Social Determinants and Health Disparities Associated With Outcomes of Women of Childbearing Age Who Receive Public Health Nurse Home Visiting Services.

OBJECTIVE: To examine the associations between social and behavioral determinants of health (SBDH), health disparities, and the outcomes of women who received public health nurse home visits for pregnancy and parenting support. DESIGN: Observational exploratory data analysis and comparative outcome evaluation. SETTING: An extant dataset from women served in a Midwestern U.S. state, including demographics and Omaha System problems, signs/symptoms, interventions, and outcome assessments. PARTICIPANTS: Women (N = 4,263) with an average age of 23.6 years (SD = 6.1); 21.4% were married, and 39.1% were White. METHODS: An evaluation dataset was constructed that included all women of childbearing age, their demographics, and outcome assessments. A summative SBDH Index based on Institute of Medicine-recommended instruments was computed based on sign/symptom data. Visualizations were developed using Microsoft Excel, and outcome significance statistics were computed using SPSS version 22 and SAS version 9.4. RESULTS: Outcome evaluation showed positive, significant changes from baseline after public health nurse intervention. Visualization showed variable concentrations of problem-specific signs/symptoms by SBDH Index subgroups. There were between-group differences in overall outcome attainment across SBDH Index subgroups. Compared with White women, minority women had greater improvement; however, despite these gains overall minority final ratings were lower. CONCLUSION: An informatics approach showed that SBDH are important factors for understanding a comprehensive and holistic view of health and health care outcomes. There is potential to use large datasets to further explore intervention effectiveness and progress toward health equity related to SBDH.

Family home visiting outcomes for Latina mothers with and without mental health problems.

OBJECTIVE: To evaluate outcomes of a public health nursing family home visiting (FHV) intervention for Latina mothers with and without mental health problems. DESIGN AND SAMPLE: Retrospective cohort analysis of de-identified FHV data. Latina clients served by public health nurses (PHNS) in an urban Midwest public health agency (2007-2010). Of the 680 clients there were 158 with mental health problems (n = 30, 14-17 year olds; n = 128, 18-52 year olds) and 522 without mental health problems (n = 100, 14-17 year olds; n = 422, 18-52 year olds). MEASURES: Client age, number of problems, number of visits, length of service, presence of mental health problem, and Omaha System knowledge, behavior, and status scores for all client problems. Analysis included general linear mixed models adjusted for co-variables (i.e., age, comorbidities). RESULTS: All groups improved knowledge, behavior, and status. Knowledge improvement was not significantly different across groups. Behavior improved more among adults with mental health problems (p = .013). Status improved more among adolescents with mental health problems (p = .012). CONCLUSIONS: Latina mothers, particularly those with mental health problems, improve after PHN FHV services. Further study should examine intervention patterns associated with these outcomes, and seek explanations for differences in outcomes.

Somali immigrant women and the American health care system: discordant beliefs, divergent expectations, and silent worries.

The civil war in Somalia resulted in massive resettlement of Somali refugees. The largest diaspora of Somali refugees in the United States currently reside in Minnesota. Partnering with three community organizations in 2007-8, we implemented the Community Connections and Collaboration Project to address health disparities that Somali refugees experienced. Specifically, we examined factors that influenced Somali women's health experiences. Utilizing a socio-ecological perspective and a social action research design, we conducted six community-based focus groups with 57 Somali women and interviewed 11 key informants including Somali healthcare professionals. Inductively coding, sorting and reducing data into categories, we analyzed each category for specific patterns. The categorical findings on healthcare experiences are reported here. We found that Somali women's health beliefs related closely to situational factors and contrasted sharply with the biological model that drives Western medicine. These discordant health beliefs resulted in divergent expectations regarding treatment and healthcare interactions. Experiencing unmet expectations, Somali women and their healthcare providers reported multiple frustrations which often diminished perceived quality of health care. Moreover, silent worries about mental health and reproductive decision making surfaced. To provide high quality, transcultural health care, providers must encourage patients to voice their own health explanations, expectations, and worries.