Provider perceptions of mHealth engagement for low-resourced, safety-net communities.

OBJECTIVE: Evaluate nurses' and other health care professionals' (HCPs) perceptions about implementing mobile health technology (mHealth) in clinical practice to support health care delivery for low-resourced, safety-net communities. DESIGN: Qualitative exploratory study using data collected from focus group sessions. Respondents addressed four topics: (1) technology's role in health care delivery; (2) barriers to incorporating mHealth data in clinical practice; (3) need for mHealth Clinical Practice Guide (CPG); and (4) mHealth's potential to improve health care access for marginalized communities. SAMPLE: Thirty HCPs providing services to community health center patients in Washington State and Washington, DC. MEASUREMENTS: Thematic analysis of qualitative data. RESULTS: Themes included:(1) mHealth's ability to provide customized reminders and data accuracy; (2) patients' mistrust of technology; (3) the possibility of linking community resources to address the social determinants of health;(4) mHealth's potential to improve patient-provider communication. CONCLUSION: Health care professionals support incorporating mHealth inpatient care but suggest that an mHealth CPG would improve its potential for facilitating health care delivery in low-resourced communities.

Physical Activity Support Predicts Safety-Net Patients' Digital Health-Care Engagement: Implications for Patient Care Delivery.

PURPOSE: Assess relationship among health services received and patients' digital health-care engagement. DESIGN: Quantitative cross-sectional survey study. SETTING: Community health centers in Washington state and DC. SAMPLE: N = 164 adult safety-net patients. INTERVENTION: Not applicable. MEASURES: Outcomes were knowledge and use of health apps. Predictors were health service access (access to specialists and health information); health service delivery (healthy eating and physical activity counsel); health service satisfaction; and perceived service value. ANALYSIS: Descriptive and multivariate regression analyses. Odds ratios (OR) reported for 95% confidence interval (CI). RESULTS: Response rate was 35%. Of all, 71% were knowledgeable of smartphone use for wellness and 48% used health apps. Physical activity (PA) counseling predicted knowledge and health apps use. Respondents receiving PA counseling were 2.61 times more likely to be knowledgeable about using smartphones for health promotion (OR = 2.61; P = .047; 95% CI: 1.01-6.73). Respondents receiving PA counseling were 2.89 times more likely to use health apps (OR = 2.89; P = .022; 95% CI: 1.17-7.17). Health information access predicted health apps use; respondents with easy access to general health information were 0.29 times as likely to use health apps (OR = 0.29; P = .043; 95% CI: 0.09-0.96). CONCLUSION: Targeted preventive care support encourages digital health-care engagement. mHealth may supplement health-care needs outside clinics.

Mobile Health Technology Knowledge and Practices Among Patients of Safety-Net Health Systems in Washington State and Washington, DC.

PURPOSE: Mobile health technology (mHealth) can reduce health disparities, but research on the health behaviors of low-income patients is needed. This study evaluates mHealth knowledge and practices of low-resource safety-net patients. METHODS: We administered a 47-item questionnaire to 164 low-income patients accessing services at community health centers in the state of Washington and Washington, DC. Predictor variables included demographic factors: age, race, ethnicity, income. Outcome variables were smartphone knowledge (smartphones as a wellness tool), medical app knowledge (availability of medical-based apps), smartphone practices (ever used smartphones for wellness), health apps practices (ever used health-based apps), and medical apps practices (ever used medical-based apps). Multivariate logistic regression assessed relationships between predictor and outcome variables. RESULTS: Mean age was 35.2 years (median: 34), and study cohort (N=159) consisted of mostly women (68%), white race (36%), and income of <$20,000/year (63%). Outcomes: 71% and 58% reported knowledge of using smartphones for wellness and knowledge of medical apps, respectively; 76% used smartphones for wellness, with adults 50+ years of age significantly less likely than younger adults (odds ratio [OR]: 0.94, 95% confidence interval [CI]: 0.88-0.99); 48% used health apps, with adults 50+ years of age less likely than younger adults (OR: 0.95, 95% CI: 0.91-0.99) and respondents earning <$20,000/year less likely than higher earners (OR: 3.13, 95% CI: 1.02-9.57); and 58% used medical apps, with Hispanics/Latinos significantly more likely than non-Hispanics/Latinos (OR: 6.38, 95% CI: 1.04-39.02). CONCLUSIONS: Safety-net patients use mobile devices for health promotion. Age and income are important predictive factors, suggesting a more tailored design of the technology is required for broad engagement and health equity.

Evaluating the relationships among psychological distress, executive cognitive function and economic factors on mammography use in unaffected African American women at risk for breast cancer.

OBJECTIVE: Psychological distress impairs the cognitive function involved in planning and decision-making (executive cognitive function), and hinders engagement in health promoting behaviors. This study examined the relationship among distress, executive cognitive function (ECF) and mammography use in African American women at risk for breast cancer. DESIGN: A cross-sectional sample of mammography screening adherers (n = 44) and non-adherers (n = 16) completed measures of psychological distress (Brief Symptom Inventory) and executive cognitive function, (Wisconsin Card Sort Task and Stroop Color Word Test). RESULTS: More than one-quarter of the high-risk sample had high levels of distress. Distress scores explained 12% of the variance in two ECF components (abstract concept formation and cognitive flexibility), suggesting a significant relationship between psychological distress and cognitive function. Distress scores and ECF measures did not predict mammography use; employment status emerged as the strongest predictor of mammography screening (OR = 4.36, 95% CI: 1.18-16.07). CONCLUSION: Elevated psychological distress is evident in high-risk African American women and appears to have an effect on the cognitive function involved in behavioral regulation and planning. Results also support the role of socioeconomic status as a significant predictor of mammography use.

Caveats in the neuropsychological assessment of African Americans.

This preliminary investigation examined the predictive accuracy of six neuropsychological tests in a population of non-brain-injured African Americans. False positives were unacceptably high on five of the neuropsychological tests administered. These pilot data raise important questions about the utility of neuropsychological test norms with groups dissimilar in sociocultural background to the normative population. These findings are examined in terms of the relative merits of the race-homogenous and race-comparative paradigms and underscore the importance of conducting normative studies that involve ethnic minority populations.