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1.
Public Health Nurs ; 35(4): 353-359, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29566271

RESUMEN

OBJECTIVES: A community-academic team implemented a study involving collection of quantitative data using a computer-based audience response system (ARS) whereby community partners led data collection efforts. The team participated in a reflection exercise after the data collection to evaluate and identify best practices and lessons learned about the community partner-led process. DESIGN & SAMPLE: The methods involved a qualitative research consultant who facilitated the reflection exercise that consisted of two focus groups-one academic and one community research team members. The consultant then conducted content analysis. Nine members participated in the focus groups. RESULTS: The reflection identified the following themes: the positive aspects of the ARS; challenges to overcome; and recommendations for the future. CONCLUSION: The lessons learned here can help community-academic research partnerships identify the best circumstances in which to use ARS for data collection and practical steps to aid in its success.


Asunto(s)
Investigación Participativa Basada en la Comunidad/métodos , Recolección de Datos/métodos , Grupos Focales/métodos , Relaciones Comunidad-Institución , Procesamiento Automatizado de Datos/métodos , Ejercicio , Humanos , Investigación Cualitativa
2.
Contemp Clin Trials ; 64: 22-29, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-29170075

RESUMEN

Rural African Americans are disproportionately exposed to numerous stressors such as poverty that place them at risk for experiencing elevated levels of depressive symptoms. Effective treatments for decreasing depressive symptoms exist, but rural African Americans often fail to receive adequate and timely care. Churches have been used to address physical health outcomes in rural African American communities, but few have focused primarily on addressing mental health outcomes. Our partnership, consisting of faith community leaders and academic researchers, adapted an evidence-based behavioral activation intervention for use with rural African American churches. This 8-session intervention was adapted to include faith-based themes, Scripture, and other aspects of the rural African American faith culture (e.g. bible studies) This manuscript describes a Hybrid-II implementation trial that seeks to test the effectiveness of the culturally adapted evidence-based intervention (Renewed and Empowered for the Journey to Overcome in Christ: REJOICE) and gather preliminary data on the strategies necessary to support the successful implementation of this intervention in 24 rural African American churches. This study employs a randomized one-way crossover cluster design to assess effectiveness in reducing depressive symptoms and gather preliminary data regarding implementation outcomes, specifically fidelity, associated with 2 implementation strategies: training only and training+coaching calls. This project has the potential to generate knowledge that will lead to improvements in the provision of mental health interventions within the rural African American community. Further, the use of the Hybrid-II design has the potential to advance our understanding of strategies that will support the implementation of and sustainability of mental health interventions within rural African American faith communities. TRIAL REGISTRATION: NCT02860741. Registered August 5, 2016.


Asunto(s)
Afroamericanos , Terapia Conductista/métodos , Depresión/terapia , Organizaciones Religiosas/organización & administración , Promoción de la Salud/organización & administración , Población Rural , Servicios de Salud Comunitaria/organización & administración , Estudios Cruzados , Competencia Cultural , Depresión/etnología , Femenino , Humanos , Masculino , Proyectos de Investigación , Sudeste de Estados Unidos
3.
AIDS Care ; 29(11): 1337-1345, 2017 11.
Artículo en Inglés | MEDLINE | ID: mdl-28599599

RESUMEN

In the United States, HIV-related stigma in the healthcare setting is known to affect the utilization of prevention and treatment services. Multiple HIV/AIDS stigma scales have been developed to assess the attitudes and behaviors of the general population in the U.S. towards people living with HIV/AIDS, but fewer scales have been developed to assess HIV-related stigma among healthcare providers. This systematic review aimed to identify and evaluate the measurement tools used to assess HIV stigma among healthcare providers in the U.S. The five studies selected quantitatively assessed the perceived HIV stigma among healthcare providers from the patient or provider perspective, included HIV stigma as a primary outcome, and were conducted in the U.S. These five studies used adapted forms of four HIV stigma scales. No standardized measure was identified. Assessment of HIV stigma among providers is valuable to better understand how this phenomenon may impact health outcomes and to inform interventions aiming to improve healthcare delivery and utilization.


Asunto(s)
Actitud del Personal de Salud , Infecciones por VIH/psicología , Personal de Salud/psicología , Estigma Social , Femenino , Humanos , Masculino
4.
Prog Community Health Partnersh ; 11(1): 81-86, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28603154

RESUMEN

BACKGROUND: Academic partners typically build community capacity for research, but few examples exist whereby community partners build community research capacity. This paper describes the benefits of communities sharing their "best practices" with each other for the purpose of building health research capacity. METHODS: In the context of a grant designed to engage African American communities to address health disparities (Faith Academic Initiatives Transforming Health [FAITH] in the Delta), leaders of two counties exchanged their "best practices" of creating faith-based networks and community health assessment tools to conduct a collective health assessment. LESSONS LEARNED: There were numerous strengths in engaging communities to build each other's capacity to conduct research. Communities identified with each other, perceived genuineness, conveyed legitimacy, and provided insider knowledge. CONCLUSIONS: Engaging communities to build each other's research capacity is a potentially valuable strategy.


Asunto(s)
Afroamericanos , Creación de Capacidad/organización & administración , Redes Comunitarias/organización & administración , Investigación Participativa Basada en la Comunidad , Relaciones Comunidad-Institución , Promoción de la Salud/organización & administración , Arkansas , Disparidades en el Estado de Salud , Humanos , Población Rural
5.
J Health Care Poor Underserved ; 28(1): 548-565, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28239018

RESUMEN

A number of approaches have been used to obtain community members' health perspectives. Health services researchers often conduct focus groups while political scientists and community groups may hold forums. To compare and contrast these two approaches, we conducted six focus groups (n = 50) and seven deliberative democracy forums (n = 233) to obtain the perspectives of rural African Americans on mental health problems in their community. Inductive qualitative analysis found three common themes: rural African Americans (1) understood stresses of poverty and racism were directly related to mental health, (2) were concerned about widespread mental illness stigma, and (3) thought community members could not identify mental health problems requiring treatment. Deductive analyses identified only minor differences in content between the two approaches. This single case study suggests that researchers could consider using deliberative democracy forums rather than focus groups with marginalized populations, particularly when seeking to mobilize communities to create community-initiated interventions.


Asunto(s)
Afroamericanos/psicología , Recolección de Datos/métodos , Trastornos Mentales/etnología , Salud Mental/etnología , Población Rural , Adolescente , Adulto , Participación de la Comunidad , Femenino , Grupos Focales , Alfabetización en Salud , Humanos , Masculino , Persona de Mediana Edad , Pobreza/psicología , Investigación Cualitativa , Racismo/psicología , Determinantes Sociales de la Salud/etnología , Estigma Social , Estrés Psicológico/etnología , Adulto Joven
6.
Psychiatr Serv ; 68(6): 573-578, 2017 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-28142389

RESUMEN

OBJECTIVE: Rural African Americans are disproportionately affected by social stressors that place them at risk of developing psychiatric disorders. This study aimed to understand mental health, mental health treatment, and barriers to treatment from the perspective of rural African-American residents and other stakeholders in order to devise culturally acceptable treatment approaches. METHODS: Seven focus groups (N=50) were conducted with four stakeholder groups: primary care providers, faith community representatives, college students and administrators, and individuals living with mental illness. A semistructured interview guide was used to elicit perspectives on mental health, mental health treatment, and ways to improve mental health in rural African-American communities. Inductive analysis was used to identify emergent themes and develop a conceptual model grounded in the textual data. RESULTS: Stressful living environments (for example, impoverished communities) and broader community-held beliefs (for example, religious beliefs and stigma) had an impact on perceptions of mental health and contributed to barriers to help seeking. Participants identified community-level strategies to improve emotional wellness in rural African-American communities, such as providing social support, improving mental health literacy, and promoting emotional wellness. CONCLUSIONS: Rural African Americans experience several barriers that impede treatment use. Strategies that include conceptualizing mental illness as a normal reaction to stressful living environments, the use of community-based mental health services, and provision of mental health education to the general public may improve use of services in this population.


Asunto(s)
Afroamericanos/psicología , Necesidades y Demandas de Servicios de Salud , Disparidades en el Estado de Salud , Trastornos Mentales/terapia , Población Rural , Adolescente , Adulto , Arkansas , Femenino , Grupos Focales , Humanos , Entrevistas como Asunto , Masculino , Salud Mental , Persona de Mediana Edad , Pobreza , Investigación Cualitativa , Estigma Social , Apoyo Social , Adulto Joven
7.
J Public Health (Oxf) ; 38(3): 502-510, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-26359314

RESUMEN

BACKGROUND: Health assessments are used to prioritize community-level health concerns, but the role of individuals' health concerns and experiences is unknown. We sought to understand to what extent community health assessments reflect health concerns of the community-at-large versus a representation of the participants sampled. METHODS: We conducted a health assessment survey in 30 rural African American churches (n = 412). Multivariable logistic regression produced odds ratios examining associations between personal health concern (this health concern is important to me), personal health experience (I have been diagnosed with this health issue) and community health priorities (this health concern is important to the community) for 20 health issues. RESULTS: Respondents reported significant associations for 19/20 health conditions between personal health concern and the ranking of that concern as a community priority (all P < 0.05). Inconsistent associations were seen between personal health experience of a specific health condition and the ranking of that condition as a community priority. CONCLUSIONS: Personal health concerns reported by individuals in a study sample may impact prioritization of community health initiatives. Further research should examine how personal health concerns are formed.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Salud Pública , Afroamericanos/psicología , Afroamericanos/estadística & datos numéricos , Investigación Participativa Basada en la Comunidad , Femenino , Prioridades en Salud/estadística & datos numéricos , Estado de Salud , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Población Rural/estadística & datos numéricos , Virginia
8.
J Clin Psychiatry ; 76(8): 1068-74; quiz 1074, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-26335084

RESUMEN

OBJECTIVE: Persons with schizophrenia often receive suboptimal physical health care, but the reasons are poorly understood. Vignettes have been used to examine how a patient's race, gender, or physical health influences a provider's practice; in this study, we used vignettes to examine the effect of a mental health diagnosis (schizophrenia) on providers' clinical expectations and decision making regarding physical health care. METHOD: A cross-sectional survey was administered from August 2011 to April 2012 to 275 primary care and mental health providers in 5 US Department of Veterans Affairs medical centers. Vignettes described identical scenarios for patients with and without schizophrenia. The survey assessed providers' clinical expectations of patients (adherence, competence, ability to read and understand health education materials) and practice behaviors (referrals to weight reduction, pain management, and sleep study). RESULTS: Clinicians expected persons with schizophrenia would be less adherent to treatment (P = .04), less able to read and understand educational materials (P = .03), and less capable of managing their health and personal affairs (P < .01). Providers were less likely to refer a patient with schizophrenia to a weight-reduction program (P = .03). Other types of referral decisions (for pain management and sleep study) were not influenced by a schizophrenia diagnosis. CONCLUSIONS: For both mental health and primary care providers, a history of schizophrenia was found to negatively affect provider expectations of patients' adherence to treatment, ability to understand educational materials, and capacity to manage their treatment and financial affairs as well as some treatment decisions, such as referral to a weight-reduction program.


Asunto(s)
Actitud del Personal de Salud , Servicios de Salud Mental/normas , Atención Primaria de Salud/normas , Esquizofrenia/terapia , Adulto , Toma de Decisiones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermeras y Enfermeros/normas , Médicos/normas , Pautas de la Práctica en Medicina , Derivación y Consulta , Estados Unidos , United States Department of Veterans Affairs
9.
Race Gend Cl ; 22(3-4): 154-171, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-31749601

RESUMEN

An issue in addressing racial healthcare disparities is the need to reduce, often unconscious, provider bias. Provider empathy can overcome such bias. Patient perceptions of provider empathy were explored to identify which provider behaviors patients perceived as conveying empathy and how perceived provider empathy influenced patient-provider interactions. In this qualitative study utilizing in-depth interviews and medical records, interviewers conducted in-depth interviews with 23 patients from three clinics. Patients reported that the following influenced perceptions of provider empathy: Taking time, patient engagement, valuing the patient, clear communication, and the healthcare system. Subtle racial differences existed. This information contributes to research on empathy and patient-provider interaction and provides preliminary evidence for racial differences.

10.
Artículo en Inglés | MEDLINE | ID: mdl-24859098

RESUMEN

BACKGROUND: The Mental Health-Clergy Partnership Program established partnerships between institutional (Department of Veterans' Affairs [VA] chaplains, mental health providers) and community (local clergy, parishioners) groups to develop programs to assist rural veterans with mental health needs. OBJECTIVES: Describe the development, challenges, and lessons learned from the Mental Health-Clergy Partnership Program in three Arkansas towns between 2009 and 2012. METHODS: Researchers identified three rural Arkansas sites, established local advisory boards, and obtained quantitative ratings of the extent to which partnerships were participatory. RESULTS: Partnerships seemed to become more participatory over time. Each site developed distinctive programs with variation in fidelity to original program goals. Challenges included developing trust and maintaining racial diversity in local program leadership. CONCLUSIONS: Academics can partner with local faith communities to create unique programs that benefit the mental health of returning veterans. Research is needed to determine the effectiveness of community based programs, especially relative to typical "top-down" outreach approaches.


Asunto(s)
Clero , Servicios Comunitarios de Salud Mental/organización & administración , Investigación Participativa Basada en la Comunidad/organización & administración , Salud de los Veteranos/estadística & datos numéricos , Arkansas , Servicios Comunitarios de Salud Mental/tendencias , Investigación Participativa Basada en la Comunidad/tendencias , Humanos , Asociación entre el Sector Público-Privado , Religión y Psicología , Servicios de Salud Rural/organización & administración , Servicios de Salud Rural/tendencias , Salud de los Veteranos/tendencias , Recursos Humanos
11.
Psychiatry Res ; 218(1-2): 35-8, 2014 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-24774076

RESUMEN

People with serious mental illness have higher rates of mortality and morbidity due to physical illness. In part, this occurs because primary care and other health providers sometimes make decisions contrary to typical care standards. This might occur because providers endorse mental illness stigma, which seems inversely related to prior personal experience with mental illness and mental health care. In this study, 166 health care providers (42.2% primary care, 57.8% mental health practice) from the Veteran׳s Affairs (VA) medical system completed measures of stigma characteristics, expected adherence, and subsequent health decisions (referral to a specialist and refill pain prescription) about a male patient with schizophrenia who was seeking help for low back pain due to arthritis. Research participants reported comfort with previous mental health interventions. Path analyses showed participants who endorsed stigmatizing characteristics of the patient were more likely to believe he would not adhere to treatment and hence, less likely to refer to a specialist or refill his prescription. Endorsement of stigmatizing characteristics was inversely related to comfort with one׳s previous mental health care. Implications of these findings will inform a program meant to enhance VA provider attitudes about people with mental illness, as well as their health decisions.


Asunto(s)
Actitud del Personal de Salud , Toma de Decisiones , Trastornos Mentales , Salud Mental , Esquizofrenia , Estigma Social , Personal de Salud , Humanos , Atención Primaria de Salud , Derivación y Consulta
12.
Public Health Nurs ; 31(3): 262-71, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24720658

RESUMEN

OBJECTIVE: The aim of this study was to explore how a rural African American faith community would address depression within their congregations and the community as a whole. DESIGN AND SAMPLE: A qualitative, interpretive descriptive methodology was used. The sample included 24 participants representing pastors, parishioners interested in health, and African American men who had experienced symptoms of depression in a community in the Arkansas Delta. MEASURES: The primary data sources for this qualitative research study were focus groups. RESULTS: Participants identified three key players in the rural African American faith community who can combat depression: the Church, the Pastor/Clergy, and the Layperson. The roles of each were identified and recommendations for each to address depression disparities in rural African Americans. CONCLUSIONS: The recommendations can be used to develop faith-based interventions for depression targeting the African American faith community.


Asunto(s)
Afroamericanos/psicología , Depresión/etnología , Disparidades en el Estado de Salud , Religión , Población Rural , Adulto , Afroamericanos/estadística & datos numéricos , Anciano , Arkansas , Clero/estadística & datos numéricos , Depresión/prevención & control , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Adulto Joven
13.
J Relig Health ; 53(3): 796-808, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23288483

RESUMEN

Among African-Americans, the faith community has a long history of providing support to its members. Because African-American men tend to delay and decline traditional depression treatment, the faith community may be an effective source of support. The aim of this study was to determine how a rural African-American faith community describes and perceives experiences of depression among African-American males. A convenience sample of 24 men and women participated in focus groups and interview. Four themes were identified: defining depression, etiology of depression, denial of depression, and effect of masculine roles on depression experience.


Asunto(s)
Afroamericanos/psicología , Actitud Frente a la Salud , Servicios de Salud Comunitaria , Trastorno Depresivo/psicología , Trastorno Depresivo/terapia , Curación por la Fe , Cuidado Pastoral , Religión y Psicología , Población Rural , Adaptación Psicológica , Adulto , Anciano , Estudios de Cohortes , Investigación Participativa Basada en la Comunidad , Trastorno Depresivo/etnología , Práctica Clínica Basada en la Evidencia , Femenino , Disparidades en Atención de Salud , Humanos , Masculino , Persona de Mediana Edad , Estrés Psicológico/complicaciones , Estrés Psicológico/psicología , Estados Unidos , Adulto Joven
14.
J Relig Health ; 53(4): 1267-82, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23775218

RESUMEN

The history of the relationship between religion and mental health is one of commonality, conflict, controversy, and distrust. An awareness of this complex relationship is essential to clinicians and clergy seeking to holistically meet the needs of people in our clinics, our churches, and our communities. Understanding this relationship may be particularly important in rural communities. This paper briefly discusses the history of this relationship and important areas of disagreement and contention. The paper moves beyond theory to present some current practical tensions identified in a brief case study of VA/Clergy partnerships in rural Arkansas. The paper concludes with a framework of three models for understanding how most faith communities perceive mental health and suggests opportunities to overcome the tensions between "the pew" and "the couch."


Asunto(s)
Clero/psicología , Conducta Cooperativa , Trastornos Mentales/psicología , Religión y Psicología , Características de la Residencia , United States Department of Veterans Affairs , Arkansas , Humanos , Población Rural , Estados Unidos , Veteranos/psicología
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