Pharmacists’ Perceptions of Participation in a Community Pharmacy-Based Nicotine Replacement Therapy Distribution Program

The community pharmacy has been proposed as an ideal location for providing smoking cessation therapy to large numbers of patients. Studies of public health initiatives providing free nicotine replacement products through telephone quitlines have found increased call volumes and cessation rates. The purpose of this study was to evaluate a program where nicotine replacement therapy starter packs were provided to patients through community pharmacies at no cost. An online survey was developed to assess community pharmacists' participation in the program, perceptions of the initiative as a whole, and perceptions of smoking cessation counseling activities. Eighty-three pharmacists working at participating pharmacies completed the survey (65% response rate). Ninety-nine percent of pharmacists provided smoking cessation counseling during the study period; the median (IQR) number of patients counseled over the initial 3.5-months of the NRT distribution program was 50 (24-100), and the median number of minutes per counseling session was five (3-7). Most (89%) agreed smoking cessation counseling was accommodated into the pharmacy work-flow. A majority (85%) agreed the community pharmacy is an ideal location for distributing free NRT products and that the program should be replicated in other pharmacies (78%). Participating pharmacists viewed the program positively and perceived it to be effective in helping patients quit smoking. In conclusion, the community pharmacy is a viable location for implementation of community-based public health initiatives related to smoking cessation.     

Use of a Unique Farmers’ Market Program Targeting Lower-Income Community Members

We examined use of a farmers’ market that leverages community partnerships to provide free produce to lower-income persons. Participants (n?=?422) were asked to complete a questionnaire and given an ID number, which was used to track market use from 2014 to 2015. Chi square tests were used to examine associations between 2014/2015 market use and reasons for market use, financial support received, and how attendees had learned about the market. Ordinal regression was used to identify household characteristics associated with increased market attendance. Although the proportion of lower-income attendees declined over the study period, a substantial proportion of households in 2014 (69.1%) and 2015 (54.6%) were below the poverty threshold. We identified significant differences in attendees’ reasons for market use and ways attendees heard about the market from 2014 to 2015. The most frequently reported reason for 2014 market use was retirement/fixed income (P?<?0.001) and in 2015 was low-income (P?<?0.001). Most attendees heard about the market through flyers (P?<?0.001) and word of mouth (P?≤?0.001) in 2014 and through local, non-profit services (P?<?0.001) in 2015. In the ordinal regression, households with an older person registering the household for the market used the market more times per year (P?<?0.001). Impoverished households (P?=?0.020) and households receiving more financial support services (P?<?0.001) used the market fewer times per year. While a substantial proportion of lower-income persons used the free-produce market, frequency of use was still lowest among this group indicating a need to address barriers beyond produce cost.     

A Community Collaborative for the Exploration of Local Factors Affecting Black Mothers’ Experiences with Perinatal Care

Maternal and Child Health Journal - Black women face disparities in maternal morbidity and mortality when compared to White women. Multiple factors contribute to these disparities. This study...     

Which Risk Factors for Child Maltreatment Predict Mothers’ Enrollment in a Parenting Support Program?

Parenting support programs are an effective means of preventing child maltreatment. However, these programs are often criticized for their limited ability to enroll and engage the parents who need them most. The present study aimed to determine which risk factors associated with child maltreatment predicted mothers’ enrollment in the Triple P—Positive Parenting Program in Quebec. To this end, 240 mothers of children aged 6 months to 8 years enrolled in Triple P were compared with 834 mothers randomly selected from the general population. The results suggest that mothers who perceived their child to be more difficult, used fewer positive parenting practices, and reported a lower parenting sense of competence were more likely to enroll in the program. Being unemployed, having a lower income, and being a single parent or part of a stepfamily also increased the mothers’ likelihood of participating in Triple P. These results suggest that Triple P was implemented in such a way as to attract families presenting various risk factors, which is promising in a child maltreatment prevention context.

     

System-Level Factors Affecting Clinicians’ Perceptions and Use of Interpreter Services in California Public Hospitals

Professional language interpreters are skilled in the nuances of interpretation and are less likely to make errors of clinical significance but clinicians infrequently use them. We examine system-level factors that may shape clinicians’ perceptions and use of professional interpreters. Exploratory qualitative study in 12 California public hospitals. We conducted in-person key informant interviews with hospital leadership, clinical staff, and administrative staff. Five emergent themes highlight system-level factors that may influence clinicians’ perceptions and use of professional interpreters in hospitals: (1) organization-wide commitment to improving language access for LEP patients; (2) organizational investment in remote interpreter technologies to increase language access; (3)training clinicians on how to access and work with interpreters; (4) hospital supports the training and certification of bilingual staff to serve as interpreters to expand in-person, on-site, interpreter capacity; and (5)organizational investment in readily accessible telephonic interpretation. Multiple system-level factors underlie clinicians’ use of professional interpreters. Interventions that target these factors could improve language services for patients with limited English proficiency.     

Vocational Community College Students’ Conversations about Binge Drinking

The large amount of vocational community college students that continue showing binge-drinking behavior might be an indication that interventions targeting this behavior have not been hugely successful. It might be that these interventions targeted beliefs that are less or not related with vocational community college binge-drinking behavior. The aim of this study was to identify vocational community college students` salient beliefs about binge drinking. In the context of the integrative model of behavioral prediction, we applied deductive qualitative content analysis of conversations about binge drinking. The analysis of vocational community college students` conversations about binge drinking revealed a significant amount of salient beliefs, such as cognitive and affective outcome beliefs and efficacy beliefs. These beliefs may be important indicators of vocational community college students` binge drinking. Moreover, to our knowledge, this study was the first to reveal a new set of beliefs, namely social judgment beliefs (i.e., vocational community college students` judgments about their peers` binge-drinking behavior). We believe that our study yielded salient beliefs that may serve as input for future interventions targeting binge drinking among vocational community college students.     

Factors Affecting Latina Immigrants’ Perceptions of Maternal Health Care: Findings From a Qualitative Study

Due to the influx of Latino immigration in the United States, health care services are faced with the challenge of meeting the needs of this growing population. In this qualitative study, we explored Latina immigrants’ experiences with maternal health care services. We found that despite enduring language barriers and problems, Spanish-speaking women expressed satisfaction with their care. Factors influencing women's perceptions of care included sociocultural norms (respeto, personalismo, and familismo), previous experiences with care in their countries of origin, having healthy babies, and knowledge about entitlement to interpreter services. We offer recommendations for public health practice and research.     

Community Health Advisors’ Participation in a Dissemination and Implementation Study of an Evidence-Based Physical Activity and Healthy Eating Program in a Faith-Based Setting

Community health advisors (CHAs) have been widely involved in health promotion, but few details on role expectations, retention, and evaluation have been reported. In a dissemination and implementation (D&I) study of an evidence-based healthy eating and physical activity program, 59 churches were randomized to an intervention (n?=?39) or control (delayed intervention) (n?=?20) condition. In a novel approach, CHAs worked with church committees rather than congregants by providing training (n?=?59) and technical assistance (n?=?54) to the committees to implement a program focused on structural and policy-level changes to support congregants’ behavioral changes. CHA training comprised self-study via electronic training modules, in-person training, and telephone-based training. Evaluation methods were pilot test participants’ and CHAs’ ratings of their training; observers’ ratings of CHAs’ church training delivery; church committee members’ ratings of the training experience, including CHAs’ performance; and data from the TA database to assess CHAs’ adherence to the protocol. The main challenge was the early dropout of one CHA and the reduced role of another. CHAs trained 142 intervention and 60 control church committee members in nine sessions; they covered 99% (intervention) and 90% (control) of training content, indicating high fidelity. Observers’ scored CHAs’ teaching and facilitation skills at 96.7% (intervention) and 80% (control) of the possible score. CHAs completed 92% of intervention and 93% of control TA calls. The great majority of church participants’ comments regarding CHAs were positive. This study demonstrates that with training and support, CHAs demonstrate high levels of intervention fidelity, confidence, and competence.     

Factors that Influence Physicians’ and Medical Students’ Confidence in Counseling Patients About Physical Activity

Less than half of US adults and two-thirds of US high school students do not meet current US guidelines for physical activity. We examined which factors promoted physicians’ and medical students’ confidence in counseling patients about physical activity. We established an online exercise survey targeting attending physicians, resident and fellow physicians, and medical students to determine their current level of physical activity and confidence in counseling patients about physical activity. We compared their personal level of physical activity with the 2008 Physical Activity Guidelines of the US Department of Health and Human Services (USDHHS). We administered a survey in 2009 and 2010 that used the short form of the International Physical Activity Questionnaire. A total of 1,949 individuals responded to the survey, of whom 1,751 (i.e., 566 attending physicians, 138 fellow physicians, 806 resident physicians, and 215 medical students) were included in this analysis. After adjusting for their BMI, the odds that physicians and medical students who met USDHHS guidelines for vigorous activity would express confidence in their ability to provide exercise counseling were more than twice that of physicians who did not meet these guidelines. Individuals who were overweight were less likely to be confident than those with normal BMI, after adjusting for whether they met the vigorous exercise guidelines. Physicians with obesity were even less likely to express confidence in regards to exercise counseling. We conclude that physicians and medical students who had a normal BMI and met vigorous USDHHS guidelines were more likely to feel confident about counseling their patients about physical activity. Our findings suggest that graduate medical school education should focus on health promotion in their students, as this will likely lead to improved health behaviors in their students’ patient populations.     

Students’ Assessment of Problems in a Problem-Based Learning Pharmacology Course

Problem-based learning has been widely employed in Medical Education. One of its main components is that students construct their knowledge working with problems. Therefore, in literature special attention has been given to the design of problems, while assessment has not received the same emphasis. To assess problems implies determining to which extent the resulting work fulfills the purposes that the designers of problems had planned, based on theoretical rationale. This study was developed to determine: if working with the problems allowed the students to carry out the expected learning activities; if the conditions in which they worked were suitable and if the problems were correctly structured. Participants were second-year medical students, enrolled in a problem-based learning pharmacology course. They were asked to assess each problem they used, by means of a questionnaire. The results suggest that when students worked with the problems they carried out activities related to elaboration of knowledge and activation of prior knowledge. They reported to have doubts after working with problems; this can probably be attributed to deficiencies in the students' prior knowledge. Furthermore, the type of problem in which students had low preference were those where they have to analyze tables and charts taken from pharmacological experiment reports; neither the time available to gather the information and to prepare the study issues was sufficient, nor was to study for other subjects. The information produced by assessment is useful for the designers of problems and as feedback to the educational process. The students' participation in the evaluation phase is a way to keep the congruence with a student-centered approach.     

Following a Calorie-Restricted Diet May Help in Reducing Healthcare Students’ Fat-Phobia

Data from National Health and Nutrition Examination Survey 2005/2006 show that 32.7% of US adults are overweight (BMI 25.0–29.9), 34.3% are obese (BMI 30–39.9), and 5.9% are extremely obese (BMI ≥ 40). For the first time, the number of obese American adults is greater than those who are merely overweight. Negative attitudes and fat phobia toward the overweight exist not only in the general population, but also among health professionals including dietitians and dietetics students. The purpose of this study was to determine if fat phobia might be reduced among future professionals by putting students on a calorie-restricted diet for a short period. Forty dietetics and health promotion students enrolled in a university obesity course completed the Fat Phobia Scale test before and after following a calorie restricted diet for 1 week (1,200 calories and 1,500 calories for women and men, respectively). Students also reflected their thoughts about following such a diet via brief journal entries. Results showed the change in fat phobias after following a calorie-restricted diet was significant. Many journal entries reflected a newfound respect for individuals struggling to lose weight and change in prior negative attitudes. Students reported that this experience would impact their future dealings with overweight/obese clients. It may be useful to incorporate this type of activity into the training of nutrition and other health professional students to increase sensitivity and reduce existing biases and negative attitudes toward overweight/obese clients.