Suchergebnisse

There is a growing interest in community-level characteristics such as social capital and its relationship to health care access. To assess the rigor with which this construct has been empirically applied in research on health care access, a systematic review was conducted. A total of 2,396 abstracts were reviewed, and 21 met the criteria of examining some measure of social capital and its effects on health care access. The review found a lack of congruence in how social capital was measured and interpreted and a general inconsistency in findings, which made it difficult to draw firm conclusions about the effects of social capital on health care access. Insights from the social network literature can help improve the conceptual and measurement problems. Future work should distinguish among bonding, bridging, and linking social capital and their sources and benefits, and examine whether three dimensions of social capital actually exist: cognitive, behavioral, and structural.

Many Latinos have limited English proficiency and this may negatively affect their use of health care services. To examine this, the authors interviewed 465 Spanish-speaking Latinos and 259 English speakers of various ethnicities who presented to a public hospital emergency department with nonurgent medical problems to assess previous physician visits, sociodemographic characteristics, and level of English proficiency. The proportion of patients who reported no physician visit during the 3 months before study enrollment was not related to English proficiency. However, among the 414 patients who saw a physician at least once, Latinos with fair and poor English proficiency reported approximately 22 percent fewer physician visits (p = 0.020 and p = 0.015, respectively) than non-Latinos whose native language was English, even after adjusting for other determinants of physician visits. The magnitude of the association between limited English proficiency and number of physician visits was similar to that for having poor health, no health insurance, or no regular source of care.

An evaluation of Community Voices Miami (CVM), a project aimed at enhancing health care access and quality for the underserved in Miami-Dade County, Florida. The report concludes that CVM affected intermediate outcomes--raising awareness of issues, getting safety-net providers to collaborate, nurturing neighborhood-based solutions, and advocating for establishment of an independent health care planning body; but measurement of ultimate outcomes--access to health care--remains for future study

An examination of the governance of public funds for health care in Miami-Dade County. Principles of good governance are discussed, and approaches of other locales to providing health care to the uninsured are summarized. The agency that operates Miami-Dade's health care facilities is also responsible for countywide health care planning, a dual mission that inherently creates a conflict of interest

Purpose. Examine how religious congregations engage in social entrepreneurship as they strive to meet health-related needs in their communities. Design. Multiple case studies. Setting. Los Angeles County, California. Participants. Purposive sample of 14 congregations representing diverse races/ethnicities (African-American, Latino, and white) and faith traditions (Jewish and various Christian). Method. Congregations were recruited based on screening data and consultation of a community advisory board. In each congregation, researchers conducted interviews with clergy and lay leaders (n = 57); administered a congregational questionnaire; observed health activities, worship services, and neighborhood context; and reviewed archival information. Interviews were analyzed by using a qualitative, code-based approach. Results. Congregations' health-related activities tended to be episodic, small in scale, and local in scope. Trust and social capital played important roles in congregations' health initiatives, providing a safe, confidential environment and leveraging resources from—and for—faith-based and secular organizations in their community networks. Congregations also served as "incubators" for members to engage in social entrepreneurship. Conclusion. Although the small scale of congregations' health initiatives suggest they may not have the capacity to provide the main infrastructure for service provision, congregations can complement the efforts of health and social providers with their unique strengths. Specifically, congregations are distinctive in their ability to identify unmet local needs, and congregations' position in their communities permit them to network in productive ways.

Describes the involvement of churches and other faith-based organizations (FBOs) in addressing the HIV/AIDS epidemic in Belize, Guatemala, and Honduras. The authors describe the range of FBO activities and discuss the advantages and challenges to such involvement and possible ways that FBOs can enhance their efforts, both independently and in collaboration with other organizations, such as government ministries of health

This study examines the extent to which uncompensated care is provided by hopitals in Miami-Dade County, USA, other than Jackson Memorial Hospital (JMH), and whether the greater access to surtax-funded care at JMH might cause patients to pass up facilities nearer to the homes

Objective The purpose of the study is to present a comprehensive systematic review of the effects of park-based interventions on health outcomes among youth, defined as children and adolescents. Data Source Web of Science, MEDLINE, and Scopus databases searched through November 2020. Study Inclusion and Exclusion Criteria Interventions conducted in publicly accessible parks that evaluated health outcomes (i.e., physical, mental, and emotional); focused on children and adolescents (up to 18 years old, or up to 22 years old for individuals with developmental needs); and was published in English, Spanish, and Chinese. Data Extraction Two independent reviewers extracted data and assessed the quality of the 15 included studies using the Guide to Community Preventive Services tool. Data Synthesis Descriptive summary of study characteristics and summarized methodological quality of the studies. Results Twelve studies were person-based interventions involving the evaluation of health outcome changes in cohorts, and the remaining studies were park-based, focused on changing the park environment and observing changes in youth participation in parks. All identified interventions were positively associated with individual-level and park-level outcomes ranging from body weight, moderate-to-vigorous-intensity physical activity, park utilization, and health behavior knowledge. Conclusions This systematic review demonstrated that parks as sites of interventions can provide an environment that promotes health and wellbeing for youth. Nevertheless, the number of relevant studies were limited, thus it is important to leverage and expand on existing knowledge of the utility of parks as sites of intervention to address health concerns at this critical juncture of the life course.

Over the past 15 years, striking new settlement patterns have emerged that have brought about unprecedented geographic dispersion in the population of approximately 45 million Hispanics in the United States. In this study, the authors compare the health care experiences of working age U.S.-born Mexican Americans and Mexican immigrants living in new and traditional Hispanic destinations. They use a geocoded version of the Medical Expenditure Panel Survey Household Component linked to contextual data from secondary sources. They characterize destinations as new or traditional using information on the percentage of the population that was Hispanic in 1990 and the growth in percent Hispanic between 1990 and 2000. The authors find that, compared with living in destinations with a well-established Hispanic presence, U.S.-born Mexican Americans living in new destinations have less favorable health care outcomes, including a greater probability of having an unmet need for or delay in receiving medical care and reduced satisfaction with care.

Inadequate access and poor quality care for immigrants could have serious consequences for their health and that of the overall U.S. population. The authors conducted a systematic search for post-1996, population-based studies of immigrants and health care. Of the 1,559 articles identified, 67 met study criteria of which 77% examined access, 27% quality, and 6% cost. Noncitizens and their children were less likely to have health insurance and a regular source of care and had lower use than the U.S. born. The foreign born or non-English speakers were less satisfied and reported lower ratings and more discrimination. Immigrants incurred lower costs than the U.S. born, except emergency department expenditures for immigrant children. Policy solutions are needed to improve health care for immigrants and their children. Research is needed to elucidate immigrants' nonfinancial barriers, receipt of specific processes of care, cost of care, and health care experiences in nontraditional U.S. destinations.

We conducted a cross-sectional secondary analysis of data from the 2012 National Congregation Study, a nationally representative survey of religious congregations in the United States ( N = 1,331). Multivariate logistic regression was used to identify congregational characteristics associated with providing substance use support programing. Nearly one-third (38%) of U.S. congregations indicated that they provided substance use support programming; approximately half (52%) of all congregational attendees were in a congregation that provided some type of substance use support. The internal factors associated with a congregation providing substance use programming include having members who are unemployed and younger, being conservative Protestant, engaging in the practice of speaking in tongues, and having the resources to support social services. The analysis also identifies external factors (i.e., assessing community needs and hosting social service speakers) as being associated with a congregation's likelihood of providing substance use programming. Findings identify factors associated with congregations providing substance use support.

Faith-based organizations (FBOs) are an important community-based resource for veterans as they readjust to civilian life. Through interviews with both national-level and smaller, local FBOs, the authors sought to understand better the current and potential roles for FBOs in veteran reintegration. Interviewees suggested that veterans may look to FBOs for support because they offer privacy and confidentiality, two features that may be especially critical when a potential stigma is involved. Some FBOs have also developed a reputation as safe places for veterans, providing supportive, judgment-free environments. FBOs not only help veterans with spiritual matters but address diverse areas of veteran health and wellness, including vocation, education, financial and legal stability, shelter, access to goods and services, mental health, access to health care, physical health, family, and social networks. In some cases, the support is offered to veterans directly; in other instances, the support is indirect, via training individuals to help veterans or educating the public about them. In the process of providing support, FBOs interact with varied organizations, including government entities, private nonprofits, and one another, for training, outreach, referrals, information exchange, obtaining donations, and collaboration. Yet challenges exist, including insufficient connections with chaplains working in different settings and others in the web of support, resource and capacity constraints, lack of awareness of experience with veterans, issues related to religious philosophy or orientation, and characteristics of veterans themselves. To move forward, the authors offer recommendations for policymakers, organizations that interact with FBOs, and FBOs themselves to help FBOs engage fully in the web of reintegration support.

Residential segregation is associated geographic disparities in access to care, but its impact on local health care policy, including public hospitals, is unknown. We examined the effects of racial residential segregation on U.S. urban public hospital closures from 1987 to 2007, controlling for hospital, market, and policy characteristics. We found that a high level of residential segregation moderated the protective effects of Black population composition, such that a high level of residential segregation, in combination with a high percentage of poor residents, conferred a higher likelihood of hospital closure. More segregated and poorer communities face disadvantages in access to care that may be compounded as a result of instability in the health care safety net. Policy makers should consider the influence of social factors such as residential segregation on the allocation of the safety net resources.