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1.
Sleep Health ; 6(2): 205-213, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31983611

RESUMEN

BACKGROUND: Despite the high prevalence of inadequate sleep in racially/ethnically diverse, low-income adults, there is scant research targeting sleep health interventions among underserved populations. Sleep hygiene (SH) recommendations may help promote sleep health for the general population; however, they likely require tailoring to optimize uptake and effectiveness in the "real world" given socio-contextual factors. As an initial step to developing contextually appropriate and effective community-based SH interventions, we conducted qualitative research to understand SH behaviors, beliefs, and barriers in a low-income, ethnically diverse sample of adults. METHODS: We recruited 24 racially/ethnically diverse adults from an affordable housing community who self-reported sleeping ≤6 hours on average. Participants were invited to either an individual interview (n = 5) or a focus group (n = 3). A deductive, thematic-analysis approach was employed. Data collection and interpretation were informed by the Socio-Contextual Model of Behavior Change. RESULTS: There was evidence of high acceptability of SH and interest in improving sleep health. Barriers to implementing SH were multifaceted, including individual (knowledge, motivation, habits, medical issues, stress, trauma), interpersonal (caregiving), organizational (job strain), and environmental (noise) factors. CONCLUSIONS: Future strategies for adapting behavioral SH interventions should target knowledge, skill development, and behavioral change domains, such as motivation, social support, and self-efficacy. In addition, adapting SH beyond the clinical context for a high-need community population requires attention to multilevel sociocontextual factors that contribute to sleep health, particularly chronic stress, prior trauma, and adverse sleeping environments. Development of novel trauma-informed SH interventions may promote effective and safe implementation.


Asunto(s)
Etnicidad/psicología , Pobreza/etnología , Grupos Raciales/psicología , Higiene del Sueño , Adulto , Anciano , Anciano de 80 o más Años , Servicios de Salud Comunitaria , Etnicidad/estadística & datos numéricos , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Grupos Raciales/estadística & datos numéricos , Adulto Joven
2.
Sleep Med ; 60: 81-88, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-30606643

RESUMEN

OBJECTIVE: Deficient sleep is highly prevalent in disadvantaged adolescents and contributes to a range of adverse health and behavioral outcomes. We examined mediating mechanisms and strategies that adolescents adopt to improve sleep, and possible levers for promoting sleep in this population. METHODS: We conducted three focus groups (N = 27 total, age 14-18 years) in adolescents living in low- and middle-income racially/ethnically diverse neighborhoods of Boston, Massachusetts. Participants completed a survey on their sleep and health habits prior to the moderator-led discussions. Discussions were audio-recorded, transcribed, and thematically analyzed. RESULTS: The study population did not meet the minimum sleep recommendations, and we found a high prevalence of "social jet-lag." We also identified a disconnect between the acknowledgment of the importance of sleep and actual behavior, especially for electronic use. Phone use and screen time were the most commonly cited barriers to a good night's sleep, along with caffeine consumption, which was also high in this sample. There was also a general lack of awareness of sleep hygiene practices and recommendations. Participants reported regulating food intake and physical activity, using allopathic sleep aids, creating a comfortable sleeping environment, and a routine as some strategies to improve sleep. CONCLUSION: Results from this study suggest facilitating the linkage between participant-generated mediating factors and strategies for better-designed interventions. These include making the negative impact of sleep on health more explicit, improving youth awareness about sleep hygiene, targeting caffeine consumption and electronic use, and introducing sleep recommendations through appropriate and effective channels.


Asunto(s)
Privación de Sueño , Higiene del Sueño/fisiología , Adolescente , Concienciación , Boston , Cafeína/administración & dosificación , Cafeína/efectos adversos , Teléfono Celular , Ejercicio Físico , Femenino , Grupos Focales , Humanos , Masculino , Pobreza , Investigación Cualitativa , Tiempo de Pantalla , Privación de Sueño/etnología , Encuestas y Cuestionarios
3.
Behav Sleep Med ; 17(5): 573-585, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-29400557

RESUMEN

Background: Daily behaviors such as sleep can be targeted by smartphone app-based interventions, with potential utility among young people of minority ethnic backgrounds who commonly access smartphone devices and are short sleepers. There is a need to understand the acceptability and youth's readiness to use apps to improve sleep, and to identify desired app components that would motivate engagement. Participants and Methods: We conducted three focus group discussions (N = 27 total, age 14-18 years) within low- and middle-income ethnically diverse Boston neighborhoods. We also interviewed 10 participants who provided specific feedback on two commercially available sleep-promoting apps, one of which they had used on their smartphone preceding the interviews. All focus group discussions and interviews were audio-recorded, transcribed, and thematically analyzed. Results: We identified several barriers to adoption of sleep hygiene interventions, namely reluctance to follow scheduled sleep routines on weekends and concern about "parting" with electronics at bedtime. Participants were intrigued by the idea of adopting an app-based sleep intervention, but were skeptical that they could successfully adopt sleep hygiene practices, and were more interested in making changes on school days than on weekends. Nonetheless, the overall feedback on two commercial sleep apps, neither targeted at youth, was positive, with a good adherence and engagement rate, and perceived health benefits. Conclusions: Our findings highlight the need to adapt sleep hygiene recommendations to targeted populations, considering preferences and social and cultural contextual factors. Our research also underscores the importance of the platform, setting, and messenger when delivering health information to adolescents.


Asunto(s)
Aplicaciones Móviles/estadística & datos numéricos , Trastornos del Sueño-Vigilia/diagnóstico , Sueño/fisiología , Teléfono Inteligente/instrumentación , Adolescente , Femenino , Humanos , Masculino , Grupos Minoritarios , Pobreza , Investigación Cualitativa
4.
Ann Am Thorac Soc ; 14(1): 76-84, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27768852

RESUMEN

RATIONALE: Prior researchers found that individual-level environmental and social indicators did not explain the racial disparity in obstructive sleep apnea syndrome. Neighborhood socioeconomic variables, as well as risk factors for a range of adverse behavioral and health outcomes, may better explain this racial disparity and help identify modifiable intervention targets. OBJECTIVES: To evaluate the associations of neighborhood socioeconomic variables with obstructive sleep apnea severity and to assess whether the neighborhood variables explain the association between race and obstructive sleep apnea severity. METHODS: We performed a cross-sectional analysis of data of 774 children in six cities who participated in the Childhood Adenotonsillectomy Trial. The outcome variable was the apnea-hypopnea index (AHI). Neighborhood socioeconomic variables were obtained on the basis of the children's residential addresses and information in the American Community Survey. Regression models were used to assess the associations among neighborhood conditions, race, and AHI. MEASUREMENTS AND MAIN RESULTS: Higher poverty rate and percentage of single-female-headed households were associated with higher AHI (P = 0.008 and 0.002, respectively). African American race was associated with a 1.33 (1.08-1.64 95% confidence interval)-fold increase in AHI, adjusting for age and sex. After controlling for poverty rate or percentage of single-female-headed households with children, the association between race and AHI levels was no longer significant (P = 0.15 and 0.26, respectively), and the magnitude of race association decreased 34 or 55%, suggesting that the association between race and AHI levels was largely explained by poverty rate or percentage of single-female-headed households with children. CONCLUSIONS: Neighborhood socioeconomic variables in comparison with individual-level socioeconomic indicators provides better explanations for the racial disparity in pediatric obstructive sleep apnea syndrome. Further research aimed at identifying factors that aggregate in disadvantaged neighborhoods and increase sleep apnea risk may suggest modifiable intervention targets. Clinical trial registered with clinicaltrials.gov (NCT00560859).


Asunto(s)
Etnicidad , Disparidades en el Estado de Salud , Pobreza , Características de la Residencia , Familia Monoparental , Apnea Obstructiva del Sueño/epidemiología , Clase Social , Negro o Afroamericano , Niño , Preescolar , Femenino , Hispánicos o Latinos , Humanos , Masculino , Índice de Severidad de la Enfermedad , Apnea Obstructiva del Sueño/fisiopatología , Población Blanca
5.
JAMA Intern Med ; 175(2): 218-26, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25506771

RESUMEN

IMPORTANCE: Widening socioeconomic disparities in mortality in the United States are largely explained by slower declines in tobacco use among smokers of low socioeconomic status (SES) than among those of higher SES, which points to the need for targeted tobacco cessation interventions. Documentation of smoking status in electronic health records (EHRs) provides the tools for health systems to proactively offer tobacco treatment to socioeconomically disadvantaged smokers. OBJECTIVE: To evaluate a proactive tobacco cessation strategy that addresses sociocontextual mediators of tobacco use for low-SES smokers. DESIGN, SETTING, AND PARTICIPANTS: This prospective, randomized clinical trial included low-SES adult smokers who described their race and/or ethnicity as black, Hispanic, or white and received primary care at 1 of 13 practices in the greater Boston area (intervention group, n = 399; control group, n = 308). INTERVENTIONS: We analyzed EHRs to identify potentially eligible participants and then used interactive voice response (IVR) techniques to reach out to them. Consenting patients were randomized to either receive usual care from their own health care team or enter an intervention program that included (1) telephone-based motivational counseling, (2) free nicotine replacement therapy (NRT) for 6 weeks, (3) access to community-based referrals to address sociocontextual mediators of tobacco use, and (4) integration of all these components into their normal health care through the EHR system. MAIN OUTCOMES AND MEASURES: Self-reported past-7-day tobacco abstinence 9 months after randomization ("quitting"), assessed by automated caller or blinded study staff. RESULTS: The intervention group had a higher quit rate than the usual care group (17.8% vs 8.1%; odds ratio, 2.5; 95% CI, 1.5-4.0; number needed to treat, 10). We examined whether use of intervention components was associated with quitting among individuals in the intervention group: individuals who participated in the telephone counseling were more likely to quit than those who did not (21.2% vs 10.4%; P < .001). There was no difference in quitting by use of NRT. Quitting did not differ by a request for a community referral, but individuals who used their referral were more likely to quit than those who did not (43.6% vs 15.3%; P < .001). CONCLUSIONS AND RELEVANCE: Proactive, IVR-facilitated outreach enables engagement with low-SES smokers. Providing counseling, NRT, and access to community-based resources to address sociocontextual mediators among smokers reached in this setting is effective. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01156610.


Asunto(s)
Pobreza , Atención Primaria de Salud , Cese del Hábito de Fumar/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Relaciones Comunidad-Institución , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Cese del Hábito de Fumar/métodos , Adulto Joven
6.
J Gen Intern Med ; 30(6): 719-23, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25527336

RESUMEN

BACKGROUND: Collection of data on race, ethnicity, and language preference is required as part of the "meaningful use" of electronic health records (EHRs). These data serve as a foundation for interventions to reduce health disparities. OBJECTIVE: Our aim was to compare the accuracy of EHR-recorded data on race, ethnicity, and language preference to that reported directly by patients. DESIGN/SUBJECTS/MAIN MEASURES: Data collected as part of a tobacco cessation intervention for minority and low-income smokers across a network of 13 primary care clinics (n = 569). KEY RESULTS: Patients were more likely to self-report Hispanic ethnicity (19.6 % vs. 16.6 %, p < 0.001) and African American race (27.0 % vs. 20.4 %, p < 0.001) than was reported in the EHR. Conversely, patients were less likely to complete the survey in Spanish than the language preference noted in the EHR suggested (5.1 % vs. 6.3 %, p < 0.001). Thirty percent of whites self-reported identification with at least one other racial or ethnic group, as did 37.0 % of Hispanics, and 41.0 % of African Americans. Over one-third of EHR-documented Spanish speakers elected to take the survey in English. One-fifth of individuals who took the survey in Spanish were recorded in the EHR as English-speaking. CONCLUSION: We demonstrate important inaccuracies and the need for better processes to document race/ ethnicity and language preference in EHRs.


Asunto(s)
Documentación/normas , Registros Electrónicos de Salud/normas , Etnicidad/estadística & datos numéricos , Lenguaje , Grupos Raciales/estadística & datos numéricos , Cese del Hábito de Fumar/etnología , Adulto , Anciano , Femenino , Disparidades en el Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Autoinforme , Adulto Joven
7.
Cancer Causes Control ; 24(10): 1849-63, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23860953

RESUMEN

PURPOSE: Year-to-year decreases in smoking in the US have been observed only sporadically in recent years, which suggest a need for intensified efforts to identify those at risk for persistent smoking. To address this need, we examined the association between a variety of psychosocial stressors and smoking persistence, cessation, and relapse over 9-10 years among adults in the United States (n = 4,938, ages 25-74). METHODS: Using information provided at baseline and follow-up, participants were categorized as non-smokers, persistent smokers, ex-smokers, and relapsed smokers. Stressors related to relationships, finances, work-family conflict, perceived inequality, neighborhood, discrimination, and past-year family problems were assessed at baseline and follow-up. RESULTS: High stress at both assessments was associated with greater odds of persistent smoking for stressors related to relationships, finances, work, perceived inequality, past-year family problems, and a summary score. Among respondents who were smokers at baseline, high stress at both time points for relationship stress, perceived inequality, and past-year family problems was associated with nearly double the odds of failure to quit. CONCLUSIONS: Interventions to address psychosocial stress may be important components within smoking cessation efforts.


Asunto(s)
Cese del Hábito de Fumar/psicología , Cese del Hábito de Fumar/estadística & datos numéricos , Fumar/epidemiología , Fumar/psicología , Adulto , Anciano , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estrés Psicológico/epidemiología , Estrés Psicológico/psicología , Estados Unidos/epidemiología , Adulto Joven
8.
Prev Chronic Dis ; 10: E84, 2013 May 23.
Artículo en Inglés | MEDLINE | ID: mdl-23701721

RESUMEN

INTRODUCTION: Practice-Based Research Networks (PBRNs) and health systems may provide timely, reliable data to guide the development and distribution of public health resources to promote healthy behaviors, such as quitting smoking. The objective of this study was to determine if PBRN data could be used to make neighborhood-level estimates of smoking prevalence. METHODS: We estimated the smoking prevalence in 32 greater Boston neighborhoods (population = 877,943 adults) by using the electronic health record data of adults who in 2009 visited one of 26 Partners Primary Care PBRN practices (n = 77,529). We compared PBRN-derived estimates to population-based estimates derived from 1999-2009 Behavioral Risk Factor Surveillance System (BRFSS) data (n = 20,475). RESULTS: The PBRN estimates of neighborhood smoking status ranged from 5% to 22% and averaged 11%. The 2009 neighborhood-level smoking prevalence estimates derived from the BRFSS ranged from 5% to 26% and averaged 13%. The difference in smoking prevalence between the PBRN and the BRFSS averaged -2 percentage points (standard deviation, 3 percentage points). CONCLUSION: Health behavior data collected during routine clinical care by PBRNs and health systems could supplement or be an alternative to using traditional sources of public health data.


Asunto(s)
Fumar/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Sistema de Vigilancia de Factor de Riesgo Conductual , Boston/epidemiología , Femenino , Investigación sobre Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Características de la Residencia/estadística & datos numéricos , Adulto Joven
9.
Am J Public Health ; 102(10): 1911-20, 2012 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-22970692

RESUMEN

OBJECTIVES: We examined the association of Internet-related communication inequalities on human papillomavirus (HPV) vaccine awareness and infection knowledge. METHODS: We drew data from National Cancer Institute's 2007 Health Information National Trends Survey (n = 7674). We estimated multivariable logistic regression models to assess Internet use and Internet health information seeking on HPV vaccine awareness and infection knowledge. RESULTS: Non-Internet users, compared with general Internet users, had significantly lower odds of being aware of the HPV vaccine (odds ratio [OR] = 0.42; 95% confidence interval [CI] = 0.34, 0.51) and knowing that HPV causes cervical cancer (OR = 0.70; 95% CI = 0.52, 0.95). Among general health information seekers, non-Internet seekers compared with Internet information seekers exhibit significantly lower odds of HPV vaccine awareness (OR = 0.59; 95% CI = 0.46, 0.75), and of knowing about the link between HPV infection and cervical cancer (OR = 0.79; 95% CI = 0.63, 0.99) and the sexual transmission of HPV (OR = 0.71; 95% CI = 0.57, 0.89). Among cancer information seekers, there were no differences in outcomes between Internet seekers and non-Internet seekers. CONCLUSIONS: Use of a communication channel, such as the Internet, whose use is already socially and racially patterned, may widen observed disparities in vaccine completion rates.


Asunto(s)
Comunicación , Conocimientos, Actitudes y Práctica en Salud , Internet , Vacunas contra Papillomavirus/uso terapéutico , Adolescente , Adulto , Femenino , Conocimientos, Actitudes y Práctica en Salud/etnología , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Infecciones por Papillomavirus/prevención & control , Estados Unidos , Adulto Joven
10.
Health Serv Res ; 47(3 Pt 2): 1255-77, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22568674

RESUMEN

OBJECTIVE: To illustrate the complex patterns that emerge when race/ethnicity, socioeconomic status (SES), and gender are considered simultaneously in health care disparities research and to outline the needed research to understand them by using disparities in lung cancer risks, treatment, and outcomes as an example. PRINCIPAL FINDINGS: SES, gender, and race/ethnicity are social categories that are robust predictors of variations in health and health services utilization. These are usually considered separately, but intersectionality theory indicates that the impact of each depends on the others. Each reflects historically and culturally contingent variations in social, economic, and political status. Distinct patterns of risk and resilience emerge at the intersections of multiple social categories and shape the experience of health, health care access, utilization, quality, and outcomes where these categories intersect. Intersectional approaches call for greater attention to understand social processes at multiple levels of society and require the collection of relevant data and utilization of appropriate analytic approaches to understand how multiple risk factors and resources combine to affect the distribution of disease and its management. CONCLUSIONS: Understanding how race/ethnicity, gender, and SES are interactive, interdependent, and social identities can provide new knowledge to enhance our efforts to effectively address health disparities.


Asunto(s)
Etnicidad/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Neoplasias Pulmonares/etnología , Grupos Raciales/estadística & datos numéricos , Clase Social , Cultura , Emigración e Inmigración , Predisposición Genética a la Enfermedad , Investigación sobre Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Humanos , Neoplasias Pulmonares/mortalidad , Prejuicio , Proyectos de Investigación/estadística & datos numéricos , Factores de Riesgo , Factores Sexuales , Fumar/etnología , Identificación Social , Factores Socioeconómicos
11.
Soc Sci Med ; 73(1): 22-32, 2011 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-21683493

RESUMEN

People of lower-socioeconomic position (SEP) and most racial/ethnic minorities face significant communication challenges which may negatively impact their health. Previous research has shown that these groups rely heavily on interpersonal sources to share and receive health information; however, little is known about these lay sources. The purpose of this paper is to apply the concept of a market maven to the public health sector with the aims of identifying determinants of high health information mavenism among low-SEP and racial/ethnic minority groups and to assess the information they may be sharing based on their own health beliefs. Data for this study were drawn from the baseline survey (n = 325) of a US randomized control intervention study aimed at eliciting an understanding of Internet-related challenges among lower-SEP and minority individuals. Regression models were estimated to distinguish significant determinants of health information mavenism among the sample. Similarly, bivariate and logistic multivariable models were estimated to determine the association between health information mavenism and accurate health beliefs relating to diet, physical activity and smoking. The data illustrate that having a larger social network, being female and being older were important factors associated with higher mavenism scores. Additionally being a moderate consumer of general media as well as fewer years in the US and lower language acculturation were significant predictors of higher mavenism scores. Mavens were more likely than non-mavens to maintain accurate beliefs regarding diet; however, there was no distinction between physical activity and smoking beliefs between mavens and non-mavens. These results offer a unique understanding of health information mavenism which could better leverage word-of-mouth health communication efforts among lower-SEP and minority groups in order to reduce communication inequalities. Moreover, the data indicate that health information mavens may serve as an ideal point of intervention in attempts to modify health beliefs with the goal of reducing health disparities among these populations.


Asunto(s)
Comunicación , Educación en Salud , Conocimientos, Actitudes y Práctica en Salud , Grupos Minoritarios , Pobreza , Adulto , Femenino , Disparidades en el Estado de Salud , Humanos , Masculino , Medios de Comunicación de Masas , Persona de Mediana Edad , Salud Pública , Estados Unidos
12.
Nat Rev Cancer ; 11(2): 142-50, 2011 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-21258398

RESUMEN

The direct-to-consumer advertising (DTCA) phenomenon has received attention because of its attempt to reach out to consumers by bypassing important gatekeepers such as physicians. The emergence of new information platforms and the introduction of genetic tests directly to the consumer have heightened the concern with DTCA and its potential consequences. These effects of DTCA are particularly important given the communication inequalities among social groups, with class, race and ethnicity influencing how people access, seek, process and act on information. This Science and Society article reviews the major issues regarding general and cancer-related DTCA and also offers data from a national survey in the United States as an example of the communication inequalities in genetic testing awareness.


Asunto(s)
Publicidad , Pruebas Genéticas , Neoplasias/genética , Antineoplásicos , Regulación Gubernamental , Alfabetización en Salud , Disparidades en Atención de Salud , Humanos , Difusión de la Información , Internet , Neoplasias/tratamiento farmacológico , Estados Unidos
13.
J Health Commun ; 15 Suppl 3: 216-35, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-21154095

RESUMEN

Social media, and specifically social networking sites (SNSs), are emerging as an important platform for communication and health information exchange. Yet, despite the increase in popularity and use, only a limited number of empirical studies document which segments of the adult population are and are not using social networking sites and with what, if any, affect on health. The purpose of this study is to identify potential communication inequalities in social networking site use among a representative sample of U.S. adults and to examine the association between SNS use and psychological well-being. We analyzed data from the National Cancer Institute's 2007 Health Information National Trends Survey (HINTS). Thirty-five percent of online adults reported SNS use within the past 12 months, and there were no significant differences in SNS use by race/ethnicity or socioeconomic position. Younger age (p = .00) was the most significant predictor of SNS use, while being married (p = .02) and having a history of cancer (p = .02) were associated with a decreased odds of SNS use. SNS use was significantly associated with a 0.80 (p = .00) increment in psychological distress score after controlling for other factors. The absence of inequalities in adult SNS use across race/ethnicity and class offers some support for the continued use of social media to promote public health efforts; however, issues such as the persisting digital divide and potential deleterious effects of SNS use on psychological well-being need to be addressed.


Asunto(s)
Comunicación en Salud/métodos , Internet/estadística & datos numéricos , Salud Pública , Apoyo Social , Adolescente , Adulto , Factores de Edad , Anciano , Investigación Empírica , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Estado Civil , Salud Mental , Persona de Mediana Edad , Neoplasias/diagnóstico , Estrés Psicológico , Estados Unidos , Adulto Joven
14.
J Med Internet Res ; 9(4): e31, 2007 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-17951215

RESUMEN

BACKGROUND: Despite the increasing penetration of the Internet and amount of online health information, there are significant barriers that limit its widespread adoption as a source of health information. One is the "digital divide," with people of higher socioeconomic position (SEP) demonstrating greater access and usage compared to those from lower SEP groups. However, as the access gap narrows over time and more people use the Internet, a shift in research needs to occur to explore how one might improve Internet use as well as website design for a range of audiences. This is particularly important in the case of novice users who may not have the technical skills, experience, or social connections that could help them search for health information using the Internet. The focus of our research is to investigate the challenges in the implementation of a project to improve health information seeking among low SEP groups. The goal of the project is not to promote health information seeking as much as to understand the barriers and facilitators to computer and Internet use, beyond access, among members of lower SEP groups in an urban setting. OBJECTIVE: The purpose was to qualitatively describe participants' self-identified barriers and facilitators to computer and Internet use during a 1-year pilot study as well as the challenges encountered by the research team in the delivery of the intervention. METHODS: Between August and November 2005, 12 low-SEP urban individuals with no or limited computer and Internet experience were recruited through a snowball sampling. Each participant received a free computer system, broadband Internet access, monthly computer training courses, and technical support for 1 year as the intervention condition. Upon completion of the study, participants were offered the opportunity to complete an in-depth semistructured interview. Interviews were approximately 1 hour in length and were conducted by the project director. The interviews were held in the participants' homes and were tape recorded for accuracy. Nine of the 12 study participants completed the semistructured interviews. Members of the research team conducted a qualitative analysis based on the transcripts from the nine interviews using the crystallization/immersion method. RESULTS: Nine of the 12 participants completed the in-depth interview (75% overall response rate), with three men and six women agreeing to be interviewed. Major barriers to Internet use that were mentioned included time constraints and family conflict over computer usage. The monthly training classes and technical assistance components of the intervention surfaced as the most important facilitators to computer and Internet use. The concept of received social support from other study members, such as assistance with computer-related questions, also emerged as an important facilitator to overall computer usage. CONCLUSIONS: This pilot study offers important insights into the self-identified barriers and facilitators in computer and Internet use among urban low-SEP novice users as well as the challenges faced by the research team in implementing the intervention.


Asunto(s)
Internet , Microcomputadores/estadística & datos numéricos , Pobreza , Factores Socioeconómicos , Población Urbana , Boston , Humanos , Entrevistas como Asunto , Proyectos Piloto
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