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BACKGROUND: A critical unmet need for underserved patients with diabetes is regular access to sufficient support for diabetes self-management. Although advances in digital technologies have made way for eHealth applications that provide a scalable path for tailored interventions for self-management of chronic conditions, health and digital literacy has remained an obstacle to leveraging these technologies for effective diabetes self-management education. Studies have shown that the availability of coaches helps to maintain engagement in internet-based studies and improves self-efficacy for behavior change. However, little is known about the substances involved in these interactions. OBJECTIVE: This study aims to compare the content of conversations between patient-coach pairs that achieved their self-management goals and those that did not. The context is a clinical implementation study of diabetes self-management behavior change using Health360x within the practices of the Morehouse Choice Accountable Care Organization in the Atlanta metro area. Health360x is a coach-assisted consumer health information technology designed to support self-management skills acquisition and behavior among underserved, high-risk patients with diabetes. METHODS: We provide a novel analysis of the discursive emphasis on patients and coaches. We examined transcripts of visits using a structural topic model to estimate topic content and prevalence as a function of patient and coach characteristics. We compared topics between patient-coach pairs that achieved diabetes-related self-management goals and those who did not. We also estimated a regression in which utterances are the units, the dependent variable is the proportion of an utterance that is about a given topic, and the independent variables are speaker types and explored other themes. RESULTS: Transcripts from 50 patients who were recruited and consented, starting in February 2015, were analyzed. A total of 44 topics were estimated for patient-coach pairs that achieved their intended health goals and 50 topics for those who did not. Analysis of the structural topic model results indicated that coaches in patient-coach pairs that were able to achieve self-management goals provided more contextual feedback and probed into patients' experience with technology and trust in consumer information technologies. We also found that discussions around problem areas and stress, support (ßCoach=.015; P<.001), initial visits (ßCoach=.02; P<.001), problems with technology (ßCoach=.01; P<.001), health eating goals (ßCoach=.01; P=.04), diabetes knowledge (ßCoach=.02; P<.001), managing blood sugar (ßCoach=.03; P<.001), and using Health360x (ßCoach=.003; P=.03) were dominated by coaches. CONCLUSIONS: Coach-facilitated, technology-based diabetes self-management education can help underserved patients with diabetes. Our use of topic modeling in this application sheds light on the actual dynamics in conversations between patients and coaches. Knowledge of the key elements for successful coach-patient interactions based on the analysis of transcripts could be applied to understanding everyday patient-provider encounters, given the recent paradigm shift around the use of telehealth.
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Diabetes Mellitus , Tutoria , Autogestão , Glicemia , Diabetes Mellitus/terapia , Humanos , TecnologiaRESUMO
Persons without health care coverage have poorer health outcomes. We investigated the association between health care coverage and trends in the prevalence of cardiovascular disease (CVD) and diabetes pre- and post-Affordable Care Act (ACA) periods. Using data from 3,824,678 surveyed adults in the Behavioral Risk Factor Surveillance System survey from 2007 - 2016, we calculated the yearly prevalence of CVD and diabetes. Using logistic regression, we investigated the association between health care coverage and CVD and diabetes, controlling for sociodemographic factors (age, sex, race, marital status, education and income). The mean age of participants was 55.3 ± 18.9 years. Health care coverage increased from 88.6% in 2007 to 93% in 2016. The prevalence of CVD and diabetes increased from pre- to post-ACA periods. After adjustment, in pre-ACA period, the odds ratio (OR) for the association between health care coverage and CVD and diabetes was 1.32 (95% CI:1.30-1.34) and 1.44 (95% CI:1.41-1.46), respectively; in the post-ACA period, the OR was 1.26 (95% CI:1.22-1.30) and 1.48 (95% CI:1.44-1.52), respectively. We found a significant association between health care coverage and trends in the prevalence of CVD and diabetes in the pre- and post-ACA periods.
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Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Acessibilidade aos Serviços de Saúde , Cobertura do Seguro , Fatores Etários , Feminino , Instalações de Saúde , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/tendências , Humanos , Cobertura do Seguro/estatística & dados numéricos , Cobertura do Seguro/tendências , Masculino , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act/legislação & jurisprudência , Patient Protection and Affordable Care Act/tendências , Prevalência , Fatores Sexuais , Estados Unidos/epidemiologiaRESUMO
The objective of this study was to assess the differences in HPV-related knowledge, attitudes, and beliefs among African American and non-Hispanic white women and to determine their communication preferences for cancer-related information. Data was obtained from the National Cancer Institute's (NCI) 2014 Health Interview National Trends Survey (HINTS), a cross-sectional survey of US adults 18 years of age or older. Descriptive statistics, bivariate, and multivariate logistic regression were used to identify differences in awareness and knowledge. Data was collected in 2014 and analyzed in 2016. HPV awareness (71 vs. 77%) and knowledge that HPV causes cervical cancer (64 vs. 81%) were significantly lower among blacks. Additionally, there were significant disparities in awareness of the HPV vaccine (66 vs. 79%), with only 25% of Black women indicating that they or a family member was recommended the HPV vaccine by a health care professional. There were also differences in cancer communication preferences. Blacks were more likely than Whites to trust cancer information from family (OR 2.7, confidence interval [CI] 0.725-10.048), television (OR 3.0, 95% [CI] 0.733-12.296), government health agencies (OR 5.8, [CI] 0.639-52.818), and religious organizations (OR 6.4, 95% [CI] 1.718-23.932). Study results indicate that racial/ethnic differences exist in HPV knowledge/awareness and cancer communication preferences. These results highlight the need to increase HPV prevention and education efforts using methods that are tailored to Black women. To address HPV/cervical cancer disparities, future interventions should utilize preferred communication outlets to effectively increase HPV knowledge and vaccine awareness.
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Negro ou Afro-Americano/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Infecções por Papillomavirus/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Neoplasias do Colo do Útero/prevenção & controle , População Branca/estatística & dados numéricos , Adolescente , Adulto , Negro ou Afro-Americano/psicologia , Idoso , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/transmissão , Vacinas contra Papillomavirus/administração & dosagem , Estados Unidos/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , População Branca/psicologia , Adulto JovemRESUMO
PURPOSE: The purpose of this study was to compare differences in health-related quality of life (HRQOL) between African-American female breast cancer survivors, African-American female survivors of other cancers, and African-American women with no history of cancer. METHODS: Using data from the 2010 National Health Interview Survey (NHIS), the HRQOL of African-American women aged 35 years or older was compared by cancer status. Physical and mental health items from the Patient-Reported Outcomes Measurement Information System (PROMIS) global health scale were used to assess differences in HRQOL. RESULTS: For summary physical and mental health measures, no significant differences were found between breast cancer survivors and women with no history of cancer; survivors of other cancers reported poorer physical and mental health than did women with no history of cancer. Similar differences were found at the item level. When we examined the two African-American female cancer survivor groups, we found that cancer survivors whose cancer was being treated reported substantially poorer physical health and mental health than did those whose cancer was not being treated. Survivors who had private insurance and were cancer free reported better physical and mental health than did those who did not have private insurance and those who were not cancer free. Breast cancer survivors reported slightly better physical and mental health than did survivors of other cancers. CONCLUSIONS: Our findings highlight the need for public health agencies to adopt practices to improve the mental and physical health of African-American female survivors of cancer.
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Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Nível de Saúde , Saúde Mental , Qualidade de Vida/psicologia , Adulto , Negro ou Afro-Americano/psicologia , Índice de Massa Corporal , Depressão/psicologia , Exercício Físico , Fadiga/psicologia , Feminino , Humanos , Renda , Cobertura do Seguro , Seguro Médico Ampliado/estatística & dados numéricos , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
In a previous report, we demonstrated the efficacy of an educational intervention focused on increasing colorectal cancer screening rates among African Americans. Despite participating in the intervention, however, nearly two-thirds of participants did not seek and receive screening. Participants were African-Americans over age 49 (N = 257) who had not been screened for colorectal cancer according to guidelines. At baseline, participants completed tests measuring fatalism, perceived stress, self-esteem, attitudes/benefits/barriers, social support, and social network diversity. Those who completed the educational intervention were followed up by telephone to learn if they had been screened. We compared the scores on the psychometric tests of the participants who had been screened against the scores of those who had not. Only the mean scores on the attitudes, benefits, and barriers scale distinguished participants who had been screened from those who had not (p = 0.0816 on bivariate testing and p = 0.0276 in the logistic regression model). Social interaction among participants or social cognitive learning may have played a role in determining which participants were screened, but we were not able to demonstrate this. The major factor distinguishing participants who were not screened was their attitude toward screening at baseline. There is a subset of African Americans who are persistently resistant to screening, and their perspective in this regard must be addressed if colorectal cancer disparities are to be reduced.
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Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer/estatística & dados numéricos , Educação em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Atitude Frente a Saúde , Detecção Precoce de Câncer/psicologia , Educação em Saúde/métodos , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Testes Psicológicos , Inquéritos e QuestionáriosRESUMO
Successful integration of behavioral health and primary care services is informed by perceptions of its usefulness to the consumer. An examination of provider, staff and patient perceptions was conducted across five integrated care sites in order to describe and examine perceptions and level of satisfaction with integrated care. A quantitative study was conducted with data collected through surveys administered to 51 patients, 27 support staff, and 11 providers in integrated care settings. Survey responses revealed high levels of satisfaction with integration of primary and behavioral health services. Integrated care can be enhanced by addressing provider competency and confidence concerns through continued education, increased collaboration and utilization of diagnostic tools. This analysis provides evidence to support that successful integration increases access to mental healthcare, which is instrumental in reduction of the mental health treatment gap by scaling up services for mental and substance use disorders among individuals with chronic medical conditions.
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Atitude do Pessoal de Saúde , Prestação Integrada de Cuidados de Saúde , Satisfação do Paciente , Adulto , Idoso , Feminino , Humanos , Masculino , Serviços de Saúde Mental/organização & administração , Pessoa de Meia-Idade , Atenção Primária à Saúde/organização & administração , Inquéritos e Questionários , Adulto JovemRESUMO
Objective: Although there are many international college students in the state of Georgia, few studies have been conducted on how social determinants affect their health outcomes and academic success. This study examined the effects of social determinants on the health outcomes and academic success of international college students in Georgia. Participants: Participants were international college students (n = 136) in Georgia. Methods: A mixed methods cross-sectional design was used for the study. Results: The lack of access to sufficient funds caused study participants to experience anxiety (39.0%), depression (20.6%), and stress (52.9%). Cultural differences (16.9%), lack of access to health care (15.4%), transportation (14.7%), poor housing (7.4%), and financial insecurity (54.5%) affected study participant health outcomes and academic success. Conclusion: Addressing financial insecurity, the lack of access to health care, poor housing, transportation issues, and cultural differences experienced by international college students in Georgia, is crucial to their health outcomes and academic success.
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Background: Human immunodeficiency virus (HIV)-related stigma has been identified as one of the principal factors that undermines HIV prevention efforts and the quality of life of people living with HIV (PLWH) in many developing countries including Ghana. While studies have been conducted on HIV-related stigma reduction, very few have sought the views of PLWH on how this might be done. The purpose of the study was to (i) identify factors that cause HIV-related stigma in Ghana from the perspective of PLWH, (ii) identify challenges that HIV-related stigma poses to the treatment and care of PLWH, and (iii) to obtain recommendations from PLWH on what they think various groups (community members, health care providers, and adolescents) including themselves should do to help reduce HIV-related stigma in Ghana. Methods: A mixed methods cross-sectional study design was used to collect data from 404 PLWH at the Suntreso Government Hospital in the Kumasi Metropolis of Ghana across six domains using Qualtrics from November 1-30, 2022. Quantitative data was analyzed using the Statistical Package for Social Sciences (SPSS) version 26 and the Statistical Analysis System (SAS) version 9.4. Qualitative data was analyzed using a thematic approach. Results: Most of the study participants (70.5%) said HIV-related stigma in Ghana is due to ignorance. Of this population, 90.6% indicated that they had experienced stigma because they have HIV, causing them to feel depressed (2.5%), ashamed (2.2%), and hurt (3.0%). Study participants (92.8%) indicated that the challenges associated with HIV-related stigma has affected their treatment and care-seeking behaviors. Recommendations provided by study participants for HIV destigmatization include the need for PLWH not to disclose their status (cited 94 times), community members to educate themselves about HIV (96.5%), health care providers to identify their stigmatizing behaviors (95.3%), health care providers to avoid discriminating against PLWH (96.0%), and the need for adolescents to be educated on HIV and how it is transmitted (97.0%). Conclusion: It is important for the government and HIV prevention agencies in Ghana to target and address co-occurring HIV-related stigma sources at various levels of intersection simultaneously This will help to shift harmful attitudes and behaviors that compromise the health and wellbeing of PLWH effectively.
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OBJECTIVE: Due to racism, over 20% of African Americans, including college students in Georgia, receive poor quality health care. Consequently, most students are reluctant to utilize health care services in the state. This study examined biased racial attitudes of health care providers in Georgia, and African American Georgia State University (GSU) School of Public Health (SPH) students' perceptions of the quality of health care they receive from providers, the effects of such care, and student recommendations for the way forward. DESIGN: A mixed-methods cross-sectional design was used to collect data from 63 students across six domains using Qualtrics. RESULTS: Provider brushes off patient concerns when providing medical care (29.9%), stereotyping (26.9%), and the lack of communication during medical care (25.4%) were the three main implicit racial attitudes identified by GSU SPH students. Owing to the poor quality of care they receive from their health care providers, some students (28.4%) are reluctant to utilize health care services, distrust doctors that are not from their race (34.3%), do not adhere to treatment (19.4%), and prefer to use home remedies (28.4%) when ill. Students recommended cultural competency training, holding health care providers accountable for their actions, and increasing African American health care providers in Georgia as ways to address health care provider attitudes and quality of care. CONCLUSION: Negative provider attitudes impact the health and health-seeking behavior of African American college students in Georgia. These attitudes must be eliminated so barriers to clinical participation are removed, and student health outcomes optimized.
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Racismo , Humanos , Georgia , Negro ou Afro-Americano , Estudos Transversais , Atitude do Pessoal de Saúde , Estudantes , Pessoal de SaúdeRESUMO
Introduction: African Americans are disproportionately affected by mortality risk for colorectal cancer. This study aimed to determine the most effective educational approach of 4 study arms that enhances the likelihood of pursuing subsequent colorectal cancer screening, and to identify the associated factors. Methods: Age-eligible adults (N=2,877) were recruited to participate in a cluster randomized control dissemination and intervention implementation trial titled Educational Program to Increase Colorectal Cancer Screening. The project began in May 2012 and ended in March 2017 (the implementation phase lasted 36 months). Educational sessions were conducted through 16 community coalitions that were randomized into 1 of 4 conditions: website access (to facilitator training materials and toolkits) without technical assistance, website access with technical assistance, in-person training (provided by research staff and website access) without technical assistance, and in-person training with technical assistance. A follow-up to determine participant CRC screening was conducted 3 months later. Results: Compared with the website access with technical assistance intervention group, 2 groups, in-person training with technical assistance and without technical assistance, indicated significantly higher odds for obtaining colorectal cancer screening (OR=1.31; 95% CI=1.04, 1.64; p=0.02 and OR=1.35; 95% CI=1.07, 1.71; p=0.01, respectively). Though sociodemographic factors were not significantly associated with pursuing subsequent colorectal cancer screening, the postintervention cancer knowledge increased significantly among the study participants. Conclusions: The importance of in-person interactions, local coalitions, and community contexts may play a key role for successfully increasing colorectal cancer screening rates among African Americans as reflected through this study. The integration of telehealth and use of other virtual technologies to engage the public in research have increased since the COVID-19 pandemic and should be assessed to determine their impact on the degree to which in-person interventions are significantly more effective when compared with solely web-assisted ones. Trial registration: The study is registered at www.clinicaltrials.gov NCT01805622.
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The COVID-19 pandemic has significantly taxed scientific research and seems to have exacerbated existing inequities within the research field, particularly for early-stage investigators (ESIs). This study examines the effects of the COVID-19 pandemic on traditionally underrepresented ESIs enrolled in an NIH-supported study evaluating the effectiveness of developmental networks, grant writing coaching, and mentoring on research career advancement. The survey consisted of 24 closed-ended (quantitative) and 4 open-ended questions (qualitative) linked to a participant's ability to meet grant submission deadlines, research and professional development disruptions, stress level, career transition level, self-efficacy and management of scholarly tasks, and familial responsibilities. Results from 32 respondents (53%) suggest that COVID-19 adversely impacted the continuity of research (81%) and grant submissions (63%). On average, grant submissions were delayed by 6.69 months (i.e., greater than one grant cycle). We also conducted additional analyses characterizing nonresponse and found that there were no significant predictors of nonresponse, indicating a limited threat to the validity of our findings. The disruption caused by COVID-19 to the careers of ESIs from underrepresented groups in the biomedical workforce has been profound in the short term. The long-term consequences to the future success of these groups are unknown but is a worthwhile area of research and potential innovation.
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Pesquisa Biomédica , COVID-19 , Equidade em Saúde , Tutoria , Humanos , Pandemias , COVID-19/epidemiologia , Tutoria/métodos , MentoresRESUMO
There are several institutions of higher learning in the United States that award degrees in public health to undergraduate students. While these institutions serve as potential pipelines for the public health workforce, it is unclear if the curricula and training students receive from these institutions, really prepare them for the public health workforce or higher education. The questions sometimes asked are whether the programs offered by these institutions exist to provide students with a good understanding of public health issues so they can become good citizens for building a responsible society, or if it is to prepare students for graduate school. Regardless of what the goals are, students in undergraduate public health programs need to be exposed to curricula that adequately prepare them to enter well-defined careers in public health. Thus, institutions of higher learning offering degrees in public health to undergraduate students need to understand the market, assess, and understand the needs of public health agencies, and tailor course curricula to match those needs. Georgia State University established its undergraduate public health program in 2016. Since then, over 200 students have graduated from the program. The purpose of the study was to assess student perception of the role of high impact educational practices such as study abroad, signature experience, and undergraduate research curricula in preparing them for careers in public health.
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Mão de Obra em Saúde , Saúde Pública , Currículo , Humanos , Saúde Pública/educação , Estudantes , Estados Unidos , Recursos HumanosRESUMO
Digital health innovations, such as telehealth and remote monitoring, have shown promise in addressing patient barriers to accessing evidence-based programs and providing a scalable path for tailored behavioral interventions that support self-management skills, knowledge acquisition and promotion of relevant behavioral change. However, significant attrition continues to plague internet-based studies, a result we believe can be attributed to characteristics of the intervention, or individual user characteristics. In this paper, we provide the first analysis of determinants of non usage attrition in a randomized control trial of a technology-based intervention for improving self-management behaviors among Black adults who face increased cardiovascular risk factors. We introduce a different way to measure nonusage attrition that considers usage over a specific period of time and estimate a cox proportional hazards model of the impact of intervention factors and participant demographics on the risk of a nonusage event. Our results indicated that not having a coach (compared to having a coach) decreases the risk of becoming an inactive user by 36% (HR = .63, P = 0.04). We also found that several demographic factors can influence Non-usage attrition: The risk of nonusage attrition amongst those who completed some college or technical school (HR = 2.91, P = 0.04) or graduated college (HR = 2.98, P = 0.047) is significantly higher when compared to participants who did not graduate high school. Finally, we found that the risk of nonsage attrition among participants with poor cardiovascular from "at-risk" neighborhoods with higher morbidity and mortality rates related to CVD is significantly higher when compared to participants from "resilient" neighborhoods (HR = 1.99, P = 0.03). Our results underscore the importance of understanding challenges to the use of mhealth technologies for cardiovascular health in underserved communities. Addressing these unique barriers is essential, because a lack of diffusion of digital health innovations exacerbates health disparities.
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BACKGROUND: We sought to investigate the relationship between echocardiographic left ventricular hypertrophy (LVH) and acute non-ST-elevation segment myocardial infarction (NSTE-MI) in patients with chest pain and angiographically normal coronary arteries. METHODS: Retrospective analysis of patients admitted for acute chest pain in a large urban hospital serving predominantly African American patients. RESULTS: 131 (of 700) patients had normal coronary arteries or only minimal luminal irregularities (ie, <10% luminal narrowing) on cardiac angiography and available cardiac biomarker data to define the presence or absence of MI. Mean age was 53 +/- 10 years, 76% were African Americans, 88% had a history of hypertension (49% uncontrolled) and 74% had LVH by echocardiography. Of these 131 patients, 22 (17%) had an acute NSTE-MI by creatine kinase MB criteria. The mean systolic blood pressure (BP) was significantly higher in patients with NSTE-MI compared with non-NSTE-MI group (156 +/- 30 vs 143 +/- 25 mm Hg, P=.04). Patients with NSTE-MI were more likely to have LVH (95% vs 70%, P=.03). NSTE-MI was present in 22% of patients with LVH compared with 3% without LVH (P=.02). The in-hospital course of NSTE-MI patients with LVH was not benign: 19% had persistent angina and positive stress thallium suggestive of recurrent myocardial ischemia and 48% had congestive heart failure. The results of multivariable model after adjusting for selected variables revealed that these two preexisting conditions were independently associated with NSTE-MI: LVH (OR=4.0, CI 1.06-10.05) and elevated systolic BP (OR=3.7, CI 1.01-10.64). CONCLUSION: These findings provide preliminary evidence that LVH and uncontrolled hypertension predispose to NSTE-MI in this patient group.
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Negro ou Afro-Americano , Hipertensão/complicações , Hipertrofia Ventricular Esquerda/complicações , Infarto do Miocárdio/complicações , Infarto do Miocárdio/etnologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Dor no Peito/etiologia , Angiografia Coronária , Vasos Coronários/patologia , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Hipertensão/etnologia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/etnologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de RiscoRESUMO
Introduction: Adding developmental networks (DN) to grant-writing coaching can significantly enhance ESIs' research careers. Herein, we present study design, ESIs' characteristics and encountered challenges/lessons learned and their resolutions when deploying/implementing (a) NCR algorithm(s), (b) recruitment/retention and (c) implementing DN intervention. Methods: Nested Cluster Randomization (NCR) design governs this study implementation. The sample size is 220 ESIs intending to submit an NIH K, R, U, and/or Minority Supplement application(s). Primary outcome: intensity/sustainability of grant submission(s)/funding(s), measured by time to/between application(s). Outcome(s) analyses modes: summaries, Kaplan Meir and Cox proportional hazard models as a function of randomization groups and other predictors of outcomes. Results: In the present study, we recruited two cohorts of ESIs (N = 85): 39% African Americans, 18% Latinx, 18% Whites, 20% Asians and 6% Hawaiian/Pacific Islander/other ethnicities; 65% are women; 73% are assistant professors, 4% are Associate Professors and 23% are instructors/scientists/post-doctoral. Participants' disciplines: 32% basic/biomedical, 36% clinical/translational and 32% social/behavioral. Proposal(s) mechanisms: 61% research grants (R series), 31% career development (K series), 7% support of competitive research (SCORE) and 1% National Science Foundation applications. NCR did produce balance in the distribution of ESIs' demographics, sex at birth, ethnicity, professional appointments, background disciplines, and mechanism of sought funding. Lessons learned/challenges: NCR implementation was methodologically challenged during implementation by added constraints (e.g., assigning coaches to the same randomization arm of their participants as well as blinding them to ESIs' randomization group). Recruitment and retention were hampered by the COVID-19 pandemic and more progressive and innovative strategies were needed to heighten the visibility and outreach of this program. DN delivery was also affected by the pandemic and monitoring of ESIs' engagement and facilitation of communications interventions were needed. Resolution of these challenges effectively reconfigured NCR algorithms, recruitment/retention plans, and DN intervention delivery. We intend to recruit an additional 135 ESIs focusing on underrepresented scholars from RCMIs, CTSAs, and other programs. COVID-19 rendered this program 100% virtual, with recruitment/retention challenges and substantial disruption of ESIs' research. We may extend the grant writing period, coaching, and Mock Study Section support.
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Pesquisa Biomédica , COVID-19 , Tutoria , Feminino , Humanos , Pandemias , SARS-CoV-2RESUMO
Background: Assuring health equity throughout the U.S. continues to challenge the public and private research enterprise. Even with some progress, racial and ethnic health disparities continue, particularly among African Americans. Health equity for African Americans is improbable unless participation in clinical trials is measurably increased. Method: To inform efforts to enhance participation, interviews were conducted with three African American leadership groups from across the country to document their perceptions of why the research community is unable to engage African Americans effectively in clinical trials. The results of thirty-five interviews, conducted from three leadership groups, were analyzed and are reported in this article. The leadership groups include health/education, faith, and civic society. Ethical Considerations: This research was conducted based upon the ethical protocols of the National Center for Bioethics in Research and Health Care, research ethics, and confidentiality. Results: Findings indicate that trustworthiness must precede trust; both are essential in enhancing African American participation in research, especially in less understood clinical trials. Conclusion: Respondents agreed that the research community must demonstrate trustworthiness before trust can be established. They also indicated the importance of increasing the number of African American researchers in leadership roles. Also, suggestions were made regarding the need to develop short and long-term positive relationships between the research community and the African American population, at various levels, if increases in participation in clinical trials are expected. With the likely development of new clinical research and the attention to increasing excess deaths among African Americans, there must be representative numbers of African Americans and other underserved populations in leadership roles if health disparities are to be eliminated and health equity is to be achieved.
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In 2003, the United States (US) Institute of Medicine of the National Academies recommended that all undergraduate students have access to an education in public health to assist with diversifying the public health workforce and ensuring an educated citizenry on public health issues. In line with this recommendation, and that of the Consensus Conference on Undergraduate Public Health Education, Georgia State University established a Bachelor of Science in Public Health (BSPH) program in 2016, with the mission of advancing health through leadership, scholarship, research, and service, to better the human condition and to promote the common good, especially for urban communities in the US and for global populations. Using integrative approaches that encourage student empowerment, self-development, integrative thinking, and reflective learning, the Georgia State University BSPH program currently offers a range of generalist introductory public health courses to over 400 students. This review seeks to examine student perceptions of integrative practices utilized by Georgia State University faculty in the BSPH program and to investigate the extent to which student perceive these integrative educational practices as preparing them to use insights gained in the classroom and from the field, to question, modify, connect, and integrate material learned in the academic setting, to real-life public health challenges. It also seeks to identify which of the integrative educational practices have the highest impact of helping students integrate the knowledge and skills gained to public health issues.
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BACKGROUND: Obesity is a growing problem in the United States and is disproportionately increasing among African Americans. The objective of this study is to examine the sociodemographic and biometric factors associated with eating behaviors among African American women. METHODS: We analyzed data from the 2009-2010 dietary screener and weight history questionnaire from the National Health and Nutrition Examination Survey. Multivariable analyses were used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) to determine the association between six specific eating behaviors and different sociodemographic and biometric factors. Analyses were conducted using SAS 9.4. RESULTS: The analyses show that being middle aged (45-64) decreased the likelihood of consuming soft drinks (AOR: 0.48; 95% CI: 0.27-0.86); consuming red meat (AOR: 0.45; 95% CI: 0.25-0.82); and consuming processed meat (AOR: 0.55; 95% CI: 0.31-0.97). In addition, high school grads were over 3 times as likely to consume high amounts of soft drinks (AOR: 3.04; 95% CI: 1.33-6.94) and 65% less likely to consume high amounts of leafy/lettuce salads than college grads (AOR: 0.35; 95% CI: 0.15-0.82). Finally, single/widowed/divorced African American women were 13% less likely to eat high amounts of leafy green salads than married African American women (AOR: 0.82; 95% CI: 0.70-0.97). CONCLUSIONS: The results indicate that some sociodemographic factors have an association with certain eating behaviors. Further exploration of sociodemographic and biometric factors, with the inclusion of culture and its association with eating behaviors will help to expand the literature.
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BACKGROUND: Diminished social support lias shown to lead to worse cardiovascular outcomes and since cardiovascular disease (CVD) is the leading cause of death in the United States (U.S.), it is critical to non-invasively study its precursor- vascular disease (VD). Assessing the impact social support lias on vascular outcomes can unveil potential CVD susceptibilities in at-risk populations. African American women exhibit the greatest burden of CVD morbidity and mortality; therefore, the purpose of tins study is to examine the association between living arrangement/social support and impaired vascular function in asymptomatic African American women. METHODS: Vascular function was assessed by a non-invasive screening tool, HDI/PulseWave CR-2000, during screenings at community outreach events on participants clinically free of CVD. Vascular disease was defined as abnormal/impaired vascular function. Living arrangement, a binary variable (living with someone/living alone), was determined by survey responses (N=67) and represented social support. Multivariable analyses were used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) to determine the association between living arrangement and vascular disease after controlling for confounders. Analyses were conducted using SAS 9.2. RESULTS: Of those who lived alone, 82% had vascular disease (p=0.03). After adjusting for family CVD, and other CVD risk factors, those who lived with a spouse/partner or relative were 78% (p=0.04) less likely to develop vascular disease (AOR=0.22; 95% 0=0.05, 0.98). CONCLUSIONS: Our study provides preliminary evidence to suggest that among African American women, clinically free of CVD, living arrangement is associated with vascular disease. While living alone may place individuals at an increased risk of CVD because of the association, living with a spouse/partner or relative may act as a protective factor against vascular disease and reduce the risk of CVD. Public health practitioners may use individuals' living arrangement as preventive measure for CVD risk.
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Accountable Care Organizations (ACOs) seek sustainable innovation through the testing of new care delivery methods that promote shared goals among value-based health care collaborators. The Morehouse Choice Accountable Care Organization and Education System (MCACO-ES), or (M-ACO) is a physician led integrated delivery model participating in the Medicare Shared Savings Program (MSSP) offered through the Centers for Medicare and Medicaid Services (CMS) Innovation Center. The MSSP establishes incentivized, performance-based payment models for qualifying health care organizations serving traditional Medicare beneficiaries that promote collaborative efficiency models designed to mitigate fragmented and insufficient access to health care, reduce unnecessary cost, and improve clinical outcomes. The M-ACO integration model is administered through participant organizations that include a multi-site community based academic practice, independent physician practices, and federally qualified health center systems (FQHCs). This manuscript aims to present a descriptive and exploratory assessment of health care programs and related innovation methods that validate M-ACO as a reliable simulator to implement, evaluate, and refine M-ACO's integration model to render value-based performance outcomes over time. A part of the research approach also includes early outcomes and lessons learned advancing the framework for ongoing testing of M-ACO's integration model across independently owned, rural, and urban health care locations that predominantly serve low-income, traditional Medicare beneficiaries, (including those who also qualify for Medicaid benefits (also referred to as "dual eligibles"). M-ACO seeks to determine how integration potentially impacts targeted performance results. As a simulator to test value-based innovation and related clinical and business practices, M-ACO uses enterprise-level data and advanced analytics to measure certain areas, including: 1) health program insight and effectiveness; 2) optimal implementation process and workflows that align primary care with specialists to expand access to care; 3) chronic care management/coordination deployment as an effective extender service to physicians and patients risk stratified based on defined clinical and social determinant criteria; 4) adoption of technology tools for patient outreach and engagement, including a mobile application for remote biometric monitoring and telemedicine; and 5) use of structured communication platforms that enable practitioner engagement and ongoing training regarding the shift from volume to value-based care delivery.