Mobile Health Clinic Research Articles

Well-child visit attendance of children who have experienced a parental COVID-19 diagnosis.

Due to the COVID-19 pandemic, rates of well-child visit (WCV) attendance have significantly decreased. We wanted to see how a parent's positive diagnosis for COVID-19 affected a child's WCV attendance along with other factors. Therefore, we hypothesized that in families with at least 1 positive COVID-19 diagnosis, the rates of WCV attendance would be lower than in families that have not experienced COVID-19. Using National Health Interview Survey (NHIS) data from 2020, we analyzed sample adult responses for the sample child to questions about last WCV attendance. We included children whose parents completed the survey during quarters 3 and 4 of 2020. The outcome of this study was WCV attendance in the past 12 months with the exposure of interest being parental diagnosis of COVID-19. In our sample (N=1,413), 91% of children attended a WCV in the past 12 months, and 5% had a parent with a positive COVID-19 diagnosis. On adjusted analysis, there was a negative but not statistically significant association between a parent with a positive COVID-19 diagnosis and WCV attendance (OR=0.32; 95% CI: 0.09, 1.20; p=0.092). Nationwide, there has been a significant decrease in children attending recommended WCVs since the start of the pandemic. Having a parent test positive for COVID-19 may contribute to decreases in WCV attendance in traditional medical office settings. Alternative options exist that may improve WCV attendance; these include telemedicine or virtual visits, as well as visits completed in non-traditional settings such as mobile health clinics and school-based clinics. Further expansion of these options for WCVs must still take into account health disparities that exist among marginalized communities.

A community-led mobile health clinic to improve structural and social determinants of health among (im)migrant workers

BackgroundCommunity-led interventions that address structural and social determinants of health are lacking among (im)migrant workers, especially seafood workers. This lack of medical attention is especially alarming given their high rate of injury and death.MethodsCommunity-based participatory research (CBPR), a relational model that values the participants as equal partners in research, dissemination, and implementation, guided the interviews and mobile clinic. Seafood workers were engaged throughout data collection, analysis, and interpretation and played a significant role in moving the findings from research into actionable change.ResultsTo address the lack of healthcare options for (im)migrants, and at the request of the seafood workers participating in the ongoing CBPR study, we successfully implemented and treated workers in our mobile clinic.DiscussionMany of these individuals had not been seen by a healthcare provider in years, highlighting the importance of community trust and rapport building when addressing interconnected health and safety issues.ConclusionsAlthough CBPR and free (mobile) health clinics are in and of themselves not novel concepts, when applied to high-risk occupational settings with under-reached populations (e.g., (im)migrant workers), they have the ability to improve health and prevent injury. This intervention adds to the growing literature detailing the potential benefits of using CBPR, and meeting people where they are, especially with historically marginalized populations.

From Supply Chain Stakeholder to Service Customer: An Engineering Framework for Vehicle-Based Services

AbstractGeographic distance between supply and demand reduces spatial accessibility. Vehicles have been contributing to improved spatial accessibility by offering transport services for people and goods. From traditional trucks to mobile health clinics, vehicles can offer a wide range of functionalities on wheels. To develop context-specific vehicles-based services, we propose a novel engineering framework based on a supply chain perspective. Requirements are derived from supply chain stakeholders and translated into vehicle-based services and vehicle components.

Pediatric Mobile Health Care Delivery During COVID-19.

Approximately 2000 Mobile Health Clinics (MHCs) are operational in the United States.1 MHCs represent diverse clinical platforms, with the majority providing screenings and other primary care-based services. MHCs provide cost effective, patient-centered care to patients who may experience obstacles to care receipt such as transportation, structural barriers, and the anxiety of attending visits in a traditional clinic setting.1 Additionally, literature shows that MHCs have been effectively utilized in health care crises such as the opioid epidemic.

Awareness, perception and utilization of a mobile health clinic by people who use drugs

Introduction People who use drugs (PWUD) face a multitude of barriers to accessing healthcare and other services. Mobile health clinics (MHC) are an innovative, cost-effective health care delivery approach that increases healthcare access to vulnerable populations and medically underserved areas. There is limited understanding, however, of how PWUD perceive and experience MHCs. Methods Semi-structured interviews were conducted with 31 PWUD – 16 who had received care (clients) on an MHC (The Spot) and 15 who had not (non-clients) – to explore their perceptions and utilization of an MHC partnered with a mobile syringe services program in Baltimore, Maryland. Data analysis of the text was conducted using an iterative thematic constant comparison process informed by grounded theory. Results Clients and non-clients, once aware of the MHC, had positive perceptions of The Spot and its benefits for their individual health as well as for the wellbeing of their community. These sentiments among clients were largely driven by access to low-barrier buprenorphine and service delivery without stigma around drug use. However, lack of general awareness of the spot and specific service offering were barriers to its use among non-clients. Discussion MHCs provide an important opportunity to engage PWUD in healthcare and to expand buprenorphine use; however, even with accessibility near where PWUD access injection equipment, barriers to its use remain. Peer dissemination may be able to facilitate program information sharing and recruitment. KEY MESSAGES People who use drugs perceive a mobile health clinic in their neighbourhood as a benefit to their communities and themselves by improving access to healthcare services, providing access to low-threshold buprenorphine dispensation, and offering services without drug use stigma. People who use drugs learned about a mobile health clinic in their neighbourhood largely through word-of-mouth. As a result, people received limited information about the mobile health clinic services creating a barrier to its use.

HIV care and support services offered in mobile health clinics: a systematic review

HIV care and support services offered in mobile health clinics: a systematic review

Novel Platforms for Biomedical HIV Prevention Delivery to Key Populations - Community Mobile Clinics, Peer-Supported, Pharmacy-Led PrEP Delivery, and the Use of Telemedicine.

Purpose of ReviewA gap exists between PrEP interest and PrEP uptake in key populations (KP) for HIV prevention that may be ascribed to PrEP delivery services not being acceptable. This review summarizes novel platforms for HIV prevention outside of the traditional health facilities environment.Recent FindingsMobile health clinics provide highly acceptable integrated, KP-focused services at convenient locations with the potential of high PrEP uptake. Telemedicine and health apps decongest health systems and allow for personal agency and informed decision-making on personal health. Pharmacy-led PrEP delivery provides de-medicalized, confidential PrEP services at extended hours in community locations, from trusted medical professionals. Peer-supported delivery encourages continued PrEP use.SummaryCommunity-based, differentiated and de-medicalized PrEP delivery can address uptake and continued use barriers in key populations. Future research should assess scalability, cost-effectiveness and sustainability of these PrEP delivery platforms, as well as focus on ways to simplify PrEP provision.

Disparities in Healthcare Services and Spatial Assessments of Mobile Health Clinics in the Border Regions of Thailand.

Reducing the disparities in healthcare access is one of the important goals in healthcare services and is significant for national health. However, measuring the complexity of access in truly underserved areas is the critical step in designing and implementing healthcare policy to improve those services and to provide additional support. Even though there are methods and tools for modeling healthcare accessibility, the context of data is challenging to interpret at the local level for targeted program implementation due to its complexity. Therefore, the purpose of this study is to develop a concise and context-specific methodology for assessing disparities for a remote province in Thailand to assist in the development and expansion of the efficient use of additional mobile health clinics. We applied the geographic information system (GIS) methodology with the travel time-based approach to visualize and analyze the concealed information of spatial data in the finer analysis resolution of the study area, which was located in the border region of the country, Ubon Ratchathani, to identify the regional differences in healthcare allocation. Our results highlight the significantly inadequate level of accessibility to healthcare services in the regions. We found that over 253,000 of the population lived more than half an hour away from a hospital. Moreover, the relationships of the vulnerable residents and underserved regions across the province are underlined in the study and substantially discussed in terms of expansion of mobile health delivery to embrace the barrier of travel duration to reach healthcare facilities. Accordingly, this research study addresses regional disparities and provides valuable references for governmental authorities and health planners in healthcare strategy design and intervention to minimize the inequalities in healthcare services.

Attitudes and Beliefs of COVID-19 and Vaccine Uptake among Amish Women

The Amish, a Christian religious group living in rural areas with distinct beliefs about remaining separate from the outside world, have communities in 31 states and four Canadian provinces with just over 600 settlements. Their access to health care and technology is often limited. Several studies have noted low vaccination rates for preventable diseases among the Amish, often due to lack of knowledge about efficacy and safety of vaccines. To gain an understanding of beliefs surrounding COVID-19 and attitudes toward vaccine uptake, we surveyed 863 Amish and Mennonite women throughout Ohio who participated in rural mobile health clinics between 2015 and 2019 at two time periods: before and after the 2020 election. We received 372 completed surveys, 252 of which were completed by respondents who identified themselves as Amish. While 100% of the Amish respondents had heard of COVID-19 and 90% reported knowing someone who had contracted the disease, a mere 1.7% (4) indicated a willingness to get vaccinated. In terms of COVID-19 diagnosis, post-election participants were two times more likely to report having a positive test than pre-election respondents (p = .011). Qualitative analyses revealed significant differences in keywords used to describe COVID-19. Post-election respondents were less likely to use words like "evil" and "bad" and associate COVID-19 with the flu. A notable shift in vaccine hesitancy among Amish participants centered on the perceived politicization of the pandemic and safety/efficacy of the vaccines. Public health efforts should center on raising awareness of the severity of COVID-19 and the benefits of vaccine uptake for distinctive subcultures like the Amish.

Scoping Review on the Impact of Outbreaks on Sexual and Reproductive Health Services: Proposed Frameworks for Pre-, Intra-, and Postoutbreak Situations.

Introduction Recent experiences from global outbreaks have highlighted the severe disruptions in sexual and reproductive health services that expose women and girls to preventable health risks. Yet, to date, there is no review studying the possible impact of outbreaks on sexual and reproductive health (SRH). Methodology. Studies reporting outbreaks impacting sexual and reproductive health and pregnancy outcomes were identified using MEDLINE, Embase, and ISI-WoS. Reported impacts were reviewed at systems, community, and legislative levels. Results The initial run listed 4423 studies; the 37 studies that met all inclusion criteria were mainly from Latin America and Africa. Studies on outbreaks of diseases like Zika and Ebola have documented declines in facility-based deliveries, contraceptive use, and antenatal and institutional care due to burdened healthcare system. Service usage was also impacted by a lack of trust in the healthcare system and system shocks, including workforce capacity and availability. At the community level, poverty and lack of awareness were critical contributors to poor access to SRH services. Assessing the target population's knowledge, attitude, beliefs, and behavior and using health literacy principles for communication were fundamental for designing service delivery. Online resources for SRH services were an acceptable medium of information among young adults. In outbreak situations, SRH and pregnancy outcomes were improved by implementing laboratory surveillance, free-of-cost contraceptive services, improved screening through professional training, and quality of care. In addition, mobile health clinics were reported to be effective in remote areas. Knowledge Contribution. In outbreaks, the interventions are categorized into preoutbreak, during, and postoutbreak periods. The proposed steps can help to improve and do course correction in emergencies. Though conducted before the COVID-19 crisis, the authors believe that lessons can be drawn from the paper to understand and mitigate the impact of the pandemic on sexual and reproductive health services.

Using mobile clinics to deliver care to difficult-to-reach populations: A COVID-19 practice we should keep

In the United States, mobile health clinics are an important method for delivering care to medically underserved populations. Mobile clinics have long been used in pediatric primary care, but there is little published to help pediatricians disseminate this practice more widely. During the COVID-19 pandemic, reduced in-person medical visits and subsequent declines in routine pediatric vaccination rates highlighted the importance of using a variety of care delivery models to reach patients. To improve vaccination coverage among young children in Boston during summer 2020, Mattapan Community Health Center and Codman Square Health Center deployed mobile clinics as an adjunct to their in-person preventive pediatric clinical services. In total, the health centers completed 17 mobile clinic sessions and served 50 unique patients, 77% of whom were African-American/Black and 75% of whom were under the age of two. A total of 146 vaccine injections were administered. A quality improvement survey of participating families demonstrated high levels of patient satisfaction and a high likelihood of using mobile services again in the future. The mobile clinic model was most valuable in reaching families who avoided in-person care due to COVID-19 transmission concerns or faced barriers to in-person care. The health centers fostered trust and demonstrated cultural competency during this novel initiative by leveraging established patient-provider relationships, using interpreters, and involving staff who reflected the diversity of the communities. Although there are challenges to implementing mobile health clinics, this initiative demonstrates the value of mobile clinics in delivering high quality pediatric preventive care to difficult-to-reach populations.

A community-based mobile clinic model delivering PrEP for HIV prevention to adolescent girls and young women in Cape Town, South Africa

BackgroundDaily doses of pre-exposure prophylaxis (PrEP) can reduce the risk of acquiring HIV by more than 95 %. In sub-Saharan Africa, adolescent girls and young women (AGYW) are at disproportionately high risk of acquiring HIV, accounting for 25 % of new infections. There are limited data available on implementation approaches to effectively reach and deliver PrEP to AGYW in high HIV burden communities.MethodsWe explored the feasibility and acceptability of providing PrEP to AGYW (aged 16–25 years) via a community-based mobile health clinic (CMHC) known as the Tutu Teen Truck (TTT) in Cape Town, South Africa. The TTT integrated PrEP delivery into its provision of comprehensive sexual and reproductive health services (SRHS). We analyzed data from community meetings and in-depth interviews with 30 AGYW PrEP users to understand the benefits and challenges of PrEP delivery in this context.ResultsA total of 585 young women started PrEP at the TTT between July 2017 – October 2019. During in-depth interviews a subset of 30 AGYW described the CMHC intervention for PrEP delivery as acceptable and accessible. The TTT provided services at times and in neighborhood locations where AGYW organically congregate, thus facilitating service access and generating peer demand for PrEP uptake. The community-based nature of the CMHC, in addition to its adolescent friendly health providers, fostered a trusting provider-community-client relationship and strengthened AGYW HIV prevention self-efficacy. The integration of PrEP and SRHS service delivery was highly valued by AGYW. While the TTT’s integration in the community facilitated acceptability of the PrEP delivery model, challenges faced by the broader community (community riots, violence and severe weather conditions) also at times interrupted PrEP delivery.ConclusionsPrEP delivery from a CMHC is feasible and acceptable to young women in South Africa. However, to effectively scale-up PrEP it will be necessary to develop diverse PrEP delivery locations and modalities to meet AGYW HIV prevention needs.

COVID-19 Testing and Social Determinants of Health Among Disadvantaged Baltimore Neighborhoods: A Community Mobile Health Clinic Outreach Model.

The objective was to summarize data on coronavirus disease 2019 (COVID-19) testing uptake, social determinants of health, and patient satisfaction with mobile health clinic services within underserved minority and low-income communities. This COVID-19 pilot project was conducted during June and July 2020 in low-income residential neighborhoods in West Baltimore, Maryland. Quantitative data were collected and assessed cross-sectionally. Demographically, 85% of the patients identified as Black or African American (n = 265) and 58.2% as female (n = 184). The COVID-19 test was administered by the registered nurse to 78.2% (n = 288) of the patients. More than 90% of patients confirmed high levels of satisfaction with the services they received from the community mobile health clinic. Social determinants were assessed and females reported significantly worse health literacy than their male counterparts (P < 0.05). Study findings suggest that the community mobile health clinic model was effective in attracting hard-to-reach and marginalized individuals, who otherwise may have gone untested or undiagnosed. This care delivery model can be one solution to disparities by improving access to COVID-19 testing and primary care for communities with higher vulnerability to COVID-19 complications.

Kaiser Permanente's Good Health & Great Hair Program: Partnering With Barbershops and Beauty Salons to Advance Health Equity in West Baltimore, Maryland.

The Good Health & Great Hair program was developed by Kaiser Permanente in partnership with a network of trusted neighborhood barbershops and beauty salons in West Baltimore, Maryland. The initiative aimed to increase health awareness and knowledge and reduce health disparities by making no-cost health care services available beyond traditional health care settings in predominantly Black, historically redlined neighborhoods in West Baltimore. This initiative, established by an integrated health care system, is the first to utilize mobile health clinics into a holistic community health outreach program in partnership with barbershops and beauty salons to provide medical and social services to underserved populations. In addition to the mobile health clinics, key features of this program included lay first responder trainings on topics of physical and behavioral health, on-site medical and social services offered by community partners, and culturally relevant mental health programming. The majority of participants (n = 1823) were male (58%), Black (86%), and between the ages of 45 and 64 years (51%). Data presented include the number of clinical and social services provided. More than 8000 clinical and social services were provided between September 2016 and March 2020. Blood pressure (n = 2317), diabetes (n = 469), tobacco (n = 448), and cholesterol (n = 443) were the most accessed clinical screening services. The median number of clinical services provided per client was 2. Fitness (n = 1496), job search support (n = 1123), mental health (n = 603), and health insurance (n = 455) were the most accessed social services. The initiative delivered critical health and social support services through a partnership with an established integrated health care system, community barbershops and beauty salons, a mobile health team, and social supports. This novel program utilized a mobile health clinic to provide extensive clinical services complemented by on-site social services. Patterns of service utilization and lessons learned could inform the design of similar programs.

Use of a Community Center Primary Care Clinic and Subsequent Emergency Department Visits Among Unhoused Women

In the United States, the frequent amalgamation of homelessness, drug use, and exchange of sex for money, shelter, food, or drugs increases the risk of serious health conditions, including trauma and HIV.1 Women who are unhoused have an all-cause mortality 5 to 8 times higher than housed women.2 Seattle, Washington, is facing a housing crisis, with a 31% increase in homelessness from 2008 to 20183 and a growing epidemic of opioid and methamphetamine use. In 2018, these overlapping epidemics created the context for an HIV outbreak in Seattle among unhoused heterosexual people.4 Several US cities have created mobile health clinics in an effort to engage unhoused people in medical care.5 In July 2018, the Safe, Healthy, Empowered (SHE) Clinic was founded to provide care for unhoused women colocated at Aurora Commons, a drop-in community center with a long-standing relationship with unhoused people in Seattle. Patients at the SHE Clinic reflect the unhoused population’s high rates of injection drug use, exchange sex, unplanned pregnancy, and sexually transmitted infections.6 In this cohort study, we evaluated the association between use of the SHE Clinic and the frequency of nonemergent emergency department (ED) visits among women living unhoused who exchange sex and inject drugs.

Barriers and facilitators to use of a mobile HIV care model to re-engage and retain out-of-care people living with HIV in Atlanta, Georgia.

Novel strategies to re-engage and retain people living with HIV (PLWH) who are out of care are greatly needed. While mobile clinics have been used effectively for HIV testing and linkage, evidence guiding their use in providing HIV care domestically has been limited. To guide the development of a mobile HIV clinic (MHC) model as a strategy to re-engage and retain PLWH who are out of care, we aimed to explore stakeholder perceptions of barriers and facilitators to MHC implementation and use. From June 2019-July 2020, we conducted 41 in-depth interviews with HIV clinic providers, administrators, staff, legal authorities, and community advisory board members, PLWH, AIDS service organizations and city officials in Atlanta, Georgia, and domestic and international mobile health clinics to explore barriers and facilitators to use of MHCs. Interviews were transcribed, coded and thematically analysed. Barriers raised include potential for: breach of confidentiality with resulting heightened stigmatization, fractured continuity of care, safety concerns, staffing challenges, and low community acceptance of MHC presence in their locality. Participants provided suggestions regarding appropriate exterior design, location, timing, and co-delivery of non-HIV services that could facilitate MHC acceptance and address the concerns. In identifying key barriers and facilitators to MHC use, this study informs design and implementation of an MHC as a novel strategy for re-engaging and retaining PLWH who are out of care.

Co-locating art and health: engaging civil society to create an enabling environment to respond to HIV in Indonesia.

Mixed methods were used to evaluate the project, including a visitor (n = 1181) and artist (n = 85) log book, a convenience audience survey (n = 231), and qualitative semi-structured interviews (n = 13) with artists and audience to explore the effect of arts-based activities on access to sexual health information and services, and stigma and discrimination. In total, 85 artists curated five separate exhibitions that were attended by 1181 people, of which 62% were aged ≤24 years. Gallery attendance improved awareness and participatory and interactive engagement with sexual health information through a medium described as interesting, fun, cool, and unique. The co-located clinic facilitated informal pathways to sexual health services, including HIV/AIDS testing, treatment, and care. Importantly, the project created shared understandings and empathy that challenged stereotypes and myths, reducing stigmatising beliefs and practices. Arts-based programs are transformative and can be effectively implemented, replicated and scaled up in low-resource settings to create awareness and initiate for HIV prevention, testing, treatment, and care. Art-based health programs engages people in their communities, mobilises civil society, builds enabling environments to reduce stigma and discrimination and improves access to testing and prevention; essential features needed to end AIDS in Indonesia (and the Southeast Asia region) while improving the lives of those most vulnerable to infection.

Overview of the Issue

The e-learnings focused on sexual and reproductive health information to adolescents in Mexico and provided content around three themes: self-esteem, gender equality, and decision-making and self-efficacy and included digital tools and scenarios to help participants engage with the content. Gance-Cleveland and colleagues observed disparities in Hispanic perinatal outcomes, which lead to higher rates of obesity, diabetes, gestational diabetes, preterm birth, pregnancy-related hypertension, and infant deaths. The authors' examination of the acceptability and feasibility of mHealth tools designed to address the concerns of CSE-affected girls and women, including the study participants' desires for psychosocial support, health education, and digital assistance navigating complex judicial systems, exemplifies the potential to enhance the power and agency of marginalized populations with tools designed from the perspectives of those with lived experience of inequitable treatment. The authors used the COVID-19 Vulnerability Index to prioritize patients at high risk by location and then dispatched a mobile health clinic staffed with a registered nurse and community health worker to those neighborhoods, which provided COVID-19 testing, social needs screening (i.e., assess food availability, housing needs, financial situation), telemedicine services (i.e., basic clinical health screenings to the extent possible virtually), access to the electronic health record, and virtual visits with advanced practice providers.

Effect of Mobile- Based Educational Program through Bluetooth and WhatsApp. Application on the Oral Health Values, Dental Literacy, and Oral Self-Efficacy among Older Adults.

Background: With the advent of preventive dentistry and an expanded array of treatment options, the possibility of maintaining oral health throughout the life span has increased. This interdependence between oral health and general well-being further validates the need to explore factors related to the improvement of the oral health status of community-dwelled older adults. Essential to the process of enhancing the oral health status of this segment is the exploration of the numerous variables which must be considered in the development of mobile-based educational program. Thus, the adequate assessment of the health values, literacy, and perception related to the performance of oral hygiene is of upmost importance. Only then effective elder-specific oral interventions could be developed and implemented. Aim: The purpose of this quasi-experimental study was to measure the effect of mobile- based educational program through Bluetooth and WhatsApp Application on the oral health values, dental literacy, and oral self-efficacy among older adults.Setting: The study was conducted in El-Wafaa club of elderly persons affiliated to the Ministry of Social Solidarity. Subjects: A 67- participant, own smart phones, able to download and deal with related software applications, and capable of reading sent messages were operationalized using four specified tools. Tools: These were (1) Developed Demographic and Oral Health Profile for the Older Adults Structured Interview Schedule, (2) Health Literacy in Dentistry Scale (HeLD- short form), (3) Oral Health Values Scale (OHVS), and (4) Geriatric Self- Efficacy Scale for Oral Health (GSEOH). Results: Initially revealed that the higher prevalence of mouth health problems was related to tooth decay (64.2%) and tooth plaque (62.7%). Oral health problems had mostly a negative impact on satisfaction with fluids drinking and mouth appearance (40.3% each). There was a highly statistical positive significant improvement in the older adults’ oral-related literacy, values, and efficacy post-program than before. A strong positive significant correlation was proved between the studied variables along the whole implementing periods. Oral health literacy was a predicting / independent factor for both Self- Efficacy and values in each period of interventions. Conclusion: The proposed program succeeded in improving the main studied variables’ subscales with different degrees as represented by the mean percent scores, immediately after application that decreased at a 3- week follow up of mobile-based oral care implementation but still significant compared with the pre- intervention period. Recommendations: Digital or e-health interventions to prevent or rectify oral problems of older adults should be wide-ranging and multi-faceted to be conducted via the social networks and invest in mobile health clinics. Design a preventive program to target older adults living in Egypt, through increasing access and minimize barriers to treatment for elderly with low financial standard and collecting systematic data on oral health status as well as general medical conditions to be monitored and included in national oral health promotion plans for older adults.

Erratum for "Nurse-Led Mobile Health Clinics: An Opportunity for Student Scholarship and Faculty Practice".

Erratum for "Nurse-Led Mobile Health Clinics: An Opportunity for Student Scholarship and Faculty Practice".