Exploring Primary Care Non-Attendance: A Study of Low-Income Patients.

INTRODUCTION: While evidence has been established on the impact of medical appointment non-attendance on the healthcare system and patient health, previous research has not focused on how poverty and rurality may influence patient experiences with non-attendance. This paper explores patient perceptions of non-attendance among those experiencing poverty in a rural U.S county to better inform providers to the context in which their patients make attendance-related decisions. METHODS: Using a grounded theory approach, we conducted semi-structured interviews with 32 U.S. low-income adults in the rural Western U.S. who recurrently missed primary care appointments. We also used a questionnaire to assess individual characteristics related to health, resiliency, personal mastery, medical mistrust, life chaos, and adverse childhood experiences. RESULTS: Participants identified 3 barriers to attending appointments: appointment disinterest, competing demands, and insufficient systems. Appointment disinterest stemmed from physical and mental health issues, misalignment between needs and treatment, and comfort with the provider. Competing demands included family responsibilities, employment, and relationships. Finally, participants reported that current scheduling and transportation systems were helpful but insufficient. To provide further context, participants also reported low overall health, moderate levels of medical mistrust, life chaos, and mastery, moderate to low resilience, and very a high number of adverse childhood experiences. CONCLUSIONS: Results point to the need for modified structures that allow low-income patients more control over their personal health and highlight opportunities for clinics to address patients' lack of interest and fear in the medical encounter.

Promoting school lunch fruit and vegetable intake through role modeling: a pilot study.

OBJECTIVES: Child fruit and vegetable consumption is a critical component of adult chronic disease prevention, yet fruit and vegetable intake remains low among elementary school children in the United States. This pilot study tested a role modeling intervention designed to promote fruit and vegetable consumption in a U.S elementary school cafeteria setting. METHODS: This one-year, repeated cross-sectional study used digital photographs to assess fruit and vegetable waste at baseline (n = 566 trays) and follow-up (n = 231 trays) of kindergarten through fifth grade students in one elementary school. Differences in waste were assessed through Mann-Whitney statistical tests. Feedback on intervention acceptability was provided by the intervention team during implementation. RESULTS: The proportion of students consuming all of their selected fruits and vegetables increased by 11.1% and 8.7% respectively (p < 0.01). There was a significant decrease in the proportion of students not consuming any of their selected fruit (16.0%, p < 0.001). Staff and students provided positive reports of intervention acceptance. CONCLUSIONS AND IMPLICATIONS: Findings from this pilot study indicate that role modeling in a school cafeteria setting may be a promising health promotion strategy and provide groundwork for future research in the development of school cafeteria role modeling interventions. Further research is needed to assess intervention efficacy and acceptability at a larger scale.