Social Support and Health-Related Quality of Life Among Low-Income Women: Findings from Community-Based Participatory Research

Abstract Using principles of community-based participatory research we developed a new theory-based measure of health-related quality of life (HRQOL) for individuals with intellectual disability (ID). We recruited adults with ID (n = 129) to take part in interviews and review successive versions of HRQOL items. Critical input about content and understandability shaped the items, as did input from four focus groups of parents/caregivers (n = 16) and representative stakeholders from community-based agencies (n = 7). The resulting HRQOL measure, called the HRQOL-IDD, contains 42 items. The response format depicts a gradient of fluid-filled cups (“none” to “full”) to represent frequency of experience of each item on a 5-point scale.

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A randomized controlled trial of the effect of a community-based intervention on patient activation, health-related quality of life, and acute care use.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.1 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 1-1

Author(s):

Manali I. Patel ◽

Sana Indravadan Khateeb ◽

Ivana Krajcinovic ◽

Deb Salava ◽

Tumaini Coker

Keyword(s):

Quality Of Life ◽

Acute Care ◽

Low Income ◽

Cancer Care ◽

Patient Activation ◽

Health Related Quality ◽

Community Based ◽

Related Quality ◽

Health Related

1 Background: Low-income and minority populations have disproportionately less activation in their cancer care, worse health-related quality of life (HrQOL), and greater acute care use than affluent and white populations. Community-based interventions are needed to improve patient experiences and quality of cancer care among these populations. We used community-based participatory methods to refine a previously tested intervention for use in Atlantic City NJ. The intervention, LEAPS, uses community health workers trained to activate patients to discuss advance care planning and their symptom burden with cancer clinicians and to connect patients with culturally-relevant community resources to overcome complications from social determinants of health. We conducted a randomized controlled trial of LEAPS in collaboration with a employer-union health fund. Members of the employer-union health fund with newly diagnosed with hematologic and solid tumor cancers were randomized to the 6-month intervention or to usual care. The objective was to determine if the intervention improved HrQOL at 4 months post-enrollment as compared to baseline more than usual care and secondarily the effect on change in patient activation at 4 months post-enrollment as compared to baseline and acute care use within 12 months post-enrollment. Methods: We conducted patient interviews to assess HrQOL and patient activation and obtained claims data for health care use. We used regression models to evaluate differences in health-related quality of life (validated Functional Assessment of Cancer Therapy-General) scores and patient activation (validated Patient Activation Measure) scores between groups over time and exact poisson regression adjusted for length of follow-up to compare emergency department and hospitalization utilization. Results: A total of 160 patients were consented and randomized into the study (80 intervention; 80 control). There were no differences in demographic or clinical factors across groups. The majority were non-white (74%), female (53%), mean age 57 years. The most common diagnoses were breast (31%) and lung (21%) cancer and the majority were diagnosed with stage 3 or 4 (63%). At 4 months, the intervention group had greater improvements in quality of life as compared to the control group (difference in difference: 9.56 p < 0.001), greater change in patient activation (difference in difference: 12.43 (p < 0.001)), and lower acute care use (hospital visits (1.10 (1.53) +/- 1.83 (1.31), p = 0.02) and emergency department use (1.2 (2.82) versus 3.47 (3.62) p = 0.03). Conclusions: Integration of community-based interventions into cancer care for low-income and minority populations may be a more effective and sustainable way to ensure equitable cancer care. Clinical trial information: NCT03699748.

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Oral health-related quality of life outcomes in a randomized clinical trial to assess a community-based oral hygiene intervention among adults living in low-income senior housing

Health and Quality of Life Outcomes ◽

10.1186/s12955-021-01859-w ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Susan Reisine ◽

Jean J. Schensul ◽

Apoorva Salvi ◽

James Grady ◽

Toan Ha ◽

...

Keyword(s):

Quality Of Life ◽

Health Status ◽

Oral Health ◽

Low Income ◽

Oral Hygiene ◽

Health Related Quality ◽

Community Based ◽

Related Quality ◽

Health Related

Abstract Background Quality of life outcomes have been used frequently in clinical trials of oral health interventions. This study assessed the effects of a randomized trial on oral health related quality of life comparing an individual-based oral hygiene intervention to a community-based intervention. Methods Participants were recruited from six low-income senior housing residences. Buildings were randomly assigned to receive the individual-based intervention followed by the community-based intervention or to receive the community-based intervention followed by the individual intervention. Participants’ oral hygiene was assessed at baseline (T0), one month after the first intervention (T1) and one month after the second intervention (T2) and six months after the T2 assessment (T3). Oral hygiene was measured by the Gingival Index (GI) and Plaque scores (PS). Surveys collected data on beliefs, attitudes, behaviors and self-reported health status at T0, T1 and T2. Only oral hygiene and quality of life, measured by the General Oral Health Assessment Index (GOHAI), was assessed at all time points. general linear mixed models (GLMM) were used to assess changes in GOHAI over time, the interaction of condition by time and the contribution of psychosocial, behavioral, health status and background variables to changes in GOHAI. Results 331 people completed T0 assessments; 306 completed T1; 285 completed T2 and 268 completed T3. Scores on GOHAI at T0 ranged from 10 to 48 with a mean of 39.7 (sd = 7.8) and a median of 42. At T1, mean GOHAI was 40.7 (sd = 8.2), at T2 mean GOHAI was 41.1 (sd = 7.8) and at T3, GOHAI was 42.3 (sd = 8.2). GLMM showed that GOHAI improved significantly from T0 to T3 (p = 0.01) but the time by intervention interaction was not significant indicating that both interventions were effective in improving GOHAI but one intervention was not better than the other. Ethnicity, health status, worries, self-efficacy, number of missing teeth and symptoms of dry mouth were related to improvements in GOHAI. Neither GI nor PS were related to GOHAI. Conclusions The participants reported relatively good oral health related quality of life which improved significantly over time. Improvement occurred among all participants regardless of condition, suggesting that either intervention would be effective in future studies. Trial Registry: Clinicaltrials.gov, Clinical Trials ID #NCT02419144; Title: A Bi-level Intervention to Improve Older Adult Oral Health Status; Registered 04/07/2015 URL: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0005H9X&selectaction=Edit&uid=U0000KBK&ts=2&cx=-rajj5q

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