In the U.S., the number of persons who cannot afford health care continues to rise. Providing a "safety net" for such persons is becoming increasingly important. Medical professional volunteerism provides access to health care for people who have little or no access to health care otherwise. At a not-for-profit free health clinic in Tampa, Florida, hundreds of physicians have volunteered their time in an attempt to reduce the health care gap in their community. The clinic sees thousands of persons who have very limited options in regards to their health care. This study investigates the reasons physicians volunteer and the barriers physicians face when providing free medical service. Through a survey, shadowing sessions, and focused in-depth videotaped interviews with volunteer physicians concerning the risks, rewards, experiences, and barriers of professional volunteering, a greater understanding of this important topic was obtained. This applied visual anthropological project was developed in collaboration with the free clinic in order to provide a product which would be of use to the organization at the end of the research process. This research led to an enhanced understanding of this population as well as recommendations in volunteer physician recruitment strategies.

Introduction: Family physicians provide access to medical and behavioral healthcare for many underserved populations. Integrating behavioral health clinicians into primary care practices has been proposed as one of the most effective ways to increase access to necessary behavioral health services for many Americans. Integrated behavioral healthcare (IBHC) has begun to be implemented in family medicine practices but there is limited research examining the impact for patients and clinic staff. This study begins to fill this gap in the literature by examining the effects of implementing integrated behavioral healthcare in an urban family medicine clinic in a medically underserved area. Objective: The objective of this study is to describe patients who use IBHC services, examine behavioral health outcomes, and study patient and staff satisfaction with IBHC services. This is done in the context of the Quadruple Aim of Healthcare which purposes to improve population health, provide a better patient experience, create smarter healthcare spending, and improve medical staff work quality of life. Aspects of implementation are addressed as well, namely the appropriateness, acceptability, adoption, feasibility, and penetration of IBHC services. Methods: IBHC services were introduced to an urban family medicine clinic in a medically underserved area with a census of greater than 4,500 patients (56.17% African American, 24.4% White, 1% Asian, 22.9% Latino/a; 33.3 % Children under 18). Using information from medical records, a description and comparison of the general clinic population and those that use IBHC services is provided. Behavioral health outcomes were measured by tracking patient anxiety and depression over time, from initial session through follow-up at least 3 months after their final session for a subset of patients. Patient and clinic staff satisfaction were assessed using qualitative and quantitative methods. Supplemental analysis compare behavioral health outcomes against a previous sample of patients from the same clinic before IBHC services were present. Results: Demographic information is presented and compared to highlight the unique difference between race/ethnicity, age, and gender. This study showed that adult patients experienced a significant reduction over time from initial session to follow-up with regards to anxiety, F(1.77, 130.63) = 65.65, p < .001, and depression, F(1.78, 131.68) = 37.88, p < .001. Patient interviews and surveys were analyzed and found that patients generally reported high satisfaction with IBHC services and found their behavioral health needs where addressed in the way they wanted them to be. Finally, medical staff reported high satisfaction with IBHC services and reported that they had reduced stress, increased comfort in caring for patients with behavioral health needs, and improved work quality of life. Discussion: IBHC services were implemented at a family medicine clinic with a population that is overrepresented by minorities and uninsured patients. This study showed that implementation of IBHC addressed components of the Quadruple Aim of Healthcare, namely improvement of population health, enhanced patient experience, and improvement of clinic staff work life. IBHC services were found by patients and staff to be acceptable, appropriate, and feasible. Further, this study demonstrated the ability of a clinic to adopt IBHC services with sufficient penetration (10.8% of patients received at least brief services) after 2 years. Implications for practice and research and future directions are also discussed.

Health literacy affects caregivers' ability to engage in preventive health care behaviors for themselves and their children. Studies suggest that health literacy among low income families needs improvement, and this possibly contributes to disparities in preventive health care rates. Additionally, parents and caregivers may not be able to provide or seek preventive health care for their children because of lack of knowledge and skills to do so effectively. This study designed and piloted an intervention that delivered to parents of young children, 1) health literacy information in an experiential manner, and 2) practical skills to engage their families in healthy lifestyle choices, with the decisions for healthy lifestyle choices being based on the health knowledge provided in the intervention. Specifically, the intervention focused on diet/nutrition, physical activity, sleep hygiene, parenting skills, and mental wellness. The intervention was successful at improving diet/nutrition knowledge at least one month post-intervention and more immediate changes were found for participants' overall beliefs about diet/nutrition, children's vegetable consumption, and parents' fruits and vegetable consumption. Immediate improvements were also found for factual knowledge about physical activity, sleep, and the relationship between mental health and stress. Additionally, the intervention was successful at improving general knowledge and beliefs about sleep, knowledge about the relationship between sleep and health, and knowledge about common childhood sleep problems at least one month post-intervention. The intervention also reduced participants' bedtime interactions with children that are indicative of sleep problems at least one month post-intervention. Future research should conceptualize the intervention as a multiple health behavior intervention and reflect this in the evaluation.

Made available in DSpace on 2014-06-11T19:30:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-08-10Bitstream added on 2014-06-13T20:20:49Z : No. of bitstreams: 1 moraes_dr_me_bauru.pdf: 1880980 bytes, checksum: affa937103ac1050d5bb99900a872e2c (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A área de saúde pública e privada, segmento de serviços, em 2012 consumiu 8% (oito por cento) do Produto Interno Bruto Brasileiro, apesar desse volume de recursos direcionados para a área da saúde, em comparação com outros países, o investimento deveria receber um aporte adicional de um terço do valor atual. No cenário atual, faltam recursos compatíveis com a necessidade da população (que envelhece), e sobram queixas dos usuários, prinicipalmente pela demora no atendimento e na falta de atenção dos agentes envolvidos. A saúde suplementar (setor privado) que iniciou suas atividades no Brasil na década de 50, atendendo as necessidades dos funcionários de algumas empresas multinacionais que se instalavam no país, atende hoje 46 milhoes de beneficiários. Com menor número de usuários e com mais recursos, o setor privado recebe menos reclamações que o setor público, mas as reclamações existem e em número considerável, pelas mesmas causas do setor público. O modelo SERVQUAL desenvolvida e posteriormente aperfeiçoada por Parassuraman, Zeithaml e Berry (1990), permite a mensuração da qualidade dos serviços prestados. A medição proposta pelos autores começa na expectativa do cliente, antes do consumo, e a sua percepção após a utilização, bem como a visão dos gestores, dos fucionários e ainda o impacto da comunicação midiática ada empresa na expectativa do cliente. O presente trabalho tem como objetivo: avaliar a qualidade hospitalar em dois hospitais de Bauru com a adaptação do model SERVQUAL. A pesquisa foi realizada em dois momentos: no momento da venda do plano, antes do uso (questionário de expectativa) e, no momento do uso (questionário de percepção), comparando sua expectativa (antes do uso) e a percepção (após o uso). Seguindo a metodologia proposta pelos autores, foram... / The public and private health area services segment in 2010 consumed 8% (eight percent) of the Brazilian Gross Domestic Product, despite this volume of resources allocated to the health sector, compared with other countries, the investment should receive an additional one third of the current value. In the current scenario, there is a lack resources compatible with the needs of the population (aging), and abound complaints from users, mainly by delays in care and the lack of attention of the agents involved. The supplimental health (private sector) that began operations in Brazil in the 50s, meeting the needs of employees of some multinational companies settled in the country, today serves 46 million beneficiaries. With fewer users and more resources, the private sector receives fewer complaints than the public sector, but there area complaints and in a considerable amount, for the same reasons the public sector. The SERVQUAL model developed and subsequently refined by Parasuraman, Zeithml and Berry (1190), permits the measurement of service quality. The measure proposed by the authors starts on customer expectation, before consumption, and their perception after use, as well as the vision of managers, employees and even the impact of media communication company in customer expectation. The present sudy aims: to assess hospital quality in two hospitals in Bauru with the adaptation of SERVQUAL model. The research was conducted in two stages: at the time of the plan sale, before use (expectation questionnaire), and at the time of use (perception questionnaire), comparing their expectation (before use) and perception (after use). Following the methodoloy the methodology proposed by the authours, gaps were identified in questions and dimensions of quality. In summary, the adaptation of the model SERVQUAL questionnaires... (Complete abstract click electronic access below)

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Studies have shown that many low-income and disadvantaged Americans have a poor diet quality, which increases obesity and chronic disease risk. According to the Massachusetts Department of Public Health, education and income levels of Springfield residents are well below state averages, and racial diversity in Springfield has increased significantly over the past few decades. Springfield’s demographics increase the risk of health disparities in the community, and higher rates of diabetes, heart disease, and obesity are seen in Springfield. To promote healthy eating behaviors among Springfield residents, Mason Square Health Task Force (MSHTF), a Live Well Springfield (LWS) partner, created a 6-session nutrition curriculum, entitled The MENU Program. The goal was to increase overall health awareness and healthy eating behaviors among residents in communities that are being targeted by the LWS initiative. Topics of the The MENU Program included MyPlate guidelines and label reading, budget shopping and cooking, healthy restaurant choices, diet and chronic disease, and food justice. The objective of this study was to evaluate The MENU Program to assess its strengths, weaknesses, and effectiveness using both quantitative and qualitative data from surveys, process evaluation, and facilitator observations. There were two phases of this study: Phase 1 was the evaluation of the pilot program delivered to a group of senior women recruited through the Dunbar YMCA; Phase 2 evaluated the second offering of the curriculum to Mason Square residents enrolled in the Task Force Fit Challenge. All participants responded positively to The MENU Program sessions and positive changes were seen in knowledge, attitudes, and behaviors after both Phases. Participant-perceived useful material included handouts, group discussions, and hands-on activities. Observational data supports the usefulness of group discussion over lecture-based teaching methods. This study supports the use of The MENU Program as an effective community education program for Springfield, MA. It has the potential to positively influence residents’ diet quality and nutrition-related behaviors through improved nutrition knowledge and attitudes.

Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2019 / The challenges faced by members of underserved communities in South Africa have frequently been reported in literature. To ameliorate these challenges, different interventions have been introduced both locally and internationally to improve the wellbeing of the members of these communities. One such intervention is the introduction of information and communication technology ICT as a means to close the digital divide and meeting the socio-economic needs of the community. Youth living in these communities are expected to derive more benefit from ICT interventions as they have been reported to be more technology savvy and dependent on technology than the older adults are. However, the failures of ICT interventions deployed by donors have also been reported in literature. Authors have identified several reasons for the failure of ICT interventions, but a lack of consultation with the beneficiaries of this type of intervention is common to many findings. The exclusion of the youth as major beneficiaries of ICT interventions causes a lack of alignment between the interventions deployed for their use and the actual wellbeing needs of the youth in underserved communities. The failure of ICT interventions increases the digital divide and frustrates the good intentions of local and national government as well as international donors to improve the wellbeing of the youth in underserved communities. By using the concept of wellbeing, the study aimed to explore how youth wellbeing indicators can be used to facilitate effective ICT interventions for youth empowerment and development in underserved communities in South Africa. Furthermore, the study aimed todesign an ICT-based artefact to prioritise youth wellbeing indicators in underserved communities in South Africa. The study was implemented through a qualitative research method using a service design strategy that allowed for a participatory research approach and co-design instrument for data collection from the youth living in Grabouw anunderserved community in the Western Cape Province of South Africa. Data was collected from 40 youth aged between 15 and 30 at two workshops. Content analysis technique was used to analyse data. Findings from the research show that given the opportunity, the youth are able to determine their social-economic needs. A comprehensive set of wellbeing indicators was developed. Thirteen wellbeing indicators symbolising the issues in the community were prioritised, which are:unemployment, self-image, reaching full potential, family support,access to water, sanitation and electricity,meaning and purpose of life,being healthy,religious practice,educational level,future expectations,freedom of expression,skills to get a job, and access to skills and training. Overall, nine categories of wellbeing indicators were identified; of these, seven are similar to theGlobal Youth Wellbeing Index(GYWI) categories. Three new categories – aspiration, social support, and infrastructure and services – were realised. The three factors are an indication that the Grabouw youth may have special needs different from the global perspective as specified by the GYWI categories. Moreover, the priorities of the wellbeing indicators when compared to the GYWI rating for South Africa differ significantly, which may indicate that the needs of the youth living in underserved communities may vary largelyfrom other youth in the country. Furthermore, an artefact that can be used to prioritise wellbeing indicators was designed. It is important for stakeholders of ICT interventions to embrace participation of the beneficiaries as a means of aligning interventions to their needs. These stakeholders need to seek ways of developing artefacts that address the needs, not limited to health, so that the youth can take advantage of technology to improve their wellbeing on a continuous basis.

Abstract: Social Determinants of Health in Belize Free Clinic Introduction: To determine the most appropriate ways to serve patients in rural Belize through medical mission work, it is important to assess social determinants of health (SDOH). It has long been agreed that a variety of factors affect health, including environment, community and social context, access to healthcare, stress, income, mental health, education, and transportation. Many people in Roaring Creek, Belize, a village with a population of approximately 2,000, use Body and Soul Ministries, a nonprofit that invites medical teams from all over to deliver medical care, as their primary source of healthcare. During one of these trips, a medical team from East Tennessee State University (ETSU) provided medical care and employed the TeamCare survey, already used in several clinics in east Tennessee to assess the SDOH needs of the patient population in Roaring Creek. The purpose of this study was to use a survey that assesses several SDOH to determine better ways to address health needs in the community of Roaring Creek as well as connect patients with resources to meet those needs. Methods: A team of ETSU medical students, a resident, and five physicians served in a free clinic in Roaring Creek, Belize in October 2017. The team saw approximately 500 patients. Some patients were randomly selected to take the TeamCare survey to assess for six SDOH, including literacy, financial needs, drug use, abuse, transportation, and mental health. Based on the results of the survey, patients were connected with their local community health worker to assist in locating resources for patients. Using SPSS, results from the survey were arranged for frequencies and measures of central tendency. Results: Overall, a total of 106 patients responded to the TeamCare survey. Based on the survey results, 83.2% of patients responded “yes” to at least one question regarding needs related to SDOH. In fact, 7.9% of patients answered “yes” to five questions. Of note, 53.5% of patients responded positively for financial need, 46.5% positive for mental health needs, 37.6% positive for environmental alcohol or drug abuse, and 32.7% positive for transportation needs. More women stated positively for physical or verbal abuse compared to men (-1.48, p=0.001). Discussion and Conclusion: Roaring Creek, Belize is a rural community that illustrates how SDOH can impact health outcomes. There has been a recent effort for clinicians to address SDOH, especially in rural areas, but perhaps not enough globally. One way this can be done is by surveying for SDOH at clinic visits and then linking patients with relevant community resources. However, resources are not always readily available in Roaring Creek, Belize. Many patients are positive for SDOH, but with an overall lack of resources, it is important to do more research to determine how global health efforts can best serve these populations. Perhaps the best way for SDOH needs to be addressed is for Body and Soul to collaborate with community health workers and mission teams to establish ongoing programs and longstanding resources for the community.

BACKGROUND AND SIGNIFICANCE. Various studies have identified physical risk factors for musculoskeletal disorders (MSDs) associated with hand harvesting of crops, due to repetitive motions, lifting or carrying of heavy loads, and working in flexed trunk postures. A paucity of research exists on ergonomic risks to tomato farmworkers. The available studies have estimated risk based on self-reports of injury and semi-quantitative measures. METHODS. A partnership between East Tennessee State University (ETSU) and a migrant health center (Rural Medical Services) has identified some of the occupational health needs of this population. With the aid of surface electromyography (sEMG), an objective-quantitative tool, a more refined understanding of ergonomic health risks for this population will be developed. The purpose of this study is to evaluate the muscle load and fatigue induced on the anterior deltoid and upper trapezius muscles during three tasks: driving stakes into the ground, tying of tomatoes to stakes, and hoisting of a 35-pound bucket full of tomatoes. Space for a mock test plot, where the study will be conducted, is available at the ETSU’s Valleybrook facility. Muscle activity recordings will be obtained from 15 tomato farmworkers. Spectral analysis and the amplitude probability distribution function (APDF) will be used to assess fatigue and muscle load respectively. A repeated measures ANOVA will be employed in the study. ANTICIPATED RESULTS. Findings of this study should show that localized muscle loading increases muscle fatigue. Neuromuscular demand should vary, depending on the type of task performed. Stake pounding may show a higher neuromuscular demand than the other tasks. AIM 1. Evaluate the magnitude of muscle activity during three simulated tomato-field tasks and measure the intensity of movement during the stake pounding task. AIM 2. Compare estimates of muscle fatigue and muscle load induced on the anterior deltoid and upper trapezius muscles during three simulated tomato-field tasks.