Members Of Vulnerable Populations Research Articles

Factors affecting urinary organophosphate pesticide metabolite levels among Californian agricultural community members

Organophosphate (OP) pesticides are widely used in California for agricultural pest and weed control despite their well-documented adverse health effects among infants, children, and adults. We sought to identify factors affecting urinary OP metabolites among families living in high-exposure communities. Our study included 80 children and adults who lived within 61 m (200 ft) of agricultural fields in the Central Valley of California in January and June 2019, which are pesticide non-spraying and spraying seasons, respectively. We collected one urine sample per participant during each visit to measure dialkyl phosphate (DAP) metabolites; these were coupled with in-person surveys to identify health, household, sociodemographic, pesticide exposure, and occupational risk factors. We used a data-driven, best subsets regression approach to identify key factors that influenced urinary DAPs. Participants were mostly Hispanic/Latino(a) (97.5 %), over half were female (57.5 %), and most households reported having a member who worked in agriculture (70.6 %). Among the 149 urine samples suitable for analysis, DAP metabolites were detected in 48.0 % and 40.5 % of samples during January and June, respectively. Total diethyl alkylphosphates (EDE) were only detected in 4.7 % (n = 7) of samples, but total dimethyl alkylphosphates (EDM) were detected in 41.6 % (n = 62) of samples. No differences were observed in urinary DAP levels by visit month or by occupational exposure to pesticides. Best subsets regression identified several individual- and household-level variables that influenced both urinary EDM and total DAPs: the number of years spent living at the current address, household use of chemical products to control mice/rodents, and seasonal employment status. Among adults only, we identified educational attainment (for total DAPs) and age category (for EDM) as significant factors. Our study found consistent urinary DAP metabolites among participants, regardless of spraying season, and identified potential mitigating factors that members of vulnerable populations can implement to protect their health against OP exposure.

Disguising Reddit sources and the efficacy of ethical research

Concerned researchers of online forums might implement what Bruckman (2002) referred to as disguise. Heavy disguise, for example, elides usernames and rewords quoted prose so that sources are difficult to locate via search engines. This can protect users (who might be members of vulnerable populations, including minors) from additional harms (such as harassment or additional identification). But does disguise work? I analyze 22 Reddit research reports: 3 of light disguise, using verbatim quotes, and 19 of heavier disguise, using reworded phrases. I test if their sources can be located via three different search services (i.e., Reddit, Google, and RedditSearch). I also interview 10 of the reports’ authors about their sourcing practices, influences, and experiences. Disguising sources is effective only if done and tested rigorously; I was able to locate all of the verbatim sources (3/3) and many of the reworded sources (11/19). There is a lack of understanding, among users and researchers, about how online messages can be located, especially after deletion. Researchers should conduct similar site-specific investigations and develop practical guidelines and tools for improving the ethical use of online sources.

What do Veterans with homeless experience want us to know that we are not asking? A qualitative content analysis of comments from a national survey of healthcare experience.

Surveys of people who experience homelessness can portray their life and healthcare experiences with a level of statistical precision; however, few have explored how the very same surveys can deliver qualitative insights as well. In responding to surveys, people experiencing homelessness can use the margins to highlight health and social concerns that investigators failed to anticipate that standard question batteries miss. This study describes the unprompted comments of a large national survey of Veterans with homeless experiences. The Primary Care Quality-Homeless Services Tailoring (PCQ-HOST) survey presented 85 close-ended items to solicit social and psychological experiences, health conditions, and patient ratings of primary care. Amongst 5377 Veterans responding to the paper survey, 657 (12%) offered 1933 unprompted comments across nearly all domains queried. Using a team-based content analysis approach, we coded and organised survey comments by survey domain, and identified emergent themes. Respondents used comments for many purposes. They noted when questions called for more nuanced responses than those allowed, especially 'sometimes' or 'not applicable' on sensitive questions, such as substance use, where recovery status was not queried. On such matters, the options of 'no' and 'yes' failed to capture important contextual and historical information that mattered to respondents, such as being in recovery. Respondents also elaborated on negative and positive care experiences, often naming specific clinics or clinicians. This study highlights the degree to which members of vulnerable populations, who participate in survey research, want researchers to know the reasons behind their responses and topics (like chronic pain and substance use disorders) that could benefit from open-ended response options. Understanding patient perspectives can help improve care. Quantitative data from surveys can provide statistical precision but may miss key patient perspectives. The content that patients write into survey margins can highlight shortfalls of a survey and point towards future areas of inquiry. Veterans with homeless experience want to provide additional detail about their lives and care experiences in ways that transcend the boundaries of close-ended survey questions. Questions on substance use proved especially likely to draw comments that went beyond the permitted response options, often to declare that the respondent was in recovery. Respondents frequently clarified aspects of their care experiences related to pain, pain care, transportation and experiences of homelessness.

Effects of Smoking on SARS-CoV-2 Positivity: A Study of a Large Health System in Northern and Central California.

IntroductionCOVID-19 continues to impact vulnerable populations disproportionally. Identifying modifiable risk factors could lead to targeted interventions to reduce infections. The purpose of this study is to identify risk factors for testing positive for SARS-CoV-2.MethodsUsing electronic health records collected from a large ambulatory care system in northern and central California, the study identified patients who had a test for SARS-CoV-2 between 2/20/2020 and 3/31/2021. The adjusted effect of active and passive smoking and other risk factors on the probability of testing positive for SARS-CoV-2 were estimated using multivariable logistic regression. Analyses were conducted in 2021.ResultsOf 556 690 eligible patients in our sample, 70 564 (12.7%) patients tested positive for SARS-CoV-2. Younger age, being male, racial/ethnic minorities, and having mild major comorbidities were significantly associated with a positive SARS-CoV-2 test. Current smokers (adjusted OR: 0.69, 95% CI: 0.66-0.73) and former smokers (adjusted OR: 0.92, 95% CI: 0.89-0.95) were less likely than nonsmokers to be lab-confirmed positive, but no statistically significant differences were found when comparing passive smokers with non-smokers. The patients with missing smoking status (25.7%) were more likely to be members of vulnerable populations with major comorbidities (adjusted OR ranges from severe: 2.52, 95% CI = 2.36-2.69 to mild: 3.28, 95% CI = 3.09-3.48), lower income (adjusted OR: 0.85, 95% CI: 0.85-0.86), aged 80 years or older (adjusted OR: 1.11, 95% CI: 1.07-1.16), have less access to primary care (adjusted OR: 0.07, 95% CI: 0.07-0.07), and identify as racial ethnic minorities (adjusted OR ranges from Hispanic: 1.61, 95% CI = 1.56-1.65 to Non-Hispanic Black: 2.60, 95% CI = 2.5-2.69).ConclusionsOur findings suggest that the odds of testing positive for SARS-CoV-2 were significantly lower in smokers compared to nonsmokers. Other risk factors include missing data on smoking status, being under 18, being male, being a racial/ethnic minority, and having mild major comorbidities. Since those with missing data on smoking status were more likely to be members of vulnerable populations with higher smoking rates, the risk of testing positive for SARS-CoV-2 among smokers may have been underestimated due to missing data on smoking status. Future studies should investigate the risk of severe outcomes among active and passive smokers, the role that exposure to tobacco smoke constitutes among nonsmokers, the role of comorbidities in COVID-19 disease course, and health disparities experienced by disadvantaged groups.

S799 A Qualitative Analysis of the Impact of COVID-19 on IBD Management Among Vulnerable Patient Populations

Introduction: Since the onset of the COVID-19 pandemic, three surges in California resulted in severe case outbreaks and fatalities. In this unprecedented time, there were rapid changes in healthcare delivery as remote access became the norm. The aim of this study was to understand the IBD patient experience with the changes in healthcare delivery during the COVID-19 pandemic, particularly those who are members of vulnerable populations. Methods: Patients with established primary IBD at the Colitis and Crohn’s Disease Center at University of California San Francisco (UCSF) or the Gastroenterology Division at Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG), were identified for study inclusion. A standardized questionnaire invited patients to provide their perspective on how the changes in health delivery and economic/financial stability impacted their IBD management and disease control. Participants were invited to participate in a qualitative interview. From October 2020 to December 2020, in-depth, semi-structured interviews were conducted and analyzed using qualitative techniques. Results: A total of 178 surveys were completed and examined experience of care and patient perceptions about COVID-19 related to IBD (Figure 1). In addition, 21 participants (8 at UCSF and 13 at ZSFG) completed interviews, yielding 8.03 hours of interviews and 217 pages of transcript. Analysis revealed 7 primary themes mechanisms by which the COVID-19 pandemic impacted IBD care: age, language, medication use, lockdown, stress, technology, and access (Table 1). Patients who did not speak English were more likely to report difficulties using technology software with telehealth visits and contacting their IBD providers with updates in symptoms. Conclusion: In this qualitative study of IBD patients, among vulnerable patient groups, barriers of language discordance, technology aversion, age and financial/emotional stress contributed to perceptions of worsened care and IBD activity during the COVID-19 pandemic. This study highlights that in IBD, vulnerable patient groups particularly those with lower socioeconomic status and language discordance from their providers, may face more challenges with changes to healthcare delivery and have difficulty in access to care and conveying changes in IBD activity.Figure 1.: Endoscopic Results at Week 12: Values above brackets are differences vs PBO adjusted for stratification factors (95% CI). ***P ≤ .001 vs PBO. AP, abdominal pain; CD, Crohn’s disease; CDAI, CD Activity Index; PBO, placebo; RZB, risankizumab; SES CD, Simple Endoscopic Score for CD; SF, stool frequency. Endoscopic remission: SES-CD ≤ 4 and ≥ 2-point reduction from baseline and no subscore >1 in any individual variable. Ulcer-free endoscopy: SES-CD ulcerated surface subscore of 0 in patients with SES-CD ulcerated surface subscore ≥ 1 at baseline. CDAI clinical response: ≥ 100-point decrease in CDAI from baseline. Endoscopic response: > 50% decrease from baseline in SES-CD (or for patients with isolated ileal disease and baseline SES-CD of 4, ≥ 2-point reduction from baseline). Data for endoscopic response alone has been reported previously.1,2 Enhanced clinical response: ≥ 60% decrease from baseline in average daily SF and/or ≥ 35% decrease from baseline in average daily AP and both not worse than baseline, and/or clinical remission (average daily SF ≤ 2.8 and not worse than baseline and average daily AP ≤ 1 and not worse than baseline).Table 1.: Crude Odds Ratio and Adjusted Differences for Primary and Secondary Outcomes in Patients with Crohn’s Disease with High Output ECF Requiring PN vs ECF Not Requiring PN

Why Indigenous Canadians on reserves are reluctant to complain about the police

Recent widespread protests and intensive media coverage of actual and alleged acts of police misconduct against members of vulnerable populations (e.g., Indigenous and racialized persons, mentally ill and/or addicted persons) overrepresented in the criminal justice system have renewed interest internationally in the factors influencing civilian complaints against police. In Canada, a major concern exists regarding how Indigenous persons who feel improperly treated by the police perceive and confront barriers to making formal complaints about such treatment. This study focuses on the Royal Canadian Mounted Police (RCMP), the police agency providing services to the majority of rural and northern reserve communities. Our survey and interviews with influential “community informants” (in this instance community court workers) with intimate knowledge of such local communities, shared culture and language, and vicarious appreciation of the experiences of community members support the view that Indigenous persons do encounter significant barriers to launching formal complaints and are consistent with other research literature. We discuss our findings, raise policy considerations for decision makers such as police leaders and police complaints bodies, and outline implications for future research.

Understanding shared decision-making experience among vulnerable population: Focus group with food bank clients.

Shared decision-making (SDM) is a critical component of delivering patient-centered care. Members of vulnerable populations may play a passive role in clinical decision-making; therefore, understanding their prior decision-making experiences is a key step to engaging them in SDM. To understand the previous healthcare experiences and current expectations of vulnerable populations on clinical decision-making regarding therapeutic options. Clients of a local food bank were recruited to participate in focus groups. Participants were asked to share prior health decision experiences, explain difficulties they faced when making a therapeutic decision, describe features of previous satisfactory decision-making processes, share factors under consideration when choosing between treatment options, and suggest tools that would help them to communicate with healthcare providers. We used the inductive content analysis to interpret data gathered from the focus groups. Twenty-six food bank clients participated in four focus groups. All participants lived in areas of socioeconomic disadvantage. Four themes emerged: prior negative clinical decision-making experience with providers, patients preparing to engage in SDM, challenges encountered during the decision-making process, and patients' expectations of decision aids. Participants also reported they were unable to discuss therapeutic options at the time of decision-making. They also expressed financial concerns and the need for sufficiently detailed information to evaluate risks. Our findings suggest the necessity of developing decision aids that would improve the engagement of vulnerable populations in the SDM process, including consideration of affordability, use of patient-friendly language, and incorporation of drug-drug and drug-food interactions information.

Strengthening Health in Mixed-Age Housing Communities

The aim of this article is to present the findings of a secondary analysis of quantitative data collected from a public housing community composed of older and disabled adults (n=100) ages 18-92 (Study 1 -2011) and relate these findings to a subsequent qualitative study (Study 2 -2015) completed in the same community. Both study samples included community residents who resided in three high rise buildings situated in one square block in a metropolitan setting. Both older and younger residents’ concerns, including perceived health, psychological and social needs were analyzed using Bronfenbrenner’s social ecology framework. Community residents were predominately African-American with 77% over 50 years of age. Most study measures identified little difference between the older and younger groups. Key physical, social and environment challenges identified included: chronic medical conditions, abuse and safety, psychological distress, and social isolation. A subsequent qualitative study was conducted with older women (50+) within the same community (2015). The qualitative study focused on the life course experiences of women (n = 25) who were survivors of interpersonal trauma. All groups in both the quantitative secondary data analysis and the qualitative study reported low functioning in health and mental health. They also reported social isolation and safety concerns. Identifying the health and well-being related needs of individual housing communities and examining experiences and perceptions of residents should become a priority in designing community interventions to reduce health disparities and improve health and quality of life for members of vulnerable populations. Entities and providers focused on this population should carefully examine how environmental influences such as social isolation and safety concerns impact chronic physical and mental health outcomes.

A Prospective Patient Reported Outcomes (PRO) Study Assessing Outcomes of Surgically Managed Ankle Fractures

Category:AnkleIntroduction/Purpose:Ankle fractures are a common cause of functional mobility that have seen a dramatic rise incidence over the past decade1. The purpose of this study was to compare the outcomes and prognosis of various fracture sub-types by utilizing two validated patient reported outcome measures: the PROMIS Physical Function and Pain Interference Computer Adaptive Tests (CATs) for patients at a major tertiary facility and level I trauma center.Methods:12-month post-operative PROMIS Physical Function and Pain Interference CATs were collected for 125 ankle fracture patients presenting between 2014 and 2017. Patients were initially stratified by ankle fracture sub-type after examining pre- operative X-rays and further refined by the presence or absence of concomitant deltoid injury or posterior malleolar fracture.Patients defined as members of vulnerable populations and patients presenting more than 2 weeks from time of injury/with prior acute ipsilateral fracture were excluded. The distribution of PROMIS physical function and pain interference T-scores were assessed via a Shapiro-Wilk test and a one-way ANOVA was used for further evaluation. If significant differences were found between groups, pair-wise comparisons were tested via Dwass, Steel, Critchlow-Fligner multiple comparison analysis.Results:Fracture types and corresponding n-value in this study: (44) isolated lateral malleolar, (12) isolated medial malleolar, (12) bimalleolar, (44) trimalleolar, (6) isolated syndesmotic injury, and (8) isolated posterior malleolar fractures. Mean values for the PROMIS physical function and pain interference domains for each fracture sub-type were calculated and compared to reference population mean T-scores of 50 (SD = 10): isolated lateral malleolar (PF:50/PI:51), isolated medial malleolar (PF:52/PI:49), bimalleolar (PF:48/PI:50), trimalleoar (PF:47/PI:51), isolated posterior malleolar (PF:53/PI:44), and isolated syndesmotic injury (PF:60/PI:46). The Shapiro-Wilk test indicated a non-normal distribution for the post-operative PROMIS physical function T-scores across all fracture patients (p-value = 0.0421). Pair-wise comparisons were done to compare relative prognosis between fracture sub-types but failed to yield statistically significant differences in physical function or pain domains.Conclusion:Surgical intervention is effective in returning patients to normal levels of physical function and pain interference across all sub-types according to post-op T-scores. Although our analysis indicated a significant difference when comparing across all fracture sub-types, none of the pairwise sub-type comparisons showed statistical significance. Analyses of fracture sub-types determined trimalleolar injuries report the poorest outcomes for both PROMIS domains while the isolated syndesmotic and posterior malleolar groups reported the best outcomes. Further investigation with a larger sample size for each group is needed to delineate whether a significant difference exists for PROMIS physical function and pain interference scores.

Online fraud victims’ experiences of participating in qualitative interviews

Institutional Review Boards often raise concerns about qualitative research with vulnerable populations such as crime victims, and assume that research with vulnerable populations will be distressing for participants. It is therefore vital to examine whether participants do in fact experience adverse effects stemming from their participation. The existing research is clear that some members of vulnerable populations do feel distressed when they participate in research; however, in most cases, this distress is outweighed by the benefits of participation, such as a sense of having contributed to community awareness raising. This literature is, however, predominantly quantitative. In addition, it overwhelmingly focuses on violent trauma, providing no insight into participants’ experiences of research on non-violent traumatic events. The current study addresses these shortcomings by examining the research participation experiences of victims of online fraud. Specifically, an online questionnaire designed to elicit qualitative data was administered to victims of online fraud who had previously participated in a semi-structured qualitative interview. Among other findings, the study suggests that perceptions about the outcomes of research, in addition to the research process, influence victims’ satisfaction with their participation in qualitative research.

Involving members of vulnerable populations in the development of patient decision aids: a mixed methods sequential explanatory study

BackgroundPatient decision aids aim to present evidence relevant to a health decision in understandable ways to support patients through the process of making evidence-informed, values-congruent health decisions. It is recommended that, when developing these tools, teams involve people who may ultimately use them. However, there is little empirical evidence about how best to undertake this involvement, particularly for specific populations of users such as vulnerable populations.MethodsTo describe and compare the development practices of research teams that did and did not specifically involve members of vulnerable populations in the development of patient decision aids, we conducted a secondary analysis of data from a systematic review about the development processes of patient decision aids. Then, to further explain our quantitative results, we conducted semi-structured telephone interviews with 10 teams: 6 that had specifically involved members of vulnerable populations and 4 that had not. Two independent analysts thematically coded transcribed interviews.ResultsOut of a total of 187 decision aid development projects, 30 (16%) specifically involved members of vulnerable populations. The specific involvement of members of vulnerable populations in the development process was associated with conducting informal needs assessment activities (73% vs. 40%, OR 2.96, 95% CI 1.18–7.99, P = .02) and recruiting participants through community-based organizations (40% vs. 11%, OR 3.48, 95% CI 1.23–9.83, P = .02). In interviews, all developers highlighted the importance, value and challenges of involving potential users. Interviews with developers whose projects had involved members of vulnerable populations suggested that informal needs assessment activities served to center the decision aid around users’ needs, to better avoid stigma, and to ensure that the topic truly matters to the community. Partnering with community-based organizations may facilitate relationships of trust and may also provide a non-threatening and accessible location for research activities.ConclusionsThere are a small number of key differences in the development processes for patient decision aids in which members of vulnerable populations were or were not specifically involved. Some of these practices may require additional time or resources. To address health inequities, researchers, communities and funders may need to increase awareness of these approaches and plan accordingly.

Being patient, being vulnerable: exploring experiences of general practice waiting rooms through elicited drawings

For members of vulnerable populations, articulating feelings and emotions about a place to a cultural outsider may be challenging. This article describes a study using participatory visual methodology, in which participants were invited to create drawings to explore their experiences as patients in general practice waiting rooms, and interacting with receptionists. Set in New Zealand, the Pākehā (white) male researcher used a traditional meeting protocol (hui process) as a process for trust building with the participants; most were Māori, many were female, of a different age group, and had mental health vulnerabilities. As well as explaining the research, the preamble to the interviews also involved making family connections, gift giving and a mutual sharing of ideas. Elicited drawings provided the framework for conversational interviews. Colour, materials, symbols and metaphors were jointly explored through a process of shared analysis of images created. Through this process, participants reflected on, and conceptualised, ideas that addressed disempowerment, discrimination and racism. Key to the project’s success was the adoption of a culturally safe approach and willingness on the part of the researcher and participants to not only trust the process, but also be patient and vulnerable – in a context in which being a vulnerable patient prevails.

Envisioning Libraries as Collaborative Community Anchors for Social Service Provision to Vulnerable Populations

The authors envision libraries as collaborative centres blending information provision, opportunities through Local Authority and human services in partnership with members of vulnerable populations. The authors offer a rationale for local public libraries as community anchors, offer a dual focus guiding interprofessional collaboration, identify five roles librarians working with social workers can serve to strengthen libraries as community anchors and suggest intersections among libraries and Local Authorities. They conclude the paper by offering blended strategies to enact libraries as community anchors for assisting people who either are reluctant to access formal assistance or who find that assistance too limiting or stigmatising.

Concepts Unifying Social Work and Nursing Collaboration in Practice with Vulnerable Populations

The authors focus on how social work and nursing can collaborate in addressing vulnerability as a result of people’s exposure to serious social issues and the challenges they can experience when they are embedded in situations in which deprivation is prevalent. The observations the authors make about interprofessional collaboration emerged from a social work–nursing collaboration the authors developed over a 14-year period in which they worked to conceptualise, test, and refine interventions useful in helping older African American women cope with and emerge out of homelessness. The authors provide background on a community-based project and the issues that it addressed. They also identify and elaborate six concepts useful in unifying social work and nursing in helping members of vulnerable populations, particularly when they experience health issues as a consequence of their exposure to a serious social problem.

Promoting Health by Addressing Basic Needs: Effect of Problem Resolution on Contacting Health Referrals.

Members of vulnerable populations have heightened needs for health services. One advantage of integrating health risk assessment and referrals into social service assistance systems such as 2-1-1 is that such systems help callers resolve problems in other areas (e.g., housing). Callers to 2-1-1 in Missouri (N= 1,090) with at least one behavioral risk factor or cancer screening need were randomly assigned to one of three health referral interventions: verbal referrals only, verbal referrals + a tailored mailed reminder, or verbal referrals + telephone health navigator. After 1 month, we assessed whether the nonhealth problems that prompted the 2-1-1 call had been resolved. Logistic regression estimated effects of having the problem resolved on calling a health referral. Callers were predominantly female (85%) and had a high school education or less (61%); nearly half (47%) had incomes under $10,000. The most common service requests were for utility assistance (35%), home/family problems (23%), and rent/mortgage assistance (12%). At follow-up, 38% of callers reported that all problems prompting their 2-1-1 call had been resolved, and 24% reported calling a health referral. Resolving all problems prompting the 2-1-1 call was associated with a higher odds of contacting a health referral (odds ratio = 1.44, 95% confidence interval [1.02, 2.05]) compared to people whose problems were not resolved. Multifaceted interventions that help meet non-health-related needs and provide support in reaching health-related goals may promote health in vulnerable populations.

The Relevance of Four Narrative Themes for Understanding Vulnerability Among Homeless Older African-American Women

Narrative strategy can strengthen social work practice, given its usefulness in revealing how social forces influence people’s experiences with situations that can compromise their well-being. In this paper, a product of long-term developmental research, the authors consider the versatility of narrative strategy to address homelessness among older African-American women, a growing segment of the homeless population in the United States. After considering homelessness as a social issue, and the distress it can produce, often resulting in serious health and mental health problems among older minority women, the authors examine vulnerability from a narrative perspective, offer background on their long-term narrative research and summarise their observations about the nature of narrative practice in working with members of vulnerable populations. The authors develop a thematic framework for conceptualising narrative as a practice research tool for social workers and other human service professionals. For each of the four narrative themes (involving plight, efficacy, hope and recovery), useful in helping people who are vulnerable, the authors document the distinctive focus of each one, and they then conclude the paper with implications for helping people who are vulnerable.

Health Promotion with Vulnerable Population Groups

Vulnerable population groups often have limited access to preventive and health promotion services. Marginalized population groups may think of healthcare in terms of negative experiences that emphasize deficiencies rather than proactive health behaviors. Members of vulnerable populations are more likely to learn and practice healthy behaviors when the concepts are introduced in stages and when participation of individuals is sought. Integration of behavioral change strategies that promote wellness are based on readiness and include opportunities to practice healthy behaviors in comfortable settings. This article describes the development and outcomes of three health promotion programs that served individuals representing vulnerable population groups. The health promotion programs utilized principles of engagement, partnership, and assessment of stages of change to improve the understanding of both health and self-care. The programs provided opportunities for nursing faculty and nursing students to engage in a collaborative process that utilizes readiness-to-change skills and involves community population groups in self-care activities.

Vulnerable populations in healthcare

This review is designed to update readers on recent discussions and research regarding vulnerable populations in medicine, including patients who are socioeconomically disadvantaged, queer, in prison or labeled with a stigmatizing complex medical disease. Recent studies have more closely examined the effects of being part of a vulnerable population. Greater societal income inequality impacts those at the lower end of the income curve by increasing mortality and heightening the importance of individual personal situations. Recommendations from an extensive WHO report on the social determinants of health may affect social policy and use of public resources in Europe. Clinicians are undereducated about the lives and concerns of vulnerable populations, including LGBTQI persons, immigrants, physicians, prisoners, and families of patients with diseases considered 'incompatible with life'. Greater understanding of the cause of the health effects of being socioeconomically disadvantaged or being a member of a vulnerable population may be the first steps toward specific policy recommendations. Professional medical organizations and advocacy groups should raise awareness, provide education, publish guidelines and define the goals for the medical care for certain vulnerable populations.Vulnerable populations are at risk for disparate healthcare access and outcomes because of economic, cultural, ethnic or health characteristics. Vulnerable populations include patients who are racial or ethnic minorities, children, elderly, socioeconomically disadvantaged, underinsured or those with certain medical conditions. Members of vulnerable populations often have health conditions that are exacerbated by unnecessarily inadequate healthcare.

Providing Culturally Competent Care During Disasters: Strategies for Nurses

Planning for and responding to disasters involves more than traditional emergency management; members of vulnerable populations should be included in the disaster response cycle. Nurses are key to employing culturally competent strategies with vulnerable populations during disasters, enhancing the access of these populations to care and reducing their health disparities.

Preparing Families of Children With Special Health Care Needs for Disasters: An Education Intervention

Children with special health care needs pose a special challenge in post-disaster response. Current research suggests that the general population is not adequately prepared for a major disaster event, with members of vulnerable populations even less prepared. The purpose of this study was to determine the short-term effectiveness of a brief patient education intervention aimed at increasing levels of disaster preparedness among families of special health care needs children. One hundred twenty-one families were randomly assigned to either intervention or intervention plus incentive group. Families were surveyed prior to the intervention using a previously published instrument on family preparedness, and at 30–45 days post-intervention. A Preparedness Score was assigned to each family based on the number of items completed on the preparedness instrument. Significant differences were found between pre- and posttest scores for families that received the intervention, regardless of whether or not an incentive item was provided. Posttest scores were significantly higher than pretest scores, suggesting that the intervention was successful in increasing short-term overall levels of family preparedness in this population.