scholarly journals THE ROLE OF CULTURE AND LANGUAGE IN DEPRESSION CARE EXPERIENCES AMONG OLDER LATINAS/OS AND HEALTH CARE PROVIDERS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S585-S586
Author(s):  
Maria P Aranda ◽  
Janelle Christensen ◽  
Iris Aguilar
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Low Income ◽  
Quality Care ◽  
Intervention Development ◽  
Relationship Building ◽  
Care Providers ◽  
Depression Care ◽  
Study Implementation ◽  
Shared Culture

Abstract Older Latinas/os face significant difficulties in accessing quality depression treatment due to cultural and language barriers. In our study, Programa Esperanza (a randomized behavioral trial), we conducted after-treatment, in-depth interviews with two groups: 21 low-income Latinas/os (55+) receiving psychosocial depression care (Problem Solving Treatment, and Psychoeducation) in a health care setting, and 22 staff (interventionists, supervisors) participating in study implementation. Speaking the same language was highlighted by both groups as an overarching factor in effective depression care, although matching providers and patients by country of origin was considered less a priority than a shared language. The mechanisms by which language serves as a facilitator of effective care were highlighted: fomenting rapport; facilitating the expression of feelings; shortening initial relationship-building; understanding nuanced words and linguistic expressions; etc. Similarly, we found that shared culture included themes around intervention uptake, decreased stigma, increased advocacy, enhanced identification of coping strategies, etc. Unlike patients, providers were more likely to speak in diverse narratives of “them,” and “us.” Given that depression is still a stigmatizing disorder in our society, asking for help and receiving quality care remain significant challenges for older persons in general, and older underrepresented minorities, in particular. Our work signals the importance of differentiating language from culture in intervention development for older, primarily Spanish-speaking Latinas/os with high medical comorbidity.

Current Practices and Challenges of Medical Services on Health Care System of Mandalay General Hospital

2019 ◽  
Vol 31 (2) ◽  
pp. 131
Keyword(s):  
Health Care ◽  
General Hospital ◽  
Health Care Providers ◽  
Quality Care ◽  
Healthcare Providers ◽  
Medical Services ◽  
Tertiary Level ◽  
Care Providers ◽  
Level Hospital ◽  
Care System

In Myanmar, the main challenge to provide quality healthcare by Universal Health Care approach is documented as low health services coverage with substantial wealth-based inequality. To achieve the effective health care system, strong medical care system is essential. Understanding on challenges and needs in provision of medical services among patients and health care providers is critical to provide quality care with desirable outcomes. The aim of the study was to explore the patients’ and health care providers’ perceptions on the challenges in provision of medical services at the Mandalay General Hospital. This was a qualitative study conducted at the tertiary level hospital (Mandalay General Hospital). The data was collected by using focus group discussions and in-depth interviews with hospitalized patients or attendants, healthcare providers such as medical doctors, nurses, laboratory scientists and hospital administrators in March 2017. The qualitative data was analyzed using themes by themes matrix analysis. Most patients were satisfied with the care provided by the doctors because they believed that they received quality care. However, some patients complained about long waiting time for elective operation, congested conditions in the ward, burden for investigations outside the hospital for urgent needs and impolite manners of general workers. Healthcare providers reported that they had heavy workload due to limited human and financial resources in the hospital, poor compliances with hospital rules and regulation among patients and attendants, and inefficient referral practices from other health facilities. Other challenges experienced by healthcare providers were lack of ongoing training to improve knowledge and skills, limited health infrastructure and inadequate medicinal supplies. The findings highlighted the areas needed to be improved to provide quality health care at the tertiary level hospital. The challenges and problems encountered in this hospital can be improved by allocating adequate financial and human resources. The systematic referral system and hospital management guidelines are needed to reduce workload of health staff.

Immigrant Communities and COVID-19: Strengthening the Public Health Response

2021 ◽  
Vol 111 (S3) ◽  
pp. S224-S231
Author(s):  
Lan N. Đoàn ◽  
Stella K. Chong ◽  
Supriya Misra ◽  
Simona C. Kwon ◽  
Stella S. Yi
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Providers ◽  
Low Income ◽  
Immigrant Communities ◽  
Care Providers ◽  
Public Health Response ◽  
The Public ◽  
Public Health Infrastructure ◽  
Health Infrastructure

The COVID-19 pandemic has exposed the many broken fragments of US health care and social service systems, reinforcing extant health and socioeconomic inequities faced by structurally marginalized immigrant communities. Throughout the pandemic, even during the most critical period of rising cases in different epicenters, immigrants continued to work in high-risk-exposure environments while simultaneously having less access to health care and economic relief and facing discrimination. We describe systemic factors that have adversely affected low-income immigrants, including limiting their work opportunities to essential jobs, living in substandard housing conditions that do not allow for social distancing or space to safely isolate from others in the household, and policies that discourage access to public resources that are available to them or that make resources completely inaccessible. We demonstrate that the current public health infrastructure has not improved health care access or linkages to necessary services, treatments, or culturally competent health care providers, and we provide suggestions for how the Public Health 3.0 framework could advance this. We recommend the following strategies to improve the Public Health 3.0 public health infrastructure and mitigate widening disparities: (1) address the social determinants of health, (2) broaden engagement with stakeholders across multiple sectors, and (3) develop appropriate tools and technologies. (Am J Public Health. 2021;111(S3):S224–S231. https://doi.org/10.2105/AJPH.2021.306433 )

scholarly journals A Study Protocol for Increasing Access to Smoking Cessation Treatments for Low-Income Minority Smokers

2021 ◽  
Vol 9 ◽  
Author(s):  
Alicia K. Matthews ◽  
Karriem S. Watson ◽  
Cherdsak Duang ◽  
Alana Steffen ◽  
Robert Winn
Keyword(s):  
Health Care ◽  
Smoking Cessation ◽  
Health Care Providers ◽  
Low Income ◽  
Access To Health Care ◽  
Social Determinant ◽  
Evidence Based ◽  
Patient Portal ◽  
Care Providers ◽  
Access To Health

Background: Smoking rates among low-income patients are double those of the general population. Access to health care is an essential social determinant of health. Federally qualified health care centers (FQHC) are government-supported and community-based centers to increase access to health care for non-insured and underinsured patients. However, barriers to implementation impact adherence and sustainability of evidence-based smoking cessation within FQHC settings. To address this implementation barrier, our multi-disciplinary team proposes Mi QUIT CARE (Mile Square QUITCommunity-Access-Referral-Expansion) to establish the acceptability, feasibility, and capacity of an FQHC system to deliver an evidence-based and multi-level intervention to increase patient engagement with a state tobacco quitline.Methods: A mixed-method approach, rooted in an implementation science framework of RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance), will be used in this hybrid effectiveness-implementation design. We aim to evaluate the efficacy of a novel delivery system (patient portal) for increasing access to smoking cessation treatment. In preparation for a future randomized clinical trial of Mi QUIT CARE, we will conduct the following developmental research: (1) Examine the burden of tobacco among patient populations served by our partner FQHC, (2) Evaluate among FQHC patients and health care providers, knowledge, attitudes, barriers, and facilitators related to smoking cessation and our intervention components, (3) Evaluate the use of tailored communication strategies and patient navigation to increase patient portal uptake among patients, and (4) To test the acceptability, feasibility, and capacity of the partner FQHC to deliver Mi QUIT CARE.Discussion: This study provides a model for developing and implementing smoking and other health promotion interventions for low-income patients delivered via patient health portals. If successful, the intervention has important implications for addressing a critical social determinant of cancer and other tobacco-related morbidities.Trial Registration: U.S. National Institutes of Health Clinical Trials, NCT04827420, https://clinicaltrials.gov/ct2/show/NCT04827420.

scholarly journals Adults on the Autism Spectrum Face Significant Challenges Accessing Health Care Services

2021 ◽  
Vol 14 (1) ◽  
pp. 53
Author(s):  
Setareh Ghahari ◽  
Megan Widmer ◽  
Tom Heneghan ◽  
Methuna Naganathan ◽  
Thanusha Kathiravel
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Services ◽  
Quality Care ◽  
Autism Spectrum ◽  
Service Access ◽  
Care Providers ◽  
Spectrum Access ◽  
Health Service Access ◽  
Care Services

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by difficulties with social skills, verbal and non-verbal communication, repetitive behaviours and atypical sensory processing. Individuals on the autism spectrum face a higher prevalence of health conditions and have a higher mortality rate than the general population. There is a critical need to understand adults’ experiences on the autism spectrum when accessing health care services to understand how to improve accessibility to health care for these individuals. The purpose of this scoping review was to investigate how adults on the autism spectrum access and experience health care services. Four databases, including Embase, MEDLINE, CINAHL, and PsycInfo, were systematically searched for literature exploring how individuals on the autism spectrum access and experience health care. Results were extracted and categorized into five determinants based on the accessibility framework described by Levesque et al. (2013). Results indicated adults on the autism spectrum experience numerous barriers when accessing health care services. The dimension of access most frequently cited was the appropriateness of care, followed by the acceptability of care. It is essential to explore access as it is often conceptualized as the availability and affordability of services; however, results of this study indicate the broader experience of quality care provision and acceptance of the individual are important in understanding the complex experience individuals on the autism spectrum face. Based on these findings, there is a need to provide comprehensive education and clinical practice guidelines for health care providers to help reduce barriers to providing appropriate care for adults on the autism spectrum. Efforts to destigmatize intrapersonal and extra-personal perceptions of individuals on the autism spectrum will help overcome the barriers that affect care acceptability. Further research must understand how to design and implement strategies to maximize health service access for adults on the autism spectrum.

Seeing the Patient and Family Through: Nurses and Physicians Experiences With Withdrawal of Life-Sustaining Therapy in the ICU

2018 ◽  
Vol 36 (1) ◽  
pp. 13-23 ◽  
Author(s):  
Debra L. Wiegand ◽  
Jooyoung Cheon ◽  
Giora Netzer
Keyword(s):  
Health Care ◽  
Critical Care ◽  
Data Analysis ◽  
Health Care Providers ◽  
Quality Care ◽  
Phenomenological Approach ◽  
Critical Care Nurses ◽  
Care Providers ◽  
Therapy Decision ◽  
Nurses And Physicians

Withdrawal of life-sustaining therapy at the end of life is a complex phenomenon. Intensive care nurses and physicians are faced with caring for patients and supporting families, as these difficult decisions are made. The purpose of this study was to explore and describe the experience of critical care nurses and physicians participating in the process of withdrawal of life-sustaining therapy. A hermeneutic phenomenological approach was used to guide this qualitative investigation. Interviews were conducted with critical care nurses and physicians from 2 medical centers. An inductive approach to data analysis was used to understand similarities between the nurses and the physicians’ experiences. Methodological rigor was established, and data saturation was achieved. The main categories that were inductively derived from the data analysis included from novice to expert, ensuring ethical care, uncertainty to certainty, facilitating the process, and preparing and supporting families. The categories aided in understanding the experiences of nurses and physicians, as they worked individually and together to see patients and families through the entire illness experience, withdrawal of life-sustaining therapy decision-making process and dying process. Understanding the perspectives of health-care providers involved in the withdrawal of life-sustaining therapy process will help other health-care providers who are striving to provide quality care to the dying and to their families.

Prenatal Care among Low-Income Women

1994 ◽  
Vol 75 (3) ◽  
pp. 152-159 ◽  
Author(s):  
Marjorie A. Schaffer ◽  
Betty Lia-Hoagberg
Keyword(s):  
Health Care ◽  
Prenatal Care ◽  
Pregnant Women ◽  
Health Care Providers ◽  
Low Income ◽  
Healthcare Personnel ◽  
Care Providers ◽  
Healthy Baby ◽  
Low Income Women ◽  
High Level

Forty low-income pregnant women were interviewed about the personal, family, and provider rewards and costs they experienced in obtaining prenatal care. The women identified important rewards as the health of their babies, their own health, partner's desire for a healthy baby, monitoring of the pregnancy by qualified healthcare personnel, and the evaluation of problems by health-care providers. The authors suggest strategies to strengthen personal, family, and provider rewards aimed at achieving a high level of prenatal care for low-income women.

Successful Strategies to Address Disparities: Insurer and Employer Perspectives

2020 ◽  
pp. 292-300
Author(s):  
Manali I. Patel ◽  
Richard Snyder ◽  
Otis Brawley
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Low Income ◽  
Cancer Care ◽  
Care Delivery ◽  
The United States ◽  
Cancer Disparities ◽  
Care Providers ◽  
High Quality ◽  
Quality Cancer Care

Disparities in cancer have been documented for decades and continue to persist despite clinical advancements in cancer prevention, detection, and treatment. Disparate cancer outcomes continue to affect many populations in the United States and globally, including racial and ethnic minorities, populations with low income and education, and residents of rural areas or low socioeconomic neighborhoods, among others. Addressing cancer disparities requires approaches that are multilevel. Addressing social determinants of health, such as removing obstacles to health (e.g., poverty, discrimination, access to housing and education, jobs with fair pay, and health care) can reduce cancer disparities. However, to achieve cancer health equity, multilevel approaches are required to ensure that access to high-quality cancer care and equitable receipt of evidence-based services can reduce cancer disparities. Policy, health system interventions, and innovative delivery and health care coverage approaches by private and public payers, employer-based payers, and labor union organizations can assist in ensuring access to and receipt of high-quality cancer care while addressing the high costs of care delivery. Partnerships among patients, caregivers, employers, health care providers, and health care payers can make impactful changes in the way in which cancer care is delivered and, in turn, can assist in reducing cancer disparities.

scholarly journals The Pre-Kindergarten Learning Enterprise (PKLE)

2011 ◽  
Vol 15 (3) ◽  
pp. 19
Author(s):  
Kahina Lasfer ◽  
Art Pyster ◽  
Brian Sauser
Keyword(s):  
Health Care ◽  
Home Environment ◽  
Health Care Providers ◽  
Low Income ◽  
Weak Interactions ◽  
Financial System ◽  
Kindergarten Children ◽  
Care Providers ◽  
Role Of Parents ◽  
Effective Development

To meet the challenges that todays pre-Kindergarten children will face as adults, they need effective development and learning organizations. Together, those organizations form the pre-Kindergarten (pre-K) learning enterprise, whose characteristics and behaviors greatly influence what pre-K children learn and how well they learn it. In this paper, the pre-K learning enterprise is explicitly defined and modeled for the first time and then analyzed through a systems thinking lens using systemigrams and related causal loop diagrams. Defining and modeling the pre-K learning enterprise is itself valuable as a means to understand the various relationships that exist among the identified constituent systems (e.g., home environment, preschool, financial, health care, state, and government) and the stakeholders identified within the enterprise (e.g., parents, educators, health care providers, and policy makers). That value is enhanced through an analysis which reveals the predominant reliance of several key pre-K learning enterprise component systems on the financial system while exposing weak interactions among the three main participating systems (preschools, home environment, and government). Heavy reliance on the financial system in todays economy reduces the effectiveness of the pre-K learning enterprise. To ease such reliance on the financial system while enhancing key interrelationships, three improvements to the existing enterprise are postulated: (1) enhance the role of parents through better education on child development, learning, health and nutrition and their increased voluntary involvement with preschools, (2) reduce the dependency on the financial system and promote partnerships among preschools, sports facilities, libraries and other learning systems to share resources, and (3) enhance government role through implementation of curriculum standardization, assessment and evaluation, and an effective policy towards mandatory education of low-income children.

scholarly journals The lived experience of health-management in patients with Parkinson’s disease

2020 ◽  
Vol 26 (4) ◽  
pp. 423-433
Author(s):  
Hye Gyeong Son ◽  
Hyun-Joo Park ◽  
Sang Jin Kim ◽  
A-Leum Han
Keyword(s):  
Parkinson’S Disease ◽  
Health Care ◽  
Parkinson's Disease ◽  
Lived Experience ◽  
Health Care Providers ◽  
Health Management ◽  
Intervention Development ◽  
Nursing Intervention ◽  
Care Providers ◽  
Study Results

Purpose: The purpose of this study was to describe the health care experiences among patients with Parkinson’s disease.Methods: Of the qualitative research methods, Colaizzi’s phenomenological method was used in this study. A total of nine patients, who were diagnosed with Parkinson’s disease and receiving outpatient treatment, were selected as the subjects of this study. Subsequently, data were collected through individual in-depth interview.Results: The four categories obtained as a result were ‘strenuous efforts to control my own body,’ ‘subject of health that no one can replace,’ ‘focus on the current while expecting a breakthrough in health management,’ and ‘human dignity that cannot be lost to the end.’Conclusion: The study results are expected to help health care providers deeply understand the experiences in health care among patients with Parkinson’s disease and to provide source data for nursing intervention development that can be helpful in managing the health status of patients with Parkinson’s disease.

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