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Using e-Health to Enable Culturally Appropriate Mental Healthcare in Rural Areas

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The objective of this study was to review relevant research issues in the provision of culturally appropriate e-mental healthcare and make recommendations for expanding and prioritizing research efforts in this area. A workshop was convened by the Office of Rural Mental Health Research (ORMHR) at the National Institute of Mental Health (NIMH), the Center for Reducing Health Disparities at the University of California, Davis, the California Telemedicine and e-Health Center, and the California Endowment in December 2005, during which papers were presented concerning culture and e-mental health. Relevant literature was reviewed and research questions were developed. Major issues in the provision of culturally appropriate e-mental healthcare were defined, as were the barriers to the provision of such care in rural areas and interventions to overcome these barriers. Rural areas have increased barriers to culturally appropriate mental healthcare because of increased rates of poverty, increasingly large ethnic minority populations, and various degrees of geographical isolation and cultural factors specific to rural communities. Although culture and language are major barriers to receiving appropriate mental healthcare, including e-mental healthcare, they cannot be separated from other related influential variables, such as poverty and geography. Each of these critical issues must be taken into account when planning technologically enabled rural mental health services. This review describes one in a series of ORMHR/NIMH efforts aimed at stimulating research using culturally appropriate e-mental health strategies that address unique characteristics of various racial/ethnic groups, as well as rural and frontier populations.

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Health Equity
Health Disparities, Health Equity, Health Psychology
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Twelve myths about shared decision making - Patient Education and Counseling

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Objective

As shared decision makes increasing headway in healthcare policy, it is under more scrutiny. We sought to identify and dispel the most prevalent myths about shared decision making.

Methods

In 20 years in the shared decision making field one of the author has repeatedly heard mention of the same barriers to scaling up shared decision making across the healthcare spectrum. We conducted a selective literature review relating to shared decision making to further investigate these commonly perceived barriers and to seek evidence supporting their existence or not.

Results

Beliefs about barriers to scaling up shared decision making represent a wide range of historical, cultural, financial and scientific concerns. We found little evidence to support twelve of the most common beliefs about barriers to scaling up shared decision making, and indeed found evidence to the contrary.

Conclusion

Our selective review of the literature suggests that twelve of the most commonly perceived barriers to scaling up shared decision making across the healthcare spectrum should be termed myths as they can be dispelled by evidence.

Practice implications

Our review confirms that the current debate about shared decision making must not deter policy makers and clinicians from pursuing its scaling up across the healthcare continuum.

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The State of Health Equity Research: - Health Equity Research and Policy - Medical Research - Initiatives - AAMC

The State of Health Equity Research: - Health Equity Research and Policy - Medical Research - Initiatives - AAMC | Health Equity | Scoop.it
Closing Knowledge Gaps to Address Inequities

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AAMC and Acad
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Social Determinants of Health Equity

Social Determinants of Health Equity | Health Equity | Scoop.it
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Language is important. The call for papers in this supplement was entitled health equity. Yet the call asked for papers that address disparities in health. In the United States, disparities, most often, has been used to refer to racial/ethnic differences in health, or more commonly health care. We note that the call in this supplement expands the focus and highlights differences by socioeconomic status and geographic location, among others. By tradition, in the United Kingdom we have used the term inequalities to describe the differences in health between groups defined on the basis of socioeconomic conditions. To reduce health inequalities requires action to reduce socioeconomic and other inequalities. There are other factors that influence health, but these are outweighed by the overwhelming impact of social and economic factors—the material, social, political, and cultural conditions that shape our lives and our behaviors.

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Health Literate Care Model | Health.gov (ODPHP)

Health Literate Care Model | Health.gov (ODPHP) | Health Equity | Scoop.it
Resources on the Health Literate Care Model. Find health literacy and health information related resources, tools, research and reports.
bacigalupe's insight:

In order for health outcomes to improve, patients must be fully engaged in prevention, decision making, and self-management. The Health Literate Care Model weaves health literacy principles into the widely adopted Chronic Care Model and calls for health care providers to:

Approach all patients as if they are at risk of not understanding health information.Employ a range of strategies for clear communication.Confirm patients’ understanding.

When a health care organization adopts the Health Literate Care Model, health literacy becomes an organizational value infused into all aspects of planning and operations.

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Health Beyond Health Care: Q&A with Matthew Trowbridge, MD, MPH

Health Beyond Health Care: Q&A with Matthew Trowbridge, MD, MPH | Health Equity | Scoop.it
Health Beyond Health Care: Q&A with Matthew Trowbridge, MD, MPH
bacigalupe's insight:

Through a collaboration between with Terry Huang, who was a program officer at the National Institute of Child Health and Human Development and a leader in that institute’s childhood obesity research portfolio. [Editor’s note: He is now a Professor and Chair of the Department of Health Promotion, Social & Behavioral Health University of Nebraska Medical Center College of Public Health.] Back in 2007, Terry had been thinking about how architecture, and particularly school architecture, could be utilized as a tool for obesity prevention. The thinking behind that is that schools have always been a particularly interesting environment for child health very broadly, but also obesity prevention in particular, partly because children spend so much time at school and because the school day provides an important opportunity to help children develop healthy lifelong attitudes and behaviors. 

(Image courtesy: Tom Daly)

One of the insights that Terry had was that while public health had done a lot to develop programming for school-based obesity prevention, the actual school building itself had really not been looked at in terms of opportunities to help make school-based obesity prevention programs work most effectively. In 2007, Terry actually wrote a journal article outlining ideas for ways in which architecture could be used to augment school-based childhood obesity prevention programs that was published in one of the top obesity journals. When I met Terry at NIH, we realized we both shared an interest in moving beyond studying the association between built environment and health toward real world translation. In other words, providing tangible tools and guidelines to foster collaboration between public health and the design community to bring these ideas into action.

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WHO/Europe | Events - New evidence-based tools to reduce health inequities in Europe

WHO/Europe | Events - New evidence-based tools to reduce health inequities in Europe | Health Equity | Scoop.it
Fact sheet
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Case Abstracts of a Multi-Year, Multi-Project Public Engagement Initiative to Better Inform Governmental Public Health Policy Decisions | Journal of Participatory Medicine

Case Abstracts of a Multi-Year, Multi-Project Public Engagement Initiative to Better Inform Governmental Public Health Policy Decisions | Journal of Participatory Medicine | Health Equity | Scoop.it
This paper examines a CDC initiative aimed at developing a feasible method of engaging the public that would better inform agency or sponsor decision making in the short term and build trust between the agency or sponsor and the public over the longer term. The initiative succeeded in the short term, but no ongoing infrastructure devoted to public engagement was created to achieve similar results over the longer term.
bacigalupe's insight:

A public engagement initiative was undertaken in 2001 to find ways in which the Centers for Disease Control and Prevention (CDC) could work productively with the public to better inform decision making in the short term and improve trust over the longer term. A new model, renamed the Decision-focused Public Engagement Table (DPET), was developed and used in nine projects between 2005 and 2009. The origins of this initiative, the characteristics of the DPET model, and detailed case abstracts describing the key features and conclusions from each project are described in this paper.

While there was variation in how the model was replicated, its essential features demonstrated that it is feasible and practical to carry out for a variety of difficult decisions involving different agency sponsors. The degree to which public advice influenced decisions was mixed. For some projects the advice was clearly used to shape the decision making, for others it was difficult to isolate the public’s influence from that of other contributors, and for some projects the public input was not seriously considered.

The project evaluations showed an increase in trust, at least in local government, at the time the projects ended, and citizens reported they were more likely to participate in other types of engagement in the future. Taken as a whole, the projects provided “proof of principle” that engaging the public in participatory policy making sponsored by governmental agencies is feasible and can be influential. The initiative also provided clear evidence that citizens make policy choices which are different from those made by experts on the same issue. And, they appear to be better decisions because they are both well-informed and well-aligned with public values and the broader public interest.

Despite the success achieved, the projects did not result in the creation of any permanent infrastructure to support and strengthen public engagement work within the participating agencies. This was disappointing and the reasons are numerous and complex. They are the subject of a companion paper being published in this issue of the Journal which examined the challenges encountered from a broader perspective.[1] It also includes possible approaches to overcome the challenges and embed public engagement as an effective means of addressing the frequent gridlock caused by difficult, values-based public policy decisions.

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The Future Role of the Family Physician in the United States: A Rigorous Exercise in Definition

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As the US health care delivery system undergoes rapid transformation, there is an urgent need to define a comprehensive, evidence-based role for the family physician. A Role Definition Group made up of members of seven family medicine organizations developed a statement defining the family physician’s role in meeting the needs of individuals, the health care system, and the country. The Role Definition Group surveyed more than 50 years of foundational manuscripts including published works from the Future of Family Medicine project and Keystone III conference, external reviews, and a recent Accreditation Council on Graduate Medical Education Family Medicine Milestones definition. They developed candidate definitions and a “foil” definition of what family medicine could become without change. The following definition was selected: “Family physicians are personal doctors for people of all ages and health conditions. They are a reliable first contact for health concerns and directly address most health care needs. Through enduring partnerships, family physicians help patients prevent, understand, and manage illness, navigate the health system and set health goals. Family physicians and their staff adapt their care to the unique needs of their patients and communities. They use data to monitor and manage their patient population, and use best science to prioritize services most likely to benefit health. They are ideal leaders of health care systems and partners for public health.” This definition will guide the second Future of Family Medicine project and provide direction as family physicians, academicians, clinical networks, and policy-makers negotiate roles in the evolving health system.

 
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Health Literacy Out Loud Podcast #60: Creating, Finding, and Growing in a Health Literacy Career: MP3 online hören - Health Literacy Out Loud Podcast - Audio 123319424

Health Literacy Out Loud Podcast #60: Creating, Finding, and Growing in a Health Literacy Career: MP3 online hören - Health Literacy Out Loud Podcast - Audio 123319424 | Health Equity | Scoop.it
Health Literacy Out Loud Podcast #60: Creating, Finding, and Growing in a Health Literacy Career - MP3 online hören.
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PSA Discoverer Says Antigen Test Is Misused, Unreliable

PSA Discoverer Says Antigen Test Is Misused, Unreliable | Health Equity | Scoop.it
Are you still doing routine PSA screening? The man who discovered the antigen questions the test's validity.
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HIV in America has disproportionately hurt blacks — even after treatment

HIV in America has disproportionately hurt blacks — even after treatment | Health Equity | Scoop.it
Why is HIV such a problem in the black community? 8 charts explore why.
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La salud y sus determinantes sociales. Desigualdades y exclusión en la sociedad del siglo XXI | Palomino Moral | Revista Internacional de Sociología

La salud y sus determinantes sociales. Desigualdades y exclusión en la sociedad del siglo XXI
bacigalupe's insight:
El concepto de salud ha experimentado un proceso de revisión constante. Desde mediados del siglo XX se ha producido un desplazamiento desde la búsqueda de las causas de la enfermedad centradas en el individuo a la aparición de los determinantes sociales, los principales moduladores del fenómeno salud y la enfermedad. Hoy sabemos que la salud y la calidad de vida son un resultado social directamente relacionado con las condiciones generales de la vida de las personas y con la forma de vivir; en este sentido se han hecho notables esfuerzos en las últimas décadas para comprender cómo interactúan los determinantes sociales y se producen los resultados en salud. Analizamos las aportaciones que han conseguido poner de manifiesto los principales factores generadores de las desigualdades sociales incluyendo un análisis de las desigualdades en salud de las mujeres, la vulnerabilidad y el riesgo de exclusión.
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mhealth knowledge

mhealth knowledge | Health Equity | Scoop.it
bacigalupe's insight:

mHealth Knowledge connects you—health professionals—to the people, products, and ideas that you need to do your mHealth work effectively. This site features the mHealth collaborations and products created and maintained by the USAID-funded Knowledge for Health (K4Health) Project. Through mHealth Knowledge, you can advance your mHealth efforts—click on the blocks above to learn the basics; access the latest evidence about what works; plan your mHealth initiative or find key resources; or connect with other mHealth practitioners. Stay up to date on mHealth hot topics via our newsfeed or by subscribing to receive our quarterly newsletter. 

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Epidemic of overtreatment of prostate cancer must stop

Epidemic of overtreatment of prostate cancer must stop | Health Equity | Scoop.it
Studies found that a large number of American men with prostate cancer get unnecessary and aggressive treatment, Dr. Otis Brawley says.
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Evaluation of an eHealth Intervention in Chronic Care for Frail Older People: Why Adherence is the First Target

Evaluation of an eHealth Intervention in Chronic Care for Frail Older People: Why Adherence is the First Target | Health Equity | Scoop.it
bacigalupe's insight:

Background:  Older people suffering from frailty often receive fragmented chronic care from multiple professionals. According to the literature, there is an urgent need for coordination of care.

Objective:  The objective of this study was to investigate the effectiveness of an online health community (OHC) intervention for older people with frailty aimed at facilitating multidisciplinary communication.

 

Methods:  The design was a controlled before-after study with 12 months follow-up in 11 family practices in the eastern part of the Netherlands. Participants consisted of frail older people living in the community requiring multidisciplinary (long-term) care. The intervention used was the health and welfare portal (ZWIP): an OHC for frail elderly patients, their informal caregivers and professionals. ZWIP contains a secure messaging system supplemented by a shared electronic health record. Primary outcomes were scores on the Instrumental Activities of Daily Living scale (IADL), mental health, and social activity limitations.

 

Results:  There were 290 patients in the intervention group and 392 in the control group. Of these, 76/290 (26.2%) in the intervention group actively used ZWIP. After 12 months follow-up, we observed no significant improvement on primary patient outcomes. ADL improved in the intervention group with a standardized score of 0.21 (P=.27); IADL improved with 0.50 points, P=.64.

 

Conclusions:  Only a small percentage of frail elderly people in the study intensively used ZWIP, our newly developed and innovative eHealth tool. The use of this OHC did not significantly improve patient outcomes. This was most likely due to the limited use of the OHC, and a relatively short follow-up time. Increasing actual use of eHealth intervention seems a precondition for large-scale evaluation, and earlier adoption before frailty develops may improve later use and effectiveness of ZWIP.

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The Case for Reparations

The Case for Reparations | Health Equity | Scoop.it
Two hundred fifty years of slavery. Ninety years of Jim Crow. Sixty years of separate but equal. Thirty-five years of racist housing policy. Until we reckon with our compounding moral debts, America will never be whole.
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Lessons Learned from Implementing a Multi-Year, Multi-Project Public Engagement Initiative to Better Inform Governmental Public Health Policy Decisions | Journal of Participatory Medicine

Lessons Learned from Implementing a Multi-Year, Multi-Project Public Engagement Initiative to Better Inform Governmental Public Health Policy Decisions | Journal of Participatory Medicine | Health Equity | Scoop.it
The author outlines lessons learned from a CDC initiative on public engagement and public policy decision making.
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Shared Decision Making and Motivational Interviewing: Achieving Patient-Centered Care Across the Spectrum of Health Care Problems

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Patient-centered care requires different approaches depending on the clinical situation. Motivational interviewing and shared decision making provide practical and well-described methods to accomplish patient-centered care in the context of situations where medical evidence supports specific behavior changes and the most appropriate action is dependent on the patient’s preferences. Many clinical consultations may require elements of both approaches, however. This article describes these 2 approaches—one to address ambivalence to medically indicated behavior change and the other to support patients in making health care decisions in cases where there is more than one reasonable option—and discusses how clinicians can draw on these approaches alone and in combination to achieve patient-centered care across the range of health care problems.

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Alex Thomson's curator insight, May 25, 3:08 PM

Really glad to see shared decision-making receiving increasing emphasis and attention in healthcare. This article is very relevant to work we're doing locally in collaborating with local GPs to draw up care plans for patients with complex illnesses or higher than needed consultation rates.