Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 115
Filtrar
Más filtros










Base de datos
Intervalo de año de publicación
1.
Psychiatr Serv ; 70(7): 578-585, 2019 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-30991907

RESUMEN

OBJECTIVE: This study examined the mental health status, need for services, and unmet need of community-dwelling Native Hawaiian and other Pacific Islanders (NHPI). METHODS: Survey data were collected from 223 NHPI adults of Samoan or Marshallese heritage. Surveys were translated into Samoan and Marshallese by using back-translation, with feedback from cultural experts. Severity of depression, anxiety, and alcohol use were measured, as were perceived need for and avoidance of, or delay in, seeking mental health services. Logistic regressions calculated adjusted odds ratios for past-year perceived need for services and avoidance or delay of needed services, controlling for depression, anxiety, and alcohol use. RESULTS: Participants' screened prevalence of major depression, generalized anxiety disorder, and alcohol use disorder was 21%, 12%, and 22%, respectively. In the past year, 35% and 26% of participants reported needing services and avoiding or delaying needed services, respectively. Urban Samoan and rural Marshallese participants did not differ significantly in measures of depression, anxiety, or alcohol use, even though the groups had significant demographic differences. Female gender and greater familiarity-contact with persons with mental illness were significant predictors of both reporting service need and reporting avoiding or delaying services. CONCLUSIONS: Community-dwelling NHPIs reported a heavy burden of depression, anxiety, and alcohol use, and high perceived need for services, yet low levels of help-seeking. The large unmet need in the sample suggests that a gap may exist between service need and engagement in U.S. NHPI communities that could be targeted with culturally tailored approaches that promote engagement in care.

2.
Glob Qual Nurs Res ; 6: 2333393618825253, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30746425

RESUMEN

In this study, we examined the sociocultural factors underlying infant feeding practices. We conducted four focus groups with 19 Latina mothers of children 0 to 2 years of age enrolled in Early Head Start programs in the United States over a 1-year period. We found these mothers considered both science- and family-based feeding recommendations. However, advice from family was often inconsistent with science- and nutrition-based recommended feeding practices. In the interest of showing respect and preserving harmonious relationships, some mothers accepted family advice instead of recommended practices while others employed strategies to follow recommended practices without offending. Nutrition educators need to consider the intersection of macro, organizational, and community factors with micro-level processes in shaping the implementation of recommended feeding practices within family systems. Nutrition interventions for Latino families should capitalize on Latina mothers' strategies for navigating multiple information sources while preserving cultural values and family relationships.

3.
Medicine (Baltimore) ; 97(31): e11690, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30075566

RESUMEN

There are many barriers that prevent people from receiving human immunodeficiency virus (HIV) testing; however, little is known about the impact of age and ethnicity on HIV testing. We explored differences in self-reported HIV risk and willingness to be tested in the 2014 Get Tested Coachella Valley Community Survey by age and ethnicity.Data were collected from 995 participants via survey methods (online, hard copy, and in person). Surveys asked about demographics, sexual history, HIV testing history, thoughts on who should get tested, and future preferences for HIV testing.Most participants were women (62.5%), Hispanic (55.8%), and older than 50 years (51%). Participants who did not receive testing said they did not do so because they did not perceive themselves as at risk of contracting HIV (51.8%). Many participants (24.1%) said they did not receive testing because their health care provider never offered them the HIV test. Participants were more likely to have been tested if they were between 25 and 49 years old, compared to participants aged 50 or older (70.2% vs 48.6%, respectively, P < .001). Participants who were not Hispanic or Latino were more likely to have had an HIV test compared to Hispanic or Latino participants (62.5% vs 51.1%, P < .001).Interventions are needed to reach older adults to address HIV testing and beliefs. These interventions must debunk beliefs among physicians that older adults are not sexually active and beliefs among older adults that only certain populations are at risk of HIV.


Asunto(s)
Factores de Edad , Grupos Étnicos/psicología , Infecciones por VIH/psicología , Tamizaje Masivo/psicología , Aceptación de la Atención de Salud/psicología , Adulto , California , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/etnología , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/etnología , Asunción de Riesgos , Autoinforme , Conducta Sexual/etnología , Conducta Sexual/psicología
4.
J Anxiety Disord ; 55: 39-47, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29576380

RESUMEN

The present study examines how both between group (i.e., ethnic group membership) and within group cultural factors (i.e., nativity status, age of immigration, and perceived discrimination) may contribute to anxiety and related symptoms in Latinx with anxiety disorders. Baseline data were examined from patients who participated in one of the largest intervention studies for adults with anxiety disorders in primary care settings; 196 Latinx and 568 NLW (non-Latinx White) patients participated. Proportions of anxiety disorders were similar between Latinx and NLWs; however, Latinx, on average, had a greater number of anxiety disorders than NLWs. Levels of anxiety and depression symptom severity, anxiety sensitivity, and mental functional impairment were similar between the ethnic groups. Latinx expressed greater somatization and physical functional impairment than NLWs. Among Latinx, perceived discrimination, but not other cultural variables, was predictive of mental health symptoms while controlling for age, gender, education, and poverty. Overall, these findings suggest more similarities than differences in types and levels of anxiety and anxiety-related impairment, with some important exceptions, including greater levels of somatization and physical functional impairment among Latinx patients. Further, perceived discrimination may be an important factor to consider when examining risk for greater symptom burden among Latinx with anxiety.


Asunto(s)
Trastornos de Ansiedad/etnología , Ansiedad/etnología , Cultura , Hispanoamericanos/psicología , Salud Mental , Adulto , Ansiedad/psicología , Trastornos de Ansiedad/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud , Autoimagen
5.
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
6.
Clin Gerontol ; 41(4): 271-281, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-28960158

RESUMEN

OBJECTIVES: The objective of this study was to examine age differences in the likelihood of endorsing of death and suicidal ideation in primary care patients with anxiety disorders. METHOD: Participants were drawn from the Coordinated Anxiety Learning and Management (CALM) Study, an effectiveness trial for primary care patients with panic disorder (PD), generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and/or social anxiety disorder (SAD). RESULTS: Approximately one third of older adults with anxiety disorders reported feeling like they were better off dead. Older adults with PD and SAD were more likely to endorse suicidal ideation lasting at least more than half the prior week compared with younger adults with these disorders. Older adults with SAD endorsed higher rates of suicidal ideation compared with older adults with other anxiety disorders. Multivariate analyses revealed the importance of physical health, social support, and comorbid MDD in this association. CONCLUSIONS: Suicidal ideation is common in anxious, older, primary care patients and is particularly prevalent in socially anxious older adults. Findings speak to the importance of physical health, social functioning, and MDD in this association. CLINICAL IMPLICATIONS: When working with anxious older adults it is important to conduct a thorough suicide risk assessment and teach skills to cope with death and suicidal ideation-related thoughts.


Asunto(s)
Trastornos de Ansiedad/mortalidad , Ideación Suicida , Intento de Suicidio/psicología , Adulto , Factores de Edad , Anciano , Trastornos de Ansiedad/psicología , Comorbilidad , Estudios Transversales , Trastorno Depresivo Mayor/complicaciones , Trastorno Depresivo Mayor/epidemiología , Trastorno Depresivo Mayor/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastorno de Pánico/psicología , Aptitud Física/psicología , Prevalencia , Atención Primaria de Salud , Factores de Riesgo , Apoyo Social , Trastornos por Estrés Postraumático/psicología , Intento de Suicidio/estadística & datos numéricos
7.
Eval Program Plann ; 66: 70-78, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29053983

RESUMEN

OBJECTIVES: Collaborations between communities, healthcare practices and academic institutions are a strategy to address health disparities. Trust is critical in the development and maintaining of effective collaborations. The aim of this pilot study was to engage stakeholders in defining determinants of trust in community academic research partnerships and to develop a framework for measuring trust. METHODS: The study was conducted by five collaborating National Institute of Health' Clinical and Translational Sciences Awardees. We used concept mapping to engage three stakeholders: community members, healthcare providers and academicians. We conducted hierarchical cluster analysis to assess the determinants of trust in community-academic research partnerships. RESULTS: A total of 186 participants provided input generating 2,172 items that were consolidated into 125 unique items. A five cluster solution was defined: authentic, effective and transparent communication; mutually respectful and reciprocal relationships; sustainability; committed partnerships; and, communication, credibility and methodology to anticipate and resolve problems. CONCLUSION: Results from this study contribute to an increasing empirical body of work to better understand and improve the underlying factors that contribute to building and sustaining trust in community academic research partnerships.


Asunto(s)
Investigación Participativa Basada en la Comunidad/organización & administración , Relaciones Comunidad-Institución , Investigación sobre Servicios de Salud/organización & administración , Confianza , Universidades/organización & administración , Comunicación , Conducta Cooperativa , Femenino , Personal de Salud/organización & administración , Personal de Salud/psicología , Humanos , Masculino , National Institutes of Health (U.S.)/organización & administración , Proyectos Piloto , Investigadores/organización & administración , Investigadores/psicología , Estados Unidos
8.
J Stud Alcohol Drugs ; 78(4): 588-596, 2017 05.
Artículo en Inglés | MEDLINE | ID: mdl-28728641

RESUMEN

OBJECTIVE: Substance use disorders (SUDs) are associated with elevated rates of mortality. Little is known about whether receiving appropriate care is associated with lower mortality for patients with SUDs. This study examined the association between the receipt of care for SUDs and subsequent 12- and 24-month mortality. METHOD: This was a retrospective cohort study of veterans who received care for SUDs paid for by the Veterans Health Administration during October 2006- September 2007 (n = 339,966). Logistic regressions were used to examine the association between quality indicators measuring receipt of care and mortality while controlling for patient characteristics and facility service area. RESULTS: There were four quality indicators: SUD treatment initiation, SUD treatment engagement, SUD-related psychosocial treatment, and SUD-related psychotherapy. Outcomes measured were mortality 12 and 24 months after the end of the observation period, through September 2009. Receipt of indicated care ranged from 26.5% to 58.6%, and 12- and 24-month mortality rates were 3% and 6%, respectively. Adjusted odds ratios [95% CI] of 12-month mortality by indicator were: initiation, 0.86 [0.79, 0.93]; engagement, 0.65 [0.58, 0.74]; psychosocial treatment, 0.88 [0.84, 0.92]; and psychotherapy, 0.84 [0.79, 0.89]. For the 24-month mortality outcome, adjusted odds ratios were: initiation, 0.88 [0.84, 0.93]; engagement, 0.78 [0.71, 0.85]; psychosocial treatment, 0.91 [0.88, 0.94]; and psychotherapy, 0.87 [0.83, 0.91]. Results were similar when controlling for facility service area. CONCLUSIONS: Receiving appropriate care is associated with lower mortality for patients with SUDs. Significant overall and within-facility service area associations of quality indicators and mortality support their use in encouraging providers to deliver the indicated care. These indicators should be prioritized above others lacking comparably strong process-outcome associations.


Asunto(s)
Indicadores de Calidad de la Atención de Salud , Trastornos Relacionados con Sustancias/terapia , Adulto , Anciano , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Psicoterapia , Estudios Retrospectivos , Trastornos Relacionados con Sustancias/mortalidad
9.
Behav Ther ; 48(4): 490-500, 2017 07.
Artículo en Inglés | MEDLINE | ID: mdl-28577585

RESUMEN

There has been increasing recognition of the value of personalized medicine where the most effective treatment is selected based on individual characteristics. This study used a new method to identify a composite moderator of response to evidence-based anxiety treatment (CALM) compared to Usual Care. Eight hundred seventy-six patients diagnosed with one or multiple anxiety disorders were assigned to CALM or Usual Care. Using the method proposed by Kraemer (2013), 35 possible moderators were examined for individual effect sizes then entered into a forward-stepwise regression model predicting differential treatment response. K-fold cross validation was used to identify the number of variables to include in the final moderator. Ten variables were selected for a final composite moderator. The composite moderator effect size (r = .20) was twice as large as the strongest individual moderator effect size (r = .10). Although on average patients benefitted more from CALM, 19% of patients had equal or greater treatment response in Usual Care. The effect size for the CALM intervention increased from d = .34 to d = .54 when accounting for the moderator. Findings support the utility of composite moderators. Results were used to develop a program that allows mental health professionals to prescribe treatment for anxiety based on baseline characteristics (http://anxiety.psych.ucla.edu/treatmatch.html).


Asunto(s)
Trastornos de Ansiedad/terapia , Modelos Estadísticos , Selección de Paciente , Medicina de Precisión/métodos , Adulto , Trastornos de Ansiedad/psicología , Femenino , Humanos , Masculino , Medicina de Precisión/estadística & datos numéricos , Análisis de Regresión
10.
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
11.
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
12.
Health Educ Behav ; 44(1): 182-191, 2017 02.
Artículo en Inglés | MEDLINE | ID: mdl-27230272

RESUMEN

Community-academic research partnerships aim to build stakeholder trust in order to improve the reach and translation of health research, but there is limited empirical research regarding effective ways to build trust. This multisite study was launched to identify similarities and differences among stakeholders' perspectives of antecedents to trust in research partnerships. In 2013-2014, we conducted a mixed-methods concept mapping study with participants from three major stakeholder groups who identified and rated the importance of different antecedents of trust on a 5-point Likert-type scale. Study participants were community members ( n = 66), health care providers ( n = 38), and academic researchers ( n = 44). All stakeholder groups rated "authentic communication" and "reciprocal relationships" the highest in importance. Community members rated "communication/methodology to resolve problems" ( M = 4.23, SD = 0.58) significantly higher than academic researchers ( M = 3.87, SD = 0.67) and health care providers ( M = 3.89, SD = 0.62; p < .01) and had different perspectives regarding the importance of issues related to "sustainability." The importance of communication and relationships across stakeholders indicates the importance of colearning processes that involve the exchange of knowledge and skills. The differences uncovered suggest specific areas where attention and skill building may be needed to improve trust within partnerships. More research on how partnerships can improve communication specific to problem solving and sustainability is merited.


Asunto(s)
Centros Médicos Académicos/organización & administración , Investigación Participativa Basada en la Comunidad , Investigadores/psicología , Confianza , Comunicación , Conducta Cooperativa , Grupos Étnicos , Femenino , Humanos , Masculino
13.
Depress Anxiety ; 33(12): 1099-1106, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27775823

RESUMEN

BACKGROUND: Many patients with anxiety disorders remain symptomatic after receiving evidence-based treatment, yet research on treatment-resistant anxiety is limited. We evaluated effects of cognitive behavioral therapy (CBT) on outcomes of patients with medication-resistant anxiety disorders using data from the Coordinated Anxiety Learning and Management (CALM) trial. METHODS: Primary care patients who met study entry criteria (including DSM-IV diagnosis of generalized anxiety disorder, panic disorder, posttraumatic stress disorder, or social anxiety disorder) despite ongoing pharmacotherapy of appropriate type, dose, and duration were classified as medication resistant (n = 227). Logistic regression was used to estimate effects of CALM's CBT program (CALM-CBT; chosen by 104 of 117 medication-resistant patients randomized to CALM) versus usual care (UC; n = 110) on response [≥ 50% reduction of 12-item Brief Symptom Inventory (BSI-12) anxiety and somatic symptom score] and remission (BSI-12 < 6) at 6, 12, and 18 months. Within-group analyses examined outcomes by treatment choice (CBT vs. CBT plus medication management) and CBT dose. RESULTS: Approximately 58% of medication-resistant CALM-CBT patients responded and 46% remitted during the study. Relative to UC, CALM-CBT was associated with greater response at 6 months (AOR = 3.78, 95% CI 2.02-7.07) and 12 months (AOR = 2.49, 95% CI 1.36-4.58) and remission at 6, 12, and 18 months (AORs = 2.44 to 3.18). Patients in CBT plus medication management fared no better than those in CBT only. Some evidence suggested higher CBT dose produced better outcomes. CONCLUSIONS: CBT can improve outcomes for patients whose anxiety symptoms are resistant to standard pharmacotherapy.


Asunto(s)
Ansiolíticos/uso terapéutico , Trastornos de Ansiedad/terapia , Terapia Cognitivo-Conductual/métodos , Conducta Cooperativa , Adulto , Trastornos de Ansiedad/tratamiento farmacológico , Terapia Combinada/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Resultado del Tratamiento
14.
J Subst Abuse Treat ; 69: 1-8, 2016 10.
Artículo en Inglés | MEDLINE | ID: mdl-27568504

RESUMEN

IMPORTANCE: Individuals with co-occurring mental and substance use disorders have increased rates of mortality relative to the general population. The relationship between measures of treatment quality and mortality for these individuals is unknown. OBJECTIVE: To examine the association between 5 quality measures and 12- and 24-month mortality. DESIGN, SETTING AND PARTICIPANTS: Retrospective cohort study of patients with co-occurring mental illness (schizophrenia, bipolar disorder, post-traumatic stress disorder and major depression) and substance use disorders who received care for these disorders paid for by the Veterans Administration between October 2006 and September 2007. Logistic regression models were used to examine the association between 12 and 24-month mortality and 5 patient-level quality measures, while risk-adjusting for patient characteristics. Quality measures included receipt of psychosocial treatment, receipt of psychotherapy, treatment initiation and engagement, and a measure of continuity of care. We also examined the relationship between number of diagnosis-related outpatient visits and mortality, and conducted sensitivity analyses to examine the robustness of our findings to an unobserved confounder. MAIN OUTCOMES MEASURE: Mortality 12 and 24 months after the end of the observation period. RESULTS: All measures except for treatment engagement at 24 months were significantly associated with lower mortality at both 12 and 24 months. At 12 months, receiving any psychosocial treatment was associated with a 21% decrease in mortality; psychotherapy, a 22% decrease; treatment initiation, a 15% decrease, treatment engagement, a 31% decrease; and quarterly, diagnosis-related visits a 28% decrease. Increasing numbers of visits were associated with decreasing mortality. Sensitivity analyses indicated that the difference in the prevalence of an unobserved confounder would have to be unrealistically large given the observed data, or there would need to be a large effect of an unobserved confounder, to render these findings non-significant. CONCLUSIONS AND RELEVANCE: This is the first study to show an association between process-based quality measures and mortality in patients with co-occurring mental and substance use disorders, and provides initial support for the predictive validity of the measures. By devising strategies to improve performance on these measures, health care systems may be able to decrease the mortality of this vulnerable population.


Asunto(s)
Trastornos Mentales/epidemiología , Indicadores de Calidad de la Atención de Salud , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Estudios de Cohortes , Diagnóstico Dual (Psiquiatría) , Femenino , Humanos , Modelos Logísticos , Masculino , Trastornos Mentales/mortalidad , Trastornos Mentales/terapia , Persona de Mediana Edad , Estudios Retrospectivos , Trastornos Relacionados con Sustancias/mortalidad , Trastornos Relacionados con Sustancias/rehabilitación , Factores de Tiempo , Estados Unidos , United States Department of Veterans Affairs
15.
Implement Sci ; 11: 65, 2016 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-27164866

RESUMEN

BACKGROUND: Broadly disseminating and implementing evidence-based psychotherapies with high fidelity, particularly cognitive behavioral therapy (CBT), has proved challenging for many health-care systems, including the Department of Veterans Affairs, especially in primary care settings such as small or remote clinics. A computer-based tool (based on the coordinated anxiety learning and management (CALM) program) was designed to support primary care-based mental health providers in delivering CBT. The objectives of this study are to modify the CALM tool to meet the needs of mental health clinicians in veterans affairs (VA) community-based outpatient clinics (CBOCs) and rural "veterans", use external facilitation to implement CBT and determine the effect of the CALM tool versus a manualized version of CALM to improve fidelity to the CBT treatment model, and conduct a needs assessment to understand how best to support future implementation of the CALM tool in routine care. METHODS/DESIGN: Focus groups will inform the redesign of the CALM tool. Mental health providers at regional VA CBOCs; CBT experts; VA experts in implementation of evidence-based mental health practices; and veterans with generalized anxiety disorder, panic disorder, social anxiety disorder, posttraumatic stress disorder, "with or without" depression will be recruited. A hybrid type III design will be used to examine the effect of receiving CBT training plus either the CALM tool or a manual version of CALM on treatment fidelity. External facilitation will be used as the overarching strategy to implement both CBT delivery methods. Data will also be collected on symptoms of the targeted disorders. To help prepare for the future implementation of the CALM tool in VA CBOCs, we will perform an implementation need assessment with mental health providers participating in the clinical trial and their CBOC directors. DISCUSSION: This project will help inform strategies for delivering CBT with high fidelity in VA CBOCs to veterans with anxiety disorders and PTSD with or without depression. If successful, results of this study could be used to inform a national rollout of the CALM tool in VA CBOCs including providing recommendations for optimizing the adoption and sustained use of the computerized CALM tool among mental health providers in this setting. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02488551.


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Implementación de Plan de Salud/métodos , Trastornos Mentales/terapia , Población Rural , Veteranos/psicología , Humanos , Terapia Asistida por Computador/métodos , Resultado del Tratamiento , Estados Unidos , United States Department of Veterans Affairs
16.
Perm J ; 20(2): 89-92, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26909777

RESUMEN

Compared with people living in the community, researchers often have different frameworks or paradigms for thinking about health and wellness. These differing frameworks are often accompanied by differences in terminology or language. The purpose of this commentary is to describe some of our "Aha!" moments from conducting two pilot studies funded by the Patient-Centered Outcomes Research Institute. Over time, we came to understand how our language and word choices may have been acting as a wedge between ourselves and our community research partners. We learned that fruitful collaborative work must attend to the creation of a common language, which we refer to as the language of engagement. Such patient-centered language can effectively build a bridge between researchers and community partners. We encourage other researchers to think critically about their cultural competency, to be mindful of the social power dynamics between patient and physician, to reflect on how their understanding might differ from those of their patient partners, and to find ways to use a common language that engages patients and other community partners.


Asunto(s)
Lenguaje , Evaluación del Resultado de la Atención al Paciente , Conducta Cooperativa , Competencia Cultural , Humanos , Proyectos Piloto
17.
Psychiatr Serv ; 67(1): 55-61, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26325457

RESUMEN

OBJECTIVE: Providers share many stigmatizing attitudes with the general public regarding persons with mental illness. These attitudes may contribute to suboptimal general medical care for patients with schizophrenia. This study tested the hypothesis that provider contact (personal and professional) with persons with mental illness would be associated with clinical expectations and that this relationship would be mediated by provider stigmatizing attitudes. METHODS: Between August 2011 and April 2012, 192 health care providers from five Veterans Affairs medical centers responded to a clinical vignette describing a patient with schizophrenia who is seeking treatment for back pain. Providers completed a survey to determine their expectations regarding the vignette patient's treatment adherence, ability to read and understand health education materials, and social and vocational functioning. Self-report data on the amount of contact each provider had with persons with mental illness in their practices and in their personal lives were also collected. RESULTS: Structural equation modeling showed that providers with greater professional contact with patients with mental illness in their clinical practice and greater personal contact with individuals with mental illness exhibited significantly lower stigmatizing attitudes toward the patient with schizophrenia in the vignette and were more likely to expect the vignette patient to have better treatment adherence, a better understanding of educational material, and higher social and vocational functioning. CONCLUSIONS: Greater personal and professional contact with persons with mental illness was associated with lower provider stigma and higher expectations of patient adherence, increased ability to understand educational material, and higher social and vocational functioning. It is possible that interventions involving contact with persons with mental illness could reduce providers' stigma.


Asunto(s)
Actitud del Personal de Salud , Personal de Salud/psicología , Esquizofrenia , Estigma Social , Estereotipo , Adulto , Dolor de Espalda/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Esquizofrenia/complicaciones , Autoinforme , Estados Unidos
18.
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
20.
Health Educ Behav ; 43(5): 577-83, 2016 10.
Artículo en Inglés | MEDLINE | ID: mdl-26520152

RESUMEN

Interventions involving contact with a person who has recovered from mental illness are most effective at reducing stigma. This study sought input from health care providers to inform the design of a contact intervention intended to reduce provider stigma toward persons with serious mental illness. Using a purposive sampling strategy, data were collected from providers at five Veterans Affairs hospitals in the southeastern United States. Seven focus groups were conducted, and 83 health care providers participated. A semistructured interview guide was used to elicit providers' opinions about the target group of a contact intervention for providers, what providers would consider a credible contact, the preferred format for delivery, the usefulness of potentially tailoring the intervention to a specific facility, and how to measure change in clinical behaviors. Focus group data were analyzed using rapid data analysis techniques. Participants uniformly recommended a broad target audience for the stigma-reduction intervention, including all primary care and specialist providers. They suggested that the person providing the "lived experience" for the contact intervention should be either a health care provider or a patient with serious mental illness. Face-to-face presentation was favored, but video presentation was considered more feasible. Participants stated that information about local disparities in care rendered to patients with or without mental illness would convince providers of how stigma may be a contributing factor to these disparities. Multiple training opportunities were favored, while mandatory training was disliked. Standard stigma-reduction interventions with subgroups of the general public (e.g., providers) may need to be modified for optimum subgroup effectiveness.


Asunto(s)
Actitud del Personal de Salud , Personal de Salud/psicología , Promoción de la Salud/métodos , Trastornos Mentales/psicología , Estigma Social , Grupos Focales , Disparidades en Atención de Salud , Hospitales de Veteranos , Humanos , Entrevistas como Asunto , Sudeste de Estados Unidos , Estados Unidos , United States Department of Veterans Affairs
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA