Experiences of using the MINDSET Self-Management mobile health app among Hispanic Patients:Results of a qualitative study.

BACKGROUND: Interventions focusing on epilepsy self-management (ESM) are vital for promoting the health of people living with epilepsy. E-technology and mobile health (mHealth) tools are becoming increasingly integrated into practice to promote self-management strategies for chronic diseases, enhance care delivery, and reduce health disparities. Management Information and Decision Support Epilepsy Tool (MINDSET), a bilingual decision support tool (available in English and Spanish), was found to be both feasible and effective in facilitating goal-based ESM in the clinic. PURPOSE: To assess the experience of using MINDSET as an ESM intervention among Hispanic patients with epilepsy to inform future interventional studies. METHODS: This study used a Qualitative Descriptive (QD) framework to provide a rich and straightforward description of patients' subjective experiences using MINDSET. Participants were enrolled in the intervention group of a larger parent study (RCT) to assess the efficacy of MINDSET among Hispanic People with Epilepsy (PWE). The purposive, convenient, criterion-based sample for this qualitative analysis comprised of 42 patients who agreed to participate in a semi-structured interview at the end of the larger RCT. This RCT was conducted between August 2017 and January 2019. Spanish and English-speaking Hispanic adult patients (n = 94) with epilepsy in Arizona (n = 53) and Texas (n = 41) were randomly assigned within 6 neurology clinics to treatment (MINDSET plus Usual Care, hereafter referred to as MINDSET; n = 46) and comparison (Usual Care Only; n = 48) conditions. RESULTS: Patient demographics, epilepsy conditions, and ESM behavioral characteristics were representative of the intervention group. Study participants were Hispanic, mainly of Mexican descent (94 %), with a mean age of 39 years, mostly female (53 %), and most of the participants reported having had one or more seizures per month (54 %). The MINDSET intervention revealed five ESM themes: (1) Awareness and Realization of Epilepsy Self-Management, (2) Communication and Partnership with Health Care Providers HCP, (3) Epilepsy Self-Management and Quality of Life, (4) Seizure Control, and (5) Optimism and Agency. CONCLUSION: The participants who used MINDSET as a self-management intervention reported an overall positive experience. Qualitative data in this study show that MINDSET is a valuable ESM tool for Hispanic patients with epilepsy. Findings from this qualitative study were consistent with results from a larger parent study that recognized MINDSET as an effective platform for improving epilepsy self-management adherence.

Feasibility and Outcomes of Meta Salud Diabetes Behavioral Health Intervention: A Pilot Study of a Community Health Worker-Administered Educational Intervention to Prevent Cardiovascular Disease and Its Complications among Hispanic Patients with Type-2 Diabetes.

BACKGROUND: Hispanics in the United States experience a greater burden of type-2 diabetes (T2D), with a prevalence rate (17%) more than twice that of non-Hispanic whites (8%). Cardiovascular disease (CVD) is the leading cause of death among people with T2D. A culturally appropriate behavioral health intervention that addresses healthy lifestyle promotion is an impactful approach for health systems with scarce medical resources and a high prevalence of chronic conditions, including obesity and high blood pressure, which increase the likelihood of CVD mortality among type-2 diabetics. PURPOSE: To assess the feasibility and outcomes of a behavioral intervention to decrease CVD and complications in a Hispanic diabetic population. METHODS: Meta Salud Diabetes (MSD), a behavioral intervention effective in a Mexican population, consists of a 13-week intervention addressing CVD and T2D knowledge and risk reduction. It was implemented in a sample of Hispanic diabetic patients from two federally qualified health centers (FQHCs). Clinical and behavioral variables were measured at baseline, postintervention, and 1-year follow-up. RESULTS: The feasibility of MSD was rated as successful by all FQHC staff and well-received by both staff and study participants, with positive remarks about the culturally relevant components of the intervention. The sample size was n = 30 (baseline), n = 23 (postintervention), and n = 19 (1-year follow-up). Of note, quantitative results showed trending decreases in Hba1c (7.06; 6.80; 6.30), blood pressure (132/83; 126/80; 123/78), and total cholesterol (160; 159; 154). CONCLUSION: MSD is a feasible intervention and can address the need to improve health outcomes among Hispanic patients with T2D.

Determining Regional Differences in Barriers to Accessing Health Care Among Farmworkers Using the National Agricultural Workers Survey.

Farmworkers are an essential workforce in the U.S. We assessed the regions in the National Agricultural Workers Survey on the difficulty of accessing health care among farmworkers in the U.S. The study included 9577 farmworkers. Farmworkers in all regions were more likely to report having difficulty accessing health care because it was too expensive. The overall odds ratio for difficulty accessing health care was lower in the MW after adjusting. Farmworkers employed in the SE had greater difficulty accessing health care because of language barriers. Farmworkers employed in CA had difficulty accessing health care in the U.S. because it was too expensive or far away. Results follow previous studies on barriers to access health care among the farmworker population. Understanding regional disparities in the presence of barriers to accessing health care among farmworkers is an essential step to improving equitable health care access in the U.S.

Health conditions among farmworkers in the Southwest: An analysis of the National Agricultural Workers Survey.

Agricultural jobs pose many challenges to the health and wellbeing of a disadvantaged population. In the Southwest region, the socioeconomic factors of living along the U.S.-Mexico border, migration patterns, lack of access to health care, low utilization of health care services, lack of health insurance, and highly demanding occupation may uniquely affect health outcomes for farmworkers. This paper presents descriptive information for professionals to improve access to care by tackling barriers afforded by the agricultural industry. The National Agricultural Worker Survey (NAWS) is an employment-based, random-sample survey of U.S. agricultural workers in six regions: East, Southeast, Midwest, Southwest, Northwest, and California. We examined farmworkers' self-reported health conditions, including asthma, diabetes, high blood pressure, other chronic conditions, or any condition by region from 2013 to 2016. We used logistic regression to determine differences in lifetime prevalence of health conditions between farmworkers in the Southwest region (n = 727) and farmworkers in other regions (n = 8,850) using weighted data. After adjusting for age, gender, income, insurance status, and English-speaking ability, the odds of high blood pressure and other condition were similar in all regions. The prevalence of diabetes was almost double in the Southwest (114.2 per 1,000 farmworkers). The odds of diabetes were 1.31 (95% CI 0.99, 1.74) times greater in the Southwest region than in the other regions. Asthma was the only condition that was lower in the Southwest (22 per 1,000 farmworkers) compared to the other regions. The odds of asthma were 0.61 (95% CI 0.36, 1.03) times lower in the Southwest region than in other regions. The results follow previous studies on the prevalence of asthma among the farmworker population and elevated probability of chronic diseases including diabetes among the Latino population in the U.S.

The Arizona Prevention Research Center partnerships in Arizona to promote COVID-19 vaccine health equity.

Background: Vaccine hesitancy in the face of the COVID-19 pandemic is a complex issue that undermines our national ability to reduce the burden of the disease and control the pandemic. The COVID-19 pandemic revealed widening health disparities and disproportionate adverse health outcomes in terms of transmission, hospitalizations, morbidity and mortality among Arizona's Latinx rural, underserved, farmworker, disabled and elderly populations. In March 2021, ~8.1% of those vaccinated were Latinx, though Latinxs make up 32% of Arizona's population. The Arizona Vaccine Confidence Network (AzVCN) proposed to leverage the expertise of the Arizona Prevention Research Center (AzPRC) and the resources of the Mel and Enid Zuckerman College of Public Health (MEZCOPH) Mobile Health Unit (MHU) to identify, implement and evaluate a MHU intervention to increase uptake of COVID-19 vaccines. Methods: The AzVCN focused efforts on Latinx, rural, un/underinsured and farmworker communities in the four Arizona border counties that are at greater risk of COVID-19 morbidity and mortality and may have limited access to vaccination and other essential health services. The AzVCN used listening sessions to create a feedback loop with key stakeholders and critical health care workers to validate barriers/enablers and identify solutions to increase vaccination uptake emerging from the network. The AzVCN also implemented a community-based intervention using community health workers (CHWs) based in a MHU to increase knowledge of the COVID-19 vaccines, reduce vaccination hesitancy and increase vaccination uptake among Latinx rural, un/underinsured and farmworker populations in Southern Arizona. Results: AzVCN outcomes include: identification of enablers and barriers of COVID-19 vaccination in the priority populations; identification of strategies and solutions to address vaccine hesitancy and increase vaccine uptake among priority population; and evidence that the proposed solutions being tested through the AzVCN contribute to increased vaccine uptake among the priority populations. Conclusion: Through these efforts the AzPRC contributed to the CDC's Vaccinate with Confidence Strategy by collaborating with CHWs and other key stakeholders to engage directly with communities in identifying and addressing structural and misinformation barriers to vaccine uptake.

MINDSET: Clinic-based decision support demonstrates longitudinal efficacy for increased epilepsy self-management adherence among Spanish speaking patients.

BACKGROUND: MINDSET, a bilingual (Eng./Span.) decision support tool was found feasible for facilitating goal-based epilepsy self-management (ESM) in the clinic. PURPOSE: To evaluate the efficacy of MINDSET to increase ESM adherence among Hispanic patients. METHODS: A RCT was conducted from August 2017 through January 2019. Spanish and English speaking Hispanic adult patients (n=94) with epilepsy in Arizona (n=53) and Texas (n=41) were randomly assigned within 6 neurology clinics to treatment (MINDSET plus Usual Care, hereafter referred to as MINDSET; n=46) and comparison (Usual Care Only; n=48) conditions. Self-reported self-management behavior (assessed through the Epilepsy Self-management scale) were categorized as adherent if performed 'usually' or 'always.' The proportion of adherence was compared between study conditions for 36 individual ESM behaviors and 5 ESM domains using Fischer's exact test. RESULTS: The average time between visit 1 through 3 was 350+/-79 days with retention at 96.8%. Participants in the treatment condition had more college education and less unemployment. Self-management adherence improved across visits for all self-management behaviors irrespective of study condition. Compared to usual care MINDSET use led to greater ESM adherence for 86.1% behaviors (5 with statistical significance; p<0.05) and to significant improvement in the ESM domain of 'information management' (p<0.05). CONCLUSIONS: Implementation of MINDSET within regular neurology visits may assist Hispanic adults with epilepsy to increase their adherence to ESM behaviors and maintain this adherence longitudinally. Replication with a broader demographic population of people with epilepsy is indicated.

MINDSET: Clinical feasibility of utilizing the revised epilepsy self-management tool for Spanish speaking patients.

This paper describes the expanded English/Spanish version of the Management Information and Decision Support Epilepsy Tool (MINDSET) as well as the methods and findings from a feasibility study conducted from July 2016 through February 2017 with 43 Spanish and English-speaking Hispanic people living with epilepsy (PWE) in Arizona (n = 23) and Texas (n = 20) over two consecutive regular clinic visits. The expansion of MINDSET added goal setting and strategy selection to improve self-management (S-M) in PWE. The previous study tested the feasibility of English MINDSET, which was designed to facilitate the identification and discussion of S-M issues between the patient and healthcare provider (HCP) during a regular clinic visit. Results indicate MINDSET feasibility for use in the following: 1) identifying S-M issues across several domains; 2) selecting and assessing confidence in tailored S-M goals/strategies for improvement; 3) discussing S-M issues/goals/strategies/confidence with a HCP; and 4) creating an action plan (AP) and tracking achievement during regular clinic visits. Across two visits, 80-90% of patients agreed that the revised version of MINDSET was helpful, understandable, trustworthy, promoted careful thinking about management, was of appropriate duration, and would be helpful in future management and communication with HCP. Participating HCPs agreed that MINDSET improved the ease, thoroughness, and accuracy in identifying patient S-M issues and establishing a plan for improvement.