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1.
Artículo en Inglés | MEDLINE | ID: mdl-31942631

RESUMEN

OBJECTIVES: We tested the hypothesis that education's effect on cognitive aging operates in part through measures of material and psychosocial wellbeing. METHODS: Our sample was of non-Latino black and white participants of the National Social Life Health and Aging Project who had valid cognitive assessments in Waves 2 and 3 (n=2,951; age range: 48-95). We used structural equation modeling to test for mediation and moderated mediation by income, assets, perceived stress, social status and allostatic load on the relationships between race, education, and cognition at two time points. RESULTS: Education consistently mediated the race-cognition relationship, explaining about 20% of the relationship between race and cognition in all models. Income and assets were moderated by race; these factors were associated with cognition for whites but not blacks. Social status mediated the association between race and cognition, and social status and perceived stress mediated the education-cognition pathway. Allostatic load was not a mediator of any relationship. DISCUSSION: Education remains the best explanatory factor for cognitive aging disparities, though material wellbeing and subjective social status help to explain a portion of the racial disparity in cognitive aging.

2.
Artículo en Inglés | MEDLINE | ID: mdl-30955411

RESUMEN

Alzheimer's disease (AD) is a growing public health concern with large disparities in incidence and prevalence between African Americans (AAs) and non-Hispanic whites (NHWs). The aim of this review was to examine the evidence of association between six modifiable risk factors (education, smoking, physical inactivity, obesity, social isolation, and psychosocial stress) and Alzheimer's disease risk in AAs and NHWs. We identified 3,437 studies; 45 met inclusion criteria and were included in this review. Of the examined risks, education provided the strongest evidence of association with cognitive outcomes in AAs and NHWs. This factor may operate directly on Alzheimer's disease risk through the neurocognitive benefits of cognitive stimulation or indirectly through social status.

3.
BMC Public Health ; 19(1): 875, 2019 Jul 04.
Artículo en Inglés | MEDLINE | ID: mdl-31272444

RESUMEN

BACKGROUND: Hearing loss is among the leading causes of disability in persons 65 years and older worldwide and is known to have an impact on quality of life as well as social, cognitive, and physical functioning. Our objective was to assess statewide prevalence of self-reported hearing ability in Arizona adults and its association with general health, cognitive decline, diabetes and poor psychosocial health. METHODS: A self-report question on hearing was added to the 2015 Behavioral Risk Factor Surveillance System (BRFSS), a telephone-based survey among community-dwelling adults aged > 18 years (n = 6462). Logistic and linear regression were used to estimate the associations between self-reported hearing loss and health outcomes. RESULTS: Approximately 1 in 4 adults reported trouble hearing (23.2, 95% confidence interval: 21.8, 24.5%), with responses ranging from "a little trouble hearing" to being "deaf." Adults reporting any trouble hearing were at nearly four times higher odds of reporting increased confusion and memory loss (OR 3.92, 95% CI: 2.94, 5.24) and decreased odds of reporting good general health (OR = 0.50, 95% CI: 0.40, 0.64) as compared to participants reporting no hearing difficulty. Those reporting any trouble hearing also reported an average 2.5 more days of poor psychosocial health per month (ß = 2.52, 95% CI: 1.64, 3.41). After adjusting for sex, age, questionnaire language, race/ethnicity, and income category the association between diabetes and hearing loss was no longer significant. CONCLUSIONS: Self-reported hearing difficulty was associated with report of increased confusion and memory loss and poorer general and psychosocial health among Arizona adults. These findings support the feasibility and utility of assessing self-reported hearing ability on the BRFSS. Results highlight the need for greater inclusion of the full range of hearing disability in the planning process for public health surveillance, programs, and services at state and local levels.


Asunto(s)
Pérdida Auditiva/epidemiología , Pérdida Auditiva/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Arizona/epidemiología , Sistema de Vigilancia de Factor de Riesgo Conductual , Cognición , Personas con Discapacidad/psicología , Personas con Discapacidad/estadística & datos numéricos , Femenino , Estado de Salud , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Prevalencia , Autoinforme , Adulto Joven
4.
BMC Public Health ; 19(1): 759, 2019 Jun 14.
Artículo en Inglés | MEDLINE | ID: mdl-31200685

RESUMEN

BACKGROUND: Due to multiple and interacting factors, Latino children are disproportionately at risk for overweight and obesity in the United States. Childhood obesity increases the risk for adverse physical and psychosocial outcomes throughout the lifespan. Intensive behavioral interventions recommended in primary care settings may not conform to current practices, and the most vulnerable populations are often unable to access these services. Community Health Workers (CHWs) offer a promising approach to bridging the gap between vulnerable communities and culturally competent services. La Vida Buena (The Good Life) is an 8-week family-focused intervention for Latino children 5-8 years old and their parents or caregivers who are patients at a Federally-Qualified Community Health Center (FQHC). It is a culturally and linguistically appropriate curriculum, facilitated by CHWs, that targets family behaviors to foster a healthy lifestyle in order to prevent and mitigate childhood overweight and obesity. METHODS: The primary objective is to test the effectiveness of the La Vida Buena (LVB) childhood obesity program among Latino children 5-8 years old and their families as compared with a single educational session. This study uses a parallel two-arm quasi-experimental design. The intervention group receives the 8-week La Vida Buena intervention and the comparison group receives a single educational session. The primary outcome is the change in the child's BMI z-score from baseline to 6 months. DISCUSSION: The implementation and evaluation of La Vida Buena may inform research and practice for linking Latino patients in FQHCs to culturally responsive community-based childhood obesity interventions. It will also contribute to the literature about CHWs as facilitators of behavior change for families underserved by health services and preventive programs. La Vida Buena can serve as a culturally and linguistically appropriate early intervention curriculum that will foster a healthy home environment for childhood obesity mitigation and prevention. TRIAL REGISTRATION: The trial was retrospectively registered on December 18, 2018. The ClinicalTrials.gov Identifier is NCT03781856.


Asunto(s)
Agentes Comunitarios de Salud , Familia/etnología , Hispanoamericanos/psicología , Obesidad Pediátrica/etnología , Programas de Reducción de Peso/organización & administración , Niño , Preescolar , Familia/psicología , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , México , Obesidad Pediátrica/prevención & control , Evaluación de Programas y Proyectos de Salud , Estados Unidos
5.
BMC Public Health ; 19(1): 399, 2019 Apr 11.
Artículo en Inglés | MEDLINE | ID: mdl-30975126

RESUMEN

BACKGROUND: Latinos are currently the largest and fastest growing racial/ethnic group in the United States and have the lowest rates nationally of regular sources of primary care. The changing demographics of Latino populations have significant implications for the future health of the nation, particularly with respect to chronic disease. Community-based agencies and clinics alike have a long history of engaging community health workers (CHWs) to provide a broad range of tangible and emotional support strategies for Latinos with chronic diseases. In this paper, we present the protocol for a community intervention designed to evaluate the impact of CHWs in a Community-Clinical Linkage model to address chronic disease through innovative utilization of electronic health records (EHRs) and application of mixed methodologies. Linking Individual Needs to Community and Clinical Services (LINKS) is a 3-year, prospective matched observational study designed to examine the feasibility and impact of CHW-led Community-Clinical Linkages in reducing chronic disease risk and promoting emotional well-being among Latinos living in three U.S.-Mexico border communities. METHODS: The primary aim of LINKS is to create Community-Clinical Linkages between three community health centers and their respective county health departments in southern Arizona. Our primary analysis is to examine the impact of the intervention 6 to 12-months post program entry. We will assess chronic disease risk factors documented in the EHRs of participants versus matched non-participants. By using a prospective matched observational study design with EHRs, we have access to numerous potential comparators to evaluate the intervention effects. Secondary analyses include modeling within-group changes of extended research-collected measures. This approach enhances the overall evaluation with rich data on physical and emotional well-being and health behaviors of study participants that EHR systems do not collect in routine clinical practice. DISCUSSION: The LINKS intervention has practical implications for the development of Community-Clinical Linkage models. The collaborative and participatory approach in LINKS illustrates an innovative evaluation framework utilizing EHRs and mixed methods research-generated data collection. TRIAL REGISTRATION: This study protocol was retrospectively registered, approved, and made available on Clinicaltrials.gov by NCT03787485 as of December 20, 2018.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Agentes Comunitarios de Salud/organización & administración , Promoción de la Salud/métodos , Hispanoamericanos/estadística & datos numéricos , Arizona , Enfermedad Crónica/prevención & control , Centros Comunitarios de Salud/organización & administración , Femenino , Humanos , Masculino , México , Atención Primaria de Salud/organización & administración , Estudios Prospectivos , Conducta de Reducción del Riesgo , Estados Unidos , Adulto Joven
6.
SSM Popul Health ; 7: 100357, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30886886

RESUMEN

Background: Social gradients in health have been observed for many health conditions and are suggested to operate through the effects of status anxiety. However, the gradient between education and Alzheimer's disease is presumed to operate through cognitive stimulation. We examined the possible role of status anxiety through testing for state-level income inequality and social gradients in markers of socioeconomic position (SEP) for Alzheimer's disease risk. Methods: Using data from the cross-sectional 2015 and 2016 Behavioral Risk Factor Surveillance System (BRFSS) and the U.S. Census Bureau's American Community Survey, we tested for the association between U.S. state-level income inequality and individual SEP on subjective cognitive decline (SCD) - a marker of dementia risk - using a generalized estimating equation and clustering by state. Results: State income inequality was not significantly associated with SCD in our multivariable model (OR 1.2; 95% CI: 0.9, 1.6; p=0.49). We observed a clear linear relationship between household income and SCD where those with an annual household income of 50k to 75k had 1.4 (95% CI: 1.3, 1.6) times the odds and those with household incomes of less than $10,000 had 4.7 (95% CI: 3.8, 5.7) times the odds of SCD compared to those with household income of more than $75,000. We also found that college graduates (ref.) and those who completed high school (OR: 1.1; 95% CI 1.04, 1.2) fared better than those with some college (OR: 1.3, 95% CI 1.2, 1.4) or less than a high school degree (OR: 1.5; 95% CI: 1.4, 1.7). Conclusions: Income inequality does not play a dominant role in SCD, though a social gradient in individual income for SCD suggests the relationship may operate in part via status anxiety.

7.
J Allergy Clin Immunol ; 143(2): 755-764, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30118728

RESUMEN

BACKGROUND: School-supervised use of a once-daily inhaled corticosteroid regimen (supervised therapy) can improve medication adherence and asthma control. OBJECTIVE: We sought to evaluate the effectiveness of supervised therapy in a unique setting and population. METHODS: We conducted a cluster randomized trial of supervised therapy in 20 elementary schools with a disproportionate enrollment of low-income Latino students. Schools were purposively selected, matched, and randomized to receive 9 months of supervised therapy with mometasone furoate or usual care. All English- or Spanish-speaking students with self-reported asthma were eligible. The Asthma Control Questionnaire (ACQ) was interviewer administered quarterly at school. Students in supervised therapy schools were hypothesized to have lower ACQ scores than students in usual-care schools. RESULTS: Of 393 enrolled students, 189 students receiving immediate intervention and 143 students receiving delayed intervention provided 1 or more ACQ data points, were between 6 and 10 years of age, and were included in the primary analysis. At baseline, 39% of students reported taking a controller medication, and 24% had well-controlled asthma. Eighty percent of students receiving immediate intervention were prescribed mometasone. Schools administered 98% of prescribed doses when students attended school. Absences, weekends, and holidays reduced calendar adherence to 53%. During the first year, the mean ACQ score for students receiving immediate and delayed intervention was 1.55 (95% CI, 1.41-1.70) and 1.64 (95% CI, 1.47-1.80), respectively. The estimated treatment effect was -0.08 (95% CI, -0.31 to 0.14). DISCUSSION: Compared with usual care, supervised therapy did not improve asthma control among this population of Latino students. Additional research is warranted to confirm these results.


Asunto(s)
Corticoesteroides/uso terapéutico , Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , Furoato de Mometasona/uso terapéutico , Servicios de Salud Escolar/estadística & datos numéricos , Administración por Inhalación , Asma/epidemiología , Niño , Femenino , Humanos , Masculino , Cumplimiento de la Medicación , Pobreza , Instituciones Académicas , Encuestas y Cuestionarios , Estados Unidos/epidemiología
8.
Health Promot Pract ; 19(3): 349-360, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29363334

RESUMEN

Despite the proliferation of community-clinical linkage (CCL) interventions with community health workers (CHWs), little is known about the components of these programs or how linkages are realized. In this scoping review, we synthesize evidence concerning the role of CHWs in creating and sustaining CCLs aimed at improving individual health outcomes. Our inclusion criteria included peer-reviewed articles that described a CHW intervention in the United States that used a CCL model. A total of 2,776 titles and/or abstracts were screened and 47 articles underwent full text review. Two independent reviewers rated the screened articles based on additional criteria including the CHW connection to community and evidence of linkage follow up rather than simple referral. For the 11 peer-reviewed articles included in the final review, we describe the CHW's relationship to the community, training, and role within the intervention, linkage, and outcomes. We used a standardized framework to determine commonalities in CHW roles across the interventions. CCLs with CHWs positively affect the delivery of both clinical care and community resources across a range of disease areas in a variety of contexts. To identify effective CCL models, additional information on CHW training, CCL follow-up methods, and the CHW role in CCLs is recommended.


Asunto(s)
Agentes Comunitarios de Salud , Redes Comunitarias , Conducta Cooperativa , Promoción de la Salud/organización & administración , Prestación de Atención de Salud , Humanos , Derivación y Consulta , Determinantes Sociales de la Salud , Estados Unidos
9.
Am J Public Health ; 107(10): 1668-1674, 2017 10.
Artículo en Inglés | MEDLINE | ID: mdl-28817321

RESUMEN

OBJECTIVES: To investigate community health worker (CHW) effects on chronic disease outcomes using electronic health records (EHRs). METHODS: We examined EHRs of 32 147 patients at risk for chronic disease during 2012 to 2015. Variables included contact with clinic-based CHWs, vitals, and laboratory tests. We estimated a mixed model for all outcomes. RESULTS: Within-group findings showed statistically significant improvements in chronic disease indicators after exposure to CHWs. In health center 1, HbA1c (glycated hemoglobin) decreased 0.15 millimoles per mole (95% confidence interval [CI] = -0.24, -0.06), body mass index decreased 0.29 kilograms per meter squared (CI = -0.39, -0.20), and total cholesterol decreased 11.9 milligrams per deciliter (CI = -13.5, -10.2). In health center 2, HbA1c decreased 0.43 millimoles per mole (CI = -0.7, -0.17), body mass index decreased by 0.08 kilograms per meter squared (CI = -0.14, -0.02), and triglycerides decreased by 22.50 milligrams per deciliter (CI = -39.0, -6.0). Total cholesterol of 3.62 milligrams per deciliter (CI = -6.6, -0.6) in health center 1 was the only improvement tied to CHW contact. CONCLUSIONS: Although patients' chronic disease indicators consistently improved, between-group models provided no additional evidence of impact. EHRs' evolution may elucidate CHW contributions moving forward.


Asunto(s)
Enfermedad Crónica/terapia , Agentes Comunitarios de Salud/organización & administración , Registros Electrónicos de Salud/estadística & datos numéricos , Atención Primaria de Salud/organización & administración , Adulto , Anciano , Índice de Masa Corporal , Femenino , Hemoglobina A Glucada , Conductas Relacionadas con la Salud , Humanos , Lípidos/sangre , Masculino , Salud Mental , Persona de Mediana Edad , Educación del Paciente como Asunto , Navegación de Pacientes , Autocuidado
10.
Front Public Health ; 5: 152, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28740845

RESUMEN

This paper describes a community coalition-university partnership to address health needs in an underserved US-Mexico border, community. For approximately 15 years, this coalition engaged in community-based participatory research with community organizations, state/local health departments, and the state's only accredited college of public health. Notable efforts include the systematic collection of health-relevant data 12 years apart and data that spawned numerous health promotion activities. The latter includes specific evidence-based chronic disease-preventive interventions, including one that is now disseminated and replicated in Latino communities in the US and Mexico, and policy-level changes. Survey data to evaluate changes in a range of health problems and needs, with a specific focus on those related to diabetes and access to health-care issues-identified early on in the coalition as critical health problems affecting the community-are presented. Next steps for this community and lessons learned that may be applicable to other communities are discussed.

11.
Eval Program Plann ; 62: 15-24, 2017 06.
Artículo en Inglés | MEDLINE | ID: mdl-28242511

RESUMEN

This formative evaluation develops a novel conceptual model for a discipline approach fostering intrinsic motivation and positive relationships in schools. We used concept mapping to elicit and integrate perspectives on kind discipline from teachers, administrators, and other school staff. Three core themes describing kind discipline emerged from 11 identified clusters: (1) proactively developing a positive school climate, (2) responding to conflict with empathy, accountability, and skill, and (3) supporting staff skills in understanding and sharing expectations. We mapped the identified components of kind discipline onto a social ecological model and found that kind discipline encompasses all levels of that model including the individual, relational, environmental/structural, and even community levels. This contrasts with the dominant individual-behavioral discipline approaches that focus on fewer levels and may not lead to sustained student and staff motivation. The findings illustrate the importance of setting and communicating clear expectations and the need for them to be collaboratively developed. Products of the analysis and synthesis reported here are operationalized materials for teachers grounded in a "be kind" culture code for classrooms.


Asunto(s)
Personal Administrativo/organización & administración , Ambiente , Evaluación de Programas y Proyectos de Salud/métodos , Maestros/organización & administración , Instituciones Académicas/organización & administración , Personal Administrativo/psicología , Análisis por Conglomerados , Empatía , Humanos , Motivación , Negociación , Proyectos de Investigación , Maestros/psicología
12.
J Ambul Care Manage ; 40(4): 305-315, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28350634

RESUMEN

The Patient Protection and Affordable Care Act provided community health workers (CHWs) with new opportunities, and current efforts develop evidence-based guidelines for CHW integration into clinical teams. This qualitative study documents CHW roles and activities in 3 federally qualified health care centers in southern Arizona. Community health worker clinical roles, activities, and integration varied by health center and were in flux. Integration included complementary roles, scheduled and everyday communications with team members, and documentation in the electronic health records. These findings contribute to evidence-based guidelines for CHW integration into clinical teams that are critical to maximizing CHW contributions to patient health improvements.


Asunto(s)
Agentes Comunitarios de Salud , Prestación Integrada de Atención de Salud , Documentación , Grupo de Atención al Paciente , Atención Primaria de Salud , Rol Profesional , Arizona , Servicios de Salud Comunitaria , Investigación Participativa Basada en la Comunidad , Práctica Clínica Basada en la Evidencia , Femenino , Promoción de la Salud , Hispanoamericanos , Humanos , Masculino , Patient Protection and Affordable Care Act , Investigación Cualitativa
13.
Patient ; 9(4): 293-301, 2016 08.
Artículo en Inglés | MEDLINE | ID: mdl-26689700

RESUMEN

BACKGROUND: Consideration of patient preferences regarding delivery of mental health services within primary care may greatly improve access and quality of care for the many who could benefit from those services. OBJECTIVES: This project evaluated the feasibility and usefulness of adding a consumer-products design method to qualitative methods implemented within a community-based participatory research (CBPR) framework. RESEARCH DESIGN: Discrete-choice conjoint experiment (DCE) added to systematic focus group data collection and analysis. SUBJECTS: Focus group data were collected from 64 patients of a Federally-Qualified Health Center (FQHC) serving a predominantly low-income Hispanic population. A total of 604 patients in the waiting rooms of the FQHC responded to the DCE. MEASURES: The DCE contained 15 choice tasks that each asked respondents to choose between three mental health services options described by the levels of two (of eight) attributes based on themes that emerged from focus group data. RESULTS: The addition of the DCE was found to be feasible and useful in providing distinct information on relative patient preferences compared with the focus group analyses alone. According to market simulations, the package of mental health services guided by the results of the DCE was preferred by patients. CONCLUSIONS: Unique patterns of patient preferences were uncovered by the DCE and these findings were useful in identifying pragmatic solutions to better address the mental health service needs of this population. However, for this resource-intensive method to be adopted more broadly, the scale of the primary care setting and/or scope of the issue addressed have to be relatively large.


Asunto(s)
Conducta de Elección , Hispanoamericanos/psicología , Servicios de Salud Mental/organización & administración , Prioridad del Paciente , Pobreza , Proyectos de Investigación , Adulto , Anciano , Investigación Participativa Basada en la Comunidad , Competencia Cultural , Interpretación Estadística de Datos , Femenino , Grupos Focales , Humanos , Lenguaje , Masculino , Persona de Mediana Edad , Atención Primaria de Salud , Derivación y Consulta/organización & administración
14.
Artículo en Inglés | MEDLINE | ID: mdl-25981424

RESUMEN

BACKGROUND: Public health advocacy is by necessity responsive to shifting sociopolitical climates, and thus a challenge of advocacy research is that the intervention must by definition be adaptive. Moving beyond the classification of advocacy efforts to measurable indicators and outcomes of policy, therefore, requires a dynamic research approach. OBJECTIVES: The purposes of this article are to (1) describe use of the CBPR approach in the development and measurement of a community health worker (CHW) intervention designed to engage community members in public health advocacy and (2) provide a model for application of this approach in advocacy interventions addressing community-level systems and environmental change. METHODS: The Kingdon three streams model of policy change provided a theoretical framework for the intervention. Research and community partners collaboratively identified and documented intervention data. We describe five research methods used to monitor and measure CHW advocacy activities that both emerged from and influenced intervention activities. DISCUSSION: Encounter forms provided a longitudinal perspective of how CHWs engaged in advocacy activities in the three streams. Strategy maps defined desired advocacy outcomes and health benefits. Technical assistance notes identified and documented intermediate outcomes. Focus group and interview data reflected CHW efforts to engage community members in advocacy and the development of community leaders. APPLICATION OF LESSONS LEARNED: We provide a model for application of key principles of CPBR that are vital to effectively capturing the overarching and nuanced aspects of public health advocacy work in dynamic political and organizational environments.


Asunto(s)
Agentes Comunitarios de Salud , Investigación Participativa Basada en la Comunidad , Defensa del Consumidor , Evaluación de Programas y Proyectos de Salud/métodos , Humanos , Lactante , Rol Profesional
15.
J Immigr Minor Health ; 17(4): 1025-32, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24859806

RESUMEN

Lacking in the literature are data addressing the extent to which changes in reproductive and lifestyle factors predispose women in developing nations to higher breast cancer rates, and the degree to which these are due to globalization influences. This article describes the development and psychometric assessment of an instrument intended to measure global, predominantly U.S., influences on breast cancer risk profile among women residing in Mexico. Using investigator consensus and a focus group methodology, the Measure of Globalization Influence on Health Risk (MGIHR) was developed and completed by 341 women. Psychometric analysis support the use of an 11-item Consumerism and Modernity scale and 7-item Reproductive Control and Gender Role scale. The MGIHR is a valid and reliable instrument for understanding changing lifestyle and reproductive factors for breast cancer risk and may provide a more complete understanding of breast cancer development and needed interventions.


Asunto(s)
Neoplasias de la Mama/etiología , Internacionalidad , Neoplasias de la Mama/epidemiología , Femenino , Grupos Focales , Humanos , México/epidemiología , Persona de Mediana Edad , Psicometría , Factores de Riesgo , Encuestas y Cuestionarios
16.
Health Expect ; 18(6): 3007-18, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25306904

RESUMEN

BACKGROUND: Mexican American farmworkers experience high rates of mental health conditions; however, it is difficult for them to access care. Patient-centred care is a systems-wide approach to improving the delivery of services for diverse populations in the primary care setting. AIM: We describe the application of community-based participatory research methods to assess and address gaps in perceptions of mental health care between providers and migrant workers living in a US-Mexico Border community. SETTING: A federally qualified health centre (FQHC) serving a community of approximately 60 000 agricultural workers who live in Yuma County and harvest vegetables during the winter season. DESIGN: We conducted patient focus groups (n = 64) and FQHC staff interviews (n = 16) to explore attributes and dimensions of patient-centred mental health care. RESULTS: Patients and staff both prioritized increased access to mental health care and patient-centred care, while patients were more concerned with interpersonal care and providers with coordination of care. All participants stressed the relationship between life events and mental health and the centrality of family in care. Patients also emphasized the importance of a good attitude, the ability to solve problems, positive family relationships and reliance on faith. Patients suggested that the FQHC inform patients about mental health resources, provide community informational talks to address stigma, and offer support groups. DISCUSSION: The participatory approach of this qualitative study resulted in a wealth of data regarding patient preferences that will enable the FQHC to develop protocols and training to provide patient-centred mental health-care services for their community.


Asunto(s)
Servicios Comunitarios de Salud Mental/métodos , Investigación Participativa Basada en la Comunidad , Agricultores , Americanos Mexicanos , Atención Dirigida al Paciente/métodos , Arizona , Centros Comunitarios de Salud Mental , Investigación Participativa Basada en la Comunidad/métodos , Grupos Focales , Humanos
17.
Am J Public Health ; 104(8): e94-e100, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24922148

RESUMEN

OBJECTIVES: We investigated whether access to and use of health care services increased among residents of a low-income, predominantly Mexican American border community affected by the expansion of Arizona's Medicaid program in 2001 and multiple community-level programs and policies. METHODS: We used data from a probability sample of 1623 adult residents of Douglas, Arizona, who participated in cross-sectional health surveys in 1998 and 2010. Response rates were 83% and 86%, respectively. RESULTS: In 2010, participants were more likely to have a usual source of care, to have visited a provider in the previous year, and to have been screened for diabetes and hypertension and less likely to have delayed needed care or to have seen a regular provider in Mexico (P < .001 for all outcomes). Improvements in access to and use of health care were most pronounced among residents with less than a high school education, which reduced or eliminated educational disparities in health care. CONCLUSIONS: Expansion of public insurance programs can effectively reduce health care disparities when paired with other community-level policies and programs that target medically underserved populations.


Asunto(s)
Servicios de Salud Comunitaria/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Medicaid/organización & administración , Adulto , Arizona/epidemiología , Estudios Transversales , Escolaridad , Femenino , Encuestas de Atención de la Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Masculino , Americanos Mexicanos/estadística & datos numéricos , Persona de Mediana Edad , Factores Socioeconómicos , Estados Unidos
19.
J Prim Prev ; 35(2): 119-23, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24363179

RESUMEN

Public policy that seeks to achieve sustainable improvements in the social determinants of health, such as income, education, housing, food security and neighborhood conditions, can create positive and sustainable health effects. This paper describes preliminary results of Acción para la Salud, a public health intervention in which Community health workers (CHWs) from five health agencies engaged their community in the process of making positive systems and environmental changes. Academic-community partners trained Acción CHWs in community advocacy and provided ongoing technical assistance in developing strategic advocacy plans. The CHWs documented community advocacy activities through encounter forms in which they identified problems, formulated solutions, and described systems and policy change efforts. Strategy maps described the steps of the advocacy plans. Findings demonstrate that CHWs worked to initiate discussions about underlying social determinants and environment-related factors that impact health, and identified solutions to improve neighborhood conditions, create community opportunities, and increase access to services.


Asunto(s)
Agentes Comunitarios de Salud/organización & administración , Participación de la Comunidad , Defensa del Consumidor , Política de Salud , Determinantes Sociales de la Salud , Humanos , Cambio Social
20.
J Immigr Minor Health ; 16(6): 1176-82, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23813347

RESUMEN

This study examines factors relating to farmworkers' health status from sociocultural factors, including stress embedded within their work and community contexts. A cross-sectional household survey of farmworkers (N = 299) included social-demographics, immigration status descriptors, and a social-ecologically grounded, community-responsive, stress assessment. Outcomes included three standard US national surveillance measures of poor mental, physical, and self-rated health (SRH). Logistic regression models showed that higher levels of stress were significantly associated (Ps < .001) with increased risk for poor mental health and poor physical health considering all variables. Stress was not associated with SRH. Regarding two of the three outcomes, mental health and physical health, stress added explanatory power as expected. For poor SRH, a known marker for mortality risk and quite high in the sample at 38%, only age was significantly associated. Clinical and systems-level health promotion strategies may be required to mitigate these stressors in border-residing farmworkers.


Asunto(s)
Agricultores/psicología , Americanos Mexicanos/psicología , Estrés Psicológico/epidemiología , Adulto , Factores de Edad , Anciano , Arizona/epidemiología , Estudios Transversales , Agricultores/estadística & datos numéricos , Femenino , Estado de Salud , Humanos , Masculino , Americanos Mexicanos/estadística & datos numéricos , México/etnología , Persona de Mediana Edad , Factores de Riesgo , Factores Socioeconómicos , Estrés Psicológico/etiología , Estrés Psicológico/psicología , Adulto Joven
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