Utilizing an Ecomap to Visualize the Impact of Social Determinants of Health in an Interprofessional Forum.

INTRODUCTION: Graphical representations of a case study can help learners recognize how systems and institutions impact health. The impact of the social determinants of health (SDoH) on individual and community health is well established, yet it may be challenging for students to visualize the impact of these components within a case study. PURPOSE: This study explored the use of ecomaps in an interprofessional forum and examined the perceptions from students and faculty regarding use of this educational tool. METHODS: This tool was assessed over two semesters, Fall 2021 (n=968) and Fall 2022 (n= 835) to evaluate student and faculty perceptions of the use of the tool along with faculty's assessment of student completion of the tool within a rubric. RESULTS: Nearly all students (99%) came prepared to the forum and presented their ecomaps to others during the small group discussion to facilitate conversation as they explored the role of SDoH related to the case study. Both students and faculty rated the use of this tool favorably. DISCUSSION: In conclusion, ecomaps were viewed favorably by both students and faculty. This visual exploration of SDoH helps students to visualize both positive and negative factors that impact a patient's experience.

Social Determinants of Mental Health Among Karen Refugees from Burma.

Extant literature has documented a higher level of mental health issues among refugee populations compared with that of the general population. Mental health problems may significantly decrease refugees' quality of life and interfere with a successful transition to their country of resettlement. Using the social determinants of mental health framework, we examined factors affecting psychological distress among Karen refugees from Burma residing in a mid-size city in a northeastern state in the United States. A total of 201 participants completed face-to-face interviews conducted in the Karen language. Results showed that trauma and religious participation were positively associated and education and health status were negatively associated with psychological distress. The findings of this study reiterate the importance of trauma and health conditions to mental health and suggest potential points of interventions among the resettled Karen refugees.

Challenges in health-care service use among Burmese refugees: A grounded theory approach.

The timely use of health-care services is essential to achieve the best health outcomes. We explore barriers to health-care access among refugees from Burma through interviews with key community informants who serve their community as interpreters, health-care professionals, paraprofessionals, and/or representatives. The interviews with a convenience sampling of 11 leaders from Burmese and Karen ethnic communities revealed three stages of health-care use (i.e., before, during, and after doctor's appointments), in which their community members encounter difficulties in accessing health-care services. Using grounded theory analysis approach, specific difficulties and cultural considerations for each stage were emerged. This study suggests that training programs for health-care providers on refugee populations' needs, cultural expectations, attitudes, and health behaviors may ease the process for refugees during each of these three stages. Interpreters as cultural brokers have an important role in facilitating cross-cultural communications not only before and during the appointment but also after doctor's visits, such as in the pharmacy and labs.

Strengthening effective preventive services for refugee populations: toward communities of solution.

Refugee populations have unequal access to primary care and may not receive appropriate health screening or preventive service recommendations. They encounter numerous health care disadvantages as a consequence of low-income status, race and ethnicity, lower educational achievement, varying degrees of health literacy, and limited English proficiency. Refugees may not initially embrace the concept of preventive care, as these services may have been unavailable in their countries of origin, or may not be congruent with their beliefs on health care. Effective interventions in primary care include the appropriate use of culturally and linguistically trained interpreters for health care visits and use of evidence-based guidelines. Effective approaches for the delivery of preventive health and wellness services require community engagement and collaborations between public health and primary care. In order to provide optimal preventive and longitudinal screening services for refugees, policies and practice should be guided by unimpeded access to robust primary care systems. These systems should implement evidence-based guidelines, comprehensive health coverage, and evaluation of process and preventive care outcomes.

Differential Patterns of Healthcare Service Use Among Chinese and Korean Immigrant Elders.

Previous studies of healthcare service use among Asian immigrant elders have been conducted in major metropolitan areas with established ethnic enclaves. The factors that affect levels of utilization by Asian immigrant elders who live in places where systematic support from an ethnic community is not readily available are unknown. This study employed the Andersen-Newman healthcare service utilization model to examine unique correlates of healthcare service use among Chinese and Korean immigrant elders. Between 2005 and 2007, we used a snowball sampling method to collect data from Chinese (n = 116) and Korean (n = 101) immigrant elders living in Arizona. We then performed two negative binomial regressions based on ethnic background to identify factors associated with the number of annual physician visits. The results indicated that the number of medical conditions they experienced was positively associated with an increased likelihood of healthcare service utilization for both subgroups. However, the results indicated that each ethnic group had distinctive predisposing (sex and length of US stay for Chinese; marital status for Korean), enabling (English proficiency and cultural gap; insurance status), and need factors (depressive symptoms; self-reported health status) for predicting healthcare service utilization. Asian immigrant elders in this study experienced unique barriers and facilitators based on their ethnic backgrounds. Communicating with these two different groups in their native languages and better understanding their cultural backgrounds are imperative to understanding the factors related to their healthcare service utilization. Thus, rather than viewing Asians as a homogeneous population, the differences found in heterogeneous ethnic groups, such as language and cultural variations, should be taken into account when planning and implementing approaches to intervention.

Depression among Korean immigrant elders living in Canada and the United States: a comparative study.

Korean immigrant elders in North America experience a high level of depression. This study explored the correlates of depression among a sample of 245 Korean immigrant elders living in metropolitan cities in Canada (n = 128) and a southwestern state in the United States (n = 117), using a stress-coping framework. Results revealed discrepancies between the 2 subgroups. Years since immigration and number of health concerns were positively associated, and English proficiency was negatively associated with depressive symptoms among Korean immigrant elders in the United States; only health status was significant among Korean immigrant elders in Canada. Implications of the study are presented.

Factors associated with mental health service use among Latino and Asian Americans.

Literature concur that there is a disparity between epidemiological prevalence and mental health services (MHS) utilization rates for Latino and Asian Americans. This study adapted the behavioral model of health service use to examine factors associated with MHS use among Latino and Asian Americans. The model consists of predisposing, enabling, and need factors. This study used the National Latino and Asian American Study data, including six ethnic groups. The outcome measure for this study was the use of MHS in the past 12 months. Age, sex, and education predicted higher odds of MHS use among Latinos, none of which were significant among Asians. Needs factors were strongly associated with higher odds of MHS use among Latinos and Asians.