Prescribed self-management behaviors have been found to be important factors affecting the rates of morbidity and mortality in multiple medical conditions including chronic diseases such as diabetes, a condition that disproportionately affects high health risk populations such as African Americans. This study focused on understanding health behaviors, beliefs, and associated factors such as support systems and access to care that played a role in diabetes self-management and glucose control. The study also explored diabetes self-management education and its role in diabetes self-management. The research conducted in Pinellas and Hillsborough counties in Florida, included twenty-five African American women between the ages of forty-six and eighty-seven, with self-identified diabetes mellitus (type 2 diabetes). The study also included seven diabetes self-management educators consisting of nutritionists, a nurse educator, physicians, and an exercise physiologist--key members of the diabetes self-management team. Additionally, five diabetes education programs were observed. Methods included semi-structured qualitative interviews, with direct and participant observation of the Diabetes Intervention Prevention Program (DIPP), the St. Petersburg Free Clinic Diabetes Program, and the Morton Plant Meese/Joslin Diabetes Program in Pinellas County. Hillsborough County sites included the USF Diabetes Program, and University Community Hospital's Diabetes Care Program. Site selection included a cross-section of program types: non-clinic/community-based, community-based clinic, hospital-based, and university clinic-based. The study also utilized a thirty-nine question survey designed to elicit information about self-management beliefs and behaviors. Results revealed several self-management behavioral variables affecting glucose control: (1) nutritional/dietary changes, (2) exercise, (3) medication use, (4) blood glucose monitoring, (5) physician-patient interaction, (6) support systems, and (7) patient education/knowledge. Results also identified access to care as a contributor to self-management. Two models of diabetes self-management emerged from the findings: a model of balanced self-management held by the diabetes educators and self-management programs, and a model of Interruption practiced by the women. Recommendations highlighted the need for the awareness of socio-cultural factors affecting self-management, the elimination of barriers affecting access to care, improvement in physician-patient interaction, provision of culturally aware patient education, and stronger community and family support systems.

The purpose of this dissertation was to understand perceived hearing loss and hearing health care use among older adults from Hispanic/Latino backgrounds using the Andersen model of health care utilization as a framework. A cross sectional analysis of audiometric and survey data from the Hispanic Community Health Study/Study of Latinos was used to estimate factors that characterize perceived hearing handicap and hearing aid use, and to determine hearing aid use rates in a large group of older Hispanic/Latino adults. Data came from 6970 adults aged 45 to 76. Results revealed that self-perceived hearing handicap is significantly correlated to measured hearing levels, and is characterized by health insurance status, age, sex, pure tone average, and language acculturation. Reported hearing aid use was characterized by poorer measured pure tone average of the better ear, higher Hearing Handicap Inventory – Screening scores, and current health insurance. Overall hearing aid uptake rate among included individuals was 3.7%. Hearing aid uptake rates among included individuals were low compared to rates of clinically significant hearing loss. The primary variable associated with underutilization of hearing aid uptake for those who could pose to benefit was a lack of health insurance.

Bakgrunn: Studien tar utgangspunkt i resultatet av en brukerundersøkelse om pasient-tilfredshet ved fysioterapipoliklinikken, Avdeling for Fysikalsk Medisin og Rehabilitering, Ullevål universitetssykehus i2003. Resultatet: av denne studien var at pasienter med et ikke-skandinavisk morsmål var signifikant mindre tilfredse med behandlingen enn øvrige pasienter. Hensikten med studien var å undersøke hvilke faktorer som er viktige for å oppnå pasienttilfredshet blant pasienter med et ikke-skandinavisk morsmål. Metode: Materialet besto av pasienter som hadde avsluttet sin behandling for en langvarig muskel-skjelettlidelse. De fleste hadde kommet fra Asia. De hadde ikke brukt tolk. Kvantitative og kvalitative forskningsmetoder samt en metodetriangulering ble benyttet. Tretti pasienter ble inkludert i den anonyme spørreskjemaundersøkelse. To fokusgruppe- intervjuer, ett med kvinner og ett med menn, ble gjennomført. Fenomenografi ble benyttet. Resultat: Det var i store trekk sammenfallende funn i den kvantitaive og kvalitative undersøkelsen. I spørreskjemaundersøkelsen var resultatetat eldre pasienter var mer fornøyde enn yngre. Det var ingen forskjell mellom kjønnene. Mange pasienter var ikke blitt bedre av behandlingen, men mange var likevel fornøyde. Det som betydde mest for tilfredsheten var at informasjonen og kommunikasjon var god, at fysioterapeuten var dyktig og hadde nok tid til pasienten. Lokalene, utstyr, etc hadde mindre betydning. Konklusjon: Resultatet indikerte at i tillegg til bedring av tilstanden var informasjon, kommunikasjon og tilstrekkelig med tid viktige faktorer for tilfredsheten blant disse pasientene. Dette er det viktig å ta hensyn til ved behandling av pasienter med fremmed kultur og språk / Background: This study is a follow up of a patient survey study done in the Physiotherapy outpatient clinic, Department of Physical Medicine andRehabilitation, Ullevaal university hospital, 2003. The previous study showed that patients with a non- Scandinavian mother tongue were less overall satisfied with the treatment than other patients. Purpose: of this study was to find out why patients with a non- Scandinavian mother tongue were less overall satisfied with the treatment than other patients, and to assess with which factors the patients were most dissatisfied and how the patients had experienced the treatment. Methods: The material consisted of patients who had finished their physiotherapy treatment for muscle skeleton diseases. Most of them came from Asia. Both quantitative and qualitative (phenomenography) research methods were used. In the patient survey 30 patients were included. Another four patients were included in focus group interviews. Results: Older patients were more satisfied than younger. There was no significant association between gender and satisfaction. The main dissatisfaction factor was no improvement following treatment. However, many patients were satisfied despite that there had not been any improvement. Other factors that had impact on the overall satisfaction were communication, professional skills, information, enough time and expectations. Facilities and equipment were of less importance. Conclusion: The results indicate that in addition to improved condition, communication, information and enough time were of great importance for patient satisfaction. These factors should be taken into consideration while treating patients with foreign culture and language / <p>ISBN 978-91-85721-01-6</p>

Every year universities across the United States administer the National College Health Assessment (NCHA) to assess their students’ general health based on nine topic areas (i.e. sleep, nutrition, mental health, drug use, sexual behavior, etc.) in relation to their impact on academics. Overall, there is low participation among minority-serving institutions, more specifically Historically Black Colleges and Universities. The lack of participation among these universities may be for several reasons, such as financial constraints on the university or the use their own instruments to assess their students’ health and wellness needs. Further, they may not see a need for the NCHA. Most universities use data analyzed from the NCHA to tailor their wellness programs to their students’ specific needs. This foundational research study utilized a case study design to explore the capacity of one HBCU to provide wellness programs and services to their students and to assess how the wellness needs of current students are identified and met. The secondary purpose of this study was to assess the attitudes of health administrators and students regarding their schools’ wellness programs and services as well as to identify the strengths and gaps in services provided. One-on-one interviews with university staff and administrators, student focus groups, and document analysis were used to collect data. Case analysis was performed to generate research themes to answer the research questions. Six themes were created to answer the corresponding research questions. Conclusions from this study may provide insight into how this university developed and implemented wellness related programs and services to meet the wellness needs of its students.

Providers’ Perspectives on Treating Patients for Substance Use Disorder in Northeast Tennessee Stefan Pienkowski MA, Abbey Mann PhD Department of Family Medicine, Quillen College of Medicine, East Tennessee State University, Johnson CIty, TN ABSTRACT Previous research has shown that people who identify as lesbian, gay, bisexual, transgender, and/or queer/questioning (LGTBQ+) have higher rates of substance use disorder (SUD) compared to the general population.1,2 Additionally, gender and sexual minorities have shown less treatment-seeking intentions than their heterosexual cis-gender counterparts.3 Given these circumstances, increasing approachability to SUD treatment options for people who identify as LGBTQ+ may significantly reduce this health disparity. Through this action research study, we set out to identify barriers to SUD treatment in northeast Tennessee as well as identify SUD treatment providers that make special accommodations for people who identify as LGBTQ+. Through purposive sampling, we identified nine providers of SUD treatment in Washington, Carter, and Sullivan counties. Providers included three physicians, three certified peer support specialists, a licensed counselor, and two facility directors. Providers each participated in a one-on-one semi-structured interview that lasted approximately 45 minutes and was audio recorded without the use of identifying information. Interview data were reviewed, and preliminary analysis was performed in order to identify themes. Themes included barriers to care, general resources, and stigma. LGBTQ+ specific findings revealed that none of the interviewed providers had received formal LGBTQ+ cultural competency training, but most providers expressed interest in receiving LGBTQ+ cultural competency training. Additionally, many providers did not believe that LGBTQ+ patients have specific needs concerning SUD treatment. Only three of the providers interviewed made special accommodations for their LGBTQ+ patients. In addition to identifying themes in the interview data, the results of this project were used to create a LGBTQ+ friendly SUD treatment resource guide for northeast Tennessee. Next steps for this action research project include 1) interviewing people who have experience with SUD treatment in northeast Tennessee and identify as LGBTQ+, 2) developing a community-based LGBTQ+ cultural competency training module informed by those interviews, 3) implementing and evaluating that module with SUD treatment providers in northeast Tennessee. 1. Medley, Grace, et al. “Sexual Orientation and Estimates of Adult Substance Use and Mental Health: Results from the 2015 National Survey on Drug Use and Health.” Substance Abuse and Mental Health Services Administration, Oct. 2016, www.samhsa.gov/data/sites/default/files/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015.htm. 2. Mereish, Ethan H, and Judith B Bradford. “Intersecting Identities and Substance Use Problems: Sexual Orientation, Gender, Race, and Lifetime Substance Use Problems.” Journal of Studies on Alcohol and Drugs, Rutgers University, Jan. 2014, www.ncbi.nlm.nih.gov/pubmed/24411810.` 3. Benz, Madeline. “Stigma and Help-Seeking: The Interplay of Substance Use and Gender and Sexual Minority Identity.” Addictive Behaviors, Pergamon, 23 May 2019, www.sciencedirect.com/science/article/abs/pii/S0306460318311316.

TITLE: Race, gender, and mental health outcomes in Tennessee AUTHOR INFO Eugene Annor Manik Ahuja PhD, MA1 Author Affiliations: 1College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States Background: Tennessee has been disproportionally burdened with high levels of mental health disorders. Over the last decade, Tennessee has consistently ranked in the bottom 10 U.S. states in prevalence of mental health disorders. While it is known that Tennessee ranks lower in mental health status, less is known of how these differences vary across race. Methods: We used cross-sectional data from the 2019 Behavioral Risk Factor Surveillance System, a nationally representative U.S. telephone-based survey of adults aged 18 years or older for the State of Tennessee (n=6,242). Chi-square tests were conducted to assess differences across race. Logistic regression analyses were conducted to test the association between gender and past month mentally unhealthy days, stratified by race. We coded mentally unhealthy days binary, at 15 or more mentally unhealthy days in the past month, and less than 15 days. We controlled for income, educational attainment, health insurance, and age. Results: Overall, 22.9% of American Indian/Alaska Natives, followed by White (14.8%), Black (13.6%) and Hispanic (12.0%) reported 15 or more mentally unhealthy days in the past month. Among Blacks, there were no significant differences between males (13.2%) and females (13.9%) for 15 or more past month mentally unhealthy days (p=.76), as well as among Hispanics (p=.17) Among Whites, females (16.6) reported a significantly higher (p Conclusions: Our findings reveal that among Blacks and Hispanics in Tennessee, there were no significant gender differences in mental health outcomes. White among Whites and American Indian/Alaska Natives, females reported a significantly higher rate of past month mentally unhealthy days. The current study reports that the gap among males and females in report of poorer mental health has narrowed, particularly among Blacks and Hispanics in Tennessee. Further efforts towards providing equitable access to mental health services across race and gender in Tennessee, is essential.

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Implementation of Evidenced-Based Practices to Improve Follow-up Care Following Inpatient Mental Health Hospitalizations. Jacqlyne W Bowman, Dr. Judy Rice, Dr. Beth Schreiner, Dr. Ernie Maupin, College of Nursing, East Tennessee State University Persons hospitalized for mental health conditions are frequently lost to follow up after discharge. The aim of this quality improvement project is to increase the rate of attendance at follow up appointments after hospital discharge back to the community. The focus of this project is the development and implementation of a discharge questionnaire for both clients and case management to better understand the needs of the clients during the discharge process. Behavioral health technicians employed by the agency are including the discharge questionnaire in the admission packet for a 12-week trial period. This discharge questionnaire asks clients their preferred location for follow up appointments, if they are active in their care, if transportation is needed for follow up appointments and verifies the patient’s phone number. Clients complete the discharge questionnaire and return it to the behavioral health technicians with their admission packet. The discharge questionnaire is then given to case managers to assess and address concerns outlined on the questionnaire. Data will be gathered over 12-weeks to determine if the rate of non-attendance decreases with the integration of the questionnaire. The project is in the implementation phase. The anticipated outcome is there will be an increase in the rate of attendance at follow-up appointments post discharge with the use of the discharge questionnaire. By utilizing the discharge questionnaire, case managers will be better able to determine barriers that lead to non-attendance to follow up appointments. With the barriers identified and addressed, individuals will be more likely to attend their follow-up appointments and medication compliance and rates of re-hospitalizations will improve.

There is a low representation of Black American women (BAW) in health care senior leadership. With the high level of health problems found among the Black community, diversifying the executive leadership with BAW may be instrumental in increasing provider trust and reducing discriminatory action. Using critical race theory as the conceptual framework, this study examined the experiences, perceptions, and influential or deterrent factors inhibiting advancement of BAW in the health care field. Inquiry centered on factors related to lack of advancement, experiences at different stages of career progression, and strategies impacting career advancement. A qualitative research design using a transcendental phenomenological approach was the chosen method. Seven BAW who met the criteria for inclusion were selected by purposive sampling. Data were collected from semi-structured, audio-recorded, interviews using a newly created protocol. Data analysis included open coding; line-by-line data review; and the use of NVivo to search for frequencies of themes, coding, and text queries. Emergent themes were identified that provided comprehensive descriptions of the participants' experiences. According to study findings, perceived and experienced racial issues were apparent in hiring and work relations. Disparate practices were evident through a lack of inclusion in succession planning, being overlooked despite qualifications, and stereotyping. These findings may stimulate social change by helping those BAW aspiring for senior healthcare leadership to be more successful and by improving health outcomes for BAW through enhanced trust.

The purpose of this study was to better understand the way that intersectional identities affect one's perception of one's healthcare experience. Many previous studies focus on one facet of the minority experience, such as race or sexual orientation, and even then, limit it to a comparison between the majority population and one small subsection of the population of interest (ex: studying only African-Americans as racial minorities and disregarding other minority races). This study was more of a broad survey that sought to account for the unique intersection of different minority identities that one may possess and which ultimately affects how they are perceived and treated in society. This study surveyed 115, primarily college-aged, participants that fell into one of four categories: White/Caucasian and Cisgender/Heterosexual, White/Caucasian and LGBTQ+, Racial Minority and Cisgender/Heterosexual, and Racial Minority and LGBTQ+. Participants were asked to complete an open-ended survey and a Likert scale to rate and review their experiences with healthcare in general, and in regards to their identity. Results showed that although minority participants, especially those who were double minorities (racial minority and LGBTQ+) did not always explicitly express being discriminated against, they often showed it through other ways, such as being more likely to report distrust of their healthcare provider or an unwillingness to seek healthcare despite possessing health concerns. LGBTQ+ individuals were also much more likely to report discriminatory practices in healthcare than racial minorities or the majority group on a statistically significant level. This indicates that minority identities predispose individuals to lower quality of care and this health discrepancy manifests at different intensities based on an individual's specific minority makeup.