This qualitative study focused on the dental disparities in Blount County, TN and sought to determine if there are enough dental clinics within the dental safety net. Interviews were conducted with 18 individuals who were either service providers or clients of organizations such as the Salvation Army, Alcoa Good Samaritan Clinic, the local health department, Trinity Dental Clinic, Volunteer Ministry Center, Remote Area Medical, and Blount Memorial Hospital. Inclusion criteria for clients included: homeless or living below the poverty level, uninsured, 18 to 65 years of age, has not seen a dentist in the past year and currently suffering a dental problem. The most obvious common theme among the 11 clients interviewed was that they struggle with getting dental care. Patients were asked when the last time they had seen a dentist and they answered years ago, most over ten years ago. Eight of the eleven clients did not know of any facilities they could go to. Cost was the main reason for these clients not seeking dental care. Two dentists were asked about the reasons for disparities in dental care. The major common themes between the dentists were cost, access to care, and education. All five case managers said that they had clients experiencing dental needs ranging from a simple cleaning to an abscess. Currently in Blount County only one dental clinic serves over 17,000 residents who live in poverty.

Organizations that deliver programs to promote the entry of students from marginalized populations into the U.S. health workforce often struggle to demonstrate the effective achievement of outcomes, and face diminishing fiscal resources. This study was an empirical examination of the extent and manner that a statewide, precollege, health careers exploration program fostered the matriculation of underrepresented minority students into health degree education programs. Schneider and Stevenson's aligned ambitions framework provided the theoretical foundation. The research questions for this study examined the relationship between program participation and the successful health degree matriculation of racial minority students based on the extent of participation, the type of participation, and the extent and type of participation controlling for gender, profession, and region using a quantitative trend analysis of archived program data and longitudinal, preexisting matriculation data. Completion of the analysis used sequential logistic regression. The selection criteria for study included high school students who participated in the program between 2006 to 2010 and who subsequently enrolled in college (N = 246). No statistically significant relationships between program participation and matriculation into health care education programs were found resulting in the recommendation to reassess and revise data collection and analysis processes for future official program evaluation. The resulting white paper recommends that Area Health Education Consortium (AHEC) career exploration program designers create continuous and effective review and evaluation processes to ultimately enable the positive social impact of a more representative number of students from marginalized populations into the U.S. health workforce.

Poor oral care is detrimental to the overall health of the population. In the United States, oral health diseases affect millions of individuals, especially children and adolescents. Guided by the health belief model, the purpose of this study was to identify parents' perceived barriers to oral health care access among their 5- to 10-year-old children. A phenomenological approach was used to gather data and thematically analyze interview data from 20 parents who were recruited from a health center in the northeastern United States. All participants had at least one child between 5-10 years old and all identified as under-served. Data were coded and analyzed for emerging themes, with the assistance of Nvivo software. The findings demonstrated that lack of time, the location of dental facilities, and the lack of sensitivity of dental providers were issues for parents in managing their children's oral health. This study might be beneficial in eliciting positive social change at the individual and organizational levels by illuminating the constraints faced by the underserved population in Massachusetts.

Submitted by Letícia Nunes (leticiafcnunes@gmail.com) on 2015-06-11T16:44:52Z No. of bitstreams: 1 Dissertação - Leticia Nunes - Practice Location of Physicians.pdf: 569206 bytes, checksum: bde07c17bc4ab59a76a947e9fa27f35e (MD5) / Approved for entry into archive by BRUNA BARROS (bruna.barros@fgv.br) on 2015-06-18T13:46:34Z (GMT) No. of bitstreams: 1 Dissertação - Leticia Nunes - Practice Location of Physicians.pdf: 569206 bytes, checksum: bde07c17bc4ab59a76a947e9fa27f35e (MD5) / Approved for entry into archive by Marcia Bacha (marcia.bacha@fgv.br) on 2015-06-29T12:13:05Z (GMT) No. of bitstreams: 1 Dissertação - Leticia Nunes - Practice Location of Physicians.pdf: 569206 bytes, checksum: bde07c17bc4ab59a76a947e9fa27f35e (MD5) / Made available in DSpace on 2015-06-29T12:13:22Z (GMT). No. of bitstreams: 1 Dissertação - Leticia Nunes - Practice Location of Physicians.pdf: 569206 bytes, checksum: bde07c17bc4ab59a76a947e9fa27f35e (MD5) Previous issue date: 2015-04-07 / Economists and policymakers have long been concerned with increasing the supply of health professionals in rural and remote areas. This work seeks to understand which factors influence physicians’ choice of practice location right after completing residency. Differently from previous papers, we analyse the Brazilian missalocation and assess the particularities of developing countries. We use a discrete choice model approach with a multinomial logit specification. Two rich databases are employed containing the location and wage of formally employed physicians as well as details from their post-graduation. Our main findings are that amenities matter, physicians have a strong tendency to remain in the region they completed residency and salaries are significant in the choice of urban, but not rural, communities. We conjecture this is due to attachments built during training and infrastructure concerns.

Background: Social media (Facebook, WhatsApp, Instagram, Twitter) as communication channels have great potential to deliver Human papillomavirus self‐test (HPVST) intervention to medically underserved women (MUW) such as women of low income. However, little is known about MUW’s willingness to participate in HPVST intervention delivered through social media. We evaluated factors that contribute to MUW’s intention to participate in the social media‐related intervention for HPVST. Methods: A 21‐item survey was administered among women receiving food from a local food pantry in a U.S. southern state. Independent variables were social media usage facilitators (including confidentiality, social support, cost, and convenience), and barriers (including misinformation, time‐consuming, inefficient, and privacy concerns). Dependent variables included the likelihood of participating in social‐driven intervention for HPVST. Both variables were measured on a 5‐point scale. We used multinomial logistic regression to analyze the data. Results: A total of 254 women (mean age 48.9 ± 10.7 years) comprising Whites (40%), Hispanics (29%), Blacks (27%), and Other (4%) participated in the study. We found that over 44% of the women were overdue for their pap smears for the past three years, 12% had never had a pap smear, and 34% were not sure if they had had a pap smear. Over 82% reported frequent social media (e.g., Facebook) usage, and 52% reported willingness to participate in social media‐driven intervention for HPVST. Women who reported that social media provide privacy (Adjusted Odds Ratio (AOR) = 6.23, 95% CI: 3.56, 10.92), provide social support (AOR = 7.18, 95% CI: 4.03, 12.80), are less costly (AOR = 6.71, 95% CI: 3.80, 11.85), and are convenient (AOR = 6.17, 95% CI: 3.49, 10.92) had significantly increased odds of participating in social media intervention for HPVST. Conclusions: The findings underscore that the majority of the MUW are overdue for cervical cancer screening, regularly use social media, and are willing to participate in social media‐driven intervention. Social media could be used to promote HPV self‐testing among MUW.

Objective: This dissertation analyzed one state's physician assistant (PA) workforce focusing on recruitment and retention. The goal was to identify factors associated with Indiana PAs working in medically underserved, rural, and primary-care medicine. The study evaluated characteristics of PAs who chose initially to work in rural versus urban areas and who have continued to do so. From the literature and as a result of study outcomes, a framework was developed, upon which recommendations were made for effective methods of increasing and retaining the number of PAs in primary care within rural areas. Subjects: Data were obtained from applications for PA licensure submitted to the Indiana Professional Licensing Agency between the years 2000 and 2010. Additionally, PAs working in Indiana who graduated during this period were surveyed. Methods: Descriptive statistics quantitatively defined the Indiana PA workforce. Survey questions to this population focused on provider upbringing, education, and specialization interest, as well as recruitment and retention to rural, primary-care, or underserved areas. Chi Square tests and logistic regression were used, where appropriate, to examine the influence of independent variables on the choice of practicing in rural, primary-care, and medically underserved areas. Based on these responses, recommendations were developed for strategies to increase the supply of physician assistants in rural areas. Findings: Among applicants for PA licensure in Indiana from 2000 to 2010, there were more females (70%) than males (30%), and the median age of applicants was 35 years. Respondent PAs predominantly worked in counties that were designated by the United States Department of Agriculture as metropolitan (91.3%) and largely in areas designated as Code 1 according to Rural-Urban Continuum Codes, the highest level of urbanicity. Additionally, more PAs worked in a specialty area (79%) than in primary care (21%). Chi Square analyses revealed significant relationships (p < .05) between primary care and gender; educated outside of Indiana and working in an underserved area; and being born in a rural area and choosing to practice in a rural area. Binary logistic regression identified that female gender was predictive of the decision to practice in primary care, and birth in a rural area was predictive of current rural practice. In reflecting upon their first employment following training, 70 percent of respondents believed that the job offer was neither directly nor indirectly a result of having completed a clinical rotation at that particular site, or having worked with a particular preceptor, during their experiential training. A relationship was found between the respondents' initial job location being urban and living in a metro location at the time of high school graduation. Finally, educational debt influenced males' initial practice location and specialty but did not similarly affect choice of practice among females. Conclusions: There were several important characteristics of recently licensed PAs in Indiana that were identified in this study. Educational institutions, policymakers, and communities may increase recruitment and retention of PAs to rural and primary-care practice by actively identifying PAs who possess selected characteristics for the area of interest and providing incentives to reduce educational debt.

Home visits are a required training component of many Family Medicine residency programs in the United States. However, they are becoming less popular due to such factors as increasing resident responsibilities, decreasing reimbursement, and a decline in resident intention to incorporate home visits into future practice. This study’s aims are: (1) to evaluate the current practices of one Family Medicine residency training program’s time and resource expenditure to conduct home visits, and (2) to evaluate resident and faculty experiences of home visits. Residents and faculty in a Family Medicine training program were provided with a 12- question survey immediately after completing a home visit. A total of 19 surveys from residents and faculty were collected and analyzed. Average reported time spent per home visit was 90 minutes (range = 50-180 minutes), and the home visit teams included an average of 4 members (range = 2-6 members). The providers felt that they knew their patients and the patients’ circumstances better after the home visit with a score of 4.1 (on a 1-5 scale with 5 being a positively framed statement). Resident opinions were neutral (average score 3.1 on a 1-5 scale) regarding whether they found home visits to be educational to their residency training in Family Medicine. Residents also had mixed feelings (average score 2.9) regarding whether they would perform more home visits during their residency training if given the opportunity. Most faculty members (5/7) indicated they had done home visits during their residency training and all faculty (7/7) felt that home visits added value to their training in Family Medicine. Finally, qualitative recommendations were collected from respondents which may allow this training program to improve home visits in the future. Overall, significant time is currently being spent conducting home visits, with a difference in perceived efficacy between residents and faculty. Future research may include a cost analysis to quantify financial value, as well as expanding data collection to other Family Medicine residency training programs to improve generalizability.

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As medical students undergo their clinical years, they exhibit a well-documented loss of idealism, increasingly negative attitudes towards poor and underserved patients, and less interest in working with these patients. Here we describe the pilot year of a longitudinal service-learning requirement implemented as a part of the medical student pre-clinical curriculum. We hypothesized that increased non-clinical contact would decrease the formation of negative attitudes towards underserved patients. Students completed service hours at assigned community sites each semester along with written reflections. Surveys were administered to track attitudes towards the underserved. Written reflections were analyzed qualitatively for thematic content as well as feedback on the experience. The requirement was largely acceptable to medical students, and many found value and enjoyment in the experience. The most common critique was that the required hours were insufficient to develop continuity, and that students desired more thorough briefing beforehand to increase their effectiveness. Students reported practicing clinical skills and communication skills. They identified social determinants of health and learned about their patients. They reflected on their professional identity, motivations for entering medicine, and specialty choices. Students experienced moments of connection and belonging, as well as feelings of guilt, otherness, and awareness of privilege. We continue to explore how working collaboratively and learning reciprocally with community members outside of the hospital and clinic may teach students cultural humility and help insulate students from cynicism and negative views of poor and medically underserved patients. / Urban Bioethics