Availability Of Community Resources Research Articles

131 A review of the implementation of a specialist older persons 7 day service within an acute setting

Abstract Background As part of Winter Planning Initiatives 2021–2023 additional funding was allocated to expand the service being offered to older persons within the acute hospital setting, across the disciplines of Occupational Therapy (OT), Physiotherapy (PT) and Nursing. This is aimed at providing a person centred 7 day service, supporting admission avoidance and promoting patient flow through the hospital by enhancing timely discharges and transfers of care. Methods Referrals to the specialist older persons service were primarily received from the Homefirst team (Frailty at the front door). Those who were referred had been admitted onto an acute ward and had been identified as requiring specialist therapy input to enhance the quality of their stay in addition to supporting safe and timely discharges home or transfers of care. A comprehensive OT assessment was carried out with all patients. A reduced 7 day service was commenced in order to gather information to assist future service planning. Results 2 Occupational Therapists were recruited prior to additional team members therefore, initial referrals accepted were those with identified OT needs. All referrals were accepted with a triaging system being developed as the service became more established. All referrals had a Clinical Frailty Score (CFS) of between 3–7. Patient Outcomes included discharge direct to home or transfer of care including rehab, stepdown, nursing home and hospice facilities. These outcomes were impacted by social support systems, availability of community resources and limited access to ongoing specialist team input. Conclusion The introduction of a specialist older persons 7 day service working within an integrated model of care, has wide ranging impacts for patients and the organisation. Access to specialist acute older persons services provides targeted assessment and intervention, supporting early decision making, quality and flow.

Negotiating the care convoys for a diverse group of older Australians living in rural communities: a large qualitative study

AbstractWhilst ageing in place is integral to international policy, there is less understanding of how individuals utilise formal services and informal supports in diverse rural environments to maintain their wellness and independence. Consequently, how older people negotiate their care within rural communities is subject to misconceptions. This paper draws on the convoy of care model to explore how older rural Australians negotiate their preferences and needs in the context of informal networks, availability of community resources, and the health and aged care system. The analysis draws on 60 in-depth interviews in six diverse rural communities across two Australian states. Three distinct care convoys are identified and demonstrate the interaction of multiple factors including individual preferences and needs, availability of family and community supports, and accessibility of local health and aged care services in the context of resource allocation. The findings highlight how families and communities compensate for a lack of accessible formal services. For older people without family and strong social networks, formal services are relied upon despite their inadequacy in some locales. This research has provided evidence that some Australian rural locales have limited resources resulting in challenges for older people to access home care and support. This results in many older people facing challenges to age in place. With aged care and health policy commonly designed for an urban context, our findings illustrate the importance of tailoring policy to respect the strengths and challenges existing in rural communities.

A formal evaluation of The Ottawa Hospital Pain Clinic orientation session: A quality improvement project

ABSTRACT Background Chronic pain affects approximately one in every five Canadians and has a substantial impact on psychological well-being, relationships, ability to attend work or school, and overall functioning.The Ottawa Hospital Pain Clinic introduced orientation sessions, with the aim of providing new patients with pain education to help prepare patients for engagement with multimodal pain management strategies. This report summarizes the results of a formative evaluation of the orientation session at The Ottawa Hospital Pain Clinic to determine whether patients perceived the orientation session as beneficial. Methods Interviews were conducted, transcribed, and then thematically analyzed to understand patients’ perspectives on the orientation session. Coding was done by two team members using the constant comparison analyses method with key ideas, concepts, and patterns identified and compared to identify similarities. Results Between September 6 and October 18, 2019, 18 patients attended an orientation session and 12 consented to participation and completed telephone interviews. The six themes identified included (1) feeling of community, (2) participants feeling heard by providers, (3) appreciation of the holistic approach, (4) availability of community resources, (5) barriers to access, and (6) discordant feelings of preparedness for the physician appointment. Conclusion Results from this evaluation indicate that the orientation session offered at The Ottawa Hospital Pain Clinic improves chronic pain literacy, reduces feeling of isolation, and instills hope. As such, it appears to be a valuable component of pain clinic programs.

Conducive Learning Environment: Avenue in Coping Student’s Struggle in the New Normal

This research was entitled “Conducive Learning Environment: Avenue in Coping Student’s Struggle In The New Normal”. The primary purpose of this study is to build conducive learning environment as an avenue in coping students’ struggle in New Normal. The researcher wanted to utilize conducive learning environment in aiding the struggles of the students. The accomplishment of this study can help greatly the presentation of topic in TLE subjects. Specifically, it assessed the level of conducive learning environment in terms of attainment of learning objectives, use of varied performance tasks, availability of community resources, and managing support system; assessed the level of students’ struggles in terms of evaluation performance, self-instruction, absence of classroom environment and teamwork; and lastly significant difference of conducive learning environment to the level of students’ struggles. The researcher employed descriptive quantitative as its research design. The research respondents of this study composed of one hundred (100) TVL Grade 11 senior high school students who were purposively chosen by the researcher based on the needs of this study. The research locale of this study focused on Camp Vicente Lim Integrated High School. The researcher developed a Likert scale questionnaire as the main research instrument tool. It composed of five statements per indicator assessed on objectives.

Intersecting systemic and personal barriers to accessing social services: qualitative interviews in northern California

BackgroundAddressing social risks in the clinical setting can increase patient confidence in the availability of community resources and may contribute to the development of a therapeutic alliance which has been correlated with treatment adherence and improved quality of life in mental health contexts. It is not well understood what barriers patients face when trying to connect to community resources that help address social risks. This paper aims to describe patient-reported barriers to accessing and using social needs-related resources to which they are referred by a program embedded in a safety net primary care clinic.MethodsThis is a qualitative assessment of patient-reported barriers to accessing and using social needs assistance programs. We conducted over 100 in-depth interviews with individuals in Northern California who participated in a navigation and referral program to help address their social needs and describe a unique framework for understanding how policies and systems intersect with an individual’s personal life circumstances.ResultsIndividuals described two distinct domains of barriers: 1) systems-level barriers that were linked to the inequitable distribution of and access to resources, and 2) personal-level barriers that focused on unique limitations experienced by each patient and impacted the way that they accessed services in their communities. While these barriers often overlapped or manifested in similar outcomes, this distinction was key because the systems barriers were not things that individuals could control or overcome through their own initiative or by increasing individual capacity.ConclusionsRespondents describe intersecting systemic and personal barriers that compound patients’ challenges to getting their social needs met; this includes both a picture of the inequitable distribution of and access to social services and a profile of the limitations created by individual life histories. These results speak to the need for structural changes to improve adequacy, availability, and accessibility of social needs resources. These findings highlight the need for advocacy to address systems barriers, especially the stigma that is faced by people who struggle with a variety of health and social issues, and investment in incentives to strengthen relationships between health care settings and social service agencies.

Caregiver Knowledge of Long-Term Services and Supports: Effects of Rurality and Support

Caregivers often lack knowledge regarding available long-term services and supports (LTSS). Certain barriers, such as rurality and levels of social support, may contribute to a lack of knowledge and accessibility of LTSS. The Caregiver Beginnings Workshop, held in 12 communities throughout 11 counties in Iowa, was a one-time educational session created to increase knowledge and awareness of LTSS. Data were collected from pre- and post-tests completed during the workshop (N = 98). To assess caregivers’ initial knowledge of LTSS, a hierarchical regression model was estimated to examine knowledge of LTSS in caregivers as predicted by caregiver education, number of health problems in care recipient, relationship type, feelings of social support, and rurality. Results showed that rurality (β = 0.33, p = 0.047) and infrequent or no support (β = -0.30, p = 0.02) were significant predictors (R2 = 0.21), indicating that caregivers living in rural areas reported higher knowledge of LTSS and those who reported infrequent or no support reported less knowledge. Additional analyses examined county-level data to better understand the availability of community resources in rural areas. County-level variables (e.g., number of home healthcare services, education level, income, health status) were included in a regression model to predict knowledge of LTSS. The results indicated that median income (β = -0.32, p = 0.002) and an educational attainment of an associate’s level degree or higher (β = -0.30, p = 0.004) were significant predictors. Discussion focuses on the importance of support and accessible resources for caregivers in all geographic areas.

Abstract PO-039: The African American Cancer Survivor Network study: Utilizing social support and social networks to address unmet needs and challenges of African American cancer survivors

Abstract Introduction: More research is needed to understand the role of social support and social networking in addressing the unmet needs experienced by African American cancer survivors, as well as the effects of such programs. A study of low income African American cancer survivors documented their need for support services, especially emotional support, in their own neighborhoods. Our study continues this work to explore the unmet needs and challenges of this population. Methods: We conducted five 90-minute focus groups with cancer survivors, and 1 focus group and 5 interviews with service providers and key informant leaders. Focus groups were audio-recorded and transcripts were checked for accuracy and maintained in MAXQDA. Transcripts were independently coded while the team collectively discussed interpretations, created corresponding codes, and categorized codes into larger representative groups. Results: Twenty-six participants have completed a focus group or interview to date (n =16 survivors, n=10 key informants). Survivor participants’ ages range from 44 to 78 years. Survivor participants’ cancer types are primarily breast, but also includes colon and lung, among others. Key informant interviews included oncologists, nurses, navigators, and peer leaders. Key topics that emerged were health literacy, treatment costs, limited support groups, and community resources. As one key informant describes, “A lot of the African- American cancer survivors that I've worked with, they don't have -They're not given enough resources. They don't know about the Nurse Navigators, they don't know about a lot of things that they -They don't know about American Cancer Society (sic) or, you know, the things that are offered to them.” Yet other survivors have leveraged the expertise of their peers through cancer support groups to meet their needs. As one survivor describes, “the most helpful thing that I've found once I was diagnosed was [to] meet another woman who was also diagnosed. That was the most helpful thing I found.” Conclusions: African American cancer survivors face many challenges and unmet needs around survivorship care. Our next step is to develop an intervention that raise awareness of minority-led support groups; improve the knowledge and availability of community resources; and connect individuals to local resources. Citation Format: Jamila L. Kwarteng, Staci Young, Bria Grant, Melinda R. Stolley. The African American Cancer Survivor Network study: Utilizing social support and social networks to address unmet needs and challenges of African American cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-039.

Examining contextual and relational factors influencing perceptions of societal and interpersonal mattering among rural youth.

Researchers have shown that interpersonal and societal mattering have important implications for adolescent development. Yet, few researchers have focused on what predicts mattering, particularly societal mattering, and even fewer have studied mattering among rural youth. Thus, the purpose of this study is to explore how perceived contextual and relationship factors affect rural youths' perceptions of societal and interpersonal mattering. Participants for this study were 381 middle school youth from two rural school districts in Michigan. Using structural equation modeling, we found that more positive perceptions regarding opportunities for youth involvement, availability of community resources, student input in decision-making at school, and support for autonomy at school were associated with greater perceptions of societal mattering. In addition, greater support from friends, higher quality parent-child communication, and more parental involvement were associated with a greater sense of interpersonal mattering. This study identifies important relational and contextual factors that can be enhanced in an effort to foster greater perceptions of interpersonal and societal mattering among rural youth, and ultimately help us to promote positive youth development.

Resource Well-Being among Family Child Care Business Owners

Family child care, a paid child care service operated out of a care provider’s home, is a common child care choice for working parents. While studies show positive associations between providers’ income and care quality, little is known about their resource management and perceived resource well-being. Using surveys and interviews, this study explored the association between household income and overall perceived resource well-being among seven family child care providers in the Los Angeles, California area. The surveys offered providers’ demographic information and characteristics about their child care businesses. The analysis of the interview data identified four resource well-being themes regarding perceptions about: past and present economic situations, demands on time, contributions providers’ family members make to support the business functions, and quality and availability of community resources. The findings suggest household income predicts little about how providers perceive their overall resource well-being. Understanding income as only a part of resource management may better elucidate links between income and child care quality. Discussions include implications for financial counselors and planners.

3107 Understanding barriers to and facilitators of a healthy lifestyle of Hispanic adults with end stage renal disease in hemodialysis: Intensive Development and Experiences in Advancement of Research and Increased Opportunities (IDEARIO)

OBJECTIVES/SPECIFIC AIMS: Physical inactivity and mineral imbalances greatly contribute to morbidity and mortality in patients with end-stage renal disease (ESRD). Barriers for engaging in physical activity and adhering to the hemodialysis diet have been reported predominantly with white participants from countries other than Puerto Rico. Therefore, this study’s aims were to explore the barriers and facilitators that Hispanic adults with end-stage renal disease encountered for engaging in physical activity and adhering to the hemodialysis diet. METHODS/STUDY POPULATION: Three focus groups were conducted among 19 adults living with ESRD who received services from a renal center in Puerto Rico. Sessions were recorded, transcribed, and coded first using inductive methods. RESULTS/ANTICIPATED RESULTS: The presence of fatigue, lack of acceptance of the renal condition, and lack of knowledge of appropriate exercises for patients in hemodialysis were the most frequently reported barriers to engage in physical activities. Cost of the renal diet, limited availability of the renal diet products, the restrictive nature and the lack of Puerto Rican taste of the renal diet, and inadequate educational materials were the most frequent barriers to adhere to the hemodialysis diet reported by the sample. The most commonly reported facilitators to engaging in physical activities were having a positive attitude, opportunities for group exercises, and listening to Hispanic music while exercising. Health benefits, family support, having financial resources, availability of community resources, and having willpower were the most commonly reported facilitators to adhere to the hemodialysis diet. DISCUSSION/SIGNIFICANCE OF IMPACT: We identified a number of culturally relevant individual, interpersonal, institutional, and community-related barriers and facilitators to physical activity and adherence to the hemodialysis diet in patients with ESRD living in Puerto Rico. Evidence-based solutions to overcome these barriers and strategies for enhancing these facilitators should be addressed in future studies aimed at increasing the level of physical activity and increasing adherence to the hemodialysis diet in patients with ESRD living in Puerto Rico.

Availability of post-hospital services supporting community reintegration for children with identified surgical need in Uganda

BackgroundCommunity services and supports are essential for children transitioning home to recover from the hospital after surgery. This study assessed the availability and geographic capacity of rehabilitation, assistive devices, familial support, and school reintegration programs for school-aged children in Uganda with identified surgical need.MethodsThis study assessed the geographic epidemiology and spatial analysis of resource availability in communities in Uganda. Participants were children with identified surgical need using the Surgeons OverSeas Assessment of Surgical need (SOSAS). Community-based resources available to children and adolescents after surgery in Uganda were identified using publicly available data sources and searching for resources through consultation with in-country collaborators We sought resources available in all geographic regions for a variety of services.ResultsOf 1082 individuals surveyed aged 5 to 14 yearsr, 6.2% had identified surgical needs. Pediatric surgical conditions were most prevalent in the Northern and Central regions of Uganda. Of the 151 community-based services identified, availability was greatest in the Central region and least in the Northern region, regardless of type. Assuming 30% of children with surgical needs will need services, a maximum of 50.1% of these children would have access to the needed services in the extensive capacity estimates, while only 10.0% would have access in the minimal capacity estimates. The capacity varied dramatically by region with the Northern region having much lower capacity in all scenarios as compared to the Central, Eastern, or Western regions.ConclusionsOur study found that beyond the city of Kampala in the Central region, community-based services were severely lacking for school-aged children in Uganda. Increased pediatric surgical capacity to additional hospitals in Uganda will need to be met with increased availability and access to community-based services to support recovery and community re-integration.

Supporting Diabetes Management—Perspectives on Care Management in a Medicaid Health Home in Alabama

Background: Chronic diseases like diabetes require constant and ongoing self-management. The Health Home model provides a unique platform to facilitate diabetes management and connect patients to community resources that support and promote self-management. However, little is known about specific activities, barriers, and needs that exist in Health Homes particularly in Alabama which suffers disparately high rates of diabetes compared to other regions. To address this knowledge gap, the purpose of this study is to understand how a Medicaid Health Home facilitates diabetes management in Alabama. Methods: Three interviewers conducted semi-structured interviews with six staff at a health home organization. A guide facilitated discussion on patient recruitment, frequency and mode of communication with patients and health care delivery team, and clinical and non-clinical patient-related barriers. Content analysis was performed to identify major themes using an iterative, combined deductive and inductive approach. Results: Six female participants were aged a mean 49 years; majority employed 4 to 5 years in current role. Professional qualifications included a dietician, social worker, and nurses. Five care management domains were identified: health education, medication management, nutrition therapy, and addressing psychosocial issues. Facilitators of staff roles discussed were a high degree of collaboration within their organization and externally with providers and other professionals. For example, staff described the value of reciprocal relationships in which providers interacted with the health home. Barriers to care management included state Medicaid cost-sharing policies, medication limits, timely access to care, and variation in the availability of community resources. Conclusions: These findings suggest that opportunities exist to intervene at the policy and healthcare system level to improve adult diabetes management for a vulnerable population. Disclosure A.A. Agne: None. F. Mondesir: None. J.P. Shelley: None. M. Pisu: None. A. Cherrington: Advisory Panel; Self; AstraZeneca. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. Consultant; Self; Novo Nordisk Inc..

The Variables Associated With Health Promotion Behaviors Among Urban Black Women.

To improve understanding of variables impacting health promotion behaviors among urban Black women. A cross-sectional survey was used. Urban Black women (N = 132) between the ages of 30 to 64 years participated. The study was conducted in a U.S. metropolitan region in 2015. Health literacy (Newest Vital Sign [NVS]), self-efficacy (New General Self-Efficacy Scale [NGSE]), and readiness for change (Health Risk Instrument [HRI]) were correlated with health promotion behaviors (Health Promotion Lifestyle Profile II [HPLPII]). Univariate statistics addressed demographic characteristics; bivariate/simultaneous linear regression determined the relationships between the NVS, NGSE, and HRI to health promotion behaviors (HPLPII). Demographics: 72.6% completed high school and 25% completed college, and the mean body mass index (BMI) was >32. Positive correlations existed between each variable to health promotion behaviors: NVS (r = .244, p < .002), NGSE (r = .312, p < .001), HRI (r = .440, p < .001), and accounted for 29.8% of variances in health promotion behaviors. Education and health literacy were also correlated (rs = .414, p = .001). Although health literacy, self-efficacy, and readiness for change are associated with health promotion behaviors, readiness for change was the most highly correlated. The development and incorporation of interventions to promote health promotion behaviors should include readiness for change, health literacy, BMI, and education, especially among urban Black women in order to reduce critical health disparities. Community-based and culturally relevant strategies in promoting health that are integrated into existing lifestyles and designed to impact readiness for change will have the greatest impact on reducing health disparities both in the United States and in countries experiencing rapid urbanization. For example, healthy eating behaviors or increased physical activity may be best adopted when integrated into existing community-based spiritual or cultural events via trusted community leaders. Replication of this study in other populations of Black women will improve the generalizability of this study, both in the United States and globally. However, the addition of other demographic variables, such as a history of chronic conditions, military service, domestic or other violence, spirituality, and the availability of community resources, would strengthen the results in future studies.

Provider Perspectives of High-Quality Pediatric Hospital-to-Home Transitions for Children and Youth With Chronic Disease.

The objective of this study was to describe health care providers' and hospital administrators' perspectives on how to improve pediatric hospital-to-home transitions for children and youth with chronic disease (CYCD). Focus groups and key informant interviews of inpatient attending physicians, primary care physicians, pediatric residents, nurses, care coordinators, and social workers were conducted at a tertiary care children's hospital. Key informant interviews were performed with hospital administrators. Semistructured questions were used to elicit perceptions of transitional care quality and to identify key structures and processes needed to improve transitional care outcomes. Transcripts of discussions were coded to identify emergent themes. Participants (N = 22) reported that key structures needed to enhance transitional care were a multidisciplinary team, inpatient provider-patient continuity, hospital resource availability, an interoperative electronic health record, and availability of community resources. Key processes needed to achieve high-quality transitional care included setting individualized transition goals, involving parents in care planning, establishing parental competency with home care tasks, and consistently communicating with primary care physicians. Providers identified a lack of reliable roles and processes, insufficient assessment of patient and/or family psychosocial factors, and consistent 2-way communication with community providers as elements to target to improve transitional care outcomes for CYCD. Many key structures and processes of care perceived as important to achieving high-quality transitional care outcomes for CYCD have the opportunity for improvement at the institution studied. Engaging key stakeholders in designing quality improvement interventions to address these deficits in the current care model may improve transitional care outcomes for this vulnerable population.

Stability Analysis of an SEIR Model with Treatment

We study the dynamics of a SEIR epidemic model with nonlinear treatment function, that takes into account the limited availability of resources in community. Under some conditions we prove the existence of two possible equilibria: the disease-free equilibrium and the endemic equilibrium. Using Lyapunov's method and Li's geometrical approach, We also show that the reproduction number R0 is a threshold parameter: the disease-free equilibrium is globally asymptotically stable when the basic reproduction number is less than unity and the unique endemic equilibrium is globally asymptotically stable when the basic reproduction number is greater than this critical value. In the end, we give some concluding remarks concerning the role of treatment on the epidemic propagation.

Shaping our Kids’ Diets: Home and Neighborhood

ObjectiveFollowing the social‐ecological framework, we aimed to characterize barriers and facilitators that primary caregivers living in a food desert experience when providing foods for their children, and strategies to overcome those barriers.MethodsUsing a purposive sampling design, we identified 15 primary caregivers of young children (&lt; 10 years old) who live in Ward 7, a food desert in Washington DC. Semi‐structured, in‐depth interview guides were used to ask primary caregivers about a typical day, whether they agreed with the statement that they are feeding their children the foods that they would like to feed them, and what made it easier or harder for them to provide the foods they want to provide for the children. A participatory workshop with all respondents sought to identify common barriers and strategies to overcome those barriers. Interviews from all sessions were recorded, transcribed verbatim, and analyzed systematically following the social ecological framework (ATLAS.ti version 5).ResultsWe interviewed five mothers and ten grandparents. Common factors that acted as barriers or facilitators included health concerns of the primary caregiver that shape what was available at home to eat; monetary and time budgeting for food acquisition and preparation; child's food preferences and requests on foods; perceptions that kids waste foods if they are not fed what they desire; perception that kids’ appetite is not satisfied by what is offered at school or at home. The support of or conflict with family and friends can either mitigate or exacerbate challenges faced by kids’ preferences and health concerns. At the community level, respondents valued resources provided by organized groups (i.e. food giveaways, church lunches, dinners, and other programs offered by non‐governmental organizations). Results provide some evidence that the themes typically associated with a food desert emerged only among respondents who had access to a car (or to a friends’ or relative's car). For example, these respondents described how distance to supermarkets, external appearance of stores, and internal appearance of products, influenced place and frequency of shopping, and limited the types of foods they would have preferred to offer to their children. Among those who did not have good access to transportation, these themes did not emerge, and their barriers and facilitators related more to money and time budgeting, home and family conflicts, and availability of community resources. Participants expressed the desire to gain more knowledge about nutrition and diet, resources available in the community, and budgeting skills. A small group of respondents was interested in organizing to demand that the one supermarket in the neighborhood provided better food products.ConclusionBarriers and facilitators at the individual level are exacerbated or mitigated by family, social, and neighborhood characteristics. Our results suggest that perceived barriers and identified strategies were influenced by the respondents’ ability to compare and contrast their community environment to other neighborhoods.Support or Funding InformationHoney W. Nashman Center for Civic Engagement and Public Service

Facilitators and Barriers to Care Coordination in Patient-centered Medical Homes (PCMHs) from Coordinators' Perspectives.

Care coordinators are increasingly featured in patient-centered medical home (PCMH) projects, yet little research examines how coordinators themselves define and experience their role. This is the first study describing experiences of care coordinators across the US from their own perspectives. This qualitative study used a 5-month private, online discussion forum to gather data from 25 care coordinators from PCMH practices representing diversity in practice size, setting, and type. Participants answered questions and interacted with one another, creating an online social learning collaborative while allowing for data collection for research. Coordinators identified barriers and facilitators in their work at the organization/system level, the interpersonal level, and the individual level. Some factors emerged as both barriers and facilitators, including the functionality of clinical information technology; the availability of community resources; interactions with clinicians and other health care facilities; interactions with patients; and self-care practices for mental health and wellness. Colocation and full integration into practices were other key facilitators, whereas excessive case loads and data management responsibilities were felt to be important barriers. While all the barriers and facilitators were important to performing coordinators' roles, relationship building materialized as key to effective care coordination, whether with clinicians, patients, or outside organizations. We discuss implications for practice and provide suggestions for further research.

Community stakeholders' perceptions of barriers to childhood obesity prevention in low-income families, Massachusetts 2012-2013.

IntroductionThe etiology of childhood obesity is multidimensional and includes individual, familial, organizational, and societal factors. Policymakers and researchers are promoting social–ecological approaches to obesity prevention that encompass multiple community sectors. Programs that successfully engage low-income families in making healthy choices are greatly needed, yet little is known about the extent to which stakeholders understand the complexity of barriers encountered by families. The objective of this study was to contextually frame barriers faced by low-income families reported by community stakeholders by using the Family Ecological Model (FEM).MethodsFrom 2012 through 2013, we conducted semistructured interviews with 39 stakeholders from 2 communities in Massachusetts that were participating in a multisector intervention for childhood obesity prevention. Stakeholders represented schools; afterschool programs; health care; the Special Supplemental Nutrition Program for Women, Infants, and Children; and early care and education. Interviews were audio-recorded, transcribed, coded, and summarized.ResultsStakeholder reports of the barriers experienced by low-income families had a strong degree of overlap with FEM and reflected awareness of the broader contextual factors (eg, availability of community resources, family culture, education) and social and emotional dynamics within families (eg, parent knowledge, social norms, distrust of health care providers, chronic life stressors) that could affect family adoption of healthy lifestyle behaviors. Furthermore, results illustrated a level of consistency in stakeholder awareness across multiple community sectors.ConclusionThe congruity of stakeholder perspectives with those of low-income parents as summarized in FEM and across community sectors illustrates potential for synergizing the efforts necessary for multisector, multilevel community interventions for the prevention of childhood obesity.

Integrating community health workers into a patient-centered medical home to support disease self-management among Vietnamese Americans: lessons learned.

There is evidence that patient-centered medical homes (PCMHs) and community health workers (CHWs) improve chronic disease management. There are few models for integrating CHWs into PCMHs in order to enhance disease self-management support among diverse populations. In this article, we describe how a community-based nonprofit agency, a PCMH, and academic partners collaborated to develop and implement the Patient Resource and Education Program (PREP). We employed CHWs as PCMH care team members to provide health education and support to Vietnamese American patients with uncontrolled diabetes and/or hypertension. We began by conducting focus groups to assess patient knowledge, desire for support, and availability of community resources. Based on findings, we developed PREP with CHW guidance on cultural tailoring of educational materials and methods. CHWs received training in core competencies related to self-management support principles and conducted the 4-month intervention for PCMH patients. Throughout the program, we conducted process evaluation through structured team meetings and patient satisfaction surveys. We describe successes and challenges associated with PREP delivery including patient recruitment, structuring/documenting visits, and establishing effective care team integration, work flow, and communication. Strategies for mitigating these issues are presented, and we make recommendations for other PCMHs seeking to integrate CHWs into care teams.

A need for cancer patient education from the perspective of Chinese patients and nurses: a comparison study

Little is known about Chinese cancer patients' desire for cancer education, nor what cancer nurses perceive their cancer patients need to know about cancer. The purpose of this study was to assess the need for cancer patient education from both patients' and nurses' perspectives. A descriptive, correlational study was conducted by surveying 49 Chinese cancer patients and 49 cancer nurses using a cancer education need assessment tool. SPSS 16.0 statistical program was used for data analysis. Based on the needs assessment, the desire for cancer patient education was clearly supported by both cancer patients and cancer nurses. The data showed that the topics were very wide and diverse with categories that include cancer as a disease, ways cancer is treated, side effect management, how therapies are determined, diet management, impact on family, and availability of community resources. Differences between nurses' and patients' responses were mostly in the degree of "need or want to learn" but not statistically significant. Patient responses appeared to be influenced by their age, educational level, and type of treatment being received, whereas length of the nurses' work experience impacted their responses. A cancer patient education curriculum should be based on a well-designed needs assessment. This study reports the results of a needs assessment from a selected group of cancer patients and oncology nurses in a large Chinese cancer hospital. Information about living with cancer was identified as the need of greatest importance for both patients and oncology nurses.