Face Additional Challenges Research Articles

Navigating the academic ladder as an early career researcher in earth and environmental sciences

AbstractThere is growing concern in Higher Education around job security, work–life balance and inequalities, and early career researchers (ECRs) must make difficult trade‐offs and life choices. Literature confirms that women navigating academia face additional challenges compared to their male counterparts. Few studies connected contractual circumstances, employment priorities and their impacts on the life choices of individual academics. We report results from a survey exploring the experiences of 37 ECRs who completed PhDs in the United Kingdom (UK) navigating the academic ladder in geomorphology and earth/environmental science, and contextualize these findings by drawing on personal experiences and wider literature. We find evidence of multi‐directional pressures that have materially negative effects on individuals' life choices, including concern that academic employment is a barrier to living where and with whom one may want to. The level of precarity amongst survey respondents is stark in terms of number of years they have held fixed‐term contracts (maximum 10 years), the number of individual contracts held (maximum 14) and number of different institutions worked at (maximum six). Women respondents were less prepared to be employed on precarious contracts and put more emphasis on job security when applying for academic posts, with men being generally more satisfied by financial aspects of university employment; which will amplify the leaky pipeline and gender gaps at more senior levels. We also find that perceived institutional prestige was a surprisingly low priority for the majority of respondents, and there were notable divergences between career advice given by more senior colleagues and the priorities of ECRs seeking guidance. We put forward a set of key considerations: improving policies on parental leave and flexible working; formalizing and improving mentorship; more considerate recruitment procedures; reducing contract precarity; and, transparency on pay and promotion. We believe these are within the scope of action by departments, laboratories and research groups.

"We Live on an Island": Perspectives on Rural Family Caregivers for Adults with Alzheimer's Disease and Related Dementias in the United States.

As the United States' aging population grows, there will be increased prevalence of individuals living with Alzheimer's Disease and related dementias (ADRD), who largely rely on the support of their family caregivers. Family caregivers residing in rural areas face additional challenges with managing caregiving responsibilities and navigating support services. The purpose of this multilevel phenomenological qualitative study was to explore the assets, unique needs, and resources of rural-residing ADRD caregivers from the caregiver, provider, and policy influencers' perspectives. The study took place between 2019 through 2021 in northern Arizona, a largely rural and geographically vast area home to caregivers from diverse backgrounds. Twenty-seven caregivers to a loved one with ADRD participated in focus groups. Twelve health and social services providers and twelve policy influencers, those involved in leadership positions for aging programs or advocacy groups, completed individual interviews. Caregivers demonstrate many assets which contribute to their ability to manage and cope with their caregiving role. However, caregivers face a series of issues related to their caregiving role and need early and ongoing education regarding ADRD. There is a lack of resources available in rural areas, in particular providers, making it challenging to obtain needed resources necessary to support their loved one with ADRD. Furthermore, there is a need for more providers trained in working with aging adults and those experiencing ADRD, and a need for more culturally relevant resources.

Recent trends in ultra-high performance concrete (UHPC): Current status, challenges, and future prospects

• UHPC is promptly developing as a leading concrete material for construction industries. • UHPC has exceptional properties, making it a potential functional solution for a sustainable construction. • This article scientifically reviews the carbon capturing, challenges, limitations, and applications of UHPC. • The findings of this review likely to help specialists in establishing the design guidelines for sustainable UHPC. • Further efforts are required to standardize testing characterization for the materials used in UHPC. Ultra-high performance concrete (UHPC) combines advanced fibrous and cementitious material technologies to achieve high strength and exceptional durability. The material tends to have microscopic pores that prevent harmful substances such as water, gas, and chlorides from entering. UHPC can also achieve compressive strengths above 200 MPa and tensile strengths above 20 MPa. It also shows significant tensile strain hardening and softening behavior. Owing to all these characteristics, UHPC has excellent performance, making it a potentially attractive solution for improving the sustainability of construction components. Despite UHPC’s outstanding mechanical properties, superior toughness and ductility, and extraordinary durability, various challenges prevent its widespread use. At the same time, several challenges are currently being faced in the applications of UHPC, which include i) design aspects such as material properties; ii) production technology for large-volume and/or long-span elements with low workability, high spalling, and high shrinkage strains; and iii) unknown durability characteristics after the appearance of long-term concrete cracking. With a lack of industry experience, UHPC specialists face additional challenges in spreading hands-on practice to concrete industry professionals so that the latter can be well versed in applying this sophisticated concrete technology. For these reasons, a comprehensive literature study on recent development trends of UHPC should be conducted to determine its current status and prospects. This article scientifically reviews the current status, carbon capturing capabilities, sustainability aspects, challenges and limitations, and potential applications of UHPC. This state-of-the-art review is aimed at helping scientific researchers, designers, and practitioners widen the use of UHPCs in advanced infrastructure applications. This review will help specialists to develop the design guidelines to enable the widespread application of sustainable UHPC. In doing so, design engineers will be provided with an assurance to fully exploit the high strength and other special properties of UHPC and develop models that can efficaciously estimate the ultimate bearing capacity of UHPC sections under various loading conditions.

Mother tongue reading materials as a bridge to literacy

Children whose mother tongue is different from the language of instruction at school face additional challenges developing literacy skills. One approach to this favours immersion in the language of instruction, while another favours a transitional period of bilingual education. This paper evaluates the impact of a primary school literacy intervention. In addition to multi-faceted literacy support, the programme included a component of transitional bilingual education for students whose mother tongue is not the usual language of instruction. Over two years, the intervention raised literacy scores in the language of instruction by ＋0.41 sd, and literacy in mother tongue for minority language speakers by ＋0.75 sd. Our findings suggests that a light-touch transitional bilingual component can support minority language literacy without crowding out acquisition of the language of instruction.

South Asian youth mental health in Peel Region, Canada: Service provider perspectives.

The Peel Region of Toronto, Canada is home to over a third of the province's South Asian population. Youth are at a vulnerable time period in terms of their mental health. South Asian youth populations may face additional challenges to their mental health such as acculturative stress, intergenerational conflict, and racism and discrimination. This qualitative study set out to understand the mental health concerns and service access barriers experienced by South Asian youth populations in the Peel Region of Toronto, Canada from the perspective of mental health service providers. In-depth semi-structured interviews were carried out with mental health service providers (n = 22) who work with South Asian youth living in Peel Region. Thematic analysis was used to elucidate themes related to mental health stressors and service access barriers experienced by youth. According to mental health service providers, South Asian youth navigate a number of unique stressors related to the domains of culture, religion, and family dynamics, experiences of discrimination, the impact of migration, beliefs around mental illness and help-seeking, help-seeking trajectories and therapy recommendations, and lastly, sex differences. Mental health service providers outlined steps needed to effectively address the unique mental health challenges, best practice guidelines, and recommendations for working with South Asian youth, families, and communities to provide a practical and nuanced overview on how a multi-level strategy for mental health care can effectively meet the needs of South Asian youth populations.

Impact of the COVID-19 Pandemic on the Wellbeing of International Oncology and Hematology Fellows at the Princess Margaret Cancer Center (PMCC)

BackgroundThe COVID-19 pandemic has led to significant disruptions across all levels of medical training. International fellows in subspecialty training programs are essential members of the frontline physician workforce, but may face additional and unique challenges as a result of being away from their home country. In this study, we aimed to understand the impact of the COVID-19 pandemic on the wellbeing of international fellows in the Hematology and/or Oncology fellowship program at the PMCC.MethodsIn collaboration with our staff psychiatrist, we conducted an online survey of hematology and/or oncology fellows at the PMCC from July 6 to August 10, 2020. The survey consisted of 60 questions divided into 4 sections: demographics, wellbeing assessment using the validated Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS), fellowship specific questions (personal and professional) and coping strategies using the validated brief COPE scale.ResultsOverall 24/52 (46%) fellows completed the survey: 21/24 were international fellows with 48% from Asia, 3/24 were Canadian fellows but away from home; 54% were male; 48% were aged 31–35 years; 65% were married, 48% had children. Mean SWEMWBS score was 21, indicating lower overall wellbeing than the general population who had a score of 23.6. Compared to their pre-COVID status, many reported a decline in their wellbeing (63%), sense of guilt for not being with their family (45%) or helping their country (41%), stress in personal relationships (26%), fatigue (50%), sleep disorders (38%) and loss of interest in daily activities (38%). Personal events were altered by almost 80%; and 20% planned to extend their fellowship. According to the Brief-COPE scale, during the pandemic, most fellows used more adaptive coping mechanisms (mean score 39.2) as opposed to maladaptive ones (mean score 21.8).ConclusionsThe ongoing COVID-19 pandemic has negatively affected the overall wellbeing of international fellows. Understanding the specific challenges and coping mechanisms used by international fellows may help institutions develop better targeted strategies to promote wellbeing, professional development and ensure high-quality patient care during unprecedented times like the COVID pandemic.

Latent change modeling of Latino parent–child conflict and pathways to mental health

AbstractObjectiveThis secondary analysis of longitudinal data on Latino immigrant parents applied latent change modeling to investigate the association between within‐family change in parent–child conflict and within‐individual change in parent's psychological distress, and how within‐individual change in parenting stress mediates that association over time.BackgroundImmigrant parents face additional challenges when parenting their children. There is limited research regarding how parent–child conflict may influence parenting stress and parents' overall well‐being, in particular in Latino immigrant families.MethodSecondary analysis was conducted on data from a sample of 344 Latino immigrant parents who participated in a community‐based parenting skills invention. In the original intervention study, they were assigned randomly to intervention or waitlist control groups and assessed at three points: baseline, 4 months (post‐intervention), and a follow‐up 10 months after the baseline assessment.ResultsAcross 4 months, change in parent–child conflict was significantly associated with changes in parenting stress and psychological distress, whereas across 10 months, change in parent–child conflict was only associated with change in psychological distress. The indirect effects through parenting stress were non‐significant. However, participating in the intervention had a protective indirect effect by reducing parenting stress across 4 months and reducing psychological distress across 10 months via change in parent–child conflict.ConclusionChanges in parent–child relations were related to changes in parents' individual well‐being, with those associations varying across different time periods.

Navigating the open innovation paradox: an integrative framework for adopting open innovation in pharmaceutical R&D in developing countries

In this paper, we combine evidence from eight Indian pharmaceutical firms with extant literature and global best practices to conceptualize an integrative framework addressing the open innovation paradox (OIP), i.e., the tension between intellectual protection and openness. Firms in developing countries face additional challenges in the adoption of open innovation, such as the prevalence of open science norms, weak technology transfer systems, and mistrust between universities and industry; therefore, they employ open innovation selectively for pharmaceutical research. Prior research has examined the strategies to resolve OIP in the context of developed countries; the integrative framework proposed in this paper describes strategies for resolving the OIP in the context of developing countries. This framework illuminates the coping processes of the case firms and provides guidelines to uplift and accelerate the adoption of open innovation strategies in developing countries’ pharmaceutical sectors, and thus provides value to both theory and praxis.

Faculty Perceptions of Persons with Disabilities and Students with Special Needs in the New Normal: Basis for Drafting Advocacy Program in Philippine State Universities and Colleges

As the world’s largest minority, people with disabilities (PWD) students and students with special needs face additional challenges to become successful in higher education during the COVID-19 pandemic. This study investigated faculty attitudes toward these students in the new normal. Specifically, the study looked at how faculty perceived PWDs and their knowledge, experiences, and opinions about them, as well as their willingness to make significant accommodations. Ninety faculty members from a state university were surveyed and the results revealed that faculty members generally perceive that they are considerate of the requests of students who have disabilities and special needs. Likewise, findings showed that faculty members are willing to: (1) set up extended time exams; (2) give these students extra time to complete assignments; (3) alter the way exams are answered; (4) permit these students to tape record lectures; and (5) spend additional time with these students to clarify course-related material.

Understanding the interplay between immigrant nascent entrepreneurship and cross-cultural adaptation

PurposeAll entrepreneurs face challenges during their venture start-up process, but immigrant entrepreneurs face additional and distinctive challenges due to their contextual newness. This paper focuses on understanding the intertwined journeys of nascent entrepreneurship and cross-cultural adaptation of immigrants in a small Western European country where immigrant entrepreneurship is still a relatively new phenomenon.Design/methodology/approachThe induction-driven, 18-month longitudinal empirical inquiry focused on six early-stage nascent entrepreneurs. Qualitative methods included participant observation during an enterprise program, qualitative interviews and ongoing informal communication.FindingsThe data uncovered the interplay between the nascent immigrant entrepreneurship and cross-cultural adaptation. This led to the development of a novel conceptual framework which highlights how the cross-cultural adaptation domain links with the process of recognition, evaluation and exploitation of entrepreneurial opportunities by immigrant entrepreneurs. While varying temporarily and contextually, cross-cultural adaptation was found to create both enabling and constraining tensions within the nascent entrepreneurial experiences of immigrants.Research limitations/implicationsIt is recognized that undertaking just six cases may present a significant limitation of the research, but a close examination of even one individual's lived experience can yield valuable insights. It is hoped that future work will test the highlighted research propositions and other findings in different empirical contexts, and so add to the emerging conceptual framework on nascent immigrant entrepreneurship within the context of cross-cultural adaptation.Originality/valueNo previous qualitative studies have been undertaken seeking to understand how cross-cultural adaptation interacts with the early stages of nascent immigrant entrepreneurial activity. By integrating new venture creation and cross-cultural adaptation theories, this research contributes to the conceptualisation of early stages of nascent entrepreneurial activities of immigrants in a new host environment. The implications of the research are also relevant to enterprise support bodies, policymakers and practitioners who support immigrant entrepreneurship.

When the Odds are Stacked Against You: Female Entrepreneurs in Male-dominated Industries

One of the most well-documented gaps in entrepreneurship is the gender gap which manifests itself in various ways—females are less likely to become entrepreneurs, less likely to attract external capital and less likely to scale up their ventures. In spite of the growing empirical evidence suggesting that the current entrepreneurial system might favor men, we know less about the drivers of these gender disparities. In this project, we study female entrepreneurs in male-dominated industries—industries where women might face additional challenges. We find that in the first two years after venture creation, female founders exit at higher rates than their male counterparts. The data patterns do not seem to validate the gender underperformance hypothesis though—while few women enter male-dominated industries, the ones that do perform as well as the men. Further analysis suggests that one of the reasons for higher exit rates among women might be related to the way the entrepreneurial process unfolds for both genders (for example, women seem to encounter more hurdles and benefit less from pre-existing relations with clients and suppliers). This project highlights the importance of delving into the entrepreneurial process when examining gender disparities.

WARChain: Consensus-based trust in web archives via proof-of-stake blockchain technology1

Web archives store born-digital documents, which are usually collected from the Internet by crawlers and stored in the Web Archive (WARC) format. The trustworthiness and integrity of web archives is still an open challenge, especially in the news portal domain, which face additional challenges of censorship even in democratic societies. The aim of this paper is to present a light-weight, blockchain-based solution for web archive validation, which would ensure that documents retrieved by crawlers are authentic for many years to come. We developed our archive validation solution as an extension and continuation of our work in web crawler development mainly targeting news portals. The system is designed as an overlay over a blockchain with a proof-of-stake (PoS) distributed consensus algorithm. PoS was chosen due to its lower ecological footprint compared to proof-of-work solutions (e.g. Bitcoin) and lower expected investment in computing infrastructure. We based our prototype on the open-source Nxt blockchain and implemented it in Python. The prototype was tested on web archive content crawled from Hungarian news portals at two different timestamps with more than 1 million articles in total. We concluded that the proposed solution is accessible, usable by different stakeholders to validate crawled content, deployable on cheap commodity hardware, tackles the archive integrity challenge and is capable to efficiently manage duplicate documents.

A Qualitative Study Evaluating the Factors Affecting Families' Adherence to the First COVID-19 Lockdown in England Using the COM-B Model and TDF.

The ability of families to adhere to public health guidance is critical to controlling a pandemic. We conducted qualitative interviews with 30 parents of children aged 18 and under, between 16 and 21 April 2020 when schools in England were closed due to the COVID-19 pandemic. Using the Theoretical Domains Framework, we classified the factors that influenced adherence to seven non-pharmaceutical interventions. We found 40 factors that influenced a family’s ability to adhere. Parents generally indicated they could adhere and reported how their family had changed their behaviour to comply with the guidance. Parents primarily reported they were motivated to adhere out of concern for the health consequences of COVID-19, and because the guidance was delivered by the government. However, we found that reduced access to resources (e.g., technology, transport, and outside space) and social influences that encouraged non-adherent behaviour, decreased adherence. Furthermore, we suggest that families with low psychological and physical ability may face additional challenges to adherence and need to be supported. During future school closures, public health agencies should account for these factors when developing guidance.

Mobile Ecological Tracking of mood as a predictor for resilience among male and female Israeli combatants

IntroductionBackground: Mental resilience refers to the capacity to overcome the negative effects of setbacks and associated stress on performance. In the face of stressors, lack of mental resilience may even cause psychopathology, such as depression. While all combatants are exposed to stressors, female combatants face additional challenges compared with their male counterparts. Resilience is often measured using retrospective self-reports, which do not consider ecological fluctuations across situations and environments. A mobile ecological momentary monitoring allowed us to study gender differences in factors contributing to resilience.ObjectivesObjective: We aimed to characterize gender differences in resilience trajectory in combatants using ecological momentary assessments (EMA).MethodsMethods: 156 Combatants (98F, 58M) completed mood EMA daily for two weeks using a mobile app. In addition, resilience, QOL and mental health questionnaires were administered three times in four weeks. Stepwise regression models were used to predict resilience after 2-4 weeks.ResultsResults: Female combatants reported higher levels of anxiety and lower resilience, self efficacy and QOL, as well as higher mood variability over time (t(149)=4.9, p<.0001). In addition, while for females, baseline anxiety, self-efficacy and mood EMA all contributed to resilience prediction (37% of variance explained), baseline anxiety was the sole predictor for males (explaining 28% of variance).ConclusionsConclusion: Gender differences in resilience were found in combatants who participate in the same occupation. These results emphasize the importance of considering the inclusion smartphone-delivered EMA tools in QOL models.DisclosureNo significant relationships.

Quality Improvement Project to Improve COVID-19 Vaccination Uptake on an Old Age Psychiatric Ward (Meridian Ward)

AimsPeople with mental health issues have challenges in accessing medical care and it is hypothesised that this may result in a significant number failing to receive protection from COVID -19 by means of vaccination. This study aimed to identify the number of inpatients on a psychiatric general ward (Meridian ward) between May 2021 and June 2021 who were fully vaccinated against COVID-19 so that unvaccinated patients could be offered vaccination during their inpatient stay.MethodsData were gathered on the COVID-19 vaccination status of all patients on Meridian ward (inpatient mental health ward) admitted between May and June 2021. This was a total of 10 patients. This information was gathered directly from the patients, their summary care records and GP records. We also audited whether the patient's vaccination status was recorded in the notes.Results50% of the patients were fully vaccinated. 20% had received one vaccine and 30% of patients were unvaccinated. 20% of the unvaccinated patients received their first dose during admission.ConclusionPatients with mental health issues sufficient to result in psychiatric admission face additional challenges when it comes to receiving a COVID-19 vaccine. It is important that healthcare workers are aware of this and facilitate interventions that maximise vaccination in this at-risk group. To improve uptake among this group it is recommended: •Patients’ vaccination status is assessed and recorded during inpatient admissions.•GP surgeries should identify patients on their database with mental health issues who are unvaccinated and providing these individuals with support around accessing information, transport or providing vaccinations at patient's homes.•There should be clear documentation of vaccination status on summary care record and ward notes.

A high-touch outreach model to re-engage patients in mammogram screening.

e18555 Background: Disparities in cancer screening have been well documented during the Covid-19 pandemic. However, there are limited patient-reported data describing the prevalence and drivers of patient hesitancy towards cancer screening and willingness to resume screening. As health systems continue to experience pandemic-related capacity strain, there is an urgent need for innovative models of re-engaging patients in preventive screening. To address this issue, we developed a medical student-led, high-touch outreach model to re-engage primary care patients at Brookside Community Health Center in cancer screening. Methods: We iteratively optimized semi-structured call scripts and surveys in English and Spanish to contact patients overdue for mammography screening. Student callers included medical and pre-medical students with native Spanish fluency. Using the call script, students identified patient-reported barriers and facilitated mammogram scheduling for consenting patients. For consenting patients, student callers placed a telephone encounter with a pended screening mammogram order in the electronic medical record. PCP confirmation of the order triggered outreach by the radiology department for mammogram scheduling. Patients also received reminder calls from students the week of their appointment. Primary outcomes include screening consent rates, mammogram scheduling and completion rates, and screening results. Patient survey responses were securely recorded using the REDCap survey platform. Results: 198 patients were eligible for the intervention. 60% are primarily Spanish-speaking and 81% are insured by Medicaid. 145 patients (73%) have successfully been contacted, of which 129 (89%) consented for mammogram screening. 74 (57%) of the consenting patients have scheduled their mammogram and 38 (29%) have completed their mammogram. 36% of consenting Spanish-speaking patients with active mammogram orders did not have a mammogram scheduled, compared to 9% of consenting English-speaking. To date, 6 patients had abnormal mammograms requiring subsequent diagnostic imaging, and 1 patient was diagnosed with ductal carcinoma in situ requiring oncologic care. Qualitative analysis of patient surveys found that primary barriers to screening included factors associated with the Covid-19 pandemic (32.9% of contacted patients), lack of awareness of overdue status (25.9%) and patient unavailability (e.g. outside of country) (20%). Conclusions: In this single-center quality improvement study, we found that patients had a high willingness to engage in cancer screening during the pandemic and that trainees can play a vital role in re-engaging patients in preventative care. The disparity between Spanish and English-speaking patients’ ability to schedule a mammogram after the consent process suggests that patients with limited English proficiency face additional challenges in accessing screenings.

CYCLANDS: Cycling geo-located accidents, their details and severities

Several cities and national authorities across the globe publish records on road accidents and crashes. This data is vital for road safety analysis, enabling researchers to develop models to understand how different factors impact the frequency and severity of accidents. However, researchers studying cycling safety face additional challenges as datasets containing solely cycling accidents are scarce, may contain errors, among others. Thus, we publish CYCLANDS: CYCling geo-Located AccideNts, their Details and Severities. CYCLANDS is a curated collection of 30 datasets on cycling crashes to lower the barrier in objective cycling research comprising nearly 1.6 M cycling accidents. All observations include the severity and location of the accident. This collection fosters the worldwide study of cycling safety by providing a testbed for researchers to develop tools and models for cycling safety analysis, ultimately improving the safety of those who cycle.

Shared decision-making in Argentina in 2022

Argentina is an upper-middle income country located in South America with an estimated population of 46.2 million inhabitants. There is no unified research agenda or government initiatives encouraging the implementation and research of Shared Decision-Making (SDM). Our working group at the Family and Community Medicine Division of the Hospital Italiano de Buenos Aires is the leading centre for research and implementation of SDM in the country. The implementation strategy is articulated in undergraduate, postgraduate and continuous medical education. However, it is challenged by the professionals' perception that they are already doing it or lack time during consultations. We have advanced research to understand how to adapt tools to measure and implement SDM in our settings. Still, we face additional challenges related to funding, accessing diverse populations beyond the reach of our institution and incorporating patients in the co-production of research. While most of our efforts arise from the voluntary work of our healthcare professionals, we believe this is a strength since SDM research and implementation are then directly linked to patient care.

Etiology and Management of Dyslipidemia in Patients With Cancer.

Patients with cancer are now living longer than ever before due to the growth and expansion of highly effective antineoplastic therapies. Many of these patients face additional health challenges, of which cardiovascular disease (CVD) is the leading contributor to morbidity and mortality. CVD and cancer share common biological mechanisms and risk factors, including lipid abnormalities. A better understanding of the relationship between lipid metabolism and cancer can reveal strategies for cancer prevention and CVD risk reduction. Several anticancer treatments adversely affect lipid levels, increasing triglycerides and/or LDL-cholesterol. The traditional CVD risk assessment tools do not include cancer-specific parameters and may underestimate the true long-term CVD risk in this patient population. Statins are the mainstay of therapy in both primary and secondary CVD prevention. The role of non-statin therapies, including ezetimibe, PCSK9 inhibitors, bempedoic acid and icosapent ethyl in the management of lipid disorders in patients with cancer remains largely unknown. A contemporary cancer patient needs a personalized comprehensive cardiovascular assessment, management of lipid abnormalities, and prevention of late CVD to achieve optimal overall outcomes.

Perceived Health Care Needs of Amish Populations in Two Newly Established Districts

The Amish population in the United States is growing rapidly, leading to many new Amish communities. This mixed-methods study establishes the demographic characteristics within two newly formed Amish districts in New York State and determines the community's perceived health care needs. The study targeted married individuals within the two districts, utilizing informational meetings, individual meetings, and the creation of a Perceived Health Care Needs Questionnaire. The findings included baseline demographics, barriers to health care access, desired health care provider qualities, and perceptions related to health care costs. Conclusions: The Amish are an underserved population with significant barriers to health care, and newly established districts located in rural geographical areas where Amish communities previously did not exist face additional challenges. Opportunities exist for health care providers to help the newly established Amish districts meet their desired health care needs in a culturally competent manner.