Session
Addressing Health Disparities through Health Promotion Initiatives
APHA 2022 Annual Meeting and Expo
Abstract
Challenges and Opportunities Implementing Evidence-Based Interventions in Rural Primary Care Clinics to Increase HPV Vaccination Uptake
APHA 2022 Annual Meeting and Expo
Effective evidence-based interventions (EBI) and strategies to increase HPV vaccination exist but have been developed and tested in urban clinics. Working with rural clinics, we sought to test a learning collaborative implementation strategy designed by the American Cancer Society (ACS) that had been used in urban clinics. There are unique barriers to implementation and lower rates of vaccination in rural clinics. We conducted a process evaluation to understand barriers and facilitators to implementing the ACS’s learning collaborative strategy in rural clinics and determine potential adaptations. Two small, rural health systems with three primary care clinics each participated in the collaborative. We interviewed clinic staff prior to implementation (n=16), at 6-months (n=12), and 12-months (n=9). Interview questions targeted clinic processes, Immunization Quality Improvement for Providers best practices, ACS recommendations, and impact of the pandemic. The Consolidated Framework for Implementation Research informed development of the codebook. Preliminary findings indicate participation in the collaborative was varied and inconsistent based on staffing challenges due to COVID-19. Clinics do not have the most up-to-date electronic health record systems and staff are not fully trained in using it, which results in challenges tracking vaccinations and sending reminders to patients. This research sets the groundwork for further adapting ACS’s learning collaborative approach to be appropriate for rural clinics. This session will focus on describing the barriers and facilitators to implementing EBIs from the perspective of the rural healthcare team and offer recommendations to increase the uptake of EBIs to increase HPV vaccination rates in rural clinics.
Abstract
The Impact of Social Determinants of Health on the Relationships between Digital health Tool Adoption and Medication Adherence: A Scoping Review
APHA 2022 Annual Meeting and Expo
Background
There is an increasing focus on how health service providers use eHealth/mHealth and telemedicine to promote medication management and adherence. However, little is known about how social determinants of health (SDOH) may impact the relationship between patients’ adoption of these digital tools and their medication management. Therefore, this review aims to identify how previous studies characterized SDOH when using eHealth /mHealth and telemedicine to enhance medication adherence.
Methods
This scoping review was conducted using the Arksey and O'Malley Framework. A search was conducted in four health databases and the gray literature. Four reviewers screened the articles for eligibility, extracted relevant articles and analyzed data.
Results
The search identified 241 articles published from 2010 to 2022. The selected studies included various digital health tools for medication management and a wide range of patient populations. Two main themes emerged from the analysis: (1) SDOH as barriers to adopting eHealth/mHealth and telemedicine for medication management and (2) eHealth/mHealth and telemedicine as a tool to address the impacts of SDOH on medication management. Most studies focus on economic stability, healthcare access, and education access. Only few studies investigated the impacts of social and community context and neighborhood and built environment on patients’ use of eHealth/mHealth and telemedicine for medication adherence.
Conclusion
Social/community context and neighborhood/built environment, such as housing and food security, reliable transportation, and their association with patient digital medication management deserve more attention. To enhance digital health engagement, future research should design strategies to address these SDOH factors.
Abstract
Thematic Assessment of Outreach Materials to Understand Best Health Promotion Strategies within Asian and African Immigrant Populations
APHA 2022 Annual Meeting and Expo
Background:
Asian Health Coalition (AHC) utilizes collaborative partnership approaches to support the development of culturally and linguistically appropriate health programs and initiatives. AHC supports over 27 different ethnic community-based organizations on 5 programs throughout the Chicagoland area. For each program, outreach materials in the form of flyers, social media toolkits, posters, and videos are created and sent to our different, diverse partners to educate and inform their community members. AHC acknowledges that the materials provided must be relevant and appropriate for that community. Therefore, we made it a priority to aggregate outreach material feedback from all of our partners to understand the best health promotion strategies for our Asian and African Immigrant communities.
Methods:
Eight focus group sessions were held, within five Asian and three African communities. During each focus group three separate outreach materials, created by AHC and the CDC, were shown. Questions were asked to gauge the community members’ thoughts on how well the material would resonate in their community, what information was helpful or felt missing, overall impressions, and future recommendations. During monthly or one-on-one meetings more specific information was gathered including translation needs, platforms most often used, and challenges using our outreach materials.
Results:
There were four major themes that heavily overlapped between communities. First, increasing representation and diversity in the images used. Including but not limited to including more Black people, women wearing Hijabs, and age groups. Second, using images of real people instead of cartoon-like characters because it humanizes and makes the materials more relatable. Third, providing more concrete action steps. Posts often end with “contact your local health department/ doctor , but that confuses members who did not know who their local health department was or did not have a primary physician. Last, decrease texts and increase pictures, figures, and statistics because too many words are overwhelming and often hard for people of limited reading capacity to understand.
Conclusions:
AHC will supplement general outreach materials with individualized ones specific for Asian and African populations using real people, this will help increase representation and eliminate the use of cartoon-like people. In order to create more actionable steps, AHC will instead link a general email for community members to reach out to with further questions. AHC is also going to provide our website link, where we will have a “linkage to care page with local health departments and clinic phone numbers that offer certain services.
Abstract
The feasibility of implementing the Deep South Witness Project
APHA 2022 Annual Meeting and Expo
Culturally relevant cancer education interventions have been shown to be effective at increasing breast cancer screening rates. The Witness Project is an evidence- and theory-based cancer education intervention that is targeted towards Black women living in rural communities in the US. Core components of the Witness Project include the use of storytelling and experiential learning. The Intervention Mapping-ADAPT framework was used to guide the adaption of the original Witness Project program materials to fit the population specific needs of Black women living in Mississippi and Alabama. Due to the COVID-19 pandemic, the Deep South Witness Project was adapted to be delivered online by Black breast cancer survivors (n = 5). A hybrid type III study design was used to assess the feasibility of implementing the program and the effect of the program on participants’ breast cancer screening knowledge and behaviors. The feasibility study participants (n = 37) ranged in age from 20 to 72. Results showed that it was feasible to adapt the core components of the Witness Project to be delivered online. In addition, we found that it was feasible to recruit Black women to participate in the program, and acceptability of the program was high. However, low digital health literacy was a major barrier for several participants. Qualitative data from the 3-week and 6-week follow up interviews indicated that there were no significant changes in the participants’ intentions to obtain age- and risk-appropriate breast cancer screenings. The analysis of the pre/posttest data showed a small increase in breast cancer knowledge. In conclusion, evidence-based cancer education interventions can be delivered via online platforms. However, interventions aimed at improving digital health literacy and reducing the digital divide are needed.
Abstract
Ethnoracial Factors Present in Uterine Fibroid Treatment for Women of African Descent
APHA 2022 Annual Meeting and Expo
Background/Purpose: Uterine fibroids (UF) are non-cancerous uterine growths that have major public health implications with a prevalence of nearly 70% in women and $34 billion allocated in annual UF treatment-related costs. Women of African descent (BW) are diagnosed with UF at higher rates and experience a higher disease burden when seeking treatment compared to Non-Hispanic White women. The present study aims to identify the impact of ethnoracial factors concerning UF treatment in BW.
Methods: We utilized a community-engaged (CE) research approach; for our CE studios, we created a comprehensive facilitator guide to administer to patient stakeholders. Detailed notes were acquired and analyzed using traditional content analysis.
Results: We had 6 cis-gendered, BW participants. A codebook was developed of overarching themes relating to ethnoracial influences such as menstrual health literacy, biases in health, and conversation starters. Overall, the women agreed that barriers to UF treatment stemmed from culturally related normalization of symptoms and lack of information.
Summary & Conclusions: Our results suggest that addressing the ethnoracial impacts present in the treatment of UF may prevent treatment delays. Our results also suggest that targeting the distribution of resources and promoting/facilitating conversations with BW would improve health literacy and prevent misinformation. The present study identified ethnoracially motivated factors amongst BW with regards to UF treatment. The data collected from these CE studios necessitate designing effective care opportunities and research studies for ethnoracially diverse women with high risk for UF.
Abstract
Ktanaqson (Abundance): Moving towards food sovereignty by promoting health, wellness, and resiliency through connection to Wabanaki culture and community
APHA 2022 Annual Meeting and Expo
Prior to colonization and reservation systems, indigenous communities were a healthy and thriving population that lived an active lifestyle and a naturally healthy diet that prevented disease. Wabanaki peoples’ natural and traditional food and food systems reflected the traditional way of life that encompassed cultural practices such as language, traditional harvesting and gathering, hunting, and fishing, and traditional medicines, many of which have diminished as colonization has reduced tribal land sovereignty and introduced pollutions to rivers, marshlands, and farmland. As a result, Wabanaki people experience lowered life expectancies and disparate health status with high incidences of disease that are disproportional to any racial or vulnerable group in Maine. These disproportionate incidences have been compounded by climate change, creating more strain on food systems.
Wabanaki Public Health and Wellness, in collaboration with the four tribes in Maine, has been working hard to address the complex food insecurity needs in Wabanaki territory by working towards a Wabanaki food sovereignty system. The Ktanaqson (pronounced duh-nuck-son) “Abundance program seeks to develop a sovereign and sustainable tribal food system for all five Wabanaki communities in Maine by focusing on reconnecting traditional nutrition/food systems as the key to preserving the past, surviving the present, and securing the future.
This presentation will highlight how the Ktanaqson program promotes health, focusing on the areas of increasing physical activity through modern and traditional activities, improving nutrition through education and the inclusion of traditional foods in the diet, and expanding cultural knowledge and connection to increase the sense of belonging in Wabanaki communities. This program promotes abundance through facilitating experiences in traditional food growing, hunting, harvesting, preparation, and preservation as well as the sharing of cultural skills, practices, and traditions.
Abstract
Informative research with key stakeholders to adapt a human papillomavirus (HPV) vaccine educational material for young Latino men who have sex with men
APHA 2022 Annual Meeting and Expo
BACKGROUND: Men who have sex with men (MSM) are at increased risk for acquiring a human papilloma virus (HPV) infection and subsequently developing an HPV-related cancer. No prior culturally relevant HPV vaccine educational interventions have been developed and specifically targeted to young Latino men who have sex with men (YLMSM) ages 18-26.
OBJECTIVE: To conduct 10 in-depth interviews with key stakeholders (i.e., healthcare clinic leadership, providers and staff, community-based organization staff who provide care to sexual and gender minority individuals) in Puerto Rico (PR) and Florida (FL) for feedback on a previously-developed general HPV prevention educational material for the purpose of adapting and targeting the intervention to a YLMSM audience.
METHODS: Using semi-structured interviews with stakeholders in PR and FL, we obtained feedback on the following elements: a) comprehension elements b) visual appeal, c) cultural and linguistic acceptability, d) educational/learner appeal.
RESULTS: Findings suggested that the materials should better specify and better highlight: 1) general information regarding sexual health and LGBT health education; 2) images appealing to YLMSM; 3) culturally-relevant information such as the use of informal Spanish and photos that appear to have been taken locally; 4) HPV modes of transmission and 5) information on how HPV prevention strategies are different than those for other infections.
DISCUSSION: Educational interventions that promote HPV vaccination are critical to prevent HPV-related cancer incidence and mortality among this high-risk population. These preliminary data are the first step in the process of culturally adapting and refining an existing HPV educational resource for YLMSM.
Abstract
Tailoring data-informed women’s health education programs for intimate partner violence survivors at the grayson crisis center, sherman, TX
APHA 2022 Annual Meeting and Expo
Background: Women with a history of intimate partner violence (IPV) are at increased risk for cardiovascular disease, human papillomavirus (HPV), cervical cancer, and human immunodeficiency virus (HIV), which we collectively termed women’s health issues (WHI). Educating IPV survivors about WHIs is essential in facilitating a dialogue with their physicians since only 6% of IPV victims believe their doctors recognize IPV as a risk factor for WHIs.
Objective: The objective of this study is to develop a trauma-informed, culturally sensitive WHI education program tailored to the needs and experiences of IPV victims.
Methods: An education program was created based on the data derived from ten focus groups (n=38) and consisted of an in-person, interactive presentation and informative brochures about WHIs. Participants completed a demographic survey that included questions about physician acknowledgment of IPV as a risk factor for chronic conditions. A pre and post-test will be given to participants to evaluate the utility of providing educational sessions regarding these maladies.
Results: According to the data from the focus groups, approximately 24% of the participants have never heard of HPV, 21% have not received a Pap smear in the last three years, and 13% do not know where to get tested for HIV. In addition, we have identified the main theme, namely perceptions of chronic conditions and its four subthemes: personal experiences related to cervical cancer, shared experiences related to cancer, the stigma associated with HIV, and perceptions of the risk factors associated with chronic diseases.
Conclusion: Education modules have been created to address misconceptions and gaps in information about significant risk factors for cancer, HIV stigma, and prevention strategies regarding WHIs. Future implementation of these modules will evaluate perceived knowledge gain of the chronic conditions.
Abstract
Impact and Perceptions of CHANGE INC. Community Health and Empowerment Navigators Addressing Food and Health Services Insecurity in Cleveland, OH
APHA 2022 Annual Meeting and Expo
Background: Navigators improve health outcomes of individuals they serve. However, there is limited information regarding the impact of serving as a navigator on navigators themselves or navigator perceptions of their impact on and persisting issues withing the communities in which they serve.
Methods: CHANGE INC. is a community-based program in which Community Health and Empowerment Navigators (CHENs) assist in navigation of available food and health resources for food and health services insecure residents. CHENs serve 1+-year terms as AmeriCorps members. Pre/post surveys assessing personal growth, civic attitudes and engagement, and multicultural awareness were completed. CHENs were invited to complete an in-depth interview (IDI) at the end of their service year. Interviews were transcribed verbatim and thematic analyses were completed by researchers (n=2) who used comparative analysis to determine major themes.
Results: CHEN (n=11) demographics: mean age 32.55±17.81y, 81.82% (n=9) female, and 63.64% (n=7), 18.18% (n=2), and 18.18% (n=2) White, Black, and Hispanic, respectively. CHEN personal growth, civic attitudes and engagement, and multicultural awareness scores improved, albeit insignificantly (114.33±2.38:118.00±2.76 [p=0.33]; 164.22±5.53:170.28±6.14 [p=0.47]; 47.55±1.28:48.14±1.71 [p=0.78]). Average interview time (n=9) was 43:49.67. Major (and sub) themes that emerged: CHEN Impacts (Personal Skills Developed, Impact on Community), Barriers/Needs (CHEN, Resident, Community) and Developing a Successful Navigators Program (Navigator Training Needs, Skills/Tools to Succeed).
Conclusions: Navigator-based programs may provide opportunities for personal growth, skills development, and civic and multicultural awareness. CHENs have a unique, front-line understanding of persisting issues that food and health services insecure residents face.
Abstract
Evaluating Barriers to Remote Patient Monitoring Device Usage in Hypertensive Populations
APHA 2022 Annual Meeting and Expo
Introduction: Clinicians continue to integrate digital health technology into patient care through modalities including patient portals, video visits, and remote patient moitoring (RPM) devices. While access to devices is often cited as the primary patient barrier to engagement with digital health, there are other barriers to uptake. The study team explored reasons for non-use of RPM devices for monitoring vital signs (blood pressure, weight, and SpO2) among a population of patients who were provided with devices by the health care system.
Methods: We conducted telephone surveys (between 10/4/2021 and 12/19/2021) of patients who were provided a Bluetooth-enabled blood pressure cuff, scale, or pulse oximeter from Jefferson Health clinics. Patients were asked questions regarding frequency of device use, perceptions on benefit/safety of the devices, and experience using general technology modalities (with questions being adapted and modified from Neter et al.1). We describe differences between patients with “frequent (every day or every other day) device use and “infrequent (once per week or less) device use, using descriptive statistics.
Results: Out of 101 patients with attempted contacted, we successfully reached 37 patients and 22 patients completed the survey. Among “infrequent device users, the primary reasons for non-use were “forgetfulness (54%) and motivation (18%). When comparing frequent users and infrequent users, frequent users were more likely to perceive benefits of using their devices to manage their HTN, maintain their overall health, and stay connected to their health care provider. There were no statistically significant differences between frequent and infrequent users in terms of their access to stable internet and their experience using most modalities of general technology such as using technology to research health information or browse social media. There was a difference in that infrequent users utilized technology to download or stream media at a higher rate than frequent users.
Discussion: Simple provision of a digital health device does not guarantee regular use. Our population identified forgetfulness and motivation as primary patient barriers to uptake. These findings suggest that focused education and coaching at the time of device deployment on how to incorporate the device use into the daily routine (e.g. link to another regular activity, such as brushing teeth) and why regular use is important may increase patient uptake
Neter E, Brainin E. eHealth literacy: extending the digital divide to the realm of health information. J Med Internet Res. 2012 Jan 27;14(1):e19. doi: 10.2196/jmir.1619. PMID: 22357448; PMCID: PMC3374546.