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N C Med J ; 81(1): 5-13, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908325


BACKGROUND In 2016, the North Carolina Division of Public Health (DPH) launched the Improving Community Outcomes for Maternal and Child Health (ICO4MCH) program to provide 5 local health departments (LHDs) with financial resources and technical assistance to address 3 aims: improve birth outcomes, reduce infant mortality, and improve health for children from birth to 5 years.METHOD: State legislation established an academic-practice partnership between NCDPH and the University of North Carolina at Chapel Hill (UNC) to provide program evaluation and implementation coaching to LHDs. ICO4MCH used a collective impact framework, principles of implementation science, and a health equity approach to implement evidence-based strategies to address the program's aims.RESULTS: A shared measurement system was developed by an evaluation stakeholders group led by the NCDPH and UNC in which LHDs reported data on a quarterly basis and the evaluators returned reports to drive improvements. Structured assessments and technical assistance provided by implementation coaches helped grantees address barriers to implementation including cultivating and sustaining a diverse community action team, addressing staff turnover, and using data to drive improvements.LIMITATIONS: It was challenging for grantees to balance community needs and build partnerships in the first year while integrating data from multiple assessments into action plans to meet the performance measures. It was necessary to streamline assessments and reduce indicators to make data more actionable.CONCLUSION: An academic-practice partnership was integral to successful implementation of the ICO4MCH program and may serve as a model for moving evidence-based maternal child health programs to practice in LHDs.

Saúde da Criança , Promoção da Saúde/organização & administração , Relações Interinstitucionais , Saúde Materna , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , North Carolina , Gravidez , Avaliação de Programas e Projetos de Saúde
J Ambul Care Manage ; 39(1): 76-86, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26650748


Peer support (PS) is a strategy for improving quality of care for people with chronic disease and is increasingly being integrated with primary care. We conducted semistructured qualitative interviews with 18 staff members from 4 practices that have integrated PS and primary care. From these interviews, we identified several benefits of PS and primary care integration as well as challenges to integrating and sustaining PS programs. We also identified key considerations and strategies for facilitating integration. Strategies for developing messaging to promote understanding of the unique role of peer supporters are discussed.

Annu Rev Public Health ; 35: 363-83, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24387085


As reviewed in the article by Perry and colleagues (2014) in this volume, ample evidence has documented the contributions of peer support (PS) to health, health care, and prevention. Building on that foundation, this article discusses characteristics, contexts, and dissemination of PS, including (a) fundamental aspects of the social support that is often central to it; (b) cultural influences and ways PS can be tailored to specific groups; (c) key features of PS and the importance of ongoing support and backup of peer supporters and other factors related to its success; (d) directions in which PS can be expanded beyond prevention and chronic disease management, such as in mental health or interventions to prevent rehospitalization; (e) other opportunities through the US Affordable Care Act, such as through patient-centered medical homes and chronic health homes; and (f) organizational and policy issues that will govern its dissemination. All these demonstrate the extent to which PS needs to reflect its contexts--intended audience, health problems, organizational and cultural settings--and, thus, the importance of dissemination policies that lead to flexible response to contexts rather than constraint by overly prescriptive guidelines.

Promoção da Saúde/organização & administração , Grupo Associado , Prática de Saúde Pública , Apoio Social , Fatores Etários , Análise Custo-Benefício , Cultura , Humanos , Disseminação de Informação , Saúde Mental , Patient Protection and Affordable Care Act , Fatores Sexuais , Fatores Socioeconômicos , Populações Vulneráveis/psicologia
J Am Dent Assoc ; 142(11): 1275-82, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22041414


BACKGROUND: Racial or ethnic and economic disparities exist in terms of oral diseases among pregnant women and children. The authors hypothesized that women of a racial or ethnic minority have less oral health knowledge than do women not of a racial or ethnic minority. Therefore, the authors conducted a study to assess and compare maternal oral health knowledge and beliefs and to determine if maternal race and ethnicity or other maternal factors contributed to women's knowledge or beliefs. METHODS: The authors administered a written oral health questionnaire to pregnant women. The authors calculated the participants' knowledge and belief scores on the basis of correct answers or answers supporting positive oral health behaviors. They conducted multivariable analysis of variance to assess associations between oral health knowledge and belief scores and characteristics. RESULTS: The authors enrolled 615 women in the study, and 599 (97.4 percent) completed the questionnaire. Of 599 participants, 573 (95.7 percent) knew that sugar intake is associated with caries. Almost one-half (295 participants [49.2 percent]) did not know that caries and periodontal disease are oral infections. Median (interquartile range) knowledge and belief scores were 6.0 (5.5-7.0) and 6.0 (5.0-7.0), respectively. Hispanic women had median (interquartile range) knowledge and belief scores significantly lower than those of white or African American women (6.0 [4.0-7.0] versus 7.0 [6.0-7.0] versus 7.0 [6.0-7.0], respectively [P < .001]; and 5.0 [4.0-6.0] versus 6.0 [5.0-7.0] versus 6.0 [5.0-7.0], respectively [P < .001]). Multivariable analysis of variance results showed that being of Hispanic ethnicity was associated significantly with a lower knowledge score, and that an education level of eighth grade or less was associated significantly with a lower belief score. CONCLUSIONS: Pregnant women have some oral health knowledge. Knowledge varied according to maternal race or ethnicity, and beliefs varied according to maternal education. Including oral health education as a part of prenatal care may improve knowledge regarding the importance of oral health among vulnerable pregnant women, thereby improving their oral health and that of their children. CLINICAL IMPLICATIONS: Including oral health education as a part of prenatal care should be considered.

Atitude Frente a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Saúde Bucal , Gravidez/psicologia , Adulto , Afro-Americanos/psicologia , Americanos Asiáticos/psicologia , Cariostáticos/uso terapêutico , Cárie Dentária/etiologia , Cárie Dentária/microbiologia , Sacarose na Dieta/efeitos adversos , Escolaridade , Grupos Étnicos/psicologia , Grupo com Ancestrais do Continente Europeu/psicologia , Feminino , Fluoretos/uso terapêutico , Comportamentos Relacionados com a Saúde , Hispano-Americanos/psicologia , Humanos , Renda , Cobertura do Seguro , Estado Civil , Comportamento Materno , North Carolina , Higiene Bucal , Doenças Periodontais/microbiologia , Inquéritos e Questionários
J Am Dent Assoc ; 141(5): 553-61, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20436103


BACKGROUND: Daily oral hygiene and regular dental visits are important components of oral health care. The authors' objective in this study was to examine women's oral hygiene practices and use of dental services during pregnancy. METHODS: The authors developed a written oral health questionnaire and administered it to 599 pregnant women. They collected demographic information, as well as data on oral hygiene practices and use of dental services during pregnancy. They used chi2 and multivariable logistic regression models to assess associations between oral hygiene practice and dental service use during pregnancy and to identify maternal predictor variables. RESULTS: Of the 599 participants, 83 percent (n=497) reported brushing once or twice per day. Twenty-four percent (n=141) reported flossing at least once daily; Hispanic women were more likely to floss than were white or African American women (28 percent [52 of 183] versus 22 percent [54 of 248] versus 19 percent [23 of 121], respectively, P<.001). Seventy-four percent (n=442) of the participants reported having received no routine dental care during pregnancy. Hispanic women were significantly less likely than were black or white women to receive routine dental care during pregnancy (13 percent versus 21 percent versus 36 percent, respectively, P<.001). The authors found that being older than 36 years, being of Hispanic race or ethnicity, having an annual income of less than $30,000, flossing infrequently and receiving no dental care when not pregnant were significantly associated with lack of routine dental care during pregnancy (adjusted odds ratios, 95 percent confidence intervals: 2.56 [1.33-4.92]; 2.19 [1.11-4.29]; 2.02 [1.12-3.65]; 1.86 [1.13-3.07]; and 4.35 [2.5-7.69], respectively). A woman's lack of receiving routine dental care when not pregnant was the most significant predictor of lack of receiving dental care during pregnancy. CONCLUSION: Racial, ethnic and economic disparities related to oral hygiene practices and dental service utilization during pregnancy exist. CLINICAL IMPLICATIONS: Medical and dental care providers who treat women of reproductive age and pregnant women need to develop policy strategies to address this population's access barriers to, and use of, dental care services.

Assistência Odontológica/estatística & dados numéricos , Higiene Bucal/estatística & dados numéricos , Gravidez , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Fatores Etários , Estudos de Coortes , Dispositivos para o Cuidado Bucal Domiciliar/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Previsões , Conhecimentos, Atitudes e Prática em Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Seguro Odontológico/estatística & dados numéricos , Idade Materna , Saúde Bucal , Autoimagem , Inquéritos e Questionários , Escovação Dentária/estatística & dados numéricos , Adulto Jovem