Community Healthcare Practice Research Articles

Peer education as a strategy to promote vaccine acceptance: A randomized controlled trial within New York community healthcare practices

BackgroundEffective strategies are needed to improve vaccine acceptance. This study sought to determine if a peer-led vaccine education intervention embedded within community medical practices increases parental acceptance of pediatric pneumococcal conjugate vaccination. MethodsFrom March 2022-July 2023, we conducted a randomized trial at three pediatric health practices in predominantly Hasidic Jewish neighborhoods in New York, where vaccine deferral is common. Parents of children up to 18 months due/overdue for routine pneumococcal vaccination were randomized (1:1) to receive routine care alone or routine care plus a peer educational intervention. Peer educators trained in motivational interviewing and vaccine science provided counseling at enrollment and follow-up telephone engagement in the intervention arm at day 30 and 60. Primary outcome was child’s pneumococcal immunization status by allocation arm expressed as at least one dose received between enrollment and 90 days post-enrollment. Results144 parent–child dyads were eligible for outcome analysis. Participants in the group receiving routine care along with peer-led vaccine counseling were significantly more likely to have their child receive at least 1 vaccine dose between enrollment and 90 days compared to the group who received routine care alone (28.4 % vs 12.9 %, risk ratio [RR] 2.21, confidence interval [CI] 1.09–4.49, p = 0.022). The effect of peer education was greatest in dyads with children less than 1 year old at enrollment (34 % vs 12.7 %, RR 2.67, CI (1.22–5.86), p = 0.009). ConclusionsPeer vaccine education can increase vaccine acceptance compared to routine care alone and may be particularly valuable in decreasing vaccination delays for younger infants. (Funded by EGL Charitable Foundation, ClinicalTrials.gov NCT05875779).

Whose infrastructure, which commons? On the maintenance of an emergent health commons in the Netherlands

ABSTRACT This article explores how and by what means an emergent health commons is (re)produced in practice. Drawing on recent studies that consider the materiality of citizens’ struggles over the commons, it adopts a more-than-human approach to commoning. Employing ethnographic research on a communal healthcare cooperative in a region of the Netherlands that faces depopulation and institutional failure, I argue that the durability of an emergent health commons is a continuous and contested achievement involving infrastructuring. To articulate the ongoing infrastructural work needed to create and maintain the commons, I employ insights from Maintenance and Repair Studies that explore maintenance as a practice of material care. By exploring the care for infrastructure ethnographically, I specify which aspects of the community healthcare practice, precisely, are maintained in common, and for whom. My analysis reveals that commoning ‘opens up’ new ways of organizing health and existing in common, but may not always sustain radical openness when the social arrangements of the commons transform into steel and bricks. The maintainability of health in common, I suggest, hinges as much on nurturing ‘social’ bonds as on how such bonds are variously infrastructured.

Insurance Is No Longer a Determinant to Improve Overall Survival for Patients Diagnosed with HL, DLBCL or PCNS in an Enriched Hispanic Community

BackgroundVariables that determine overall survival (OS) in patients diagnosed with Hodgkin (HL) and Non-Hodgkin lymphomas (NHL) have been widely studied in the United States. Inequalities in survival has been noted when patients lack insurance (CancerPMID: 26058564). However, healthcare disparities exist within the different cancer subtypes and ethnic minorities. In the case of Follicular lymphoma, uninsurance has been linked with worse outcomes (BloodPMC6137560). For Burkitt and plasmablastic lymphomas, insurance does not seem to have a repercussion in survival (Blood136 Supplement 1:45-46) (Leuk LymphomaPMC6923579). In subgroup analysis, Hispanics (HI) have been noted to have higher rate of uninsurance with no significant distinction in OS in patients with DLBCL (Blood136 Supplement 1: 9). There is a need to understand determinants in ethnic disparities in outcomes for HL and NHL. This is the first large statewide population-based study differentiating ethnicity, insurance status and survival for HL, diffuse large B cell lymphoma (DLBCL) and primary central nervous system lymphoma (PCNS) in Texas.Material and MethodsA retrospective analysis of patients diagnosed with HL, DLBCL, PCNS recorded in the Texas Cancer Registry from 2006-2017 was carried out. Inclusion criteria was histopathologic proven HL, DLBCL, and PCNS. Patients were divided into HI and non-Hispanics (NH), and subsequently in insured (i) and uninsured (un), for a total of four cohorts for comparison: iHI, unHI, iNH and unNH. Survival time was measured using the day of diagnosis to last date of follow up or death. For each cohort, median survival (MS) and analysis at 2,5 and 10 years (y) was calculated. Survival distribution were determined based on Kaplan-Meier curves.ResultsFrom 2006-2017, 21,229 patients with HL, DLBCL, PCNS were diagnosed in Texas. Of these, 6,004 patients (iHI n=1,369, unHI n=376, iNH n=3,781, unNH n=478) were diagnosed with HL (Graph 1), 14,366 patients (iHI n=2,810, unHI n=635, iNH n=10,273, unNH n=648) were diagnosed with DLBCL (Graph 2) and 859 patients (iHI n=195, unHI n=54, iNH n=559, unNH n=51) were diagnosed with PCNS (Graph 3).MS was outstanding for uninsured compared to insured patients with HL, DLBCL and PCSN. In HL, MS for iHI was 9.8 y, unHI was not reached, iNH was 10.3 y, and unNH was 10.8 y. In DLBC, MS was 3.7 y, 9.3 y, 4.2 y and 5.3 y, respectively. In PCNS, MS for these groups corresponded to 0.9 y, 0.8 y, 0.7 y and 3.2 y.Survival probability at 2-,5- and 10y among i vs un was noteworthy in HL, DLBCL and PCNS (Table 1). In HL, iHI was 0.762, 0.686 and 0.448; unHI was 0.873, 0.784 and N/A; iNH was 0.843, 0.765 and 0.584, and unNH was 0.846, 0.782 and 0.703, respectively. In DLBCL, for iHI it was 0.573, 0.456 and 0.222; unHI was 0.685, 0.631 and 0.350; iNH was 0.602, 0.469 and 0.174; unNH was 0.583, 0.510 and 0.239, accordingly. In PCNS, for iHI it was 0.374, 0.219 and N/A; unHI was 0.314, 0.174 and N/A; iNH was 0.354, 0.229 and 0.061; unNH was 0.516, 0.473 and 0.473, correspondingly.Overall Survival (OS) was statistically significant for iHI vs unHI vs iNH vs unNH when comparing HL, DLBCL and PCNS, with p values of <0.0001, <0.0001 and 0.037, respectively (Graph1-3). In HL the group with the best OS was unHI. This was also evidenced for DLBCL. However, for PCNS this trend was noted in unNH. In both three malignancies, the highest OS rate was reported in uninsured population.ConclusionsFor HL, DLBCL and PCNS the uninsured population has statistically significant better OS at 10 y. Interestingly for HL and DLBCL this corresponded to unHI while for PCNS was unNH. This paroxysmal finding may be due to standardized treatment, immediate healthcare enrolling after diagnosis and/or different community healthcare practices. Additionally, this population may have unique behaviors such as higher rate of compliance/adherence, environmental exposures or genetic predisposition to improved survival. Nonetheless, lack of insurance may delay diagnosis, need for multiple lines of chemotherapies, increase the rate of metastatic disease or recurrences. Accordingly, as more expensive and personalized therapies evolve, insurance status can limit access to these treatment regimens. Therefore, although insurance is no longer a determinant for improving OS for patients diagnosed with HL, DLBCL or PCNS, it can have implications for other oncological outcomes. [Display omitted] DisclosuresDiaz Duque: Incyte: Consultancy; Morphosys: Speakers Bureau; Astra Zeneca: Research Funding; Hutchinson Pharmaceuticals: Research Funding; Epizyme: Consultancy; ADCT: Consultancy.

Interviews with Community Healthcare Registered Nurses in Norway: Examination Practices and Clinical Evaluation Processes.

AimThis study describes the examination practices and clinical evaluation processes that Registered Nurses in Norway perform in the community healthcare sector.DesignA qualitative exploratory design.MethodsTwenty interviews were conducted with Registered Nurses employed in the community healthcare sector in Norway. The data were analysed using a thematic analysis.ResultsWe found four major themes: (1) evaluations are embedded in nurses’ daily work, (2) significance of a Registered Nurse's clinical competency, (3) different tasks require various roles and (4) access to resources and equipment. Registered Nurses possess several skills in a range of different examination techniques and clinical evaluation processes in the community healthcare sector. They perform complex assessments in their daily work and must rely on other healthcare professionals, facilities and equipment to provide high‐quality care. Ongoing education and training will enable Registered Nurses to complete accurate assessments in their community healthcare practice.

Secondary prevention of coronary heart disease: The effect of a nursing intervention using Cox's interaction model of client health behaviour.

Secondary prevention of coronary heart disease is of utmost importance to facilitate people to achieve health outcomes and behaviours. This study was to investigate the effect of a nursing intervention based on Cox's interaction model of client health behaviour to improve health outcomes and behaviours of secondary prevention of coronary heart disease. This study is a cluster randomised controlled trial. Participants were recruited between August and November 2019 in two community settings in Hengyang city, Hunan province, China. Participants in the intervention group received a nursing intervention based on Cox's interaction model of client health behaviour and routine health education, while those in the control group received routine health education only. The outcome variables included self-management, physical activity, medication compliance, anxiety, sexual knowledge, the ability to identify sexual health education needs, blood pressure, body mass index (BMI), and low-density lipoprotein cholesterol (LDL-C). The influential statistical tests applied to analyse the data included χ2 tests and t tests. Seventy-seven participants completed this study. Compared with the control group (n=40), the intervention group (n=37) showed statistically significant better health outcomes and behaviours regarding self-management, physical activity (except for high energy consumption), medication compliance, anxiety, sexual knowledge, the ability to identify sexual health education needs, systolic blood pressure, BMI, and LDL-C. However, there was nostatistically significant difference in diastolic blood pressure and high energy consumption for physical activity. A well-developed nursing intervention based on Cox's interaction model of client health behaviour could successfully improve health outcomes and behaviours of secondary prevention of coronary heart disease. Such an intervention may be incorporated into community healthcare practice by nurses to improve patient care. This study provides a valuable insight to facilitate further development of effective nursing interventions to improve secondary prevention of coronary heart disease in community settings.

Long-term impact of undergraduate community-based clinical training on community healthcare practice in Japan: a cross-sectional study

BackgroundCommunity-based medical education (CBME) has been evolving globally. However, the long-term impacts of CBME programs on career intention are ambiguous. Therefore, this study aimed to reveal the long-term impact of community-based clinical training (CBCT) such as CBME programs in Japan on current community healthcare (CH) practice.MethodsThis cross-sectional study targeted physicians who had graduated from Kobe University School of Medicine between 1998 and 2004 and had over 15 years’ experience after graduation. Self-administered questionnaires were mailed to participants between September and November 2019. Of the 793 potential subjects, 325 questionnaires were undeliverable. A total of 468 questionnaires substantially sent to the subjects. The exposure was the undergraduate CBCT defined as clinical training about CH in a community. The primary outcome was the provision of current CH practice. The secondary outcome was rural retention. The odds ratios (ORs) and confidence intervals (CIs) were calculated, and the confounders (age, gender, and attitude toward CH at admission; primary outcome, and age, gender, attitude toward rural healthcare at admission, own and spouse’s hometown, and emphasis on child education; secondary outcomes) were adjusted using multivariate logistic regression analysis.ResultsA total of 195 (41.7%) questionnaires were analyzed. The mean (standard deviation [SD]) age of study participants was 43.8 (3.5) years and 76.4% were men. A total of 48 physicians (24.6%) experienced CBCT, of which the mean (SD) training period was 26.3 (27.3) days. As many as 148 (76.3%) physicians provided CH at the time of the study, and 12 (6.5%) worked in rural areas. There was no notable impact of undergraduate CBCT on current CH practice (OR, 1.24; 95% CI, 0.53–3.08; adjusted OR [aOR], 1.00; 95% CI, 0.43–2.30) and rural retention (OR, 0.59; 95% CI, 0.06–2.94; aOR, 0.59; 95% CI, 0.11–3.04).ConclusionsIt may be insufficient to use conventional CBCT in Japan to develop CH professionals effectively. Japanese CBME programs should be standardized through a review of their content and quality. They should continue to be evaluated for their medium- to long-term effects.

Medicosocial Study on the Influence of Indigenous Knowledge on Perception of Disease Status: Using a Cardiovascular Disease as a Model

Objective: Cultural beliefs may shape understanding of disease. Cardiovascular disease (CVD) is increasing in prevalence in urban Nigerian communities; hence, the aim of this research is to explore spiritual views in this context. Material and Methods: This study employed convenience sampling to recruit 50 participants via word of mouth, posters, handbills and community networks. The author drew from his indigenous knowledge to design tools in collaboration with stakeholders, including the community members, faith leaders and leaders in community healthcare practice; to investigate and explore the views of an urban community members in Nigeria on their indigenous beliefs about factors that contribute to CVD. Results: The views that emerged in exploring perceived spiritual factors that contribute to CVD were organised into two preceptions, namely: spiritual inflicted diseases influenced by humans and spiritual inflicted diseases influenced by non-humans. The perceived spiritually inflicted diseases influenced by humans are through witchery and sorcery. The perceived spiritual inflicted diseases influenced by non-humans are through Satan, deities, and God. Spiritually inflicted diseases are perceived to be transmitted through pets, such as domestic cats, birds like owls, bats and objects. Perceived spiritually inflicted diseases can only be healed through spiritual means. Conclusion: In a well-educated, ethnically diverse urban setting the view that spiritual factors have an impact on health and disease is prevalent. Since this may have an impact on healthcare choices, it should be accommodated for in public health planning, and further explored through community-based participatory research.

Association of Community Factors with Hospital-onset Clostridioides (Clostridium) difficile Infection: A Population Based U.S.-wide Study

BackgroundClostridioides (Clostridium) difficile ranks first among the pathogens of hospital-acquired infections with hospital-based preventive strategies being only partially successful in containing its spread. MethodsWe performed a spatial statistical analysis to examine the association between population characteristics and parameters of community healthcare practice and delivery with hospital-onset Clostridioides (Clostridium) difficile infection (HO-CDI), using data from the Medicare Hospital Compare, Medicare Provider Utilization Part D, and other databases. Among the areas with the highest HO-CDI rates (“hot spots”), we conducted a geographically weighted regression (GWR) to quantify the effect of the decrease in the modifiable risk factors on the HO-CDI rate. FindingsPercentage of population > 85 years old, community claims of antimicrobial agents and acid suppressants, and density of hospitals and nursing homes within the hospital service areas (HSAs) had a statistically significant association with the HO-CDI incidence (p < 0.001). The model including the community claims of antimicrobial agents and number of hospital centers per HSA km2 was associated with 10% (R2 = 0.10, p < 0.001) of the observed variation in HO-CDI rate. The hot spots were organized into 5 Combined Statistical areas that crossed state borders. The association of the antimicrobial claims and HO-CDI rate was as high as 71% in the Boston–Worcester–Providence area (R2 = 0.71, SD 0.19), with a 10% decrease in the rate of antimicrobial claims having the potential to lead to up to 23.1% decrease in the HO-CDI incidence in this area. InterpretationThese results outline the association of HO-CDI with community practice and characteristics of the healthcare delivery system and support the need to further study the effect of community and nursing home-based antimicrobial and acid suppressant stewardship programs in the rate of HO-CDI in geographic areas that may cross state lines.

Opioid Prescribing Rates in Nonmetropolitan and Metropolitan Counties Among Primary Care Providers Using an Electronic Health Record System - United States, 2014-2017.

Drug overdose is the leading cause of unintentional injury-associated death in the United States. Among 70,237 fatal drug overdoses in 2017, prescription opioids were involved in 17,029 (24.2%) (1). Higher rates of opioid-related deaths have been recorded in nonmetropolitan (rural) areas (2). In 2017, 14 rural counties were among the 15 counties with the highest opioid prescribing rates.* Higher opioid prescribing rates put patients at risk for addiction and overdose (3). Using deidentified data from the Athenahealth electronic health record (EHR) system, opioid prescribing rates among 31,422 primary care providers† in the United States were analyzed to evaluate trends from January 2014 to March 2017. This analysis assessed how prescribing practices varied among six urban-rural classification categories of counties, before and after the March 2016 release of CDC's Guideline for Prescribing Opioids for Chronic Pain (Guideline) (4). Patients in noncore (the most rural) counties had an 87% higher chance of receiving an opioid prescription compared with persons in large central metropolitan counties during the study period. Across all six county groups, the odds of receiving an opioid prescription decreased significantly after March 2016. This decrease followed a flat trend during the preceding period in micropolitan and large central metropolitan county groups; in contrast, the decrease continued previous downward trends in the other four county groups. Data from EHRs can effectively supplement traditional surveillance methods for monitoring trends in opioid prescribing and other areas of public health importance, with minimal lag time under ideal conditions. As less densely populated areas appear to indicate both substantial progress in decreasing opioid prescribing and ongoing need for reduction, community health care practices and intervention programs must continue to be tailored to community characteristics.

The Intermediary Roles of Public Health Nurses (PHNs) in Utilizing Communication Robots (CRs) in Community Health Care Practice

Robot technology is expected to reduce the burden of medical professionals, a concern in the super-aged society. The aim of this article is to determine the intermediary roles of Public Health Nurses (PHNs) in using Communication Robots (CRs) in Community Health care. It is necessary to consider who will manage, and how to draw lines of responsibility when a problem occurs when using robots in the future. Regarding the mediator or intermediary role of PHNs in the use of CRs, PHNs are expected to be cognizant of varieties of robots for use with persons of diverse ages and health levels, as well as of robot performances. As one of the community healthcare workers who service the elderly living in the community, the role of PHNs as mediators or intermediaries is to pay attention to ethical and moral issues while working with CRs to manage the health of the community. Lack of understanding of the intermediary role might create possible ethico-moral issues in the future. Therefore, it is critical for PHNs to understand their role as intermediaries. In doing so, it is expected that older people at home will be able to live peaceful lives, as well as be physically and mentally healthy.

Association of Patient Perceptions of Cardiovascular Risk and Beliefs on Statin Drugs With Racial Differences in Statin Use

African American individuals face higher atherosclerotic cardiovascular disease risk than white individuals; reasons for these differences, including potential differences in patient beliefs regarding preventive care, remain unknown. To evaluate differences in statin use between white and African American patients and identify the potential causes for any observed differences. Using the 2015 Patient and Provider Assessment of Lipid Management (PALM) Registry data, we compared statin use and dosing between African American and white outpatient adults who were potentially eligible for primary or secondary prevention statins. A total of 138 US community health care practices contributed to the data. Data analysis was conducted from March 2017 to May 2018. Primary outcomes were use and dosing of statin therapy according to the 2013 American College of Cardiology/American Heart Association guideline by African American or white race. Secondary outcomes included lipid levels and patient-reported beliefs. Poisson regression was used to evaluate the association between race and statin undertreatment, a category combining people who were not taking a statin or those taking a dose intensity lower than recommended. A total of 5689 patients (806 [14.2%] African American) in the PALM registry were eligible for statin therapy. African American individuals were less likely than white individuals to be treated with a statin (570/807 [70.6%] vs 3654/4883 [74.8%]; P = .02). Among those treated, African American patients were less likely than white patients to receive a statin at guideline-recommended intensity (269 [33.3%] vs 2145 [43.9%], respectively; P < .001; relative risk, 1.07 [95% CI, 1.00-1.15]; P = .05, after adjustment for demographic and clinical factors). The median (interquartile range) low-density lipoprotein cholesterol levels of patients receiving treatment were higher among African American than white individuals (97.0 [76.0-121.0] mg/dL vs 85.0 [68.0-105.0] mg/dL; P < .001). African American individuals were less likely than white individuals to believe statins were safe (292 [36.2%] vs 2800 [57.3%]; P < .001) or effective (564 [70.0%] vs 3635 [74.4%]; P = .008) and were less likely to trust their clinician (663 [82.3%] vs 4579 [93.8%]; P < .001). Group differences in statin undertreatment were not significant after adjusting for demographic, clinical, and clinician factors, socioeconomic status, and patient beliefs (final adjusted relative risk, 1.03 [95% CI 0.96-1.11]; P = .35). African American individuals were less likely to receive guideline-recommended statin therapy. Demographic, clinical, socioeconomic, belief-related, and clinician differences contributed to observed differences and represent potential targets for intervention.

An Integrative Behavioral Health Care Model Using Automated SBIRT and Care Coordination in Community Health Care.

Efficient and effective integration of behavioral health programs in a community health care practice emphasizes patient-centered medical home principles to improve quality of care. A prospective, 3-period, interrupted time series study was used to explore which of 3 different integrative behavioral health care screening and management processes were the most efficient and effective in prompting behavioral health screening, identification, interventions, and referrals in a community health practice. A total of 99.5% (P < .001) of medical patients completed behavioral health screenings; brief intervention rates nearly doubled to 83% (P < .001) and 100% (P < .001) of identified at-risk patients had referrals made using a combination of electronic tablets, electronic medical record, and behavioral health care coordination.

Mainstream health professionals' stigmatising attitudes towards people with intellectual disabilities: a systematic review

Equal access to mainstream healthcare services for people with intellectual disabilities (ID) still requires attention. Although recent studies suggest that health professionals hold positive attitudes towards people with ID, stigmatising attitudes may influence their efforts to serve people with ID in community healthcare practice. To stimulate inclusion in mainstream healthcare services, this systematic review focussed on barriers in attitudes of mainstream health professionals towards people with ID. Five electronic databases were systematically searched and references in full text articles were checked for studies published in the English language between January 1994 and January 2016. A social-psychological triad of cognitive, affective and behavioural dimensions of stigmatising attitudes is used to structure and discuss the results. The literature search generated 2190 records with 30 studies that passed our exclusion criteria. Studies were mostly cross-sectional and of moderate quality. With respect to stigma, a lack of familiarity with and knowledge about people with ID was found. ID was considered as a stable condition not under personal control. Moreover, mainstream health professionals had either low or high expectations of the capabilities of people with ID. Professionals reported stress, lack of confidence, fear and anxiety, a tendency to treat people with ID differently and a lack of supporting autonomy. Stigmatising attitudes towards people with ID appeared to be present among mainstream health professionals. This might affect the ongoing challenges regarding inclusion in mainstream healthcare services. To facilitate inclusion in mainstream healthcare services, it is recommended to include contact and collaboration with experts-by-experience in education programs of health professionals. Future research should progress beyond descriptive accounts of stigma towards exploring relationships between cognitive, affective and behavioural dimensions as pointers for intervention. Finally, inclusion would benefit from an understanding of 'equal' treatment that means reasonable adjustments instead of undifferentiated treatment.

Engaging the Community in the Dissemination, Implementation, and Improvement of Health-Related Research.

To help maximize the real-world applicability of available interventions in clinical and community healthcare practice, there has been greater emphasis over the past two decades on engaging local communities in health-related research. While there have been numerous successful community-academic partnered collaborations, there continues to be a need to articulate the common barriers experienced during the evolution of these partnerships, and to provide a roadmap for best practices that engage healthcare providers, patients, families, caregivers, community leaders, healthcare systems, public agencies and academic medical centers. To this end, this paper presents a summary of a forum discussion from the 2014 Southern California Dissemination, Implementation and Improvement (DII) Science Symposium, sponsored by the University of California Los Angeles (UCLA) Clinical Translational Science Institute (CTSI), University of Southern California (USC) CTSI, and Kaiser Permanente. During this forum, a diverse group of individuals representing multiple constituencies identified four key barriers to success in community-partnered participatory research (CPPR) and discussed consensus recommendations to enhance the development, implementation, and dissemination of community health-related research. In addition, this group identified several ways in which the over 60 NIH funded Clinical and Translational Science Institutes across the country could engage communities and researchers to advance DII science.

Reducing costs and avoiding hospital admissions: can mobile working help?

The UK has an increased length of hospital stay in comparison with other European countries, and the need for further investment in community services is required if patients are to truly receive care closer to home. The increase in hospital admissions over the last few years may be attributed to the ageing UK population, as well as poor management of long-term conditions. This may be due to variations in the service provision and availability of case managers and community matrons. The poor working relationships and fragmentation of health and social care services remain a significant issue, despite renewed calls to improve integrated working, which is considered fundamental to achieving a reduction in avoidable hospital admissions. Mobile working was introduced in the NHS to help reform community health-care practice and improve continuity of care. Among other things, it provides clinicians with access to electronic patient records in real time, thus helping to reduce delays in treatment. However, we have to bear in mind that a number of factors could hinder the reduction in hospital admissions.

Dissemination and Implementation Research in Health (R21): PAR-13-054

Also note: Dissemination and Implementation Research in Health (R01): PAR-13-055 Details at: http://grants.nih.gov/grants/guide/pa-files/PAR-13-055.html. Also note: Dissemination and Implementation Research in Health (R03): PAR-13-056 Details at: http://grants.nih.gov/grants/guide/pa-files/PAR-13-056.html. Components of Participating Organizations...

Seeking health care: Marshallese migrants in Hawai‘i

Objective. The number of Marshallese migrants has dramatically increased in the US and its territories since the 1986 Compact of Free Association agreement. Their poor health status and patterns of untimely care are considered a great public concern in the host society. This paper examines the health care patterns of Marshallese migrants in Hawai‘i and how their specific characteristics and circumstances affect their behaviors when seeking health care services. Design. In-depth interviews were conducted with Marshallese migrants, key informants in the Marshallese community, and health and social service providers in the local community. Results. This study reveals three important patterns of health care seeking behavior among Marshallese migrants. First, Marshallese migrants do not seek health care until they perceive a health crisis, usually indicated by pain. This cultural notion of ‘present crisis-oriented health care’ governs overall health care behaviors of Marshallese migrants. Second, Marshallese migrants are highly reliant on parochial networks for health care, given the strong mutual trust and the value assigned to interdependency within their culture. Despite many benefits of these networks, heavy dependence on them results in failure to obtain timely care when network resources become inaccessible or unavailable. Last, Marshallese migrants in Hawai‘i do not rely on traditional health care practices as much as on the allopathic health care system. Their health care depends heavily on curative and tertiary care and health care assistance in the public sector. Conclusion. Health care seeking behaviors of migrants are shaped by cultural definition of health and health care and macro-social factors such as characteristics of the co-ethnic community and social networks, the health care system, and health policies, in addition to individual's socioeconomic status. These findings have important implications for community health care practices and policies.

Purulent pericarditis caused by nontypeable Haemophilus influenzae in a pediatric patient

We report the 1st case of purulent pericarditis due to nontypeable Haemophilus influenzae in an immunocompetent 2-year-old male, which was successfully treated with surgical drainage, debridement, and antimicrobial therapy. The shifting microbial epidemiology of this disease, associated with changes in community health care practices, and the increasing virulence of this organism are discussed.

Discovering popular education in professional community health care practices

Exploring the relationship between popular education and health care as regards to public and community health nursing, a case is made that popular education is more than a pedagogical approach to teaching. Following an inductive strategy, experiential vignettes of the author’s practices and commitments in impoverished Brazilian populations are systematized to identify contributions of popular education in health care. Experiential learning leads to a preferential option for the poor, a reduction of power inequalities between program agents and the people, the use of Observe-Judge-Act methodology and a theory that is realistic in terms of possible changes of consciousness. Popular education fosters both the emergence of tacit nursing care actions and includes those of voiceless populations living in poverty.

Culture and therapy: complementary strategies for the treatment of type-2 diabetes in an urban setting in Kerala, India

There is an epidemic rise in diabetes in the developing world, with ensuing concern about the management and control of the disease. This study investigates the use of complementary therapies to manage Type 2 diabetes in an urban population in Kerala, a state in Southern India. Using ethnographic methods, it shows that the subjects’ experiences of the disease and their health management decisions are closely linked to their cultural background and the environmental resources of the region. Participants in the study relied on biomedicine for treating diabetes, but frequently used Ayurvedic medicine and folk herbal remedies as supplements. They named 24 local plants and plant products that were employed to lower blood glucose levels. Knowledge of tried and tested local or regional remedies and their incorporation into individual and community health care practices are evidence of medical knowledge as cultural capital. Greater attention needs to be paid to the broader systems of the environment and culture and their interconnections to understand the use of complementary therapies by persons with chronic illnesses such as diabetes.