An Interactive, Mobile-Based Tool for Personal Social Network Data Collection and Visualization Among a Geographically Isolated and Socioeconomically Disadvantaged Population: Early-Stage Feasibility Study with Qualitative User Feedback

Background: Personal social networks have a profound impact on our health, yet collecting personal network data for use in health communication, behavior change, or translation and dissemination interventions has proved challenging. Recent advances in social network data collection software have reduced the burden of network studies on researchers and respondents alike, yet little testing has occurred to discover whether these methods are: (1) acceptable to a variety of target populations, including those who may have limited experience with technology or limited literacy; and (2) practical in the field, specifically in areas that are geographically and technologically disconnected, such as rural Appalachian Kentucky. Objective: We explored the early-stage feasibility (Acceptability, Demand, Implementation, and Practicality) of using innovative, interactive, tablet-based network data collection and visualization software (OpenEddi) in field collection of personal network data in Appalachian Kentucky. Methods: A total of 168 rural Appalachian women who had previously participated in a study on the use of a self-collected vaginal swab (SCVS) for human papillomavirus testing were recruited by community-based nurse interviewers between September 2013 and August 2014. Participants completed egocentric network surveys via OpenEddi, which captured social and communication network influences on participation in, and recruitment to, the SCVS study. After study completion, we conducted a qualitative group interview with four nurse interviewers and two participants in the network study. Using this qualitative data, and quantitative data from the network study, we applied guidelines from Bowen et al to assess feasibility in four areas of early-stage development of OpenEddi: Acceptability, Demand, Implementation, and Practicality. Basic descriptive network statistics (size, edges, density) were analyzed using RStudio. Results: OpenEddi was perceived as fun, novel, and superior to other data collection methods or tools. Respondents enjoyed the social network survey component, and visualizing social networks produced thoughtful responses from participants about leveraging or changing network content and structure for specific health-promoting purposes. Areas for improved literacy and functionality of the tool were identified. However, technical issues led to substantial (50%) data loss, limiting the success of its implementation from a researcher\u27s perspective, and hindering practicality in the field. Conclusions: OpenEddi is a promising data collection tool for use in geographically isolated and socioeconomically disadvantaged populations. Future development will mitigate technical problems, improve usability and literacy, and test new methods of data collection. These changes will support goals for use of this tool in the delivery of network-based health communication and social support interventions to socioeconomically disadvantaged populations

Cancer control needs of 2-1-1 callers in Missouri, North Carolina, Texas, and Washington

Innovative interventions are needed to connect underserved populations to cancer control services. With data from Missouri, North Carolina, Texas, and Washington this study a) estimated the cancer control needs of callers to 2-1-1, an information and referral system used by underserved populations, b) compared rates of need to state and national data, and c) examined receptiveness to needed referrals. From October 2009 to March 2010 callers’ (N = 1408) cancer control needs were assessed in six areas: breast, cervical, and colorectal cancer screening, HPV vaccination, smoking, and smoke-free homes using Behavioral Risk Factor Surveillance System (BRFSS) survey items. Standardized estimates were compared to state and national rates. Nearly 70% of the sample had at least one cancer control need. Needs were greater for 2-1-1 callers compared to state and national rates, and callers were receptive to referrals. 2-1-1 could potentially be a key partner in efforts to reduce cancer disparities

<html>Cancer Control Needs of <i>2-1-1</i> Callers in Missouri, North Carolina, Texas, and Washington</html>

Innovative interventions are needed to connect underserved populations to cancer control services. With data from Missouri, North Carolina, Texas, and Washington this study a) estimated the cancer control needs of callers to 2-1-1, an information and referral system used by underserved populations, b) compared rates of need to state and national data, and c) examined receptiveness to needed referrals. From October 2009 to March 2010 callers’ (N = 1408) cancer control needs were assessed in six areas: breast, cervical, and colorectal cancer screening, HPV vaccination, smoking, and smoke-free homes using Behavioral Risk Factor Surveillance System (BRFSS) survey items. Standardized estimates were compared to state and national rates. Nearly 70% of the sample had at least one cancer control need. Needs were greater for 2-1-1 callers compared to state and national rates, and callers were receptive to referrals. 2-1-1 could potentially be a key partner in efforts to reduce cancer disparities

Assessing Social and Communication Networks and Knowledge of the 2010 Affordable Care Act in a Socioeconomically Disadvantaged Population

Socioeconomically disadvantaged populations stand to benefit greatly from the 2010 Patient Protection and Affordable Care Act (ACA), which will provide Medicaid or subsidized insurance coverage for the lowest-income Americans. Yet to see judge the potential value from of the ACA to themselves and their families, these individuals will need to be aware of how the law may benefit them, know their eligibility for benefits, and enroll in an appropriate plan. Existing mechanisms to reach the most socioeconomically disadvantaged populations with information about the ACA may not be ideal. This study explores characteristics of those with low knowledge versus high knowledge of health reform legislation in a low-income population with disproportionately high rates of uninsurance and cancer prevention and control needs, and investigates the sources of health reform and related communication by mapping social networks. Recruiting participants from United Way 2-1-1 Missouri - an information and referral hotline that reaches low-income and minority Missourians and connects them to local resources that can help meet their basic needs -- this study: 1) Assesses knowledge of the Affordable Care Act and describes social and word-of-mouth communication networks in a sample of callers to 2-1-1, 2) Tests whether individual characteristics and social support and communication network characteristics of participants differ between lower and higher scorers on ACA knowledge, 3) Compares the relative importance of network characteristics versus individual characteristics in predicting ACA knowledge by creating a model predicting high knowledge of ACA in a low-income population, and 4) Evaluates the relative contribution of community on ACA knowledge by including census level variables in a multi-level predictive model of ACA knowledge. Results include a structural and communication model of ACA- and health-related knowledge in a socioeconomically disadvantaged population. Through a better understanding of communication networks in and knowledge of the ACA among socioeconomically disadvantaged populations, we can inform communication strategies and shape policy to disseminate knowledge of ACA benefits and health services to millions of Americans greatly impacted by the ACA. This may help increase access to and use of health care services, resulting in reduced health disparities

Clinician identified barriers to treatment for individuals in Appalachia with opioid use disorder following release from prison: a social ecological approach

Abstract Background The non-medical use of opioids has reached epidemic levels nationwide, and rural areas have been particularly affected by increasing rates of overdose mortality as well as increases in the prison population. Individuals with opioid use disorder (OUD) are at increased risk for relapse and overdose upon reentry to the community due to decreased tolerance during incarceration. It is crucial to identify barriers to substance use disorder treatment post-release from prison because treatment can be particularly difficult to access in resource-limited rural Appalachia. Methods A social ecological framework was utilized to examine barriers to community-based substance use treatment among individuals with OUD in Appalachian Kentucky following release from prison. Semi-structured qualitative interviews with 15 social service clinicians (SSCs) employed by the Department of Corrections were conducted to identify barriers at the individual, interpersonal, organizational/institutional level, community, and systems levels. Two independent coders conducted line-by-line coding to identify key themes. Results Treatment barriers were identified across the social ecological spectrum. At the individual-level, SSCs highlighted high-risk drug use and a lack of motivation. At the interpersonal level, homogenous social networks (i.e., homophilious drug-using networks) and networks with limited treatment knowledge inhibited treatment. SSC’s high case load and probation/parole officer’s limited understanding of treatment were organizational/institutional barriers. Easy access to opioids, few treatment resources, and a lack of community support for treatment were barriers at the community level. SSC’s noted system-level barriers such as lack of transportation options, cost, and uncertainty about the implementation of the Affordable Care Act. Conclusions More rural infrastructure resources as well as additional education for family networks, corrections staff, and the community at large in Appalachia are needed to address barriers to OUD treatment. Future research should examine barriers from the perspective of other key stakeholders (e.g., clients, families of clients) and test interventions to increase access to OUD treatment