The use of ecological momentary assessment for family caregivers of adults with chronic conditions: A systematic review.

Background: Ecological momentary assessment (EMA) as a real-time data collection method can provide insight into the daily experiences of family caregivers. Purpose: This systematic review aimed to synthesize studies involving EMA completed by family caregivers of adults with chronic conditions. Methods: A systematic search was conducted within six databases for articles published from the inception of the database through September 2023. We extracted the characteristics of the included studies and data on EMA-specific methods to determine the quality of the included studies. Results: A total of 12 studies involving EMA completed by family caregivers of adults with chronic conditions were identified, with almost all studies focused on caregivers of persons with Alzheimer's or dementia-related conditions. The average compliance rate across the included studies was 75%, below the recommended rate. In addition, most of the included studies did not collect the family caregivers' daily activities and care contexts in their responses (i.e., affect, stress, well-being, care demand, and fatigue) to the EMA prompts. Discussion: This review showed that using EMA to collect information on family caregivers of adults with chronic health conditions appeared feasible and acceptable. However, the methodology or design of using EMA to collect caregiver information in this population is still preliminary. The limited number of existing studies that have used EMA to capture the daily experiences of family caregivers does not provide key information that could improve understanding of caregivers' emotional experiences and well-being in real-life situations. We identified gaps in the literature that warrant additional EMA studies for this population.

Health Literacy among Korean American Immigrant Women in the USA: Role of Social Support.

Health literacy is associated with health behaviors and outcomes. Using Andersen's Behavioral Model of Health Services Use, this study examined the role of limited English proficiency (LEP) and social support for the health literacy of Korean American immigrant women, one of the most affected groups by LEP. Researchers surveyed 232 Korean American immigrant women in a metro area in a Southeastern state, U.S. Health literacy was measured by the CDC Behavioral Risk Factor Surveillance System Questionnaire and the California Health Interview Survey. Participants with better English proficiency and larger social support had higher health literacy. LEP and social support interaction was significantly associated with health literacy, illustrating social support as a buffer that mitigates the negative impact of LEP on health literacy. Community programs that enhance social support through community health advocates or peer educators may increase health literacy and reduce health disparities among Korean American immigrant women with LEP.

Quality of Care at the End of Life: Applying the Intersection of Race and Gender.

BACKGROUND AND OBJECTIVES: Research on racial and gender disparities in end-of-life care quality has burgeoned over the past few decades, but few studies have incorporated the theory of intersectionality, which posits that membership in 2 or more vulnerable groups may result in increased hardships across the life span. As such, this study aimed to examine the intersectional effect of race and gender on the quality of care received at the end of life among older adults. RESEARCH DESIGN AND METHODS: Data were derived from the combined Round 3 to Round 10 of the National Health and Aging Trends Study. For multivariate analyses, 2 logistic regression models were run; Model 1 included the main effects of race and gender and Model 2 included an interaction term for race and gender. RESULTS: Results revealed that White men were the most likely to have excellent or good care at the end of life, followed by White women, Black men, and Black women, who were the least likely to have excellent or good care at the end of life. DISCUSSION AND IMPLICATIONS: These results point to a significant disadvantage for Black women, who had worse end-of-life care quality than their gender and racial peers. Practice interventions may include cultural humility training and a cultural match between patients and providers. From a policy standpoint, a universal health insurance plan would reduce the gap in end-of-life service access and quality for Black women, who are less likely to have supplemental health care coverage.

Factors Associated with Korean American Women's Health-Related Internet Use: Findings from Andersen's Behavioral Model.

Literature suggests that access to health information improves health outcomes in various medical domains. This study investigated health-related Internet use levels and examined which factors influence health-related Internet use in Korean American women, grounded by Andersen's Behavioral Model. Participants included 243 Korean American women aged 19-85 years old residing in a Southeastern metropolitan area. Health-related Internet use was assessed by 11 items taken from HINTS 4 Cycle 2. Multiple regression analysis was conducted to reveal factors significantly associated with health-related Internet use of Korean American women. Predisposing factors of being aged 60 or older (ß = - 0.329, SE = 0.694, p = 0.004) and employment status (ß = 0.179, SE = 0.404, p = 0.037), as well as an enabling factor of having a primary care physician (ß = 0.217, SE = 0.423, p = 0.013), were significantly associated with health-related Internet use. The differences in health-related Internet use may exacerbate disparities in access to healthcare services. The primary care physician's role is important in enhancing health-related Internet use. Research, policy, and programmatic attention are necessary to enhance physicians' encouragement and education for patients to use existing digital technology to improve their health and wellness.

HPV and HPV Vaccine Awareness Among African Americans in the Black Belt Region of Alabama.

This study aims to examine the factors associated with the level of HPV infection and HPV vaccine awareness among rural African Americans living in the Black Belt region of Alabama. A cross-sectional survey on cancer screening and health behaviors was conducted in the Black Belt region of Alabama. Adults (18 years or older) recruited through convenience sampling completed the self-administered survey. Binary logistic regressions were conducted to identify factors associated with HPV infection and HPV vaccine awareness among African American participants. Slightly more than half of the participants were aware of HPV (62.5%) and HPV vaccine (62.1%). Married or partnered participants had lower awareness of HPV or HPV vaccine. Family cancer history and self-reported health status were positively associated with both HPV and HPV vaccine awareness. In addition, employment was positively associated with HPV awareness, and participation in social groups was positively associated with HPV vaccine awareness. Tailored educational interventions that consider our findings might increase HPV and HPV vaccine awareness and contribute to better vaccine uptakes.

Church Leaders Share and Implement Solution-Focused Health Strategies During the COVID-19 Pandemic in Rural Alabama.

Bridging the healthcare access gap and addressing COVID-19 vaccine hesitancy among rural-dwelling Black American adults residing in the Deep South require involvement of faith-based leaders in the community. This study explored perceived barriers and resources to meeting community needs, including vaccination, during the COVID-19 pandemic as reported by 17 Black American church leaders in the rural West Alabama Black Belt geographic region in May 2022. The main themes that emerged included (1) attending to community impact of COVID-19 illness and death; (2) maximizing health literacy and diminishing vaccine hesitancy through engaging in preventive health practices and sharing public health information; (3) addressing challenges created or exacerbated by COVID-19, including reduction in in-person attendance (particularly among adolescents and young adults), limited access to and literacy with technology, and political perceptions influencing engagement in preventive health behaviors; (4) maximizing technological solutions to increase attendance in the church; and (5) engaging in solution-focused and innovative initiatives to meet the identified needs in the congregation and community. Church leaders in West Alabama rural areas facing economic, health, and technological disparities identified "silver linings" as well as challenges created or exacerbated during the pandemic. As the need for COVID-19 vaccination and booster vaccination continues, Black American church leaders play pivotal roles in meeting rural community needs.

Correlations between Social Determinants of Health and Technology Access among Rural African American Alabamians.

Certain populations have been excluded from the benefits of telehealth and the recent advances and widespread use of technology in health promotion due to limited technology access. Although research has identified these specific groups, none has explored these issues using the social determinants of health (SDH) framework. This exploratory study aimed 1) to investigate technology access and 2) to identify associated SDHs. A cross-sectional research design was implemented, and participants were recruited from rural Alabama (N=185). Binary logistic regressions were conducted. Only 60% of participants had technology access. People with food insecurity and health illiteracy were less likely to have internet and PC/tablet access. In addition, older age was associated with a lower likelihood of access to a smartphone. This study provided insights into SDH correlates of the digital divide, particularly among rural African Americans, and indicated that addressing affordability could be a partial solution.

Depression among Korean American immigrants living in rural Alabama: use of social determinants of health framework.

OBJECTIVES: Depression among Korean American (KA) immigrants in rural Alabama is understudied. This study aims to utilize the social determinants of health (SDOH) framework to explore factors associated with depressive symptoms among KA immigrants living in rural communities of Alabama. DESIGN: Data were collected from two sites in rural Alabama from September 2019 to February 2020. Convenience sampling was conducted to recruit study participants from the KA community. A total number of 261 KA immigrants aged 23-75 were included in the study. All measures originally in English were translated into Korean using back-translation to assure comparability and equivalence in the meaning of measures. Multiple linear regression modeling was used to explore the predictors of depression. RESULTS: Perceived race discrimination was significantly associated with greater depressive symptoms (ß = .180, SE = .534, p < .01). Three SDOH were identified to have significant relationship with depressive symptoms. Participants who could not see a doctor because of cost (ß = .247, SE = 1.118, p < .001), had lower level of health literacy (ß = -.121, SE = .280, p < .05), and had higher social isolation scores (ß = .157, SE = .226, p < .05) tended to have higher scores of depressive symptoms. CONCLUSION: Rural-living KA immigrants' depression can be significantly affected by race discrimination and SDOH factors, emphasizing the need for culturally competent interventions and services. Policymakers, federal and local governments, non-governmental organizations, and social workers can make joint efforts to address racial discrimination and improve the mental health services among immigrant populations, especially those living in rural areas.

Does the Use of Social Media Affect Online Health Information-Seeking Behaviors among Underserved African Americans in Rural Alabama?

PURPOSE: This study aimed (1) to investigate levels of technology device access and social media use among African Americans in rural Alabama, (2) to examine the prevalence of online health information-seeking behaviors, and (3) to identify associations of technology device access and social media use with online health information-seeking behaviors. METHODS: A convenience sample of 185 African Americans aged 18 and older was recruited from a rural county in Alabama. Multilinear regression was conducted to examine the associations. RESULTS: Nearly 60% of participants had access to the internet, smartphone, and tablets/computers. The prevalence of online health information-seeking behaviors was low. Technology device access was not associated with online health information-seeking behaviors, while more social networking sites were associated with more online health information-seeking behaviors. CONCLUSION: Public health interventions are needed to promote internet use for health purposes among rural African Americans. Offline health information services should also target those lacking internet access.

Self-Rated Health and Mental Health Among African Americans in the Rural South: The Influence of Social Determinants of Health.

BACKGROUND: The current study examines the influence of seven categories of social determinants of health (i.e., financial resource strain, food insecurity, transportation needs, housing instability, education and health literacy, social isolation, and interpersonal safety), as well as perceived race-related discrimination and disparities in received health care quality on self-rated health and mental health. METHODS: Multiple linear regression was used to test whether social determinants of health and race-related stressors were associated with self-reported health status and self-reported mental health status in a sample of rural African Americans residing in the Southeastern United States. RESULTS: The results suggest that food insecurity was significantly associated with lower levels of self-rated health and mental health. In contrast, greater health literacy was significantly associated with higher levels of self-rated health and mental health. Surprisingly, greater transportation needs were also associated with higher levels of self-rated mental health status. Among the race-related stressors, racial discrimination was associated with lower levels of self-rated health status. CONCLUSIONS: Community-based interventions that seek to alter social determinants of health and reduce experiences with racial discrimination may improve self-rated health and mental health among rural African Americans.

Racial/Ethnic disparities in drug use during the COVID 19 pandemic: Moderating effects of non-profit substance use disorder service expenditures.

The COVID-19 pandemic influenced individuals' anxiety and depression across the United States over a short period, and some Americans relied on drugs for coping. This study examines American adults' drug use trajectories in response to changing anxiety and depression levels during the COVID-19 pandemic and the moderating role of substance use disorder (SUD) services provided by non-profit facilities in anxiety/depression-induced drug use. Heterogeneity in such relationships is further explored based on race/ethnicity. This study used a nationally representative sample of 1,176 American adults who reported drug use between May 1, 2020, and June 30, 2021. Using individual-fixed effects Poisson estimators, the current study empirically modeled drug use changes according to changing anxiety/depression levels. Interaction terms between anxiety/depression levels and per capita spending by non-profit SUD facilities were used to explore the moderating effect of SUD service expenditures. Racial/ethnic disparities were explored in subgroup analyses on non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian samples. We found more frequent drug use in response to elevated anxiety and depression during the COVID-19 pandemic. Greater spending on SUD service by non-profit facilities at the county level was associated with reduced drug consumption associated with anxiety and depression, with greater benefits for racial/ethnic minorities. Findings provide important policy implications for distributing public funds for non-profit SUD facilities for mitigating SUD risks, especially among racial/ethnic minorities.

Urban/Rural Digital Divide Exists in Older Adults: Does It Vary by Racial/Ethnic Groups?

Despite the overall increase in older adults' internet use, the digital divide within older Americans remains substantial, particularly for those in rural areas and with racial/ethnic minority backgrounds. The current study examines how one's residential area and racial/ethnicity relate to internet access, both singularly and in concert. Data were from the 2016 Health and Retirement Study. The sample consisted of 17,372 Americans aged 50 and above. Logistic regression analyses were performed to test the direct effects of residence and race/ethnicity and their interaction effects on internet use. The odds of internet use were significantly lower for older adults living in suburban and rural residences as well as for Black and Hispanic individuals. Furthermore, rural living reduced the probability of using the internet more for Blacks than Whites. These findings underscore the need for targeted interventions to narrow the digital divide, with particular attention required for older Blacks in rural communities.

Is Pap Test Awareness Critical to Pap Test Uptake in Women Living in Rural Vietnam?

INTRODUCTION: Cervical cancer is the second leading cause of cancer death among Vietnamese females. By detecting precancerous cells, Pap test screening plays a critical role in the fight against cervical cancer. The present study aims to investigate health-related factors associated with receipt of Pap test among Vietnamese females living in rural Vietnam, particularly examining the correlation between awareness level of the Pap test and the receiving of Pap test. METHODS: Anderson's Behavioral Model of Health Services Use was utilized as the present study's theoretical framework. A self-administrated questionnaire was completed among 193 females residing in Quantri City, Vietnam. RESULTS: Only 15.5% (N=30) of participants in our sample have had a Pap test. Pap test awareness (OR = 18.38, p <.001) was a strong predictor of Pap test receipt. Participants who had heard about Pap test were 18.38 times more likely to take a Pap test compared to those who had no prior knowledge. Besides the awareness, variables including employment (OR = .18, p <.05), and health insurance coverage (OR = 10.75, p <.05) were significantly associated with Pap test uptake. CONCLUSION: Findings from the present study suggests interventions should be provided through public health efforts to enhance awareness of Pap test by aiming at increasing primary prevention of cervical cancer, especially among Vietnamese women living in rural areas, in order to reduce cancer health disparities.

Opioid Literacy of Korean Americans in Rural Alabama: Addressing the Role of Social Determinants of Health.

INTRODUCTION: Opioid crisis has disproportionately affected Alabamians with the highest opioid prescription rate, and it is subjected to affect Korean Americans (KA) negatively based on common predictors of opioid misuse that KA possess. METHOD: Cross-sectional data of KA in rural Alabama (N = 230) were analyzed. Opioid literacy was assessed by the Brief Opioid Overdose Knowledge survey. Six social determinants of health factors were considered: financial status, educational attainment, English proficiency, household food insecurity, health literacy, and social contact. RESULTS: Participants had limited opioid literacy (M = 3.56, SD = 3.06). After adjusting for demographics and health covariates, higher levels of overall opioid literacy were associated with higher household income (B = .48, p < .01), higher levels of health literacy (B = .71, p < .01), and less frequent social contact (B = -.40, p < .01). Significant social determinants of health predictors varied across subdomains of opioid literacy. DISCUSSION: The findings suggest that culturally competent and community-level interventions are needed to increase opioid literacy in KA in rural Alabama.

Role of Health Literacy in Health-Related Information-Seeking Behavior Online: Cross-sectional Study.

BACKGROUND: The internet has emerged as a main venue of health information delivery and health-related activities. However, few studies have examined how health literacy determines online health-related behavior. OBJECTIVE: The aim of this study was to investigate the current level of health-related information-seeking using the internet and how health literacy, access to technology, and sociodemographic characteristics impact health-related information-seeking behavior. METHODS: We conducted a cross-sectional study through a survey with Minnesotan adults (N=614) to examine their health literacy, access to technology, and health-related information-seeking internet use. We used multivariate regression analysis to assess the relationship between health-related information-seeking on the internet and health literacy and access to technology, controlling for sociodemographic characteristics. RESULTS: Better health literacy (ß=.35, SE 0.12) and greater access to technological devices (eg, mobile phone and computer or tablet PC; ß=.06, SE 0.19) were both associated with more health-related information-seeking behavior on the internet after adjusting for all other sociodemographic characteristics. Possession of a graduate degree (ß=.28, SE 0.07), female gender (ß=.15, SE 0.05), poor health (ß=.22, SE 0.06), participation in social groups (ß=.13, SE 0.05), and having an annual health exam (ß=.35, SE 0.12) were all associated with online health-related information-seeking. CONCLUSIONS: Our findings indicate that access to online health-related information is not uniformly distributed throughout the population, which may exacerbate disparities in health and health care. Research, policy, and practice attention are needed to address the disparities in access to health information as well as to ensure the quality of the information and improve health literacy.

Adherence to Cervical Cancer Screening in Korean American Immigrant Women: Identifying Malleable Variables for Intervention Development.

Introduction. Despite Korean American women having a high incidence rate of cervical cancer, many are unaware of the significance of Pap test. The purpose of this research was to examine the rates of Pap test receipt and factors associated with the uptake. Method. The study was guided by Andersen's Model of Health Service Use and used a cross-sectional research design. A sample of 230 women residing in metro-Atlanta, Georgia, participated in this study. Results. Slightly more than half (55.7%) had lifetime Pap tests while less than half (45.7%) had it within the last 3 years. Binary logistic regression indicated that marital status, monthly income, and annual checkups were significantly correlated with receiving Pap tests. Discussion. Special attention is needed for women who are unmarried and have low income to increase Pap test receipt. Suggested intervention programs include better communication strategies, extended Medicare coverage, and outreach programs within Korean American community.

Health Literacy in Korean Adults and Korean American Immigrants: Implications for Achieving Health Equity.

Health literacy is necessary to understand health information and make appropriate decisions regarding one's health. This study aims to investigate (1) the health literacy level of Korean citizens and Korean American (KA) immigrants in the United States and (2) factors that influence health literacy across three age groups. A quota sampling method was used to collect cross-sectional survey data from 404 Korean participants and 404 KA immigrants. Andersen's behavioral model was used as the theoretical framework for this study. Overall, Korean participants had a higher mean score on health literacy than did the KA immigrants. Only one of predisposing and enabling factors were significant variables influencing health literacy in KA immigrants, while several predisposing, enabling and need factors were significantly associated with health literacy in Korean adults. Our findings indicate that both countries need to have a community-based health literacy educational program that is tailored to each age group.

Older adults' technology use and its association with health and depressive symptoms: Findings from the 2011 National Health and Aging Trends Study.

Background: Information and communication technology (ICT) provides older adults with access to information and resources that benefit their health. Purpose: To explore ICT use among older adults and examine the influence of information technology (IT), communication technology (CT), or ICT use on older adults' self-rated health status and depressive symptoms. Method: A sample of community-dwelling Medicare beneficiaries aged 65 and older in the United States (N = 4,976) from the 2011 National Health and Aging Trends Study. Findings: Older adults who embraced ICT and used this technology for a variety of purposes were more likely to report better health status, and were less likely to experience major depressive symptoms than nonusers. Discussion: In accordance with the Health Information Technology for Economic and Clinical Health Act, nursing professional can play an important role by responding to older adults' diverse technology preferences and effectively incorporating them into nursing practice.

Latent Growth Model of Predictors of Health Status in Korean Older Adults.

Objectives: In this study, we investigated the health status trajectory of Korean older adults with chronic diseases and its relationship with relevant ecological level factors. Methods: We analyzed data from the 2013 to 2015 Korea Health Panel Survey using the latent growth model. Results: Results showed that Korean older adults' health status decreased over time. Relevant ecological level factors affecting older adults' health status directly or indirectly included alcohol problems, caregiver burden, and healthcare cost burdens. The higher the initial health status was found to be, the higher the initial alcohol problem and initial caregiver burden. The higher the initial caregiver burden was found to be, the higher the initial alcohol problem and initial healthcare cost burden. Conclusions: To improve the health status of older adults with chronic diseases, interventions and health policies to reduce alcohol problem, caregiver burden, and healthcare cost burden should be developed and implemented.

Mechanisms of action in AWARE: A culturally informed intervention for 1.5- and 2nd-generation Asian American women.

Young Asian American women have high rates of depression and suicidality; however, few interventions address the urgent need for culturally informed care. Asian Women's Action for Resilience and Empowerment (AWARE) aims to be the first gender and culturally specific group psychotherapy intervention designed to improve mental and sexual health in Asian American women with trauma. This article specifically focuses on identifying the mechanisms of action that were responsible for improving mental health and well-being among those who participated in AWARE randomized controlled trial. Of the 435 women screened for the study, 63 Chinese, Korean, and Vietnamese women with histories of interpersonal violence were randomized into either the intervention (n = 32) or waitlist control groups (n = 31). Data from 16 posttrial focus group sessions were then thematically analyzed to explore the key themes and mechanisms of action of the AWARE intervention. Analysis revealed four cultural mechanisms that facilitated mental health improvements: psychoeducation on disempowering parenting, the reduction of mental illness-related stigma, community and relational building, and a heightened sense of empowerment. Results suggest that the AWARE intervention fosters Asian American women's well-being on an individual level and encourages social engagement through culturally salient messages. Women in the study were able to expand their social support network, engage in activism, and develop an empowered connection to their community. (PsycINFO Database Record (c) 2019 APA, all rights reserved).