Angelia M. Paschal

Stigma and safe havens: A medical sociological perspective on African-American female epilepsy patients

PURPOSE Very little is known about the attitudes and behaviors of minorities with epilepsy. This pilot study explored access to health care, help-seeking behaviors, and adherence to treatment among African-American females with epilepsy. METHODS Ethnographic interviews were conducted with 10 African-American female adults. RESULTS Findings indicate four major obstacles to care: limited financial resources, lack of knowledge about epilepsy among African-Americans, poor patient-provider communication, and lack of social support. Social support impacted individuals seeking surgery, and also affected purchasing medication, adherence to medical treatment, and needed transportation. Lack of knowledge and misinformation about epilepsy in the African-American community and poor communication with physicians contribute to the social stigma felt by these patients. CONCLUSIONS The behavioral epidemiology of epilepsy among African-Americans is lacking. This disease exacerbates health disparities for this population. These findings point to a need for a safe haven for these individuals.

Measures of adherence to epilepsy treatment: Review of present practices and recommendations for future directions

Epilepsy is one of the most common neurological disorders worldwide, and the majority of people with epilepsy who live in developed countries manage their condition with antiseizure medication. Surprisingly, therefore, the literature on epilepsy does not document a comprehensive investigation of patient adherence to medication treatment. This paper reviews existing literature on direct and indirect measures of adherence. Based on this review, areas in need for further research have been identified, including improvement of self‐report instruments, consideration of cultural factors, attention to patient literacy or numeracy levels, and inclusion of patient‐guided measures. While no single method of determining adherence has proved effective, combining direct and indirect measures in a patient‐guided, culturally competent atmosphere may increase adherence to treatment, improving health outcomes for this population.

Text messaging immunization reminders: Feasibility of implementation with low-income parents

Text messaging reminder systems are a cost-effective way of improving attendance in a variety of healthcare settings (Downer et al., 2006; Geraghty et al., 2008; Koshy et al., 2008; Leong et al., 2006). Due to the complicated nature of the child immunization schedule (Massoudi, 2003), and the penetration of mobile phones among hard-to-reach populations (Blumberg and Luke, 2008), text messaging may be a successful strategy to increase immunizations (Vilella et al., 2004). The only identified study regarding text message immunization reminders suggests parents of adolescents are open to receiving such text reminders (Kharbanda et al., 2009). However, this study involved focus groups of only 28 parents. A major public health goal is to increase immunization rates among children to 90% to prevent the circulation of vaccinepreventable diseases (Massoudi, 2003). In particular, programs that promote the 4-3-1-3-3 series among children 2 years of age and younger have been found to dramatically reduce the incidence of these diseases (Nelson et al., 2007). The purpose of this formative study was to determine the feasibility of developing text immunization reminders for parents of young children. A brief survey was administered to 200 consecutive parents of children under six years of age at a Midwestern Pediatric Residency clinic. The survey was approved by two local Institutional Review Boards. All questions were fixed response, and included current use of a cell phone, type of text messaging service, and interest in receiving text messages from health care providers. Finally, respondents provided demographic information. Surveys were completed by 190 parents (95%). The majority were female (165; 87%), had a high school diploma or less (114; 60%), had a household income less than

Perceived Fatherhood Roles and Parenting Behaviors Among African American Teen Fathers

20,000 a year (117; 62%), and received public insurance (153; 81%). Nearly all participants owned a cellular phone (174; 92%) and of those, 96% (167) could receive text messages. In addition, 81% (141) had an unlimited text messaging plan. Ninety percent (156) of cell phone owners would be open to receiving text messages from their doctor or nurse. Parents with unlimited text capabilities were more likely (97%) to be open to receiving text messages from health care providers than those with limited text plans (64%) (χ(1)=32.98, pb .001). Of those respondents who own a cell phone andwere interested in receiving text messages from their health care provider (156), 99% (155) would be open to receiving appointment reminders, 87% (135) immunization reminders, 76% (119) test results, and 46% (72) general health tips. Most respondents (136; 87%) would prefer to receive immunization reminders one week or less before the shots are due. Of those parents who would enroll in a text immunization reminder service, 19% (29) would pay up to

Parent Opinions About Use of Text Messaging for Immunization Reminders

9.99 a year for the program, but the majority (97; 62%) would only enroll if the program was free or covered by insurance.

Content of text messaging immunization reminders: What low-income parents want to know

Despite the growing body of research on the topic of adolescent parenthood, few studies have examined the perceptions and lived experiences of African American teen fathers. The primary aim of this study was to examine how this group defines and performs the father role. In-depth interviews were conducted with 30 African American fathers aged 14 to19 years old. Three themes emerged from the data: provider role, nurturer role, and autonomous fathers. The study results generate important questions that require further research. Information from African American teens in particular could be used to develop and evaluate interventions.

Baseline assessment of the health status and health behaviors of African Americans participating in the activities-for-life program: a community-based health intervention program.

Background Adherence to childhood immunization schedules is a function of various factors. Given the increased use of technology as a strategy to increase immunization coverage, it is important to investigate how parents perceive different forms of communication, including traditional means and text-message reminders. Objective To examine current forms of communication about immunization information, parents’ satisfaction levels with these communication modes, perceived barriers and benefits to using text messaging, and the ideal content of text messages for immunization reminders. Methods Structured interviews were developed and approved by two Institutional Review Boards. A convenience sample of 50 parents was recruited from two local pediatric clinics. The study included a demographics questionnaire, the shortened form of the Test of Functional Health Literacy for Adults (S-TOFHLA), questions regarding benefits and barriers of text communication from immunization providers, and preferred content for immunization reminders. Content analyses were performed on responses to barriers, benefits, and preferred content (all Cohen’s kappas > 0.70). Results Respondents were mostly female (45/50, 90%), white non-Hispanic (31/50, 62%), between 20–41 years (mean = 29, SD 5), with one or two children (range 1–9). Nearly all (48/50, 96%) had an S-TOFHLA score in the “adequate” range. All parents (50/50, 100%) engaged in face-to-face contact with their child’s physician at appointments, 74% (37/50) had contact via telephone, and none of the parents (0/50, 0%) used email or text messages. Most parents were satisfied with the face-to-face (48/50, 96%) and telephone (28/50, 75%) communication. Forty-nine of the 50 participants (98%) were interested in receiving immunization reminders by text message, and all parents (50/50, 100%) were willing to receive general appointment reminders by text message. Parents made 200 comments regarding text-message reminders. Benefits accounted for 63.5% of comments (127/200). The remaining 37.5% (73/200) regarded barriers; however, no barriers could be identified by 26% of participants (13/50). Parents made 172 comments regarding preferred content of text-message immunization reminders. The most frequently discussed topics were date due (50/172, 29%), general reminder (26/172, 26%), and child’s name (21/172, 12%). Conclusions Most parents were satisfied with traditional communication; however, few had experienced any alternative forms of communication regarding immunizations. Benefits of receiving text messages for immunization reminders far outweighed the barriers identified by parents. Few barriers identified were text specific. Those that were, centered on cost if parents did not have unlimited texting plans.

Correlating reading comprehension and health numeracy among adults with low literacy

OBJECTIVE The purpose of this project was to gather preliminary data on preferred content for text reminders sent to low-income parents. METHODS A brief, IRB-approved survey was administered to 200 consecutive English-speaking parents of children under 6 years old at a Pediatric Residency clinic. Because text messages can hold only limited content, parents were given three example texts ranging from very basic to very specific information and asked to select the information they would wish to receive. RESULTS Of the 190 parents (95%) who responded, 22.1% (42) were Hispanic and 76.3% (145) were non-Hispanic. Over 80% (153) received Medicaid. Of the 79.5% (151) of respondents interested in receiving text messages who responded to the question regarding content, nearly 50% (74) preferred Option 2, with the remaining respondents divided between Option 1 (43) and Option 3 (35). Results differed significantly between Hispanic and non-Hispanic respondents (χ(2)(2)=6.36, p=0.042). CONCLUSION The majority of parents preferred a message containing the childs name, specific immunization information and physician information. However, Hispanic respondents were significantly more likely to endorse an option that included additional information. PRACTICE IMPLICATIONS Text messaging may be an optimal vehicle for provider-patient communication, however cultural differences should be considered when developing messages.

The Role of Local Health Departments in Providing Sexually Transmitted Disease Services and Surveillance in Rural Communities

Obesity is a serious problem in the United States and is associated with hypertension, diabetes, and other health problems such as heart disease and some forms of cancer. There is a higher prevalence of being overweight among African American adults than among their Caucasian counterparts. The objective of this study was to assess baseline health behaviors and health status (hypertension, body mass indices, cholesterol and blood sugar levels) of African Americans participating in a community-based health education and physical fitness program. The sample consisted of 134 African American adults (30% males) from a low-income urban area in the Midwest. A health survey was administered to assess their health behaviors and previously diagnosed health problems. Additional data was obtained from health screenings to obtain current information on height, weight, and blood sugar, blood pressure and cholesterol levels. In addition to the sample being markedly overweight and obese (30% and 60% respectively), the results of the health screenings indicated a disproportionate number of participants (62%) with hypertension; 74% of the male participants had high blood pressure. Moreover, the self-reported data suggested that the participants had poor eating habits, sedentary lifestyles, and previously diagnosed health conditions (hypertension, diabetes, and high cholesterol levels) that were comparable to the results of their health screenings. These findings suggest that culturally-relevant, community-based programs that incorporate both nutrition education and physical fitness are needed in order to educate and motivate participants to decrease behaviors that put them at risk for obesity and other health related problems.

Using a Community-Based Participatory Research Approach to Improve the Performance Capacity of Local Health Departments: The Kansas Immunization Technology Project

OBJECTIVE Using the Test of Functional Health Literacy for Adults (TOFHLA), a pilot study was conducted to assess whether reading comprehension and numeracy scores sufficiently correlate in health contexts among adults with low literacy skills. METHODS The TOFHLA was administered to 144 adults with low literacy enrolled in a health literacy program prior to the start of coursework. Raw scores for reading and numeracy were calculated. Weighted numeracy scores were calculated and compared to raw reading comprehension scores. RESULTS Among 143 participants, 20% (n=28) had a higher numeracy score than reading comprehension score, while an additional 20% scored lower in numeracy than in reading comprehension. CONCLUSION This study found that reading comprehension and numeracy skill in the context of understanding health information do not necessarily correlate for specific disadvantaged groups. This finding calls attention to the need to further examine numeracy as a construct which is conceptually separate from reading comprehension, and highlights the importance of including a numerate component in health literacy evaluations. PRACTICE IMPLICATIONS The results of this study have important implications for medical decision-makers, health educators, and health promoters working with traditional methods of assessing health literacy.