ABSTRACT
Primary care physicians (PCPs) are well suited to manage patients with non-alcoholic fatty liver disease (NAFLD), but the limited, existing research suggests inadequate knowledge about the natural history, diagnostic methods, and management of NAFLD. The purpose of this qualitative study is to further understand the knowledge and practices for the diagnosis and management of NAFLD among PCPs. We conducted in-depth interviews with PCPs in the Greater Houston area, addressing current clinical practices used for diagnosing and managing NAFLD, as well as the perceptions of the PCPs regarding the burden of NAFLD on patients. We recorded interviews, transcribed them, coded transcripts, and identified patterns and themes. The interviewed PCPs (n = 16) were from internal or family medicine, with a range of experience (1.5-30 years). We found variations in NAFLD diagnosis and management across practices and by insurance status. Patients with abnormal liver imaging who had insurance or were within a safety-net healthcare system were referred by PCPs to specialists. Uninsured patients with persistently elevated liver enzymes received lifestyle recommendations from PCPs without confirmatory imaging or specialist referral. The role of PCPs in NAFLD management varied, with some helping patients set dietary and physical activity goals while others provided only general recommendations and/or referred patients to a dietitian. The diagnosis and management of NAFLD vary widely among PCPs and may be impacted by patients' insurance status and clinic-specific practices. The increasing burden of NAFLD in the U.S. medical system highlights the need for more PCPs involvement in managing NAFLD.
Subject(s)
Non-alcoholic Fatty Liver Disease , Physicians, Primary Care , Humans , Non-alcoholic Fatty Liver Disease/diagnosis , Non-alcoholic Fatty Liver Disease/therapy , Qualitative ResearchABSTRACT
Background: Economic and social hardships have worsened food insecurity, particularly among low income and racial-ethnic minority groups. Given the core goal of the 150+ member Houston Health Equity Collective (HEC) to reduce food insecurity by 5% in 2025, we explored member organizations' capacity and challenges faced in screening and responding to food insecurity through care coordination efforts. Methods: A twice-administered Qualtrics XM survey (Provo, Utah) with 76 organizations, followed by five focus groups with 22 of these organizations, explored reach and response efforts to food insecurity. Qualitative assessments lasted between 0.5 to 1.5 h, were audio-recorded, cleaned, coded, and thematically analyzed using NVivo, version 11 (Burlington, Massachusetts). The qualitative study was guided by a general inductive approach. In total, over 6 h of audiovisual recording were extracted, and over 100 pages of text exported to NVivo for data analysis. The research team read and coded transcripts independently using the codebook, and met routinely to discuss and resolve codes -resulting in numerous revisions to the codebook. Coding structure was discussed at multiple meetings and differences were addressed through consensus. Predominant qualitative themes impacting food insecurity screening were "stigma and cultural-related barriers", "clinic capacity and attitudes", "need to focus on upstream influences of food insecurity and SDOH needs", "impact of COVID-19", and "need for HEC system responses". Main recommendations to enhance screening and reach included improving staff culture, enhancing cultural sensitivity across organizational practices, and using shared technology to coordinate care. Respondents stated that the HEC can drive these recommendations through networking opportunities, use of shared resource directory, and placing focus on upstream factors. Conclusions: Recommendations to target food insecurity must focus on organizational staff responsiveness and sensitivity to patients' needs. Of equal importance is the need for increased attention to the upstream influencers and integration of systems-level interventions to holistically target the barriers impacting food insecurity.
Subject(s)
COVID-19 , Ethnicity , Humans , COVID-19/epidemiology , Minority Groups , Qualitative Research , Focus GroupsABSTRACT
Partnerships between food prescription programs and food banks can address food insecurity and support health; however, few studies have examined the experience and perceptions of health care partners about these programs. Our objective was to analyze secondary qualitative data from clinicians and clinic staff involved in implementing a food prescription program in Houston, Texas. We collected data from 17 health care clinics from May 2018 through March 2021 to learn how implementation of the food prescription program was perceived, and we received 252 responses. Principal themes were the importance of a value-based care strategy, patient and food pantry barriers to success, the importance of interorganizational care coordination, and the need to integrate food prescriptions into clinic workflow. Insights of clinicians and clinic staff on implementation of food prescription programs can inform program development and dissemination.
Subject(s)
Delivery of Health Care , Food , Humans , Qualitative Research , Ambulatory Care Facilities , PrescriptionsABSTRACT
BACKGROUND: Limited information exists on how the family unit aids or impedes physical activity (PA) engagement within Hispanic populations. This qualitative study explored family-level influences on PA in dyads of adult Hispanic family members (eg, parent-adult child, siblings, spouses). METHODS: In-person interviews and brief surveys were conducted together with 20 dyads lasting 1.5 hours each. Two researchers coded and analyzed text using thematic analysis in NVivo (version 11.0). They resolved discrepancies through consensus and used matrix coding analysis to examine themes by participants' demographics. RESULTS: The participants were mainly women (70%), from Mexico (61.5%), and they reported low levels of acculturation (87.5%). Themed facilitators for PA included "verbal encouragement," "help with responsibilities," "exercising with someone," and "exercising to appease children." Themed challenges included "lack of support," "challenges posed by children," "sedentary behaviors," and "competing responsibilities." Women more so than men described family-level challenges and facilitators, and dyads where both study partners were physically active provided more positive partner interaction descriptions for PA support than other dyads. CONCLUSIONS: This study suggests that leveraging family support may be an important approach to promote and sustain PA, and that family-focused interventions should integrate communication-building strategies to facilitate family members' ability to solicit support from each other.
Subject(s)
Exercise , Family , Hispanic or Latino , Adult , Female , Humans , Male , Parents , Qualitative Research , Sedentary Behavior , Adult ChildrenABSTRACT
OBJECTIVES: Early first trimester prenatal counseling could reduce adverse maternal and child health outcomes. Existing literature does not identify the length of time between suspecting pregnancy and attending their first prenatal visit. Identifying this potential window for change is critical for clinical practice, intervention programming and policy change. METHODS: The study sample was composed of women in the United States who responded to the Pregnancy Risk Assessment Monitoring Systems survey in 2016, for the following questions-when they first suspected pregnancy, when they attended their first prenatal visit, were they able to receive prenatal care as early as they wished, and perceived barriers to receiving prenatal care. RESULTS: On average, participants became certain they were pregnant at 6.0 (SE = 0.1) weeks gestation, while participants reported having their first prenatal care visit at 9.3 (SE = 0.1) weeks, with clear health disparities by race, age, WIC participation, education level, and marital status. About 15% of women reported not receiving prenatal care as early as they wished. Structural or financial barriers in the health care system were common: 38.1% reported that no appointments available, 28.2% reported not having money or insurance to pay for the visit, 27.3% reported that the doctor or health plan would not start care, and 22.5% reported not having a Medicaid card. CONCLUSIONS FOR PRACTICE: This study illustrates a window for opportunity to provide earlier prenatal care, which would facilitate earlier implementation of prenatal counseling. Strategies to address barriers to care on the patient, provider and systemic levels, particularly among vulnerable population groups, are warranted. WHAT IS ALREADY KNOWN ON THIS SUBJECT?: Seeking prenatal care early is associated with better health outcomes for women and infants. A window of opportunity exists between suspecting pregnancy and attending a first prenatal visit. WHAT THIS STUDY ADDS?: Clear health disparities were apparent in both recognizing their pregnancies, and receiving early prenatal care by race, age, WIC participation, education level, and marital status. About 15% of women reported not receiving prenatal care as early as they wished, and many attributed this later care to structural or financial barriers in the health care system.
Subject(s)
Population Surveillance , Prenatal Care , Child , Female , Gestational Age , Humans , Infant , Pregnancy , Pregnancy Trimester, First , Risk Assessment , United StatesABSTRACT
Understanding sociodemographic, behavioral, clinical, and laboratory risk factors in patients diagnosed with COVID-19 is critically important, and requires building large and diverse COVID-19 cohorts with both retrospective information and prospective follow-up. A large Health Information Exchange (HIE) in Southeast Texas, which assembles and shares electronic health information among providers to facilitate patient care, was leveraged to identify COVID-19 patients, create a cohort, and identify risk factors for both favorable and unfavorable outcomes. The initial sample consists of 8,874 COVID-19 patients ascertained from the pandemic's onset to June 12th, 2020 and was created for the analyses shown here. We gathered demographic, lifestyle, laboratory, and clinical data from patient's encounters across the healthcare system. Tobacco use history was examined as a potential risk factor for COVID-19 fatality along with age, gender, race/ethnicity, body mass index (BMI), and number of comorbidities. Of the 8,874 patients included in the cohort, 475 died from COVID-19. Of the 5,356 patients who had information on history of tobacco use, over 26% were current or former tobacco users. Multivariable logistic regression showed that the odds of COVID-19 fatality increased among those who were older (odds ratio = 1.07, 95% CI 1.06, 1.08), male (1.91, 95% CI 1.58, 2.31), and had a history of tobacco use (2.45, 95% CI 1.93, 3.11). History of tobacco use remained significantly associated (1.65, 95% CI 1.27, 2.13) with COVID-19 fatality after adjusting for age, gender, and race/ethnicity. This effort demonstrates the impact of having an HIE to rapidly identify a cohort, aggregate sociodemographic, behavioral, clinical and laboratory data across disparate healthcare providers electronic health record (HER) systems, and follow the cohort over time. These HIE capabilities enable clinical specialists and epidemiologists to conduct outcomes analyses during the current COVID-19 pandemic and beyond. Tobacco use appears to be an important risk factor for COVID-19 related death.
Subject(s)
COVID-19/mortality , Health Information Exchange/statistics & numerical data , Health Information Exchange/trends , Age Factors , Cohort Studies , Comorbidity , Ethnicity , Healthcare Disparities , Hospitalization , Humans , Pandemics , Prospective Studies , Retrospective Studies , Risk Factors , SARS-CoV-2/metabolism , SARS-CoV-2/pathogenicity , Sex Factors , Smoking , TexasABSTRACT
BACKGROUND: Physical activity (PA), sedentary behavior, and sleep are interconnected, promoting optimal health. Few studies have examined these factors holistically. Therefore, the purpose of this study was to capture the 24-hour activity cycles of the US population by examining PA, sedentary behavior, and sleep based on the presence of a child within the home, as well as gender and weight. METHODS: Cross-sectional health-related variables from the National Health and Nutrition Examination Survey were used for analysis. The primary variables were the total and type of PA (recreation, work, and active transportation), sedentary behavior, and sleep. Chi-square and regression models were applied to compare the outcomes across participants' characteristics. RESULTS: The adults with children within the home reported less recreational PA, more work activity, less sedentary activity, and less sleep, but no differences in total PA. The females with children in the home not only had the lowest levels of recreational activity and sleep, but also the lowest levels of sedentary behavior. The obese individuals with children in the home had less sedentary time than the adults without children in the home, regardless of weight status. CONCLUSIONS: Unhealthy sleep and PA behaviors are prevalent in adults with children living at home, and women are particularly impacted.
Subject(s)
Exercise , Sedentary Behavior , Adult , Child , Cross-Sectional Studies , Female , Humans , Nutrition Surveys , SleepABSTRACT
This article presents the structure and function of the Health Equity Collective in developing a systemic approach to promoting health equity across the Greater Houston area. Grounded in Kania and Kramer's five phases of collective impact for coalition building, The Collective operationalizes its mission through its backbone team, steering committees, and eight workgroups; each has goals that mutually reinforce and advance its vision. To date, Phase I (generating ideas), Phase II (initiating action), and Phase III (organizing for impact) have been completed. Phases IV (implementation) and Phase V (sustainability) are currently underway.
ABSTRACT
INTRODUCTION: Associations across self-efficacy, social support, and multiple measures of physical activity (PA) have not been thoroughly explored in hospital employees. METHODS: Validated surveys assessed psychosocial factors; the IPAQ-long assessed PA, and mixed-effects analyses examined relations between psychosocial variables and PA in 920 employees from 6 Texas hospitals. RESULTS: At P <.05, self-efficacy was significantly associated with light (ß = 1.67), moderate (ß = 1.63), and vigorous (ß = 2.78) leisure PA; with domestic PA (ß = 1.64); and with moderate commute PA (ß = 0.03). At P < .05, family social-support was significantly associated with light (ß = 0.94), moderate (ß = 0.63), and vigorous (ß = .74) leisure PA; with moderate (ß = 0.46) and vigorous (ß = 1.24) occupation PA; with light (ß = 0.58) and moderate (ß = 0.20) commute PA; and with domestic PA (ß = 1.18). At P < .05, social support from friends was significantly associated with light (ß = 0.74), moderate (ß = 0.58), and vigorous (ß = .91) leisure PA; with moderate commute (ß = 0.21); and with domestic PA (ß = 0.82). CONCLUSION: Interventions must emphasize self-efficacy-building strategies and the role of family support to meaningfully impact PA behaviors in this unique population.
Subject(s)
Exercise/psychology , Personnel, Hospital/psychology , Self Efficacy , Social Support , Adolescent , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Young AdultABSTRACT
Objectives: In this study, we examined how racial discrimination and neighborhood perceptions relate to physical activity and sedentary behavior mediated through depression symptoms. Methods: Data were from the first year of a longitudinal cohort study, Project Creating a Higher Understanding of cancer Research and Community Health (CHURCH), based on a convenience community sample of church-attending African Americans collected between April 2012 and March 2013 (N = 370) in Houston, Texas. Measures included racial discrimination, perceived neighborhood problems and vigilance, depression (CES-D), physical activity (IPAQ-short), and sedentary behavior. Results: Main effects from the structural equation model showed that racial discrimination (b = .20, p < .01) was related to greater depression symptoms. The same pattern emerged for neighborhood problems, but the effect was not significant (b = .20, p = .07). Further, depression symptoms were related to less physical activity (b = -.62, p = .03) and greater sedentary behavior (b = .64, p < .01). Indirect effects showed that depression mediated the relationship between racial discrimination and neighborhood problems on physical activity and sedentary behavior. Conclusions: Depression symptoms are an important mechanism by which racial discrimination and perceived neighborhood problems impact physical activity and sedentary behavior.
Subject(s)
Black or African American/ethnology , Depression/ethnology , Exercise , Racism/ethnology , Residence Characteristics/statistics & numerical data , Sedentary Behavior/ethnology , Stress, Psychological/ethnology , Adult , Female , Humans , Longitudinal Studies , Male , Middle Aged , Texas/ethnologyABSTRACT
OBJECTIVE: This study examined physical activity (PA) profiles of hospital employees and evaluated associations between PA domains (occupation, commute, leisure, and domestic) and intensity levels (light, moderate, and vigorous) with body mass index (BMI). METHODS: Nine hundred twenty employees across six Texas hospitals were enrolled in the multisite study, 2012 to 2013. Analysis of covariance tests assessed equality of means (minutes) across PA measures, and mixed effects analyses evaluated associations between PA measures and BMI, while controlling for covariates. RESULTS: Over 78% of participants were overweight or obese. Mixed effects models showed significant inverse associations with BMI: light leisure PA (ßâ=â-0.0183|Pâ=â0.003), moderate leisure PA (ßâ=â-0.0182|Pâ=â0.005), vigorous leisure PA (ßâ=â-0.0248|Pâ=â0.000), moderate commute PA (ßâ=â-0.0315|Pâ=â0.02), moderate domestic PA (ßâ=â-0.0087|Pâ=â0.018), and vigorous occupation PA (ßâ=â-0.0158|Pâ=â0.001). CONCLUSION: Delivery of effective interventions in this population must consider the nature of the work environment as well as employees' PA profiles.
Subject(s)
Body Mass Index , Exercise , Personnel, Hospital , Adolescent , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Young AdultABSTRACT
We investigated class clustering patterns of four behaviors-physical activity, fruit and vegetable (F&V) intake, smoking, and alcohol use-in a faith-based African American cohort. Guided by socio-ecological models, we also examined the psychosocial and neighborhood social environmental factors associated with the clustering patterns. Participants were 1,467 African American adults recruited from a mega church in the metropolitan Houston, TX, in 2008-2009. They completed a survey and health assessment. Latent class analysis and multinomial regression analysis were conducted. Results supported a three-class model: Class 1 was characterized by low physical activity, low F&V intake, and low substance use (smoking and alcohol use). Class 2 was characterized by high physical activity, low F&V intake, and mild drinking. Class 3 seemed to be the healthiest group, characterized by high physical activity, moderate-to-high F&V intake, and low substance use. The probabilities of being included in Classes 1, 2, and 3 were .33, .48, and .19, respectively. Participants in Class 1 (vs. Class 3) reported lower physical activity norm ( p < .001) and higher smoking norm ( p = .002) and lower neighborhood social cohesion ( p = .031). Participants in Class 2 (vs. Class 3) reported higher cancer risk perception ( p < .001), lower F&V norm ( p = .022), lower physical activity norm ( p < .001), higher smoking norm ( p < .001), and lower social cohesion ( p = .047). As health behaviors are clustered together, future interventions for African Americans may consider targeting multiple health behaviors instead of targeting a single health behavior. Interventions addressing social norm and neighborhood social cohesion may enhance multiple health behaviors engagement in this population.