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Autism spectrum disorder (ASD) is associated with a variety of physical, mental, and behavioral healthcare needs. However, parents of autistic children consistently report difficulty accessing necessary services, and no instrument has been validated to assess and quantify these barriers for autistic children. The current study aims to adapt and validate the Barriers to Care Questionnaire (BCQ), a pre-existing measure of barriers to healthcare for children with specific healthcare needs, for families of autistic children. The BCQ and theoretically related measures were collected from 242 parents (117 parents of autistic children, 125 parents of non-autistic children). Cronbach’s alpha statistics (ranging from 0.87 to 0.96 for BCQ subscales) provide evidence of reliability for the BCQ. The BCQ subscales were correlated with unmet treatment need, treatment experiences, and theoretically related variables at the child, parent, and family level, providing evidence of convergent validity. Correlations were of low magnitude with theoretically unrelated variables (parent personality and socially desirable responding), suggesting preliminary evidence of discriminant validity. Additionally, the BCQ subscales predicted a significant amount of variance in unmet need and treatment experiences over and above other predictors for autistic youth, indicating incremental validity. Parents of autistic children reported significantly more barriers to care across all subscales of the BCQ than parents of non-autistic children, and the highest average item score was on the “skills” subscale, which measures difficulties with navigating the healthcare system. Results support that the BCQ can be used among autistic youth, and suggest the critical need for family-centered supports and provider education in order to ameliorate barriers to healthcare for autistic children. / M.S. / Autism spectrum disorder (ASD) is related to many physical, mental, and behavioral healthcare needs. However, parents of autistic children state that it is often hard to receive healthcare when their child needs it. No questionnaire exists to measure barriers that make getting healthcare harder for autistic children. Our study adapted the Barriers to Care Questionnaire (BCQ) for families of autistic children. The BCQ and related questionnaires were filled out by 242 parents (117 parents of autistic children, 125 parents of non-autistic children). The BCQ reliably and consistently measured barriers to care in these groups. The BCQ subscales were associated with unmet treatment need, treatment experiences, and other related variables at the child, parent, and family level. The questionnaire was less strongly related to variables that we would not expect to be associated with barriers to care, like personality and social desirability. Also, the BCQ subscales predicted healthcare experiences even when accounting for other factors that might impact access to care. Parents of autistic children reported more barriers to care on all subscales of the BCQ than parents of non-autistic children, and the highest average item score was on the “skills” subscale, which measures difficulties with navigating the healthcare system. Results show that the BCQ can be used among autistic youth, and suggest the need for family-centered supports and provider education in order to improve barriers to healthcare for autistic children.

The relationship between nutrition and HIV is multifactorial. Nutrition counseling provided by a Registered Dietitian (RD) has the potential for improving disease risk outcomes for PLWH. To determine barriers to access nutritional counseling with an RD in PLWH, and evaluate the relationship of this counseling on dietary intake, nutritional status, cardiovascular disease (CVD), and HIV-disease outcomes. This is a cross-sectional study of a consecutive convenience sample of 130 PLWH on stable ART from the MASH cohort. After consenting, participants completed a survey on types and frequency of nutritional services received in the last 12 months, and on barriers to access these services. Participants were assigned to groups according to their responses. Demographics, anthropometries, dietary intake, medical history and laboratory information were obtained. The Alternative Healthy Eating Index (AHEI) scores were calculated after obtaining two 24-hour dietary recalls, and Nutribase and SPSS 20 were used for analyses. Mean age was 47.7 years, 62.0% were male and 77.0% were Black; 48% percent were seeing an RD, with 48.3% of those visiting an RD³4 times within the year. Frequently identified barriers to nutritional services were difficulty in keeping appointments (33.8%) location (24.6%) and lack of referrals (23.8%) by medical personnel. Lack of referral was associated with lower CD4 cell count (r=-0.2, P=0.029). Compared to those who did not visit an RD, participants who did had higher AHEI scores (34.7 vs. 29.2, P < 0.001), lower waist circumference (35.5 vs. 38.5 in., P=0.003), and BMI (26.0 vs. 28.8 kg/m2, P=0.019), with higher proportion of participants within the normal range of BMI (48% vs. 25%, P=0.017). The group consulting an RD had significantly lower risk factors for CVD, with better lipid profiles for all biomarkers, and lower waist circumference (35.5 vs. 38.5 inches, P = 0.003) and systolic blood pressure (114.8 vs. 127.9 mmHg, P < 0.001). Other CVD risk factors such as ART and substance abuse, common in this population, were not significantly different between the groups. Our findings suggest that consulting with an RD is associated with better nutritional status, dietary intake and lower risk factors for CVD.

Master of Public Health - MPH / The number of street children, in the Democratic Republic of Congo (DRC), is estimated at 70,000 and it increases each year. The President's Emergency Plan for AIDS Relief reported a 75.1% of street boys and 81.1% of street girls report multiple sex partners in DRC, thereby increasing their risk for transmission. Access to HIV treatment remains one of the challenges for the street children with HIV/AIDS. A study conducted in Lubumbashi and Kipushi in the Province of Haut Katanga, found that 78.2% of street children have no access to health care The District of Katuba as in other local districts in the province, has seen a growing number of street children in recent years. T

For decades, healthcare access and quality in central and southern Appalachia have trailed the rest of the country. Entrenched poverty and low educational attainment compound healthcare problems. This study examines the healthcare obstacles women encounter in southern and central Appalachia and analyzes how technology use, such as Internet searching and social media affect women’s healthcare decisions. Data were analyzed from four focus groups conducted with women from the region. Results indicate that seeing a physician or not did not influence women’s propensity to search the Internet for health-related information or to seek support through social media sites. Additionally, women reported facing many barriers including trust in local physicians, access, availability, cost, and quality of healthcare. These issues often impede women’s access to preventative care and place burdens on their health and an already strained healthcare system.