Enhancing organizational health literacy in a rural Missouri clinic: a qualitative case study

Purpose: The purpose of this paper is to evaluate a collaborative effort between a health care organization and academic institution to strengthen organizational health literacy. Design/methodology/approach: The intervention took place at a rural, federally qualified health clinic in Missouri between May 2009 and April 2011. Qualitative interviews of key informants were conducted before (n=35) and after (n=23) the intervention to examine program implementation and success in effecting organizational change. Findings: Intervention activities helped establish a comprehensive understanding of health literacy. The project achieved moderate, fundamental and sustainable organizational change. The program successfully integrated health literacy practices into clinic systems and garnered leadership and organizational commitment, helped the workforce improve interpersonal communication and embedded practices making health education materials more accessible. Originality/value: The study points to programmatic, conceptual and methodological challenges that must be addressed for organizations to improve health literacy practices, and suggests change management strategies to advance organizational health literacy

Disparities in Deceased Organ Donor Research Authorization: Experience at One Organ Procurement Organization and Call for National Conversations

Research with deceased donor organs can provide an important platform for studying interventions to improve organ use and outcomes after authorization from the next-of-kin (NOK) or before death by the decedent (i.e., first-person authorization [FPA]). To date, information on authorization rates across donor subgroups is lacking. We performed a retrospective chart review of all 690 deceased organ donors from January 2017 to December 2019 at a midsized Midwestern organ procurement organization (OPO). Multivariable logistic regression was used to assess associations between donor factors and research decline (adjusted odds ratio [aOR], 95% confidence interval [CI]). Electronic records for all 690 deceased donors were reviewed. Of these, 659 (95.5%) yielded at least one transplanted organ. Overall, research was declined in 10.8% of donations. Compared to White donors, research decline was higher for Black (16.0% vs. 8.9%; aOR, 1.87; 95% CI, 1.03-3.40; P = 0.04) and other non-White donors (24.0% vs. 8.9%; aOR, 4.21; 95% CI, 1.02-17.39; P = 0.05). Unadjusted research decline trended higher for Hispanic donors versus non-Hispanic donors (23.1% vs. 10.5%; P = 0.14). Compared to donors age <40 years, research decline trended higher for donors age ≥65 years (16.7% vs. 11.8%; aOR, 4.87; 95% CI, 1.12-21.05; P = 0.03), whereas research decline was 55% lower when donors provided FPA (7.3% vs 15.0%; aOR, 0.45; 95% CI, 0.27-0.76; P = 0.003). Deceased donor research authorization decline is higher for Black, other non-White, and older donors, but lower when the descendent provides FPA. Identification of disparities in research authorization may stimulate educational strategies to reduce barriers to scientific investigations directed at optimizing the outcomes of organ donation. [Display omitted

Vulnerability to extreme heat by socio-demographic characteristics and area green space among the elderly in Michigan, 1990–2007

OBJECTIVES: We examined how individual and area socio-demographic characteristics independently modified the extreme heat (EH)-mortality association among elderly residents of 8 Michigan cities, May-September, 1990-2007. METHODS: In a time-stratified case-crossover design, we regressed cause-specific mortality against EH (indicator for 4-day mean, minimum, maximum or apparent temperature above 97th or 99th percentiles). We examined effect modification with interactions between EH and personal marital status, age, race, sex and education and ZIP-code percent “non-green space” (National Land Cover Dataset), age, race, income, education, living alone, and housing age (U.S. Census). RESULTS: In models including multiple effect modifiers, the odds of cardiovascular mortality during EH (99(th) percentile threshold) vs. non-EH were higher among non-married individuals (1.21, 95% CI = 1.14-1.28 vs. 0.98, 95% CI = 0.90-1.07 among married individuals) and individuals in ZIP codes with high (91%) non-green space (1.17, 95% CI = 1.06-1.29 vs. 0.98, 95% CI = 0.89-1.07 among individuals in ZIP codes with low (39%) non-green space). Results suggested that housing age may also be an effect modifier. For the EH-respiratory mortality association, the results were inconsistent between temperature metrics and percentile thresholds of EH but largely insignificant. CONCLUSIONS: Green space, housing and social isolation may independently enhance elderly peoples’ heat-related cardiovascular mortality vulnerability. Local adaptation efforts should target areas and populations at greater risk