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Journal of Health Care for the Poor and Underserved

Donaldson F Conserve, Keren Middelkoop, Gary King, Linda-Gail Bekker
We examined factors associated with discussing HIV and condom use with a sexual partner. Two cross-sectional surveys were conducted in 2004 prior to the implementation of an HIV awareness campaign in a South African community and in 2008 after a three-year education program. Overall, the proportion of individuals who had discussed HIV with a sexual partner increased from 76% in 2004 to 89% in 2008 (p < .001). Among respondents who had sex six months before completing the surveys, condom use significantly increased from 64% in 2004 to 79% in 2008 (p < ...
February 2016: Journal of Health Care for the Poor and Underserved
Dominic Mack, Shun Zhang, Megan Douglas, Charles Sow, Harry Strothers, George Rust
This study evaluates electronic health record (EHR) adoption by primary care providers in Georgia to assess adoption disparities according to practice size and type, payer mix, and community characteristics. Frequency variances of EHR "Go Live" status were estimated. Odds ratios were calculated by univariate and multivariate logistic regression models. Large practices and community health centers (CHCs) were more likely to Go Live (>80% EHR adoption) than rural health clinics and other underserved settings (53%)...
February 2016: Journal of Health Care for the Poor and Underserved
Kinna Thakarar, Jake R Morgan, Jessie M Gaeta, Carole Hohl, Mari-Lynn Drainoni
BACKGROUND: The importance of HIV viral suppression is widely known, however few studies have examined the effects of homelessness on HIV viral suppression. METHODS: The study included HIV-seropositive patients in a health care for the homeless program (HCH). Electronic medical record data for 138 patients were analyzed to compare demographic characteristics, health characteristics, and utilization by housing status. For the 95 individuals with available HIV viral loads, multivariable logistic analysis was performed to examine factors associated with incomplete viral suppression...
February 2016: Journal of Health Care for the Poor and Underserved
Gyasi Moscou-Jackson, Jerilyn Allen, Michael T Smith, Carlton Haywood
BACKGROUND: The Insomnia Severity Index (ISI) is an instrument to evaluate insomnia symptoms. The psychometric properties have not been established in adults (18 years of age or older) with sickle cell disease (SCD). OBJECTIVE: Evaluate the reliability and validity of the ISI among adults with SCD. METHODS: Analysis included psychometric evaluation with exploratory factor analysis. RESULTS: Our 263 participants had a mean age of 35...
February 2016: Journal of Health Care for the Poor and Underserved
Kelly Brittain, Shannon M Christy, Susan M Rawl
African Americans have higher colorectal cancer (CRC) mortality rates. Research suggests that CRC screening interventions targeting African Americans be based upon cultural dimensions. Secondary analysis of data from African-Americans who were not up-to-date with CRC screening (n=817) was conducted to examine: 1) relationships among cultural factors (i.e., provider trust, cancer fatalism, health temporal orientation (HTO)), health literacy, and CRC knowledge; 2) age and gender differences; and 3) relationships among the variables and CRC screening intention...
February 2016: Journal of Health Care for the Poor and Underserved
Charles P Mouton, Margaret K Hargreaves, Jianguo Liu, Saudat Fadeyi, William J Blot
OBJECTIVES: Adverse childhood experiences (ACE) can affect health in adulthood. We investigate the relationship between childhood experiences and adult cancer risk and screening behaviors in a racially diverse, low income population. METHODS: Nearly 22,000 adults 40 years and older in the Southern Community Cohort Study were administered the ACE questionnaire. We estimated odds ratios (OR) for the prevalence of smoking, alcohol consumption, BMI and five cancer screening methods in relation to the ACE score...
February 2016: Journal of Health Care for the Poor and Underserved
Bowen Chung, Arleen Brown, Gerardo Moreno, Pattie Cuen, Visith Uy, Sitaram Vangala, Douglas Bell, A Eugene Washington, Keith C Norris, Carol Mangione
This manuscript describes the development and implementation of community engagement as a mission at UCLA's David Geffen School of Medicine (DGSOM) and UCLA Health System, and summarizes survey results documenting existing community-engaged projects and interest between 2010 to 2013.
February 2016: Journal of Health Care for the Poor and Underserved
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2016: Journal of Health Care for the Poor and Underserved
Iulia D Ursan, Jerry A Krishnan, A Simon Pickard, Elizabeth Calhoun, Robert DiDomenico, Valentin Prieto-Centurion, Jamie B Sullivan, Lauren Valentino, Mark V Williams, Min Joo
Limited socioeconomic resources contribute to high readmission rates at minority serving institutions (MSIs). A better understanding of patient-level factors and need for patient navigators could inform approaches to enhance care transitions tailored to these vulnerable patient populations. We sought to understand the perspectives of patients and their caregivers about hospital to home transitions from an MSI, as well as their attitudes about patient navigators to facilitate care transitions. We conducted qualitative research using focus groups (FGs)-five disease-specific patient FGs and two caregiver FGs, including 23 patients and 10 caregivers...
2016: Journal of Health Care for the Poor and Underserved
Patricia O'Campo, Rhonda BeLue, Heidi Borenstein, Maxine Reed-Vance, Robin Gaines Lanzi, Peter Schafer, Loretta Jones, Richard Woolord
The inclusion of biomarkers in studies of stress and health outcomes is of growing interest, including for community-based participatory research (CBPR) studies. Yet the perspectives of participants and communities have been infrequently consulted to inform the biomarker collection process. The objective of this paper is to describe the process and outcomes of using CBPR in framing biomarker collection in a study of allostatic load in a maternal and child health population. Through analysis of focus group data, we identify aspects of CBPR that facilitate increased community trust and endorsement related to collecting biological samples, and also provide a community perspective that is often overlooked in the literature...
2016: Journal of Health Care for the Poor and Underserved
Darrell L Hudson, Kimberly A Kaphingst, Merriah A Croston, Melvin S Blanchard, Melody S Goodman
We examined the prevalence of mental disorders in a primary care setting affiliated with a large academic medical center. We also examined whether there were racial differences in mental health disorders. Patients were seeking medical care in an outpatient medical clinic; mental health data were available for them via medical records (n=767). Overall, 45% of patients had a diagnosed mental health problem; the most commonly reported form of mental disorder was depression. African Americans (OR= 1.88; CI: 1.21-2...
2016: Journal of Health Care for the Poor and Underserved
Michael Hochman, Medell Briggs-Malonson, Erin Wilkes, Jonathan Bergman, Lauren Patty Daskivich, Tannaz Moin, Ilanit Brook, Gery W Ryan, Robert H Brook, Carol M Mangione
In 2007, the Martin Luther King, Jr.-Harbor Hospital (MLK-Harbor), which served a large safety-net population in South Los Angeles, closed due to quality challenges. Shortly thereafter, an agreement was made to establish a new hospital, Martin Luther King, Jr. Community Hospital (MLKCH), to serve the unmet needs of the community. To assist the newly appointed MLKCH Board of Directors in building a culture of quality, we conducted a series of interviews with five high-performing hospital systems. In this report, we describe our findings...
2016: Journal of Health Care for the Poor and Underserved
Jennifer Hamm, Lee Hilliard, Thomas Howard, Jeffrey Lebensburger
Traveling to and from university-based clinics is a major health care barrier for children with sickle cell disease in Alabama. To reduce this barrier, the University of Alabama at Birmingham (UAB) developed satellite clinics. This study seeks to determine if these satellite clinics provide a similar level of comprehensive care when compared with the university-based clinic using four surrogate markers: 1) attendance rates, 2) percentage of patients on hydroxyurea, 3) percentage of screening MRIs obtained, and 4) percentage of transcranial dopplers (TCD) completed...
2016: Journal of Health Care for the Poor and Underserved
Audrey H Calderwood, Paul C Schroy, Matthew A Kluge, Howard J Cabral, James F Burgess
OBJECTIVE: To identify predictors of adherence with surveillance colonoscopy at a safety-net hospital. METHODS: We evaluated average-risk patients aged 50-75 with adenomas diagnosed at screening colonoscopy between 1/1/05-12/31/07. The primary outcome was on-time follow-up defined as attendance at surveillance colonoscopy within 5.5 years of screening colonoscopy. RESULTS: Among 881 patients, of whom 38% were English-speaking non-Hispanic Blacks, 38...
2016: Journal of Health Care for the Poor and Underserved
Elizabeth Lightfoot, Jennifer Blevins, Terry Lum, Amano Dube
This community-based participatory research study sought to identify the cultural health assets of the Somali and Oromo communities in one Minnesota neighborhood that could be mobilized to develop culturally appropriate health interventions. Community asset mappers conducted 76 interviews with Somali and Oromo refugees in in Minnesota regarding the cultural assets of their community. A community-university data analysis team coded data for major themes. Key cultural health assets of the Somali and Oromo refugee communities revealed in this study include religion and religious beliefs, religious and cultural practices, a strong culture of sharing, interconnectedness, the prominence of oral traditions, traditional healthy eating and healthy lifestyles, traditional foods and medicine, and a strong cultural value placed on health...
2016: Journal of Health Care for the Poor and Underserved
Nicholas Arlas, Harry Jergesen
Factors endemic in safety-net hospitals may breed poor outcomes in hip and knee arthroplasty. This review highlights these challenges and discusses strategies to reduce operative risk and promote better surgical outcomes. Sub-optimally managed medical co-morbidities, poverty, and substance abuse are examples of challenges common in safety-net hospital populations and are associated with poor surgical outcomes. Patient management strategies that positively affect surgical outcomes may be nonexistent, underfunded, or underused...
2016: Journal of Health Care for the Poor and Underserved
Patrick J Dillon, Ambar Basu
Over the past decade, scholars and practitioners have called for efforts to reduce disparities in the cost and quality of end-of-life care; a key contributor to these disparities is the underuse of hospice care by African American patients. While previous studies have often relied on interviewing minority individuals who may or may not have been terminally ill, among them only few who were using hospice care services, this essay reports the findings of a grounded theory analysis of interviews with 26 African American hospice patients (n = 10) and lay caregivers (n = 16)...
2016: Journal of Health Care for the Poor and Underserved
Jalie A Tucker, Cathy A Simpson, Susan D Chandler, Casey A Borch, Susan L Davies, Shatomi J Kerbawy, Terri H Lewis, M Scott Crawford, JeeWon Cheong, Max Michael
Emerging adulthood often entails heightened risk-taking with potential life-long consequences, and research on risk behaviors is needed to guide prevention programming, particularly in under-served and difficult to reach populations. This study evaluated the utility of Respondent Driven Sampling (RDS), a peer-driven methodology that corrects limitations of snowball sampling, to reach at-risk African American emerging adults from disadvantaged urban communities. Initial "seed" participants from the target group recruited peers, who then recruited their peers in an iterative process (110 males, 234 females; M age = 18...
2016: Journal of Health Care for the Poor and Underserved
Shaniece Criss, Dahiana Rodriguez, Roberta E Goldman
Our qualitative study examined how stresses of daily life affected substance use and perceived risk among Black and Hispanic adolescents. We conducted 11 focus groups with students aged 13-25 in public and alternative schools in Providence, Rhode Island, using Bourdieu's Social Practice theoretical approach to guide questioning and data analysis. Despite participants' frequent marijuana use, they perceived the emphasis society places on substance use as misguided, obfuscating the persistence of more critical problems such as stress and reduced opportunity resulting from neighborhood violence, poor schools, financial difficulties, and home troubles...
2016: Journal of Health Care for the Poor and Underserved
Ugo Ikwuka, Niall Galbraith, Ken Manktelow, Josephine Chen-Wilson, Femi Oyebode, Rosemary C Muomah, Anuli Igboaka
The striking gaps in formal mental health care in the developing world are largely traceable to Instrumental and Ideological Barriers. Focusing on south-eastern Nigeria, the study aimed to establish the relative weight, significance and determinants of these barriers for prioritised policy interventions. Multistage sampling method was used to select participants (n = 706) to whom questionnaires were administered. Ideological Barriers (cultural and mental health literacy constraints) were more significantly perceived (84...
2016: Journal of Health Care for the Poor and Underserved
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