended to alleviate health worker shortages: A (future) health worker enters into a contract to work for a number of years in an underserved area in exchange for a financial pay-off. Methods We carried out systematic literature searches of PubMed, the Excerpta Medica database, the Cumulative Index to Nursing and Allied Health Literature, and the National Health Services Economic Evaluation Database for studies evaluating outcomes of financial-incentive programs published up to February 2009. To identify articles for review, we combined three search themes (health workers or students, underserved areas, and financial incentives). In the initial search, we identified 10,495 unique articles, 10,302 of which were excluded based on their titles or abstracts. We conducted full-text reviews of the remaining 193 articles and of 26 additional articles identified in reference lists or by colleagues. Forty-three articles were included in the final review. We extracted from these articles information on the financial-incentive programs (name, location, period of operation, objectives, target groups, definition of underserved area, financial incentives and obligation) and information on the individual studies (authors, publication dates, types of study outcomes, study design, sample criteria and sample size, data sources, outcome measures and study findings, conclusions, and methodological limitations). We reviewed program results (descriptions of recruitment, retention, and participant satisfaction), program effects (effectiveness in influencing health workers to provide care, to remain, and to be satisfied with work and personal life in underserved areas), and program impacts (effectiveness in influencing health systems and health outcomes). Results Of the 43 reviewed studies 34 investigated financial-incentive programs in the US. The remaining studies evaluated programs in Japan (five studies), Canada (two), New Zealand (one) and South Africa (one). The programs started between 1930 and 1998. We identified five different types of programs (service-requiring scholarships, educational loans with service requirements, service-option educational loans, loan repayment programs, and direct financial incentives). Financial incentives to serve for one year in an underserved area ranged from year-2000 United States dollars 1,358 to 28,470. All reviewed studies were observational. The random-effects estimate of the pooled proportion of all eligible program participants who had either fulfilled their obligation or were fulfilling it at the time of the study was 71% (95% confidence interval 60–80%). Seven studies compared retention in the same (underserved) area between program participants and non-participants. Six studies found that participants were less likely than non-participants to remain in the same area (five studies reported the difference to be statistically significant, while one study did not report a significance level); one study did not find a significant difference in retention in the same area. Thirteen studies compared provision of care or retention in any underserved area between participants and non-participants. Eleven studies found that participants were more likely to (continue to) practice in any underserved area (nine studies reported the difference to be statistically significant, while two studies did not provide the results of a significance test); two studies found that program participants were significantly less likely than non-participants to remain in any underserved area. Seven studies investigated the satisfaction of participants with their work and personal lives in underserved areas. Conclusion Financial-incentive programs for return of service are one of the few health policy interventions intended to improve the distribution of human resources for health on which substantial evidence exists. However, the majority of studies are from the US, and only one study reports findings from a developing country, limiting generalizability. The existing studies show that financial-incentive programs have placed substantial numbers of health workers in underserved areas and that program participants are more likely than non-participants to work in underserved areas in the long run, even though they are less likely to remain at the site of original placement. As none of the existing studies can fully rule out that the observed differences between participants and non-participants are due to selection effects, the evidence to date does not allow the inference that the programs have caused increases in the supply of health workers to underserved areas. PMID:19480656

A national study on nurses' retention in healthcare facilities in underserved areas in Lebanon.

PubMed

El-Jardali, Fadi; Alameddine, Mohamad; Jamal, Diana; Dimassi, Hani; Dumit, Nuhad Y; McEwen, Mary K; Jaafar, Maha; Murray, Susan F

2013-09-30

Nursing shortages and maldistribution are priority issues for healthcare systems around the globe. Such imbalances are often aggravated in underserved areas, especially in developing countries. Despite the centrality of this issue, there is a dearth of studies that examine the retention of nurses in underserved areas in the Middle East Region. This study investigates the characteristic and the factors associated with the retention of nurses working in rural areas in Lebanon. This study uses a non-experimental cross-sectional design to survey nurses working in underserved areas of Lebanon. Underserved areas in Lebanon were identified using WHO definition. A total of 103 health facilities (hospitals and primary healthcare centers) located in these areas were identified and all nurses working at these facilities received a copy of the survey questionnaire. The questionnaire included five sections: demographic, work-life, career plan, job satisfaction, and assessment of work environment. Analysis included univariate and bivariate (chi-square, Student's t-test and ANOVA) tests to describe the respondents and examine the significance between nurses' characteristics and their intent to stay. A logistic regression model was constructed to identify factors associated with nurses' intent to stay in underserved areas. A total of 857 nurses from 63 Primary Healthcare (PHC) centers and hospitals responded to the questionnaire (75.5% response rate). Only 35.1% of nurses indicated their intent to stay in their current job over the coming one to three years. Surveyed nurses were most satisfied with relationship with co-workers and least satisfied with extrinsic rewards. Rural nurses working in PHC centers were more satisfied than their hospital counterparts on all aspects of work and had significantly higher intention to stay (62.5% compared to 31.5% in hospitals, P < 0.001). Regression analysis revealed that nurses less likely to report intent to stay were younger, unmarried, with less years of work experience and were not working towards a higher degree. Analysis reveals a directly proportional relationship between nurses' reported job satisfaction and their intent to stay. This study reveals poor retention of nurses in rural and underserved areas in Lebanon, especially in the hospital sector. The status quo is disquieting as it reflects an unstable and dissatisfied nursing workforce. Developing targeted retention strategies for younger nurses and those working in hospitals as well as the offering of professional development opportunities and devising an incentive scheme targeting rural nurses is pivotal to enhance nurses' job satisfaction and retention in rural settings.

A national study on nurses’ retention in healthcare facilities in underserved areas in Lebanon

PubMed Central

2013-01-01

Background Nursing shortages and maldistribution are priority issues for healthcare systems around the globe. Such imbalances are often aggravated in underserved areas, especially in developing countries. Despite the centrality of this issue, there is a dearth of studies that examine the retention of nurses in underserved areas in the Middle East Region. This study investigates the characteristic and the factors associated with the retention of nurses working in rural areas in Lebanon. Methods This study uses a non-experimental cross-sectional design to survey nurses working in underserved areas of Lebanon. Underserved areas in Lebanon were identified using WHO definition. A total of 103 health facilities (hospitals and primary healthcare centers) located in these areas were identified and all nurses working at these facilities received a copy of the survey questionnaire. The questionnaire included five sections: demographic, work-life, career plan, job satisfaction, and assessment of work environment. Analysis included univariate and bivariate (chi-square, Student’s t-test and ANOVA) tests to describe the respondents and examine the significance between nurses’ characteristics and their intent to stay. A logistic regression model was constructed to identify factors associated with nurses’ intent to stay in underserved areas. Results A total of 857 nurses from 63 Primary Healthcare (PHC) centers and hospitals responded to the questionnaire (75.5% response rate). Only 35.1% of nurses indicated their intent to stay in their current job over the coming one to three years. Surveyed nurses were most satisfied with relationship with co-workers and least satisfied with extrinsic rewards. Rural nurses working in PHC centers were more satisfied than their hospital counterparts on all aspects of work and had significantly higher intention to stay (62.5% compared to 31.5% in hospitals, P < 0.001). Regression analysis revealed that nurses less likely to report intent to stay were younger, unmarried, with less years of work experience and were not working towards a higher degree. Analysis reveals a directly proportional relationship between nurses’ reported job satisfaction and their intent to stay. Conclusion This study reveals poor retention of nurses in rural and underserved areas in Lebanon, especially in the hospital sector. The status quo is disquieting as it reflects an unstable and dissatisfied nursing workforce. Developing targeted retention strategies for younger nurses and those working in hospitals as well as the offering of professional development opportunities and devising an incentive scheme targeting rural nurses is pivotal to enhance nurses’ job satisfaction and retention in rural settings. PMID:24079458

Redesigning pictographs for patients with low health literacy and establishing preliminary steps for delivery via smart phones.

PubMed

Wolpin, Seth E; Nguyen, Juliet K; Parks, Jason J; Lam, Annie Y; Morisky, Donald E; Fernando, Lara; Chu, Adeline; Berry, Donna L

2016-01-01

Pictographs (or pictograms) have been widely utilized to convey medication related messages and to address nonadherence among patients with low health literacy. Yet, patients do not always interpret the intended messages on commonly used pictographs correctly and there are questions how they may be delivered on mobile devices. Our objectives are to refine a set of pictographs to use as medication reminders and to establish preliminary steps for delivery via smart phones. Card sorting was used to identify existing pictographs that focus group members found "not easy" to understand. Participants then explored improvements to these pictographs while iterations were sketched in real-time by a graphic artist. Feedback was also solicited on how selected pictographs might be delivered via smart phones in a sequential reminder message. The study was conducted at a community learning center that provides literacy services to underserved populations in Seattle, WA. Participants aged 18 years and older who met the criteria for low health literacy using S-TOFHLA were recruited. Among the 45 participants screened for health literacy, 29 were eligible and consented to participate. Across four focus group sessions, participants examined 91 commonly used pictographs, 20 of these were ultimately refined to improve comprehensibility using participatory design approaches. All participants in the fifth focus group owned and used cell phones and provided feedback on preferred sequencing of pictographs to represent medication messages. Low literacy adults found a substantial number of common medication label pictographs difficult to understand. Participative design processes helped generate new pictographs, as well as feedback on the sequencing of messages on cell phones, that may be evaluated in future research.

A novel educational strategy targeting health care workers in underserved communities in Central America to integrate HIV into primary medical care.

PubMed

Flys, Tamara; González, Rosalba; Sued, Omar; Suarez Conejero, Juana; Kestler, Edgar; Sosa, Nestor; McKenzie-White, Jane; Monzón, Irma Irene; Torres, Carmen-Rosa; Page, Kathleen

2012-01-01

Current educational strategies to integrate HIV care into primary medical care in Central America have traditionally targeted managers or higher-level officials, rather than local health care workers (HCWs). We developed a complementary online and on-site interactive training program to reach local HCWs at the primary care level in underserved communities. The training program targeted physicians, nurses, and community HCWs with limited access to traditional onsite training in Panama, Nicaragua, Dominican Republic, and Guatemala. The curriculum focused on principles of HIV care and health systems using a tutor-supported blended educational approach of an 8-week online component, a weeklong on-site problem-solving workshop, and individualized project-based interventions. Of 258 initially active participants, 225 (225/258=87.2%) successfully completed the online component and the top 200 were invited to the on-site workshop. Of those, 170 (170/200=85%) attended the on-site workshop. In total, 142 completed all three components, including the project phase. Quantitative and qualitative evaluation instruments included knowledge assessments, reflexive essays, and acceptability surveys. The mean pre and post-essay scores demonstrating understanding of social determinants, health system organization, and integration of HIV services were 70% and 87.5%, respectively, with an increase in knowledge of 17.2% (p<0.001). The mean pre- and post-test scores evaluating clinical knowledge were 70.9% and 90.3%, respectively, with an increase in knowledge of 19.4% (p<0.001). A survey of Likert scale and open-ended questions demonstrated overwhelming participant satisfaction with course content, structure, and effectiveness in improving their HIV-related knowledge and skills. This innovative curriculum utilized technology to target HCWs with limited access to educational resources. Participants benefited from technical skills acquired through the process, and could continue working within their underserved communities while participating in the online component and then implement interventions that successfully converted theoretical knowledge to action to improve integration of HIV care into primary care.

Un Abrazo Para La Familia: providing low-income Hispanics with education and skills in coping with breast cancer and caregiving.

PubMed

Marshall, Catherine A; Badger, Terry A; Curran, Melissa A; Koerner, Susan Silverberg; Larkey, Linda K; Weihs, Karen L; Verdugo, Lorena; García, Francisco A R

2013-02-01

Un Abrazo Para La Familia (A Hug for the Family) is an intervention designed to increase the accessibility of cancer information to low-income and medically underserved co-survivors of cancer. Co-survivors are family members or friends of an individual diagnosed with cancer. Our goal was to increase socio-emotional support for these co-survivors and improve skills in coping with cancer. The purpose of our pilot study was to explore the effectiveness of the intervention in increasing cancer knowledge and self-efficacy among co-survivors. Un Abrazo consisted of three one-hour sessions, in either Spanish or English. Sessions were delivered by a trained promotora (community health worker), in partnership with a counselor. Sixty participants completed measures of cancer knowledge and self-efficacy preceding (pre-test) and following the intervention (post-test). From pre-test to post-test, the percentage of questions answered correctly about cancer knowledge increased (p < 0.001), as did ratings of self-efficacy (p < 0.001). Decreases were seen in 'Do not know' responses for cancer knowledge (p < 0.01), with a negative correlation between number of 'Do not knows' on cancer knowledge at pre-test and ratings of self-efficacy at pre-test (r = -0.47, p < 0.01). When provided an accessible format, co-survivors of cancer from underserved populations increase their cancer knowledge and self-efficacy. This is notable because research indicates that family members and friends with increased cancer knowledge assume more active involvement in the cancer care of their loved ones. Copyright © 2011 John Wiley & Sons, Ltd.

The effect of the physician J-1 visa waiver on rural Wisconsin.

PubMed

Crouse, Byron J; Munson, Randy L

2006-10-01

One strategy to increase the number of physicians in rural and other underserved areas grants a waiver to foreign physicians in this country on a J-1 education visa allowing them to stay in the United States if they practice in designated underserved areas. The goal of this study is to evaluate the retention and acceptance of the J-1 Visa Waiver physicians in rural Wisconsin. Sites in Wisconsin at which physicians with a J-1 Visa Waiver practiced between 1996 and 2002 were identified. A 12-item survey that assessed the acceptance and retention of these physicians was sent to leaders of institutions that had participated in this program. Retention of J-1 Visa Waiver physicians was compared to other physicians recruited to rural Wisconsin practices by the Wisconsin Office of Rural Health during the same time period. While there was a general perception that the communities were well satisfied with the care provided and the physicians worked well with the medical community, there was a lower satisfaction with physician integration into the community-at-large. This was found to correlate with the poor retention rate of physicians with a J-1 Visa Waiver. Physicians participating in a placement program without J-1 Visa Waivers entering practice in rural communities had a significantly higher retention rate. Physicians with J-1 Visa Waivers appear to provide good care and work well in health care environments while fulfilling the waiver requirements. To keep these physicians practicing in these communities, successful integration into the community is important.

Welcoming Blue-Collar Scholars into the Ivory Tower: Developing Class-Conscious Strategies for Student Success. Series on Special Student Populations

ERIC Educational Resources Information Center

Soria, Krista M.

2015-01-01

"Welcoming Blue-Collar Scholars Into the Ivory Tower" is the first volume in a new book series designed to explore how institutional policies, practices, and cultures shape learning, development, and success for students who have been historically underserved or given limited consideration in the design of higher education contexts.…

Early College Designs: An Increasingly Popular College-Readiness Strategy for School Districts to Reach More Traditionally Underserved Students

ERIC Educational Resources Information Center

Vargas, Joel H.; Miller, Marc S.

2011-01-01

Once a radical concept, early college high schools are flying soundly today. The challenge today--and the excitement of those involved--centers on learning from this successful innovation and bringing the early college design to many more young people. Expansion is taking place through the creation of early college districts covering all students…

An Exploratory Assessment of the Validity of the Community College Survey of Men (CCSM): Implications for Serving Veteran Men

ERIC Educational Resources Information Center

De La Garza, Thomas; Wood, J. Luke; Harris, Frank, III

2015-01-01

The Community College Survey of Men (CCSM) assesses predictors of student success for historically underrepresented and underserved men in community colleges. The instrument is designed to inform programming and service-delivery for male students (Wood & Harris, 2013). While the instrument was designed for community college men in general,…

The evaluation of a culturally appropriate, community-based lifestyle intervention program for elderly Chinese immigrants with chronic diseases: a pilot study.

PubMed

Lu, Yifan; Dipierro, Moneika; Chen, Lingjun; Chin, Richard; Fava, Maurizio; Yeung, Albert

2014-03-01

The 'Healthy Habits Program' is a 6-month community-based program, which offers exercise facilities, training and weekly health education group to underserved elderly Chinese Americans with chronic medical diseases in their native languages. This pilot study evaluates the acceptability and the health effects of the 'Healthy Habits Program'. Ninety-nine subjects participated in the 'Healthy Habits Program' in 2011. Before and after the program, the participants were assessed in their physical and mental health using various fitness tests as well as measures of disability and psychological functioning. Participants provided overwhelmingly positive feedback on the program, which was associated with significant improvements in physical and mental health including a significant decrease in body mass index (BMI), blood pressure and increase in stamina. The participants reported lower mean scores on the Patient Health Questionnaire-9 item Scale (PHQ-9), indicating improved psychological well-being. These promising pilot study results from this lifestyle intervention program for elderly Chinese American immigrants with chronic diseases inform the design of a more definitive trial using a randomized design and larger sample size.

Columbia University's Informatics for Diabetes Education and Telemedicine (IDEATel) Project

PubMed Central

Shea, Steven; Starren, Justin; Weinstock, Ruth S.; Knudson, Paul E.; Teresi, Jeanne; Holmes, Douglas; Palmas, Walter; Field, Lesley; Goland, Robin; Tuck, Catherine; Hripcsak, George; Capps, Linnea; Liss, David

2002-01-01

The Columbia University Informatics for Diabetes Education and Telemedicine (IDEATel) Project is a four-year demonstration project funded by the Centers for Medicare and Medicaid Services with the overall goals of evaluating the feasibility, acceptability, effectiveness, and cost-effectiveness of telemedicine in the management of older patients with diabetes. The study is designed as a randomized controlled trial and is being conducted by a state-wide consortium in New York. Eligibility requires that participants have diabetes, are Medicare beneficiaries, and reside in federally designated medically underserved areas. A total of 1,500 participants will be randomized, half in New York City and half in other areas of the state. Intervention participants receive a home telemedicine unit that provides synchronous videoconferencing with a project-based nurse, electronic transmission of home fingerstick glucose and blood pressure data, and Web access to a project Web site. End points include glycosylated hemoglobin, blood pressure, and lipid levels; patient satisfaction; health care service utilization; and costs. The project is intended to provide data to help inform regulatory and reimbursement policies for electronically delivered health care services. PMID:11751803

Caring for the Underserved: Exemplars in Teaching

PubMed Central

Shane-McWhorter, Laura; Scott, Doneka R.; Chen, Judy T.; Seaba, Hazel H.

2009-01-01

The objective was to identify exemplars in teaching pharmacy students awareness, knowledge, and the skills needed to provide care and services to the underserved. A call for exemplars was sent out in spring 2007. A subcommittee of the AACP Task Force on Caring for the Underserved reviewed all applications received. The 3 best exemplars for teaching pharmacy students the awareness, attitudes, knowledge, and skills needed to care for the underserved were selected and are described in this manuscript. Included are 1 didactic, 1 experiential, and 1 international experience. These exemplars in educating students on working with the underserved provide schools with models which could be adapted to fit individual programmatic curricular needs. PMID:19513156

Partnering Urban Academic Medical Centers And Rural Primary Care Clinicians To Provide Complex Chronic Disease Care

PubMed Central

Arora, Sanjeev; Kalishman, Summers; Dion, Denise; Som, Dara; Thornton, Karla; Bankhurst, Arthur; Boyle, Jeanne; Harkins, Michelle; Moseley, Kathleen; Murata, Glen; Komaramy, Miriam; Katzman, Joanna; Colleran, Kathleen; Deming, Paulina; Yutzy, Sean

2013-01-01

Many of the estimated thirty-two million Americans expected to gain coverage under the Affordable Care Act are likely to have high levels of unmet need for various chronic illnesses and to live in areas that are already underserved. In New Mexico an innovative new model of health care education and delivery known as Project ECHO (Extension for Community Healthcare Outcomes) provides high-quality primary and specialty care to a comparable population. Using state-of-the-art telehealth technology and case-based learning, Project ECHO enables specialists at the University of New Mexico Health Sciences Center to partner with primary care clinicians in underserved areas to deliver complex specialty care to patients with hepatitis C, asthma, diabetes, HIV/AIDS, pediatric obesity and mental illness. As of March 2011, 298 Project ECHO teams across New Mexico have delivered more than 10,000 specialty care consultations for hepatitis C and other chronic diseases. PMID:21596757

Understanding and predicting social media use among community health center patients: a cross-sectional survey.

PubMed

Hanson, Carl L; West, Josh; Thackeray, Rosemary; Barnes, Michael D; Downey, Jordan

2014-11-26

The use of social media by health care organizations is growing and provides Web-based tools to connect patients, caregivers, and providers. The aim was to determine the use and factors predicting the use of social media for health care-related purposes among medically underserved primary care patients. A cross-sectional survey was administered to 444 patients of a federally qualified community health center. Community health center patients preferred that their providers use email, cell phones for texting, and Facebook and cell phone apps for sharing health information. Significantly more Hispanic than white patients believed their providers should use Facebook (P=.001), YouTube (P=.01), and Twitter (P=.04) for sharing health information. Use and intentions to use social media for health-related purposes were significantly higher for those patients with higher subjective norm scores. Understanding use and factors predicting use can increase adoption and utilization of social media for health care-related purposes among underserved patients in community health centers.

Community health navigators for breast- and cervical-cancer screening among Cambodian and Laotian women: intervention strategies and relationship-building processes.

PubMed

Ngoc Nguyen, Tu-Uyen; Tanjasiri, Sora Park; Kagawa-Singer, Marjorie; Tran, Jacqueline H; Foo, Mary Anne

2008-10-01

In recent years, there has been a growing number of programs employing health navigators to assist underserved individuals in overcoming barriers to obtaining regular and quality health care. This article describes the perspectives and experiences of community-based health navigators in the Cambodian and Laotian communities involved in a REACH 2010 project to reduce health disparities in breast and cervical cancer among Pacific Islander and Southeast Asian communities in California. These community health navigators, who have extensive training and knowledge about the cultural, historical, and structural needs and resources of their communities, are well equipped to build trusting relationships with community members traditionally ignored by the mainstream medical system. By comparing the different social support roles and intervention strategies employed by community health navigators in diverse communities, we can better understand how these valuable change agents of the health workforce are effective in improving health access and healthy behaviors for underserved communities.

The Affordable Care Act and genetic testing for inheritable cancer syndromes: impact on high-risk underserved minorities.

PubMed

Walcott, Farzana L; Dunn, Barbara K; DeShields, Mary; Baquet, Claudia

2014-02-01

Genetic testing for inheritable cancer syndromes is becoming a critical part of preventive health services. The Patient Protection and Affordable Care Act (PPACA) Essential Health Benefits package addresses breast cancer susceptibility-gene testing for women who are unaffected by cancer. The absence of provisions for 1) men, 2) cancer patients, 3) other inheritable cancer syndromes, and 4) risk-reducing interventions are limitations of PPACA. We discuss provisions and limitations of PPACA pertaining to genetic testing and effects on high-risk populations, in particular minorities. The PPACA is the beginning of an ongoing process of incorporating genetic testing in the armamentarium of cancer prevention. Future efforts should focus on ensuring equitable access to genetic testing as a preventive service under PPACA to high-risk populations other than women. Consideration should also be given to provisions for risk-reducing interventions, especially in underserved minority populations, who are known to underutilize genetic testing and may have limited financial resources for medical intervention.

Remote Patient Management in a Mammographic Screening Environment in Underserved Areas

DTIC Science & Technology

2005-09-01

PERFORMING ORGANIZATION NAME(S) AND ADDRESS( ES ) 8. PERFORMING ORGANIZATION REPORT NUMBER University of Pittsburgh Pittsburgh, PA 15260 9. SPONSORING...MONITORING AGENCY NAME(S) AND ADDRESS( ES ) 10. SPONSOR/MONITOR’S ACRONYM(S) U.S. Army Medical Research and Materiel Command Fort Detrick, Maryland 21702-5012...Langer, JL Lichtenfeld, JR Osuch, LN Reynolds, ES de Paredes, RE Williams, "Responsibilities of the mammography facility," In: Quality determinants of

Quality Indicators of Continuity and Coordination of Care for Vulnerable Elder Persons

DTIC Science & Technology

2004-08-01

TN, Bergman H, Champagne F, Clarfield AM, Kogan S. Compliance of frail elderly with health services prescribed at discharge from an acute-care... geriatric ward. Med Care. 1998;36:904-14. 36. Beers MH, Sliwkowski J, Brooks J. Compliance with medication orders among the elderly after hospital...Does insurance make a difference? J Health Care Poor Underserved. 1993;4:133-142. 41. Tangalos EG, Freeman PI. Assessment of geriatric patients

Rural Health, Center of Excellence for Remote and Medically Under-served Area (CERMUSA)

DTIC Science & Technology

2007-05-01

Pretest I Posttest of Cognitive Knowledge, • Pretest I Posttest of Knowledge (Self Perception), • VCS Feature Comparison. Pretest I Posttest of Cognitive...This measurement was the change between the pretest and posttest scores. Figure 6 represents the average pretest , posttest , and difference scores for...to the educational intervention, each case student’s average posttest scores increased over the pretest scores. Also, in each case, the

Determining medical staffing requirements for humanitarian assistance missions.

PubMed

Negus, Tracy L; Brown, Carrie J; Konoske, Paula

2010-01-01

The primary mission of hospital ships is to provide acute medical and surgical services to U.S. forces during military operations. Hospital ships also provide a hospital asset in support of disaster relief and humanitarian assistance (HA) operations. HA missions afford medical care to populations with vastly different sets of medical conditions from combat casualty care, which affects staffing requirements. Information from a variety of sources was reviewed to better understand hospital ship HA missions. Factors such as time on-site and location shape the mission and underlying goals. Patient encounter data from previous HA missions were used to determine expected patient conditions encountered in various HA operations. These data points were used to project the medical staffing required for future missions. Further data collection, along with goal setting, must be performed to accomplish successful future HA missions. Refining staffing requirements allows deployments to accomplish needed HA and effectively reach underserved areas.

Displacement of the underserved: medical needs of Hurricane Katrina evacuees in West Virginia.

PubMed

Ridenour, Marilyn L; Cummings, Kristin J; Sinclair, Julie R; Bixler, Danae

2007-05-01

On August 29, 2005 Hurricane Katrina struck Louisiana, Mississippi, and Alabama. During the aftermath of the storm, hurricane victims were evacuated to over 1,000 evacuation centers in 27 states. Three-hundred and twenty-three evacuees from 220 households were provided housing, food, and medical care at an evacuation center in West Virginia. A needs assessment followed to identify current needs of the evacuees. One-hundred and sixty-four evacuees were interviewed. Twenty-five percent reported an acute illness, while 46% reported having at least one chronic medical condition. The greatest need reported was for dental care (57%), followed by eyeglasses (34%), dentures (28%), and medical services (25%). Two weeks after the hurricane, the basic needs of food, shelter, and hygiene were met. The assessment identified and led to a successful response regarding the ongoing need for durable medical equipment (dentures and eyeglasses), as well as dental care.

Dream Weavers

ERIC Educational Resources Information Center

Miranda, Maria Eugenia

2010-01-01

This article shares the success story of Hamissou Samari, an immigrant from Togo, who realized his dream through the help of the Kaplan Foundation scholarship and leadership program for nontraditional students enrolled in community colleges. Designed for underserved community college students in New York, the comprehensive, first-of-its-kind…

Using stakeholder engagement to develop a patient-centered pediatric asthma intervention.

PubMed

Shelef, Deborah Q; Rand, Cynthia; Streisand, Randi; Horn, Ivor B; Yadav, Kabir; Stewart, Lisa; Fousheé, Naja; Waters, Damian; Teach, Stephen J

2016-12-01

Stakeholder engagement has the potential to develop research interventions that are responsive to patient and provider preferences. This approach contrasts with traditional models of clinical research in which researchers determine the study's design. This article describes the effect of stakeholder engagement on the design of a randomized trial of an intervention designed to improve child asthma outcomes by reducing parental stress. The study team developed and implemented a stakeholder engagement process that provided iterative feedback regarding the study design, patient-centered outcomes, and intervention. Stakeholder engagement incorporated the perspectives of parents of children with asthma; local providers of community-based medical, legal, and social services; and national experts in asthma research methodology and implementation. Through a year-long process of multidimensional stakeholder engagement, the research team successfully refined and implemented a patient-centered study protocol. Key stakeholder contributions included selection of patient-centered outcome measures, refinement of intervention content and format, and language framing the study in a culturally appropriate manner. Stakeholder engagement was a useful framework for developing an intervention that was acceptable and relevant to our target population. This approach might have unique benefits in underserved populations, leading to sustainable improvement in health outcomes and reduced disparities. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Lessons Learned from Implementing a Prostate Cancer Risk Assessment Program for Underserved High-Risk Men in the Community: the Prostate REACH Project.

PubMed

Fleisher, Linda; Davis, Stacy N; Gross, Laura; Bagden, Loretta; Zakrzewski, Debra; González, Evelyn; Kandadai, Venk; Rusten, Cheryl; Baskett, Jerilyn; Obeid, Elias; Giri, Veda N

2016-03-01

Prostate cancer disproportionately affects Black men, who may also encounter barriers to participation in prostate cancer risk assessment. The Prostate Risk, Education and Assessment in the Community with Help (REACH) project was a community-based extension of a comprehensive prostate cancer risk assessment program at a comprehensive cancer center. The goals of the REACH project were the following: (1) establish a community prostate cancer risk assessment clinic, (2) conduct targeted recruitment, and (3) provide navigation services including follow-up for uninsured men. Key implementation steps included the following: (1) choosing a clinic site, (2) establishing patient access procedures, (3) establishing navigator services, (4) developing subsidy fund use guidelines, and (5) designing recruitment and promotion. Through community-based promotion, 64 men inquired about the program and 26 (41 %) participated. Of those screened, 46 % had abnormal results, and 2 men were diagnosed with prostate cancer. Here, we describe a unique demonstration project to implement a comprehensive prostate cancer risk assessment program in an underserved Black community and describe successes and challenges to inform future efforts to promote access to underserved men.

Enhancing formal educational and in-service training programs in rural Rwanda: a partnership among the public sector, a nongovernmental organization, and academia.

PubMed

Cancedda, Corrado; Farmer, Paul E; Kyamanywa, Patrick; Riviello, Robert; Rhatigan, Joseph; Wagner, Claire M; Ngabo, Fidele; Anatole, Manzi; Drobac, Peter C; Mpunga, Tharcisse; Nutt, Cameron T; Kakoma, Jean Baptiste; Mukherjee, Joia; Cortas, Chadi; Condo, Jeanine; Ntaganda, Fabien; Bukhman, Gene; Binagwaho, Agnes

2014-08-01

Global disparities in the distribution, specialization, diversity, and competency of the health workforce are striking. Countries with fewer health professionals have poorer health outcomes compared with countries that have more. Despite major gains in health indicators, Rwanda still suffers from a severe shortage of health professionals.This article describes a partnership launched in 2005 by Rwanda's Ministry of Health with the U.S. nongovernmental organization Partners In Health and with Harvard Medical School and Brigham and Women's Hospital. The partnership has expanded to include the Faculty of Medicine and the School of Public Health at the National University of Rwanda and other Harvard-affiliated academic medical centers. The partnership prioritizes local ownership and-with the ultimate goals of strengthening health service delivery and achieving health equity for poor and underserved populations-it has helped establish new or strengthen existing formal educational programs (conferring advanced degrees) and in-service training programs (fostering continuing professional development) targeting the local health workforce. Harvard Medical School and Brigham and Women's Hospital have also benefited from the partnership, expanding the opportunities for training and research in global health available to their faculty and trainees.The partnership has enabled Rwandan health professionals at partnership-supported district hospitals to acquire new competencies and deliver better health services to rural and underserved populations by leveraging resources, expertise, and growing interest in global health within the participating U.S. academic institutions. Best practices implemented during the partnership's first nine years can inform similar formal educational and in-service training programs in other low-income countries.

Supporting underserved patients with their medicines: a study protocol for a patient/professional coproduced education intervention for community pharmacy staff to improve the provision and delivery of Medicine Use Reviews (MURs).

PubMed

Latif, Asam; Pollock, Kristian; Anderson, Claire; Waring, Justin; Solomon, Josie; Chen, Li-Chia; Anderson, Emma; Gulzar, Sulma; Abbasi, Nasa; Wharrad, Heather

2016-12-09

Community pharmacy increasingly features in global strategies to modernise the delivery of primary healthcare. Medicine Use Reviews (MURs) form part of the English Government's medicines management strategy to improve adherence and reduce medicine waste. MURs provide space for patient-pharmacist dialogue to discuss the well-known problems patients experience with medicine taking. However, 'underserved' communities (eg, black and minority ethnic communities, people with mental illness), who may benefit the most, may not receive this support. This study aims to develop, implement and evaluate an e-learning education intervention which is coproduced between patients from underserved communities and pharmacy teams to improve MUR provision. This mixed-methods evaluative study will involve a 2-stage design. Stage 1 involves coproduction of an e-learning resource through mixed patient-professional development (n=2) and review (n=2) workshops, alongside informative semistructured interviews with patients (n=10) and pharmacy staff (n=10). Stage 2 involves the implementation and evaluation of the intervention with community pharmacy staff within all community pharmacies within the Nottinghamshire geographical area (n=237). Online questionnaires will be completed at baseline and postintervention (3 months) to assess changes in engagement with underserved communities and changes in self-reported attitudes and behaviour. To triangulate findings, 10 pharmacies will record at baseline and postintervention, details of actual numbers of MURs performed and the proportion that are from underserved communities. Descriptive and inferential statistics will be used to analyse the data. The evaluation will also include a thematic analysis of one-to-one interviews with pharmacy teams to explore the impact on clinical practice (n=20). Interviews with patients belonging to underserved communities, and who received an MUR, will also be conducted (n=20). The study has received ethical approval from the NHS Research Ethics Committee (East Midlands-Derby) and governance clearance through the NHS Health Research Authority. Following the evaluation, the educational intervention will be freely accessible online. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Shoot for the Moon! the Mentors and the Middle Schoolers Explore the Intersection of Design Thinking and STEM

ERIC Educational Resources Information Center

Carroll, Maureen P.

2014-01-01

This paper describes the journey of a group of university students as they worked with underserved middle school students as mentors in a STEM-based afterschool program. Design thinking provided a frame within which students learned how to be mentors, how to create user-centered learning experiences, and how to share their experiences as…

Medical student experiences in prison health services and social cognitive career choice: a qualitative study.

PubMed

Brooker, Ron; Hu, Wendy; Reath, Jennifer; Abbott, Penelope

2018-01-02

One of the purposes of undergraduate medical education is to assist students to consider their future career paths in medicine, alongside the needs of the societies in which they will serve. Amongst the most medically underserved groups of society are people in prison and those with a history of incarceration. In this study we examined the experiences of medical students undertaking General Practice placements in a prison health service. We used the theoretical framework of the Social Cognitive Career Theory (SCCT) to explore the potential of these placements to influence the career choices of medical students. Questionnaire and interview data were collected from final year students, comprising pre and post placement questionnaire free text responses and post placement semi-structured interviews. Data were analysed using inductive thematic analysis, with reference to concepts from the SCCT Interest Model to further develop the findings. Clinical education delivered in a prison setting can provide learning that includes exposure to a wide variety of physical and mental health conditions and also has the potential to stimulate career interest in an under-served area. While students identified many challenges in the work of a prison doctor, increased confidence (SCCT- Self-Efficacy) occurred through performance success within challenging consultations and growth in a professional approach to prisoners and people with a history of incarceration. Positive expectations (SCCT- Outcome Expectations) of fulfilling personal values and social justice aims and of achieving public health outcomes, and a greater awareness of work as a prison doctor, including stereotype rejection, promoted student interest in working with people in contact with the criminal justice system. Placements in prison health services can stimulate student interest in working with prisoners and ex-prisoners by either consolidating pre-existing interest or expanding interest into a field they had not previously considered. An important aspect of such learning is the opportunity to overcome negative preconceptions of consultations with prisoners.

34 CFR 303.227 - Traditionally underserved groups.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 2 2012-07-01 2012-07-01 false Traditionally underserved groups. 303.227 Section 303... groups. The State must ensure that policies and practices have been adopted to ensure— (a) That traditionally underserved groups, including minority, low-income, homeless, and rural families and children with...

34 CFR 303.227 - Traditionally underserved groups.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 2 2013-07-01 2013-07-01 false Traditionally underserved groups. 303.227 Section 303... groups. The State must ensure that policies and practices have been adopted to ensure— (a) That traditionally underserved groups, including minority, low-income, homeless, and rural families and children with...

34 CFR 303.227 - Traditionally underserved groups.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 2 2014-07-01 2013-07-01 true Traditionally underserved groups. 303.227 Section 303... groups. The State must ensure that policies and practices have been adopted to ensure— (a) That traditionally underserved groups, including minority, low-income, homeless, and rural families and children with...

Sleep duration of underserved minority children in a cross-sectional study

USDA-ARS?s Scientific Manuscript database

Short sleep duration has been shown to associate with increased risk of obesity. Childhood obesity is more prevalent among underserved minority children. The study measured the sleep duration of underserved minority children living in a large US urban environment using accelerometry and its relation...

76 FR 9626 - Community Advantage Pilot Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-18

... businesses in underserved markets, including Veterans and members of the military community. The Community... that are focused on economic development in underserved markets, access to 7(a) loan guaranties for... underserved markets and to veterans and other members of the military community. This new pilot program will...

Addressing Children's Oral Health in the New Millennium: Trends in the Dental Workforce

PubMed Central

Mertz, Elizabeth; Mouradian, Wendy

2009-01-01

The Surgeon General's Report on Oral Health (SGROH) and the Call to Action to Promote Oral Health outlined the need to increase the diversity, capacity and flexibility of the dental workforce to reduce oral health disparities. This paper provides an update on dental workforce trends since the SGROH in the context of children's oral health needs. Major challenges remain to ensure a workforce that is adequate to address the needs of all children. The dentist to population ratio is declining, while mal-distribution of dentists continues for rural and underserved communities. The diversity of the dental workforce has only improved slightly, while the diversity of the pediatric population has increased substantially. More pediatric dentists have been trained, and dental educational programs are preparing students for practice in underserved areas, but the impact of these efforts on underserved children is uncertain. Other workforce developments with the potential to improve children's oral health include: enhanced training in children's oral health for general dentists; expanded scope of practice for allied dental health professionals; new dental practitioners including the dental health aid therapist; and increased engagement of pediatricians and other medical practitioners in children's oral health. The evidence for increasing caries experience in young children points to the need for continued efforts to bolster the oral health workforce. However, workforce strategies alone will not be sufficient to change this situation. Requisite policy changes, educational efforts and strong partnerships with communities will be needed to effect substantive changes in children's oral health. PMID:19854121

Addressing children's oral health in the new millennium: trends in the dental workforce.

PubMed

Mertz, Elizabeth; Mouradian, Wendy E

2009-01-01

Oral Health in America: A Report of the Surgeon General (SGROH) and National Call to Action to Promote Oral Health outlined the need to increase the diversity, capacity, and flexibility of the dental workforce to reduce oral health disparities. This paper provides an update on dental workforce trends since the SGROH in the context of children's oral health needs. Major challenges remain to ensure a workforce that is adequate to address the needs of all children. The dentist-to-population ratio is declining while shortages of dentists continue in rural and underserved communities. The diversity of the dental workforce has only improved slightly, and the the diversity of the pediatric population has increased substantially. More pediatric dentists have been trained, and dental educational programs are preparing students for practice in underserved areas, but the impact of these efforts on underserved children is uncertain. Other workforce developments with the potential to improve children's oral health include enhanced training in children's oral health for general dentists, expanded scope of practice for allied dental health professionals, new dental practitioners including the dental health aid therapist, and increased engagement of pediatricians and other medical practitioners in children's oral health. The evidence for increasing caries experience in young children points to the need for continued efforts to bolster the oral health workforce. However, workforce strategies alone will not be sufficient to change this situation. Requisite policy changes, educational efforts, and strong partnerships with communities will be needed to effect substantive changes in children's oral health.

Engaging Health Systems to Increase Colorectal Cancer Screening: Community–Clinical Outreach in Underserved Areas of Wisconsin

PubMed Central

Weeth-Feinstein, Lauren; Conlon, Amy; Scott, Sheryl

2013-01-01

Background Colorectal cancer is the fourth most commonly diagnosed cancer and the second leading cause of cancer-related death in Wisconsin. Incidence and mortality rates for colorectal cancer vary by age, race/ethnicity, geography, and socioeconomic status. From 2010 through 2012, the Wisconsin Comprehensive Cancer Control Program awarded grants to 5 regional health systems for the purpose of planning and implementing events to increase colorectal cancer screening rates in underserved communities. Community Context Grantees were chosen for their ability to engage community partners in reaching underserved groups including African American, Hispanic/Latino, Hmong, rural, and uninsured populations in their service areas. Methods Grantees identified target populations for proposed screening events, designated institutional planning teams, engaged appropriate local partner organizations, and created plans for follow-up. All grantees implemented 1 or more colorectal cancer screening events within 6 months of receiving their awards. Events were conducted in 2 phases. Outcomes Participating health systems organized 36 screening events and distributed 633 individual test kits; 506 kits were returned, of which 57 (9%) tested positive for colorectal abnormalities. Of attendees who received screening, 63% were uninsured or underinsured, 55% had no previous screening, 46% were of a racial/ethnic minority group, 22% had a family history of cancer, and 13% were rural residents. This project strengthened partnerships between health systems and local organizations. Interpretation An effective strategy for improving colorectal cancer screening rates, particularly among underserved populations, is to award health systems grants for implementing community-based screening events in conjunction with community partners. PMID:24262024

Cultural Competence in Afterschool Programs

ERIC Educational Resources Information Center

Simpkins, Sandra D.; Riggs, Nathaniel R.

2014-01-01

Increasing ethnic diversity among American youth, in combination with funding priorities often targeting underserved populations, has increased the number of diverse youth attending afterschool programs (ASPs). At present, there is little guidance on how to best design ASPs and prepare staff to support the development of these diverse youth. The…

Effect of Extramural Experiences on Dental Students' Attitudes.

ERIC Educational Resources Information Center

Grantham, Emily V.; Block, Marvin J.

1983-01-01

A study designed to determine the effect of a set of community dentistry extramural experience on student attitudes is discussed. The experiences involved one or more of four underserved or special populations: the mentally retarded, the mentally ill, correctional center inmates, and indigent children. (Author/MLW)

Youth Exploring Science

NASA Astrophysics Data System (ADS)

Miller, Diane

2008-04-01

This session features Youth Exploring Science (YES), Saint Louis Science Center's nationally recognized work-based teen development program. In YES, underserved audiences develop interest and understanding in physics through design engineering projects. I will discuss breaking down barriers, helping youth develop skills, and partnering with community organizations, universities and engineering firms.

75 FR 20977 - Agency Information Collection Activities: Proposed Collection; Comment Request-Evaluation of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-22

...: Proposed Collection; Comment Request--Evaluation of Reaching the Underserved Elderly and Working Poor in... Reaching the Underserved Elderly and Working Poor in SNAP. DATES: Written comments must be received on or.... SUPPLEMENTARY INFORMATION: Title: Evaluation of Reaching the Underserved Elderly and Working Poor in SNAP: FY...

Underserved Gifted Populations: Responding to Their Needs and Abilities. Perspectives on Creativity Research.

ERIC Educational Resources Information Center

Smutny, Joan Franklin, Ed.

Twenty-five papers address issues of the underserved gifted, including environmental influences, multicultural and global factors, special learning problems, and the highly gifted and creatively gifted. The papers are: "Twenty-five Teaching Strategies that Promote Learning Success for Underserved Gifted Populations" (Jerry Flack); "The Invisible…

Nurse Education, Center of Excellence for Remote and Medically Under-Served Areas (CERMUSA)

DTIC Science & Technology

2014-04-01

didactic portion o Online pre-test and post-test o Online survey • Statistical validity: o The study investigators enrolled 134 participants...NURSE.SAS Datacut: 2014-01-17 Generated: 2014-01-26:16:40 Table 2.09: Summary Statistics , Does your curriculum teach students how to develop a personal...disasters. Pre-test post-test results indicated that the delivery of didactic material via an online course management system is an effective

Are public health physicians still needed in medically underserved rural areas in Korea?

PubMed

Na, Baeg Ju; Lee, Jin Yong; Kim, Hyun Joo

2017-05-01

Public health physicians (PHPs) are certified physicians who are serving in a public health center or subcenter in a rural village, instead of serving in the military. However, the PHP program has recently become the subject of a profound debate, over 30 years after its adoption. In this study, we attempted to ascertain physicians' perspectives on the PHP program, including: whether the PHP policy should continue; if they agree on changing the role of PHPs in healthcare; what would be the desired role of PHPs; and what resources would be required and what possible barriers would be anticipated under the changes. We selected 88 PHPs as our study sample using quota sampling. Over 60% of respondents were in support of continuing the PHP program. They believed some remote islands and mountainous areas are still in need of public healthcare doctors. However, some of them believed that the role of PHPs should be changed to take on community health promotion, because the problem of medically underserved rural areas has almost been resolved. However, people living in rural areas are ageing and suffering from a lack of education and health information. In particular, in order to successfully transition into new roles, PHPs must be provided with continuing education and professional development programs covering their new responsibilities. It is imperative to refurbish the PHP program to meet current needs and continue its central role in public healthcare.

Survivorship Care Plan Information Needs: Perspectives of Safety-Net Breast Cancer Patients.

PubMed

Burke, Nancy J; Napoles, Tessa M; Banks, Priscilla J; Orenstein, Fern S; Luce, Judith A; Joseph, Galen

2016-01-01

Despite the Institute of Medicine's (IOM) 2005 recommendation, few care organizations have instituted standard survivorship care plans (SCPs). Low health literacy and low English proficiency are important factors to consider in SCP development. Our study aimed to identify information needs and survivorship care plan preferences of low literacy, multi-lingual patients to support the transition from oncology to primary care and ongoing learning in survivorship. We conducted focus groups in five languages with African American, Latina, Russian, Filipina, White, and Chinese medically underserved breast cancer patients. Topics explored included the transition to primary care, access to information, knowledge of treatment history, and perspectives on SCPs. Analysis of focus group data identified three themes: 1) the need for information and education on the transition between "active treatment" and "survivorship"; 2) information needed (and often not obtained) from providers; and 3) perspectives on SCP content and delivery. Our data point to the need to develop a process as well as written information for medically underserved breast cancer patients. An SCP document will not replace direct communication with providers about treatment, symptom management and transition, a communication that is missing in participating safety-net patients' experiences of cancer care. Women turned to peer support and community-based organizations in the absence of information from providers. "Clear and effective" communication of survivorship care for safety-net patients requires dedicated staff trained to address wide-ranging information needs and uncertainties.

Hispanic migrant farm workers' attitudes toward mobile phone-based telehealth for management of chronic health conditions.

PubMed

Price, Matthew; Williamson, Deborah; McCandless, Romina; Mueller, Martina; Gregoski, Mathew; Brunner-Jackson, Brenda; Treiber, Eveline; Davidson, Lydia; Treiber, Frank

2013-03-30

Mobile phone-based interventions present a means of providing high quality health care to hard-to-reach underserved populations. Migrant farm workers (MFWs) are among the most underserved populations in the United States due to a high prevalence of chronic diseases yet limited access to health care. However, it is unknown if MFWs have access to mobile phone devices used in mobile health (mHealth) interventions, or if they are willing to use such technologies. Determine rates of ownership of mobile devices and willingness to use mHealth strategies in MFWs. A demonstration of mHealth devices and a survey were individually administered to 80 Hispanic MFWs to evaluate use of mobile phones and mHealth devices and willingness to use such technologies. Of the 80 participants, 81% (65/80) owned cell phones capable of sending and receiving health-related messages. Most participants (65/80, 81%) were receptive to using mHealth technology and felt it would be helpful in enhancing medication adherence, self-monitoring health conditions, and receiving quicker medication changes from their doctors (median scores ≥4 on 5-point Likert scales). Relations between age and attitudes toward using mHealth were not statistically significant. Hispanic MFWs have access to mobile phones and are willing to use mHealth devices. Future work is needed to comprehensively evaluate the degree to which these devices could be used.

Clinical outcomes of a diabetes education program for patients with diabetes mellitus in the Micronesian community in Hawaii.

PubMed

Chong, Mok Thoong

2016-01-01

Hawaii has diverse population made up of a cultural mix of different races. Due to different cultural and social influences and language barrier, many of the under-served population who migrated to Hawaii and having diabetes mellitus may be susceptible to long-term complications due to uncontrolled hyperglycemia and medication nonadherence. The purpose of this study was to evaluate the impact of a diabetes education program on the clinical outcomes in patients with diabetes mellitus in the Micronesian community of Hawaii. This study included patients over age 18 years, with a diagnosis of type 2 diabetes mellitus. The diabetes education program was customized for its weekly classes to fit to the under-served population. Data were collected on participants on the 1(st) day and then 6 months after attending the education program. Data on primary and secondary endpoints were collected and analyzed. The mean glycosylated hemoglobin A1c, fasting blood glucose, and triglyceride levels of participants fell significantly from baseline after attending the diabetes education program for 6 months. No significant changes were observed in other secondary outcomes during the study time period. Based on our findings, the diabetes education program that was tailored to the Micronesian population was successful in achieving glycemic goals, enhancing medication adherence, improving clinical outcomes, and also preventing long-term complications among its participants.

Finding the Underserved

ERIC Educational Resources Information Center

Futterman, Marc

2008-01-01

The heart of the public library mission is to provide service to the entire community and serve the underserved. But how does a library identify the people it is not reaching, where they live, and what they need? And what does it mean for a library's services if in its community the underserved are not also underprivileged? Contrary to popular…

Where Do We Start? Using Family Navigation to Help Underserved Families

ERIC Educational Resources Information Center

Blenner, Stephanie; Fernández, Ivys; Giron, Adriana; Grossman, Xena; Augustyn, Marilyn

2014-01-01

The period of time after a child is identified with a developmental or mental health condition can be highly challenging. This is particularly true for diverse, underserved families who may face competing concerns related to poverty, culture, language, immigration, and family issues. Likewise, clinicians working with underserved families may…

Redefining Science, Technology, Engineering, and Mathematics (STEM) Educational Opportunities for Underserved and Underrepresented Students at NASA

ERIC Educational Resources Information Center

Hackler, Amanda Smith

2011-01-01

Underserved and underrepresented students consistently leave science, technology, engineering, and mathematics (STEM) degree fields to pursue less demanding majors. This perpetual problem slowed the growth in STEM degree fields (United States Department of Labor, 2007). Declining enrollment in STEM degree fields among underserved and…

Ending DACA Has Pragmatic and Ethical Implications for U.S. Health Care.

PubMed

Zaidi, Danish; Kuczewski, Mark

2017-11-01

In 2012, Loyola University Chicago's Stritch School of Medicine became the first medical school in the United States to actively recruit and accept undocumented immigrants who received protections granted under the Deferred Action for Childhood Arrivals program that was established by presidential memorandum. By 2016, sixty-one medical schools were considering applications from DACA recipients for admission, and more than 110 students applied. According to the American Association of Medical Colleges, sixty-five DACA recipients matriculated in U.S. medical schools in the 2016-2017 school year. These students contribute both diversity and talent to our medical community; they could also have a significant impact on the care of underserved and immigrant populations. The recent decision by the Trump administration to rescind DACA therefore comes with serious pragmatic and ethical ramifications, impeding our medical community's efforts to develop a diverse and representative workforce committed to improving access to quality care for all patients. © 2017 The Hastings Center.

Honoring the Ways of American Indian Women: A Group Therapy Intervention

ERIC Educational Resources Information Center

McWhirter, Paula T.; Robbins, Rockey; Vaughn, Karen; Youngbull, Natalie; Burks, Derek; Willmon-Haque, Sadie; Schuetz, Suzan; Brandes, Joyce A.; Nael, Andrea Zainab Omidy

2010-01-01

A culturally grounded group intervention for a typically underserved population of urban American Indian women is described. The intervention is designed to increase interpersonal connection, improve inter-tribal acceptance and trust, and enhance psychological well being of marginalized urban American Indian women. Topics used to structure the…

78 FR 5469 - Announcement of Requirements and Registration for the 2013 NIBIB DEsign by Biomedical...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-25

... tools, tissue engineering, drug and gene delivery (c) Technology to Aid Underserved Populations and... and engineering and associated technologies and modalities with biomedical applications; and (3) to...: September 2013, Biomedical Engineering Society Conference (exact date to be announced at http://debut2013...

Designing Ensemble Based Security Framework for M-Learning System

ERIC Educational Resources Information Center

Mahalingam, Sheila; Abdollah, Mohd Faizal; bin Sahibuddin, Shahrin

2014-01-01

Mobile Learning has a potential to improve efficiency in the education sector and expand educational opportunities to underserved remote area in higher learning institutions. However there are multi challenges in different altitude faced when introducing and implementing m-learning. Despite the evolution of technology changes in education,…

UNITE 3D Rover Summer Workshop: An Overview and Assessment

ERIC Educational Resources Information Center

Hsiung, Steve C.; Deal, Walter F.; Tuluri, Francis

2017-01-01

UNITE is a program sponsored by the Army Educational Outreach Program (AEOP, 2015). The STEM Enrichment Activities of AEOP are designed to spark student interest in science, technology, engineering, and mathematics, especially among the underserved and those in earlier grades and educators by providing exciting, engaging, interactive, hands-on…

Austin Community College District's P-16 Initiative Graduates America

ERIC Educational Resources Information Center

Hensley, Mary; Madsen, Gary

2010-01-01

Austin Community College (ACC) District's P-16 Initiative supports partnerships with 30 school districts--reaching traditionally underserved students and bridging the gap between high school and college--so more Texas students can reach their educational goals. The P-16 Initiative is a constellation of efforts designed to provide broad-based…

Physicians' Perceptions of Volunteer Service at Safety-Net Clinics.

PubMed

Mcgeehan, Laura; Takehara, Michael A; Daroszewski, Ellen

2017-01-01

Volunteer physicians are crucial for the operation of safety-net clinics, which provide medical care for uninsured and underinsured populations. Thus, identifying ways to maximize the number of physicians volunteering at such clinics is an important goal. To investigate the perceptions, motivations, functions, and barriers associated with physician volunteering in four safety-net clinics in San Bernardino County, Southern California, a location of great medical need with many barriers to care. The study participants are physicians belonging to the Southern California Permanente Medical Group who use a combination of discretionary time (during regular work hours) and personal time in evening and weekend hours to volunteer their services. The experimental design incorporates a mixed methodology: an online survey of 31 physicians and follow-up interviews with 8 of them. Physicians conveyed uniformly positive perceptions of their volunteer service, and most were motivated by humanitarian or prosocial desires. Volunteering also provided a protective "escape hatch" from the pressures of the physicians' regular jobs. Physicians cited few challenges to volunteering. The most common personal barrier was a lack of time. The most common professional barriers were organizational and supply issues at the clinic, along with the patients' social, transportation, and financial challenges. The results suggest that appealing to physicians' values and faith, and highlighting the burnout-prevention qualities of volunteering, may be key to recruitment and retention of volunteer physicians who serve underserved and underinsured populations in community clinics.

Struggling to be seen and heard: the underserved and unserved populations.

PubMed

Cheng, Li-Rong Lilly

2014-01-01

The purpose of this paper is to provide some current information on the topic of the underserved and unserved populations including modern-day slaves, stateless/displaced persons, refugees/migrants and indigenous populations. Speech-language pathology education and services for the underserved as well as unserved populations are discussed. Three case studies which demonstrate knowledge transfer and exchange as potential models for future development are presented. These case studies lead to more inquiries, studies, innovations and involvement from individuals and groups who are concerned about the underserved and unserved populations. © 2015 S. Karger AG, Basel.

HealthATM: personal health cyberinfrastructure for underserved populations.

PubMed

Botts, Nathan E; Horan, Thomas A; Thoms, Brian P

2011-05-01

There is an opportunity for personal health record (PHR) systems to play a vital role in fostering health self-management within underserved populations. If properly designed and promoted, it is possible that patients will use PHRs to become more empowered in taking an active role toward managing their health needs. This research examines the potential of a cyberinfrastructure-based PHR to encourage patient activation in health care, while also having population health implications. A multi-phased, iterative research approach was used to design and evaluate a PHR system called HealthATM, which utilizes services from a cloud computing environment. These services were integrated into an ATM-style interface aimed at providing a broad range of health consumers with the ability to manage health conditions and encourage accomplishment of health goals. Evaluation of the PHR included 115 patients who were clients of several free clinics in Los Angeles County. The majority of patients perceived ease of use (74%) and confidence (73%) in using the HealthATM system, and thought they would like to use it frequently (73%). Patients also indicated a belief in being responsible for their own health. However, fewer felt as though they were able to maintain necessary life changes to improve their health. Findings from the field tests suggest that PHRs can be a beneficial health management tool for underserved populations. In order for these types of tools to be effective within safety-net communities, they must be technically accessible and provide meaningful opportunities to increase patient engagement in their health care. Copyright © 2011. Published by Elsevier Inc.

Preparing Physicians for Rural-Based Primary Care Practice: A Preliminary Evaluation of Rural Training Initiatives at OSU-COM.

PubMed

Wheeler, Denna L; Hackler, Jeffrey B

2017-05-01

The physician shortage in Oklahoma coupled with geographic maldistribution of primary care physicians limits access to care in rural and underserved areas. One of the most effective strategies to recruit and retain physicians in rural areas is to create undergraduate and graduate medical education training sites in these locations. Oklahoma State University Center for Health Sciences College of Osteopathic Medicine has implemented a rural training program that begins with early recruitment of rural high school students, introduces medical students to rural practice options through rural clinical training opportunities, and provides opportunities to remain in rural Oklahoma for residency training through ongoing graduate medical education development. The purpose of this article is to provide a case study of the development of the college's Rural Medical Track. Preliminary findings indicate that rural-based clinical training for third- and fourth-year students strengthens performance on standardized tests.

Evaluating the Relationship Between Participation in Student-Run Free Clinics and Changes in Empathy in Medical Students.

PubMed

Modi, Anita; Fascelli, Michele; Daitch, Zachary; Hojat, Mohammadreza

2017-07-01

We explored differences in changes in medical student empathy in the third year of medical school between volunteers at JeffHOPE, a multisite medical student-run free clinic of Sidney Kimmel Medical College (SKMC), and nonvolunteers. Volunteerism and leadership experience at JeffHOPE were documented for medical students in the Class of 2015 (n = 272) across their medical educations. Students completed the Jefferson Scale of Empathy at the beginning of medical school and at the end of the third year. Students who reported participation in other Jefferson-affiliated clinics (n = 44) were excluded from this study. Complete data were available for 188 SKMC students. Forty-five percent of students (n = 85) volunteered at JeffHOPE at least once during their medical educations. Fifteen percent of students (n = 48) were selected for leadership positions involving weekly clinic participation. Nonvolunteers demonstrated significant decline in empathy in medical school ( P = 0.009), while those who volunteered at JeffHOPE at least once over the course of their medical educations did not show any significant decline ( P = 0.07). These findings suggest that medical students may benefit from volunteering at student-run free clinics to care for underserved populations throughout medical school.

The relevance and role of homestays in medical education: a scoping study

PubMed Central

Hughes, Bonnie Olivia; Moshabela, Mosa; Owen, Jenni; Gaede, Bernhard

2017-01-01

ABSTRACT Background: The community-based medical education curriculum is growing in popularity as a strategy to bring universal health coverage to underserved communities by providing medical students with hands-on training in primary health care. Accommodation and immersion of medical students within the community will become increasingly important to the success of community-based curricula. In the context of tourism, homestays, where local families host guests, have shown to provide an immersive accommodation experience. Objective: By exploring homestays in the educational context, this scoping study investigates their role in providing an immersive pedagogical experience for medical students. Design: A scoping review was performed using the online databases ScienceDirect and the Duke University Library Database, which searches Academic Search Complete, JSTOR, LexisNexis Academic, Web of Science, Proquest, PubMed and WorldCat. Using the inclusion term ‘homestays’ and excluding the term ‘tourism’, 181 results were returned. AClose assessment using inclusion criteria narrowed this to 14 relevant articles. Results: There is very little published research specific to the experience of medical students in community homestays, indicating a gap in the literature. However, the existing educational outcomes suggest homestays may have the potential to serve a significant role in medical education, especially as a component of decentralised or community-based programmes. The literature reveals that educational homestays influence language learning, cultural immersion, and the development of professional skills for health science careers. These outcomes relate to the level of engagement between students and hosts, including the catalytic role of community liaisons. Conclusions: Homestays offer a unique depth of experience that has the potential to enrich the education of participating students, and require further research, particularly in the context of distributed and decentralised training platforms for medical and health sciences students. Future studies should explore the potential for homestays as a pedagogical component of community-based medical curriculum. Abbreviations: CBME: Community-based medical education PMID:28460606

SafeMed: Using pharmacy technicians in a novel role as community health workers to improve transitions of care.

PubMed

Bailey, James E; Surbhi, Satya; Bell, Paula C; Jones, Angel M; Rashed, Sahar; Ugwueke, Michael O

2016-01-01

To describe the design, implementation, and early experience of the SafeMed program, which uses certified pharmacy technicians in a novel expanded role as community health workers (CPhT-CHWs) to improve transitions of care. A large nonprofit health care system serving the major medically underserved areas and geographic hotspots for readmissions in Memphis, TN. The SafeMed program is a care transitions program with an emphasis on medication management designed to use low-cost health workers to improve transitions of care from hospital to home for superutilizing patients with multiple chronic conditions and polypharmacy. CPhT-CHWs were given primary responsibility for patient outreach after hospital discharge with the use of home visits and telephone follow-up. SafeMed program CPhT-CHWs served as pharmacist extenders, obtaining medication histories, assisting in medication reconciliation and identification of potential drug therapy problems (DTPs), and reinforcing medication education previously provided by the pharmacist per protocol. CPhT-CHW training included patient communication skills, motivational interviewing, medication history taking, teach-back techniques, drug disposal practices, and basic disease management. Some CPhT-CHWs experienced difficulties adjusting to an expanded scope of practice. Nonetheless, once the Tennessee Board of Pharmacy affirmed that envisioned SafeMed CPhT-CHW roles were consistent with Board rules, additional responsibilities were added for CPhT-CHWs to enhance their effectiveness. Patient outreach teams including CPhT-CHWs achieved increases in home visit and telephone follow-up rates and were successful in helping identify potential DTPs. The early experience of the SafeMed program demonstrates that CPhT-CHWs are well suited for novel expanded roles to improve care transitions for superutilizing populations. CPhT-CHWs can identify and report potential DTPs to the pharmacist to help target medication therapy management. Critical success factors include strong CPhT-CHW patient-centered communication skills and strong pharmacist champions. In collaboration with state pharmacy boards and pharmacist associations, the SafeMed CPhT-CHW model can be successfully scaled to serve superutilizing patients throughout the country. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Re-Presenting Slavery: Underserved Questions in Museum Collections

ERIC Educational Resources Information Center

Levenson, Cyra

2014-01-01

This article looks at the notion of what, not who, is underserved in museum education. The importance of looking through, in, and from objects in order to uncover underserved questions and themes is vital. A willingness to consider new ways to approach collections and display is necessary to have a dialogue with our audiences about how museums can…

Factors Limiting Youth Participation in 4-H and Other Youth Development Programs in Underserved Communities

ERIC Educational Resources Information Center

Avent, Martellis D.; Jayaratne, K. S. U.

2017-01-01

The purpose of the study described here was to identify factors limiting children's participation in youth development programs in underserved communities and ways to overcome those limitations. Findings are based on focus group interviews conducted with members of two underserved communities in North Carolina. Lack of awareness about the 4-H…

24 CFR 81.13 - Central Cities, Rural Areas, and Other Underserved Areas Housing Goal.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Central Cities, Rural Areas, and...) Housing Goals § 81.13 Central Cities, Rural Areas, and Other Underserved Areas Housing Goal. (a) Purpose... cities, rural areas, and other underserved areas is intended to achieve increased purchases by the GSEs...

24 CFR 81.13 - Central Cities, Rural Areas, and Other Underserved Areas Housing Goal.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Central Cities, Rural Areas, and...) Housing Goals § 81.13 Central Cities, Rural Areas, and Other Underserved Areas Housing Goal. (a) Purpose... cities, rural areas, and other underserved areas is intended to achieve increased purchases by the GSEs...

Use of Community Health Workers and Patient Navigators to Improve Cancer Outcomes Among Patients Served by Federally Qualified Health Centers: A Systematic Literature Review

PubMed Central

Roland, Katherine B.; Milliken, Erin L.; Rohan, Elizabeth A.; DeGroff, Amy; White, Susan; Melillo, Stephanie; Rorie, William E.; Signes, Carmita-Anita C.; Young, Paul A.

2017-01-01

Abstract Introduction: In the United States, disparities in cancer screening, morbidity, and mortality are well documented, and often are related to race/ethnicity and socioeconomic indicators including income, education, and healthcare access. Public health approaches that address social determinants of health have the greatest potential public health benefit, and can positively impact health disparities. As public health interventions, community health workers (CHWs), and patient navigators (PNs) work to address disparities and improve cancer outcomes through education, connecting patients to and navigating them through the healthcare system, supporting patient adherence to screening and diagnostic services, and providing social support and linkages to financial and community resources. Clinical settings, such as federally qualified health centers (FQHCs) are mandated to provide care to medically underserved communities, and thus are also valuable in the effort to address health disparities. We conducted a systematic literature review to identify studies of cancer-related CHW/PN interventions in FQHCs, and to describe the components and characteristics of those interventions in order to guide future intervention development and evaluation. Method: We searched five databases for peer-reviewed CHW/PN intervention studies conducted in partnership with FQHCs with a focus on cancer, carried out in the United States, and published in English between January 1990 and December 2013. Results: We identified 24 articles, all reporting positive outcomes of CHW/PNs interventions in FQHCs. CHW/PN interventions most commonly promoted breast, cervical, or colorectal cancer screening and/or referral for diagnostic resolution. Studies were supported largely through federal funding. Partnerships with academic institutions and community-based organizations provided support and helped develop capacity among FQHC clinic leadership and community members. Discussion: Both the FQHC system and CHW/PNs were borne from the need to address persistent, complex health disparities among medically underserved communities. Our findings support the effectiveness of CHW/PN programs to improve completion and timeliness of breast, cervical, and colorectal cancer screening in FQHCs, and highlight intervention components useful to design and sustainability. PMID:28905047

A new framework for designing programmes of assessment

PubMed Central

Van der Vleuten, C. P. M.; Schuwirth, L. W. T.

2009-01-01

Research on assessment in medical education has strongly focused on individual measurement instruments and their psychometric quality. Without detracting from the value of this research, such an approach is not sufficient to high quality assessment of competence as a whole. A programmatic approach is advocated which presupposes criteria for designing comprehensive assessment programmes and for assuring their quality. The paucity of research with relevance to programmatic assessment, and especially its development, prompted us to embark on a research project to develop design principles for programmes of assessment. We conducted focus group interviews to explore the experiences and views of nine assessment experts concerning good practices and new ideas about theoretical and practical issues in programmes of assessment. The discussion was analysed, mapping all aspects relevant for design onto a framework, which was iteratively adjusted to fit the data until saturation was reached. The overarching framework for designing programmes of assessment consists of six assessment programme dimensions: Goals, Programme in Action, Support, Documenting, Improving and Accounting. The model described in this paper can help to frame programmes of assessment; it not only provides a common language, but also a comprehensive picture of the dimensions to be covered when formulating design principles. It helps identifying areas concerning assessment in which ample research and development has been done. But, more importantly, it also helps to detect underserved areas. A guiding principle in design of assessment programmes is fitness for purpose. High quality assessment can only be defined in terms of its goals. PMID:19821042

A new framework for designing programmes of assessment.

PubMed

Dijkstra, J; Van der Vleuten, C P M; Schuwirth, L W T

2010-08-01

Research on assessment in medical education has strongly focused on individual measurement instruments and their psychometric quality. Without detracting from the value of this research, such an approach is not sufficient to high quality assessment of competence as a whole. A programmatic approach is advocated which presupposes criteria for designing comprehensive assessment programmes and for assuring their quality. The paucity of research with relevance to programmatic assessment, and especially its development, prompted us to embark on a research project to develop design principles for programmes of assessment. We conducted focus group interviews to explore the experiences and views of nine assessment experts concerning good practices and new ideas about theoretical and practical issues in programmes of assessment. The discussion was analysed, mapping all aspects relevant for design onto a framework, which was iteratively adjusted to fit the data until saturation was reached. The overarching framework for designing programmes of assessment consists of six assessment programme dimensions: Goals, Programme in Action, Support, Documenting, Improving and Accounting. The model described in this paper can help to frame programmes of assessment; it not only provides a common language, but also a comprehensive picture of the dimensions to be covered when formulating design principles. It helps identifying areas concerning assessment in which ample research and development has been done. But, more importantly, it also helps to detect underserved areas. A guiding principle in design of assessment programmes is fitness for purpose. High quality assessment can only be defined in terms of its goals.

Community-based distributive medical education: Advantaging society

PubMed Central

Farnsworth, Tracy J.; Frantz, Alan C.; McCune, Ronald W.

2012-01-01

This paper presents a narrative summary of an increasingly important trend in medical education by addressing the merits of community-based distributive medical education (CBDME). This is a relatively new and compelling model for teaching and training physicians in a manner that may better meet societal needs and expectations. Issues and trends regarding the growing shortage and imbalanced distribution of physicians in the USA are addressed, including the role of international medical graduates. A historical overview of costs and funding sources for medical education is presented, as well as initiatives to increase the training and placement of physicians cost-effectively through new and expanded medical schools, two- and four-year regional or branch campuses and CBDME. Our research confirms that although medical schools have responded to Association of American Medical Colleges calls for higher student enrollment and societal concerns about the distribution and placement of physicians, significant opportunities for improvement remain. Finally, the authors recommend further research be conducted to guide policy on incentives for physicians to locate in underserved communities, and determine the cost-effectiveness of the CBDME model in both the near and long terms. PMID:22355240

Community participatory research with deaf sign language users to identify health inequities.

PubMed

Barnett, Steven; Klein, Jonathan D; Pollard, Robert Q; Samar, Vincent; Schlehofer, Deirdre; Starr, Matthew; Sutter, Erika; Yang, Hongmei; Pearson, Thomas A

2011-12-01

Deaf people who use American Sign Language (ASL) are medically underserved and often excluded from health research and surveillance. We used a community participatory approach to develop and administer an ASL-accessible health survey. We identified deaf community strengths (e.g., a low prevalence of current smokers) and 3 glaring health inequities: obesity, partner violence, and suicide. This collaborative work represents the first time a deaf community has used its own data to identify health priorities.

Community Participatory Research With Deaf Sign Language Users to Identify Health Inequities

PubMed Central

Barnett, Steven; Klein, Jonathan D.; Pollard, Robert Q.; Samar, Vincent; Schlehofer, Deirdre; Starr, Matthew; Sutter, Erika; Yang, Hongmei

2011-01-01

Deaf people who use American Sign Language (ASL) are medically underserved and often excluded from health research and surveillance. We used a community participatory approach to develop and administer an ASL-accessible health survey. We identified deaf community strengths (e.g., a low prevalence of current smokers) and 3 glaring health inequities: obesity, partner violence, and suicide. This collaborative work represents the first time a deaf community has used its own data to identify health priorities. PMID:22021296

Deportation proceedings against Canadian MDs may hold lesson for others heading south

PubMed Central

Korcok, M

1997-01-01

Two Alberta physicians who emigrated to a medically underserviced part of Kentucky have learned a harsh lesson about American immigration law. Drs. David Zetter and Sabina Seitz had been settled in western Kentucky for 2 years when the US government launched deportation proceedings against them. American officials allege that they misrepresented themselves when they entered the US on a temporary visa. They may be allowed to stay following a public outcry against their deportation. PMID:9327804

Supporting underserved patients with their medicines: a study protocol for a patient/professional coproduced education intervention for community pharmacy staff to improve the provision and delivery of Medicine Use Reviews (MURs)

PubMed Central

Latif, Asam; Pollock, Kristian; Anderson, Claire; Waring, Justin; Solomon, Josie; Chen, Li-Chia; Anderson, Emma; Gulzar, Sulma; Abbasi, Nasa; Wharrad, Heather

2016-01-01

Introduction Community pharmacy increasingly features in global strategies to modernise the delivery of primary healthcare. Medicine Use Reviews (MURs) form part of the English Government's medicines management strategy to improve adherence and reduce medicine waste. MURs provide space for patient–pharmacist dialogue to discuss the well-known problems patients experience with medicine taking. However, ‘underserved’ communities (eg, black and minority ethnic communities, people with mental illness), who may benefit the most, may not receive this support. This study aims to develop, implement and evaluate an e-learning education intervention which is coproduced between patients from underserved communities and pharmacy teams to improve MUR provision. Methods and analysis This mixed-methods evaluative study will involve a 2-stage design. Stage 1 involves coproduction of an e-learning resource through mixed patient–professional development (n=2) and review (n=2) workshops, alongside informative semistructured interviews with patients (n=10) and pharmacy staff (n=10). Stage 2 involves the implementation and evaluation of the intervention with community pharmacy staff within all community pharmacies within the Nottinghamshire geographical area (n=237). Online questionnaires will be completed at baseline and postintervention (3 months) to assess changes in engagement with underserved communities and changes in self-reported attitudes and behaviour. To triangulate findings, 10 pharmacies will record at baseline and postintervention, details of actual numbers of MURs performed and the proportion that are from underserved communities. Descriptive and inferential statistics will be used to analyse the data. The evaluation will also include a thematic analysis of one-to-one interviews with pharmacy teams to explore the impact on clinical practice (n=20). Interviews with patients belonging to underserved communities, and who received an MUR, will also be conducted (n=20). Ethics and dissemination The study has received ethical approval from the NHS Research Ethics Committee (East Midlands–Derby) and governance clearance through the NHS Health Research Authority. Following the evaluation, the educational intervention will be freely accessible online. PMID:27940633

Facilitators of Survivorship Care Among Underserved Breast Cancer Survivors: a Qualitative Study.

PubMed

Ustjanauskas, Amy E; Quinn, Gwendolyn P; Pan, Tonya M; Rivera, Maria; Vázquez-Otero, Coralia; Ung, Danielle; Roetzheim, Richard G; Laronga, Christine; Johnson, Kenneth; Norton, Marilyn; Carrizosa, Claudia; Muñoz, Dariana; Goldenstein, Marissa; Nuhaily, Sumayah; Wells, Kristen J

2017-12-01

Research investigating facilitators of survivorship care among underserved breast cancer survivors (BCS) is sparse. This study aimed to explore facilitators of survivorship care among underserved BCS within the first 5 years following chemotherapy, radiation, or surgery for breast cancer. In-depth interviews were conducted, using a semi-structured interview guide, with underserved BCS exploring survivorship care experiences. Content analysis of the verbatim transcripts was applied, and results were summarized according to themes related to facilitators of breast cancer survivorship care. Interviews were conducted with 25 BCS. Eight main themes were identified: coordination of care; positive perceptions of health care providers; communication between patient and health care providers; financial and insurance facilitators; information, classes, and programs provided; assistance provided by organizations and health care professionals; transportation facilitators; and job flexibility. This study provides a comprehensive look at facilitators of survivorship care among underserved BCS. BCS endorsed several facilitators of their survivorship care, mainly at the interpersonal, organizational, and societal level. This study adds to the research literature on catalysts of care among underserved BCS. Results from this study are currently being used to inform a patient navigation intervention to facilitate care among this population.

Training future health providers to care for the underserved: a pilot interprofessional experience.

PubMed

Hasnain, Memoona; Koronkowski, Michael J; Kondratowicz, Diane M; Goliak, Kristen L

2012-01-01

Interprofessional teamwork is essential for effective delivery of health care to all patients, particularly the vulnerable and underserved. This brief communication describes a pilot interprofessional learning experience designed to introduce medicine and pharmacy students to critical health issues affecting at-risk, vulnerable patients and helping students learn the value of functioning effectively in interprofessional teams. With reflective practice as an overarching principle, readings, writing assignments, a community-based immersion experience, discussion seminars, and presentations were organized to cultivate students' insights into key issues impacting the health and well-being of vulnerable patients. A written program evaluation form was used to gather students' feedback about this learning experience. Participating students evaluated this learning experience positively. Both quantitative and qualitative input indicated the usefulness of this learning experience in stimulating learners' thinking and helping them learn to work collaboratively with peers from another discipline to understand and address health issues for at-risk, vulnerable patients within their community. This pilot educational activity helped medicine and pharmacy students learn the value of functioning effectively in interprofessional teams. Given the importance of interprofessional teamwork and the increasing need to respond to the health needs of underserved populations, integrating interprofessional learning experiences in health professions training is highly relevant, feasible, and critically needed.

Randomized Trial of a Family-based, Automated, Conversational Obesity Treatment Program for Underserved Populations

PubMed Central

Wright, J. A.; Phillips, B.D.; Watson, B.L.; Newby, P.K.; Norman, G. J.; Adams, W.G.

2013-01-01

Objective To evaluate the acceptability and feasibility of a scalable obesity treatment program integrated with pediatric primary care and delivered using interactive voice technology (IVR) to families from underserved populations. Design and Methods Fifty parent-child dyads (child 9–12 yrs, BMI >95th percentile) were recruited from a pediatric primary care clinic and randomized to either an IVR or a wait-list control (WLC) group. The majority were lower-income, African-American (72%) families. Dyads received IVR calls for 12 weeks. Call content was informed by two evidenced-based interventions. Anthropometric and behavioral variables were assessed at baseline and 3 mo follow-up. Results Forty-three dyads completed the study. IVR parents ate 1 cup more fruit than WLC (p < .05). No other groups differences were found. Children classified as high users of the IVR decreased weight, BMI and BMI z-score compared to low users (p<.05). Mean number of calls for parents and children were 9.1 (5.2 SD) and 9.0 (5.7 SD), respectively. Of those who made calls, >75% agreed that the calls were useful, made for people like them, credible, and helped them eat healthy foods. Conclusion An obesity treatment program delivered via IVR may be an acceptable and feasible resource for families from underserved populations. PMID:23512915

Determining the efficacy of national strategies aimed at addressing the challenges facing health personnel working in rural areas in KwaZulu-Natal, South Africa

PubMed Central

2017-01-01

Background Shortages of Human Resources for Health (HRH) in rural areas are often driven by poor working and living conditions, inadequate salaries and benefits, lack of training and career development opportunities amongst others. The South African government has adopted a human resource strategy for the health sector in 2011 aimed at addressing these challenges. Aim This study reviews the challenges faced by health personnel against government strategies aimed at attracting and retaining health personnel in these underserved areas. Setting The study was conducted in six primary health care service sites in the Hlabisa sub-district of Umkhanyakude, located in northern KwaZulu-Natal, South Africa. Methods The study population comprised 25 health workers including 11 professional nurses, 4 staff nurses and 10 doctors (4 medical doctors, 3 foreign medical doctors and 3 doctors undertaking community service). Qualitative data were collected from semi-structured interviews and analysed using thematic analysis. Results Government initiatives including the rural allowance, deployment of foreign medical doctors and the presence of health personnel undertaking their community service in rural areas are positively viewed by health personnel working in rural health facilities. However, poor living and working conditions, together with inadequate personal development opportunities, remain unresolved challenges. It is these challenges that will continue to dissuade experienced health personnel from remaining in these underserved areas. Conclusion South Africa’s HRH strategy for the Health Sector 2012/13–2015/16 had highlighted the key challenges raised by respondents and identified strategies aimed at addressing these challenges. Implementation of these strategies is key to improving both living and working conditions, and providing health personnel with opportunities for further development will require inter-ministerial collaboration if the HRH 2030 objectives are to be realised. PMID:28828878

Title VII funding and physician practice in rural or low-income areas.

PubMed

Krist, Alex H; Johnson, Robert E; Callahan, David; Woolf, Steven H; Marsland, David

2005-01-01

Whether Title VII funding enhances physician supply in underserved areas has not clearly been established. To determine the relation between Title VII funding in medical school, residency, or both, and the number of family physicians practicing in rural or low-income communities. A retrospective cross sectional analysis was carried out using the 2000 American Academy of Family Physicians physician database, Title VII funding records, and 1990 U.S. Census data. Included were 9,107 family physicians practicing in 9 nationally representative states in the year 2000. Physicians exposed to Title VII funding through medical school and residency were more likely to have their current practice in low-income communities (11.9% vs 9.9%, P< or =.02) and rural areas (24.5% vs 21.8%, P< or =.02). Physicians were more likely to practice in rural communities if they attended medical schools (24.2% vs 21.4%; P =.009) and residencies (24.0% vs 20.3%; P =.011) after the school or program had at least 5 years of Title VII funding vs before. Similar increases were not observed for practice in low-income communities. In a multivariate analysis, exposure to funding and attending an institution with more years of funding independently increased the odds of practicing in rural or low-income communities. Title VII funding is associated with an increase in the family physician workforce in rural and low-income communities. This effect is temporally related to initiation of funding and independently associated with effect in a multivariate analysis, suggesting a potential causal relationship. Whereas the absolute 2% increase in family physicians in these underserved communities may seem modest, it can represent a substantial increase in access to health care for community members.

Patient navigation for lung cancer screening in an urban safety-net system: Protocol for a pragmatic randomized clinical trial.

PubMed

Gerber, David E; Hamann, Heidi A; Santini, Noel O; Abbara, Suhny; Chiu, Hsienchang; McGuire, Molly; Quirk, Lisa; Zhu, Hong; Lee, Simon J Craddock

2017-09-01

The National Lung Screening Trial demonstrated improved lung cancer mortality with annual low-dose computed tomography (CT) screening, leading to lung cancer screening endorsement by the United States Preventive Services Task Force and coverage by the Centers for Medicare and Medicaid. Adherence to annual CT screens in that trial was 95%, which may not be representative of real-world, particularly medically underserved populations. This pragmatic trial will determine the effect of patient-focused, telephone-based patient navigation on adherence to CT-based lung cancer screening in an urban safety-net population. 340 adults who meet standard eligibility for lung cancer screening (age 55-77years, smoking history≥30 pack-years, quit within 15years if former smoker) are referred through an electronic medical record-based order by physicians in community- and hospital-based primary care settings within the Parkland Health and Hospital System in Dallas County, Texas. Eligible patients are randomized to usual care or patient navigation, which addresses adherence, patient-reported barriers, smoking cessation, and psycho-social concerns related to screening completion. Patients complete surveys and semi-structured interviews at baseline, 6-month, and 18-month follow-ups to assess attitudes toward screening. The primary endpoint of this pragmatic trial is adherence to three sequential, prospectively defined steps in the screening protocol. Secondary endpoints include self-reported tobacco use and other patient-reported outcomes. Results will provide real-world insight into the impact of patient navigation on adherence to CT-based lung cancer screening in a medically underserved population. This study was registered with the NIH ClinicalTrials.gov database (NCT02758054) on April 26, 2016. Copyright © 2017 Elsevier Inc. All rights reserved.

Determining the efficacy of national strategies aimed at addressing the challenges facing health personnel working in rural areas in KwaZulu-Natal, South Africa.

PubMed

Mburu, Grace; George, Gavin

2017-07-31

Shortages of Human Resources for Health (HRH) in rural areas are often driven by poor working and living conditions, inadequate salaries and benefits, lack of training and career development opportunities amongst others. The South African government has adopted a human resource strategy for the health sector in 2011 aimed at addressing these challenges. This study reviews the challenges faced by health personnel against government strategies aimed at attracting and retaining health personnel in these underserved areas. The study was conducted in six primary health care service sites in the Hlabisa sub-district of Umkhanyakude, located in northern KwaZulu-Natal, South Africa. The study population comprised 25 health workers including 11 professional nurses, 4 staff nurses and 10 doctors (4 medical doctors, 3 foreign medical doctors and 3 doctors undertaking community service). Qualitative data were collected from semi-structured interviews and analysed using thematic analysis. Government initiatives including the rural allowance, deployment of foreign medical doctors and the presence of health personnel undertaking their community service in rural areas are positively viewed by health personnel working in rural health facilities. However, poor living and working conditions, together with inadequate personal development opportunities, remain unresolved challenges. It is these challenges that will continue to dissuade experienced health personnel from remaining in these underserved areas. South Africa's HRH strategy for the Health Sector 2012/13-2015/16 had highlighted the key challenges raised by respondents and identified strategies aimed at addressing these challenges. Implementation of these strategies is key to improving both living and working conditions, and providing health personnel with opportunities for further development will require inter-ministerial collaboration if the HRH 2030 objectives are to be realised.

Understanding and Predicting Social Media Use Among Community Health Center Patients: A Cross-Sectional Survey

PubMed Central

2014-01-01

Background The use of social media by health care organizations is growing and provides Web-based tools to connect patients, caregivers, and providers. Objective The aim was to determine the use and factors predicting the use of social media for health care–related purposes among medically underserved primary care patients. Methods A cross-sectional survey was administered to 444 patients of a federally qualified community health center. Results Community health center patients preferred that their providers use email, cell phones for texting, and Facebook and cell phone apps for sharing health information. Significantly more Hispanic than white patients believed their providers should use Facebook (P=.001), YouTube (P=.01), and Twitter (P=.04) for sharing health information. Use and intentions to use social media for health-related purposes were significantly higher for those patients with higher subjective norm scores. Conclusions Understanding use and factors predicting use can increase adoption and utilization of social media for health care–related purposes among underserved patients in community health centers. PMID:25427823

"You Need to Be a Good Listener": Recruiters' Use of Relational Communication Behaviors to Enhance Clinical Trial and Research Study Accrual.

PubMed

Morgan, Susan E; Occa, Aurora; Potter, JoNell; Mouton, Ashton; Peter, Megan E

2017-02-01

Medical and research professionals who discuss clinical trials and research studies with potential participants face an often daunting challenge, particularly when recruiting from minority and underserved populations. This study reports on findings from a focus group study of 63 research coordinators, study nurses, professional recruiters, and other professionals in Indianapolis, IN and Miami, FL who work to recruit from minority and underserved populations. These professionals discussed the importance of creating a sense of connection with potential participants as part of the recruitment and retention process. Building a relationship, however fleeting, involved a number of concrete behaviors, including listening to personal information, expressing empathy, and then providing reciprocal self-disclosures; having repeated contact, usually by working in the same environment over an extended period of time; demonstrating respect through politeness and the use of honorifics; going the extra mile for participants; offering flexibility in scheduling follow-up appointments; and creating a sense of personal and community trust by being truthful. The implications of these findings for clinical trial and research study accrual are discussed.

Underserved Pregnant and Postpartum Women's Access and Use of Their Health Records.

PubMed

Guo, Yuqing; Hildebrand, Janet; Rousseau, Julie; Brown, Brandon; Pimentel, Pamela; Olshansky, Ellen

The purpose of this study was to examine knowledge of and experiences with use of their electronic health record (EHR) among mostly Hispanic women during pregnancy and postpartum. Women who were in the MOMS Orange County prenatal or postpartum home visitation program completed surveys and participated in focus groups. Descriptive and content analyses were used. Twenty-six women participated. Nearly all women (24, 92.3%) knew what health records were and most (80.8%) felt that keeping their records would increase or greatly increase their confidence in caring for themselves and their families. Approximately one third reported already keeping a copy of their health records. Common barriers to accessing and understanding health records included healthcare providers' noncompliance with the Health Information Technology for Economic and Clinical Health Act, limited EHR adoption, unfriendly patient portals, complicated medical terminology, rushed appointments with healthcare providers, lack of Spanish interpreters, and lack of Spanish-speaking healthcare providers. Programs are needed to educate and support women and providers in using health records to promote health literacy, pregnancy management, and patient-provider relationships in underserved populations.

Barriers to Gender Transition-Related Healthcare: Identifying Underserved Transgender Adults in Massachusetts

PubMed Central

White Hughto, Jaclyn M.; Rose, Adam J.; Pachankis, John E.; Reisner, Sari L.

2017-01-01

Abstract Purpose: The present study sought to examine whether individual (e.g., age, gender), interpersonal (e.g., healthcare provider discrimination), and structural (e.g., lack of insurance coverage) factors are associated with access to transition-related care in a statewide sample of transgender adults. Method: In 2013, 364 transgender residents of Massachusetts completed an electronic web-based survey online (87.1%) or in person (12.9%). A multivariable logistic regression model tested whether individual, interpersonal, and structural factors were associated with access to transition-related care. Results: Overall, 23.6% reported being unable to access transition-related care in the past 12 months. In a multivariable model, younger age, low income, low educational attainment, private insurance coverage, and healthcare discrimination were significantly associated with being unable to access transition-related care (all p<0.05). Discussion: Despite state nondiscrimination policies and universal access to healthcare, many of the Massachusetts transgender residents sampled were unable to access transition-related care. Multilevel interventions are needed, including supportive policies and policy enforcement, to ensure that underserved transgender adults can access medically necessary transition-related care. PMID:29082331

Lessons Learned Recruiting Minority Participants for Research in Urban Community Health Centers.

PubMed

Fam, Elizabeth; Ferrante, Jeanne M

2018-02-01

To help understand and mitigate health disparities, it is important to conduct research with underserved and underrepresented minority populations under real world settings. There is a gap in the literature detailing real-time research staff experience, particularly in their own words, while conducting in-person patient recruitment in urban community health centers. This paper describes challenges faced at the clinic, staff, and patient levels, our lessons learned, and strategies implemented by research staff while recruiting predominantly low-income African-American women for an interviewer-administered survey study in four urban Federally Qualified Health Centers in New Jersey. Using a series of immersion-crystallization cycles, fieldnotes and research reflections written by recruiters, along with notes from team meetings during the study, were qualitatively analyzed. Clinic level barriers included: physical layout of clinic, very low or high patient census, limited private space, and long wait times for patients. Staff level barriers included: unengaged staff, overburdened staff, and provider and staff turnover. Patient level barriers included: disinterested patients, patient mistrust and concerns over confidentiality, no-shows or lack of patient time, and language barrier. We describe strategies used to overcome these barriers and provide recommendations for in-person recruitment of underserved populations into research studies. To help mitigate health disparities, disseminating recruiters' experiences, challenges, and effective strategies used will allow other researchers to build upon these experience in order to increase recruitment success of underserved and underrepresented minority populations into research studies. Copyright © 2018 National Medical Association. Published by Elsevier Inc. All rights reserved.

Mobile health care operations and return on investment in predominantly underserved children with asthma: the breathmobile program.

PubMed

Morphew, Tricia; Scott, Lyne; Li, Marilyn; Galant, Stanley P; Wong, Webster; Garcia Lloret, Maria I; Jones, Felita; Bollinger, Mary Elizabeth; Jones, Craig A

2013-08-01

Underserved populations have limited access to care. Improved access to effective asthma care potentially improves quality of life and reduces costs associated with emergency department (ED) visits. The purpose of this study is to examine return on investment (ROI) for the Breathmobile Program in terms of improved patient quality-adjusted life years saved and reduced costs attributed to preventable ED visits for 2010, with extrapolation to previous years of operation. It also examines cost-benefit related to reduced morbidity (ED visits, hospitalizations, and school absenteeism) for new patients to the Breathmobile Program during 2008-2009 who engaged in care (≥3 visits). This is a retrospective analysis of data for 15,986 pediatric patients, covering 88,865 visits, participating in 4 Southern California Breathmobile Programs (November 16, 1995-December 31, 2010). The ROI calculation expressed the cost-benefit ratio as the net benefits (ED costs avoided+relative value of quality-adjusted life years saved) over the per annum program costs (∼$500,000 per mobile). The ROI across the 4 California programs in 2010 was $6.73 per dollar invested. Annual estimated emergency costs avoided in the 4 regions were $2,541,639. The relative value of quality-adjusted life years saved was $24,381,000. For patients new to the Breathmobile Program during 2008-2009 who engaged in care (≥3 visits), total annual morbidity costs avoided per patient were $1395. This study suggests that mobile health care is a cost-effective strategy to deliver medical care to underserved populations, consistent with the Triple Aims of Therapy.

The Urban Food Hubs Solution: Building Capacity in Urban Communities

ERIC Educational Resources Information Center

O'Hara, Sabine

2017-01-01

Access to affordable fresh food is an ongoing challenge for underserved urban neighborhoods across the United States. Several are designated food deserts with no access to a full-service grocery store within a one-mile radius. The Urban Food Hubs of the College of Agriculture, Urban Sustainability, and Environmental Sciences (CAUSES) of the…

Treatment Fidelity among Family Health Promoters Delivering a Physical Activity and Nutrition Intervention to Immigrant and Refugee Families

ERIC Educational Resources Information Center

Bronars, Carrie A.; Hanza, Marcelo M.; Meiers, Sonja J.; Patten, Christi A.; Clark, Matthew M.; Nigon, Julie A.; Weis, Jennifer A.; Wieland, Mark L.; Sia, Irene G.

2017-01-01

Lack of treatment fidelity can be an important source of variation affecting the credibility and utility of outcomes from behavioral intervention research. Development and implementation of a well-designed treatment fidelity plan, especially with research involving underserved populations, requires careful conceptualization of study needs in…

Working with Social Service Agencies: Providing Access for the Underserved

ERIC Educational Resources Information Center

Dotolo, Lawrence G.

2007-01-01

The Virginia Tidewater Consortium's effort to reach out to the community began twenty-seven years ago when it received an Educational Opportunity Center (EOC) grant from the U.S. Department of Education. The EOC was specifically designed to work with adults from low socioeconomic backgrounds, most of them minorities. In southeastern Virginia,…

Behavior Therapy for Tics via Videoconference Delivery: An Initial Pilot Test in Children

ERIC Educational Resources Information Center

Himle, Michael B.; Olufs, Erin; Himle, Joseph; Tucker, Benjamin T. P.; Woods, Douglas W.

2010-01-01

Habit reversal training (HRT) has been proven effective for reducing tics in children with Tourette's syndrome (TS). However, the availability of the intervention is limited. Videoconference technology represents a promising mode through which HRT may be disseminated to underserved areas. Using a multiple-baseline across participants design, the…

Emotion Regulation Difficulties, Youth-Adult Relationships, and Suicide Attempts among High School Students in Underserved Communities

ERIC Educational Resources Information Center

Pisani, Anthony R.; Wyman, Peter A.; Petrova, Mariya; Schmeelk-Cone, Karen; Goldston, David B.; Xia, Yinglin; Gould, Madelyn S.

2013-01-01

To develop and refine interventions to prevent youth suicide, knowledge is needed about specific processes that reduce risk at a population level. Using a cross-sectional design, the present study tested hypotheses regarding associations between self-reported suicide attempts, emotion regulation difficulties, and positive youth-adult relationships…

Meeting the Needs of Underserved Patients in Western Kenya by Creating the Next Generation of Global Health Pharmacists.

PubMed

Miller, Monica L; Karwa, Rakhi; Schellhase, Ellen M; Pastakia, Sonak D; Crowe, Susie; Manji, Imran; Jakait, Beatrice; Maina, Mercy

2016-03-25

Objective. To describe a novel training model used to create a sustainable public health-focused pharmacy residency based in Kenya and to describe the outcomes of this training program on underserved populations. Design. The postgraduate year 2 residency was designed to expose trainees to the unique public health facets of inpatient, outpatient, and community-based care delivery in low and middle-income countries. Public health areas of focus included supply chain management, reproductive health, pediatrics, HIV, chronic disease management, and teaching. Assessment. The outcomes of the residency were assessed based on the number of new clinical programs developed by residents, articles and abstracts written by residents, and resident participation in grant writing. To date, six residents from the United States and eight Kenyan residents have completed the residency. Eleven sustainable patient care services have been implemented as a result of the residency program. Conclusion. This pharmacy residency training model developed accomplished pharmacists in public health pharmacy, with each residency class expanding funding and clinical programming, contributing to curriculum development, and creating jobs.

A systematic review of strategies to recruit and retain primary care doctors.

PubMed

Verma, Puja; Ford, John A; Stuart, Arabella; Howe, Amanda; Everington, Sam; Steel, Nicholas

2016-04-12

There is a workforce crisis in primary care. Previous research has looked at the reasons underlying recruitment and retention problems, but little research has looked at what works to improve recruitment and retention. The aim of this systematic review is to evaluate interventions and strategies used to recruit and retain primary care doctors internationally. A systematic review was undertaken. MEDLINE, EMBASE, CENTRAL and grey literature were searched from inception to January 2015. Articles assessing interventions aimed at recruiting or retaining doctors in high income countries, applicable to primary care doctors were included. No restrictions on language or year of publication. The first author screened all titles and abstracts and a second author screened 20%. Data extraction was carried out by one author and checked by a second. Meta-analysis was not possible due to heterogeneity. Fifty-one studies assessing 42 interventions were retrieved. Interventions were categorised into thirteen groups: financial incentives (n = 11), recruiting rural students (n = 6), international recruitment (n = 4), rural or primary care focused undergraduate placements (n = 3), rural or underserved postgraduate training (n = 3), well-being or peer support initiatives (n = 3), marketing (n = 2), mixed interventions (n = 5), support for professional development or research (n = 5), retainer schemes (n = 4), re-entry schemes (n = 1), specialised recruiters or case managers (n = 2) and delayed partnerships (n = 2). Studies were of low methodological quality with no RCTs and only 15 studies with a comparison group. Weak evidence supported the use of postgraduate placements in underserved areas, undergraduate rural placements and recruiting students to medical school from rural areas. There was mixed evidence about financial incentives. A marketing campaign was associated with lower recruitment. This is the first systematic review of interventions to improve recruitment and retention of primary care doctors. Although the evidence base for recruiting and care doctors is weak and more high quality research is needed, this review found evidence to support undergraduate and postgraduate placements in underserved areas, and selective recruitment of medical students. Other initiatives covered may have potential to improve recruitment and retention of primary care practitioners, but their effectiveness has not been established.

Poor representation of Blacks, Latinos, and Native Americans in medicine.

PubMed

Rodriguez, José E; Campbell, Kendall M; Adelson, Wendi J

2015-04-01

In this article, the authors discuss how various systems in medicine are limiting representation of blacks, Latinos, and Native Americans. Flat and decreasing percentages of Underrepresented Minorities in Medicine (URMM), especially in the black and Native American populations, is concerning for family medicine since members from URMM groups care for minority and underserved populations in greater numbers. Underrepresentation is not only noted in the medical community but also in our medical schools when it comes to numbers of URMM faculty. The changing definition of "disadvantaged" in medical school admissions has also played a part in limiting URMM representation. In addition, the Medical College Admissions Test (MCAT) excludes black, Latino, and Native American students in greater numbers. The authors support these arguments with evidence from the medical literature. Although unintentional, these systems effectively limit representation of blacks, Latinos, and Native Americans in medicine. Effective changes are suggested and can be implemented to ensure that URMM individuals have equal representation in careers in medicine.

Psychological and medical care of gender nonconforming youth.

PubMed

Vance, Stanley R; Ehrensaft, Diane; Rosenthal, Stephen M

2014-12-01

Gender nonconforming (GN) children and adolescents, collectively referred to as GN youth, may seek care to understand their internal gender identities, socially transition to their affirmed genders, and/or physically transition to their affirmed genders. Because general pediatricians are often the first point of contact with the health care system for GN youth, familiarity with the psychological and medical approaches to providing care for this population is crucial. The objective of this review is to provide an overview of existing clinical practice guidelines for GN youth. Such guidelines emphasize a multidisciplinary approach with collaboration of medical, mental health, and social services/advocacy providers. Appropriate training needs to be provided to promote comprehensive, culturally competent care to GN youth, a population that has traditionally been underserved and at risk for negative psychosocial outcomes. Copyright © 2014 by the American Academy of Pediatrics.

Medical advocacy on behalf of detained immigrants.

PubMed

Venters, Homer D; Foote, Mary; Keller, Allen S

2011-06-01

Detention of immigrants by Immigration and Customs Enforcement (ICE) is a rapidly growing form of incarceration in the U.S. with almost 400,000 people detained in 2008 (Schriro in Immigration and Customs Enforcement, 2009, http://www.ice.gov/doclib/091005_ice_detention_report-final.pdf ). ICE detainees are predominantly from Mexico and Latin America and only a small minority of detainees are asylum seekers. Immigrant detainees lack a legal guarantee of medical care (unlike criminal arrestees and prisoners) and face challenges in receiving medical care, particularly those with chronic medical conditions (Venters and Keller in J Health Care Poor Underserved 20:951-957, 2009). Although we and others have long been involved in advocating for detained asylum seekers, few resources are dedicated to medical advocacy for the broader population of ICE detainees. At the NYU Center for Health and Human Rights (CHHR), a program of medical advocacy was initiated in 2007 on behalf of ICE detainees focused on improvement of care in detention and medical parole. Our preliminary efforts reveal a pressing need for more involvement by physicians and other health advocates in this area.

Integration of pharmacists into patient-centered medical homes in federally qualified health centers in Texas.

PubMed

Wong, Shui Ling; Barner, Jamie C; Sucic, Kristina; Nguyen, Michelle; Rascati, Karen L

To describe the integration and implementation of pharmacy services in patient-centered medical homes (PCMHs) as adopted by federally qualified health centers (FQHCs) and compare them with usual care (UC). Four FQHCs (3 PCMHs, 1 UC) in Austin, TX, that provide care to the underserved populations. Pharmacists have worked under a collaborative practice agreement with internal medicine physicians since 2005. All 4 FQHCs have pharmacists as an integral part of the health care team. Pharmacists have prescriptive authority to initiate and adjust diabetes medications. The PCMH FQHCs instituted co-visits, where patients see both the physician and the pharmacist on the same day. PCMH pharmacists are routinely proactive in collaborating with physicians regarding medication management, compared with UC in which pharmacists see patients only when referred by a physician. Four face-to-face, one-on-one semistructured interviews were conducted with pharmacists working in 3 PCMH FQHCs and 1 UC FQHC to compare the implementation of PCMH with emphasis on 1) structure and workflow, 2) pharmacists' roles, and 3) benefits and challenges. On co-visit days, the pharmacist may see the patient before or after physician consultation. Pharmacists in 2 of the PCMH facilities proactively screen to identify diabetes patients who may benefit from pharmacist services, although the UC clinic pharmacists see only referred patients. Strengths of the co-visit model include more collaboration with physicians and more patient convenience. Payment that recognizes the value of PCMH is one PCMH principle that is not fully implemented. PCMH pharmacists in FQHCs were integrated into the workflow to address specific patient needs. Specifically, full-time in-house pharmacists, flexible referral criteria, proactive screening, well defined collaborative practice agreement, and open scheduling were successful strategies for the underserved populations in this study. However, reimbursement plans and provider status for pharmacists should be established to sustain this model of care. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

The Reality of Evaluating Community-Based Sport and Physical Activity Programs to Enhance the Development of Underserved Youth: Challenges and Potential Strategies

ERIC Educational Resources Information Center

Whitley, Meredith A.; Forneris, Tanya; Barker, Bryce

2014-01-01

In recent years, underserved communities have received much attention within the field of positive youth development (PYD). While there are an increasing number of opportunities for underserved youth to join PYD-based programs, there is growing concern surrounding the lack of critical evaluation of these programs (Kidd, 2008). Unfortunately, there…

Are public health physicians still needed in medically underserved rural areas in Korea?

PubMed Central

Na, Baeg Ju; Lee, Jin Yong; Kim, Hyun Joo

2017-01-01

Abstract Public health physicians (PHPs) are certified physicians who are serving in a public health center or subcenter in a rural village, instead of serving in the military. However, the PHP program has recently become the subject of a profound debate, over 30 years after its adoption. In this study, we attempted to ascertain physicians’ perspectives on the PHP program, including: whether the PHP policy should continue; if they agree on changing the role of PHPs in healthcare; what would be the desired role of PHPs; and what resources would be required and what possible barriers would be anticipated under the changes. We selected 88 PHPs as our study sample using quota sampling. Over 60% of respondents were in support of continuing the PHP program. They believed some remote islands and mountainous areas are still in need of public healthcare doctors. However, some of them believed that the role of PHPs should be changed to take on community health promotion, because the problem of medically underserved rural areas has almost been resolved. However, people living in rural areas are ageing and suffering from a lack of education and health information. In particular, in order to successfully transition into new roles, PHPs must be provided with continuing education and professional development programs covering their new responsibilities. It is imperative to refurbish the PHP program to meet current needs and continue its central role in public healthcare. PMID:28489812

Relationships Between Health Literacy and Genomics-Related Knowledge, Self-Efficacy, Perceived Importance, and Communication in a Medically Underserved Population

PubMed Central

Kaphingst, Kimberly A.; Blanchard, Melvin; Milam, Laurel; Pokharel, Manusheela; Elrick, Ashley; Goodman, Melody S.

2017-01-01

The increasing importance of genomic information in clinical care heightens our need to examine how individuals understand, value, and communicate about this information. Based on a conceptual framework of genomics-related health literacy, we examined whether health literacy was related to knowledge, self-efficacy, and perceived importance of genetics and FHH and communication about FHH in a medically underserved population. The analytic sample was comprised of 624 patients at a primary care clinic at a large urban hospital. About half of participants (47%) had limited health literacy; 55% had no education beyond high school and 58% were Black. In multivariable models, limited health literacy was associated with lower genetic knowledge (β=−0.55; SE=0.10, p<.0001), lower awareness of FHH (OR=0.50; 95% CI=0.28,0.90, p=.020), greater perceived importance of genetic information (OR=1.95; 95% CI=1.27,3.00, p=.0022) but lower perceived importance of FHH information (OR=0.47; 95% CI=0.26,0.86, p=.013), and more frequent communication with a doctor about FHH (OR=2.02; 95% CI=1.27,3.23, p=.0032). The findings highlight the importance of considering domains of genomics-related health literacy (e.g., knowledge, oral literacy) in developing educational strategies for genomic information. Health literacy research is essential to avoid increasing disparities in information and health outcomes as genomic information reaches more patients. PMID:27043759

Impact of a Plant-Based Diet and Support on Mitigating Type 2 Diabetes Mellitus in Latinos Living in Medically Underserved Areas.

PubMed

Ramal, Edelweiss; Champlin, Andrea; Bahjri, Khaled

2018-03-01

To determine the impact that a high-fiber, low-fat diet, derived from mostly plant-based sources, when coupled with support has upon self-management of type 2 diabetes mellitus in Latinos from medically underserved areas (MUAs). Experimental randomized controlled community pilot study. Three community clinics in MUAs located within San Bernardino County, California. Thirty-two randomly assigned Latinos with A1 C greater than 6.4: 15 control and 17 experimental. Participants completed a 5-week education program. Researchers provided follow-up support for 17 randomly assigned experimental group participants through focus groups held at participating clinics-1, 3, and 6 months posteducation. Changes in fat and fiber consumption were measured using a modified Dietary Screener for Mexican Americans. Self-management was measured through the Self-Efficacy for Exercise Scale and Diabetes Quality of Life Measure. Baseline characteristics for both groups were analyzed using independent t tests and χ 2 tests. A 2-way repeated-measures analysis of variance was used to analyze biometric data between baseline and 6 months for both groups. Mean A1 C levels decreased from baseline to 6 months for both groups: control, μ 1 = 9.57, μ 2 = 9.49; experimental, μ 1 = 8.53, μ 2 = 7.31. The experimental group demonstrated a statistically significant reduction in mean A1 C levels ( P = .002) when compared to the control group.

Assessment of Annual Diabetic Eye Examination Using Telemedicine Technology Among Underserved Patients in Primary Care Setting.

PubMed

Hatef, Elham; Alexander, Miriam; Vanderver, Bruce G; Fagan, Peter; Albert, Michael

2017-01-01

Digital retinal imaging with the application of telemedicine technology shows promising results for screening of diabetic retinopathy in the primary care setting without requiring an ophthalmologist on site. We assessed whether the establishment of telemedicine technology was an effective and efficient way to increase completion of annual eye examinations among underserved, low-income (Medicaid) diabetic patients. A cross-sectional study in a primary care setting. Health care claims data were collected before the establishment of telemedicine technology in 2010 and after its implementation in 2012 for Medicaid patients at East Baltimore Medical Center (EBMC), an urban health center that is part of Johns Hopkins Health System. The primary outcome measure was the compliance rate of patients with diabetic eye examinations; calculated as the number of diabetic patients with a completed telemedicine eye examination, divided by the total number of diabetic patients. In 2010, EBMC treated 213 Medicaid diabetic patients and in 2012 treated 228 Medicaid patients. In 2010, 47.89% of patients completed their annual diabetic eye examination while in 2012 it was 78.07% ( P < 0.001). After adjustment for age, gender, HgBA1C, disease severity, using resource utilization band score as a proxy, and medication possession ratio; telemedicine technology significantly increased the compliance (odds ratio: 4.98, P < 0.001). Adherence to annual eye examinations is low in the studied Medicaid diabetic population. Telemedicine technology in a primary care setting can increase compliance with annual eye examinations.

Privacy and Confidentiality Practices In Adolescent Family Planning Care At Federally Qualified Health Centers.

PubMed

Beeson, Tishra; Mead, Katherine H; Wood, Susan; Goldberg, Debora Goetz; Shin, Peter; Rosenbaum, Sara

2016-03-01

The confidentiality of family planning services remains a high priority to adolescents, but barriers to implementing confidentiality and privacy practices exist in settings designed for teenagers who are medically underserved, including federally qualified health centers (FQHCs). A sample of 423 FQHCs surveyed in 2011 provided information on their use of five selected privacy and confidentiality practices, which were examined separately and combined into an index. Regression modeling was used to assess whether various state policies and organizational characteristics were associated with FQHCs' scores on the index. In-depth case studies of six FQHCs were conducted to provide additional contextual information. Among FQHCs reporting on confidentiality, most reported providing written or verbal information regarding adolescents' rights to confidential care (81%) and limiting access to family planning and medical records to protect adolescents' confidentiality (84%). Far fewer reported maintaining separate medical records for family planning (10%), using a security block on electronic medical records to prevent disclosures (43%) or using separate contact information for communications regarding family planning services (50%). Index scores were higher among FQHCs that received Title X funding than among those that did not (coefficient, 0.70) and among FQHCs with the largest patient volumes than among those with the smallest caseloads (0.43). Case studies highlighted how a lack of guidelines and providers' confusion over relevant laws present a challenge in offering confidential care to adolescents. The organizational practices used to ensure adolescent family planning confidentiality in FQHCs are varied across organizations. Copyright © 2016 by the Guttmacher Institute.

A review and update on orphan drugs for the treatment of noninfectious uveitis

PubMed Central

You, Caiyun; Sahawneh, Haitham F; Ma, Lina; Kubaisi, Buraa; Schmidt, Alexander; Foster, C Stephen

2017-01-01

Introduction Uveitis, a leading cause of preventable blindness around the world, is a critically underserved disease in regard to the medications approved for use. Multiple immunomodulatory therapy (IMT) drugs are appropriate for uveitis therapy but are still off-label. These IMT agents, including antimetabolites, calcineurin inhibitors, alkylating agents, and biologic agents, have been designated as “orphan drugs” and are widely used for systemic autoimmune diseases or organ transplantation. Area covered The purpose of this paper is to comprehensively review and summarize the approved orphan drugs and biologics that are being used to treat systemic diseases and to discuss drugs that have not yet received approval as an “orphan drug for treating uveitis” by the US Food and Drug Administration (FDA). Our perspective IMT, as a steroid-sparing agent for uveitis patients, has shown promising clinical results. Refractory and recurrent uveitis requires combination IMT agents. IMT is continued for a period of 2 years while the patient is in remission before considering tapering medication. Our current goals include developing further assessments regarding the efficacy, optimal dose, and safety in efforts to achieve FDA approval for “on-label” use of current IMT agents and biologics more quickly and to facilitate insurance coverage and expand access to the products for this orphan disease. PMID:28203051

Effects of a culturally tailored physical activity promotion program on selected self-regulation skills and attitudes in adolescents of an underserved, multiethnic milieu.

PubMed

Laberge, Suzanne; Bush, Paula Louise; Chagnon, Miguel

2012-01-01

To implement a culturally tailored physical activity (PA) promotion program (FunAction) and to assess its impact on five self-regulation skills and attitudes in adolescents. Design . The design and implementation of the FunAction program were informed by social marketing principles. The study used a quasi-experimental approach to assess the impact of the program on specific outcome variables. A multiethnic, underserved middle school in Montreal, Quebec, Canada. The intervention group was made up of grade 8 students (n  =  165) and the control group was made up of grade 7 students (n  =  137). During the 16-week intervention, adolescents were able to choose from a variety of 45-minute cardiovascular PAs offered daily during their school lunch period. Adolescents participated in the activities on a voluntary basis. A self-report questionnaire was administered preintervention and postintervention to measure adolescents' scores on the following self-regulation skills and attitudes: self-control, self-esteem, attention/concentration, social competence, and interethnic relationships. Three-way repeated measures analyses of variance and correlational analyses were used. Results . A significant improvement was observed only in attention/concentration. Girls' attention/concentration scores improved significantly in the intervention group compared to the control group (F(1,127)  =  16.26, p < .001). The improvement in attention/concentration scores for boys in the intervention group was correlated with their frequency of participation in the program PAs (r  =  .24, p  =  .008). Using social marketing principles can help encourage adolescents from underserved, multiethnic milieus to participate in PA during their school lunch hour. Furthermore, voluntary participation in a culturally tailored PA program can improve youths' attention/concentration.

Facilitating risk reduction among homeless and street-involved youth.

PubMed

Busen, Nancy H; Engebretson, Joan C

2008-11-01

The purposes of this evaluation project were to describe a group of homeless adolescents and street-involved youth who utilized a mobile unit that provided medical and mental healthcare services and to assess the efficacy of the services provided in reducing their health risk behaviors. The records of 95 youth aged 15-25 years who used the medical mobile unit for an average of 14 months were examined and evaluated according to the national health indicators related to risk reduction. Current literature related to health risk behavior among homeless youth was reviewed, synthesized, and provided the background for this article. Data were obtained from the records of mostly heterosexual youth with a mean age of 20.5 years. Approximately one third of the participants were high school graduates and most were without health insurance. Living situations were transient including friends, shelters, crash pads, or the streets. Abuse accounted for the majority leaving home. Psychiatric conditions and substance abuse were common. Medical conditions were related to transient living situations, substance abuse, and sexual activity. Success of the program was associated with sustained counseling, stabilizing youth on psychotropic medications, decreasing substance use, providing birth control and immunizations, and treating medical conditions. Homeless youth are one of the most underserved vulnerable populations in the United States with limited access and utilization of appropriate healthcare services. Nurse practitioners often serve as care providers but are also in a position to effectively lobby to improve health care for homeless youth through professional organizations and community activism. Furthermore, when designing and evaluating healthcare services, multidisciplinary teams need to consider risk reduction for homeless youth in the context of their environment.

Community health centers tackle rising demands and expectations.

PubMed

Hurley, Robert; Felland, Laurie; Lauer, Johanna

2007-12-01

As key providers of preventive and primary care for underserved people, including the uninsured, community health centers (CHCs) are the backbone of the U.S. health care safety net. Despite significant federal funding increases, community health centers are struggling to meet rising demand for care, particularly for specialty medical, dental and mental health services, according to findings from the Center for Studying Health System Change's (HSC) 2007 site visits to 12 nationally representative metropolitan communities. Health centers are responding to these pressures by expanding capacity and adding services but confront staffing, resource and other constraints. At the same time, CHCs are facing other demands, including increased quality reporting expectations, addressing racial and ethnic disparities, developing electronic medical records, and preparing for public health emergencies.

Africa's middle class women bring entrepreneurial opportunities in breast care medical tourism to South Africa.

PubMed

Ahwireng-Obeng, Frederick; van Loggerenberg, Charl

2011-01-01

Africa's distribution of specialized private health services is severely disproportionate. Mismatch between South Africa's excess supply and a huge demand potential in an under-serviced continent represents an entrepreneurial opportunity to attract patients to South Africa for treatment and recuperative holidays. However, effective demand for intra-African medical tourism could be constrained by sub-Saharan poverty. Results from interviewing 320 patients and five staff at the Johannesburg Breast care Centre of Excellence, however, reject this proposition, Africa's middle class women being the target market estimated to grow annually by one million while breast cancer incidence increases with middle-class lifestyles. Uncovering this potential involves an extensive marketing strategy. Copyright © 2010 John Wiley & Sons, Ltd.

Process and impact evaluation of a legal assistance and health care community partnership.

PubMed

Teufel, James A; Brown, Stephen L; Thorne, Woody; Goffinet, Diane M; Clemons, Latesha

2009-07-01

Community health partnerships have increased in popularity, but their effectiveness is often not evaluated. Through secondary data analysis, this study evaluates a program that offered access to legal services to address health-related issues, such as Medicaid reimbursement, Social Security benefits, medication coverage, and divorce. Based on the analysis reimbursements to expenditures, the health and law program appears to be cost-effective and thereby economically sustainable. The cost-effectiveness of this program increases the likelihood that it will be institutionalized and/or expanded. This program evaluation is used to exemplify how community stakeholders could partner to leverage resources to establish a sustainable community health and law program to address the needs of people living in medically underserved areas.

Flowers, Fruits, & Fingers: Preservice Teachers Write about Difficult Topics for a Child Audience

ERIC Educational Resources Information Center

Williams, Brian; May, Laura A.; Williams, Rhina Fernandes

2012-01-01

The authors of this article work in a university-based teacher preparation program designed to prepare teachers to serve in urban, historically underserved schools. Entrance to the program is competitive. Preservice teachers are selected, in part, for their rich life experiences and interest in working in high-needs schools. Even with this…

Designing Nutrition Education Programs for Somali Audiences: The Role of Cultural and Religious Practices

ERIC Educational Resources Information Center

Van Offelen, Sara; Sherman, Shelley; May, Jill; Rhodes, Felisha

2011-01-01

A focus group of Somali immigrants was conducted as part of a larger study of underserved communities in Minnesota. The goal was to capture Somali women's personal experiences and views on nutrition. This understanding assists Health and Nutrition educators in assessing the quality and effectiveness of current programming efforts and making…

The Girl Game Company: Engaging Latina Girls in Information Technology

ERIC Educational Resources Information Center

Denner, Jill; Bean, Steve; Martinez, Jacob

2009-01-01

This article describes the Girl Game Company's involvement in teaching Latina girls to design and program computer games while building a network of support to help them pursue IT courses and careers. Afterschool programs like the Girl Game Company can fill an important gap by providing opportunities for underserved youth to build IT fluency. A…

How Online Schools Serve and Fail to Serve At-Risk Students

ERIC Educational Resources Information Center

Figueiredo-Brown, Regina

2013-01-01

Purpose: Online schools were initially designed to provide access to diverse courses to advanced and homeschooled students, however, many online schools now market their programs specifically to students whose needs place them at-risk in traditional schools. The capacity of technology to address any of the needs of under-served students is largely…

Integrating Lesbian, Gay, Bisexual, and Transgender (LGBT) Content Into Undergraduate Medical School Curricula: A Qualitative Study.

PubMed

Sequeira, Gina M; Chakraborti, Chayan; Panunti, Brandy A

2012-01-01

The lesbian, gay, bisexual, and transgender (LGBT) community is a diverse, underserved, and often stigmatized group that faces many barriers to accessing quality healthcare. Not only are few practicing physicians knowledgeable about and sensitive to the needs of LGBT patients, but medical school curricula include limited LGBT-related content. Our goals were to use LGBT-related educational sessions to gauge undergraduate medical students' interest and their perceptions of relevance and to eventually incorporate this topic into the curriculum. We provided 4 educational sessions to preclinical medical students at the Tulane University School of Medicine: 3 optional, 1-hour didactic sessions and 1 standardized patient encounter. Following sessions 1-3, students completed electronic feedback forms; we then analyzed their responses thematically. THE THEMATIC ANALYSIS OF STUDENT RESPONSES IDENTIFIED KEY THEMES: a current lack of exposure to LGBT content, agreement that LGBT material is applicable to students' work as future physicians, and the relevance of including such information in the medical school curriculum. The study validated the underlying assumption that LGBT educational sessions are meaningful to and valued by medical students.

Evaluating the Relationship Between Participation in Student-Run Free Clinics and Changes in Empathy in Medical Students

PubMed Central

Modi, Anita; Fascelli, Michele; Daitch, Zachary; Hojat, Mohammadreza

2016-01-01

Purpose: We explored differences in changes in medical student empathy in the third year of medical school between volunteers at JeffHOPE, a multisite medical student–run free clinic of Sidney Kimmel Medical College (SKMC), and nonvolunteers. Method: Volunteerism and leadership experience at JeffHOPE were documented for medical students in the Class of 2015 (n = 272) across their medical educations. Students completed the Jefferson Scale of Empathy at the beginning of medical school and at the end of the third year. Students who reported participation in other Jefferson-affiliated clinics (n = 44) were excluded from this study. Complete data were available for 188 SKMC students. Results: Forty-five percent of students (n = 85) volunteered at JeffHOPE at least once during their medical educations. Fifteen percent of students (n = 48) were selected for leadership positions involving weekly clinic participation. Nonvolunteers demonstrated significant decline in empathy in medical school (P = 0.009), while those who volunteered at JeffHOPE at least once over the course of their medical educations did not show any significant decline (P = 0.07). Conclusions: These findings suggest that medical students may benefit from volunteering at student-run free clinics to care for underserved populations throughout medical school. PMID:28033737

Show me the money! An analysis of underserved stakeholders' funding priorities in Patient Centered Outcomes Research domains.

PubMed

Cargill, Stephanie Solomon; Baker, Lauren Lyn; Goold, Susan Dorr

2017-07-01

Develop an accessible exercise to engage underserved populations about research funding priorities; analyze the criteria they use to prioritize research; contrast these criteria to those currently used by Patient Centered Outcomes Research Institute (PCORI). Academic and community partners collaborated to develop an Ipad exercise to facilitate group deliberation about PCOR funding priorities. 16 groups (n = 183) of underserved individuals in both urban and rural areas participated. Recordings were qualitatively analyzed for prioritization criteria. Analysis yielded ten codes, many of which were similar to PCORI criteria, but all of which challenged or illuminated these criteria. Directly involving underserved populations in determining funding criteria is both feasible and important, and can better fulfill PCORI's goal of incorporating patient priorities.

Physicians’ Perceptions of Volunteer Service at Safety-Net Clinics

PubMed Central

McGeehan, Laura; Takehara, Michael A; Daroszewski, Ellen

2017-01-01

Background: Volunteer physicians are crucial for the operation of safety-net clinics, which provide medical care for uninsured and underinsured populations. Thus, identifying ways to maximize the number of physicians volunteering at such clinics is an important goal. Objective: To investigate the perceptions, motivations, functions, and barriers associated with physician volunteering in four safety-net clinics in San Bernardino County, Southern California, a location of great medical need with many barriers to care. Methods: The study participants are physicians belonging to the Southern California Permanente Medical Group who use a combination of discretionary time (during regular work hours) and personal time in evening and weekend hours to volunteer their services. The experimental design incorporates a mixed methodology: an online survey of 31 physicians and follow-up interviews with 8 of them. Results: Physicians conveyed uniformly positive perceptions of their volunteer service, and most were motivated by humanitarian or prosocial desires. Volunteering also provided a protective “escape hatch” from the pressures of the physicians’ regular jobs. Physicians cited few challenges to volunteering. The most common personal barrier was a lack of time. The most common professional barriers were organizational and supply issues at the clinic, along with the patients’ social, transportation, and financial challenges. Conclusion: The results suggest that appealing to physicians’ values and faith, and highlighting the burnout-prevention qualities of volunteering, may be key to recruitment and retention of volunteer physicians who serve underserved and underinsured populations in community clinics. PMID:28241907

Universities form research partnership to improve care in Mozambique

PubMed Central

Rose, John; Bendix, Peter; Funzamo, Carlos; Vaz, Fernando; da Costa, Antonio Assis; Bickler, Stephen; Noormahomed, Emilia Virginia

2017-01-01

Mozambique, a country in sub-Saharan Africa, has experienced a severe physician shortage for many years, with patients having particularly limited access to surgical care. Medical education and surgical research partnerships formed in 2010 between Universidade Eduardo Mondlane (UEM) in Mozambique and the University of California, San Diego (UCSD), is developing potential solutions to the nation’s surgical care crisis. The findings that have emerged from this initiative, which are aimed at scaling up surgical services, will likely have important implications for improving surgical care in Mozambique and other underserved nations. PMID:25626263

The rural community care gerontologic nurse entrepreneur: role development strategies.

PubMed

Caffrey, Rosalie A

2005-10-01

Rural elderly individuals are an underserved population with limited access to health care. There is an increasing need for independent community care nurses to provide assistance to home-based elderly individuals with chronic illnesses to prevent unnecessary medical and placement decisions and, thus, allow them to maintain independence and quality of life. This article describes the rural setting and why community care nurses are needed, and explores strategies for implementing the role of the independent nurse entrepreneur in caring for community-based elderly individuals in rural settings.

Initiating pain and palliative care outpatient services for the suburban underserved in Montgomery County, Maryland: Lessons learned at the NIH Clinical Center and MobileMed.

PubMed

Aggarwal, Sunil K; Ghosh, Amrita; Cheng, M Jennifer; Luton, Kathleen; Lowet, Peter F; Berger, Ann

2016-08-01

With the ongoing expansion of palliative care services throughout the United States, meeting the needs of socioeconomically marginalized populations, as in all domains of healthcare, continues to be a challenge. Our specific aim here was to help meet some of these needs through expanding delivery of pain and palliative care services by establishing a new clinic for underserved patients and collecting descriptive data about its operation. In November of 2014, the National Institutes of Health Clinical Center's Pain and Palliative Care Service (PPCS) launched a bimonthly offsite pain and palliative care outpatient clinic in collaboration with Mobile Medical Care Inc. (MobileMed), a private not-for-profit primary care provider in Montgomery County, Maryland, serving underserved area residents since 1968. Staffed by NIH hospice and palliative medicine clinical fellows and faculty, the clinic provides specialty pain and palliative care consultation services to patients referred by their primary care healthcare providers. A patient log was maintained, charts reviewed, and referring providers surveyed on their satisfaction with the service. The clinic had 27 patient encounters with 10 patients (6 males, 4 females, aged 23-67) during its first 7 months of operation. The reason for referral for all but one patient was chronic pain of multiple etiologies. Patients had numerous psychosocial stressors and comorbidities. All primary care providers who returned surveys (n = 4) rated their level of satisfaction with the consultation service as "very satisfied" or "extremely satisfied." This brief descriptive report outlines the steps taken and logistical issues addressed to launch and continue the clinic, the characteristics of patients treated, and the results of quality-improvement projects. Lessons learned are highlighted and future directions suggested for the clinic and others that may come along like it.

Population targeting amid complex mental health programming: Are California's Full Service Partnerships reaching underserved children?

PubMed

Cordell, Katharan D; Snowden, Lonnie R

2017-01-01

California's Mental Health Services Act (MHSA) created Full Service Partnership programs (FSPs) targeting socially and economically vulnerable children with mental illness who are underserved by counties' public mental health treatment system. To determine whether FSPs reach a distinctive group of children, this study compares indicators of FSP-targeted underservice for FSP entrants (n = 15,598) versus everyone treated in the counties' public mental health systems (n = 282,178) and for FSP entrants versus entrants in the most intensive Medicaid delivered program in California, Therapeutic Behavioral Services (TBS, n = 11,993). Results identify that, despite first encountering mental health services systems at earlier ages, FSP clients had fewer months of treatment and were less likely to have been treated in the prior 6 months, except for crisis care, as compared to all other children served, after considering clinical severity and indicators of service need. FSP entrants also had more substance abuse and trauma-related problems. Although less seriously ill than TBS served children, FSP served children were significantly underserved. The results indicate that, amid overlapping policies and programs, carving out and reaching a distinctly underserved population can be achieved in practice, and that specialized programs, such as the FSP program, which target underserved children, have the potential to augment a system's ability to reach the underserved. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Partnerships between the faith-based and medical sectors: Implications for preventive medicine and public health.

PubMed

Levin, Jeff

2016-12-01

Interconnections between the faith-based and medical sectors are multifaceted and have existed for centuries, including partnerships that have evolved over the past several decades in the U.S. This paper outlines ten points of intersection that have engaged medical and healthcare professionals and institutions across specialties, focusing especially on primary care, global health, and community-based outreach to underserved populations. In a time of healthcare resource scarcity, such partnerships-involving religious congregations, denominations, and communal and philanthropic agencies-are useful complements to the work of private-sector medical care providers and of federal, state, and local public health institutions in their efforts to protect and maintain the health of the population. At the same time, challenges and obstacles remain, mostly related to negotiating the complex and contentious relations between these two sectors. This paper identifies pressing legal/constitutional, political/policy, professional/jurisdictional, ethical, and research and evaluation issues that need to be better addressed before this work can realize its full potential.

GRID Alternatives: Solar Programs in Underserved Communities

EPA Pesticide Factsheets

Introduces GRID Alternatives: Solar Programs in Underserved Communities, a program that partners with a variety of organizations to help low-income communities access the benefits of solar technology.

Assessment of self-care and medication adherence in individuals with mental health conditions.

PubMed

Bible, Lisa J; Casper, Kristin A; Seifert, Jennifer L; Porter, Kyle A

This descriptive study explored whether patients with mental health conditions engage in personal medicine (self-care activities) as part of their treatment regimen. Personal medicine is patient-identified and -initiated activities of self-care that can improve mental health through various means, including physical activity, social engagement, and spiritual connectedness. The purpose of this study was to explore patient engagement in personal medicine within an underserved population and to evaluate the impact self-care might have on self-reported medication use and adherence and patient perception of mental health control. Cross-sectional study design with a face-to-face verbally administered survey assessing medication adherence, engagement in self-care activities, perception of self-care, and mental health control. The study site was a nonprofit charitable pharmacy in an urban setting. The pharmacy provides medications and pharmacy services at no charge, including disease state education, point-of-care testing, and medication therapy management. Study participants included those who fill medications for mental health conditions and who are age 18 years and older. Main outcomes included engagement in self-care and self-reported medication adherence. Additional measures included stratification of dimensions of self-care, perception of mental health control, and patient knowledge of community resources. Overall, 81.7% of participants engaged in activities of self-care, with 98.3% recognizing self-care as important to improving and maintaining their mental health. Greater self-reported adherence rates and mental health control were seen with patients who participate in self-care. Participants who identify and engage in personal medicine recognize its value and are willing to incorporate it into their treatment regimen. As accessible and trusted health care providers, pharmacists can encourage patients to identify and use personal medicine to aid in the improvement of their mental health condition. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

The Office Guidelines Applied to Practice program improves secondary prevention of heart disease in Federally Qualified Healthcare Centers.

PubMed

Olomu, Adesuwa; Khan, Nazia Naz; Todem, David; Huang, Qinhua; Kumar, Esha; Holmes-Rovner, Margaret

2016-12-01

The burden of cardiovascular disease (CVD) among minority and low-income populations is well documented. This study aimed to assess the impact of patient activation and shared decision-making (SDM) on medication use through the Office-Guidelines Applied to Practice (Office-GAP) intervention in Federally Qualified Healthcare Centers (FQHCs). Patients (243) with diabetes and CHD participated in Office-GAP between October 2010 and March 2014. Two-site (FQHCs) intervention/control design. Office-GAP integrates health literacy, communication skills education for patients and physicians, decision support tools, and SDM into routine care. 1) implementation rates, 2) medication use at baseline, 3, 6, and 12 months, and 3) predictors of medication use. Logistic regression with propensity scoring assessed impact on medication use. Intervention arm had 120 and control arm had 123 patients. We found that program elements were consistently used. Compared to control, the Office-GAP program significantly improved medications use from baseline: ACEIs or ARBs at 3 months (OR 1.88, 95% CI = 1.07; 3.30, p < 0.03), 6 months (OR 2.68, 95% CI = 1.58;4.54; p < 0.01); statin at 3 months (OR 2.00, 95% CI = 0.1.22; 3.27; p < 0.05), 6 months (OR 3.05, 95% CI = 1.72; 5.43; p < 0.01), Aspirin and/or clopidogrel at 3 months OR 1.59, 95% CI = 1.02, 2.48; p < 0.05), 6 months (OR 3.67, 95% CI = 1.67; 8.08; p < 0.01). Global medication adherence was predicted only by Office-GAP intervention presence and hypertension. Office-GAP resulted in increased use of guideline-based medications for secondary CVD prevention in underserved populations. The Office-GAP program could serve as a model for implementing guideline-based care for other chronic diseases.

A Systematic Review of the Literature Addressing Veterinary Care for Underserved Communities.

PubMed

LaVallee, Elizabeth; Mueller, Megan Kiely; McCobb, Emily

2017-01-01

Currently, there is a care gap in veterinary medicine affecting low-income and underserved communities, resulting in decreased nonhuman-animal health and welfare. The use of low-price and community veterinary clinics in underserved populations is a strategy to improve companion-animal health through preventative care, spay/neuter, and other low-price care programs and services. Little research has documented the structure and effectiveness of such initiatives. This systematic review aimed to assess current published research pertaining to accessible health care, community-based veterinary medicine, and the use of community medicine in teaching programs. The review was an in-depth literature search identifying 51 publications relevant to the importance, benefits, drawbacks, and use of low-price and community clinics in underserved communities. These articles identified commonly discussed barriers to care that may prevent underserved clientele from seeking veterinary care. Five barriers were identified including the cost of veterinary care, accessibility of care, problems with or lack of veterinarian-client communication, culture/language, and lack of client education. The review also identified a need for additional research regarding evidence of effectiveness and efficiency in community medicine initiatives.

Disparity in rates of HPV infection and cervical cancer in underserved US populations

PubMed Central

Karuri, Asok Ranjan; Kashyap, Vivek Kumar; Yallapu, Murali Mohan; Zafar, Nadeem; Kedia, Satish K.; Jaggi, Meena; Chauhan, Subhash C.

2018-01-01

There is a higher rate of HPV infection and cervical cancer incidence and mortality in underserved US population who reside in Appalachian mountain region compared to Northern Plains. Social and behavioral factors such as smoking and alcohol consumption are for such a high incidence. However, by and large, the reasons for these discrepancies lie in the reluctance of the underserved population to adopt preventive measures such as prophylactic Human papilloma virus (HPV) vaccines and Pap smear screening that have significantly reduced the incidence and mortality rate of cervical cancer in Caucasian women. Thus, it is clear that drastic change in social behavior and implementation of preventive measures is required to effectively reduce the incidence and mortality from cervical cancer in this underserved population. PMID:28410118

Medical students’ characteristics as predictors of career practice location: retrospective cohort study tracking graduates of Nepal’s first medical college

PubMed Central

Shakya, Rabina; Pokhrel, Bharat M; Eyal, Nir; Rijal, Basista P; Shrestha, Ratindra N; Sayami, Arun

2012-01-01

Objective To determine, in one low income country (Nepal), which characteristics of medical students are associated with graduate doctors staying to practise in the country or in its rural areas. Design Observational cohort study. Setting Medical college registry, with internet, phone, and personal follow-up of graduates. Participants 710 graduate doctors from the first 22 classes (1983-2004) of Nepal’s first medical college, the Institute of Medicine. Main outcome measures Career practice location (foreign or in Nepal; in or outside of the capital city Kathmandu) compared with certain pre-graduation characteristics of medical student. Results 710 (97.7%) of the 727 graduates were located: 193 (27.2%) were working in Nepal in districts outside the capital city Kathmandu, 261 (36.8%) were working in Kathmandu, and 256 (36.1%) were working in foreign countries. Of 256 working abroad, 188 (73%) were in the United States. Students from later graduating classes were more likely to be working in foreign countries. Those with pre-medical education as paramedics were twice as likely to be working in Nepal and 3.5 times as likely to be in rural Nepal, compared with students with a college science background. Students who were academically in the lower third of their medical school class were twice as likely to be working in rural Nepal as those from the upper third. In a regression analysis adjusting for all variables, paramedical background (odds ratio 4.4, 95% confidence interval 1.7 to 11.6) was independently associated with a doctor remaining in Nepal. Rural birthplace (odds ratio 3.8, 1.3 to 11.5) and older age at matriculation (1.1, 1.0 to 1.2) were each independently associated with a doctor working in rural Nepal. Conclusions A cluster of medical students’ characteristics, including paramedical background, rural birthplace, and lower academic rank, was associated with a doctor remaining in Nepal and with working outside the capital city of Kathmandu. Policy makers in medical education who are committed to producing doctors for underserved areas of their country could use this evidence to revise their entrance criteria for medical school. PMID:22893566

78 FR 28274 - Council on Underserved Communities, Re-Establishment

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-14

... underserved communities. Its members provide an essential connection between SBA and small businesses in inner... economic growth, job creation, competiveness, and sustainability. Council members bring a number of...

Crowdsourced Microfinance for Energy Efficiency in Underserved Communities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baird, Donnel; Cox, Morris; Harmarneh, Sarey

BlocPower’s mission is to provide access to energy efficiency financing for underserved communities across the United States. This project, “Crowdsourced Microfinance for Energy Efficiency in Underserved Communities,” is an extension of that goal and is grounded in the principles of providing engineering and financing services to those in need. The project is based on the creation of a BlocPower Marketplace as a central hub for connecting shovel-ready green buildings to institutional investors. This ‘connection’ entails using online crowdfunding to aggregate debt and equity capital from institutional investors to connect to customers (building owners) across various financial portfolios. BlocPower Marketplace ismore » intended to bring social, environmental, and financial returns to investors while also decreasing investor risk by loaning out funds for energy installations in individual buildings. In detail, the intended benefits of crowdsourcing are two-sided. Firstly, for building owners, clean energy retrofit installations improve building operations, reduce utility costs, and reduce harmful impacts to their surrounding environment. Secondly, for institutional investors, they gain access to a new market of energy efficiency and are able to provide debt or equity capital with high financial returns. This gives investors the opportunity to create social and environmental impact in communities around the country as well. With this in mind, BlocPower designed the marketplace to specifically answer exploratory research questions with respect to the pricing of energy financing. Institutional investors typically charge high rates on project financing solutions in the energy space, particularly in low and middle-income communities, because of fears that required debt service will not be made. This makes access to energy capital exorbitantly difficult for those that need it the most. Through this project, BlocPower tested investor appetite to determine if crowdsourcing would lower prices and subsequently lower barriers to entry for underserved communities’ access to energy capital. BlocPower’s results in this project were extremely informative for the industry. The project demonstrates that the marketplace is a scalable tool to help overcome barriers to entry for small building owners in underserved communities to access energy efficiency financing, but that crowdfunding by itself does not necessarily lower interest rates and make energy efficiency projects feasible. For that, we need a repayment mechanism that lowers perceived risk. That mechanism is on bill repayment.« less

Negotiating the "Middle" Ground: How English Learner (EL) Focused Teacher Leaders and Teachers Work towards EL Instructional Change in Mainstream Elementary School Classrooms

ERIC Educational Resources Information Center

Von Esch, Kerry Soo

2013-01-01

This dissertation investigates the relationship between district supported teacher leadership and improving the teaching and learning of English learner (EL) students, a rapidly growing, yet continually underserved population of students. Utilizing a comparative case study design, this dissertation focuses on the work of two district-supported…

Training of Lay Health Educators to Implement an Evidence-Based Behavioral Weight Loss Intervention in Rural Senior Centers

ERIC Educational Resources Information Center

Krukowski, Rebecca A.; Lensing, Shelly; Love, ShaRhonda; Prewitt, T. Elaine; Adams, Becky; Cornell, Carol E.; Felix, Holly C.; West, Delia

2013-01-01

Purpose of the Study: Lay health educators (LHEs) offer great promise for facilitating the translation of evidence-based health promotion programs to underserved areas; yet, there is little guidance on how to train LHEs to implement these programs, particularly in the crucial area of empirically validated obesity interventions. Design and Methods:…

An Innovative Multiphased Strategy to Recruit Underserved Adults into a Randomized Trial of a Community-Based Diabetes Risk Reduction Program

ERIC Educational Resources Information Center

Santoyo-Olsson, Jasmine; Cabrera, Julissa; Freyre, Rachel; Grossman, Melanie; Alvarez, Natalie; Mathur, Deepika; Guerrero, Maria; Delgadillo, Adriana T.; Kanaya, Alka M.; Stewart, Anita L.

2011-01-01

Purpose: To conduct and evaluate a two-phased community-based approach to recruit lower socioeconomic status, minority, or Spanish-speaking adults at risk of developing diabetes to a randomized trial of a lifestyle intervention program delivered by a public health department. Design: Within geographic areas comprising our target population, 4…

Assisted Living and Special Populations: What Do We Know about Differences in Use and Potential Access Barriers?

ERIC Educational Resources Information Center

Hernandez, Mauro; Newcomer, Robert

2007-01-01

Purpose: The purpose of this article was to review existing knowledge about assisted living (AL) use by traditionally underserved populations, including people of color, low-income people, and those living in rural communities. Design and Methods: We reviewed methodologies and findings of research on AL and residential care up to June 2004.…

Economic feasibility of alternative practitioners for provision of dental care to the underserved.

PubMed

Matthiesen, Anne

2012-01-01

This study assesses the viability of three alternative practitioner types for provision of dental care to the underserved. Key factors modeled include compensation, training and practice costs, productivity, and payer mix scenarios. Utilizing dental therapists or dental health aide therapists is cost-effective for enhancing access. However, to be sustainable, the practices will require a subsidy or a better reimbursement than modeled. Without tuition support, the debt burden will deter applicants mostlikely to treat the underserved.

Comprehensive approach for hypertension control in low-income populations: rationale and study design for the hypertension control program in Argentina.

PubMed

Mills, Katherine T; Rubinstein, Adolfo; Irazola, Vilma; Chen, Jing; Beratarrechea, Andrea; Poggio, Rosana; Dolan, Jacquelyn; Augustovski, Federico; Shi, Lizheng; Krousel-Wood, Marie; Bazzano, Lydia A; He, Jiang

2014-08-01

Although the efficacy and effectiveness of lifestyle modifications and antihypertensive pharmaceutical treatment for the prevention and control of hypertension and concomitant cardiovascular disease have been demonstrated in randomized controlled trials, this scientific knowledge has not been fully applied in the general population, especially in low-income communities. This article summarizes interventions to improve hypertension management and describes the rationale and study design for a cluster randomized trial testing whether a comprehensive intervention program within a national public primary care system will improve hypertension control among uninsured hypertensive men and women and their families. We will recruit 1,890 adults from 18 clinics within a public primary care network in Argentina. Clinic patients with uncontrolled hypertension, their spouses and hypertensive family members will be enrolled. The comprehensive intervention program targets the primary care system through health care provider education, a home-based intervention among patients and their families (home delivery of antihypertensive medication, self-monitoring of blood pressure [BP], health education for medication adherence and lifestyle modification) conducted by community health workers and a mobile health intervention. The primary outcome is net change in systolic BP from baseline to month 18 between intervention and control groups among hypertensive study participants. The secondary outcomes are net change in diastolic BP, BP control and cost-effectiveness of the intervention. This study will generate urgently needed data on effective, practical and sustainable intervention programs aimed at controlling hypertension and concomitant cardiovascular disease in underserved populations in low- and middle-income countries.

Comprehensive Approach for Hypertension Control in Low-income Populations: Rationale and Study Design for the Hypertension Control Program in Argentina (HCPIA)

PubMed Central

Mills, Katherine T.; Rubinstein, Adolfo; Irazola, Vilma; Chen, Jing; Beratarrechea, Andrea; Poggio, Rosana; Dolan, Jacquelyn; Augustovski, Federico; Shi, Lizheng; Krousel-Wood, Marie; Bazzano, Lydia A.; He, Jiang

2014-01-01

Although the efficacy and effectiveness of lifestyle modifications and antihypertensive pharmaceutical treatment for the prevention and control of hypertension and concomitant cardiovascular disease have been demonstrated in randomized controlled trials, this scientific knowledge has not been fully applied in the general population, especially in low-income communities. This paper summarizes interventions to improve hypertension management and describes the rationale and study design for a cluster randomized trial testing whether a comprehensive intervention program within a national public primary care system will improve hypertension control among uninsured hypertensive men and women and their families. We will recruit 1,890 adults from 18 clinics within a public primary care network in Argentina. Clinic patients with uncontrolled hypertension, their spouses and hypertensive family members will be enrolled. The comprehensive intervention program targets the primary care system through health care provider education, a home-based intervention among patients and their families (home delivery of antihypertensive medication, self-monitoring of blood pressure, health education for medication adherence and lifestyle modification) conducted by community health workers, and a mobile health intervention. The primary outcome is net change in systolic blood pressure from baseline to month 18 between intervention and control groups among hypertensive study participants. The secondary outcomes are net change in diastolic blood pressure, blood pressure control, and cost-effectiveness of the intervention. This study will generate urgently needed data on effective, practical, and sustainable intervention programs aimed at controlling hypertension and concomitant cardiovascular disease in underserved populations in low- and middle-income countries. PMID:24978148

Feasibility of developing a pediatric telehealth network in Honduras with international consultation support.

PubMed

Brooks, Mary; Holden, Kenton R; Durón, Reyna M; McElligott, James T; Summer, Andrea

2017-01-01

Honduras is the second poorest country in Central America, and roughly 50% of the population lives in rural areas. A telehealth network linking these areas to larger health centers may improve patient access to care, and physician access to educational opportunities. This pilot study assessed the feasibility of establishing a pediatric telehealth network between underserved clinics in Honduras and the Medical University of South Carolina (MUSC). Two underserved Honduran clinics were identified and invited to participate in the telehealth network. Providers from these clinics connected remotely to educational conferences at MUSC, and received teleconsults from MUSC physicians and physicians from the other Honduran site. Honduran providers completed five-point Likert scale satisfaction surveys following participation in the conferences and teleconsults. Survey feedback was positive, with 100% of respondents stating they would utilize telemedicine in the future. Dissatisfaction was expressed subjectively in the survey comments with regards to poor Internet connectivity and unreliable electrical power. The establishment of a telehealth network between Honduras and MUSC is feasible, and rural providers were receptive to the clinical and educational opportunities this network provides. Future projects will expand telehealth capabilities to other Honduran sites and focus on intra-country collaboration to ensure sustainability.

The Impact of Public Hospital Closure on Medical and Residency Education: Implications and Recommendations

PubMed Central

Walker, Kara Odom; Calmes, Daphne; Hanna, Nancy; Baker, Richard

2010-01-01

Background Challenges around safety-net hospital closure have impacted medical student and resident exposure to urban public healthcare sites that may influence their future practice choices. Objective To assess the impact of the closure of a public safety-net teaching hospital for the clinical medical education of Charles Drew University medical students and residents. Method Retrospective cohort study of medical students’ and residents’ and clinical placement into safety-net experiences after the closure of the primary teaching hospital. Results The hospital closure impacted both medical student and residency training experiences. Only 71% (17/24) of medical student rotations and 13% (23/180) of residents were maintained at public safety-net clinical sittings. The closure of the public safety-net hospital resulted in the loss of 36% of residency training spots sponsored by historically black medical schools in the United States and an even larger negative impact on the number of physicians training in underserved urban areas of Los Angeles County. Conclusion While the medical educational program changes undertaken in the wake of hospital closure have negatively affected the immediate clinical educational experiences of medical students and residents, it remains to be seen whether the training site location changes will alter their long-term preferences in specialty choice and practice location. PMID:19110905

The impact of public hospital closure on medical and residency education: implications and recommendations.

PubMed

Walker, Kara Odom; Calmes, Daphne; Hanna, Nancy; Baker, Richard

2008-12-01

Challenges around safety-net hospital closure have impacted medical student and resident exposure to urban public healthcare sites that may influence their future practice choices. To assess the impact of the closure of a public safety-net teaching hospital for the clinical medical education of Charles Drew University medical students and residents. Retrospective cohort study of medical students' and residents' and clinical placement into safety-net experiences after the closure of the primary teaching hospital. The hospital closure impacted both medical student and residency training experiences. Only 71% (17/24) of medical student rotations and 13% (23/180) of residents were maintained at public safety-net clinical sittings. The closure of the public safety-net hospital resulted in the loss of 36% of residency training spots sponsored by historically black medical schools in the United States and an even larger negative impact on the number of physicians training in underserved urban areas of Los Angeles County. While the medical educational program changes undertaken in the wake of hospital closure have negatively affected the immediate clinical educational experiences of medical students and residents, it remains to be seen whether the training site location changes will alter their long-term preferences in specialty choice and practice location.

LOCUS: immunizing medical students against the loss of professional values.

PubMed

Carufel-Wert, Donald A; Younkin, Sharon; Foertsch, Julie; Eisenberg, Todd; Haq, Cynthia L; Crouse, Byron J; Frey Iii, John J

2007-05-01

The Leadership Opportunities with Communities, the Underserved, and Special populations (LOCUS) program at the University of Wisconsin School of Medicine and Public Health is a longitudinal, extracurricular experience for medical students who wish to develop leadership skills and expand their involvement in community health activities during medical school. The program consists of a core curriculum delivered through retreats, workshops, and seminars; a mentor relationship with a physician who is engaged in community health services; and a community service project. On-line surveys and interviews with current and past participants as well as direct observations were used to evaluate the effects of the program on participants. Participants indicated that the program was worthwhile, relevant, and effective in building a community of like-minded peers and physician role models. Participants also reported that the program sustained their interest in and commitment to community service and allowed them to cultivate new skills during medical school. The curriculum and structure of the LOCUS program offers a successful method for helping medical students learn important leadership skills and maintain an altruistic commitment to service.

Effect of Active Videogames on Underserved Children's Classroom Behaviors, Effort, and Fitness.

PubMed

Gao, Zan; Lee, Jung Eun; Pope, Zachary; Zhang, Dachao

2016-09-30

The purpose of this study was to examine the effect of active videogames (AVGs) on underserved minority children's on-task classroom behavior, academic effort, and fitness. A one group pre- and posttest repeated measures design was used. In Fall 2013, 95 fourth grade children (57 boys, 38 girls; 96% of minority) from three classes at an underserved urban elementary school participated in teacher-supervised AVG activities (e.g., Wii Sports, Xbox Just Dance). Specifically, students participated in a 50-minute weekly AVG program at school for 6 weeks. Children's academic effort was evaluated by classroom teachers using a validated scale that assessed activity, attention, conduct, and social/emotional behavior. Moreover, children's classroom behavior was observed immediately before and after each AVG session by trained researchers. Finally, cardiovascular fitness was also measured. A paired t-test was used to assess teacher-rated student effort, while one-way (gender) analysis of variance (ANOVA) with repeated measures was performed to analyze children's on-task classroom behavior. There was a significant effect on children's effort between the first (mean = 3.24, SD = 0.75) and last week (mean = 3.41, SD = 0.73) assessments, t = 2.42, P = 0.02. In addition, there was a significant effect on classroom behavior, F = 33.103, P < 0.01. In detail, children scored significantly higher on on-task behavior during the post-AVG observation (mean = 81.4, SD = 12.3) than seen during the pre-AVG observation (mean = 69.8, SD = 14.9). However, no main effect was indicated for gender, F = 0.39, P = 0.54. No significant improvement in cardiovascular fitness was observed, although slight improvements were seen. Offering an AVG program at school could improve underserved minority children's classroom on-task behavior and academic effort. Future studies may include a control group to further confirm the effectiveness of AVG activities. Practical implications for educators and other stakeholders are provided.

The organization and delivery of family planning services in community health centers.

PubMed

Goldberg, Debora Goetz; Wood, Susan F; Johnson, Kay; Mead, Katherine Holly; Beeson, Tishra; Lewis, Julie; Rosenbaum, Sara

2015-01-01

Family planning and related reproductive health services are essential primary care services for women. Access is limited for women with low incomes and those living in medically underserved areas. Little information is available on how federally funded health centers organize and provide family planning services. This was a mixed methods study of the organization and delivery of family planning services in federally funded health centers across the United States. A national survey was developed and administered (n = 423) and in-depth case studies were conducted of nine health centers to obtain detailed information on their approach to family planning. Study findings indicate that health centers utilize a variety of organizational models and staffing arrangements to deliver family planning services. Health centers' family planning offerings are organized in one of two ways, either a separate service with specific providers and clinic times or fully integrated with primary care. Health centers experience difficulties in providing a full range of family planning services. Major challenges include funding limitations; hiring obstetricians/gynecologists, counselors, and advanced practice clinicians; and connecting patients to specialized services not offered by the health center. Health centers play an integral role in delivering primary care and family planning services to women in medically underserved communities. Improving the accessibility and comprehensiveness of family planning services will require a combination of additional direct funding, technical assistance, and policies that emphasize how health centers can incorporate quality family planning as a fundamental element of primary care. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Learning from history: the legacy of Title VII in academic family medicine.

PubMed

Newton, Warren; Arndt, Jane E

2008-11-01

The current renaissance of interest in primary care could benefit from reviewing the history of federal investment in academic family medicine. The authors review 30 years of experience with the Title VII, Section 747 Training in Primary Care Medicine and Dentistry (Title VII) grant program, addressing three questions: (1) What Title VII grant programs were available to family medicine, and what were their goals? (2) How did Title VII change the discipline? and (3) What impact did Title VII family medicine programs have outside the discipline?Title VII grant programs evolved from broad support for the new discipline of family medicine to a sharper focus on specific national workforce objectives such as improving care for underserved and vulnerable populations and increasing diversity in the health professions. Grant programs were instrumental in establishing family medicine in nearly all medical schools and in supporting the educational underpinnings of the field. Title VII grants helped enhance the social capital of the discipline. Outside family medicine, Title VII fostered the development of innovative ambulatory education, institutional initiatives focusing on underserved and vulnerable populations, and primary care research capacity. Adverse effects include relative inattention to clinical and research missions in family medicine academic units and, institutionally, the development of medical education initiatives without core institutional support, which has put innovation and extension of education to communities at risk as grant funding has decreased. Reinvestment in academic family medicine can yield substantial benefits for family medicine and help reorient academic health centers. This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

Correlates of Community-Based Colorectal Cancer Screening in a Rural Population: The Role of Fatalism.

PubMed

Crosby, Richard A; Collins, Tom

2017-09-01

One largely unexplored barrier to colorectal cancer (CRC) screening is fatalistic beliefs about cancer. The purpose of this study was to identify correlates of ever having endoscopy screenings for CRC and to determine whether fatalism plays a unique role. Because evidence suggests that cancer-associated fatalistic beliefs may be particularly common among rural Americans, the study was conducted in a medically underserved area of rural Appalachia.  METHODS: Rural residents (N = 260) between 51 and 75 years of age, from a medically underserved area of Appalachia, Kentucky, were recruited for a cross-sectional study. The outcome measure was assessed by a single item asking whether participants ever had a colonoscopy or flexible sigmoidoscopy. Demographic and health-related correlates of this outcome were selected based on past studies of rural populations. A single item assessed perceptions of fatalism regarding CRC. Age-adjusted analyses of correlates testing significant at the bivariate level were conducted.  RESULTS: The analytic sample was limited to 135 rural residents indicating they had ever had CRC endoscopy and 107 indicating never having endoscopy. In age-adjusted analyses, only the measure of fatalism had a significant association with having endoscopy. Those endorsing the statement pertaining to fatalism were 2.3 times more likely (95% CI = 1.24-4.27, P = .008) than the remainder to indicate never having endoscopy.  CONCLUSIONS: A community-based approach to the promotion of endoscopy for CRC screening could focus on overcoming CRC-associated fatalism, thereby potentially bringing more unscreened people to endoscopy clinics. © 2017 National Rural Health Association.

Stakeholder assessment of comparative effectiveness research needs for Medicaid populations.

PubMed

Fischer, Michael A; Allen-Coleman, Cora; Farrell, Stephen F; Schneeweiss, Sebastian

2015-09-01

Patients, providers and policy-makers rely heavily on comparative effectiveness research (CER) when making complex, real-world medical decisions. In particular, Medicaid providers and policy-makers face unique challenges in decision-making because their program cares for traditionally underserved populations, especially children, pregnant women and people with mental illness. Because these patient populations have generally been underrepresented in research discussions, CER questions for these groups may be understudied. To address this problem, the Agency for Healthcare Research and Quality commissioned our team to work with Medicaid Medical Directors and other stakeholders to identify relevant CER questions. Through an iterative process of topic identification and refinement, we developed relevant, feasible and actionable questions based on issues affecting Medicaid programs nationwide. We describe challenges and limitations and provide recommendations for future stakeholder engagement.

Staying Connected: Sustaining Collaborative Care Models with Limited Funding.

PubMed

Johnston, Brenda J; Peppard, Lora; Newton, Marian

2015-08-01

Providing psychiatric services in the primary care setting is challenging. The multidisciplinary, coordinated approach of collaborative care models (CCMs) addresses these challenges. The purpose of the current article is to discuss the implementation of a CCM at a free medical clinic (FMC) where volunteer staff provide the majority of services. Essential components of CCMs include (a) comprehensive screening and assessment, (b) shared development and communication of care plans among providers and the patient, and (c) care coordination and management. Challenges to implementing and sustaining a CCM at a FMC in Virginia attempting to meet the medical and psychiatric needs of the underserved are addressed. Although the CCM produced favorable outcomes, sustaining the model long-term presented many challenges. Strategies for addressing these challenges are discussed. Copyright 2015, SLACK Incorporated.

Stakeholder assessment of comparative effectiveness research needs for Medicaid populations

PubMed Central

Fischer, Michael A; Allen-Coleman, Cora; Farrell, Stephen F; Schneeweiss, Sebastian

2015-01-01

Patients, providers and policy-makers rely heavily on comparative effectiveness research (CER) when making complex, real-world medical decisions. In particular, Medicaid providers and policy-makers face unique challenges in decision-making because their program cares for traditionally underserved populations, especially children, pregnant women and people with mental illness. Because these patient populations have generally been underrepresented in research discussions, CER questions for these groups may be understudied. To address this problem, the Agency for Healthcare Research and Quality commissioned our team to work with Medicaid Medical Directors and other stakeholders to identify relevant CER questions. Through an iterative process of topic identification and refinement, we developed relevant, feasible and actionable questions based on issues affecting Medicaid programs nationwide. We describe challenges and limitations and provide recommendations for future stakeholder engagement. PMID:26388438

Individual Breast Cancer risk assessment in Underserved Populations: Integrating empirical Bioethics and Health Disparities Research

PubMed Central

Anderson, Emily E.; Hoskins, Kent

2013-01-01

Research suggests that individual breast cancer risk assessment may improve adherence to recommended screening and prevention guidelines, thereby decreasing morbidity and mortality. Further research on the use of risk assessment models in underserved minority populations is critical to informing national public health efforts to eliminate breast cancer disparities. However, implementing individual breast cancer risk assessment in underserved patient populations raises particular ethical issues that require further examination. After reviewing these issues, we will discuss how empirical bioethics research can be integrated with health disparities research to inform the translation of research findings. Our in-progress National Cancer Institute (NCI) funded study, How Do Underserved Minority Women Think About Breast Cancer?, conducted in the context of a larger study on individual breast cancer risk assessment, is presented as a model. PMID:23124498

Health Insurance Portability and Accountability Act-Compliant Ocular Telehealth Network for the Remote Diagnosis and Management of Diabetic Retinopathy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, Yaquin; Karnowski, Thomas Paul; Tobin Jr, Kenneth William

2011-01-01

In this article, we present the design and implementation of a regional ocular telehealth network for remote assessment and management of diabetic retinopathy (DR), including the design requirements, network topology, protocol design, system work flow, graphics user interfaces, and performance evaluation. The Telemedical Retinal Image Analysis and Diagnosis Network is a computer-aided, image analysis telehealth paradigm for the diagnosis of DR and other retinal diseases using fundus images acquired from primary care end users delivering care to underserved patient populations in the mid-South and southeastern United States.

A health insurance portability and accountability act-compliant ocular telehealth network for the remote diagnosis and management of diabetic retinopathy.

PubMed

Li, Yaqin; Karnowski, Thomas P; Tobin, Kenneth W; Giancardo, Luca; Morris, Scott; Sparrow, Sylvia E; Garg, Seema; Fox, Karen; Chaum, Edward

2011-10-01

In this article, we present the design and implementation of a regional ocular telehealth network for remote assessment and management of diabetic retinopathy (DR), including the design requirements, network topology, protocol design, system work flow, graphics user interfaces, and performance evaluation. The Telemedical Retinal Image Analysis and Diagnosis Network is a computer-aided, image analysis telehealth paradigm for the diagnosis of DR and other retinal diseases using fundus images acquired from primary care end users delivering care to underserved patient populations in the mid-South and southeastern United States.

Racial/ethnic differences in health insurance adequacy and consistency among children: Evidence from the 2011/12 National Survey of Children’s Health

PubMed Central

Soylu, Tulay G.; Elashkar, Eman; Aloudah, Fatemah; Ahmed, Munir; Kitsantas, Panagiota

2018-01-01

Background Surveillance of disparities in healthcare insurance, services and quality of care among children are critical for properly serving the medical/healthcare needs of underserved populations. The purpose of this study was to assess racial/ethnic differences in children’s (0 to 17 years old) health insurance adequacy and consistency (child has insurance coverage for the last 12 months). Design and methods We used data from the 2011/2012 National Survey of Children’s Health (n=79,474). Descriptive statistics and logistic regression analyses were conducted to examine the distribution and influence of several sociodemographic/family related factors on insurance adequacy and consistency across different racial/ethnic groups. Results Stratified analyses by race/ethnicity revealed that white and black children living in households at or below 299% of the Federal Poverty Level (FPL) were approximately 29 to 42% less likely to have adequate insurance compared to children living in families of higher income levels. Regardless of race/ethnicity, we found that children with public health insurance were more likely to have adequate insurance than their privately insured counterparts, while adolescents were at greater risk of inadequate coverage. Hispanic and black children were more likely to lack consistent insurance coverage. Conclusions This study provides evidence that racial/ethnic differences in adequate and consistent health insurance exists with both white and minority children being affected adversely by poverty. Establishing outreach programs for low income families, and cross-cultural education for healthcare providers may help increase health insurance adequacy and consistency within certain underserved populations. Significance for public healthAs the number of minority US children increases, monitoring racial/ethnic differences in health insurance coverage becomes critical in creating insurance programs that can provide adequate and consistent coverage. Using a nationally representative sample, the findings of this study suggest that low income and poor maternal health can adversely affect insurance consistency and adequacy for both minority and white children. This indicates that research studies on inequalities of healthcare coverage should also focus on underserved white populations of children as their insurance coverage is affected by similar factors as those for minority children. Elimination of inequalities may require targeted interventions that include the well-being of the entire family, cross-cultural education of healthcare providers, policy changes to grant low-income children with appropriate and reliable health insurance, and an ongoing monitoring of disparities by health plans. PMID:29780766

When a LIC came to town: the impact of longitudinal integrated clerkships on a rural community of healthcare practice.

PubMed

Hudson, Judith N; Thomson, Brett; Weston, Kathryn M; Knight-Billington, Patricia J

2015-01-01

Two small rural towns in Australia, where medical practitioners provide primary care to the population, including emergency, anaesthetic and obstetric services, were early adopters of an innovative year-long integrated clerkship (clinical placement) designed to foster medical student skill attainment and a commitment to underserved rural communities. Primary care vocational trainees had previously trained in the region. Engaging with the university to participate in the clerkship initiative for undergraduate medical education offered the local healthcare service an opportunity to really integrate education with service. This study sought perspectives from a multidisciplinary group of stakeholders on the impact of the longitudinal integrated clerkship (LIC) on the healthcare community. Three analysts independently analysed the transcripts arising from semi-structured interviews with a range of health care clinicians and managers (N=23). Themes were identified using inductive content analysis methodology. Four major themes emerged from the perspectives of a multi-professional group of participants from both towns: transforming a community of practice, realising the potential of the health service, investment in rural return, and sustainability. There was significant clinical exposure, skill and teaching capacity in these previously unrecognised rural placements but realising the potential of the health service needs careful management to sustain this resource. Early engagement and initial enthusiasm have produced many positive outcomes for the healthcare community, but this alone is not sufficient to sustain an increasing role for rural primary care in medical education. The study identified issues that need addressing for sustainability, namely validation, time and costs. Strategies to address these are key to continuation of LICs in small rural communities.

Design and methodology of a randomized clinical trial of home-based telemental health treatment for U.S. military personnel and veterans with depression.

PubMed

Luxton, David D; Pruitt, Larry D; O'Brien, Karen; Stanfill, Katherine; Jenkins-Guarnieri, Michael A; Johnson, Kristine; Wagner, Amy; Thomas, Elissa; Gahm, Gregory A

2014-05-01

Home-based telemental health (TMH) treatments have the potential to address current and future health needs of military service members, veterans, and their families, especially for those who live in rural or underserved areas. The use of home-based TMH treatments to address the behavioral health care needs of U.S. military healthcare beneficiaries is not presently considered standard of care in the Military Health System. The feasibility, safety, and clinical efficacy of home-based TMH treatments must be established before broad dissemination of home-based treatment programs can be implemented. This paper describes the design, methodology, and protocol of a clinical trial that compares in-office to home-based Behavioral Activation for Depression (BATD) treatment delivered via web-based video technology for service members and veterans with depression. This grant funded three-year randomized clinical trial is being conducted at the National Center for Telehealth and Technology at Joint-base Lewis-McChord and at the Portland VA Medical Center. Best practice recommendations regarding the implementation of in-home telehealth in the military setting as well as the cultural and contextual factors of providing in-home care to active duty and veteran military populations are also discussed. Published by Elsevier Inc.

Implementation and Evaluation of a Recurring Interdisciplinary Community Health Fair in a Remote U.S.-Mexico Border Community.

PubMed

Lee, July; McKennett, Marianne; Rodriguez, Xavier; Smith, Sunny

2018-03-06

The purpose of this project was to design, implement, and assess a recurring interdisciplinary community health fair in an underserved border town. University of California San Diego (UCSD) medical and pharmacy students, under faculty supervision, worked alongside community partners in Calexico, California to implement a health fair two miles from the U.S.-Mexico border. Demographic and screening data were described from 293 participants from 2014 to 2016. Over 90% (269/293) listed Mexico as their country of birth, 82.9% (243/293) were monolingual Spanish speakers, 75.4% (221/293) had an annual household income of ≤ $20,000, and 58.7% (172/293) described their health as fair or poor. Screening revealed 91.1% (265/291) were overweight or obese, 37.8% (109/288) had hypertension, 9.3% (27/289) had elevated blood sugar, and 11.4% (33/289) had elevated total cholesterol levels. This model could be replicated in other training settings to increase exposure to border health issues and connect patients to local health services.

Integrating community health workers within Patient Protection and Affordable Care Act implementation.

PubMed

Islam, Nadia; Nadkarni, Smiti Kapadia; Zahn, Deborah; Skillman, Megan; Kwon, Simona C; Trinh-Shevrin, Chau

2015-01-01

The Patient Protection and Affordable Care Act's (PPACA) emphasis on community-based initiatives affords a unique opportunity to disseminate and scale up evidence-based community health worker (CHW) models that integrate CHWs within health care delivery teams and programs. Community health workers have unique access and local knowledge that can inform program development and evaluation, improve service delivery and care coordination, and expand health care access. As a member of the PPACA-defined health care workforce, CHWs have the potential to positively impact numerous programs and reduce costs. This article discusses different strategies for integrating CHW models within PPACA implementation through facilitated enrollment strategies, patient-centered medical homes, coordination and expansion of health information technology (HIT) efforts, and also discusses payment options for such integration. Title V of the PPACA outlines a plan to improve access to and delivery of health care services for all individuals, particularly low-income, underserved, uninsured, minority, health disparity, and rural populations. Community health workers' role as trusted community leaders can facilitate accurate data collection, program enrollment, and provision of culturally and linguistically appropriate, patient- and family-centered care. Because CHWs already support disease management and care coordination services, they will be critical to delivering and expanding patient-centered medical homes and Health Home services, especially for communities that suffer disproportionately from multiple chronic diseases. Community health workers' unique expertise in conducting outreach make them well positioned to help enroll people in Medicaid or insurance offered by Health Benefit Exchanges. New payment models provide opportunities to fund and sustain CHWs. Community health workers can support the effective implementation of PPACA if the capacity and potential of CHWs to serve as cultural brokers and bridges among medically underserved communities and health care delivery systems is fully tapped. Patient Protection and Affordable Care Act and current payment structures provide an unprecedented and important vehicle for integrating and sustaining CHWs as part of these new delivery and enrollment models.

Integrating Community Health Workers Within Patient Protection and Affordable Care Act Implementation

PubMed Central

Islam, Nadia; Nadkarni, Smiti Kapadia; Zahn, Deborah; Skillman, Megan; Kwon, Simona C.; Trinh-Shevrin, Chau

2015-01-01

Context The Patient Protection and Affordable Care Act’s (PPACA) emphasis on community-based initiatives affords a unique opportunity to disseminate and scale up evidence-based community health worker (CHW) models that integrate CHWs within health care delivery teams and programs. Community health workers have unique access and local knowledge that can inform program development and evaluation, improve service delivery and care coordination, and expand health care access. As a member of the PPACA-defined health care workforce, CHWs have the potential to positively impact numerous programs and reduce costs. Objective This article discusses different strategies for integrating CHW models within PPACA implementation through facilitated enrollment strategies, patient-centered medical homes, coordination and expansion of health information technology (HIT) efforts, and also discusses payment options for such integration. Results Title V of the PPACA outlines a plan to improve access to and delivery of health care services for all individuals, particularly low-income, underserved, uninsured, minority, health disparity, and rural populations. Community health workers’ role as trusted community leaders can facilitate accurate data collection, program enrollment, and provision of culturally and linguistically appropriate, patient- and family-centered care. Because CHWs already support disease management and care coordination services, they will be critical to delivering and expanding patient-centered medical homes and Health Home services, especially for communities that suffer disproportionately from multiple chronic diseases. Community health workers’ unique expertise in conducting outreach make them well positioned to help enroll people in Medicaid or insurance offered by Health Benefit Exchanges. New payment models provide opportunities to fund and sustain CHWs. Conclusion Community health workers can support the effective implementation of PPACA if the capacity and potential of CHWs to serve as cultural brokers and bridges among medically underserved communities and health care delivery systems is fully tapped. Patient Protection and Affordable Care Act and current payment structures provide an unprecedented and important vehicle for integrating and sustaining CHWs as part of these new delivery and enrollment models. PMID:25414955