Cultivating a cycle of trust with diverse communities in practice-based research: a report from PRIME Net.

PURPOSE: Practice-based research networks (PBRNs) are increasingly seen as important vehicles to translate research into practice, although less is known about the process of engaging diverse communities in PBRN research. The objective of this study was to identify strategies for successfully recruiting and retaining diverse racial/ethnic communities into PBRN research studies. METHODS: This collaborative, multisite study engaged 5 of the 8 networks of the PRImary care MultiEthnic Network (PRIME Net) consortium that conducts research with traditionally underrepresented/underserved populations. We used a sequential, qualitative research design. We first conducted 1 key informant interview with each of 24 researchers experienced in recruiting research participants from 5 racial/ethnic communities (African American, Arab/Chaldean, Chinese, Hispanic, and Native American). Subsequently, we conducted 18 focus groups with 172 persons from these communities. RESULTS: Participants' comments indicated that successful recruitment and retention of underrepresented populations in PBRN studies is linked to the overall research process. This process, which we termed the cycle of trust, entailed developing and sustaining relationships of trust during 4 interrelated stages: before the study, during study recruitment, throughout study conduct, and after study completion. Participants identified a set of flexible strategies within each stage and called for close engagement with clinic and community partners. CONCLUSIONS: Our participants suggest that approaches to research that lay a foundation of trust, demonstrate respect for community members, and extend beyond the enrollment and data collection phases are essential to enhance the participation of diverse populations in PBRN research. These findings offer the PBRN community a guide toward achieving this important goal.

Correlates of mothers' perception of their communities' social capital: a community-based study.

Psychosocial issues have been recognized as important factors in children's health for decades. This study documents the relation among several important psychosocial variables (e.g., mothers' depressive symptoms) and a new instrument that assesses parents' perception of their communities' social capital. Mothers were recruited from their children's primary care (PC) pediatricians' offices within the Southwestern Ohio Ambulatory Research Network or from a children's hospital developmental clinic (DC). Mothers completed a questionnaire that included the Social Capital Scale (SCS), Children with Special Health Care Needs Screener (CSHCNS), Pediatric Quality of Life Inventory, Maternal Social Support Index and the Center for Epidemiologic Studies Depression Scale (CES-D). Mothers were sorted into three subgroups based on site of recruitment (PC or DC) and results of the CSHCNS. The sample (N = 620) was also sorted into terciles based on SCS scores. Mean SCS was about 73 for each of the three subgroups. Compared to mothers in the highest SCS tercile, mothers in the lowest SCS tercile reported lower education, lower income and higher CES-D median scores. The SCS subscale "sense of belonging" had an inverse correlation with CES-D scores (r = -.248, p < 0.001). Mothers from primary care and sub-specialty clinics had similar perceptions about their communities' social capital. Compared to mothers in the highest one third of SCS scores, mothers in the lowest one third were more likely to report less education and income as well as more depressive symptoms. A decreased sense of belonging in their communities was also correlated with more depressive symptoms. The SCS is a new useful tool for investigators and clinicians who work with children and their families.

Parents' perspectives on their children's health insurance: plight of the underinsured.

OBJECTIVES: To determine the prevalence and correlates of children's underinsurance within a primary care, practice-based research network. STUDY DESIGN: A survey of 13 practices within the Southwestern Ohio Ambulatory Research Network using the Medical Expenses for Children Survey in 2009 and 2010 yielded a sample of 2972 parents of children >6 months old with health insurance in the previous 12 months. Data were analyzed using bivariate and loglinear model analyses. RESULTS: Of the study children, 17.2% were classified as underinsured because of their inability to pay for ≥ 1 of their pediatrician's recommendations for care in the past 12 months. In addition, 15.5% reported it was harder to get medical care for their child in the past 3 years, and 6.5% indicated that their child's health had suffered. Multivariate analysis reveals complex relationships among the 3 factors related to ability to obtain care and between these factors and sociodemographic and health status factors. Across education and income categories, the underinsured rate ranged from 57% to 93% for parents who reported their child's health had suffered. CONCLUSIONS: One in 6 parents reported that their child was underinsured. A similar percentage reported that it had become more difficult to get needed medical care over the past 3 years. The relationship between the perception that an underinsured child's health has suffered is much stronger for the highest socioeconomic category in this sample than for the other categories; 93% of these families were underinsured in 2009. It is possible that high deductible features of insurance plans contribute to these circumstances.

Mothers with positive or negative depression screens evaluate a maternal resource guide.

INTRODUCTION: Social isolation is common in mothers with high depressive symptoms. This study tested the hypothesis that a maternal resource guide that provided mothers with links to community human service agencies would be deemed more helpful by mothers with positive depression screens (PDS) compared with mothers with negative depression screens (NDS). METHOD: This investigation was a cross-sectional survey study of a convenience sample from a primary care practice-based research network, the Southwestern Ohio Ambulatory Research Network (SOAR-Net). English-speaking mothers who took their child(ren) to SOAR-Net practices were eligible to participate in the study. Data were collected between May 2006 and March 2009. A total of 1048 mothers completed the survey, and 234 mothers refused to participate. RESULTS: Mothers were more likely to report that "This guide is helpful to me" if they were single (odds ratio [OR] = 4.05; 95% confidence interval [CI]: 2.77-5.94), their child had public health insurance (OR = 3.59; 95% CI: 2.39-5.40), or they had PDS (OR = 3.57; 95% CI: 2.13-5.98). After adjusting for a number of demographic variables, PDS continued to be significantly associated with "This guide is helpful to me" (adjusted OR = 2.68; 95% CI: 1.58-4.56). DISCUSSION: Mothers with PDS were more likely to report that the maternal resource guide would be personally helpful compared with mothers with NDS.

Bexar County's dental safety net for children: an estimate of our capacity and need.

BACKGROUND: It has been well established that poor uninsured children lack access to dental care and have greater dental needs than their insured counterparts. OBJECTIVE: To assess the capacity of the Bexar County dental safety net to treat children. To assess the dental needs of Bexar County children ages 0-18 who are uninsured or are Medicaid or Texas Children's Health Insurance Program (CHIP) recipients. METHODS: Dental clinics that treat children ages 0-18 and act as the safety net were identified in order to assess their capacity to treat children. Clinic directors were contacted to request data on the number of child patient encounters per clinic for 2005. Data from the census, NHANES and other sources were used to establish an estimate of the dental needs of the uninsured and Medicaid/CHIP children. The dental needs of this population were calculated as maximum possible number of patient encounters per year. RESULTS: The capacity of the current safety net to treat children is 33,537 patient encounters per year. The dental needs of the community are 227,124 patient encounters per year. CONCLUSION: The results of the study suggest that the Bexar County is not prepared to treat the dental needs of the underserved children in San Antonio.

Neighborhood economic conditions, social processes, and self-rated health in low-income neighborhoods in Texas: a multilevel latent variables model.

This paper develops and tests a comprehensive model to explain the relationships of neighborhood economic indicators to multiple dimensions of neighborhood social and physical organization as well as the pathways through which neighborhood social and physical characteristics influence individual health outcomes. We hypothesized that neighborhood poverty would be associated with lower collective efficacy, lower social capital, higher degrees of social and physical disorder, worse social processes pertaining to children such as trust, and higher degrees of fear of crime and racism. Neighborhood social and physical characteristics were hypothesized to mediate the effect of neighborhood poverty on self-rated health, both directly and indirectly through their influence on neighborhood differences in social support and health behaviors, which in turn affect individual health. The results, based on data from low-income neighborhoods in Texas, USA generally supported the model and indicated that the effect of neighborhood impoverishment on health is mediated by social and physical neighborhood characteristics.

Contributions of social context to inequalities in years of life lost to heart disease in Texas, USA.

Several recent articles have pointed to the effect of social context on heart disease mortality after adjusting for individual level indicators. This study investigates the contributions of individual socioeconomic factors (sex, race, and education) and social context at the neighborhood level (wealth, education, social capital, and racial/ethnic composition), and the county level (social inequality, human and social capital, economic and demographic characteristics) on premature cardiovascular mortality. Death certificate information was obtained for all those who died of heart disease in Texas, USA, in 1991. Deaths were geocoded to obtain block-group, census tract, and county social context from the census. Multilevel hierarchical models quantified the contributions of individual characteristics and block-group, tract, and county social context on years of potential life lost to heart disease. Cross-level analyses investigated the interaction between individual and contextual factors. Being female, having more education, and residing in areas with higher median house value were associated with less premature mortality. Although blacks and Hispanics lost more years of life to heart disease than whites, blacks and Hispanics living in tracts with higher own racial/ethnic group density lost fewer years of life than their peers living in less homogenous tracts. At the county level, premature mortality was negatively associated with social capital. The tract and county level variances were statistically significant indicating the importance of social context to premature heart disease mortality. Plausible mechanisms through which these effects operate are explored. Social context at the block-group, tract, and county level played an important role, though a smaller role than individual factors, in explaining years of life lost to heart disease.