Provision of Health Care in a Frontier Setting: An Alaskan Perspective

The Community Health Aide Program is the Indian Health Service's answer to to the provision of care to 45,000 Alaska Native people living in remote areas of the state. Community health aides are local people who live and work in their villages. They offer health services from emergency to preventative care with the help of their referral physician, who may be up to 1,300 miles away. Nurse practitioners play an important role in the training and supervision of community health aides. This article gives an overview of the program, its successes and problems, with implications as a health care delivery model for care in other underserved areas of the United States.     

Increasing Hepatitis C Knowledge Among Homeless Adults: Results of a Community-Based, Interdisciplinary Intervention

Homeless adults have high rates of hepatitis C virus infection (HCV) and low levels of HCV knowledge. This study reports results of an interdisciplinary, community-based intervention using stakeholder cooperation, case management, risk factor identification, and modification of dysfunctional psychosocial factors to increase HCV knowledge among homeless adults (N?=?747). Data are from a randomized quasi-experimental study, with the major goal of evaluating the effectiveness of a Nurse Case Managed Intervention compared to a Standard Intervention, encouraging completion of a three-series hepatitis A/hepatitis B vaccination program. Increased HCV knowledge was measured with an 18-item questionnaire discerning risk factors for HCV and common misconceptions about individuals with HCV. A significant increase in HCV knowledge resulted regardless of intervention format. Receiving the Nurse Case Managed Intervention predicted greatest gain in HCV knowledge (p?<?0.000). Successfully engaging key stakeholders, outreach workers, community organizations, and homeless people themselves proved most efficacious in increasing HCV knowledge.     

Research Presentations: Disseminating Knowledge for Practice

The abstract should have a title and should include the purpose and the significance of the study to the target audience, the design and procedures used for data collection, a succinct summary of the most important findings, and a brief statement of conclusion (Table 1). Careful attention should be given when constructing a title. The title should be interesting, brief, representative of the focus of the study, and attract attention to the research. Most research titles include the type of study, the variables, and the population studied (Ryan, 1989).
It is important to identify whether there is a limitation on the number of words to be contained in the abstract. If there is not a limitation, follow the rule, "Never more than one typewritten page." The abstract that is sent with a query letter to an editor of a journal does not have a word limit, but the above rule generally applies. The limit for conferences can vary from 150 to 300 words, and will be indicated in the Call for Abstracts. Use of the word count feature in a word processing program will assist in the construction of an abstract that adheres to the word count stated in the Call for Abstracts (Plaut, 1982).
Specific references to the literature are included in rare instances. The language used in writing the abstract should not be highly technical. It should be clear and concise and should communicate to the reader the motive of the study, why and how the study was conducted, and what knowledge was gained from the study. Many conferences print the abstracts in the conference syllabus. A clear, concise, well-organized abstract has a greater probability of being accepted for presentation and is more likely to be well attended at a conference than one that is highly technical or disorganized.     

Attitudes of Homeless and Drug-Using Youth Regarding Barriers and Facilitators in Delivery of Quality and Culturally Sensitive Health Care

PROBLEM:  Major barriers to care included a lack of culturally competent, accessible care despite the proximity of numerous health service agencies serving homeless youth.
METHODS:  A qualitative approach using semistructured focus groups was used to assess the perspectives of 54 homeless and drug-using youth, aged 18–24 years, recruited from street- and shelter-based settings.
FINDINGS:  Substance use was perceived as an adaptive response to psychological pain and survival on the streets as well as a health risk and barrier to care.
CONCLUSIONS:  Facilitators to care and suggestions for improved health delivery and quality of care included utilization of health "mentors" to assist in navigating the medical system, cultural competency enhancements, improved amenities in clinic wait areas, and expanded pharmaceutical services.