Nicole Cook

Assessing the acceptability of self-sampling for HPV among Haitian immigrant women: CBPR in action

ObjectiveTo determine whether pairing self-sampling for HPV with community health workers (CHWs) is a culturally acceptable method for cervical cancer screening among Haitian immigrant women residing in Little Haiti, the predominately Haitian neighborhood in Miami, FL.MethodsAs part of a larger, ongoing community-based participatory research (CBPR) initiative in Little Haiti, Haitian CHWs recruited 246 eligible women to this study. Participants provided self-collected cervical specimens for HPV testing and answered a series of questions about their experience with self-sampling for HPV.ResultsThe vast majority of women (97.6%) was comfortable using the self-sampler at home, would recommend this screening method to their friends and/or family members (98.4%), and described the sampler as easy to use (95.1%). Additionally, 97% of all self-collected specimens were deemed adequate for HPV testing.ConclusionsWhen paired with CHWs, who are of Haitian descent and well respected in Little Haiti, self-sampling is a highly acceptable method of cervical screening for Haitian women in this ethnic enclave. This approach addresses critical access barriers, including poverty, language difficulties, and sociocultural concerns about modesty, that may similarly affect Pap smear utilization among other immigrant or medically underserved population sub-groups. Coupled with generally positive reviews of the device, the low rate of insufficient specimens for testing suggests that this device is promising for use in non-clinical settings.

Supporting medical home transformation through evaluation of patient experience in a large culturally diverse primary care safety net

CONTEXT The prevalence of chronic disease in the United States is rapidly increasing, with a disproportionate number of underserved, vulnerable patients sharing the burden. The Patient-Centered Medical Home (PCMH) is a care delivery model that has shown promise to improve primary care and address the burden of chronic illness. OBJECTIVE The purpose of this study was to (1) understand patient characteristics that might influence perceived patient experience in a large primary care safety net undergoing PCMH transformation; (2) identify community-level quality improvement opportunities to support ongoing transformation activities; and (3) establish a baseline of patient experience across the primary care safety net that could be used in repeated evaluations over the course of transformation. DESIGN A cross-sectional study design was used to conduct this research. SETTING AND PARTICIPANTS A total of 351 racially and ethnically diverse patients of 4 primary care safety net organizations in Broward County, Florida, were surveyed regarding their experience with access to care and coordination of care. MAIN OUTCOME MEASURE Reported access to care and coordination of care. RESULTS Patients with chronic disease who reported having visited the clinic 3 or more times in the past 12 months reported a better coordination of care experience than patients who had fewer than 3 visits in the past 12 months (odds ratio = 3.57; 95% confidence interval, 1.76-7.24). Patients without chronic disease who had been receiving care at the clinic for 2 or more years of care reported worse experience with access to care than patients with less than 2 years of care (odds ratio = 0.26; 95% confidence interval, 0.11-0.60.) Race, ethnicity, language, and education were not significant predictors of patient experience. CONCLUSION Findings support ongoing efforts to improve patient engagement among all patients and to enhance resources to manage chronic disease, including community-based self-management programs, in primary care safety nets undergoing PCMH transformation.

Pilot test of a six-week group delivery caregiver training program to reduce sleep disturbances among older adults with dementia-Innovative Practice

The purpose of the pilot program was to examine the adaptability and feasibility of a modified group-delivery sleep education program (NITE-AD) designed to reduce nocturnal disturbances in community-dwelling older adults with dementia. We recruited seven caregivers of persons with dementia from two adult day care centers in South Florida into a six-week group program at adult day care centers. A trained sleep educator taught caregivers about the impact of aging and dementia on sleep and how non-pharmacological interventions such as increasing light, regular exercise, and sleep hygiene strategies can improve sleep in persons with dementia. The curriculum incorporated ongoing problem solving and goal setting. Results suggest improvement in caregiver depression and persons with dementia sleep problems. Caregivers reported that the program provided them support and valuable strategies that they will continue to apply. Educating caregivers in a group setting about non-pharmacologic strategies for managing sleep may reduce caregiver burden and improve sleep among persons with dementia.