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- Creators: School of International Letters and Cultures
- Creators: Thrall, Charlotte
Description
We examined the relations between maternal depression, discipline practices, and toddler mental health outcomes, specifically competence and total problem behavior. Ethnicity was considered as a moderator in all analyses. For the first time, ethnicity was considered as a moderator of the heritability of toddler competence and total problem behavior. The data came from the Arizona Twin Project. A subsample containing only Caucasian (66%) and Hispanic (34%; 87% of Mexican descent) participants was used. Primary caregivers (>95% mothers) reported on levels of maternal depression, discipline practices, and their twins' competency and problem behaviors. It was hypothesized that maternal depression would be associated with less competency and more problem behaviors in toddlers; inductive discipline practices would be associated with higher competency and fewer problem behaviors; and punitive discipline practices would be associated with lower competency and more problem behaviors. Ethnicity was predicted to moderate only the relation between discipline practices and toddler mental health. Consistent with predictions, maternal depression predicted less competency and more problem behaviors, and inductive discipline predicted higher competency and fewer problem behaviors, while punitive discipline predicted lower competency and more problem behaviors. Ethnicity moderated the relation between maternal depression at 12 months and total problem behaviors. The heritability of competence and total problem behavior varied across the Caucasian and Hispanic samples.
ContributorsChon, Sarah Maria (Author) / Lemery-Chalfant, Kathryn (Thesis director) / Knight, George (Committee member) / Bradley, Robert (Committee member) / Barrett, The Honors College (Contributor) / Department of Psychology (Contributor) / School of International Letters and Cultures (Contributor)
Created2015-05
Description
Hispanic neighborhoods, referred to as barrios, reveal several key characteristics unique to their ethnic neighborhood identity. The housescapes in the neighborhoods exhibit three characteristics which distinguish them as Latino housescapes: bright color exteriors, fences around the property and a display of religious iconography. In a spatial and landscape analysis of two key barrios in Arizona: Barrio Anita in Tucson and El Campito in Nuestro Barrio in Phoenix, research reveals the prevalence of the three housescape characteristics. The multiple case study explores the extent to which Hispanic housescapes exhibit bright house color exteriors, fences and religious iconography. The least prevalent of these characteristics is the display of religious symbols which indicates a growing change in the way Hispanic ethnicity is displayed in neighborhoods.
ContributorsStockham, Sarah Theresa (Author) / Pijawka, David (Thesis director) / Foster, David (Committee member) / Barrett, The Honors College (Contributor) / School of Geographical Sciences and Urban Planning (Contributor) / School of International Letters and Cultures (Contributor)
Created2014-05
DescriptionThis project largely focuses on the Latino population and how Hispanic parents should become more involved with their student's education in order to have them prosper in today's society.
ContributorsSanchez Ruiz, Dorian Nazaret (Author) / Walters, Molina (Thesis director) / Oliver, Jill (Committee member) / Barrett, The Honors College (Contributor) / School of Politics and Global Studies (Contributor) / School of International Letters and Cultures (Contributor)
Created2014-05
Description
The purpose of this study is to investigate the role of health misinformation and the lack of credible health information as determinants of health disparities affecting the Hispanic population in the United States during public health emergencies. Using the COVID-19 pandemic as a quintessential and relevant exhibit of a public health emergency, a review of literature was conducted to identify the interactions between the accessibility of health misinformation and credible health information in exacerbating pre-existing socio-economic barriers that affect the Hispanic population. The findings of this study were then analyzed to develop solutions for future public health emergencies to ensure that vulnerable communities are provided equally accurate and accessible health information as non-vulnerable communities in order to promote a more effective nationwide public health response. These solutions include providing more educational resources to help vulnerable communities find accurate information online and increasing surveillance of misinformation sources online, especially in the Spanish language.
ContributorsRahman, Amir (Author) / Estevez, Dulce (Thesis director) / Hartwell, Leland (Committee member) / Barrett, The Honors College (Contributor) / School of International Letters and Cultures (Contributor) / School of Life Sciences (Contributor)
Created2023-05
Description
Declaration of Conflicts: This project has no conflicts of interest to declare.
Context: This project was completed at a federally qualified primary healthcare clinic in Phoenix, Arizona that served patients of all age groups, but primarily cared for the Hispanic population providing primary care, preventative services, family planning, two lab technicians, one promoter, two medical assistant supervisors, five front desk staff, one chief administrative officer, one chief financial officer, two medical directoers who were also providers at the clinic.
Problem and Analysis Assessment: During my clinical rotations, I saw the burden a missed patient appointment had not only on the patients themselves, but also on the clinic, providers, and the staff. It caused delay in treatment for patients, and it did not allow other patients that wanted to be seen to be seen. It also increased unnecessary costs and wasted provider time. Thereafter, I met with some of the leadership team and one of the medical directors to determine a solution to reduce the number of missed appointments that were occurring. An educational session was kept to discuss the findings of this problem to the providers and the staff and when surveys were handed out to the patients, providers, and staff to assess their satisfaction with the old scheduling system versus the new scheduling system, they were also provided with a cover letter discussing the project.
Intervention: In order for improvements in care to occur, a system process change including the way patients are scheduled must occur. In this case, an open-access scheduling system (OAS) was implemented. OAS allows a patient to schedule an appointment on the 'same-day' or the 'next-day' to be seen. One provider at each of the clinics, each day of the week was available for 'same-day' appointments from 1300-1600. The providers were still available for scheduled appointments using the previous scheduling method. Walk-ins were still accepted, and were scheduled based on patient provider preference; however, if an appointment was not available for their preferred provider, they were typically seen with the provider that was the 'same-day' provider for that day.
Strategy for change: Since patients were only allowed to schedule appointments one month in advance, only one month was needed to implement this process change. A recommendation for the future would be to clearly identify the patient encounter type, and label it as a same-day appointment, as this would be helpful when gathering and extracting data for this type of patient group specifically.
Measurement of Improvement: Over a three-month period, a data collection plan was used to determine the number of Mas over a three-month period before and after implementation of this change. Satisfaction scores were measured using likert scales for patients, provider, and staff, and a dichotomous scale was used to determine the likelihood of emergency room or urgent care use. A comparison was done to measure revenue during the same time frame. During the three months, a clinically significant decrease in MAs was seen (<0.52%), with an increase in revenue by 41%. Additionally, a statistically significant increase in patient, provider and staff satisfaction was also noted when compared to the old scheduling system, as >68% of all patients, providers and staff reported feeling either very satisfied or extremely satisfied with the new scheduling system. Additionally, patients also reported that they were less likely to visit an emergency room(88%) or urgent care (90%) since they were able to be seen the same-day or the next-day by a provider.
Effects of changes: An incidental finding occurred during this study - where 877 more patients were seen in the three months during the implementation of this project, compared to the three months prior; which likely resulted in a 41% increase in revenue. Additionally this project, allowed patients that wanted to be seen on the same day, to be seen, and it decreased unnecessary costs associated with emergency room or urgent care visits. Some of the limitations involved included the current political environment, appointment slots that were previously 15 minutes in length (in 2016), increased to 20 minutes in length (in 2017), a language barrier was noted for the patient surveys since English was not the first language for many of the patients who completed the survey (although documents were translated), and the surveys used were not reliable instrument given that a reliable instrument in previous studies could not be found.
Lessons learnt: In order to have accuracy of the survey results, it is best for the author of the study to hand out and provide scripture for the survey so that complete data is received from the surveyors.
Messages for others: Begin by making a small process change where only one provider allows for the open-access scheduling so that the entire office is not affected by it, and if results begin to look promising then it can be expanded. Additionally, correct labeling of patients as 'same-day' is also important so that additional data can be gathered when needed regarding the 'same-day' patients.
Patient/Family/Guardian Involvement: Patients who benefited from the new scheduling system (open-access scheduling) were asked to fill out a survey that asked them to disclose some demographic data and asked them to determine their satisfaction with the new vs old scheduling system and their likelihood of visiting an emergency room or urgent care.
Ethics Approval: Arizona State University Institutional Review Board (IRB) Received: September 2017
Context: This project was completed at a federally qualified primary healthcare clinic in Phoenix, Arizona that served patients of all age groups, but primarily cared for the Hispanic population providing primary care, preventative services, family planning, two lab technicians, one promoter, two medical assistant supervisors, five front desk staff, one chief administrative officer, one chief financial officer, two medical directoers who were also providers at the clinic.
Problem and Analysis Assessment: During my clinical rotations, I saw the burden a missed patient appointment had not only on the patients themselves, but also on the clinic, providers, and the staff. It caused delay in treatment for patients, and it did not allow other patients that wanted to be seen to be seen. It also increased unnecessary costs and wasted provider time. Thereafter, I met with some of the leadership team and one of the medical directors to determine a solution to reduce the number of missed appointments that were occurring. An educational session was kept to discuss the findings of this problem to the providers and the staff and when surveys were handed out to the patients, providers, and staff to assess their satisfaction with the old scheduling system versus the new scheduling system, they were also provided with a cover letter discussing the project.
Intervention: In order for improvements in care to occur, a system process change including the way patients are scheduled must occur. In this case, an open-access scheduling system (OAS) was implemented. OAS allows a patient to schedule an appointment on the 'same-day' or the 'next-day' to be seen. One provider at each of the clinics, each day of the week was available for 'same-day' appointments from 1300-1600. The providers were still available for scheduled appointments using the previous scheduling method. Walk-ins were still accepted, and were scheduled based on patient provider preference; however, if an appointment was not available for their preferred provider, they were typically seen with the provider that was the 'same-day' provider for that day.
Strategy for change: Since patients were only allowed to schedule appointments one month in advance, only one month was needed to implement this process change. A recommendation for the future would be to clearly identify the patient encounter type, and label it as a same-day appointment, as this would be helpful when gathering and extracting data for this type of patient group specifically.
Measurement of Improvement: Over a three-month period, a data collection plan was used to determine the number of Mas over a three-month period before and after implementation of this change. Satisfaction scores were measured using likert scales for patients, provider, and staff, and a dichotomous scale was used to determine the likelihood of emergency room or urgent care use. A comparison was done to measure revenue during the same time frame. During the three months, a clinically significant decrease in MAs was seen (<0.52%), with an increase in revenue by 41%. Additionally, a statistically significant increase in patient, provider and staff satisfaction was also noted when compared to the old scheduling system, as >68% of all patients, providers and staff reported feeling either very satisfied or extremely satisfied with the new scheduling system. Additionally, patients also reported that they were less likely to visit an emergency room(88%) or urgent care (90%) since they were able to be seen the same-day or the next-day by a provider.
Effects of changes: An incidental finding occurred during this study - where 877 more patients were seen in the three months during the implementation of this project, compared to the three months prior; which likely resulted in a 41% increase in revenue. Additionally this project, allowed patients that wanted to be seen on the same day, to be seen, and it decreased unnecessary costs associated with emergency room or urgent care visits. Some of the limitations involved included the current political environment, appointment slots that were previously 15 minutes in length (in 2016), increased to 20 minutes in length (in 2017), a language barrier was noted for the patient surveys since English was not the first language for many of the patients who completed the survey (although documents were translated), and the surveys used were not reliable instrument given that a reliable instrument in previous studies could not be found.
Lessons learnt: In order to have accuracy of the survey results, it is best for the author of the study to hand out and provide scripture for the survey so that complete data is received from the surveyors.
Messages for others: Begin by making a small process change where only one provider allows for the open-access scheduling so that the entire office is not affected by it, and if results begin to look promising then it can be expanded. Additionally, correct labeling of patients as 'same-day' is also important so that additional data can be gathered when needed regarding the 'same-day' patients.
Patient/Family/Guardian Involvement: Patients who benefited from the new scheduling system (open-access scheduling) were asked to fill out a survey that asked them to disclose some demographic data and asked them to determine their satisfaction with the new vs old scheduling system and their likelihood of visiting an emergency room or urgent care.
Ethics Approval: Arizona State University Institutional Review Board (IRB) Received: September 2017
ContributorsPatel, Dimple (Author) / Thrall, Charlotte (Thesis advisor) / Glover, Johannah-Uriri (Thesis advisor)
Created2018-05-02
Description
Primary health care clinics are essential first defenders determined to confront the upsurge in health-related leading causes of death in the United States. Unfortunately, the underserved or uninsured community continues to struggle to access these vital health care services. Consequently, this vulnerable population seeks venues such as community services events to obtain these unmet primary care services. Community services events effectively disseminate health-related material and provide access to vital medical services. Currently, community services strive to bridge the gap between underserved individuals and primary care clinics by providing participants referrals for low-fee or free clinics to establish ongoing care. A lack of data exists on whether these events sufficiently impact the participants to motivate them to follow-up with a health care clinic. A critical appraisal of evidence showed that follow-up adherence rates are remarkably improved by directly referring participants to a primary clinic during a community services event. This paper explores the effect on health outcomes and health disparities when establishing connections between community services participants and ongoing healthcare services.
ContributorsNavarrete, Elizabeth (Author) / Thrall, Charlotte (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-22
Description
This study identifies and examines healthcare barriers experienced by the Hispanic1 population in Phoenix, Arizona. A cross-sectional survey was used to explore these barriers for 123 members of the community, and the findings reveal that the main impediments to healthcare faced by the Hispanic population are structured by their language, immigration status, education level, and access to health insurance. The results of the survey were then analyzed to explore possible mechanisms of the origin or intensification of the barriers, as well as potential solutions such as educating future providers to be culturally competent, usage of integrated medical settings, and the advertisement and extension of Promotoras to the community.
ContributorsMusch, Cristina Lizbeth (Author) / Rosales, Jesus (Thesis director) / Estevez, Dulce (Committee member) / Sanford School of Social and Family Dynamics (Contributor) / School of International Letters and Cultures (Contributor) / School of Molecular Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
Description
Homeless individuals encounter barriers such as lack of health insurance, increased cost of care and unavailability of resources. They have increased risk of comorbid physical disease and poor mental health. Depression is a prevalent mental health disorder in the US linked to increased risk of mortality. Literature suggests depression screening can identify high-risk individuals with using the patient health questionnaire (PHQ-9).
The objective of this project is to determine if screening identifies depression in the homeless and how it impacts healthcare access. Setting is a local organization in Phoenix offering shelter to homeless individuals. An evidence-based project was implemented over two months in 2019 using convenience sampling. Intervention included depression screening using the PHQ-9, referring to primary care and tracking appointment times. IRB approval obtained from Arizona State University, privacy discussed, and consent obtained prior to data collection. Participants were assigned a random number to protect privacy.
A chart audit tool was used to obtain sociodemographics and insurance status. Descriptive statistics used and analyzed using Intellectus. Sample size was (n = 18), age (M = 35) most were White-non-Hispanic, 44% had a high school diploma and 78% were insured. Mean score was 7.72, three were previously diagnosed and not referred. Three were referred with a turnaround appointment time of one, two and seven days respectively. No significant correlation found between age and depression severity. A significant correlation found between previous diagnosis and depression severity. Attention to PHQ-9 varied among providers and not always addressed. Future projects should focus on improving collaboration between this facility and providers, increasing screening and ensuring adequate follow up and treatment.
ContributorsParamo, Cinthia Arredondo (Author) / Thrall, Charlotte (Thesis advisor)
Created2020-05-04
Description
The United States healthcare system plays a very important role in everyone’s lives. Americans rely on the system for their overall health and well-being. It is imperative that all Americans have equal access to and quality of healthcare services and healthcare should not differentiate between minorities and nonminorities. The Hispanic population does not have or receive equitable healthcare in comparison to their nonHispanic white counterparts. Due to extreme gaps in quality of and access to care, Hispanics are at risk to endure worse health outcomes. This review dives into defining the necessary definitions of healthcare and racial disparities, looks at what causes these disparities and gaps in care, what outcomes are more prevalent in the Hispanic American population because of the inequities, what solutions are already in place to combat these issues and finally, what solutions need to be implemented at the administration level of healthcare organizations to better treat the Hispanic population in the ways in which they deserve.
ContributorsFaltz, Jaclyn (Author) / Don, Rachael (Thesis director) / Reddy, Swapna (Committee member) / Barrett, The Honors College (Contributor) / Dean, W.P. Carey School of Business (Contributor) / School of International Letters and Cultures (Contributor)
Created2022-05
Description
Purpose: Hispanics diagnosed with type 2 diabetes mellitus (DM) have poorer health outcomes than non-Hispanic whites. Approximately one- half of all Hispanic DM patients utilize community health clinics for their DM needs. Evidence suggests that using a culturally-tailored approach to DM education can uniquely improve health outcomes in this population. The purpose of this evidence-based practice (EBP) project was to improve glycemic control in a medically underserved Hispanic community through a culturally-tailored DM education program.
Methods: This quasi-experimental pre/post design project was guided by the ACE Star Model and Leininger’s Theory of Cultural Care. The affiliated University’s IRB approved this project. The Diabetes Empowerment Education Program (DEEP) was implemented in a free, community clinic in a medically underserved area. Spanish speaking patients (n = 15) with A1C levels
> 8mg/dl were recruited to participate in a 6-week group educational program facilitated by community health workers. Outcomes included A1C levels, weight, and two surveys from the Michigan Diabetes Research Center - DM knowledge test and the DM empowerment scale.
Results: Paired sample t-tests were used to analyze the outcomes. The participants had an average pre-A1C of 8.82 mg/dl with post-A1C of 8.01 mg/dl (p = .028). Pre-knowledge test scores averaged 9.40 with post-test average of 12.07 (p < .001). Empowerment scores increased from 4.09 to 4.63 (p = .001). The reduction between the average pre-and post-weight measures were not statistically significant (p = .681).
Discussion: The implementation of a culturally-tailored DM educational program in a medically underserved community had a significant impact on reducing A1C levels, improving DM knowledge, and enhancing empowerment levels. Although the sample size was small and limited to one clinic, applying these programs can have a measurable clinical impact in the treatment of Hispanic DM patients. Future research can further exam how to duplicate this project on a larger scale and over a sustained period.
Methods: This quasi-experimental pre/post design project was guided by the ACE Star Model and Leininger’s Theory of Cultural Care. The affiliated University’s IRB approved this project. The Diabetes Empowerment Education Program (DEEP) was implemented in a free, community clinic in a medically underserved area. Spanish speaking patients (n = 15) with A1C levels
> 8mg/dl were recruited to participate in a 6-week group educational program facilitated by community health workers. Outcomes included A1C levels, weight, and two surveys from the Michigan Diabetes Research Center - DM knowledge test and the DM empowerment scale.
Results: Paired sample t-tests were used to analyze the outcomes. The participants had an average pre-A1C of 8.82 mg/dl with post-A1C of 8.01 mg/dl (p = .028). Pre-knowledge test scores averaged 9.40 with post-test average of 12.07 (p < .001). Empowerment scores increased from 4.09 to 4.63 (p = .001). The reduction between the average pre-and post-weight measures were not statistically significant (p = .681).
Discussion: The implementation of a culturally-tailored DM educational program in a medically underserved community had a significant impact on reducing A1C levels, improving DM knowledge, and enhancing empowerment levels. Although the sample size was small and limited to one clinic, applying these programs can have a measurable clinical impact in the treatment of Hispanic DM patients. Future research can further exam how to duplicate this project on a larger scale and over a sustained period.
ContributorsBrown, Fionnuala S. (Author) / Thrall, Charlotte (Thesis advisor)
Created2018-04-23