The Impact of Coming Out on Health and Health Care Access

Abstract Background As the COronaVIrus Disease 2019 (COVID-19) continues to unfold, drastic changes in daily life pose significant challenges on mental and clinical health. While public health interventions such as national lockdowns and social distancing are enforced to reduce the spread of COVID-19, the psychosocial and physical consequences have yet to be determined that may disproportionately affect people living with HIV (PLWH). Methods To evaluate the impact of COVID-related stress on mental and clinical health, we conducted a 20-minute questionnaire eliciting sociodemographic information, clinical and psychological factors from people living in Miami, Fl. All individuals >18 years with or without a history of COVID-19 were included. Participating PLWH were recruited from an existing HIV registry and HIV uninfected participants from community flyers and word of mouth. Results A total of 135 participants were recruited from 05/2020-06/2020. The mean age was 50 years old, 73/135 (54%) were female, and 102/135 (75%) were PLWH. Among participating PLWH, 60/102 (58.8%) self-identified as African American, and 9/102 (8.8%) were positive for COVID-19 by a commercially approved test. Among HIV-negative participants, 15/33 (45.5%) self-identified as White and 11/33 (33%) were positive for COVID-19. Both PLWH and HIV-negative participants described significant disruptions in health care access (47%), difficulty paying basic needs (41%), and feelings of anxiety and depression (48%); there was no statistically significant difference by HIV status. However, HIV negative participants were less likely to experience job loss and income disruption compared to PLWH during the pandemic (70% for HIV-negative vs 48% for PLWH; OR 0.40, p=0.03). Conclusion The impact of COVID-19 on emotional and clinical health is significant in both PLWH and HIV-negative groups. These findings highlight the need for providing mental and physical health care during the pandemic, especially for coping with stress and anxiety during these difficult times and ensuring adequate access to health care. Disclosures All Authors: No reported disclosures

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The Association of Residence Permits on Utilization of Health Care Services by Migrant Workers in China

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18189623 ◽

2021 ◽

Vol 18 (18) ◽

pp. 9623

Author(s):

Haochuan Xu ◽

Han Yang ◽

Hui Wang ◽

Xuefeng Li

Keyword(s):

Public Health ◽

Health Care ◽

Health Care Access ◽

Migrant Workers ◽

Health Care Services ◽

Public Health Care ◽

Chinese Government ◽

Care Access ◽

Care Services ◽

The Impact

Due to the limitations in the verifiability of individual identity, migrant workers have encountered some obstacles in access to public health care services. Residence permits issued by the Chinese government are a solution to address the health care access inequality faced by migrant workers. In principle, migrant workers with residence permits have similar rights as urban locals. However, the validity of residence permits is still controversial. This study aimed to examine the impact of residence permits on public health care services. Data were taken from the China Migrants Dynamic Survey (CMDS). Our results showed that the utilization of health care services of migrant workers with residence permits was significantly better than others. However, although statistically significant, the substantive significance is modest. In addition, megacities had significant negative moderating effects between residence permits and health care services utilization. Our research results emphasized that reforms of the household registration system, taking the residence permit system as a breakthrough, cannot wholly address the health care access inequality in China. For developing countries with uneven regional development, the health care access inequality faced by migrant workers is a structural issue.

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Roles for Health Educators in a Time of Health Care Cutbacks: Preventive and Ameliorative Approaches

International Quarterly of Community Health Education ◽

10.2190/uq25-e77l-6dd7-jqq1 ◽

1984 ◽

Vol 4 (4) ◽

pp. 293-302 ◽

Cited By ~ 2

Author(s):

E. Richard Brown

Keyword(s):

Health Care ◽

Low Income ◽

Health Care Access ◽

Community Organization ◽

Public Health Care ◽

Federal State ◽

Health Educators ◽

Care Access ◽

State And Local ◽

The Impact

Cutbacks in public health care programs at federal, state, and local levels have reduced the health care access of many low-income persons. Based on findings from several California studies, this article suggests several roles for health educators intended to prevent cutbacks or mitigate their impact. Methods of preventing cutbacks rely on community organization methods and coalitions including health education professional groups. When preventive actions are unsuccessful, health educators may ease the impact of cutbacks by developing adequate education interventions for users of affected services and community organization strategies to improve access to remaining services. Specific methods are suggested and discussed.

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Measuring Staff Empowerment Regarding Health Care for Clients with Intellectual Disabilities

International Journal of Family Medicine ◽

10.1155/2014/678127 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6

Author(s):

Joanne Wilkinson ◽

Nechama W. Greenwood ◽

Claire Tienwey Wang ◽

Laura F. White ◽

Larry Culpepper

Keyword(s):

Breast Cancer ◽

Health Care ◽

Intellectual Disabilities ◽

Health Care Access ◽

Breast Cancer Mortality ◽

Care Access ◽

Direct Support ◽

Reliable Instrument ◽

Tool Set ◽

The Impact

Background. Women with intellectual disabilities (ID) contract breast cancer at the same rate as the general population but have higher breast cancer mortality and lower rates of breast cancer screening. Many women with ID live in group homes or supported residences where they are cared for by direct support workers. While direct support workers are thought to influence client health, this effect is underresearched, and we lack tools for measuring staff empowerment and perceptions regarding client health. Methods. We developed and validated an instrument, the staff empowerment tool (SET), to measure staff empowerment as related to supporting clients in preventive health. Results. The SET was found to be a reliable instrument for measuring staff activation and empowerment in helping clients access mammography screening. Discussion. Quantifying staff empowerment and perspectives is important in studying and reducing disparities among adults with ID, a vulnerable population. Further research to determine the impact of staff empowerment levels on their clients’ health and health care access is suggested. The SET is a valuable tool for measuring the construct of staff empowerment, evaluating interventions, and collecting data regarding variation in staff empowerment.

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Access to health care for people with disabilities in rural Malawi what are the barriers?

10.21203/rs.2.13970/v1 ◽

2019 ◽

Author(s):

Josephine Harrison ◽

Rachael Thomson ◽

Hastings T. Banda ◽

Grace B. Mbera ◽

Stefanie Gregorius ◽

...

Keyword(s):

Health Care ◽

Health Care Access ◽

Access To Health Care ◽

People With Disabilities ◽

Randomised Control Trial ◽

Care Access ◽

Health Care Accessibility ◽

Access To Health ◽

Lung Condition ◽

The Impact

Abstract Introduction People with disabilities experience significant health inequalities. In Malawi, where most individuals live in low-income rural settings, many of these inequalities are exacerbated by restricted access to health care services. This qualitative study explores the barriers to health care access experienced by individuals with a mobility or sensory impairment, or both, living in rural villages in Dowa district, central Malawi. In addition, the impact of a chronic lung condition, alongside an impairment, on health care accessibility is explored. Method Using data from survey responses obtained through the Research for Equity And Community Health (REACH) Trust’s randomised control trial in Malawi, 12 adult participants, with scores of either 3 or 4 in the Washington Group Questions, were recruited. People with cognitive impairments were excluded. Each of the selected participants underwent an individual in-depth interview and full recordings of these were then transcribed and translated. Findings and discussion Through thematic analysis of the transcripts, three main barriers to timely and adequate health care were identified: 1) Cost of transport, drugs and services, 2) Insufficient health care resources, and 3) Dependence on others. Other barriers identified were distance to a facility, which was most hindering for the participants with a chronic lung condition, and unfavourable health seeking behaviour, whilst ‘time’ was found to be a common underlying factor. Attitudinal factors were not found to influence health care accessibility for this cohort. Conclusions This study finds that health care access for people with disabilities in rural Malawi is hindered by closely interconnected financial, practical and social barriers. There is a clear requirement for policy makers to consider the challenges identified here, and in similar studies, and to address them through improved social security systems and health system infrastructure, including outreach services, in a drive for equitable health care access and provision.

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The Impact Of A Whole Health Model Of Care On Patient Outcomes

Innovation in Aging ◽

10.1093/geroni/igab046.3043 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 838-838

Author(s):

Anna Faul ◽

Pamela Yankeelov ◽

Joseph D'Ambrosio ◽

Sam Cotton ◽

Barbara Gordon ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Social Determinants ◽

Health Care Access ◽

Determinants Of Health ◽

Education Attainment ◽

Psychological Determinants ◽

Care Access ◽

The Impact ◽

Over Time

Abstract The FlourishCare Model (FCM) transforms primary care sites by addressing all determinants of health and focusing on helping patients to flourish. The FlourishCare Index (FCI) is a clinical measure to assess the effectiveness of the FCM to address all determinants of health. We will present data on the effectiveness of the FCM serving 159 older adults with MCCs. The sample was mostly female (77%), White (64%), retired (54%), married (30%) or widowed (20%) and living in urban areas (64%). The mean age was 69 (SD=15), with 13 years education (SD=3). Patients changed significantly over time on total FCI scores (57%-72%;□=3.80,SE=0.63). Results show significant growth over time for individual health behaviors (58%-67%;□=2.14,SE=0.84), health care access (71%-89%;□=4.43,SE=1.00) and social determinants (62%-85%;□=5.54,SE=1.02) with psychological determinants (54%-61%;□=1.74,SE=0.95) and environmental determinants (70%-81%;□=2.81,SE=1.62) showing a trend to significance. Interaction effects with time show that the FCM supported patients with lower education attainment to improve at a higher rate than those with higher education attainment, for the total FCI score (□=-0.59,SE=0.24) and health care access (□=-0.94,SE=0.38). Receiving mental health counseling resulted in more improvement in psychological determinants than those who did not receive counseling (□=3.43,SE=2.04). The FCM was able to support rural patients at a higher rate than urban patients to gain access to health care (□=4.13,SE=2.02). The FCM supported Hispanic patients the most in improving social determinants of health (□=8.40,SE=3.93). This study showed the importance of a systems approach to care using measures that focus on what matters most to older adults who value quality-of-life outcomes.

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Access to health care for people with disabilities in rural Malawi: what are the barriers?

10.21203/rs.2.13970/v3 ◽

2020 ◽

Author(s):

Josephine Harrison ◽

Rachael Thomson ◽

Hastings T. Banda ◽

Grace B. Mbera ◽

Stefanie Gregorius ◽

...

Keyword(s):

Health Care ◽

Health Care Access ◽

Access To Health Care ◽

People With Disabilities ◽

Randomised Control Trial ◽

Sensory Impairment ◽

Care Access ◽

Health Care Accessibility ◽

Access To Health ◽

The Impact

Abstract Background People with disabilities experience significant health inequalities. In Malawi, where most individuals live in low-income rural settings, many of these inequalities are exacerbated by restricted access to health care services. This qualitative study explores the barriers to health care access experienced by individuals with a mobility or sensory impairment, or both, living in rural villages in Dowa district, central Malawi. In addition, the impact of a chronic lung condition, alongside a mobility or sensory impairment, on health care accessibility is explored. Methods Using data from survey responses obtained through the Research for Equity And Community Health (REACH) Trust’s randomised control trial in Malawi, 12 adult participants, with scores of either 3 or 4 in the Washington Group Short Set (WGSS) questions, were recruited. The WGSS questions concern a person’s ability in core functional domains (including seeing, hearing and moving), and a score of 3 indicates ‘a lot of difficulty’ whilst 4 means ‘cannot do at all’. People with cognitive impairments were not included in this study. All who were selected for the study participated in an individual in-depth interview and full recordings of these were then transcribed and translated. Results Through thematic analysis of the transcripts, three main barriers to timely and adequate health care were identified: 1) Cost of transport, drugs and services, 2) Insufficient health care resources, and 3) Dependence on others. Attitudinal factors were explored and, whilst unfavourable health seeking behaviour was found to act as an access barrier for some participants, community and health care workers’ attitudes towards disability were not reported to influence health care accessibility in this study. Conclusions This study finds that health care access for people with disabilities in rural Malawi is hindered by closely interconnected financial, practical and social barriers. There is a clear requirement for policy makers to consider the challenges identified here, and in similar studies, and to address them through improved social security systems and health system infrastructure, including outreach services, in a drive for equitable health care access and provision.

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