Colleen O’Brien Cherry

Healthcare Providers’ Perceptions and Self-Reported Fall Prevention Practices: Findings from a Large New York Health System

Among older adults, falls are the leading cause of injury-related deaths and emergency department visits, and the incidence of falls in the United States is rising as the number of older Americans increases. Research has shown that falls can be reduced by modifying fall-risk factors using multifactorial interventions implemented in clinical settings. However, the literature indicates that many providers feel that they do not know how to conduct fall-risk assessments or do not have adequate knowledge about fall prevention. To help healthcare providers incorporate older adult fall prevention (i.e., falls risk assessment and treatment) into their clinical practice, the Centers for Disease Control and Prevention’s (CDC) Injury Center has developed the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool kit. This study was conducted to identify the practice characteristics and providers’ beliefs, knowledge, and fall-related activities before they received training on how to use the STEADI tool kit. Data were collected as part of a larger State Fall Prevention Project funded by CDC’s Injury Center. Completed questionnaires were returned by 38 medical providers from 11 healthcare practices within a large New York health system. Healthcare providers ranked falls as the lowest priority of five conditions, after diabetes, cardiovascular disease, mental health, and musculoskeletal conditions. Less than 40% of the providers asked most or all of their older patients if they had fallen during the past 12 months. Less than a quarter referred their older patients to physical therapists for balance or gait training, and <20% referred older patients to community-based fall prevention programs. Less than 16% reported they conducted standardized functional assessments with their older patients at least once a year. These results suggest that implementing the STEADI tool kit in clinical settings could address knowledge gaps and provide the necessary tools to help providers incorporate fall-risk assessment and treatment into clinical practice.

Building a “Better Life”: The Transformative Effects of Adolescent Pregnancy and Parenting

Adolescent pregnancy is often described as a major concern in public health and is associated with negative outcomes for educational and career attainment. Our objective was to compare the future aspirations of pregnant and parenting adolescents and identify social or structural barriers that they experience in their daily lives using journal entries from pregnant and parenting adolescents. The journals, which served as primary data sources, were completed by 52 multi-ethnic pregnant and parenting adolescents aged 15 to 19 in Indiana. Both pregnant and parenting adolescents aspired to provide a “better life” for their children that included finishing school and obtaining a career. An emergent theme is that the experience of pregnancy and parenting is transformative and may invoke a positive refocusing of life aspirations for educational and career attainment. However, social stigma and barriers exist that make achieving educational and employment opportunities difficult. The study findings indicate that pregnant and parenting adolescents need strong social support networks and practical tools to help harness their motivation and transcend social and material barriers to achieve their goals and aspirations.

An in-depth mixed-methods approach to Ryan White HIV/AIDS care program comprehensive needs assessment from the Northeast Georgia Public Health District: The significance of patient privacy, psychological health, and social stigma to care

We apply a social-ecological interpretive framework to understanding relationships among patient privacy, psychological health, social stigma, and continuity in care in the HIV treatment cascade in the rural southeastern US. This research was conducted as part of the 2013 comprehensive needs assessment for the Northeast Georgia Ryan White Consortium using an anthropologically informed mixed-methods design, and a deductive-inductive approach to thematic analysis of qualitative data obtained in interviews and focus groups with service providers and service utilizers. Our comprehensive needs assessment yielded two key components. First, we identified salient phenomena influencing introduction to, retention among, and satisfaction of patients in the Ryan White-coordinated treatment cascade in NE-GA. Second, we formulated actionable recommendations around leverage points identified in the current district-wide system of care. Results highlight spatial, institutional, and interpersonal aspects of the system of care that intersect around issues of patient privacy, psychological health, and social stigma. These intersections constitute pathways by which persons living with HIV are exposed to stigma and other negative social signals regarding their health status without sufficient access to behavioral health services. These negative issues, in turn, can erect significant barriers to long-term continuity in care.

The Clinician Engagement and Education Session Modernizing “Academic Detailing”

In industrial processes, Deming demonstrated that “quality” required the active application of a measured systems approach to production. Eisenberg effectively began the wide dissemination of promoting the “quality” process in health care, with his disciples recognizing that research discovery does not automatically lead to practice. It has been clearly shown that systems innovations in health care, including changing physician practice behavior, can improve quality and reduce cost. Central to the implementation of quality in the health care system are the social and professional processes that influence clinician behavior. Traditionally, “academic detailing” has been used widely as a way to engage physicians to influence clinical practice. Modeled from the approach taken by the pharmaceutical industry, academic detailing focuses on establishing credibility, assessing baseline knowledge, and identifying physician opinion leaders for follow-up interaction. Many others have studied and further developed this approach, with Grol providing a highly effective summary of available tools to initiate change in physician practice behavior (eg, rewards, penalties, audit, feedback, decision support) that can result in improvement of outcomes by between 4% and 22%. It has been predicted that clinical outcomes could be improved by as much as 75% with a focus on changing clinician systems of care.

Variation and transmission of Sonoran wild food knowledge in southern Arizona.

Since knowledge about wild foods is thought to be declining in younger generations worldwide, this studys objective was to describe variation in Sonoran wild food knowledge in southern Arizona between adults (n = 19) and students (n = 110) using free lists, an identification exercise, and structured interviews. There are fundamental differences in the quantity and quality of knowledge that adults and students have about wild desert foods. Adults know more native species, specific names, and correctly identify Sonoran wild foods twice as often as students. Fewer direct nature experiences in the younger generation may account for the observed variation in wild food knowledge.Since knowledge about wild foods is thought to be declining in younger generations worldwide, this studys objective was to describe variation in Sonoran wild food knowledge in southern Arizona between adults (n = 19) and students (n = 110) using free lists, an identification exercise, and structured interviews. There are fundamental differences in the quantity and quality of knowledge that adults and students have about wild desert foods. Adults know more native species, specific names, and correctly identify Sonoran wild foods twice as often as students. Fewer direct nature experiences in the younger generation may account for the observed variation in wild food knowledge.

Prevalence of Risk Factors for the Metabolic Syndrome in the Middle Income Caribbean Nation of St. Lucia

The objective of this research was to measure the presence of metabolic syndrome risk factors in a sample population in the middle income Caribbean nation of St. Lucia and to identify the demographic and behavioral factors of metabolic syndrome among the study participants. Interviews and anthropometric measures were conducted with 499 St. Lucians of ages 18–99. Descriptive statistics were used for the analysis. Fifty-six percent of females and 18 percent of males had a waist size equal to or above the indicator for the metabolic syndrome. Behavioral risk factors such as sedentary lifestyle, smoking, and alcohol consumption varied by gender. Thirty-six percent of women and 22% of men reported a sedentary lifestyle and 43% of women and 65% of men reported any alcohol consumption. More research should be done to determine the cultural norms and gender differences associated with modifiable risk behaviors in St. Lucia.

A Cross-Cultural Analysis of Physician Management of Obesity. Comparing the US, France, Israel and Japan: Little Interest and Little Success

Background: Obesity is a global health problem. Physicians are frequently engaged with overweight and obese patients. Obesity guidelines have been successfully implemented on a small scale, but generally physicians struggle to manage obesity effectively. Methods: In a web-based survey, primary care physicians in the United States (US), France, Israel and Japan, were asked how they manage cardiovascular risk factors. They were specifically asked how frequently they saw patients in follow-up for hypertension, hyperlipidemia and obesity. Results: Respondents (956) included 656 French, 198 Israeli, 45 Japanese, and 53 US physicians. Follow-up for obesity no sooner than 3 months was recommended, by 73% (US) and 79% (Israeli) physicians, whereas 67% of French and 66% of Japanese physicians recommended more frequent follow-up (3 months or less). Hypertension and hyperlipidemia was managed more aggressively, especially the US, Israel and Japan. Discussion: Obesity is an international concern, with rates increasing everywhere. The prevalence of obesity is high in the US and Israel and much lower in France and Japan. Chronic disease management is most effective with frequent follow-up. US obesity guidelines recommend frequent (often monthly) follow-up visits. US and Israeli physicians do not appear to be aggressive in managing obesity, whereas French and Japanese physicians report more effort to manage obesity. In the US, obesity management is not considered effective and physicians are uncomfortable attempting to manage obesity with their patients. In France especially, physicians have a more social relationship with their patients and seem oriented toward chronic disease management, including greater attention to lifestyle change. Conclusion: Obesity has been medicalized and is a profound problem internationally. The medical care system must address obesity management more effectively. Further studies are needed to understand how physicians manage obesity and new approaches should be promoted to improve the outcomes of obesity management.

Rewriting Life Narratives: Positive Coping Mechanisms in Adolescent Mothers

Abstract Purpose The primary aim of this chapter is to explore stigmatization, stress, and coping among adolescent mothers and to identify positive coping mechanisms that not only resist stigmatization but also generate positive affect. Methodology/approach Fifty-two pregnant and parenting adolescents in an urban county in the Midwestern United States were recruited to participate. A journaling tool was developed and used to allow participants to express their thoughts and concerns in a real-time, reflexive manner. Data were coded at different “nodes” or themes. Concepts, such as stigma, stress, strength, and empowerment were operationalized into key words and “themes” based on previous published literature. Key phrases were used to code the journaling data. Findings Adolescent mothers used positive reappraisal of life circumstances to create a positive self-image and resist the stress of stigma and parenting. Overcoming stereotypes and success in parenting were reappraised as “strength,” which allowed the young women to feel empowered in their caregiving role. Research implications/limitations The chapter also contributes to the sociological literature on positive coping responses to stigma and stress. Indeed, very few studies have employed the sociological imagination of pregnant and parenting adolescents by describing not only their lives but also seeking their understanding and explaining their lives sociologically. This chapter also has direct implications for several health care providers, including nurses and social workers. For example, nurses and social workers are a vital part of the healthcare team for pregnant and parenting adolescents, and they often serve as the link between the adolescent, her family and significant others, and healthcare and social service agencies. Originality/value This chapter described the mechanisms that adolescent mothers use to cope with stress with a focus on how caregiving generates positive affect through the voices of these young mothers themselves. This chapter contributed to the sociological literature on stress and coping. In particular, our findings were also in line with the work of sociologist Antonovsky’s Sense of Coherence concept. SOC is a global measure that indicates the availability of, and willingness to use, adaptive coping resources as a key variable in maintaining health.

Expanding collaborative technologies in rural veteran health care using tele-robotic stroke therapy delivery and monitoring systems

This poster reports on a qualitative evaluation of a tele-robotic stroke therapy delivery and monitoring system intervention.