Racial Anxiety among Medical Residents: Institutional Implications of Social Accountability.

As the U.S. population becomes more racially diverse, physicians need to have cultural skills for optimal health outcomes; however, the literature is sparse for cultural skill application of medical trainees. This paper focuses on Family Medicine residents' perceptions of racial anxiety and their preparedness to manage cross-racial interactions. Of the 24 respondents, the majority were female. The ethnicities of respondents were 16 non-Hispanic White, five African American, and three Native American. Most participants demonstrated good general knowledge and/or self-efficacy on racial anxiety, but produced lower scores in workplace skills and actions related to racial anxiety. Thus, physician training programs should incorporate more skill development around racial anxiety. More research is needed to examine how medical schools approach multicultural education as a method of disrupting health disparities to reflect trends of social accountability and social justice.

Physician Trust and Home Remedy Use Among Low-Income Blacks and Whites with Hypertension: Findings from the TRUST Study.

INTRODUCTION: Home remedies are used for the treatment of hypertension despite unsubstantiated claims of their effectiveness. Home remedy use is often attributed to mistrust towards healthcare providers. Few studies examine the relationship between home remedy use and physician trust. The objective of this study was to examine and compare the association between home remedy use and trust in physicians in a cohort of low-income Blacks and Whites with hypertension living in an inner city in Alabama. METHODS: A cross-sectional examination was conducted among 925 Black and White patients receiving care at an urban hospital. Data was collected from in-person surveys. Trust in physicians was self-reported using the Hall General Trust Scale which included questions about honesty, confidentiality, and trust. Home remedy use was self-reported using the Brown and Segal scale which included questions about home remedy use and types of home remedies used. Covariates included demographic factors such as age, race, gender, and health outcomes. Data were analyzed using linear regression. RESULTS: Twenty-eight percent of Black and 15% of White participants reported home remedy use (p = 0.001). Black home remedy users (38.9) and non-users (39.3) had similar trust scores (p = 0.582). Whites home remedy users (32.9) reported lower trust in physicians than White non-users (37.7) (p = 0.026). CONCLUSIONS: Black home remedy users, non-users, and White non-users reported similar trust scores; the lowest trust scores were found among White home remedy users. Home remedy use was higher among Black participants. Future studies should examine the context of mistrust and home remedy use among Whites.

HIV Knowledge, Perceived Risk and Gender as Modulators of Salivary HIV Rapid Testing in African Americans.

BACKGROUND: Of more than 1.2 million people in the United States (US) living with HIV infection, almost 1 in 8 (12.8%) are unaware of their infection. The introduction of a rapid HIV test using a saliva sample in 2004 made immediate results possible in community-based settings. Despite use of salivary rapid testing (SRT) over the last ten years, not enough is known about barriers to and acceptability of SRT among African Americans (AAs). PURPOSE: The purpose of this study was to identify factors associated with SRT for HIV among AAs. METHODS: A cross-sectional study was conducted with 329 AA men and women recruited from a sexually transmitted infection (STI) clinic. RESULTS: Results of study showed that participants with higher AIDS knowledge (p<0.001) and problem-focused coping (p<0.003) tended to have higher likelihood for participation in testing. In terms of seeking medical help, participants with lower emotional-focused coping, lower risky behavior and higher AIDS knowledge tended to be more likely to seek medical help (p=0.015, p<0.001, p<0.04, respectively). Female participants with higher values of risky behavior tended to be more likely to participate in testing (p=0.001). CONCLUSIONS: The findings support the need to assess barriers and facilitators to testing decisions in order to increase testing rates. In particular, AIDS knowledge and either problem or emotional-focused coping and risky behaviors, based on gender may be important in making testing and care entry decisions.

Barriers and Facilitators to HIV Testing Among Women.

AIM: The purpose of this secondary analysis was to analyze for barriers and facilitators to HIV testing in women attending community health clinics. INTRODUCTION: The Centers for Disease Control and Prevention (CDC), reported that all women account for 20% or 1 in 5 of new HIV cases (CDC, 2012). Of those new cases in heterosexual women, 5,300 were Black, 1,300 were White, and 1,200 were Hispanic/Latina. The CDC estimated that in 2012 there were 9,268 individuals living with a diagnosis of HIV or AIDS, of which 19% were women. RESULTS: The existing de-identified data consisted of thirty individual interviews conducted using a semi-structured interview guide was collected as the initial phase of the parent study, "HIV Testing and Women's Attitudes on HIV Vaccine Trials". This secondary analysis addressed the identification of key obstacles to HIV testing and only those related portions of the transcripts were analyzed. The major themes identified were familiarity with testing, stigma, fear, perceived risks, and access to care. CONCLUSION: The themes implicated the need to further assess women for barriers and facilitators to testing, tailor community based interventions that have the ability to decrease fear and stigma, increase trust in testing methods and offer counseling to positive results.

Reverse Migration, the Black Church and Sexual Health: Implications for Building HIV/AIDS Prevention Capacity in the Deep South.

The Black Church has long been purported as being strongly influential in the lives of Blacks in America. Recent U.S. census data trends highlight a "reverse migration" pattern where Blacks are moving back to the South from larger metropolitan areas in other U.S. geographical regions. This migration pattern parallels the increasing HIV/AIDS prevalence among Blacks in the Deep South. This paper reviews both the historical and current migration patterns among Blacks, as well as the current HIV/AIDS epidemic among Blacks in the Deep South. Thereafter, the authors discuss an existing framework for increasing HIV/AIDS prevention capacity through a conceptual connection of migration, religion and sexual health. The authors use case studies to support the proposed framework. It is hoped that the framework could be used to address HIV/AIDS health disparities and other chronic diseases affecting Blacks in America.

Bringing Community and Academic Scholars Together to Facilitate and Conduct Authentic Community Based Participatory Research: Project UNITED.

Cultural competency, trust, and research literacy can affect the planning and implementation of sustainable community-based participatory research (CBPR). The purpose of this manuscript is to highlight: (1) the development of a CBPR pilot grant request for application; and (2) a comprehensive program supporting CBPR obesity-related grant proposals facilitated by activities designed to promote scholarly collaborations between academic researchers and the community. After a competitive application process, academic researchers and non-academic community leaders were selected to participate in activities where the final culminating project was the submission of a collaborative obesity-related CBPR grant application. Teams were comprised of a mix of academic researchers and non-academic community leaders, and each team submitted an application addressing obesity-disparities among rural predominantly African American communities in the US Deep South. Among four collaborative teams, three (75%) successfully submitted a grant application to fund an intervention addressing rural and minority obesity disparities. Among the three submitted grant applications, one was successfully funded by an internal CBPR grant, and another was funded by an institutional seed funding grant. Preliminary findings suggest that the collaborative activities were successful in developing productive scholarly relationships between researchers and community leaders. Future research will seek to understand the full-context of our findings.

Narratives to enhance smoking cessation interventions among African-American smokers, the ACCE project.

BACKGROUND: Low-income, African-American smokers are less likely to have resources to aid in quitting smoking. Narrative communication may provide an enhancement to traditional smoking cessation interventions like NRT, medications, or behavioral treatments for this audience. After extensive pilot testing of stories and personal experiences with smoking cessation from African-Americans from a low-income community, we conducted a randomized control trial using stories to augment routine inpatient treatment among African-Americans at an urban Southern hospital (N = 300). RESULTS: Differences in smoking cessation outcomes between the intervention (stories DVD + routine clinical treatment) and control (routine clinical treatment) arms were compared using self-report and carbon monoxide measurement at 6-months. Compared to control, individuals who viewed the intervention stories DVD reported greater intentions to quit. Although continuous quitting marginally favored the intervention, our main result did not reach statistical significance (p = 0.16). CONCLUSION: Narrative communication via storytelling to promote smoking cessation among African-Americans in the South is one method to communicate smoking cessation. Results suggest this may not be sufficient as a stand-alone augmentation of routine clinical treatment for continuous smoking cessation. Smoking cessation efforts need to continually assess different means of communicating to smokers about quitting. CLINICAL TRIALS REGISTRATION: The ClinicalTrials.gov Identifier is NCT00101491. This trial was registered January 10, 2005.

A Health Literacy Program Using Family Health History for Young Black Rural Students: Implications for Reducing Health Disparities.

This report from the field introduces use of the U.S. Surgeon General's Family Health Portrait in an African American rural middle school population in Alabama. It is believed that use of this online tool in this population could serve as a model for addressing chronic health disparities between African Americans and Whites at an earlier age.

The evolution of a community-based telepsychiatry program in rural Alabama: lessons learned-a brief report.

The purpose of this paper is to describe the partnership between a community-based rural mental health clinic and an academic health center to provide telepsychiatry services in rural Alabama. The partnership was developed to meet the needs of a clinic that serves an underserved rural population with limited psychiatric services. This paper offers valuable lessons learned for mental health practitioners who may be considering the benefits and challenges of forming community-based partnerships in use of telepsychiatry to build capacity to deliver clinical mental health services to rural mental health shortage areas.

Assessment of HIV/AIDS prevention of rural African American Baptist leaders: implications for effective partnerships for capacity building in American communities.

PURPOSE: This exploratory study sought to elicit information from rural Baptist leaders about their interest in HIV prevention activities within their congregation and other influencers in their human deficiency virus (HIV) prevention activities based on their geographical residence (urban vs rural). METHODS: This study utilized both qualitative (in-depth interviews, N = 8) and quantitative (written survey, N = 56) methodologies (mixed method) in order to obtain pertinent information. A ministerial liaison was hired to assist in recruitment of participants within a statewide Baptist conference. Written surveys were distributed at a statewide meeting. RESULTS: The majority of participants (N = 50) in this study (89.3%) were receptive to conducting HIV/AIDS prevention activities within their congregations. The study also revealed rural/urban differences, including: interest in HIV/AIDS prevention, direct experiences with infected persons, or whether churches have a health-related ministry. Positive influencers of HIV/AIDS prevention in rural church leaders included either the participant or their spouse being in a health-related occupation, migratory patterns from larger metropolitan areas in other areas of the country to the rural south, and whether the church has a health-related ministry. CONCLUSIONS: Findings from this study are significant for a variety of reasons, including use of faith-based models for HIV/ AIDS capacity building and use of potential influencers on HIV/AIDS prevention in African Americans in the rural Deep South, where the epidemic is growing fastest. Future implications of this study might include expansion of faith-based models to include other denominations and health care providers as well of use of positive influencers to develop future HIV/AIDS intervention strategies.

Recruitment of rural physicians in a diabetes internet intervention study: overcoming challenges and barriers.

PURPOSE: This paper highlights a descriptive study of the challenges and lessons learned in the recruitment of rural primary care physicians into a randomized clinical trial using an Internet-based approach. METHODS: A multidisciplinary/multi-institutional research team used a multilayered recruitment approach, including generalized mailings and personalized strategies such as personal office visits, letters, and faxes to specific contacts. Continuous assessment of recruitment strategies was used throughout study in order to readjust strategies that were not successful. RESULTS: We recruited 205 primary care physicians from 11 states. The 205 lead physicians who enrolled in the study were randomized, and the overall recruitment yield was 1.8% (205/11231). In addition, 8 physicians from the same practices participated and 12 nonphysicians participated. The earlier participants logged on to the study Web site, the greater yield of participation. Most of the study participants had logged on within 10 weeks of the study. CONCLUSION: Despite successful recruitment, the 2 major challenges in recruitment in this study included defining a standardized definition of rurality and the high cost of chart abstractions. Because many of the patients of study recruits were African American, the potential implications of this study on the field of health disparities in diabetes are important.

Older African Americans' management of HIV/AIDS stigma.

The purpose of this study was to describe HIV/AIDS-related stigma in older African Americans living in the South, a population disproportionately affected by HIV/AIDS. Four focus groups were conducted with 24 men and women over 50 years old and a confirmed diagnosis of HIV. The focus group discussions were audiotaped and transcribed for analysis. Additionally, two stigma instruments, Self-Perceptions of HIV Stigma, and Stigma Impact of HIV, were used to enhance the qualitative data from the focus groups. Constant comparative data analysis of the focus group discussions resulted in four themes related to HIV/AIDS stigma: (1) disclosure; (2) stigma experiences; (3) need for HIV/AIDS education; and (4) acceptance of the disease. Strategies to prevent or decrease anticipated stigma were described, such as selective or non-disclosure and not receiving care where they lived. The stigma instruments indicated that the participants had experienced the most stigma related to their internalized shame about having HIV disease, and had experienced little or no direct stigma. The study findings have implications for designing prevention programs, and strategies to improve social support for this age group.