A Patient-Centered Asthma Management Communication Intervention for Rural Latino Children: Protocol for a Waiting-List Randomized Controlled Trial

Background: Rural Latino children with asthma suffer high rates of uncontrolled asthma symptoms, emergency department visits, and repeat hospitalizations. This vulnerable population must negotiate micro- and macrolevel challenges that impact asthma management, including language barriers, primary care access, parental time off from work, insurance coverage, distance from specialty sites, and documentation status. There are few proven interventions that address asthma management embedded within this unique context. Objective: Using a bio-ecological approach, we will determine the feasibility of a patient-centered collaborative program between rural Latino children with asthma and their families, school-based nursing programs, and primary care providers, facilitated by the use of a smartphone-based mobile app with a Spanish-language interface. We hypothesize that improving communication through a collaborative, patient-centered intervention will improve asthma management, empower the patient and family, decrease outcome disparities, and decrease direct and indirect costs. Methods: The specific aims of this study include the following: (1) Aim 1: produce and validate a Spanish translation of an existing asthma management app and evaluate its usability with Latino parents of children with asthma, (2) Aim 2: develop and evaluate a triadic, patient-centered asthma intervention preliminary protocol, facilitated by the bilingual mobile app validated in Aim 1, and (3) Aim 3: investigate the feasibility of the patient-centered asthma intervention from Aim 2 using a waiting-list randomized controlled trial (RCT) to investigate the effects of the intervention on school days missed and medication adherence. Results: Mobile app translation, initial usability testing, and app software refinement were completed in 2019. Analysis is in progress. Preliminary protocol testing is underway; we anticipate that the waiting-list RCT, using the refined protocol developed in Aim 2, will commence in fall 2020. Conclusions: Tailored, technology-based solutions have the potential to successfully address issues affecting asthma management, including communication barriers, accessibility issues, medication adherence, and suboptimal technological interventions

Acculturation, Body Mass Index, Waist Circumference, and Physical Activity in Mexican Origin Women

Purpose: Longer time in the United States (US) is associated with increased risk of obesity in Hispanic immigrants, particularly for women. Although previous research has established an association between nutrition and acculturation, little attention has focused on physical activity. In this study, we examine the associations between acculturation on Mexican origin women’s body mass index (BMI), waist circumference (WC), and report of moderate to vigorous physical activity (MVPA). Method: Mexican origin women ≥18 years (n=120) from South Carolina (n=60) and Texas Lower Rio Grande Valley (n=60) completed a survey and anthropometric measures. Participants reported MVPA in hours per week, country of birth, age at migration (\u3c16\u3eyears, 16-25 years, and ≥26 years), and language use. Using these latter two as indicators of acculturation, we evaluated associations between acculturation and BMI, WC, and MVPA. Results: Age standardized means for BMI indicated lowest BMI and waist circumference measures among women either with middle-range English language proficiency or who had immigrated to the US between the ages of 16-25; however, the relationship with BMI was more robust. Age standardized means for MVPA show that women who migrated at younger ages (\u3c16\u3eyears) had the lowest MVPA levels, followed by those migrating as younger adults (16-25 years), then adults (≥26 years). Similarly, women with lowest English proficiency levels had the lowest reported MVPA and those with highest English proficiency had highest reported MVPA. Conclusions: The relationship between acculturation and obesity and MVPA is multifaceted. While the relationship between MVPA and the two indicators of acculturation appear to be linear, the direction of association varied by acculturation indicator. Moreover, the association with acculturation indicators and measures of obesity was not linear. The findings from this study have implications in how researchers interpret the relationship between acculturation, obesity and obesity risk factors

The experience and impact of chronic disease peer support interventions: A qualitative synthesis

OBJECTIVE: Our aim was to synthesise qualitative literature about the perceived impact and experience of participating in peer support interventions for individuals with chronic disease. METHODS: We carried out a meta-ethnography to synthesize 25 papers meeting specific inclusion criteria. RESULTS: Thirteen concepts were identified that reflected participants' perceptions of the experience and impact of intervention participation. These were brought together in a conceptual model that highlighted both positive and negative perceptions, while also indicating if specific experiences and impacts had greater pertinence for mentors, mentees, or were mutually experienced. CONCLUSION: Although peer support interventions may establish uneven power relationships between mentors and mentees, there is also potential for initially asymmetrical relationships to become more symmetrical over time. Our synthesis suggests that emotional support is particularly valued when delivered under conditions that do not merely reproduce biomedical hierarchies of power. PRACTICE IMPLICATIONS: This synthesis suggests that those developing and implementing peer support interventions need to be sensitive to their potential negative effects. They will need to manage the tension between the hierarchical and egalitarian aspects of peer support interventions, and consider the impact on both mentors and mentees

Peer Support Workers in Health:A Qualitative Metasynthesis of Their Experiences

Peer support models, where an individual has a specific illness or lifestyle experience and supports others experiencing similar challenges, have frequently been used in different fields of healthcare to successfully engage hard-to-reach groups. Despite recognition of their value, the impact of these roles on the peer has not been systematically assessed. By synthesising the qualitative literature we sought to review such an impact, providing a foundation for designing future clinical peer models.Systematic review and qualitative metasynthesis of studies found in Medline, CINAHL or Scopus documenting peer worker experiences.1,528 papers were found, with 34 meeting the criteria of this study. Findings were synthesised to reveal core constructs of reframing identity through reciprocal relations and the therapeutic use of self, enhancing responsibility.The ability of the Peer Support Worker to actively engage with other marginalised or excluded individuals based on their unique insight into their own experience supports a therapeutic model of care based on appropriately sharing their story. Our findings have key implications for maximising the effectiveness of Peer Support Workers and in contributing their perspective to the development of a therapeutic model of care

Using peer advocates to improve access to services among hard-to-reach populations with hepatitis C:a qualitative study of client and provider relationships

BACKGROUND: Peer support programmes use individuals with specific experiences to improve engagement and outcomes among new clients. However, the skills and techniques used to achieve this engagement have not been mapped. This potentially restricts the development and replication of successful peer advocate models of care. This study explored how a group of peer advocates with experience of homelessness, alcohol and drug misuse made and sustained relationships with their client group. For the purposes of this project, the client group were located among a hepatitis C-positive cohort of people who have a history of injecting drug use and homelessness. METHODS: Five self-selecting advocates gave a narrative interview lasting 40-90 min. These interviews were double transcribed using both thematic analysis and narrative analysis in order to triangulate the data and provide a robust set of findings about the unique skills of peer advocates in creating and sustaining relationships with clients from hard-to-reach populations. RESULTS: Peer advocates build rapport with clients through disclosing personal details about their lives. While this runs counter to assumptions about the need to maintain distance in client-patient relationships, the therapeutic benefits appear to outweigh the potential costs of this engagement. CONCLUSION: We conclude the therapeutic benefits of self-disclosure between peer advocates and their clients offer a moral grounding for self-disclosure as a means of building relationships with key hard-to-reach populations

Task-Sharing Approaches to Improve Mental Health Care in Rural and Other Low-Resource Settings: A Systematic Review.

PURPOSE: Rural areas persistently face a shortage of mental health specialists. Task shifting, or task sharing, is an approach in global mental health that may help address unmet mental health needs in rural and other low-resource areas. This review focuses on task-shifting approaches and highlights future directions for research in this area. METHODS: Systematic review on task sharing of mental health care in rural areas of high-income countries included: (1) PubMed, (2) gray literature for innovations not yet published in peer-reviewed journals, and (3) outreach to experts for additional articles. We included English language articles published before August 31, 2013, on interventions sharing mental health care tasks across a team in rural settings. We excluded literature: (1) from low- and middle-income countries, (2) involving direct transfer of care to another provider, and (3) describing clinical guidelines and shared decision-making tools. FINDINGS: The review identified approaches to task sharing focused mainly on community health workers and primary care providers. Technology was identified as a way to leverage mental health specialists to support care across settings both within primary care and out in the community. The review also highlighted how provider education, supervision, and partnerships with local communities can support task sharing. Challenges, such as confidentiality, are often not addressed in the literature. CONCLUSIONS: Approaches to task sharing may improve reach and effectiveness of mental health care in rural and other low-resource settings, though important questions remain. We recommend promising research directions to address these questions

Utilização do "soro caseiro" nas doenças diarréicas: um programa de promotores de saúde do Baixo Amazonas

Reidratação oral, iniciado do princípio da diarréia, pode combater efetivamente a desidratação, eliminar uma dependência de recursos e tecnologia de tratamento parenteral e prevenir uma resultante desnutrição. O êxito desta terapia é um avanço importante na fea de doenças diarréicas. A sua base científica se encontra na fisiologia da absorção de água e eletrólitos pela mucosa do intestino delgado. Num programa de assistência primária, é necessário criar uma tecnologia apropriada que facilite a transferência dos conhecimentos científicos à realidade das condições locais. A autora atua na zona rural do Baixo Amazonas, uma região onde a diarréia figura entre as causas principais de morbidade e mortalidade infantil. Este trabalho descreve os métodos utilizados para a divulgação e implementação do "Soro Caseiro" através de elementos comunitários treinados para serem Promotores de Saúde