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"Burke, Nancy"
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Improving healthcare empowerment through breast cancer patient navigation: a mixed methods evaluation in a safety-net setting
Background
Breast cancer mortality rates in the U.S. remain relatively high, particularly among ethnic minorities and low-income populations. Unequal access to quality care, lower follow up rates, and poor treatment adherence contribute to rising disparities among these groups. Healthcare empowerment (HCE) is theorized to improve patient outcomes through collaboration with providers and improving understanding of and compliance with treatment. Patient navigation is a health care organizational intervention that essentially improves healthcare empowerment by providing informational, emotional, and psychosocial support. Patient navigators address barriers to care through multilingual coordination of treatment and incorporation of access to community services, support, and education into the continuum of cancer care.
Methods
Utilizing survey and qualitative methods, we evaluated the patient navigation program in a Northern California safety-net hospital Breast Clinic by assessing its impact on patients’ experiences with cancer care and providers’ perspectives on the program. We conducted qualitative interviews with 16 patients and 4 service providers, conducted approximately 66 hours of clinic observations, and received feedback through the self-administered survey from 66 patients.
Results
The role of the patient navigator at the Breast Clinic included providing administrative assistance, psychosocial support, improved knowledge, better understanding of treatment process, and ensuring better communication between patients and providers. As such, patient navigators facilitated improved collaboration between patients and providers and understanding of interdisciplinary care processes. The survey results suggested that the majority of patients across all ethnic backgrounds and age groups were highly satisfied with the program and had a positive perception of their navigator. Interviews with patients and providers highlighted the roles of a navigator in ensuring continuity of care, improving treatment completion rates, and reducing providers’ workload and waiting time. Uncertainty about the navigator’s role among the patients was a weakness of the program.
Conclusions
Patient navigation in the Breast Clinic had a positive impact on patients’ experiences with care and healthcare empowerment. Clarifying uncertainties about the navigators’ role would aid successful outcomes.
Journal Article
Survivorship Care Plan Information Needs: Perspectives of Safety-Net Breast Cancer Patients
Despite the Institute of Medicine's (IOM) 2005 recommendation, few care organizations have instituted standard survivorship care plans (SCPs). Low health literacy and low English proficiency are important factors to consider in SCP development. Our study aimed to identify information needs and survivorship care plan preferences of low literacy, multi-lingual patients to support the transition from oncology to primary care and ongoing learning in survivorship.
We conducted focus groups in five languages with African American, Latina, Russian, Filipina, White, and Chinese medically underserved breast cancer patients. Topics explored included the transition to primary care, access to information, knowledge of treatment history, and perspectives on SCPs.
Analysis of focus group data identified three themes: 1) the need for information and education on the transition between \"active treatment\" and \"survivorship\"; 2) information needed (and often not obtained) from providers; and 3) perspectives on SCP content and delivery.
Our data point to the need to develop a process as well as written information for medically underserved breast cancer patients. An SCP document will not replace direct communication with providers about treatment, symptom management and transition, a communication that is missing in participating safety-net patients' experiences of cancer care. Women turned to peer support and community-based organizations in the absence of information from providers.
\"Clear and effective\" communication of survivorship care for safety-net patients requires dedicated staff trained to address wide-ranging information needs and uncertainties.
Journal Article
Post-Resettlement Food Insecurity: Afghan Refugees and Challenges of the New Environment
Background: Lack of access to adequate, safe, and nutritious food is a major concern for the Afghan population due to ongoing war and humanitarian crises. Recently resettled Afghan refugees in the US continue to face challenges securing adequate, nutritious food resources in new environments. This study examined Afghan refugees’ food access and insecurity in the San Joaquin Valley, California. Methods: Semi-structured, in-depth interviews were conducted to collect the perspectives and experiences of key informants and newly arrived Afghan refugees. Results: This study highlights environmental and structural factors (availability and accessibility of grocery stores; availability of religious-appropriate items in the stores; the public benefit received by a family; and public transportation) and individual factors (religious and cultural practices; financial and language barriers) as major determinants of post-resettlement food insecurity. Conclusion: Increasing the accessibility and affordability of culturally and religiously appropriate food items within the US food system, enhancing the collaboration of community volunteers and resettlement organizations in the direct assistance of new families, and providing continuous access to public benefits are possible steps to mitigate the risk of food insecurity among Afghan refugees. This study suggests a continuous examination of the degree of food insecurity in this population and its attendant health impacts.
Journal Article
Partnering With Community Health Workers to Address COVID-19 Health Inequities: Experiences of the California Alliance Against COVID-19
With funding from the National Institutes of Health’s Community Engagement Alliance, starting in fall 2020, 11 academic medical centers and 75 community partners came together as the California Alliance Against COVID-19 to address COVID-19 inequities in California. Using data from focus groups, statewide meetings, and a statewide partner survey, we describe how promotoras and community health workers (P/CHWs; n = 540) helped to promote access to COVID-19 information, testing, and vaccination. We highlight opportunities to promote health equity among other public health collaborators with a P/CHW model. (Am J Public Health. 2024;114(S1):S45–S49. https://doi.org/10.2105/AJPH.2023.307471 )
Journal Article
Precarity in the Time of COVID-19: Aging Housing and Aging Population in Cuba
In January 2020 the Cuban government launched a rapid and comprehensive multisectoral response to the threat posed by SARS-CoV-2. This response built upon the strengths of the nation’s public health infrastructure, including an expansive health professional workforce experienced with prior epidemics (e.g., dengue, HIV, and Ebola). It also revealed the challenges posed by the vulnerabilities of aging and weak municipal infrastructures. Deteriorating housing, poor airflow, and sweltering heat undermined adherence to lockdown measures, putting those over age sixty—an increasingly large proportion of Cuba’s population—at particular risk. I discuss challenges posed by a rapidly graying population, vulnerabilities and increasing inequality stemming from Raul Castro’s 2009 economic reforms, and the island’s struggle to address its precarious housing stock to highlight the severe difficulties sheltering in place posed for the most vulnerable: elderly Cubans living without family support. The COVID-19 pandemic crisis has underscored the multiple forms infrastructure—including pipes, energy grids, and social networks—takes on the island, and the implications infrastructural strain and weakness have for maintenance of the socialist state and its continued provision of universal health care, housing, and nutrition.
Journal Article
Theorizing Social Context: Rethinking Behavioral Theory
Major behavioral theories focus on proximal influences on behavior that are considered to be predominantly cognitive characteristics of the individual largely uninfluenced by social context. Social ecological models integrate multiple levels of influence on health behavior and are noted for emphasizing the interdependence of environmental settings and life domains. This theory-based article explains how social context is conceptualized in the social sciences and how the social science conceptualization differs from and can broaden the analytic approach to health behavior. The authors use qualitative data from the Behavioral Constructs and Culture in Cancer Screening study to illustrate our conceptualization of social context. We conclude that the incorporation into health behavior theory of a multidimensional socioculturally oriented, theoretical approach to social context is critical to understand and redress health disparities in multicultural societies like the United States.
Journal Article
Public support for policies to regulate flavoured tobacco and e-cigarette products in rural California
IntroductionFlavoured tobacco control policy exemptions and electronic cigarette products may contribute to increased youth access and tobacco use disparities.MethodsWe assessed public support among California Central Valley residents for four policies to regulate flavoured tobacco products and e-cigarettes. The probability-based, multimode survey was conducted with English-speaking and Spanish-speaking registered voters (n=845) across 11 counties between 13 and 18 August 2020. Weighted logistic regression analyses measured odds of policy support, adjusting for predictor variables (attitudes and beliefs) and covariates.ResultsThe weighted sample was 50% female and predominantly Latino (30%) or non-Hispanic white (46%); 26% had a high school education or less, and 22% an annual household income
Journal Article
