Sarah Esmond

The relationship between staffing and quality in long-term care facilities: exploring the views of nurse aides.

Research on staffing and quality of care in long-term care facilities confirms that adequate staffing levels are important to ensuring quality but few studies have examined how the two are linked. The research reported in this article used participant observation and indepth interviewing to explore how nurse aides (NAs) understand the link between staffing and quality. The findings show that NAs deem their relationships with residents to be the central determinant of quality of care as well as an important outcome in itself. Adequate staffing is essential to allowing NAs to nurture these relationships.

Improving Primary Care for Persons with Disabilities: The nature of expertise

It has been well documented that persons with disabilities (PWDs) have a more vulnerable health status than persons without disabilities; yet, they often receive inadequate primary care within the US health care system. This study explores how PWDs think about the health care they receive, particularly how primary care providers facilitate or hinder quality care for PWDs. The findings from this study expand the concept of expertise in health care, suggesting it goes well beyond technical competence of health care providers. For PWDs, expertise is multi-dimensional, not solely the domain of providers and includes having knowledge and using that knowledge within the context of the provider-patient relationship. PWDs identified three distinct areas of expertise: medical/technical, medical/biographical, and systems. Expertise can be brought to health care encounters by both PWDs and providers, and it can be developed through collaboration during interactions between providers and PWDs.

Community-Based Participatory Development, Implementation, and Evaluation of a Cancer Screening Educational Intervention among American Indians in the Northern Plains

The study describes the creation and implementation of a culturally appropriate cancer education intervention, and assesses its efficacy among American Indians in a community with documented cancer-related disparities. Education workshops were developed and conducted on three western South Dakota reservations and in Rapid City by trained community representatives. Over 400 individuals participated in the 2-h workshops. Participants answered demographic questions, questions about previous cancer screening (to establish baseline screening rates), and completed a pre- and post-workshop quiz to assess learning. Participants demonstrated significant increases in cancer screening-related knowledge levels. Surveys reveal that participants found the information of high quality, great value and would recommend the program to friends. Pre-workshop data reveals cancer screening rates well below the national average. Workshop participants increased their knowledge about cancer etiology and screening. This intervention may represent an effective tool for increasing cancer screening utilization among American Indians.

Patient Navigation & Cultural Competency in Cancer Care

(2007). Patient Navigation & Cultural Competency in Cancer Care. Oncology Issues: Vol. 22, No. 5, pp. 38-41.

The Health Equity Leadership Institute (HELI): Developing workforce capacity for health disparities research

Introduction Efforts to address health disparities and achieve health equity are critically dependent on the development of a diverse research workforce. However, many researchers from underrepresented backgrounds face challenges in advancing their careers, securing independent funding, and finding the mentorship needed to expand their research. Methods Faculty from the University of Maryland at College Park and the University of Wisconsin-Madison developed and evaluated an intensive week-long research and career-development institute—the Health Equity Leadership Institute (HELI)—with the goal of increasing the number of underrepresented scholars who can sustain their ongoing commitment to health equity research. Results In 2010-2016, HELI brought 145 diverse scholars (78% from an underrepresented background; 81% female) together to engage with each other and learn from supportive faculty. Overall, scholar feedback was highly positive on all survey items, with average agreement ratings of 4.45-4.84 based on a 5-point Likert scale. Eighty-five percent of scholars remain in academic positions. In the first three cohorts, 73% of HELI participants have been promoted and 23% have secured independent federal funding. Conclusions HELI includes an evidence-based curriculum to develop a diverse workforce for health equity research. For those institutions interested in implementing such an institute to develop and support underrepresented early stage investigators, a resource toolbox is provided.

Achievements in Health Equity: Nesting an NIMHD Center of Excellence within a CTSA

The Clinical and Translational Science Awards (CTSA) program of the National Center for Advancing Translational Sciences (NCATS) aims to speed the process of transforming new discoveries into improvements in human health. Critical to achieving this outcome of improving human health is the engagement of community, broadly defined, across the research spectrum. Moreover, including community members who do not traditionally participate in research nor benefit from research findings, must occur. Indeed, the Institute of Medicine highlighted the importance of engagement and collaboration in its recent review of the CTSA program (IOM, 2013). Translational science is a team-based endeavor; the more diverse the team, the greater the likelihood new discoveries will benefit more people. Unique populations (age, ethnicity, gender, place, race) experience disparities in health outcomes that translational science must address. The challenge becomes one of how to minimize these disparities by harnessing the promise of translational science through the CTSA program, while bringing voices of all constituencies to the table. In the latest strategic plan to combat health disparities (HD), the NIH listed four major goals: promoting HD research; fostering innovative collaborations and partnerships; training a diverse workforce; and translating and disseminating new discoveries. It is evident that both the CTSA program and the NIH strategic HD plan emphasize the necessity to engage community. Likewise, a CTSA Advisory Work Group identified three additional strategic goals that align with the HD plan: workforce development, integration, and development of novel methods. Thus, a rather unique opportunity exists to improve human health and reduce disparities, while achieving these established goals. At the University of Wisconsin Madison (UW), we integrated a P60 Center of Excellence funded by the National Institutes for Minority Health and Health Disparities (NIMHD) within our CTSA program to create the partnership required to effectively conduct community engaged HD research. Institutional commitment, along with shared personnel, resources, and complementary expertise, are transforming the academic culture to value engagement along the entire translational research spectrum. In time, we believe “nesting” of the P60 within the CTSA will improve the health of Wisconsin citizens and increase health equity.