Elements for successful implementation of a clinic-based health literacy intervention.

Improving health literacy is a national public health priority. Given the context of the COVID-19 pandemic, it is even more critical for health and medical information to be clear and understandable for patients and their families. Clinic-based programs to improve health literacy need to be pragmatic, feasible, and helpful for the implementing clinic and patients. This paper describes the development, implementation, and evaluation of a pragmatic, clinic-based health literacy intervention in a safety-net clinic that serves uninsured and indigent patients. Study methods are guided by a previous pilot study and components recommended for pragmatic interventions. An electronic readiness assessment was distributed to out-patient clinics affiliated with a statewide hospital association. The AskMe3 tool was used for the intervention as it is evidence informed and relatively easy to implement. Implementation included ongoing dialogue between the clinic and the academic research team. Within the implementing clinic, data collected from patients via verbally administered questionnaires was analyzed using descriptive statistics and chi-squares. Interview data collected from the clinic director was analyzed qualitatively for themes. The implementing clinic had some of the lowest average scores of the 34 clinics who participated in the initial readiness assessment. Despite this, they were able to successfully implement the health literacy intervention during a global pandemic. Eighty-eight participants completed patient questionnaires at this clinic. Most patients (96%) agreed the AskMe3 questions helped them talk with the doctor or nurse at their current appointment. Most (99%) also perceived the AskMe3 tool to be very helpful when used in a clinical setting. The clinic director offered that the staff initially thought the intervention would be difficult to implement. However, implementation by clinic volunteers with encouragement and prioritization of health literacy by the clinic director contributed to success. When considering interventions for clinical settings, a pragmatic approach can help with selection and implementation of a program that fits with the realities on the ground. Further, frequent technical assistance can help resolve implementation barriers. Interventions utilizing tools such as AskMe3, because of their simplicity, allow creative solutions to capacity issues for clinics who see a need for health literacy improvements.

A qualitative report of the perceptions of the COVID-19 pandemic from collegiate student-athletes

Context The COVID-19 pandemic led to an abrupt disruption in access to services and personnel for collegiate student-athletes in the spring and summer of 2020. We sought to identify the effects of this unprecedented change by examining the psychological well-being, changes to normal routines, and return-to-play considerations of current student-athletes in order to guide support for both current and future student-athletes who may face similar situations. Methods We utilized a phenomenological approach to interview a purposeful sample of eighteen collegiate student-athletes (7 males, 11 females;mean age = 20 years) from across the United States. The participants were interviewed using a semi-structured interview protocol, which was audio recorded and transcribed verbatim using Zoom. The data were then analyzed and coded by a 3-person team via the consensual qualitative research tradition. Results Four domains emerged after data analysis: 1) ambiguity, 2) perspective, 3) bonding and cohesion, and 4) resource utilization. Participants discussed ambiguity in terms of eligibility and participation questions, academic changes, and varying COVID-19 policies. Participants shared a wide range of perspectives, from apprehension at the onset of the pandemic, to excitement when returning to campus and competition. They shared how bonding and team development were affected due to a lack of socialization and that support system dynamics between family, coaches, and teammates were strengthened. When describing resource utilization, participants discussed the use of personnel and supplies to help them adjust to changes in facility and space availability. The identification and utilization of resources enabled them to establish a “new normal” for their academics, workouts, and hobbies during the pandemic. Conclusions Collegiate student-athletes realized the seriousness of the pandemic and utilized their resources and support systems to adjust their routines and keep a positive attitude during COVID-19. At the same time, some student-athletes struggled with these changes. Personnel should be aware of these effects to provide care and prevent future negative effects.

Social Determinants of Health and Depression among African American Adults: A Scoping Review of Current Research.

Depression in the United States (US) is increasing across all races and ethnicities and is attributed to multiple social determinants of health (SDOH). For members of historically marginalized races and ethnicities, depression is often underreported and undertreated, and can present as more severe. Limited research explores multiple SDOH and depression among African American adults in the US. Guided by Healthy People (HP) 2030, and using cross-disciplinary mental health terminology, we conducted a comprehensive search to capture studies specific to African American adults in the US published after 2016. We applied known scoping review methodology and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. From 12,315 initial results, 60 studies were included in our final sample. Most studies explored the HP 2030 Social and Community Context domain, with a heavy focus on discrimination and social support; no studies examined Health Care Access and Quality. Researchers typically utilized cross-sectional, secondary datasets; no qualitative studies were included. We recommend research that comprehensively examines mental health risk and protective factors over the life course within, not just between, populations to inform tailored health promotion and public policy interventions for improving SDOH and reducing racial and ethnic health disparities.