Community Health Centers Research Articles

Community Nursing Practice in Hypertension Management in China: Qualitative Analysis Using a Bourdieusian Framework.

This study explores the practices of Chinese community nurses in hypertension management, using Pierre Bourdieu's theory of practice to understand how their routines are shaped by sociocultural and institutional forces, along with their professional dispositions. A qualitative descriptive study was conducted in Shenzhen, China, between March and June 2024, and is reported following the COREQ guidelines. Eighteen nurses, each with at least 1 year of full-time experience in hypertension care within the local community healthcare system, were recruited from a participant pool established through prior research. Face-to-face individual semistructured interviews were conducted using a structured interview protocol, and data were analyzed through thematic analysis. Community nurses face tensions between traditional health beliefs and modern hypertension care, as well as institutional pressures that prioritize efficiency over personalized care. Power imbalances, particularly the authority of doctors, complicate their role. However, nurses adapt their care strategies through embodied practices, balancing clinical standards with patient needs. Community nurses are not mere enforcers of guidelines but adaptive professionals who navigate complex sociocultural norms, institutional demands, and power dynamics in hypertension care. This study underscores the necessity for flexible, culturally sensitive practices to improve public health outcomes.

AAAAI Position Statement on Changing Electronic Health Record Allergy Documentation to "Alerts" to Lead to Easily Understood, Actionable Labels.

The term "allergy" is inaccurate for the vast majority of the contents in the current allergy fields of electronic health records (EHRs). While EHRs have transformed access to health information and streamlined the delivery of care, their ability to reliably indicate medications, vaccines, or foods that mandate avoidance versus preferences or mild intolerances, is suboptimal. The current systems are reactive instead of being proactive and frequently fail to communicate the appropriate course of action. This Position Statement of the American Academy of Allergy, Asthma and Immunology (AAAAI) advocates for a change in terminology. The section of the EHR currently labeled "allergies" should be renamed "alerts." The term "alert" accurately captures the purpose of this section without incorrectly assigning an allergic mechanism, and prioritizes easily understood and actionable labels. This change has the potential to simultaneously improve patient safety and care. This shift will be the first step in the transformation of the alerts section of the EHR. This document provides a framework for categorizing what should be included in this section. Enacting these changes will require EHR and clinical decision support vendors, healthcare and data standard regulators, allergists, and the larger health care community to work together to bring about these important advances.

Military Medical Simulations-Scoping Review.

The military employs a wide variety of training paradigms to prepare a ready medical force. Simulation-based training is prominently used in the military for all roles of care to provide the knowledge, skills, and abilities needed to render care from the battlefield to the hospital. The purpose of this scoping review is to synthesize the body of research in military healthcare simulation, highlight trends in the literature, and identify research gaps. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis process, the databases of PubMed, Google Scholar, and targeted conferences were searched for articles focused on simulation-based training in the military healthcare community. Inclusion criteria required that the studies assessed a healthcare simulation intervention and had military participants. Data were gathered on population parameters (branch of service and provider level) as well as study parameter (simulation modality, medical domain, and outcome measures). Outcome measures were categorized according to the Kirkpatrick model of training evaluation. A total of 43 articles met inclusion criteria. Article summaries and descriptive data on the participant populations and study parameters are provided in Tables1, 2, and Supplementary Table S1. Participant populations were inclusive of all the services and roles of care, suggesting appropriate representation of the broad military healthcare community. The majority of literature has studied physical simulations, such as manikins or task trainers. Few studies employed augmented or virtual reality as the training intervention, likely because of the nascency of the technology. Trauma care was the focus of 65% of the studies; this is attributable to the criticality of trauma care within battlefield medicine and casualty response. Related to study outcomes, participant reactions, such as usability and user acceptance, and immediate learning outcomes were heavily studied. Retention and behavioral changes were rarely studied and represent a significant research gap. Future research assessing mixed reality technologies would be beneficial to determine whether the technology warrants inclusion in programs of instruction. Finally, studies with outcome measures including long-term knowledge and skills retention, behavioral change, or patient outcomes are strongly recommended for future research.

Health Care Delivery Site- and Patient-Level Factors Associated With COVID-19 Primary Vaccine Series Completion in a National Network of Community Health Centers.

Objectives. To assess multilevel factors associated with variation in COVID-19 vaccination rates in a US network of community health centers. Methods. Using multilevel logistic regression with electronic health record data from ADVANCE (Accelerating Data Value Across a National Community Health Center Network; January 1, 2022-December 31, 2022), we assessed associations between health care delivery site-level (n = 1219) and patient-level (n = 1 864 007) characteristics and COVID-19 primary vaccine series uptake. Results. A total of 1 337 440 patients completed the COVID-19 primary vaccine series. Health care delivery site characteristics were significantly associated with lower series completion rates, including being located in non-Medicaid expansion states and isolated or rural communities and serving fewer patients. Patient characteristics associated with significantly lower likelihood of completing the vaccine series included being Black/African American or American Indian/Alaska Native (vs White), younger age, lower income, being uninsured or publicly insured (vs using private insurance), and having fewer visits. Conclusions. Both health care delivery site- and patient-level factors were significantly associated with lower COVID-19 vaccine uptake. Community health centers have been a critical resource for vaccination during the pandemic. (Am J Public Health. 2024;114(11):1242-1251. https://doi.org/10.2105/AJPH.2024.307773).

Collaborating for Health Equity: A Perspective of an Federally Qualified Health Center's Community Partnerships and Initiatives.

Collaborating for Health Equity: A Perspective of an Federally Qualified Health Center's Community Partnerships and Initiatives.

JUE Insight: The labor market effects of place-based policies: Evidence from England’s Neighbourhood Renewal Fund

Neighbourhood renewal programs are a type of place-based policy that aim to revive underperforming localities. The literature on place-based policies has found mixed results regarding their effects on local labor market outcomes, but there are relatively few studies of policies that aim to improve local labor supply. In this paper we examine the labor market effects of the Neighbourhood Renewal Fund, which targeted 88 of the most deprived areas in England during the early 2000s as part of the Labour government’s National Strategy for Neighbourhood Renewal. The fund disbursed almost £3 billion for spending on community safety, education, healthcare and worklessness, with supply-side interventions making up the bulk of the program’s spending on worklessness. Using a difference-in-differences approach, we find statistically significant impacts on local employment. Our results suggest that policy interventions to improve local labor supply can be a successful strategy for neighborhood renewal.

AMCP Partnership Forum: Patient input and payer decision-making.

There has been growing consensus for the health care community to become more patient centered by considering patient needs, preferences, and values in decision-making. To advance partnership between payers and patient representatives to gather patient input and incorporate their perspective on the broad range of managed care pharmacy decisions, the AMCP held a multistakeholder Partnership Forum on December 6 and 7, 2023, in Alexandria, Virginia. Forum participants were asked to (1) identify opportunities for patient representatives to engage with payers and other managed care pharmacy decision-makers, (2) recognize challenges and propose potential solutions to establish patient engagement programs between payers and patient representatives, and (3) review and provide input on draft frameworks created by the 2023-24 AMCP Patient Voice Advisory Group. Key themes that emerged from the participant discussion included to assemble and draw upon successful examples and best practices, recognize different levels of engagement, build trust and relationships proactively, create defined access points and open dialogue channels, incorporate the patient perspective as an element of coverage decision-making, leverage existing patient data and reports, crystallize a key message furthering common goals, and facilitate ongoing education and learning.

A feasibility study of upcycled smartphone-based colposcopy for visual inspection of cervix performed by community healthcare workers in rural Vietnam

A feasibility study of upcycled smartphone-based colposcopy for visual inspection of cervix performed by community healthcare workers in rural Vietnam

Depression Among Resettled Karen Refugees in the United States: An Exploratory Pilot Study

Due to prolonged ethnic and religious persecution, the Karen have endured numerous traumatic experiences including systematic violence and mistreatment, resulting in long-term psychological sequelae. This study examines the prevalence of depression among Karen refugees from Burma ( N = 37) using a culturally grounded mental health screening tool within a primary health care community clinic in the southern United States. A total of 48.60% met the clinical cutoff for depression. The researchers identified three themes: (a) manifestations of depression, (b) depression linked to post-migration stressors, and (c) importance of support and education about depression. Family service organizations and resettlement agencies can assist Karen refugees by connecting them with social and tangible support, as well as providing education about depression. Future research should include Karen refugees from various parts of the United States to improve generalizability.

Reporting MRONJ as an adverse drug reaction: an oral surgery survey.

Introduction Medication-related osteonecrosis of the jaw (MRONJ) is a significant adverse drug reaction associated with anti-angiogenic and anti-resorptive medications. The aim of this survey was to highlight the importance of reporting adverse drug reactions, including MRONJ.Methodology An electronic survey was disseminated to dentists working in the oral surgery department Birmingham Community Healthcare Trust in November 2021. The survey consisted of 14 open and closed questions relating to the identification and reporting of MRONJ as an adverse drug reaction.Results Although 97% of participants had seen a patient with MRONJ, only 19% had reported an adverse drug reaction to any medication. Interestingly, 27% of respondents felt that MRONJ should be classified as a 'post-operative complication' rather than an 'adverse drug reaction'. In total, 22% of participants were unaware of how to report an adverse drug reaction.Conclusion This survey acts as an important reminder to encourage both patients and dental professionals to report adverse drug reactions, including suspected MRONJ, to the Medicines and Healthcare products Regulatory Agency. Reporting aids accurate national data collection, highlights risk and supports ongoing research in this area.

Kaupapa Māori development of te reo Māori assessments and culturally responsive hearing healthcare in Te Waipounamu: findings from wānanga

ABSTRACT The development of valid and robust te reo Māori (te reo) hearing assessments in Aotearoa New Zealand (Aotearoa) is an area of research that requires further attention from a Kaupapa Māori stance. In support of te reo revitalisation, this article shares findings from two wānanga in Te Waipounamu (the South Island of Aotearoa) with research partners (hearing healthcare professionals and Māori health and education professionals). Research partners’ perspectives and experiences of barriers and facilitators to ear and hearing healthcare in Te Waipounamu, development of te reo assessments, and their application in clinical and community settings are explored. Embedded within Kaupapa Māori theory and methodology, data was analysed using reflexive thematic analysis to identify commonalities and patterns in ‘Hauora Māori Community’ and ‘Hearing Healthcare Community’. This paper presents seven whakaaro themes and first steps from provider perspectives towards the development of culturally appropriate and responsive hearing healthcare tools and services.

Analysis of Transparency and Accountability of the Health Operational Assistance (BOK) Budget at Sirombu Inpatient Health Center

Health Operational Assistance (HOA) is a fund that is used to ease the public burden on financing the health sector, especially service in community health centers, reduction in maternal mortality, infant mortality and malnutrition. Puskesmas Sirombu as a health service unit is used as a medical center for the welfare of the community, but in reality the Puskesmas Sirombu has not been optimal in realizing the budgeted funds. This study aims to determine the transparency and accountability of budget execution Bantuan Operasional Kesehatan (BOK) at Puskesmas Rawat Inap Sirombu in 2021. The research sample was taken using the method purposive sampling (specific goals or criteria). The data analysis technique used is triangulation method which combines in-depth interviews and document searches and triangulation of sources using different information to do cross check information from several sources, to improve the results of the data obtained when getting different data. Based on the research results, it can be concluded that the Puskesmas Sirombu has implemented its transparency and accountability well but has not been optimal in managing the budget for transportation assistance for Health Operational Officers (BOK), this can be seen from the fact that some of the budget was not realized.

“…considered ‘essential workers’, so we report to work and serve the community”: experiences of community health workers during COVID-19 pandemic in the Eastern Cape, South Africa

BackgroundCommunity health workers (CHWs) played an essential part in providing health services to the communities they served prior to and during the COVID-19 pandemic, and they had some positive impact on community/household health service promotion and delivery. Nonetheless, restricted movement and social isolation made it challenging for community members to access CHW services, which are normally provided in person. We explore community health workers’ opinions on the impact of COVID-19 on their responsibilities, clients, and communities in South Africa’s Eastern Cape.MethodsUsing a semi-structured interview guide, we conducted individual (n = 10) and focus group discussions (n = 13) with 23 community health workers. Participants were community health workers servicing three Black township communities in Buffalo Municipality District, Eastern Cape, South Africa. Transcripts from audiotaped and transcribed verbatim interviews were analysed thematically using Atlas.ti.ResultsThe COVID-19 had an impact on the CHWs’ job-related activities, the clients’ health, and caused disruptions in community social and economic activities, all of these had a negative impact on population health. COVID-19 had detrimental effects on the clients’ health in various ways, including restricted movement and fear of contracting the virus, isolation and deaths created anxiety and terror, or refusal to attend clinics for routine medical check-ups and treatment. Furthermore, CHWs claimed that COVID-19 affected community livelihoods, exacerbating food insecurity and job insecurity. The vast majority of CHWs, who were predominantly women, had to balance their employment workload tasks with domestic responsibilities, which added extra pressure and burden. In addition, many individuals experienced personal loss and bereavement. However, the clients and the community exhibited remarkable resilience and perseverance despite the multifaceted obstacles faced by the COVID-19 pandemic.ConclusionFinancial hardships, unemployment, and work disruptions or changes created by the COVID-19 pandemic triggered stress, sadness, worry, and terror among the CHWs. The client’s health conditions were adversely affected, as some clients refrained from visiting clinics for their medications and treatment because of restricted movements, concerns about contracting the virus, and isolation, all of which contributed to their anxiety and fear. The social isolation and quarantine, as well as food and job insecurity, all had an impact on the community’s social and economic life. Despite the COVID-19 risks and stressors, CHWs demonstrated resilience during the COVID-19 pandemic burden and emphasising their importance as “essential workers” in community health care which further underscores the need to provide CHWs with adequate resources and training in preparation for future pandemics.

Social Disadvantage and Disparities in Chronic Liver Disease: A Systematic Review

Introduction: Social determinants of health (SDOH) may impact chronic liver disease (CLD) outcomes but are not clearly understood. We conducted a systematic review to describe the associations of SDOH with mortality, hospitalizations, and readmissions among patients with CLD. Methods: This review was registered (PROSPERO ID: CRD42022346654) and identified articles through MEDLINE, Embase, Cochrane Library, and Scopus databases. The review included studies that reported SDOH characteristics within the domains of economic stability, health care access, education, social and community context, and the neighborhood built environment. Associated outcomes of interest were mortality, hospitalizations, or readmissions. The Cochrane Risk of Bias in Non-randomized Studies for Exposure (ROBINS-E) was used to assess study quality and risk of bias. Results: A total of 5,205 abstracts were screened, 60 articles underwent full-text review, and 27 articles were included in the final review. Poor economic stability, healthcare access, social support, and household/environmental conditions were associated with higher mortality and hospital readmissions among patients with CLD. Increasing distance (≥25 miles away) from a liver transplantation (LT) center was associated with higher mortality despite increasing access to the LT waitlist. When assessing the overall risk of bias among included studies, most had “Some Concern” (N=13, 48.1%) or “High Risk” (N=11, 40.7%) while a minority had “Very High Risk” (N=3, 11.1%). No studies were categorized as “Low Risk.” Conclusions: Unfavorable SDOH were associated with increased mortality and hospital readmissions among patients with CLD. Rigorous empirical research is needed to identify evidence-based strategies that aim to mitigate disparities among vulnerable populations.

Innovative healthcare solutions for resource-limited settings expanding pharmaceutical care to remote populations

Access to essential healthcare and pharmaceutical services remains a significant challenge in resource-limited settings. This paper explores innovative strategies for expanding pharmaceutical care to remote populations, focusing on the integration of mobile health technologies and community-based interventions. Mobile health (mHealth) technologies, including telemedicine and mobile pharmacies, offer a cost-effective means of delivering healthcare services, enhancing access, and improving real-time monitoring. Community-based interventions, such as the deployment of community health workers, health education campaigns, and peer support groups, play a critical role in addressing healthcare disparities and improving health literacy and medication adherence. The paper also discusses the integration of pharmaceutical care models, emphasizing the importance of collaboration among healthcare providers, pharmacists, and community health workers. Future directions highlight emerging innovations like AI and blockchain technology, while policy recommendations emphasize the need for investment in healthcare infrastructure, professional training, and regulatory support. By leveraging these strategies and innovations, healthcare outcomes and equity in resource-limited settings can significantly improve.

SARS-CoV-2 outbreak management in nursing homes in Ireland: reflections of COVID-19 response teams from earlier to later waves of the pandemic

BackgroundA review of key learnings from the response to the COVID-19 pandemic in nursing homes in Ireland can inform planning for future pandemics. This study describes barriers and facilitators contributing to COVID-19 outbreak management from the perspective of frontline teams.MethodsA qualitative study involving ten online focus group meetings was conducted. Data was collected between April and June 2023. The focus group discussions explored the views, perceptions and experiences of COVID-19 Response Team (CRT) members, clinical/public health experts who worked with them, and care professionals who worked in frontline managerial roles during the pandemic. All nine Community Healthcare Organisations and six Public Health Areas in Ireland were represented. Inductive reflexive thematic analysis was carried out using NVivo Pro 20.ResultsIn total, 54 staff members participated in focus group meetings. Five themes were developed from a thematic analysis that covered topics related to (1) infection prevention and control challenges and response to the pandemic, (2) social model of care and the built environment of nursing homes, (3) nursing home staffing, (4) leadership and staff practices, and (5) support and guidance received during the pandemic.ConclusionsThe response to the COVID-19 pandemic has resulted in a steep learning curve, internationally and in Ireland. Preparing better for future pandemics not only requires changes to infection control and outbreak response but also to the organisation and operation of nursing homes. There is a great need to strengthen the long-term care sector’s regulations and support around staffing levels, nursing home facilities, governance, use of technology, infection prevention and control, contingency planning, and maintaining collaborative relationships and strategic leadership. Key findings and recommendations from the Irish example can be used to improve the quality of care and service delivery at local, national, and policy levels and improve preparedness for future pandemics, in Ireland and internationally.

Healthcare Seeking Behaviour and Associated Factor Among Community Based Health Insurance Members and Non-Members in Addis Ababa, Ethiopia, 2023

Background: Community based health insurance (CBHI) is voluntary, non-profit health insurance. It helps to mobilize additional resource to the health sector. Community Based Health Insurance uses principles of insurance, members pay fees to the insurance scheme and in return their health service cost is covered by the scheme. This way risks can be shared among individuals and financial inputs pooled between individuals who need health service but are not able because they cannot afford it and those who are well but pay premium. Objective: To assess health Care seeking behavior and Community based health insurance among members and non-members in Addis Ababa, Ethiopia 2023. Methodology: A community based comparative cross-sectional study was conducted. A total of 580 households included in this study. Data was collected by data collectors using a standardized questionnaire through interviews. Associated factors for healthcare seeking behavior is identified by binary and multivariate logistic regression analysis and expressed by adjusted odds ratio (AOR). Multivariate analysis also used to control the effect of confounders. Result: Healthcare-Seeking Behavior of the Study Participants Factors Associated with Healthcare-Seeking Behavior participants the study indicated that the decision-making to visit a health facility for illnesses, disease severity, and CBHI membership had a statistically significant association with HSB. Conclusion: The overall household Health Seeking Behavior was 56.3% for Community Based Health Insurance members and 43.7% for non-Community Based Health Insurance members. Membership status has significant positive effect on healthcare seeking behavior. Decision- making process to visit a health facility for illnesses, disease severity was positively associated with membership status.

Coparenting Approach to Being Successful Exclusively Breastfeeding

Breast milk is the first nutrient for infants because it contains essential nutrients for growth and development, so exclusive breastfeeding can prevent the risk of stunting and wasting in children. The lack of breastfeeding in infants is a threat to the long-term growth and development of children. Effective coparenting strongly impacts breastfeeding success rates because of its positive energy. Developing effective coparenting during the transition to becoming a parent is very helpful in the process of carrying out the role of parent, resolving conflict and supporting one's partner in raising children. The study aimed to analyze the success of Coparenting Approach to Being Successful Exclusively Breastfeeding. This research method is an observational study with an analytic cross-sectional design using a quantitative approach; the population in this study was 393 people in the Glagahagung Community Health Center Working Area sampling with a purposive sampling technique, based on inclusion and exclusion criteria where a number of respondents were exclusively breastfeeding with a total of 78 respondents. The results showed family support p value = 0.000, technological advances p value = 0.000, and lifestyle p value = 0.000. Based on the results show that the regression coefficient for family support is .716, this shows that increasing the family support variable will increase the coparenting approach variable in the success of providing EBF by .716, the trends and lifestyle regression coefficient is -.452, so this shows that trend and lifestyle variables reduce the influence on the coparenting approach in the success of providing EBF.

Overlapping markets and quality competition among community health centers.

To examine the response of community health center (CHC) quality to quality levels at neighboring CHCs in the presence of non-price competition. A quasi-experimental study of US community health centers. Outcome variables were indices that measured overall quality of CHC care. Using patient flow data, we constructed CHC-specific Hirschman-Herfindahl index (HHI) and competitors' composite quality measure. The plausibly exogenous change in characteristics of "competitors' competitors" was exploited to identify the relationship between competition and quality of care, using a generalized two-stage least square model with instrumental variables. Using the Health Center Program Uniform Data System (2014-2018), linked with American Community Survey and Medical Expenditure Panel Survey, we analyzed 1098 unique federally funded CHCs in 50 states and District of Columbia which had at least one neighboring CHC and had non-missing data for 2015-2018 (4226 CHC-years). Most of CHCs served populations in overlapping geographic markets, with median market concentration decreasing during the study period. A one-percent increase in competitors' quality was associated with a 0.71-percent increase in an index CHC's composite quality (p < 0.01), consisting of a 0.59-percent increase in chronic condition control rates (p < 0.01); a 0.68-percent increase in the screening and assessment rates (p < 0.01); and a 0.78-percent increase in medication management rates (p < 0.01). The association was stronger at CHCs serving a smaller proportion of uninsured patients. No significant quality reaction was observed at CHCs with a percentage of uninsured patients larger than the 75th percentile. We observed no significant associations between HHI and quality. Increasing competition does not harm quality of care at CHCs. A CHC appears to improve its quality if its competitors improved quality. The beneficial quality effect was less pronounced in CHCs providing a significant proportion of care to uninsured patients, suggesting lack of incentives faced by these CHCs.

Community mental health care in Croatia: Mobile team for psychosocial support in the community

Abstract The Republic of Croatia has initiated numerous reforms in the mental health care system in the community. Within the framework of EU JA Implement, a mobile team was formed to provide interventions in the community, that is, in the homes of persons discharged from psychiatric hospitals. The mobile team was formed during 2023. The team includes: one psychiatrist, leader and coordinator of the mobile team, three graduate nurses, a case manager, a social worker, three experienced experts who are employed in the team as peer workers, and one social pedagogue and psychologist. The wider composition of the team includes a psychiatrist who provides outpatient psychiatric treatment, who is familiar with the individual recovery plan and, if necessary, participates in the development of the plan. The goal of establishing a mobile team is to implement an individual recovery plan in the community, that is, in the patient’s home, using biopsychosocial interventions, with the aim of better and faster recovery of the user and inclusion in the community, as well as prevention of rehospitalization and disability. Before the patients home visits, the experts in the team were trained. 15 patients were included in the pilot project, with whom 96 home visits or interventions were carried out in the time period from the establishment of the team to April 2024. As a result of the effectiveness of the pilot project, in 2024, in accordance with the Strategic Framework for the Development of Mental Health until 2030, the Republic of Croatia adopted a new network of health institutions, within which 30 mobile psychiatric teams and 24 psychological teams at the primary level of health care are planned. Empowerment of users, engagement of people with experience in the implementation of interventions, increase in mental health literacy of the population and destigmatization are additional results of the implementation of mental health protection in the community through JA impleMENTAL.