Introduction: Many people are not aware of stroke symptoms, the need for emergency care for those... more Introduction: Many people are not aware of stroke symptoms, the need for emergency care for those symptoms, and that calling 9-1-1 is recommended. The New York State Department of Health developed and implemented a multimedia campaign to increase stroke symptom awareness and awareness of the need to call 9-1-1. Methods: The evaluation of the campaign's impact was a pre/post intervention matched comparison design. A random-digit-dialed list-assisted telephone survey was administered to measure reach of the campaign and change in intention to seek emergency care for stroke by calling 9-1-1 in response to 4 signs or symptoms. Results: A larger proportion of respondents in the intervention region than in the comparison region reported seeing a stroke advertisement and reported the advertisement's message was to call 9-1-1. There was a significant increase between baseline and follow-up in intention to call 9-1-1 for the 4 stroke symptoms. These increases were greater in the intervention region than the comparison region. The differences between intervention and comparison groups in the increases in intention to call 9-1-1 ranged from 9% to 12% for specific stroke symptoms identified in oneself and from 4% to 12% for symptoms identified in another person. Conclusion: This multimedia campaign effectively increased intention to call 9-1-1 for stroke symptoms in the intervention region compared with a region matched for demographics and stroke rates. Multimedia campaigns are effective in increasing awareness of stroke symptoms and intention to immediately call 9-1-1.
Introduction: Stroke is the third leading cause of death and a leading cause of disability in New... more Introduction: Stroke is the third leading cause of death and a leading cause of disability in New York State. A New York study determined that only 19.9% of patients arrived at a designated stroke center within 3 hours of symptom onset. Yet, receiving treatment within 90 minutes of stroke symptom onset is optimal for improved outcomes. Delay in recognition of stroke symptoms and their severity contributes to treatment delay. Methods: A random-digit-dialed, list-assisted telephone survey about stroke knowledge was administered to 1789 adults aged 30 years or older in upstate New York in 2006. Bivariate and regression analysis were used to examine factors associated with intent to call 9-1-1 for symptoms of stroke. Results: The largest proportion of respondents (72.4%; 95% confidence interval [CI], 69.9%-74.8%) reported they would call 9-1-1 if they noticed they or someone else had difficulty speaking, and the fewest (33.3%; 95% CI, 30.7%-36.0%) respondents reported they would call 9-1-1 for trouble seeing or double vision. Multivariate analysis found that those who had a history of delay in getting medical care in the past 6 months had decreased odds of intending to call 9-1-1 for stroke symptoms (difficulty speaking: adjusted odds ratio [AOR], 0.76; 95% CI, 0.58-1.00; trouble seeing: AOR, 0.69; 95% CI, 0.53-0.91; facial droop: AOR, 0.85; 95% CI, 0.65-1.11; arm weakness: AOR, 0.80; 95% CI, 0.63-1.03). Age, education, and history of a stroke or heart event were not consistently associated with intent to call 9-1-1. Conclusion: Survey respondents do not interpret some stroke symptoms as urgent enough to activate the emergency medical system. History of delaying care is a behavioral pattern that influenced intent to call 9-1-1.
IntroductionMany people are not aware of stroke symptoms, the need for emergency care for those s... more IntroductionMany people are not aware of stroke symptoms, the need for emergency care for those symptoms, and that calling 9-1-1 is recommended. The New York State Department of Health developed and implemented a multimedia campaign to increase stroke symptom awareness and awareness of the need to call 9-1-1.MethodsThe evaluation of the campaign's impact was a pre/post intervention matched comparison design. A random-digit–dialed list-assisted telephone survey was administered to measure reach of the campaign and change in intention to seek emergency care for stroke by calling 9-1-1 in response to 4 signs or symptoms.ResultsA larger proportion of respondents in the intervention region than in the comparison region reported seeing a stroke advertisement and reported the advertisement's message was to call 9-1-1. There was a significant increase between baseline and follow-up in intention to call 9-1-1 for the 4 stroke symptoms. These increases were greater in the intervention region than the comparison region. The differences between intervention and comparison groups in the increases in intention to call 9-1-1 ranged from 9% to 12% for specific stroke symptoms identified in oneself and from 4% to 12% for symptoms identified in another person.ConclusionThis multimedia campaign effectively increased intention to call 9-1-1 for stroke symptoms in the intervention region compared with a region matched for demographics and stroke rates. Multimedia campaigns are effective in increasing awareness of stroke symptoms and intention to immediately call 9-1-1.
141st APHA Annual Meeting and Exposition (November 2 - November 6, 2013), Nov 2, 2013
ABSTRACT Community-based participatory research (CBPR) has been employed to address health dispar... more ABSTRACT Community-based participatory research (CBPR) has been employed to address health disparities by engaging multiple stakeholders in the research process. However, most often, CBPR engages community-based organization representatives who work on the ground in areas with underserved populations and social and health services professionals. Specifically, the use of CBPR in childhood obesity research is increasing, but parents, who are key stakeholders because they have direct influence over children's home environment and lifestyle choices, are still infrequently engaged (1). More typical stakeholders include school administrators, teachers, cooks, providers and other community-based professionals (2). Studies that engage parents, most often fall between Rung 3 and 5 of the Ladder of Participation in which parents provide input and are informed of study processes, often during formative of the study, but do not have decision making power. Although other studies have involved parents, there are no other known examples in which parents are engaged throughout the entire research process. Given the history of hierarchical relationships between low-income families and service or health professionals (3), engaging parents throughout the research process may serve to open communication, break down hierarchical relationships and build trust. Low-income parents are engaged as equal partners, providing unique expertise during the development, implementation and evaluation of a childhood obesity prevention initiative. The case study of Communities for Healthy Living (CHL), so named by the partnership, section of the learning institute will be a round table during which the aforementioned learning objectives will be met. Then there will be time for participants to ask questions of both parents and academics and discuss new ideas generated from sharing this parent-centered CBPR case study that engaged parents directly throughout the entire research process with the goal of fostering parent empowerment and encouraging co-learning across all stakeholders (4). The Communities for Healthy Living case study (2) takes place within the context of a study funded by the National Institute of Minority Health and Health Disparities of NIH, which funded 6 research studies utilizing CBPR in the development of interventions addressing health disparities. Because the studies were funded under the American Recovery and Reinvestment Act of 2009, each was constrained to a rapid two-year timeline to develop and pilot test the intervention. The goal of this study was to develop and pilot test a childhood obesity intervention for low-income families using a CBPR approach to actively engage parents across three phases, Phase 1: Partnership development, Phase 2: Community assessment and intervention development, and Phase 3: Intervention implementation and evaluation. The family-centered intervention targeted parent/caregivers with children participating in Head Start programs in Rensselaer County, NY (about 500 children ages 6 weeks to 5 years old) for childhood obesity prevention. Rensselaer County, in Upstate New York, has areas designated as Medically Underserved Areas (6), and 28% of all families with children under age 5 living below the poverty level (7).
Intellectual and Developmental Disabilities, Feb 1, 2008
People with intellectual disabilities have few opportunities to actively participate in research ... more People with intellectual disabilities have few opportunities to actively participate in research affecting programs and policies. Employment of participatory action research has been recommended. Although use of this approach with people who have intellectual disabilities is growing, articles on specific participatory research methods are rare. Photovoice is a participatory method often used with underrepresented groups and is effective for engaging people with intellectual disabilities in research or program development. A literature review is presented for use with this population as is a description of Photovoice as a participatory research tool for engaging people with intellectual disabilities. An example of a participatory study among people with intellectual disabilities is provided. Benefits and challenges of employing Photovoice with this population are discussed.
Access to emergency food is critical for the survival and health of vulnerable populations, but i... more Access to emergency food is critical for the survival and health of vulnerable populations, but its importance is not understood in the context of food deserts. Using a cross-sectional survey based on Albany and Troy, New York, we compared the two food desert models, one based on paid (e.g., grocery stores) and the other based on free food options (e.g., emergency food sites such as pantries and soup kitchens). Structural equation modeling was conducted to identify pathways among people’s access to food sites, food consumption patterns, food insecurity, and health conditions. Access to grocery stores did not show significant links to food insecurity or health conditions, whereas access to emergency food, especially time taken to such food outlets, was found to be a significant factor for increased consumption of fresh food. Among the diet-related variables, food insecurity showed the strongest link to negative health outcomes. Access to free or low-cost options needs to be taken into consideration when designing research and practice concerning food deserts, food insecurity, and subsequent health effects.
Although an often desired goal, true partnership between community members and university researc... more Although an often desired goal, true partnership between community members and university researchers can be difficult to achieve. Strategies implemented in a diabetes prevention and control program in a Latino community may be effective in overcoming hurdles to collaborative research. The development of selection criteria can be useful for objectively choosing a community organization as a partner agency. The implementation of formal partnership principles is proposed as a strategy for building a successful partnership. Partnership principles are a powerful mechanism to assure ethical relations between collaborators. As a strategy for process evaluation, they can help organize data on the extent to which intent has translated into action. They provide a structure for project stability that can outlast individual commitments and a mechanism to keep project commitment on course and maintain active engagement.
ABSTRACT To assess sociocultural factors associated with delaying routine healthcare among Latina... more ABSTRACT To assess sociocultural factors associated with delaying routine healthcare among Latinas. Using community-based participatory research; we interviewed 287 Latinas from the Capital District, NY. The Andersen model of healthcare utilization was used to assess predisposing, enabling and need factors influencing delay in seeking care. Modified Poisson regression was used to estimate prevalence risk ratios (PRR) and 95% confidence intervals. Overall 70% of women reported delaying care. After controlling for other factors, women who were not married (PRR 1.21), had chronic disease (PRR 1.24), preferred a Latino doctor (PRR 1.18), used alternative medicine (PRR 1.28), were uninsured (PRR 1.29), or had faced discrimination during earlier health care visits (PRR 1.23), were significantly more likely to delay care. Delay in seeking care among Latinas is determined by cultural and social factors that need to be incorporated in interventions aimed at improving access.
Introduction: Many people are not aware of stroke symptoms, the need for emergency care for those... more Introduction: Many people are not aware of stroke symptoms, the need for emergency care for those symptoms, and that calling 9-1-1 is recommended. The New York State Department of Health developed and implemented a multimedia campaign to increase stroke symptom awareness and awareness of the need to call 9-1-1. Methods: The evaluation of the campaign's impact was a pre/post intervention matched comparison design. A random-digit-dialed list-assisted telephone survey was administered to measure reach of the campaign and change in intention to seek emergency care for stroke by calling 9-1-1 in response to 4 signs or symptoms. Results: A larger proportion of respondents in the intervention region than in the comparison region reported seeing a stroke advertisement and reported the advertisement's message was to call 9-1-1. There was a significant increase between baseline and follow-up in intention to call 9-1-1 for the 4 stroke symptoms. These increases were greater in the intervention region than the comparison region. The differences between intervention and comparison groups in the increases in intention to call 9-1-1 ranged from 9% to 12% for specific stroke symptoms identified in oneself and from 4% to 12% for symptoms identified in another person. Conclusion: This multimedia campaign effectively increased intention to call 9-1-1 for stroke symptoms in the intervention region compared with a region matched for demographics and stroke rates. Multimedia campaigns are effective in increasing awareness of stroke symptoms and intention to immediately call 9-1-1.
Introduction: Stroke is the third leading cause of death and a leading cause of disability in New... more Introduction: Stroke is the third leading cause of death and a leading cause of disability in New York State. A New York study determined that only 19.9% of patients arrived at a designated stroke center within 3 hours of symptom onset. Yet, receiving treatment within 90 minutes of stroke symptom onset is optimal for improved outcomes. Delay in recognition of stroke symptoms and their severity contributes to treatment delay. Methods: A random-digit-dialed, list-assisted telephone survey about stroke knowledge was administered to 1789 adults aged 30 years or older in upstate New York in 2006. Bivariate and regression analysis were used to examine factors associated with intent to call 9-1-1 for symptoms of stroke. Results: The largest proportion of respondents (72.4%; 95% confidence interval [CI], 69.9%-74.8%) reported they would call 9-1-1 if they noticed they or someone else had difficulty speaking, and the fewest (33.3%; 95% CI, 30.7%-36.0%) respondents reported they would call 9-1-1 for trouble seeing or double vision. Multivariate analysis found that those who had a history of delay in getting medical care in the past 6 months had decreased odds of intending to call 9-1-1 for stroke symptoms (difficulty speaking: adjusted odds ratio [AOR], 0.76; 95% CI, 0.58-1.00; trouble seeing: AOR, 0.69; 95% CI, 0.53-0.91; facial droop: AOR, 0.85; 95% CI, 0.65-1.11; arm weakness: AOR, 0.80; 95% CI, 0.63-1.03). Age, education, and history of a stroke or heart event were not consistently associated with intent to call 9-1-1. Conclusion: Survey respondents do not interpret some stroke symptoms as urgent enough to activate the emergency medical system. History of delaying care is a behavioral pattern that influenced intent to call 9-1-1.
IntroductionMany people are not aware of stroke symptoms, the need for emergency care for those s... more IntroductionMany people are not aware of stroke symptoms, the need for emergency care for those symptoms, and that calling 9-1-1 is recommended. The New York State Department of Health developed and implemented a multimedia campaign to increase stroke symptom awareness and awareness of the need to call 9-1-1.MethodsThe evaluation of the campaign's impact was a pre/post intervention matched comparison design. A random-digit–dialed list-assisted telephone survey was administered to measure reach of the campaign and change in intention to seek emergency care for stroke by calling 9-1-1 in response to 4 signs or symptoms.ResultsA larger proportion of respondents in the intervention region than in the comparison region reported seeing a stroke advertisement and reported the advertisement's message was to call 9-1-1. There was a significant increase between baseline and follow-up in intention to call 9-1-1 for the 4 stroke symptoms. These increases were greater in the intervention region than the comparison region. The differences between intervention and comparison groups in the increases in intention to call 9-1-1 ranged from 9% to 12% for specific stroke symptoms identified in oneself and from 4% to 12% for symptoms identified in another person.ConclusionThis multimedia campaign effectively increased intention to call 9-1-1 for stroke symptoms in the intervention region compared with a region matched for demographics and stroke rates. Multimedia campaigns are effective in increasing awareness of stroke symptoms and intention to immediately call 9-1-1.
141st APHA Annual Meeting and Exposition (November 2 - November 6, 2013), Nov 2, 2013
ABSTRACT Community-based participatory research (CBPR) has been employed to address health dispar... more ABSTRACT Community-based participatory research (CBPR) has been employed to address health disparities by engaging multiple stakeholders in the research process. However, most often, CBPR engages community-based organization representatives who work on the ground in areas with underserved populations and social and health services professionals. Specifically, the use of CBPR in childhood obesity research is increasing, but parents, who are key stakeholders because they have direct influence over children's home environment and lifestyle choices, are still infrequently engaged (1). More typical stakeholders include school administrators, teachers, cooks, providers and other community-based professionals (2). Studies that engage parents, most often fall between Rung 3 and 5 of the Ladder of Participation in which parents provide input and are informed of study processes, often during formative of the study, but do not have decision making power. Although other studies have involved parents, there are no other known examples in which parents are engaged throughout the entire research process. Given the history of hierarchical relationships between low-income families and service or health professionals (3), engaging parents throughout the research process may serve to open communication, break down hierarchical relationships and build trust. Low-income parents are engaged as equal partners, providing unique expertise during the development, implementation and evaluation of a childhood obesity prevention initiative. The case study of Communities for Healthy Living (CHL), so named by the partnership, section of the learning institute will be a round table during which the aforementioned learning objectives will be met. Then there will be time for participants to ask questions of both parents and academics and discuss new ideas generated from sharing this parent-centered CBPR case study that engaged parents directly throughout the entire research process with the goal of fostering parent empowerment and encouraging co-learning across all stakeholders (4). The Communities for Healthy Living case study (2) takes place within the context of a study funded by the National Institute of Minority Health and Health Disparities of NIH, which funded 6 research studies utilizing CBPR in the development of interventions addressing health disparities. Because the studies were funded under the American Recovery and Reinvestment Act of 2009, each was constrained to a rapid two-year timeline to develop and pilot test the intervention. The goal of this study was to develop and pilot test a childhood obesity intervention for low-income families using a CBPR approach to actively engage parents across three phases, Phase 1: Partnership development, Phase 2: Community assessment and intervention development, and Phase 3: Intervention implementation and evaluation. The family-centered intervention targeted parent/caregivers with children participating in Head Start programs in Rensselaer County, NY (about 500 children ages 6 weeks to 5 years old) for childhood obesity prevention. Rensselaer County, in Upstate New York, has areas designated as Medically Underserved Areas (6), and 28% of all families with children under age 5 living below the poverty level (7).
Intellectual and Developmental Disabilities, Feb 1, 2008
People with intellectual disabilities have few opportunities to actively participate in research ... more People with intellectual disabilities have few opportunities to actively participate in research affecting programs and policies. Employment of participatory action research has been recommended. Although use of this approach with people who have intellectual disabilities is growing, articles on specific participatory research methods are rare. Photovoice is a participatory method often used with underrepresented groups and is effective for engaging people with intellectual disabilities in research or program development. A literature review is presented for use with this population as is a description of Photovoice as a participatory research tool for engaging people with intellectual disabilities. An example of a participatory study among people with intellectual disabilities is provided. Benefits and challenges of employing Photovoice with this population are discussed.
Access to emergency food is critical for the survival and health of vulnerable populations, but i... more Access to emergency food is critical for the survival and health of vulnerable populations, but its importance is not understood in the context of food deserts. Using a cross-sectional survey based on Albany and Troy, New York, we compared the two food desert models, one based on paid (e.g., grocery stores) and the other based on free food options (e.g., emergency food sites such as pantries and soup kitchens). Structural equation modeling was conducted to identify pathways among people’s access to food sites, food consumption patterns, food insecurity, and health conditions. Access to grocery stores did not show significant links to food insecurity or health conditions, whereas access to emergency food, especially time taken to such food outlets, was found to be a significant factor for increased consumption of fresh food. Among the diet-related variables, food insecurity showed the strongest link to negative health outcomes. Access to free or low-cost options needs to be taken into consideration when designing research and practice concerning food deserts, food insecurity, and subsequent health effects.
Although an often desired goal, true partnership between community members and university researc... more Although an often desired goal, true partnership between community members and university researchers can be difficult to achieve. Strategies implemented in a diabetes prevention and control program in a Latino community may be effective in overcoming hurdles to collaborative research. The development of selection criteria can be useful for objectively choosing a community organization as a partner agency. The implementation of formal partnership principles is proposed as a strategy for building a successful partnership. Partnership principles are a powerful mechanism to assure ethical relations between collaborators. As a strategy for process evaluation, they can help organize data on the extent to which intent has translated into action. They provide a structure for project stability that can outlast individual commitments and a mechanism to keep project commitment on course and maintain active engagement.
ABSTRACT To assess sociocultural factors associated with delaying routine healthcare among Latina... more ABSTRACT To assess sociocultural factors associated with delaying routine healthcare among Latinas. Using community-based participatory research; we interviewed 287 Latinas from the Capital District, NY. The Andersen model of healthcare utilization was used to assess predisposing, enabling and need factors influencing delay in seeking care. Modified Poisson regression was used to estimate prevalence risk ratios (PRR) and 95% confidence intervals. Overall 70% of women reported delaying care. After controlling for other factors, women who were not married (PRR 1.21), had chronic disease (PRR 1.24), preferred a Latino doctor (PRR 1.18), used alternative medicine (PRR 1.28), were uninsured (PRR 1.29), or had faced discrimination during earlier health care visits (PRR 1.23), were significantly more likely to delay care. Delay in seeking care among Latinas is determined by cultural and social factors that need to be incorporated in interventions aimed at improving access.
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