Bonnie Braun

Depression and Poverty Among Rural Women: A Relationship of Social Causation or Social Selection?

CONTEXT AND PURPOSE Depression among rural women is a major public health concern. The purpose of this study was to test the competing theories of social causation and social selection to assess the relationship between depression and economic status for a sample of rural, low-income women in the United States. METHODS Structural equation modeling was used to analyze data from Rural Families Speak, a US Department of Agriculture-funded multi-state, longitudinal study of rural low-income families (N = 413). FINDINGS Results indicated that the social causation theory yielded a better approximation of the relationship between economic status and depression (RMSEA = 0.50 for a model based on this theory) than the social selection theory (RMSEA = 0.067). CONCLUSIONS The association between lesser economic status and depressive symptoms is pressing in rural areas, given the high prevalence of both depression and poverty. These findings further emphasize the need for improved mental health services in this vulnerable population.

What Do Health Literacy and Cultural Competence Have in Common? Calling for a Collaborative Health Professional Pedagogy

Limited health literacy is recognized as contributing to racial/ethnic and other health disparities through mechanisms of poor understanding and adherence, as well as to limited access to health care. Recent studies have focused on interventions to address literacy gaps between patients and health care providers, focusing on communication techniques and redefining the responsibility for closing gaps. Cultural differences between patient and provider, if left unaddressed, have been shown to contribute to poor health outcomes through misunderstanding, value conflicts, and disparate concepts of health and illness. The dual challenges of limited health literacy and cultural differences are likely to increase with an expanding, increasingly diverse, and older population. There is evidence that training providers to attend to both issues can reduce medical errors, improve adherence, patient-provider-family communication, and outcomes of care at both individual and population levels. The two fields continue to have separate trajectories, vocabularies, and research agendas, competing for limited curricular resources. This article presents a conceptual framework for health professions education that attends simultaneously to limited health literacy and cultural differences as a coherent way forward in training culturally competent providers with a common skill-set to deliver patient-centered care that focuses on health disparities reduction.

Resiliency Capacities Among Rural Low-Income Families

The purpose of this article is to help human service practitioners recognize and understand the stressor events and crises faced by rural low-income families as a basis for development of appropriate social support strategies. Identifying protective and recovery factors utilized by these families fills a gap in research on stress, crises, and resilience. The article is based on a study involving in-depth interviews of 34 rural mothers. Analysis revealed that these families used a variety of protective and recovery factors to manage stress and prevent crisis or cope with crises–indicators of their resiliency capacities. Implications, as corroborated by previous research for human service practitioners, are discussed.

Religious beliefs, faith community involvement and depression: a study of rural, low-income mothers.

ABSTRACT The current study investigated the connection between religion and mental health of 131 rural, low-income mothers. Two dimensions of religion, beliefs and faith community involvement, were included and depression was assessed by the CES-D. The sample consisted of mothers who participated in Wave 2 of a multi-state research project. As hypothesized, both religious beliefs and faith community involvement were negatively related to depressive symptoms indicating that mothers with stronger religious beliefs and more involvement in religious activities may experience less depressive symptoms. The results of the current study confirm previous work and support a multifaceted view of religion.

Relationship Constellations and Dynamics of Low-Income Rural Mothers

To address the policy debate surrounding the use of funds from TemporaryAssistance to Needy Families for marriage-promotion activities, this article profiles thenature of low-income rural mothers’ relationships with their partners and thenonresidential fathers of their children. It presents the results of interviews with 35lowincome mothers from two rural Maryland counties. Although the analyses revealedthat the presence of a male partner was not related to a mother’s economic oremotional well-being, other sources of social support buffered mothers against theireconomic challenges. The authors conclude that social workers should integrateinformal family support into their service delivery plans and that policy makers need toconsider alternatives to fostering economic self-sufficiency among rural low-incomepopulations.

Grandmothers’ Involvement in Preschool-Aged Children’s Consumption of Fruits and Vegetables An Exploratory Study

A social-ecological frame- work suggests that nutrition education programs designed to increase young childrens fruit and vegetable con- sumption should address the influence of immediate and extended family. However, very few nutrition education programs recognize the importance of grandmothers in shaping preschool- aged childrens consumption pat- terns. This study explored the impact of grandmothers on their grandchil- drens fruit and vegetable consump- tion. Specifically, the authors addressed 3 research questions: (1) Are grand- mothers involved in purchasing food for or feeding their preschool-aged grandchildren? (2) What resources do mothers and grandmothers have to purchase fruits and vegetables, and do these resources allow them to pur- chase a healthy amount of fruits and vegetables? (3) Do mothers and grand- mothers consume fruits and vegeta- bles and understand their importance? Using a sample of 62 low-income moth- ers and grandmothers from rural Maryland, the authors found evidence that grandmothers shaped their grand- childrens fruit and vegetable consump- tion by purchasing and providing food for their daughters and grandchildren. However, grandmothers also reported consuming less than the recommended daily amount of fruits and vegetables, which suggests they may negatively affect their grandchildrens fruit and vegetable consumption. Implications for future research and programming are discussed.

Getting Off TANF: Experiences of Rural Mothers

This 3-year study followed 16 rural mothers who left Temporary Assistance for Needy Families. A family economic functioning framework was used to identify pathways and barriers to financial self-sufficiency. At a designated point, most mothers had incomes below 130% of poverty level, inadequate to support families financially. This was found to be a result of barriers such as low levels of education, limited employment choices, and transportation problems. Those with higher incomes had access to education or training programs and reliable transportation. For many of the mothers, extended family support was critical for getting off TANF. This framework provides social workers with a tool to determine the best points of intervention to reduce barriers and enhance pathways to success.

Smart Choice Health Insurance©: A New, Interdisciplinary Program to Enhance Health Insurance Literacy.

Smart Choice Health Insurance© is a consumer education program based on the definition and emerging measurement of health insurance literacy and a review of literature and appropriate theoretical frameworks. An interdisciplinary team of financial and health educators was formed to develop and pilot the program, with the goal of reducing confusion and increasing confidence in the consumer’s ability to make a smart health insurance decision. Educators in seven states, certified to teach the program, conducted workshops for 994 consumers. Results show statistically significant evidence of increased health insurance literacy, confidence, and capacity to make a smart choice health insurance choice. Discussion centers on the impact the program had on specific groups, next steps to reach a larger audience, and implications for educators, consumers, and policymakers nationwide.

Assessing health literacy and oral health: preliminary results of a multi-site investigation

OBJECTIVES To introduce a multi-site assessment of oral health literacy and to describe preliminary analyses of the relationships between health literacy and selected oral health outcomes within the context of a comprehensive conceptual model. METHODS Data for this analysis came from the Multi-Site Oral Health Literacy Research Study (MOHLRS), a federally funded investigation of health literacy and oral health. MOHLRS consisted of a broad survey, including several health literacy assessments, and measures of attitudes, knowledge, and other factors. The survey was administered to 922 initial care-seeking adult patients presenting to university-based dental clinics in California and Maryland. For this descriptive analysis, confidence filling out forms, word recognition, and reading comprehension comprised the health literacy assessments. Dental visits, oral health functioning, and dental self-efficacy were the outcomes. RESULTS Overall, up to 21% of participants reported having difficulties with practical health literacy tasks. After controlling for sociodemographic confounders, no health literacy assessment was associated with dental visits or dental caries self-efficacy. However, confidence filling out forms and word recognition were each associated with oral health functioning and periodontal disease self-efficacy. CONCLUSIONS Our analysis showed that dental school patients exhibit a range of health literacy abilities. It also revealed that the relationship between health literacy and oral health is not straightforward, depending on patient characteristics and the unique circumstances of the encounter. We anticipate future analyses of MOHLRS data will answer questions about the role that health literacy and various mediating factors play in explaining oral health disparities.

Single Female Breast Cancer Patients' Perspectives on Intimate Relationships.

This qualitative study examined how female breast cancer patients without partners conceptualized their relationship status. Qualitative data were collected from 20 participants who did not have partners during diagnosis and treatment. Phenomenology informed the methodology and thematic analysis. Breast cancer patients without partners discussed how they made meaning of their relationship status within the context of their cancer experience and barriers they faced dating post-diagnosis or treatment. Oncology care providers, public health professionals, and family scientists can use the study results to better understand the specific concerns and experiences of breast cancer patients without partners. Additional implications of these findings for patients, practice, and research are discussed.