Underserved Populations Research Articles

Analysis of Member Quality and Portfolio Quality in Deposit-Taking SACCOs in Kenya: Positivism Paradigm Approach

Deposit-Taking SACCOs have been actively recruiting and expanding financial services to promote financial inclusion, reaching out to all segments of society, especially the underserved populations, particularly those marginalized in rural areas. However, during membership recruitment, traits such as loyalty, profitability, engagement, and advocacy set high-quality members apart. These traits play pivotal roles in driving business growth, building brand reputation, and ensuring long-term sustainability. During the loan appraisal and approval process, customer characteristics and their perceived value carry significant weight. Therefore, evaluating member quality in terms of creditworthiness, financial literacy, and the ability to make timely payments stands as the central activity in the loan appraisal and approval process. Nevertheless, the empirical studies that were reviewed have presented diverse findings on this subject. The present study, therefore, investigated the effect of member quality on portfolio quality in deposit-taking SACCOs in Kenya. The study used primary data, and structured and unstructured questionnaires were administered to purposely selected credit managers in deposit-taking SACCOs in Kenya. Results of the study revealed that member quality positively and significantly influences the portfolio quality of DT SACCOs in Kenya (p =0.000<0.05) and R2= 31.9%. These results are essential to SACCO managers, SACCO regulators like SASRA, scholars, and policymakers like the government.

A longitudinal health promotion program for autistic children and their caregivers: Impact of an urban community-based program.

Autistic children, as well as their primary caregivers (e.g., parents), experience greater health disparities when compared with the general population. Despite this reality, there has been relatively little priority placed on promoting positive trajectories of health in either of these underserved populations. The primary purpose of this study was to examine the impact of participation in a 12-month, longitudinal health promotion program designed for both autistic children and their parent. A total of 27 families participated in the intervention, including 29 autistic children (83% male, M = 8.28 ± 3.60 years) and 27 parents (93% female, M = 40.04 ± 7.95). Families attended in-person health promotion programming for 90 min per week. Children and parents were evaluated at four time points across the program, including baseline (0-months), 4-months, 8-months, and 12-months. Children were measured on fundamental motor competence, physical fitness, body composition, and proxy-reported physical activity. Parents were measured on body composition, physical fitness, and self-reported physical activity. Significant improvements were observed for autistic children in motor competence (p < 0.001) and grip strength (p = 0.006), and for parents in body mass index (p = 0.004) and aerobic capacity (p = 0.003) across the 12-month intervention. Differing trajectories of improvement were noted between urban- and suburban-dwelling families on multiple outcomes. The knowledge acquired from this research may offer initial support for the need to bolster opportunities for accessible and ongoing health promotion programs for both autistic children and their parents.

Exploring the Feasibility of Digital Voice Assistants for Delivery of a Home-Based Exercise Intervention in Older Adults With Obesity and Type 2 Diabetes Mellitus: Randomized Controlled Trial.

Current clinical guidelines for the management of type 2 diabetes mellitus (T2DM) in older adults recommend the use of antihyperglycemic medications, monitoring of blood glucose levels, regular exercise, and a healthy diet to improve glycemic control and reduce associated comorbidities. However, adherence to traditional exercise programs is poor (<35%). Common barriers to adherence include fear of hypoglycemia and the need for blood glucose level monitoring before exercise. Digital health strategies offer great promise for managing T2DM as they facilitate patient-practitioner communication, support self-management, and improve access to health care services for underserved populations. We have developed a novel web-based software program allowing practitioners to create tailored interventions and deliver them to patients via digital voice assistants (DVAs) in their own homes. We aim to evaluate the feasibility of a 12-week, home-based, personalized lifestyle intervention delivered and monitored by DVAs for older adults with obesity and T2DM. In total, 50 older adults with obesity aged 50-75 years with oral hypoglycemic agent-treated T2DM were randomized to the intervention (DVA, n=25) or a control group (n=25). Participants allocated to the DVA group were prescribed a home-based muscle strengthening exercise program (~20- to 30-min sessions) and healthy eating intervention, delivered via DVAs (Alexa Echo Show 8; Amazon) using newly developed software ("Buddy Link"; Great Australian Pty Ltd). Control group participants received generalized physical activity information via email. Outcomes were feasibility, DVA usability (System Usability Scale), and objectively assessed physical activity and sedentary time (wrist-worn accelerometers). In total, 45 (90%) out of 50 participants completed this study. Mean adherence to prescribed exercise was 85% (SD 43%) with no intervention-related adverse events. System usability was rated above average (70.4, SD 16.9 out of 100). Compared with controls, the DVA group significantly decreased sedentary time (mean difference -67, SD 23; 95% CI -113 to -21 min/d), which was represented by a medium to large effect size (d=-0.6). A home-based lifestyle intervention delivered and monitored by health professionals using DVAs was feasible for reducing sedentary behavior and increasing moderate-intensity activity in older adults with obesity and T2DM. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000307808; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381364&isReview=true.

Barriers to HIV Care among Transgender Sex Workers of Colour in the USA and Canada: An Intersectional Scoping Review

Objectives In 2018, HIV prevalence among transgender women of color in the USA was 14.11%, with similar severe trends observed in Canada. This highlights the persistent challenge of HIV/AIDS in both countries, particularly for transgender sex workers of color (TSWOC), who face significant barriers to accessing crucial HIV/AIDS care services due to stigma, systemic discrimination, and biased healthcare practices. To address these issues, a scoping review was undertaken to explore the specific barriers to HIV/AIDS care experienced by TSWOC in the United States and Canada. Methods After various database searches (MEDLINE, PubMed, and Google Scholar) using the PRISMA-ScR methodology, 47 studies were extracted. Studies were then screened on Covidence by using the set inclusion and exclusion criteria. After screening, fifteen studies met the criteria. Results The results were thematically organized using an intersectionality-grounded socio-ecological model. Results revealed individual-level challenges of internalized stigma, interpersonal issues with biased healthcare providers, and community-level problems such as lack of support and enduring stigma. Notable structural barriers, consistent across studies, included homelessness, economic marginalization, and institutional transphobia. Institutionalized cisnormativity in healthcare was also found to exacerbate these challenges. Conclusions The findings underscore a feedback loop intensifying HIV/AIDS burdens within TSWOC due to intersecting stigmas and structural disparities. The review advocates for trans-specific and trans-inclusive HIV/AIDS services to address unique challenges, emphasizing the imperative for holistic, trauma-informed HIV care for this underserved population.

Using publicly available UK datasets to identify recruitment sites to maximise inclusion of under-served groups: three case studies

Background There is strong evidence that those recruited into studies are not always representative of the population for whom the research is most relevant. Development of the study design and funding decisions are points in the research process where considerations about inclusion of under-served populations may usefully be made. Current practical guidance focuses on designing and modifying participant recruitment and retention approaches but an area that has not been addressed is recruitment site selection. Methods We present case studies of three NIHR funded trials to demonstrate how publicly available UK population datasets can be used to facilitate the identification of under-served communities for inclusion in trials. The trials have different designs, address different needs and demonstrate recruitment planning across Trauma centres, NHS Trusts and special educational settings. We describe our use of national freely available datasets, such as those provided by NHS Digital and the Office for National Statistics, to identify potential recruitment sites with consideration of health status, socio-economic status and ethnicity as well as clinical and risk factors to support inclusivity. For all three studies, we produced lists of potential recruitment sites in excess of the number anticipated as necessary to meet the recruitment targets. Discussion We reflect on the challenges to our approach and some potential future developments. The datasets used are all free to use but each has their limitations. Agreeing search parameters, acceptable proxies and identifying the appropriate datasets, then cross referencing between datasets takes considerable time and particular expertise. The case studies are trials, but the methods are generalisable for various other study types. Conclusion Through these exemplars, we aim to build on the NIHR INCLUDE project, by providing trialists with a much needed practical approach to embedding EDI into trial design at the grant application stage.

B - 120 Participant Satisfaction with Tele-Neuropsychology: the Framingham Heart Study

Abstract Objective Tele-neuropsychological assessments (tele-np) have grown in importance since the COVID-19 pandemic, allowing for ongoing surveillance of underserved remote participant populations when traditional in-person evaluations are not practical, convenient, or possible. However, literature addressing satisfaction and acceptance with tele-np is scarce. This study examines participants’ satisfaction with a unique tele-np protocol in a cohort-based epidemiological study, the Framingham Heart Study (FHS). Methods FHS participants who have completed a tele-np evaluation via HIPAA-compliant Zoom since 2021 were included. Tele-np participants completed the same protocol as in-person evaluations. Record forms and a digital pen to capture drawing tasks and Boston Process Approach variables are mailed with a return label to participants. Participants provided feedback on their experience on four, five-point Likert scale questions (1 = strongly negative, 5 = strongly positive). Results Sixty-three largely college-educated (87.30%) participants, with average age of 74.28 years (SD = 7.82), 47.62% female, representing 21 US states completed a tele-np visit. Average completion time was 78.74 minutes (SD = 10.78). 94.83% reported a positive overall experience (M = 4.47, SD = 0.71) with tele-np protocol. Participants reported positive experiences with the use of video conferencing (M = 4.33, SD = 0.73), shipping and test-related materials (M = 4.52, SD = 0.60), and clarity of instructions (M = 4.53, SD = 0.54). Conclusions Older adults positively relate to a tele-np protocol that allows for robust remote assessment of cognition. Tele-np is a feasible and acceptable mode for large scale neuropsychological data collection in older adults and can minimize attrition due to travel limitations. Continued study of participant feedback is imperative as tele-np is expanded to improve accessibility for underserved and diverse populations.

Developing and Evaluating Digital Public Health Interventions Using the Digital Public Health Framework DigiPHrame: A Framework Development Study.

Digital public health (DiPH) interventions may help us tackle substantial public health challenges and reach historically underserved populations, in addition to presenting valuable opportunities to improve and complement existing services. However, DiPH interventions are often triggered through technological advancements and opportunities rather than public health needs. To develop and evaluate interventions designed to serve public health needs, a comprehensive framework is needed that systematically covers all aspects with relevance for public health. This includes considering the complexity of the technology, the context in which the technology is supposed to operate, its implementation, and its effects on public health, including ethical, legal, and social aspects. We aimed to develop such a DiPH framework with a comprehensive list of core principles to be considered throughout the development and evaluation process of any DiPH intervention. The resulting digital public health framework (DigiPHrame) was based on a scoping review of existing digital health and public health frameworks. After extracting all assessment criteria from these frameworks, we clustered the criteria. During a series of multidisciplinary meetings with experts from the Leibniz ScienceCampus Digital Public Health, we restructured each domain to represent the complexity of DiPH. In this paper, we used a COVID-19 contact-tracing app as a use case to illustrate how DigiPHrame may be applied to assess DiPH interventions. The current version of DigiPHrame consists of 182 questions nested under 12 domains. Domain 1 describes the current status of health needs and existing interventions; domains 2 and 3, the DiPH technology under assessment and aspects related to human-computer interaction, respectively; domains 4 and 5, structural and process aspects, respectively; and domains 6-12, contextual conditions and the outcomes of the DiPH intervention from broad perspectives. In the CWA use case, a number of questions relevant during its development but also important for assessors once the CWA was available were highlighted. DigiPHrame is a comprehensive framework for the development and assessment of digital technologies designed for public health purposes. It is a living framework and will, therefore, be updated regularly and as new public health needs and technological advancements emerge.

Use of AI in Pediatric Occupational Therapy: A Review

The utilization of artificial intelligence (AI) in pediatric occupational therapy (OT) has emerged as a promising avenue for enhancing assessment, intervention, and outcomes for children with diverse developmental needs. This paper provides a comprehensive review of the current state of AI applications in pediatric OT, highlighting key findings, benefits, challenges, and future directions. AI technologies, including machine learning algorithms, computer vision systems, and wearable sensors, offer innovative approaches to assess children&amp;apos;s motor skills, sensory responses, and cognitive functions objectively and efficiently. AI-driven intervention strategies, such as personalized treatment planning, adaptive task selection, virtual reality environments, and gamified activities, promote engagement, motivation, and skill acquisition among pediatric patients. AI can be helpful in early diagnosis as well as early intervention. Additionally, AI-powered telehealth platforms enable remote delivery of OT services, real-time monitoring of patient progress, and access to care for underserved populations. However, challenges related to data privacy, ethical decision-making, disparities in access, and therapist education must be addressed to ensure the ethical, effective, and equitable integration of AI into pediatric OT practice. By embracing ongoing research, collaboration, and innovation, pediatric OT practitioners can harness the transformative potential of AI to improve outcomes and quality of life for children and families worldwide.

Justice, Equity, Diversity, and Inclusion-Related Curricular Elements in Entry-Level Physical Therapist Education: A Delphi Study.

The purpose of this Delphi study was to determine whether experts in justice, equity, diversity, and inclusion (JEDI) in the field of physical therapy could achieve consensus on the key JEDI-related curricular content topics to be included in entry-level physical therapist education. Inequities exist at all levels of health care for historically underserved populations, including referrals, access, and quality of physical therapy services. The physical therapy field is facing challenges and opportunities in how to best prepare providers to address individual, community, and population health inequities. There is a lack of consensus in physical therapist education regarding essential curricular content related to justice, equity, diversity, inclusion, and antiracism. Eighty-four experts in JEDI in the physical therapy profession were invited through email to participate in the Delphi process. A Delphi survey brought together 39 identified experts in justice, equity, diversity, and inclusion within the field of physical therapy to reach consensus on key JEDI-related curricular topics in physical therapist education. In the first-round survey, participants answered an open-ended question: "What JEDI-related curricular content should be included in entry-level physical therapist education?" The work team coded these free-text responses to populate an initial list of curricular elements. Over 2 subsequent rounds of surveys, the experts came to a consensus on which curricular elements should be addressed within physical therapist education. Nineteen experts completed all survey rounds. In round I, coding of the expert group's responses generated 61 initial JEDI-related curricular elements. By round III, the group refined the list to 43 curricular elements; 41 of the 43 (95%) elements garnered 94% or higher consensus. The expert group deemed 30 of the elements "entry-level" content and 13 as more "advanced practice" topics. Experts had a strong consensus on key JEDI-related curricular elements that physical therapist education programs should include to best prepare providers to improve the health of society. Future scholarship will explore recommendations for how physical therapist education programs might prioritize and implement JEDI-related content.

Pregnant People-Infant Linkage for Surveillance

Objectives and ApproachAs maternal mortality and morbidity continue to progress, better data is needed to comprehensively understand the problem, especially in underserved populations who are differentially impacted. Surveillance in safety-net populations is complicated by care fragmentation and interoperability challenges between primary care and hospital settings. . AllianceChicago (AC), a health center-controlled network, supports a common data infrastructure across a set of Federally Qualified Health Centers (FQHCs) in Chicago that is further linked to a distributed query infrastructure connecting Chicago’s major health systems known as CAPriCORN. Leveraging electronic health record (EHR) data collected by the AC and CAPriCORN consortium, the objective of this surveillance effort was to connect infant data with maternal data while protecting privacy. We developed a deterministic matching algorithm that utilized multiple approaches and technologies for Pregnant People-Infant (PPI) pair identification. The linkage process involved a five-step method in which each step is recorded within the linkage database and the confidence interval is calculated. ResultsPreliminary analyses are ongoing. Through each step of the linkage process, the confidence interval increased with the increase of matching nodes, highlighting its accumulative accuracy. The result demonstrates the feasibility of linking maternal and baby healthcare characteristics using a range of clinical and demographic variables captured in pseudonymized hospital and ambulatory data. Conclusions and ImplicationsOur approach improves the capacity of EHR data for surveillance while protecting patient privacy and preserving data confidentiality. Triangulating outcomes recorded in different settings can help improve data quality for research and surveillance.

Education of U.S. primary care physicians at the Latin American medical school in Cuba

Background: Growing global health disparities have led to an international call for reform in physician education to meet the need for more responsive providers, emphasizing social accountability, with its four main criteria being relevance, quality, cost-effectiveness, and equity. In contrast to traditional models, Cuba’s Latin American Medical School (la Escuela Latinoamericana de Medicina, ELAM) promotes primary healthcare for disadvantaged populations by providing free medical education to foreign students from low-income communities, including United States (U.S.) citizens. This study examines the processes and standards by which the Latin American Medical School provides socially accountable education, with an emphasis on current and former students from the U.S. The objective of this study is to assess the efforts of ELAM to educate medical students in socially accountable and ethical ways. Methods: Guided by the four abovementioned criteria of social accountability, we thematically analyzed survey comments from 56 past U.S. graduates of the ELAM and interviews with four current U.S. students and eight instructors. Results: Relevance of the ELAM´s training was reflected in the integration of public health practices (e.g., community assessments) and medical care relevant to local and international health concerns. Quality is manifested in the school’s promotion of evidence-based care through tailored academic content for the U.S. students, expanded educational facilities throughout Cuba, and extensive clinical experiences. ELAM exhibits cost-effectiveness via free education and other financial assistance. Promoting equity in healthcare is evident in students’ desire to care for underserved populations with whom they identify. Graduates, current students, and instructors demonstrate that educating physicians from marginalized communities helps to answer the call for social accountability; this was supported by the educational processes and achieved outcomes. Discussion: These findings indicate that the Latin American Medical School’s mission and core activities meet the WHO’s criteria for social accountability and advance current understanding of such programs.

Diabetes Disparities: Addressing Health Inequities and Improving Outcomes in Underserved Populations

Diabetes mellitus, characterized by high blood sugar levels due to insulin deficiency or resistance, is a global public health crisis with significant disparities in prevalence, management, and outcomes, particularly among underserved populations such as racial and ethnic minorities, low-income groups, and rural residents. These populations faced higher rates of diabetes and complications due to social determinants of health, including economic instability, inadequate education, and limited access to healthcare. Barriers such as lack of insurance, transportation challenges, and cultural and linguistic differences further hindered effective diabetes management. Lifestyle and behavioral factors, including diet, physical activity, medication adherence, and mental health, play critical roles in diabetes outcomes. Policy and system-level interventions, such as expanding healthcare coverage, improving access to care, and addressing social determinants of health, are essential to reducing disparities. Technological innovations like telehealth, mobile health applications, wearable devices, and data analytics offered significant potential to enhance diabetes management in underserved populations. This review was conducted using a comprehensive analysis of current literature and existing studies to provide insights into the multifaceted nature of diabetes disparities and to highlight successful interventions and necessary policy changes to improve health outcomes for underserved populations. Addressing these inequities required a multifaceted approach, including community-based interventions, policy reforms, and technological advancements to ensure equitable diabetes care for all. Keywords: Diabetes disparities, Underserved populations, social determinants of health, Healthcare access, Technological innovations.

Abstract IA013: Increasing Diversity in Pediatric Cancer Clinical Trials: Challenges and Opportunities

Abstract Although childhood cancer is the leading cause of death by disease past infancy in the US, with 17,000 children younger than 21 years being diagnosed annually, survival has improved dramatically, and is now greater than 80% overall. Because of unequal access to services and adverse Social Determinants of Health (SDOH) affecting underserved populations, disparities in survival exist among minoritized youth with cancer. For example, Hispanic children have higher incidence of certain cancers and poorer survival rates than non-Hispanic White children. Minorities are severely under-represented in research. This means that cancer outcomes data are largely based on data from non-Hispanic White participants, and there is incomplete information to adequately assess treatment benefits for minorities. We showed that 53% of Latino parents declined research participation, compared to 20% of non-Hispanic White parents, in our institution. There are several barriers to informed consent for clinical trials. First, there are no mandates to ensure comprehension, and informed consent forms are complex, long, and difficult to understand. This leaves parents of children with cancer with an incomplete understanding of risks, procedures, randomization, alternative treatments, and the voluntary nature of clinical trial participation. Furthermore, pediatric cancer often requires urgent treatment, leaving little time for decision-making. We developed COMPRENDO (ChildhOod Malignancy Peer REsearch NavigatiOn), a peer-navigation intervention to improve research literacy and diversity in pediatric cancer clinical trials. In this intervention, trained peer-navigators, who have the lived experience of having a child diagnosed with cancer, provide in-hospital support. The goals of COMPRENDO are to improve parents’ informed consent experience and comprehension of informed consent for cancer treatment, to explain to parents terms to be discussed by the oncologist during the treatment conference, to introduce to parents concepts of clinical trials and research, and to facilitate and empower shared decision-making. In a pilot study at Rady Children’s Hospital-San Diego, this intervention showed a significant increase in comprehension of therapeutic trials, particularly in Hispanic and Spanish-speaking parents. The demographics of children with cancer enrolled in clinical trials should be comparable to the US population, and approaches to improve enrollment must also be tailored to specific settings. Structural barriers for participation of minorities should be considered during study and informed consent design and planning. Strategies to increase clinical trial enrollment of minority individuals include: Provider-level training on patient-provider communication, development of linguistically appropriate tools, and promotion of culturally aware staff. Key strategies at the patient-level include building trust; education and awareness of clinical trials; implementation of culture, language, and health literacy-concordant interventions; and initiatives to address adverse SDOH. Citation Format: Paula Aristizabal. Increasing Diversity in Pediatric Cancer Clinical Trials: Challenges and Opportunities [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pediatric Cancer Research; 2024 Sep 5-8; Toronto, Ontario, Canada. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl):Abstract nr IA013.

Predictors of white matter hyperintensities in the elderly Congolese population.

White matter hyperintensities (WMHs) are strongly linked to cardiovascular risk factors and other health conditions such as Alzheimer's disease. However, there is a dearth of research on this topic in low-income countries and underserved populations, especially in the Democratic Republic of Congo (DRC) where the population is aging rapidly with increasing cardiovascular risk factors and dementia-related diseases. This study evaluates health factors associated with WMH in the elderly Sub-Saharan Africa (SSA), specifically Congolese adults. In a cross-sectional study of 77 people from the DRC, participants underwent neuroimaging to analyze WMH volume and completed clinical evaluation, laboratory-based blood exams, self-reported questionnaires, and interviews. A simple linear regression model was conducted to test the association between WMH and potential predictors (neurological status, age, sex, hypertension, diabetes, tobacco abuse, stroke, high cholesterol, cardiovascular medication, and alcohol abuse). Stepwise selection and backward elimination analyses were performed to obtain the final model. Finally, a multiple linear regression model was conducted to assess the association between WMH and variables retained in the final model (neurological status, sex, and age). Of the 77 individuals, 47 (61%) had dementia, 40 (52.6%) were males, and the mean age was 73 years (± 8.0 years standard deviation). In simple linear regression models, WMH was significantly associated with dementia (expβ1=1.75, 95% CI=1.14 - 2.71, p-value=0.01) though it had a weak association with age (expβ1=1.03, 95% CI=1.00 - 1.05, p-value=0.05) and sex (male) (expβ1=0.66, 95% CI=0.43 - 1.01, p-value=0.05). In multiple linear regression models, WMH was statistically significantly associated with dementia (expβ1=1.97, 95% CI=1.31 - 2.95, p-value =0.001), male sex (expβ2=0.54, 95% CI=0.36 - 0.80, p-value=0.003), and age (expβ3=1.03, 95% CI=1.00 - 1.06, p-value=0.03). However, WMH was not significantly associated with common cardiovascular risk factors, such as high blood pressure, diabetes, tobacco use, obesity, and high cholesterol levels. WMH is significantly associated with neurological status, sex, and age in the Congolese population. Understanding these predictors may improve our ability to diagnose, assess, and develop preventative treatments for white matter disease in SSA/DRC populations, where neuroimaging is difficult to obtain.

The Intersection of HIV and Social Determinants of Health: A Comprehensive Review

The Human Immunodeficiency Virus (HIV) epidemic remained a profound global health challenge, significantly impacting marginalized and underserved populations. While advances in antiretroviral therapy (ART) and prevention strategies have transformed HIV into a manageable chronic condition, the epidemic’s persistence is deeply intertwined with social determinants of health (SDOH). This comprehensive review examined the intersection of HIV and SDOH, highlighting how factors such as poverty, education, gender inequality, healthcare access, and stigma influenced HIV vulnerability and outcomes. Through a synthesis of current research and data, and utilizing a methodology that includes a systematic review of peer-reviewed literature and global health reports, the review underscored the critical role of SDOH in shaping HIV dynamics. It explored regional and population-based disparities, discussed innovations and interventions in HIV prevention and treatment, and proposed strategies to address these underlying determinants. Understanding and addressing the intersection of HIV and SDOH is crucial for developing more effective, equitable, and sustainable HIV prevention and treatment approaches, ultimately advancing global health equity and moving closer to ending the HIV epidemic as a public health threat. Keywords: Social Determinants of Health (SDOH), HIV Prevention, Economic Inequality, Stigma and Discrimination, Innovative Interventions.

Factors Influencing Vaccine Receipt During a 2018 Pediatric Typhoid Conjugate Vaccine Campaign in Navi Mumbai, India.

In 2018, the Navi Mumbai Municipal Corporation implemented phase 1 of a public sector typhoid conjugate vaccine campaign in Navi Mumbai, India, targeting all children aged 9 months to 14 years within its administrative boundaries. To assess associations with receipt of vaccine in phase 1, we used generalized estimating equations to calculate estimates of vaccination by child-, household-, and community-level demographics (child education and age; household head education, income, and occupation; community informal settlement percent). Campaign vaccine receipt was most associated with children enrolled in school (odds ratio [OR] = 3.84, 95% CI: 2.18-6.77), the lowest household income tertile when divided into three equal parts (OR = 1.64, 95% CI: 1.43-1.84), and lower community-level socioeconomic status (OR = 1.06, 95% CI: 1.04-1.08 per 10% informal settlement proportion). The campaign was successful in reaching the most underserved populations of its target communities.

Algorithm-defined memory impairment in older American Indians: The Strong Heart Study.

Assessment of cognition in American Indians poses challenges, including barriers to healthcare, unvalidated clinical standards, and confounding social determinants of health. Alternative strategies for case identification include algorithmic methods, which can outperform clinical judgment in some circumstances. Algorithmic methods can be maximized using single-domain tests with multiple-serial trial tasks, such as the California Verbal Learning Test II-Short Form (CVLT-SF). We collected CVLT-SF and detailed clinical data, including dementia gold standard by consensus adjudication, in 818 American Indians aged 65-95 in 2010-2013 and repeated in 403 returning participants in 2017-2019 (mean follow-up 6.7 years, range: 4-9). Our algorithm categorized CVLT-SF scores into four memory deficit categories: none, encoding, storage, and retrieval. At Visit 1, 75.4% had no memory deficit, 15.6% encoding deficit, 3.5% storage deficit, and 5.5% retrieval deficit. At Visit 2, comparable percentages were 68.7%, 10.6%, 6.5%, and 14.2% (respectively). The majority with any deficit at Visit 1-especially encoding-were lost to follow-up by Visit 2. Most with deficits at Visit 2 were newly categorized from those previously intact. The performance of our memory algorithm, compared with adjudication for dementia, was moderately good: correct classification 69%, sensitivity 51%, and specificity 91%. These descriptive findings encompass a novel contribution in defining memory impairment among American Indians from a single cognitive test. However, more work is needed to improve the sensitivity of this algorithm and maximize its utility for case identification over conventional methods. Altogether, these data provide an important step toward better cognitive characterization and dementia care for an understudied, underserved population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Addressing Hypertension Disparities via Systems Dynamics: Insights From Community Health Connections.

Background and objective Hypertension remains a major public health challenge in the United States, disproportionately affecting various demographic groups. Significant disparities persist in hypertension prevalence and control due to interactions between socioeconomic factors, healthcare access, and systemic inequities. In this study, we aimed todetermine the impact of socioeconomic and healthcare factors on hypertension control among patients at Community Health Connections (CHC), a Federally Qualified Health Center serving 36 communities in North Central Massachusetts, and identify effective interventions using systems dynamics modeling to promote health equity. Materials and methods This was a retrospective observational study using data from 2023 CHC patients, and the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Systems dynamics modeling was employed to visualize interactions among factors influencing hypertension outcomes. The study included 4,870 CHC patients. Participants were selected based on clinical records and comprised 3,690 White participants (76%), 464 Black/African American participants (10%), 108 Asian participants (2%), and 608 classified as Other/Non-reported (12%). The cohort included 2,490 males (51%) and 2,380 females (49%). Socioeconomic factors (e.g., race, age, insurance status) and healthcare access were the study variables. The primary outcome was hypertension control, defined as a blood pressure reading of <140/90 mmHg. The study measured control rates across different demographic groups and assessed the impact of socioeconomic and healthcare factors on these rates. Results Among the 4,870 CHC patients, 3,007 (62%) achieved hypertension control. The overall hypertension control rate varied significantly by race: White: 68.6%, Black/African American: 61.6%, Asian: 63.2%, and Other/Non-reported: 65.6%. Insured patients had a control rate of 67.7%, compared to 37.5% for uninsured patients (p<0.001). Systems dynamics models illustrated how socioeconomic disparities and healthcare access issues amplify health inequities. Key interventions identified include, but are not limited to, multidisciplinary care teams, community health worker programs, and telehealth services. Conclusions Addressing hypertension disparities among CHC patients requires a systemic approach integrating socioeconomic, healthcare, and policy-related interventions. Systems dynamics modeling provides a framework for designing and implementing targeted interventions, enhancing health equity, and improving hypertension control outcomes in underserved populations. Further research is needed to test the effectiveness of these interventions before their broad implementation.

Impact of an Automated Digital Navigation Program on Colonoscopy No-Show Rates: A Study in an Underserved Population

Impact of an Automated Digital Navigation Program on Colonoscopy No-Show Rates: A Study in an Underserved Population

A Community-Based Cervical Cancer Education and Navigation Program for Korean American Women.

In the United States (US), rates of cervical cancer screening among Asian American women (notably Korean American women) lag far behind other populations. Thus, guided by the Health Belief Model, we developed a multi-component intervention to enhance Korean American women's knowledge and beliefs about screening and to increase screening uptake. The intervention group (N=341) received a culturally-relevant cancer education program and navigation services. The control group (N=335) received a similar program on cervical cancer risk and screening, along with information about free/low-cost screening sites. Women's knowledge and beliefs were measured at baseline and post-program, and screening behavior was assessed at 12-months post-program. It was hypothesized that the intervention would lead to positive changes in health beliefs and knowledge about cervical cancer and screening, which were then evaluated as potential mediators of the intervention on screening behavior. From pre- to post-program, the intervention group reported significantly greater increases in knowledge (p<0.01) and perceived risk (p=0.02) and significantly greater decreases in perceived barriers (p<0.001) compared to the control group. However, changes in knowledge and health beliefs did not mediate intervention effects on screening behavior. Use of navigation services was associated with greater odds of obtaining screening (OR=3.15, 95% CI=2.28-4.01, p<0.001) and attenuated the significant effect of group assignment (intervention vs. control) on screening behavior to non-significance. In conclusion, although our intervention program was effective in improving women's knowledge and beliefs about screening, delivery of navigation services was the critical component in increasing cervical cancer screening rates in this underserved population.