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.

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.

Health IT-enabled Care for Underserved Rural Populations: The Role of Nursing

PubMed Central

Effken, Judith A.; Abbott, Patricia

2009-01-01

This white paper explains the strong roles that nursing can play in using information technology (IT) to improve healthcare delivery in rural areas. The authors describe current challenges to providing care in rural areas, and how technology innovations can help rural communities to improve their health and health care. To maximize benefits, rural stakeholders (as individuals and groups) must collaborate to effect change. Because nonphysician providers deliver much of the health care in rural communities, this paper focuses on the critical roles of nurses on IT-enabled caremanagement teams. The authors propose changes in nursing practice, policy, and education to better prepare, encourage, and enable nurses to assume leadership roles in IT-enabled health care management in rural communities. PMID:19261937

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.

Perceived impact of an interprofessional education program on community resilience: an exploratory study.

PubMed

Slack, Marion Kimball; McEwen, Marylyn Morris

2013-09-01

The purpose of this study was to explore the perceived impact of an interprofessional education (IPE) program for health sciences students on two culturally diverse, underserved communities. A community resilience/capacity framework, consisting of catalysts (primarily the creation of awareness) and capital components: human (workforce development), social (networking and empowerment) and economic (volunteer labor and money spent by the program), provided the conceptual underpinnings for the study. Focus groups with stakeholders in two communities, one rural and one metropolitan, were audio-recorded, transcribed and analyzed by categorizing data according to each capital component. In addition to the concepts contained in the capacity framework a new category, informational capital (data specific to the community) emerged during the analysis. We suggest that by acting as a catalyst a community based interprofessional program can affect components of community resilience/capacity, primarily human, social, and informational capital. Using the community resilience/capacity framework facilitated exploration of the perceived impact of an educational program on one rural and one urban underserved community beyond assessing student outcomes or number of clients served.

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.

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

STRUCTURAL INEQUALITY AND SOCIAL SUPPORT FOR WOMEN PRISONERS RELEASED TO RURAL COMMUNITIES

PubMed Central

Nicdao, Ethel G.; Trott, Elise M.; Kellett, Nicole C.

2016-01-01

Incarceration and community reentry for rural women reflect gendered processes. We draw upon in-depth semi-structured interviews and focus groups to examine the return of women prisoners to underserved rural communities, while attending to the perspectives of their closest social supporters. Our findings underscore the complexity of the reentry process for rural women and its particular impact on their families. We challenge dominant discourses of personal responsibility that detract from the structura violence and injustice shaping reentry experiences for women and their social supporters. We also consider the policy implications of discharge and reentry planning for rural women and their families, as well as strategies to reduce recidivism. PMID:27274615

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.

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

78 FR 38099 - Notice of Funds Availability Inviting Applications for the Rural Veterans Coordination; Amendment

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-25

... who are transitioning from military service to civilian life in rural or underserved communities. To... accordance with this NOFA no later than midnight eastern standard time on September 19, 2013. Applications.... In the interest of fairness to all competing applicants, this deadline of no later than midnight...

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...

78 FR 18415 - Council on Underserved Communities, Re-Establishment

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-26

... provide an essential connection between SBA and small businesses in inner city and rural communities. The Council's scope of activities includes reviewing SBA current programs and policies, while working towards... has a total of twenty (20) members, 19 members-at-large and one Chair. Members consist of current or...

Place-Based Education for Environmental Behavior: A 'Funds of Knowledge' and Social Capital Approach

ERIC Educational Resources Information Center

Cruz, Austin R.; Selby, Samantha T.; Durham, William H.

2018-01-01

In this paper we suggest that a new theoretical framework is needed within environmental education in the discussion of rural, underserved communities in Latin America. We argue that a community-resources approach, comprised of funds of knowledge and social capital, should be incorporated into contemporary research on place- and community-based…

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.

Challenges for developing RHIOs in rural America: a study in Appalachian Ohio.

PubMed

Phillips, Brian O; Welch, Elissa E

2007-01-01

A healthy population is essential for the socioeconomic success of the Appalachian region and other rural, underserved areas in the United States. However, rural communities are only beginning to deploy the advanced health information technologies being used by larger urban institutions. Regional health information organizations have the potential to be the building blocks that will harmonize HIT exchange on a national scale. But there are many challenges to developing RHIOs in rural communities. In 2004, the Ohio University College of Osteopathic Medicine convened the Appalachian Regional Informatics Consortium, a community-based cross-section of healthcare providers in southeastern Ohio. The consortium was awarded an Integrated Advanced Information Management Systems planning grant from the National Institutes of Health to investigate rural RHIO development, the first such rural project. This article examines the consortium and the challenges facing rural RHIO development in Appalachian Ohio.

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...

Impact of an interprofessional education program on developing skilled graduates well-equipped to practise in rural and underserved areas.

PubMed

Mpofu, Ratie; Daniels, Priscilla S; Adonis, Tracy-Ann; Karuguti, Wallace M

2014-01-01

Poverty, limited access to resources and a lack of infrastructure characterise the division of rural areas from urban South Africa. Low numbers of social welfare professionals compound the problem. With education linked inextricably in social responsibility, higher education institutions (HEIs) are called upon increasingly to create conditions that encourage students and graduates to practise in more socially responsible ways, involving more than mere disciplinary expertise or technical knowledge, and that consider the problems of rural areas. Use of interprofessional education (IPE) programs, based on teamwork, could enable HEIs to train and guide health sciences students in how best to cooperate with each other and combine their skills to mutual benefit. This would enable them to develop professional skills facilitated by interactive engagement within community settings. Referencing experience gained in Australia and elsewhere, the Faculty of Community and Health Sciences (FCHS) at the University of Western Cape (UWC) has developed and applied an IPE program for South Africa. Students were placed in interdisciplinary groups in a rural and underserved municipality of the Western Cape - 17 students participated in a study on the effectiveness of this program. A quantitative self-administered questionnaire, followed by qualitative focus group discussions, established student perceptions of their IPE experience, how the experience influenced their intentions for or against future practice in rural and underserved areas, and their interest in future interprofessional collaboration and practice. More than 75% of the participating students agreed that they had learnt to develop knowledge base, procedural and healthcare practice presentation skills, along with preparing written community health histories. Student willingness to practise in rural areas was evidenced, citing community- and resource-based factors as determinants; however, concerns that some community members had 'own agendas' were expressed. Nearly all students highly appreciated their learning and service delivery development, but 47% felt that their educational experience did not go as far as expected. Student concerns were a lack of structured student placement for IPE to occur in the program, as well as limited staff supervision of students. The UWC FCHS IPE program is evidenced as a valid approach to encouraging health sciences students and graduates to choose to practise in more socially responsible ways. However, improvement of placement and supervision methodology and practice should be explored at faculty level and implemented in future IPE programs.

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…

Exploring the Use of Electronic Mobile Technologies among Distance Learners in Rural Communities for Safe and Disruptive Learning

ERIC Educational Resources Information Center

Ntloedibe-Kuswani, Gomang Seratwa

2013-01-01

Several studies indicated the potential of electronic mobile technologies in reaching (safe learning) under-served communities and engaging (disruptive learning) disadvantaged peoples affording them learning experiences. However, the potential benefits of (electronic mobile learning) e-mobile learning have not been well understood from the…

76 FR 76905 - Extension of Comment Period for Proposed Rulemaking on Substantially Underserved Trust Areas (SUTA)

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-09

... and community development. By financing improvements to rural electric, water and waste, and telecom..., water and waste, and telecom and broadband programs. The proposed rule invited the public to submit...

Librarian-initiated HIV/AIDS prevention intervention program outcome in rural communities in Oyo State, Nigeria.

PubMed

Ajuwon, G A; Komolafe-Opadeji, H O; Ikhizama, B

2013-01-01

The objective of this study was to meet the HIV/AIDS information and service needs of citizens living in selected rural, underserved communities in Oyo State, Nigeria. This was a librarian-initiated intervention program (pre-post) study of heads of rural households in Oyo State. A questionnaire was used for pre- and post-intervention assessment. The education covered knowledge about HIV/AIDS, routes of transmission, prevention strategies, and attitude toward persons living with HIV. It increased participants' knowledge about AIDS and improved attitude toward those living with HIV. Provision and dissemination of information on HIV/AIDS through librarians to rural settlers is an important prevention strategy and librarians can make major contributions.

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.

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.

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.

Teaching Health Center Graduate Medical Education Locations Predominantly Located in Federally Designated Underserved Areas.

PubMed

Barclift, Songhai C; Brown, Elizabeth J; Finnegan, Sean C; Cohen, Elena R; Klink, Kathleen

2016-05-01

Background The Teaching Health Center Graduate Medical Education (THCGME) program is an Affordable Care Act funding initiative designed to expand primary care residency training in community-based ambulatory settings. Statute suggests, but does not require, training in underserved settings. Residents who train in underserved settings are more likely to go on to practice in similar settings, and graduates more often than not practice near where they have trained. Objective The objective of this study was to describe and quantify federally designated clinical continuity training sites of the THCGME program. Methods Geographic locations of the training sites were collected and characterized as Health Professional Shortage Area, Medically Underserved Area, Population, or rural areas, and were compared with the distribution of Centers for Medicare and Medicaid Services (CMS)-funded training positions. Results More than half of the teaching health centers (57%) are located in states that are in the 4 quintiles with the lowest CMS-funded resident-to-population ratio. Of the 109 training sites identified, more than 70% are located in federally designated high-need areas. Conclusions The THCGME program is a model that funds residency training in community-based ambulatory settings. Statute suggests, but does not explicitly require, that training take place in underserved settings. Because the majority of the 109 clinical training sites of the 60 funded programs in 2014-2015 are located in federally designated underserved locations, the THCGME program deserves further study as a model to improve primary care distribution into high-need communities.

Recognizing the potential for a national fresh food financing initiative to provide an effective and economically sustainable solution to the problem of limited access to healthy foods in underserved urban, suburban, and rural low-income communities, while also improving health and stimulating local economic development.

THOMAS, 111th Congress

Rep. Schwartz, Allyson Y. [D-PA-13

2009-12-15

House - 03/29/2010 Referred to the Subcommittee on Rural Development, Biotechnology, Specialty Crops, and Foreign Agriculture. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

The Knowledge Is Power Program (KIPP): An Analysis of One Model's Efforts to Promote Achievement in Underserved Communities

ERIC Educational Resources Information Center

Macey, Erin; Decker, Janet; Eckes, Suzanne

2009-01-01

Many claim that the Knowledge is Power Program has experienced success in closing the achievement gap in urban and rural communities across America. Studies suggest that KIPP charter schools enroll an overwhelming proportion of poor and minority students and often outperform their district peers. However, the purpose of this study is not to…

Coaching mental health peer advocates for rural LGBTQ people.

PubMed

Willging, Cathleen E; Israel, Tania; Ley, David; Trott, Elise M; DeMaria, Catherine; Joplin, Aaron; Smiley, Verida

Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) people are affected by mental health disparities, especially in rural communities. We trained peer advocates in rural areas in the fundamentals of mental health, outreach, education, and support for this population. The peer advocates were coached by licensed mental health professionals. We evaluated this process through iterative qualitative analysis of semi-structured interviews and written logs from coaches and advocates. The six major themes comprising the results centered on (1) coaching support, (2) peer advocate skills and preparation, (3) working with help seekers, (4) negotiating diversity, (5) logistical challenges in rural contexts, and (6) systemic challenges. We concluded that peer advocacy for LGBTQ people with mental distress offers an affirmative, community-based strategy to assist the underserved. To be successful, however, peer advocates will likely require ongoing training, coaching, and infrastructural support to negotiate contextual factors that can influence provision of community resources and support to LGBTQ people within rural communities.

Coaching mental health peer advocates for rural LGBTQ people

PubMed Central

Willging, Cathleen E.; Israel, Tania; Ley, David; Trott, Elise M.; DeMaria, Catherine; Joplin, Aaron; Smiley, Verida

2016-01-01

Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) people are affected by mental health disparities, especially in rural communities. We trained peer advocates in rural areas in the fundamentals of mental health, outreach, education, and support for this population. The peer advocates were coached by licensed mental health professionals. We evaluated this process through iterative qualitative analysis of semi-structured interviews and written logs from coaches and advocates. The six major themes comprising the results centered on (1) coaching support, (2) peer advocate skills and preparation, (3) working with help seekers, (4) negotiating diversity, (5) logistical challenges in rural contexts, and (6) systemic challenges. We concluded that peer advocacy for LGBTQ people with mental distress offers an affirmative, community-based strategy to assist the underserved. To be successful, however, peer advocates will likely require ongoing training, coaching, and infrastructural support to negotiate contextual factors that can influence provision of community resources and support to LGBTQ people within rural communities. PMID:27458498

Should Master's Level Training To Provide Rural Services Survive?

ERIC Educational Resources Information Center

Keller, Peter A.

Despite recent efforts to encourage federal funding of psychological services for underserved populations such as the elderly and residents of rural areas, ample evidence suggests that rural areas are underserved by psychologists. Drawing on data from rural and urban areas in Pennsylvania, this paper argues that master's level training can provide…

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.

Strong Hearts, healthy communities: a rural community-based cardiovascular disease prevention program.

PubMed

Seguin, Rebecca A; Eldridge, Galen; Graham, Meredith L; Folta, Sara C; Nelson, Miriam E; Strogatz, David

2016-01-28

Cardiovascular disease is the leading cause of death in the United States and places substantial burden on the health care system. Rural populations, especially women, have considerably higher rates of cardiovascular disease, influenced by poverty, environmental factors, access to health care, and social and cultural attitudes and norms. This community-based study will be a two-arm randomized controlled efficacy trial comparing a multi-level, community program (Strong Hearts, Healthy Communities) with a minimal intervention control program (Strong Hearts, Healthy Women). Strong Hearts, Healthy Communities was developed by integrating content from three evidence-based programs and was informed by extensive formative research (e.g. community assessments, focus groups, and key informant interviews). Classes will meet twice weekly for one hour for 24 weeks and focus on individual-level skill building and behavior change; social and civic engagement are also core programmatic elements. Strong Hearts, Healthy Women will meet monthly for hour-long sessions over the 24 weeks covering similar content in a general, condensed format. Overweight, sedentary women 40 years of age and older from rural, medically underserved communities (12 in Montana and 4 in New York) will be recruited; sites, pair-matched based on rurality, will be randomized to full or minimal intervention. Data will be collected at baseline, midpoint, intervention completion, and six-month, one-year, and eighteen months post-intervention. The primary outcome is change in body weight; secondary outcomes include physiologic, anthropometric, behavioral, and psychosocial variables. In the full intervention, engagement of participants' friends and family members in partnered activities and community events is an intervention target, hypothesizing that there will be a reciprocal influence of physical activity and diet behavior between participants and their social network. Family members and/or friends will be invited to complete baseline and follow-up questionnaires about their health behaviors and environment, height and weight, and attitudes and beliefs. Strong Hearts, Healthy Communities aims to reduce cardiovascular disease morbidity and mortality, improve quality of life, and reduce cardiovascular disease-related health care burden in underserved rural communities. If successful, the long-term goal is for the program to be nationally disseminated, providing a feasible model to reduce cardiovascular disease in rural settings. ClinicalTrials.gov Identifier: NCT02499731 Registered on July 1, 2015.

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.

"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.

National Telerehabilitation Service System: Helping Rural Under-Served Communities and Individuals with Disabilities

ERIC Educational Resources Information Center

Exceptional Parent, 2006

2006-01-01

The National Telerehabilitation Service System (NTSS) was created to provide access to quality rehabilitation services by researching new or existing telecommunications (communicating information, including data, text, pictures, voice, and video, over long distances) and computing technologies and modifying them to meet the needs of people with…

Stated Preferences of Doctors for Choosing a Job in Rural Areas of Peru: A Discrete Choice Experiment

PubMed Central

Miranda, J. Jaime; Diez-Canseco, Francisco; Lema, Claudia; Lescano, Andrés G.; Lagarde, Mylene; Blaauw, Duane; Huicho, Luis

2012-01-01

Background Doctors’ scarcity in rural areas remains a serious problem in Latin America and Peru. Few studies have explored job preferences of doctors working in underserved areas. We aimed to investigate doctors’ stated preferences for rural jobs. Methods and Findings A labelled discrete choice experiment (DCE) was performed in Ayacucho, an underserved department of Peru. Preferences were assessed for three locations: rural community, Ayacucho city (Ayacucho’s capital) and other provincial capital city. Policy simulations were run to assess the effect of job attributes on uptake of a rural post. Multiple conditional logistic regressions were used to assess the relative importance of job attributes and of individual characteristics. A total of 102 doctors participated. They were five times more likely to choose a job post in Ayacucho city over a rural community (OR 4.97, 95%CI 1.2; 20.54). Salary increases and bonus points for specialization acted as incentives to choose a rural area, while increase in the number of years needed to get a permanent post acted as a disincentive. Being male and working in a hospital reduced considerably chances of choosing a rural job, while not living with a partner increased them. Policy simulations showed that a package of 75% salary increase, getting a permanent contract after two years in rural settings, and getting bonus points for further specialisation increased rural job uptake from 21% to 77%. A package of 50% salary increase plus bonus points for further specialisation would also increase the rural uptake from 21% to 52%. Conclusions Doctors are five times more likely to favour a job in urban areas over rural settings. This strong preference needs to be overcome by future policies aimed at improving the scarcity of rural doctors. Some incentives, alone or combined, seem feasible and sustainable, whilst others may pose a high fiscal burden. PMID:23272065

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

A Mixed Methods Review of Education and Patient Navigation Interventions to Increase Breast and Cervical Cancer Screening for Rural Women.

PubMed

Falk, Derek

2018-01-01

Reviews have assessed studies of breast and cervical cancer screening access and utilization for rural women, but none analyze interventions to increase screening rates. A mixed methods literature search identified studies of breast and/or cervical cancer prevention education and patient navigation interventions for rural women. Rural areas need greater implementation and evaluation of screening interventions as these services address the challenges of delivering patient-centered cancer care to un-/underserved communities. The lack of intervention studies on breast and cervical cancer education and patient navigation programs compared to urban studies highlights the need for validation of these programs among diverse, rural populations.

Providing Education to Girls from Remote and Rural Areas. Advocacy Brief

ERIC Educational Resources Information Center

Bista, Min B.; Cosstick, Frances Elizabeth

2005-01-01

Background: The Dakar Framework for Action calls on the world community to develop strategies for educating underserved groups and those children who live under difficult circumstances. To achieve this Education For All (EFA) goal, one approach is the use of boarding schools. Purpose: To document the advantages and disadvantages of how boarding…

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.

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

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.

Partnering on a Curriculum To Address the Dental Care Crisis in a Rural Island Community: The First Step of a Career Ladder Program in Dental Assisting.

ERIC Educational Resources Information Center

Pezzoli, J. A.; Johnson, Nancy

This document describes the curriculum and objectives of the Certificate of Completion in Dental Assisting at Maui Community College, Hawaii. Hawaii is below the national average in oral health care, with as many as 40% of Maui residents being underserved. Dental disease among the uninsured and underinsured in Hawaii is three times the national…

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.

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.

Strengthening the rural dietetics workforce: examining early effects of the Northern Ontario Dietetic Internship Program on recruitment and retention.

PubMed

Hill, Mary Ellen; Raftis, Denise; Wakewich, Pamela

2017-01-01

As with other allied health professions, recruitment and retention of dietitians to positions in rural and isolated positions is challenging. The aim of this study was to examine the early effects of the Northern Ontario Dietetic Internship Program (NODIP) on recruitment and retention of dietitians to rural and northern dietetics practice. The program is unique in being the only postgraduate dietetics internship program in Canada that actively selects candidates who have a desire to live and work in northern and rural areas. Objectives of the survey were to track the early career experiences of the first five cohorts (2008-2012) of NODIP graduates, with an emphasis on employment in underserviced rural and northern areas of Ontario. NODIP graduates (62) were invited to complete a 27-item, self-administered, mailed questionnaire approximately 22 months after graduation. The survey, reflecting issues identified in the rural allied health and dietetics literature, documented their work history, practice locations, employment settings, roles, future career intentions and rural background. Aggregated data were analyzed descriptively to assess their early work experiences, with a focus on their acceptance of positions in rural and northern communities. Items also assessed professional and personal factors influencing their most recent decisions concerning practice locations. Three-quarters of graduates chose organizations serving rural or northern communities for their first employment positions and two-thirds were practicing in rural and underserviced areas when surveyed. Most worked as clinical, community health or public health dietitians, in diverse settings including clinics, hospitals and diabetes care programs. Although most had found permanent positions, working for more than one employer at a time was not uncommon. Factors affecting practice choices included prior awareness of employers, prospects for full-time employment, flexible working conditions, access to interprofessional practice and continuing education, as well as community and family concerns. Intentions to remain in current positions were also shaped by a mixture of professional and personal considerations. Some would relocate in search of opportunities for specialization; a few would leave due to dissatisfaction with employment conditions and disinterest in work; others would move due to personal and family commitments. This study provides early evidence that the NODIP distributed and community-engaged learning model has been very successful in its goal of augmenting the rural and northern dietetics workforce, with a majority of graduates accepting and remaining in rural positions during their first 2 years of practice. Whether graduates remain in rural practice, however, depends on a number of other factors, including career aspirations, availability of professional supports and personal commitments. This suggests that additional supports, above and beyond the NODIP internship, may be needed to encourage graduate dietitians to stay in rural and northern practice locations over the longer term.

Men's Educational Group Appointments in Rural Nicaragua.

PubMed

Campbell, Bruce B; Gonzalez, Hugo; Campbell, McKenzie; Campbell, Kent

2017-03-01

Men's preventive health and wellness is largely neglected in rural Nicaragua, where a machismo culture prevents men from seeking health care. To address this issue, a men's educational group appointment model was initiated at a rural health post to increase awareness about hypertension, and to train community health leaders to measure blood pressure. Men's hypertension workshops were conducted with patient knowledge pretesting, didactic teaching, and posttesting. Pretesting and posttesting performances were recorded, blood pressures were screened, and community leaders were trained to perform sphygmomanometry. An increase in hypertension-related knowledge was observed after every workshop and community health leaders demonstrated proficiency in sphygmomanometry. In addition, several at-risk patients were identified and follow-up care arranged. Men's educational group appointments, shown to be effective in the United States in increasing patient knowledge and satisfaction, appear to function similarly in a resource-constrained environment and may be an effective mechanism for reaching underserved men in Nicaragua.

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...

A Comparison of Intellectual Assessments over Video Conferencing and In-Person for Individuals with ID: Preliminary Data

ERIC Educational Resources Information Center

Temple, V.; Drummond, C.; Valiquette, S.; Jozsvai, E.

2010-01-01

Background: Video conferencing (VC) technology has great potential to increase accessibility to healthcare services for those living in rural or underserved communities. Previous studies have had some success in validating a small number of psychological tests for VC administration; however, VC has not been investigated for use with persons with…

The Importance of Location for Tobacco Cessation: Rural-Urban Disparities in Quit Success in Underserved West Virginia Counties

ERIC Educational Resources Information Center

Northridge, Mary E.; Vallone, Donna; Xiao, Haijun; Green, Molly; Blackwood, Julia Weikle; Kemper, Suzanne E.; Duke, Jennifer; Watson, Kimberly A.; Burrus, Barri; Treadwell, Henrie M.

2008-01-01

Context: Adults who live in rural areas of the United States have among the highest smoking rates in the country. Rural populations, including Appalachian adults, have been historically underserved by tobacco control programs and policies and little is known about their effectiveness. Purpose: To examine the end-of-class quit success of…

Characteristics of Rural Communities with a Sole, Independently Owned Pharmacy.

PubMed

Nattinger, Matthew; Ullrich, Fred; Mueller, Keith J

2015-04-01

Prior RUPRI Center policy briefs have described the role of rural pharmacies in providing many essential clinical services (in addition to prescription and nonprescription medications), such as blood pressure monitoring, immunizations, and diabetes counseling, and the adverse effects of Medicare Part D negotiated networks on the financial viability of rural pharmacies.1 Because rural pharmacies play such a broad role in health care delivery, pharmacy closures can sharply reduce access to essential health care services in rural and underserved communities. These closures are of particular concern in rural areas served by a sole, independently owned pharmacy (i.e., a pharmacy unaffiliated with a chain or franchise). This policy brief characterizes the population of rural areas served by a sole, independently owned pharmacy. Dependent on a sole pharmacy, these areas are at highest risk to lose access to many essential clinical services. Key Findings. (1) In 2014 over 2.7 million people lived in 663 rural communities served by a sole, independently owned pharmacy. (2) More than one-quarter of these residents (27.9 percent) were living below 150 percent of the federal poverty level. (3) Based on estimates from 2012, a substantial portion of the residents of these areas were dependent on public insurance (i.e., Medicare and/or Medicaid, 20.5 percent) or were uninsured (15.0 percent). (4) If the sole, independent retail pharmacy in these communities were to close, the next closest retail pharmacy would be over 10 miles away for a majority of rural communities (69.7 percent).

Bringing cutting-edge Earth and ocean sciences to under-served and rural audiences through informal science education

NASA Astrophysics Data System (ADS)

Cooper, S. K.; Petronotis, K. E.; Ferraro, C.; Johnson, K. T. M.; Yarincik, K.

2017-12-01

The International Ocean Discovery Program (IODP) is an international marine research collaboration that explores Earth's history and dynamics using ocean-going research platforms to recover data recorded in seafloor sediments and rocks and to monitor subseafloor environments. The JOIDES Resolution is the flagship vessel of IODP and is operated by the National Science Foundation. It is an inspirational hook for STEM Earth and ocean topics for children and the general public of all ages, but is not easily accessible due to its international travels and infrequent U.S. port calls. In response, a consortium of partners has created the Pop-Up/Drill Down Science project. The multi-year project, funded by NSF's Advancing Informal Science Learning program, aims to bring the JR and its science to under-served and rural populations throughout the country. Consisting of an inflatable walk-through ship, a multi-media experience, a giant interactive seafloor map and a series of interactive exhibit kiosks, the exhibit, entitled, In Search of Earth's Secrets: A Pop-Up Science Encounter, will travel to 12 communities throughout the next four years. In each community, the project will partner with local institutions like public libraries and small museums as hosts and to train local Girl Scouts to serve as exhibit facilitators. By working with local communities to select events and venues for pop-up events, the project hopes to bring cutting edge Earth and ocean science in creative new ways to underserved populations and inspire diverse audiences to explore further. This presentation will provide details of the project's goals, objectives and development and provide avenues to become involved.

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.

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.…

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

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.

Profiles of rural longitudinal integrated clerkship students: a descriptive study of six consecutive student cohorts *.

PubMed

Brooks, Kathleen D; Eley, Diann S; Zink, Therese

2014-02-01

Medical schools worldwide are challenged to address the rural primary care workforce shortage by creating community-engaged curricula to nurture student interest in rural practice. To examine the personal characteristics of six consecutive rural longitudinal integrated clerkship student cohorts to understand whom the programs attract and select and thus inform the development of such programs. A cross-sectional cohort design was used. Six cohorts (2007-2012) completed a survey on demographics and factors that influenced their choice of rural primary care. The Temperament and Character Inventory was used to measure personality. Analysis was mainly descriptive. Where appropriate univariate analysis compared variables between groups. Sample size was 205 with the majority female (61%), between 25 and 29 years (64%), single (60%) and lived longest in rural communities with populations less than 20,000 (60%). Rural lifestyle, background and desire to work in underserved areas were noted to impact rural medicine interest. Professional satisfaction, personal and professional goals and family needs had the highest impact on career decisions, and financial concerns lowest. The stability of students' personal characteristics across cohorts and the workforce outcomes of this program suggest the recruitment process successfully nurtures students who will fit well into future rural practice.

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.

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:…

75 FR 29447 - Public Health Service Act, Rural Physician Training Grant Program, Definition of “Underserved...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-26

..., identified by the Regulatory Information Number (RIN), by any of the following methods: Federal eRulemaking... assisting eligible entities in recruiting students most likely to practice medicine in underserved rural... determined that good cause exists which makes the usual notice and comment procedure impractical, unnecessary...

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…

New Mexico community voices: policy reform to reduce oral health disparities.

PubMed

Powell, Wayne; Hollis, Christine; de la Rosa, Mario; Helitzer, Deborah L; Derksen, Daniel

2006-02-01

Using a socio-ecological framework to guide the initiative, New Mexico Community Voices developed, with state and local stakeholders, responsive oral health policies to address oral health disparities. Several policy objectives were achieved: increasing awareness of the public health importance of oral health; improving access to dental services for uninsured or underserved populations; enhancing dental services specialty care; and increasing sustainable oral health infrastructure through pipeline development of oral health providers to relieve service shortages and diversify the oral health workforce. Improving access to oral health and augmenting numbers of dental providers in rural areas were also successful. The governor has appointed the New Mexico Oral Health Advisory Council to address state oral health issues. The New Mexico partnerships have demonstrated how effective policy change can generate important incremental shifts in oral health care delivery and provide best practice models that diminish the oral health crisis faced by underserved populations.

African American community breast health education: a pilot project.

PubMed

Robertson, Ethel M; Franklin, Anett Wakefield; Flores, AnnMarie; Wherry, Shari; Buford, Juanita

2006-01-01

This paper reports the results of a project designed to examine the effectiveness of a Train the Trainer breast health education and screening program for African American, elderly and underserved women residing in the greater Nashville area. The project aimed to identify a cadre of women from the community willing to serve as leaders advocated and peer breast health educators. Data collected from the community leaders and the women from the local community during the course of the project suggest that the Train the Trainer model was well suited to provide education, support and breast cancer resource referral to women residing within this rural Tennessee community.

Identifying environmental health priorities in underserved populations: a study of rural versus urban communities

PubMed Central

Bernhard, M.C.; Evans, M.B.; Kent, S.T.; Johnson, E.; Threadgill, S.L.; Tyson, S.; Becker, S.M.; Gohlke, J.M.

2013-01-01

Objectives Understanding and effectively addressing persistent health disparities in minority communities requires a clear picture of members’ concerns and priorities. This study was intended to engage residents in urban and rural communities in order to identify environmental health priorities. Specific emphasis was placed on how the communities defined the term environment, their perceptions of environmental exposures as affecting their health, specific priorities in their communities, and differences in urban versus rural populations. Study design A community-engaged approach was used to develop and implement focus groups and compare environmental health priorities in urban versus rural communities. Methods A total of eight focus groups were conducted: four in rural and four in urban communities. Topics included defining the term environment, how the environment may affect health, and environmental priorities within their communities, using both open discussion and a predefined list. Data were analysed both qualitatively and quantitatively to identify patterns and trends. Results There were important areas of overlap in priorities between urban and rural communities; both emphasized the importance of the social environment and shared a concern over air pollution from industrial sources. In contrast, for urban focus groups, abandoned houses and their social and physical sequelae were a high priority while concerns about adequate sewer and water services and road maintenance were high priorities in rural communities. Conclusions This study was able to identify environmental health priorities in urban versus rural minority communities. In contrast to some previous risk perception research, the results of this study suggest prioritization of tangible, known risks in everyday life instead of rare, disaster-related events, even in communities that have recently experienced devastating damage from tornadoes. The findings can help inform future efforts to study, understand and effectively address environmental issues, and are particularly relevant to developing effective community-based strategies in vulnerable populations. PMID:24239281

Men’s Educational Group Appointments in Rural Nicaragua

PubMed Central

Campbell, Bruce B.; Gonzalez, Hugo; Campbell, McKenzie; Campbell, Kent

2016-01-01

Men’s preventive health and wellness is largely neglected in rural Nicaragua, where a machismo culture prevents men from seeking health care. To address this issue, a men’s educational group appointment model was initiated at a rural health post to increase awareness about hypertension, and to train community health leaders to measure blood pressure. Men’s hypertension workshops were conducted with patient knowledge pretesting, didactic teaching, and posttesting. Pretesting and posttesting performances were recorded, blood pressures were screened, and community leaders were trained to perform sphygmomanometry. An increase in hypertension-related knowledge was observed after every workshop and community health leaders demonstrated proficiency in sphygmomanometry. In addition, several at-risk patients were identified and follow-up care arranged. Men’s educational group appointments, shown to be effective in the United States in increasing patient knowledge and satisfaction, appear to function similarly in a resource-constrained environment and may be an effective mechanism for reaching underserved men in Nicaragua. PMID:27885146

Qualitative evaluation of a physical activity-based chronic disease prevention program in a low-income, rural South African setting.

PubMed

Draper, Catherine E; Nemutandani, Simon M; Grimsrud, Anna T; Rudolph, Michael; Kolbe-Alexander, Tracy L; de Kock, Lauren; Lambert, Estelle V

2010-01-01

Chronic diseases, an increasing global concern, are prevalent in the low-income communities of South Africa, where rural health systems bear the double burden of infectious and chronic diseases. The Discovery Healthy Lifestyle Programme (DHLP) is a physical activity-based chronic disease prevention program that has been implemented in a low-income, rural setting in South Africa. The DHLP consists of both school- and primary healthcare clinic-based interventions for learners (Healthnutz) and adults (Live it Up), facilitated by teachers, nurses and community volunteers. The aim of this evaluation was to qualitatively assess the process by which the DHLP was implemented, identifying enabling factors and barriers. Data were collected in target communities at schools and clinics from semi-structured focus groups of program leaders and members, teachers and community members (n = 45), situational analyses of the school physical activity environment, informal community observations and informal interviews with program coordinators. The target communities faced socioeconomic and health inequalities and remained under-resourced and under-served. In spite of these and other challenges, the DHLP was well received by community members and stakeholders. It was valued by respondents for its health and psychosocial outcomes, evidenced by increased knowledge and awareness of the importance of physical activity and healthy lifestyles, and positively altered perceptions of physical activity. Program implementers believed the Live it Up component was growing, and this suggested the sustainability of the program. There were, however, some concerns about the fidelity of the Healthnutz intervention, due to timetabling difficulties. Despite this, teachers were positive about the program and its value for their learners, staff and school. The community characteristics of being under-resourced and under-served appeared to positively influence DHLP implementation. Local government involvement in the DHLP resulted in greater ownership of the program, which enabled successful implementation. This study presents a unique opportunity to assess the implementation and sustainability requirements of programs in environments of limited resources, considerable burden of infectious and chronic diseases and extensive socioeconomic challenges. The findings suggest that through enhancement of knowledge, transfer of appropriate skills and the provision of an enabling environment, participation in physical activity can be effectively promoted in a low-income, rural setting. Physical activity interventions that promote the participation and empowerment of rural communities can be feasible and accessible, thereby assisting in addressing the growing burden of chronic diseases in low-income.

Using an Interactive Systems Framework to Expand Telepsychology Innovations in Underserved Communities

PubMed Central

Alaniz, Angela B.

2016-01-01

Literature indicates that the use of promising innovations in mental health care can be improved. The advancement of telepsychology is one innovation that has been utilized as a method to reduce rural health disparities and increase the number of people with access to mental health services. This paper describes a successful pilot telepsychology program implemented in a rural community to increase access to mental health services and the model's replication and expansion into four additional communities using concepts described in an Interactive Systems Framework. The Interactive Systems Framework highlights how building local capacity specific to organizational functioning and innovations are necessary to support, deliver, and disseminate innovations within new settings. Based on the knowledge gained from this telepsychology innovation, the application of an Interactive Systems Framework and funding mechanisms are discussed. PMID:27403374

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.

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...

Sources and perceptions of indoor and ambient air pollution in rural Alaska.

PubMed

Ware, Desirae; Lewis, Johnnye; Hopkins, Scarlett; Boyer, Bert; Noonan, Curtis; Ward, Tony

2013-08-01

Even though Alaska is the largest state in the United States, much of the population resides in rural and underserved areas with documented disparities in respiratory health. This is especially true in the Yukon-Kuskokwim (southwest) and Ahtna (southcentral) Regions of Alaska. In working with community members, the goal of this study was to identify the air pollution issues (both indoors and outdoors) of concern within these two regions. Over a two-year period, 328 air quality surveys were disseminated within seven communities in rural Alaska. The surveys focused on understanding the demographics, home heating practices, indoor activities, community/outdoor activities, and air quality perceptions within each community. Results from these surveys showed that there is elevated potential for PM10/PM2.5 exposures in rural Alaska communities. Top indoor air quality concerns included mold, lack of ventilation or fresh air, and dust. Top outdoor air pollution concerns identified were open burning/smoke, road dust, and vehicle exhaust (e.g., snow machines, ATVs, etc.). These data can now be used to seek additional funding for interventions, implementing long-term, sustainable solutions to the identified problems. Further research is needed to assess exposures to PM10/PM2.5 and the associated impacts on respiratory health, particularly among susceptible populations such as young children.

Empowering Promotores de Salud as partners in cancer education and research in rural southwest Kansas.

PubMed

Cupertino, Ana Paula; Saint-Elin, Mercedes; de Los Rios, Johana Bravo; Engelman, Kimberly K; Greiner, K Allen; Ellerbeck, Edward F; Nápoles, Anna M

2015-01-01

To describe community-based participatory processes used to develop promotore training on cancer research, and to assess the feasibility of training promotores from rural communities to disseminate cancer research information. Prospective, cohort design. Rural communities in the state of Kansas. 34 Spanish-speaking promotores attended an information session; 27 enrolled and 22 completed training. With input from a community advisory board, the authors developed a leadership and cancer curriculum and trained Spanish-speaking promotores to disseminate information on cancer research. Promotores completed pretraining and post-training surveys in Spanish to assess demographic characteristics and changes in knowledge of cancer, cancer treatment and cancer research studies, and intent to participate in cancer research. Cancer knowledge, awareness of cancer clinical trials, interest in participating in cancer clinical research studies. Compared to pretraining, after training, promotores were more likely to correctly define cancer, identify biopsies, describe cancer stages, and report ever having heard of cancer research studies. Completion rates of the training and willingness to participate in cancer research were high, supporting the feasibility of training promotores to deliver community-based education to promote cancer research participation. Nursing professionals and researchers can collaborate with promotores to disseminate cancer education and research among underserved rural Latino communities in Kansas and elsewhere. Members of these communities appear willing and interested in improving their knowledge of cancer and cancer clinical trials.

A mixed methods descriptive investigation of readiness to change in rural hospitals participating in a tele-critical care intervention

PubMed Central

2013-01-01

Background Telemedicine technology can improve care to patients in rural and medically underserved communities yet adoption has been slow. The objective of this study was to study organizational readiness to participate in an academic-community hospital partnership including clinician education and telemedicine outreach focused on sepsis and trauma care in underserved, rural hospitals. Methods This is a multi-method, observational case study. Participants included staff from 4 participating rural South Carolina hospitals. Using a readiness-for-change model, we evaluated 5 general domains and the related factors or topics of organizational context via key informant interviews (n=23) with hospital leadership and staff, compared these to data from hospital staff surveys (n=86) and triangulated data with investigators’ observational reports. Survey items were grouped into 4 categories (based on content and fit with conceptual model) and scored, allowing regression analyses for inferential comparisons to assess factors related to receptivity toward the telemedicine innovation. Results General agreement existed on the need for the intervention and feasibility of implementation. Previous experience with a telemedicine program appeared pivotal to enthusiasm. Perception of need, task demands and resource need explained nearly 50% of variation in receptivity. Little correlation emerged with hospital or ED leadership culture and support. However qualitative data and investigator observations about communication and differing support among disciplines and between staff and leadership could be important to actual implementation. Conclusions A mixed methods approach proved useful in assessing organizational readiness for change in small organizations. Further research on variable operational definitions, potential influential factors, appropriate and feasible methods and valid instruments for such research are needed. PMID:23360332

The Rural Outreach Project

NASA Technical Reports Server (NTRS)

Coleman, Clarence D.

2000-01-01

The Rural Outreach Project was designed to increase the diversity of NASA's workforce by: 1) Conducting educational research designed to investigate the most effective strategies for expanding innovative, NASA-sponsored pre-college programs into rural areas; 2) Field-testing identified rural intervention strategies; 3) Implementing expanded NASA educational programs to include 300 rural students who are disabled, female and/or minority; and 4) Disseminating project strategies. The Project was a partnership that included NASA Langley Research Center's Office of Education, Norfolk State University, Cooperative Hampton Roads Organizations for Minorities in Engineering (CHROME) and Paul D. Camp Community College. There were four goals and activities identified for this project; 1) Ascertain effective strategies for expanding successful NASA-sponsored urban-based, pre-college programs into rural settings; 2) Field test identified rural intervention strategies; 3) Publish or disseminate two reports, concerning project research and activities at a national conference; 4) Provide educational outreach to 300, previously underserved, rural students who are disabled, female and /or minority.

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.

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.

Human transportation needs in rural Oklahoma.

DOT National Transportation Integrated Search

2012-09-01

Mobility is extremely important, especially in rural areas, which have dispersed populations and locations. : This study was conducted among rural minority populations to evaluate human transportation needs of the : underserved rural population in Ok...

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.

Physician recruitment and retention in rural and underserved areas.

PubMed

Lee, Dane M; Nichols, Tommy

2014-01-01

The purpose of this paper is to identify the challenges when recruiting and retaining rural physicians and to ascertain methods that make rural physician recruitment and retention successful. There are studies that suggest rural roots is an important factor in recruiting rural physicians, while others look at rural health exposure in medical school curricula, self-actualization, community sense and spousal perspectives in the decision to practice rural medicine. An extensive literature review was performed using Academic Search Complete, PubMed and The Cochrane Collaboration. Key words were rural, rural health, community hospital(s), healthcare, physicians, recruitment, recruiting, retention, retaining, physician(s) and primary care physician(s). Inclusion criteria were peer-reviewed full-text articles written in English, published from 1997 and those limited to USA and Canada. Articles from foreign countries were excluded owing to their unique healthcare systems. While there are numerous articles that call for special measures to recruit and retain physicians in rural areas, there is an overall dearth. This review identifies several articles that suggest recruitment and retention techniques. There is a need for a research agenda that includes valid, reliable and rigorous analysis regarding formulating and implementing these strategies. Rural Americans are under-represented when it comes to healthcare and what research there is to assist recruitment and retention is difficult to find. This paper identify the relevant research and highlights key strategies.

Community strategies to address cancer disparities in Appalachian Kentucky.

PubMed

Schoenberg, Nancy E; Howell, Britteny M; Fields, Nell

2012-01-01

Central Appalachian residents suffer disproportionate health disparities, including an all-cancer mortality rate 17% higher than the general population. During 10 focus groups and 19 key informant interviews, 91 Appalachian residents identified cancer screening challenges and strategies. Challenges included (1) inadequate awareness of screening need, (2) insufficient access to screening, and (3) lack of privacy. Strategies included (1) witnessing/storytelling, (2) capitalizing on family history, (3) improving publicity about screening resources, (4) relying on lay health advisors, and (5) bundling preventive services. These insights shaped our community-based participatory research intervention and offered strategies to others working in Appalachia, rural locales, and other traditionally underserved communities.

Using Videoconferencing to Deliver Individual Therapy and Pediatric Psychology Interventions with Children and Adolescents

PubMed Central

Patton, Susana

2016-01-01

Abstract Background: Because of the widening access gap between need for individual and pediatric psychology services and child specialist availability, secure videoconferencing options are more needed than ever to address access challenges across underserved settings. Methods: The authors summarize real-time videoconferencing evidence to date across individual therapy with children and pediatric psychology interventions using videoconferencing. The authors summarize emerging guidelines that inform best practices for individual child therapy over videoconferencing. Results: The authors present three case examples to illustrate best practices. The first behavioral pediatrics case summarizes evidence-based approaches in treating a rural young adolescent with attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and hearing impairment. The second pediatric psychology case describes similarities and difference between on-site and videoconferencing services in treating a rural child with toileting concerns. The third adolescent case describes treatment of an urban honors student with depression. Conclusions: Videoconferencing is an effective approach to improving access to individual and pediatric psychology interventions for children and adolescents. Videoconferencing approaches are well accepted by families and show promise for disseminating evidence-based treatments to underserved communities. PMID:26745607

Using Videoconferencing to Deliver Individual Therapy and Pediatric Psychology Interventions with Children and Adolescents.

PubMed

Nelson, Eve-Lynn; Patton, Susana

2016-04-01

Because of the widening access gap between need for individual and pediatric psychology services and child specialist availability, secure videoconferencing options are more needed than ever to address access challenges across underserved settings. The authors summarize real-time videoconferencing evidence to date across individual therapy with children and pediatric psychology interventions using videoconferencing. The authors summarize emerging guidelines that inform best practices for individual child therapy over videoconferencing. The authors present three case examples to illustrate best practices. The first behavioral pediatrics case summarizes evidence-based approaches in treating a rural young adolescent with attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and hearing impairment. The second pediatric psychology case describes similarities and difference between on-site and videoconferencing services in treating a rural child with toileting concerns. The third adolescent case describes treatment of an urban honors student with depression. Videoconferencing is an effective approach to improving access to individual and pediatric psychology interventions for children and adolescents. Videoconferencing approaches are well accepted by families and show promise for disseminating evidence-based treatments to underserved communities.

Prevalence and determinants of caesarean section in private and public health facilities in underserved South Asian communities: cross-sectional analysis of data from Bangladesh, India and Nepal

PubMed Central

Neuman, Melissa; Alcock, Glyn; Azad, Kishwar; Kuddus, Abdul; Osrin, David; More, Neena Shah; Nair, Nirmala; Tripathy, Prasanta; Sikorski, Catherine; Saville, Naomi; Sen, Aman; Colbourn, Tim; Houweling, Tanja A J; Seward, Nadine; Manandhar, Dharma S; Shrestha, Bhim P; Costello, Anthony; Prost, Audrey

2014-01-01

Objectives To describe the prevalence and determinants of births by caesarean section in private and public health facilities in underserved communities in South Asia. Design Cross-sectional study. Setting 81 community-based geographical clusters in four locations in Bangladesh, India and Nepal (three rural, one urban). Participants 45 327 births occurring in the study areas between 2005 and 2012. Outcome measures Proportion of caesarean section deliveries by location and type of facility; determinants of caesarean section delivery by location. Results Institutional delivery rates varied widely between settings, from 21% in rural India to 90% in urban India. The proportion of private and charitable facility births delivered by caesarean section was 73% in Bangladesh, 30% in rural Nepal, 18% in urban India and 5% in rural India. The odds of caesarean section were greater in private and charitable health facilities than in public facilities in three of four study locations, even when adjusted for pregnancy and delivery characteristics, maternal characteristics and year of delivery (Bangladesh: adjusted OR (AOR) 5.91, 95% CI 5.15 to 6.78; Nepal: AOR 2.37, 95% CI 1.62 to 3.44; urban India: AOR 1.22, 95% CI 1.09 to 1.38). We found that highly educated women were particularly likely to deliver by caesarean in private facilities in urban India (AOR 2.10; 95% CI 1.61 to 2.75) and also in rural Bangladesh (AOR 11.09, 95% CI 6.28 to 19.57). Conclusions Our results lend support to the hypothesis that increased caesarean section rates in these South Asian countries may be driven in part by the private sector. They also suggest that preferences for caesarean delivery may be higher among highly educated women, and that individual-level and provider-level factors interact in driving caesarean rates higher. Rates of caesarean section in the private sector, and their maternal and neonatal health outcomes, require close monitoring. PMID:25550293

Telemental Health Training, Team Building, and Workforce Development in Cultural Context: The Hawaii Experience.

PubMed

Alicata, Daniel; Schroepfer, Amanda; Unten, Tim; Agoha, Ruby; Helm, Susana; Fukuda, Michael; Ulrich, Daniel; Michels, Stanton

2016-04-01

The goal of the University of Hawaii (UH) child and adolescent psychiatry telemental health (TMH) program is to train child and adolescent psychiatry fellows to provide behavioral health services for the children of Hawaii and the Pacific Islands in the cultural context of their rural communities using interactive videoteleconferencing (IVTC). The training experience balances learning objectives with community service. Learning objectives include: Understanding mental health disparities in rural communities, leveraging community resources in ongoing treatment, providing culturally effective care, and improving health care access and delivery through TMH service research and evaluation. We describe the UH experience. Several UH faculty are experienced with IVTC technology. They are triple-board trained, are recognized for their research in program evaluation and mental health disparities, and are committed to serving Hawaii's rural communities. We demonstrate the role of TMH in linking children and their families living in rural communities with multiple mental health treatment providers. The service-learning curriculum and a unique collaboration with Mayo Clinic provide the opportunity to examine the role of TMH in global service, and training, education, and research. TMH provides direct services to patients and consultation on Hawaii Island and Maui County. The collaboration with the Mayo Clinic brings further consultation in complex diagnostics, pharmacogenomics, and cross-cultural psychiatry. A curriculum provides trainees experience with IVTC with the goal of potential recruitment to underserved rural communities. The TMH program at UH is unique in its team building and workforce development by joining multiple entities through IVTC and translating expertise from the Mayo Clinic to rural communities, and strengthening collaboration with local child and adolescent psychiatrists, and primary care and other mental health providers. The UH psychiatry program is a model program to develop an expert mental health workforce in cultural context for children living in rural communities.

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...

Telecommunications and Education. Hearing before the Subcommittee on Communications of the Committee on Commerce, Science, and Transportation. United States Senate, One Hundred Second Congress, Second Session (July 29, 1992).

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on Commerce, Science, and Transportation.

Testimony on the use of telecommunications technologies in education was given at this hearing. The focus was to examine how new and old technologies can be used to help schools and universities serve children more effectively and to extend the reach of educational institutions to rural and underserved communities. Although there is a great deal…

Potential use of mobile phones in improving animal health service delivery in underserved rural areas: experience from Kilosa and Gairo districts in Tanzania.

PubMed

Karimuribo, Esron D; Batamuzi, Emmanuel K; Massawe, Lucas B; Silayo, Richard S; Mgongo, Frederick O K; Kimbita, Elikira; Wambura, Raphael M

2016-10-07

Sub-optimal performance of the animal health delivery system in rural areas is common in developing countries including Tanzania. However, penetration of mobile phones and availability of good road network and public transport systems offer opportunities for improving the access of rural communities to diagnostic and advisory services from facilities and expertise located in urban areas. A questionnaire survey on possession and use of mobile phones by pastoral and agro-pastoral communities in Kilosa and Gairo districts was carried out between November and December 2015. A total number of 138 livestock keepers from three villages of Chakwale (54), Mvumi (41) and Parakuyo (43) participated in the study. An e-based system was designed and tested to link rural communities with urban diagnostic facilities. It was observed that the average number of phones possessed by individuals interviewed and household families was 1.1 ± 0.26 (1-2) and 3.5 ± 2.23 (1-10), respectively. It was further observed that out of 138 livestock keepers interviewed, 133 (96.4 %) had feature phones while 10 (7.2 %) of them possessed smartphones. Mobile phone is currently used to support livestock production by communicating on animal health in Parakuyo (18, 41.9 %), Mvumi (18, 43.9 %) and Chakwale (14, 25.9 %). Other contributions of mobile phones in livestock and crop agriculture observed in the study area include: exchange of livestock price information, crop price information, communicating on plant health/diseases, livestock extension and advisory services as well as crop farming extension and advisory services. We also designed and tested an e-based SUAVetDiag® system to support timely diagnosis of infectious disease conditions and prompt advice on case management in veterinary underserved areas. Availability of mobile phones in rural areas, in combination with supporting infrastructure and facilities in urban areas, has potential to stimulate local development and improving delivery of animal health and extension services. It is recommended that more development and refinement of the system should be conducted to ensure that this potential is tapped to revolutionalise delivery of animal health services in rural areas.

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

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

Developing a "toolkit" to measure implementation of concurrent palliative care in rural community cancer centers.

PubMed

Zubkoff, Lisa; Dionne-Odom, J Nicholas; Pisu, Maria; Babu, Dilip; Akyar, Imatullah; Smith, Tasha; Mancarella, Gisella A; Gansauer, Lucy; Sullivan, Margaret Murray; Swetz, Keith M; Azuero, Andres; Bakitas, Marie A

2018-02-01

Despite national guidelines recommending early concurrent palliative care for individuals newly diagnosed with metastatic cancer, few community cancer centers, especially those in underserved rural areas do so. We are implementing an early concurrent palliative care model, ENABLE (Educate, Nurture, Advise, Before Life Ends) in four, rural-serving community cancer centers. Our objective was to develop a "toolkit" to assist community cancer centers that wish to integrate early palliative care for patients with newly diagnosed advanced cancer and their family caregivers. Guided by the RE-AIM (Reach, Effectiveness-Adoption, Implementation, Maintenance) framework, we undertook an instrument-development process based on the literature, expert and site stakeholder review and feedback, and pilot testing during site visits. We developed four instruments to measure ENABLE implementation: (1) the ENABLE RE-AIM Self-Assessment Tool to assess reach, adoption, implementation, and maintenance; (2) the ENABLE General Organizational Index to assess institutional implementation; (3) an Implementation Costs Tool; and (4) an Oncology Clinicians' Perceptions of Early Concurrent Oncology Palliative Care survey. We developed four measures to determine early palliative care implementation. These measures have been pilot-tested, and will be integrated into a comprehensive "toolkit" to assist community cancer centers to measure implementation outcomes. We describe the lessons learned and recommend strategies for promoting long-term program sustainability.

Impact of Medicare Part D on independent and chain community pharmacies in rural Illinois--A qualitative study.

PubMed

Bono, James D; Crawford, Stephanie Yvonne

2010-06-01

Although the sustainability of rural pharmacy services is a concern of long standing, the rural marketplace is not monolithic. Enhanced understanding of different experiences, strengths, and potential weaknesses of rural chain and independent pharmacies could help inform health policy debates, legislation, and consideration of disparities and access. This study compared and contrasted experiences by pharmacists in chain and independent community pharmacies during Medicare Part D implementation. The objective was to obtain and describe experiential narratives from rural Illinois pharmacists regarding the implementation of Medicare Part D. Similarities and differences experienced in chain and independent community pharmacies were examined, as well as pharmacists' perceptions about potential implications of the newly implemented Act on the accessibility of rural pharmacy care and services. A semistructured qualitative research approach was used, involving focus groups and telephone interviews, to elicit the subjective experiences of rural Illinois pharmacists. Participants were selected through purposive sampling to include representative perspectives of independent and chain community pharmacists in rural areas across the state. Using a systematic, iterative coding process, recurrent themes were identified in 8 substantive categories. Areas of similarity between the 2 groups included universal criticism of the initial implementation processes, but consensus belief that Medicare patients ultimately benefited if they did not have previous prescription drug coverage. Pharmacists in independent drugstores expressed more concern about their future viability. Corporate communications and infrastructure support were available in chain pharmacies and believed to present them with competitive advantages and a stronger long-term financial position. The findings showed a disparate impact of Medicare Part D on the initial experiences and perceived viability of independent community pharmacies, in comparison with their chain pharmacy counterparts. The long-term implications of changing regulatory environments and customers' pharmacy needs in underserved communities should be carefully considered and monitored. Copyright 2010 Elsevier Inc. All rights reserved.

The impact of socially-accountable, community-engaged medical education on graduates in the Central Philippines: Implications for the global rural medical workforce.

PubMed

Siega-Sur, J L; Woolley, T; Ross, S J; Reeve, C; Neusy, A-J

2017-10-01

Developing and retaining a high quality medical workforce, especially within low-resource countries has been a world-wide challenge exacerbated by a lack of medical schools, the maldistribution of doctors towards urban practice, health system inequities, and training doctors in tertiary centers rather than in rural communities. To describe the impact of socially-accountable health professional education on graduates; specifically: their motivation towards community-based service, preparation for addressing local priority health issues, career choices, and practice location. Cross-sectional survey of graduates from two medical schools in the Philippines: the University of Manila-School of Health Sciences (SHS-Palo) and a medical school with a more conventional curriculum. SHS-Palo graduates had significantly (p < 0.05) more positive attitudes to community service. SHS-Palo graduates were also more likely to work in rural and remote areas (p < 0.001) either at district or provincial hospitals (p = 0.032) or in rural government health services (p < 0.001) as Municipal or Public Health Officers (p < 0.001). Graduates also stayed longer in both their first medical position (p = 0.028) and their current position (p < 0.001). SHS-Palo medical graduates fulfilled a key aim of their socially-accountable institution to develop a health professional workforce willing and able, and have a commitment to work in underserved rural communties.

Maryland's Special Populations Network. A model for cancer disparities research, education, and training.

PubMed

Baquet, Claudia R; Mack, Kelly M; Mishra, Shiraz I; Bramble, Joy; Deshields, Mary; Datcher, Delores; Savoy, Mervin; Brooks, Sandra E; Boykin-Brown, Stephanie; Hummel, Kery

2006-10-15

The unequal burden of cancer in minority and underserved communities nationally and in Maryland is a compelling crisis. The Maryland Special Populations Cancer Research Network (MSPN) developed an infrastructure covering Maryland's 23 jurisdictions and Baltimore City through formal partnerships between the University of Maryland School of Medicine, University of Maryland Statewide Health Network, University of Maryland Eastern Shore, and community partners in Baltimore City, rural Eastern Shore, rural Western Maryland, rural Southern Maryland, and Piscataway Conoy Tribe and statewide American Indians. Guided by the community-based participatory framework, the MSPN undertook a comprehensive assessment (of needs, strengths, and resources available) that laid the foundation for programmatic efforts in community-initiated cancer awareness and education, research, and training. The MSPN infrastructure was used to implement successful and innovative community-based cancer education interventions and technological solutions; conduct education and promotion of clinical trials, cancer health disparities research, and minority faculty cancer research career development; and leverage additional resources for sustainability. MSPN engaged in informed advocacy among decision- and policymakers at state and national levels, and its community-based clinical trials program was recognized by the U.S. Department of Health and Human Services as a Best Practice Award. The solutions to reduce and eliminate cancer health disparities are complex and require comprehensive and focused multidisciplinary cancer health disparities research, training, and education strategies implemented through robust community-academic partnerships. Cancer 2006. (c) American Cancer Society.

Delivering new malaria drugs through grassroots private sector.

PubMed

Chiguzo, A N; Mugo, R W; Wacira, D G; Mwenda, J M; Njuguna, E W

2008-09-01

To demonstrate that micro-franchising system is an effective way of improving access to effective health care such as the introduction of first line antimalarias in populations living in underserved rural areas in Kenya. A descriptive study. Child and family wellness (CFW) micro-franchised nurse run clinics in Kenya. In 2007, 39.3% of RDTs carried out were positive for malaria. All malaria positive (RDTs and microscopy) patients received artemether lumefantrine (AL) according to their weight in accordance with the Government approved treatment guidelines. During the same period a total of 3,248 community members were reached with malaria information, however, community expectations took longer to change as patients demanded AL even when the malaria diagnosis was negative. Initially, this led to the dispensing of other antimalarials to patients with malaria like symptoms even with a negative test. This demand decreased with more community education on the importance of the tests. Engaging the private sector though with challenges proved feasible and appropriate in accessing malaria treatment based on clinical diagnosis supported by RDTs to confirm the diagnosis instead of presumptive treatment based on fever. This led to a reduction of antimalarial prescriptions by more than 50%, implying better patient care, rational drug use as well as cost savings on malaria treatment. A micro-franchising system is an effective and sustainable way of improving access to effective health care by populations living in underserved rural areas of Africa. With appropriate supportive training and supervision, the system can adapt to changes in treatment guidelines and to new regimens.

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.

Assessing local capacity to expand rural breast cancer screening and patient navigation: An iterative mixed-method tool.

PubMed

Inrig, Stephen J; Higashi, Robin T; Tiro, Jasmin A; Argenbright, Keith E; Lee, Simon J Craddock

2017-04-01

Despite federal funding for breast cancer screening, fragmented infrastructure and limited organizational capacity hinder access to the full continuum of breast cancer screening and clinical follow-up procedures among rural-residing women. We proposed a regional hub-and-spoke model, partnering with local providers to expand access across North Texas. We describe development and application of an iterative, mixed-method tool to assess county capacity to conduct community outreach and/or patient navigation in a partnership model. Our tool combined publicly-available quantitative data with qualitative assessments during site visits and semi-structured interviews. Application of our tool resulted in shifts in capacity designation in 10 of 17 county partners: 8 implemented local outreach with hub navigation; 9 relied on the hub for both outreach and navigation. Key factors influencing capacity: (1) formal linkages between partner organizations; (2) inter-organizational relationships; (3) existing clinical service protocols; (4) underserved populations. Qualitative data elucidate how our tool captured these capacity changes. Our capacity assessment tool enabled the hub to establish partnerships with county organizations by tailoring support to local capacity and needs. Absent a vertically integrated provider network for preventive services in these rural counties, our tool facilitated a virtually integrated regional network to extend access to breast cancer screening to underserved women. Copyright © 2016 Elsevier Ltd. All rights reserved.

Impact of the University of California, Los Angeles/Charles R. Drew University Medical Education Program on medical students' intentions to practice in underserved areas.

PubMed

Ko, Michelle; Edelstein, Ronald A; Heslin, Kevin C; Rajagopalan, Shobita; Wilkerson, Luann; Colburn, Lois; Grumbach, Kevin

2005-09-01

To estimate the impact of a U.S. inner-city medical education program on medical school graduates' intentions to practice in underserved communities. The authors conducted an analysis of secondary data on 1,088 medical students who graduated from either the joint University of California, Los Angeles/Charles R. Drew University Medical Education Program (UCLA/Drew) or the UCLA School of Medicine between 1996 and 2002. Intention to practice in underserved communities was measured using students' responses to questionnaires administered at matriculation and graduation for program improvement by the Association of American Medical Colleges. Multivariate logistic regression analysis was used to compare the odds of intending to practice in underserved communities among UCLA/Drew students with those of their counterparts in the UCLA School of Medicine. Compared with students in the UCLA School of Medicine, UCLA/Drew students had greater adjusted odds of reporting intention to work in underserved communities at graduation, greater odds of maintaining or increasing such intentions between matriculation and graduation, and lower odds of decreased intention to work in underserved communities between matriculation and graduation. Training in the UCLA/Drew program was independently associated with intention to practice medicine in underserved communities, suggesting that a medical education program can have a positive effect on students' goals to practice in underserved areas.

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.

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).

Community strategies to address cancer disparities in Appalachian Kentucky

PubMed Central

Schoenberg, Nancy E.; Howell, Britteny M.; Fields, Nell

2012-01-01

Central Appalachian residents suffer disproportionate health disparities, including an all-cancer mortality rate 17% higher than the general population. During 10 focus groups and 19 key informant interviews, 91 Appalachian residents identified cancer screening challenges and strategies. Challenges included: (1) inadequate awareness of screening need; (2) insufficient access to screening; and (3) lack of privacy. Strategies included (1) witnessing/storytelling; (2) capitalizing on family history; (3) improving publicity about screening resources; (4) relying on lay health advisors; and (5) bundling preventive services. These insights shaped our CBPR intervention and offer strategies to others working in Appalachia, rural locales, and other traditionally underserved communities. PMID:22143486

Implementation of a new 'community' laboratory CD4 service in a rural health district in South Africa extends laboratory services and substantially improves local reporting turnaround time.

PubMed

Coetzee, L M; Cassim, N; Glencross, D K

2015-12-16

The CD4 integrated service delivery model (ITSDM) provides for reasonable access to pathology services across South Africa (SA) by offering three new service tiers that extend services into remote, under-serviced areas. ITSDM identified Pixley ka Seme as such an under-serviced district. To address the poor service delivery in this area, a new ITSDM community (tier 3) laboratory was established in De Aar, SA. Laboratory performance and turnaround time (TAT) were monitored post implementation to assess the impact on local service delivery. Using the National Health Laboratory Service Corporate Data Warehouse, CD4 data were extracted for the period April 2012-July 2013 (n=11,964). Total mean TAT (in hours) was calculated and pre-analytical and analytical components assessed. Ongoing testing volumes, as well as external quality assessment performance across ten trials, were used to indicate post-implementation success. Data were analysed using Stata 12. Prior to the implementation of CD4 testing at De Aar, the total mean TAT was 20.5 hours. This fell to 8.2 hours post implementation, predominantly as a result of a lower pre-analytical mean TAT reducing from a mean of 18.9 to 1.8 hours. The analytical testing TAT remained unchanged after implementation and monthly test volumes increased by up to 20%. External quality assessment indicated adequate performance. Although subjective, questionnaires sent to facilities reported improved service delivery. Establishing CD4 testing in a remote community laboratory substantially reduces overall TAT. Additional community CD4 laboratories should be established in under-serviced areas, especially where laboratory infrastructure is already in place.

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

Feasibility of a low-cost hearing screening in rural Indiana.

PubMed

Khan, Khalid M; Bielko, Sylvanna L; Barnes, Priscilla A; Evans, Sydney S; Main, Anna L K

2017-09-18

Hearing loss remains a neglected public health issue in the rural and agricultural communities in the United States and therefore, promotion of a low-cost hearing screening may be important for these underserved populations. The major objectives of our study were to assess feasibility of a low-cost telephone-administered hearing test in rural Indiana and to identify the challenges, barriers and viable implementation strategies associated with this test. Also, we evaluated whether a focus group session could change the hearing health attitude of rural residents. We recruited 126 adults from six rural Indiana counties who participated in study activities in the following order: 1) a pre-focus group demographic, knowledge and attitude survey, 2) a focus group for discussing the feasibility of a telephone-administered hearing screening, 3) a post focus group attitude survey and 4) hearing was screened using an audiometer and self-assessment scale. These activities generated both qualitative and quantitative data, which were subsequently analyzed. Hearing impairment was perceived as an important public health issue. Many participants expressed interests to try the low-cost National Hearing Test (NHT). However, participants recommended NHT to be facilitated by community organizations to provide access to landline phones. The focus group turned out to be an excellent awareness building activity producing significant improvement in hearing health attitudes. Comparison of self and audiometric evaluations indicated underestimation of hearing handicap in our rural study population. The study results underscore the urgent need for an effective strategy to promote low-cost hearing screening in rural US communities.

Confronting health disparities: Latin American social medicine in Venezuela.

PubMed

Briggs, Charles L; Mantini-Briggs, Clara

2009-03-01

We explored the emergence and effectiveness of Venezuela's Misión Barrio Adentro, "Inside the Neighborhood Mission," a program designed to improve access to health care among underserved residents of the country, hoping to draw lessons to apply to future attempts to address acute health disparities. We conducted our study in 3 capital-region neighborhoods, 2 small cities, and 2 rural areas, combining systematic observations with interviews of 221 residents, 41 health professionals, and 28 government officials. We surveyed 177 female and 91 male heads of household. Interviews suggested that Misión Barrio Adentro emerged from creative interactions between policymakers, clinicians, community workers, and residents, adopting flexible, problem-solving strategies. In addition, data indicated that egalitarian physician-patient relationships and the direct involvement of local health committees overcame distrust and generated popular support for the program. Media and opposition antagonism complicated physicians' lives and clinical practices but heightened the program's visibility. Top-down and bottom-up efforts are less effective than "horizontal" collaborations between professionals and residents in underserved communities. Direct, local involvement can generate creative and dynamic efforts to address acute health disparities in these areas.

Rural Religious Leaders' Perspectives on their Communities' Health Priorities and Health.

PubMed

Schoenberg, Nancy E; Swanson, Mark

2017-07-01

In traditionally underserved communities, faith-based interventions have been shown to be effective for health promotion. Religious leaders-generally the major partner in such interventions-however, are seldom are consulted about community health priorities and health promotion preferences. These insights are critical to ensure productive partnerships, effective programming, and sustainability. Mixed-methods surveys were administered in one of the nation's most under-resourced regions: rural Appalachia. A sample of 60 religious leaders, representing the main denominations in central Appalachia, participated. Measures included closed- and open-ended survey questions on health priorities and recommendations for health promotion. Descriptive statistics were used for closed-ended survey items and conventional qualitative content analysis was used for open-ended responses. Substance abuse, diabetes mellitus, suboptimal dietary intake and obesity/overweight, and cardiovascular and respiratory illnesses constitute major health concerns. Addressing these challenging conditions requires realistically acknowledging sparse community resources (particularly healthcare provider shortages); building in accountability; and leveraging local assets and traditions such as testimonials, intergenerational support, and witnessing. With their extensive reach within the community and their accurate understanding of community health threats, practitioners and researchers may find religious leaders to be natural allies in health-promotion and disease-prevention activities.

Rural nursing education: a photovoice perspective.

PubMed

Leipert, Beverly; Anderson, Emma

2012-01-01

For many rural Canadians nursing care is the primary and often the sole access point to health care. As such, rural nurses are an invaluable resource to the health and wellbeing of rural populations. However, due to a nursing workforce that is aging and retiring, limited resources and support, healthcare reform issues, and other factors, these rural professionals are in short supply. Because of limited opportunities to learn about rural practice settings, nursing students may be reluctant to select rural practice locations. Relevant and effective educational initiatives are needed to attract nursing students to underserved rural and remote communities so that rural people receive the health care they require. The purpose of this study was to explore the use of the innovative research approach called photovoice as an educational strategy to foster learning about and interest in rural locations and rural nursing as future practice settings. Fostering of interest in rural may help to address nursing workforce shortages in rural settings. Thirty-eight third and fourth year nursing and health sciences students enrolled in an elective 'Rural Nursing' course used the qualitative research method photovoice to take photographs that represented challenges and facilitators of rural nursing practice. They then engaged in written reflection about their photos. Photos were to be taken in rural settings of their choice, thus fostering both urban and rural student exposure to diverse rural communities. One hundred forty-four photos and reflections were submitted, representing students' appreciation of diverse facilitators and challenges to rural nursing practice. Facilitators included technology, a generalist role, strong sense of community, and slower pace of life. Challenges included inadequate rural education in undergraduate nursing programs, professional isolation, safety issues, few opportunities for professional development, lack of anonymity, and insider/outsider status. Exemplar photos and reflections are provided. The photovoice research approach used in this rural education endeavour proved to be very useful in fostering students' exposure to, interest in, and understanding of rural settings and their influence on rural nursing practice. Photovoice is also recommended for use in rural courses other than nursing. Suggested strategies include group photovoice experience and the expansion of reflection to enhance rural health research.

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…

Outreach to Space - A Collaborative Model for Rural Community Engagement

NASA Astrophysics Data System (ADS)

Schafer, Sheldon; Space Museum Collaborative, Outreach to

2008-05-01

Outreach to Space is a collaborative project of 11 mid-western and west coast science museums, designed to provide astronomy and space exploration content to non-traditional audiences in non-traditional venues. Members have developed a set of 12 portable, interactive astronomy exhibits that will be delivered to mostly underserved rural populations, at non-traditional venues in 2008-2009. These venues are to include county and regional fairs, and summer and fall festivals - places that attract diverse and underserved audiences. During the intervening year, the exhibits will visit groups and agencies such as Rotary clubs, Urban League after-school programs, inner city youth clubs & agencies, rural libraries, and other similar venues. The primary target audience is 5-13 year old children and their extended families that live in rural and lower-economic areas. Outreach to Space Partner Museums Alaska: The Imaginarium, Anchorage California: The Exploratorium, San Francisco Illinois: Discovery Center, Rockford Lakeview Museum, Peoria SciTech, Aurora Indiana: Children's Science Museum, Terre Haute Evansville Museum of Arts and Science Science Central, Fort Wayne Iowa: Bluedorn Imaginarium, Waterloo Science Station, Cedar Rapids Oregon: Science Works, Ashland This session will include an opportunity to interact with each of the exhibits, review the educational materials, and use the personal media player programs that have been developed to provide additional depth to the visitor experience. The exhibit development process and organizational elements of the collaborative will also be discussed. Outreach to Space is funded by a grant from the National Science Foundation's Informal Science Program.

Off the rails in rural South Carolina: a qualitative study of healthcare provider perspectives on the long-term health impact of the Graniteville train disaster.

PubMed

Annang Ingram, Lucy; Tinago, Chiwoneso B; Estrada, Robin; Wilson, Sacoby; Wright Sanders, Louisiana; Bevington, Tina; Carlos, Bethany; Cornelius, Evangeline; Svendsen, Erik R; Ball, Julia

2016-01-01

In 2005, a train derailment and subsequent chlorine spill ravaged the rural town of Graniteville in South Carolina, resulting in one of the worst chlorine gas exposures in US. Significant health and economic challenges persist in the community more than a decade later. Healthcare providers offered healthcare services to community members in the immediate aftermath of the disaster, and many still live in the community and continue to provide healthcare services. As such, healthcare professionals provide a unique and important perspective to help understand the impact of the disaster on the community's health. The purpose of this study was to explore healthcare providers' perspectives about the long-term effects of the disaster on community health, healthcare access, and wellbeing. Semi-structured interviews were conducted with 30 healthcare providers who treated survivors of the Graniteville train disaster. A qualitative, essentialist, inductive thematic analytic approach was used to analyze study data. Four themes emerged regarding the disaster's long-term impact: effects of chlorine exposure on physical health, issues with healthcare access, residual effects of the disaster on personal and community wellbeing, and improving health and community wellbeing. Disaster recovery should not be considered solely an acute event; agencies must be prepared for long-term, potentially chronic ailments, particularly in underserved, rural communities. Efforts to address the long-term health needs of communities post-disaster should consider the perspectives of healthcare providers to offer a well-rounded assessment of community needs. Study findings can help inform future disaster response strategies in communities locally and globally.

Breastfeeding patterns in the rural community of Hilo, Hawai'i: an exploration of existing data sets.

PubMed

Flood, Jeanie L

2013-03-01

Before any breastfeeding promotion effort, an understanding of the existing breastfeeding patterns is essential. Hawai'i County is a rural, ethnically diverse, medically underserved community. The purpose of this study was to describe the breastfeeding patterns of women living in Hilo, Hawai'i. Data from several existing national, state, and local data sets were accessed to identify and describe the breastfeeding patterns of women in this community. Available breastfeeding data about women in Hilo was obtained from the Hawai'i WIC program and includes initiation, duration, exclusivity of breastfeeding, and reasons for not breastfeeding. These data were compared to data from published reports available at the county, state, and national level. The State of Hawai'i and Hilo exceed national targets for breastfeeding initiation; however, rates soon drop following delivery, and mixed feedings of infants is common. The highest percentage of mothers weaned their infants within the first four weeks postpartum. The reasons the majority of the mothers gave for weaning were tied to breastfeeding situations that are amenable to skilled lactation support (eg, milk supply issues and latch or sucking problems). While available data sets offer valuable information on the breastfeeding patterns in this rural community, there are limitations to their usefulness, primarily due to the inconsistent operational definitions of infant feeding variables used in the surveys, and the lack of availability of community level data.

Breastfeeding Patterns in the Rural Community of Hilo, Hawai‘i: An Exploration of Existing Data Sets

PubMed Central

2013-01-01

Before any breastfeeding promotion effort, an understanding of the existing breastfeeding patterns is essential. Hawai‘i County is a rural, ethnically diverse, medically underserved community. The purpose of this study was to describe the breastfeeding patterns of women living in Hilo, Hawai‘i. Data from several existing national, state, and local data sets were accessed to identify and describe the breastfeeding patterns of women in this community. Available breastfeeding data about women in Hilo was obtained from the Hawai‘i WIC program and includes initiation, duration, exclusivity of breastfeeding, and reasons for not breastfeeding. These data were compared to data from published reports available at the county, state, and national level. The State of Hawai‘i and Hilo exceed national targets for breastfeeding initiation; however, rates soon drop following delivery, and mixed feedings of infants is common. The highest percentage of mothers weaned their infants within the first four weeks postpartum. The reasons the majority of the mothers gave for weaning were tied to breastfeeding situations that are amenable to skilled lactation support (eg, milk supply issues and latch or sucking problems). While available data sets offer valuable information on the breastfeeding patterns in this rural community, there are limitations to their usefulness, primarily due to the inconsistent operational definitions of infant feeding variables used in the surveys, and the lack of availability of community level data. PMID:23520565

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.

Developing a student-led health and wellbeing clinic in an underserved community: collaborative learning, health outcomes and cost savings.

PubMed

Stuhlmiller, Cynthia M; Tolchard, Barry

2015-01-01

The University of New England (UNE), Australia decided to develop innovative placement opportunities for its increasing numbers of nursing students. Extensive community and stakeholder consultation determined that a community centre in rural New South Wales was the welcomed site of the student-led clinic because it fit the goals of the project-to increase access to health care services in an underserved area while providing service learning for students. Supported by a grant from Health Workforce Australia and in partnership with several community organisations, UNE established a student-led clinic in a disadvantaged community using an engaged scholarship approach which joins academic service learning with community based action research. The clinic was managed and run by the students, who were supervised by university staff and worked in collaboration with residents and local health and community services. Local families, many of whom were Indigenous Australians, received increased access to culturally appropriate health services. In the first year, the clinic increased from a one day per week to a three day per week service and offered over 1000 occasions of care and involved 1500 additional community members in health promotion activities. This has led to improved health outcomes for the community and cost savings to the health service estimated to be $430,000. The students learned from members of the community and community members learned from the students, in a collaborative process. Community members benefited from access to drop in help that was self-determined. The model of developing student-led community health and wellbeing clinics in underserved communities not only fulfils the local, State Government, Federal Government and international health reform agenda but it also represents good value for money. It offers free health services in a disadvantaged community, thereby improving overall health and wellbeing. The student-led clinic is an invaluable and sustainable link between students, health care professionals, community based organisations, the university, and the community. The community benefits from the clinic by learning to self-manage health and wellbeing issues. The benefits for students are that they gain practical experience in an interdisciplinary setting and through exposure to a community with unique and severe needs.

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…

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.

Associations between Self-Reported Gastrointestinal Illness and Water System Characteristics in Community Water Supplies in Rural Alabama: A Cross-Sectional Study.

PubMed

Stauber, Christine E; Wedgworth, Jessica C; Johnson, Pauline; Olson, Julie B; Ayers, Tracy; Elliott, Mark; Brown, Joe

2016-01-01

Community water supplies in underserved areas of the United States may be associated with increased microbiological contamination and risk of gastrointestinal disease. Microbial and health risks affecting such systems have not been systematically characterized outside outbreak investigations. The objective of the study was to evaluate associations between self-reported gastrointestinal illnesses (GII) and household-level water supply characteristics. We conducted a cross-sectional study of water quality, water supply characteristics, and GII in 906 households served by 14 small and medium-sized community water supplies in Alabama's underserved Black Belt region. We identified associations between respondent-reported water supply interruption and any symptoms of GII (adjusted odds ratio (aOR): 3.01, 95% confidence interval (CI) = 1.65-5.49), as well as low water pressure and any symptoms of GII (aOR: 4.51, 95% CI = 2.55-7.97). We also identified associations between measured water quality such as lack of total chlorine and any symptoms of GII (aOR: 5.73, 95% CI = 1.09-30.1), and detection of E. coli in water samples and increased reports of vomiting (aOR: 5.01, 95% CI = 1.62-15.52) or diarrhea (aOR: 7.75, 95% CI = 2.06-29.15). Increased self-reported GII was associated with key water system characteristics as measured at the point of sampling in a cross-sectional study of small and medium water systems in rural Alabama in 2012 suggesting that these water supplies can contribute to endemic gastro-intestinal disease risks. Future studies should focus on further characterizing and managing microbial risks in systems facing similar challenges.

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.

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.

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.

Oral Health Inequalities between Rural and Urban Populations of the African and Middle East Region.

PubMed

Ogunbodede, E O; Kida, I A; Madjapa, H S; Amedari, M; Ehizele, A; Mutave, R; Sodipo, B; Temilola, S; Okoye, L

2015-07-01

Although there have been major improvements in oral health, with remarkable advances in the prevention and management of oral diseases, globally, inequalities persist between urban and rural communities. These inequalities exist in the distribution of oral health services, accessibility, utilization, treatment outcomes, oral health knowledge and practices, health insurance coverage, oral health-related quality of life, and prevalence of oral diseases, among others. People living in rural areas are likely to be poorer, be less health literate, have more caries, have fewer teeth, have no health insurance coverage, and have less money to spend on dental care than persons living in urban areas. Rural areas are often associated with lower education levels, which in turn have been found to be related to lower levels of health literacy and poor use of health care services. These factors have an impact on oral health care, service delivery, and research. Hence, unmet dental care remains one of the most urgent health care needs in these communities. We highlight some of the conceptual issues relating to urban-rural inequalities in oral health, especially in the African and Middle East Region (AMER). Actions to reduce oral health inequalities and ameliorate rural-urban disparity are necessary both within the health sector and the wider policy environment. Recommended actions include population-specific oral health promotion programs, measures aimed at increasing access to oral health services in rural areas, integration of oral health into existing primary health care services, and support for research aimed at informing policy on the social determinants of health. Concerted efforts must be made by all stakeholders (governments, health care workforce, organizations, and communities) to reduce disparities and improve oral health outcomes in underserved populations. © International & American Associations for Dental Research 2015.

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…

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…

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.

A Longitudinal Process Analysis of Mother-Child Emotional Relationships in a Rural Appalachian European American Community

PubMed Central

Bornstein, Marc H.; Putnick, Diane L.; Suwalsky, Joan T. D.

2012-01-01

This prospective longitudinal study examines emotional relationships in 58 Appalachian mother-child dyads observed at home at 5 and 20 months. Between infancy and toddlerhood, 3 of 4 dimensions of dyadic emotional relationships were stable, and 3 remained continuous in their mean level. Increasing maternal age was associated with greater maternal sensitivity and structuring and with more responsive and involving children. Marital status and father presence in the home as well as maternal openness, parenting knowledge, investment, and satisfaction accounted for effects of maternal age on dyadic emotional relationships. This longitudinal process analysis provides unique insights into temporal dynamics of mother-child emotional relationships and their determinants in an underserved and underresearched U.S. community. Implications for community-specific interventions are discussed. PMID:22080397

The Regional Asthma Disease Management Program (RADMP) for low income underserved children in rural western North Carolina: a National Asthma Control Initiative Demonstration Project.

PubMed

Shuler, Melinda S; Yeatts, Karin B; Russell, Donald W; Trees, Amy S; Sutherland, Susan E

2015-01-01

A substantial proportion of low-income children with asthma living in rural western North Carolina have suboptimal asthma management. To address the needs of these underserved children, we developed and implemented the Regional Asthma Disease Management Program (RADMP); RADMP was selected as one of 13 demonstration projects for the National Asthma Control Initiative (NACI). This observational intervention was conducted from 2009 to 2011 in 20 rural counties and the Eastern Band Cherokee Indian Reservation in western North Carolina. Community and individual intervention components included asthma education in-services and environmental assessments/remediation. The individual intervention also included clinical assessment and management. Environmental remediation was conducted in 13 childcare facilities and 50 homes; over 259 administrative staff received asthma education. Fifty children with mild to severe persistent asthma were followed for up to 2 years; 76% were enrolled in Medicaid. From 12-month pre-intervention to 12-month post-intervention, the total number of asthma-related emergency department (ED) visits decreased from 158 to 4 and hospital admissions from 62 to 1 (p < 0.0001). From baseline to intervention completion, lung function FVC, FEV1, FEF 25-75 increased by 7.2%, 13.2% and 21.1%, respectively (all p < 0.001), and average school absences dropped from 17 to 8.8 days. Healthcare cost avoided 12 months post-intervention were approximately $882,021. The RADMP program resulted in decreased ED visits, hospitalizations, school absences and improved lung function and eNO. This was the first NACI demonstration project to show substantial improvements in healthcare utilization and clinical outcomes among rural asthmatic children.

Telerehabilitation clinical and vocational applications for assistive technology: research, opportunities, and challenges.

PubMed

Schmeler, Mark R; Schein, Richard M; McCue, Michael; Betz, Kendra

2009-01-01

Rehabilitation service providers in rural or underserved areas are often challenged in meeting the needs of their complex patients due to limited resources in their geographical area. Recruitment and retention of the rural clinical workforce are beset by the ongoing problems associated with limited continuing education opportunities, professional isolation, and the challenges inherent in coordinating rural community healthcare. People with disabilities who live in rural communities also face challenges accessing healthcare. Traveling long distances to a specialty clinic for necessary expertise may be troublesome due to inadequate or unavailable transportation, disability specific limitations, and financial limitations. Distance and lack of access are just two threats to quality of care that now being addressed by the use of videoconferencing, information exchange, and other telecommunication technologies that facilitate telerehabilitation. This white paper illustrates and summarizes clinical and vocational applications of telerehabilitation. We provide definitions related to the fields of telemedicine, telehealth, and telerehabilitation, and consider the impetus for telerehabilitation. We review the telerehabilitation literature for assistive technology applications; pressure ulcer prevention; virtual reality applications; speech-language pathology applications; seating and wheeled mobility applications; vocational rehabilitation applications; and cost-effectiveness. We then discuss external telerehabilitation influencers, such as the positions of professional organizations. Finally, we summarize clinical and policy issues in a limited context appropriate to the scope of this paper.

The hub-and-spoke organization design revisited: a lifeline for rural hospitals.

PubMed

Elrod, James K; Fortenberry, John L

2017-12-13

Characterized by declining populations, high poverty, reduced employment opportunities, and high numbers of uninsured residents, rural communities pose significant challenges for healthcare providers desirous of addressing these medically underserved areas. Such difficult environments, in fact, have forced the closure of many rural hospitals across America, with scores facing the same threat, compelling intensive efforts to identify pathways which will yield an improved future. Collaborations with stronger urban or suburban healthcare institutions offer a prudent avenue for rural hospitals to continue serving their patients. Such relationships can be structured in many different ways, but Willis-Knighton Health System found that its use of the hub-and-spoke organization design set the stage for the institution to cast a vital lifeline to neighboring rural hospitals, affording the relatively seamless integration and assimilation of partner facilities into its network, ensuring continuity of services in remote regions. This article supplies an overview of the hub-and-spoke network and discusses Willis-Knighton Health System's use of it to facilitate the establishment of productive partnerships with rural hospitals. The delivery of healthcare services in rural environments is essential, but with small community hospitals increasingly being under threat, the outlook is not particularly attractive. Partnerships with better positioned healthcare entities offer significant hope, but care must be taken to structure these arrangements optimally. Willis-Knighton Health System found utility and value in its hub-and-spoke organization design, with the insights presented in this account potentially offering a pathway for others to follow as they go about addressing the healthcare needs of rural populations.

Dental practitioner rural work movements: a systematic review.

PubMed

Godwin, Diana M; Hoang, Ha; Crocombe, Leonard A; Bell, Erica

2014-01-01

There is a globally observed unequal distribution of dental and other health practitioners between urban and rural areas in OECD countries. Dental practitioners provide important primary healthcare services to rural populations. Workforce shortages and stability issues in underserved areas can have negative effects on rural communities. Strategies used to fix the dental practitioner workforce maldistribution need to be investigated. The study had primary focus on Australia and included relevant international literature. Databases used were PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Informit, Web of Science, Scopus and Summon. Search terms included dental practitioner, rural, remote, retention, recruitment and strategies. Sixteen articles met the inclusion criteria. The articles described a total of eight different positive factors and 12 negative factors towards rural practice. The positive factors related to the nature of the type of clinical work being a 'challenge', close social and professional support networks, enjoyment of rural lifestyle and successful integration into the rural community. The negative factors mentioned included social and professional isolation, workload and type of clinical work, access to further education opportunities, access to facilities, education for children and job opportunities for a partner, and inability to integrate into the rural community. The articles that analysed recruitment incentives described three strategies currently used to influence recruitment, all of which were financial or contractual in nature. Articles mentioning retention factors described seven long-term retention motivators; of these, six of them were personal reasons. The most commonly mentioned motivational factor for recruitment and retention of the rural dental practitioner workforce was the effect of prior rural exposure for dental practitioners. The results of this review indicate that the most important influences on rural dental practitioner workforce recruitment and retention were a combination of financial reimbursement and personal reasons. There was also a large influence of rural medical workforce research on untested assumptions and drivers of the rural dental practitioner workforce. The high recruitment rate compared with the low retention rate indicates that current strategies were not effective in addressing rural dental practitioner workforce shortages in the long term.

Confronting Health Disparities: Latin American Social Medicine in Venezuela

PubMed Central

Mantini-Briggs, Clara

2009-01-01

Objectives. We explored the emergence and effectiveness of Venezuela's Misión Barrio Adentro, “Inside the Neighborhood Mission,” a program designed to improve access to health care among underserved residents of the country, hoping to draw lessons to apply to future attempts to address acute health disparities. Methods. We conducted our study in 3 capital-region neighborhoods, 2 small cities, and 2 rural areas, combining systematic observations with interviews of 221 residents, 41 health professionals, and 28 government officials. We surveyed 177 female and 91 male heads of household. Results. Interviews suggested that Misión Barrio Adentro emerged from creative interactions between policymakers, clinicians, community workers, and residents, adopting flexible, problem-solving strategies. In addition, data indicated that egalitarian physician–patient relationships and the direct involvement of local health committees overcame distrust and generated popular support for the program. Media and opposition antagonism complicated physicians’ lives and clinical practices but heightened the program's visibility. Conclusions. Top-down and bottom-up efforts are less effective than “horizontal” collaborations between professionals and residents in underserved communities. Direct, local involvement can generate creative and dynamic efforts to address acute health disparities in these areas. PMID:19150916

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.

Perceptions of Global Warming Among the Poorest Counties in the Southeastern United States.

PubMed

Kearney, Gregory D; Bell, Ronny A

2018-03-07

The geographic position and high level of poverty in the southeastern United States are significant risk factors that contribute to the region's high vulnerability to climate change. The goal of this study was to evaluate beliefs and perceptions of global warming among those living in poverty in the poorest counties in the southeastern United States. Results from this project may be used to support public health efforts to increase climate-related messaging to vulnerable and underserved communities. This was an ecological study that analyzed public opinion poll estimates from previously gathered national level survey data (2016). Responses to 5 questions related to beliefs, attitudes, and perceptions of global warming were evaluated. Counties below the national average poverty level (13.5%) were identified among 11 southeastern US states (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Michigan, North Carolina, South Carolina, Tennessee, Virginia). Student t tests were used to compare public perceptions of global warming among the poorest urban and rural counties with national-level public opinion estimates. Overall, counties below the national poverty level in the southeastern US were significantly less likely to believe that global warming was happening compared with national-level estimates. The poorest rural counties were less likely to believe that global warming was happening than the poorest urban counties. Health care providers and public health leaders at regional and local levels are in ideal positions to raise awareness and advocate the health implications of climate change to decision makers for the benefit of helping underserved communities mitigate and adequately adapt to climate-related threats.

Engaging diverse underserved communities to bridge the mammography divide.

PubMed

Engelman, Kimberly K; Cupertino, Ana Paula; Daley, Christine M; Long, Trish; Cully, Angelia; Mayo, Matthew S; Ellerbeck, Edward F; Geana, Mugur V; Greiner, Allen

2011-01-21

Breast cancer screening continues to be underutilized by the population in general, but is particularly underutilized by traditionally underserved minority populations. Two of the most at risk female minority groups are American Indians/Alaska Natives (AI/AN) and Latinas. American Indian women have the poorest recorded 5-year cancer survival rates of any ethnic group while breast cancer is the number one cause of cancer mortality among Latina women. Breast cancer screening rates for both minority groups are near or at the lowest among all racial/ethnic groups. As with other health screening behaviors, women may intend to get a mammogram but their intentions may not result in initiation or follow through of the examination process. An accumulating body of research, however, demonstrates the efficacy of developing 'implementation intentions' that define when, where, and how a specific behavior will be performed. The formulation of intended steps in addition to addressing potential barriers to test completion can increase a person's self-efficacy, operationalize and strengthen their intention to act, and close gaps between behavioral intention and completion. To date, an evaluation of the formulation of implementation intentions for breast cancer screening has not been conducted with minority populations. In the proposed program, community health workers will meet with rural-dwelling Latina and American Indian women one-on-one to educate them about breast cancer and screening and guide them through a computerized and culturally tailored "implementation intentions" program, called Healthy Living Kansas-Breast Health, to promote breast cancer screening utilization. We will target Latina and AI/AN women from two distinct rural Kansas communities. Women attending community events will be invited by CHWs to participate and be randomized to either a mammography "implementation intentions" (MI2) intervention or a comparison general breast cancer prevention informational intervention (C). CHWs will be armed with notebook computers loaded with our Healthy Living Kansas-Breast Health program and guide their peers through the program. Women in the MI2 condition will receive assistance with operationalizing their screening intentions and identifying and addressing their stated screening barriers with the goal of guiding them toward accessing screening services near their community. Outcomes will be evaluated at 120-days post randomization via self-report and will include mammography utilization status, barriers, and movement along a behavioral stages of readiness to screen model. This highly innovative project will be guided and initiated by AI/AN and Latina community members and will test the practical application of emerging behavioral theory among minority persons living in rural communities.

Engaging diverse underserved communities to bridge the mammography divide

PubMed Central

2011-01-01

Background Breast cancer screening continues to be underutilized by the population in general, but is particularly underutilized by traditionally underserved minority populations. Two of the most at risk female minority groups are American Indians/Alaska Natives (AI/AN) and Latinas. American Indian women have the poorest recorded 5-year cancer survival rates of any ethnic group while breast cancer is the number one cause of cancer mortality among Latina women. Breast cancer screening rates for both minority groups are near or at the lowest among all racial/ethnic groups. As with other health screening behaviors, women may intend to get a mammogram but their intentions may not result in initiation or follow through of the examination process. An accumulating body of research, however, demonstrates the efficacy of developing 'implementation intentions' that define when, where, and how a specific behavior will be performed. The formulation of intended steps in addition to addressing potential barriers to test completion can increase a person's self-efficacy, operationalize and strengthen their intention to act, and close gaps between behavioral intention and completion. To date, an evaluation of the formulation of implementation intentions for breast cancer screening has not been conducted with minority populations. Methods/Design In the proposed program, community health workers will meet with rural-dwelling Latina and American Indian women one-on-one to educate them about breast cancer and screening and guide them through a computerized and culturally tailored "implementation intentions" program, called Healthy Living Kansas - Breast Health, to promote breast cancer screening utilization. We will target Latina and AI/AN women from two distinct rural Kansas communities. Women attending community events will be invited by CHWs to participate and be randomized to either a mammography "implementation intentions" (MI2) intervention or a comparison general breast cancer prevention informational intervention (C). CHWs will be armed with notebook computers loaded with our Healthy Living Kansas - Breast Health program and guide their peers through the program. Women in the MI2 condition will receive assistance with operationalizing their screening intentions and identifying and addressing their stated screening barriers with the goal of guiding them toward accessing screening services near their community. Outcomes will be evaluated at 120-days post randomization via self-report and will include mammography utilization status, barriers, and movement along a behavioral stages of readiness to screen model. Discussion This highly innovative project will be guided and initiated by AI/AN and Latina community members and will test the practical application of emerging behavioral theory among minority persons living in rural communities. Trial Registration ClinicalTrials (NCT): NCT01267110 PMID:21255424

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…

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.

eHealth as a facilitator of equitable access to primary healthcare: the case of caring for non-communicable diseases in rural and refugee settings in Lebanon.

PubMed

Saleh, Shadi; Alameddine, Mohamad; Farah, Angie; El Arnaout, Nour; Dimassi, Hani; Muntaner, Carles; El Morr, Christo

2018-06-01

Assess the effect of selected low-cost eHealth tools on diabetes/hypertension detection and referrals rates in rural settings and refugee camps in Lebanon and explore the barriers to showing-up to scheduled appointments at Primary Healthcare Centers (PHC). Community-based screening for diabetes and hypertension was conducted in five rural and three refugee camp PHCs using an eHealth netbook application. Remote referrals were generated based on pre-set criteria. A phone survey was subsequently conducted to assess the rate and causes of no-shows to scheduled appointments. Associations between the independent variables and the outcome of referrals were then tested. Among 3481 screened individuals, diabetes, hypertension, and comorbidity were detected in 184,356 and 113 per 1000 individuals, respectively. 37.1% of referred individuals reported not showing-up to scheduled appointments, owing to feeling better/symptoms resolved (36.9%) and having another obligation (26.1%). The knowledge of referral reasons and the employment status were significantly associated with appointment show-ups. Low-cost eHealth netbook application was deemed effective in identifying new cases of NCDs and establishing appropriate referrals in underserved communities.

Effects of a proposed rural dental school on regional dental workforce and access to care.

PubMed

Wanchek, Tanya N; Rephann, Terance J

2013-01-01

Southwest Virginia is a rural, low-income region with a relatively small dentist workforce and poor oral health outcomes. The opening of a dental school in the region has been proposed by policy-makers as one approach to improving the size of the dentist workforce and oral health outcomes. A policy simulation was conducted to assess how a hypothetical dental school in rural Southwest Virginia would affect the availability of dentists and utilization levels of dental services. The simulation focuses on two channels through which the dental school would most likely affect the region. First, the number of graduates who are expected to remain in the region was varied, based on the extensiveness of the education pipeline used to attract local students. Second, the number of patients treated in the dental school clinic under different dental school clinical models, including the traditional model, a patient-centered clinic model and a community-based clinic model, was varied in the simulation to obtain a range of additional dentists and utilization rates under differing dental school models. Under a set of plausible assumptions, the low yield scenario (ie private school with a traditional clinic) would result in three additional dentists residing in the region and a total of 8090 additional underserved patients receiving care. Under the high yield scenario (ie dental pipeline program with community based clinics) nine new dentists would reside in the region and as many as 18 054 underserved patients would receive care. Even with the high yield scenario and the strong assumption that these patients would not otherwise access care, the utilization rate increases to 68.9% from its current 60.1%. While the new dental school in Southwest Virginia would increase the dentist workforce and utilization rates, the high cost combined with the continued low rate of dental utilization suggests that there may be more effective alternatives to improving oral health in rural areas. Alternative policies that have shown considerable promise in expanding access to disadvantaged populations include virtual dental homes, enhanced Medicaid reimbursement programs, and school-based dental care systems.

The WORD (Wholeness, Oneness, Righteousness, Deliverance): design of a randomized controlled trial testing the effectiveness of an evidence-based weight loss and maintenance intervention translated for a faith-based, rural, African American population using a community-based participatory approach.

PubMed

Yeary, Karen Hye-cheon Kim; Cornell, Carol E; Prewitt, Elaine; Bursac, Zoran; Tilford, J Mick; Turner, Jerome; Eddings, Kenya; Love, ShaRhonda; Whittington, Emily; Harris, Kimberly

2015-01-01

The positive effects of weight loss on obesity-related risk factors diminish unless weight loss is maintained. Yet little work has focused on the translation of evidence-based weight loss interventions with the aim of sustaining weight loss in underserved populations. Using a community-based participatory approach (CBPR) that engages the strong faith-based social infrastructure characteristic of rural African American communities is a promising way to sustain weight loss in African Americans, who bear a disproportionate burden of the obesity epidemic. Led by a collaborative community-academic partnership, The WORD aims to change dietary and physical activity behaviors to produce and maintain weight loss in rural, African American adults of faith. The WORD is a randomized controlled trial with 450 participants nested within 30 churches. All churches will receive a 16-session core weight loss intervention. Half of the churches will be randomized to receive an additional 12-session maintenance component. The WORD is a cultural adaptation of the Diabetes Prevention Program, whereby small groups will be led by trained church members. Participants will be assessed at baseline, 6, 12, and 18 months. A detailed cost-effectiveness and process evaluation will be included. The WORD aims to sustain weight loss in rural African Americans. The utilization of a CBPR approach and the engagement of the faith-based social infrastructure of African American communities will maximize the intervention's sustainability. Unique aspects of this trial include the focus on weight loss maintenance and the use of a faith-based CBPR approach in translating evidence-based obesity interventions. Copyright © 2014 Elsevier Inc. All rights reserved.

Establishing Community Learning and Information Centers (CLICs) in Underserved Malian Communities. Final Report

ERIC Educational Resources Information Center

Academy for Educational Development, 2005

2005-01-01

The purpose of the Community Learning and Information Center (CLIC) project was "to accelerate economic, social and political growth by providing residents in twelve underserved Malian communities with access to easily accessible development information and affordable access to information and communication technology (ICT), high-value…

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...

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

Rural-Urban Differences in Awareness and Use of Family Planning Services Among Adolescent Women in California.

PubMed

Yarger, Jennifer; Decker, Martha J; Campa, Mary I; Brindis, Claire D

2017-04-01

The purpose of this study was to compare awareness and use of family planning services by rural and urban program site among a sample of adolescent women before participation in the federal Personal Responsibility Education Program in California. We conducted a secondary analysis of survey data collected from youth before participation in California's Personal Responsibility Education Program. Bivariate and multivariate analyses were conducted for a sample of 4,614 females ages 14-18 years to compare awareness and use of family planning services between participants at rural and urban program sites, controlling for the program setting and participant demographic, sexual, and reproductive characteristics. Overall, 61% of participants had heard of a family planning provider in their community, and 24% had visited a family planning provider. Awareness and use of family planning services were lower among rural participants than urban participants. After adjusting for the program setting and participant characteristics, rural participants were less likely to know about a family planning provider in their community (odds ratio, .64; 95% confidence interval, .50-.81) or receive family planning services (odds ratio, .76; 95% confidence interval, .58-.99) than urban participants. Findings suggest that adolescents in rural areas face greater barriers to accessing family planning services than adolescents in urban areas. Targeted efforts to increase awareness and use of family planning services among adolescents in rural areas and among other underserved populations are needed. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Recall and Effectiveness of Messages Promoting Smoke-Free Policies in Rural Communities.

PubMed

Rayens, Mary Kay; Butler, Karen M; Wiggins, Amanda T; Kostygina, Ganna; Langley, Ronald E; Hahn, Ellen J

2016-05-01

Low-cost media campaigns increase demand for smoke-free policies in underserved rural areas. The study examined the impact of loss- and gain-framed smoke-free print ads on recall and perceived effectiveness in rural communities, controlling for personal characteristics. Following 6- to 9-month print media campaigns in three rural counties, recall and perceived effectiveness of loss-framed (ie, targeting dangers of secondhand smoke [SHS]) and gain-framed (ie, highlighting positive aspects of smoke-free air) ads were assessed using random-digit-dial phone surveys. Respondents were asked if they remembered each ad, whether they liked it, whether they were prompted to contact a smoke-free coalition, whether the ad made them think, and whether it prompted emotion. Mixed modeling assessed whether personal factors predicted ad recall or perceived effectiveness. Loss-framed ads were less likely to be recalled but more likely to prompt emotion. For ads of both frame types, females reported greater recall and perceived effectiveness than males. Those with less education reported higher perceived effectiveness of the ads but lower recall. Nonsmokers were more likely than smokers to perceive the ads as effective. Knowledge of SHS risk and support for smoke-free workplaces were positively associated with recall and effectiveness. Ad recall and perceived effectiveness were associated with framing and demographic and personal characteristics. Smoke-free efforts in rural areas may be bolstered by continuing to promote benefits of smoke-free workplace policies and educate on SHS risks. Rural areas may need to provide a combination of ad types and framing strategies to appeal to a wide audience. Rural communities are disproportionately affected by SHS and less likely to be protected by smoke-free policies. This study adds evidence-based guidance for tailoring rural smoke-free media campaigns using different framing: gain-framed messages (ie, benefits of smoke-free environments) to promote recall and loss-framed content (ie, dangers of SHS) to prompt emotion. Further, gain-framed messages that are localized to the rural community may be especially effective. Findings support designing smoke-free campaigns in rural communities with the audience in mind by tailoring messages to age, sex, and education level. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Recall and Effectiveness of Messages Promoting Smoke-Free Policies in Rural Communities

PubMed Central

Butler, Karen M.; Wiggins, Amanda T.; Kostygina, Ganna; Langley, Ronald E.; Hahn, Ellen J.

2016-01-01

Abstract Introduction: Low-cost media campaigns increase demand for smoke-free policies in underserved rural areas. The study examined the impact of loss- and gain-framed smoke-free print ads on recall and perceived effectiveness in rural communities, controlling for personal characteristics. Methods: Following 6- to 9-month print media campaigns in three rural counties, recall and perceived effectiveness of loss-framed (ie, targeting dangers of secondhand smoke [SHS]) and gain-framed (ie, highlighting positive aspects of smoke-free air) ads were assessed using random-digit-dial phone surveys. Respondents were asked if they remembered each ad, whether they liked it, whether they were prompted to contact a smoke-free coalition, whether the ad made them think, and whether it prompted emotion. Mixed modeling assessed whether personal factors predicted ad recall or perceived effectiveness. Results: Loss-framed ads were less likely to be recalled but more likely to prompt emotion. For ads of both frame types, females reported greater recall and perceived effectiveness than males. Those with less education reported higher perceived effectiveness of the ads but lower recall. Nonsmokers were more likely than smokers to perceive the ads as effective. Knowledge of SHS risk and support for smoke-free workplaces were positively associated with recall and effectiveness. Conclusions: Ad recall and perceived effectiveness were associated with framing and demographic and personal characteristics. Smoke-free efforts in rural areas may be bolstered by continuing to promote benefits of smoke-free workplace policies and educate on SHS risks. Rural areas may need to provide a combination of ad types and framing strategies to appeal to a wide audience. Implications: Rural communities are disproportionately affected by SHS and less likely to be protected by smoke-free policies. This study adds evidence-based guidance for tailoring rural smoke-free media campaigns using different framing: gain-framed messages (ie, benefits of smoke-free environments) to promote recall and loss-framed content (ie, dangers of SHS) to prompt emotion. Further, gain-framed messages that are localized to the rural community may be especially effective. Findings support designing smoke-free campaigns in rural communities with the audience in mind by tailoring messages to age, sex, and education level. PMID:26385925

Goal setting using telemedicine in rural underserved older adults with diabetes: experiences from the informatics for diabetes education and telemedicine project.

PubMed

West, Susan P; Lagua, Carina; Trief, Paula M; Izquierdo, Roberto; Weinstock, Ruth S

2010-05-01

To describe the use of telemedicine for setting goals for behavior change and examine the success in achieving these goals in rural underserved older adults with diabetes. Medicare beneficiaries with diabetes living in rural upstate New York who were enrolled in the telemedicine intervention of the Informatics for Diabetes Education and Telemedicine (IDEATel) project (n = 610) participated in home televisits with nurse and dietitian educators every 4-6 weeks for 2-6 years. Behavior change goals related to nutrition, physical activity, monitoring, diabetes health maintenance, and/or use of the home telemedicine unit were established at the conclusion of each televisit and assessed at the next visit. Collaborative goal setting was employed during 18,355 televisits (mean of 33 goal-setting televisits/participant). The most common goals were related to monitoring, followed by diabetes health maintenance, nutrition, exercise, and use of the telemedicine equipment. Overall, 68% of behavioral goals were rated as "improved" or "met." The greatest success was achieved for goals related to proper insulin injection technique and daily foot care. These elderly participants had the most difficulty achieving goals related to use of the computer. No gender differences in goal achievement were observed. Televisits can be successfully used to collaboratively establish behavior change goals to help improve diabetes self-management in underserved elderly rural adults.

Community Colleges in Higher Education: The Role of Community Colleges in Serving the Underserved Student

ERIC Educational Resources Information Center

Freeman, Jerrid P.

2007-01-01

The changing economy is increasing the significance of community colleges. While community colleges have served an important role in higher education, their importance and value to individuals and society is at an all time high. While community college characteristics have made these institutions attractive, the underserved population and the…

12 CFR 1282.13 - Central Cities, Rural Areas, and Other Underserved Areas Housing Goal.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Central Cities, Rural Areas, and Other... HOUSING GOALS AND MISSION ENTERPRISE HOUSING GOALS AND MISSION Housing Goals § 1282.13 Central Cities... purchase by each Enterprise of mortgages on housing located in central cities, rural areas, and other...

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…

A rural Appalachian faith-placed smoking cessation intervention.

PubMed

Schoenberg, Nancy E; Bundy, Henry E; Baeker Bispo, Jordan A; Studts, Christina R; Shelton, Brent J; Fields, Nell

2015-04-01

Although health promotion programming in faith institutions is promising, most faith-based or placed health projects focus on diet, exercise, or cancer screening and many have been located in urban environments. This article addresses the notable absence of faith programming for smoking cessation among underserved rural US residents who experience tobacco-related health inequities. In this article, we describe our faith-oriented smoking cessation program in rural Appalachia, involving 590 smokers in 26 rural churches randomized to early and delayed intervention groups. We present three main themes that account for participants' positive evaluation of the program; the program's ability to leverage social connections; the program's convenience orientation; and the program's financial support for smoking cessation. We also present themes on the roles of faith and church in smoking cessation programming, including some mixed perceptions on smoking stigma and comfort in church settings; challenges in faith-placed smoking cessation recruitment; and the positive perception of such programming by church leaders. We conclude that faith-placed smoking cessation programs offer great potential, although they must be administered with great sensitivity to individual and community norms.

A Rural Appalachian Faith-Placed Smoking Cessation Intervention

PubMed Central

Schoenberg, Nancy E.; Bundy, Henry E.; Baeker Bispo, Jordan A.; Studts, Christina R.; Shelton, Brent J.; Fields, Nell

2014-01-01

Although health promotion programming in faith institutions is promising, most faith-based or placed health projects focus on diet, exercise, or cancer screening and many have been located in urban environments. This article addresses the notable absence of faith programming for smoking cessation among underserved rural US residents who experience tobacco-related health inequities. In this article, we describe our faith-oriented smoking cessation program in rural Appalachia, involving 590 smokers in 26 rural churches randomized to early and delayed intervention groups. We present three main themes that account for participants’ positive evaluation of the program; the program’s ability to leverage social connections; the program’s convenience orientation; and the program’s financial support for smoking cessation. We also present themes on the roles of faith and church in smoking cessation programming, including some mixed perceptions on smoking stigma and comfort in church settings; challenges in faith-placed smoking cessation recruitment; and the positive perception of such programming by church leaders. We conclude that faith-placed smoking cessation program offer great potential, although they must be administered with great sensitivity to individual and community norms. PMID:24691565

Utah's Mobile Earth Science Outreach Vehicle

NASA Astrophysics Data System (ADS)

Schoessow, F. S.; Christian, L.

2016-12-01

Students at Utah State University's College of Natural Resources have engineered the first mobile Earth Science outreach platform capable of delivering high-tech and interactive solar-powered educational resources to the traditionally-underserved, remote communities of rural Utah. By retrofitting and modifying an industrial box-truck, this project effectively created a highly mobile and energy independent "school in a box" which seeks to help change the way that Earth science is communicated, eliminate traditional barriers, and increase science accessibility - both physically and conceptually. The project's education platform is focused on developing a more effective, sustainable, and engaging platform for presenting Earth science outreach curricula to community members of all ages in an engaging fashion. Furthermore, this project affords university students the opportunity to demonstrate innovative science communication techniques, translating vital university research into educational outreach operations aimed at doing real, measurable good for local communities.

Interprofessional collaborative practice incorporating training for alcohol and drug use screening for healthcare providers in rural areas.

PubMed

Puskar, Kathy; Mitchell, Ann M; Albrecht, Susan A; Frank, Linda R; Kane, Irene; Hagle, Holly; Lindsay, Dawn; Lee, Heeyoung; Fioravanti, Marie; Talcott, Kimberly S

2016-07-01

Interprofessional collaborative practice expands resources in rural and underserved communities. This article explores the impact of an online education programme on the perceptions of healthcare providers about interprofessional care within alcohol and drug use screening for rural residents. Nurses, behavioural health counsellors, and public health professionals participated in an evidence-based practice (screening, brief intervention, and referral to treatment-SBIRT) model that targets individuals who use alcohol and other drugs in a risky manner. SBIRT is recommended by the United States Preventive Services Task Force as a universal, evidence-based screening tool. Online modules, case simulation practice, and interprofessional dialogues are used to deliver practice-based learning experiences. A quasi-experimental method with pre-tests and post-tests was utilised. Results indicate increased perceptions of professional competence, need for cooperation, actual cooperation, and role values pre-to-post training. Implications suggest that online interprofessional education is useful but the added component of professional dialogues regarding patient cases offers promise in promoting collaborative practice.

Traditional birth attendants (TBAs) as potential agents in promoting male involvement in maternity preparedness: insights from a rural community in Uganda.

PubMed

Turinawe, Emmanueil Benon; Rwemisisi, Jude T; Musinguzi, Laban K; de Groot, Marije; Muhangi, Denis; de Vries, Daniel H; Mafigiri, David K; Katamba, Achilles; Parker, Nadine; Pool, Robert

2016-03-12

Since the 1994 International Conference on Population and Development, male involvement in reproductive health issues has been advocated as a means to improve maternal and child health outcomes, but to date, health providers have failed to achieve successful male involvement in pregnancy care especially in rural and remote areas where majority of the underserved populations live. In an effort to enhance community participation in maternity care, TBAs were trained and equipped to ensure better care and quick referral. In 1997, after the advent of the World Health Organization's Safe Motherhood initiative, the enthusiasm turned away from traditional birth attendants (TBAs). However, in many developing countries, and especially in rural areas, TBAs continue to play a significant role. This study explored the interaction between men and TBAs in shaping maternal healthcare in a rural Ugandan context. This study employed ethnographic methods including participant observation, which took place in the process of everyday life activities of the respondents within the community; 12 focus group discussions, and 12 in-depth interviews with community members and key informants. Participants in this study were purposively selected to include TBAs, men, opinion leaders like village chairmen, and other key informants who had knowledge about the configuration of maternity services in the community. Data analysis was done inductively through an iterative process in which transcribed data was read to identify themes and codes were assigned to those themes. Contrary to the thinking that TBA services are utilized by women only, we found that men actively seek the services of TBAs and utilize them for their wives' healthcare within the community. TBAs in turn sensitize men using both cultural and biomedical health knowledge, and become allies with women in influencing men to provide resources needed for maternity care. In this study area, men trust and have confidence in TBAs; closer collaboration with TBAs may provide a suitable platform through which communities can be sensitized and men actively brought on board in promoting maternal health services for women in rural communities.

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.

Teleneurology applications

PubMed Central

Wechsler, Lawrence R.; Tsao, Jack W.; Levine, Steven R.; Swain-Eng, Rebecca J.; Adams, Robert J.; Demaerschalk, Bart M.; Hess, David C.; Moro, Elena; Schwamm, Lee H.; Steffensen, Steve; Stern, Barney J.; Zuckerman, Steven J.; Bhattacharya, Pratik; Davis, Larry E.; Yurkiewicz, Ilana R.; Alphonso, Aimee L.

2013-01-01

Objective: To review current literature on neurology telemedicine and to discuss its application to patient care, neurology practice, military medicine, and current federal policy. Methods: Review of practice models and published literature on primary studies of the efficacy of neurology telemedicine. Results: Teleneurology is of greatest benefit to populations with restricted access to general and subspecialty neurologic care in rural areas, those with limited mobility, and those deployed by the military. Through the use of real-time audio-visual interaction, imaging, and store-and-forward systems, a greater proportion of neurologists are able to meet the demand for specialty care in underserved communities, decrease the response time for acute stroke assessment, and expand the collaboration between primary care physicians, neurologists, and other disciplines. The American Stroke Association has developed a defined policy on teleneurology, and the American Academy of Neurology and federal health care policy are beginning to follow suit. Conclusions: Teleneurology is an effective tool for the rapid evaluation of patients in remote locations requiring neurologic care. These underserved locations include geographically isolated rural areas as well as urban cores with insufficient available neurology specialists. With this technology, neurologists will be better able to meet the burgeoning demand for access to neurologic care in an era of declining availability. An increase in physician awareness and support at the federal and state level is necessary to facilitate expansion of telemedicine into further areas of neurology. PMID:23400317

Teleneurology applications: Report of the Telemedicine Work Group of the American Academy of Neurology.

PubMed

Wechsler, Lawrence R; Tsao, Jack W; Levine, Steven R; Swain-Eng, Rebecca J; Adams, Robert J; Demaerschalk, Bart M; Hess, David C; Moro, Elena; Schwamm, Lee H; Steffensen, Steve; Stern, Barney J; Zuckerman, Steven J; Bhattacharya, Pratik; Davis, Larry E; Yurkiewicz, Ilana R; Alphonso, Aimee L

2013-02-12

To review current literature on neurology telemedicine and to discuss its application to patient care, neurology practice, military medicine, and current federal policy. Review of practice models and published literature on primary studies of the efficacy of neurology telemedicine. Teleneurology is of greatest benefit to populations with restricted access to general and subspecialty neurologic care in rural areas, those with limited mobility, and those deployed by the military. Through the use of real-time audio-visual interaction, imaging, and store-and-forward systems, a greater proportion of neurologists are able to meet the demand for specialty care in underserved communities, decrease the response time for acute stroke assessment, and expand the collaboration between primary care physicians, neurologists, and other disciplines. The American Stroke Association has developed a defined policy on teleneurology, and the American Academy of Neurology and federal health care policy are beginning to follow suit. Teleneurology is an effective tool for the rapid evaluation of patients in remote locations requiring neurologic care. These underserved locations include geographically isolated rural areas as well as urban cores with insufficient available neurology specialists. With this technology, neurologists will be better able to meet the burgeoning demand for access to neurologic care in an era of declining availability. An increase in physician awareness and support at the federal and state level is necessary to facilitate expansion of telemedicine into further areas of neurology.

Engaging Youth in Underserved Communities through Digital-Mediated Arts Learning Experiences for Community Inquiry

ERIC Educational Resources Information Center

Lin, Ching-Chiu; Bruce, Bertram C.

2013-01-01

Learning for underserved youth is integral to social progress. Yet, too often, young people experience disconnects between their educational experiences and both individual and community needs. Arts can help these youth recover a unity through collective action in the community. Drawing from the experiences of a 4-year interdisciplinary research…

Increasing Educational Attainment and Aspiration in an Underserved Community: The Perspective of Urban-Community Leaders

ERIC Educational Resources Information Center

Person, Dawn; Garcia, Yvonne; Fujimoto, Eugene; Nguyen, Kayla; Saunders, Katherine; Hoffman, John

2014-01-01

Latino students are significantly underrepresented in higher education. As the largest and fastest growing racial/ethnic population in the US, this is cause for national concern. Additionally, this rapid population growth is a call for community and school leaders from underserved communities to assess their service areas and focus on…

Gender Differences in Rural and Urban Practice Location among Mid-Level Health Care Providers

ERIC Educational Resources Information Center

Lindsay, Sally

2007-01-01

Context: Mid-level providers comprise an increasing proportion of the health care workforce and play a key role in providing health services in rural and underserved areas. Although women comprise the majority of mid-level providers, they are less likely to work in a rural area than men. Maldistribution of health providers between urban and rural…

Mobile and Home-based Vendors’ Contributions to the Retail Food Environment in Rural South Texas Mexican-origin Settlements

PubMed Central

Valdez, Zulema; Dean, Wesley R; Sharkey, Joseph R

2012-01-01

A growing concern with high rates of obesity and overweight among immigrant minority populations in the U.S. has focused attention on the availability and accessibility to healthy foods in such communities. Small-scale vending in rural, impoverished and underserved areas, however, is generally overlooked; yet, this type of informal activity and source for food is particularly important in such environs, or “food desserts,” where traditional forms of work and mainstream food outlets are limited or even absent. This exploratory study investigates two types of small-scale food vending that take place in rural colonias, or Mexican-origin settlements along the South Texas border with Mexico: mobile and home-based. Using a convenience sample of 23 vendors who live and work in Texas colonias, this study identifies the characteristics associated with mobile and home-based food vendors and their businesses and its contributions to the rural food environment. Findings reveal that mobile and home-based vending provides a variety of food and beverage options to colonia residents, and suggests that home-based vendors contribute a greater assortment of food options, including some healthier food items, than mobile food vendors, which offer and sell a limited range of products. Findings may contribute to the development of innovative policy solutions and interventions aimed at increasing healthy food options or reducing health disparities in immigrant communities. PMID:22531289

Telerehabilitation Clinical and Vocational Applications for Assistive Technology: Research, Opportunities, and Challenges

PubMed Central

Schmeler, Mark R.; Schein, Richard M.; McCue, Michael; Betz, Kendra

2009-01-01

Rehabilitation service providers in rural or underserved areas are often challenged in meeting the needs of their complex patients due to limited resources in their geographical area. Recruitment and retention of the rural clinical workforce are beset by the ongoing problems associated with limited continuing education opportunities, professional isolation, and the challenges inherent in coordinating rural community healthcare. People with disabilities who live in rural communities also face challenges accessing healthcare. Traveling long distances to a specialty clinic for necessary expertise may be troublesome due to inadequate or unavailable transportation, disability specific limitations, and financial limitations. Distance and lack of access are just two threats to quality of care that now being addressed by the use of videoconferencing, information exchange, and other telecommunication technologies that facilitate telerehabilitation. This white paper illustrates and summarizes clinical and vocational applications of telerehabilitation. We provide definitions related to the fields of telemedicine, telehealth, and telerehabilitation, and consider the impetus for telerehabilitation. We review the telerehabilitation literature for assistive technology applications; pressure ulcer prevention; virtual reality applications; speech-language pathology applications; seating and wheeled mobility applications; vocational rehabilitation applications; and cost-effectiveness. We then discuss external telerehabilitation influencers, such as the positions of professional organizations. Finally, we summarize clinical and policy issues in a limited context appropriate to the scope of this paper. PMID:25945163

Academic Health Center Management of Chronic Diseases through Knowledge Networks: Project ECHO

PubMed Central

Arora, Sanjeev; Geppert, Cynthia M. A.; Kalishman, Summers; Dion, Denise; Pullara, Frank; Bjeletich, Barbara; Simpson, Gary; Alverson, Dale C.; Moore, Lori B.; Kuhl, Dave; Scaletti, Joseph V.

2013-01-01

The authors describe an innovative academic health center (AHC)-led program of health care delivery and clinical education for the management of complex, common, and chronic diseases in underserved areas, using hepatitis C virus (HCV) as a model. The program, based at the University of New Mexico School of Medicine, represents a paradigm shift in thinking and funding for the threefold mission of AHCs, moving from traditional fee-for-service models to public health funding of knowledge networks. This program, Project Extension for Community Healthcare Outcomes (ECHO), involves a partnership of academic medicine, public health offices, corrections departments, and rural community clinics dedicated to providing best practices and protocol-driven health care in rural areas. Telemedicine and Internet connections enable specialists in the program to comanage patients with complex diseases, using case-based knowledge networks and learning loops. Project ECHO partners (nurse practitioners, primary care physicians, physician assistants, and pharmacists) present HCV-positive patients during weekly two-hour telemedicine clinics using a standardized, case-based format that includes discussion of history, physical examination, test results, treatment complications, and psychiatric, medical, and substance abuse issues. In these case-based learning clinics, partners rapidly gain deep domain expertise in HCV as they collaborate with university specialists in hepatology, infectious disease, psychiatry, and substance abuse in comanaging their patients. Systematic monitoring of treatment outcomes is an integral aspect of the project. The authors believe this methodology will be generalizable to other complex and chronic conditions in a wide variety of underserved areas to improve disease outcomes, and it offers an opportunity for AHCs to enhance and expand their traditional mission of teaching, patient care, and research. PMID:17264693

Increasing interest in rural mental health work: the impact of a short term program to orientate allied health and nursing students to employment and career opportunities in a rural setting.

PubMed

Sutton, Keith P; Patrick, Kent; Maybery, Darryl; Eaton, Kaytlyn

2015-01-01

Ongoing workforce shortages affect the provision of mental health services to rural and remote communities. This article examines the immediate impact of a novel recruitment strategy that aims to increase the number of mental health professionals commencing their careers in a rural area of Australia. This study utilised a sequential confirmatory mixed methods design which included both online pre- and post-program surveys and semi-structured individual interviews. Statistical analyses compared participants' pre- and post-program survey interest in rural work/career, mental health work/career and rural mental health work/career. Content analysis was undertaken to explore interview transcripts for data that confirmed, contradicted or added depth to the quantitative findings. Comparison of pre- and post-program surveys indicated a significant increase in participants' interest in rural work/career and rural mental health work/career. The qualitative findings provided depth to and supported the change in interest toward working in a rural environment. Despite qualitative evidence that the program has increased participants' knowledge and understanding of the mental health sector as a whole, overt support for the changes in interest toward mental health work was not evident. The study provides evidence that a short-term program can change allied health and nursing students' interest in rural mental health work. The findings have important implications for the recruitment of mental health practitioners to underserved rural areas.

Adapting and implementing evidence-based cancer education interventions in rural Appalachia: real world experiences and challenges

PubMed Central

Vanderpool, RC; Gainor, SJ; Conn, ME; Spencer, C; Allen, AR; Kennedy, S

2014-01-01

Introduction There is recognition among public health scholars and community practitioners that translating cancer prevention and control research into practice is challenging. This circumstance is particularly germane to medically underserved communities, such as rural Appalachia, where few evidence-based interventions originate and cancer incidence and mortality are elevated. Methods A case study approach was selected to examine the collective experience of 13 West Virginia community organizations awarded mini-grants requiring the use of an evidence-based cancer control intervention. Methods included a systematic review of grant applications and final programmatic reports, a faxed survey, and qualitative, in-depth interviews with key stakeholders. Results Appalachian grantees reported notable challenges with selecting, adapting, and implementing evidence-based cancer education interventions. Evidence-based programming was viewed as a barrier. Grantees made a range of adaptations to meet constituent needs, thereby jeopardizing intervention fidelity. However, programs were perceived as successful due to community participation and engagement, some element of behavioral change, dissemination of the health message, and establishment of collaborative partnerships. Conclusions A descriptive examination provides insights into the challenges of translating research to practice. This Appalachian cancer education grant program also highlights areas of compromise that are important for researchers and practitioners to understand. PMID:21988459

Outcomes of Hepatitis C Treatment by Primary Care Providers

PubMed Central

Arora, Sanjeev; Thornton, Karla; Murata, Glen; Deming, Paulina; Kalishman, Summers; Dion, Denise; Parish, Brooke; Burke, Thomas; Pak, Wesley; Dunkelberg, Jeffrey; Kistin, Martin; Brown, John; Jenkusky, Steven; Komaromy, Miriam; Qualls, Clifford

2013-01-01

Background The Extension for Community Healthcare Outcomes (ECHO) model was developed to improve access to care for complex health problems such as hepatitis C virus (HCV) infection for underserved populations. Using videoconferencing technology, ECHO trains primary care providers to treat complex diseases. Methods A prospective cohort study compared treatment of HCV at the University of New Mexico (UNM) HCV clinic to treatment by primary care clinicians at 21 ECHO sites in rural areas and prisons in New Mexico. A total of 407 treatment naive patients with chronic HCV were enrolled. The primary end point was a sustained viral response (SVR). Results The rate of SVR was 57.5% (84/146) for patients treated at UNM and 58.2% (152 /261) at ECHO sites (P=0.89); difference between SVR rates 0.7% (95% CI -9.2%, 10.7%). In genotype 1 infection the SVR rate was 45.8% (38 /83) at UNM and 49.7% (73 /147) at ECHO sites (P=0.57). Serious adverse events occurred in 13.7% of the UNM HCV clinic cohort and 6.9% of the ECHO cohort. Conclusions This study demonstrates that the ECHO model is an effective way to treat HCV in underserved communities. Implementation of this model would allow other states and nations to treat more patients with HCV. PMID:21631316

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.

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…

Rural versus Suburban Primary Care Needs, Utilization, and Satisfaction with Telepsychiatric Consultation

ERIC Educational Resources Information Center

Hilty, Donald M.; Nesbitt, Thomas S.; Kuenneth, Christina A.; Cruz, Grace M.; Hales, Robert E.

2007-01-01

Context and Purpose: Rural and suburban populations remain underserved in terms of psychiatric services but have not been compared directly in terms of using telepsychiatry. Methods: Patient demographics, reasons for consultation, diagnosis, and alternatives to telepsychiatric consultation were collected for 200 consecutive, first-time…

Considering the Role of Stress in Populations of High-Risk, Underserved Community Networks Program Centers.

PubMed

Hébert, James R; Braun, Kathryn L; Kaholokula, Joseph Keawe'aimoku; Armstead, Cheryl A; Burch, James B; Thompson, Beti

2015-01-01

Cancer disparities are associated with a broad range of sociocultural determinants of health that operate in community contexts. High-risk populations may be more vulnerable to social and environmental factors that lead to chronic stress. Theoretical and empirical research indicates that exposure to contextual and sociocultural stress alters biological systems, thereby influencing cancer risk, progression, and, ultimately, mortality. We sought to describe contextual pathways through which stress likely increases cancer risk in high-risk, underserved populations. This review presents a description of the link between contextual stressors and disease risk disparities within underserved communities, with a focus on 1) stress as a proximal link between biological processes, such as cytokine responses, inflammation, and cancer and 2) stress as a distal link to cancer through biobehavioral risk factors such as poor diet, physical inactivity, circadian rhythm or sleep disruption, and substance abuse. These concepts are illustrated through application to populations served by three National Cancer Institute-funded Community Networks Program Centers (CNPCs): African Americans in the Deep South (the South Carolina Cancer Disparities Community Network [SCCDCN]), Native Hawaiians ('Imi Hale-Native Hawaiian Cancer Network), and Latinos in the Lower Yakima Valley of Washington State (The Center for Hispanic Health Promotion: Reducing Cancer Disparities). Stress experienced by the underserved communities represented in the CNPCs is marked by social, biological, and behavioral pathways that increase cancer risk. A case is presented to increase research on sociocultural determinants of health, stress, and cancer risk among racial/ethnic minorities in underserved communities.

Expanding Home-Based Primary Care to American Indian Reservations and Other Rural Communities: An Observational Study.

PubMed

Kramer, B Josea; Creekmur, Beth; Mitchell, Michael N; Saliba, Debra

2018-04-01

Home-based primary care (HBPC) is a comprehensive, interdisciplinary program to meet the medical needs of community-dwelling populations needing long-term care (LTC). The U.S. Department of Veterans Affairs (VA) expanded its HBPC program to underserved rural communities, including American Indian reservations, providing a "natural laboratory" to study change in access to VA LTC benefits and utilization outcomes for rural populations that typically face challenges in accessing LTC medical support. Pretest-Posttest quasi-experimental approach with interrupted time-series design using linked VA, Medicare, and Indian Health Service (IHS) records. American Indian reservations and non-Indian communities in rural HBPC catchment areas. 376 veterans (88 IHS beneficiaries, 288 non-IHS beneficiaries) with a HBPC length of stay of 12 months or longer. Baseline demographic and health characteristics, activities of daily living (ADL), previous VA enrollment, and hospital admissions and emergency department (ED) visits as a function of time, accounting for IHS beneficiary and functional statuses. For HBPC users, VA enrollment increased by 22%. At baseline, 30% of IHS and non-IHS beneficiaries had 2 or more ADLs impairments; IHS populations were younger (P < .001) and had more diagnosed chronic diseases (P = .007). Overall, hospital admissions decreased by 0.10 (95% confidence interval (CI) = -0.14 to -0.05) and ED visits decreased by 0.13 (95% CI = -0.19 to -0.07) in the 90 days after HBPC admission (Ps < .001) and these decreases were maintained over 1 year follow-up. Before HBPC, probability of hospital admission was 12% lower for IHS than non-IHS beneficiaries (P = .02). Introducing HBPC to rural areas increased access to LTC and enrollment for healthcare benefits, with equitable outcomes in IHS and non-IHS populations. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.

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

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

42 CFR 5a.1 - Statutory basis and purpose.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Statutory basis and purpose. 5a.1 Section 5a.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS RURAL... the Public Health Service Act. These provisions define “underserved rural community” for purposes of...

42 CFR 5a.1 - Statutory basis and purpose.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Statutory basis and purpose. 5a.1 Section 5a.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS RURAL... the Public Health Service Act. These provisions define “underserved rural community” for purposes of...

42 CFR 5a.1 - Statutory basis and purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Statutory basis and purpose. 5a.1 Section 5a.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS RURAL... the Public Health Service Act. These provisions define “underserved rural community” for purposes of...

Conducting Program Evaluation with Hispanics in Rural Settings: Ethical Issues and Evaluation Challenges

ERIC Educational Resources Information Center

Loi, Claudia X. Aguado; McDermott, Robert J.

2010-01-01

Conducting evaluations that are both valid and ethical is imperative for the support and sustainability of programs that address underserved and vulnerable populations. A key component is to have evaluators who are knowledgeable about relevant cultural issues and sensitive to population needs. Hispanics in rural settings are vulnerable for many…

42 CFR 5a.1 - Statutory basis and purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Statutory basis and purpose. 5a.1 Section 5a.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS RURAL... the Public Health Service Act. These provisions define “underserved rural community” for purposes of...

42 CFR 5a.1 - Statutory basis and purpose.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Statutory basis and purpose. 5a.1 Section 5a.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS RURAL... the Public Health Service Act. These provisions define “underserved rural community” for purposes of...

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

Influence of community-based education on undergraduate health professions students' decision to work in underserved areas in Uganda.

PubMed

Kizito, Samuel; Baingana, Rhona; Mugagga, Kintu; Akera, Peter; Sewankambo, Nelson K

2017-12-08

Uganda is beset by a shortage of health workers and the few available are mal-distributed. Providing rural exposure through community-based education could positively influence students' perspectives towards work in rural areas. We aimed to assess the impact of Community-Based Education and Research (COBERS) on health professions students' attitudes towards working in rural areas. This was a before-and-after study among 525 students of 4 medical universities in Uganda. Data was collected using self-administered paper-based questionnaires. Logistic regression and Poisson regression respectively were used to assess intention and intended number of years of work in rural areas. Before COBERS, 228/518 (44.0%) students indicated that they intended to work in rural areas as compared to 245/506 (48.4%) after the COBERS placement. Before the COBERS placement, the factors that were associated with students considering to work in a rural area were: extra allowance (OR = 0.2; 95% CI 0.1-0.6), and availability of social amenities (OR = 0.2; 95% CI 0.1-0.7). After their COBERS placement, the factors were: access to long distance courses (OR = 2.0; 95% CI 1.0-3.7) and being posted to a facility in a rural area (OR = 15.0; 95% CI 6.5-35.5). Before the COBERS placement the factors that influenced how long students thought they would be willing to work in a rural environment were: reliable electricity (IRR = 0.6; 95% CI 0.3-1.0) and Internet (IRR = 1.5; 95% CI 1.0-2.3), high salary (IRR = 0.4; 95% CI 0.3-0.7), and having skills to practice in rural settings (IRR = 2.0; 95% CI 1.3-3.1). Reliable electricity (IRR = 0.5; 95% CI 0.3-0.8) and long distance courses (IRR = 2.1; 95% CI 1.4-3.1) were significant motivators after having undergone the COBERS placement. The majority of health professions students do not intend to work in rural areas after they graduate. Improving the welfare of health professionals working in rural areas could attract more health professionals to rural areas thus addressing the maldistribution of health workers in Uganda.

76 FR 42760 - SBA Council on Underserved Communities Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-19

... SMALL BUSINESS ADMINISTRATION SBA Council on Underserved Communities Meeting AGENCY: U.S. Small Business Administration (SBA). ACTION: Notice of Federal advisory committee meeting. SUMMARY: The SBA is... meeting will be held at the U.S. Small Business Administration: 409 3rd St SW., Eisenhower Conference Room...

Evaluation of a Coordinated School-Based Obesity Prevention Program in a Hispanic Community: Choosing Healthy and Active Lifestyles for Kids/healthy Schools Healthy Families

ERIC Educational Resources Information Center

Berger-Jenkins, Evelyn; Rausch, John; Okah, Ebiere; Tsao, Daisy; Nieto, Andres; Lyda, Elizabeth; Meyer, Dodi; McCord, Mary

2014-01-01

Background: Obesity is a public health concern that disproportionately affects underserved and minority communities. Purpose: To evaluate whether a comprehensive obesity prevention program that targets children and school staff in an underserved Hispanic community affects obesity related knowledge, attitudes, and behaviors among both students and…

Web-Based Interventions Alone or Supplemented with Peer-Led Support or Professional Email Counseling for Weight Loss and Weight Maintenance in Women from Rural Communities: Results of a Clinical Trial

PubMed Central

Pullen, Carol H.; Pozehl, Bunny; Eisenhauer, Christine; Boeckner, Linda S.

2017-01-01

Objective. This trial compared the effectiveness of a web-based only (WO) intervention with web-based supplemented by peer-led discussion (WD) or professional email counseling (WE) across 3 phases to achieve weight loss and weight maintenance in women from underserved rural communities. Methods. 301 women (BMI of 28–45 kg/m2) randomly assigned to groups participated in guided weight loss (baseline to 6 months), guided weight loss and maintenance (6 to 18 months), and self-managed weight maintenance (18 to 30 months). Results. Retention was 88.7%, 76.5%, and 71.8% at 6, 18, and 30 months, respectively. Intent-to-treat analyses demonstrated no group differences in change in weight within any phases. At 6 months, observed mean (SD) weight loss was 5.1 (6.0) kg in WO, 4.1 (5.6) kg in WD, and 6.0 (6.3) kg in WE, with 42%, 38%, and 51%, respectively, meeting ≥ 5% weight loss. These proportions dropped by a third after phase 2 with no further change during phase 3. Conclusion. Web-based interventions assisted women from rural communities in achieving 6-month weight loss, with weight regain by half at 30 months. No group differences were potentially due to the robust nature of the web-based intervention. Trial Registration. This trial is registered with ClinicalTrials.gov NCT01307644. PMID:28480078

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.

Evaluating a De-Centralized Regional Delivery System for Breast Cancer Screening and Patient Navigation for the Rural Underserved.

PubMed

Inrig, Stephen J; Tiro, Jasmin A; Melhado, Trisha V; Argenbright, Keith E; Craddock Lee, Simon J

2014-01-01

Providing breast cancer screening services in rural areas is challenging due to the fractured nature of healthcare delivery systems and complex reimbursement mechanisms that create barriers to access for the under- and uninsured. Interventions that reduce structural barriers to mammography, like patient navigation programs, are effective and recommended, especially for minority and underserved women. Although the literature on rural healthcare is significant, the field lacks studies of adaptive service delivery models and rigorous evaluation of evidence-based programs that facilitate routine screening and appropriate follow-up across large geographic areas. To better understand how to implement a decentralized regional delivery "hub & spoke" model for rural breast cancer screening and patient navigation, we have designed a rigorous, structured, multi-level and mixed-methods evaluation based on Glasgow's RE-AIM model (Reach, Effectiveness, Adoption, Implementation, and Maintenance). The program is comprised of three core components: 1) Outreach to underserved women by partnering with county organizations; 2) Navigation to guide patients through screening and appropriate follow-up; and 3) Centralized Reimbursement to coordinate funding for screening services through a central contract with Medicaid Breast and Cervical Cancer Services (BCCS). Using Glasgow's RE-AIM model, we will: 1) assess which counties have the resources and capacity to implement outreach and/or navigation components, 2) train partners in each county on how to implement components, and 3) monitor process and outcome measures in each county at regular intervals, providing booster training when needed. This evaluation strategy will elucidate how the heterogeneity of rural county infrastructure impacts decentralized service delivery as a navigation program expands. In addition to increasing breast cancer screening access, our model improves and maintains time to diagnostic resolution and facilitates timely referral to local cancer treatment services. We offer this evaluation approach as an exemplar for scientific methods to evaluate the translation of evidence-based federal policy into sustainable health services delivery in a rural setting.

Evaluating a De-Centralized Regional Delivery System for Breast Cancer Screening and Patient Navigation for the Rural Underserved

PubMed Central

Inrig, Stephen J.; Tiro, Jasmin A.; Melhado, Trisha V.; Argenbright, Keith E.; Craddock Lee, Simon J.

2017-01-01

Providing breast cancer screening services in rural areas is challenging due to the fractured nature of healthcare delivery systems and complex reimbursement mechanisms that create barriers to access for the under- and uninsured. Interventions that reduce structural barriers to mammography, like patient navigation programs, are effective and recommended, especially for minority and underserved women. Although the literature on rural healthcare is significant, the field lacks studies of adaptive service delivery models and rigorous evaluation of evidence-based programs that facilitate routine screening and appropriate follow-up across large geographic areas. Objectives To better understand how to implement a decentralized regional delivery “hub & spoke” model for rural breast cancer screening and patient navigation, we have designed a rigorous, structured, multi-level and mixed-methods evaluation based on Glasgow’s RE-AIM model (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Methods and Design The program is comprised of three core components: 1) Outreach to underserved women by partnering with county organizations; 2) Navigation to guide patients through screening and appropriate follow-up; and 3) Centralized Reimbursement to coordinate funding for screening services through a central contract with Medicaid Breast and Cervical Cancer Services (BCCS). Using Glasgow’s RE-AIM model, we will: 1) assess which counties have the resources and capacity to implement outreach and/or navigation components, 2) train partners in each county on how to implement components, and 3) monitor process and outcome measures in each county at regular intervals, providing booster training when needed. Discussion This evaluation strategy will elucidate how the heterogeneity of rural county infrastructure impacts decentralized service delivery as a navigation program expands. In addition to increasing breast cancer screening access, our model improves and maintains time to diagnostic resolution and facilitates timely referral to local cancer treatment services. We offer this evaluation approach as an exemplar for scientific methods to evaluate the translation of evidence-based federal policy into sustainable health services delivery in a rural setting. PMID:28713882

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.

Considering the Role of Stress in Populations of High-Risk, Underserved Community Networks Program Centers

PubMed Central

Hébert, James R.; Braun, Kathryn L.; Kaholokula, Joseph Keawe‘aimoku; Armstead, Cheryl A.; Burch, James B.; Thompson, Beti

2015-01-01

Background Cancer disparities are associated with a broad range of sociocultural determinants of health that operate in community contexts. High-risk populations may be more vulnerable to social and environmental factors that lead to chronic stress. Theoretical and empirical research indicates that exposure to contextual and sociocultural stress alters biological systems, thereby influencing cancer risk, progression, and, ultimately, mortality. Objective We sought to describe contextual pathways through which stress likely increases cancer risk in high-risk, underserved populations. Methods This review presents a description of the link between contextual stressors and disease risk disparities within underserved communities, with a focus on 1) stress as a proximal link between biological processes, such as cytokine responses, inflammation, and cancer and 2) stress as a distal link to cancer through biobehavioral risk factors such as poor diet, physical inactivity, circadian rhythm or sleep disruption, and substance abuse. These concepts are illustrated through application to populations served by three National Cancer Institute-funded Community Networks Program Centers (CNPCs): African Americans in the Deep South (the South Carolina Cancer Disparities Community Network [SCCDCN]), Native Hawaiians (‘Imi Hale—Native Hawaiian Cancer Network), and Latinos in the Lower Yakima Valley of Washington State (The Center for Hispanic Health Promotion: Reducing Cancer Disparities). Conclusions Stress experienced by the underserved communities represented in the CNPCs is marked by social, biological, and behavioral pathways that increase cancer risk. A case is presented to increase research on sociocultural determinants of health, stress, and cancer risk among racial/ethnic minorities in underserved communities. PMID:26213406

Impact of Potential Accreditation and Certification in Family Medicine Maternity Care.

PubMed

Eden, Aimee R; Peterson, Lars E

2017-01-01

Advanced maternity care training in family medicine is highly variable at both the residency and fellowship levels. Declining numbers of family physicians providing maternity care services may exacerbate disparities in access to maternal and child care, especially in rural and other underserved communities. Accreditation of maternity care fellowships and board certification may be one potential avenue to address this trend. This study sought to understand the perceptions and beliefs of key family medicine stakeholders in advanced maternity care regarding the formalization of maternity care training through fellowship accreditation and the creation of a certificate of added qualification (CAQ). In 2014 and 2015, the authors conducted semi-structured interviews with 51 key stakeholders in family medicine maternity care. Transcribed interviews were coded using an iterative process to identify themes and patterns until saturation was reached. Participants generally supported both maternity care fellowship accreditation and a CAQ and recognized multiple advantages such as legitimization of training. Many had concerns about potential negative unintended consequences such as a loss of curricular flexibility; however, most felt that these could be mediated. Only a few did not support one or both aspects of formalization. Most participants interviewed support formalizing maternity care fellowship training in family medicine through accreditation and a subsequent CAQ, if implemented with attention to minimizing the potential negative consequences. Such formalization would recognize the advanced skill and training of family physicians practicing advanced maternity care and could address some access issues to essential maternity care services for rural and other underserved populations.

Structure and characteristics of family medicine maternity care fellowships.

PubMed

Peterson, Lars E; Blackburn, Brenna; Phillips, Robert L; Puffer, James C

2014-05-01

Fewer family physicians are providing maternity care. Maternity Care Fellowships (MCFs) provide training in advanced obstetrical skills, including cesarean sections. These programs lack official recognition and certification. MCF graduates have been studied, but there are no studies of the fellowships. The objective of this study was to assess the structure and organization of family medicine MCFs. We identified MCFs from the American Academy of Family Physicians website. Twenty-nine unique and active programs were included in the final sample. We surveyed programs via an anonymous internet methodology. The survey asked about program structure, organization, and educational aspects of the program. A total of 18 programs responded, for a 62% response rate. Eighty-eight percent of MCFs were 1 year in length, and the mean number of fellows per year was 1.9. All but one program were associated with a residency training program, and 55.6% were based in community hospitals. All but two programs had a standardized curriculum. Eighty-eight percent of MCFs had obstetricians involved in teaching or clinical supervision. Mean estimated number of deliveries performed by fellows were 80 vaginal and 108 caesarian. Graduates of MCFs were largely able to obtain caesarian privileges after graduation, and many were working in rural and/or underserved areas. Many MCF directors favored formal accreditation and a standardized curriculum across programs. Despite lack of formal accreditation, MCFs have academic affiliations and internally standardized curricula. MCFs provide an obstetric workforce for rural and underserved areas, and formal accreditation may ensure program survival and boost educational standards.

Area Health Education Center (AHEC) programs for rural and underrepresented minority students in the Alabama Black Belt.

PubMed

Patel, Ashruta; Knox, Regina J; Logan, Alicia; Summerville, Katie

2017-01-01

This paper evaluated the implementation West Central Alabama Area Health Education Center programs for high school students in grades 9-12 through participant-reported evaluations and feedback during the  September 1st, 2013 to August 31st, 2014 fiscal year. The programs targeted racial/ethnic minorities and/or rural individuals interested in pursuing a career as a healthcare provider in medically underserved counties of Alabama. Students participated in enrichment activities related to prospective health careers that included: successful college preparedness, knowledge about health careers, and the types of primary care health professions that are needed in underserved Alabama communities. The curriculum studied 593 (ACT preparation: n  = 172, AHEC 101: n  = 56, FAFSA: n  = 109, Health Career Exploration: n  = 159, College Career Readiness: n  = 67, Dixie Scholars NERD: n  = 30) baseline measures for the programs to evaluate effectiveness when rated by participants both quantitatively and qualitatively. Interactive activities with video incorporation, hands-on experiences, and group discussions paired with student motivation and interest in specific health career-related activities provided the highest program ratings. It is important to use a variety of successful program strategies when forming healthcare workforce development interventions. Student evaluations can help adapt methods for future program implementation to ultimately achieve strategies for health professional recruitment, training, and retention in areas that lack access to quality healthcare.

Mobile and home-based vendors' contributions to the retail food environment in rural South Texas Mexican-origin settlements.

PubMed

Valdez, Zulema; Dean, Wesley R; Sharkey, Joseph R

2012-10-01

A growing concern with high rates of obesity and overweight among immigrant minority populations in the US has focused attention on the availability and accessibility to healthy foods in such communities. Small-scale vending in rural, impoverished and underserved areas, however, is generally overlooked; yet, this type of informal activity and source for food is particularly important in such environs, or "food desserts," where traditional forms of work and mainstream food outlets are limited or even absent. This exploratory study investigates two types of small-scale food vending that take place in rural colonias, or Mexican-origin settlements along the South Texas border with Mexico: mobile and home-based. Using a convenience sample of 23 vendors who live and work in Texas colonias, this study identifies the characteristics associated with mobile and home-based food vendors and their businesses and its contributions to the rural food environment. Findings reveal that mobile and home-based vending provides a variety of food and beverage options to colonia residents, and suggests that home-based vendors contribute a greater assortment of food options, including some healthier food items, than mobile food vendors, which offer and sell a limited range of products. Findings may contribute to the development of innovative policy solutions and interventions aimed at increasing healthy food options or reducing health disparities in immigrant communities. Copyright © 2012 Elsevier Ltd. All rights reserved.

Evaluation of a patient navigation program to promote colorectal cancer screening in rural Georgia, USA.

PubMed

Honeycutt, Sally; Green, Rhonda; Ballard, Denise; Hermstad, April; Brueder, Alex; Haardörfer, Regine; Yam, Jennifer; Arriola, Kimberly J

2013-08-15

Colorectal cancer (CRC) is a leading cause of cancer death in the United States. Early detection through recommended screening has been shown to have favorable treatment outcomes, yet screening rates among the medically underserved and uninsured are low, particularly for rural and minority populations. This study evaluated the effectiveness of a patient navigation program that addresses individual and systemic barriers to CRC screening for patients at rural, federally qualified community health centers. This quasi-experimental evaluation compared low-income patients at average risk for CRC (n = 809) from 4 intervention clinics and 9 comparison clinics. We abstracted medical chart data on patient demographics, CRC history and risk factors, and CRC screening referrals and examinations. Outcomes of interest were colonoscopy referral and examination during the study period and being compliant with recommended screening guidelines at the end of the study period. We conducted multilevel logistic analyses to evaluate the program's effectiveness. Patients at intervention clinics were significantly more likely than patients at comparison clinics to undergo colonoscopy screening (35% versus 7%, odds ratio = 7.9, P < .01) and be guideline-compliant on at least one CRC screening test (43% versus 11%, odds ratio = 5.9, P < .001). Patient navigation, delivered through the Community Cancer Screening Program, can be an effective approach to ensure that lifesaving, preventive health screenings are provided to low-income adults in a rural setting. Copyright © 2013 American Cancer Society.

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.

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.

Swinging bridges of opportunity and challenges: memoirs of an African American nurse practitioner pioneer on providing primary care for the underserved.

PubMed

Brown, Viola D; Marfell, Julie

2005-01-01

This article presents the memoirs of Mrs. Viola D. Brown, RN, FNP, a pioneer African American nurse practitioner, on opportunities and challenges involved in providing primary and public health care for underserved populations in urban and rural areas of Kentucky. Mrs. Brown began her career with a visit to Mary Breckinridge and the Frontier Nursing Service, and she was elected into the University of Kentucky's Department of Public Health Hall of Fame in 2005. This article is an adapted version of the closing keynote address presented at the 13th Primary Care for the Underserved Conference held March 2005.

Alumni Engaging Students from Under-Served Groups in Southern Appalachia

ERIC Educational Resources Information Center

Williams, Mitchell R.; Leatherwood, Laura; Byrd, Laura; Boyd, Monica S.; Pennington, Kevin

2010-01-01

The study explores how alumni can help community colleges in Southern Appalachia to create greater access for people in groups which are traditionally under-served by higher education. Semi-structured interviews conducted with alumni program directors and admissions officers at seven community colleges in the Southern Appalachian Region explore…

The Quick Peek Program: A Model for Developmental Screening within Underserved Communities

ERIC Educational Resources Information Center

Harris, Jill; Norton, Amy

2016-01-01

Developmental screening of young children is important in all populations, especially underserved communities with known health care disparities. The American Academy of Pediatrics created guidelines and a toolkit for pediatricians to conduct developmental surveillance and screening, yet these guidelines are not uniformly implemented within…

Conducting Research With Community Groups.

PubMed

Doornbos, Mary Molewyk; Ayoola, Adejoke; Topp, Robert; Zandee, Gail Landheer

2015-10-01

Nurse scientists are increasingly recognizing the necessity of conducting research with community groups to effectively address complex health problems and successfully translate scientific advancements into the community. Although several barriers to conducting research with community groups exist, community-based participatory research (CBPR) has the potential to mitigate these barriers. CBPR has been employed in programs of research that respond in culturally sensitive ways to identify community needs and thereby address current health disparities. This article presents case studies that demonstrate how CBPR principles guided the development of (a) a healthy body weight program for urban, underserved African American women; (b) a reproductive health educational intervention for urban, low-income, underserved, ethnically diverse women; and (c) a pilot anxiety/depression intervention for urban, low-income, underserved, ethnically diverse women. These case studies illustrate the potential of CBPR as an orientation to research that can be employed effectively in non-research-intensive academic environments. © The Author(s) 2015.

Conducting Research with Community Groups

PubMed Central

Doornbos, Mary Molewyk; Ayoola, Adejoke; Topp, Robert; Zandee, Gail Landheer

2016-01-01

Nurse scientists are increasingly recognizing the necessity of conducting research with community groups to effectively address complex health problems and successfully translate scientific advancements into the community. While several barriers to conducting research with community groups exist, community based participatory research (CBPR) has the potential to mitigate these barriers. CBPR has been employed in programs of research that respond in culturally sensitive ways to identify community needs and thereby address current health disparities. This manuscript presents case studies that demonstrate how CBPR principles guided the development of: (a) a healthy body weight program for urban, underserved African-American women, (b) a reproductive health educational intervention for urban, low-income, underserved, ethnically diverse women, and (c) a pilot anxiety/depression intervention for urban, low-income, underserved, ethnically diverse women. These case studies illustrate the potential of CBPR as an orientation to research that can be employed effectively in non-research intensive academic environments. PMID:25724557

Community health workers in rural India: analysing the opportunities and challenges Accredited Social Health Activists (ASHAs) face in realising their multiple roles.

PubMed

Saprii, Lipekho; Richards, Esther; Kokho, Puni; Theobald, Sally

2015-12-09

Globally, there is increasing interest in community health worker's (CHW) performance; however, there are gaps in the evidence with respect to CHWs' role in community participation and empowerment. Accredited Social Health Activists (ASHAs), whose roles include social activism, are the key cadre in India's CHW programme which is designed to improve maternal and child health. In a diverse country like India, there is a need to understand how the ASHA programme operates in different underserved Indian contexts, such as rural Manipur. We undertook qualitative research to explore stakeholders' perceptions and experiences of the ASHA scheme in strengthening maternal health and uncover the opportunities and challenges ASHAs face in realising their multiple roles in rural Manipur, India. Data was collected through in-depth interviews (n = 18) and focus group discussions (n = 3 FGDs, 18 participants). Participants included ASHAs, key stakeholders and community members. They were purposively sampled based on remoteness of villages and primary health centres to capture diverse and relevant constituencies, as we believed experiences of ASHAs can be shaped by remoteness. Data were analysed using the thematic framework approach. Findings suggested that ASHAs are mostly understood as link workers. ASHA's ability to address the immediate needs of rural and marginalised communities meant that they were valued as service providers. The programme is perceived to be beneficial as it improves awareness and behaviour change towards maternal care. However, there are a number of challenges; the selection of ASHAs is influenced by power structures and poor community sensitisation of the ASHA programme presents a major risk to success and sustainability. The primary health centres which ASHAs link to are ill-equipped. Thus, ASHAs experience adverse consequences in their ability to inspire trust and credibility in the community. Small and irregular monetary incentives demotivate ASHAs. Finally, ASHAs had limited knowledge about their role as an 'activist' and how to realise this. ASHAs are valued for their contribution towards maternal health education and for their ability to provide basic biomedical care, but their role as social activists is much less visible as envisioned in the ASHA operational guideline. Access by ASHAs to fair monetary incentives commensurate with effort coupled with the poor functionality of the health system are critical elements limiting the role of ASHAs both within the health system and within communities in rural Manipur.

The Reality of Sustaining 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

2015-01-01

Many community-based sport and physical activity programs take a positive youth development approach when operating in underserved communities around the world (Forneris, Whitley, & Barker, 2013). However, one of the biggest challenges for these programs is sustainability (Lindsey, 2008). The purpose of this article is to present the 3…

Rural Mexican-Americans' perceptions of family health history, genetics, and disease risk: implications for disparities-focused research dissemination.

PubMed

Malen, Rachel; Knerr, Sarah; Delgado, Fernanda; Fullerton, Stephanie M; Thompson, Beti

2016-01-01

Disseminating the results of transdisciplinary health disparities research will increasingly involve discussing family health history and/or genetic information with study participants and their communities. Often, individuals' familiarity and comfort with these topics will be unclear. To inform the dissemination activities of a Center for Population Health and Health Disparities (CPHHD) studying multilevel determinants of breast cancer disparities in Latinas, we talked with Spanish-speaking Mexican-Americans from a rural agricultural community about family health history, genetics, and disease risk. We found that participants had limited genetic literacy but were familiar with some concepts related to family health history. Participants emphasized the role of individual behavior in shaping health and expressed a strong desire for health-related information. This included genetic information about future disease risk, which participants were previously unaware of but thought could be useful for disease prevention. These findings suggest that for research dissemination to facilitate health promotion, gaps in knowledge, particularly genetic knowledge, will need to be overcome. Outreach to underserved Latino communities should take advantage of this existing knowledge of family health history and strong desire for health information, but also take care to not overstate the significance of unreplicated or low-penetrance genetic associations.

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.

76 FR 3633 - Consumer Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-20

..., and outreach to underserved populations such as Native Americans and persons living in rural areas... technologies (e.g., availability of broadband, digital television, cable, satellite, low power FM, and the...

Adaptation of Consultation Planning for Native American and Latina Women with Breast Cancer

ERIC Educational Resources Information Center

Belkora, Jeffrey; Franklin, Lauren; O'Donnell, Sara; Ohnemus, Julie; Stacey, Dawn

2009-01-01

Context: Resource centers in rural, underserved areas are implementing Consultation Planning (CP) to help women with breast cancer create a question list before a doctor visit. Purpose: To identify changes needed for acceptable delivery of CP to rural Native Americans and Latinas. Methods: We interviewed and surveyed 27 Native American and Latino…

Exploring How the School Context Mediates Intern Learning in Underserved Rural Border Schools

ERIC Educational Resources Information Center

Ajayi, Lasisi

2013-01-01

This research used poststructural theories to examine a crucial issue of teacher-learning in rural border schools that are under pressure from high-stakes school accountability, fewer resources, and significant numbers of English language learners (ELLs). The methodology was based on a multiple case study of four intern teachers who participated…

Mobile and portable dental services catering to the basic oral health needs of the underserved population in developing countries: a proposed model.

PubMed

Ganavadiya, R; Chandrashekar, Br; Goel, P; Hongal, Sg; Jain, M

2014-05-01

India is the second most populous country in the world with an extensive rural population (68.8%). Children less than 18 years constitute about 40% of the population. Approximately, 23.5% of the urban population resides in urban slums. The extensive rural population, school children and the urban slum dwellers are denied of even the basic dental services though there is continuous advancement in the field of dentistry. The dentist to population ratio has dramatically improved in the last one to two decades with no significant improvement in the oral health status of the general population. The various studies have revealed an increasing trend in oral diseases in the recent times especially among this underserved population. Alternate strategies have to be thought about rather than the traditional oral health-care delivery through private dentists on fee for service basis. Mobile and portable dental services are a viable option to take the sophisticated oral health services to the doorsteps of the underserved population. The databases were searched for publications from 1900 to the present (2013) using terms such as Mobile dental services, Portable dental services and Mobile and portable dental services with key articles obtained primarily from MEDLINE. This paper reviews the published and unpublished literature from different sources on the various mobile dental service programs successfully implemented in some developed and developing countries. Though the mobile and portable systems have some practical difficulties like financial considerations, they still seem to be the only way to reach every section of the community in the absence of national oral health policy and organized school dental health programs in India. The material for the present review was obtained mainly by searching the biomedical databases for primary research material using the search engine with key words such as mobile and/or portable dental services in developed and developing countries (adding each of these terms in a sequential order). Based on the review of the programs successfully implemented in developed countries, we propose a model to cater to the basic oral health needs of an extensive underserved population in India that may be pilot tested. The increasing dental manpower can best be utilized for the promotion of oral health through mobile and portable dental services. The professional dental organizations should have a strong motive to translate this into reality.

A call for formal telemedicine training during stroke fellowship

PubMed Central

Jia, Judy; Gildersleeve, Kasey; Ankrom, Christy; Cai, Chunyan; Rahbar, Mohammad; Savitz, Sean I.; Wu, Tzu-Ching

2016-01-01

During the 20 years since US Food and Drug Administration approval of IV tissue plasminogen activator for acute ischemic stroke, vascular neurology consultation via telemedicine has contributed to an increased frequency of IV tissue plasminogen activator administration and broadened geographic access to the drug. Nevertheless, a growing demand for acute stroke coverage persists, with the greatest disparity found in rural communities underserved by neurologists. To provide efficient and consistent acute care, formal training in telemedicine during neurovascular fellowship is warranted. Herein, we describe our experiences incorporating telestroke into the vascular neurology fellowship curriculum and propose recommendations on integrating formal telemedicine training into the Accreditation Council for Graduate Medical Education vascular neurology fellowship. PMID:27016522

A call for formal telemedicine training during stroke fellowship.

PubMed

Jagolino, Amanda L; Jia, Judy; Gildersleeve, Kasey; Ankrom, Christy; Cai, Chunyan; Rahbar, Mohammad; Savitz, Sean I; Wu, Tzu-Ching

2016-05-10

During the 20 years since US Food and Drug Administration approval of IV tissue plasminogen activator for acute ischemic stroke, vascular neurology consultation via telemedicine has contributed to an increased frequency of IV tissue plasminogen activator administration and broadened geographic access to the drug. Nevertheless, a growing demand for acute stroke coverage persists, with the greatest disparity found in rural communities underserved by neurologists. To provide efficient and consistent acute care, formal training in telemedicine during neurovascular fellowship is warranted. Herein, we describe our experiences incorporating telestroke into the vascular neurology fellowship curriculum and propose recommendations on integrating formal telemedicine training into the Accreditation Council for Graduate Medical Education vascular neurology fellowship. © 2016 American Academy of Neurology.

28 CFR 90.16 - Availability and allocation of funds.

Code of Federal Regulations, 2010 CFR

2010-07-01

... aside a portion for evaluation, training and technical assistance, a base amount shall be allocated for... not limited to, populations underserved because of geographic location (such as rural isolation...

28 CFR 90.16 - Availability and allocation of funds.

Code of Federal Regulations, 2011 CFR

2011-07-01

... aside a portion for evaluation, training and technical assistance, a base amount shall be allocated for... not limited to, populations underserved because of geographic location (such as rural isolation...

The prevalence of uncorrected refractive errors in underserved rural areas.

PubMed

Hashemi, Hassan; Abbastabar, Hedayat; Yekta, Abbasali; Heydarian, Samira; Khabazkhoob, Mehdi

2017-12-01

To determine the prevalence of uncorrected refractive errors, need for spectacles, and the determinants of unmet need in underserved rural areas of Iran. In a cross-sectional study, multistage cluster sampling was done in 2 underserved rural areas of Iran. Then, all subjects underwent vision testing and ophthalmic examinations including the measurement of uncorrected visual acuity (UCVA), best corrected visual acuity, visual acuity with current spectacles, auto-refraction, retinoscopy, and subjective refraction. Need for spectacles was defined as UCVA worse than 20/40 in the better eye that could be corrected to better than 20/40 with suitable spectacles. Of the 3851 selected individuals, 3314 participated in the study. Among participants, 18.94% [95% confidence intervals (CI): 13.48-24.39] needed spectacles and 11.23% (95% CI: 7.57-14.89) had an unmet need. The prevalence of need for spectacles was 46.8% and 23.8% in myopic and hyperopic participants, respectively. The prevalence of unmet need was 27% in myopic, 15.8% in hyperopic, and 25.46% in astigmatic participants. Multiple logistic regression showed that education and type of refractive errors were associated with uncorrected refractive errors; the odds of uncorrected refractive errors were highest in illiterate participants, and the odds of unmet need were 12.13, 5.1, and 4.92 times higher in myopic, hyperopic and astigmatic participants as compared with emmetropic individuals. The prevalence of uncorrected refractive errors was rather high in our study. Since rural areas have less access to health care facilities, special attention to the correction of refractive errors in these areas, especially with inexpensive methods like spectacles, can prevent a major proportion of visual impairment.

HPV Vaccine Acceptance in a Clinic-Based Sample of Women in the Rural South

ERIC Educational Resources Information Center

Brandt, Heather M.; Sharpe, Patricia A.; McCree, Donna H.; Wright, Marcie S.; Davis, Jennifer; Hutto, Brent E.

2009-01-01

Background: Human papillomavirus (HPV) is a very common sexually transmitted infection linked to cervical disease. Vaccines for some types of HPV were in development at the time of the study. Purpose: The study examined HPV vaccine acceptability among underserved women in a rural region of the southeastern U.S. with high rates of cervical cancer…

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/.

Meeting People Where They Are: A Study of Social Supports for Culturally and Linguistically Diverse Families of Children with Disabilities

ERIC Educational Resources Information Center

Montgomery, LaQuita Spivey

2017-01-01

Little research has been devoted to the study of parent centers serving culturally and linguistically diverse (CLD) families of children with disabilities. Community Parent Resource Centers (CPRCs), provide information and emotional supports to families from traditionally underserved communities. The traditionally underserved for the most part are…

75 FR 80562 - Council on Underserved Communities, Establishment of and Request for Nominations

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-22

... Underserved Communities may be directed to Dan Jones, telephone (202) 205-7583, fax (202) 481-6536, e-mail dan... made. Nominees may be asked to submit additional information. Nominations must be sent to Dan Jones at [email protected] . Dated: December 16, 2010. Dan Jones, SBA Committee Management Officer. [FR Doc. 2010...

Leadership Advocacy: Bringing Nursing to the Homeless and Underserved.

PubMed

Porter-OʼGrady, Tim

Nurses have historically played a key role in advocacy and service for all members of the community, including those who are traditionally underserved by other providers or the health system. Nurses from a local Atlanta community health system, both clinical and administrative, have continued this tradition by developing an advocacy and service program for the downtown homeless of Atlanta. From its beginnings as a highly informal volunteer program to its current structure as a strongly integrated community health center for the underserved and homeless of Atlanta, local nurses have demonstrated their strong value of service advocacy. Their leadership, insight, discipline, and strategic development have facilitated the growth of a focused, viable health service network for marginalized people of the city of Atlanta.

Widening access to medicine may improve general practitioner recruitment in deprived and rural communities: survey of GP origins and current place of work.

PubMed

Dowell, J; Norbury, M; Steven, K; Guthrie, B

2015-10-01

Widening access to medicine in the UK is a recalcitrant problem of increasing political importance, with associated strong social justice arguments but without clear evidence of impact on service delivery. Evidence from the United States suggests that widening access may enhance care to underserved communities. Additionally, rural origin has been demonstrated to be the factor most strongly associated with rural practice. However the evidence regarding socio-economic and rural background and subsequent practice locations in the UK has not been explored. The aim of this study was to investigate the association between general practitioners' (GPs) socio-economic and rural background at application to medical school and demographic characteristics of their current practice. The study design was a cross-sectional email survey of general practitioners practising in Scotland. Socio-economic status of GPs at application to medical school was assessed using the self-coded National Statistics Socio-Economic Classification. UK postcode at application was used to define urban-rural location. Current practice deprivation and remoteness was measured using NHS Scotland defined measures based on registered patients' postcodes. A survey was sent to 2050 Scottish GPs with a valid accessible email address, with 801 (41.5 %) responding. GPs whose parents had semi-routine or routine occupations had 4.3 times the odds of working in a deprived practice compared to those with parents from managerial and professional occupations (95 % CI 1.8-10.2, p = 0.001). GPs from remote and rural Scottish backgrounds were more likely to work in remote Scottish practices, as were GPs originating from other UK countries. This study showed that childhood background is associated with the population GPs subsequently serve, implying that widening access may positively affect service delivery in addition to any social justice rationale. Longitudinal research is needed to explore this association and the impact of widening access on service delivery more broadly.

Developing a Community-Academic Partnership to Improve Recognition and Treatment of Depression in Underserved African American and White Elders

PubMed Central

Dobransky-Fasiska, Deborah; Brown, Charlotte; Pincus, Harold A.; Nowalk, Mary P.; Wieland, Melissa; Parker, Lisa S.; Cruz, Mario; McMurray, Michelle L.; Mulsant, Benoit; Reynolds, Charles F.

2011-01-01

Objective Reducing mental health disparities among underserved populations, particularly African American elders, is an important public health priority. The authors describe the process and challenges of developing a community/academic research partnership to address these disparities. Methods The authors are using a Community-Based Participatory Research approach to gain access to underserved populations in need of depression treatment. The authors identify six stages: 1) Collaborating to Secure Funding; 2) Building a Communications Platform and Research Infrastructure; 3) Fostering Enduring Relationships; 4) Assessing Needs/Educating about Research Process; 5) Initiating Specific Collaborative Projects (meeting mutual needs/interests); and 6) Maintaining a Sustainable and Productive Partnership. Data from a needs assessment developed collaboratively by researchers and community agencies facilitated agreement on mutual research goals, while strengthening the partnership. Results A community/academic-based partnership with a solid research infrastructure has been established and maintained for 3 years. Using the results of a needs assessment, the working partnership prioritized and launched several projects. Through interviews and questionnaires, community partners identified best practices for researchers working in the community. Future research and interventional projects have been developed, including plans for sustainability that will eventually shift more responsibility from the academic institution to the community agencies. Conclusions To reach underserved populations by developing and implementing models of more effective mental health treatment, it is vital to engage community agencies offering services to this population. A successful partnership requires “cultural humility,” collaborative efforts, and the development of flexible protocols to accommodate diverse communities. PMID:20104053

Internet support groups for suicide survivors: a new mode for gaining bereavement assistance.

PubMed

Feigelman, William; Gorman, Bernard S; Beal, Karyl Chastain; Jordan, John R

2008-01-01

Taken among parents who sustained the loss of a child to suicide this study explores the participation of parents in Internet support groups, comparing their demographic and loss-related characteristics (N = 104) to other parent survivors participating in face-to-face support groups (N = 297). Contrary to expectations that Internet affiliates would be concentrated in under-served rural areas, we found similar levels of urban, suburban, small city and rural residents in both Internet and face-to-face subsamples. Bivariate and multivariate analyses suggested several important factors contributing to interest in Internet grief support including: 24/7 availability and opportunities to invest more time into this type of support group experience. Compared to their face-to-face group counterparts, Internet affiliates experienced greater suicide stigmatization from their families and other associates. Unable to find ready comfort and support from their personal communities, Internet users-and especially highly depressed survivors-sought and obtained valuable help from the Internet support resource.

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.

Training Psychologists for Rural Practice: Exploring Opportunities and Constraints.

PubMed

Domino, Marisa Elena; Lin, Ching-Ching Claire; Morrissey, Joseph P; Ellis, Alan R; Fraher, Erin; Richman, Erica L; Thomas, Kathleen C; Prinstein, Mitchell J

2018-04-17

To examine trends in the psychologist workforce and training opportunities, including factors that may influence the decision of clinical psychologists to practice in rural settings. We use a mixed-methods approach to examine the psychologist workforce nationally and in North Carolina (NC), including (1) an analysis of the location of programs awarding doctoral degrees; (2) an analysis of the practice, demographic, and educational characteristics of the psychologist workforce; and (3) interviews with directors of doctoral programs in clinical psychology to understand where current graduates are getting jobs and why they may or may not be choosing to practice in rural communities. Fewer than 1% of programs and institutions awarding doctoral degrees in psychology in the United States are located in rural areas. In NC, approximately 80% of practicing psychologists have out-of-state degrees and about 80% of recent NC graduates are not currently licensed in the state. This juxtaposition undermines the utility of adding more in-state degree programs. While expansion of training programs within rural areas could help alleviate the shortages of mental health providers, adding new degree-granting programs alone will not necessarily increase supply. We discuss complementary recruitment and retention strategies, including greater incentives for rural training and practice as well as training in emerging technologies that don't require providers to be physically located in underserved areas, such as telemedicine. Increasing the supply of psychologists practicing in rural areas will require a thoughtful, multipronged approach to training this critical part of the behavioral health workforce. © 2018 National Rural Health Association.

Evaluating Tablet Computers as a Survey Tool in Rural Communities

PubMed Central

Newell, Steve M.; Logan, Henrietta L.; Guo, Yi; Marks, John G.; Shepperd, James A.

2015-01-01

Purpose Although tablet computers offer advantages in data collection over traditional paper-and-pencil methods, little research has examined whether the 2 formats yield similar responses, especially with underserved populations. We compared the 2 survey formats and tested whether participants’ responses to common health questionnaires or perceptions of usability differed by survey format. We also tested whether we could replicate established paper-and-pencil findings via tablet computer. Methods We recruited a sample of low-income community members living in the rural southern United States. Participants were 170 residents (black = 49%; white = 36%; other races and missing data = 15%) drawn from 2 counties meeting Florida’s state statutory definition of rural with 100 persons or fewer per square mile. We randomly assigned participants to complete scales (Center for Epidemiologic Studies Depression Inventory and Regulatory Focus Questionnaire) along with survey format usability ratings via paper-and-pencil or tablet computer. All participants rated a series of previously validated posters using a tablet computer. Finally, participants completed comparisons of the survey formats and reported survey format preferences. Findings Participants preferred using the tablet computer and showed no significant differences between formats in mean responses, scale reliabilities, or in participants’ usability ratings. Conclusions Overall, participants reported similar scales responses and usability ratings between formats. However, participants reported both preferring and enjoying responding via tablet computer more. Collectively, these findings are among the first data to show that tablet computers represent a suitable substitute among an underrepresented rural sample for paper-and-pencil methodology in survey research. PMID:25243953

Evaluating tablet computers as a survey tool in rural communities.

PubMed

Newell, Steve M; Logan, Henrietta L; Guo, Yi; Marks, John G; Shepperd, James A

2015-01-01

Although tablet computers offer advantages in data collection over traditional paper-and-pencil methods, little research has examined whether the 2 formats yield similar responses, especially with underserved populations. We compared the 2 survey formats and tested whether participants' responses to common health questionnaires or perceptions of usability differed by survey format. We also tested whether we could replicate established paper-and-pencil findings via tablet computer. We recruited a sample of low-income community members living in the rural southern United States. Participants were 170 residents (black = 49%; white = 36%; other races and missing data = 15%) drawn from 2 counties meeting Florida's state statutory definition of rural with 100 persons or fewer per square mile. We randomly assigned participants to complete scales (Center for Epidemiologic Studies Depression Inventory and Regulatory Focus Questionnaire) along with survey format usability ratings via paper-and-pencil or tablet computer. All participants rated a series of previously validated posters using a tablet computer. Finally, participants completed comparisons of the survey formats and reported survey format preferences. Participants preferred using the tablet computer and showed no significant differences between formats in mean responses, scale reliabilities, or in participants' usability ratings. Overall, participants reported similar scales responses and usability ratings between formats. However, participants reported both preferring and enjoying responding via tablet computer more. Collectively, these findings are among the first data to show that tablet computers represent a suitable substitute among an underrepresented rural sample for paper-and-pencil methodology in survey research. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Project ECHO: A Telementoring Program for Cervical Cancer Prevention and Treatment in Low-Resource Settings.

PubMed

Lopez, Melissa S; Baker, Ellen S; Milbourne, Andrea M; Gowen, Rose M; Rodriguez, Ana M; Lorenzoni, Cesaltina; Mwaba, Catherine; Msadabwe, Susan Citonje; Tavares, José Humberto; Fontes-Cintra, Georgia; Zucca-Matthes, Gustavo; Callegaro-Filho, Donato; Ramos-Martin, Danielle; Thiago de Carvalho, Icaro; Coelho, Robson; Marques, Renato Moretti; Chulam, Thiago; Pontremoli-Salcedo, Mila; Nozar, Fernanda; Fiol, Veronica; Maza, Mauricio; Arora, Sanjeev; Hawk, Ernest T; Schmeler, Kathleen M

2017-10-01

Cervical cancer incidence and mortality rates are significantly higher in low- and middle-income countries compared with the United States and other developed countries. This disparity is caused by decreased access to screening, often coupled with low numbers of trained providers offering cancer prevention and treatment services. However, similar disparities are also found in underserved areas of the United States, such as the Texas-Mexico border, where cervical cancer mortality rates are 30% higher than in the rest of Texas. To address these issues, we have adopted the Project ECHO (Extension for Community Healthcare Outcomes) program, a low-cost telementoring model previously proven to be successful in increasing local capacity, improving patient management skills, and ultimately improving patient outcomes in rural and underserved areas. We use the Project ECHO model to educate local providers in the management of cervical dysplasia in a low-resource region of Texas and have adapted it to inform strategies for the management of advanced cervical and breast cancer in Latin America and sub-Saharan Africa. This innovative approach, using ECHO, is part of a larger strategy to enhance clinical skills and develop collaborative projects between academic centers and partners in low-resource regions.

Mapping a Strategic Plan for Health: Community-Based Participatory Research with Underserved, Low-Income, Urban Neighborhoods

ERIC Educational Resources Information Center

Zandee, Gail

2012-01-01

Since 2002, community-based participatory research methods have been used by the Calvin College Nursing Department to map out a strategic health plan for three urban, low-income, underserved neighborhoods. Nine focus groups and 449 door-to-door health surveys were completed across the three urban neighborhoods between 2002 and 2004. Neighborhood…

Bridging Scientific Expertise to Underserved Communities: Initiating and Sustaining Local STEM Outreach

NASA Astrophysics Data System (ADS)

Anderson, Tania; Kenney, Jessica; Maple, John

2017-06-01

This presentation will feature effective outreach strategies used to recruit, engage, and sustain student involvement from underserved communities in out-of-school science outreach programs. For example, one strategy is to partner with subject matter experts to provide your audience with a deeper understanding of and a unique perspective on current science. Join us to learn more about how you can initiate and sustain a STEM based program in your local community.

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.

Retaining health workforce in rural and underserved areas of India: What works and what doesn't? A critical interpretative synthesis.

PubMed

Goel, Sonu; Angeli, Federica; Bhatnagar, Nidhi; Singla, Neetu; Grover, Manoj; Maarse, Hans

2016-01-01

Human resource for health is critical in quality healthcare delivery. India, with a large rural population (68.8%), needs to urgently bridge the gaps in health workforce deployment between urban and rural areas. We did a critical interpretative synthesis of the existing literature by using a predefined selection criteria to assess relevant manuscripts to identify the reasons for retaining the health workforce in rural and underserved areas. We discuss different strategies for retention of health workforce in rural areas on the basis of four major retention interventions, viz. education, regulation, financial incentives, and personal and professional support recommended by WHO in 2010. This review focuses on the English-language material published during 2005-14 on human resources in health across low- and middle-income countries. Healthcare in India is delivered through a diverse set of providers. Inequity exists in health manpower distribution across states, area (urban-rural), gender and category of health personnel. India is deficient in health system development and financing where health workforce education and training occupy a low priority. Poor governance, insufficient salary and allowances, along with inability of employers to provide safe, satisfying and rewarding work conditions-are causing health worker attrition in rural India. The review suggests that the retention of health workers in rural areas can be ensured by multiplicity of interventions such as medical schools in rural areas, rural orientation of medical education, introducing compulsory rural service in lieu of incentives providing better pay packages and special allowances, and providing better living and working conditions in rural areas. A complex interplay of factors that impact on attraction and retention of health workforce necessitates bundling of interventions. In low-income countries, evidence- based strategies are needed to ensure context-specific, field- tested and cost-effective solutions to various existing problems. To ensure retention these strategies must be integrated with effective human resource management policies and rural orientation of the medical education system.

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.

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.

Engaging with community-based public and private mid-level providers for promoting the use of modern contraceptive methods in rural Pakistan: results from two innovative birth spacing interventions.

PubMed

Azmat, Syed Khurram; Hameed, Waqas; Hamza, Hasan Bin; Mustafa, Ghulam; Ishaque, Muhammad; Abbas, Ghazunfer; Khan, Omar Farooq; Asghar, Jamshaid; Munroe, Erik; Ali, Safdar; Hussain, Wajahat; Ali, Sajid; Ahmed, Aftab; Ali, Moazzam; Temmerman, Marleen

2016-03-17

Family planning (FP) interventions aimed at reducing population growth have negligible during the last two decades in Pakistan. Innovative FP interventions that help reduce the growing population burden are the need of the hour. Marie Stopes Society--Pakistan implemented an operational research project--'Evidence for Innovating to Save Lives', to explore effective and viable intervention models that can promote healthy timing and spacing of pregnancy in rural and under-served communities of Sindh, Punjab and Khyber Pakhtunkhwa provinces of Pakistan. We conducted a quasi-experimental (pre- and post-intervention with control arm) study to assess the effectiveness of each of the two intervention models, (1) Suraj model (meaning 'Sun' in English), which uses social franchises (SF) along with a demand-side financing (DSF) approach using free vouchers, and (2) Community Midwife (CMW) model, in promoting the use of modern contraceptive methods compared to respective controls. Baseline and endline cross-sectional household surveys were conducted, 24 months apart, by recruiting 5566 and 6316 married women of reproductive age (MWRA) respectively. We used Stata version 8 to report the net effect of interventions on outcome indicators using difference-in-differences analysis. Multivariate Cox proportional hazard regression analysis was used to assess the net effect of the intervention on current contraceptive use, keeping time constant and adjusting for other variables in the model. The Suraj model was effective in significantly increasing awareness about FP methods among MWRA by 14% percentage points, current contraceptive use by 5% percentage points and long term modern method--intrauterine device (IUD) use by 6% percentage points. The CMW model significantly increased contraceptive awareness by 28% percentage points, ever use of contraceptives by 7% percentage points and, IUD use by 3% percentage points. Additionally the Suraj intervention led to a 35% greater prevalence (prevalence ratio: 1.35, 95% CI: 1.22-1.50) of contraceptive use among MWRA. Suraj intervention highlights the importance of embedding subsidized FP services within the communities of the beneficiaries. The outcomes of the CMW intervention also improved the use of long-term contraceptives. These findings indicate the necessity of designing and implementing FP initiatives involving local mid-level providers to expand contraceptive coverage in under-served areas.

From Systematic Review to Call for Action.

PubMed

Sawin, Erika Metzler; Sobel, Linda L; Annan, Sandra L; Schminkey, Donna L

2017-06-01

Intimate partner violence (IPV) is a global public health and criminal justice concern with significant impacts; especially high rates are seen among rural Hispanic American (HA) communities, the fastest growing population in the United States. They experience additional barriers to care including extreme poverty, lesser education, gender norms, and language and immigration issues. A systematic literature review was conducted using Cooper's framework to identify evidence supporting associations between interventions and prevention, reduction, and elimination of IPV among rural HA women. Searches conducted on databases including CINAHL, PubMed, Medline, Women's Studies International, MedicLatina, and JSTOR used the MeSH terms Hispanic Americans (Latino/a and Hispanic), domestic violence, and intimate partner violence. Selected studies were published between January 1, 2000, and January 1, 2014. Of the 617 yielded articles, only 6 met the inclusion criteria. Of these, none closely examined rurality or provided valid and reliable measures of outcomes, instead reporting program descriptions and suggested interventions. We identify key findings to guide program, screening, and tool development. Our study identifies a gap in knowledge, research, and effective practices and issues a call for action to create evidence-based tools to prevent, reduce, and eliminate IPV in these underserved populations.

Marathon works

PubMed Central

Orrantia, Eliseo

2005-01-01

PROBLEM BEING ADDRESSED Medical care in rural Canada has long been hampered by insufficient numbers of physicians. How can a rural community’s physicians change the local medical culture and create a new approach to sustaining their practice? OBJECTIVE OF PROGRAM To create a sustainable, collegial family practice group and address one rural community’s chronically underserviced health care needs. PROGRAM DESCRIPTION Elements important to physicians’ well-being were incorporated into the health care group’s functioning to enhance retention and recruitment. The intentional development of a consensus-based approach to decision making has created a supportive team of physicians. Ongoing communication is kept up through regular meetings, retreats, and a Web-based discussion board. Individual physicians retain control of their hours worked each year and their schedules. A novel obstetric call system was introduced to help make schedules more predictable. An internal governance agreement on an alternative payment plan supports varied work schedules, recognizes and funds non-clinical medical work, and pays group members for undertaking health-related projects. CONCLUSION This approach has helped maintain a stable number of physicians in Marathon, Ont, and has increased the number of health care services delivered to the community. PMID:16190174

Motherhood: making it safer for Filipino women.

PubMed

Baylon, M C

1996-01-01

In November 1995, in the Philippines, the Department of Health implemented the Women's Health and Safe Motherhood Project. Its target audience is poor women in remote and underserved provinces. It addresses maternal health, reproductive tract infections (RTIs), sexually transmitted diseases (STDs), cervical cancer, domestic violence, and the desire to space births. It aims to improve the quality of women's health services through training of health providers, providing women with information to help them make informed choices, providing regular supplies and drugs, privacy and infection control at service delivery points, providing follow-up care, and improved cost-effective and technically-sound referral systems. The project also aims to ensure accessible service delivery points, well-equipped and maintained facilities, client and community feedback in managing service delivery, and information provision in order to increase acceptability of health services. The major components of the project include service delivery, institutional strengthening (via information, education, and communication; training of health providers; and improvement of the logistics system), community partnership for women's health development, and policy and operations research. The service delivery component will adopt a life-cycle approach to service delivery in Region 8 (urban and rural communities). It will pilot the syndromic approach in the management and detection of RTIs and STDs in 10 provinces. The biggest tasks of the project are upgrading referral networks from provincial and district hospitals to rural health units and barangay health stations and upgrading primary hospitals.

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

Area-level risk factors for adverse birth outcomes: trends in urban and rural settings.

PubMed

Kent, Shia T; McClure, Leslie A; Zaitchik, Ben F; Gohlke, Julia M

2013-06-10

Significant and persistent racial and income disparities in birth outcomes exist in the US. The analyses in this manuscript examine whether adverse birth outcome time trends and associations between area-level variables and adverse birth outcomes differ by urban-rural status. Alabama births records were merged with ZIP code-level census measures of race, poverty, and rurality. B-splines were used to determine long-term preterm birth (PTB) and low birth weight (LBW) trends by rurality. Logistic regression models were used to examine differences in the relationships between ZIP code-level percent poverty or percent African-American with either PTB or LBW. Interactions with rurality were examined. Population dense areas had higher adverse birth outcome rates compared to other regions. For LBW, the disparity between population dense and other regions increased during the 1991-2005 time period, and the magnitude of the disparity was maintained through 2010. Overall PTB and LBW rates have decreased since 2006, except within isolated rural regions. The addition of individual-level socioeconomic or race risk factors greatly attenuated these geographical disparities, but isolated rural regions maintained increased odds of adverse birth outcomes. ZIP code-level percent poverty and percent African American both had significant relationships with adverse birth outcomes. Poverty associations remained significant in the most population-dense regions when models were adjusted for individual-level risk factors. Population dense urban areas have heightened rates of adverse birth outcomes. High-poverty African American areas have higher odds of adverse birth outcomes in urban versus rural regions. These results suggest there are urban-specific social or environmental factors increasing risk for adverse birth outcomes in underserved communities. On the other hand, trends in PTBs and LBWs suggest interventions that have decreased adverse birth outcomes elsewhere may not be reaching isolated rural areas.

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.

The Results of the "Positive Action for Today's Health" (PATH) Trial for Increasing Walking and Physical Activity in Underserved African-American Communities.

PubMed

Wilson, Dawn K; Van Horn, M Lee; Siceloff, E Rebekah; Alia, Kassandra A; St George, Sara M; Lawman, Hannah G; Trumpeter, Nevelyn N; Coulon, Sandra M; Griffin, Sarah F; Wandersman, Abraham; Egan, Brent; Colabianchi, Natalie; Forthofer, Melinda; Gadson, Barney

2015-06-01

The "Positive Action for Today's Health" (PATH) trial tested an environmental intervention to increase walking in underserved communities. Three matched communities were randomized to a police-patrolled walking plus social marketing, a police-patrolled walking-only, or a no-walking intervention. The 24-month intervention addressed safety and access for physical activity (PA) and utilized social marketing to enhance environmental supports for PA. African-Americans (N=434; 62% females; aged 51±16 years) provided accelerometry and psychosocial measures at baseline and 12, 18, and 24 months. Walking attendance and trail use were obtained over 24 months. There were no significant differences across communities over 24 months for moderate-to-vigorous PA. Walking attendance in the social marketing community showed an increase from 40 to 400 walkers per month at 9 months and sustained ~200 walkers per month through 24 months. No change in attendance was observed in the walking-only community. Findings support integrating social marketing strategies to increase walking in underserved African-Americans (ClinicalTrials.gov #NCT01025726).

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.

Mexican doctors serve rural areas.

PubMed

Grossi, J

1991-02-01

The Mexican Foundation for Family Planning (MEXFAM) worked to solve the unemployment problems of physicians and to increase health services to underserved rural areas. In Mexico, 75% of practicing physicians were located in 16 urban areas. Mexico had a large population of 83 million, of whom many in rural areas have been deprived of family planning and medical services. MEXFAM initiated the Community Doctors Project in 1986. The aim was to help Mexican doctors set up a medical practice in marginal urban towns and small towns with low income residents. Funding to physicians was provided for conducting a market survey of the proposed region and for advertising the new medical services. Loans of furniture and medical supplies were provided, and options were provided for purchase of equipment at a later date. During the promotion, services for maternal and child health care were provided for a small fee, while family planning was provided for free. Doctors usually become self-sufficient after about two years. The MEXFAM project established 170 community doctor's offices in 30 out of 32 states. Services were provided for at least 2500 families per office. In 1990, 13 offices were opened to serve an estimated 182,000 clients. A new effort is being directed to owners of Mexican factories. MEXFAM will set up a medical and family planning clinic very close to factories for a company contribution of only $12,000. The clinic promotion is being marketed through videos. MEXFAM found two companies that agreed to support a clinic.

Improving access to care through the patient-centered medical home.

PubMed

North, Stephen W; McElligot, James; Douglas, Gaye; Martin, Amanda

2014-02-01

School-based health centers (SBHCs) serve an essential role in providing access to high-quality, comprehensive care to underserved children and adolescents in more than 2,000 schools across the United States. SBHCs are an essential component of the health care safety net, and their role in the patient-centered medical home (PCMH) continues to evolve as both collaborating partners and, when fully functioning, independent PCMHs. The American Academy of Pediatrics (AAP) supports the use of SBHCs, citing the proven benefits and exciting potential as justification, but also offers caution and recommends a focus on communication within the community. Traditional "brick and mortar" SBHCs are more likely to be located in urban communities (54.2% urban versus 18.0% rural) and be in schools with more students, allowing for a greater return on investment. Current SBHCs are located in schools with an average population of 997 students. The need for a large school population to help an SBHC approach financial viability excludes children in rural communities who are more likely to attend a school with fewer than 500 students, be poor, and have difficulty accessing health care.2 The expansion of telehealth technologies allows the creation of solutions to decrease geographic barriers that have limited the growth of SBHCs in rural communities. Telehealth school-based health centers (tSBHCs) that exclusively provide services through telemedicine are operating and developing in communities where geographic barriers and financial challenges have prevented the establishment of brick and mortar SBHCs. TSBHCs are beginning to increase the number and variety of services they provide through the use of telehealth to include behavioral health, nutrition services, and pediatric specialists. Understanding the role of tSBHCs in the growth of the PCMH model is critical for using these tools to continue to improve child and adolescent health. Copyright 2014, SLACK Incorporated.

Mobile and Portable Dental Services Catering to the Basic Oral Health Needs of the Underserved Population in Developing Countries: A Proposed Model

PubMed Central

Ganavadiya, R; Chandrashekar, BR; Goel, P; Hongal, SG; Jain, M

2014-01-01

India is the second most populous country in the world with an extensive rural population (68.8%). Children less than 18 years constitute about 40% of the population. Approximately, 23.5% of the urban population resides in urban slums. The extensive rural population, school children and the urban slum dwellers are denied of even the basic dental services though there is continuous advancement in the field of dentistry. The dentist to population ratio has dramatically improved in the last one to two decades with no significant improvement in the oral health status of the general population. The various studies have revealed an increasing trend in oral diseases in the recent times especially among this underserved population. Alternate strategies have to be thought about rather than the traditional oral health-care delivery through private dentists on fee for service basis. Mobile and portable dental services are a viable option to take the sophisticated oral health services to the doorsteps of the underserved population. The databases were searched for publications from 1900 to the present (2013) using terms such as Mobile dental services, Portable dental services and Mobile and portable dental services with key articles obtained primarily from MEDLINE. This paper reviews the published and unpublished literature from different sources on the various mobile dental service programs successfully implemented in some developed and developing countries. Though the mobile and portable systems have some practical difficulties like financial considerations, they still seem to be the only way to reach every section of the community in the absence of national oral health policy and organized school dental health programs in India. The material for the present review was obtained mainly by searching the biomedical databases for primary research material using the search engine with key words such as mobile and/or portable dental services in developed and developing countries (adding each of these terms in a sequential order). Based on the review of the programs successfully implemented in developed countries, we propose a model to cater to the basic oral health needs of an extensive underserved population in India that may be pilot tested. The increasing dental manpower can best be utilized for the promotion of oral health through mobile and portable dental services. The professional dental organizations should have a strong motive to translate this into reality. PMID:24971198

Knowledgeable Neighbors: a mobile clinic model for disease prevention and screening in underserved communities.

PubMed

Hill, Caterina; Zurakowski, David; Bennet, Jennifer; Walker-White, Rainelle; Osman, Jamie L; Quarles, Aaron; Oriol, Nancy

2012-03-01

The Family Van mobile health clinic uses a "Knowledgeable Neighbor" model to deliver cost-effective screening and prevention activities in underserved neighborhoods in Boston, MA. We have described the Knowledgeable Neighbor model and used operational data collected from 2006 to 2009 to evaluate the service. The Family Van successfully reached mainly minority low-income men and women. Of the clients screened, 60% had previously undetected elevated blood pressure, 14% had previously undetected elevated blood glucose, and 38% had previously undetected elevated total cholesterol. This represents an important model for reaching underserved communities to deliver proven cost-effective prevention activities, both to help control health care costs and to reduce health disparities.

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.

Male engagement as a strategy to improve utilization and community-based delivery of maternal, newborn and child health services: evidence from an intervention in Odisha, India

PubMed Central

2015-01-01

Background In response to persistently poor levels of maternal, newborn and child health (MNCH) in rural India, the National Rural Health Mission (NRHM) was launched to support the provision of accessible, affordable and quality health care in deprived and underserved communities. The Accredited Social Health Activists (ASHAs), local women, are trained as health promoters to generate demand for, and facilitate access to MNCH care in their communities. While they are also expected to provide husbands of expectant women with information on MNCH care and family planning, their reach to the husbands is limited. The aim of this study is to describe the influence of a male engagement project on the utilization and community-based delivery of MNCH care in a rural district of the country. Methods We used qualitative data from the evaluation of a project which recruited and trained male Community Health Workers (CHWs) known as Male Health Activists (MHAs) to complement the work of ASHAs and target outreach to men. This paper uses data from in-depth interviews (IDIs) with ASHAs (n=11), Anganwadi Workers (AWWs) (n=4) and Auxiliary Nurse Midwives (ANMs) (n=2); with women who had delivered at home, community health center or district hospital in the few months preceding the date of the interview (n=11); and with husbands of these women (n=7). Results Participants’ responses are broadly organized around the facilitation of ASHAs’ work by MHAs, and male engagement activities undertaken by MHAs. More specifically, the narratives reflected gender-based divisions of work and space in three core areas of delivery and use of MNCH services: escorting women to health centers for facility-based deliveries; mobilizing women and children to attend Village Health and Nutrition Days and Immunization Days; and raising awareness among men on MNCH and family planning. Conclusion This study sheds light on male engagement as a strategy to improve the delivery, access and uptake of maternal, newborn and child health in the context of prevailing gender norms and gendered roles in rural India. Ultimately, it unveils the complementarity of male and female CHWs in the community-based delivery of, and increased demand for, MNCH services. PMID:26062910

“ENHANCING LIFE AFTER CANCER IN DIVERSE COMMUNITIES”

PubMed Central

Kaur, Judith S.; Coe, Kathryn; Rowland, Julia; Braun, Kathryn L.; Conde, Francisco A.; Burhansstipanov, Linda; Heiney, Sue; Kagawa-Singer, Marjorie; Lu, Qian; Witte, Catherine

2012-01-01

Background Although large numbers of cancer survivors exist in every community, including minority communities, there is a significant gap in knowledge about best practices for these patients. Methods Community Networks Programs (CNPs) funded by the National Cancer Institute’s Center to Reduce Cancer Health Disparities, have developed and tested unique services for these communities. These programs have utilized community based participatory research techniques under a framework of diffusion of innovation and communications theory. Results This article describes some specifically tailored interventions that may be useful to a wide range of providers working with the underserved Conclusions Enhancing life after cancer can be achieved in underserved communities by supplementing local resources. PMID:22434384

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.

Community perceptions of mental illness in rural Uganda: An analysis of existing challenges facing the Bwindi Mental Health Programme.

PubMed

Shah, Arya; Wheeler, Lydia; Sessions, Kristen; Kuule, Yusufu; Agaba, Edwin; Merry, Stephen P

2017-10-11

To assess community perceptions of mental illness in the Bwindi Community Hospital (BCH) catchment area: to recognise beliefs about the causes and the treatments for mental illness. To provide community data to staff at BCH as they work to develop more effective community mental health programmes. A shortage of mental health providers in Uganda has prompted research into community-based task-sharing models for the provision of mental health services in underserved communities. Six focus group discussions, with a total of 54 community members (50% male, n = 27; mean age + s.d. [39.9 + 10.9 years]) from the BCH catchment area, were conducted to assess community member and stakeholder perceptions of mental illness and belief in the feasibility of community-based programming. Qualitative study of data through thematic analysis was conducted to assess the presence of commonly occurring perceptions. Qualitative thematic analysis revealed two major themes: (1) belief that any given patient's metal illness results from either an intrinsic or an extrinsic cause and (2) belief in a need to determine treatment of mental illness based on the believed cause. As BCH designs community-based mental health services, our findings provide support for the need for further education of community members and training of community health workers to address and integrate the above-stated beliefs regarding mental illness.

Community perceptions of mental illness in rural Uganda: An analysis of existing challenges facing the Bwindi Mental Health Programme

PubMed Central

2017-01-01

Objectives To assess community perceptions of mental illness in the Bwindi Community Hospital (BCH) catchment area: to recognise beliefs about the causes and the treatments for mental illness. To provide community data to staff at BCH as they work to develop more effective community mental health programmes. Background A shortage of mental health providers in Uganda has prompted research into community-based task-sharing models for the provision of mental health services in underserved communities. Methods Six focus group discussions, with a total of 54 community members (50% male, n = 27; mean age + s.d. [39.9 + 10.9 years]) from the BCH catchment area, were conducted to assess community member and stakeholder perceptions of mental illness and belief in the feasibility of community-based programming. Qualitative study of data through thematic analysis was conducted to assess the presence of commonly occurring perceptions. Results Qualitative thematic analysis revealed two major themes: (1) belief that any given patient’s metal illness results from either an intrinsic or an extrinsic cause and (2) belief in a need to determine treatment of mental illness based on the believed cause. Conclusion As BCH designs community-based mental health services, our findings provide support for the need for further education of community members and training of community health workers to address and integrate the above-stated beliefs regarding mental illness. PMID:29041798

Balancing the cost of leaving with the cost of living: drivers of long-term retention of health workers: an explorative study in three rural districts in Eastern Uganda

PubMed Central

Namusoke Kiwanuka, Suzanne; Akulume, Martha; Tetui, Moses; Muhumuza Kananura, Rornald; Bua, John; Ekirapa-Kiracho, Elizabeth

2017-01-01

ABSTRACT Background: Health worker retention in rural and underserved areas remains a persisting problem in many low and middle income countries, and this directly affects the quality of health services offered. Objective: This paper explores the drivers of long-term retention and describes health worker coping mechanisms in rural Uganda. Methods: A descriptive qualitative study explored the factors that motivated health workers to stay, in three rural districts of Uganda: Kamuli, Pallisa, and Kibuku. In-depth interviews conducted among health workers who have been retained for at least 10 years explored factors motivating the health workers to stay within the district, opportunities, and the benefits of staying. Results: Twenty-one health workers participated. Ten of them male and 11 female with the age range of 33–51 years. The mean duration of stay among the participants was 13, 15, and 26 years for Kamuli, Kibuku, and Pallisa respectively. Long-term retention was related to personal factors, such as having family ties, community ties, and opportunities to invest. The decentralization policy and pension benefits also kept workers in place. Opportunities for promotion or leadership motivated long stay only if they came with financial benefits. Workload reportedly increased over the years, but staffing and emoluments had not increased. Multiple job, family support, and community support helped health workers cope with the costs of living, and holding a secure pensionable government job was valued more highly than seeking uncertain job opportunities elsewhere. Conclusion: The interplay between the costs of leaving and the benefit of staying is demonstrated. Family proximity, community ties, job security, and pension enhance staying, while higher costs of living and an unpredictable employment market make leaving risky. Health workers should be able to access investment opportunities in order to cope with inadequate remuneration. Promotions and leadership opportunities only motivate if accompanied by financial benefits. PMID:28838292

Pharmacogenetic research in partnership with American Indian and Alaska Native communities

PubMed Central

Woodahl, Erica L; Lesko, Lawrence J; Hopkins, Scarlett; Robinson, Renee F; Thummel, Kenneth E; Burke, Wylie

2014-01-01

Pharmacogenetics is a subset of personalized medicine that applies knowledge about genetic variation in gene–drug pairs to help guide optimal dosing. There is a lack of data, however, about pharmacogenetic variation in underserved populations. One strategy for increasing participation of underserved populations in pharmacogenetic research is to include communities in the research process. We have established academic–community partnerships with American Indian and Alaska Native people living in Alaska and Montana to study pharmacogenetics. Key features of the partnership include community oversight of the project, research objectives that address community health priorities, and bidirectional learning that builds capacity in both the community and the research team. Engaging the community as coresearchers can help build trust to advance pharmacogenetic research objectives. PMID:25141898

Liability concerns and shared use of school recreational facilities in underserved communities.

PubMed

Spengler, John O; Connaughton, Daniel P; Maddock, Jason E

2011-10-01

In underserved communities, schools can provide the physical structure and facilities for informal and formal recreation as well as after-school, weekend, and summer programming. The importance of community access to schools is acknowledged by authoritative groups; however, fear of liability is believed to be a key barrier to community access. The purpose of this study was to investigate perceptions of liability risk and associated issues among school administrators in underserved communities. A national survey of school administrators in underserved communities (n=360, response rate of 21%) was conducted in 2009 and analyzed in 2010. Liability perceptions in the context of community access were assessed through descriptive statistics. The majority of respondents (82.2%) indicated concern for liability should someone be injured on school property after hours while participating in a recreational activity. Among those that did not allow community access, 91% were somewhat to very concerned about liability and 86% believed that stronger legislation was needed to better protect schools from liability for after-hours recreational use. Among those who claimed familiarity with a state law that offered them limited liability protection, nearly three fourths were nevertheless concerned about liability. Liability concerns are prevalent among this group of school administrators, particularly if they had been involved in prior litigation, and even if they indicated they were aware of laws that provide liability protection where use occurs after hours. Reducing these concerns will be important if schools are to become locations for recreational programs that promote physical activity outside of regular school hours. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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.

A community intervention: AMBER: Arab American breast cancer education and referral program.

PubMed

Ayash, Claudia; Axelrod, Deborah; Nejmeh-Khoury, Sana; Aziz, Arwa; Yusr, Afrah; Gany, Francesca M

2011-12-01

Although the number of Arab Americans is growing in the United States, there is very little data available on this population's cancer incidence and screening practices. Moreover, there are few interventions addressing their unique needs. This study aims to determine effective strategies for increasing breast cancer screening in at-risk underserved Arab American women. AMBER utilizes a community based participatory approach to conduct formative research and program interventions, including culturally appropriate Arabic language breast cancer education, screening coordination, and cultural competency training for healthcare professionals in New York City. In 2 years, 597 women were educated, 189 underserved women were identified as being in need of assistance, 68 were screened, one new case of breast cancer was detected, and four active cases in need of follow-up reconnected with care. The AMBER model is an important intervention for breast cancer screening and care in the underserved Arab American community.

Poor retention does not have to be the rule: retention of volunteer community health workers in Uganda.

PubMed

Ludwick, Teralynn; Brenner, Jennifer L; Kyomuhangi, Teddy; Wotton, Kathryn A; Kabakyenga, Jerome Kahuma

2014-05-01

Globally, health worker shortages continue to plague developing countries. Community health workers are increasingly being promoted to extend primary health care to underserved populations. Since 2004, Healthy Child Uganda (HCU) has trained volunteer community health workers in child health promotion in rural southwest Uganda. This study analyses the retention and motivation of volunteer community health workers trained by HCU. It presents retention rates over a 5-year period and provides insight into volunteer motivation. The findings are based on a 2010 retrospective review of the community health worker registry and the results of a survey on selection and motivation. The survey was comprised of qualitative and quantitative questions and verbally administered to a convenience sample of project participants. Between February 2004 and July 2009, HCU trained 404 community health workers (69% female) in 175 villages. Volunteers had an average age of 36.7 years, 4.9 children and some primary school education. Ninety-six per cent of volunteer community health workers were retained after 1 year (389/404), 91% after 2 years (386/404) and 86% after 5 years (101/117). Of the 54 'dropouts', main reasons cited for discontinuation included 'too busy' (12), moved (11), business/employment (8), death (6) and separation/divorce (6). Of 58 questionnaire respondents, most (87%) reported having been selected at an inclusive community meeting. Pair-wise ranking was used to assess the importance of seven 'motivational factors' among respondents. Those highest ranked were 'improved child health', 'education/training' and 'being asked for advice/assistance by peers', while the modest 'transport allowance' ranked lowest. Our findings suggest that in our rural, African setting, volunteer community health workers can be retained over the medium term. Community health worker programmes should invest in community involvement in selection, quality training, supportive supervision and incentives, which may promote improved retention.

Poor retention does not have to be the rule: retention of volunteer community health workers in Uganda

PubMed Central

Ludwick, Teralynn; Brenner, Jennifer L; Kyomuhangi, Teddy; Wotton, Kathryn A; Kabakyenga, Jerome Kahuma

2014-01-01

Globally, health worker shortages continue to plague developing countries. Community health workers are increasingly being promoted to extend primary health care to underserved populations. Since 2004, Healthy Child Uganda (HCU) has trained volunteer community health workers in child health promotion in rural southwest Uganda. This study analyses the retention and motivation of volunteer community health workers trained by HCU. It presents retention rates over a 5-year period and provides insight into volunteer motivation. The findings are based on a 2010 retrospective review of the community health worker registry and the results of a survey on selection and motivation. The survey was comprised of qualitative and quantitative questions and verbally administered to a convenience sample of project participants. Between February 2004 and July 2009, HCU trained 404 community health workers (69% female) in 175 villages. Volunteers had an average age of 36.7 years, 4.9 children and some primary school education. Ninety-six per cent of volunteer community health workers were retained after 1 year (389/404), 91% after 2 years (386/404) and 86% after 5 years (101/117). Of the 54 ‘dropouts’, main reasons cited for discontinuation included ‘too busy’ (12), moved (11), business/employment (8), death (6) and separation/divorce (6). Of 58 questionnaire respondents, most (87%) reported having been selected at an inclusive community meeting. Pair-wise ranking was used to assess the importance of seven ‘motivational factors’ among respondents. Those highest ranked were ‘improved child health’, ‘education/training’ and ‘being asked for advice/assistance by peers’, while the modest ‘transport allowance’ ranked lowest. Our findings suggest that in our rural, African setting, volunteer community health workers can be retained over the medium term. Community health worker programmes should invest in community involvement in selection, quality training, supportive supervision and incentives, which may promote improved retention. PMID:23650334

Examination of the relative importance of hospital employment in non-metropolitan counties using location quotients.

PubMed

Smith, Jon L

2013-01-01

The US Health Care and Social Services sector (North American Industrial Classification System 'sector 62') has become an extremely important component of the nation's economy, employing approximately 18 million workers and generating almost $753 billion in annual payrolls. At the county level, the health care and social services sector is typically the largest or second largest employer. Hospital employment is often the largest component of the sector's total employment. Hospital employment is particularly important to non-metropolitan or rural communities. A high quality healthcare sector serves to promote economic development and attract new businesses and to provide stability in economic downturns. The purpose of this study was to examine the intensity of hospital employment in rural counties relative to the nation as a whole using location quotients and to draw conclusions regarding how potential changes in Medicare and Medicaid might affect rural populations. Estimates for county-level hospital employment are not commonly available. Estimates of county-level hospital employment were therefore generated for all counties in the USA the Census Bureau's County Business Pattern Data for 2010. These estimates were used to generate location quotients for each county which were combined with demographic data to generate a profile of factors that are related to the magnitude of location quotients. The results were then used to draw inferences regarding the possible impact of the Patient Protection and Affordable Care Act 2010 (ACA) and the possible imposition of aspects of the Budget Control Act 2011 (BCA). Although a very high percentage of rural counties contain medically underserved areas, an examination of location quotients indicates that the percentage of the county workforce employed by hospitals in the most rural counties tends to be higher than for the nation as a whole, a counterintuitive finding. Further, when location quotients are regressed upon data related to poverty, county demographics, and the percentage of the population insured, a relationship between the proportion of the population over 65 years, the percentage of the population living in poverty, the percentage of the population without insurance and county density was found. The results of the analysis suggest that hospital employment in rural communities is higher than would be expected in the absence of programs that provide external funding to support hospital hiring. The most important public programs providing this support are Medicare and Medicaid. Social Security is another source of federal funding important for rural populations. Sequestration and other cuts in funding could impact rural communities significantly. This can be even worse in states that fail to expand Medicaid and in states that fail to increase Medicaid reimbursements for services important in rural communities.

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.

Access and Quality of Care in Direct-to-Consumer Telemedicine.

PubMed

Uscher-Pines, Lori; Mulcahy, Andrew; Cowling, David; Hunter, Gerald; Burns, Rachel; Mehrotra, Ateev

2016-04-01

Direct-to-consumer (DTC) telemedicine serves millions of patients; however, there is limited research on the care provided. This study compared the quality of care at Teladoc ( www.teladoc.com ), a large DTC telemedicine company, with that at physician offices and compared access to care for Teladoc users and nonusers. Claims from all enrollees 18-64 years of age in the California Public Employees' Retirement System health maintenance organization between April 2012 and October 2013 were analyzed. We compared the performance of Teladoc and physician offices on applicable Healthcare Effectiveness Data and Information Set measures. Using geographic information system analyses, we compared Teladoc users and nonusers with respect to rural location and available primary care physicians. Of enrollees offered Teladoc (n = 233,915), 3,043 adults had a total of 4,657 Teladoc visits. For the pharyngitis performance measure (ordering strep test), Teladoc performed worse than physician offices (3% versus 50%, p < 0.01). For the back pain measure (not ordering imaging), Teladoc and physician offices had similar performance (88% versus 79%, p = 0.20). For the bronchitis measure (not ordering antibiotics), Teladoc performed worse than physician offices (16.7 versus 27.9%, p < 0.01). In adjusted models, Teladoc users were not more likely to be located within a healthcare professional shortage area (odds ratio = 1.12, p = 0.10) or rural location (odds ratio = 1.0, p = 0.10). Teladoc providers were less likely to order diagnostic testing and had poorer performance on appropriate antibiotic prescribing for bronchitis. Teladoc users were not preferentially located in underserved communities. Short-term needs include ongoing monitoring of quality and additional marketing and education to increase telemedicine use among underserved patients.

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.

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.

Assessment of the nutrition and physical activity education needs of low-income, rural mothers: can technology play a role?

PubMed

Atkinson, Nancy L; Billing, Amy S; Desmond, Sharon M; Gold, Robert S; Tournas-Hardt, Amy

2007-08-01

The purpose of this study was to examine the perceptions of low-income, rural mothers regarding their need for nutrition and physical activity education and the role of technology in addressing those needs. Quantitative and qualitative research was combined to examine the nature and scope of the issues faced by this target population. Women who were currently receiving food stamps and had children in nursery school to eighth grade were recruited through a state database to participate in a telephone survey (N = 146) and focus groups (N = 56). Low-income, rural mothers were aware of and practiced many health behaviors related to nutrition and physical activity, but they faced additional barriers due to their income level, rural place of residence, and having children. They reported controlling the fat content in the food they cooked and integrating fruits and vegetables but showed less interest in increasing fiber consumption. They reported knowing little about physical activity recommendations, and their reported activity patterns were likely inflated because of seeing housework and child care as exercise. To stretch their food budget, the majority reported practicing typical shopping and budgeting skills, and many reported skills particularly useful in rural areas: hunting, fishing, and canning. Over two-thirds of the survey respondents reported computer access and previous Internet use, and most of those not yet online intended to use the Internet in the future. Those working in rural communities need to consider technology as a way to reach traditionally underserved populations like low-income mothers.

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.

Knowledgeable Neighbors:A Mobile Clinic Model for Disease Prevention and Screening in Underserved Communities

PubMed Central

Zurakowski, David; Bennet, Jennifer; Walker-White, Rainelle; Osman, Jamie L.; Quarles, Aaron; Oriol, Nancy

2012-01-01

The Family Van mobile health clinic uses a “Knowledgeable Neighbor” model to deliver cost-effective screening and prevention activities in underserved neighborhoods in Boston, MA. We have described the Knowledgeable Neighbor model and used operational data collected from 2006 to 2009 to evaluate the service. The Family Van successfully reached mainly minority low-income men and women. Of the clients screened, 60% had previously undetected elevated blood pressure, 14% had previously undetected elevated blood glucose, and 38% had previously undetected elevated total cholesterol. This represents an important model for reaching underserved communities to deliver proven cost-effective prevention activities, both to help control health care costs and to reduce health disparities. PMID:22390503

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.

Recruitment for health disparities preventive intervention trials: the early childhood caries collaborating centers.

PubMed

Tiwari, Tamanna; Casciello, Alana; Gansky, Stuart A; Henshaw, Michelle; Ramos-Gomez, Francisco; Rasmussen, Margaret; Garcia, Raul I; Albino, Judith; Batliner, Terrence S

2014-08-07

Four trials of interventions designed to prevent early childhood caries are using community-engagement strategies to improve recruitment of low-income, racial/ethnic minority participants. The trials are being implemented by 3 centers funded by the National Institute of Dental and Craniofacial Research and known as the Early Childhood Caries Collaborating Centers (EC4): the Center for Native Oral Health Research at the University of Colorado, the Center to Address Disparities in Children's Oral Health at the University of California San Francisco, and the Center for Research to Evaluate and Eliminate Dental Disparities at Boston University. The community contexts for the EC4 trials include urban public housing developments, Hispanic communities near the US-Mexican border, and rural American Indian reservations. These communities have a high prevalence of early childhood caries, suggesting the need for effective, culturally acceptable interventions. Each center's intervention(s) used community-based participatory research approaches, identified community partners, engaged the community through various means, and developed communication strategies to enhance recruitment. All 3 centers have completed recruitment. Each center implemented several new strategies and approaches to enhance recruitment efforts, such as introducing new communication techniques, using media such as radio and newspapers to spread awareness about the studies, and hosting community gatherings. Using multiple strategies that build trust in the community, are sensitive to cultural norms, and are adaptable to the community environment can enhance recruitment in underserved communities.

77 FR 6619 - Community Advantage Pilot Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-08

... access to capital for small businesses and entrepreneurs in underserved markets, SBA is issuing this... (``CA Pilot Program'') (76 FR 9626). The CA Pilot Program was introduced to increase SBA-guaranteed... small businesses and entrepreneurs in underserved markets, SBA is issuing this Notice to revise several...

Breaking Barriers to Bike Share: Insights from Residents of Traditionally Underserved Neighborhoods

DOT National Transportation Integrated Search

2017-06-01

Evidence has shown that higher income and white populations are overrepresented in both access to and use of bike share. Efforts to overcome underserved communities barriers to access and use of bike share have been initiated in a number of cities...

The Results of the “Positive Action for Today’s Health” (PATH) Trial for Increasing Walking and Physical Activity in Underserved African-American Communities

PubMed Central

Wilson, Dawn K.; Van Horn, M. Lee; Siceloff, E. Rebekah; Alia, Kassandra A.; St. George, Sara M.; Lawman, Hannah G.; Trumpeter, Nevelyn N.; Coulon, Sandra M.; Griffin, Sarah F.; Wandersman, Abraham; Egan, Brent; Colabianchi, Natalie; Forthofer, Melinda; Gadson, Barney

2015-01-01

Background The “Positive Action for Today’s Health” (PATH) trial tested an environmental intervention to increase walking in underserved communities. Methods Three matched communities were randomized to a police-patrolled walking plus social marketing, a police-patrolled walking-only, or a no-walking intervention. The 24-month intervention addressed safety and access for physical activity (PA) and utilized social marketing to enhance environmental supports for PA. African-Americans (N=434; 62 % females; aged 51±16 years) provided accelerometry and psychosocial measures at baseline and 12, 18, and 24 months. Walking attendance and trail use were obtained over 24 months. Results There were no significant differences across communities over 24 months for moderate-to-vigorous PA. Walking attendance in the social marketing community showed an increase from 40 to 400 walkers per month at 9 months and sustained ~200 walkers per month through 24 months. No change in attendance was observed in the walking-only community. Conclusions Findings support integrating social marketing strategies to increase walking in underserved African-Americans (ClinicalTrials.gov #NCT01025726). PMID:25385203

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.

Retaining new dentists in Iowa: a role for dental schools in facilitating graduates' connections to practice opportunities in underserved areas.

PubMed

Hoyle, Debra A; Ryan, Penni M; Hand, Jed S; Damiano, Peter; Schneider, Galen B

2014-04-01

Like many other states, Iowa has an aging dental workforce. As this aging population of dentists retires and communities are unable to find new dentists to take over their practices, more small and rural communities lack easy access to oral health care. The University of Iowa College of Dentistry and Dental Clinics established the Office of Iowa Practice Opportunities in 2006 to promote dental practice opportunities in Iowa for its graduates. With this office, an infrastructure connecting the college with practices and communities across the state has been developed. The Office of Iowa Practice Opportunities is the first place many students go to decide what they will do after graduation and to identify practice opportunities in Iowa. The office has exceeded the college's initial expectations and has provided significant assistance in retaining recently graduated dentists in the state of Iowa and ensuring access to oral health care in the state. This article will show that facilitating connections to practice opportunities has a place in a college of dentistry.

Further development of pharmacy student-facilitated diabetes management clinics.

PubMed

Nuffer, Wesley; McCollum, Marianne; Ellis, Samuel L; Turner, Christopher J

2012-04-10

To further develop and evaluate a diabetes disease state management (DSM) program that provided direct patient care responsibilities to advanced pharmacy practice experience (APPE) students as members of healthcare teams. Nine new clinics and 3 established sites that provide self-care management education to patients with diabetes were established and maintained in rural Colorado pharmacies and supported by students in APPE training for 48 weeks per year. The 12 clinics provided 120 APPE student placements in 2010-2011. Students' perceptions of their experiences were positive. Patients who completed the student-supported diabetes self-management education program had improvements in blood glucose, blood pressure, and lipid values. Twelve diabetes DSM clinics provided direct patient care opportunities to APPE students working as part of healthcare teams while expanding healthcare resources in underserved communities in Colorado.

77 FR 35245 - Substantially Underserved Trust Areas (SUTA)

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-13

... projects with the greatest need, financial analysis and underwriting will continue to be used to determine... Utilities Service (RUS) is issuing regulations related to loans and grants to finance the construction... INFORMATION CONTACT: Michele Brooks, Director, Program Development and Regulatory Analysis, Rural Utilities...

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.

Barriers and facilitators to implementation of VA home-based primary care on American Indian reservations: a qualitative multi-case study.

PubMed

Kramer, B Josea; Cote, Sarah D; Lee, Diane I; Creekmur, Beth; Saliba, Debra

2017-09-02

Veterans Health Affairs (VA) home-based primary care (HBPC) is an evidence-based interdisciplinary approach to non-institutional long-term care that was developed in urban settings to provide longitudinal care for vulnerable older patients. Under the authority of a Memorandum of Understanding between VA and Indian Health Service (IHS) to improve access to healthcare, 14 VA medical centers (VAMC) independently initiated plans to expand HBPC programs to rural American Indian reservations and 12 VAMC successfully implemented programs. The purpose of this study is to describe barriers and facilitators to implementation in rural Native communities with the aim of informing planners and policy-makers for future program expansions. A qualitative comparative case study approach was used, treating each of the 14 VAMC as a case. Using the Consolidated Framework for Implementation Research (CFIR) to inform an open-ended interview guide, telephone interviews (n = 37) were conducted with HBPC staff and clinicians and local/regional managers, who participated or oversaw implementation. The interviews were transcribed, coded, and then analyzed using CFIR domains and constructs to describe and compare experiences and to identify facilitators, barriers, and adaptations that emerged in common across VAMC and HBPC programs. There was considerable variation in local contexts across VAMC. Nevertheless, implementation was typically facilitated by key individuals who were able to build trust and faith in VA healthcare among American Indian communities. Policy promoted clinical collaboration but collaborations generally occurred on an ad hoc basis between VA and IHS clinicians to optimize patient resources. All programs required some adaptations to address barriers in rural areas, such as distances, caseloads, or delays in hiring additional clinicians. VA funding opportunities facilitated expansion and sustainment of these programs. Since program expansion is a responsibility of the HBPC program director, there is little sharing of lessons learned across VA facilities. Opportunities for shared learning would benefit federal healthcare organizations to expand other medical services to additional American Indian communities and other rural and underserved communities, as well as to coordinate with other healthcare organizations. The CFIR structure was an effective analytic tool to compare programs addressing multiple inner and outer settings.

Prevention of Diabetes in Rural India with a Telemedicine Intervention

PubMed Central

Mohan, Viswanathan; Deepa, Mohan; Pradeepa, Rajendra; Prathiba, Venkat; Datta, Manjula; Sethuraman, Ravikumar; Rakesh, Hari; Sucharita, Yarlagadda; Webster, Premila; Allender, Steven; Kapur, Anil; Anjana, Ranjit Mohan

2012-01-01

Background Diabetes care is not presently available, accessible, or affordable to people living in rural areas in developing countries, such as India. The Chunampet Rural Diabetes Prevention Project (CRDPP) was conceived with the aim of implementing comprehensive diabetes screening, prevention, and treatment using a combination of telemedicine and personalized care in rural India. Methods This project was undertaken in a cluster of 42 villages in and around the Chunampet village in the state of Tamil Nadu in southern India. A telemedicine van was used to screen for diabetes and its complications using retinal photography, Doppler imaging, biothesiometry, and electrocardiography using standardized techniques. A rural diabetes center was set up to provide basic diabetes care. Results Of the total 27,014 adult population living in 42 villages, 23,380 (86.5%) were screened for diabetes, of which 1138 (4.9%) had diabetes and 3410 (14.6%) had prediabetes. A total of 1001 diabetes subjects were screened for complications (response rate of 88.0%). Diabetic retinopathy was detected in 18.2%, neuropathy in 30.9%, microalbuminuria in 24.3%, peripheral vascular disease in 7.3%, and coronary artery disease in 10.8%. The mean hemoglobin A1c levels among the diabetes subjects in the whole community decreased from 9.3 ± 2.6% to 8.5 ± 2.4% within 1 year. Less than 5% of patients needed referral for further management to the tertiary diabetes hospital in Chennai. Conclusions The Chunampet Rural Diabetes Prevention Project is a successful model for screening and for delivery of diabetes health care and prevention to underserved rural areas in developing countries such as India. PMID:23294780

The Health IT Regional Extension Center Program: evolution and lessons for health care transformation.

PubMed

Lynch, Kimberly; Kendall, Mat; Shanks, Katherine; Haque, Ahmed; Jones, Emily; Wanis, Maggie G; Furukawa, Michael; Mostashari, Farzad

2014-02-01

Assess the Regional Extension Center (REC) program's progress toward its goal of supporting over 100,000 providers in small, rural, and underserved practices to achieve meaningful use (MU) of an electronic health record (EHR). Data collected January 2010 through June 2013 via monitoring and evaluation of the 4-year REC program. Descriptive study of 62 REC programs. Primary data collected from RECs were merged with nine other datasets, and descriptive statistics of progress by practice setting and penetration of targeted providers were calculated. RECs recruited almost 134,000 primary care providers (PCPs), or 44 percent of the nation's PCPs; 86 percent of these were using an EHR with advanced functionality and almost half (48 percent) have demonstrated MU. Eighty-three percent of Federally Qualified Health Centers and 78 percent of the nation's Critical Access Hospitals were participating with an REC. RECs have made substantial progress in assisting PCPs with adoption and MU of EHRs. This infrastructure supports small practices, community health centers, and rural and public hospitals to use technology for care delivery transformation and improvement. © Health Research and Educational Trust.

OB fellowship outcomes 1992-2010: where do they go, who stops delivering, and why?

PubMed

Rodney, W MacMillan; Martinez, Conchita; Collins, Millard; Laurence, Greg; Pean, Carl; Stallings, Joe

2010-01-01

This study describes characteristics and the evolution of the careers of graduates from a 1-year post-residency fellowship program whose primary objectives included clinical skills in Cesarean section. Besides obstetrical practice, rural service and attainment of faculty appointment were used as surrogate measures of fulfilling an underserved need for family medicine obstetrics. For 18 years, the authors maintained contact with all 80 physicians completing 1-year fellowships in family medicine obstetrics in Memphis and Nashville. The founding chair of these programs surveyed each physician and maintained a network of contacts to study outcomes such as graduation, service location, hospital privileges, retention, and career changes. The study tracked 100% of the sample and documented high rates of fellowship completion (74/80 [93%]), Cesarean privileges (71/74 [96%]), and service in a rural community for at least 2 years (47/74 [64%]). The fellowship was also associated with participation as faculty (36/74 [46%]). This paper produces the first and longest-term data describing attrition over time and examines the reasons why fellowship-trained family physicians stop doing maternity care. It is the only series with a 100% response rate and provides longitudinal data on the outcomes of these fellowship programs. Attrition was highest at rural sites. Workforce planners and fellowship designers might benefit from these considerations.

78 FR 69698 - Agency Information Collection Activities; Proposed Collection; Public Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-20

.... Information Collection Request Title: Nurse Anesthetist Traineeship (NAT) Program Application. OMB No. 0915... education nursing training grants to educational institutions to increase the numbers of Nurse Anesthetists..., and the distribution of Nurse Anesthetists to practice in underserved, rural, or public health...

Feasibility and effectiveness of two community-based HIV testing models in rural Swaziland.

PubMed

Parker, Lucy Anne; Jobanputra, Kiran; Rusike, Lorraine; Mazibuko, Sikhathele; Okello, Velephi; Kerschberger, Bernhard; Jouquet, Guillaume; Cyr, Joanne; Teck, Roger

2015-07-01

To evaluate the feasibility (population reached, costs) and effectiveness (positivity rates, linkage to care) of two strategies of community-based HIV testing and counselling (HTC) in rural Swaziland. Strategies used were mobile HTC (MHTC) and home-based HTC (HBHTC). Information on age, sex, previous testing and HIV results was obtained from routine HTC records. A consecutive series of individuals testing HIV-positive were followed up for 6 months from the test date to assess linkage to care. A total of 9 060 people were tested: 2 034 through MHTC and 7 026 through HBHTC. A higher proportion of children and adolescents (<20 years) were tested through HBHTC than MHTC (57% vs. 17%; P < 0.001). MHTC reached a higher proportion of adult men than HBHTC (42% vs. 39%; P = 0.015). Of 398 HIV-positive individuals, only 135 (34%) were enrolled in HIV care within 6 months. Of 42 individuals eligible for antiretroviral therapy, 22 (52%) started treatment within 6 months. Linkage to care was lowest among people who had tested previously and those aged 20-40 years. HBHTC was 50% cheaper (US$11 per person tested; $797 per individual enrolled in HIV care) than MHTC ($24 and $1698, respectively). In this high HIV prevalence setting, a community-based testing programme achieved high uptake of testing and appears to be an effective and affordable way to encourage large numbers of people to learn their HIV status (particularly underserved populations such as men and young people). However, for community HTC to impact mortality and incidence, strategies need to be implemented to ensure people testing HIV-positive in the community are linked to HIV care. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

What Goes Around: the process of building a community-based harm reduction research project.

PubMed

Jalloh, Chelsea; Illsley, Shohan; Wylie, John; Migliardi, Paula; West, Ethan; Stewart, Debbie; Mignone, Javier

2017-11-16

Often, research takes place on underserved populations rather than with underserved populations. This approach can further isolate and stigmatize groups that are already made marginalized. What Goes Around is a community-based research project that was led by community members themselves (Peers). This research aimed to implement a community-based research methodology grounded in the leadership and growing research capacity of community researchers and to investigate a topic which community members identified as important and meaningful. Chosen by community members, this project explored how safer sex and safer drug use information is shared informally among Peers. Seventeen community members actively engaged as both community researchers and research participants throughout all facets of the project: inception, implementation, analysis, and dissemination of results. Effective collaboration between community researchers, a community organization, and academics facilitated a research process in which community members actively guided the project from beginning to end. The methods used in What Goes Around demonstrated that it is not only possible, but advantageous, to draw from community members' involvement and direction in all stages of a community-based research project. This is particularly important when working with a historically underserved population. Purposeful and regular communication among collaborators, ongoing capacity building, and a commitment to respect the experience and expertise of community members were essential to the project's success. This project demonstrated that community members are highly invested in both informally sharing information about safer sex and safer drug use and taking leadership roles in directing research that prioritizes harm reduction in their communities.

Remote monitoring technologies for the prevention of metabolic syndrome: the Diabetes and Technology for Increased Activity (DaTA) study.

PubMed

Stuckey, Melanie; Fulkerson, Robyn; Read, Emily; Russell-Minda, Elizabeth; Munoz, Claudio; Kleinstiver, Peter; Petrella, Robert

2011-07-01

Remote monitoring technologies are ideally suited for rural communities with limited access to health care. In an 8-week pilot study, we examined the feasibility of implementing and conducting a technology-intensive intervention in an underserviced rural setting. Our goal was to test the utility of self-monitoring technologies, physical activity, and education as tools to manage health indicators for the development of the cardiovascular complications (CVCs) of type 2 diabetes. The Diabetes and Technology for Increased Activity study was an open single-center study conducted in a community-based research setting. All 24 participants were provided with a Blackberry™ Smartphone, blood pressure monitor, glucometer, and pedometer. Smartphones transmitted measurements and survey results to the database, interfaced participants with the clinical team, and allowed for self-monitoring. Outcomes were improved body composition, improved markers of CVC risk factors, increased daily exercise, and interest in or awareness of lifestyle changes that impact health outcomes. Participants had excellent compliance for measurements, as self-monitoring provided a sense of security that improved from week 4 to week 8. Our team gained substantial insight into the operational requirements of technology-facilitated health care, including redefined hours of service; data reporting, management, and access protocols; and the utility of real-time clinical measures by remote monitoring. We developed an understanding of knowledge translation strategies as well as successful motivational and educational tools. Importantly, remote monitoring technology was found to be feasible and accepted in a rural setting. © 2011 Diabetes Technology Society.

Remote Monitoring Technologies for the Prevention of Metabolic Syndrome: The Diabetes and Technology for Increased Activity (DaTA) Study

PubMed Central

Stuckey, Melanie; Fulkerson, Robyn; Read, Emily; Russell-Minda, Elizabeth; Munoz, Claudio; Kleinstiver, Peter; Petrella, Robert

2011-01-01

Objectives Remote monitoring technologies are ideally suited for rural communities with limited access to health care. In an 8-week pilot study, we examined the feasibility of implementing and conducting a technology-intensive intervention in an underserviced rural setting. Our goal was to test the utility of self-monitoring technologies, physical activity, and education as tools to manage health indicators for the development of the cardiovascular complications (CVCs) of type 2 diabetes. Research Design and Methods The Diabetes and Technology for Increased Activity study was an open single-center study conducted in a community-based research setting. All 24 participants were provided with a Blackberry™ Smartphone, blood pressure monitor, glucometer, and pedometer. Smartphones transmitted measurements and survey results to the database, interfaced participants with the clinical team, and allowed for self-monitoring. Results Outcomes were improved body composition, improved markers of CVC risk factors, increased daily exercise, and interest in or awareness of lifestyle changes that impact health outcomes. Participants had excellent compliance for measurements, as self-monitoring provided a sense of security that improved from week 4 to week 8. Conclusions Our team gained substantial insight into the operational requirements of technology-facilitated health care, including redefined hours of service; data reporting, management, and access protocols; and the utility of real-time clinical measures by remote monitoring. We developed an understanding of knowledge translation strategies as well as successful motivational and educational tools. Importantly, remote monitoring technology was found to be feasible and accepted in a rural setting. PMID:21880237

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.

Designing an Intervention for Women with Systemic Lupus Erythematosus from Medically Underserved Areas to Improve Care: A Qualitative Study

PubMed Central

Feldman, Candace H; Bermas, Bonnie L; Zibit, Melanie; Fraser, Patricia; Todd, Derrick J; Fortin, Paul R; Massarotti, Elena; Costenbader, Karen H

2013-01-01

Objective Systemic lupus erythematosus (lupus) disproportionately affects women, racial/ethnic minorities and low-income populations. We held focus groups for women from medically underserved communities to discuss interventions to improve care. Methods From our Lupus Registry, we invited 282 women, > 18 years, residing in urban, medically underserved areas. Hospital-based clinics and support groups also recruited participants. Women were randomly assigned to 3 focus groups. 75-minute sessions were recorded, transcribed and coded thematically using interpretative phenomenologic analysis and single counting methods. We categorized interventions by benefits, limitations, target populations and implementation questions. Results 29 women with lupus participated in 3 focus groups, (n=9, 9, 11). 80% were African American and 83% were from medically underserved zip codes. Themes included the desire for lupus education, isolation at the time of diagnosis, emotional and physical barriers to care, and the need for assistance navigating the healthcare system. 20 of 29 participants (69%) favored a peer support intervention; 17 (59%) also supported a lupus health passport. Newly diagnosed women were optimal intervention targets. Improvements in quality of life and mental health were proposed outcome measures. Conclusion Women with lupus from medically underserved areas have unique needs best addressed with an intervention designed through collaboration between community members and researchers. PMID:23087258

34 CFR 364.32 - What are the requirements for outreach?

Code of Federal Regulations, 2014 CFR

2014-07-01

... outreach to populations in the State that are unserved or underserved by programs under title VII, including minority groups and urban and rural populations. (b) The State plan must identify the populations... control number 1820-0527) (Authority: 29 U.S.C. 796c(l)) ...

34 CFR 364.32 - What are the requirements for outreach?

Code of Federal Regulations, 2013 CFR

2013-07-01

... outreach to populations in the State that are unserved or underserved by programs under title VII, including minority groups and urban and rural populations. (b) The State plan must identify the populations... control number 1820-0527) (Authority: 29 U.S.C. 796c(l)) ...

34 CFR 364.32 - What are the requirements for outreach?

Code of Federal Regulations, 2012 CFR

2012-07-01

... outreach to populations in the State that are unserved or underserved by programs under title VII, including minority groups and urban and rural populations. (b) The State plan must identify the populations... control number 1820-0527) (Authority: 29 U.S.C. 796c(l)) ...

Meeting EFA: Reaching the Underserved through Complementary Models of Effective Schooling. Working Paper

ERIC Educational Resources Information Center

DeStefano, Joseph; Moore, Audrey-Marie Schuh; Balwanz, David; Hartwell, Ash

2007-01-01

In 2004, the United States Agency for International Development (USAID)-funded Educational Quality Improvement Program 2 (EQUIP2) began investigating community-based schools as a mechanism for reaching the underserved populations. The team identified nine models that successfully organized schooling in regions least served by the formal education…

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…

Clinical Telemedicine Utilization in Ontario over the Ontario Telemedicine Network.

PubMed

O'Gorman, Laurel D; Hogenbirk, John C; Warry, Wayne

2016-06-01

Northern Ontario is a region in Canada with approximately 775,000 people in communities scattered across 803,000 km(2). The Ontario Telemedicine Network (OTN) facilitates access to medical care in areas that are often underserved. We assessed how OTN utilization differed throughout the province. We used OTN medical service utilization data collected through the Ontario Health Insurance Plan and provided by the Ministry of Health and Long Term Care. Using census subdivisions grouped by Northern and Southern Ontario as well as urban and rural areas, we calculated utilization rates per fiscal year and total from 2008/2009 to 2013/2014. We also used billing codes to calculate utilization by therapeutic area of care. There were 652,337 OTN patient visits in Ontario from 2008/2009 to 2013/2014. Median annual utilization rates per 1,000 people were higher in northern areas (rural, 52.0; urban, 32.1) than in southern areas (rural, 6.1; urban, 3.1). The majority of usage in Ontario was in mental health and addictions (61.8%). Utilization in other areas of care such as surgery, oncology, and internal medicine was highest in the rural north, whereas primary care use was highest in the urban south. Utilization was higher and therapeutic areas of care were more diverse in rural Northern Ontario than in other parts of the province. Utilization was also higher in urban Northern Ontario than in Southern Ontario. This suggests that telemedicine is being used to improve access to medical care services, especially in sparsely populated regions of the province.

Smart Growth and Equitable Development

EPA Pesticide Factsheets

This page discusses how smart growth, environmental justice, and equitable development can improve communities and provide economic, environmental, health, and social benefits to underserved communities.

Area-level risk factors for adverse birth outcomes: trends in urban and rural settings

PubMed Central

2013-01-01

Background Significant and persistent racial and income disparities in birth outcomes exist in the US. The analyses in this manuscript examine whether adverse birth outcome time trends and associations between area-level variables and adverse birth outcomes differ by urban–rural status. Methods Alabama births records were merged with ZIP code-level census measures of race, poverty, and rurality. B-splines were used to determine long-term preterm birth (PTB) and low birth weight (LBW) trends by rurality. Logistic regression models were used to examine differences in the relationships between ZIP code-level percent poverty or percent African-American with either PTB or LBW. Interactions with rurality were examined. Results Population dense areas had higher adverse birth outcome rates compared to other regions. For LBW, the disparity between population dense and other regions increased during the 1991–2005 time period, and the magnitude of the disparity was maintained through 2010. Overall PTB and LBW rates have decreased since 2006, except within isolated rural regions. The addition of individual-level socioeconomic or race risk factors greatly attenuated these geographical disparities, but isolated rural regions maintained increased odds of adverse birth outcomes. ZIP code-level percent poverty and percent African American both had significant relationships with adverse birth outcomes. Poverty associations remained significant in the most population-dense regions when models were adjusted for individual-level risk factors. Conclusions Population dense urban areas have heightened rates of adverse birth outcomes. High-poverty African American areas have higher odds of adverse birth outcomes in urban versus rural regions. These results suggest there are urban-specific social or environmental factors increasing risk for adverse birth outcomes in underserved communities. On the other hand, trends in PTBs and LBWs suggest interventions that have decreased adverse birth outcomes elsewhere may not be reaching isolated rural areas. PMID:23759062

Screening and Follow-Up Monitoring for Substance Use in Primary Care: An Exploration of Rural-Urban Variations.

PubMed

Chan, Ya-Fen; Lu, Shou-En; Howe, Bill; Tieben, Hendrik; Hoeft, Theresa; Unützer, Jürgen

2016-02-01

Rates of substance use in rural areas are close to those of urban areas. While recent efforts have emphasized integrated care as a promising model for addressing workforce shortages in providing behavioral health services to those living in medically underserved regions, little is known on how substance use problems are addressed in rural primary care settings. To examine rural-urban variations in screening and monitoring primary care- based patients for substance use problems in a state-wide mental health integration program. This was an observational study using patient registry. The study included adult enrollees (n = 15,843) with a mental disorder from 133 participating community health clinics. We measured whether a standardized substance use instrument was used to screen patients at treatment entry and to monitor symptoms at follow-up visits. While on average 73.6 % of patients were screened for substance use, follow-up on substance use problems after initial screening was low (41.4 %); clinics in small/isolated rural settings appeared to be the lowest (13.6 %). Patients who were treated for a mental disorder or substance abuse in the past and who showed greater psychiatric complexities were more likely to receive a screening, whereas patients of small, isolated rural clinics and those traveling longer distances to the care facility were least likely to receive follow-up monitoring for their substance use problems. Despite the prevalent substance misuse among patients with mental disorders, opportunities to screen this high-risk population for substance use and provide a timely follow-up for those identified as at risk remained overlooked in both rural and urban areas. Rural residents continue to bear a disproportionate burden of substance use problems, with rural-urban disparities found to be most salient in providing the continuum of services for patients with substance use problems in primary care.

The State as Community in Community-based Participatory Research

PubMed Central

Goold, Susan Dorr; Rowe, Zachary; Szymecko, Lisa; Coombe, Chris; Danis, Marion; Hammad, Adnan; Calhoun, Karen; Salman, Cengiz

2017-01-01

Background Community-based participatory research (CBPR) typically defines communities by geography, ethnicity, shared health needs, or some combination. Objectives We describe a CBPR project aiming to engage diverse minority and underserved communities throughout Michigan in deliberations about health research priorities. Methods A Steering Committee (SC) with 15 members from minority and underserved communities, and 4 members from research organizations led the project, with the help of regional advisory groups (RAGs) formed at the SC’s request. Evaluation of the SC used questionnaires, focused group discussion, and review of SC meetings to describe engagement, partnership, and communication. Lessons Learned An academic-community partnership with a diverse, dispersed and broadly defined community found value in RAGs, dedicated academic staff, face-to-face meetings, varied communication modalities, capacity building tailored to varying levels of CBPR experience, and ongoing evaluation. Conclusions A geographically and culturally diverse partnership presents challenges and opportunities in representativeness, relationship building, capacity building, and communication. PMID:28569676

Building a workforce of physicians to care for underserved patients.

PubMed

Anthony, David; El Rayess, Fadya; Esquibel, Angela Y; George, Paul; Taylor, Julie

2014-09-02

There is a shortage of physicians to care for underserved populations. Medical educators at The Warren Alpert Medical School of Brown University have used five years of Health Resources and Services Administration funding to train medical students to provide outstanding primary care for underserved populations. The grant has two major goals: 1) to increase the number of graduating medical students who practice primary care in underserved communities ("Professional Development"); and 2) to prepare all medical school graduates to care for underserved patients, regardless of specialty choice ("Curriculum Development"). Professional Development, including a new scholarly concentration and an eight-year primary care pipeline, has been achieved in partnership with the Program in Liberal Medical Education, the medical school's Admissions Committee, and an Area Health Education Center. Curriculum Development has involved systematic recruitment of clinical training sites and disease-specific curricula including tools for providing care to vulnerable populations. A comprehensive, longitudinal evaluation is ongoing.

Remote eye care screening for rural veterans with Technology-based Eye Care Services: a quality improvement project.

PubMed

Maa, April Y; Wojciechowski, Barbara; Hunt, Kelly; Dismuke, Clara; Janjua, Rabeea; Lynch, Mary G

2017-01-01

Veterans are at high risk for eye disease because of age and comorbid conditions. Access to eye care is challenging within the entire Veterans Hospital Administration's network of hospitals and clinics in the USA because it is the third busiest outpatient clinical service and growing at a rate of 9% per year. Rural and highly rural veterans face many more barriers to accessing eye care because of distance, cost to travel, and difficulty finding care in the community as many live in medically underserved areas. Also, rural veterans may be diagnosed in later stages of eye disease than their non-rural counterparts due to lack of access to specialty care. In March 2015, Technology-based Eye Care Services (TECS) was launched from the Atlanta Veterans Affairs (VA) as a quality improvement project to provide eye screening services for rural veterans. By tracking multiple measures including demographic and access to care metrics, data shows that TECS significantly improved access to care, with 33% of veterans receiving same-day access and >98% of veterans receiving an appointment within 30 days of request. TECS also provided care to a significant percentage of homeless veterans, 10.6% of the patients screened. Finally, TECS reduced healthcare costs, saving the VA up to US$148 per visit and approximately US$52 per patient in round trip travel reimbursements when compared to completing a face-to-face exam at the medical center. Overall savings to the VA system in this early phase of TECS totaled US$288,400, about US$41,200 per month. Other healthcare facilities may be able to use a similar protocol to extend care to at-risk patients.

Assessing nutrition and physical health disparisties for a college population

USDA-ARS?s Scientific Manuscript database

Rural regions are often underserved, and although the Delta region of the United States has a rich history, health disparities abound. A university located in the region has an obligation to address issues of importance to its constituents. Healthy lifestyle obstacles faced by students who hail from...

Mountain Plains Telecommunications: 1987 Survey of Colleges Serving Nonmetropolitan Distance Learners.

ERIC Educational Resources Information Center

Slotten, Marjorie Hacker

Information is provided about the use of telecommunications in the delivery of postsecondary coursework to off-campus nonmetropolitan sites in the Mountain Plains states. The five chapters cover the following: introduction; review of the literature (shift to information society, underserved rural adult population, historical sketch, selected…

Is the Shine off the A.P. Apple?

ERIC Educational Resources Information Center

Hurwitz, Nina; Hurwitz, Sol

2003-01-01

Describes challenges facing College Board's efforts to expand Advanced Placement (A.P.) courses to provide equal access to previously underserved low-performing urban and rural school students while maintaining the program's high academic standards. Includes list of strategies school boards can use to achieve greater access to A.P. courses while…

Parent behavior and child weight status among a diverse group of underserved rural families

USDA-ARS?s Scientific Manuscript database

The purpose of this study was threefold: to investigate the association between three parenting behaviors (parenting style, feeding style, and feeding practices); to evaluate whether these behaviors were associated with child weight; and to determine whether style (parenting and feeding) moderated t...

Building Connections: Strategies to Address Rurality and Accessibility Challenges

ERIC Educational Resources Information Center

Hartman, Sara; Hines-Bergmeier, Jennifer

2015-01-01

Operating a museum in a high poverty, underserved area creates many challenges related to accessibility, programming, and funding. Over the course of nearly a decade, the Ohio Valley Museum of Discovery (OVMoD) has identified several organizational practices that help mitigate these challenges. Located in the southeastern corner of Appalachian…

Investments in blood safety improve the availability of blood to underserved areas in a sub-Saharan African country

PubMed Central

Pitman, J. P.; Wilkinson, R.; Basavaraju, S. V.; von Finckenstein, B.; Sibinga, C. Smit; Marfin, A. A.; Postma, M. J.; Mataranyika, M.; Tobias, J.; Lowrance, D. W.

2015-01-01

Background and Objectives Since 2004, several African countries, including Namibia, have received assistance from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Gains have been documented in the safety and number of collected units in these countries, but the distribution of blood has not been described. Materials and Methods Nine years of data on blood requests and issues from Namibia were stratified by region to describe temporal and spatial changes in the number and type of blood components issued to Namibian healthcare facilities nationally. Results Between 2004 and 2007 (early years of PEPFAR support) and 2008–2011 (peak years of PEPFAR support), the average number of red cell units issued annually increased by 23.5% in seven densely populated but less-developed regions in northern Namibia; by 30% in two regions with urban centres; and by 35.1% in four sparsely populated rural regions. Conclusion Investments in blood safety and a policy decision to emphasize distribution of blood to underserved regions improved blood availability in remote rural areas and increased the proportion of units distributed as components. However, disparities persist in the distribution of blood between Namibia’s urban and rural regions. PMID:26478742

Magnetometer Data in the Classroom as a part of the NASA THEMIS Satellite Mission

NASA Astrophysics Data System (ADS)

Peticolas, L. M.; Bean, J.; Walker, A.

2011-12-01

The NASA-funded THEMIS mission was designed to determine the onset time and location of magnetic substorms of Earth's space environment, a prerequisite to understanding space weather. THEMIS is an acronym for Time History of Events and Macroscale Interactions during Substorms. he Geomagnetic Event Observation Network by Students (GEONS) project was the flagship, formal education component of the E/PO program. With the placement of magnetometers in the proximity of rural schools throughout the country, middle and high school teachers along with their students benefited from the opportunity to work with 'real-time' data and participated in hands-on space science activities. Particular attention was paid to placing the magnetometer stations at schools in rural communities whose students were traditionally underserved and underrepresented in the sciences. The project offered to the teachers of these students long-term professional development opportunities that centered around THEMIS-related space science and the magnetometer data. The THEMIS E/PO final evaluation report for the main phase of the THEMIS mission covered the period from 2003-2009, describing the impact of this program such as this program placed magnetometers sites at 13 rural, underserved schools/communities, two-fifths of which are on tribal lands; and provided intensive professional development for 20 teachers from 2004 through 2009. A core group of eight teachers estimated reaching more than 2,720 students with THEMIS-related materials/ideas. 75% of these students are minorities in science. Core teachers provided evidence of the project's positive impact on students' attitudes toward science and their choices for courses that position them for STEM-related careers. Core teachers reported sharing THEMIS-related materials/ideas with 275 colleagues. The NewsHour with Jim Lehrer featured the Petersburg, Alaska site potentially reaching more than 5 million viewers in two airings, according to Nielsen ratings. The PBS NewsHour piece was picked up by National Public Radio and made available on the Online NewsHour Web site where it was linked to NOVA Science NOW's Web site. Nearly all core teachers have become involved in other NASA-related programs-Heliophysics Educator Ambassadors, GSFC's Cosmic Times, SOPHIA, RBSE, etc. Jim Bean, one of the teachers in the program, highlights the benefits of this program in the classroom as: 1) inquiry/application based learning at an advanced high school level (physics; magnetism-B-field, electromagnetic radiation), 2) real-time data collection from multiple sources, i.e. Magnetometers, SOHO, iPhone and other phone Applications, etc., 3) data analysis, vector analysis, graphical representations, and 4) multiple subject integration; physics, math, geology, and astronomy.

Mobile Technology for Empowering Health Workers in Underserved Communities: New Approaches to Facilitate the Elimination of Neglected Tropical Diseases.

PubMed

Stanton, Michelle; Molineux, Andrew; Mackenzie, Charles; Kelly-Hope, Louise

2016-01-01

As global mobile phone penetration increases, direct health information communication from hard-to-reach communities is becoming commonplace. Mobile health (mHealth) tools that enable disease control programs to benefit from this information, while simultaneously empowering community members to take control of their own health, are vital to the goal of universal health care. Our aim was to highlight the development of the Liverpool mHealth Suite (LMS), which has been designed to address this need and improve health services for neglected tropical diseases being targeted for global elimination, such as lymphatic filariasis. The LMS has two main communication approaches-short message service and mobile phone apps-to facilitate real-time mass drug administration (MDA) coverage, reporting patient numbers, managing stock levels of treatment supplies, and exchanging health information to improve the quality of care of those affected. The LMS includes the MeasureSMS-MDA tool to improve drug supplies and MDA coverage rates in real-time (currently being trialed in urban Tanzania); the MeasureSMS-Morbidity tool to map morbidity, including lymphedema and hydrocele cases (initially piloted in rural Malawi and Ghana, then extended to Ethiopia, and scaled up to large urban areas in Bangladesh and Tanzania); the LyMSS-lymphedema management supply system app to improve distribution of treatments (trialed for 6 months in Malawi with positive impacts on health workers and patients); and the HealthFront app to improve education and training (in development with field trials planned). The current success and scale-up of the LMS by many community health workers in rural and urban settings across Africa and Asia highlights the value of this simple and practical suite of tools that empowers local health care workers to contribute to local, national, and global elimination of disease.

American Dental Association White Paper Targets Dental Care for the Underserved

ERIC Educational Resources Information Center

Berthold, Mark

2005-01-01

Reaffirming its leadership role toward better oral health for all Americans, the ADA has produced a white paper that also challenges policy-makers and the US to improve access to dental services. The white paper, "State and Community Models for Improving Access to Dental Care for the Underserved," was presented October 1 to the House of…

Arts Infusion and Literacy Achievement within Underserved Communities: A Matter of Equity

ERIC Educational Resources Information Center

Carney, Charles L.; Weltsek, Gustave J.; Hall, M. Lynne; Brinn, Ginger

2016-01-01

There is ample evidence that arts added to the K-12 curriculum can have many positive learning impacts. Nevertheless, many states do not promote such instruction as an integral part of classroom plans. For particular schools with underserved populations, arts-enhanced curricula can be a powerful learning tool. Beyond arts integration, arts…

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.

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.

Markets, voucher subsidies and free nets combine to achieve high bed net coverage in rural Tanzania.

PubMed

Khatib, Rashid A; Killeen, Gerry F; Abdulla, Salim M K; Kahigwa, Elizeus; McElroy, Peter D; Gerrets, Rene P M; Mshinda, Hassan; Mwita, Alex; Kachur, S Patrick

2008-06-02

Tanzania has a well-developed network of commercial ITN retailers. In 2004, the government introduced a voucher subsidy for pregnant women and, in mid 2005, helped distribute free nets to under-fives in small number of districts, including Rufiji on the southern coast, during a child health campaign. Contributions of these multiple insecticide-treated net delivery strategies existing at the same time and place to coverage in a poor rural community were assessed. Cross-sectional household survey in 6,331 members of randomly selected 1,752 households of 31 rural villages of Demographic Surveillance System in Rufiji district, Southern Tanzania was conducted in 2006. A questionnaire was administered to every consenting respondent about net use, treatment status and delivery mechanism. Net use was 62.7% overall, 87.2% amongst infants (0 to 1 year), 81.8% amongst young children (>1 to 5 years), 54.5% amongst older children (6 to 15 years) and 59.6% amongst adults (>15 years). 30.2% of all nets had been treated six months prior to interview. The biggest source of nets used by infants was purchase from the private sector with a voucher subsidy (41.8%). Half of nets used by young children (50.0%) and over a third of those used by older children (37.2%) were obtained free of charge through the vaccination campaign. The largest source of nets amongst the population overall was commercial purchase (45.1% use) and was the primary means for protecting adults (60.2% use). All delivery mechanisms, especially sale of nets at full market price, under-served the poorest but no difference in equity was observed between voucher-subsidized and freely distributed nets. All three delivery strategies enabled a poor rural community to achieve net coverage high enough to yield both personal and community level protection for the entire population. Each of them reached their relevant target group and free nets only temporarily suppressed the net market, illustrating that in this setting that these are complementary rather than mutually exclusive approaches.

Casting a Wider Net: Engaging Community Health Worker Clients and Their Families in Cancer Prevention

PubMed Central

Roman, Lee Anne; Zambrana, Ruth Enid; Ford, Sabrina; Meghea, Cristian

2016-01-01

Engaging family members in an intervention to prevent breast and cervical cancer can be a way to reach underserved women; however, little is known about whether family member recruitment reaches at-risk women. This study reports the kin relationship and risk characteristics of family members who chose to participate in the Kin KeeperSM cancer prevention intervention, delivered by community health workers (CHWs) via existing community programs. African American, Latina, and Arab family members reported risk factors for inadequate screening, including comorbid health conditions and inadequate breast or cervical cancer literacy. CHW programs can be leveraged to reach underserved families with cancer preventive interventions. PMID:27634780

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…

Higher Education In Michigan: Overcoming Challenges to Expand Access

ERIC Educational Resources Information Center

Cunningham, Alisa F.; Erisman, Wendy; Looney, Shannon E.

2008-01-01

This report examines access to higher education in underserved regions of Michigan. This study focuses on specific concerns about postsecondary education access in three geographically diverse areas of the state: suburban Macomb County; the city of Saginaw; and six rural counties in the northeastern Lower Peninsula. The report provides a summary…

78 FR 19496 - Agency Information Collection Activities: Submission to OMB for Review and Approval; Public...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-01

... Collection Request (ICR) to the Office of Management and Budget (OMB). Comments submitted during the first... management needs, and respond to emerging workforce concerns. The proposed revised data collection will... distribution of practitioners to practice in underserved and rural areas; (3) enhancing the quality of...

78 FR 45540 - Agency Information Collection Activities: Proposed Collection: Public Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-29

... education nurses through the AENT Program. The AENT Program is governed by Title VIII, Section 811(a)(2) of... of primary care nurse practitioners and nurse midwives who plan to practice in rural, underserved, or... provision of primary care nurse practitioner and nurse midwifery programs accredited by a national nurse...

78 FR 36520 - U.S. Department of Agriculture Multi-Family Housing Section 515-Underserved Counties and Colonias...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-18

... DEPARTMENT OF AGRICULTURE Rural Housing Service U.S. Department of Agriculture Multi-Family...-Discrimination Statement The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers... letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400...

Positive Behavior Interventions and Support in a Physical Activity Summer Camp

ERIC Educational Resources Information Center

Hinton, Vanessa; Buchanan, Alice M.

2015-01-01

This purpose of this study was to investigate the implementation of positive behavior interventions and support (PBIS) in a summer camp. The camp provided physical activity opportunities to underserved children attending a summer program at a local, rural public school. Certified physical education teachers led activity stations. Participants in…

Online School Psychology: Blueprint to Higher Education Conversations

ERIC Educational Resources Information Center

Dixon, Robert J.

2018-01-01

The author is convinced that the school psychology profession needs to develop innovative programs to address the shortages of school psychologists across the nation, specifically, online programs that can reach the rural and underserved districts of each state. Current educators seeking to expand their skill set can be the untapped answer to…

The Balika Shivir: A Girls' Education Program with a Social Change Agenda

ERIC Educational Resources Information Center

Singh, Manjari

2010-01-01

The Balika Shivir, a six-month, non-formal, residential, education program for illiterate adolescent girls was an intervention strategy used to reach a traditionally underserved and marginalized population in rural western India. The primary objective of the Balika Shivir was to impart literacy and numeracy skills to attending girls, and to…

Influence of depression, anxiety and stress on cognitive performance in community-dwelling older adults living in rural Ecuador: results of the Atahualpa Project.

PubMed

Del Brutto, Oscar H; Mera, Robertino M; Del Brutto, Victor J; Maestre, Gladys E; Gardener, Hannah; Zambrano, Mauricio; Wright, Clinton B

2015-04-01

To assess the relationship between cognitive status and self-reported symptoms of depression, anxiety and stress of older adults living in an underserved rural South American population. Community-dwelling Atahualpa residents aged ≥60 years were identified during a door-to-door census, and evaluated with the Depression Anxiety Stress Scale-21 (DASS-21) and the Montreal Cognitive Assessment (MoCA). We explored whether positivity in each of the DASS-21 axes was related to total and domain-specific MoCA performance after adjustment for age, sex and education. A total of 280 persons (59% women; mean age, mean age 70 ± 8 years) were included. Based on established cut-offs for the DASS-21, 12% persons had depression, 15% had anxiety and 5% had stress. Mean total MoCA scores were significantly lower for depressed than for not depressed individuals (15.9 ± 5.5 vs 18.9 ± 4.4, P < 0.0001). Depressed participants had significantly lower total and domain-specific MoCA scores for abstraction, short-term memory and orientation. Anxiety was related to significantly lower total MoCA scores (17 ± 4.7 vs 18.8 ± 4.5, P = 0.02), but not to differences in domain-specific MoCA scores. Stress was not associated with significant differences in MoCA scores. The present study suggests that depression and anxiety are associated with poorer cognitive performance in elderly residents living in rural areas of developing countries. © 2014 Japan Geriatrics Society.

77 FR 21067 - Funding Opportunity Title: Risk Management Education and Outreach Partnerships Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-09

... access and participation of underserved communities, and providing risk management education and..., community based organizations or a coalition of community-based organization that has demonstrated... applicant's employees or the community. The applicant must demonstrate that performance under the...

Interactive NCORP Map Details Community Research Sites | Division of Cancer Prevention

Cancer.gov

An interactive map of the NCI Community Oncology Research Program (NCORP) with detailed information on hundreds of community sites that take part in clinical trials is available on the NCORP website. NCORP Map NCORP Community Sites, Minority/Underserved Community Sites, and Research Bases |

Exercise and Sports Medicine Issues in Underserved Populations.

PubMed

Morelli, Vincent; Bedney, Daniel L; Eric Dadush, Arie

2017-03-01

Primary care providers can make a strong argument for exercise promotion in underserved communities. The benefits are vitally important in adolescent physical, cognitive, and psychological development as well as in adult disease prevention and treatment. In counseling such patients, we should take into account a patient's readiness for change and the barriers to exercise. Copyright © 2016 Elsevier Inc. All rights reserved.

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…

The Healthnet project: extending online information resources to end users in rural hospitals.

PubMed

Holtum, E; Zollo, S A

1998-10-01

The importance of easily available, high quality, and current biomedical literature within the clinical enterprise is now widely documented and accepted. Access to this information has been shown to have a direct bearing on diagnosis, choices of tests, choices of drugs, and length of hospital stay. However, many health professionals do not have adequate access to current health information, particularly those practicing in rural, isolated, or underserved hospitals. Thanks to a three-year telemedicine award from the National Library of Medicine, The University of Iowa (UI) has developed a high-speed, point-to-point telecommunications network to deliver clinical and educational applications to ten community-based Iowa hospitals. One of the services offered over the network allows health professionals from the site hospitals to access online health databases and order articles via an online document delivery service. Installation, training, and troubleshooting support are provided to the remote sites by UI project staff. To date, 1,339 health professionals from the ten networked hospitals have registered to use the Healthnet program. Despite the friendly interface on the computer workstations installed at the sites, training emerged as the key issue in maximizing health professional utilization of these programs.

The Healthnet project: extending online information resources to end users in rural hospitals.

PubMed Central

Holtum, E; Zollo, S A

1998-01-01

The importance of easily available, high quality, and current biomedical literature within the clinical enterprise is now widely documented and accepted. Access to this information has been shown to have a direct bearing on diagnosis, choices of tests, choices of drugs, and length of hospital stay. However, many health professionals do not have adequate access to current health information, particularly those practicing in rural, isolated, or underserved hospitals. Thanks to a three-year telemedicine award from the National Library of Medicine, The University of Iowa (UI) has developed a high-speed, point-to-point telecommunications network to deliver clinical and educational applications to ten community-based Iowa hospitals. One of the services offered over the network allows health professionals from the site hospitals to access online health databases and order articles via an online document delivery service. Installation, training, and troubleshooting support are provided to the remote sites by UI project staff. To date, 1,339 health professionals from the ten networked hospitals have registered to use the Healthnet program. Despite the friendly interface on the computer workstations installed at the sites, training emerged as the key issue in maximizing health professional utilization of these programs. PMID:9803302

Recruitment and retention of physicians in rural Alberta: the spousal perspective.

PubMed

Myroniuk, Lana; Adamiak, Paul; Bajaj, Sameer; Myhre, Douglas L

2016-01-01

The overall geographic distribution of physicians in Canada, including Alberta, is misaligned with the population distribution. Some strategies, such as debt repayment, are currently in practice to increase recruitment and retention of physicians in rural locations. Of the factors influencing choice of practice location, 'spousal influence' is considered to play a significant role in recruitment and retention of physicians in literature. Most studies have focused on the physicians' perspective of their spouses' influence on staying in a rural location. This study is unique as it approaches rural recruitment and retention from the perspective of the physician spouse. The physician population for this study consisted of doctors practicing in rural southern Alberta. Participants were recruited via an email invitation and were invited to complete an online survey. The survey collected information regarding physician demographics and some relationship characteristics. The email invitation also contained a link to a second survey specific to the physician spouse or partner, asking a similar panel of questions. Physicians were asked to request their spouse or partner to complete this survey. Semi-structured interviews were conducted for those who consented to be contacted for interviews. Descriptive statistical analysis of the survey data was carried out. Thematic analysis of the qualitative interview data was conducted and was organized into three sections. The first and second sections present the personal experiences of rural recruitment and rural retention. The third section presents recommendations made by physicians and spouses to improve these processes. Specific interview quotes led the authors to derive themes under each section. The results of this study raise the voice and profile of the spouse in the process of rural recruitment and retention. In this study, the spouses of Canadian medical graduates were a positive influence in rural recruitment and retention, while the spouses of international medical graduates were generally less supportive of a rural lifestyle. Considerations to accommodate the educational, professional and cultural needs of the physician spouse must be incorporated into policy if large areas of underserved rural communities will continue to rely on international recruitment.

Rural Latino adolescent health: preliminary examination of health risks and cultural correlates.

PubMed

Nelson, Timothy D; Kidwell, Katherine M; Armenta, Brian E; Crockett, Lisa J; Carlo, Gustavo; Whitbeck, Les B

2014-06-01

Latino adolescents living in rural settings may be at increased risk of health problems; however, data describing the health status of this population are limited. This study examined 60 rural Latino adolescents and found high rates of health risk, including at-risk/clinical results for hemoglobin A1C (23.3%), high-density lipoprotein cholesterol (55%), systolic blood pressure (21.7%), and overweight/obesity (55%). Time in sedentary behaviors was high and physical activity was limited. Adolescent language use was associated with health risk status, with greater use of English associated with lower risk. Health psychologists could promote improved health by providing health behavior interventions to this underserved population. © The Author(s) 2013.

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

Social franchising and vouchers to promote long-term methods of family planning in rural Pakistan: a qualitative stocktaking with stakeholders.

PubMed

Azmat, Syed Khurram; Mustafa, Ghulam; Hameed, Waqas; Asghar, Jamshaid; Ahmed, Aftab; Shaikh, Babar T

2013-04-01

The overall use of modern contraception in Pakistan is quite low, especially in rural areas. Several studies have demonstrated the effectiveness of social franchising (SF) approaches in increasing access to modern contraception and improving the quality of healthcare in resource-poor areas in Asia and Africa. Drawing on best practices in SF, the Marie Stopes Society (MSS) implemented an SF model in certain rural areas of Pakistan to increase access to affordable and quality family planning (FP) services. The model was branded as Suraj (sun) and complemented with an innovative voucher scheme for intrauterine contraceptive devices (IUCDs). This paper describes the perspectives of Suraj clients, field workers mobilization (FWMs), and providers on various components of the Suraj model. A qualitative exploratory study was conducted in six randomly selected intervention districts in the Sindh and Punjab provinces. Data were collected using focus group discussions (FGDs) with clients and in-depth interviews (IDIs) with providers and FWMs. Data were manually analyzed using constant comparison and the thematic analysis approach. Clients showed positive attitudes towards modern contraceptive methods and identified Suraj FWMs and signboards as sources of information. Almost all clients reported IUCDs as effective methods as they have manageable side effects and require fewer visits to clinics. They spoke highly of voucher schemes as these enabled them to avail free IUCD services. Clients also appreciated many components of Suraj clinics, including cleanliness, privacy, confidentiality, the sterilization of instruments, and courteous Suraj providers and FWMs. Most Suraj providers said that IUCD insertion and infection-prevention training enhanced their ability to provide IUCD services and increased their standing in local communities. They reported that the role of FWMs was crucial in mobilizing the community and increasing their FP clientele. The FWMs said that attitudes towards FP were changing because of economic pressure at the household level, increases in literacy, and community mobilization efforts. The Suraj intervention influenced attitudes towards FP and modern contraception, positively. Women using IUCDs showed greater satisfaction with the method. The findings emphasize that SF approaches like Suraj, when complemented with vouchers and community mobilization efforts, can improve the utilization of long-term contraceptive methods among rural and underserved women. The study also identified the need for integrating FP, antenatal care, and safe delivery services.

Expanding Health Care Access Through Education: Dissemination and Implementation of the ECHO Model.

PubMed

Katzman, Joanna G; Galloway, Kevin; Olivas, Cynthia; McCoy-Stafford, Kimberly; Duhigg, Daniel; Comerci, George; Kalishman, Summers; Buckenmaier, Chester C; McGhee, Laura; Joltes, Kristin; Bradford, Andrea; Shelley, Brian; Hernandez, Jessica; Arora, Sanjeev

2016-03-01

Project ECHO (Extension for Community Healthcare Outcomes) is an evidence-based model that provides high-quality medical education for common and complex diseases through telementoring and comanagement of patients with primary care clinicians. In a one to many knowledge network, the ECHO model helps to bridge the gap between primary care clinicians and specialists by enhancing the knowledge, skills, confidence, and practice of primary care clinicians in their local communities. As a result, patients in rural and urban underserved areas are able to receive best practice care without long waits or having to travel long distances. The ECHO model has been replicated in 43 university hubs in the United States and five other countries. A new replication tool was developed by the Project ECHO Pain team and U.S. Army Medical Command to ensure a high-fidelity replication of the model. The adoption of the tool led to successful replication of ECHO in the Army Pain initiative. This replication tool has the potential to improve the fidelity of ECHO replication efforts around the world. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Contextual attributes promote or hinder self-regulated learning: A qualitative study contrasting rural physicians with undergraduate learners in Japan.

PubMed

Matsuyama, Yasushi; Nakaya, Motoyuki; Okazaki, Hitoaki; Leppink, Jimmie; van der Vleuten, Cees

2018-03-01

Previous studies support the notion that East Asian medical students do not possess sufficient self-regulation for postgraduate clinical training. However, some East Asian physicians who are employed in geographically isolated and educationally underserved rural settings can self-regulate their study during the early phase of their postgraduate career. To explore the contextual attributes that contribute to self-regulated learning (SRL), we examined the differences in self-regulation between learning as an undergraduate and in a rural context in East Asia. We conducted interviews and diary data collection among rural physicians (n = 10) and undergraduates (n = 11) in Japan who undertook self-study of unfamiliar diseases. We analyzed three domains of Zimmerman's definition of SRL: learning behaviors, motivation, and metacognition using constructivist grounded theory. Rural physicians recognized their identity as unique, and as professionals with a central role of handling diseases in the local community by conducting self-study. They simultaneously found themselves being at risk of providing inappropriate aid if their self-study was insufficient. They developed strategic learning strategies to cope with this high-stakes task. Undergraduates had a fear of being left behind and preferred to remain as one of the crowd with students in the same school year. Accordingly, they copied the methods of other students for self-study and used monotonous and homogeneous strategies. Different learning contexts do not keep East Asian learners from being self-regulated. Awareness of their unique identity leads them to view learning tasks as high-stakes, and to initiate learning strategies in a self-regulated manner. Teacher-centered education systems cause students to identify themselves as one of the crowd, and tasks as low-stakes, and to accordingly employ non-self-regulated strategies.

A Primary Care System to Improve Health Care Efficiency: Lessons from Ecuador.

PubMed

Aldulaimi, Sommer; Mora, Francisco E

2017-01-01

Ecuador is a country with few resources to spend on health care. Historically, Ecuador has struggled to find a model for health care that is efficient, effective, and available to all people in the country, even those in underserved and rural communities. In 2000, the Ecuador Ministry of Public Health implemented a new system of health care that used primary care as its platform. Since then, Ecuador has been able to increase its health care efficiency, increasing its ranking from 111 of 211 countries worldwide in 2000, to 20 of 211 countries in 2014. This article briefly reviews the new components of the system implemented in Ecuador and examines the tools used to accomplish this. The discussion also compares and contrasts the Ecuador and US systems, and identifies concepts and policies from Ecuador that could improve the US system. © Copyright 2017 by the American Board of Family Medicine.

The Emerging Business Models and Value Proposition of Mobile Health Clinics

PubMed Central

AUNG, KHIN-KYEMON; HILL, CATERINA; BENNET, JENNIFER; SONG, ZIRUI; ORIOL, NANCY E.

2018-01-01

Mobile health clinics are increasingly used to deliver healthcare to urban and rural populations. An estimated 2000 vehicles in the United States are now delivering between 5 and 6 million visits annually; however, despite this growth, mobile health clinics represent an underutilized resource that could transform the way healthcare is delivered, especially in underserved areas. Preliminary research has shown that mobile health clinics have the potential to reduce costs and improve health outcomes. Their value lies primarily in their mobility, their ability to be flexibly deployed and customized to fit the evolving needs of populations and health systems, and their ability to link clinical and community settings. Few studies have identified how mobile health clinics can be sustainably utilized. We discuss the value proposition of mobile health clinics and propose 3 potential business models for them—adoption by accountable care organizations, payers, and employers. PMID:29516055

Barriers to Cervical Cancer Screening among Middle-aged and Older Rural Appalachian Women

PubMed Central

Studts, Christina R.; Tarasenko, Yelena N.; Schoenberg, Nancy E.

2012-01-01

Although cervical cancer rates in the United States have declined sharply in recent decades, certain groups of women remain at elevated risk, including middle-aged and older women in central Appalachia. Cross-sectional baseline data from a community-based randomized controlled trial were examined to identify barriers to cervical cancer screening. Questionnaires assessing barriers were administered to 345 Appalachian women aged 40-64, years when Pap testing declines and cervical cancer rates increase. Consistent with the PRECEDE/PROCEED framework, participants identified barriers included predisposing, enabling, and reinforcing factors. Descriptive and bivariate analyses are reported, identifying (a) the most frequently endorsed barriers to screening, and (b) significant associations of barriers with sociodemographic characteristics in the sample. Recommendations are provided to decrease these barriers and, ultimately, improve rates of Pap tests among this traditionally underserved and disproportionately affected group. PMID:23179390

The Emerging Business Models and Value Proposition of Mobile Health Clinics.

PubMed

Aung, Khin-Kyemon; Hill, Caterina; Bennet, Jennifer; Song, Zirui; Oriol, Nancy E

2015-12-01

Mobile health clinics are increasingly used to deliver healthcare to urban and rural populations. An estimated 2000 vehicles in the United States are now delivering between 5 and 6 million visits annually; however, despite this growth, mobile health clinics represent an underutilized resource that could transform the way healthcare is delivered, especially in underserved areas. Preliminary research has shown that mobile health clinics have the potential to reduce costs and improve health outcomes. Their value lies primarily in their mobility, their ability to be flexibly deployed and customized to fit the evolving needs of populations and health systems, and their ability to link clinical and community settings. Few studies have identified how mobile health clinics can be sustainably utilized. We discuss the value proposition of mobile health clinics and propose 3 potential business models for them-adoption by accountable care organizations, payers, and employers.

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.

2015/2016 Urban Waters Small Grants Request for Proposals

EPA Pesticide Factsheets

The 2015/2016 Urban Waters Small Grants Request for Proposals: Proposed projects will address urban runoff pollution through diverse partnerships that produce multiple community benefits, with emphasis on underserved communities.

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…

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…

Perceptions of cardiovascular health in underserved communities.

PubMed

Bryant, Lucinda L; Chin, Nancy P; Cottrell, Lesley A; Duckles, Joyce M; Fernandez, I Diana; Garces, D Marcela; Keyserling, Thomas C; McMilin, Colleen R; Peters, Karen E; Samuel-Hodge, Carmen D; Tu, Shin-Ping; Vu, Maihan B; Fitzpatrick, Annette L

2010-03-01

Cardiovascular disease is the leading cause of deaths and illnesses in US adults, and the prevalence is disproportionately high in underserved populations. In this study, we assessed respondents' understanding of context-specific differences in knowledge and perceptions of disease, risk, and prevention in 6 underserved communities, with the longer-term goal of developing appropriate interventions. Thirty-nine small-group sessions and 14 interviews yielded data from 318 adults. Each site's researchers coded, analyzed, and extracted key themes from local data. Investigators from all sites synthesized results and identified common themes and differences. Themes clustered in 3 areas (barriers to cardiovascular health, constraints related to multiple roles, and suggestions for effective communications and programs). Barriers spanned individual, social and cultural, and environmental levels; women in particular cited multiple roles (eg, competing demands, lack of self-care). Programmatic suggestions included the following: personal, interactive, social context; information in language that people use; activities built around cultural values and interests; and community orientation. In addition, respondents preferred health-related information from trusted groups (eg, AARP), health care providers (but with noticeable differences of opinion), family and friends, and printed materials. Interventions to decrease barriers to cardiovascular health are needed; these strategies should include family and community context, small groups, interactive methods, culturally sensitive materials, and trusted information sources. New-immigrant communities need culturally and linguistically tailored education before receiving more substantive interventions.

Improving cardiovascular health of underserved populations in the community with Life's Simple 7.

PubMed

Murphy, Marcia Pencak; Coke, Lola; Staffileno, Beth A; Robinson, Janis D; Tillotson, Robin

2015-11-01

The purpose of this nurse practitioner (NP) led initiative was to improve the cardiovascular health of two underserved populations in the community using the American Heart Association (AHA) Life's Simple 7 and My Life Check (MLC) tools. Two inner city community sites were targeted: (a) a senior center servicing African American (AA) older adults, and (b) a residential facility servicing homeless women. Preprogram health data (blood pressure, cholesterol, blood glucose levels, body mass index, and health behaviors) were collected to calculate MLC scores. Postprogram health data were obtained on participants with the lowest MLC scores who completed the program. Eight older adults completed the program with a 37.1% increase in average MLC score (6.2 vs. 8.5). Ten women completed the program with a 9.3% decrease in average MLC score (4.3 vs. 3.9). Favorable benefits were observed in the AA older adults. In contrast, similar benefits were not observed in the women, which may be because of a constellation of social, environmental, biological, and mental health factors. NPs are prepared to target community-based settings to address the health of underserved populations. Engaging key stakeholders in the planning and implementation is essential for success. ©2015 American Association of Nurse Practitioners.

The NASA Education Forum at SAO on the Structure and Evolution of the Universe

NASA Technical Reports Server (NTRS)

Gould, Roy; Cooper, Larry (Technical Monitor)

2005-01-01

The past year for the SEU Forum has been a highly productive one and has moved us forward on three major objectives: 1) Using the Einstein Centennial to involve the public in the Universe Exploration theme, with emphasis on exciting discoveries about dark energy, cosmology, and black holes; 2) Further implementing the recommendations of the Knappenberger Report, in order to strengthen the educational coherence of our collective activities and our collaborations within NASA; and 3) Developing strategic partnerships with underserved communities and other key customers. Among our activities for the past year are the following: 1) Serving the Informal Science Education Communities; 2) Serving the Formal Education (Pre-college) Community; and 3) Serving Minority and Underserved Communities. A summary of goals, plans and activities for the year 9/15/05 through 9/14/06 are also presented.

Forging University-Community Collaboration: The Agency Perspective on National Service.

ERIC Educational Resources Information Center

Tice, Carol H.

1994-01-01

With passage of the National and Community Service Trust Act of 1993, national service volunteers will be joining forces with community-based organizations to work with underserved populations, creating many challenges. The community agency perspective on some anticipated challenges, possible responses, and application of principles of good…

Rural GRATEFUL MED outreach: project results, impact, and future needs.

PubMed Central

Dorsch, J L; Landwirth, T K

1993-01-01

The Library of the Health Sciences-Peoria (LHS-Peoria), located at a regional site of the University of Illinois College of Medicine, conducted an eighteen-month GRATEFUL MED outreach project funded by the National Library of Medicine. The project was designed to enhance information services for health professionals at eight underserved rural hospitals in west central Illinois. One hundred rural health professionals, mainly nonphysicians, received GRATEFUL MED training at these hospitals; LHS delivered more than 350 documents to the trainees. In this paper, investigators describe the project and its goals and discuss results and their evaluation, from both individual and institutional perspectives. Outcome is examined in the context of future outreach plans, both at LHS and elsewhere. PMID:8251973

Using an academic-community partnership model and blended learning to advance community health nursing pedagogy.

PubMed

Ezeonwu, Mabel; Berkowitz, Bobbie; Vlasses, Frances R

2014-01-01

This article describes a model of teaching community health nursing that evolved from a long-term partnership with a community with limited existing health programs. The partnership supported RN-BSN students' integration in the community and resulted in reciprocal gains for faculty, students and community members. Community clients accessed public health services as a result of the partnership. A blended learning approach that combines face-to-face interactions, service learning and online activities was utilized to enhance students' learning. Following classroom sessions, students actively participated in community-based educational process through comprehensive health needs assessments, planning and implementation of disease prevention and health promotion activities for community clients. Such active involvement in an underserved community deepened students' awareness of the fundamentals of community health practice. Students were challenged to view public health from a broader perspective while analyzing the impacts of social determinants of health on underserved populations. Through asynchronous online interactions, students synthesized classroom and community activities through critical thinking. This paper describes a model for teaching community health nursing that informs students' learning through blended learning, and meets the demands for community health nursing services delivery. © 2013 Wiley Periodicals, Inc.

Living the Dream: The Lived Experience of an English Language Arts Professional Learning Community at a College Preparatory Boarding School for Underserved Youth

ERIC Educational Resources Information Center

Worth, Kim A.

2014-01-01

Teachers working in schools where the majority of the population is underserved students often feel a sense of helplessness. The purpose of the study is to uncover the lived experience of a small group of English Language Arts teachers working in such an environment. Specifically, the purpose is to determine if working within an effective…

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...

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.

Multicultural Milky Way: Ethnoastronomy and Planetarium Shows for Under-served Arizonans

NASA Astrophysics Data System (ADS)

Knierman, Karen

2018-01-01

The astronomy outreach initiative, Multicultural Milky Way, partners the School of Earth and Space Exploration (SESE) at Arizona State University (ASU) with under-served populations in Arizona in learning about our Milky Way and other galaxies. Arizona is home to many diverse populations with rich cultural histories such as Mayan, Navajo, and Apache. Linking astronomy practiced by one’s indigenous culture to that of Western astronomy may increase the interest in science. Through multicultural planetarium shows and associated hands-on activities, under-served students and families will learn how the Milky Way is represented in different cultures and about the science of galaxies. New planetarium shows using the Mesa Community College (MCC) Digital Planetarium and STARLAB portable planetarium explore how the Milky Way is interpreted in different cultures. STARLAB shows and associated new hands-on activities have been featured during school visits, teacher trainings, and Community Astronomy Nights around Arizona. For authentic assessment, evaluation techniques and procedures were developed.

Defining an integrative approach for health promotion and disease prevention: A population health equity framework

PubMed Central

Trinh-Shevrin, Chau; Nadkarni, Smiti; Park, Rebecca; Islam, Nadia; Kwon, Simona C.

2015-01-01

Background Eliminating health disparities in racial ethnic minority and underserved populations requires a paradigm shift from disease-focused biomedical approaches to a health equity framework that aims to achieve optimal health for all by targeting social and structural determinants of health. Methods We describe the concepts and parallel approaches that underpin an integrative population health equity framework. Using a case study approach we present the experience of the NYU Center for the Study of Asian American Health (CSAAH) in applying the framework to guide its work. Results This framework is central to CSAAH’s efforts moving towards a population health equity vision for Asian Americans. Discussion Advancing the health of underserved populations requires community engagement and an understanding of the multilevel contextual factors that influence health. Applying an integrative framework has allowed us to advance health equity for Asian American communities and may serve as a useful framework for other underserved populations. PMID:25981095

These Doors Are Open!

ERIC Educational Resources Information Center

Achinstein, Betty; Athanases, Steven Z.; Curry, Marnie W.; Ogawa, Rodney T.; de Oliveira, Luciana C.

2013-01-01

Lower-income students of color in California are often underserved, as evidenced by low-resourced schools, an achievement gap, and low college-going rates. Educators increasingly call for "community schools" that link schools with community members and agencies to promote educational achievement and to access communities as resources for…

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:…

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…

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.

Community Health Advisor Programs. An Issue Paper.

ERIC Educational Resources Information Center

National Rural Health Association, Kansas City, MO.

Third World countries have used community health advisors (CHAs) for many years to deliver health services, health education, and linkages to isolated and underserved communities. In 1998 the National Community Health Advisor Study estimated there were at least 600 such programs in the United States using about 12,500 CHAs. Program activities and…

Current Demographics and Roles of Florida Community Health Workers: Implications for Future Recruitment and Training.

PubMed

Tucker, Carolyn M; Smith, Tasia M; Hogan, Maggie L; Banzhaf, Marion; Molina, Nanette; Rodríguez, Brendaly

2018-06-01

The high prevalence of health disparity diseases (e.g., obesity, Type 2 diabetes) among underserved populations in the United States suggests the need for increased resources to prevent these diseases and to improve health care access and quality in underserved communities. Community health workers are valuable resources and facilitators of health care access and quality treatment. The purpose of the present study is to provide descriptive information about community health workers in Florida and to provide recommendations for improved training and expansion of community health workers' roles in research and intervention. The study participants were 396 adults (85.1% Female, 75.5% Community health workers) who completed the 2015 Florida Community Health Workers Census. Participants were recruited by the Health Council of South Florida through emails and phone calls to members of the Florida Community Health Worker Coalition and various organizations. It was found that several groups disproportionately affected by health disparities were underrepresented among the community health workers who participated in the census and among the communities served by these community health workers. Actions are needed to improve and increase the recruitment and training of community health workers in Florida.

On Second Chances and Stratification: How Sociologists Think about Community Colleges

ERIC Educational Resources Information Center

Schudde, Lauren; Goldrick-Rab, Sara

2015-01-01

Community colleges increase college access, extending postsecondary educational opportunities to underserved students, yet, these students exhibit low rates of program completion and transfer to 4-year colleges. Sociological research on community colleges focuses on the tension between increasing educational opportunity and failing to improve…

White matter hyperintensities of presumed vascular origin: a population-based study in rural Ecuador (The Atahualpa Project).

PubMed

Del Brutto, Oscar H; Mera, Robertino M; Del Brutto, Victor J; Zambrano, Mauricio; Lama, Julio

2015-04-01

Cerebral small vessel disease is probably one of the most common pathogenetic mechanisms underlying stroke in Latin America. However, the importance of silent markers of small vessel disease, including white matter hyperintensities of presumed vascular origin, has not been assessed so far. The study aims to evaluate prevalence and correlates of white matter hyperintensities in community-dwelling elders living in Atahualpa (rural Ecuador). Atahualpa residents aged ≥ 60 years were identified during a door-to-door survey and invited to undergo brain magnetic resonance imaging for identification and grading white matter hyperintensities and other markers of small vessel disease. Using multivariate logistic regression models, we evaluated whether white matter hyperintensities is associated with demographics, cardiovascular health status, stroke, cerebral microbleeds, and cortical atrophy, after adjusting for the other variables. Out of 258 enrolled persons (mean age, 70 ± 8 years; 59% women), 172 (67%) had white matter hyperintensities, which were moderate to severe in 63. Analyses showed significant associations of white matter hyperintensities presence and severity with age and cardiovascular health status, as well as with overt and silent strokes, and a trend for association with cerebral microbleeds and cortical atrophy. Prevalence and correlates of white matter hyperintensities in elders living in rural Ecuador is almost comparable with that reported from industrialized nations, reinforcing the concept that the burden of small vessel disease is on the rise in underserved Latin American populations. © 2014 World Stroke Organization.

Enrolling Minority and Underserved Populations in Cancer Clinical Research

PubMed Central

Wallington, Sherrie Flynt; Dash, Chiranjeev; Sheppard, Vanessa B.; Goode, Tawara D.; Oppong, Bridget A.; Dodson, Everett E.; Hamilton, Rhonda N.; Adams-Campbell, Lucile L.

2015-01-01

Research suggests that community involvement is integral to solving public health problems, including involvement in clinical trials—a “gold standard.” Significant racial/ethnic disparities exist in the accrual of participants for clinical trials. Location and cultural aspects of clinical trials influence recruitment and accrual to clinical trials. It is increasingly necessary to be aware of defining characteristics such as location and culture of the populations from which research participants are enrolled. Little research has examined the effect of location and cultural competency in adapting clinical trial research for minority and underserved communities on accrual for clinical trials. Utilizing embedded community academic sites, the authors applied cultural competency frameworks to adapt clinical trial research in order to increase minority participation in nontherapeutic cancer clinical trials. This strategy resulted in successful accrual of participants to new clinical research trials, specifically targeting participation from minority and underserved communities in metropolitan Washington, DC. From 2012 to 2014, a total of 559 participants enrolled across six non-therapeutic clinical trials, representing a 62% increase in the enrollment of blacks in clinical research. Embedding cancer prevention programs and research in the community was shown to be yet another important strategy in the arsenal of approaches that can potentially enhance clinical research enrollment and capacity. The analyses showed that the capacity to acquire cultural knowledge about patients—their physical locales, cultural values, and environments in which they live—is essential to recruiting culturally and ethnically diverse population samples. PMID:26470805

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.

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.

Factors affecting recruitment and retention of rehabilitation professionals in Northern Ontario, Canada: a cross-sectional study.

PubMed

Winn, C S; Chisholm, B A; Hummelbrunner, J A

2014-01-01

Historically, Northern Ontario, Canada, has been an underserviced area for health care, including the rehabilitation professions of occupational therapy, physiotherapy, speech-language pathology and audiology. The Rehabilitation Studies and Northern Studies Stream programs were created in the 1990s to improve the recruitment and retention of rehabilitation professionals to Northern Ontario. However, no recent research has been conducted examining the factors that lead to rehabilitation professionals relocating to and remaining in the region. A cross-sectional survey of rehabilitation professionals living and working in Northern Ontario was administered in 2009. Information collected included demographics and a rating of the personal and professional factors that had an impact on an individual's decision to continue living and working in Northern Ontario. A total of 345 individuals completed the survey (response rate 57%). Multiple personal and professional factors were closely linked to recruitment and retention with differences noted between those individuals originally from Northern Ontario and those who were not. Rural or remote education experiences and rural/remote origin were identified as important recruitment factors while job satisfaction and lifestyle options were important factors for retention of rehabilitation professionals to rural and remote areas of practice. This study has provided updated information specific to the recruitment and retention of rehabilitation professionals in Northern Ontario, Canada. These findings support previous work examining health professions worldwide and have clear implications for educational programs, funding agencies, and health human resource planning in underserviced areas.

College Radio.

ERIC Educational Resources Information Center

Sauls, Samuel J.

As with commercial stations, the underlying premise of the college radio station is to serve the community, whether it be the campus community or the community at large, but in unique ways often geared to underserved niches of the population. Much of college radio's charm lies in its unpredictable nature and constant mutations. The stations give…

Empowering Students through Literature.

ERIC Educational Resources Information Center

Cukras, Grace-Ann Gorga

2000-01-01

A literary club formed a community of readers among underserved and nontraditional community college students. Members meet to discuss literature and host authors' visits. The environment enables students to share their perspectives and develop deeper understanding of literature and of themselves. (SK)

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.

Integrating social capital theory, social cognitive theory, and the technology acceptance model to explore a behavioral model of telehealth systems.

PubMed

Tsai, Chung-Hung

2014-05-07

Telehealth has become an increasingly applied solution to delivering health care to rural and underserved areas by remote health care professionals. This study integrated social capital theory, social cognitive theory, and the technology acceptance model (TAM) to develop a comprehensive behavioral model for analyzing the relationships among social capital factors (social capital theory), technological factors (TAM), and system self-efficacy (social cognitive theory) in telehealth. The proposed framework was validated with 365 respondents from Nantou County, located in Central Taiwan. Structural equation modeling (SEM) was used to assess the causal relationships that were hypothesized in the proposed model. The finding indicates that elderly residents generally reported positive perceptions toward the telehealth system. Generally, the findings show that social capital factors (social trust, institutional trust, and social participation) significantly positively affect the technological factors (perceived ease of use and perceived usefulness respectively), which influenced usage intention. This study also confirmed that system self-efficacy was the salient antecedent of perceived ease of use. In addition, regarding the samples, the proposed model fitted considerably well. The proposed integrative psychosocial-technological model may serve as a theoretical basis for future research and can also offer empirical foresight to practitioners and researchers in the health departments of governments, hospitals, and rural communities.

Integrating Social Capital Theory, Social Cognitive Theory, and the Technology Acceptance Model to Explore a Behavioral Model of Telehealth Systems

PubMed Central

Tsai, Chung-Hung

2014-01-01

Telehealth has become an increasingly applied solution to delivering health care to rural and underserved areas by remote health care professionals. This study integrated social capital theory, social cognitive theory, and the technology acceptance model (TAM) to develop a comprehensive behavioral model for analyzing the relationships among social capital factors (social capital theory), technological factors (TAM), and system self-efficacy (social cognitive theory) in telehealth. The proposed framework was validated with 365 respondents from Nantou County, located in Central Taiwan. Structural equation modeling (SEM) was used to assess the causal relationships that were hypothesized in the proposed model. The finding indicates that elderly residents generally reported positive perceptions toward the telehealth system. Generally, the findings show that social capital factors (social trust, institutional trust, and social participation) significantly positively affect the technological factors (perceived ease of use and perceived usefulness respectively), which influenced usage intention. This study also confirmed that system self-efficacy was the salient antecedent of perceived ease of use. In addition, regarding the samples, the proposed model fitted considerably well. The proposed integrative psychosocial-technological model may serve as a theoretical basis for future research and can also offer empirical foresight to practitioners and researchers in the health departments of governments, hospitals, and rural communities. PMID:24810577

Association between maternal health literacy and child vaccination in India: a cross-sectional study

PubMed Central

Johri, Mira; Subramanian, S V; Sylvestre, Marie-Pierre; Dudeja, Sakshi; Chandra, Dinesh; Koné, Georges K; Sharma, Jitendar K; Pahwa, Smriti

2015-01-01

Background Education of mothers may improve child health. We investigated whether maternal health literacy, a rapidly modifiable factor related to mother's education, was associated with children's receipt of vaccines in two underserved Indian communities. Methods Cross-sectional surveys in an urban and a rural site. We assessed health literacy using Indian child health promotion materials. The outcome was receipt of three doses of diphtheria-tetanus-pertussis (DTP3) vaccine. We used multivariate logistic regression to investigate the relationship between maternal health literacy and vaccination status independently in each site. For both sites, adjusted models considered maternal age, maternal and paternal education, child sex, birth order, household religion and wealth quintile. Rural analyses used multilevel models adjusted for service delivery characteristics. Urban analyses represented cluster characteristics through fixed effects. Results The rural analysis included 1170 women from 60 villages. The urban analysis included 670 women from nine slum clusters. In each site, crude and adjusted models revealed a positive association between maternal health literacy and DTP3. In the rural site, the adjusted OR was 1.57 (95% CI 1.11 to 2.21, p=0.010) for those with medium health literacy, and OR=1.30 (95% CI 0.89 to 1.91, p=0.172) for those with high health literacy. In the urban site, the adjusted OR was 1.10 (95% CI 0.65 to 1.88, p=0.705) for those with medium health literacy, and OR=2.06 (95% CI 1.06 to 3.99, p=0.032) for those with high health literacy. Conclusions In these study settings, maternal health literacy is independently associated with child vaccination. Initiatives targeting health literacy could improve vaccination coverage. PMID:25827469

Beyond Access: An Analysis of the Influence of the E-Rate Program in Bridging the Digital Divide in American Schools

ERIC Educational Resources Information Center

Park, Euna; Sinha, Hansa; Chong, Jing

2007-01-01

E-Rate is a U.S. federal funding program for providing discounts for telecommunications, Internet access and internal networking costs for schools and libraries to ensure access equity across poor and rich, rural, urban and suburban areas, and highly served and underserved areas. This paper examines the impact of the E-Rate program on social…

The Pathway Program: A Collaboration between 3 Universities to Deliver a Social Work Distance Education (DL) Program to Underserved Areas of California

ERIC Educational Resources Information Center

Morris, Teresa; Jones, Celeste A.; Sehrawats, Seema

2016-01-01

This paper describes the development of a partnership between three campuses to develop a (DL) education program-serving employees of county and tribal Health and Human Service Departments in remote rural areas of California. Specifically, the program supports the development of a career pathway for students living in isolated regions of Northern…

Brief Report: Use of Interactive Television in Identifying Autism in Young Children--Methodology and Preliminary Data

ERIC Educational Resources Information Center

Reese, R. Matthew; Jamison, T. Rene; Braun, Matt; Wendland, Maura; Black, William; Hadorn, Megan; Nelson, Eve-Lynn; Prather, Carole

2015-01-01

Children living in rural and underserved areas experience decreased access to health care services and are often diagnosed with autism at a later age compared to those living in urban or suburban areas. This study examines the utility and validity of an ASD assessment protocol conducted via video conferencing (VC). Participants (n = 17) included…

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.

Convening Young Leaders for Climate Resilience in New York State

NASA Astrophysics Data System (ADS)

Kretser, J.

2017-12-01

This project, led by The Wild Center, will partner with Cornell Cooperative Extension of Delaware County, the Kurt Hahn Expeditionary Learning School in Brooklyn, and the Alliance for Climate Education to do the following over three years: 1) increase climate literacy and preparedness planning in high school students through place-based Youth Climate Summits in the Adirondacks, Catskills, and New York City; 2) enhance young people's capacity to lead on climate issues through a Youth Climate Leadership Practicum 3) increase teacher comprehension and understanding of climate change through a Teacher Climate Institute and 4) communicate climate change impacts and resilience through student-driven Community Climate Outreach activities. The project will align with New York State's climate resiliency planning by collaborating with the NYS Department of Environmental Conservation Office of Climate (OCC), NYS Energy Research Development Authority (NYSERDA), and NOAA's Climate Program Office to provide accurate scientific information, resources, and tools. This collaboration will result in an increase in understanding of the impacts of climate change in rural (Adirondacks, Catskills) and urban (New York City) regions of New York State; a wider awareness of the threats and vulnerabilities that are associated with a community's location; and a stronger connection between current community resilience initiatives, educators, and youth. All three of the project sites are critically underserved in both climate literacy and action, making addressing the need of these sites to be resilient and proactive in the face of climate change critical. Our model will provide pilot lessons for how youth in both rural and urban areas can draw on local assets to address resiliency in ways appropriate for their own areas, and these lessons may be able to be applied across the United States.The proposed project is informed by best practices and specifically strengthens and replicates The Wild Center's past success with the Adirondack Youth Climate Summit, student leadership, and student-led community outreach for climate awareness - all work that has been tested or piloted over the last seven years.

Attracting Child Psychiatrists to a Televideo Consultation Service: The TeleLink Experience.

PubMed

Volpe, Tiziana; Boydell, Katherine M; Pignatiello, Antonio

2013-01-01

Objective. Identify aspects of psychiatry work that are rewarding, as well as those that are challenging, from the perspective of psychiatrists and residents participating in televideo consultation services. Method. A web-based survey was distributed to psychiatrists within the Division of Child Psychiatry at the University of Toronto. Also, semistructured interviews were conducted with six child psychiatrists providing services to a telepsychiatry program. Finally, a focus group interview was held with four psychiatry residents. Results. Child psychiatrists are very comfortable conducting assessments via televideo. Factors identified as being important in the decision to participate in telepsychiatry include assisting underserved communities, supportive administrative staff, enhanced rural provider capacity, financial incentives, and convenience. The study's qualitative phase identified four themes in the decision to participate in telepsychiatry: (1) organizational, (2) shared values, (3) innovation, and (4) the consultation model. Conclusion. The success of televideo consultation programs in attracting child psychiatrists to provide consultation services to underresourced communities makes an important contribution to psychiatric workforce shortages. Understanding what aspects of telepsychiatry are most appreciated by consulting psychiatrists and residents offers useful strategies to telepsychiatry administrators and medical school educators seeking to attract, train, and retain psychiatry practitioners.

Attracting Child Psychiatrists to a Televideo Consultation Service: The TeleLink Experience

PubMed Central

Boydell, Katherine M.; Pignatiello, Antonio

2013-01-01

Objective. Identify aspects of psychiatry work that are rewarding, as well as those that are challenging, from the perspective of psychiatrists and residents participating in televideo consultation services. Method. A web-based survey was distributed to psychiatrists within the Division of Child Psychiatry at the University of Toronto. Also, semistructured interviews were conducted with six child psychiatrists providing services to a telepsychiatry program. Finally, a focus group interview was held with four psychiatry residents. Results. Child psychiatrists are very comfortable conducting assessments via televideo. Factors identified as being important in the decision to participate in telepsychiatry include assisting underserved communities, supportive administrative staff, enhanced rural provider capacity, financial incentives, and convenience. The study's qualitative phase identified four themes in the decision to participate in telepsychiatry: (1) organizational, (2) shared values, (3) innovation, and (4) the consultation model. Conclusion. The success of televideo consultation programs in attracting child psychiatrists to provide consultation services to underresourced communities makes an important contribution to psychiatric workforce shortages. Understanding what aspects of telepsychiatry are most appreciated by consulting psychiatrists and residents offers useful strategies to telepsychiatry administrators and medical school educators seeking to attract, train, and retain psychiatry practitioners. PMID:23864854

Leveraging Telehealth to Bring Volunteer Physicians Into Underserved Communities.

PubMed

Uscher-Pines, Lori; Rudin, Robert; Mehrotra, Ateev

2017-06-01

Many disadvantaged communities lack sufficient numbers of local primary care and specialty physicians. Yet tens of thousands of physicians, in particular those who are retired or semiretired, desire meaningful volunteer opportunities. Multiple programs have begun to use telehealth to bridge the gap between volunteer physicians and underserved patients. In this brief, we describe programs that are using this model and discuss the promise and pitfalls. Physician volunteers in these programs report that the work can be fulfilling and exciting, a cutting-edge yet convenient way to remain engaged and contribute. Given the projected shortfall of physicians in the United States, recruiting retired and semiretired physicians to provide care through telehealth increases the total supply of active physicians and the capacity of the existing workforce. However, programs typically use volunteers in a limited capacity because of uncertainty about the level and duration of commitment. Acknowledging this reality, most programs only use volunteer physicians for curbside consults rather than fully integrating them into longitudinal patient care. The part-time availability of volunteers may also be difficult to incorporate into the workflow of busy safety net clinics. As more physicians volunteer in a growing number of telehealth programs, the dual benefits of enriching the professional lives of volunteers and improving care for underserved communities will make further development of these programs worthwhile.

Mental Health Screening in North Sulawesi, Indonesia: Kessler 6 pilot data and needs assessment results from the LearnToLive Indonesian Health Initiative.

PubMed

Kinzie, Erik; Blake, Adam; Alvares, Ryan; McCormick-Ricket, Iben

2016-06-01

Communities around the world are increasing their focus on mental health and substance use disorders. However, the struggle to identify and treat patients remains great. The sequelae of these disorders, including severe chronic disability and suicide, are significant, and its impact is felt most in lower and middle-income countries. In the rural and underserved region of North Sulawesi, Indonesia, there are limited data published regarding the prevalence of depression, anxiety, and other symptoms of psychological distress. In order to characterize and quantify some specific areas of psychological distress, the LearnToLive Indonesian Health Initiative completed a retroactive review of Kessler 6 data from 697 people in rural communities of North Sulawesi. Our results demonstrate a rate of near 10% for psychological distress, particularly with anxiety and depressive symptoms. We also found that the village of Sapa scored higher on most of the subcomponents of the screen compared with the other villages in the study. While the Kessler 6 screening tool is not diagnostic, our results suggest significant mental health issues in need of further exploration and research. We found that these results exist in an environment with high stigma, limited education regarding mental illness, and limited outpatient services. The results from this analysis will hopefully guide future mental health education in the region and will ultimately assist in the development of the clinical infrastructure needed to effectively identify, treat, and manage mental health conditions. © 2015 Wiley Publishing Asia Pty Ltd.

Positive implications from socially accountable, community-engaged medical education across two Philippines regions.

PubMed

Woolley, Torres; Cristobal, Fortunato; Siega-Sur, Jusie; Ross, Simone; Neusy, Andre-Jacques; Halili, Servando; Reeve, Carole

2018-02-01

Hundreds of millions of people worldwide lack access to quality health services, largely because of geographic and socioeconomic maldistribution of qualified practitioners. This study describes differences between the practice locations of Philippines medical graduates from two 'socially accountable, community-engaged' health professional education (SAHPE) schools and the practice locations of graduates from two 'conventionally trained' medical schools located in the same respective geographic regions. Licensed medical graduates were currently practising in the Philippines and had been practising for at least 6 months. Graduates were from two Philippines SAHPE schools (Ateneo de Zamboanga University-School of Medicine (ADZU-SOM) on the Zamboanga Peninsula (n=212) and the University of the Philippines Manila-School of Health Sciences (SHS-Palo) in Eastern Visayas (n=71), and from two 'conventional' medical schools Methods: Current graduate practice locations in municipalities or cities were linked with their respective population size and socioeconomic income class, and geocoded using Geographical Information System software onto a geospatial map of the Philippines. Bivariate analysis compared the population size and socioeconomic class of communities where the SAHPE medical graduates practised to communities where 'conventional' medical school graduates practised. Thirty-one percent of ADZU-SOM medical graduates practised in communities <100 000 population versus 7% of graduates from the conventional school in the Zamboanga region (p<0.001), while 61% of SHS-Palo medical graduates practised in communities <100 000 population versus 12% of graduates from the conventional school in the Visayas region (p<0.001). Twenty-seven percent of ADZU-SOM graduates practised in lower income category communities (categories 2-6) versus 8% of graduates from the conventional school in the same region (p<0.001), while 49% of SHS-Palo graduates practised in lower income category communities (categories 2-6) versus 11% of graduates from the conventional school in the same region (p<0.001). SAHPE has contributed to increased medical coverage across rural and/or economically disadvantaged areas in two Philippines regions. The extensive community-based medical student placements associated with SAHPE likely play a significant role in graduates choosing to practice in rural and/or economically disadvantaged communities. Governments experiencing medical workforce maldistributions similar to those in the Philippines should consider SAHPE as a potentially cost-effective strategy in recruiting and retaining health graduates to underserved areas.

Values, Obstacles, and Needs of Campus Outdoor Programs to Serve Local Underserved Communities

ERIC Educational Resources Information Center

Marchand, Geneviève; Sanford, Paul

2017-01-01

Although participation in outdoor recreation activities is a right and is essential for the health of individuals and their communities, not all communities have access to outdoor recreation opportunities. Fortunately, many successful outdoor programs at colleges and universities are already in place around the country. These programs have the…

Leadership, Partnerships, and Organizational Development: Exploring Components of Effectiveness in Three Full-Service Community Schools

ERIC Educational Resources Information Center

Sanders, Mavis

2016-01-01

Full-service community schools are viewed as an approach to improve educational opportunities and outcomes for underserved student populations. The realization of these goals, however, is not guaranteed. According to Richardson's (2009) research-based model of highly effective community schools (HECS), the effectiveness of full-service community…

Do Community Colleges Promote Postsecondary and Labor Market Success for First-Generation Students

ERIC Educational Resources Information Center

Ampaw, Frimpomaa; Partlo, Margaret; Hullender, Tammy; Wagner, Nick

2015-01-01

Community colleges are becoming the primary access point for a growing number of underrepresented and underserved students in the higher education system. First-generation college students make up a large proportion of this population, comprising about 45% of community college attendees (Nomi, 2005). Research has explored the transfer success of…

Mentoring Partnerships in a Community Technology Centre: A Constructionist Approach for Fostering Equitable Service Learning

ERIC Educational Resources Information Center

Kafai, Yasmin B.; Desai, Shiv; Peppler, Kylie A.; Chiu, Grace M.; Moya, Jesse

2008-01-01

Mentoring programmes have gained increasing popularity in institutions of higher education to support undergraduates in community service or outreach efforts. Many of these programmes partner mentors with inner-city youth, providing assistance in underserved communities while mentors gain experiences that connect theory and practice. Here we…

Improving Student Attainment in Community Colleges: Institutional Characteristics and Policies

ERIC Educational Resources Information Center

Bailey, Thomas; Alfonso, Mariana; Calcagno, Juan Carlos; Jenkins, Davis; Kienzl, Gregory; Leinbach, Tim

2004-01-01

Community colleges are a crucial point of access to higher education for low-income, minority, and other underserved students. These groups are overrepresented (with respect to their share of undergraduate enrollment) in two year and less than two year post secondary institutions. The community college access mission is built on low tuition, …

Screening for autism spectrum disorder in underserved communities: Early childcare providers as reporters.

PubMed

Janvier, Yvette M; Harris, Jill F; Coffield, Caroline N; Louis, Barbara; Xie, Ming; Cidav, Zuleyha; Mandell, David S

2016-04-01

Early diagnosis of autism typically is associated with earlier access to intervention and improved outcomes. Daycares and preschools largely have been ignored as possible venues for early identification. This may be especially important for minority children in the United States who are typically diagnosed with autism later than White children, limiting their access to early specialized interventions and possibly resulting in poorer outcomes. Early childcare providers within underserved communities completed autism screening tools for a sample of low-risk young children (n = 967) in their programs. Early childcare providers returned screening tools for 90% of the children for whom parental consent had been received. A total of 14% of children screened positive for autism spectrum disorder and 3% of the sample met criteria for autism spectrum disorder. Among those who screened positive, 34% were lost to follow-up. Findings suggest that early childcare providers can effectively screen young children for autism spectrum disorder in preschool/daycare settings, thus improving access to early diagnosis and reducing potential healthcare disparities among underserved populations. © The Author(s) 2015.

Curriculum Recommendations of the AACP-PSSC Task Force on Caring for the Underserved

PubMed Central

Roche, Victoria F.; Assemi, Mitra; Conry, John M.; Shane-McWhorter, Laura; Sorensen, Todd D.

2008-01-01

A task force was convened by the American Association of Colleges of Pharmacy (AACP) and the Pharmaceutical Services Support Center (PSSC) and charged with the development of a curriculum framework to guide pharmacy programs in educating students on caring for the underserved. Utilizing a literature-based model, the task force constructed a framework that delineated evidence-based practice, clinical prevention and health promotion, health systems and policy, and community aspects of practice. Specific learning outcomes tailored to underserved populations were crafted and linked to resources readily available to the academy. The AACP-PSSC curriculum framework was shared with the academy in 2007. Schools and Colleges are urged to share experiences with implementation so that the impact of the tool can be evaluated. The task force recommends that the AACP Institutional Research Advisory Committee be involved in gathering assessment data. Implementation of the curriculum framework can help the academy fulfill the professional mandate to proactively provide the highest quality care to all, including underserved populations. PMID:18698398

Green Care: A Review of the Benefits and Potential of Animal-Assisted Care Farming Globally and in Rural America

PubMed Central

Artz, Brianna; Bitler Davis, Doris

2017-01-01

Simple Summary The term Green Care encompasses a number of therapeutic strategies that can include farm-animal-assisted therapy, horticultural therapy, and general, farm-based therapy. This review article provides an overview of how Green Care has been used as part of the therapeutic plan for a variety of psychological disorders and related physical disabilities in children, adolescents and adults. While many countries have embraced Green Care, and research-based evidence supports its efficacy in a variety of therapeutic models, it has not yet gained widespread popularity in the United States. We suggest that Green Care could prove to be an effective approach to providing mental health care in the U.S., particularly in rural areas that are typically underserved by more traditional mental health facilities, but have an abundance of farms, livestock, and green spaces where care might be effectively provided. Abstract The term Green Care includes therapeutic, social or educational interventions involving farming; farm animals; gardening or general contact with nature. Although Green Care can occur in any setting in which there is interaction with plants or animals, this review focuses on therapeutic practices occurring on farms. The efficacy of care farming is discussed and the broad utilization of care farming and farm care communities in Europe is reviewed. Though evidence from care farms in the United States is included in this review, the empirical evidence which could determine its efficacy is lacking. For example, the empirical evidence supporting or refuting the efficacy of therapeutic horseback riding in adults is minimal, while there is little non-equine care farming literature with children. The health care systems in Europe are also much different than those in the United States. In order for insurance companies to cover Green Care techniques in the United States, extensive research is necessary. This paper proposes community-based ways that Green Care methods can be utilized without insurance in the United States. Though Green Care can certainly be provided in urban areas, this paper focuses on ways rural areas can utilize existing farms to benefit the mental and physical health of their communities. PMID:28406428

Advancing STEM Career and Learning through Civic Engagement

ERIC Educational Resources Information Center

Xie, Yichun

2014-01-01

The Mayor's Youth Technology Corps (MYTC)--Creating Safe Communities through Information Technology Training in Homeland Security Applications (2008-2012)--offered a collaboration of resources, supports, and opportunities for strengthening science, technology, engineering, and mathematics (STEM) education efforts in an underserved community, the…

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.

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,…

Enrolling Minority and Underserved Populations in Cancer Clinical Research.

PubMed

Wallington, Sherrie F; Dash, Chiranjeev; Sheppard, Vanessa B; Goode, Tawara D; Oppong, Bridget A; Dodson, Everett E; Hamilton, Rhonda N; Adams-Campbell, Lucile L

2016-01-01

Research suggests that community involvement is integral to solving public health problems, including involvement in clinical trials-a gold standard. Significant racial/ethnic disparities exist in the accrual of participants for clinical trials. Location and cultural aspects of clinical trials influence recruitment and accrual to clinical trials. It is increasingly necessary to be aware of defining characteristics, such as location and culture of the populations from which research participants are enrolled. Little research has examined the effect of location and cultural competency in adapting clinical trial research for minority and underserved communities on accrual for clinical trials. Utilizing embedded community academic sites, the authors applied cultural competency frameworks to adapt clinical trial research in order to increase minority participation in nontherapeutic cancer clinical trials. This strategy resulted in successful accrual of participants to new clinical research trials, specifically targeting participation from minority and underserved communities in metropolitan Washington, DC. From 2012 to 2014, a total of 559 participants enrolled across six nontherapeutic clinical trials, representing a 62% increase in the enrollment of blacks in clinical research. Embedding cancer prevention programs and research in the community was shown to be yet another important strategy in the arsenal of approaches that can potentially enhance clinical research enrollment and capacity. The analyses showed that the capacity to acquire cultural knowledge about patients-their physical locales, cultural values, and environments in which they live-is essential to recruiting culturally and ethnically diverse population samples. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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

A simple and low-cost Internet-based teleconsultation system that could effectively solve the health care access problems in underserved areas of developing countries.

PubMed

Kuntalp, Mehmet; Akar, Orkun

2004-08-01

In many developing countries including Turkey, telemedicine systems are not in wide use due to the high cost and complexity of the required technology. Lack of these systems however has serious implications on patients who live in rural areas. The objective of this paper is to present a simple and economically affordable alternative to the current systems that would allow experts to easily access the medical data of their remote patients over the Internet. The system is developed in client-server architecture with a user-friendly graphical interface and various services are implemented as dynamic web pages based on PHP. The other key features of the system are its powerful security features and platform independency. An academic prototype is implemented and presented to the evaluation of a group of physicians. The results reveal that the system could find acceptance from the medical community and it could be an effective means of providing quality health care in developing countries.

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.

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…

Community Arts and Teacher Candidates: A Study in Civic Engagement

ERIC Educational Resources Information Center

Briggs, Judith; McHenry, Kimberly

2013-01-01

Within an afterschool community arts program for underserved children, teacher candidates tested prescribed teaching methods, experimented with teaching styles, and worked cooperatively with peers and faculty to enhance the children's creativity and sense of accomplishment. Students connected theoretical classroom knowledge to real-world…

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.

Global Forum: Spine Research and Training in Underserved, Low and Middle-Income, Culturally Unique Communities: The World Spine Care Charity Research Program's Challenges and Facilitators.

PubMed

Brady, O'Dane; Nordin, Margareta; Hondras, Maria; Outerbridge, Geoff; Kopansky-Giles, Deborah; Côté, Pierre; da Silva, Sophia; Ford, Timothy; Eberspaecher, Stefan; Acaroğlu, Emre; Mmopelwa, Tiro; Hurwitz, Eric L; Haldeman, Scott

2016-12-21

The World Spine Care (WSC), established by volunteers from 5 continents, is dedicated to providing sustainable, evidence-based spine care to individuals and communities in low and middle-income countries consistent with available health-care resources and integrated within the local culture. The research committee approves and oversees the WSC's collaborative research and training projects worldwide and serves to create a sustainable research community for underserved populations focused on preventing disability from spinal disorders. The purpose of this article is to describe 4 projects overseen by the WSC research committee and to discuss several challenges and specific facilitators that allowed successful completion of initiatives. These novel projects, which involved establishing spine surgery expertise and data collection in the WSC clinics and surrounding communities, all met their aims. This was achieved by overcoming language and resource challenges, adapting to local customs, and taking time to build mutual respect and to nurture relationships with local investigators and stakeholders.

Access to and Exclusion from Primary Education in Slums of Dhaka, Bangladesh. CREATE Pathways to Access. Research Monograph No. 45

ERIC Educational Resources Information Center

Cameron, Stuart

2010-01-01

Bangladesh's urban population is rising fast. In the capital, Dhaka, some 4 million people live in slums. They are lacking in wealth, power and social connections; probably under-counted in national surveys; and under-served by both government and non-government organisations, many of whom still see poverty as a rural issue or see the urban poor…

Improving the Quality of Basic Education for the Future Youth of Yemen Post Arab Spring. Global Economy & Development. Working Paper 59

ERIC Educational Resources Information Center

Yuki, Takako; Kameyama, Yuriko

2013-01-01

This paper looks at the issue of the quality of education in Yemen. It uses micro-data from TIMSS and from surveys conducted in underserved rural areas, as well as macro-level policy information from the System Assessment for Better Education Results (SABER) database. The analysis indicates that the availability of teachers and resources at…

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…

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%).

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.

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.

Assimilation of Web-Based Urgent Stroke Evaluation: A Qualitative Study of Two Networks

PubMed Central

Mathiassen, Lars; Switzer, Jeffrey A; Adams, Robert J

2014-01-01

Background Stroke is a leading cause of death and serious, long-term disability across the world. Urgent stroke care treatment is time-sensitive and requires a stroke-trained neurologist for clinical diagnosis. Rural areas, where neurologists and stroke specialists are lacking, have a high incidence of stroke-related death and disability. By virtually connecting emergency department physicians in rural hospitals to regional medical centers for consultations, specialized Web-based stroke evaluation systems (telestroke) have helped address the challenge of urgent stroke care in underserved communities. However, many rural hospitals that have deployed telestroke have not fully assimilated this technology. Objective The objective of this study was to explore potential sources of variations in the utilization of a Web-based telestroke system for urgent stroke evaluation and propose a telestroke assimilation model to improve stroke care performance. Methods An exploratory, qualitative case study of two telestroke networks, each comprising an academic stroke center (hub) and connected rural hospitals (spokes), was conducted. Data were collected from 50 semistructured interviews with 40 stakeholders, telestroke usage logs from 32 spokes, site visits, published papers, and reports. Results The two networks used identical technology (called Remote Evaluation of Acute isCHemic stroke, REACH) and were of similar size and complexity, but showed large variations in telestroke assimilation across spokes. Several observed hub- and spoke-related characteristics can explain these variations. The hub-related characteristics included telestroke institutionalization into stroke care, resources for the telestroke program, ongoing support for stroke readiness of spokes, telestroke performance monitoring, and continuous telestroke process improvement. The spoke-related characteristics included managerial telestroke championship, stroke center certification, dedicated telestroke coordinator, stroke committee of key stakeholders, local neurological expertise, and continuous telestroke process improvement. Conclusions Rural hospitals can improve their stroke readiness with use of telestroke systems. However, they need to integrate the technology into their stroke delivery processes. A telestroke assimilation model may improve stroke care performance. PMID:25601232

Research challenges and lessons learned from conducting community-based research with the Hmong community.

PubMed

Kue, Jennifer; Thorburn, Sheryl; Keon, Karen Levy

2015-05-01

Conducting research with underserved communities with little exposure to research presents a number of challenges and opportunities. Our study used a community-based approach to better understand factors that influence breast and cervical cancer screening among Hmong women. This article shares lessons learned during the process of developing and conducting qualitative research with a Hmong community with limited experience with research. We conducted 17 key informant and 84 in-depth interviews with Hmong women and men. Research team discussions, insights from Hmong research team members, input from our Community Advisory Committee, and project documents were sources of information about the process of conducting research in this community. Lessons learned concern including a cultural insider as an investigator; building community partnerships and support; establishing and working with a community advisory committee; hiring and training bilingual, bicultural staff; and using culturally appropriate materials and methods in a small, kinship-based community. We used multiple strategies to ensure that this study was conducted in a culturally appropriate manner. The lessons learned from our experiences can provide guidance to researchers on methodological and practical issues in conducting research with the Hmong and can inform future research with the Hmong and other similar underserved populations. © 2014 Society for Public Health Education.

Mediators and Moderators of the Effectiveness of a Community Health Worker Intervention That Improved Dietary Outcomes in Pregnant Latino Women

ERIC Educational Resources Information Center

Shah, Megha K.; Kieffer, Edith C.; Choi, Hwajung; Schumann, Christina; Heisler, Michele

2015-01-01

Background. Pregnancy is an opportune time to initiate diabetes prevention strategies for minority and underserved women, using culturally tailored interventions delivered by community health workers. A community-partnered randomized controlled trial (RCT) with pregnant Latino women resulted in significantly improved vegetable, fiber, added sugar,…

Community-Based Health Programmes: Role Perceptions and Experiences of Female Peer Facilitators in Mumbai's Urban Slums

ERIC Educational Resources Information Center

Alcock, Glyn A.; More, Neena Shah; Patil, Sarita; Porel, Maya; Vaidya, Leena; Osrin, David

2009-01-01

Community-based initiatives have become a popular approach to addressing the health needs of underserved populations, in both low- and higher-income countries. This article presents findings from a study of female peer facilitators involved in a community-based maternal and newborn health intervention in urban slum areas of Mumbai. Using…

Engaging with Underserved Urban Communities on Climate Resilience

NASA Astrophysics Data System (ADS)

Akerlof, K.; Moser, F. C.; Baja, K.; Dindinger, J. M.; Chanse, V.; Rowan, K. E.; Rohring, B.

2016-12-01

Meeting the needs of urban high-risk/low-resource communities is one of the most critical challenges in improving climate resilience nationally, but little tailored information exists to guide community engagement efforts specifically for these contexts. This case study describes a collaboration between universities, local governments, and community members working in underserved neighborhoods of the City of Baltimore and Prince George's County, Maryland. In service of current and developing community programs, the team surveyed residents door-to-door about their perceptions of the socio-environmental risks they face, their priorities for change, and the ways in which communication may build protective social capital. We highlight theoretical, applied, and pedagogical aspects of the study that inform both the promise and limitations of these collaborations. These include: 1) the role of citizen participation in climate adaptation decision-making; 2) the meaning, use, and potential impact of community data; 3) balancing differing organizational priorities, timelines, and cultures within community-based projects; and 4) research participation of undergraduate students. The results of the survey illuminate climate risk perceptions in neighborhoods facing complex stressors with lessons for communication and engagement in other urban areas facing similar adaptation challenges.

Extending the Pathway: Building on a National Science Foundation Workforce Development Project for Underserved k-12 Students

NASA Astrophysics Data System (ADS)

Slattery, W.; Smith, T.

2014-12-01

With new career openings in the geosciences expected and a large number of presently employed geoscientists retiring in the next decade there is a critical need for a new cadre of geoscientists to fill these positions. A project funded by the National Science Foundation titled K-12 Students, Teachers, Parents, Administrators and Higher Education Faculty: Partners Helping Rural Disadvantaged Students Stay on the Pathway to a Geoscience Career involving Wright State University and the Ripley, Lewis, Union, Huntington k-12 school district in Appalachian Ohio took led to dozens of seventh and eighth grade students traveling to Sandy Hook, New Jersey for a one week field experience to study oceanography with staff of the New Jersey Sea Grant Consortium. Teachers, parent chaperones, administrators and university faculty accompanied the students in the field. Teachers worked alongside their students in targeted professional development during the weeklong field experience. During the two academic years of the project, both middle school and high school teachers received professional development in Earth system science so that all students, not just those that were on the summer field experience could receive enhanced science learning. All ninth grade high school students were given the opportunity to take a high school/college dual credit Earth system science course. Community outreach provided widespread knowledge of the project and interest among parents to have their children participate. In addition, ninth grade students raised money themselves to fund a trip to the International Field Studies Forfar Field Station on Andros Island, Bahamas to study a tropical aquatic system. Students who before this project had never traveled outside of Ohio are currently discussing ways that they can continue on the pathway to a geoscience career by applying for internships for the summer between their junior and senior years. These are positive steps towards taking charge of their own learning and shows promise of raising parents, teachers, administrators and other k-12 students awareness of educational opportunities in the geosciences, confidence in the ability of underserved rural students to reach their educational goals and supporting them through the critical middle and high school years towards a geoscience career.

A pilot study of prostate cancer knowledge among African American men and their health care advocates: implications for screening decisions.

PubMed

Oliver, JoAnn S; Allen, Rebecca S; Eichorst, Morgan K; Mieskowski, Lisa; Ewell, Patrick J; Payne-Foster, Pamela; Ragin, Camille

2018-05-26

Prostate cancer (PCa) is the second leading cause of cancer death in U.S. men [American Cancer Society (ACS)], most often affecting men age 50 and older. The study provides information about factors that influence rural AA men in their decision to undergo screening for PCa with a specific focus on PCa knowledge among AA men and their health care advocates. A longitudinal quantitative study included AA males and their health care advocates. Participants were from three Alabama rural counties. Measures included demographics, PCa knowledge, decisional conflict, and health literacy scales. Thirty-three men with a mean age of 54.61 and 35 health care advocates were included in the study. PROCASE Knowledge Index measure results indicate a lack of PCa knowledge among both male primary participants and their advocates. The knowledge of AA men in the study was somewhat low, with individuals correctly answering approximately six questions out of ten at multiple time points (baseline total M = 6.42, SD = 1.52). Decisional conflict responses at 12 months (38.64) were lower than at baseline (M = 62.88) and at 6 months (M = 58.33), p < .005. Health care advocates of the 33 male participants were usually women, spouses, or significant others, supporting the vital role women play in men's health specifically in rural underserved communities. Low overall PCa knowledge, including their risk for PCa, among these participants indicates a need for PCa and screening educational interventions and dialogue that include males and their significant others.

77 FR 67433 - Community Advantage Pilot Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-09

... comments. SUMMARY: The Community Advantage (``CA'') Pilot Program is a pilot program to increase SBA... small businesses and entrepreneurs in underserved markets, SBA is issuing this Notice to extend the term... Pilot Program was introduced to increase the number of SBA-guaranteed loans made to small businesses in...

Discover Earth: An earth system science program for libraries and their communities

NASA Astrophysics Data System (ADS)

Curtis, L.; Dusenbery, P.

2010-12-01

The view from space has deepened our understanding of Earth as a global, dynamic system. Instruments on satellites and spacecraft, coupled with advances in ground-based research, have provided us with astonishing new perspectives of our planet. Now more than ever, enhancing the public’s understanding of Earth’s physical and biological systems is vital to helping citizens make informed policy decisions especially when they are faced with the consequences of global climate change. In spite of this relevance, there are many obstacles to achieving broad public understanding of key earth system science (ESS) concepts. Strategies for addressing climate change can only succeed with the full engagement of the general public. As reported by U.S. News and World Report in 2010, small towns in rural America are emerging as the front line in the climate change debate in the country. The Space Science Institute’s National Center for Interactive Learning (NCIL) in partnership with the American Library Association (ALA), the Lunar and Planetary Institute (LPI), and the National Girls Collaborative Project (NGCP) have received funding from NSF to develop a national project called the STAR Library Education Network: a hands-on learning program for libraries and their communities (or STAR-Net for short). STAR stands for Science-Technology, Activities and Resources. There are two distinct components of STAR-Net: Discover Earth and Discover Tech. While the focus for education reform is on school improvement, there is considerable research that supports the role that out-of-school experiences can play in student achievement. Libraries provide an untapped resource for engaging underserved youth and their families in fostering an appreciation and deeper understanding of science and technology topics. The overarching goal of the project is to reach underserved youth and their families with informal STEM learning experiences. The Discover Earth part of STAR_Net will produce ESS resources and inquiry-based activities that libraries can use to enrich the exhibit experience (focused on weather and climate). Additional resources will be provided through partnerships with relevant professional science organizations (e.g. American Geophysical Union) that will provide speakers for host library events and webinars. Online and in-person workshops will be conducted for library staff with a focus on increasing content knowledge and improving facilitation expertise. This presentation will provide an overview of the Discover Earth project and how it will address climate change issues, engage AGU scientists, and impact rural libraries nationwide.

Patient navigation for underserved patients diagnosed with breast cancer.

PubMed

Raj, Aparna; Ko, Naomi; Battaglia, Tracy A; Chabner, Bruce A; Moy, Beverly

2012-01-01

The elimination of cancer disparities is critically important for lessening the burden of breast cancer (BC). Patient navigator programs (PNPs) have been shown to improve rates of BC screening in underserved communities, but there is a dearth of evidence regarding their benefits after the actual diagnosis of BC. We retrospectively examined sociodemographic characteristics, disease characteristics, and concordance to quality measures (QMs) of BC care among women participating in a PNP that services disadvantaged minority communities in the greater Boston area. Of the 186 PNP patients diagnosed with BC in 2001-2011 in three neighborhood community health centers, treatment data was available for 158 (85%) and race and disease stage information was available for 149 (80%). Regarding stage, 25% were diagnosed with in situ cancer, 32% had stage 1, 25% had stage 2, 13% had stage 3, and 5% had stage 4 BC. Guideline-indicated care was received by 70 of 74 patients (95%) for the hormonal therapy QM, 15 of 17 (88%) patients for the chemotherapy QM, and 65 of 71 (92%) patients for the radiation QM, all similar to published concordance rates at elite National Comprehensive Cancer Network institutions. These findings suggest that PNPs may facilitate evidence-based quality care for vulnerable populations. Future research should prospectively analyze quality metrics to assess measures to improve the process and outcomes of patient navigation in diverse underserved settings, compared with control non-navigated populations.

Emotion regulation difficulties, youth-adult relationships, and suicide attempts among high school students in underserved communities.

PubMed

Pisani, Anthony R; Wyman, Peter A; Petrova, Mariya; Schmeelk-Cone, Karen; Goldston, David B; Xia, Yinglin; Gould, Madelyn S

2013-06-01

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 among 7,978 high-school students (48.6% male, 49.9% female) in 30 high schools from predominantly rural, low-income communities. 683 students (8.6%) reported a past-year suicide attempt. Emotion regulation difficulties and a lack of trusted adults at home and school were associated with increased risk for making a past-year suicide attempt, above and beyond the effects of depressive symptoms and demographic factors. The association between emotion regulation difficulties and suicide attempts was modestly lower among students who perceived themselves as having higher levels of trusted adults in the family, consistent with a protective effect. Having a trusted adult in the community (outside of school and family) was associated with fewer suicide attempts in models that controlled only for demographic covariates, but not when taking symptoms of depression into account. These findings point to adolescent emotion regulation and relationships with trusted adults as complementary targets for suicide prevention that merit further intervention studies. Reaching these targets in a broad population of adolescents will require new delivery systems and "option rich" (OR) intervention designs.

Emotion Regulation Difficulties, Youth-Adult Relationships, and Suicide Attempts Among High School Students in Underserved Communities

PubMed Central

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 among 7,978 high-school students (48.6% male, 49.9% female) in 30 high schools from predominantly rural, low-income communities. 683 students (8.6%) reported a past-year suicide attempt. Emotion regulation difficulties and a lack of trusted adults at home and school were associated with increased risk for making a past-year suicide attempt, above and beyond the effects of depressive symptoms and demographic factors. The association between emotion regulation difficulties and suicide attempts was modestly lower among students who perceived themselves as having higher levels of trusted adults in the family, consistent with a protective effect. Having a trusted adult in the community (outside of school and family) was associated with fewer suicide attempts in models that controlled only for demographic covariates, but not when taking symptoms of depression into account. These findings point to adolescent emotion regulation and relationships with trusted adults as complementary targets for suicide prevention that merit further intervention studies. Reaching these targets in a broad population of adolescents will require new delivery systems and “option rich” intervention designs. PMID:23666604

Urban-rural differences in excess mortality among high-poverty populations: evidence from the Harlem Household Survey and the Pitt County, North Carolina Study of African American Health.

PubMed

Geronimus, Arline T; Colen, Cynthia G; Shochet, Tara; Ingber, Lori Barer; James, Sherman A

2006-08-01

Black youth residing in high-poverty areas have dramatically lower probabilities of surviving to age 65 if they are urban than if they are rural. Chronic disease deaths contribute heavily. We begin to probe the reasons using the Harlem Household Survey (HHS) and the Pitt County, North Carolina Study of African American Health (PCS). We compare HHS and PCS respondents on chronic disease rates, health behaviors, social support, employment, indicators of health care access, and health insurance. Chronic disease profiles do not favor Pitt County. Smoking uptake is similar across samples, but PCS respondents are more likely to quit. Indicators of access to health care and private health insurance are more favorable in Pitt County. Findings suggest rural mortality is averted through secondary or tertiary prevention, not primary. Macroeconomic and health system changes of the past 20 years may have left poor urban Blacks as medically underserved as poor rural Blacks.

The next Community College Movement?

ERIC Educational Resources Information Center

Dassance, Charles R.

2011-01-01

The missionary zeal of community colleges in the 1960s is still needed to meet the challenges they still face today: helping underserved and underprepared students succeed, and offering a strong general education curriculum that provides the foundation and framework for later academic and professional success. Even as economic, social, and…

Community Health Workers and Their Value to Social Work

ERIC Educational Resources Information Center

Spencer, Michael S.; Gunter, Kathryn E.; Palmisano, Gloria

2010-01-01

Community health workers (CHWs) play a vital and unique role in linking diverse and underserved populations to health and social service systems. Despite their effectiveness, as documented by empirical studies across various disciplines including public health, nursing, and biomedicine, the value and potential role of CHWs in the social work…

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…

Community Schools in Practice: Research on Implementation and Impact. A PACER Policy Brief

ERIC Educational Resources Information Center

Jenkins, Della; Duffy, Mark

2016-01-01

Community schools are receiving increased attention in Pennsylvania and across the country as policymakers and practitioners strive to address the effects of poverty on academic performance, and provide more comprehensive supports for traditionally-underserved populations. While many advocates and education leaders tout the promise of community…

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

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

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…

Should I apply to medical school? High school students and barriers to application.

PubMed

Whalen, Desmond; Harris, Chelsea; Harty, Chris; Greene, Alison; Faour, Elizabeth; Thomson, Kalen; Ravalia, Mohamed

2016-01-01

A major goal of the Faculty of Medicine at the Memorial University of Newfoundland is to produce physicians who will return to rural areas that are currently underserviced. Research shows that the strongest indicator of practice in a rural area is a rural background, and thus it is important that rural students apply to medical school. We investigated what high school students believe to be preventing them from pursuing medical education. Between September 2013 and June 2014, we administered a paper survey to high school students in Newfoundland and Labrador, New Brunswick and Prince Edward Island. A total of 665 participants completed the survey. We found that fewer rural students (75.6%) than urban students (98.6%) believed that they could gain admission to medical school (p < 0.01) and that medicine was promoted as a career choice in fewer rural schools (55.7%) than urban schools (69.7%). Also, 55.4% of urban students, but only 44.4% of rural students, believed that rural students were disadvantaged when applying to medical school. In our study, rural students believed they were less likely to be accepted into medical school than urban students, and fewer rural students felt that medicine was promoted as a potential career choice. Our results may be explained by a lack of role models or perhaps by financial barriers, although further research is needed.

Socioeconomic factors explain racial disparities in invasive community-associated methicillin-resistant Staphylococcus aureus disease rates

PubMed Central

See, Isaac; Wesson, Paul; Gualandi, Nicole; Dumyati, Ghinwa; Harrison, Lee H.; Lesher, Lindsey; Nadle, Joelle; Petit, Susan; Reisenauer, Claire; Schaffner, William; Tunali, Amy; Mu, Yi; Ahern, Jennifer

2017-01-01

Introduction Invasive community-associated methicillin-resistant Staphylococcus aureus (MRSA) incidence in the United States is higher among black persons than white persons. We explored the extent to which socioeconomic factors might explain this racial disparity. Methods A retrospective cohort was based on CDC’s Emerging Infections Program surveillance data for invasive community-associated MRSA cases (isolated from a normally sterile site of an outpatient or on hospital admission day ≤3 in a patient without specified major healthcare exposures) from 2009–2011 in 33 counties of 9 states. We used generalized estimating equations to determine census tract-level factors associated with differences in MRSA incidence and inverse odds ratio weighted mediation analysis to determine the proportion of racial disparity mediated by socioeconomic factors. Results Annual invasive community-associated MRSA incidence was 4.59/100,000 among whites and 7.60/100,000 among blacks (rate ratio: 1.66, 95% CI, 1.52–1.80). In the mediation analysis, after accounting for census tract-level measures of federally-designated medically underserved areas, education, income, housing value, and rural status, 91% of the original racial disparity was explained; no significant association of black race with community-associated MRSA remained (rate ratio: 1.05, 95% CI, 0.92–1.20). Conclusions The racial disparity in invasive community-associated MRSA rates was almost entirely mediated by socioeconomic factors. The specific factors that underlie the association between tract-level socioeconomic measures and MRSA incidence, which may include modifiable social (e.g., poverty, crowding) and biological factors (not explored in this analysis), should be elucidated to define strategies for reducing racial disparities in community-associated MRSA rates. PMID:28362911

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).

Sharing Gravity's Microscope: Star Formation and Galaxy Evolution for Underserved Arizonans

NASA Astrophysics Data System (ADS)

Knierman, Karen A.; Monkiewicz, Jacqueline A.; Bowman, Catherine DD; Taylor, Wendy

2016-01-01

Learning science in a community is important for children of all levels and especially for many underserved populations. This project combines HST research of galaxy evolution using gravitationally lensed galaxies with hands-on activities and the Starlab portable planetarium to link astronomy with families, teachers, and students. To explore galaxy evolution, new activities were developed and evaluated using novel evaluation techniques. A new set of galaxy classification cards enable inquiry-based learning about galaxy ages, evolution, and gravitational lensing. Activities using new cylinder overlays for the Starlab transparent cylinder will enable the detailed examination of star formation and galaxy evolution as seen from the viewpoint inside of different types of galaxies. These activities were presented in several Arizona venues that enable family and student participation including ASU Earth and Space Open House, Arizona Museum of Natural History Homeschooling Events, on the Salt River Pima-Maricopa Indian Community, and inner city Phoenix schools serving mainly Hispanic populations. Additional events targeted underserved families at the Phoenix Zoo, in Navajo County, and for the Pascua Yaqui Tribe. After evaluation, the activities and materials will also be shared with local teachers and nationally.

Targeting community-dwelling urinary incontinence sufferers: a multi-disciplinary community based model for conservative continence services.

PubMed

St John, Winsome; Wallis, Marianne; James, Heather; McKenzie, Shona; Guyatt, Sheridan

2004-10-01

This paper presents an argument that there is a need to provide services that target community-dwelling incontinence sufferers, and presents a demonstration case study of a multi-disciplinary, community-based conservative model of service delivery: The Waterworx Model. Rationale for approaches taken, implementation of the model, evaluation and lessons learned are discussed. In this paper community-dwelling sufferers of urinary incontinence are identified as an underserved group, and useful information is provided for those wishing to establish services for them. The Waterworx Model of continence service delivery incorporates three interrelated approaches. Firstly, client access is achieved by using community-based services via clinic and home visits, creating referral pathways and active promotion of services. Secondly, multi-disciplinary client care is provided by targeting a specific client group, multi-disciplinary assessment, promoting client self-management and developing client knowledge and health literacy. Finally, interdisciplinary collaboration and linkages is facilitated by developing multidisciplinary assessment tools, using interdisciplinary referrals, staff development, multi-disciplinary management and providing professional education. Implementation of the model achieved greater client access, improvement in urinary incontinence and client satisfaction. Our experiences suggest that those suffering urinary incontinence and living in the community are an underserved group and that continence services should be community focussed, multi-disciplinary, generalist in nature.

Building a community-academic partnership to improve health outcomes in an underserved community.

PubMed

McCann, Eileen

2010-01-01

East Garfield Park, IL, is an impoverished community with 59.7% of residents falling below twice the poverty level and 42.6% of its children in poverty. In 2001, the leading causes of hospitalizations were heart disease (10.3%), diabetes (2%), and asthma (3.9%), all of which occur at frequencies 33% greater than the Chicago average. Finally, a review of the health care facilities in the community suggests that there is a need for accessible primary health care services in the area. The purpose of this project was to improve health outcomes in an impoverished, underserved community with documented health care needs and lack of adequate health care services by creating a community-academic partnership to provide on-site, interdisciplinary, health care services within an established and trusted community-based social service agency, Marillac House. The short-term objectives for this project included creating a community-academic partnership between Marillac House and Colleges of Nursing, Medicine, and Health Sciences; providing comprehensive health care services; and developing an innovative clinical education model for interdisciplinary care across specialties. Long-term objectives included providing preventative services; evidenced-based management of acute and chronic illness; evaluating client's health outcomes; and creating a sustainability plan for the long-term success of the health center.

Ensuring safe access to medication for palliative care while preventing prescription drug abuse: innovations for American inner cities, rural areas, and communities overwhelmed by addiction

PubMed Central

Francoeur, Richard B

2011-01-01

This article proposes and develops novel components of community-oriented programs for creating and affording access to safe medication dispensing centers in existing retail pharmacies and in permanent or travelling pharmacy clinics that are guarded by assigned or off-duty police officers. Pharmacists at these centers would work with police, medical providers, social workers, hospital administrators, and other professionals in: planning and overseeing the safe storage of controlled substance medications in off-site community safe-deposit boxes; strengthening communication and cooperation with the prescribing medical provider; assisting the prescribing medical provider in patient monitoring (checking the state prescription registry, providing pill counts and urine samples); expanding access to lower-cost, and in some cases, abuse-resistant formulations of controlled substance medications; improving transportation access for underserved patients and caregivers to obtain prescriptions; and integrating community agencies and social networks as resources for patient support and monitoring. Novel components of two related community-oriented programs, which may be hosted outside of safe medication dispensing centers, are also suggested and described: (1) developing medication purchasing cooperatives (ie, to help patients, families, and health institutions afford the costs of medications, including tamper-or abuse-resistant/deterrent drug formulations); and (2) expanding the role of inner-city methadone maintenance treatment programs in palliative care (ie, to provide additional patient monitoring from a second treatment team focusing on narcotics addiction, and potentially, to serve as an untapped source of opioid medication for pain that is less subject to abuse, misuse, or diversion). PMID:22312232

Ensuring safe access to medication for palliative care while preventing prescription drug abuse: innovations for American inner cities, rural areas, and communities overwhelmed by addiction.

PubMed

Francoeur, Richard B

2011-01-01

This article proposes and develops novel components of community-oriented programs for creating and affording access to safe medication dispensing centers in existing retail pharmacies and in permanent or travelling pharmacy clinics that are guarded by assigned or off-duty police officers. Pharmacists at these centers would work with police, medical providers, social workers, hospital administrators, and other professionals in: planning and overseeing the safe storage of controlled substance medications in off-site community safe-deposit boxes; strengthening communication and cooperation with the prescribing medical provider; assisting the prescribing medical provider in patient monitoring (checking the state prescription registry, providing pill counts and urine samples); expanding access to lower-cost, and in some cases, abuse-resistant formulations of controlled substance medications; improving transportation access for underserved patients and caregivers to obtain prescriptions; and integrating community agencies and social networks as resources for patient support and monitoring. Novel components of two related community-oriented programs, which may be hosted outside of safe medication dispensing centers, are also suggested and described: (1) developing medication purchasing cooperatives (ie, to help patients, families, and health institutions afford the costs of medications, including tamper-or abuse-resistant/deterrent drug formulations); and (2) expanding the role of inner-city methadone maintenance treatment programs in palliative care (ie, to provide additional patient monitoring from a second treatment team focusing on narcotics addiction, and potentially, to serve as an untapped source of opioid medication for pain that is less subject to abuse, misuse, or diversion).

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.

Rural jail telepsychiatry: a pilot feasibility study.

PubMed

Manfredi, Luisa; Shupe, Joann; Batki, Steven L

2005-10-01

New York State has a large rural population, and many of the jails in rural areas have minimal or no psychiatric services available on site. Cost of transport to off-site psychiatric services and the safety issues related to moving inmates from a secure building may limit inmate access to appropriate psychiatric services. This feasibility study describes a project that provided telepsychiatric consultation to increase access to psychiatric treatment in an underserved rural jail in upstate New York. Subjects were consenting jail inmates who requested or were found to be in need of psychiatric care. The project provided interactive two-way audio-video communication between the psychiatrist located in an urban university medical center and subjects who were incarcerated 182 miles away. During the project period, 15 inmates were assessed and treated in 37 consultations. Subjects were predominantly young white males with anxiety, mood, and substance use disorders. Services were readily accepted by inmates and staff. Telepsychiatric examination and treatment appears to be a feasible method to increase access to mental health care in rural jails. Future advocacy for increased mental health services in rural areas in criminal justice setting is likely to depend on further evidence of favorable cost benefit.

Diabetes and Technology for Increased Activity (DaTA) Study: Results of a Remote Monitoring Intervention for Prevention of Metabolic Syndrome

PubMed Central

Stuckey, Melanie; Russell-Minda, Elizabeth; Read, Emily; Munoz, Claudio; Shoemaker, Kevin; Kleinstiver, Peter; Petrella, Robert

2011-01-01

Objective: An increasingly aged, overweight, and sedentary population has resulted in elevated risk of cardiovascular disease (CVD). The escalating incidence of diabetes and other chronic illnesses, deficits in health care budgets, and physician shortages, especially in rural communities, have prompted investigations of feasible solutions. The Diabetes and Technology for Increased Activity (DaTA) study was designed to test the effectiveness of a lifestyle intervention driven by self-monitoring of blood glucose (BG), blood pressure (BP), physical activity (PA), and weight to positively impact CVD risk factors in a medically underserviced rural population with a high incidence of metabolic syndrome (MS). Research Design and Methods: Conducted in a community-based research setting, this single-center open feasibility study used smart phones to transmit BP, BG, pedometer, weight, heart rate, and activity measurements to a database. Technology allowed participants to interface with the clinical team and self-monitor their personal health indicators. Results Twenty-four participants aged 30 to 71 years completed the 8-week intervention. Participants had significant improvement in clinic (p = .046) and self-monitored diastolic BP (p = .001), body mass index (p = .002), and total cholesterol (p = .009), and steps per day. Daily PA increased as well as participants' interest in and willingness to make lifestyle changes that impact health outcomes. Conclusions The DaTA study demonstrated that self-monitoring of the risk factors for MS and increased PA improved the participant's CVD risk profile. Considering the 8-week time period of this intervention, results are encouraging. This lifestyle intervention, which uses education and technology as tools, confirms the utility of remote health monitoring. PMID:21880236

Evaluation of community provision of a preventive cardiovascular programme - the National Health Service Health Check in reaching the under-served groups by primary care in England: cross sectional observational study.

PubMed

Woringer, Maria; Cecil, Elizabeth; Watt, Hillary; Chang, Kiara; Hamid, Fozia; Khunti, Kamlesh; Dubois, Elizabeth; Evason, Julie; Majeed, Azeem; Soljak, Michael

2017-06-14

Cardiovascular disease (CVD) is the leading cause of premature mortality and a major contributor of health inequalities in England. Compared to more affluent and white counterparts, deprived people and ethnic minorities tend to die younger due to preventable CVD associated with lifestyle. In addition, deprived, ethnic minorities and younger people are less likely to be served by CVD prevention services. This study assessed the effectiveness of community-based outreach providers in delivering England's National Health Services (NHS) Health Check programme, a CVD preventive programme to under-served groups. Between January 2008 and October 2013, community outreach providers delivered a preventive CVD programme to 50,573 individuals, in their local communities, in a single consultation without prescheduled appointments. Community outreach providers operated on evenings and weekends as well as during regular business hours in venues accessible to the general public. After exclusion criteria, we analysed and compared socio-demographic data of 43,177 Health Check attendees with the general population across 38 local authorities (LAs). We assessed variation between local authorities in terms of age, sex, deprivation and ethnicity structures using two sample t-tests and within local authority variation in terms of ethnicity and deprivation using Chi squared tests and two sample t-tests respectively. Using Index of Multiple Deprivation, the mean deprivation score of the population reached by community outreach providers was 6.01 higher (p < 0.05) than the general population. Screened populations in 29 of 38 LAs were significantly more deprived (p < 0.05). No statistically significant difference among ethnic minority groups was observed between LAs. Nonetheless some LAs - namely Leicester, Thurrock, Sutton, South Tyneside, Portsmouth and Gateshead were very successful in recruiting ethnic minority groups. The mean proportion of men screened was 11.39% lower (p < 0.001) and mean proportion of 40-49 and 50-59 year olds was 9.98% and 3.58% higher (p < 0.0001 and p < 0.01 respectively) than the general population across 38 LAs. Community-based outreach providers effectively reach under-served groups by delivering preventive CVD services to younger, more deprived populations, and a representative proportion of ethnic minority groups. If the programme is successful in motivating the under-served groups to improve lifestyle, it may reduce health inequalities therein.

The influence of international medical electives on career preference for primary care and rural practice.

PubMed

Law, Iain R; Walters, Lucie

2015-11-11

Previous studies have demonstrated a correlation between medical students who undertake international medical electives (IMEs) in resource poor settings and their reported career preference for primary care in underserved areas such as rural practice. This study examines whether a similar correlation exists in the Australian medical school context. Data was extracted from the Medical Schools Outcomes Database (MSOD) of Australian medical students that completed commencing student and exit questionnaires between 2006 and 2011. Student responses were categorized according to preferred training program and preferred region of practice at commencement. The reported preferences at exit of students completing IMEs in low and middle income countries (LMIC) were compared to those completing electives in high income countries (HIC). The effect of elective experience for students expressing a preference for primary care at commencement was non-significant, with 40.32 % of LMIC and 42.11 % of HIC students maintaining a preference for primary care. Similarly there were no significant changes following LMIC electives for students expressing a preference for specialist training at commencement with 11.81 % of LMIC and 10.23 % of HIC students preferring primary care at exit. The effect of elective experience for students expressing a preference for rural practice at commencement was non-significant, with 41.51 % of LMIC and 49.09 % of HIC students preferring rural practice at exit. Similarly there were no significant changes following LMIC electives for students expressing a preference for urban practice at commencement, with 7.84 % of LMIC and 6.70 % of HIC students preferring rural practice at exit. This study did not demonstrate an association between elective experience in resource poor settings and a preference for primary care or rural practice. This suggests that the previously observed correlation between LMIC electives and interest in primary care in disadvantaged communities is likely dependent on student and elective program characteristics and supports the need for further research and critical examination of elective programs at Australian medical schools.

A qualitative study of factors related to cardiometabolic risk in rural men.

PubMed

Morgan, Emily H; Graham, Meredith L; Folta, Sara C; Seguin, Rebecca A

2016-04-11

Rural men are known to have poor health behaviors, which contribute to their elevated burden of cardiometabolic disorders in the United States. Although regular physical activity, healthy eating, and avoiding tobacco can reduce cardiometabolic risk, little is known about how to engage rural men in health promotion programs. To bridge this gap in evidence, we investigate knowledge of modifiable cardiometabolic risk factors among rural men in the western United States, identify their concerns related to heart health and motivation to reduce risk, and explore individual, social, and community-level influences on heart-healthy behaviors, specifically diet, physical activity, and tobacco use. We conducted seven focus groups with 54 sedentary, overweight/obese men (mean body mass index [BMI] = 31.3 ± 4.6) aged 43-88 residing in government-designated "medically underserved" rural Montana towns in September and October 2014. All sessions were audio-recorded and transcribed verbatim. Transcripts were coded and analyzed thematically using Nvivo software. Participants also completed a brief questionnaire about personal characteristics and health behaviors. These data were explored descriptively. Despite being classified as overweight/obese and sedentary, no participants reported to be in poor health. Many men described health relative to self-reliance and the ability to participate in outdoor recreation; concern with health appeared to be related to age. Participants were generally knowledgeable of heart-healthy behaviors, but many felt fatalistic about their own risk. Catalysts for behavior change included a serious medical event in the household and desire to reduce aging-associated functional decline. Barriers to adopting and maintaining healthy eating and physical activity habits and abstaining from tobacco included normative beliefs around masculinity and individual liberty, the limited social universe of small towns, winter weather, time constraints, and preferences for unhealthy foods. Facilitators included behavioral self-monitoring, exercising with a partner, and opportunities for preferred activities, such as hunting and team sports. These findings provide important insight about influences on rural men's health behaviors and provide guidance for possible intervention strategies to promote cardiometabolic health. ClinicalTrials.gov NCT02499731 . Registered 1 July 2015.

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.

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

Time, tact, talent, and trust: essential ingredients of effective academic-community partnerships.

PubMed

Plowfield, Lisa Ann; Wheeler, Erlinda C; Raymond, Jean E

2005-01-01

Building strong partnerships between academic institutions and community health agencies requires a commitment to time, tactful communications, talented leaders, and trust. The essential elements of partnership building are discussed based on experiences of a mid-Atlantic nursing center, an academic health center established to provide care to underserved and vulnerable populations.

IT Workforce Development: A Family and Consumer Sciences Community Capacity Model

ERIC Educational Resources Information Center

Meszaros, Peggy S.; Kimbrell, Monica R.; Swenson, Andrea

2015-01-01

This article examines Extension professionals building community capacity in 10 counties across five Appalachian states in response to the talent crisis in the United States information technology (IT) workforce. The goal has been to transfer IT knowledge and create a supportive environment to foster interest in IT careers among underserved girls…

75 FR 12272 - Notice of Availability of Funds and Solicitation for Grant Applications (SGA) for Community-Based...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-15

... provide specific types of training services. All projects must lead to employment for program participants... services offered by the CBJT grant. Further, we encourage applicants to use program models with...; and (2) the training is offered in partnership with a community college outside the underserved area...

Success of Underrepresented Nursing Students at Selected Southwest Institutions: Impact of a Nursing Retention Program

ERIC Educational Resources Information Center

Khattab, Ibrahim

2011-01-01

This study examined retention initiatives and strategies provided to underserved students in the nursing programs at three community colleges in the Southwest region. This research addressed nursing student retention, as well as ways to increase retention among underrepresented populations in the three community colleges, representing a unique…

The Information Needs and Behavior of Mature Community College Students: A Review of Literature

ERIC Educational Resources Information Center

Zeit, Krystina

2014-01-01

This paper is a review of literature devoted to the unique information needs and information-seeking behavior of the growing nontraditional or mature community college student population. This underserved user group faces distinctive challenges that librarians, researchers, and administrators must recognize and address. Much of the existing…

Ex-Offenders Prepare for Work, and Life, at Community Colleges

ERIC Educational Resources Information Center

Gonzalez, Jennifer

2012-01-01

The national push to graduate more students excludes no demographic group, and those with lagging completion rates become particular targets of attention. Now some community colleges are zeroing in on another underserved population: ex-offenders. Roughly 1.6 million people are in state and federal prisons across the country, and each year, about…

Underserved, Underrepresented, Unprepared: Experiences of African American Females in Community College with Barriers to Academic Success

ERIC Educational Resources Information Center

Jobe, LaWanda D.

2013-01-01

African American women are enrolling and returning to college in large numbers across many community college campuses, especially those women who would be characterized as nontraditional students. This qualitative study examined and analyzed the experiences, stresses, and coping mechanisms of first generation, nontraditional, single parent,…

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

Enhancing Ear and Hearing Health Access for Children With Technology and Connectivity.

PubMed

Swanepoel, De Wet

2017-10-12

Technology and connectivity advances are demonstrating increasing potential to improve access of service delivery to persons with hearing loss. This article demonstrates use cases from community-based hearing screening and automated diagnosis of ear disease. This brief report reviews recent evidence for school- and home-based hearing testing in underserved communities using smartphone technologies paired with calibrated headphones. Another area of potential impact facilitated by technology and connectivity is the use of feature extraction algorithms to facilitate automated diagnosis of most common ear conditions from video-otoscopic images. Smartphone hearing screening using calibrated headphones demonstrated equivalent sensitivity and specificity for school-based hearing screening. Automating test sequences with a forced-choice response paradigm allowed persons with minimal training to offer screening in underserved communities. The automated image analysis and diagnosis system for ear disease demonstrated an overall accuracy of 80.6%, which is up to par and exceeds accuracy rates previously reported for general practitioners and pediatricians. The emergence of these tools that capitalize on technology and connectivity advances enables affordable and accessible models of service delivery for community-based ear and hearing care.

SWAT (Student Weekend Arborist Team): A Model for Land Grant Institutions and Cooperative Extension Systems to Conduct Street Tree Inventories

ERIC Educational Resources Information Center

Cowett, F.D.; Bassuk, N.L.

2012-01-01

SWAT (Student Weekend Arborist Team) is a program affiliated with Cornell University and Extension founded to conduct street tree inventories in New York State communities with 10,000 residents or fewer, a group of communities underserved in community forestry planning. Between 2002 and 2010, SWAT conducted 40 inventories, and data from these…

Project Coach: A Case Study of a College-Community Partnerships as a Venture in Social Entrepreneurship

ERIC Educational Resources Information Center

Intrator, Sam M.; Siegel, Donald

2010-01-01

Project Coach is an after school program developed and directed by the authors. The program, which is set in a high-need urban community in Springfield, Massachusetts, teaches high school and middle school students to be sport coaches and then to run youth sport leagues for elementary-aged youth in underserved neighborhoods in their own community.…

Challenges and Opportunities to Improve Cervical Cancer Screening Rates in US Health Centers through Patient-Centered Medical Home Transformation

PubMed Central

Makaroff, Laura; Chung, Michelle; Lin, Sue C.

2015-01-01

Over the last 50 years, the incidence of cervical cancer has dramatically decreased. However, health disparities in cervical cancer screening (CCS) persist for women from racial and ethnic minorities and those residing in rural and poor communities. For more than 45 years, federally funded health centers (HCs) have been providing comprehensive, culturally competent, and quality primary health care services to medically underserved communities and vulnerable populations. To enhance the quality of care and to ensure more women served at HCs are screened for cervical cancer, over eight HCs received funding to support patient-centered medical home (PCMH) transformation with goals to increase CCS rates. The study conducted a qualitative analysis using Atlas.ti software to describe the barriers and challenges to CCS and PCMH transformation, to identify potential solutions and opportunities, and to examine patterns in barriers and solutions proposed by HCs. Interrater reliability was assessed using Cohen's Kappa. The findings indicated that HCs more frequently described patient-level barriers to CCS, including demographic, cultural, and health belief/behavior factors. System-level barriers were the next commonly cited, particularly failure to use the full capability of electronic medical records (EMRs) and problems coordinating with external labs or providers. Provider-level barriers were least frequently cited. PMID:25685561

"When We Learn Better, We Do Better": Describing Changes in Empowerment through Photovoice among Community Health Advisors in a Breast and Cervical Cancer Health Promotion Program in Mississippi and Alabama

ERIC Educational Resources Information Center

Mayfield-Johnson, Susan; Rachal, John R.; Butler, James, III.

2014-01-01

As change agents in the community, community health advisors (CHAs) are a viable solution to bridge the gap between health service delivery systems and the community. With many CHAs members of the underserved and minority populations they serve, change and empowerment experienced by CHAs should be documented. This phenomenological study describes…

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.

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.

Dementia Care Management in an Underserved Community: The Comparative Effectiveness of Two Different Approaches.

PubMed

Chodosh, Joshua; Colaiaco, Benjamin A; Connor, Karen Ilene; Cope, Dennis Wesley; Liu, Hangsheng; Ganz, David Avram; Richman, Mark Jason; Cherry, Debra Lynn; Blank, Joseph Moshe; Carbone, Raquel Del Pilar; Wolf, Sheldon Mark; Vickrey, Barbara Grace

2015-08-01

To compare the effectiveness and costs of telephone-only approach to in-person plus telephone for delivering an evidence-based, coordinated care management program for dementia. We randomized 151 patient-caregiver dyads from an underserved predominantly Latino community to two arms that shared a care management protocol but implemented in different formats: in-person visits at home and/or in the community plus telephone and mail, versus telephone and mail only. We compared between-arm caregiver burden and care-recipient problem behaviors (primary outcomes) and patient-caregiver dyad retention, care quality, health care utilization, and costs (secondary outcomes) at 6- and 12-months follow-up. Care quality improved substantially over time in both arms. Caregiver burden, care-recipient problem behaviors, retention, and health care utilization did not differ across arms but the in-person program cost more to deliver. Dementia care quality improved regardless of how care management was delivered; large differences in effectiveness or cost offsets were not detected. © The Author(s) 2015.

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.

Using Key Informant Method to Determine the Prevalence and Causes of Childhood Blindness in South-Eastern Nigeria.

PubMed

Aghaji, Ada E; Ezegwui, Ifeoma R; Shiweobi, Jude O; Mamah, Cyril C; Okoloagu, Mary N; Onwasigwe, Ernest N

2017-12-01

To determine the prevalence and causes of childhood blindness in an underserved community in south-eastern Nigeria using the key informant method. This was a descriptive cross-sectional study. Key informants (KI) appointed by their respective communities received 1-day training on identification of blind children in their communities. Two weeks later, the research team visited the agreed sites within the community and examined the identified children. The World Health Organization eye examination record for blind children was used for data collection. Data entry and analysis were done with the Statistical Package for Social Sciences (SPSS) version 17.0. Fifteen blind or severely visually impaired children (age range 3 months to 15 years) were identified in this community; nine of these were brought by the KIs. The prevalence of childhood blindness/severe visual impairment (BL/SVI) was 0.12 per 1000 children. By anatomical classification, operable cataract in 6 (40.0%) was the leading cause of BL/SVI in the series; followed by optic nerve lesions (atrophy/hypoplasia) in 3 (20.0%). The etiology of BL/SVI is unknown for the majority of the children (66.7%). It was presumed hereditary in four children (26.7%). Sixty percent of the blindness was judged avoidable. Only three children (20.0%) were enrolled in the Special Education Centre for the Blind. The prevalence of childhood BL/SVI in our study population is low but over half of the blindness is avoidable. There may be a significant backlog of operable childhood cataract in south-eastern Nigeria. The KI method is a practical method for case finding of blind children in rural communities.

Improving the Health of Cambodian Americans: Grassroots Approaches and Root Causes.

PubMed

Lee, Juliet P; Kirkpatrick, Sean; Rojas-Cheatham, Ann; Sin, Talaya; Moore, Roland S; Tan, Sotheavy; Godoy, Shadia; Ercia, Angelo

2016-01-01

Cambodian Americans experience great disparities in health compared to other Americans, yet may be underserved by conventional healthcare systems. Community-based participatory research (CBPR) is a means to engage underserved communities in health research and programming. We describe results of our efforts to engage the Cambodian grassroots members as well as formal leaders in Oakland, California. In addition to a community advisory group, we convened a Community Work Group (CWG), composed of 10 grassroots community women of varying ages and backgrounds. The project aimed to leverage the lived experiences of these women and their understandings of health and wellness in identifying specific health issues and developing culturally resonant strategies. The CWG met weekly with staff facilitators using methods for collective analysis including theater, body mapping, and other expressive arts. The approach proved logistically challenging, but resulted in novel analyses and strategies. The group identified trauma, along with poor access to education, unemployment and underemployment, social isolation, and generation gap, together with community violence, as root causes of key behavioral health issues, namely, alcohol abuse, gambling, prescription drug misuse, and domestic violence. Strategies proposed and implemented by the group and project staff were a community garden, Cambodian New Year's celebrations, and a museum exhibit on the Cambodian refugee experiences. Grassroots community engagement can support projects in identifying social determinants of health and developing the capacities of community members to conduct research and actions to improve health.

History of community health center affiliations with The New England College of Optometry.

PubMed

Wilson, Roger; Sharda, Vandhana

2008-10-01

Since the 1970s, The New England College of Optometry (NECO) has been a leader in community-based educational programming. This was accomplished through the development of affiliation agreements with health care facilities that care for the underserved, notably community health centers (CHCs). The college's clinical system, the New England Eye Institute (NEEI), develops CHC programs, manages professional services agreements, initiates teaching affiliation agreements, and leads staff recruitment and retention efforts. CHC collaborations, which effectively address disparities in access to health care and visual health status, represent a significant component of the college's primary care clinical training venues. Since their inception in 1972, these CHC academic-community partnerships have provided more than 650,000 eye examinations to the underserved and have trained more than 3,200 graduates in community-based eye care, interdisciplinary care management environment, clinical prevention strategies, and population health. This report describes NECO's longstanding success with CHCs, explains the scope of practice at CHCs, explains how students are involved in the CHCs' eye care services, and discusses the various management and business arrangements. The benefits and challenges of CHC affiliations with optometry schools and colleges are also discussed.

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.

EJ 2020 Action Agenda: EPA’s Environmental Justice Strategy

EPA Pesticide Factsheets

The EJ 2020 Action Agenda is EPA's strategic plan for integrating environmental justice into its programs, policies, and activities and will support making a difference in overburdened, underserved, and economically distressed communities.

77 FR 69929 - Open Meeting of the President's Advisory Council on Financial Capability

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-21

... Council's subcommittees (Underserved and Community Empowerment, Research and Evaluation, Partnerships, and... Empowerment), Research and Evaluation, Partnerships, and Youth. The Council met again on April 21, 2011; July...

"Dark Skies, Bright Kids" - First Year Of Outreach In Rural Virginia

NASA Astrophysics Data System (ADS)

Ries, Paul; Johnson, K.; Zasowski, G.; Beaton, R.; Carlberg, J.; Czekala, I.; de Messieres, G.; Drosback, M.; Gugliucci, N.; Jackson, L.; Lynch, R.; Romero, C.; Sivakoff, G.; Whelan, D.; Wong, A.

2010-10-01

Dark Skies, Bright Kids (DSBK) is an educational/public outreach program at the University of Virginia directed primarily towards rural elementary school students in grades 3-5. The program, which is run by a diverse community of volunteers (faculty, postdocs, grad students, and undergrads), targets schools in the rural areas surrounding UVa in southern Albemarle County. While these schools are privileged with remarkably dark skies, these same schools are also home to an economically under-privileged and educationally under-served population. DSBK seeks to use those dark skies, among other resources, to create excitement and interest in science and engineering as part of a weekly after-school program. A typical afternoon consists of 1.5-2.5 hours of science activities specifically centered around space and astronomy. Each week has a theme (e.g., rockets, invisible light) and we incorporate a mix of activities on that theme, such as hands-on experiments, stories, games, and creative play. We also encourage family involvement, so that the parents are actively involved in their children's education. Every other week, we hold a family observing night, so both the students and their parents can learn about the night sky together. The program lasts for one semester at each school, and we have just completed our second semester of work. Each new semester brings on new challenges, but also new lessons to make our program better in future semesters. Our group actively writes and then rewrites our own lesson plans as we learn what works best with the students. We are now in the process of putting our lesson plans online so other groups can take advantage of what we have learned and apply this program at other schools. On the web: http://www.astro.virginia.edu/dsbk/

States' experiences with loan repayment programs for health care professionals in a time of state budget cuts and NHSC expansion.

PubMed

Pathman, Donald E; Morgan, Jennifer Craft; Konrad, Thomas R; Goldberg, Lynda

2012-01-01

The landscape of education loan repayment programs for health care professionals has been turbulent in recent years, with doubling of the funding for the National Health Service Corps (NHSC) and cuts in funding for some states' programs. We sought to understand how this turbulence is being felt within the state offices involved in recruiting clinicians to rural and urban underserved communities. We conducted key informant telephone interviews with staff of state offices of rural health, primary care organizations, and/or related organizations within 28 diverse states to answer questions about perceived changes and interplay among solely state-funded loan repayment programs, joint state-federal programs, and the NHSC federal program. Interviews were transcribed, formally analyzed, and key issues summarized. Informants reported that solely state-funded and joint state-federal loan repayment programs are greatly valued for their ability to target a state's particular needs and to complement the NHSC federal program. However, budgets for state programs have been threatened, reduced, or eliminated entirely in many cases. All informants positively perceived the NHSC's recent growth and changes, which they feel are helping fill important workforce needs for their states. Nevertheless, the much larger NHSC federal program now competes with some states' programs for clinicians and service sites; states' programs are pushed to adjust their operations to maintain a unique "niche". States' key recruiters lament reductions in funding for states' loan repayment programs, and welcome the NHSC's recent growth and changes. Better coordination is needed to minimize competition and maximize complementarity between state and federal programs. © 2012 National Rural Health Association.

Adolescent and parent use of new technologies for health communication: a study in an urban latino community.

PubMed

Smaldone, Arlene; Stockwell, Melissa S; Osborne, Jennel C; Cortes, Yamnia; Bekele, ElShadey; Green, Nancy S

2015-02-20

Mobile communication technologies provide novel opportunities to support clinic-based health initiatives. Adoption of technologies for daily use and for health communication can differ between communities, depending upon demographic and cultural characteristics. A survey was administered in adolescent primary care and subspecialty clinics to assess parent-adolescent preferences in use of mobile technologies and social media to support provider-patient communication in an urban Latino community. Of 130 respondents (65 parent-adolescent pairs), approximately half frequently sent and received text messages but lacked agreement regarding the other's text messaging use. In contrast, adolescents only rarely used email compared to parents (15.4% versus 37.5%, P=0.006). Of social media, Facebook™/MySpace™ was most frequently used by parents and youth (60% and 55.4%, P=0.59); however, most lacked interest in using social media for health communication. Parents reported more interest than adolescents in receiving email (73.4% versus 35.9%, P<0.001) and text messages (58.5% versus 33.9%, P=0.005) for health, but had more concerns about privacy issues (26.2% versus 9.2%, P=0.01). Respondents who were American born (aOR 5.7, 95%CI 1.2-28.5) or regularly used Instant Messaging or Facebook™/MySpace™ (aOR 4.6, 95%CI 1.4-14.7) were more likely to be interested in using social media for health communication. These findings underscore the importance of targeted assessment for planning the utilization of communication technologies and social media in clinical care or research for underserved youth. Significance for public healthCommunication technologies provide novel opportunities to support clinic-based health initiatives for underserved youth. However, adoption of technologies among communities may differ depending upon demographic and cultural characteristics. We surveyed a sample of urban Latino parents and youth regarding their current use of mobile and social media technologies and preferences for use of these technologies for health communication. This is the first study to compare the perspective of underserved parents and their youth regarding use of a wide variety of mobile and social communication technologies, concordance between youth-parent pairs in perceived use of texting and preferences for the purpose of health communication. Our findings differ from those from adults surveyed in other under-served communities, highlighting heterogeneity between communities. Variations in use of communication technologies and social media and preferences between parent-youth pairs suggest that understanding these factors within target populations is crucial for successful use to support health and health services.

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.

Transforming the Cross Cultural Collaborative of Pierce County Through Assessment Capacity Building

PubMed Central

Garza, Mary A.; Abatemarco, Diane J.; Gizzi, Cindan; Abegglen, Lynn M.; Johnson-Conley, Christina

2010-01-01

Background Underserved populations are underrepresented in public health initiatives such as tobacco control and in cancer clinical trials. Community involvement is crucial to interventions aimed at reducing health disparities, and local health departments increasingly are called upon to provide both leadership and funding. The Tacoma Pierce County Health Department (TPCHD), in conjunction with 13 key community-based organizations and healthcare systems, formed the Cross Cultural Collaborative of Pierce County (CCC) that successfully employs needs-assessment and evaluation techniques to identify community health initiatives. Methods Community leaders from six underserved populations of the CCC were trained in needs-assessments techniques. Assessments measured effectiveness of the collaborative process and community health initiatives by using key informant (n = 18) and group interviews (n = 3). Results The CCC, facilitated by its partnership with the TPCHD, built capacity and competence across community groups to successfully obtain two funded public health initiatives for six priority populations. Members expressed overall satisfaction with the training, organizational structure, and leadership. The CCC’s diversity, cultural competency, and sharing of resources were viewed both as a strength and a decision-making challenge. Conclusion Public health department leadership, collaboration, and evidence-based assessment and evaluation were key to demonstrating effectiveness of the interventions, ensuring the CCC’s sustainability. PMID:19077598