Consuming untreated water in four southwestern Alaska Native communities: reasons revealed and recommendations for change.

In this article, the authors provide the first in-depth account of why some Alaska Native people drink untreated water when treated water is available. Their qualitative research was conducted in four Alaska Native village communities that have treated water available from a centralized distribution point. Most respondents (n = 172; 82%) reported that some of their household's drinking water came from an untreated source. Motives for drinking untreated water emerged from analysis of open-ended questions about drinking water practice and could be categorized into six themes: chemicals, taste, health, access, tradition, and cost. Importantly, some residents reported consuming untreated water because they both liked untreated water and disliked treated water. As such, interventions to increase safe water consumption should address this dichotomy by providing education about the benefits of treated water alongside the risks involved with drinking untreated water. Based on the findings, the authors provide specific recommendations for developing behavior change interventions that address influences at multiple social-ecological levels.

Adaptation of the barriers to help-seeking for trauma (BHS-TR) scale: a cross-cultural cognitive interview study with female intimate partner violence survivors in Iceland.

BACKGROUND: Even though traumatization is linked to substantially reduced health-related quality of life, help-seeking and service utilization among trauma survivors are very low. To date, there has not been available in Iceland a culturally attuned, self-reported measure on help-seeking barriers after trauma. This study aimed to translate and cross-culturally adapt the English version of Barriers to Help-Seeking for Trauma (BHS-TR) scale into the Icelandic language and context. METHODS: The BHS-TR was culturally adapted following well-established and rigorous guidelines, including forward-backward translation, expert committee review, and pretesting through cognitive interviews. Two rounds of interviews with 17 female survivors of intimate partner violence were conducted using a think-aloud technique and verbal probing. Data were analyzed using qualitative content analysis, a combination of deductive and inductive approaches. RESULTS: Issues with the BHS-TR that were uncovered in the study were classified into four categories related to general design, translation, cultural aspects, and post-trauma context. The trauma-specific issues emerged as a new category identified in this study and included concepts specific to trauma experiences. Therefore, modifications were of great importance-resulting in the scale becoming more trauma-informed. Revisions made to address identified issues improved the scale, and the process led to an Icelandic version, which appears to be semantically and conceptually equivalent to the original version; additionally, the results provided evidence of content validity. CONCLUSIONS: As a cognitive interview study, it adds to the growing cognitive interviewing methodology literature. Furthermore, the results provide essential insights into the self-report response process of trauma survivors, highlighting the significance of making health-related research instruments trauma-informed.

A Novel Approach to Improve Health Literacy in Immigrant Communities.

BACKGROUND: Anchorage, Alaska, has a large immigrant and refugee population. In fact, it is one of the most ethnically diverse cities in the United States with almost 100 languages spoken by children in the public school system. The city's immigrant and refugee population speaks limited English, and most of these residents are unfamiliar with where or how to obtain health care services through the American health care system. BRIEF DESCRIPTION OF ACTIVITY: We developed a peer language navigator (PLN) program. IMPLEMENTATION: The Anchorage Health Literacy Collaborative developed a community-wide program to address the health literacy needs of the city's immigrant and refugee population. Select people who attended Anchorage's adult literacy program (the Alaska Literacy Program) were chosen to learn about health and wellness topics as well as how to obtain health information from reliable online sources. These people, initially known as PLNs, were then trained to share health information resources with their respective communities. RESULTS: A recent evaluation of the program using ripple effects mapping showed that the program has demonstrated wide success, providing understandable health information to hundreds of new English learners throughout the area and guiding them to reliable health and wellness information they can use for themselves, their families, and their community. PLNs have become leaders in their communities and have been renamed peer leader navigators. LESSONS LEARNED: For similar programs to be successful, PLNs should be trained using adult learning principles, allowing them to focus on topics and issues of interest to them. The program should link with community organizations to extend the reach of the program. Care must be exercised to avoid overextending or overwhelming PLNs because after they become leaders in their communities, they will receive many requests to provide guidance and education. Finally, when possible, PLNs should be compensated so they can more fully devote their efforts to serving the community. [HLRP: Health Literacy Research and Practice. 2019;3(Suppl.):S15-S24.]. PLAIN LANGUAGE SUMMARY: The Anchorage Health Literacy Collaborative in Alaska developed a program in which immigrant and refugees attending the city's adult education program to learn beginning English are chosen to serve as peer language navigators (PLNs). The PLNs learn how to obtain credible and easy-to-understand health information and then share it with their respective cultural communities. Lessons learned over time are shared.

Breast cancer screening in an adult literacy program.

OBJECTIVES: Individuals with limited literacy have low rates of cancer screening and more advanced cancer when cancer is detected. We implemented breast cancer screening at an adult literacy center to see if students would participate and determine the rate of abnormalities detected. METHODS: The Anchorage Literacy Project (ALP), in collaboration with Providence Cancer Center (PCC), offered breast cancer screening, including mammograms, on site at ALP to all 40 female ALP students aged > or =40. Prior to screening, PCC and ALP staff provided education to students about breast cancer screening and mammograms, and information about the Alaska Breast and Cervical Health Check program that would pay for treatment if cancer was detected. RESULTS: Twenty-one women underwent screening. Three (14%) had significant abnormalities. CONCLUSIONS: Cancer screening can be provided on site in adult literacy programs. The rate of abnormalities detected through such screening may be higher than the rate in the general population.

Perspectives of college students and their primary health care providers on substance abuse screening and intervention.

The authors conducted a needs assessment among students and health-care providers of a southwestern university health center with the goal of developing health-care-provider training addressing substance-abuse screening and intervention. They collected data from focus groups of undergraduate students and structured interviews and questionnaires with health-care providers. They identified gaps in provider and student perspectives on the extent of substance abuse on campus and the perceived roles of health-care providers and patients in screening and conducting interventions for substance abuse. These findings suggest that training for college health-care providers regarding substance-abuse brief screening and intervention should emphasize confidentiality of student medical records, the importance of nonjudgmental attitudes toward students, and the role of the provider as one who is competent and appropriate to address substance abuse. Such training should also educate providers about the types of substances students are using.

Outcomes of a Seven Practice Pilot in a Pay-For-Performance (P4P)-Based Program in Pennsylvania.

OBJECTIVES: The objective of this study was to examine how targeted six-month interventions impacted Best Practice/Patient Outcomes for minority patients receiving primary care in physician practices participating in a pay-for-performance (P4P) program. METHODS: P4P Practices were invited to participate in a pilot intervention study designed to improve care for minority patients with hypertension, diabetes or pediatric asthma. Patient medical records were reviewed to assess how the interventions impacted (n=7 practices): Body mass index, diet and exercise, smoking, compliance with visits as recommended, blood pressure, sodium intake and weight management counseling, medication reconciliation, HbA1c testing, annual lipid profile, and anti-inflammatory medications. RESULTS: Significant improvements in various clinical quality measures were observed in all seven practices. Of the 19 specified interventions, 13 were statistically significant at α=0.05 level and 14 met the target proportion. This suggests that the best practice intervention had a significant impact on some of the health care processes in the physician practices. CONCLUSIONS: The most impactful interventions were those related to face-to-face educational discussions, patient medical chart documentations rather than those pertaining to medication adherence. Improvements in measuring reporting and recording of data at post-intervention were also observed.

Partnering with community-based professionals to improve substance abuse screening and intervention for youth and young adults.

The paper describes the process by which a team conducted a needs assessment and developed training programs to address service gaps in substance abuse prevention for young people.