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.

Community Perspectives and Environmental Justice Issues in an Unincorporated Black Township.

Through each era, the southeastern United States was and continues to be an epicenter for industrial companies to establish factories and plants. Though this development attracts economic gain for the companies and surrounding areas, low-income and predominantly Black communities bear the brunt of the environmental consequences while frequently remaining stagnant economically. This qualitative, community-based participatory research study grew out of a larger study designed to recruit lay community advisors from communities labeled as hard to reach in research. We focus on Holt, Alabama, an unincorporated community in the southeastern United States region. The primary goal of this research inquiry is to thematically analyze community interviews stemming from a topic of research, practice, and policy interest to community members: the effects of industrial pollution on Holt citizens' daily lives. Content analysis of focus-group transcripts revealed four emergent themes, including: (1) how the pollution affects their water, soil, and air quality; (2) illness related to pollution; (3) community engagement and empowerment; and (4) suggestions regarding what government officials could do to address this area of need. Building upon the prior research regarding environmental justice, human flourishing, and the definition of nurturing environments, suggestions are made regarding the creation, implementation, and maintenance of project advisory councils focused on issues of environmental justice. Community advocacy and empowerment as well as community and scientific partnerships are imperative to alleviate problems associated with environmental justice.

Evaluating the Use of High-Reliability Principles to Increase Error Event Reporting: A Retrospective Review.

OBJECTIVE: Assess the relationship between educating caregivers about high-reliability principles and reporting of potential adverse safety events. BACKGROUND: Persuading caregivers to report potential safety events is challenging. Learning high-reliability principles may help caregivers identify and report potential safety problems. METHODS: Event reports submitted by caregivers 6 months before and after high-reliability training were examined for event types, event significance, and shift when events occurred. χ Tests assessed relationships between variables. RESULTS: The number and type of caregiver event reports before and after training were not significantly different; however, clinical process error reports significantly decreased (χ = 9.251, P = .003). There was a significant difference in reports submitted by day and night shifts (χ = 5.942, P = .02). CONCLUSIONS: Trends suggest staff report actual, rather than potential, events regardless of training. Further research is needed to determine what motivates caregivers to report safety concerns.

Preparation and Planning for Future Care in the Deep South: Adapting a Validated Tool for Cultural Sensitivity.

BACKGROUND AND OBJECTIVES: This study describes the adaptation and validation of Sörensen et al. (2017)'s preparation for future care (PFC) scale with diverse samples including rural dwelling African Americans and certified nursing assistants (CNAs), and subsequent psychometric development. RESEARCH DESIGN AND METHODS: Responses to the five-subscale PFC survey from 33 rural African American men across 12 months and cognitive interviews with a subset of 12 of these men are described. Psychometric refinement included descriptive qualitative analyses of consultations with experienced lay research advisors (N = 4 and N = 7) regarding potential changes to the PFC and a confirmatory factor analysis of the resultant scale (N = 138). RESULTS: Cognitive interviews with rural African American men revealed difficulty understanding Eurocentric questions. Emergent themes included emotional avoidance of planning, considerations of nursing homes and possible care providers, and coping strategies. In two consultation meetings, trained lay research advisors recommended language modifications to the original questions and response options. Factor analyzing the resultant scale revealed support for the original subscale constructs (acceptable fit: χ2 = 205.03, df = 124, p < .001; root mean square error of approximation = .069 [.052-.085]; comparative fit index = .93; Tucker-Lewis index = .91). DISCUSSION AND IMPLICATIONS: PFC and engagement in advance care planning is uncommon among African Americans, possibly due to distrust of and lack of cultural competency among health care professionals. The resulting tool and response options may be used as an interview guide/survey with African Americans to gain understanding about their preparation for future health care needs.

Nurse Practitioner Perceptions of a Diabetes Risk Assessment Tool in the Retail Clinic Setting.

IN BRIEF This article describes a study to gain insight into the utility and perceived feasibility of the American Diabetes Association's Diabetes Risk Test (DRT) implemented by nurse practitioners (NPs) in the retail clinic setting. The DRT is intended for those without a known risk for diabetes. Researchers invited 1,097 NPs working in the retail clinics of a nationwide company to participate voluntarily in an online questionnaire. Of the 248 NPs who sent in complete responses, 114 (46%) indicated that they used the DRT in the clinic. Overall mean responses from these NPs indicated that they perceive the DRT as a feasible tool in the retail clinic setting. Use of the DRT or similar risk assessment tools in the retail clinic setting can aid in the identification of people at risk for type 2 diabetes.

PROMOTING CANCER SCREENING AMONG RURAL AFRICAN AMERICANS: A SOCIAL NETWORK APPROACH.

Obstacles that prevent rural African Americans (AAs) from regularly engaging in cancer screening were explored, and a theoretical approach was formulated utilizing social networks as a culturally sensitive form of health promotion. Disparities in cancer morbidity and mortality continue to exist between AAs and Caucasians in the United States. Often rural dwellers are further disadvantaged because of a potential lack of medical and financial resources and low health literacy. Social networks provide an existing framework where health concerns are discussed and health interventions in cancer screening can strengthen or encourage relevant health behaviors in rural AAs and other disadvantaged populations.

A Clinical Protocol for the Assessment of Obesity: Addressing an Epidemic.

The purpose of this article is to discuss the importance of addressing obesity, a national epidemic. Furthermore, the paper focuses on the utilization of a clinical practice protocol for identifying patients who are obese or at risk for obesity in the primary care setting. The practice protocol includes guidelines for assessment, documentation, and a consistent educational intervention for the identified priority population. The rapidly increasing incidence of obesity in our primary care practices supports the need for evidence-based approaches to ensure consistent assessment and documentation, thereby increasing the potential for weight management and obesity reduction.

Gender differences in colon cancer treatment.

UNLABELLED: Abstract Background: Despite women suffering a disproportionate burden of colon cancer mortality, few studies have examined gender differences in evidence-based treatment, especially in poorer states like Alabama. OBJECTIVE: To describe colon cancer treatment in older patients diagnosed in Alabama by gender. METHODS: Colon cancer patients 65 years and older diagnosed in 2000-2002 were identified from the Alabama Statewide Cancer Registry (N=1785). Treatment was identified from Medicare claims for 1999-2003. Outcomes were (1) receipt of surgery and adjuvant 5-fluorouracil chemotherapy (5FU) and (2) 5FU treatment duration (0-4, 5-7, and >7 months). Generalized Estimating Equation (GEE) models were used to determine significant gender differences, adjusting for clustering at the reporting hospital level, and controlling for race, age, stage, comorbid conditions, census tract-level socioeconomic variables, and adverse chemotherapy effects (when analyzing 5FU duration). RESULTS: Overall, 93.9% of the patients received surgery. Of stage II-III patients undergoing surgery, 60.4% stage III and 25.6% stage II patients received 5FU. Compared with men, women were more likely to have surgery (95.5% vs. 92.2%, p=0.003), less likely to have 5FU (38.6% vs. 45.2%, p=0.02), and more likely to have 0-4 months of 5FU (32.9% vs. 24.9%, p=0.05). Gender differences were significant for having chemotherapy (adjusted odds ratio [aOR] 0.78, confidence interval [CI] 0.61-1.00, p=0.049), but not for having 0-4 months of 5FU when adjusting for adverse effects (aOR 1.36, CI 0.95-1.94, p=0.09). CONCLUSIONS: In Alabama, some gender differences in stage-specific colon cancer treatment are worth further scrutiny.

Disparities in colorectal cancer screening behaviors: implications for African American men.

Guidelines published by the American College of Gastroenterologists suggest that African Americans (AA) begin preventive screening at the age of 45 years due to increased risk of colorectal cancer. This study examines characteristics associated with having fecal occult blood tests (FOBT), sigmoidoscopy, and colonoscopy among adults aged 45-75 years. Using cross-sectional data from the 2007 Health Information National Trends Survey, the sample included 3,725 participants (mean age = 59.01 ± 8.41), with 59.8% female, 88.8% Caucasian, and 11.2% AA. Binary logistic regression with interactions between race, gender, and age entered in block 2 revealed that odds of having FOBT, colonoscopy, or sigmoidoscopy were increased among older individuals with higher education. Fecal occult blood test was higher among women and those with insurance. Colonoscopy was higher among those with insurance and higher income. Having a sigmoidoscopy was more likely among those with higher income but was lower among AA men. Understanding the characteristics of individuals who participate in colorectal cancer screenings may contribute to the development of interventions geared toward those who do not, particularly AA men who are at greatest risk for colorectal morbidity and mortality.

Treatment for older prostate cancer patients: disparities in a southern state.

BACKGROUND: Black prostate cancer patients are less likely to receive aggressive therapy (AT) than Whites: reported rates for patients ≥ 65 years old are about 55% versus 65%. Little is known about treatment rates in socioeconomically deprived states with large Black populations like Alabama. STUDY DESIGN: Medicare claims and Alabama Statewide Cancer Registry records were linked for Alabamian men in Medicare fee-for-service diagnosed with loco-regional prostate cancer in 2000-2002. The association between race and likelihood of: (1) AT (prostatectomy or external beam radiation therapy [EBRT] or brachytherapy); (2) hormone therapy (primary androgen deprivation therapy [ADT] or orchiectomy); (3) <30 days of EBRT; and (4) <6 months of ADT, was investigated adjusting for age, clinical tumor stage, grade, Comorbidity Index, and census tract proportion of Black residents, of persons living below poverty and with ≤ high school. RESULTS: Of 3561 patients, 71.2% received AT and 38.3% hormone therapy. Blacks were less likely to receive AT (64.3% vs. 73.0%, adjusted [adj.] OR: 0.80, CI: 0.67-0.96). There was no difference between Blacks and Whites in the likelihood of receiving hormone therapy (40.8% vs. 37.7%, adj. OR: 1.10, CI: 0.91-1.34), <30 days of EBRT (30.5% vs. 31.5%, adj. OR: 0.98, CI: 0.72-1.32) or <6 months of ADT (50.7% vs. 54.0%, adj. OR: 0.84, CI: 0.63-1.12). CONCLUSIONS: In Alabama, there were racial differences in utilization of aggressive treatment for locoregional prostate cancer. Research should investigate factors associated with prostate cancer treatment among older men, such as patient behavior and access to care.

Attitudes and beliefs about prostate cancer and screening among rural African American men.

PURPOSE: The research study purpose was to describe the personal attitudes and beliefs of rural African American men related to prostate cancer and screening. PROCEDURE: Audio taped interviews were conducted with nine (9) African American men living in rural communities of West Central Alabama. FINDINGS: Six common themes were found among the rural African American men participants. The themes identified were: (1) Disparity; (2) Lack of understanding; (3) Tradition; (4) Mistrust in the system; (5) Fear; and (6) Threat to manhood. CONCLUSIONS: The results support the general significance of understanding the views of the target population and specifically its culture and offer opportunities for adapting health promotion to the population.