'I Am Not The Doctor For You': Physicians' Attitudes About Caring For People With Disabilities.

People with disabilities face barriers when attempting to gain access to health care settings. Using qualitative analysis of three physician focus groups, we identified physical, communication, knowledge, structural, and attitudinal barriers to care for people with disabilities. Physicians reported feeling overwhelmed by the demands of practicing medicine in general and the requirements of the Americans with Disabilities Act of 1990 specifically; in particular, they felt that they were inadequately reimbursed for accommodations. Some physicians reported that because of these concerns, they attempted to discharge people with disabilities from their practices. Increasing health care access for people with disabilities will require increasing the accessibility of space and the availability of proper equipment, improving the education of clinicians about the care of people with disabilities, and removing structural barriers in the health care delivery system. Our findings also suggest that physicians' bias and general reluctance to care for people with disabilities play a role in perpetuating the health care disparities they experience.

Implementation Facilitators and Challenges of a Place-Based Intervention to Reduce Health Disparities in Harlem Through Community Activation and Mobilization.

Background: To address significant health inequities experienced by residents of public housing in East and Central Harlem compared to other New Yorkers, NYC Department of Health and Mental Health (DOHMH) collaborated with community and academic organizations and the New York City Housing Authority to develop a place-based initiative to address chronic diseases in five housing developments, including a community activation and mobilization component led by community health organizers (CHOs). Purpose: Guided by the Consolidated Framework for Implementation Research (CFIR), we evaluated the initial implementation of the community activation and mobilization component to systematically investigate factors that could influence the successful implementation of the intervention. Methods: Nineteen in-depth qualitative interviews were conducted with a purposive sample of CHOs, community members and leaders, collaborating agencies and DOHMH staff. Interviews were transcribed verbatim, and themes and codes were developed to identify theoretically important concepts of the CFIR and emergent analytic patterns. Results: Findings identified important facilitators to implementation: positive community perception of the program, CHO engagement and responsiveness to community needs, CHO norms and values and adaptability of DOHMH and CHOs to community needs. Challenges included the instability of the program in the first year, limited ability to address housing related issues, concerns about long term funding, competing community priorities, low expectations by the community for the program, time and labor intensity to build trust within the community, and the dual roles of CHOs as community advocates and DOHMH employees. Conclusions: Findings will guide future community activation and mobilization activities. The study demonstrates the value of integrating implementation science and health equity frameworks.

African Americans and obesity: implications for clinical nurse specialist practice.

PURPOSE/OBJECTIVE: The purpose of this article is to examine the connection between genes, culture, and environment in the development of obesity and its impact on the health of African Americans. This information will be utilized to facilitate the design of weight management programs for African Americans. RATIONALE: Literature review of the connection between the above variables revealed a disproportionate amount of health risks associated with excess weight in African Americans. Several nonfatal consequences of obesity were noted to impact quality of life but improved significantly with small reductions in body weight. However, factors that affect weight in a culturally relevant context were seldom addressed and few intervention programs were specifically designed to treat minorities with obesity issues. DESCRIPTION: This article describes the role that genetic, cultural, and environmental factors play in energy regulation. Factors that impact lifestyle changes, self-esteem, public awareness, participation, and community involvement are highlighted. OUTCOME: Providing healing environments that are culturally acceptable can empower individuals to commit to goals as well as influence others who are resistant to change. Public awareness tools designed by clinical nurse specialists (CNSs) that appeal to ethnic values can facilitate cooperation and enhance successful outcomes. CONCLUSION: Despite genetic susceptibility to obesity, research on the African diaspora emphasized that obesity tends to be expressed in environmental conditions that are markedly different from ancestral origin. (Kruger A, Kruger HS, MacIntyre U, et al. S Afr J Sci. 2000;96:505-513. Available at: www.nrf.ac.za/sajs/absepooj.stm. Accessed April 11, 2004.) Black adults therefore have much to gain from weight management strategies that address the complexity of the disorder and are sensitive to cultural issues. IMPLICATIONS FOR NURSING PRACTICE: CNSs with advanced knowledge of the impact of obesity on health and wellness are in a unique position to utilize research-based data in the design of weight management programs for diverse populations. In practice, cultural variables that significantly impact the complex issues of weight control should be addressed in the study and treatment of obesity in black populations. By researching what is available to the community, CNSs can evaluate programs that may require adaptation to encourage greater participation.