Health Services Research Commons^™

Self-Measured Blood Pressure Monitoring In Hypertension Control: The Role Of Social Determinants Of Health, Current State In The United States, And Future Directions, Adekunle Oke

Electronic Theses and Dissertations

Hypertension, a medical condition, predisposes to other cardiovascular diseases, and can be impacted by the social determinants of health (SDOH). Self-measured blood pressure monitoring (SMBP) is an evidence-based approach to hypertension control, but not much is known about the influence of SDOH on SMBP. This dissertation aims to: 1) highlight the SDOH factors whose relationship with SMBP have been explored in research studies; 2) examine the relationship between SDOH and SMBP among United States (U.S.) adults with high blood pressure; and 3) examine the current state of SMBP in the U.S., highlight policy implications from the empirical study and provide …

Feasibility And Acceptability Of Using Mobile Health Apps In Underserved Patients With Diabetes, Jieyu Luo

Theses and Dissertations (ETD)

Introduction. Diabetes mellitus is a condition with a growing morbidity and mortality burden. An estimated 30 million adults currently live with diabetes, with each individual spending over $9500 annually on medical care. The successful management of diabetes is a lifelong endeavor. This involves balancing a variety of factors including diet, medications, and glucose monitoring. It has been well established that successful control of diabetes depends largely upon patients’ daily lifestyle habits and activities. Not all patients, however, have the resources necessary for effective diabetes management. Health disparities lead to a higher rate of diabetes development in minority and poor populations. …

Moving Past The Binary: Transgender And Gender Non-Conforming Students’ Experiences Of And Perspectives On College Campus Fitness Centers, Rachel E. Petterson

Honors Projects

Transgender and gender non-conforming (TGNC) people face various mental and physical health disparities. Despite this, spaces related to health and wellness are not always inclusive. Similarly, college campuses are often not as inclusive or accommodating as they should be. This study looks at the experiences of TGNC students at campus fitness centers. Through both quantitative and qualitative data gathered through an online survey, it aims to better understand the following: the presence of inclusive facilities; the perceived importance of facility variables; use of campus fitness facilities by TGNC students; what improvements they would like to see; and how any of …

The Impact Of The Hospital Value-Based Purchasing Program On Healthy Days, Health Inequity, And Hospital Community Benefit Spending, Samhita Kadiyala

Scripps Senior Theses

The Hospital Value-Based Purchasing Program (HVBP) is a Centers for Medicare and Medicaid Services (CMS) program implemented in 2012 to reward acute-care hospitals with incentive payments for the quality of care provided to Medicare patients in inpatient settings. Under this policy, payment adjustments are made based on a variety of factors including clinical quality, patient experience, and cost reductions. This paper uses state-level variation in the implementation of HVBP to ascertain whether the policy led to improvements in Healthy Days (a CDC-designed composite measure of individuals’ self-reported number of physically and mentally “healthy” days per month), health disparities, and community …

The Association Of Demographic Characteristics And Social Vulnerability With Covid-19 Outcomes, Gloria D. Boone

Electronic Theses and Dissertations

The Association of Demographic Characteristics and Social Vulnerability With COVID-19 Outcomes

by

Gloria Boone

(Under the Direction of Gulzar Shah)

ABSTRACT

This research explored 102 Illinois counties' COVID-19 data to determine whether demographic characteristics and social vulnerability are associated with increased vulnerability to COVID-19 infections and deaths. COVID-19 is disproportionately impacting vulnerable groups and has been deadlier for African American and Hispanic people. The findings of this research will contribute to the knowledge base regarding social vulnerability and assist public health officials in targeting resources and designing interventions. This study used a retrospective cross-sectional design to assess demographic characteristics of …

Special Issue – July 2021 The Impact Of Inequity & Health Disparities On The Human Experience, Patient Experience Journal

Patient Experience Journal

Patient Experience Journal (PXJ) is excited to announce the call for submissions for its July 2021 special issue on the impact of racial inequality, health disparities, and discrimination on the human experience. The world now finds itself in the grips of a global pandemic that is taking its toll on communities socially and economically, placing strain on healthcare workers and revealing the very systemic weaknesses and inherent biases that have been resting just beneath the surface of our society for years. The challenge of disparity and inequity is not unique to healthcare, but in the era of COVID-19, what many …

Getting Comfortable With Being Uncomfortable: A Conversation With Marsha Sinanan-Vasishta, Jason A. Wolf

Patient Experience Journal

We find ourselves managing two critical moments and a powerful confluence of events, one a crisis in health. We are still facing the COVID crisis, and we are trying very hard to rely on evidence and truth that will lead us forward in addressing that in the best way possible. We are also in a crisis of humanity, one that has been simmering beneath the surface for years, the issue of systemic racism and disparities in healthcare, further highlighted by the COVID crisis. This article shares the conversation I had with Marsha Sinanan-Vasishta, MSN, MBA, RN, NEA-BC, CPXP, Deputy Chief …

Leadership Matters: A Conversation With Dr. James Hildreth, Jason A. Wolf

Patient Experience Journal

I was extremely honored at this moment in the midst of our current health crisis to have a conversation with Dr. James Hildreth, president and chief executive officer of Meharry Medical College. The focus and commitment expressed by Dr. Hildreth reflects the very mission statement of Meharry Medical College itself, to advance health equity through innovative research, transformative education, exceptional and compassionate health services and policy-influencing thought leadership. As equally important is the alignment of Meharry’s purpose with our very own at the Institute, as Meharry’s mission continues to empower diverse populations to improve the well-being of humankind. Dr. Hildreth …

Black Women Survive Breast Cancer With Community-Based Care, Shelley I. White-Means, Jill Dapremont, Barbara D. Davis, Tronlyn Thompson

Faculty Presentations

PURPOSE Community-based breast cancer support agencies who address non-medical, social determinants of health needs that serve as barriers to maximizing breast health outcomes may play a vital role in mitigating breast cancer mortality. They share a common emphasis on addressing social, economic, and psychological needs of breast cancer survivors and those at risk of breast cancer. This paper is third in a series of papers exploring why the rate of breast cancer mortality is two times higher for African American women than white women in Memphis. We sought insights from community-based breast cancer support agencies because they have a close-up …

¡Sí, Yo Puedo Vivir Sano Con Diabetes! A Self-Management Randomized Controlled Pilot Trial For Low-Income Adults With Type 2 Diabetes In Mexico City, Robin Whittemore, Mireya Vilar-Compte, Selene De La Cerda, Roberta Delvy, Sangchoon Jeon, Soraya Burrola-Méndez, Mariana Pardo-Carrillo, Annel Lozano-Marrufo, Rafael Pérez-Escamilla

Department of Public Health Scholarship and Creative Works

Background: Type 2 diabetes (T2D) is a worldwide epidemic and a leading cause of death in Mexico, with a prevalence of 15.9%, and >70% of diagnosed adults have poor glycemic control [glycated hemoglobin (HbA1c) >7.5%]. We developed a diabetes self-management education program contextualized to the study population, including dietary preferences, health literacy, and health system.

Objectives: We aimed to evaluate the efficacy of a self-management + text message program (¡Sí, Yo Puedo Vivir Sano con Diabetes!) on primary (HbA1c), and secondary behavioral (self-management), clinical, and psychosocial outcomes in adults with T2D in Mexico City.

Methods: Participants were recruited at public …

Examining Racial & Ethnic Disparities In The Reach Of The Medicare Shared Savings Program, Lindsey Arneson

Capstone Experience

It is important to understand the quality of health care for racial and ethnic minorities covered under the largest U.S. government-run insurance program, Medicare, because the demographics of the U.S. are becoming older and more diverse. A new value-based program under Medicare is the Shared Savings Program (MSSP), which creates incentives to improve care quality and health outcomes for Medicare beneficiaries with a specific focus on increasing the provision of preventive care services. This capstone project aims to understand the representation of racial/ethnic minority Medicare beneficiaries, namely African Americans/Blacks and Hispanics/Latinxs, that receive care from providers or facilities (i.e., Accountable …

Challenges To Diabetes Self-Management For Adults With Type 2 Diabetes In Low-Resource Settings In Mexico City: A Qualitative Descriptive Study, Robin Whittemore, Mireya Vilar-Compte, Selene De La Cerda, Denise Marron, Rosabelle Conover, Roberta Delvy, Annel Lozano-Marrufo, Rafael Pérez-Escamilla

Department of Public Health Scholarship and Creative Works

Background: The prevalence of type 2 diabetes (T2D) in Mexico is one of the highest in the world, with high morbidity and mortality, and difficulty meeting glycemic targets. The purpose of this study was to identify the challenges for T2D self-management as perceived by both adults with T2D and health care providers in primary health clinics from Seguro Popular in Mexico City.

Methods: This was a qualitative descriptive study conducted in three Seguro Popular primary care clinics in Mexico City using convenience sampling. Semi-structured interviews were conducted with participants and data were analyzed using a content analysis approach.

Results: The …

Structural Approaches To Health Promotion: What Do We Need To Know About Policy And Environmental Change?, Lisa D. Lieberman, Shelley D. Golden, Jo Anne L. Earp

Department of Public Health Scholarship and Creative Works

Although the public health literature has increasingly called on practitioners to implement changes to social, environmental, and political structures as a means of improving population health, recent research suggests that articles evaluating organization, community, or policy changes are more limited than those focused on programs with individuals or their social networks. Even when these approaches appear promising, we do not fully understand whether they will benefit all population groups or can be successful in the absence of accompanying individually oriented programs. The role of this broad category of approaches, including both policy and environmental changes, in decreasing health disparities is …

Cultural Competency In Health Care: Framework, Training And Evaluation - A Review Of The Literature, Diana Salas Coronado

Center for Social Policy Publications

Healthcare professionals are now more aware of the challenges they face when providing healthcare services to a culturally and racially diverse population. Cultural competency has emerged as a framework for understanding health disparities among racial and ethnic groups in particular, but also for women, the elderly, sexual orientation and gender identity, people with disabilities, and religious minorities. Although there are several definitions of cultural competency, each emphasizes the need for healthcare systems and providers to be aware of and responsive to patients’ cultural perspectives and backgrounds. One example defines cultural competency as “a set of congruent behaviors, attitudes, and policies …

Predictors Of Clinician Tobacco Intervention Counseling In Six North Carolina Free Clinics, Joe G. Spangler, Eun-Young Song, Jessica Richardson Pockey, Erin L. Sutfin, Donald W. Helme, Cindy Jones, Kristie L. Foley

Communication Faculty Publications

While the poor and the uninsured are at increased risk for tobacco use, up to two thirds of these patients express interest in near-term quitting. Nonetheless, tobacco counseling rates remain low in clinics serving these patients. As part of a larger tobacco intervention project in North Carolina free clinics, we gathered baseline data on patient characteristics in six randomly selected facilities affiliated with the North Carolina Association of Free Clinics. An exit interview was completed by 231 patients; 126 (54%) were tobacco users. Among all patients, 71% had been asked by a clinician about tobacco use in the past 3 …