Rural Latinos Research Articles

Adapting The Dietary Guidelines for Americans for Rural Latinos

Adapting The Dietary Guidelines for Americans for Rural Latinos

Definitions of successful aging among middle-aged Latinas residing in a rural agricultural community.

Latinos are the fastest growing aging population in the U.S. However, there has been limited attention to conceptualizing successful aging among Latinos, especially those residing in rural communities. Latinos are the largest racial or ethnic group residing in rural underserved communities and rural Latinos experience significant structural barriers to access the conditions they need to age well. The goal of this study is to make unique contributions to the successful aging literature by describing what successful aging means for middle-aged Latinas residing in a rural community. This qualitative paper used inductive thematic content analysis to examine definitions of successful aging among Latina women (n = 40) residing in an underserved agricultural community and entering mid-life (mean = 49 years old; age range 40-64). With regards to definitions of successful aging, four themes emerged: 1) Having good health; 2) maintaining an active lifestyle; 3) the wellbeing of one's children; and 4) being independent. Participants' definitions of successful aging aligned to some extent with existing frameworks, specifically related to health and independence. However, middle-aged Latina participants' unique definitions of successful aging also diverged from existing frameworks, especially around the wellbeing of their children and the importance of work as a way of maintaining an active lifestyle. More research is needed to understand the unique social context and circumstances of middle-aged Latinos residing in rural communities and how they influence their aging journeys. This can provide important information for the development of culturally sensitive services, interventions, and policies to help Latinos age well.

Examining the Relationship Between Rurality, Risk Perception, and COVID-19 Vaccine Willingness Among Rural Latinos in Arizona and California.

This study aimed to investigate the relationship between rurality and risk perception of getting or transmitting COVID-19 and willingness to get the COVID-19 vaccine in a sample of Latinos across Arizona and California's Central Valley (n = 419). The results revealed that rural Latinos are more concerned about getting and transmitting COVID-19, but less willing to get vaccinated. Our findings suggest that perceptions of risk alone do not play a sole role in influencing risk management behavior among rural Latinos. While rural Latinos may have heightened perception of the risks associated with COVID-19, vaccine hesitancy persists due to a variety of structural and cultural factors. These factors included limited access to healthcare facilities, language barriers, concerns about vaccine safety and effectiveness, and cultural factors such as strong family and community ties. The study highlights the need for culturally-tailored education and outreach efforts that address the specific needs and concerns of this community to increase vaccination rates and reduce the disproportionate burden of COVID-19 among Latino communities living in rural areas.

Trends in Health Disparities of Rural Latinos Pre- and Post-Accountable Care Organization Implementation.

We present findings from a longitudinal investigation, the purpose of which was to compare health disparities of rural Latino older adult patients diagnosed with diabetes to their non-Latino White counterparts. A pre-post design was implemented treating Medicare Accountable Care Organization (ACO) participation by Rural Health Clinics (RHCs) as an intervention, and using diabetes-related hospitalizations to measure disparities. Data for a nationwide panel of 2,683 RHCs were analyzed for a study period of eight years: 2008 - 2015. In addition, data were analyzed for a subset of 116 RHCs located in Florida, Texas, and California that participated in a Medicare ACO in one or more years of the study period. Two broad findings resulted from this investigation. First, for both the nationwide panel of RHCs and the three-state sample of "ACO RHCs," there was a decrease in the mean disparities in diabetes-related hospitalization rates over the eight-year study period. Second, in comparing a three-year time period after Medicare ACO implementation in 2012 to a four-year period before the implementation, a statistically significant difference in mean disparities was found for the nationwide panel. There are a number of factors that may contribute to the decrease in diabetes-related hospitalization rates for Latinos in more recent years. Future research will identify specific contributors to reducing diabetes-related hospitalization disparities between Latinos and the general population, including the possible influence of ACO participation by RHCs. This paper presents original research conducted using data related to rural Latino older adults. The data represent multiple states and an eight-year time period. The U.S. Latino population is growing at a rapid pace. As a group, they are at a high risk for developing diabetes, the complications of which are serious and costly to the patient and the U.S. healthcare system. With the continued growth of the Latino population, it is critical that their health disparities be monitored, and that factors that contribute to their health and well-being be identified and promoted.

Healthcare Needs of U.S. Rural Latinos: A Growing, Multicultural Population.

From 2000 to 2050, the Latino population in the United States (U.S.) is expected to grow by 273%. Health outcomes vary widely among Latino subgroups and health disparities more adversely affect rural residents. The commonly used "one-size-fits-all" approach assumes that the U.S. Latino population is homogeneous. Rural Latinos in four study states: Arizona (AZ), California (CA), Florida (FL) and Texas (TX) were the focus of this study. This research describes changes in the Latino population in rural counties of the U.S. in two dimensions: 1) change in population by number, and 2) change in population by country of origin using data from 2000-2017. The following themes emerged: 1) the overall Latino population grew in each state; 2) rural Latino populations in each state also increased but at a higher rate; 3) there is a variety of diversity in the countries of origin of rural Latinos based in each state; and 4) a considerable proportion of Latinos living in rural areas are of unknown Latino origins. As the largest racial or ethnic minority in rural populations and as the second largest group in the nation, Latino health has a significant influence on the U.S. healthcare system. For nurses, evidence-based strategies can be tailored to address diverse Latino subpopulations to reduce specific disparities for various ethnic populations.

Rural Latino health and the built environment: a systematic review

ABSTRACT Objective: This study systematically reviewed literature examining the influence of the rural built environment on Latinos’ health outcomes and behaviour in the United States. A secondary aim of the study was to identify strategies developed to address challenges in the rural built environment affecting Latinos’ health. Design: This study followed the reporting guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles included in the final analysis clearly linked Latino health outcomes to characteristics of the rural built environment. Results: Of the nearly 2,500 articles identified in the initial search, the final review included approximately 146 full-text sources. The majority of the articles focused on aspects of Latinos’ physical (n = 68), behavioural (n = 43), and mental health (n = 23). Conclusions: Rural Latino neighbourhoods in the United States possess limited access to health care, internet, transportation, and recreation infrastructure, which negatively impacts health outcomes and behaviours. Strategies developed to mitigate these issues include but are not limited to: the use of telecommunications to distribute health information; the use of community health workers and mobile clinics to increase awareness and availability of select health services; the use of worksite trainings and adaptations to the workplace; and the promotion of safety net programmes, such as the Supplemental Nutrition Programme for Women, Infants and Children (WIC). This review supports the need for a more robust research agenda documenting the health experiences of rural Latinos of various nationalities, age groups, and genders.

CBPR Pilot Intervention: Understanding Social Health Determinants of Mental Health in Rural Latinos

The purpose of this study is to identify challenges and facilitators for interventions on determinants of mental health in the literature and to analyze themes and coping strategies of psychosocial health determinants described by rural Latinos in a church-based intervention. This study was a review of literature and secondary data analysis of an arm of a larger Community-Based Participatory Research (CBPR) on the mental well-being of rural Latinos in North Florida - a CBPR pilot intervention. It was developed to respond to and prevent social stressors by creating a space where rural Latinos can help one another by sharing their experiences; empowering people to address health determinants that affect their well-being. All data from the pilot intervention was thematically analyzed using NVivo11. Psychosocial determinants of mental health identified in the CBPR intervention were: social environment factors (discrimination, family conflict, social isolation, undocumented status) and health services (uninsured & poor health literacy). Positive coping strategies described by rural Latinos were: avoiding conflictive relationships, alternative medicine, exercise, family & peer support, health education, community social support, instillation of hope, learn English, spirituality and religiosity. Negative coping strategies described were: categorical thinking, isolation, substance abuse.

Mujeres Fuertes y Corazones Saludables, a Culturally Tailored Physical Activity and Nutrition Program for Rural Latinas: Findings from a Pilot Study.

In the United States, Latino adults, compared with non-Hispanic white adults, are less likely to meet physical activity and dietary recommendations, and have higher rates of obesity. There is an urgent need for culturally adapted health promotion programs that meet the needs of the growing Latino population in the United States. We systematically adapted StrongWomen—Healthy Hearts, an evidence-based physical activity and nutrition program, for rural Latinas. This paper reports results from a pilot study of the adapted program. We used mixed methods to assess the feasibility and efficacy of the adapted program, Mujeres Fuertes y Corazones Saludables, in a nonprofit community organization serving rural Latinos. The intervention consisted of sixty-minute classes held twice weekly for 12 weeks and included 30 minutes of physical activity and 30 minutes of nutrition education. To assess efficacy, we used a one-group, pre–post design with overweight/obese, sedentary, middle-aged or older, Spanish-speaking rural Latinas (n = 15). Outcome measures included weight, height, body mass index (BMI), waist circumference, cardiorespiratory fitness, physical activity, dietary behavior, and self-efficacy for diet and physical activity. Process outcomes included attendance, end of class surveys, mid-program evaluation survey, and a post-program focus group. We calculated means and standard deviations, paproired t-tests, and Cohen’s D effect size. Qualitative data were analyzed using qualitative description. Significant changes pre- to post-program included weight (−1.5 kg; p = 0.009), BMI (−0.6; p = 0.005), waist circumference (−3.0 cm; p = 0.008), 6-minute walk test (69.7 m; p < 0.001), frequency of sugar-added drink consumption (−0.7 servings; p = 0.008), fruit and vegetable intake (1.3 servings; p = 0.035), and physical activity self-efficacy (0.9 points; p = 0.022). Participants found the program motivating and enjoyable, and on average participants attended 62% of classes and fidelity was maintained. This pilot study suggests that this culturally adapted physical activity and nutrition program for rural Latinas shows promise in improving physical activity, diet, and obesity.

Migration, Health Care Behaviors, and Primary Care for Rural Latinos with Diabetes.

Many US Latinos migrate or travel between the US and Mexico on a regular basis, defined as circular migration. Latinos with diabetes (n=250) were surveyed about circular migration and their ability to use medications and perform recommended diabetes self-care activities. A review of medical charts was performed. Twenty-eight percent (n=70) of patients traveled to Mexico during the last 12months. Older Latinos were more likely to report traveling to Mexico and back into the US. Among those that traveled, 29% reported use of less medication than they wanted to or were prescribed because of travel and 20% ran out of medications. The rate of reported problem areas while traveling were 39% (27/70) for following a diabetic diet, 31% (21/70) for taking medication, and 37% (26/70) for glucose self-monitoring. The results suggest that the structure of primary care and care coordination are important for this population to fully engage in diabetes self-care.

FBO Leaders’ Perceptions of the Psycho-social Contexts for Rural Latinos

Latinos comprise the largest minority rural population in the US, and they are often exposed to adverse social health determinants that can detrimentally affect their mental health. Guided by community-based participatory research (CBPR) principles, this study aimed to describe faith-based organizations (FBOs) leaders’ perceptions of the contexts affecting the mental well-being of rural Latino immigrants and potential approaches to mental health promotion for these immigrants. This is a descriptive, qualitative arm of a larger study in which community-academic members have partnered to develop a culturally-tailored mental health promotion intervention among rural Latinos. FBO leaders (N = 15) from different denominations in North Florida were interviewed until saturation was reached. FBO leaders remarked that in addition to religiosity, which Latinos already have, more community building and involvement are necessary for the promotion of mental health.

Latinos with diabetes and food insecurity in an agricultural community.

Latinos from agricultural communities have a high prevalence of food insecurity and are at increased risk of obesity and diabetes, yet little is known about the associations between food insecurity and diabetes outcomes. To examine the associations between food insecurity and diabetes outcomes among rural Latinos. Cross-sectional survey with medical chart abstraction of 250 Latinos with diabetes. Primary outcomes are the control of 3 intermediate diabetes outcomes (hemoglobin A1C ≤8.0%, LDL-cholesterol ≤100 mg/dL, and blood pressure ≤140/90 mm Hg), a composite of control of the 3, and receipt of 6 processes of care. Secondary outcomes are cost-related medication underuse and participation in self-care activities. Fifty-two percent of patients reported food insecurity and 1-in-4 reported cost-related medication underuse. Patients with food insecurity were more likely to report cost-related medication underuse [adjusted odds ratio (AOR)=2.49; 95% confidence intervals (CI), 1.30, 4.98; P=0.003], less likely to meet the composite measure for control of the 3 intermediate outcomes (AOR=0.24; 95% CI, 0.07, 0.84; P<0.05), and less likely to receive a dilated eye examination (AOR=0.37; 95% CI, 0.18, 0.77; P<0.05) and annual foot examinations (AOR=0.42; 95% CI, 0.20, 0.84; P<0.05) compared with those who were food secure. Among this rural Latino population, food insecurity was independently associated with not having control of the intermediate diabetes outcomes captured in the composite measure, not receiving dilated eye and foot examinations, and with self-reporting cost-related medication underuse.

An ecological perspective on diabetes self-care support, self-management behaviors, and hemoglobin A1C among Latinos.

The purpose of this study was to examine the role of self, interpersonal (ie, family/friend), and organizational (ie, health care) support in performing diabetes-related self-management behaviors and hemoglobin A1C (A1C) levels among rural Latinos with type 2 diabetes. Cross-sectional data from baseline interviews and medical records were used from a randomized controlled trial conducted in rural Southern California involving a clinic sample of Latinos with type 2 diabetes (N = 317). Self-management behaviors included fruit and vegetable intake, fat intake, physical activity, glucose monitoring, daily examination of feet, and medication adherence. Multivariate linear and logistic regression models were used to assess the relationships of sources of support with self-management behaviors and A1C. Higher levels of self-support were significantly associated with eating fruits and vegetables most days/week, eating high-fat foods few days/week, engaging in physical activity most days/week, daily feet examinations, and self-reported medication adherence. Self-support was also related to A1C. Family/friend support was significantly associated with eating fruits and vegetables and engaging in physical activity most days/week. Health care support was significantly associated with consuming fats most days/week. Health care practitioners and future interventions should focus on improving individuals' diabetes management behaviors, with the ultimate goal of promoting glycemic control. Eliciting family/friend support should be encouraged to promote fruit and vegetable consumption and physical activity.

Knowledge, Awareness, and Interest in Cancer Clinical Trials among Rural Latinos Following Brief Education by Promotores de Salud

Background: Promotores have been widely used for health promotion in underserved Latino communities and are increasingly being partnered with throughout the country to enhance health care access when there are cultural and economic barriers to care. A community network approach using Promotores de Salud may be a useful strategy for increasing overall knowledge and participation of Latinos in clinical trials. Objective: To assess knowledge, attitudes, and interest related to participating in cancer clinical trials among rural Latinos following receipt of a brief community-based cancer research educational session delivered by previously trained promotores de salud. Methods: Trained promotores de salud conducted 10-15 minute one-to-one educational sessions with Latinos. Participants completed a pre-post assessment on knowledge, attitudes and interest in participating in clinical trials. Results: Over a period of two months, five trained promotores recruited and delivered a single educational session with 228 Latinos. At baseline, 68% of participants had heard about clinical trials, but only 5% had participated in one. Compared to baseline, after training, participants increased significantly their positive views of clinical trials, trust in medical researchers, and belief in general safety of clinical research (p<0.001). Interest in participating in cancer clinical trials increased from 68% to 79% (p<.001). Providing bio-specimens for research purposes (p<0.001) also increased significantly. Conclusion: Use of Promotores de Salud to conduct community-based clinical trials education is a promising approach to promote widespread community participation in cancer clinical trials available to ethnic and racial underserved populations.

Rural Latinos' mental wellbeing: a mixed-methods pilot study of family, environment and social isolation factors.

Upon immigration to the rural areas in the US, Latino families may experience cultural, geographic, linguistic and social isolation, which can detrimentally affect their wellbeing by acting as chronic stressors. Using a community engagement approach, this is a pilot mixed-method study with an embedded design using concurrent qualitative and quantitative data. The purpose of this study is to evaluate family and social environments in terms of protective factors and modifiable risks associated with mental well-being in Latino immigrants living in rural areas of Florida. Latino immigrant mother and adolescent dyads were interviewed by using in-depth ethnographic semistructured interviews and subsequent quantitative assessments, including a demographic questionnaire and three structured instruments: the Family Environment Scale Real Form, the SF-12v2™ Health Survey and the short version (eight items) of PROMIS Health Organization Social Isolation. This mixed-method pilot study highlighted how family, rural, and social environments can protect or impair wellbeing in rural Latino immigrant mother and adolescent dyads.

“I Did It for Us and I Would Do It Again”: Perspectives of Rural Latinos on Providing Biospecimens for Research

We elicited perspectives of rural Latino farmworkers and non-farmworkers about their participation in a community-based participatory pesticides exposure study in which they provided multiple biospecimens. Between March and April 2012, we conducted semistructured, one-on-one interviews with 39 rural Latino farmworkers and non-farmworkers in Washington State (n = 39). Nineteen open-ended interview questions aimed to elicit participants' attitudes toward, expectations and experiences of biospecimen collection for research, and willingness to participate in future biomedical research studies. We reviewed and coded transcriptions using qualitative principles of grounded theory in which concepts were identified and themes derived from interview data. We grouped themes into 3 major categories: (1) motivation to participate, (2) challenges of participation, and (3) perceived rewards of participation. Many participants were motivated by the perceived importance of the study topic and a desire to acquire and contribute to new knowledge. Respondents said that the benefits of participation outweighed the challenges, and many expressed satisfaction to be able to contribute to research that would benefit future generations. Our findings supported the use of community-based participatory research to engage minorities as participants and invested parties in such studies.

Neighborhood perceptions and health-related outcomes among Latinos with diabetes from a rural agricultural community.

Little is known about how neighborhood perceptions are related to diabetes outcomes among Latinos living in rural agricultural communities. Our objective was to examine the association between perceived neighborhood problems and diabetes outcomes. This is a cross-sectional survey study with medical record reviews of a random sample of 250 adult Latinos with type 2 diabetes. The predictor was a rating of patient ratings of neighborhood problems (crime, trash and litter, lighting at night, and access to exercise facilities, transportation, and supermarkets). The primary outcomes were the control of three intermediate outcomes [LDL-cholesterol (LDL-c)<100mg/dl, AlC<9.0%, and blood pressure (BP)<140/80mmHg], and body mass index (BMI)<30kg/m(2). Secondary outcomes were participation in self-care activities (physical activity, healthy eating, medication adherence, foot checks, and glucose checks). We used regression analysis and adjusted for age, gender, education, income, years with diabetes, insulin use, depressive symptoms, and co-morbidities. Forty-eight percent of patients perceived at least one neighborhood problem and out of the six problem areas, crime was most commonly perceived as a problem. Perception of neighborhood problems was independently associated with not having a BP<140/80 [Adjusted odds ratio (AOR)=0.45; 95% CI 0.22, 0.92], and BMI<30 (AOR=0.43; 95% CI 0.24, 0.77), after controlling for covariates. Receipt of recommended processes of care was not associated with perception of neighborhood. Perception of neighborhood problems among low-income rural Latinos with diabetes was independently associated with a higher BMI and BP.

Medical Mistrust, Perceived Discrimination, and Satisfaction With Health Care Among Young‐Adult Rural Latinos

Little research has analyzed mistrust and discrimination influencing receipt of health care services among Latinos, particularly those living in rural areas. This study examined the associations between medical mistrust, perceived discrimination, and satisfaction with health care among young-adult rural Latinos. This cross-sectional study analyzed data from 387 young-adult Latinos (ages 18-25) living in rural Oregon. The Behavioral Model of Vulnerable Populations was utilized as the theoretical framework. Correlations were run to assess bivariate associations among variables included in the study. Ordered logistic regression models evaluated the associations between medical mistrust, perceived discrimination, and satisfaction with health care. On average, participants used health services 4 times in the past year. Almost half of the participants had health insurance (46%). The majority reported that they were moderately (32%) or very satisfied (41%) with health care services used in the previous year. In multivariable models, medical mistrust and perceived discrimination were significantly associated with satisfaction with health care. Medical mistrust and perceived discrimination were significant contributors to lower satisfaction with health care among young-adult Latinos living in rural Oregon. Health care reform implementation, currently under way, provides a unique opportunity for developing evaluation systems and interventions toward monitoring and reducing rural Latino health care disparities.

Cancer resource center of the desert patient navigator program: removing financial barriers to access to cancer care for rural Latinos

BackgroundHealth disparities in cancer mortality for racial/ethnic minorities is a public health concern. Financial barriers are the major factors preventing cancer patients from accessing treatment in a timely manner. This article describes the characteristics of the Cancer Resource Center of the Desert (CRCD) Patient Navigator Program (PNP) in the rural underserved US-Mexico border region of the Imperial Valley. Financial navigation services and the insurance conversion process for cancer treatment are described.FindingsCRCD data from 2010 to 2011 were analyzed to report the characteristics of cancer patients, focusing on insurance status changes. Eighty-one to 87% of the patients served were Latino/Hispanic. A case scenario is presented to depict the financial navigation process in converting the patients’ insurance status. Among the total samples, about 7% (n=32) in 2010 and 16% (n=68) in 2011 were in need of health insurance assistance upon their intake. Financial navigators successfully converted virtually all non- or inadequately-insured rural cancer patients to better insurance status.ConclusionFinancial concerns are a significant thread that runs throughout the diagnostic, treatment, and post treatment journey of cancer patients. The complicated nature of patients’ circumstances and medical systems often hinders the patients going through the insurance conversion process. PNP plays a critical role in bridging the gap between patients and medical systems thus promoting cancer treatment access for this vulnerable population.

Building a community-academic partnership: implementing a community-based trial of telephone cognitive behavioral therapy for rural latinos.

Concerns about the appropriate use of EBP with ethnic minority clients and the ability of community agencies to implement and sustain EBP persist and emphasize the need for community-academic research partnerships that can be used to develop, adapt, and test culturally responsive EBP in community settings. In this paper, we describe the processes of developing a community-academic partnership that implemented and pilot tested an evidence-based telephone cognitive behavioral therapy program. Originally demonstrated to be effective for urban, middle-income, English-speaking primary care patients with major depression, the program was adapted and pilot tested for use with rural, uninsured, low-income, Latino (primarily Spanish-speaking) primary care patients with major depressive disorder in a primary care site in a community health center in rural Eastern Washington. The values of community-based participatory research and community-partnered participatory research informed each phase of this randomized clinical trial and the development of a community-academic partnership. Information regarding this partnership may guide future community practice, research, implementation, and workforce development efforts to address mental health disparities by implementing culturally tailored EBP in underserved communities.

Implementation Research: Reducing the Research-to-Practice Gap in Depression Treatment

Implementation Research: Reducing the Research-to-Practice Gap in Depression Treatment