What Drives Women Veterans’ Trust in VA Healthcare Providers?

IntroductionLittle is known about women veterans’ trust in Veterans Affairs (VA) health care and what factors promote trust in VA providers. We examined provider behaviors and characteristics of women veterans associated with trust in their VA providers.MethodsWe used a 2015 survey of women veterans who were routine users of primary care at 12 VA medical centers (n = 1,395). Patient trust in their VA provider was measured on a seven-item scale. We used multiple logistic regression to examine associations of patient-provider communication and gender appropriateness with complete trust in VA provider (100 [complete trust] vs. <100 [less than complete trust]), controlling for patient characteristics.ResultsOn average, 39.7% of women veterans reported complete trust in their VA providers. Those with complete trust reported greater patient-provider communication and gender appropriateness of VA services than those with less-than-complete trust (all ps ≤ .001). In multiple logistic regression models, higher ratings of provider communication (adjusted odds ratio, 2.37), gender-appropriate care (adjusted odds ratio, 1.93), and trauma-sensitive communication (adjusted odds ratios, 1.79–6.08) were associated with a higher likelihood of reporting complete trust in their VA provider.ConclusionsWomen veterans reported high levels of trust in their VA providers. Provider communication, gender-appropriate care, and trauma-sensitive communication were associated with greater patient trust. Although it is important to highlight the steps already taken by VA to increase the quality of care for women veterans, current findings suggest that women veterans’ trust may be further increased by interventions to improve trauma-informed care by VA providers.     

‘Snag bags’: Adapting condoms to community values in Native American communities

HIV/AIDS researchers working among Native Americans have consistently noted resistance to discussions of sexuality and the distribution of condoms. This resistance is inspired by long held values about shame and public discussions of sexuality. Also, American Indians have been reluctant to welcome public discussions of HIV/AIDS and sexuality from external entities, such as governmental agencies. As a result, Native peoples have some of the lowest documented condom use rates. However, innovations in culturally integrating condoms and safe sex messages into Native cultural ideals are proving beneficial. One such innovation is the snag bag, which incorporates popular Native sexual ideology while working within local ideals of shame to distribute condoms and safe sex materials to sexually active young people and adults. Using snag bags as an example, this research proposes that an effective approach to HIV prevention among Native peoples is not cultural sensitivity but cultural integration. That is, HIV prevention strategies must move beyond the empty promise of merely culturally‐sensitizing ideas about disease cause. Instead of simply ‘translating’ HIV/AIDS programming into Native culture, prevention strategies must be integrated by Native peoples into their own disease theories and contemporary culture.

Résumé

Les chercheurs en matière du HIV/sida qui travaillent parmi les Amérindiens rencontrent invariablement des résistances vis‐à‐vis de toute discussion de la sexualité et de la distribution des préservatifs. Cette résistance est basée sur des valeurs qui, depuis fort longtemps, portent sur la honte et sur toute discussion en public de la sexualité. En outre, les Amérindiens ont beaucoup hésité à accueillir favorablement les initiatives en provenance d'instances extérieures telles que les organismes gouvernementaux visant à encourager un débat public autour du HIV/sida et la sexualité. En conséquence, le taux d'utilisation de préservatifs chez les Amérindiens est parmi les plus bas jamais relevés. Cependant, certaines initiatives visant à intégrer dans la culture des Amérindiens des messages à propos de l'utilisation de préservatifs et des rapports sexuels sans risque commencent à porter leurs fruits. L'une de ses démarches novatrices concerne le “sac à malices”, qui, tout en tenant compte de l'idéologie sexuelle populaire amérindienne et de l'attitude de cette communauté vis‐à‐vis de la honte, distribue aux jeunes et aux adultes en activité sexuelle des préservatifs et autres matériaux favorisant les rapports sexuels protégés. Prenant ce “sac à malices” comme exemple, l'auteur suggère qu'une approche efficace de la prévention du HIV chez les Amérindiens devrait se focaliser non sur la sensibilité culturelle mais sur l'intégration culturelle. Autrement dit, toute stratégie de prévention du HIV devra aller au‐delà d'une vaine promesse de respecter les sensibilités culturelles concernant les causes de la maladie. Au lieu d'une simple “traduction” des programmes anti‐HIV/sida pour la culture amérindienne, les stratégies de prévention doivent être intégrées par les Amérindiens eux‐mêmes dans leur culture contemporaine et selon leurs propres théories concernant cette maladie.

Resumen

Los investigadores del VIH/sida que trabajan entre nativos americanos han notado una resistencia sistemática a hablar de sexualidad o la distribución de preservativos. Esta resistencia está inspirada en valores arraigados sobre la vergüenza y los discursos públicos en materia de sexualidad. Asimismo los indios americanos se niegan a aceptar que este tipo de discusiones públicas sobre el VIH/sida y la sexualidad procedan de organismos externos, tales como agencias gubernamentales. En consecuencia los nativos presentan una de las tasas más bajas del uso de preservativos que se haya documentado. Sin embargo, se han demostrado los beneficios de las innovaciones en aras de integrar culturalmente el uso de preservativos y los mensajes sobre seguridad sexual en los ideales culturales de los nativos. Una de estas innovaciones es la bolsa (snag bag) que forma parte de la ideología popular entre los nativos con respecto a la sexualidad. Con este tipo de bolsa se tienen en cuenta los ideales locales con respecto a la vergüenza para distribuir preservativos y materiales relacionados con la seguridad sexual a los jóvenes y adultos sexualmente activos. En este estudio hemos incluido estas bolsas como ejemplo para proponer que un planteamiento eficaz sobre la prevención del sida entre los nativos no consiste en sensibilidad cultural sino integración cultural. Es decir que las estrategias de prevención del sida deben ir más allá de la promesa sin sentido de que para hablar de la causa de las enfermedades hay que ser sensibles a las culturas. En vez de traducir simplemente los programas contra VIH/sida en la cultura nativa, los nativos deben incorporar las estrategias en sus propias teorías sobre enfermedades y en su cultura contemporánea.     

Medical Home Access Among American Indian and Alaska Native Children in 7 States: National Survey of Children’s Health

To describe the prevalence of medical home among American Indian and Alaska Native children (AIAN) compared to non-Hispanic white (NHW) children and identify areas for improvement in the provision of care within a medical home. Prevalence of medical home, defined as family-centered, comprehensive, coordinated, compassionate, culturally effective care, including a personal doctor or nurse and usual care location, was estimated using 2007 National Survey of Children’s Health data. Analyses included 1–17 year-olds in states reporting AIAN race as a distinct category (Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma, and South Dakota, n = 9,764). Associations between medical home and demographic (child’s age, household education and income, and state) and health-related [child’s insurance status, special health care need status, and past year Indian Health Service (IHS) utilization] characteristics were assessed among AIAN children. Overall, the prevalence of medical home was 27 % lower among AIAN children (42.6, 95 % CI = 34.4–50.8) than NHW children (58.3, 95 % CI = 56.2–60.4). Child’s age (adjusted OR [aOR] = 2.7, 95 % CI = 1.3–5.6) was significantly associated with medical home. IHS utilization was associated with medical home among AIAN children with private insurance (aOR = 0.2, 95 % CI = 0.1–0.4), but not among uninsured or publicly insured children. Care coordination and family-centered care were noted areas for improvement among AIAN children. Less than half of AIAN children had a medical home. Future studies should further examine the intersection between insurance and IHS to determine if enhanced coordination is needed for this population, which is often served by multiple federally-funded health-related programs.     

Psychosocial Responses to Healthcare: A Study on Asylum-Seeking Families’ Experiences in Denmark

Journal of Immigrant and Minority Health - Much work has gone into unpacking the range of individual, interpersonal and structural barriers that prevent asylum-seekers from accessing healthcare. In...     

Community Perceptions of Safety in Relation to Perceived Youth Violence-Delinquency in a Primarily Native Hawaiian and Asian American Community in Hawai‘i

Perception of safety is an important component to the well-being of community members in their own neighborhood. The present study was the first of its kind to model community perception of safety utilizing a primarily Native Hawaiian and Asian American community sample (N = 101) and with perceived youth violence and delinquency as prominent potential influences. The study found that the majority of participants felt that several types of youth violence and delinquency were problems in the community. The overall social-ecological model evidenced a strong fit and indicated that community perception of safety was adversely impacted by perceived youth violence and delinquency and increased through positive relations with neighbors. The implications included the need for a more comprehensive approach to positive youth development and community capacity-building, including incorporation of cultural components, and to determine whether the model is applicable to other minority communities.     

Access to Obstetric Care and Children’s Health,Growth and Cognitive Development in Vietnam: Evidence from Young Lives

Background The impact of birth with poor access to skilled obstetric care such as home birth on children’s long term development is unknown. This study explores the health, growth and cognitive development of children surviving homebirth in the Vietnam Young Lives sample during early childhood. Methods The Young Lives longitudinal cohort study was conducted in Vietnam with 1812 children born in 2001/2 with follow-up at 1, 5, and 8 years. Data were collected on height/weight, health and cognitive development (Peabody Picture Vocabulary test). Statistical models adjusted for sociodemographic and pregnancy-related factors. Results Children surviving homebirth did not have significantly poorer long-term health, greater stunting after adjusting for sociodemographic/pregnancy-related factors. Rural location, lack of household education, ethnic minority status and lower wealth predicted greater stunting and poorer scores on Peabody Vocabulary test. Conclusions Social disadvantage rather than homebirth influenced children’s health, growth and development.     

‘A preferred consultant and partner to the Royal Government,NGOs, and the community’: British American Tobacco’s access to policy-makers in Cambodia

British American Tobacco Cambodia (BATC) has dominated the country’s tobacco market since its launch in 1996. Aggressive marketing in a weak regulatory environment and strategies to influence tobacco control policy have contributed to an emerging tobacco-related public health crisis. Analysis of internal tobacco industry documents, issues of BATC’s in-house newsletter, civil society reports and media demonstrate that BATC officials have successfully sought to align the company with Cambodia’s increasingly controversial political and business leadership that is centred around the Cambodian People’s Party with the aim of gaining access to policy-makers and influencing the policy process. Connections to the political elite have resulted in official recognition of the company’s ostensible contribution to Cambodia’s economic and social development and, more significantly, provided BATC with opportunities to petition policy-makers and to dilute tobacco control regulation. Corporate promotion of its contribution to Cambodia’s economic and social development is at odds with its determined efforts to thwart public health regulation and Cambodia’s compliance with the Framework Convention on Tobacco Control.     

Overcoming Inertia: Increasing Public Health Departments’ Access to Evidence-Based Information and Promoting Usage to Inform Practice

In 2010, the New England Region–National Network of Libraries of Medicine at University of Massachusetts Medical School received funding to improve information access for public health departments in 6 New England states and Colorado. Public health departments were provided with desktop digital access to licensed e-resources available through special pricing. In January through mid-April 2012, we evaluated the effectiveness of providing access to and training for using e-resources to public health department staff to motivate usage in practice. We found that additional strategies are needed to accomplish this.Access to scientific evidence is vital to evidence-based public health and evidence-based decision-making, yet access is underutilized, limited, or both.1,2 Many public health departments (PHDs) have no access to evidence-based resources beyond those provided by the National Library of Medicine or its funding.3,4 Factors influencing evidence-based practice include information access, training, skills, leadership vision, and organizational change.5–9 By 2009, tools giving access to evidence-based information to policymakers existed but all were underutilized, as was training or technical assistance to enhance uptake.2 By 2012 many PHDs experienced massive reductions in staff or resources resulting in variable awareness of the value of using evidence to inform decision-making.8Barriers to information access include competing responsibilities, lack of full-text access, credibility of information retrieved, and infrequent training on information searching.1 Better methods of indexing, searching, and filtering information through single portal access, archiving information, and early notification of relevant information can improve access and movement toward evidence-based practice.10Beginning in 2010, University of Massachusetts Medical School Library received National Network of Libraries of Medicine funding for its Public Health Information Access (PHIA) project, which provides (1) direct electronic access to full-text scientific literature to a convenience sample of state PHDs in 6 New England states and Colorado, (2) training, and (3) a pilot for a sustainable business model to expand access nationwide.Resources selected (see the Box on page e2) for a digital library were based on national initiatives,11,12 suggestions from PHD grant partners, and metrics on resource use from publishers. The PHIA project adds journals as it identifies articles frequently requested through subsidized delivery service (Loansome Doc; National Library of Medicine, Bethesda, MD). The 7 PHDs customized the digital library template on their intranet or used shared file capability with links to e-resources. Hospital and academic medical libraries in each state provide resources not available through the digital library.

Example of Resources Provided to Public Health Departments by the Public Health Information Access Project

Access to antenatal care and children’s cognitive development: a comparative analysis in Ethiopia, Peru, Vietnam and India

Objectives

Early life interventions are considered essential for reducing the burden of health inequalities over the life course. This paper tests this issue empirically focusing on whether access to antenatal care can later reduce children’s health and educational inequalities.

Methods

Data came from the Young Lives Project for Ethiopia, Peru, Vietnam, and the State of Andhra Pradesh in India. We selected children born in early 2001/2002 and who were followed longitudinally in 2006/2007. We used multilevel mixed effects linear regression models to estimate the parameters of interest.

Results

We found a positive and significant relationship between mothers’ access to antenatal care and their children’s cognitive development in all countries. In addition, we found a positive and significant relationship between antenatal care and children’s cognitive development for stunted children but only in Peru and Vietnam.

Conclusions

We conclude that (1) antenatal care has the potential to change the negative consequences of early nutritional deficiencies on later cognitive development in Peru and Vietnam; (2) differentials in the quality of antenatal care services could explain the cross-country differentials in the role of early life interventions found here.     

Living Conditions,Access to Healthcare Services,and Occupational Health and Safety Conditions of Migrant Seasonal Agricultural Workers in the Çukurova Region

Objective: Migrant seasonal agricultural workers who are employed in one of the most hazardous occupations in Turkey experience difficulties in accessing health-care services. The aim of this study is to investigate the living conditions, access to health-care services, and occupational health and safety conditions of migrant seasonal agricultural workers in the Çukurova region.

Methods: Four hundred migrant seasonal agricultural workers were contacted in the county of Karata? located in the province of Adana, Turkey. A four-section questionnaire was administered using face-to-face interview techniques.

Results: The mean age of the participants was 32.8 ± 12.4 years. One-fourth of the participants did not have any social security coverage. Almost all had a monthly income below minimum wage, and 98% were living in tents. One-fifth experienced health problems in the last year, and 63% of them visited a health-care facility for diagnosis and treatment. About 3.3% of the participants sustained injuries at work, and only 23% of them visited a health-care facility.

Conclusion: The findings of the study show that migrant seasonal agricultural workers in Turkey have insufficient working conditions, wages, accommodation facilities, nutrition opportunities, health conditions, and occupational health and safety conditions. This insufficiency negatively affects life qualities of the workers, utilization of health-care services, and their occupational health status and safety.     

Understanding Women’s Awareness and Access to Preconception Health Care in a Rural Population: A Cross Sectional Study

Despite evidence of the benefits of preconception health care (PCHC), little is known about awareness and access to PCHC for rural, reproductive-aged women. This study aimed to assess the prevalence of PCHC conversations between rural reproductive-age women and health care providers, PCHC interventions received in the past year, and ascertain predictors of PCHC conversations and interventions. Women (n?=?868; 18–45 years) completed a questionnaire including reproductive history, health care services utilization, and interest in PCHC. The prevalence of health care providers’ PCHC conversations was 53.9?%, and the mean number of interventions reported was 2.6?±?2.7 (±SD). Significant predictors of PCHC conversation based on adjusted odds ratios from logistic regression were race (Native American 76?% greater than White), health care provider type (non-physician 63?% greater than physician), visits to a health care provider (3+ times 32?% greater than 1–2 times), and pregnancy planning (considering in next 1–5 years 51?% greater than no plans). Significant predictors of PCHC interventions received in the past 12 months based on adjusted risk ratios from negative binomial regression were race (Native American 22?% greater than White), PCHC conversation with a health care provider (yes 52?% lower than no), reporting PCHC as beneficial (yes 32?% greater than don’t know), and visits to a health care provider in the past year (3+ times 90?% greater than 1–2 times). Increasing conversations about PCHC between health care providers and their reproductive-aged patients can improve awareness and increase their likelihood of receiving all of the recommended interventions.     

Communities’ perceptions of factors contributing to child sexual abuse vulnerability in Kenya: a qualitative study

Abstract

Child sexual abuse (CSA) is a major global health concern. Although it is prevalent in Kenya, scant literature on factors contributing to CSA vulnerability exists. Using qualitative data from 28 focus groups and ethnographic field notes, we explored and assessed community perceptions of factors contributing to CSA vulnerability in Homa Bay County, Western Kenya. Findings suggest that people living in these communities perceived CSA as being influenced by multiple factors: developmental stage, peer pressure, huge gender disparities exacerbated by negative social norms and cultural practices, the HIV epidemic and social media platforms that circulate sexualised images. From our findings, it was clear that participants also regarded poverty as exacerbating children’s vulnerability to CSA. Minors from poor families engaged in transactional sex for survival and social status. Some community members perceived girls dressed in short skirts or tight clothing as warranting unwanted sexual advances. Although poverty and gender roles and relations were viewed as increasing vulnerability to CSA, blame was often placed on survivors’ modes of dress or behaviour. There is a need for comprehensive education of the communities on CSA, its consequences and the rights of women and girls.     

Healthcare professional and professional stakeholders’ perspectives on vaccine mandates in Switzerland: A mixed-methods study

BackgroundThere currently are no mandatory vaccines in Switzerland. However, Swiss federal legislation allows for vaccination mandates in settings where the risk of transmission to vulnerable groups is high, such as healthcare professionals (HCPs) working with vulnerable patients. Since HCPs are trusted information sources, a priority population for COVID-19 vaccination, and potentially subjected to mandates, we investigated HCP perspectives on mandates.MethodsA national online survey was administered to HCPs (October 2020-March 2021), including vaccine mandates questions concerning patients (measles) and HCPs (influenza). We qualitatively investigated HCP mandate perspectives through: (1) 34 interviews with HCPs, HCP professional society representatives, and health authorities; (2) a focus group discussion (FGD) with complementary medicine (CM) and biomedical physicians, and Swiss Federal Vaccination Commission members.Results1933 participants (496 physicians, 226 pharmacists, 607 nurses, 604 midwives) responded to the survey. Quantitative results show all professional groups preferred shared parent-HCP measles vaccine decisions (65%, 54%, 50%, 48%, respectively; p for trend < 0.001). Midwives (87%) and nurses (70%) preferred individual influenza vaccination decisions for HCPs, while physicians (49%) and pharmacists (44%) preferred shared employee-employer decisions (p for trend < 0.001). Physicians (p < .001) and pharmacists (p < .01) with CM training favored individual influenza vaccination decisions. Qualitative results show general HCP opposition to vaccine mandates, mainly because participants argued how other approaches, such as HCP training and better information, could encourage uptake. Arguments against COVID-19 mandates included insufficiently documented long-term safety/efficacy data. From participants’ perspectives, mandated vaccination should be used as a last resort. Some participants expressed fear that with mandates, notably for influenza and COVID-19, some HCPs might leave their jobs. HCPs were unsure what vaccine mandates would concretely look like in practice, particularly regarding sanctions for non-compliance and enforcement.ConclusionIn Switzerland, HCPs generally were opposed to vaccination mandates. Clarity and guidance are needed from health authorities to better inform discussions around vaccine mandates.     

Decline in Veterans’ Admissions to Nursing Homes during COVID-19: Fewer Beds,More Fear,and Finding Alternative Care Settings

ObjectiveExamine the decline in admission to community nursing homes among Veterans that occurred following the onset of the COVID-19 pandemic.DesignMultimethods study using Department of Veterans Affairs (VA) purchasing records to examine trends in total admissions and semistructured interviews with staff connected to the VA community nursing home program to contextualize observed trends.Setting and participantsAll VA-paid admissions to community nursing homes (N = 56,720 admissions) and national data on nursing home admissions from LTCFocUS. Semistructured interviews were conducted with 9 VA staff from 4 VA medical centers working in the VA community nursing home program, including social workers, nurses, and program coordinators.ResultsBetween April and December 2020, community nursing home admissions among Veterans were 35% lower compared with the same period in 2019. Nationally, total nursing home admissions decreased by 19.6%. VA community nursing home program staff described 3 themes that contributed to this decline: (1) fewer nursing home beds available, (2) lower admissions due to fear of Veterans being exposed to COVID-19 in nursing homes, and (3) leaving nursing homes in favor of living at home with home-based care.Conclusions and ImplicationsThe decline in nursing home admissions among Veterans raises questions about how replacing nursing home care in favor of home- and community-based care affects the health outcomes and well-being of Veterans and their caregivers.     

Reflections on Serving Remote Mountain Communities: Mobile Hospitals and Women’s and Children’s Health Care in Northern Haiti

In 2003 Alyans Sante Borgne’s (ASB) conducted the first week-long mobile hospital in Molas, a poor mountain community a 10-h walk from the main hospital in the town of Borgne in North Haiti. ASB is a partnership between Haiti Outreach—Pwoje Espwa (H.O.P.E.), a US-based NGO, and Haiti’s Ministry of Health. The paper reflects on this first experience and the evolution of an indigenous model of health care delivery, Sante Nan Lakou (SNL)/Health at the Extended Family Level, a model that prioritizes the needs of patients over those of the institution. It highlights the challenges of providing quality care to a much neglected segment of our population and documents the impact of this event for the community and for ASB. Lessons learned during that week shaped ASB’s response to the root causes of women and children’s poor health in the commune of Borgne. The response is articulated in a holistic grassroots program called Sante/Health, Edikasyon/Education, Ekonomi/Economy for Fanm/Women (SEE Fanm). SEE Fanm is a constellation of programs and initiatives that together brings quality care to women and seeks to empower them to take charge of their health and wellbeing and, by extension, that of their families and communities.     

Disparities in Health Insurance Coverage and Access to Care for Children By Mother’s Sexual Orientation

Maternal and Child Health Journal - Few population-based studies have examined the health care experiences of children with sexual minority parents. The purpose of this study was to compare health...     

Resilience in Women’s Sexual Pain After Female Genital Cutting: Adaptation Across Time and Personal and Cultural Context

Archives of Sexual Behavior -     

Access to Money and Relation to Women’s Use of Family Planning Methods Among Young Married Women in Rural India

Objectives The social positioning (i.e. social status and autonomy) of women in the household facilitates women’s access to and decision-making power related to family planning (FP). Women’s access to spending money, which may be an indicator of greater social positioning in the household, may also be greater among women who engage in income generating activities for their families, regardless of women’s status in the household. However, in both scenarios, access to money may independently afford greater opportunity to obtain family planning services among women. This study seeks to assess whether access to money is associated with FP outcomes independently of women’s social positioning in their households. Methods Using survey data from married couples in rural Maharashtra, India (n = 855), crude and adjusted regression was used to assess women’s access to their own spending money in relation to past 3 month use of condoms and other forms of contraceptives (pills, injectables, intrauterine device). Results Access to money (59 %) was associated with condom and other contraceptive use (AORs ranged 1.5–1.8). These findings remained significant after adjusting for women’s FP decision-making power in the household and mobility to seek FP services. Conclusion While preliminary, findings suggest that access to money may increase women’s ability to obtain FP methods, even in contexts where social norms to support women’s power in FP decision-making may not be readily adopted.     

Exploring Variations in North American Adults’ Attitudes,Interest, Experience,and Outcomes Related to Mixed-Gender Threesomes: A Replication and Extension

Mixed-gender threesomes (MGTs) are a type of consensually nonmonogamous sexual encounter involving three people of more than one gender. Little research has been conducted on MGTs, and what little work does exist is limited to college students, who may actually be less experienced with MGTs than older adults. The present study investigated attitudes toward, interest in, experiences with, and outcomes of MGTs in two samples (college N?=?231; online N?=?1342), comprised of 907 heterosexual and 666 sexual minority participants in total. Results indicated that participants reported neutral-to-positive attitudes toward and moderate-to-high levels of interest in MGTs (81% indicated some degree of interest). MGTs involving familiar others were preferred to those involving strangers. Men, sexual minority individuals, and participants from the online sample reported more favorable attitudes toward and greater interest in MGTs as compared to women, heterosexual individuals, and participants from the student sample. In addition, 30% of participants indicated having experience with a MGT. Sexual minority individuals reported more experience with MGTs and more positive outcomes than did heterosexual individuals. In addition, on average, participants reported that their MGT experiences “met expectations.” Overall, these results indicate that MGTs are a common sexual behavior that often results in positive outcomes, especially among sexual minority individuals. Additional research on this understudied topic is needed, particularly as it relates to outcomes and the role of MGTs in consensually nonmonogamous relationships.