Religious involvement,social support,and health among African-American women on the east side of detroit

BACKGROUND: A significant body of research suggests that religious involvement is related to better mental and physical health. Religion or spirituality was identified as an important health protective factor by women participating in the East Side Village Health Worker Partnership (ESVHWP), a community-based participatory research initiative on Detroit's east side. However, relatively little research to date has examined the mechanisms through which religion may exert a positive effect on health. OBJECTIVE: The research presented here examines the direct effects of different forms of religious involvement on health, and the mediating effects of social support received in the church as a potential mechanism that may account for observed relationships between church attendance and health. DESIGN: This study involved a random sample household survey of 679 African-American women living on the east side of Detroit, conducted as part of the ESVHWP. MAIN RESULTS: Results of multivariate analyses show that respondents who pray less often report a greater number of depressive symptoms, and that faith, as an important source of strength in one's daily life, is positively associated with chronic conditions such as asthma or arthritis. Tests of the mediating effect of social support in the church indicated that social support received from church members mediates the positive relationship between church attendance and specific indicators of health. CONCLUSIONS: These findings are consistent with the hypothesis that one of the major ways religious involvement benefits health is through expanding an individual's social connections. The implications of these findings for research and practice are discussed.     

Religious and Spiritual Supports of the Christian African-American HIV-Affected Grandparent Caregiver

ABSTRACT

This qualitative study explores the religious and spiritual supports grandparent custodial caregivers seek from the African-American church. Six female, Christian African-American HIV-affected grandparents living in North Carolina were interviewed. These caregivers perceive God and prayer to be essential to their intrinsic ability to cope. In addition to having the church pray for persons living with HIV/AIDS and their families, the grandparents would like the church to take a more active role in educating the community on HIV/AIDS prevention and in reducing the stigma associated with the disease. They seek little church support for themselves personally, but hope that through the church's efforts, others will not have to endure what they are experiencing. With this knowledge comes better informing HIV/AIDS education program design.     

Development and Testing of the Multidimensional Trust in Health Care Systems Scale

Objective  To describe the development and psychometric testing of the Multidimensional Trust in Health Care Systems Scale (MTHCSS). Methods  Scale development occurred in 2 phases. In phase 1, a pilot instrument with 70 items was generated from the review of the trust literature, focus groups, and expert opinion. The 70 items were pilot tested in a sample of 256 students. Exploratory factor analysis was used to derive an orthogonal set of correlated factors. In phase 2, the final scale was administered to 301 primary care patients to assess reliability and validity. Phase 2 participants also completed validated measures of patient-centered care, health locus of control, medication nonadherence, social support, and patient satisfaction. Results  In phase 1, a 17-item scale (MTHCSS) was developed with 10 items measuring trust in health care providers, 4 items measuring trust in health care payers, and 3 items measuring trust in health care institutions. In phase 2, the 17-item MTHCSS had a mean score of 63.0 (SD 8.8); the provider subscale had a mean of 40.0 (SD 6.2); the payers subscale had a mean of 12.8 (SD 3.0); and the institutions subscale had a mean of 10.3 (SD 2.1). Cronbach’s α for the MTHCSS was 0.89 and 0.92, 0.74, and 0.64 for the 3 subscales. The MTHCSS was significantly correlated with patient-centered care (r = .22 to .62), locus of control—chance (r = .42), medication nonadherence (r = −.22), social support (r = .25), and patient satisfaction (r = .67). Conclusions  The MTHCSS is a valid and reliable instrument for measuring the 3 objects of trust in health care and is correlated with patient-level health outcomes.     

High Medical Cost Burdens, Patient Trust, and Perceived Quality of Care

BACKGROUND  The financial burden of medical care expenses is increasing for American families. However, the association between high medical cost burdens and patient trust in physicians is not known. OBJECTIVE  To examine the association between high medical cost burdens and self-reported measures of patient trust and perceived quality of care. METHODS  Cross-sectional household survey based on random-digit dialing and conducted largely by telephone, supplemented by in-person interviews of households with no telephones. The sample for this analysis includes 32,210 adults who reported having a physician as their regular source of care. Measures of patient trust include overall trust, confidence in being referred to a specialist, and belief that the physician uses more services than necessary. Perceived quality measures include thoroughness of exam, ability to listen, and ability to explain. RESULTS  In adjusted analyses, persons with high medical cost burdens had greater odds of lacking trust in their physician to put their needs above all else (OR = 1.43, CI = 1.19, 1.73), not referring them to specialists (OR = 1.39, CI = 1.22, 1.58), and performing unnecessary tests (OR = 1.42, CI = 1.20, 1.62). Patients with high medical cost burdens also had more negative assessments of the thoroughness of care they receive from their physician (OR = 1.26, CI = 1.02, 1.56). The association of high medical cost burdens with patient trust and perceived quality of care was greatest for privately insured persons. CONCLUSION  The rising cost of medical care threatens a vital aspect of the effective delivery of medical care–patient trust in their physician and continuity of care. Exposing patients to more of the costs could lead to greater skepticism and less trust of physicians’ decision-making, thereby making health-care delivery less effective.     

Monkeys benefit from reciprocity without the cognitive burden

The debate about the origins of human prosociality has focused on the presence or absence of similar tendencies in other species, and, recently, attention has turned to the underlying mechanisms. We investigated whether direct reciprocity could promote prosocial behavior in brown capuchin monkeys (Cebus apella). Twelve capuchins tested in pairs could choose between two tokens, with one being “prosocial” in that it rewarded both individuals (i.e., 1/1), and the other being “selfish” in that it rewarded the chooser only (i.e., 1/0). Each monkey’s choices with a familiar partner from their own group was compared with choices when paired with a partner from a different group. Capuchins were spontaneously prosocial, selecting the prosocial option at the same rate regardless of whether they were paired with an in-group or out-group partner. This indicates that interaction outside of the experimental setting played no role. When the paradigm was changed, such that both partners alternated making choices, prosocial preference significantly increased, leading to mutualistic payoffs. As no contingency could be detected between an individual’s choice and their partner’s previous choice, and choices occurred in rapid succession, reciprocity seemed of a relatively vague nature akin to mutualism. Having the partner receive a better reward than the chooser (i.e., 1/2) during the alternating condition increased the payoffs of mutual prosociality, and prosocial choice increased accordingly. The outcome of several controls made it hard to explain these results on the basis of reward distribution or learned preferences, and rather suggested that joint action promotes prosociality, resulting in so-called attitudinal reciprocity.     

The vulnerability of middle-aged and older adults in a multiethnic, low-income area: contributions of age, ethnicity, and health insurance

This community-partnered study was developed and fielded in partnership with key community stakeholders and describes age- and race-related variation in delays in care and preventive service utilization between middle-aged and older adults living in South Los Angeles. The survey sample included adults aged 50 and older who self-identified as African American or Latino and lived in ZIP codes of South Los Angeles (N=708). Dependent variables were self-reported delays in care and use of preventive services. Insured participants aged 50 to 64 were more likely to report any delay in care (adjusted predicted percentage (APP)=18%, 95% confidence interval (CI)=14-23) and problems obtaining needed medical care (APP=15%, 95% CI=12-20) than those aged 65 and older. Uninsured participants aged 50 to 64 reported even greater delays in care (APP=45%, 95% CI=33-56) and problems obtaining needed medical (APP=33%, 95% CI=22-45) and specialty care (APP=26%, 95% CI=16-39) than those aged 65 and older. Participants aged 50 to 64 were generally less likely to receive preventive services, including influenza and pneumococcal vaccines and colonoscopy than older participants, but women were more likely to receive mammograms. Participants aged 50 to 64 had more problems obtaining recommended preventive care and faced more delays in care than those aged 65 and older, particularly if they were uninsured. Providing insurance coverage for this group may improve access to preventive care and promote wellness.     

From the Cover: Trust in scientists in times of pandemic: Panel evidence from 12 countries

This article analyzes the specific and critical role of trust in scientists on both the support for and compliance with nonpharmaceutical interventions (NPIs) during the COVID-19 pandemic. We exploit large-scale, longitudinal, and representative surveys for 12 countries over the period from March to December 2020, and we complement the analysis with experimental data. We find that trust in scientists is the key driving force behind individual support for and compliance with NPIs and for favorable attitudes toward vaccination. The effect of trust in government is more ambiguous and tends to diminish support for and compliance with NPIs in countries where the recommendations from scientists and the government were not aligned. Trust in others also has seemingly paradoxical effects: in countries where social trust is high, the support for NPIs is low due to higher expectations that others will voluntary social distance. Our individual-level longitudinal data also allows us to evaluate the effects of within-person changes in trust over the pandemic: we show that trust levels and, in particular, trust in scientists have changed dramatically for individuals and within countries, with important subsequent effects on compliant behavior and support for NPIs. Such findings point out the challenging but critical need to maintain trust in scientists during a lasting pandemic that strains citizens and governments.

In their fight against COVID-19, governments around the world have faced different technological constraints but also social hurdles. For more than 1 year, the COVID-19 crisis has put under strain not only trust in government but also trust in scientists and in civil society at large. This trend has had critical implications on individuals’ attitudes toward policy measures and vaccination.Indeed, the COVID-19 crisis has brought into sharp relief the importance of trust at several levels. Trust in scientists lends legibility and credibility to policy recommendations, which should lead to higher support for and compliance with the recommended nonpharmaceutical interventions (NPIs) and vaccination. But the degree to which people support more NPIs or comply with restrictions might also depend on their expectations about the behaviors of others and thus on their level of trust in others. Furthermore, trust in scientists, in government, and in others is not only likely to matter for outcomes during the pandemic, but it is also likely to have been affected and potentially undermined by the crisis, leading to further effects on behaviors and support for NPIs.This paper explores the specific impacts of the levels and the changes in different types of trust on attitudes toward NPIs, on the willingness to be vaccinated, and on compliant behavior over time across individuals and countries during the pandemic. We consider “horizontal” trust (i.e., generalized trust or trust in others) as well as two types of “vertical” trust, namely, trust in the government and in scientists.We exploit representative, large-scale, cross-country, and longitudinal surveys on the evolution of support for NPIs, attitudes toward vaccination, and compliant behaviors over the period from March to December 2020. These surveys took place in four waves (mid-March, mid-April, mid-June, and mid-December 2020) in 12 countries (Australia, Austria, Brazil, Canada, France, Germany, Italy, New Zealand, Poland, Sweden, the United Kingdom, and the United States), which differ in the types and stringency of the NPIs implemented as well as in their levels of trust in others, the government, and scientists. Such data are critical to rigorously study the questions at hand, allowing us to leverage across- and within-country, as well as within-individual, variations over many of the pandemic months.We find that trust in scientists is the key driver of the support for and compliance with NPIs across and within countries. The role of trust in government is much less clear-cut, contrary to findings in the earlier literature. In countries where the governments spoke out against social distancing and restrictions, such as the United States and Brazil, trust in government has negative effects on support for or compliance with NPIs. Trust in others also has more subtle effects. Respondents who trust others more are more willing to be vaccinated, which suggests that they may also be more civically minded and further internalize the social benefits of vaccination. But individuals who trust others more also exhibit lower support for NPIs and lower compliance with restrictions. We show that this is because they are more likely to trust others to respect social distancing and not because of a lack of social- or civic-mindedness.Our individual-level longitudinal data also allows us to evaluate the effects of within-person changes in trust over the pandemic on attitudes and compliance, thus contributing evidence to the literature. We show that trust levels, and in particular trust in scientists, have changed dramatically for individuals and within countries, with important subsequent effects on compliant behavior and support for NPIs. We are also able to check for the robustness of our results with measures of the precrisis levels of trust at the individual level.Finally, we provide experimental evidence of the causal impacts of trust in scientists and government on compliant behavior in the different countries, which confirms that trust in scientists is crucially needed for respondents to support and comply with NPIs.Earlier work has shown the positive impact of the local precrisis level of trust in government on compliance, as measured by mobility reduction using Google mobility rates across European regions during the first lockdown (1). Experimental evidence from Germany during this period has also shown that the more the respondents distrusted government, the more they opposed enforced instead of voluntary implementation of policy measures (2). Further experimental evidence in nine countries (using vignettes with hypothetical “stay-at-home” orders) suggests that a high level of trust in science generates a much larger increase in compliance than trust in government (3). Recent papers have found the level of local civic mindedness—as measured by levels of political participation across US counties (4) or blood donations, newspaper readership, and trust in others in Italian provinces (5)—to be positively associated with a reduction in the Google index of mobility rates. Previous evidence has shown that past epidemics deeply influenced trust in government and scientists (6, 7). Research related directly to the COVID-19 pandemic has focused so far on the evolution of trust in scientists in the United States (8) in the aftermath of the crisis and found little variation. We provide evidence on how the different types of trust have evolved in the longer run during the different phases of the pandemic in a large sample of countries and on how these changes are associated with variation in the support for NPIs and compliant behavior over time. Leveraging this longer-run and large-scale longitudinal data, we can show more precisely that trust in scientists is the critical driver of the support for and compliance with health policy measures, while trust in the government and trust in others have much more complicated effects. We also provide explanations for these patterns.The first two waves of our panel (March and April for eight countries) have already been used to document the existence of a gender gap in attitudes during the pandemic. Women tend to perceive COVID-19 as a more serious health problem and are more compliant with NPIs (9). However, in 10 countries from our sample in Wave 4 (December 2020), women are less willing than men to be vaccinated and to make vaccination compulsory due to more contested beliefs on the origins of the pandemic (10). For France only, among the 12 countries in our sample, the first and the third waves were used to examine how trust in governments is affected by the perceived threats to the country’s public health and economy (11). Finally, in a methodological paper, a list experiment in the third wave of the panel has been used to study how reliable the self-reported answers about compliant behavior are (12).Our paper contributes to the existing literature using this database by exploring the distinct impacts of horizontal (generalized trust) and vertical (trust in the government and in scientists) trust on attitudes toward NPIs, the willingness to be vaccinated, and compliant behavior across individuals, countries, and over time during the pandemic. Our methodology leverages longitudinal data and allows us to estimate the within-person effect of changes in trust on variation in support for NPIs and compliant behavior. Finally, we also exploit experimental data in the fourth wave (December 2020) to distinguish the causal impact of trust in scientists and in government on compliant behavior.     

Illness uncertainty, partner caregiver burden and support, and relationship satisfaction in fibromyalgia and osteoarthritis patients

OBJECTIVE: Fibromyalgia syndrome (FMS) is characterized by uncertainty in diagnosis, treatment, and outcome. This study assessed the role of uncertainty of illness in relationship satisfaction in patients with FMS and osteoarthritis (OA). METHODS: A total of 51 patients with FMS responded to self-report instruments assessing their uncertainty about their illness, functional ability, average pain, and relationship satisfaction. Their partners independently reported on their sense of caregiver burden and their supportiveness toward the patients. Thirty-two patients with OA and their partners served as a control group. RESULTS: Patients' functional ability and pain were related to partner caregiver burden. Partner caregiver burden was related to lower levels of partner supportiveness for the FMS dyads, but not for the OA dyads. Relationship satisfaction of patients with FMS was related to their higher levels of uncertainty of illness in interaction with their functional disability and pain and their partners' supportiveness. Under high levels of uncertainty of illness, low levels of partner supportiveness were related to lower patient relationship satisfaction, whereas low levels of uncertainty of illness were significant interacting variables in the OA sample. CONCLUSION: The results suggest that uncertainty of illness is a prominent feature affecting patients with FMS in their relationships with their partners. Suggestions for additional research to explore the role of uncertainty of illness in social relationships are presented, and the therapeutic implications for patient/partner relationships are explored.     

Framework for refugee and migrant health research in the WHO European Region

Migration is a longstanding, growing global phenomenon. As a social determinant of health, migration can lead to health inequities between people on the move and host populations. Thus, it is imperative that there is a coordinated effort to advance migration- and health-related goals. WHO has a specific remit to support evidence-based decision-making in its Member States. As part of that remit, WHO Europe presents this Framework for Refugee and Migrant Health Research in the WHO European Region. It is designed as a starting point for debating and analysing a broad range of options and approaches to help inform a WHO global research agenda on health and migration. This is important because refugee and migrant health research is a complex interdisciplinary field that is expanding in a fast-changing socio-political environment. The Framework is intended for all stakeholders involved: academic, civil society organisations, refugees, migrants, policy-makers, healthcare providers, educators and funders. It is developed by academics in consultation with these stakeholder groups. It reflects on three specific interrelated dynamics in research practice. These are (i) research prioritisation; (ii) study samples and (iii) research design. The Framework offers recommendations to consider for each one of these. It elucidates the value of involving refugees and migrants in research and research agendas and the need to develop an ecosystem that will support and sustain participatory, interdisciplinary, transdisciplinary and inter-sectoral projects.     

Policy,Community and Kin: Interventions That Support Rural Healthy Aging

This study examines the interventions that enable rural seniors to remain within their homes and communities as they age. Through semi-structured interviews with 40 rural seniors, the findings reveal a number of actions that facilitate rural aging. This study has important implications for a range of stakeholders from policy makers to community leaders by identifying policy, community, and kin-level interventions that support rural healthy aging in place. In identifying interventions that support rural seniors’ needs, this study provides a fundamental basis to better allocate resources, plan programs, and develop policies that reflect the needs of an aging population.     

Child and youth participatory interventions for addressing lifestyle‐related childhood obesity: a systematic review

A growing number of childhood obesity interventions involve children and youth in participatory roles, but these types of interventions have not been systematically reviewed. We aimed to identify child and youth participatory interventions in the peer‐reviewed literature in order to characterize the approaches and examine their impact on obesity and obesity‐related lifestyle behaviours. We searched PubMed/Medline, psychINFO and ERIC for quasi‐experimental and randomized trials conducted from date of database initiation through May 2015 that engaged children or youth in implementing healthy eating, physical activity or weight management strategies. Eighteen studies met our eligibility criteria. Most (n = 14) trained youth to implement pre‐defined strategies targeting their peers. A few (n = 4) assisted youth to plan and implement interventions that addressed environmental changes. Thirteen studies reported at least one statistically significant weight, physical activity or dietary change outcome. Participatory approaches have potential, but variation in strategies and outcomes leave questions unanswered about the mechanisms through which child and youth engagement impact childhood obesity. Future research should compare child‐delivered or youth‐delivered to adult‐delivered health promotion interventions and more rigorously evaluate natural experiments that engage youth to implement environmental changes. With careful attention to theoretical frameworks, process and outcome measures, these studies could strengthen the effectiveness of child and youth participatory approaches.     

信任是和谐医患关系的基础

医患信任的核心意义在于其作为医疗活动过程中的重要基础,是医疗活动顺畅开展下去的保证。当前,医患间信任缺失现象仍然存在,这对于患者疾病的治愈和医学的发展是没有益处的,同时,也不利于和谐医患关系的构建。如何重建医患信任,使医患并肩战斗,战胜病魔,这是急需解决的重要问题。     

The Child Asthma Link Line: A Coalition-initiated,Telephone-based,Care Coordination Intervention for Childhood Asthma

Background. Childhood asthma is a complex chronic disease that poses significant challenges regarding management, and there is evidence of disparities in care. Many medical, psychosocial, and health system factors contribute to recognized poor control of this most prevalent illness among children, with resultant excessive use of emergency departments and hospitalizations for care. Recent national guidelines emphasize the need for community-based initiatives to address these critical issues. To address health system fragmentation and impact asthma outcomes, the Philadelphia Allies Against Asthma coalition developed and implemented the Child Asthma Link Line, a telephone-based care coordination and system integration program, which has been in operation since 2001. This study evaluates the effectiveness of the Child Asthma Link Line integration model to improve asthma management by measuring utilization markers of morbidity. Methods. Medicaid Managed Care Organization claims data for 59 children who received the Link Line intervention in 2003 are compared to a matched sample of 236 children who did not receive the Link Line intervention. Children in the two study groups are ages 3 through 12 years and matched on 2003 emergency department visits, age, gender, and race/ethnicity. Primary outcome variables analyzed in this study are emergency department visits, hospitalizations, and office visit claims from the follow-up year (2004). Results. Link Line intervention children were significantly less likely to have follow-up hospitalizations than matched sample children (p = .02). Children enrolled in the Link Line were also more likely to attend outpatient office visits in the follow-up year (p = .045). In addition, Link Line children with multiple emergency department visits in 2003 were significantly less likely to have an emergency department visit in 2004 (p = .046). Conclusion. This coalition-developed, telephone-based, system-level intervention had a significant impact on childhood asthma morbidity as measured by utilization endpoints of follow-up hospitalizations and emergency department visits. Telephone-based care coordination and service integration may be a viable and economic way to impact childhood asthma and other chronic diseases.     

Academic incentives for faculty participation in community-based participatory research

Recognizing the need to overcome the obstacles of traditional university- and discipline-oriented research approaches, a variety of incentives to promote community-based participatory research (CBPR) are presented. Experiences of existing CBPR researchers are used in outlining how this methodological approach can appeal to faculty: the common ground shared by faculty and community leaders in challenging the status quo; opportunities to have an impact on local, regional, and national policy; and opening doors for new research and funding opportunities. Strategies for promoting CBPR in universities are provided in getting CBPR started, changing institutional practices currently inhibiting CBPR, and institutionalizing CBPR. Among the specific strategies are: development of faculty research networks; team approaches to CBPR; mentoring faculty and students; using existing national CBPR networks; modifying tenure and promotion guidelines; development of appropriate measures of CBPR scholarship; earmarking university resources to support CBPR; using Institutional Review Boards to promote CBPR; making CBPR-oriented faculty appointments; and creating CBPR centers.