Willingness of women to participate in obstetrical and pediatric research involving biobanks.

Use of biobanks for future genetic/genomic testing has increased. Biospecimens are increasingly being collected from infants/children; however, little is known about attitudes towards collection of biospecimens from postpartum women and their child. Using a hypothetical consent, this study investigated willingness to participate and attitudes, beliefs, and concerns related to consent materials requesting the biobanking genetic samples. A cross-sectional mixed methods design included women who reviewed a hypothetical consent related to biobanking genetic samples. Women were asked about their willingness to participate, followed by a focus group about biobanks and genetic/genomic testing. Post-focus group questionnaires assessed willingness to participate, the influence of study characteristics, and attitudes about genetic testing. Women (N = 37) were 29.0± 7.3 years of age (range 19-44); 51% had children and 28% were currently pregnant. A total of 46% were Hispanic (H), 38% were White non-Hispanic (WNH), and 16% were Native American (NA). Seventy-six percent (28/37) initially indicated that they would participate in the hypothetical study. Race and ethnicity impacted whether women would participate. Fewer NA women indicated that they would participate compared with H women and with WNH women (p < 0.02). Age, pregnancy status, having children, education level, insurance status, and income had no impact on participation decision and willingness to biobank specimens. NA and H women indicated that they were less likely than WNH women to agree to participate in a long-term biobank study. Given the importance of determining the genetic influence of health and disease, it is critical to attend to the questions and concerns of minority women regarding genetic studies.

A community integration approach to social determinants of health in New Mexico.

Lifestyle and Values Impacting Diabetes Awareness (LA VIDA), a community-based diabetes intervention program targeting Hispanics in southwestern New Mexico, addresses social determinants of health by utilizing promotores and collaborating with community partners and health care providers. Using a mixed-methods approach, a program evaluation documented the promotores' crucial role in providing social support, contributing to social cohesion, and accessing health care, community resources, and LA VIDA's educational and healthy lifestyle activities. Findings suggest that patients with diabetes who participated in the LA VIDA program significantly increased the number of days they checked their feet and took their diabetes medications and significantly lowered their glycated hemoglobin levels.

Overcoming cultural barriers to diabetes control: a qualitative study of southwestern New Mexico Hispanics.

This qualitative study examined the impact of cultural barriers on self-management of diabetes among Hispanic participants in LA VIDA (Lifestyle and Values Impact Diabetes Awareness), a diabetes intervention program in southwestern New Mexico. As part of the LA VIDA program evaluation, in depth interviews were conducted with 50 Hispanics who had participated in one or more activities, including diabetes education classes, grocery store tours, and support groups, and who had interacted with promotores (community health workers). LA VIDA participants reported that a sense of empowerment and increased self-efficacy enabled them to overcome cultural barriers related to the traditional Hispanic diet, lack of social support, and denial about having diabetes.

Promotores as partners in a community-based diabetes intervention program targeting Hispanics.

Promotores, community health workers, are a pivotal component of LA VIDA, a diabetes intervention program targeting Hispanics who have or are at risk for diabetes. The purpose of this qualitative study was to evaluate the role of LA VIDA promotores in reducing diabetes health disparities among Hispanics in southwestern New Mexico. Interviews with 17 promotores revealed that they effectively relate to their clients as fellow community members who understand the culture and often know clients and their families. Promotores facilitate access to healthcare and social services, enroll participants in educational and physical activities, support lifestyle changes, and conduct LA VIDA intervention and prevention activities. Through their education and advocacy for clients, promotores act as healthcare navigators for numerous health and social services while providing support for personal and family issues. Their role transcends that of educator and advocate for clients as they develop community partnerships and collaborate with community groups to implement health-related activities. In essence, promotores become community partners in their efforts to build capacity and promote healthy Hispanic communities.

Safety-net institutions buffer the impact of Medicaid managed care: a multi-method assessment in a rural state.

OBJECTIVES: This project used a long-term, multi-method approach to study the impact of Medicaid managed care. METHODS: Survey techniques measured impacts on individuals, and ethnographic methods assessed effects on safety-net providers in New Mexico. RESULTS: After the first year of Medicaid managed care, uninsured adults reported less access and use (odds ratio [OR] = 0.46; 95% confidence interval [CI] = 0.34, 0.64) and worse barriers to care (OR = 6.60; 95% CI = 3.95, 11.54) than adults in other insurance categories. Medicaid children experienced greater access and use (OR = 2.11; 95% CI = 1.21, 3.72) and greater communication and satisfaction (OR = 3.64; 95% CI = 1.13, 12.54) than children in other insurance categories; uninsured children encountered greater barriers to care (OR = 6.29; 95% CI = 1.58, 42.21). There were no consistent changes in the major outcome variables over the period of transition to Medicaid managed care. Safety-net institutions experienced marked increases in workload and financial stress, especially in rural areas. Availability of mental health services declined sharply. Providers worked to buffer the impact of Medicaid managed care for patients. CONCLUSIONS: In its first year, Medicaid managed care exerted major effects on safety-net providers but relatively few measurable effects on individuals. This reform did not address the problems of the uninsured.