Underserved Ethnic Minority Research Articles

The Relations Among Math Anxiety, Math Self-Construct, and Math Achievement in Older and Underserved Minority Students

The present study investigated the relations among math anxiety, math self-concept, and math self-efficacy on math achievement in older students and underserved ethnic minorities (i.e., Blacks and Hispanics) in higher education. These two groups have been largely neglected in the math self-construct literature. The results showed that older students reported higher math learning anxiety and lower math self-efficacy. Underserved minorities reported higher levels of both math learning and math evaluation anxiety. These math measures were related to lower math achievement (i.e., math SAT, math GPA, and the number of math classes completed). Using latent profile analysis, three distinct math profiles were identified. The high math anxiety and low self-efficacy profile was associated with older students, compared to students whose profile was average in math anxiety and math self-efficacy, or low in math anxiety and high in math self-efficacy. These findings challenge researchers and educators to devise interventions and employ pedagogical techniques to bolster older students’ and underserved ethnic minorities’ math self-construct and academic achievement in math.

Efficacy of a Smoking Cessation Program for Underserved Ethnic Minority Communities: Results of a Smoking Cessation Trial.

Objectives: Using a participatory research approach, this study reports the efficacy of the Communities Engaged and Advocating for a Smoke-free Environment (CEASE)-4 intervention offered by the local peers. Methods: CEASE-4 is a theory-based tobacco-cessation intervention, tailored to the needs of underserved populations. 842 tobacco users self-selected into: a) self-help (n = 472), b) single-session class (n = 163), and c) four-session class (n = 207). While self-help group only received educational materials, curriculum for other arms was built on the social cognitive, motivational interviewing, and trans-theoretical- frameworks. Participants could also receive nicotine replacement therapy (NRT). Outcome was self-reported smoking cessation measured 12weeks after completion of the intervention, validated by exhaled carbon monoxide (CO) test. Results: Quit rate was statistically different across groups, with highest quit rate in four-session and lowest quit rate in self-help arm. Cessation rates at follow up (12weeks after completion of the intervention) were 2.3% in the self-help arm, 6.1% in the single-session arm and 13.0% in the four-session arm. Conclusion: While theory-based smoking cessation services are effective for underserved populations, four-session curriculum might be superior to a single session program.

Monday-Enhanced CEASE Program for Underserved Ethnic Minorities: a Mixed-Methods Study.

Due to the persistence of tobacco-related health disparities in the U.S., there is a need for innovative strategies to reach the underserved ethnic minority populations who are most at risk. As contemplations for health behavior modification tend to surge on Mondays, we explored the feasibility and effect of a Monday-enhanced smoking cessation program on quitting outcomes in a low-income ethnic minority community. To compare a Monday-enhanced with a standard Communities Engaged and Advocating for a Smoke-free Environment (CEASE) program and understand the overall experiences of participants in the program. In this mixed-methods study, affordable housing complexes (n = 4) and a church were randomly assigned either a Monday-enhanced (n = 3) or standard (n = 2) CEASE smoking cessation program. CEASE comprised twelve weekly group counseling sessions facilitated by trained peer motivators plus nicotine replacement products. Participants in the Monday-enhanced arm were encouraged to pick Mondays as a quitting day. Quantitative and qualitative data were collected during the program and at 3-month post-graduation. Seventy-seven participants were enrolled in the study arms. In both groups combined, tobacco consumption reduced from 7.7 to 5.6 cig/day (mean reduction, 2.1; 95% CI: 0.9 to 5.1, p = 0.08). Although no significant difference in quit rate was observed between the two arms, more participants completed the follow-up survey in the Monday-enhanced than standard CEASE program [82.4% vs. 36.0%, p < 0.05]. While qualitative data suggested an overall satisfaction of participants with the program, motivation for quitting was higher in the Monday-enhanced CEASE program compared to the standard CEASE program. The Monday-enhanced program is promising and may enhance participants' engagement and willingness to quit smoking, particularly in low-income ethnic minority communities. Further research should include larger sample sizes to better assess the efficacy of a Monday-enhanced program across diverse populations.

"I Lay Awake at Night": Latino Family Caregivers' Experiences Covering Out-of-Pocket Costs When Caring for Someone Living With Dementia.

The financial burden of caregiving has received less research attention than physical and emotional costs. This is especially true for underserved ethnic minorities. Financial strain affects mental and physical health and is unequally distributed across caregivers of different races and ethnicities. Although caregivers overall spend, on average, one quarter of their income on caregiving, Latino caregivers, the focus of this study, spend nearly half. To better understand this disparity, we conducted 11 qualitative interviews with 14 Latino caregivers of persons living with dementia located in either California or Texas. Interview transcripts were thematically coded, guided by a material-psychosocial-behavioral conceptual model of financial strain. We identified 3 themes: daily needs and costs, psychological distress caused by financial issues, and stressful barriers to accessing family and societal support. Furthermore, interviews revealed how Latino culture may influence spending patterns and management of costs. Findings suggest that preference by Latino families to care for a family member in the home may be met with a financial disadvantage due to the high out-of-pocket costs of care. A better understanding of the factors contributing to high costs for Latino caregivers and how these costs affect caregivers will inform approaches at both the individual and policy levels and develop culturally relevant interventions to help Latino families to lower caregiving costs. This is especially important as the number of Latinos living with dementia is expected to increase over the next 4 decades and effective interventions are lacking.

Mitigating COVID-19 Risk and Vaccine Hesitancy Among Underserved African American and Latinx Individuals with Mental Illness Through Mental Health Therapist-Facilitated Discussions.

BackgroundUnderserved ethnic minorities with psychiatric disorders are at an increased risk of COVID-19. This study aims to examine the effectiveness of one-to-one counseling on COVID-19 vaccination and vaccination readiness among underserved African American and Latinx individuals with mental illnesses and adult caregivers of children with mental illness.MethodsThrough an academic-community partnered collaboration, a multidisciplinary and culturally sensitive training on COVID-19 was co-developed and delivered to 68 therapists from January to March 2021. Mental health clients and their caregivers were recruited to participate in pre- and post-intervention surveys to evaluate the impact of the intervention on their perceptions of COVID-19 public health guidelines, testing, and vaccination. Mental health therapists delivered four lessons of the COVID-19 educational intervention with 254 clients from March to June 2021, when vaccine availability was widely available. Of those clients, we collected 180 baseline and 115 follow-up surveys. The main outcome was the uptake in COVID-19 vaccine.ResultsThere was a positive shift in participant vaccine acceptance and receptivity. Pre-intervention survey shows that only 56% of adult clients and 48% of caregivers had indicated a likelihood of getting the vaccine for themselves at baseline. Post-intervention documented that more than 57% of each group had been vaccinated, with another 11–15% of the unvaccinated individuals reporting that they were somewhat or very likely to get the vaccine.ConclusionThis study demonstrated that multidisciplinary academic-community and theoretical-based educational intervention delivered by mental health therapists is an effective strategy in increasing COVID-19 vaccine acceptance and reducing the negative impact and disruption that COVID-19 caused in the daily life of mental health patients and caregivers.

Beyond the Pandemic: Leveraging Rapid Expansions in U.S. Telemental Health and Digital Platforms to Address Disparities and Resolve the Digital Divide.

The COVID-19 pandemic illuminated persistent health disparities faced by underserved ethnic minorities, immigrants, and refugee communities across the U.S. Simultaneously, expanded telemental health coverage enabled physically-distanced care, lowering the risk of COVID-19 transmission, while potentially yielding a welcomed, secondary outcome: increasing accessibility for harder-to-reach populations (1). Telehealth, or telemental health (TMH) when pertaining to mental health care and treatment, is “the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration” (2). We discuss how TMH reduces pre-existing barriers to service utilization while possibly worsening others, such as the digital divide excluding those with lower technological literacy from fully benefitting from telemedicine. Yet, we are also at a unique moment in U.S. history to leverage political momentum in response to the pandemic to increase digital connectivity for diverse populations (3).

Improving diversity in research and trial participation: the challenges of language

Improving diversity in research and trial participation: the challenges of language

Medical students attitudes toward and intention to work with the underserved: a systematic review and meta-analysis

BackgroundExperts in the field of medical education emphasized the need for curricula that improve students’ attitudes toward the underserved. However, some studies have shown that medical education tends to worsen these attitudes in students. We aimed at systematically reviewing the literature assessing the change in medical students’ attitudes toward the underserved and intention to work with the underserved throughout medical education, the sociodemographic and educational factors associated with favorable medical student attitudes toward and/or intention to work with the underserved and the effectiveness of educational interventions to improve medical student attitudes toward and/or intention to work with the underserved.MethodWe conducted a systematic review on MEDLINE, Scopus, and Web of Science databases. Three investigators independently conducted the electronic search. We assessed the change in medical students attitudes toward the underserved by computing a weighted mean effect size of studies reporting scores from validated scales. The research team performed a meta-analysis for the sociodemographic and educational factors associated with medical students attitudes toward and/or intention to work with the underserved.ResultsFifty-five articles met the inclusion criteria, including a total of 109,647 medical students. The average response rate was 73.2%. Most of the studies were performed in the USA (n = 45). We observed a significant decline of medical students attitudes toward the underserved throughout medical education, in both US and non-US studies. A moderate effect size was observed between the first and fourth years (d = 0.51). Higher favorable medical students attitudes toward or intention to work with the underserved were significantly associated with female gender, being from an underserved community or ethnic minority, exposure to the underserved during medical education and intent to practice in primary care. Regarding educational interventions, the effectiveness of experiential community-based learning and curricula dedicated to social accountability showed the most positive outcome.ConclusionsMedical students attitudes toward the underserved decline throughout medical education. Educational interventions dedicated to improving the attitudes or intentions of medical students show encouraging but mixed results. The generalizability of our results is impeded by the high number of studies from the global-North included in the review.

Clergy-Provided Mental Health Services

Most individuals with mental health needs do not receive professional care. One strategy to narrow this service provision gap is task-shifting, a process where certain responsibilities are shifted to less specialized workers. Approximately 25% of those who seek mental health care turn to clergy. This study investigated the suitability of using clergy to scale-up mental health service provision by assessing perceptions of satisfaction and helpfulness with clergy-delivered services. Using data from the National Comorbidity Survey Replication (2003), we found most respondents (n=204) who went to clergy reported satisfaction with their care (92%) and that the services were helpful (94%). Ordered logit regression revealed that racial/ethnic minorities and individuals for whom religion was more salient were disproportionately likely to find clergy-delivered mental health services satisfying and helpful, while older adults were more likely to report the services were helpful. The results suggest incorporating clergy in mental health scale-up plans via task-shifting may be a viable option, particularly for addressing the mental health needs of underserved racial and ethnic minorities, as well as older adults. Social workers—at least in theory—are well-positioned to collaborate with clergy in the process of implementing task-shifting.

Abstract A087: Community Research Navigators (CRN): The bridge to increasing Latino participation in clinical research

Abstract The participation of underserved ethnic minorities in biomedical research is critical to achieving progress in health equity. Increasing ethnic minority including Latino accrual in biomedical research, including clinical trials, is a formidable challenge that requires improving participant trust and commitment and overcoming of barriers to participation. Latinos make up about 18% of the US population. Yet Latinos are not adequately targeted in research studies, currently constituting only 7.6% of NIH clinical trial participants and only about 2%-5% of participants in cancer clinical trials. The National Cancer Institute (NCI) has recommended patient navigation as a research strategy that may be adapted to overcome ethnic minority biomedical research and clinical trial participation barriers. City of Hope has participated in training community research navigators (CRN) to increase diversity participation. These CRNs are trained to address gaps in knowledge, medical mistrust, access to participation, and engagement of under-represented groups in biomedical research. The research navigator draws from the patient navigation and promotora model and the community-engaged research approach. CRNs' curriculum include the importance of biomedical to disease prevention, diagnosis, and treatment; the value to group and family participation, Clinical Trials, HIPPA, human subject protection, ethics; patient-provider communication, cost and coverage, and family communication and decision making. In total, we trained and mentored a team of 30 CRNs from our community partner Pomona's Health Promoters for increased public education and Latino participation in research. CRNs were 25-74 years old, 97% female, 96% foreign-born, and 54% &amp;lt; high school education. Their pre- and post-test results showed an increase in willingness to participate in research (p &amp;lt; .005); increase in knowledge of the importance of biomedical including clinical research (p &amp;lt; .000); and an increase in confidence in improving community's attitude and knowledge about clinical research (p &amp;lt; .000). Our findings suggest that the CRN training is effective in improving appropriate knowledge and confidence to conduct community research navigation. This approach holds the promise of utility and applicability to address barriers to research enrollment and increase Latino biomedical research participation. Citation Format: Mayra Serrano, Marisela Garcia, Rick Kittles, Kimlin Tam Ashing. Community Research Navigators (CRN): The bridge to increasing Latino participation in clinical research [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A087.

Abstract B063: Polyethnic-1000: Advancing cancer genomics by studying ethnically diverse, underserved patient populations in New York

Abstract Recent advances in DNA sequencing technologies have revolutionized approaches to the prevention, risk assessment, early detection, diagnosis, and treatment of cancers. However, many ethnic groups, especially nonEuropean populations, have been significantly underrepresented in cancer research, including clinical trials, and have not received equal benefits in clinical practice. As a result, our current knowledge about tumor biology, cancer risk, and response to treatment has primarily been derived from patients of European descent. These inequities limit our understanding of the many types of cancer and may exacerbate health disparities in the United States. In this proposal, we address both the scientific and social issues by creating a dynamic research platform within the greater New York area that promises to enhance the ways in which cancer is prevented, diagnosed, and treated. This initiative, named Polyethnic-1000, will involve patients and staff at several academic health centers and partner hospitals in the New York City region. It will use the genomics and informatics capabilities of the New York Genome Center to determine how inherited and somatically acquired genetic variations affect the behavior of cancers occurring in ethnically diverse populations. In a first, retrospective phase, we will establish the workflow from sample acquisition to whole-exome and RNA sequencing, data analysis, and data sharing within the consortium. Then we will start a prospective study enabling the formation of cohorts of interest for particular cancer types and particular ethnicities, with uniform consent allowing broad data sharing of the somatic variants identified. Polyethnic-1000 will establish a framework to enhance interactions among our region's academic and health centers to advance cancer genomics. These efforts should improve and widen the use of genomics for all, especially currently underserved ethnic minority populations. Citation Format: Nicolas Robine, Fieke Froeling, Benjamin Hubert, Michael C. Zody, Dayna Oschwald, Harold Varmus, Charles Sawyers, David Tuveson. Polyethnic-1000: Advancing cancer genomics by studying ethnically diverse, underserved patient populations in New York [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B063.

Abstract A25: Community research navigators: The bridge to increasing ethnic minority participation in clinical research

Abstract The participation of underserved ethnic minorities in clinical research is critical to achieving progress in cancer control. Ethnic minority patient accrual in clinical trials is a formidable challenge that requires patient trust, commitment, and overcoming of barriers. Racial and ethnic minorities make up about 40% of the United States population, yet are not well represented in research studies. Less than 10% of all patients with cancer enrolled in clinical trials are minorities. Diverse participation may lead to more generalizable results for under-represented groups, more best practices for prevention and treatment to specific minority groups, increase in knowledge and awareness of disparities about cancer, and a more accurate reflection of the United States' increasingly diverse population. Although there is a proliferation of patient navigation programs to increase health care among the underserved, there is little known on its potential effects as a strategy to enhance minority clinical trial and biospecimen accrual. City of Hope has built a functional and sustainable program for addressing health inequity, which includes training a network of community research navigators (CRN) to address gaps in knowledge, medical mistrust, and access, and navigate participation and engagement of under-represented groups in research. The research navigator program draws from the patient navigation and promotora model and is a novel and innovative application to this approach. This approach has utility and applicability to address research participation barriers, including trust and referrals. It promises sustainability and cost effectiveness as trained CRNs can deliver the program. The Community Research Navigator (CRN) project enhances community advocates' capacity by training community health leaders/promotoras as community research navigators (CRN) to widen the dissemination of the clinical trial and research participation enrollment for increased ethnic minority participation in clinical trials and health-related research. CRNs attended a 1-day training on clinical trials and research. The training included educating and encouraging individuals to proactively think about and discuss clinical trial participation with their family, friends, and health care providers; disseminating information about specific research studies, targeting the African and Latino communities; and referring individuals to specific biospecimen, clinical trials, and population studies. In total, we trained and mentored a team of 14 CRNs. Participants were 24-66 years old; most were female (86%), Latino (69%), and single (43%). After participating in the training, participants were more likely to correctly define HIPAA (p=.040) and the types of clinical trials (p=.038). In addition, CRNs were more likely to encourage clinical research participation among their family after the training (p=0.034). Further, we measured confidence in various domains, including: increase in confidence in describing the purpose and process of clinical research (p=0.006); educating minority communities about clinical trials (p=0.045); and providing informational workshops/forums on clinical research (p=0.046). Participants had an increase in overall confidence (p=.033). Our findings demonstrate that the CRN strategy holds promise in increasing minority participation in cancer clinical trials. It is an innovative application of the extensively studied patient navigation approach that warrants research. Future research should focus on the CRN project as a cost-effective tool for enrollment and retention of ethnic minorities in cancer clinical trials and the potential of enhancing clinical trial understanding outcomes among participants. Citation Format: Marisela Garcia, Mayra Serrano, Alejandro Fernandez, Katty Nerio, Kimlin Ashing. Community research navigators: The bridge to increasing ethnic minority participation in clinical research [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A25.

Abstract B14: Promising effects of a culturally tailored pilot intervention to increase HPV vaccination uptake among female and male adolescents

Abstract Background: HPV vaccination is recommended for female and male adolescents in the U.S. to prevent HPV-related cancer, yet the uptake remains suboptimal nationwide. Asian American female adolescents have the lowest HPV vaccine rates. Successful HPV vaccine depends heavily on parents' attitudes, perceptions, and willingness to have their adolescents vaccinated. Objective: This study was designed to test the feasibility and outcomes of a provider-based culturally tailored intervention among Asian American parents and their eligible adolescents. Methods: Asian American parents (n=120) who had adolescent girls and boys aged 11 to 18 (n=170) were recruited from a primary-care community health center. The primary outcome was first and second shots of HPV vaccination uptake 6 months following the intervention. Secondary outcomes included third shot of HPV vaccine at 6 months after the intervention for adolescents over the age of 12, increase in knowledge and belief in HPV vaccine, and engagement of adolescents in decision-making at post intervention. Results: Among 170 adolescents, 68% of them received first and second shots of HPV vaccine (73% for girls vs 63% for boys). Among 81 adolescents over the age of 12, 63% of them received third shot (63% for girls vs 76% for boys). Parents' (n=120) knowledge and belief in HPV vaccine and engagement of adolescents in decision-making have significantly increased from baseline to post intervention (p&amp;lt;0.001). Conclusion: A culturally tailored pilot intervention in a clinical setting demonstrated promising effects, which can potentially yield significant increase in HPV vaccine uptake among Asian American and other underserved ethnic minority female and male adolescents to prevent cancer. Citation Format: Grace X. Ma, Yin Tan, Shumenghui Zhai, Philip Siu, Sarah Lai, Lin Zhu, Adeodat Ilboudo, Min Qi Wang. Promising effects of a culturally tailored pilot intervention to increase HPV vaccination uptake among female and male adolescents [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B14.

Web-Based Program Exposure and Retention in the Families Improving Together for Weight Loss Trial.

Interventions that incorporate behavioral skills training and parental involvement have been effective for promoting weight loss among middle and upper class youth; however, few studies have produced similar weight loss effects in underserved ethnic minority youth. This study examined whether online program exposure (in both an online tailored intervention and an online health education comparison program) predicted greater retention among African American youth and their parents in the Families Improving Together (FIT) for Weight Loss trial. Parent-adolescent dyads (N = 125) were randomized to either an online tailored intervention program (n = 63) or an online health education comparison program (n = 62). Paradata including login data were used to determine the number of sessions viewed (0-8) and the number of minutes spent online per session. Study retention, defined as collection of adolescent anthropometric measures at 6 months postintervention, was the outcome. Logistic regression analyses showed a significant effect for login rate on retention (OR = 1.21, 95% CI [1.04, 1.39]). Total number of sessions viewed, child age, child sex, parent age, and parent sex accounted for 11% of the variance in retention at 6 months post- intervention. Participants who were retained spent a significantly greater number of minutes during each session (M = 12.99, SD = 11.63) than participants who were not retained (M = 7.77, SD = 11.19), t(123) = 2.24, p = .027, d = 0.45. The use of paradata from online interventions is a novel and feasible approach for examining exposure in web-based interventions and program retention in underserved ethnic minority families. ClinicalTrials.gov NCT01796067. Registered January 23, 2013.

Type 2 diabetes prevention and self-management among Nicaraguan ethnic minorities: findings from phase 3 of a community-based participatory research study

PurposeThe purpose of this paper is to explore physical environmental, medical environmental, and individual factors in a sample of ethnic minority adults with or at-risk for type 2 diabetes (T2D) on the Atlantic Coast of Nicaragua.Design/methodology/approachThe study used a cross-sectional descriptive design guided by a community-based participatory research framework. Three coastal communities in the South Atlantic Autonomous Region (RAAS) of Nicaragua were sampled. Inclusion criteria were: lay adult with or at-risk for T2D, ⩾21 years of age, self-identification as Creole or Miskito, and not pregnant. Convenience sampling procedures were followed. Data were collected via objective (A1C, height, and weight) and self-report (Pan American Health Organization surveys, Diabetes Care Profile subscales, and Medical Outcomes Survey Short Form-12 (MOS SF-12) measures. Univariate and bivariate statistics were computed according to level of measurement.FindingsThe sample (N=112) was predominately comprised of Creoles (72 percent), females (78 percent), and mid-age (M=54.9, SD±16.4) adults with T2D (63 percent). For participants with T2D, A1C levels, on average, tended to be elevated (M=10.6, SD±2.5). Those with or at-risk for T2D tended to be obese with elevated body mass indices (M=31.7, SD±8.1; M=30.2, SD±6.0, respectively). For many participants, fresh vegetables (63 percent) and fruit (65 percent) were reported as ordinarily available but difficult to afford (91 and 90 percent, respectively). A majority reported that prescribed medication(s) were available without difficulty (56 percent), although most indicated difficulty in affording them (73 percent). A minority of participants with T2D reported receipt of diabetes education (46 percent). A1C levels did not significantly vary according to diabetes education received or not (M=10.9, SD±2.9; M=10.4, SD±2.5; t=−0.4, p=0.71). Participants at-risk for T2D were infrequently instructed, by a provider, to follow an exercise program (4.8 percent) or meal plan (4.8 percent) and receive diabetes education (2.38 percent). MOS SF-12 findings revealed participants with T2D (M=41.84, SD=8.9; M=37.8, SD±8.5) had significantly poorer mental and physical health quality of life relative to at-risk participants (M=45.6, SD±8.4; M=48.1, SD±9.5) (t=−2.9, p<0.01; t=−2.5, p=0.01).Research limitations/implicationsSalient physical environmental, medical environmental, and individual factors were identified in a sample of adults with or at-risk for T2D on Nicaragua’s Atlantic Coast.Practical implicationsFindings informed the development of community-based clinics to address the problem of T2D locally.Social implicationsThe community-based clinics, housed in trusted church settings, provide culturally competent care for underserved ethnic minority populations with or at-risk for T2D.Originality/valueThis is the first quantitative assessment of the T2D problem among diverse ethnic groups in Nicaragua’s underserved RAAS.

Exploring experience and perspectives of foreign-born direct care workers in dementia care: Accounts of Korean American personal care aides caring for older Korean Americans with dementia symptoms.

This focus group study explored experience of Korean American personal care aides caring for older Korean Americans with dementia symptoms. Personal care aides described dementia caregiving as challenging, demanding and stressful, yet they cared for their clients with love and affection, particularly with jeong (i.e., a Korean cultural concept of love, affection, sympathy, and bondage). They learned about dementia mostly through their caregiving experience and expressed their need and strong desire to learn more about dementia. They felt for family struggle and observed family conflict and filial obligation. They advocated the value of personal care aides' involvement in dementia care. This study revealed a pressing need for dementia training for personal care aides and called for an outreach effort to recruit and train direct care workers with potential of providing culturally competent care for traditionally underserved ethnic minorities.

The Connecticut Latino Behavioral Health System: A culturally informed community-academic collaboration.

The Connecticut Latino Behavioral Health System (LBHS) represents a culturally informed community-academic collaboration that includes agencies focused on mental health, addictions, behavioral health within community health centers, and social rehabilitation; the Yale University Department of Psychiatry; and the Connecticut Department of Mental Health and Addiction Services. The core mission of the LBHS is to expand and enhance the provision of recovery-oriented, and culturally and linguistically appropriate, services to the monolingual Spanish-speaking community in parts of South Central Connecticut. This article outlines the rationale and need for such a collaboration to meet the needs of an underrepresented and underserved ethnic minority group. The process by which these entities came together to develop and successfully implement systemic strategies is described in the context of 2 overarching priorities: (a) workforce development, and (b) access to services. The authors also highlight lessons learned that have informed the decision-making process since the inception of the LBHS, and future directions to ensure that it is prepared to meet changing consumer needs and systemic priorities. (PsycINFO Database Record

Abstract A68: Awareness of ongoing clinical trial information: physicians' and clinical trial administrators' perspectives

Abstract Introduction: Evidence-based medical decision-making is the current standard for clinical practice. Evidence is obtained from clinical trials yet few patients participate in clinical trials due to numerous barriers encountered by patients. However, barriers faced by physicians have not been comprehensively investigated. This pilot study investigated information seeking behaviors of physicians and information dissemination strategies employed by clinical trial administrators (CTAs). Methods: All attending physicians and CTAs at a public university in the southeast were eligible to participate in face-to-face, semi-structured interviews. Thematic content analysis using the constant comparative method yielded a priori themes regarding physicians' knowledge, attitude, behavior and barriers to information seeking about ongoing clinical trials and their perception regarding reliability of information obtained. Data were validated through peer debriefing. Results: Sixteen physicians from nine specialties and three CTAs were interviewed (Family Medicine/Neurology 44%; &amp;gt;20 years in practice 50%; seeing &amp;gt;100 patients per month 56%). Almost half of the physicians did not actively search for information on ongoing trials in general and a majority of physicians do not actively search for information on trials conducted at their home institution, relying mostly on direct contact from CTAs through mass email and word-of-mouth. Of those who searched, a third admitted to only searching rarely. Most of the physicians who actively search rely on Google search and clinicaltrials.gov, but few used the institution's research website. Half physicians interviewed felt that current trial advertising strategies are ineffective and disorganized, and cited time constraints as a reason why they do not search actively. Most physicians would prefer to have trial staff present trial information directly to them at staff meetings. Most physicians rely on the reputation of the Principal Investigator and Institutional Review Board approval status to determine the reliability and sufficiency of the information they gather. Few physicians read the protocol of the study or verify the information given with outside sources. Physicians who see more patients per month (&amp;gt;100) tended to search less than those who see less patients per month. More experienced physicians (&amp;gt; 20 years of practice) tended to search about the same as less experienced physicians. Of the CTAs interviewed, most used mass emails, the institution's research website and physical newsletter advertisements to advertise trials. Most assessed the effectiveness of these strategies by reviewing patient enrollment. Most do not receive or seek feedback for their strategies from physicians. Conclusion: Most physicians do not actively search for information on trials. There is a disconnect between the strategies desired by physicians and those employed by administrators. There is no assessment of the effectiveness of the advertisement strategies except for enrollment numbers. Most physicians do not use an independent search to verify the information that they have received. These findings have implications, not only for overall accrual to clinical trials but also for disparities in access to trials for medically underserved and racial ethnic minority patients who may not routinely seek out clinical trials on their own. Citation Format: Dariam Cardentey Oliva, Jose M. Soto, Hesborn Wao, Clement K. Gwede, Rahul Mhaskar. Awareness of ongoing clinical trial information: physicians' and clinical trial administrators' perspectives. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A68. doi:10.1158/1538-7755.DISP13-A68

A community health worker-led lifestyle behavior intervention for Latina (Hispanic) women: Feasibility and outcomes of a randomized controlled trial

BackgroundLow-income Latinas (Hispanics) face risk for cardiovascular disease due to high rates of overweight/obesity, sedentary lifestyle, and other factors. Limited access to health care and language barriers may prevent delivery of health promotion messages. Targeted approaches, including the integration of community health workers, may be required to promote healthy lifestyle and prevent chronic disease in underserved ethnic minority groups. The term commonly used to refer to female community health workers in Latino communities is “promotora(s).” ObjectivesThis study evaluates the outcomes and feasibility of a promotora-led lifestyle behavior intervention for overweight, immigrant Latinas. MethodsA community prevention model was employed in planning and implementing this study. A randomized controlled trial design was used. A Community Advisory Board provided expertise in evaluating feasibility of study implementation in the community and other important guidance. The sample was comprised of 223 women aged 35–64 years, predominantly with low income and ≤8th grade education. The culturally tailored Lifestyle Behavior Intervention included group education (8 classes based upon Su Corazon, Su Vida), followed by 4 months of individual teaching and coaching (home visits and telephone calls). The control group received a comparable length educational program and follow-up contacts. Evaluations were conducted at baseline and at 6 and 9 months using a dietary habits questionnaire, accelerometer readings of physical activity, and clinical measures (body mass index, weight, waist circumference, blood pressure, lipids, blood glucose). Data were collected between January 2010 and August 2012. ResultsWomen in the intervention group improved significantly in dietary habits, waist circumference, and physical activity in comparison to those in the control group. A treatment dosage effect was observed for weight and waist circumference. Knowledge about heart disease increased. High attendance at classes and participation in the individual teaching and counseling sessions and high retention rates support the feasibility and acceptability of the promotora-led lifestyle behavior intervention. ConclusionsOur findings demonstrate that lifestyle behaviors and other risk factors of overweight Latina women may be improved through a promotora-led lifestyle behavior intervention. Feasibility of implementing this intervention in community settings and engaging promotoras as facilitators is supported.

Commentary On: Self-Care Self-Efficacy, Religious Participation and Depression as Predictors of Post-Stroke Self-Care Among Underserved Ethnic Minorities.

Not required