scholarly journals 3512 Identifying Patient-Level Barriers to Non-Muscle Invasive Bladder Cancer Treatment and Surveillance Adherence in Low-Income Latino Patients: A Mixed-Methods Study

2019 ◽  
Vol 3 (s1) ◽  
pp. 90-90
Author(s):  
Sumeet Kaur Bhanvadia ◽  
Siamak Daneshmand ◽  
Mariana Stern ◽  
Lourdes Baezconde-Garbanati
Keyword(s):  
Los Angeles ◽  
Low Income ◽  
Barriers To Care ◽  
Oncologic Outcomes ◽  
Structural Barriers ◽  
Clinical Practices ◽  
Structured Interviews ◽  
Patient Level ◽  
Guideline Care ◽  
Muscle Invasive

OBJECTIVES/SPECIFIC AIMS: To evaluate the determinants of non-adherence to guideline treatment and surveillance and unique barriers to care in LIU Latinos with NMIBC that will inform the development of novel patient educational materials and navigation programs that could improve adherence and thus, oncologic outcomes. METHODS/STUDY POPULATION: We will recruit 40 Latino patients with new or existing NMIBC diagnoses who present to the Urology clinic at a large, tertiary public hospital in Los Angeles from November 2018 to March 2019. Quantitative (surveys) and qualitative (semi-structured interviews) data will be collected, analyzed and integrated in order to comprehensively determine patient-level barriers to adherence. RESULTS/ANTICIPATED RESULTS: We expect to identify a unique set of patient-level barriers to adherence to NMIBC care that is unique to this population that center around 1) structural barriers to care, 2) knowledge, attitudes, and beliefs that pertain to education, acculturation, gender and values, and 3) general and disease-specific health literacy. DISCUSSION/SIGNIFICANCE OF IMPACT: The barriers to surveillance and treatment NMIBC care are significant, particularly in LIU and minority patients, which is important as non-adherence to guideline care is linked to poorer cancer outcomes. The data generated herein will inform the development of tools and programs to aid in reducing or eliminating these barriers, but also will inform discussions on the effectiveness of current clinical practices for low-income Latino patients.

scholarly journals Provider Perceptions of Barriers to HIV Care Among Women with HIV in Miami-Dade County, Florida, and Possible Solutions: A Qualitative Study

2021 ◽  
Vol 20 ◽  
pp. 232595822110535
Author(s):  
Melissa K. Ward ◽  
Yazmine de la Cruz ◽  
Sofia B. Fernandez ◽  
Gladys E. Ibañez ◽  
Michèle Jean-Gilles ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Barriers To Care ◽  
Hiv Care ◽  
Dade County ◽  
Care Providers ◽  
Structural Barriers ◽  
Structured Interviews ◽  
Provider Perceptions ◽  
Medical Case ◽  
Women With Hiv

In Miami-Dade County, women with HIV (WWH) enrolled in Ryan White Program (RWP) services belong to groups that have historically faced structural barriers to care. To examine provider perceptions of WWH's barriers to care and elicit possible solutions, we conducted semi-structured interviews (n = 20) with medical case managers and human immunodeficiency virus (HIV) healthcare providers from medical case management sites serving WWH enrolled in the Miami-Dade RWP. Verbatim transcripts were analyzed thematically by two coders through an iterative process; disagreements were resolved through consensus. Barriers included lack of disclosure and stigma, additional psychosocial barriers to care, structural and logistical barriers, and negative interactions with health care providers. Participant suggestions to address these barriers included strategies that support women and foster individualized services that are responsive to their lived experiences and needs. Other solutions, such as those related to transportation, housing, and general funding for the RWP, will require advocacy and policy change.

scholarly journals Lunch at the library: examination of a community-based approach to addressing summer food insecurity

2017 ◽  
Vol 20 (9) ◽  
pp. 1640-1649 ◽  
Author(s):  
Janine S Bruce ◽  
Monica M De La Cruz ◽  
Gala Moreno ◽  
Lisa J Chamberlain
Keyword(s):  
Food Insecurity ◽  
Social Services ◽  
Low Income ◽  
Public Libraries ◽  
Qualitative Interviews ◽  
Food Resources ◽  
Structural Barriers ◽  
Structured Interviews ◽  
Community Based ◽  
Adult Participants

AbstractObjectiveTo examine a library-based approach to addressing food insecurity through a child and adult summer meal programme. The study examines: (i) risk of household food insecurity among participants; (ii) perspectives on the library meal programme; and (iii) barriers to utilizing other community food resources.DesignQuantitative surveys with adult participants and qualitative semi-structured interviews with a sub-sample of adult participants.SettingTen libraries using public and private funding to serve meals to children and adults for six to eight weeks in low-income Silicon Valley communities (California, USA) during summer 2015.SubjectsAdult survey participants (≥18 years) were recruited to obtain maximum capture, while a sub-sample of interview participants was recruited through maximum variation purposeful sampling.ResultsSurvey participants (n161) were largely Latino (71 %) and Asian (23 %). Forty-one per cent of participants screened positive for risk of food insecurity in the past 12 months. A sub-sample of programme participants engaged in qualitative interviews (n67). Interviewees reported appreciating the library’s child enrichment programmes, resources, and open and welcoming atmosphere. Provision of adult meals was described as building community among library patrons, neighbours and staff. Participants emphasized lack of awareness, misinformation about programmes, structural barriers (i.e. transportation), immigration fears and stigma as barriers to utilizing community food resources.ConclusionsFood insecurity remains high in our study population. Public libraries are ideal locations for community-based meal programmes due to their welcoming and stigma-free environment. Libraries are well positioned to link individuals to other social services given their reputation as trusted community organizations.

scholarly journals WIC Is Critical During the COVID-19 Pandemic: Lessons Learned From Los Angeles County Participants

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 205-205
Author(s):  
Lauren Au ◽  
Lorrene Ritchie ◽  
Nicole Vital ◽  
Marisa Tsai ◽  
Christopher Anderson ◽  
...  
Keyword(s):  
Los Angeles ◽  
Service Delivery ◽  
Nutrition Education ◽  
Low Income ◽  
Lessons Learned ◽  
Structured Interviews ◽  
Safe Delivery ◽  
Funding Sources ◽  
Low Income Families ◽  
The Impact

Abstract Objectives The COVID-19 pandemic has changed the way that the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) delivers services. The USDA granted multiple waivers to allow flexibility in WIC operations during the pandemic. The objective of this study was to hear from WIC participants about the impact of changes due to COVID-19. Methods In the summer of 2020, 60 semi-structured interviews were completed, half with English-speaking and half with Spanish-speaking WIC participants in the Los Angeles area. Interviews were recorded, transcribed, and analyzed using a deductive content analysis approach to describe responses and identify themes. Results Four themes emerged: 1) The pandemic has exacerbated the ckhallenges facing low-income families; 2) WIC continues to be a valued resource especially under the challenging circumstances; 3) WIC's transition to remote service delivery has ensured that families continue to receive not only critical WIC food benefits, but also nutrition education and support; 4) Lessons learned during COVID-19 can inform needed WIC modernizations to maximize WIC's proven benefits post-pandemic. Nearly 75% of WIC participants faced reductions in income due to job loss or reduced work hours. Nearly 60% of households reported experiencing food insecurity. Early in the pandemic, many reported challenges accessing WIC-eligible foods, resulting in lost food benefits. Approximately 43% reported getting food from a food pantry or church, with most (77%) reporting first time usage. Participants shared that even with the change to only remote education, they valued the information and were very satisfied with WIC services. The majority (83%) found the California WIC App helpful in informing what WIC foods they could purchase. Participants also reported that enrolling in WIC remotely was easier than coming in-person and they were comfortable providing documents related to income and eligibility determination remotely. Conclusions WIC has been essential in helping families cope with COVID. WIC's transition to remote service delivery has ensured seamless and safe delivery of services, helping families with young children during an unprecedented time of need. Funding Sources The David and Lucile Packard Foundation

SUSTAINING FAMILY ROUTINES AFTER TRANSITIONING INTO PARENTHOOD: COUPLES’ PERCEPTIONS OF ASSISTING FACTORS

2016 ◽  
Vol 28 (1) ◽  
pp. 3-17
Author(s):  
Christine De Goede ◽  
Abraham P Greeff
Keyword(s):  
Low Income ◽  
Transition To Parenthood ◽  
Specific Problem ◽  
Family Members ◽  
Major Theme ◽  
Structured Interviews ◽  
Theory Analysis ◽  
Family Routines ◽  
Temporal Complexity ◽  
Context Specific

The aim of this qualitative study was to explore what assists couples in sustaining family routines after the transition to parenthood. Participants were recruited from two day-care centres in Cape Town, South Africa. In-depth, semi-structured interviews were conducted with 10 couples, mostly from low-income households, who had gone through this transition between one and four years previously. Grounded theory analysis revealed one major theme, Factors that decrease task and temporal complexity, with seven subthemes: Support from the wider family network; Couple cooperation and tag-teaming; Planning and pre-empting future problems; Adhering to schedules; Facilitative characteristics and skills of individual family members; Parents’ sense of commitment and responsibility towards family members; and idiosyncratic accommodations. Results underscore the need for professionals to help parents gain support from relatives; strengthen partner teamwork; foster schedule consistency; improve skills such as planning; foster their caretaker self-concepts; and facilitate context-specific problem-solving.

Evaluating Patient-Defined Priorities for Female Patients with Bladder Cancer

2020 ◽  
pp. 1-8
Author(s):  
Amanda X. Vo ◽  
Mary Kate Keeter ◽  
Emily S. Tuchman ◽  
Joshua J. Meeks ◽  
Alicia K. Morgans
Keyword(s):  
Bladder Cancer ◽  
Locally Advanced ◽  
Invasive Bladder Cancer ◽  
Emotional Wellbeing ◽  
Structured Interviews ◽  
Muscle Invasive Bladder Cancer ◽  
Care Experience ◽  
Female Patients ◽  
Muscle Invasive ◽  
Optimal Approach

BACKGROUND: Although bladder cancer is much more common in men than in women, female patients with bladder cancer present with more locally advanced tumors and have worse disease-specific outcomes than male patients, even after controlling for biological differences. There is a paucity of research regarding the optimal approach to caring for female patients with bladder cancer in ways that maximize patient satisfaction, preferences, and values. OBJECTIVE: We sought to explore patient-defined priorities and areas in need of improvement for female patients with bladder cancer from the patient perspective. METHODS: We conducted focus group sessions and semi-structured interviews of women treated for bladder cancer to identify patient priorities and concerns until reaching topic saturation. Transcripts were analyzed thematically. RESULTS: Eight patients with muscle-invasive bladder cancer and six patients with non-muscle-invasive bladder cancer participated in two focus groups and seven interviews total. Three themes emerged as significantly affecting the care experience: physical impacts, mental health and emotional wellbeing, and the patient-provider interaction. Each theme included patient-defined specific recommendations on approaches to optimizing the care experience for women with bladder cancer. CONCLUSIONS: Although most participants were satisfied with the quality of care they received, they identified several opportunities for improvement. These concerns centered around enhancing support for patients’ physical and mental needs and strengthening the patient-provider interaction. Efforts to address these needs and reduce gender disparate outcomes via quality improvement initiatives are ongoing.

Understanding the Abortion Experiences of Young People to Inform Quality Care in Argentina, Bangladesh, Ethiopia, and Nigeria

2021 ◽  
pp. 0044118X2110110
Author(s):  
Laura E. Jacobson ◽  
Ana Maria Ramirez ◽  
Chiara Bercu ◽  
Anna Katz ◽  
Caitlin Gerdts ◽  
...  
Keyword(s):  
Young People ◽  
Quality Care ◽  
First Trimester ◽  
Structural Barriers ◽  
Structured Interviews ◽  
Safe Abortion ◽  
Medication Abortion ◽  
Abortion Care ◽  
The Mean ◽  
Reproductive Healthcare

Young people face social and structural barriers when accessing abortions. High-quality, sexual and reproductive healthcare is needed; however, literature on youth-informed abortion services is limited. This study assesses accounts of youth who obtained an abortion in Argentina, Bangladesh, Ethiopia, and Nigeria and provides recommendations to improve person-centered aspects of abortion quality. We analyzed 48 semi-structured interviews with clients recruited from clinics, safe abortion hotlines, and patent and proprietary medicine vendors. We coded transcripts and conducted a thematic analysis. The mean age was 21 years (range 16–24), and the majority had a first trimester, medication abortion. Prominent themes included access to information; privacy; stigma associated with age or marital status; the decision-making process; and comfort and rapport with providers. Youth-centered abortion care should anticipate the distinct needs of younger clients. Supportive providers have an important role in offering a non-judgmental service that makes young clients feel comfortable and prepared.

scholarly journals “My coupons are like gold”: experiences and perceived outcomes of low-income adults participating in the British Columbia Farmers’ Market Nutrition Coupon Program

2021 ◽  
pp. 1-30
Author(s):  
Stéphanie Caron-Roy ◽  
Sayeeda Amber Sayed ◽  
Katrina Milaney ◽  
Bonnie Lashewicz ◽  
Sharlette Dunn ◽  
...  
Keyword(s):  
British Columbia ◽  
Rural Communities ◽  
Low Income ◽  
Well Being ◽  
Qualitative Description ◽  
Farmers Markets ◽  
Social Connections ◽  
Structured Interviews ◽  
Program Outcomes ◽  
Farmers Market

ABSTRACT Objective: The British Columbia Farmers’ Market Nutrition Coupon Program (FMNCP) provides low-income households with coupons valued at $21/week for 16 weeks to purchase healthy foods in farmers’ markets. Our objective was to explore FMNCP participants’ experiences of accessing nutritious foods, and perceived program outcomes. Design: This study used qualitative description methodology. Semi-structured interviews were conducted with FMNCP participants during the 2019 farmers’ market season. Directed content analysis was used to analyse the data whereby the five domains of Freedman et al’s framework of nutritious food access provided the basis for an initial coding scheme. Data that did not fit within the framework’s domains were coded inductively. Setting: One urban and two rural communities in British Columbia, Canada. Participants: 28 adults who were participating in the FMNCP. Results: Three themes emerged: Autonomy and Dignity; Social Connections and Community Building; and Environmental and Programmatic Constraints. Firstly, the program promoted a sense of autonomy and dignity through financial support, increased access to high-quality produce, food-related education and skill development, and mitigating stigma and shame. Secondly, shopping in farmers’ markets increased social connections and fostered a sense of community. Finally, participants experienced limited food variety in rural farmers’ markets, lack of transportation, and challenges with redeeming coupons. Conclusions: Participation in the FMNCP facilitated access to nutritious foods and enhanced participants’ diet quality, well-being and health. Strategies such as increasing the amount and duration of subsidies, and expanding programs may help improve participants’ experiences and outcomes of farmers’ market food subsidy programs.

scholarly journals Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 94
Author(s):  
Carolyn Tarrant ◽  
Andrew M. Colman ◽  
David R. Jenkins ◽  
Edmund Chattoe-Brown ◽  
Nelun Perera ◽  
...  
Keyword(s):  
South Africa ◽  
Sri Lanka ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Low Income ◽  
System Level ◽  
Comparative Approach ◽  
Structured Interviews ◽  
Public And Private ◽  
The Uk

Antimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare contexts. Semi-structured interviews were conducted with 46 prescribers from hospitals in the UK, Sri Lanka, and South Africa, including public and private providers. Interviews explored decision making about prescribing BSAs, drivers of the use of BSAs, and benefits of BSAs to various stakeholders, and were analyzed using a constant comparative approach. Analysis identified drivers of BSA overuse at the individual, social and structural levels. Structural drivers of overuse varied significantly across contexts and included: system-level factors generating tensions with stewardship goals; limited material resources within hospitals; and patient poverty, lack of infrastructure and resources in local communities. Antimicrobial stewardship needs to encompass efforts to reduce the reliance on BSAs as a solution to context-specific structural conditions.

scholarly journals Designing Age-Friendly Communities: Exploring Qualitative Perspectives on Urban Green Spaces and Ageing in Two Indian Megacities

2021 ◽  
Vol 18 (4) ◽  
pp. 1491
Author(s):  
Deepti Adlakha ◽  
Mina Chandra ◽  
Murali Krishna ◽  
Lee Smith ◽  
Mark A. Tully
Keyword(s):  
Older Adults ◽  
Low Income ◽  
Later Life ◽  
Healthy Ageing ◽  
World Health ◽  
Social Resilience ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Urban Green ◽  
Activity Promotion

The World Health Organization and the United Nations have increasingly acknowledged the importance of urban green space (UGS) for healthy ageing. However, low- and middle-income countries (LMICs) like India with exponential ageing populations have inadequate UGS. This qualitative study examined the relationships between UGS and healthy ageing in two megacities in India. Participants were recruited using snowball sampling in New Delhi and Chennai and semi-structured interviews were conducted with consenting participants (N = 60, female = 51%; age > 60 years; fluent in English, Hindi, or Tamil). Interviews were recorded, transcribed, translated, and analysed using inductive and thematic analysis. Benefits of UGS included community building and social capital, improved health and social resilience, physical activity promotion, reduced exposure to noise, air pollution, and heat. Poorly maintained UGS and lack of safe, age-friendly pedestrian infrastructure were identified as barriers to health promotion in later life. Neighbourhood disorder and crime constrained older adults’ use of UGS in low-income neighbourhoods. This study underscores the role of UGS in the design of age-friendly communities in India. The findings highlight the benefits of UGS for older adults, particularly those living in socially disadvantaged or underserved communities, which often have least access to high-quality parks and green areas.

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