Understanding the primary health care experiences of individuals who are homeless in non-traditional clinic settings.

BACKGROUND: Despite the widespread implementation of Health Care for the Homeless programs that focus on comprehensive, integrated delivery systems of health care for people experiencing homelessness, engaging and retaining people experiencing homelessness in primary care remains a challenge. Few studies have looked at the primary care delivery model in non-traditional health care settings to understand the facilitators and barriers to engagement in care. The objective of our study was to explore the clinic encounters of individuals experiencing homelessness receiving care at two different sites served under a single Health Care for the Homeless program. METHODS: Semi-structured interviews were conducted with people experiencing homelessness for an explorative qualitative study. We used convenience sampling to recruit participants who were engaged in primary care at one of two sites: a shelter clinic, n = 16, and a mobile clinic located in a church, n = 15. We then used an iterative, thematic approach to identify emergent themes and further mapped these onto the Capability-Opportunity-Motivation model. RESULTS: Care accessibility, quality and integration were themes that were often identified by participants as being important facilitators to care. Psychological capability and capacity became important barriers to care in instances when patients had issues with memory or difficulty with perceiving psychological safety in healthcare settings. Motivation for engaging and continuing in care often came from a team of health care providers using shared decision-making with the patient to facilitate change. CONCLUSION: To optimize health care for people experiencing homelessness, clinical interventions should: (1) utilize shared-decision making during the visit, (2) foster a sense of trust, compassion, and acceptance, (3) emphasize continuity of care, including consistent providers and staff, and (4) integrate social services into Health Care for the Homeless sites.

Visual Impairment and Self-Efficacy in Diabetes Management.

PURPOSE: The purpose of this study is to examine the relationship between visual impairment and diabetes management self-efficacy. METHODS: The present study utilized pooled cross-sectional data (2008-2018) from the Medical Expenditure Panel Survey Household Component and Diabetes Care Survey. Binary and generalized ordinal logit regression models were used to compare diabetes management self-efficacy between patients with and without visual impairments. RESULTS: Compared to their non-visually impaired counterparts, visually impaired persons had a lower odds of reporting high diabetes management self-efficacy. Similarly, visually impaired adults with diabetes have a significantly lower odds of being very confident in their ability to manage their conditions compared with adults who reported being not confident, somewhat confident, or confident. Several control factors, including self-behaviors and receipt of diabetes self-management education (DSME), were also associated with diabetes management self-efficacy. CONCLUSIONS: Visually impaired persons experience significant disparities in diabetes management self-efficacy. Given the relationship between self-efficacy and diabetes-related outcomes, it is crucial that DSME be tailored to effectively meet the individual needs of this population. Future research should explore the relationship between DSME and self-care behaviors, self-efficacy, and diabetes-related outcomes in visually impaired persons.

Self pregnancy testing in an urban family planning clinic: promising results for a new approach to contraceptive follow-up.

BACKGROUND: Immediate initiation of depo-medroxyprogesterone acetate (DMPA) increases continuation and decreases pregnancies compared to conventional (next menstrual period) initiation. A drawback is the need to return in 4 weeks for a repeat pregnancy test to identify any pregnancy that was too early to diagnose on the day of injection. If women can perform home pregnancy tests (HPTs) to detect human chorionic gonadotropin (hCG) in urine, the need for this follow-up visit may be eliminated. This study assesses whether women can perform their own HPT. STUDY DESIGN: This is a single-visit observational trial of an HPT kit. Subjects recruited from a waiting room in an urban family planning clinic received an HPT kit with standard instructions to use immediately. Subjects and a research assistant each interpreted the test. Their results were then compared to a standard cassette type test for detection of hCG performed by clinic staff. kappa was calculated to assess the level of agreement. RESULTS: Three hundred ten subjects enrolled. They were young (mean age, 25.2 years), mostly Hispanic (91%) women. A change in the font and explicitness of the instructions decreased the incidence of invalid tests from 12.7% to 4.8%. The subject and research assistant's interpretation of the test had a high level of agreement, kappa=0.95 [95% confidence interval (CI), 0.92-0.99]. There was also a high level of agreement between the subjects' results and the standard test, kappa=0.88 (95% CI, 0.82-0.95). CONCLUSIONS: Women presenting for pregnancy testing at an urban clinic are able to perform HPTs with a high level of accuracy. The appearance of the instructions influenced the incidence of false-negative and invalid tests. Home pregnancy tests may be useful in follow-up protocols when immediate initiation of DMPA is employed.