Implications for Socio-environmental Determinants of Health-Informed Health Worker Wellness Programs: Findings from a Cross-Sectional Study.

PURPOSE: To explore how socio-environmental factors may potentially impact health outcomes across different groups of health workers (HW). METHOD: Data from the California Healthy Places Index (HPI) and administrative dataset including 12,715 HWs were analyzed using analysis of variance and two-step cluster analysis to evaluate variations in socio-environmental factors across 11 HW job categories. RESULTS: While physicians had the highest average HPI percentiles (69th percentile) across almost all HPI components, the lower-wage HWs consistently ranked below the state average (50th percentile). Overall, the HPI percentile was lowest for environmental living conditions and pollution for all HCWs (30th percentile). The education (52nd percentile) and economic components (59th percentile) were higher than the state average. CONCLUSIONS: The findings from this highlight the importance of socio-environmental determinants of health-informed employee wellness programs and research studies.

Patterns of Health Care Access and Use in an Urban American Indian and Alaska Native Population.

Studies of health care access and use among historically resilient populations, while common, often field a limited sample size and rarely ask the groups most impacted by health inequities to weigh in. This is especially so for research and programs that focus on the American Indian and Alaska Native (AIAN) population. The present study addresses this gap by examining data from a cross-sectional survey of AIANs in Los Angeles County. To better interpret project findings and generate culturally relevant contexts, qualitative feedback was gathered at a community forum held in Spring 2018. Because recruitment of AIANs has historically been challenging, purposive sampling was employed to strategically identify a larger eligible pool. Among those who were eligible, 94% completed the survey (n = 496). AIANs who were enrolled in a tribe were 32% more likely to use the Indian Health Service (IHS), compared with those who were not enrolled (95% CI: 20.4%, 43.2%; p < .0001). In multivariable modeling, the strongest factors influencing IHS access and use were: tribal enrollment, preference for culturally-specific health care, proximity of the services to home or work, having Medicaid, and having less than a high school education. Feedback from the community forum indicated cost and trust (of a provider) were important considerations for most AIANs. Study findings reveal heterogeneous patterns of health care access and use in this population, suggesting a need to further improve the continuity, stability, and the image of AIANs' usual sources of care (e.g., IHS, community clinics).

Pintura Mural para Recolectar Datos Sensibilizantes y Fomentar la Participación en la Investigación Entre los Latinos de EE. UU.

Proposito. Describir una intervención de murales implementadas con comunidad envecindarios Latinos para elevar conciencia de barreras delreclutamiento/retención de Latinos en EE. UU. en la investigación clínica,y aumentar acceso de los investigadores a conceptos de sensibilización críticos para el riguroso diseño de estudios. Fondo. Latinos en EE. UU. sufren desproporcionada de varias enfermedadescrónicas, pero son subrepresentados como investigadores y participantesen investigaciones financiadas por Institutos Nacionales de Salud. Faltade representación inhibe conciencia de necesidades Latinas para la saludy obstaculiza esfuerzos para abordar la falta de equidad en comunidadesdiversas. Las intervenciones de arte en comunidades Latinas siguensiendo reconocidas por capacidad a cerrar brechas e incrementar lacalidad y cantidad de asociaciones de investigación entre investigadores y Latinos. Método. Este artículo describe una intervención de murales puesta a prueba endos vecindarios mayormente Latinos entre 2016 y 2020. El método deldiseño fue guiado por prácticas de investigación participativas con lacomunidad enfocadas en Evaluación-Diagnóstico Planificación- Implementación-Evaluación. Resultados. Los murales abordaron muchos desafíos de participación que a menudo se asocian con la subrepresentación de los Latinos en la investigación académica y permitió entrevistas de sensibilización con miembros clave de la comunidad sobre temas de interés para investigación. Conclusión. Los métodos de investigación que reconocen las formas de arte tradicionales, como murales, crean espacio para generar confianza e iniciar interés en la participación en investigaciones, y aumentan acceso.

Correlates of influenza vaccination among underserved Latinx middle-aged and older adults: a cross-sectional survey.

BACKGROUND: Vaccination is a powerful tool in the fight against seasonal influenza, among underserved, middle-age and older, Latinx adults. Yet, vaccine hesitancy and inconsistent uptake in this population continues to represent a substantial challenge to public health. A better understanding of factors impacting influenza vaccination behaviors in this group could result in more effective messaging and initiatives promoting universal vaccination among Latinx. METHODS: In this cross-sectional survey, we explore correlates of influenza vaccination uptake among underserved, Latinx, older adults. Our focus was on the role of socio-demographics, living arrangements, financial strain, access and satisfaction with medical care, and the presence of major chronic conditions in terms of vaccine uptake. Middle-aged and older Latinx residents diagnosed with diabetes and/or hypertension (n=165), were recruited from the South Los Angeles Service Plan Area (SPA), a historically under-resourced community. Bi-variate and multi-variate logistical regression were performed on survey data to explore independent correlates of influenza vaccination. RESULTS: Almost half of underserved Latinx older adults in our study (45%) reported influenza vaccination within the 12 months prior to the study. The majority (~85%) reported receiving this recommendation from their primary care provider. However, thirty percent (30%) of those receiving this advice did not get the vaccine. A decreased likelihood of vaccination was significantly associated with living alone (p-value=0.026), lacking Medicare coverage (0.028), or higher levels of financial strain (0.020). Difficulty accessing medical care (p-value=0.008) or dissatisfaction with these experiences (p-value=0.001) were also strongly associated with decreased likelihood of vaccination. Participants diagnosed with COPD had 9.5 (CI: 1.76 - 51.3) higher odds of being vaccinated compared to those without; no correlation was detected for other chronic conditions. CONCLUSION: The high number of unvaccinated Latinx participants receiving a vaccine recommendation from a provider is consistent with studies among other ethnic/racial minority older adults and highlights the pivotal role of the provider in influenza vaccine adoption. Additional findings reflect negative impact of Social Determinates of Health on preventive care efforts in this group. Further efforts to quantify these associations are needed to explore structural and human factors impacting influenza vaccine uptake.

Mural Painting to Collect Sensitizing Data and Encourage Research Participation Among U.S. Latinos.

PURPOSE: To describe a mural-based intervention that can be implemented in partnership with community members in Latino neighborhoods in order to improve awareness of barriers to recruitment/retention of U.S. Latinos in clinical research, while augmenting researchers' access to sensitizing concepts critical for rigorous study design. BACKGROUND: Latinos in the United States suffer disproportionately from several chronic illnesses but are underrepresented as researchers and participants in National Institutes of Health-funded research. This lack of representation inhibits a nuanced awareness of the health needs of U.S. Latinos and hampers efforts to address a persistent lack of health equity among U.S. Latinos and other communities of color. Art-based interventions implemented in Latino communities are increasingly being recognized for their ability to bridge this gap and positively affect the quality and quantity of research partnerships between clinical researchers and U.S. Latinos. METHOD: This article describes a mural-based intervention piloted in two predominantly Latino neighborhoods between 2016 and 2020. The design of this method was guided by community partnered participatory research practices and involved an Assessment-Diagnosis-Planning-Implementation-Evaluation approach. RESULTS: Mural painting addressed many of the participation challenges often associated with underrepresentation of Latinos in academic research and allowed for sensitizing interviews with key community members surrounding topics of interest to the research team. CONCLUSION: Research methods that acknowledge traditional art forms, such as mural painting, create a space for building trust and spark interest in future research participation, while augmenting researchers' access to sensitizing concepts that may improve the cultural competence of future studies, projects, and interventions.

The Burnout Dyad: A Collaborative Approach for Including Patients in a Model of Provider Burnout.

ABSTRACT: Both patients and providers in the United States (US) suffer from burnout, which can impact the clinical relationship and quality of care. Among providers, burnout is a state of exhaustion including heightened depersonalization; among patients, burnout can negatively affect clinical outcomes. More than half of clinical providers in the United States suffer from burnout; less is known about the magnitude and prevalence among patients. Understanding patient burnout will improve our recognition of treatment barriers, understanding of patient-provider communication, and perceived quality of care. The purpose of the 2019 Stanford University MedicineX Burnout Workgroup was to use a collaborative approach to expand on the National Academy of Medicine (NAM) Wellness and Resilience Model, which does not currently include the patient as an influential member of the care team potentially experiencing burnout. This collaboration among patients, physicians, students, caregivers, technologists, and researchers used a convenience sample of conference attendees, broken into three focus groups to (1) provide an expanded definition of burnout that includes patients' perspectives, (2) analyze the NAM burnout model for inclusion of the patient experience, and (3) define a care experience that includes both patients and providers. The design of this workgroup was informed by Everyone Included, a model that recognizes and rejects hierarchical traditions in clinical practice. This approach allowed for the creation of a safe space for the exchange of knowledge between the various stakeholders. The resulting inclusive conceptual model, The Burnout Dyad, describes a cocreated care experience informed by both patient and provider characteristics.

Supporting "Bleeders" and "Billers": How Safety-Net Administrators Mitigate Provider Burnout During the COVID-19 Pandemic and Beyond.

Organizational factors impacting burnout have been underexplored among providers in low-income, minority-serving, safety-net settings. Our team interviewed 14 health care administrators, serving as key decision makers in Federally Qualified Health Center primary care clinics. Using a semistructured interview guide, we explored burnout mitigation strategies and elements of organizational culture and practice. Transcribed interviews were coded and analyzed using the Braun and Clark (2006) Thematic Analysis method. Mission-Driven Ethos to Mitigate Provider Burnout emerged as the primary theme with 2 categories: (1) Promoting the Mission: "Bleeders" and (2) Competing Priorities: "Billers." These categories represent various properties and reflect administrators' use of organizational mission statement as a driver of staff recruitment, training, retention, and stratification. Data collection occurred before and during the COVID-19 global pandemic, as such additional themes associated with administrative behaviors during a prolonged, clinical crisis provide insight into possible strategies that may mitigate burnout in this setting.

Primary Care Tasks Associated With Nursing Burnout: A Survey of Registered and Licensed Vocational Nurses in Veterans Health Administration Patient-Centered Medical Homes.

Using data from the Veterans Assessment and Improvement Laboratory for Patient-Centered Care (VAIL-PCC) Survey, this study investigated the relationship between registered nurses' (RNs') and licensed vocational nurses' (LVNs') report of responsibility for 14 distinct primary care tasks and burnout, taking into account of practice environment contexts. RNs reported higher levels of burnout than LVNs. The task of "following up on referrals" was associated with significantly higher levels of RN burnout, whereas "responding to prescription requests" was associated with higher levels of LVN burnout. "True collaboration" was associated with significantly lower levels of burnout for both RNs and LVNs.

The Secret-Self Management Loop: A grounded theory of provider mistrust among older Latinas with type 2 diabetes and mental health symptoms.

AIMS: The purpose of this study was to examine how older Latina women emotionally experience type 2 diabetes mellitus and interactions with care providers using a grounded theory approach. METHODS: Sixteen English-speaking, Latina women, 60 years and older, diagnosed with type 2 diabetes mellitus and experiencing symptoms of depression or anxiety participated in 21 phone interviews guided by a semi-structured interview guide. Data was collected and analyzed using Grounded Theory methodology; theoretical sampling was used to achieve data saturation. RESULTS: Participant data informed the creation of a theory, The Secret Self-Management Loop, with four interconnected phases: 1) having a negative relationship origin story; 2) doubting provider motivation; 3) reacting to doubts about provider; and 4) engaging in secret self-management. These phases reflected participants' lost trust in their providers and the medical system, resulting in undisclosed self-management strategies that complicated clinical management of their type 2 diabetes mellitus diagnosis. Primary sources of loss of trust were interactions that lacked empathy or caused them to question their providers' motivation. CONCLUSION: The Secret Self-Management Loop negatively influences patient disclosure and distorts providers' ability to adequately render care for this group.

Participant Engagement in a Transmedia Storytelling Web-Based App Intervention for Mental Health of Latina Women: Qualitative Analysis.

BACKGROUND: Stigma, fear, and lack of knowledge regarding treatment options or where to get help create delays for Latina women in accessing needed mental health help. Story-based media interventions hold appeal for Latina women. Thus, we drew upon the Social Cognitive Theory by Bandura to create an evidence-based, transmedia storytelling web-based app for mental health called Catalina: Confronting My Emotions to connect Latina women to a curated set of mental health resources. Understanding how Latina women perceive various aspects of the web-based app will help design future expansions. OBJECTIVE: A previously published analysis led to the development of a category on how participants related to the lead character (Catalina) in the story line of the web-based app as a real person. However, the purpose of this analysis was to gain an understanding of participants' experiences with the extension of the dramatic story line of the web-based app beyond Catalina to a Latina nurse-therapist character named Veronica, who was featured prominently in the app's interactive content and bonus videos. METHODS: Qualitative analyses were conducted with interview data from a community-based sample of 28 English-speaking Latina women aged between 21 and 50 years who scored above the threshold for anxiety (Generalized Anxiety Disorder-7) and/or depression (Patient Health Questionnaire-9) but were not suicidal at screening. Data were collected 72 hours after participants engaged with our transmedia storytelling web-based app for mental health. Grounded theory methodology guided the analysis and interpretation of data that had been collected telephonically, recorded, and transcribed with identifiers removed. Analyses included initial and focused coding using process codes (gerund form of verbs in codes focused on action), informed by symbolic interactionism, and the development of categories with properties through constant comparison, memo writing, and the use of charts and diagrams. RESULTS: Our participants experienced a multiphase process that was most heavily related to Veronica, the Latina nurse-therapist character in our web-based app, who led them through a process to a place of action. We conceptualized this process as moving from passive viewer to active participant of a transmedia storytelling web-based app intervention. Overall, 3 new conceptual categories provided insight into women's experiences, including encountering a trustworthy nurse-therapist character, taking in messages that dispel old beliefs, and preparing when and how to take action. Each category has nuanced properties that reflect participants' experiences. CONCLUSIONS: Active engagement with our web-based app led our sample to successfully transition from the viewpoint of the observer to the viewpoint of the experiencer, moving from a passive position of watching to active engagement that involved imagining, thinking, reflecting, and acting. Careful development of dramatic material for health-related web-based apps using transmedia story extension and bonus videos needs to be based on input from the target group from the start of development through evaluation and testing.

Adolescent Psychiatric Emergencies Precipitated by the COVID-19 Pandemic.

The purpose of this retrospective case series was to describe adolescent psychiatric emergencies precipitated by the coronavirus disease 2019 (COVID-19) pandemic. This study used a sample of adolescents admitted to a safety net psychiatric hospital in Los Angeles, California, between March and May 2020. Medical records and involuntary psychiatric holds were reviewed to determine if the events precipitating the psychiatric crisis were related to the pandemic (eligible N = 14). COVID-19-precipitated admissions were 24% of total admissions from March 15 to May 31, 2020; however, total admissions during this time period were reduced from the same time period in prior years. Most hospitalizations were precipitated by shelter-in-place stressors for adolescents with a psychiatric history, but for 28.6% of the sample, this was their first mental health encounter. The COVID-19 pandemic and corresponding shelter-in-place orders may precipitate psychiatric emergencies among adolescents with and without existing mental health disorders. [Journal of Psychosocial Nursing and Mental Health Services, 59(7), 17-21.].