Abstract Background Arkansas has the largest population of Marshallese Pacific Islanders residing in the continental United States. Marshallese are disproportionately burdened by poorer maternal and infant health outcomes. Exclusive breastfeeding can prevent or help mitigate maternal and infant health disparities. However, exclusive breastfeeding among United States Marshallese communities remains disproportionately low, and the reasons are not well documented. This paper describes the protocol of a mixed-methods concurrent triangulation longitudinal study designed to explore the beliefs and experiences that serve as barriers and/or facilitators to exclusive breastfeeding intention, initiation, and duration among Marshallese mothers in northwest Arkansas. Methods The mixed-methods design collects qualitative and quantitative data during simultaneous data collection events, at third trimester, six weeks postpartum, and six months postpartum. Quantitative and qualitative data will be analyzed separately and then synthesized during the interpretation phase. The research team will disseminate results to study participants, research stakeholders, the broader Marshallese community, and fellow researchers. Discussion Findings and results will be presented in subsequent manuscripts upon completion of the study. This study will be an important first step to better understand beliefs and experiences to exclusive breastfeeding intention, initiation, and duration in this community and will inform tools and interventions to help improve health outcomes. The study will also aid in filling the gap in research and providing essential information on the infant feeding beliefs and barriers among a Marshallese community in Arkansas.
Marshallese face significant health disparities, with particularly high rates of type 2 diabetes. Engaging stakeholders in the research process is essential to reduce health inequities. A community- and patient-engaged research approach was used to involve community Marshallese stakeholders in a randomized comparative effectiveness trial testing two Diabetes Prevention Program interventions. The article outlines the engagement process and the specific influence that stakeholders had on the research planning and implementation, discussing the areas of agreement and disagreement between community and patient stakeholders and academic investigators and documenting changes to the research protocol. The article provides an example of methods that can be used to design and conduct a randomized controlled trial testing with a population who has been underrepresented in research and suffered significant historical trauma.
Background: Inadequate health literacy is a national health problem that affects about 90 million people from all racial and ethnic groups in the United States. Conceptual and empirical models of health literacy position language as one of the most significant contributors to health literacy. Objective: A validated Spanish health literacy screening question asks how confident patients are at filling out medical forms, but it does not clarify whether the forms are in English or in Spanish, contributing to ambiguity and potentially affecting validity. The purpose of this study was to compare responses to questions that clarified the language of the forms referenced in the validated screening question; to explore how the clarified items predicted scores on a measure of health literacy; and to compare the predictive ability of the clarified health literacy items to that of a question about patients' self-reported English proficiency. Methods: Participants who speak Spanish ( N = 200) completed the following surveys: Spanish Health Literacy Screening Question that clarified “English forms” (HLSQ-E) and that clarified “Spanish forms” (HLSQ-S), self-reported English proficiency (SEP), demographic questions, the Short Test of Functional Health Literacy for Adults Spanish (S-TOFHLA-S), and the Newest Vital Sign-Spanish (NVS-Spanish). Key Results: Participants reported less confidence with English medical forms than Spanish forms. The sensitivity of screening approaches varied; each predicted inadequate health literacy on the NVS-Spanish and S-TOFHLA-S with different levels of sensitivity, specificity, and accuracy. In general, the HLSQ-E was a better predictor of inadequate health literacy than the HLSQ-S; however, the SEP performed nearly as well as the HLSQ-E. Conclusion: “How confident are you at filling out medical forms in English…” more appropriately identified patients with inadequate health literacy who speak Spanish. Health literacy screening practices should consider the patient's language and the language of the health care system and use questions that are less ambiguous. [ HLRP: Health Literacy Research and Practice . 2019;3(2):e110–e116.] Plain Language Summary: This project focused on patients who speak Spanish and who have a hard time understanding health information. We wanted to find out the best ways to identify these patients so that doctors and nurses can be sure to give them information in ways that they can understand. We tested screening questions that can identify these patients.
Type 2 diabetes (T2D) is a significant public health problem, with U.S. Pacific Islander communities—such as the Marshallese—bearing a disproportionate burden. Using a community-based participatory approach (CBPR) that engages the strong family-based social infrastructure characteristic of Marshallese communities is a promising way to manage T2D. Led by a collaborative community-academic partnership, the Family Model of Diabetes Self-Management Education (DSME) aimed to change diabetes management behaviors to improve glycemic control in Marshallese adults with T2D by engaging the entire family. To test the Family Model of DSME, a randomized, controlled, comparative effectiveness trial with 240 primary participants was implemented. Half of the primary participants were randomly assigned to the Standard DSME and half were randomly assigned to the Family Model DSME. Both arms received ten hours of content comprised of 6–8 sessions delivered over a 6–8 week period. The Family Model DSME was a cultural adaptation of DSME, whereby the intervention focused on engaging family support for the primary participant with T2D. The Standard DSME was delivered to the primary participant in a community-based group format. Primary participants and participating family members were assessed at baseline and immediate post-intervention, and will also be assessed at 6 and 12 months. The Family Model of DSME aimed to improve glycemic control in Marshallese with T2D. The utilization of a CBPR approach that involves the local stakeholders and the engagement of the family-based social infrastructure of Marshallese communities increase potential for the intervention's success and sustainability.
Timely receipt of colorectal cancer screening can reduce morbidity and mortality. This is the first known study to adopt Andersen's model of health services use to identify factors associated with colorectal cancer screening among U.S. adults. The data from National Health Interview Survey from 2019 was utilized to conduct the analyses. Multivariable logistic regression was used to separately analyze data from 7,503 age-eligible women and 6,486 age-eligible men. We found similar colorectal cancer screening levels among men (57.7%) and women (57.6%). Factors associated with higher screening odds in women were older age, married/cohabitating with a partner, Black race, >bachelor's degree, having a usual source of care, and personal cancer history. Factors associated with lower odds for women were American Indian/Alaska Native race, living in the United States for ≤10 years, ≤138% federal poverty level (FPL), uninsured or having Medicare, and in fair/poor health. For men, factors associated with higher screening odds were older age, homosexuality, married/cohabitating with a partner, Black race, >high school/general educational development education, having military insurance, having a usual source of care, and personal cancer history. Factors associated with lower odds for men were being a foreign-born U.S. resident, living in the South or Midwest, ≤138% FPL, and being uninsured or having other insurance. Despite lower screening rates in the past, Black adults show a significantly higher likelihood of colorectal cancer screening than White adults; yet, screening disparities remain in certain other groups. Colorectal cancer screening efforts should continue to target groups with lower screening rates to eliminate screening disparities. Significance: Timely receipt of colorectal cancer screening can reduce morbidity and mortality. Identification of populations and domains of factors associated with colorectal cancer screening receipt among men and women can help future interventions to alleviate impeding factors and target screening promotion efforts in populations not adherent with screening guidelines.
Objective Food insecurity affects millions of Americans and is associated with a range of adverse health outcomes. Food insecure individuals often obtain food from food pantries/banks, prompting health researchers to implement disease prevention/management interventions at these sites. This review examined the existing peer-reviewed research on disease prevention/management interventions implemented in food pantries/banks. Design Scoping review. Data sources Databases searched included MEDLINE, Web of Science, CINAHL and Cochrane. Search strategies included Medical Subject Headings and key terms, including food pantry, food bank, food shelf, food aid and related concepts. Eligibility criteria Studies were included if they described an intervention involving food pantries/banks where at least one biometric indicator was included as an outcome variable. Articles focused solely on the quality of foods distributed, the diet quality of food pantry/bank clients or government food aid programmes were excluded. Data extraction and synthesis Extracted data included publication details, intervention type, study design, participant characteristics, study outcomes, and barriers and facilitators of intervention implementation. Results A total of 3317 articles were assessed for eligibility. Six studies met the predefined inclusion criteria. The studies employed a range of intervention approaches to manage or prevent a number of chronic diseases, including obesity, type 2 diabetes and HIV. The studies examined a range of biometric outcomes, including body mass index, glycated haemoglobin and blood pressure. Information about the food pantries/banks where the interventions were conducted was lacking. The studies documented multiple barriers and facilitators related to costs, sustainability and organisational capacity. Conclusions To our knowledge, this is the first review to examine disease prevention and management interventions conducted in food pantries and food banks. Given the high number of households who obtain food from food pantries/banks and the chronic health conditions associated with food insecurity, this review highlights the need for more high-quality research in this setting.
We used a convergent parallel design to explore NHPI men's multi-level perspectives of the factors that influence healthy eating, physical activity, and weight, to elicit recommendations for lifestyle interventions, and to understand the intersection of masculinity and health from a social constructionist perspective. From June to December 2017, NHPI men 18 years and older were recruited to participate in a survey and focus groups. The survey included demographic questions and questions about physical and cultural activities men engage in, perceived social support for lifestyle behaviors, dietary behaviors, masculine characteristics and values important to NHPI men. The Kessler Psychological Distress Scale was used to assess psychological distress. Focus groups were audio recorded and transcribed for a thematic analysis. Descriptive statistics were computed for survey data. We conducted eight focus groups with 89 NHPI men (50% Samoan, 20% Native Hawaiian, 30% Marshallese). The mean age of participants was 39 years, 43% reported some college or college graduate, 64% were currently married, and 63% were working full time. Ninety percent of men scored 20 or higher on the K10 scale indicating mild to severe psychological distress. Men described food as a major part of their culture and their identity. Men's roles were defined as provider and protector, with little attention is paid to their own health. Our study found that hegemonic, or traditional masculinity and social norms may encourage some men to put their health at risk but may also be used to motivate healthy behaviors.
