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Health Disparities, Health Equity, Health Psychology
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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

bacigalupe's insight:

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, 2014 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.

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The Origins of 'Privilege'

The Origins of 'Privilege' | Health Equity | Scoop.it
The concept of privilege came into its own in the eighties, when the women’s-studies scholar Peggy McIntosh started writing about it.
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Sociopsychological Tailoring to Address Colorectal Cancer Screening Disparities: A Randomized Controlled Trial

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PURPOSE Interventions tailored to sociopsychological factors associated with health behaviors have promise for reducing colorectal cancer screening disparities, but limited research has assessed their impact in multiethnic populations. We examined whether an interactive multimedia computer program (IMCP) tailored to expanded health belief model sociopsychological factors could promote colorectal cancer screening in a multiethnic sample.

METHODS We undertook a randomized controlled trial, comparing an IMCP tailored to colorectal cancer screening self-efficacy, knowledge, barriers, readiness, test preference, and experiences with a nontailored informational program, both delivered before office visits. The primary outcome was record-documented colorectal cancer screening during a 12-month follow-up period. Secondary outcomes included postvisit sociopsychological factor status and discussion, as well as clinician recommendation of screening during office visits. We enrolled 1,164 patients stratified by ethnicity and language (49.3% non-Hispanic, 27.2% Hispanic/English, 23.4% Hispanic/Spanish) from 26 offices around 5 centers (Sacramento, California; Rochester and the Bronx, New York; Denver, Colorado; and San Antonio, Texas).

RESULTS Adjusting for ethnicity/language, study center, and the previsit value of the dependent variable, compared with control patients, the IMCP led to significantly greater colorectal cancer screening knowledge, self-efficacy, readiness, test preference specificity, discussion, and recommendation. During the followup period, 132 (23%) IMCP and 123 (22%) control patients received screening (adjusted difference = 0.5 percentage points, 95% CI −4.3 to 5.3). IMCP effects did not differ significantly by ethnicity/language.

CONCLUSIONS Sociopsychological factor tailoring was no more effective than nontailored information in encouraging colorectal cancer screening in a multiethnic sample, despite enhancing sociopsychological factors and visit behaviors associated with screening. The utility of sociopsychological tailoring in addressing screening disparities remains uncertain.

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WHO | Handbook on health inequality monitoring with a special focus on low- and middle-income countries

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Improving population health one person at a time? Accountable care organisations: perceptions of population health—a qualitative interview study -- Noble et al. 4 (4) -- BMJ Open

Improving population health one person at a time? Accountable care organisations: perceptions of population health—a qualitative interview study -- Noble et al. 4 (4) -- BMJ Open | Health Equity | Scoop.it
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Connected Health Opportunities For Medicaid’s Most Vulnerable Patients

Connected Health Opportunities For Medicaid’s Most Vulnerable Patients | Health Equity | Scoop.it
Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy.
bacigalupe's insight:

Low-income individuals with complex social and health needs struggle with several unique challenges that connected health can address:
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Lack of consistent contact. The social instability of this group often means that they can be difficult to locate or get in touch with. Digital health tools that incorporate texting and call features can expand the ways in which care teams can communicate with patients, track their location, and monitor clinical outcomes.Fragmented care. Many of these high-need, high-cost individuals receive care at multiple sites from multiple providers. Tools that allow care team members and providers to share information can reduce fragmentation and enable more informed and coordinated action.Difficulty managing complex medication regimens. The medically complex nature of this patient population often translates into complicated pill schedules that can be particularly challenging for people with low health literacy living in under-resourced environments. Digital tools designed to improve and track medication adherence could make this easier.Reactively, rather than proactively, managing health needs. The high emergency room visit rate of this population is indicative, among other things, of the reactive way in which these individuals often manage their care. Remote tracking tools can let care teams know in real-time when a clinical issue is arising, allowing team members to intervene before it results in an avoidable emergency room visit or inpatient admission.Difficulty accessing transportation to and from appointments. Many individuals in this groupoften struggle to arrange and pay for transportation to and from medical appointments. Providing care through texting, email, and “telehealth” by itself can alleviate much of this logistical and financial burden, and may also reduce the number of appointment “no-shows” resulting from transportation issues.
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Globalization and Health | Full text | Government capacities and stakeholders: what facilitates ehealth legislation?

Newly established high-technology areas such as eHealth require regulations regarding the interoperability of health information infrastructures and data protection. It is argued that government capacities as well as the extent to which public and private organizations participate in policy-making determine the level of eHealth legislation. Both explanatory factors are influenced by international organizations that provide knowledge transfer and encourage private actor participation.
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Forum 2015: People at the center of research and innovation for health | COHRED Blog

Forum 2015: People at the center of research and innovation for health | COHRED Blog | Health Equity | Scoop.it
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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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Helping Low-Income Families Manage Childhood Asthma: Solutions for Healthcare & Beyond | IssueLab

Helping Low-Income Families Manage Childhood Asthma: Solutions for Healthcare & Beyond | IssueLab | Health Equity | Scoop.it
IssueLab, a service of the Foundation Center, provides free access to thousands of case studies, evaluations, white papers, and issue briefs produced by the social sector.
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The Invisible Man

The Invisible Man | Health Equity | Scoop.it
Black men are "missing from the health care system," says Keith Elder of Saint Louis University. Story and infographic.
bacigalupe's insight:

He is missing from the health care system. He is less likely to hold a job that provides health insurance. Otherwise, he is underinsured. Despite chronic poverty that cries out for relief, he often slips through the cracks of a frayed social safety net. Medicaid, focused on pregnant women and children, rarely includes him. He bears a disparate burden of disease. He dies early and struggles frequently against structures that render him invisible.

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The Next America

The Next America | Health Equity | Scoop.it
Demographic transformations are dramas in slow motion. America is in the midst of two right now. Our population is becoming majority non-white at the same time a record share is going gray.
bacigalupe's insight:

Demographic transformations are dramas in slow motion. America is in the midst of two right now. Our population is becoming majority non-white at the same time a record share is going gray. Each of these shifts would by itself be the defining demographic story of its era. The fact that both are unfolding simultaneously has generated big generation gaps that will put stress on our politics, families, pocketbooks, entitlement programs and social cohesion.

Let’s start with what demographers call an “age pyramid.” Each bar represents a five year age cohort; with those ages 0-4 on the bottom and those ages 85 and older on the top. In every society since the start of history, whenever you broke down any population this way, you’d always get a pyramid.

But from 1960 to 2060, our pyramid will turn into a rectangle. We'll have almost as many Americans over age 85 as under age 5. This is the result of longer life spans and lower birthrates. It’s uncharted territory, not just for us, but for all of humanity. And while it’s certainly good news over the long haul for the sustainability of the earth’s resources, it will create political and economic stress in the shorter term, as smaller cohorts of working age adults will be hard-pressed to finance the retirements of larger cohorts of older ones.

 
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WHO | eHealth and innovation in women's and children's health: A baseline review

WHO | eHealth and innovation in women's and children's health: A baseline review | Health Equity | Scoop.it
bacigalupe's insight:

Information and communication technologies (ICTs) play an increasingly critical role in providing health services, including for women’s and children’s health. This joint publication by the World Health Organization (WHO) and the International Telecommunication Union (ITU) reports the results of the first survey to study the impact of eHealth on women’s and children’s health in developing countries. It highlights many encouraging findings including the development of national eHealth policies, the monitoring of key indicators, and the implementation of electronic information systems. Recommendations for the way forward are proposed. Never before has there been such a high response rate for a Global Observatory for eHealth (GOe) survey. This is a clear reflection that countries are now recognizing the importance of innovation through ICTs to advancing women’s and children’s health.rable populations around the world, in a wide variety of innovative ways.

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Behavioral Counseling Research and Evidence-Based Practice Recommendations: U.S. Preventive Services Task Force Perspectives

Behavioral Counseling Research and Evidence-Based Practice Recommendations: U.S. Preventive Services Task Force Perspectives | Health Equity | Scoop.it
bacigalupe's insight:

The U.S. Preventive Services Task Force (USPSTF) makes recommendations on which preventive services to routinely incorporate into primary care for specific populations. Behavioral counseling interventions are preventive services designed to help persons engage in healthy behaviors and limit unhealthy ones. The USPSTF's evaluation of behavioral counseling interventions asks 2 primary questions: Do interventions in the clinical setting influence persons to change their behavior, and does changing health behavior improve health outcomes with minimal harms?

This article discusses challenges encountered by the USPSTF in aggregating the behavioral counseling intervention literature to develop guidelines. The challenges relate broadly to study populations, intervention protocols, assessment of outcomes, and linking behavior changes to health outcomes. Recommendations to address these challenges include use of the PRECIS (Pragmatic-Explanatory Continuum Indicator Summary) tool as a guide for the development of feasible, replicable, and generalizable behavioral counseling interventions; improved reporting of study methods and results; consensus measures for key behavioral outcomes; and use of existing data sets to link behavior change and clinical outcomes.

 
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Cell phones and CHWs: a transformational marriage?

Cell phones and CHWs: a transformational marriage? | Health Equity | Scoop.it
bacigalupe's insight:

Community health workers (CHWs) have a key role to play if we are to achieve our ambitious goals to reduce child and maternal mortality globally. A wide diversity of CHW cadres have been established in many countries, both in the public sector and with nongovernmental organizations, yet several major challenges have emerged:

Limited population coverage

Motivation and retention (especially when CHWs are volunteers)

Supervision

Quality of service

Best constellation of services for the most impact, without overburdening the CHW

While mHealth is no panacea, it can help address each of these challenges substantially, notably via one simple technology—the increasingly ubiquitous cell phone. One of the strengths of CHWs is their presence in, and connection with, their communities. Among other things, this link enables them to promote crucial behavior change interventions. But ironically, being in the community can also isolate them from the rest of the health system. Moreover, despite their key service delivery role, their typically low education, skill level, and social status can limit their influence and effectiveness within the overall health system.

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