Systematic Review of Community Paramedicine and EMS Mobile Integrated Health Care Interventions in the United States.

Emergency medical services (EMS) in the United States are frequently used for nonurgent medical needs. Use of 911 and the emergency department (ED) for primary care-treatable conditions is expensive, inefficient, and undesirable for patients and providers. The objective is to describe the outcomes from community paramedicine (CP) and mobile integrated health care (MIH) interventions related to the Quadruple Aim. Three electronic databases were searched for peer-review literature on CP-MIH interventions in the United States. Eight articles reporting data from 7 interventions were included. Four studies reported high levels of patient satisfaction, and only 3 measured health outcomes. No study reported provider satisfaction measures. Reducing ED and inpatient utilization were the most common study outcomes, and programs generally were successful at reducing utilization. With reduced utilization, costs should be reduced; however, most studies did not quantify savings. Future studies should conduct economic analyses that not only compare the intervention to traditional EMS services, but also measure potential cost savings to the EMS agencies running the intervention. Most cost savings from reduced utilization will be to insurance companies and patients, but more efficient use of EMS agencies' resources could lead to cost savings that could offset intervention implementation costs. The other 3 aims (health, patient satisfaction, and provider satisfaction) were reported inconsistently in these studies and need to be addressed further. Given the small number of heterogeneous studies reviewed, the potential for CP-MIH interventions to comprehensively address the Quadruple Aim is still unclear, and more research on these programs is needed.

Does religiousness and spirituality moderate the relations between physical and mental health among aging prisoners?

OBJECTIVE: We examined positive and negative religious coping as moderators of the relation between physical limitations, depression, and desire for hastened death among male inmates incarcerated primarily for murder. METHODS: Inmates over the age of 45 years who passed a cognitive screening completed face-to-face interviews (N = 94; mean age = 57.7 years; SD = 10.68). Multiple regression analyses included age, race/ethnicity, parole belief, physical health, positive or negative religious coping, and all two-way interactions represented by the product of health and a religious coping variable. RESULTS: Older inmates and those who reported greater levels of positive religious coping endorsed fewer symptoms of depression, whereas those who reported greater levels of negative religious coping endorsed more symptoms of depression. Inmates who reported higher levels of depression endorsed a greater desire for hastened death. The effect of physical functioning on desire for hastened death is moderated by negative religious coping such that those who endorsed higher levels of negative religious coping reported a greater desire for hastened death. CONCLUSIONS: Examinations of religious/spiritual practices and mindfulness-based interventions in prison research have assumed a positive stance with regard to the potential impact of religious/spiritual coping on physical and mental health. The current findings provide cautionary information that may further assist in selection of inmates for participation in such interventions.

Spiritually based intervention to increase colorectal cancer screening among African Americans: screening and theory-based outcomes from a randomized trial.

Colorectal cancer screening has clear benefits in terms of mortality reduction; however, it is still underutilized and especially among medically underserved populations, including African Americans, who also suffer a disproportionate colorectal cancer burden. This study consisted of a theory-driven (health belief model) spiritually based intervention aimed at increasing screening among African Americans through a community health advisor-led educational series in 16 churches. Using a randomized design, churches were assigned to receive either the spiritually based intervention or a nonspiritual comparison, which was the same in every way except that it did not contain spiritual/religious content and themes. Trained and certified peer community health advisors in each church led a series of two group educational sessions on colorectal cancer and screening. Study enrollees completed a baseline, 1-month, and 12-month follow-up survey at their churches. The interventions had significant pre-post impact on awareness of all four screening modalities, and self-report receipt of fecal occult blood test, flexible sigmoidoscopy, and colonoscopy. There were no significant study group differences in study outcomes, with the exception of fecal occult blood test utilization, whereas those in the nonspiritual intervention reported significantly greater pre-post change. Both of these community-engaged, theory-driven, culturally relevant approaches to increasing colorectal cancer awareness and screening appeared to have an impact on study outcomes. Although adding spiritual/religious themes to the intervention was appealing to the audience, it may not result in increased intervention efficacy.

Spiritually based intervention to increase colorectal cancer awareness among african americans: intermediate outcomes from a randomized trial.

Colorectal cancer screening, while effective for reducing mortality, remains underutilized particularly among underserved populations such as African Americans. The present study evaluated a spiritually based approach to increasing Health Belief Model-based pre-screening outcomes in a Community Health Advisor-led intervention conducted in African American churches. Sixteen urban churches were randomized to receive either the spiritually based intervention or a nonspiritual comparison of the same structure and core colorectal cancer content. Trained Community Health Advisors led a series of two educational sessions on colorectal cancer early detection. The educational sessions were delivered over a 1-month period. Participants (N = 316) completed a baseline survey at enrollment and a follow-up survey one month after the first session. Both interventions resulted in significant pre/post increases in knowledge, perceived benefits of screening, and decreases in perceived barriers to screening. Among women, the spiritually based intervention resulted in significantly greater increases in perceived benefits of screening relative to the nonspiritual comparison. This finding was marginal in the sample as a whole. In addition, perceived benefits to screening were associated with behavioral intention for screening. It is concluded that in this population, the spiritually based was generally as effective as the nonspiritual (secular) communication.

Spiritual health locus of control and health behaviors in African Americans.

OBJECTIVE: To examine relationships between spiritual health locus of control beliefs and various health behaviors. METHODS: A cross-sectional survey of a national sample of African Americans assessed spiritual beliefs, fruit and vegetable consumption, physical activity, and alcohol consumption. RESULTS: Active spiritual beliefs were positively associated with fruit consumption and negatively associated with alcohol consumption. Passive spiritual beliefs were associated with lower vegetable and increased alcohol consumption. Among male participants, passive spiritual beliefs were associated with higher alcohol consumption. CONCLUSIONS: Findings suggest that dimensions of spiritual health locus of control beliefs have complex and varying relationships with health behaviors.

Development of a spiritually based educational program to increase colorectal cancer screening among African American men and women.

This study describes the development of a spiritually based intervention to increase colorectal cancer screening through African American churches by framing the health message with spiritual themes and scripture. The intervention development phase consisted of ideas from an advisory panel and core content identified in focus groups. In the pilot-testing phase, prototypes of the intervention materials were tested for graphic appeal in additional focus groups, and content was tested for acceptability and comprehension in cognitive interviews. Participants preferred materials showing a variety of African Americans in real settings, bright color schemes, and an uplifting message emphasizing prevention and early detection. Spiritual themes such as stewardship over the body, being well to serve God, and using faith to overcome fear, were well received. The materials were then finalized for implementation and will be used by community health advisors to encourage screening.

The stage-specific role of spirituality among African American Christian women throughout the breast cancer experience.

This study presents the results of semistructured interviews conducted with 18 African American Christian women regarding the role of spirituality throughout their breast cancer experiences. The spiritual themes relevant for phases of the breast cancer experience are identified. Analysis resulted in the identification of 11 codes and 5 subcodes that corresponded to the diagnosis, treatment, and posttreatment phases of the breast cancer experience. Most of the survivors indicated that their spirituality and faith assisted them throughout the breast cancer experience. Discussion focuses on the spiritual resources used by the participants at the different stages in the breast cancer experience. Attention is given to implications for how professionals can use these resources to assist African American women coping with breast cancer.

Improving knowledge and attitudes toward older adults through innovative educational strategies.

Our country's rapidly growing older adult population represents the core business of health care; however, few nurses are adequately prepared to care for their unique needs. This is caused, in part, by the limited attention paid by nursing educators to incorporating basic gerontological nursing principles into undergraduate programs. During the last 7 years, the American Association of Colleges of Nursing, through the generous support of the John A. Hartford Foundation, has led several initiatives to improve gerontological nursing education in baccalaureate programs. This article describes innovative educational strategies successfully implemented by three nursing programs--New York University, Tuskegee University, and University of Rhode Island--to increase knowledge and improve attitudes of nursing students in caring for older adults. Successful strategies include a long-term care guide, a senior mentor experience, student assignments addressing diversity issues, student debates, critical reflective journalizing, and an evaluation tool for measuring student attitudes. These strategies are readily reproducible and assist faculty to easily integrate gerontological nursing content into the curriculum while simultaneously enhancing student attitudes and knowledge.

Widowhood and spirituality: coping responses to bereavement.

Nearly half of women age 65 or older are widows and nearly 70% of these women live alone. Because older women are three times more likely than their male counterparts to be widowed, widowhood has been labeled a primarily female phenomenon. This review article has two aims: (a) to discuss the impact of widowhood on the lives of older women and (b) to discuss how religion and spirituality may be used as coping methods for conjugal loss. After reviewing the literature the authors conclude that older women use religious coping as well as religious and spiritual beliefs and behaviors to facilitate positive adjustment to the loss of a spouse.

Rowe and Kahn's model of successful aging revisited: positive spirituality--the forgotten factor.

PURPOSE: We explain a new concept, positive spirituality, and offer evidence that links positive spirituality with health; describe effective partnerships between health professionals and religious communities; and summarize the information as a basis for strengthening the existing successful aging model proposed by Rowe and Kahn. DESIGN AND METHODS: A missing component to Rowe and Kahn's three-factor model of successful aging is identified, and we propose strengthening the model with a fourth factor, positive spirituality. RESULTS: We developed an enhanced model of successful aging based on Rowe and Kahn's theoretical framework. Evidence presented suggests that the addition of spirituality to interventions focused on health promotion has been received positively by older adults. IMPLICATIONS: Leaders in gerontology often fail to incorporate the growing body of scientific evidence regarding health, aging, and spirituality into their conceptual models to promote successful aging. The proposed enhancement of Rowe and Kahn's model will help health professionals, religious organizations, and governmental agencies work collaboratively to promote wellness among older adults.

Should clinicians incorporate positive spirituality into their practices? What does the evidence say?

Most of the rhetoric decrying the incorporation of basic and positive spiritual care into clinical practice is not based on reliable evidence. We briefly review the current evidence, which demonstrates that (a) there is frequently a positive association between positive spirituality and mental and physical health and well being, (b) most patients desire to be offered basic spiritual care by their clinicians, (c) most patients censure our professions for ignoring their spiritual needs, (d) most clinicians believe that spiritual interventions would help their patients but have little training in providing basic spiritual assessment or care, (e) professional associations and educational institutions are beginning to provide learners and clinicians information on how to incorporate spirituality and practice, and (j) anecdotal evidence indicates that clinicians having received such training find it immediately helpful and do apply it to their practice. We point out the reasons that much more research is needed, especially outcome-based, clinical research on the effects of these spiritual interventions by clinicians. We conclude that the evidence to date demonstrates trained or experienced clinicians should encourage positive spirituality with their patients and that there is no evidence that such therapy is, in general, harmful. Further, unless or until there is evidence of harm from a clinician's provision of either basic spiritual care or a spiritually sensitive practice, interested clinicians and systems should learn to assess their patients' spiritual health and to provide indicated and desired spiritual intervention. Clinicians and health care systems should not, without compelling data to the contrary, deprive their patients of the spiritual support and comfort on which their hope, health, and well-being may hinge.