Addressing financial strain through a peer-to-peer intervention in primary care

2020 ◽  
Vol 37 (6) ◽  
pp. 815-820
Author(s):  
Andrew D Pinto ◽  
Monica Da Ponte ◽  
Madeleine Bondy ◽  
Amy Craig-Neil ◽  
Kathleen Murphy ◽  
...  
Keyword(s):  
Primary Care ◽  
Focus Groups ◽  
Social Determinant ◽  
Peer To Peer ◽  
Financial Strain ◽  
Care Organization ◽  
Peer Intervention ◽  
Degree Of Control ◽  
Peer Interventions ◽  
Social Determinant Of Health

Abstract Background Financial strain is a key social determinant of health. As primary care organizations begin to explore ways to address social determinants, peer-to-peer interventions hold promise. Objective Our objective was to evaluate a peer-to-peer intervention focussed on financial empowerment delivered in primary care, in partnership with a social enterprise. Methods This intervention was hosted by a large primary care organization in Toronto, Canada. Participants were recruited within the organization and from local services. We organized three separate groups who met over 10 weekly in-person, facilitated sessions: millennials (age 19–29) no longer in school, precariously employed adults (age 30–55) and older adults near retirement (age 55–64). We applied principles of adult education and peer-to-peer learning. We administered surveys at intake, at exit and at 3 months after the intervention, and conducted three focus groups. Results Fifty-nine people took part. At 3 months, participants had sustained higher rates of optimism about their financial situation (54% improved from baseline), their degree of control (55% improved) and stress around finances (50% improved). In focus groups, participants reported greater understanding of their finances, that they were not alone in struggling with finances, and that it was useful to meet with others. One group continued to meet for several months after the intervention. Conclusions In this study, a peer-to-peer intervention helped address a key social determinant of health, likely through reducing stigma, providing group support and creating a space to discuss solutions. Primary care can host these interventions and help engage potential participants.

scholarly journals Corrigendum to: Addressing financial strain through a peer-to-peer intervention in primary care

2020 ◽  
Vol 37 (4) ◽  
pp. 580-580
Author(s):  
Andrew D Pinto ◽  
Monica Da Ponte ◽  
Madeleine Bondy ◽  
Amy Craig-Neil ◽  
Kathleen Murphy ◽  
...  
Keyword(s):  
Primary Care ◽  
Peer To Peer ◽  
Financial Strain ◽  
Peer Intervention

scholarly journals Routinely asking patients about income in primary care: a mixed-methods study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0090
Author(s):  
Andrew David Pinto ◽  
Erica Shenfeld ◽  
Tatiana Aratangy ◽  
Ri Wang ◽  
Rosane Nisenbaum ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Electronic Health Records ◽  
Social Determinant ◽  
Mixed Methods Study ◽  
Financial Strain ◽  
Future Research ◽  
Care Organization ◽  
Health Records ◽  
Electronic Health

BackgroundIncome is a key social determinant of health yet it is rare for data on income to be routinely collected and integrated with electronic health records.AimTo examine response bias and evaluate patient perspectives of being asked about income in primary care.Design and settingMixed-methods study in a large, multi-site primary care organization in Toronto, Canada where patients are asked about income in a routinely administered sociodemographic survey.MethodsWe examined data from the electronic health records of patients who answered at least one question on the survey between December 2013 and March 2016 (n=14,247). We compared those who responded to the income question to non-responders. We also conducted structured interviews with 27 patients.Results10,441 (73%) patients responded to both parts of the income question. Female patients, minorities, caregivers of young children and seniors were less likely to respond. From interviews, many patients were comfortable answering the income question, particularly if they understood the connection between income and health, and believed the data would be used to improve care. Several patients found it difficult to estimate their income or felt the options did not reflect fluctuating financial circumstances.ConclusionsMany patients will provide data on income in the context of a survey in primary care, but accurately estimating income can be challenging. Future research should compare self-reported income to perceived financial strain. Data on income linked to health records can help identify health inequities and can help target anti-poverty interventions.

Perceived Facilitators and Barriers to Implementation of a Decision Support Tool for Adolescent Depression and Suicidality Screening: A Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Ana Radovic ◽  
Nathan Anderson ◽  
Megan Hamm ◽  
Brandie George-Milford ◽  
Carrie Fascetti ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Qualitative Study ◽  
Focus Groups ◽  
Decision Support Tool ◽  
Depression Screening ◽  
Self Disclosure ◽  
Support Tool ◽  
Adolescent Parent ◽  
Barriers To Implementation

BACKGROUND Screening Wizard (SW) is a technology-based decision support tool aimed at guiding primary care providers (PCPs) to respond to depression and suicidality screens in adolescents. Separate screens assess adolescents’ and parents’ reports on mental health symptoms, treatment preferences, and potential treatment barriers. A detailed summary is provided to PCPs, also identifying adolescent-parent discrepancies. The goal of SW is to enhance decision making to increase utilization of evidence-based treatments. OBJECTIVE We describe a multi-stakeholder qualitative study with adolescents, parents, and providers to understand potential barriers to implementation of SW. METHODS We interviewed 11 parents and 11 adolescents, and conducted 2 focus groups with 17 healthcare providers (PCPs, nurses, therapists, staff) across 2 pediatric practices. Participants described previous experiences with screening for depression and were shown a mock-up of SW and asked for feedback. Interviews and focus groups were transcribed verbatim, and codebooks inductively developed based on content. Transcripts were double-coded, and disagreements adjudicated to full agreement. Completed coding was used to produce thematic analyses of interviews and focus groups. RESULTS We identified five main themes across the interviews and focus groups: (1) parents, adolescents, and pediatric PCPs agree that depression screening should occur in pediatric primary care; (2) there is concern that accurate self-disclosure does not always occur during depression screening; (3) Screening Wizard is viewed as a tool that could facilitate depression screening, and which might encourage more honesty in screening responses; (4) parents, adolescents and providers do not want Screening Wizard to replace mental health discussions with providers; and (5) providers want to maintain autonomy in treatment decisions. CONCLUSIONS We identified that providers, parents, and adolescents all have concerns with current screening practices, mainly regarding inaccurate self-disclosure. They recognized value in SW as a computerized tool that may elicit more honest responses and identify adolescent-parent discrepancies. Surprisingly, providers did not want the SW report to include treatment recommendations, and all groups did not want the SW report to replace conversations with the PCP about depression. While SW was originally developed as a treatment decision algorithm, this qualitative study has led us to remove this component, and instead focus on aspects identified as most useful by all groups. We hope that this initial qualitative work will improve future implementation of SW.

scholarly journals Mechanisms linking teenage mothers’ educational attainment with self-reported health at age 50

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Julie Maslowsky ◽  
C. Emily Hendrick ◽  
Haley Stritzel
Keyword(s):  
Educational Attainment ◽  
Well Being ◽  
The United States ◽  
Social Determinant ◽  
Early Childbearing ◽  
Partner Characteristics ◽  
Higher Educational Attainment ◽  
The Life Course ◽  
Social Determinant Of Health

Abstract Background Early childbearing is associated with adverse health and well-being throughout the life course for women in the United States. As education continues to be a modifiable social determinant of health after a young woman gives birth, the association of increased educational attainment with long-term health for women who begin childbearing as teenagers is worthy of investigation. Methods Data are from 301 mothers in the National Longitudinal Survey of Youth 1979 who gave birth prior to age 19. We estimated path models to assess women’s incomes, partner characteristics, and health behaviors at age 40 as mediators of the relationship between their educational attainment and self-rated general health at age 50. Results After accounting for observed background factors that select women into early childbearing and lower educational attainment, higher levels of education (high school diploma and GED attainment vs. no degree) were indirectly associated with higher self-rated health at age 50 via higher participant income at age 40. Conclusions As education is a social determinant of health that is amenable to intervention after a teen gives birth, our results are supportive of higher educational attainment as a potential pathway to improving long-term health outcomes of women who begin childbearing early.

scholarly journals A qualitative exploration of patients’ experiences, needs and expectations regarding online access to their primary care record

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044221
Author(s):  
Brian McMillan ◽  
Gail Davidge ◽  
Lindsey Brown ◽  
Moira Lyons ◽  
Helen Atherton ◽  
...  
Keyword(s):  
Primary Care ◽  
Focus Groups ◽  
Negative Consequences ◽  
Face To Face ◽  
Primary Care Record ◽  
Online Access ◽  
Additional Support ◽  
The Uk ◽  
Records Access ◽  
Qualitative Exploration

ObjectivesPrimary care records have traditionally served the needs and demands of clinicians rather than those of the patient. In England, general practices must promote and offer registered patients online access to their primary care record, and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients’ needs and expectations regarding online access to their record. This study explored what patients and carers want from online access to their electronic primary care health record, their experiences of using it, how they would like to interact with their record and what support they may need.DesignFocus groups and semistructured interviews using purposive sampling to achieve a good sociodemographic spread. Interviews were digitally audiorecorded, transcribed and coded using an established thematic approach.SettingFocus groups and interviews were conducted in community settings in the UK.ParticipantsFifty-four individuals who were either eligible for the National Health Service Health Check, living with more than one long-term condition or caring for someone else.ResultsParticipants views regarding online access were categorised into four main themes: awareness, capabilities, consequences and inevitability. Participants felt online access should be better promoted, and suggested a number of additional functions, such as better integration with other parts of the healthcare system. It was felt that online access could improve quality of care (eg, through increased transparency) but also have potential negative consequences (eg, by replacing face to face contact). A move towards more online records access was considered inevitable, but participants noted a need for additional support and training in using the online record, especially to ensure that health inequalities are not exacerbated.ConclusionsDiscussions with patients and carers about their views of accessing online records have provided useful insights into future directions and potential improvements for this service.

scholarly journals Conceptual causal models of socioeconomic status, family structure, family functioning and their role in public health

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Frederik Booysen ◽  
Ferdi Botha ◽  
Edwin Wouters
Keyword(s):  
Public Health ◽  
Socioeconomic Status ◽  
Family Functioning ◽  
Family Structure ◽  
Empirical Studies ◽  
Social Determinant ◽  
Causal Models ◽  
Family Socioeconomic Status ◽  
The Family ◽  
Social Determinant Of Health

AbstractSocial determinants of health frameworks are standard tools in public health. These frameworks for the most part omit a crucial factor: the family. Socioeconomic status moreover is a prominent social determinant of health. Insofar as family functioning is poorer in poor families and family structure and functioning are linked to health, it is critical to consider the pathways between these four constructs. In this correspondence, we reflect on how empirical studies of this conceptual nexus mirror two causal models. We conclude by reflecting on future directions for research in this field.

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