scholarly journals Can Community Health Workers Increase Palliative Care Use for African American Patients? A Pilot Study

2021 ◽  
Vol 17 (2) ◽  
pp. e158-e167
Author(s):  
Ramy Sedhom ◽  
Richard Nudotor ◽  
Karen M. Freund ◽  
Thomas J. Smith ◽  
Lisa A. Cooper ◽  
...  
Keyword(s):  
Palliative Care ◽  
African American ◽  
Community Health ◽  
Social Determinants Of Health ◽  
Community Health Workers ◽  
Social Determinants ◽  
Health Workers ◽  
Symptom Assessment ◽  
Determinants Of Health ◽  
Study Patient

PURPOSE: African American patients with cancer underutilize advance care planning (ACP) and palliative care (PC). This feasibility study investigated whether community health workers (CHWs) could improve ACP and PC utilization for African American patients with advanced cancer. METHODS: African American patients diagnosed with an advanced solid organ cancer (stage IV or stage III disease with a palliative performance score < 60%) were enrolled. Patients completed baseline surveys that assessed symptom burden and distress at baseline and 3 months post-CHW intervention. The CHW intervention consisted of a comprehensive assessment of multiple PC domains and social determinants of health. CHWs provided tailored support and education on the basis of iterative assessment of patient needs. Intervention feasibility was determined by patient and caregiver retention rate above 50% at 3 months. RESULTS: Over a 12-month period, 24 patients were screened, of which 21 were deemed eligible. Twelve patients participated in the study. Patient retention was high at 3 months (75%) and 6 months (66%). Following the CHW intervention, symptom assessment as measured by Edmonton Symptom Assessment System improved from 33.8 at baseline to 18.8 ( P = .03). Psychological distress improved from 5.5 to 4.7 ( P = .36), and depressive symptoms from 42.2 to 33.6 ( P = .09), although this was not significant. ACP documentation improved from 25% at baseline to 75% at study completion. Sixty-seven percentage of patients were referred to PC, with 100% of three decedents using hospice. CONCLUSION: Utilization of CHWs to address PC domains and social determinants of health is feasible. Although study enrollment was identified as a potential barrier, most recruited patients were retained on study.

scholarly journals Social Determinants of Health as Potential Influencers of a Collaborative Care Intervention for Patients with Hypertension

2021 ◽  
Vol 31 (1) ◽  
pp. 47-56
Author(s):  
Chidinma A. Ibe ◽  
Carmen Alvarez ◽  
Kathryn A. Carson ◽  
Jill A. Marsteller ◽  
Deidra C. Crews ◽  
...  
Keyword(s):  
Health Literacy ◽  
Community Health ◽  
Social Determinants Of Health ◽  
Community Health Workers ◽  
Social Determinants ◽  
Collaborative Care ◽  
Health Workers ◽  
Determinants Of Health ◽  
Nurse Care ◽  
Care Intervention

Objectives: The use of collaborative care teams, comprising nurse care managers and community health workers, has emerged as a promising strategy to tackle hyperten­sion disparities by addressing patients’ social determinants of health. We sought to identify which social determinants of health are associated with a patient’s likelihood of engaging with collaborative care team members and with the nurse care manager’s likelihood of enlisting community health workers (CHW) to provide additional sup­port to patients.Methods: We conducted a within-group longitudinal analysis of patients assigned to receive a collaborative care intervention in a pragmatic, cluster randomized trial that aims to reduce disparities in hypertension control (N=888). Generalized estimating equations were used to identify which social deter­minants of health, reported on the study’s baseline survey, were associated with the odds of patients engaging with the col­laborative care intervention, and of nurses deploying community health workers.Results: Patients who were unable to work and those with higher health literacy were less likely to engage with the collaborative care team than those who were employed full time or had lower health literacy, respectively. Patients had a greater likeli­hood of being referred to a community health worker by their care manager if they reported higher health literacy, perceived stress, or food insecurity, while those report­ing higher numeracy had lower odds of receiving a CHW referral.Implications/Conclusions: A patient’s social determinants of health influence the extent of engagement in a collaborative care intervention and nurse care manager appraisals of the need for supplementary support provided by community health workers.Ethn Dis. 2021;31(1):47-56; doi:10.18865/ed.31.1.47

scholarly journals A mixed methods evaluation of the feasibility, acceptability, and impact of a pilot project ECHO for community health workers (CHWs)

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
April Joy Damian ◽  
Sarafina Robinson ◽  
Faaiza Manzoor ◽  
Mandy Lamb ◽  
Adriana Rojas ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Community Health ◽  
Social Determinants Of Health ◽  
Community Health Workers ◽  
Social Determinants ◽  
Self Efficacy ◽  
Social Issues ◽  
Health Workers ◽  
Determinants Of Health ◽  
Project Echo

Abstract Background Despite the positive effects of community health workers (CHWs) on addressing social determinants of health, improving patient health outcomes, and decreasing overall healthcare costs, there is a lack of standardization in training and certifying this workforce, resulting in different approaches to integrating this role into medical home models. The purpose of the current study is to evaluate the application of Project ECHO (Extension for Community Healthcare Outcomes) in enhancing CHWs’ capacity to address health and social issues of vulnerable populations. Methods An explanatory sequential mixed methods design was applied in which all participants (N = 49) completed pre (January 2019) and post (July 2019) quantitative online surveys measuring changes in self-efficacy, behavior change intent, and knowledge. Virtual focus groups were conducted with a subset of participants (n = 20) in July 2019 to assess the feasibility, acceptability, and impact of Project ECHO. Results There was a statistically significant difference of + 0.453 in the composite self-efficacy mean score pre- to post-series. For every 1 additional Project ECHO CHW session attended, there was a .05 improvement in participants’ self-efficacy to perform CHW-related job duties and address social determinants of health (SDOH). Four major themes emerged from the qualitative focus group data: value in learning from other participants’ caseloads, CHW-care team integration, availability of training and resources, and shared decision-making with patients. Conclusions This evaluation suggests that ECHO is a viable means of increasing access to training resources for CHWs. Future studies on the ECHO model as a means of educating and broadening implementation of CHWs are warranted. Programs such as Project ECHO can support CHWs by providing continuing education opportunities, as well as standardizing training content across large geographic areas.

scholarly journals Delivering comprehensive HIV services across the HIV care continuum: a comparative analysis of survival and progress towards 90-90-90 in rural Malawi

2018 ◽  
Vol 3 (1) ◽  
pp. e000552 ◽  
Author(s):  
Emily B Wroe ◽  
Elizabeth L Dunbar ◽  
Noel Kalanga ◽  
Luckson Dullie ◽  
Chiyembekezo Kachimanga ◽  
...  
Keyword(s):  
Community Health ◽  
Social Determinants Of Health ◽  
Community Health Workers ◽  
Health Systems ◽  
Social Determinants ◽  
Health Workers ◽  
Hiv Care ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Facility Level

IntroductionPartners In Health and the Malawi Ministry of Health collaborate on comprehensive HIV services in Neno, Malawi, featuring community health workers, interventions addressing social determinants of health and health systems strengthening. We conducted an observational study to describe the HIV care continuum in Neno and to compare facility-level HIV outcomes against health facilities nationally.MethodsWe compared facility-level outcomes in Neno (n=13) with all other districts (n=682) from 2013 to 2015 using mixed-effects linear regression modelling. We selected four outcomes that are practically useful and roughly mapped on to the 90-90-90 targets: facility-based HIV screenings relative to population, new antiretroviral therapy (ART)enrolments relative to population, 1-year survival rates and per cent retained in care at 1 year.ResultsIn 2013, the average number of HIV tests performed, as a per cent of the adult population, was 11.75%, while the average newly enrolled patients was 10.03%. Percent receiving testing increased by 4.23% over 3 years (P<0.001, 95% CI 2.98% to 5.49%), while percent enrolled did not change (P=0.28). These results did not differ between Neno and other districts (P=0.52), despite Neno having a higher proportion of expected patients enrolled. In 2013, the average ART 1-year survival was 80.41% nationally and 91.51% in Neno, which is 11.10% higher (P=0.002, 95% CI 4.13% to 18.07%). One-year survival declined by 1.75% from 2013 to 2015 (P<0.001, 95% CI −2.61% to −0.89%); this was similar in Neno (P=0.83). Facility-level 1-year retention was 85.43% nationally in 2013 (P<0.001, 95% CI 84.2% to 86.62%) and 12.07% higher at 97.50% in Neno (P=0.001, 95% CI 5.08% to19.05%). Retention declined by 2.92% (P<0.001, 95% CI −3.69% to −2.14%) between 2013 and 2015, both nationally and in Neno.ConclusionThe Neno HIV programme demonstrated significantly higher survival and retention rates compared with all other districts in Malawi. Incorporating community health workers, strengthening health systems and addressing social determinants of health within the HIV programme may help Malawi and other countries accelerate progress towards 90-90-90.

Social determinants of health affecting treatment of pediatric brain tumors

2019 ◽  
Vol 24 (2) ◽  
pp. 159-165
Author(s):  
Jillian M. Berkman ◽  
Jonathan Dallas ◽  
Jaims Lim ◽  
Ritwik Bhatia ◽  
Amber Gaulden ◽  
...  
Keyword(s):  
African American ◽  
Health Disparities ◽  
Brain Tumors ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Cns Tumor ◽  
Initial Symptoms ◽  
Caucasian Patients

OBJECTIVELittle is understood about the role that health disparities play in the treatment and management of brain tumors in children. The purpose of this study was to determine if health disparities impact the timing of initial and follow-up care of patients, as well as overall survival.METHODSThe authors conducted a retrospective study of pediatric patients (< 18 years of age) previously diagnosed with, and initially treated for, a primary CNS tumor between 2005 and 2012 at Monroe Carell Jr. Children’s Hospital at Vanderbilt. Primary outcomes included time from symptom presentation to initial neurosurgery consultation and percentage of missed follow-up visits for ancillary or core services (defined as no-show visits). Core services were defined as healthcare interactions directly involved with CNS tumor management, whereas ancillary services were appointments that might be related to overall care of the patient but not directly focused on treatment of the tumor. Statistical analysis included Pearson’s chi-square test, nonparametric univariable tests, and multivariable linear regression. Statistical significance was set a priori at p < 0.05.RESULTSThe analysis included 198 patients. The median time from symptom onset to initial presentation was 30.0 days. A mean of 7.45% of all core visits were missed. When comparing African American and Caucasian patients, there was no significant difference in age at diagnosis, timing of initial symptoms, or tumor grade. African American patients missed significantly more core visits than Caucasian patients (p = 0.007); this became even more significant when controlling for other factors in the multivariable analysis (p < 0.001). African American patients were more likely to have public insurance, while Caucasian patients were more likely to have private insurance (p = 0.025). When evaluating survival, no health disparities were identified.CONCLUSIONSNo significant health disparities were identified when evaluating the timing of presentation and survival. A racial disparity was noted when evaluating missed follow-up visits. Future work should focus on identifying reasons for differences and whether social determinants of health affect other aspects of treatment.

scholarly journals Exploring the Role of Community Health Workers in Providing Cancer Navigation: Perceptions of African American Older Adults

2012 ◽  
Vol 39 (3) ◽  
pp. E288-E298 ◽  
Author(s):  
Jennifer Wenzel ◽  
Randy Jones ◽  
Rachel Klimmek ◽  
Sarah Szanton ◽  
Sharon Krumm
Keyword(s):  
Older Adults ◽  
African American ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
African American Older Adults

Am I My Brother’s Keeper? African American Men’s Health Within the Context of Equity and Policy

2014 ◽  
Vol 10 (1) ◽  
pp. 73-81 ◽  
Author(s):  
Okechuku Kelechi Enyia ◽  
Yashika J. Watkins ◽  
Quintin Williams
Keyword(s):  
African American ◽  
Social Determinants Of Health ◽  
Health Equity ◽  
Social Determinants ◽  
African American Men ◽  
Men’S Health ◽  
Policy Implications ◽  
Determinants Of Health ◽  
Critical Examination ◽  
Men's Health

African American men’s health has at times been regarded as irrelevant to the health and well-being of the communities where they are born, grow, live, work, and age. The uniqueness of being male and of African descent calls for a critical examination and deeper understanding of the psycho-socio-historical context in which African American men have lived. There is a critical need for scholarship that better contextualizes African American Male Theory and cultural humility in terms of public health. Furthermore, the focus of much of the social determinants of health and health equity policy literature has been on advocacy, but few researchers have examined why health-related public policies have not been adopted and implemented from a political and theoretical policy analysis perspective. The purpose of this article will be to examine African American men’s health within the context of social determinants of health status, health behavior, and health inequalities—elucidating policy implications for system change and providing recommendations from the vantage point of health equity.

Sign in / Sign up

Export Citation Format

Share Document