Navigation Of Health Care System Research Articles

Postpartum care in a cardio-obstetric clinic after preterm preeclampsia: patient and healthcare provider perspectives

BackgroundDespite the significant disruption and health implications of preterm preeclampsia with severe features for birthing people, little is known about how the system of postpartum care might be strengthened for affected families. Multidisciplinary cardio-obstetric clinics are emerging; however, there is limited research on patient and healthcare provider perspectives. ObjectiveTo describe patient and healthcare provider perspectives of services in a cardio-obstetric clinic following preterm preeclampsia with severe features. Study DesignIndividuals who experienced preterm preeclampsia with severe features and presented to a cardio-obstetric clinic were approached for study participation. Providers were approached if they provided postpartum care to patients with preterm preeclampsia with severe features and considered referral to the cardio-obstetric clinic. Participants completed a remotely conducted, semi-structured interview between March 2022 and April 2023. The interviews were audio-recorded, professionally transcribed, and checked for accuracy. Responses were inductively coded for content analysis, around the study questions of clinical referrals, patient education, visit expectations, and care coordination in relation to ambulatory clinical services. ResultsTwenty participants (n=10 patients and n=10 providers) completed interviews. Healthcare system navigation was difficult, particularly in the context of postpartum needs. When patients were informed about their diagnosis, the information could both increase anxiety and be useful for long-term healthcare planning. Language concordant care did not always occur, and both patients and providers described gaps in quality services. Within the theme of responsibility, patients described needing to be vigilant, and providers recognized the gaps in referral and care coordination systems. Comprehensible patient education provided with birthing parents’ companions and enhanced systems for care coordination were areas for further improvement in providing postpartum cardio-obstetric care following preterm preeclampsia. ConclusionsThis qualitative study identified patients' struggles with a confusing postpartum healthcare system and captured providers' concerns about maintaining consistent care and improving access to long-term healthcare services to improve outcomes for patients at risk of cardiovascular disease.

Abstract TMP45: Assessing Adaptations of a Complex Secondary Stroke Prevention Intervention

Introduction: S econdary stroke prevention by U niting C ommunity and C hronic care model teams E arly to E nd D isparities (SUCCEED) was a randomized trial of a multilevel complex intervention to enhance risk factor control after stroke. Subjects randomized to intervention were managed by an advanced practice clinician (APC)-community health worker (CHW) team. Within the framework of ≥3 clinic and ≥3 home visits, and Chronic Disease Self-Management Program (CDSMP) workshops, the team tailored the intervention to meet participants’ needs. To describe how the intervention was implemented and adapted, we used the form/function framework. Methods: We identified key domains (overall goals of intervention), motivating needs (importance of targeting each domain), functions (methods for addressing motivating needs), and forms (tools, resources, methods for accomplishing each function). Two study leaders conducted semi-structured interviews with 4 APCs and 4 CHWs to identify forms used. APCs and CHWs described how frequently they used each form and usefulness via a RedCap survey. Descriptive statistics were subsequently run with R version 4.2.3. Results: SUCCEED targeted 7 domains: medication adherence, stroke literacy, self-management skills, care coordination, healthcare system navigation, social support, and addressing barriers. Each domain had 1-7 motivating needs and 4-13 functions. Each function had 5-23 forms, resulting in a total of 365 forms for addressing all domains. Most providers (85%) reviewed medication bottles to assess medication adherence, strongly agreeing this was useful. Pill organizers and stickers were used 53% of the time to ensure patients knew what medications they should be taking; 71% strongly agreed this was useful. Providers identified physical/environmental/social/literacy barriers during both home visits and CDSMP workshops (71%); all providers found this combination helpful. Conclusion: The form/function framework is useful for describing real-world adaptations of complex interventions. We identified key aspects of the intervention that providers used frequently and found useful, to inform future development of secondary stroke prevention interventions.

Abstract HUP9: Assessing Adaptations of a Complex Secondary Stroke Prevention Intervention

Introduction: S econdary stroke prevention by U niting C ommunity and C hronic care model teams E arly to E nd D isparities (SUCCEED) was a randomized trial of a multilevel complex intervention to enhance risk factor control after stroke. Subjects randomized to intervention were managed by an advanced practice clinician (APC)-community health worker (CHW) team. Within the framework of ≥3 clinic and ≥3 home visits, and Chronic Disease Self-Management Program (CDSMP) workshops, the team tailored the intervention to meet participants’ needs. To describe how the intervention was implemented and adapted, we used the form/function framework. Methods: We identified key domains (overall goals of intervention), motivating needs (importance of targeting each domain), functions (methods for addressing motivating needs), and forms (tools, resources, methods for accomplishing each function). Two study leaders conducted semi-structured interviews with 4 APCs and 4 CHWs to identify forms used. APCs and CHWs described how frequently they used each form and usefulness via a RedCap survey. Descriptive statistics were subsequently run with R version 4.2.3. Results: SUCCEED targeted 7 domains: medication adherence, stroke literacy, self-management skills, care coordination, healthcare system navigation, social support, and addressing barriers. Each domain had 1-7 motivating needs and 4-13 functions. Each function had 5-23 forms, resulting in a total of 365 forms for addressing all domains. Most providers (85%) reviewed medication bottles to assess medication adherence, strongly agreeing this was useful. Pill organizers and stickers were used 53% of the time to ensure patients knew what medications they should be taking; 71% strongly agreed this was useful. Providers identified physical/environmental/social/literacy barriers during both home visits and CDSMP workshops (71%); all providers found this combination helpful. Conclusion: The form/function framework is useful for describing real-world adaptations of complex interventions. We identified key aspects of the intervention that providers used frequently and found useful, to inform future development of secondary stroke prevention interventions.

The relationship between adverse childhood experiences and developmental disorders: implications for family support and child advocacy

ABSTRACT The association between developmental disorders, specifically ADHD and Autism Spectrum Disorder, and adverse childhood experiences (ACEs) is examined in this study. The National Survey of Children’s Health was utilized to generate odds ratios using logistic regression. Children with developmental disorders had higher odds of all ACEs compared to neurotypical children. ASD diagnosis had the strongest correlation with Community ACEs, while ADHD diagnosis was more strongly correlated with household ACEs. Co-occurring ASD/ADHD correlated strongly with abuse/neglect ACEs. These findings indicate the need for targeted interventions to reduce experiences of ACEs and support access to and navigation of healthcare systems.

The Role of Acculturation in Self‐Care Behaviours among Chinese Immigrants Living with Cardiovascular Disease: A Qualitative Study

Aims. To understand what domains of acculturation are experienced by Chinese immigrants with cardiovascular disease (CVD) in Australia and how these domains of acculturation influence their CVD self‐care behaviours. Design. A qualitative descriptive design. Methods. Individual phone interviews were conducted among Chinese immigrants with CVD in Sydney, recruited from Chinese Community associations and social media. Inductive and deductive thematic analysis was employed, guided by the Middle‐Range Theory of Self‐Care of Chronic Illness and the conceptual model of acculturation. Results. Twenty participants, mean age 69.9 years, were interviewed. The domains of acculturation in relation to CVD self‐care behaviours encompassed cultural practices, cultural values, healthcare system navigation, and new living environment. Retaining their Chinese culture and integrating into Australian culture regarding dietary practices, social networks, traditional values and family relationships served as both enablers and barriers of self‐care maintenance through factors such as heart‐healthy diets, physical activity, stress management and medication adherence. Many participants denied encountering difficulties to utilize primary care services, but language barriers deterred them from accessing acute services and heart‐health information from mainstream sources. Some preserved beliefs and practices in Traditional Chinese Medicine may complicate their self‐care maintenance (medication adherence) and self‐care management (responding to acute angina episodes). Conclusion. The influence of acculturation on CVD self‐care behaviours among Chinese immigrants is multifaceted and individualized. Clinicians and community health workers should assess patients’ acculturation experiences to enable culturally sensitive practices. The lack of culturally and linguistically appropriate heart health information in the community should be addressed urgently to mitigate the cardiac health disparity. Collaboration with Chinese community associations offers an opportunity for co‐design and dissemination of information about Australian healthcare systems and heart health education to upskill CVD self‐care practices and mitigate the health inequities experienced by Chinese immigrants.

Patient and family experiences of lysosomal storage diseases in Canada: A qualitative interview study.

Canadian patients and families affected by rare genetic lysosomal storage diseases (LSDs) suffer from numerous challenges related to disease management, including issues navigating healthcare and social support services, access to orphan drugs, and intensive treatment regimens. These challenges significantly impact people's quality of life, yet they remain obscure and have not been the subject of comprehensive analysis. Thus, we conducted qualitative interviews with Canadian patients and caregivers living with LSDs to advance current understanding of their experiences with rare-disease (RD) management and health systems navigation to support patient-focused RD policies and programs and improve the health outcomes of the 2.8 million Canadians affected by RDs. This study employed a qualitative descriptive research design with inductive thematic analysis. The study data were collected using semi-structured interviews. Thirty Canadian participants were interviewed in person or remotely via video chat to allow for an interactive discussion and the acquisition of rich data related to the insights and perceptions of people with LSDs. Between April and November 2019, 30 participants (16 patients and 14 caregivers) with experiences with nine types of LSDs and living in seven Canadian provinces were interviewed. Five themes were identified using comprehensive thematic analysis. These themes were the complexity of the diagnosis process; navigation of healthcare systems; psychological, social, and financial implications of LSDs; access to social support services; and access to orphan drugs. Our findings reveal that patients' access to appropriate healthcare and social services is subject to significant delays and lacks care coordination. The process of accessing orphan drugs in Canada is extremely complex and convoluted. The study results also illuminate experiences of RD stigma when navigating healthcare and social support systems. Our study offers new insights into the complex nature and extensive needs of Canadians with LSDs that are currently unmet. The management of these complex diseases requires holistic patient care and support beyond having access to orphan drugs. Our findings highlight the importance of bridging existing gaps between health and social care for RD patients. Policymakers should utilize these results when developing the forthcoming national RD strategy.

Roles and experiences of informal caregivers of older adults in community and healthcare system navigation: a scoping review

ObjectiveInformal caregivers are playing a vital role in improving the degree to which older adults access community and healthcare systems in a more seamless and timely manner, thereby fulfilling their...

Designing a Mobile e-Coaching App for Immigrant Informal Caregivers: Qualitative Study Using the Persuasive System Design Model.

Informal caregivers are vital in caring for their family and friends at home who may have illnesses or disabilities. In particular, the demands for caregiving can be even more challenging for those with limited resources, support systems, and language barriers, such as immigrant informal caregivers. They face complex challenges in providing care for their relatives. These challenges can be related to sociocultural diversity, language barriers, and health care system navigation. Acknowledging the global context of the increasing number of immigrants is essential in designing inclusive mobile health apps. This study aims to investigate the needs of immigrant informal caregivers in Sweden and discuss the application of the Persuasive System Design Model (PSDM) to develop an e-coaching prototype. By addressing the unique challenges faced by immigrant informal caregivers, this study will contribute to the development of more effective and inclusive mobile health apps. The participants were considered immigrants and included in the study if they and their parents were born outside of Sweden. Through various channels, such as the National Association of Relatives, rehabilitation departments at municipalities, and immigrant groups, we recruited 13 immigrant informal caregivers. These immigrant informal caregivers were primarily women aged 18 to 40 years. Most participants belonged to the Middle Eastern region whereas some were from North Africa. However, all of them spoke Arabic. We used semistructured interviews to gather data from the participants in Arabic, which were translated into English. Data were analyzed using thematic analysis and discussed in relation to the extended PSDM. The needs of the caregivers were compared with the description of persuasive design principles, and a design principle was chosen based on the match. The PSDM was extended if the need description did not match any principles. Several brainstorming and prototyping sessions were conducted to design the mobile e-coaching app. Immigrant informal caregivers have various needs in their caregiving role. They reported a need for training on the illness and future caregiving needs, assistance with understanding the Swedish language and culture, and help with accessing internet-based information and services. They also required recognition and appreciation for their efforts, additional informal support, and easy access to health care services, which can be important for their mental health. The PSDM was adapted to the informal caregiving context by adding "facilitating conditions" and "verbal encouragement" as additional persuasive design principles. This study also presents the subsequent mobile e-coaching app for immigrant informal caregivers in Sweden. This study revealed important immigrant informal caregivers' needs based on which design suggestions for a mobile e-coaching app were presented. We also proposed an adapted PSDM, for the informal caregiving context. The adapted PSDM can be further used to design digital interventions for caregiving.

Perceptions of conflicting information about long-term medications: a qualitative in-depth interview study of patients with chronic diseases in the Swiss ambulatory care system

ObjectivePatients with multiple long-term conditions visit various healthcare professionals and are exposed to medication information from various sources causing an increased risk of patients perceiving contradictory medication information. The aims...

Digital health literacy – an evolving concept

Abstract Digital technologies are changing our health system, health information and health communication, and digital health literacy is becoming increasingly important to ensure equitable access to health. Digital health literacy applies to all contexts of health and healthcare, such as health information seeking behavior, navigation of healthcare systems, and healthcare access. However, the concept of digital health literacy is constantly evolving due to continuous technological developments and their adoption in society and health system. One of the first to define ehealth were Norman and Skinner. Their concept is based on the concept of health literacy, to seek, understand, critically evaluate, and apply information. The talk will outline the development of the digital health literacy concept since Norman and Skinners’ definition in 2006 to the current understanding of digital health literacy in 2023. The technological changes and the increasingly digitalized societies have led not only to an expansion, but also higher specificity of the literacies embedded in the digital health literacy concept. Aim of the talk is to raise the understanding for the complexity and the relevance of digital health literacy in children and adolescents by exemplifying digital health literacy in the context of child and adolescent lives and health needs. The concept, however, is not without critique, which will be addressed and discussed with the audience.

A theory of cultural translation in healthcare for multilingual older adults living with dementia and their caregivers

Objective: The United States is a multicultural, multilingual country; as a recognized feature of the American population, the challenges of caregivers seeking services for multilingual older adults still need to be better understood. This study aims to understand the experience of caregivers who sought healthcare services for a multilingual older adult living with dementia.Methods: Using Constructivist Grounded Theory, formal and informal caregivers participated in semi-structured interviews to ascertain their experiences seeking health services for multilingual older adults with dementia.Results: Several themes emerged, including Cultural Translator, Mitigating Relationships, Leaning, Seeking Help, Meeting them where they are, and a Rigid Healthcare System. Lastly, the participants’ descriptions unveiled a phenomenon identified as cultural translator stress. Cultural Translator stress may occur due to the added responsibilities of advocacy, healthcare system navigation, language interpretation, and explanations of culturally based idioms on behalf of the multilingual older adult with dementia for the healthcare provider.Conclusions: As our understanding of care for multilingual older adults with dementia improves, awareness of their caregiver's needs and mechanisms to support this unique population should emerge. Factors such as culture, access to culturally appropriate services, and services needed to support family caregivers are needed. Further studies are needed to understand the stressors related to caring for a multilingual adult living with dementia or the phenomenon of cultural translator stress.

1166-P: Identifying Knowledge Strengths and Deficits of Young Adults with Type 1 Diabetes (T1D)

Among challenges that young adults with T1D face in their care are expectations for independence with healthcare system navigation and diabetes knowledge competency. This is a particular concern given increased hemoglobin A1c (HbA1c) and complications among young adults. A 50-item diabetes-specific knowledge assessment (KA) was developed and utilized in a young adult diabetes program to identify the areas of strength and deficits to guide education and care. To identify the competency of diabetes knowledge, KA items were categorized to describe strengths, deficits, and variable responses. A retrospective chart review was performed in patients with T1D transferring from Texas Children's Hospital to a single adult endocrinology program. Inclusion criteria included T1D for >1 year and completion of KA by diabetes educator or provider. Each KA item was scored on a 1-4 scale (4 = high). Scores were grouped into 3 categories: strengths as >80% of the young adults scoring ≥3, deficits as >50% score <3, and Variable (V) not meeting criteria for strength nor deficit. Over 4.5 years, 142 patients had KAs (M age 20.5 ± 1.4 yrs, HbA1c = 8.8 ± 1.9%, T1D duration = 10.4 ± 4.7 yrs, 54% pump, 52% CGM). KA strengths (18) included questions addressing insurance card, safe sex practices, teaching treatment of mild hypoglycemia, and insulin pump management. KA deficits (11) included diabetes specific knowledge, alcohol use, tobacco, pregnancy, and acute and chronic complications of diabetes. Variable questions (21) included diabetes pathophysiology, identifying an adult PCP and hospital, and counting carbohydrates. Complications of diabetes, the effect of alcohol on blood glucose, glucagon administration, and pregnancy and diabetes should be re-educated upon transfer to adult healthcare. Questions related to insurance cards, safe sex, and insulin pump management may not need to be immediately prioritized at transfer. Further research with this KA will validate it for implementation in clinics and research. Disclosure E.A.Kubota-mishra: None. N.Miranda: None. M.E.Hilliard: None. S.Mckay: None.

Peer-to-Patient-Aligned Care Team (Peer-to-PACT; P2P), a Peer-Led Home Visit Intervention Program for Targeting and Improving Long-term Care Services and Support for Veterans With High Needs and High Risk: Protocol for a Mixed Methods Feasibility Study.

Keeping older veterans with high needs and high risk (HNHR) who are at risk of long-term institutional care safely in their homes for as long as possible is a Department of Veterans Affairs priority. Older veterans with HNHR face disproportionate barriers and disparities to engaging in their care, including accessing care and services. Veterans with HNHR often have poor ability to maintain health owing to complicated unmet health and social needs. The use of peer support specialists (peers) is a promising approach to improving patient engagement and addressing unmet needs. The Peer-to-Patient-Aligned Care Team (Peer-to-PACT; P2P) intervention is a multicomponential home visit intervention designed to support older veterans with HNHR to age in place. Participants receive a peer-led home visit to identify unmet needs and home safety risks aligned with the age-friendly health system model; care coordination, health care system navigation, and linking to needed services and resources in collaboration with their PACT; and patient empowerment and coaching using Department of Veterans Affairs whole health principles. The primary aim of this study is to evaluate the preliminary effect of the P2P intervention on patient health care engagement. The second aim is to identify the number and types of needs and unmet needs as well as needs addressed using the P2P needs identification tool. The third aim is to evaluate the feasibility and acceptability of the P2P intervention delivered over 6 months. We will use a quantitative-qualitative convergent mixed methods approach to evaluate the P2P intervention outcomes. For our primary outcome, we will conduct an independent, 2-tailed, 2-sample t test to compare the means of the 6-month pre-post differences in the number of outpatient PACT encounters between the intervention and matched comparison groups. Qualitative data analysis will follow a structured rapid approach using deductive coding as well as the Consolidated Framework for Implementation Research. Study enrollment began in July 2020 and was completed in March 2022. Our sample size consists of 114 veterans: 38 (33.3%) P2P intervention participants and 76 (66.7%) matched comparison group participants. Study findings are expected to be published in late 2023. Peers may help bridge the gap between PACT providers and veterans with HNHR by evaluating veterans' needs outside of the clinic, summarizing identified unmet needs, and developing team-based solutions in partnership with the PACT. The home visit component of the intervention provides eyes in the home and may be a promising and innovative tool to improve patient engagement. DERR1-10.2196/46156.

Cultural safety involves new professional roles: a rapid review of interventions in Australia, the United States, Canada and New Zealand

Cultural safety is a decolonizing and transformative approach to health care aimed at achieving health care that recognizes, respects and nurtures the needs, rights and identities of Indigenous peoples. Such a transformation requires new or radically reimagined professional roles. Based on a rapid review design, this synthesis aimed to identify fundamental characteristics of cultural safety interventions that involved the creation or transformation of professional roles. The 23 included studies presented three main categories of professional roles for cultural safety. These roles were focused on (a) supporting health care system navigation, (b) providing a new or improved service offering, and (c) building organizational capacity to provide culturally safe health care. Our results demonstrate that cultural safety can be implemented by key actors playing different roles at different levels of the health care organization. These roles should be viewed as complementary to one another and be defined and implemented in partnership with Indigenous partners.

Assessment of Beneficiaries’ Satisfaction with Access to Health Care and Barriers within the Health Delivery System in Saudi Arabia

Introduction: Health care system navigation and communication with the providers are the barriers to health care access. Recently, a new health care model with the provider’s reform mechanism was introduced in Saudi Arabia. The national goal of financial reform is to provide Saudi nationals, residents, and visitors with timely access to health care. This study aimed to assess the long-term beneficiaries’ satisfaction with access to health care and explore the influencing factors and barriers, including cost and communication with the providers and probable solutions. Methods: In this cross-sectional self-administered online survey, we used the validated “6A,” namely, affordability, acceptability, adequacy, accessibility, availability, and awareness (30 items) of perceived access to health care questionnaire. The primary outcome variable was the overall satisfaction with access to health care among the long-term beneficiaries and caregivers. Demographic variables were used as predictors of the level of satisfaction. Results: A total of 118 health care long-term beneficiaries completed the questionnaires. The mean age of the participants was 49 years. Most participants were beneficiaries from the Ministry of Health (n = 62; 52.5%). Only 42 participants (35.6%) reported a high level of satisfaction. Low satisfaction level was mainly reported by non-Saudi, retired males living in big cities. Similarly, those who paid the health care services in cash reported a significantly low level of satisfaction. Moreover, the level of satisfaction was significantly associated with insurance coverage. Discussion: The first application of the “6A” perceived access to health care questionnaire in Saudi Arabia identified that 35.6% were poorly satisfied with access to health care. However, the rate is lower than that reported in six European countries, which ranged from 53% to 55%. Since after 4 years of health reform, payment methods for health services were identified as a significant predictor of variation in the mean scores of accesses to health care. Further national-level studies exploring access to health care are needed on long-term beneficiaries who are retired and those who live in rural and remote areas. In future health sector reform and health system research, addressing unaffordable to pay services is required.

Engagement with healthcare providers and healthcare system navigation among Australians with chronic conditions: a descriptive survey study

ObjectivesWith the rate of chronic conditions increasing globally, it is important to understand whether people with chronic conditions have the capacity to find the right care and to effectively engage...

Associations of Mental Health Measures and Retention in a Community-Based Perinatal Care Recovery Support Program for Women of Childbearing Age With Substance Use Disorder

Objective: This research was undertaken to evaluate factors related to program retention among participants in a community-based peer recovery program for women of childbearing age with a history of substance use disorder. Methods: In all, 184 women of childbearing age with a history of substance use disorder were enrolled in a community-based peer recovery program. Half of the participants were pregnant or postpartum. The outcome of interest was retention in the program as measured at 2 and 6 months. Participants were paired with a peer recovery coach (PRC). PRCs were women with a personal history of substance use disorder who assisted with healthcare system navigation, facilitated access to local resources, and provided advice and emotional support. All PRCs were also licensed perinatal community health workers. Independent variables included gestational status, depression, anxiety, type and frequency of substance use, childhood trauma, abuse, readiness for treatment, and attachment patterns. Results: Anxiety was found to be a key factor associated with retention. Moderate anxiety was associated with higher rates of retention compared to normal to mild anxiety. Severe anxiety was associated with lower rates of retention compared to normal to mild anxiety. Attrition was highest in the first 2 months. Conclusions: Early integration with mental health services to address severe anxiety symptoms could potentially improve retention in substance use disorder recovery programs, thereby improving outcomes. More research is needed regarding severe anxiety and care-avoidant behaviors, particularly among women of childbearing age.

Health Insurance Literacy Perceptions and the Needs of a Working-Class Community.

Background:Despite increases in the number of insured Americans, consumers continue to face barriers in accessing care. Low levels of health insurance literacy (HIL) are associated with suboptimal use of health insurance coverage. There remains a need to further contextualize the relationship between HIL and access to care, especially among insured working-class people.ObjectiveThis study was conducted to understand the pathways through which HIL affects health care decision-making and access to care in an urban working-class population.Methods:Using a qualitative descriptive approach, we conducted five focus groups with 45 adult residents of South Louisville, Kentucky. The questions explored participants' experiences of insurance enrollment, use, and health care system navigation, as well as their perceptions and needs regarding accessing health insurance information. Using inductive thematic analysis, transcripts were open coded independently by team members, a focused coding framework was agreed upon, and emergent themes were identified through constant comparison techniques.Key Results:Most participants placed high value on their insurance, considering it the most important benefit employers offer. Despite having adequate HIL, most participants expressed frustration with the amount of time and effort they spent to determine the best insurance plan, obtain covered health services, and settle claims, often with ineffective results. Despite having insurance, cost considerations influenced many participants' decisions to accept certain tests or treatments, in some cases resulting in delayed or foregone care.Conclusions:The findings of this qualitative study indicate that obtaining health care is strongly influenced both by the individual context of HIL knowledge, experience, and life circumstances, and by the structural context of the complex, bureaucratic, and costly health care system. Interventions to improve HIL should include practical examples and real-life scenarios, because HIL gained from experiential narratives was the most useful in navigating the health care system.[HLRP: Health Literacy Research and Practice. 2022;6(2):e61–e69.]Plain Language Summary: By conducting focus groups with a working-class population, this study contextualizes the pathways through which HIL affects consumers' health care decision-making and access to care. Findings demonstrate that obtaining health care is strongly influenced both by the individual context of HIL knowledge, experience, and life circumstances, and by the structural context of the complex, bureaucratic, and costly health care system.

Implementation and evaluation of social determinants of health practice models within community pharmacy

BackgroundWhile community pharmacies are an ideal setting for social needs screening and referral programs, information on social risk assessment within pharmacy practice is limited. ObjectivesOur primary objective was to describe 2 social determinant of health (SDOH) practice models implemented within community pharmacies. The secondary objective was to evaluate implementation practices utilizing the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Practice descriptionTwo pharmacy groups participated in a 3-month study, one in New York (9 pharmacies) and another in Missouri (1 pharmacy). The New York pharmacies implemented an SDOH specialist practice model, in which pharmacy staff members facilitate the program. The Missouri pharmacy implemented a community health worker (CHW) model by cross training their technicians. Each pharmacy developed their program using the Community Pharmacy Enhanced Services Network Care Model. Practice innovationBoth programs expanded the technician role to take on additional responsibilities. The SDOH specialist model partnered with a local independent practice association to create a social needs referral program using a technology platform for closed-loop communication. All workflow steps of the self-contained CHW program were completed within the pharmacy, placing additional responsibility on the CHW and pharmacy staff. Evaluation methodsRE-AIM framework dimensions of Reach, Effectiveness, and Adoption. ResultsSocial challenges were identified in 49 of 76 (65%) generated SDOH screenings. The most prevalent social needs reported were affordability of daily needs (33%) and health care system navigation (15%). While most pharmacy staff indicated that workflow steps were clearly defined, assessments and referral tools were identified as potential gaps. While approximately 50% of pharmacy staff were comfortable with their assigned roles and in addressing SDOH challenges, physical and mental health concerns required additional education for intervention. ConclusionThe successful implementation of community pharmacy SDOH programs connected patients with local resources. Community pharmacies are ideally positioned to expand their public health footprint through SDOH interactions that consequently improve patient care.

Toward a better understanding of transition from paediatric to adult care in type 1 diabetes: A qualitative study of adolescents.

Type 1 diabetes is associated with significant morbidity, with an increasing risk of acute diabetes-related complications in adolescence and emerging adulthood. Purposeful transition from paediatric to adult-oriented care could mitigate this risk but is often lacking. Detailed understanding of the perspectives of adolescents in their final year of paediatric care is essential to inform delivery of transition care programs. We conducted semi-structured interviews with adolescents (aged 17years) with type 1 diabetes at an academic institution from April 2017 to May 2018. Participants were recruited through convenience sampling. Sixty-one interviews were transcribed for analysis. Coding followed the principles of thematic analysis. Thirty-six percent of participants were male, and participants were from diverse socioeconomic backgrounds. We found three overarching themes in our analysis: first, difficulties navigating changing relationships with parents and healthcare teams; second, the need to increase type 1 diabetes self-management and differing comfort levels based on age of diagnosis; and third, perceived responsibilities for transition care preparation (for both the paediatric team and adolescents themselves) focused not only on type 1 diabetes-specific skills but also on healthcare system structures. Our findings suggest that novel transition programs addressing changing inter-personal relationships, disease-specific self-management (adapted for age of diagnosis), and healthcare system navigation, supported by parents and peers, may be needed to improve transition care for adolescents with type 1 diabetes.