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Journal of Health Care for the Poor and Underserved

Imam M Xierali, Marc A Nivet
Racial and ethnic minority physicians are more likely to practice primary care and serve in underserved communities. However, there are micro-practice patterns within primary care specialties that are not well understood. To examine the differences among primary care physician practice locations by specialty and race/ethnicity, a retrospective study was conducted on U.S. medical graduates who were direct patient care physicians in 2012. The group-specific contributions to primary care accessibility were decomposed by individual group of minorities underrepresented in medicine (URM)...
2018: Journal of Health Care for the Poor and Underserved
Galen H Smith, Cicily Hampton, William P Brandon
BACKGROUND: No studies were found that consider the role of race and gender concordance in patient-physician extender relationships. METHODS: A telephone survey in summer 2012 allowed measures of the relationship between physicians and physician extenders with race and gender concordance. Randomized stratified sampled adults (n = 1,401) enrolled in North Carolina Medicaid's managed care networks met the study's criteria. FINDINGS: The analysis determined the association of provider type and race and gender concordance...
2018: Journal of Health Care for the Poor and Underserved
Luisel J Ricks-Santi, Brittany Barley, Danyelle Winchester, Dawood Sultan, John McDonald, Yasmine Kanaan, Amari Pearson-Fields, Arnethea L Sutton, Vanessa Sheppard, Carla Williams
The aim of this study was to determine the impact of race and socioeconomic status on breast tumor clinicopathological features and survival outcomes. This study used breast cancer data from the Washington D.C. Cancer Registry (2000- 2010). Logistic regression and survival analysis assessed the association between race, socioeconomic (SES) variables, clinicopathological variables, recurrence-free survival and overall survival. African American (AA) breast cancer patients had an increased risk for stage III, ER-, and PR-breast cancer compared with White and Hispanic breast cancer patients...
2018: Journal of Health Care for the Poor and Underserved
Paul A Rebman, Mageen C Caines, Patricia A Harrison
Voluntary paternity establishment was placed in birthing hospitals by an act of Congress, but little is known about how unmarried parents experience this process. This study presents reactions from 81 racially/ethnically diverse, low-income parents. A qualitative analysis of semi-structured interviews revealed three overall themes and six subthemes: (1) paternity establishment process [subthemes: variety of experiences, strong emotional experience, and poor timing]; (2) meaning of paternity establishment [subthemes: responsible fatherhood, symbol of commitment to child, and importance of the child knowing his father's identity]; and (3) paternity establishment decision-making...
2018: Journal of Health Care for the Poor and Underserved
Tanjala S Purnell, Jessie Kimbrough Marshall, Israel Olorundare, Rosalyn W Stewart, Stephen Sisson, Brian Gibbs, Leonard S Feldman, Amanda Bertram, Alexander R Green, Lisa A Cooper
As part of a cultural competence needs assessment study at a large academic health care system, we conducted a survey among 1,220 practicing physicians to assess their perceptions of the organization's cultural competence climate and their skills and behaviors targeting patient-centered care for culturally and socially diverse patients. Less than half of providers reported engaging in behaviors to address cultural and social barriers more than 75% of the time. In multivariable logistic regression models, providers who reported moderate or major structural problems were more likely to report low skillfulness in identifying patient mistrust (aOR: 2...
2018: Journal of Health Care for the Poor and Underserved
Christoph Pimmer, Francis Mbvundula
Health workers' use of counselling information on their mobile phones for health education is a central but little understood phenomenon in numerous mobile health (mHealth) projects in Sub-Saharan Africa. Drawing on empirical data from an interpretive case study in the setting of the Millennium Villages Project in rural Malawi, this research investigates the ways in which community health workers (CHWs) perceive that audio-counselling messages support their health education practice. Three main themes emerged from the analysis: phone-aided audio counselling (1) legitimises the CHWs' use of mobile phones during household visits; (2) helps CHWs to deliver a comprehensive counselling message; (3) supports CHWs in persuading communities to change their health practices...
2018: Journal of Health Care for the Poor and Underserved
Shariska S Petersen, Marianna Sarkissyan, Yanyuan Wu, Sheila Clayton, Jaydutt V Vadgama
BACKGROUND: Time to clinical follow-up after an abnormal mammogram may be a significant factor contributing to breast cancer health disparities. OBJECTIVE: Evaluate time to follow-up in a cross-sectional cohort of African American and Hispanic women who obtained mammogram screening at a county facility. METHODS: Time to follow-up was assessed in days after an abnormal mammogram to subsequent clinical care in a cross-sectional study of 74 women...
2018: Journal of Health Care for the Poor and Underserved
S Christopher Owens, Yolanda Rainey, Pamela Tucker, Brian Edmunds
BACKGROUND: To meet the expanding need for physical therapists universities are under increasing pressure to enroll, educate, and train physical therapists. Poor academic performance can result in student dismissal from a physical therapy program. The purpose of this study is to determine if implementation of a retention program would improve student academic performance in the foundational science curriculum in a physical therapy program. METHODS: A prospective observational cohort design was used...
2018: Journal of Health Care for the Poor and Underserved
J Nwando Olayiwola, Rachel Willard-Grace, Kate Dubé, Danielle Hessler, Rebecca Shunk, Kevin Grumbach, Laura Gottlieb
PURPOSE: Primary care physicians (PCP) experience high rates of professional burnout. These symptoms may be magnified in underserved populations. This study explores relationships between clinic capacity to address patients' social needs (SN) and PCP burnout. METHODS: We conducted a cross-sectional survey of PCPs from three delivery systems in San Francisco. Surveys included three components of burnout, measured by the Maslach Burnout Inventory (MBI) and a four-item instrument exploring attitudes, confidence, individual skills and organizational capacity to address patients' SN...
2018: Journal of Health Care for the Poor and Underserved
Elizabeth Ojukwu, Lauren R Powell, Sharina D Person, Milagros C Rosal, Stephenie C Lemon, Jeroan Allison
African Americans remain underrepresented in health-related research. We examined the association between spirituality using the Self-Rating Spirituality Scale (range 6-24) and self-reported willingness to participate in health-related research studies among African Americans. Covariates included gender, education level, employment status, and previous research experience. Adjusted associations were calculated with logistic regression models, with multiple imputation to account for missing data. Results from the logistic regression model show that each one-point increase in the Self-Rating Spirituality Scale was associated with a 24% increase in the odds of being very likely to participate in research (OR: 1...
2018: Journal of Health Care for the Poor and Underserved
Bisola O Ojikutu, Laura M Bogart, David J Klein, Frank H Galvan, Glenn J Wagner
Here, we examined the association of exposure to neighborhood crime with sexual risk-taking behavior among Black men living with HIV. HIV-positive Black men on antiretroviral therapy in California completed an audio computer-assisted self-interview. Crime risk per census block group was derived from the Federal Bureau of Investigation's Uniform Crime Report. Among 193 men, the mean (SD) number of sexual partners among those who were sexually active was 2.7 (3.3). 49% reported condomless sex, and 23% reported sex with an HIV-negative or unknown-serostatus partner...
2018: Journal of Health Care for the Poor and Underserved
Kathleen M Nemer, Larry R Churchill
The purpose of this study was to identify physician actions that facilitate meaningful doctor-patient relationships, from the perspective of the medically underserved patient. Twenty-five patients were interviewed at the United Neighborhood Health Services Northeast Clinic in Nashville, Tennessee, which serves an underinsured patient population. Patients were asked to identify the qualities of engagement with their doctor that move beyond simple diagnosis and treatment. Interviews were audio-recorded, professionally transcribed, made anonymous, and analyzed by the grounded theory method of qualitative research...
2018: Journal of Health Care for the Poor and Underserved
Rainier Masa, Gina Chowa, Victor Nyirenda
The objective of this study was to evaluate the impact of Chuma na Uchizi, a livelihood intervention for people living with HIV (PLHIV) in rural Eastern Province, Zambia, on food security. The intervention included cash transfers to purchase income-generating assets, access to a savings account, and life-skills training. The study employed a non-equivalent groups design to compare intervention (n = 50) and control participants (n = 51) who were receiving outpatient care from two comparable health facilities in distinct constituencies in the same geographic area...
2018: Journal of Health Care for the Poor and Underserved
Akiko Kamimura, Mu Pye, Kai Sin, Maziar M Nourian, Nushean Assasnik, Mary Stoddard, Caren J Frost
The purpose of this study was to examine the health and well-being of women migrating from predominantly Muslim countries to the U.S. Women from predominantly Muslim countries completed a paper survey on the following topics from June to December in 2016 (N=102): depression; physical functioning; self-reported general health; experiences with health care; and demographic characteristics. There were several women's health-related issues: low rates for mammography and Pap smear screening, and preference for female physicians and/or physicians from the same culture...
2018: Journal of Health Care for the Poor and Underserved
Njoroge Kamau, Haron Njiru
Kenya has undergone rapid urbanization as people migrate to the cities in search of economic opportunities. This has given rise to informal settlements characterized by overcrowding, poor infrastructure, and inadequate social amenities. A cross-sectional study on water, sanitation, and hygiene (WASH) status was carried out in Mathare, an informal settlement in Nairobi. A random sample of 380 households was used. The average household size was five people, and 26% of the household heads had completed secondary or higher level of education...
2018: Journal of Health Care for the Poor and Underserved
Anthony Jerant, Mark C Henderson, Erin Griffin, Efrain Talamantes, Tonya Fancher, Francis Sousa, Peter Franks
Multiple Mini-Interviews (MMIs) are increasingly used in medical school admissions. We previously reported that while under-represented minority (URM) status was not associated with MMI scores, self-designated disadvantaged applicants had lower MMI scores, possibly affecting their matriculation prospects. No studies have examined how URM status or socioeconomic disadvantage (SED) are associated with academic performance following admission through an MMI. We examined the adjusted associations of MMI scores, SED, and URM status with U...
2018: Journal of Health Care for the Poor and Underserved
Lucy Annang Ingram, Chiwoneso B Tinago, Bo Cai, Louisiana Wright Sanders, Tina Bevington, Sacoby Wilson, Kathryn M Magruder, Erik Svendsen
Psychological stressors have been observed immediately following disasters, yet less is known about the long-term effects on the mental health of vulnerable communities. In 2005, Graniteville, S.C. was ravaged by a train derailment that leaked approximately 60 tons of chlorine gas and left several people dead in the small community. The purpose of this study was to examine the mental health of Graniteville-area residents in the nine years following the train disaster using a mixed methods approach. Using the photovoice method, participants reported compromised mental health with symptoms consistent with depression, post-traumatic stress disorder, fear, and anxiety...
2018: Journal of Health Care for the Poor and Underserved
Elena Cyrus, Diana M Sheehan, Kristopher Fennie, Mariana Sanchez, Christyl T Dawson, Marsha Cameron, Lorene Maddox, Mary Jo Trepka
Prompt HIV diagnosis decreases the risk of HIV transmission and improves health outcomes. The study objective was to examine rates of delayed HIV diagnosis among non-Latino Black Caribbean immigrants in Florida. The sample included 39,008 Black HIV-positive individuals, aged 13 or older from the Caribbean and the mainland U.S. Delayed HIV diagnosis was defined as AIDS diagnosis within three months of HIV diagnosis. After adjusting for demographic factors, year of HIV diagnosis, transmission mode, neighborhood level socioeconomic status, and rural-urban residence, a disparity persisted for Caribbean-born Blacks in the Bahamas and Haiti compared with U...
2018: Journal of Health Care for the Poor and Underserved
Yolanda Covington-Ward, Kafuli Agbemenu, Annamore Matambanadzo
BACKGROUND: This study examines stress and stress management from the perspective of African immigrants in southwestern Pennsylvania. Our research questions explore how participants define stress, the most common causes of stress, manifestations of stress, and common strategies for stress management. METHODS: We conducted a descriptive, cross-sectional, qualitative study with 34 African immigrants. Data were collected via three focus groups. Qualitative data were audio-recorded, transcribed verbatim, and analyzed to identify common themes...
2018: Journal of Health Care for the Poor and Underserved
Andrea N Burnett-Hartman, Scott V Adams, Aasthaa Bansal, Jean A McDougall, Stacey A Cohen, Andrew Karnopp, Victoria Warren-Mears, Scott D Ramsey
PURPOSE: We aimed to determine whether the association between late-stage cancer and American Indian/Alaska Native (AI/AN) race differed by enrollment in the Indian Health Service Care System (IHSCS). METHODS: We used Surveillance, Epidemiology, and End Results (SEER) data linked to Medicare files to compare the odds of late-stage breast, colorectal, lung, or prostate cancer between non-Hispanic Whites (NHWs) (n=285,993) and AI/ANs with (n=581) and without (n=543) IHSCS enrollment...
2018: Journal of Health Care for the Poor and Underserved
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