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Medically underserved people with type 2 diabetes mellitus face limited access to group-based diabetes care, placing them at risk for poor disease control and complications. Immersive technology and telemedicine solutions could bridge this gap. The purpose of this study was to compare the effectiveness of diabetes medical group visits (DMGVs) delivered in an immersive telemedicine platform versus an in-person (IP) setting and establish the noninferiority of the technology-enabled approach for changes in hemoglobin A (HbA ) and physical activity (measured in metabolic equivalent of task [MET]) at 6 months. This study is a noninferiority randomized controlled trial conducted from February 2017 to December 2019 at an urban safety net health system and community health center. We enrolled adult women (aged ≥18 years) who self-reported African American or Black race or Hispanic or Latina ethnicity and had type 2 diabetes mellitus and HbA ≥8%. Participants attended 8 weekly DMGVs, which included diabetes self-management education, peer support, and clinician counseling using a culturally adapted curriculum in English or Spanish. In-person participants convened in clinical settings, while virtual world (VW) participants met remotely via an avatar-driven, 3D VW linked to video teleconferencing. Follow-up occurred 6 months post enrollment. Primary outcomes were mean changes in HbA and physical activity at 6 months, with noninferiority margins of 0.7% and 12 MET-hours, respectively. Secondary outcomes included changes in diabetes distress and depressive symptoms. Of 309 female participants (mean age 55, SD 10.6 years; n=195, 63% African American or Black; n=105, 34% Hispanic or Latina; n=151 IP; and n=158 in VW), 207 (67%) met per-protocol criteria. In the intention-to-treat analysis, we confirmed noninferiority for primary outcomes. We found similar improvements in mean HbA by group at 6 months (IP: -0.8%, SD 1.9%; VW: -0.5%, SD 1.8%; mean difference 0.3, 97.5% CI -∞ to 0.3; P<.001). However, there were no detectable improvements in physical activity (IP: -6.5, SD 43.6; VW: -9.6, SD 44.8 MET-hours; mean difference -3.1, 97.5% CI -6.9 to ∞; P=.02). The proportion of participants with significant diabetes distress and depressive symptoms at 6 months decreased in both groups. In this noninferiority randomized controlled trial, immersive telemedicine was a noninferior platform for delivering diabetes care, eliciting comparable glycemic control improvement, and enhancing patient engagement, compared to IP DMGVs. ClinicalTrials.gov NCT02726425; https://clinicaltrials.gov/ct2/show/NCT02726425.

Introduction Limited adoption of first line treatments for low back pain (LBP) in primary care settings may contribute to an overreliance on pain medications by primary care providers (PCPs). While chiropractic care typically includes recommended nonpharmacologic approaches (e.g., manual therapy, exercise instruction, advice on self-care), implementation strategies to increase adoption of chiropractic care for LBP in primary care clinics are understudied, particularly in underserved communities. Methods We will use a stepped-wedge cluster randomized controlled pilot trial design to evaluate the feasibility of a multi-level implementation strategy to increase adoption of chiropractic care for LBP in primary care clinics at community health centers. Key barriers and facilitators identified by site champions and other key stakeholders will help us to develop and tailor implementation strategies including educational materials and meetings, developing a network of local chiropractors, and modifying the electronic health record to facilitate referrals. Three primary care clinics will be randomized to receive the implementation strategy first, second, or third over a fourteen-month study period. At our first clinic, we will have a four-month pre-implementation period, a two-month implementation deployment period, and a subsequent eight-month follow-up period. We will stagger the start of our implementation strategy, beginning in a new clinic every two months. We will evaluate the proportion of patients with LBP who receive a referral to chiropractic care in the first 21 days after their index visit with PCP. We will also evaluate adoption of other guideline concordant care (e.g., other nonpharmacologic treatments) and non-guideline concordant care (e.g., opioids, imaging) over the study period. Discussion LBP is currently the leading cause of disability worldwide. While there are several treatment options available for individuals with LBP, patients in underserved populations do not often access recommended nonpharmacologic treatment options such as chiropractic care. The results from this study will inform the development of practical implementation strategies that may improve access to chiropractic care for LBP in the primary care context. Furthermore, results may also inform policy changes needed to expand access to chiropractic care in underserved communities. Clintrials.gov NCT# NCT06104605.

Interest in religion and spirituality continues to grow among public health practitioners, researchers, and scholars. While there have been several recent landmark publications and efforts to understand the intersections of religion, spirituality, and public health, work remains to be done. In this commentary, we outline three challenges that impede more substantive engagement with religion and spirituality from the public health perspective; namely, the controversial aspects of religion, the perception of religion as a private matter, and limited academic space for coursework around religion and spirituality within public health training. We then describe a series of recommendations that might foster better scholarship and praxis at the crossroads of public health, religion, and spirituality: forming interdisciplinary teams, engaging a wider body of literature, building relationships with faith-inspired colleagues and communities, and considering the goals and ends of communities we serve. We remain hopeful that through ongoing dialogue and academic humility, work exploring the features of religion, spirituality, and public health will yield richer understanding of our shared humanity and the features that give rise to life.

This article, based on twenty in-depth interviews, examines the experiences of Muslim interfaith spiritual care providers in US healthcare institutions. These Muslim chaplains represent a public face of a minority religious community; provide a ministry of presence or accompaniment for those in the healthcare institution; and exercise a new form of professionalized religious leadership in the Islamic tradition. The border between religious leader and spiritual caregiver, between imam and chaplain, is blurry, gendered, and contested. We outline how Muslim healthcare chaplains interpret their authority, function, and identity within a professional space defined by dominant American religious norms as well as by shifting standards for leadership within American Muslim communities. We argue that the Christian hegemony often masked by “spiritual care” discourse and educational practice impels Muslim chaplains to critically evaluate, recover, and adapt traditional sources integral to the professional development of contemporary American Muslim religious leaders.

Abstract Objective. Integrative Medicine Group Visits (IMGVs) are an 8-week outpatient medical group visit program for chronic pain patients combining mindfulness-based stress reduction (MBSR), integrative medicine, and patient education. The authors conducted a qualitative study with IMGV participants to better understand the effects of IMGVs on patients’ health. Design. This qualitative study enrolled a convenience sample of 19 participants from the parent prospective observational cohort study of IMGVs (n = 65). All participants in the parent study were invited to participate. Setting. Boston Medical Center (BMC) is a private, not-for-profit, 496-bed, academic medical center and the largest safety net hospital in New England. Subjects. Individuals in this study had a diagnosis of chronic pain and/or one or more chronic conditions (e.g., diabetes, depression, or metabolic syndrome), had attended ≥1 group visit, and their 8-week session had ended before completing the interview. Methods. The authors conducted individual semi-structured interviews. Interviews were audio-taped, transcribed, and analyzed. Results. Participants cite gains from IMGVs including improved self-monitoring, self-regulation, and increased mindfulness. The group setting leads patients to feel “not alone” in their health conditions, gain a sense of perspective on their health, and share coping strategies in a supportive network. These improvements in physical and mental health improved clinical outcomes for participants including reductions in pain. Conclusions. Group visits and integrative medicine both offer some potential solutions in the treatment of chronic pain. Models such as IMGVs can help individuals living with chronic conditions, addressing their emotional and physical health needs.

What are we asking when we ask about spirituality? When research subjects check survey boxes for \"religiosity\" and \"spirituality\" measures on health surveys, those of us who use them often assume that these responses indicate a relationship with—or reaction against—normative, conventional, Protestant-shaped religious practice and experience. We present a qualitative interview study of 13 low-income mothers with a history of depression, analyzing their descriptions of spiritual and religious coping practices. On the basis of a focused analysis of four mother's narratives, we argue that conventional survey answers may frequently hide more than they reveal about people's cultural, religious, and idiosyncratic experiences with ghosts, spirits, magic, and haunting presences that are relevant, sometimes integral, to illness and healing. We demonstrate that listening to participants' narratives challenges researchers' unconsciously normative assumptions and ought to help us reshape our understanding of the ways spirituality and religion influence health in a hyperdiverse society.

This paper explores the relationship between acculturation and oral health in a study of Somali refugees. This cross-sectional survey included structured surveys and dental examinations of a convenience sample of 439 Somali adults living in Massachusetts. Associations between an acculturation scale and: (1) lifetime history of caries and (2) access to oral health services were calculated. In bivariate analyses, many individual questions in the scale were associated with outcomes. In multivariate analysis, speaking English (OR 0.5, CI 0.28–0.84) was associated with better access to, and utilization of, dental health services while reading American books and newspapers in English was associated with increased lifetime history of dental disease (OR 2.6, CI 1.1–6.0). As specific elements of acculturation have different relationships with oral health among Somali refugees, a summary acculturation scale may have limited utility. Ongoing efforts to remove language barriers may improve oral health.

Little is known about the acceptance of non-pharmacological group strategies delivered to low income racially diverse patients with chronic pain and depression. This paper examines how the Integrative Medical Group Visit (IMGV) addresses many of the deficits identified with usual care. Six IMGVs cohorts were held at a safety net hospital and two federally funded community health centres. Data was gathered through focus groups. Transcripts were analysed using both a priori codes and inductive coding. The intervention included ten sessions of Integrative Medical Group Visits with a primary care provider and a meditation instructor. The curriculum uses principles of Mindfulness Based Stress Reduction and evidence based integrative medicine. The visit is structured similarly to other group medical visits. Data was gathered through four focus groups held after the cohorts were completed. Participants (N=20) were largely low income minority adults with chronic pain and comorbid depression. Six themes emerged from the coding including: chronic pain is isolating; group treatment contributes to better coping with pain; loss of control and autonomy because of the unpredictability of pain as well as dependence on medication and frequent medical appointments; groups improve agency and control over one’s health condition; navigating the healthcare system and unsatisfactory treatment options; and changes after the IMGV due to non-pharmacological health management. The IMGV is a promising format of delivering integrative care for chronic pain and depression which addresses many of the problems identified by patients in usual care.

Muslim community-based health organisations (MCBHOs) represent a new wave of non-profit organisations outside of mosques and Islamic community centres. In this article we examine MBCHOs’ core management competencies because they are instantiations of institutional logics, which result in different forms of organisational hybridity within the third sector. Theoretically, we focus on the instantiations that are associated with a societal institutional logic (religion) and two organisational field logics (voluntarism and healthcare). Empirically, we draw from a survey, maps, tax filings and strategic plans. We observed convergences in financial and human resource management and divergences in community engagement and patient assessment among 110 MCBHOs located in the United States. Volunteering and patient care hold the meaning of faith. Our findings suggest that most MCBHOs resemble an assimilated hybrid, characterised by managerial practices that adhere to the core logics of healthcare and voluntarism, with traces of the Islamic religious logic. We thus introduce the concept of ‘faithwashing’.

This article discusses the origins and development of the MS Program in Medical Anthropology in the Division of Graduate Medical Sciences at Boston University School of Medicine. We review how our faculty identified the need for the program as well as how we developed its design and negotiated the degree curriculum and requirements. We trace the evolution of our Service-Learning Internship Program (SLIP) and its establishment at various facilities. Finally, we discuss how we translated anthropological research paradigms to clinical settings and how the degree experience has translated into careers in community-based anthropology.