Health extension in new Mexico: an academic health center and the social determinants of disease.

The Agricultural Cooperative Extension Service model offers academic health centers methodologies for community engagement that can address the social determinants of disease. The University of New Mexico Health Sciences Center developed Health Extension Rural Offices (HEROs) as a vehicle for its model of health extension. Health extension agents are located in rural communities across the state and are supported by regional coordinators and the Office of the Vice President for Community Health at the Health Sciences Center. The role of agents is to work with different sectors of the community in identifying high-priority health needs and linking those needs with university resources in education, clinical service and research. Community needs, interventions, and outcomes are monitored by county health report cards. The Health Sciences Center is a large and varied resource, the breadth and accessibility of which are mostly unknown to communities. Community health needs vary, and agents are able to tap into an array of existing health center resources to address those needs. Agents serve a broader purpose beyond immediate, strictly medical needs by addressing underlying social determinants of disease, such as school retention, food insecurity, and local economic development. Developing local capacity to address local needs has become an overriding concern. Community-based health extension agents can effectively bridge those needs with academic health center resources and extend those resources to address the underlying social determinants of disease.

Using the ICF to address needs of people with disabilities in international development: Cambodian case study.

International development work is designed to help developing countries strengthen their economies, infrastructure, healthcare systems and educational systems in order to decrease poverty and to improve the quality of life for citizens. However, people with disabilities often miss out on the benefits of development efforts because international organizations and donors do not know how to include them. The International Classification of Functioning, Disability and Health (ICF) could serve as a model for understanding disability from a population perspective, and has the potential to guide disability mainstreaming in international development. To use the ICF as an operational tool for international development requires highlighting the relationship between specific categories of body function impairments and the environmental factors that serve as barriers or facilitators in order to identify needed accommodations on the regional or national level. In addition, accurate and complete national data are needed that use internationally accepted definitions of disability. This paper suggests a framework based on the ICF for analyzing relationships between particular impairments and environmental factors that impede or enable activity and participation. Specific examples are offered from the developing country of Cambodia to illustrate this population-based use of the ICF.

Factors in recruiting and retaining health professionals for rural practice.

CONTEXT: Rural communities, often with complex health care issues, have difficulty creating and sustaining an adequate health professional workforce. PURPOSE: To identify factors associated with rural recruitment and retention of graduates from a variety of health professional programs in the southwestern United States. METHODS: A survey collecting longitudinal data was mailed to graduates from 12 health professional programs in New Mexico. First rural and any rural employment since graduation were outcomes for univariate analyses. Multivariate analysis that controlled for extraneous variables explored factors important to those who took a first rural position, stayed rural, or changed practice locations. FINDINGS: Of 1,396 surveys delivered, response rate was 59%. Size of childhood town, rural practicum completion, discipline, and age at graduation were associated with rural practice choice (P < .05). Those who first practiced in rural versus urban areas were more likely to view the following factors as important to their practice decision: community need, financial aid, community size, return to hometown, and rural training program participation (P < .05). Those remaining rural versus moving away were more likely to consider community size and return to hometown as important (P < .05). Having enough work available, income potential, professional opportunity, and serving community health needs were important to all groups. CONCLUSION: Rural background and preference for smaller sized communities are associated with both recruitment and retention. Loan forgiveness and rural training programs appear to support recruitment. Retention efforts must focus on financial incentives, professional opportunity, and desirability of rural locations.

Interdisciplinary health education and career choice in rural and underserved areas.

PURPOSE: To assess the association between an educational rural health interdisciplinary programme (RHIP) and subsequent practice in US rural and underserved locations. METHODS: We carried out a longitudinal cohort study of RHIP students and randomly selected classmate controls for the years 1990-2001, using a mailed survey. OUTCOMES: Main outcome measures were first rural, any rural, first underserved and any underserved practice locations. Multivariate statistical methods were used to calculate prevalence ratios (PRs) by discipline while controlling for possible extraneous variables. RESULTS: Of 1396 surveys delivered, 820 were returned, giving a response rate of 59%. After exclusions, results from 255 RHIP and 534 control students were analysed for outcomes. Pharmacy students on the RHIP chose first and any rural practice locations more often than reference controls (PRs = 2.59 and 1.97, respectively; P < 0.05). Therapies (occupational, physical and speech therapy) RHIP students were associated with all 4 practice outcomes more often (PRs = 2.07, 1.85, 1.68 and 1.65, respectively; P < 0.05). Pharmacy and Therapies control students with rural training chose first rural and any rural practices more often (PRs = 2.58 and 1.62, respectively; P < 0.05 for both). Medicine and Nursing students did not choose outcome practice locations more often, but had small sample sizes and large numbers of controls with rural training. Rural health interdisciplinary students rated participation in rural training more highly as a factor in choosing first rural practices than did the controls who chose similar practices. CONCLUSIONS: Participation in RHIP and other rural training experiences may stimulate subsequent career choices in rural and underserved locations for Pharmacy and Therapies students. Other studies are needed to confirm these findings and answer questions raised by these data.

Occupational concerns of women who are homeless and have children: an occupational justice critique.

SUMMARY The purpose of this exploratory study was to describe the occupational goals and concerns of women who are homeless with children. Twenty-seven women with children living in homeless shelters completed interviews using the Canadian Occupational Performance Measure (COPM). Occupational issues and concerns were identified for each participant, and then they were pooled. A total of 169 occupational concerns were described and analyzed. The most common occupational issues identified by participants concerned finances, employment, education, transportation, housing, time for self, personal appearance, home management, and parenting. Analysis of identified occupational concerns suggests that the homeless women with children experienced a range of institutional and social barriers to occupational participation: essentially a form of occupational injustice. This study raises questions concerning the most effective roles for occupational therapists to facilitate empowerment so that women who are homeless may fully participate in the communities where they live.

Student-developed problem-based learning cases: preparing for rural healthcare practice.

INTRODUCTION: The need for health professionals is acute throughout rural communities worldwide. The Rural Health Interdisciplinary Program (RHIP) successfully trains health professional students for practice in rural USA. Student-developed problem-based learning (PBL) cases are a central feature of the RHIP and an important educational focus of learning. METHODS: This retrospective study was designed to describe 222 PBL cases developed by health professional students in the RHIP. The analysis focused on the extent to which student-developed cases reflect demographics and health conditions of rural New Mexico, as well as how successfully cases reflect rural interdisciplinary healthcare issues and practices. RESULTS: The PBL cases do reflect rural New Mexico in terms of population demographics, certain health problems and complexity of health issues. The cases appear to address interdisciplinary, rural clinical concerns. However, the cases are less effective at raising issues related to public health, financial, legal and ethical issues, and other non-medical health topics. CONCLUSIONS: In order to strengthen attention to non-medical issues, PBL groups should have broad interdisciplinary membership, special case development training, and faculty encouragement to address a wide variety of health-related topics. Student-developed PBL cases appear to be an interesting way for health professional students to learn about rural healthcare issues and could be used in a variety of different educational settings.

Occupational goals of mothers of children with disabilities: influence of temporal, social, and emotional contexts.

OBJECTIVE: The purpose of this study was to describe the occupational concerns and goals of mothers who care for children with disabilities. METHOD: Retrospective data collected from 38 mothers of children with disabilities using the Canadian Occupational Performance Measure (COPM) were analyzed qualitatively. RESULTS: Six themes emerged: (I) doing and being alone: taking care of my own health and well-being; (II) doing and being with others: expanding my social life; (III) improving my child's quality of life; (IV) household management: organizing time and resources; (V) balancing work, home, and community responsibilities; and (VI) sharing the workload. CONCLUSION: Overarching patterns in the data suggested that the occupational performance of mothers of children with disabilities is constrained by time, overlaid by difficult emotions, and involves a desire for increased social contact. Qualitative analysis of data from the COPM may provide insight into contextual factors that affect occupational performance as well as signaling point of entry for therapists to facilitate client-centered occupational goals.

Promoting professional reflection through problem-based learning evaluation activities.

SUMMARY To become competent occupational therapy practitioners, students must develop the ability to reflect upon their current and future professional development. This paper presents one curriculum's approach (the University of New Mexico) to using evaluation activities in problem-based learning to enhance students' cultivation of professional reflection skills. A description of these evaluation activities and accompanying tools is provided along with a critique of their strengths and limitations.

Outcomes of an occupational therapy program for mothers of children with disabilities: impact on satisfaction with time use and occupational performance.

OBJECTIVE: This experimental research study evaluated the impact of an 8-week psychosocial occupational therapy intervention program for mothers who have children with disabilities. METHOD: Thirty-eight mothers of children with disabilities were randomly assigned to participate either in the treatment or the control group (19 in each). The occupational therapy intervention was designed to facilitate increased perceptions of satisfaction with time use and occupational performance, thereby positively affecting maternal and family well-being. The Canadian Occupational Performance Measure (COPM) was administered to measure self-perceptions of occupational performance and satisfaction over time. RESULTS: No significant differences were found between the two groups on time use perceptions. Although no significant differences were found between the two groups on the COPM Performance subscale, the treatment group demonstrated significantly greater score increases (p < .05) on the COPM Satisfaction subscale. CONCLUSION: This preliminary study suggests that attending to the time use and occupational concerns of mothers of children with disabilities can have a positive impact on their satisfaction with occupational performance.