Missouri Community Research Articles

Identifying and Prioritizing Factors to Improve Implementation of an Evidence-Based Program for Child Maltreatment Prevention in Rural Missouri Communities

AbstractPrevention of child abuse and maltreatment is critical in the Ozark region of Missouri where rates are higher than in other areas of the state. Community-based organizations seeking to address these issues in rural areas face significant challenges both internal and external to the organization. Guided by the Consolidated Framework for Implementation Research (CFIR), Whole Kids Outreach (WKO) utilized a modified concept mapping approach to identify strategies needed to address these challenges and more effectively implement the Healthy Families America (HFA) program in seven counties in the rural Missouri Ozark region. Semi-structured interviews were used to identify barriers and supports to the implementation of HFA. Statements were generated via in-person and telephone interviews with key stakeholders (WKO internal staff and external partners). These stakeholders then sorted statements into like piles and rated them according to importance. Concept mapping systems software, using multidimensional scaling and hierarchical cluster analysis, was used to determine the most salient cluster solution. The resulting cluster map depicted six thematic clusters and provided a visual representation of relationships between clusters. Stakeholders were then guided through a nominal group process to prioritize key issues and begin to develop strategies to address them.

Impacts of a Poverty Simulation Experience on Student Empathy Levels Toward People Living in Poverty

Many people hold negative opinions about individuals living in poverty without direct experience with poverty. Educating college students on the realities of life in poverty is critical to prepare them to serve in human-service careers. One way to educate about poverty is through an experiential education tool called a “simulation.” Poverty simulations are powerful tools that give participants embodied role-play experiences to promote social empathy and combat negative or singular perceptions of poverty. We explore the impact of the Missouri Community Action Network poverty simulation (CAPS) on student empathy for people experiencing poverty. We used the Undergraduate Perspectives of Poverty Tracking Survey (UPPTS) implemented as a retrospective pretest. While the impacts of CAPS have been studied, our unique contribution is the focus on empathy and use of the UPPTS. We found that student empathy for people living in poverty increased after the simulation with the greatest change occurring around four UTTPS factors: welfare attitudes, do more, lack of resources, and equal opportunity. Gender and financial status were the two demographics that had statistically significant difference of impact between categories with women and those who were “very financially secure” experiencing a greater change in empathy between pre and post scores.

The Poverty Simulation: A Tool to Experience the Social Determinants of HealthThe Poverty Simulation: A Tool to Experience the Social Determinants of Health

To provide holistic care that addresses all aspects of patient needs, nurses must understand the complexities of healthcare for the large population of people who live in poverty. The World Health Organization (WHO) recognizes the Social Determinants of Health (SDOH) as individual income, living conditions, social supports, and access to adequate food sources, education, and healthcare. Eighty percent of a person’s ability to attain health and well-being is related to the SDOH. In the United States, Healthy People 2030 and accrediting bodies for professional nursing programs focus on the SDOH and the impact of these determinants on health equity and access to care. Thus, as nursing students learn about challenges faced by persons who live in poverty conditions, it can be beneficial to also experience what their everyday life entails. One option available is the use of poverty simulation tools. This article provides an overview of the Missouri Community Action Network Community Action Poverty Simulation (CAPS) used in a Bachelor of Science in Nursing (BSN) curriculum to enhance student understanding about the experiences of living in poverty, to increase their ability to analyze the relationship between the SDOH and poor health outcomes, and to identify potential personal attitudes and biases. We offer information about our experiences with poverty simulation planning, implementation, and evaluation.

Impact of a Simulation Exercise on Student Perceptions of Poverty and Interprofessional Socialization

ObjectiveThis study aimed to evaluate the impact of an interprofessional poverty simulation exercise by determining if participating students demonstrated changes in attitude toward poverty (ATP) and perceptions of interprofessional socialization. MethodsThe Community Action Poverty Simulation from the Missouri Community Action Network was provided to 512 interprofessional health care students during 9 simulation exercises over a 3-year period. Primary participating professions were pharmacy, occupational therapy, and nursing. Student simulation roles were assigned to ensure a mix of professions in simulated families and debriefing groups. Debriefing sessions included questions related to interprofessional interactions. Students completed surveys before and following participation in the simulation, which included the ATP Short Form scale and the Interprofessional Socialization and Valuing Scale-9A. ResultsStatistically significant improvements in ATP were demonstrated for the overall score and 15 items of the 21-item ATP Short Form scale. The domains of stigma and structural perspective showed statistically significant improvement, while the personal deficiency domain did not. Statistically significant improvements in student perceptions related to interprofessional socialization were demonstrated for the overall score and 7 items of the 9-item Interprofessional Socialization and Valuing Scale-9A scale. ConclusionThis interprofessional poverty simulation positively altered student ATP and enhanced interprofessional socialization. The Community Action Poverty Simulation augmented with debriefing questions related to interprofessional interactions served as an effective interprofessional education experience for pharmacy, occupational therapy, and nursing students.

Wielding the Sword of the Spirit. Volume One: The Doctrine & Practice of Church Fellowship in the Missouri Synod (1838–1867) by Peter M. Prange

Reviewed by: Wielding the Sword of the Spirit. Volume One: The Doctrine & Practice of Church Fellowship in the Missouri Synod (1838–1867) by Peter M. Prange Mark Mattes Wielding the Sword of the Spirit. Volume One: The Doctrine & Practice of Church Fellowship in the Missouri Synod (1838–1867). By Peter M. Prange. Wauwatosa, Wisconsin: Joh. Ph. Koehler Press, 2021. 425 pp. Numerous books and articles have examined the early history of the Missouri Synod in relation to the Buffalo, Iowa, and Norwegian Synods. The strength of this book is the thoroughness and judiciousness of its assessment of C.F.W. Walther and his interlocutors, as well as its tendency to draw out explicitly the pastoral dimension in Walther's reasoning about church fellowship. If you are at all interested in the relationships between upper Midwest Lutheran immigrant synods in the nineteenth century, this is a satisfying book. It appreciates Walther without denigrating those with whom he disagreed. "Wielding the Sword of the Spirit" is a metaphor for discerning the conditions in which to say no to unionistic tendencies. The Prussian Union, which sought to unite the Lutheran and Reformed traditions in the kingdom of Prussia in the early nineteenth century, was opposed by Pastor Martin Stephan, J. J. Grabau, and others. Prange, a Wisconsin Synod pastor, begins his narrative with a description of the Stephanite movement, centered around Martin Stephan's ministry in Dresden; he opposed government intrusion into confessional matters, and saw those clergy who aligned with the Union church as invalidly administering sacraments. Emigrating with hundreds of parishioners and sympathizers, including Walther, Stephan was discredited soon after arriving in Missouri for alleged sexual improprieties and administrative heavy-handedness. In response to the exposure of Stephan, Walther resigned his pastoral call since he had been a devoted disciple of Stephan, now viewed as a false prophet. Even so, his congregation declined to suspend him (44). In response to Stephanism, Walther [End Page 338] proposed that the true church was "invisible" (52) and should be organized congregationally, not organically constituted by means of a ministerium independent of congregations. Even though Stephan himself proved to be "heterodox," the pastoral calls and administration of the sacraments in the Saxon communities in Missouri were still valid (53). Developing a congregationalist form of governance, Walther would soon butt heads with Grabau, whose anti-Prussian Union emigration had settled in Buffalo, New York, and Milwaukee. Walther consented that the preaching office was a divine institution. But Grabau would not concede that a pastor haphazardly called by a congregation could genuinely absolve or give communion (101). For the Missourians, Grabau represented an attempt to impose the old European order upon the new world. Similar to this conflict with Grabau, the Missourians were soon in conflict with the Bavarian missional pastor Wilhelm Loehe who had been financially supportive of the infant Missouri Synod. Walther even met with Loehe in Germany, but he would not be able to endorse Loehe's conviction that there were "open questions." For example, could faithful Lutherans disagree over how ministry is legitimated, whether through an established ministerium which calls its own or instead via congregational acknowledgement of those set aside for ordination? For Walther, such a question had been settled for good in the Lutheran confessions. Loehe's followers in the United States became the nucleus of the Iowa Synod and, with Loehe, did not believe that confessional truth remained "frozen" from the sixteenth century (297) but instead that it allowed fresh readings of the scriptures to help achieve greater clarity about truth. By bringing up numerous exchanges between Walther and his parishioners, Prange shows Walther to be not a fanatic in matters dealing with fellowship, but instead a man of wisdom and compassion. All in all, Prange provides a delightful read that explains the differences between the various synods and does so in a fair and winsome way. This is must reading for those interested in North American Lutheran history. [End Page 339] Mark Mattes Grand View University Des Moines, Iowa Copyright © 2022 Johns Hopkins University Press and Lutheran Quarterly, Inc.

Abstract P070: Individual And Environmental Correlates Of Objectively Assessed Physical Activity Levels In Rural Residents

Introduction: Rural communities in the US face disproportionately higher rates of physical inactivity as well as coronary heart disease mortality, when compared to their urban and suburban counterparts. As such, increasing physical activity (PA) and reducing barriers to PA is critical in improving population health. Neighborhood characteristics have been shown to influence PA, but are understudied in rural communities. The current analysis: (1) describes PA patterns in rural mid-western communities, and (2) examines the associations of and interactions between individual and environmental correlates of objectively assessed weekly moderate to vigorous physical activity (MVPA) minutes. Hypotheses: Overall, we expected low levels of weekly MVPA in rural residents; with lower levels anticipated in female, older, and low-income participants. We also expected positive associations of favorable perceptions of the neighborhood environment, trail use, and self-efficacy for PA with weekly MVPA. Finally, the test of interactions between intrapersonal and perceived environmental factors in relation to weekly MVPA is exploratory. Methods: Telephone surveys were conducted with 280 adults in 14 rural southeast Missouri communities, who were also asked to wear accelerometer devices for seven days. Participants were recruited via address-based sampling, and at local community events. Participants self-reported demographic information (age, sex, income), individual level behavioral factors (self-efficacy for PA, trail use) and neighborhood environment perceptions (indoor recreational access, safety from traffic, home neighborhood environment). Weekly MVPA minutes were assessed using the accelerometry data. Generalized linear mixed models using a negative binomial distribution were used examining associations of and interactions between individual characteristics and environmental correlates with weekly MVPA (Analyses were conducted using STATA V15). Results: Participants had a weekly average of 97 minutes MVPA, with 21% meeting PA guidelines. Increased age and being female were significantly associated with lower weekly MVPA. Additionally, increased self-efficacy and trail use were significantly associated with higher weekly MVPA. When exploring interaction effects, there was a significant interaction between gender and safety from traffic. For females, increased perceived safety from traffic was associated with lower MVPA. Conclusions: Rural residents have low levels of PA with less than a quarter meeting PA guidelines (75 minutes of vigorous and/or 150 minutes of moderate PA per week). Specifically, female residents face disproportionately lower levels of MVPA, with only 75 weekly minutes compared to 135 weekly minutes in males. Promoting trail use and targeting self efficacy for PA, may be effective strategies for increasing PA in rural residents.

Common Ground: An Examination of Rural Planning and the Growing Amish Presence in Missouri

How do rural communities in Missouri balance the potentially conflicting land use and economic planning needs between incoming and growing Amish populations and non-Amish populations? This qualitative research addresses a gap in the literature by examining the growing Amish population in rural America through the lens of community planning. A comparative case study was conducted in three Amish communities in Missouri and included interviews with public officials who engage in planning and planning-related tasks and an Amish leader at each case site. This project finds that Amish growth and expansion is resulting in both community conflicts and collaborative efforts in rural areas. The project culminates in the development of implications that planners might consider in order to actualize better outcomes for rural communities in the midst of the growth of this ethnoreligious group. [Abstract by author.]

Brigham Young and the Expansion of the Mormon Faith

Brigham Young and the Expansion of the Mormon Faith

Using habitat suitability and landscape connectivity in the spatial prioritization of public outreach and management during carnivore recolonization

Abstract Despite continued global declines in large carnivore abundance and distribution, some species are recovering. In North America, these recoveries can occur in large areas of suitable habitat in or near areas of human development, increasing the likelihood of human–carnivore conflicts. Understanding the intersection among habitat suitability, connectivity and human–carnivore conflicts can aid in conflict prevention and mitigation. We used GPS collar data from 97 bears and conflict reports collected from 1991 to 2020 to examine black bear Ursus americanus habitat suitability and landscape connectivity in relation to community‐level human–bear conflict occurrences and conflict rates in Missouri, USA. We used conflict–landscape relationships to predict potential community‐level human–bear conflicts given black bear recolonization. Suitable habitat for black bears comprised about 29% of Missouri and was predominantly forest and shrub cover with low habitat fragmentation and human density, and greater spring vegetation productivity. Landscape connectivity was greatest in south‐central Missouri with limited connectivity in northern and eastern portions of the state. Conflict rates were low (61 of 94 communities had 1–2 reported conflicts over 30 years), increased 6.5‐fold from 2000 to 2020, and 75% involved black bear use of anthropogenic food. The presence and rate of conflicts increased with greater amounts of suitable habitat, landscape connectivity and community size, with conflict rate also positively associated with patch density and aggregation and negatively associated with patch area. Of 1,010 communities in Missouri, we identified 99 communities with increased risk of human–bear conflicts based on surrounding landscape characteristics. Synthesis and applications. Our framework integrating landscape attributes and conflict reports can successfully identify communities at greater potential of human–carnivore conflict. In our Missouri case study, we identified 99 out of 1,010 communities which have increased risk of human–bear conflicts, knowledge which will increase the efficiency of education and mitigation rollouts as black bears re‐establish. This framework allows managers to identify communities at greater risk of conflict for many conflict‐prone species and helps prioritize communities for education and conflict mitigation actions, facilitating long‐term coexistence.

Promoting poverty awareness in health professions students

AbstractThis article highlights the utilization of Missouri Community Action Network's Poverty Simulation within an Interprofessional Education program to teach students about the complexities of poverty and enhance the development of professional identity.

Active Learning to Promote Empathy, Social Justice and Advocacy of Impoverished Families Among Education and Nursing Students

INTRODUCTION The prevalent issue of poverty in our society predisposes those affected to increased vulnerability. Two professions which interact a great deal with the impoverished population are educators and nurses, but less is known about how the professions understand poverty issues. METHODS Underpinned by Constructivist theory, the goal was to implement an active learning experience and examine pre and post-simulation student responses for common patterns and themes. Using the Missouri Community Action Poverty Simulation to immerse 85 education and nursing students into poverty, researchers explored the reactions of nursing students and education students to issues of poverty. RESULTS From pre-simulation to post-simulation, students moved toward accepting their personal opinions and judgments and realizing potential biases. In contrast with the pre-simulation reflections that discussed poverty as a choice a person makes, many students now describe poverty as a cycle that people cannot break or recover from. CONCLUSION The findings of this study have implications for exploring strategic ways for educators and nurses to collaborate in an effort to close the gap that is created with social inequities, hoping to foster the evolution of empathy, social justice and advocacy within nursing and education disciplines. Increased awareness of social justice, and examining how their experience of participating in a poverty simulation might influence advocacy in their future professional practice.

Characteristics of Resilient Hospice Workers From Their Administrators’ Perspectives: A Qualitative Study

This study explores hospice administrators’ perceptions of the characteristics of resilient hospice workers. This qualitative phenomenological study included ten participants from five hospice organizations in rural and urban Southwest Missouri communities. All participants were current hospice administrators. Administrators identified six characteristics of resilient hospice workers. These characteristics included (a) relationship building with clients, (b) having a supportive team, (c) ongoing education, (d) positivity, (e) strong boundaries, and (f) the importance of spirituality. Authors suggest identifying and encouraging these characteristics in hospice workers may lead to less employee turnover, healthier employees, and a better work environment.

Time to Throw Away the Old Economic Development Playbook

Rural communities in the United States are struggling to establish a sound economic footing in the age of globalization. The author suggests that community leaders should consider a more expansive view on recrafting a community “north star.” Based on work the author has conducted over the previous 5 years in various rural communities in Missouri, the article also outlines a set of key learnings and practical steps that local leaders can take to catalyze positive change.

School Nurse Poverty Education: Why It Is Important to Your Practice.

School nurses are seeing increased numbers of children who are living in poverty. The Missouri Community Action Program Poverty Simulation was presented to school nurses to increase their awareness of what it might be like to live in poverty and the related healthcare barriers. Participants shared their reactions and knowledge gained in the simulation in a postparticipation survey with the simulation facilitators. Some participants shared practice changes that they made as a result of their participation in the simulation, which included use of additional referral resources, being less judgmental, and increased empathy.

Consistency of chronic obstructive pulmonary disease regimens for patients visiting community pharmacies with the Global Initiative for Chronic Obstructive Lung Disease recommendations

ObjectiveDespite evidence-based Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations, outcomes are poor. GOLD uses chronic obstructive pulmonary disease (COPD) assessment test (CAT) scores with exacerbation history to categorize COPD severity into A, B, C, and D severity groups. Therapy is group-specific; monotherapy/dual long-acting bronchodilators (LABDs) therapy is preferred to inhaled corticosteroids (ICS). Pharmacist-accessible data could be used to identify evidence-based interventions to improve outcomes. The primary objective was to analyze previously collected data to compare the consistency of patient-described COPD regimens with GOLD therapeutic recommendations to identify potential pharmacist interventions. MethodsCross-sectional, nonrandomized design using a written questionnaire and CAT scores. Dispensing data from 35 Missouri community pharmacies initially identified participants aged 40 years or older with 1 or more COPD medications dispensed in the past year. Those self-reporting COPD, emphysema, or chronic bronchitis completed a demographic survey with medication history, including oral corticosteroid and antibiotic use, and CAT scores. Proportion of days covered (PDC) was calculated for any COPD maintenance medication dispensed over 1 year. The participants’ COPD was categorized into A, B, C, and D severity groups. The reported medication regimens were categorized into consistent with, escalated from, or less than initial first-line/alternative recommended therapy for the A, B, C, and D severity groups. ResultsThe participants totaled 709 (group A: 6%; group B: 35%; group C: 4%; group D: 55%). Of the regimens, 41% were consistent with, 34% were escalated from, and 24% were less than initial first-line/alternative GOLD recommendations. Most (96%) of the participants were highly symptomatic. Regimens containing ICS: (67.5%); ICS plus LABD (37.2%) exceeded dual LABD (4.2%). The average PDC was 0.43 ± 0.37; only 28.7% were adherent (PDC ≥ 0.80). ConclusionsParticipants with self-reported COPD were highly symptomatic and nonadherent; undertreatment was noted. Community pharmacists could provide therapeutic interventions consistent with GOLD A, B, C, and D severity groups, promote dual LABD versus ICS therapies, and optimize adherence.

Pharmacist and physician perception of barriers to collaborative drug therapy management in Missouri

Abstract Background Collaborative drug therapy management (CDTM) rules were implemented in 2012 in Missouri, but community pharmacists are currently not working with physicians to implement services. Purpose This study aims to uncover barriers to CDTM adoption by Missouri community pharmacists and outpatient physicians. Methods A nine question, cross-sectional survey was mailed to a sample of 500 community pharmacists and 500 outpatient physicians in Missouri. Surveys were designed to assess knowledge, attitudes, and beliefs regarding CDTM. Discussion A total of 103 community pharmacists (21.7%) and 23 outpatient physicians (4.7%) completed the survey. Pharmacists identified concerns about operational barriers such as time (93.2%), and reimbursement for services (80.6%). Physicians indicated concern with clinical risks, including potential disconnect between providers (70%) and inadequate pharmacist training (63.6%). Conclusions Demonstration of clinical abilities and development of working relationships with physicians is important for the implementation of CDTM. Development of standardized reimbursement models and workflow models should be further evaluated.

Teaching Poverty: Evaluation of Two Simulated Poverty Teaching Interventions With Undergraduate Nursing Students.

The study aim was to evaluate the effectiveness of two simulated poverty teaching interventions-the Community Action Poverty Simulation (CAPS) and the Oxfam Hunger Banquet-to improve undergraduate nursing student attitudes toward people living in poverty. Freshman and sophomore nursing students participated in a Missouri Community Action Network CAPS® experience or an Oxfam America Hunger Banquet® during a 3-year period, and completed pre- and post-assessments using the Undergraduate Perceptions of Poverty Tracking Survey (UPPTS). A significant improvement in UPPTS scores was seen in students after participating in a CAPS experience and less of an improvement was noted after participating in a Hunger Banquet. Both simulated poverty teaching interventions had positive effects on the students' perceptions toward people living in poverty, but the CAPS had a greater influence on improving student attitudes. [J Nurs Educ. 2020;59(2):83-87.].

From Contagion to Cogitation: The Evolving Television Zombie

The figure of the zombie is as versatile as it is enduring, and this article analyses two recent television shows featuring versions of the undead that belong to a worldwide wave of conscious, sentient zombies. The returned of Resurrection (US, 2014-2015) and Glitch (Australia, 2015-2019) are humane, ostracized figures who encounter prejudice and suspicion from localized communities in rural Missouri and in the Victorian outback. In their respective reconfigurations of the classic zombie narrative of menacing invaders, these shows cast the undead as sympathetic protagonists who stand as powerful metaphors for socioeconomic migration and marginalization.

A Qualitative Study Identifying Barriers and Facilitators of Physical Activity in Rural Communities.

Background Physical activity (PA) rates are lower in rural populations, compared to urban and suburban counterparts. Since PA is shown to decrease the risk of cancers and chronic diseases, increasing PA in rural environments is an important disease-prevention strategy. However, in order to develop effective interventions for rural populations, more research is needed. The purpose of the study was to elicit rural residents' thoughts and perceptions related to PA and walking trail use. Methods Key informant interviews were conducted via telephone, with 62 adults, living in six rural communities in southeast Missouri, who identified as stakeholders, walking trail users, and nontrail users. Participants were recruited through word of mouth and snowball sampling. Interviews were digitally audio-recorded, transcribed, and qualitatively analyzed. Findings Analysis revealed variation within the rural population, with each town unique in what constituted barriers and facilitators to PA. Life priorities other than physical health were found to be important motivators to PA and also influenced how PA was obtained. Community size was found to impact community resources and infrastructure, although this was mitigated by poverty rates. Conclusion Rural communities are distinct from one another with different views and approaches to PA. Future interventions designed to increase PA should be mindful of differences at the individual and town levels and avoid a one-size-fits-all approach. Interventions would benefit from insight and support from community members and stakeholders, to facilitate a tailored approach to increase PA.

Chronic long-term risk of low-level radiation exposure: Bridging the lay/expert divide

ABSTRACTThe failure of experts and lay people to understand each other has been fueling conflict around the environmental clean-up of the many sites in the United States that are contaminated by the nuclear weapons program. This mutual distrust was exacerbated by the culture of secrecy surrounding the atomic weapons program during World War II, and later by the innate culture of bureaucracy in the federal agencies that have sprung up since then. A prime example of this problem can be found in the regulation of chronic long-term risk from low-level radiation exposure affecting communities in Missouri’s North St. Louis County. This case study illuminates this divide, and illustrates opportunities to close it.