Perceived Barriers and Benefits of COVID-19 Testing among Pacific Islanders on Guam.

Pacific Islanders residing in the U.S. Affiliated Pacific Islands have had among the highest COVID-19-associated morbidity and mortality rates in the U.S. To reduce this disparity, we conducted a study to increase the reach and uptake of COVID-19 testing in Guam. Participants, who completed a pre-survey on demographics, health status, history of COVID-19 testing and vaccination, access to COVID-19 testing, sources of COVID-19 information, and knowledge and attitudes towards COVID-19 test results and transmission, were invited to attend an online educational session about COVID-19 testing and transmission and to complete a post-survey. There were significant positive changes between pre- and post-survey in knowledge and perceptions about COVID-19 testing and transmission, but changes were not necessarily due to exposure to the educational session. Compared to CHamoru participants (n = 380), Other Micronesians (n = 90) were significantly less knowledgeable about COVID-19 transmission and testing, were significantly more likely to not want to know if they had COVID-19, were more likely to believe if they did have COVID-19 there was not much that could be done for them, and that they would have difficulty in getting the needed healthcare. This study is another example of disparities in health knowledge and perceptions of certain Pacific Islander groups.

Technical note: Low clinical efficacy, but good acceptability of a point-of-care electronic palpation device for breast cancer screening for a lower middle-income environment.

BACKGROUND: Late-stage breast cancer rates in the Pacific where mammography services are limited are exceedingly high: Marshall Islands (61%), Palau (94%), and Samoa (79%). Due to the limited medical resources in these areas an alternative accessible technology is needed. The iBreast Exam (iBE) is a point-of-care electronic palpitation device that has a reported sensitivity of 86%. However, little is known about the performance and acceptability of this device for women in the Pacific. METHODS: A total of 39 women (ages 42-73 years) were recruited in Guam with 19 women having a mammogram requiring biopsy (Breast Imaging-Reporting and Data System [BI-RADS] category 4 or above) and 20 women with a negative screening mammogram before the study visit. Participants received an iBE exam and completed a 26-item breast health questionnaire to evaluate the iBE. Furthermore, the performance characteristics of the iBE were tested using gelatin breast phantoms in terms of tumor size, tumor depth, and overall breast stiffness. RESULTS: The iBE had a sensitivity of 20% (two true positives to eight false negatives) and specificity of 92% (24 false positives to 278 true negatives) when analyzed based on the location of the tumor by quadrant. The iBE also had generally poor agreement according to a Cohen's kappa value of 0.068. The phantom experiments showed that the iBE can detect tumors as deep as 2.5 cm, but only if the lesion is greater than 8 mm in diameter. However, the iBE did demonstrate acceptability; 67% of the women reported that they had high trust in iBE as an early detection device. CONCLUSIONS: The iBE had generally poor sensitivity and specificity when tested in a clinical setting which does not allow its use as a screening tool. IMPACT: This study demonstrates the need for an alternative screening method other than electronic palpation for lower-middle-income areas.

Differences in Transitional Care Provided to Mexican American and Non-Hispanic White Older Adults.

BACKGROUND: Transitional care, assisting patients to move safely through multiple health care settings, may be insufficient for older Hispanic patients. PURPOSE: Describe home health care services referral rates for Hispanic and non-Hispanic White (NHW) patients and factors that influence case managers' (CMs') discharge planning processes. DESIGN: Organized by the Ethno-Cultural Gerontological Nursing Model, health records were reviewed ( n = 33,597 cases) and supplemented with qualitative description ( n = 8 CMs). FINDINGS: Controlling for gender, insurance type, age, and hospital length of stay, NHW older adults received more home health care services referrals (odds ratio = 1.23). Insurance coverage was the most frequent determinant of CMs' post-hospital care choices, rather than patients' being Hispanic. NHW older adults were more likely to have insurance than Hispanic older adults. IMPLICATIONS: Insurance coverage being CMs' primary consideration in determining patients' dispositions is a form of systems-level discrimination for Hispanic vulnerable groups, which combined with other hospital-level constraints, should be addressed with policy-level interventions.