Matching Items (9)
Filtering by
- All Subjects: Hispanic
- Creators: Arizona State University. College of Nursing & Healthcare Innovation
- Creators: Gonzales, Nancy
- Creators: Thrall, Charlotte
Description
Mexican American adolescents report high rates of internalizing symptomatology and alcohol use. However, very little research has explored to what extent internalizing distress may contribute to alcohol use among this population. The current study utilized longitudinal data from a community sample of Mexican American adolescents (n=626, 51% female) to test a series of hypotheses about the role of internalizing distress on alcohol use and misuse. Specifically, this study used a bifactor modeling approach to investigate (1) whether different forms of internalizing distress are composed of common and unique components; (2) whether and to what extent such components confer risk for alcohol use; and (3) whether youth cultural orientation plays a role in these associations. Confirmatory factor analyses revealed that a bifactor model with a general factor and three specific factors (depressed mood, general worry, social anxiety) provided good fit to the data. The general distress factor was significantly associated with past month alcohol use but not binge drinking. However, these effects were conditional based on level of acculturation. Differential relations were found between the specific factors of internalizing distress and alcohol use. Depressed mood predicted past month alcohol use among girls; social anxiety negatively predicted past three month binge drinking among boys. Overall, results highlight the multidimensional nature of internalizing distress and suggest that both common and unique components of internalizing distress may be relevant to the etiology of alcohol use among Mexican-American adolescents. Findings underscore the importance of considering cultural orientation as a moderating factor when investigating substance use among Hispanic youth. Implications for future research examining the etiological relevance of the internalizing pathway to alcohol use among Hispanic adolescents are discussed.
ContributorsNichter, Brandon (Author) / Gonzales, Nancy (Thesis advisor) / Chassin, Laurie (Committee member) / Barrera, Manuel (Committee member) / Tein, Jenn (Committee member) / Arizona State University (Publisher)
Created2018
Description
This project modifies an existing theory-based culturally responsive nutrition and physical activity curriculum designed for early adolescent Hispanic children. Modifications to the Salud con Sabor Latino para los Ninos (SSLN) curriculum, originally designed for adolescents, include didactic content and activities which are evidence-based and age appropriate for younger children (second to fourth grade). Using a community based participatory research approach, culturally responsive and developmentally cognizant modifications were made based on child development theories, social behavior theory, and evidence of successful obesity interventions among this age group. The end goal is to assist the community partner, Esperança, and provide an opportunity to impact obesity rates in this high risk population.
The goal of the updated eight session SSLN program is to decrease BMI, increase nutritional knowledge, and improve attitude and behavior towards nutrition and physical activity in Hispanic school-aged children. After meeting with Esperança to identify which elements of the curriculum needed modification, an extensive literature review was conducted to identify new and relevant research appropriate to the modifications. Integrating child development theories, social behavior theory, and results from earlier successful obesity intervention programs, curriculum sessions will be condensed and modified using a community base participatory research approach. Once edits to the curriculum are completed and approved, Esperança will implement the newly modified curriculum, and evaluate the success of the curriculum changes.
The final project is composed of a condensed, theory-based, culturally responsive, and developmentally age appropriate eight session curricula that will educate Hispanic school-aged children on nutrition and physical activity.
The goal of the updated eight session SSLN program is to decrease BMI, increase nutritional knowledge, and improve attitude and behavior towards nutrition and physical activity in Hispanic school-aged children. After meeting with Esperança to identify which elements of the curriculum needed modification, an extensive literature review was conducted to identify new and relevant research appropriate to the modifications. Integrating child development theories, social behavior theory, and results from earlier successful obesity intervention programs, curriculum sessions will be condensed and modified using a community base participatory research approach. Once edits to the curriculum are completed and approved, Esperança will implement the newly modified curriculum, and evaluate the success of the curriculum changes.
The final project is composed of a condensed, theory-based, culturally responsive, and developmentally age appropriate eight session curricula that will educate Hispanic school-aged children on nutrition and physical activity.
ContributorsTooms, Allison Jayce (Author) / Stevens, Carol (Thesis director) / Beals, Jacqueline (Committee member) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05
Description
The purpose of this project is to create an educational activity book for Spanish-speaking children that face a language barrier when seeking care in the Emergency Room. In order to effectively develop relationships and provide exceptional healthcare for clients, nurses must understand how to effectively communicate (Escarce & Kapur, 2006). Current research reports that clients with Spanish as their primary language were more likely to have a poor experience when seeking health care assistance (Hispanic Health Disparities and Communication Barriers, 2016). Additionally, they were more likely not to seek care at all due to little or no communication capabilities with healthcare staff (Hispanic Health Disparities and Communication Barriers, 2016). The language barrier present and the lack of resources available to address the issue have created a disparity in the quality of healthcare for Spanish-speaking clients (Juckett, 2013). The book was made with the intention of being distributed to Spanish-speaking children and/or children with Spanish-speaking guardians, upon arrival to the Emergency Department. This educational activity book is to be used by the child, their guardians, and their involved health care staff to more comfortably navigate their way through the Emergency Room process.
ContributorsBurkey, Lindsey (Co-author) / Streecter, Angela (Co-author) / Stevens, Carol (Thesis director) / Murphy, Ana Orrantia (Committee member) / Sutter, Kimberlee (Committee member) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor) / Barrett, The Honors College (Contributor)
Created2016-05
Description
The purpose of this study is to examine the effect of an existing medication management program in Hispanic individuals with diabetes, focusing on overall management and perceived quality of life (QOL). Diseases such as diabetes affect an individual's physical health, mental health, and social life. The degree to which these diseases affect an individual's life depend on how well they control and self-manage care needs. It has been found that Hispanic patients report and demonstrate inadequacy with controlling their diabetes compared to other ethnicities, making this an important public health topic (Schneiderman eta al., 2014). One of the greatest issues the Hispanic population reports as causing most concern is medication management and compliance. Poor medication adherence can increase complications of diabetes and depression, thus increasing poor overall health status and perception. Medication therapy management (MTM) programs run by clinical pharmacists are available to help with medication adherence, aiding in developing a tailored plan to help individuals manage the disease. This study is a cross-sectional study which assess reported QOL and functionality of diabetics enrolled in an MTM program. Participants were recruited from a clinic in Phoenix, Az. Patients completed a questionnaire that included demographics, a QOL questionnaire and a health belief questionnaire. A total of sixteen participants completed the study. The association between time in the medication therapy management program and its effect on general health, social functioning, emotional well-being, and hemoglobin A1C were reviewed. Though no significance was found, means were similar in all groups indicating functionality and A1C control through the diabetes support program may exist.
ContributorsVarela, Zury Arely (Author) / Flom-Racoma, Kehart (Thesis director) / Ohri-Vachaspati, Punam (Committee member) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor) / Barrett, The Honors College (Contributor)
Created2016-05
Description
Although discrimination is implicated in ethnic health disparities, social support may buffer against its negative effects on health. This study investigated whether prenatal maternal discrimination and social support would predict postpartum cortisol in low-income Hispanic women and infants. Among infants whose mothers reported high discrimination, low maternal social support was associated with high infant cortisol (ß= -0.293, p= 0.03). This provides evidence for the social buffering hypothesis.
ContributorsJewell, Shannon Linda (Author) / Luecken, Linda (Thesis director) / Presson, Clark (Committee member) / Gonzales, Nancy (Committee member) / Barrett, The Honors College (Contributor) / T. Denny Sanford School of Social and Family Dynamics (Contributor) / Department of Psychology (Contributor)
Created2013-05
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
Background: Type II diabetes mellitus (T2DM) is a growing issue globally. Social determinants of health (SDH) play a crucial role on patients’ outcomes and complications from the disease. Hispanics are twice as likely to suffer from T2DM when compared to non-Hispanic whites, and they often rely on federally qualified community health centers (FQCHC) for their medical needs. These centers are then faced with high volume of patients with high acuity, which leads to limited time and resources to provide diabetic education.
Methods: The Purnell model of cultural competence will be used as a framework to provide unbiased, culturally tailored (CT) education to improve patients’ outcomes. The advancing research and clinical practice through close collaboration (ARCC) model will be used as it focuses on evidence-based practice (EPB) implementation that is sustainable across the system.
Purpose: The purpose of this EBP project is to promote culturally tailored (CT) DSME at a low-income FQCHC in greater Phoenix to improve diabetes outcomes and decrease complications from the disease. Consequently, decreasing the costly effects of diabetes complications to patients, FQCHC, and the state of Arizona.
Conclusion: Evidence suggest that diabetes self-care management education (DSME) is successful, independent of the format of delivery, in improving diabetes outcomes and patients’ self-care. However, it is underutilized in the United States even though it is a covered Medicare service.
ContributorsDavis, Maria Regiane (Author) / Rauton, Monica (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-28
Description
A federally qualified health center in the southwest United States serves low-income, uninsured communities. By provider reports, unprescribed antibiotic use is common in this clinic’s population, promoting development of antibiotic resistant bacteria. Antibiotics are widely available in Mexico and may be sold illegally in the United States without a prescription. This project’s purpose is to identify social risks and opportunities for antibiotic education. A telephone survey was administered to patients at least 18 years of age. The 32-item survey included a demographic questionnaire created for this project, the PRAPARE social determinants of health questionnaire, and the Eurobarometer antimicrobial resistance questionnaire. Any social risks identified were forwarded to clinic staff for referral. The survey was completed in English or Spanish, per the participant’s preference. A total of 20 surveys were completed. Low education level and unemployment were the most common social risks identified. Spanish language, housing and food insecurity, and difficulty meeting basic needs were associated with overall higher social risks. An antibiotic knowledge gap was identified, and self-medication with antibiotics was confirmed as a behavior within the population. Although no determinants for antibiotic misuse were identified, all participants indicated preference for provider-based education. This FQHC has an opportunity to develop a provider-based educational intervention. The length of the survey and the telephone format, required due to COVID-19 restrictions, were significant limitations, impacting recruitment. Further research is needed to determine the most effective way of delivering education. The clinic is continuing to administer the PRAPARE survey, expanding data on social risks.
ContributorsMiranda, Sarah (Author) / Tharalson, Erin (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-28
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