Mexican immigrants' attitudes and interest in health insurance: a qualitative descriptive study.

Mexican immigrants to the U.S. are nearly three times more likely to be without health insurance than non-Hispanic native citizens. To inform strategies to increase the number of insured within this population, we elicited immigrants' understanding of health insurance and preferences for coverage. Nine focus groups with Mexican immigrants were conducted across the State of North Carolina. Qualitative, descriptive methods were used to assess people's understanding of health insurance, identify their perceived need for health insurance, describe perceived barriers to obtaining coverage, and prioritize the components of insurance that immigrants value most. Individuals have a basic understanding of health insurance and perceive it as necessary. Participants most valued insurance that would cover emergencies, make care affordable, and protect family members. Barriers to obtaining insurance included cost, concerns about immigration status discovery, and communication issues. Strategies that address immigrants' preferences for and barriers to insurance should be considered.

Teaching Advanced Leadership Skills in Community Service (ALSCS) to medical students.

Inadequate access to health care, lack of health insurance, and significant health disparities reflect crises in health care affecting all of society. Training U.S. physicians to possess not only clinical expertise but also sufficient leadership skills is essential to solve these problems and to effectively improve health care systems. Few models in the undergraduate medical curriculum exist for teaching students how to combine needed leadership competencies with actual service opportunities.The Advanced Leadership Skills in Community Service (ALSCS) selective developed in response to the shortage of leadership models and leadership training for medical students. The ALSCS selective is designed specifically to increase students' leadership skills, with an emphasis on community service. The selective integrates classroom-based learning, hands-on application of learned skills, and service learning. More than 60 medical students have participated in the selective since inception. Short-term outcomes demonstrate an increase in students' self-efficacy around multiple dimensions of leadership skills (e.g., fundraising, networking, motivating others). Students have also successfully completed more than a dozen leadership and community service projects. The selective offers an innovative model of a leadership-skills-based course that can have a positive impact on leadership skill development among medical school students and that can be incorporated into the medical school curriculum.

Accuracy of self-assessed Spanish fluency in medical students.

BACKGROUND: Non-English language fluency is increasingly important in patient care. Fluency self-assessment is easily obtained, but its accuracy is unknown. PURPOSES: The purpose is to determine accuracy of medical students' self-assessed Spanish fluency. METHODS: Four matriculating classes assessed their own oral fluency as ("none":"novice";"intermediate";"advanced";"native-speaker"). Participants who rated themselves greater than "novice" and who expressed interest in medical Spanish coursework took a standardized fluency test (Spoken Language Evaluation, scaled 1-12). Using predetermined test categories (1-5 = novice, 6-8 = intermediate, 9-12 = advanced/native), we determined the predictive value of self-assessment for predicting the same or greater fluency on the test. RESULTS: Of 102 participants, 12 (12%) tested below their self-assessed level, 77 (75%) tested at their self-assessed level, and 13 (13%) tested above. The predictive value of self-assessment for having at least that fluency level was 88% (95% CI = 80, 94). CONCLUSIONS: In medical students reporting greater than "novice" capability and interest in medical Spanish coursework, fluency self-assessment was a good indicator of scores on a standardized fluency test.

Sexual orientation and sexual health care needs: a comparison of women beneficiaries in outpatient military health care settings.

The objectives of this study are to compare the sexual concerns, interest and experiences in discussing these concerns with their doctor for women of "Only Men" and "Some to Only Women" sexual orientation. A survey was mailed to women patients from two military outpatient settings, with 1,196 women responding. Of eligible respondents (N = 1,170), 90% reported "Only Men" and 10% reported "Some to Only Women" sexual orientation. Sexual concerns varied by sexual orientation, while interest and experience in discussing sexual concerns and desire for physicians to initiate the topic differed minimally. Women with "Some to Only Women" sexual orientation have both similar and differing sexual concerns compared to "male-only" oriented women. Larger primary care patient-based studies of sexual health care needs of sexual minorities are needed.

A longitudinal medical Spanish program at one US medical school.

INTRODUCTION: Policymakers have recommended recruiting or training (or both) more US physicians who can provide care in Spanish. Few longitudinal medical Spanish programs have been described and evaluated. OBJECTIVE: This study aims to describe development and evaluation of the preclinical phase of a 4-y program designed to graduate physicians who can provide language-concordant care in Spanish. SETTING: Study was done in one public medical school in southeastern USA. PROGRAM DESCRIPTION: The program targeted intermediate/advanced Spanish speakers. Standardized fluency assessments were used to determine eligibility and evaluate participants' progress. Curriculum included didactic coursework, simulated patients, socio-cultural seminars, clinical skills rotations at sites serving Latinos, service-learning, and international immersion. PROGRAM EVALUATION: For the first two cohorts (n = 45) qualitative evaluation identified program improvement opportunities and found participants believed the program helped them maintain their Spanish skills. Mean interim (2-y) speaking proficiency scores were unchanged from baseline: 9.0 versus 8.7 at baseline on 12-point scale (p = 0.15). Mean interim listening comprehension scores (second cohort only, n = 25) increased from a baseline of 77 to 86% (p = 0.003). Proportions "passing" the listening comprehension test increased from 72 to 92% (p = 0.06). DISCUSSION: We describe development of a longitudinal Spanish program within a medical school. Participation was associated with improved Spanish listening comprehension and no change in speaking proficiency.

Survey of oral health practices among adults in a North Carolina Hispanic population.

PURPOSE: The purpose of this study was to collect baseline data pertaining to the oral health of Hispanics residing in Siler City, NC, a microcosm of the flourishing Latino growth found especially in the southeastern United States. METHODS: A convenience sample of 158 Hispanic adults was recruited. A 41-item Spanish language survey was utilized. Questions addressed preventive oral health practices, oral health knowledge and beliefs, perceived needs, and demographic information. RESULTS: Analysis of data were conducted to find demographic characteristics, frequencies, and correlations. The following associations were found statistically significant (p < .05): (1) brushing frequency and belief that healthy gums bleed; (2) dental insurance and frequency of dental visits; (3) source of oral hygiene instruction and participant's reported brushing or flossing, and dental visit frequency. CONCLUSIONS: This exploratory study found that this population lacks knowledge related to oral health and that they have indicated an overwhelming need for preventive dental prophylaxis. Characteristics found in this population were low income, low education, no dental insurance, and not speaking fluent English. The following suggestions may aid in eliminating dental health care disparities among this population: 1) training and recruiting oral health care providers that are culturally sensitive and speak Spanish; 2) conducting oral health promotional programs sensitive to the needs of Hispanics; 3) Dental Hygiene programs should expand clinical rotations to provide culturally diverse dental hygiene services; 4) changes should be made in North Carolina dental hygiene practice laws to increase care to underserved population.

Patient-centered outcomes for frequent headaches.

OBJECTIVE: To identify clinical outcomes that headache sufferers consider meaningful. BACKGROUND: Several standardized instruments have been developed to assess the severity of headaches and the impact of headaches on an individual's quality of life. To our knowledge, however, little research has been conducted to determine which of these many clinical endpoints are considered by headache sufferers themselves to be most important. METHODS: We conducted 4 focus groups with patients with frequent headaches who had recently participated in a randomized clinical trial. Subjects were informed that the purpose of the focus groups was to help healthcare providers learn how to better recognize if their patients' headache conditions improved or worsened over time. RESULTS: Five salient topics emerged from the discussions: (1) severity of pain associated with headaches; (2) definition of meaningful symptom relief; (3) uncertainty regarding timing and severity of headaches; (4) devaluation of the impact of headaches on sufferers; and (5) assessments of pain. Participants stated unambiguously that headache pain is one of the most important aspects of their headache experience. Each of the 4 groups agreed that an increase in the number of pain-free days would be meaningful. Participants also reported that daily headache diaries are not overly burdensome to complete and that the diaries helped them identify useful trends over time. CONCLUSIONS: Our findings suggest that severity and frequency of headache pain are important clinical outcomes from patients' perspective, and that headache diaries are a feasible and useful method of assessing meaningful clinical change over time. Although standardized questionnaires that assess functional status, disability, or health-related quality of life may help quantify patients' response to treatment for frequent headaches, participants in this study did not consider such questionnaires particularly informative. Further research is needed to validate headache diaries among patients with headache in the primary care setting.

Intimate partner violence among Latinas in eastern North Carolina.

This article explores the correlates of intimate partner violence (IPV) among rural, southern Latinas. A sample of 1,212 women in blue-collar work sites in rural North Carolina completed a questionnaire assessing IPV and other social, demographic, and health-related variables. Social and demographic correlates of IPV were examined. Adult lifetime prevalence of IPV in Latinas was 19.5%, similar to that of non-Latinas. As compared to Latinas who did not experience IPV and non-Latinas who experienced IPV, Latinas who experienced IPV were more likely to lack social support and to have children in the home. Agencies that provide services to victims of IPV in the rural South need to be prepared to meet the unique needs of Latina immigrants.

"Una mujer trabaja doble aqui": Vignette-based focus groups on stress and work for Latina blue-collar women in eastern North Carolina.

Latina women are a growing percentage of the working population, and very little is known about their health needs and interests. The purpose of this article is to share qualitative research results gathered from Latina women with a particular focus on exploring stress and health. This project was a substudy of Health Works in the Community, a 5-year CDC-funded multiple risk-factor reduction trial using participatory action research approaches to address smoking, healthy eating, stress, and physical activity among blue-collar women from 12 manufacturing work sites in rural, eastern North Carolina. Five focus groups were conducted with trained, bilingual facilitators using a vignette-based moderator guide that appeared particularly effective with this population. Results from the focus groups are used to make recommendations for future research with Latinas and for developing effective work-site-based interventions to address issues of stress and health within this population.

Asking about intimate partner violence: advice from female survivors to health care providers.

Understanding the perspectives of women who have experienced IPV will allow us to identify specific techniques of addressing IPV that increase patient comfort and willingness to disclose and/or seek help. Our study objective was to identify what advice women who had experienced IPV would give health providers regarding how to ask about and discuss the issue of IPV. The women in our study advised that providers (1) give a reason for why they are asking about IPV to reduce women's suspicions and minimize stigma, (2) create an atmosphere of safety and support, (3) provide information, support and access to resources regardless of whether the woman discloses IPV. They emphasized that a provider's asking about IPV is an opportunity to raise patient awareness of IPV, communicate compassion and provide information and not merely a screening test to diagnose a pathologic condition.

Mini-immersion in medical Spanish for family practice residents.

BACKGROUND: Residency programs vary widely in types of training to increase cultural competency and sensitivity. Moreover, few empirical studies exist regarding effectiveness of these experiences. The purpose of our study was to offer and evaluate a linguistic mini-immersion, !Español Rápido!, required of 8 new family practice interns during their orientation month at the University of North Carolina. DESCRIPTION: The curriculum was based on accelerative learning, a pedagogy that considers all parts of the brain, the paraconscious, and the role of the emotions. EVALUATION: Pretests and posttests and a postimmersion and 6-month follow-up evaluation indicated that the mini-immersion was successful. A simple t test for paired samples showed a significant improvement in interns' comprehension after the 6-day immersion, t(7)=11.399, p<.000. CONCLUSION: This brief experience should be viewed only as a first step in a long-term plan for a comprehensive curriculum to prepare family practice residents as culturally competent practitioners.

Knowledge and attitudes about intimate partner violence among immigrant Latinos in rural North Carolina: baseline information and implications for outreach.

To create appropriate intimate partner violence (IPV) services for Latino immigrants, practitioners must be aware of their needs. We conducted interviews with 100 recent Latino immigrants in a rural North Carolina county. Overall, IPV was not perceived to be a problem; however, men and women differed in their perceptions. Men were more likely to agree with IPV myths, and both men and women felt that IPV had a detrimental impact on children. Many did not know about the local domestic violence agency, and knowledge about protective orders was limited. Outreach should emphasize the seriousness of IPV, adapt content for gender-specific audiences, and increase awareness about local resources.

Disaster down East: using participatory action research to explore intimate partner violence in eastern North Carolina.

In the aftermath of Hurricane Floyd in 1999, a Community Advisory Committee requested assistance from its university partners (University of North Carolina) to address stress and increased risk for intimate partner violence (IPV). Collected from 12 study work sites, baseline data indicated that IPV rates were higher among blue-collar women in eastern North Carolina than national population-based rates suggest. IPV victims reported higher levels of perceived stress, psychological distress, somatic complaints, and post-traumatic stress disorder (PTSD) symptoms than did nonvictimized coworkers. As for the relationship of the flood to IPV, no significant increase in IPV incidence occurred after the flood. Regardless of their flood experience, however, IPV victims consistently reported greater stress, PTSD symptoms, and somatic and psychological problems. Moreover, IPV victims may be at higher risk for stress-mediated chronic illnesses and for using negative coping behaviors. This study uses an established trusting relationship between researchers and community members to explore community needs and inform intervention design.

What happens when health care providers ask about intimate partner violence? A description of consequences from the perspectives of female survivors.

OBJECTIVE: To describe positive and negative consequences of health care screening for intimate partner violence from the perspectives of female survivors. METHOD: We conducted 7 semistructured focus group interviews with 41 women in battered women's shelters or intimate partner violence support groups. RESULTS: Positive consequences of screening included: recognizing that the violence was a problem, decreased isolation, and feeling that the medical provider cared. Negative consequences included: feeling judged by the provider, increased anxiety about the unknown, feeling that the intervention protocol was cumbersome or intrusive, and disappointment in the provider's response. CONCLUSION: We found that both positive and negative consequences can result from screening for intimate partner violence and that they are related to provider behavior. The positive consequences described by the participants reflect changes in their attitudes, thoughts, and feelings that may precede help seeking. A better understanding of consequences can help providers tailor screening approaches and interventions for intimate partner violence.

Increasing physician comfort level in screening and counseling patients for intimate partner violence: hands-on practice.

A paucity of literature exists on implementing and evaluating residency curriculum addressing intimate partner violence. We used unknown simulated patients in a university-based family practice clinic following a pilot curriculum intervention. The curriculum focused on physician comfort with screening, counseling, and referral of patients, using standard conferences as well as a role-play session. Subsequently, unknown simulated patients were inserted into residents' clinic schedules during videotaped sessions. Evaluation included skills checklists from simulated patients, review of videotapes, and post-study resident interviews. Use of unknown simulated patients encouraged residents to consider and screen for intimate partner violence. Using simulated patients is logistically complex but provides a powerful residency training tool. Residents reported attitude changes favoring a more comprehensive role and reported greater comfort and confidence with screening and counseling.