414 results on '"Burke, Nancy J."'
Search Results
2. Section II: Social Accountability and “the Gift': Internationalism and Cuban Medical Diplomacy
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Burke, Nancy J.
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- 2013
3. Section I: History, Affect, and Materiality: Public Health Campaigns and Food Insecurity
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Burke, Nancy J.
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- 2013
4. Index
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Burke, Nancy J.
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- 2013
5. 3: Eating in Cuban
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Burke, Nancy J.
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- 2013
6. 10: Masculinity and Sexuality in Cuba
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Burke, Nancy J.
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- 2013
7. 9: Family Medicine, ‘La Herencia,' and the Breast Cancer
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Burke, Nancy J.
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- 2013
8. 6: Transformative Medical Education and the Making of New Clinical Subjectivities Through Cuban-Bolivian Medical Diplomacy
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Burke, Nancy J.
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- 2013
9. 8: Conceiving Statistics
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Burke, Nancy J.
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- 2013
10. 7: Cuban Internacionalistas, Sports, and the Health of the ‘Socialist Body' in Cuba and Africa
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Burke, Nancy J.
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- 2013
11. Acknowledgments
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Burke, Nancy J.
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- 2013
12. Table of Contents
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Burke, Nancy J.
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- 2013
13. Contributors
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Burke, Nancy J.
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- 2013
14. 1: The Biocommunicable State
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Burke, Nancy J.
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- 2013
15. 4: Fifty Years of Cuba's Medical Diplomacy
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Burke, Nancy J.
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- 2013
16. 5: Fueling la Revolucion
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Burke, Nancy J.
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- 2013
17. Half Title Page, Publication Information, Title Page, Copyright
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Burke, Nancy J.
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- 2013
18. 2: Disconnecting the Mind and Essentialized Fare
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Burke, Nancy J.
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- 2013
19. Toward decolonized fiscal relationships between universities and community organizations: lessons learned from the California community engagement alliance against COVID-19
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Burke, Nancy J, Espinosa, Patricia Rodriguez, Corchado, Claudia C, Vázquez, Evelyn, Rosas, Lisa G, Wooe, Kent J, LeSarre, Monique, Gallegos-Castillo, Angela, Cheney, Ann, Lo, David D, Hintz, Rachel, Vassar, Stefanie D, and Brown, Arleen F
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Health Services and Systems ,Health Sciences ,Good Health and Well Being ,Community-based participatory research ,community engaged research ,COVID-19 ,fiscal relationships ,equity ,Public Health and Health Services ,Sociology ,Public Health ,Public health ,Anthropology - Published
- 2024
20. Acceptability and Feasibility of Survivorship Group Medical Visits for Breast Cancer Survivors in a Safety Net Hospital
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Trejo, Evelin, Velazquez, Ana I., Castillo, Elizabeth, Couey, Paul, Cicerelli, Barbara, McBride, Robin, Burke, Nancy J., and Dixit, Niharika
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- 2024
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21. Partnering With Community Health Workers to Address COVID-19 Health Inequities: Experiences of the California Alliance Against COVID-19.
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Rodriguez Espinosa, Patricia, Vázquez, Evelyn, AuYoung, Mona, Zaldivar, Frank, Cheney, Ann Marie, Sorkin, Dara, Zender, Robynn, Corchado, Claudia G, and Burke, Nancy J
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Health Services and Systems ,Public Health ,Health Sciences ,Prevention ,Health Services ,Behavioral and Social Science ,Basic Behavioral and Social Science ,Clinical Research ,Generic health relevance ,Good Health and Well Being ,Humans ,COVID-19 ,Health Promotion ,Community Health Workers ,California ,Health Inequities ,Medical and Health Sciences ,Biomedical and clinical sciences ,Health sciences - Abstract
With funding from the National Institutes of Health's Community Engagement Alliance, starting in fall 2020, 11 academic medical centers and 75 community partners came together as the California Alliance Against COVID-19 to address COVID-19 inequities in California. Using data from focus groups, statewide meetings, and a statewide partner survey, we describe how promotoras and community health workers (P/CHWs; n = 540) helped to promote access to COVID-19 information, testing, and vaccination. We highlight opportunities to promote health equity among other public health collaborators with a P/CHW model. (Am J Public Health. 2024;114(S1):S45-S49. https://doi.org/10.2105/AJPH.2023.307471).
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- 2024
22. Local Biologies and Ecologies of Screening: Tracing the Aftereffects of the “Shanghai Study”
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Burke, Nancy J.
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- 2014
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23. Post-Resettlement Food Insecurity: Afghan Refugees and Challenges of the New Environment.
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Goliaei, Zahra, Gonzalez, Mariaelena, Diaz Rios, Karina, Pokhrel, Mamata, and Burke, Nancy J
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Humans ,Environment ,Food Supply ,Food ,Refugees ,Food Insecurity ,Afghan refugees ,United States ,food access ,food assistance ,food insecurity ,resettlement ,Clinical Research ,Prevention ,Zero Hunger ,Toxicology - Abstract
BackgroundLack of access to adequate, safe, and nutritious food is a major concern for the Afghan population due to ongoing war and humanitarian crises. Recently resettled Afghan refugees in the US continue to face challenges securing adequate, nutritious food resources in new environments. This study examined Afghan refugees' food access and insecurity in the San Joaquin Valley, California.MethodsSemi-structured, in-depth interviews were conducted to collect the perspectives and experiences of key informants and newly arrived Afghan refugees.ResultsThis study highlights environmental and structural factors (availability and accessibility of grocery stores; availability of religious-appropriate items in the stores; the public benefit received by a family; and public transportation) and individual factors (religious and cultural practices; financial and language barriers) as major determinants of post-resettlement food insecurity.ConclusionIncreasing the accessibility and affordability of culturally and religiously appropriate food items within the US food system, enhancing the collaboration of community volunteers and resettlement organizations in the direct assistance of new families, and providing continuous access to public benefits are possible steps to mitigate the risk of food insecurity among Afghan refugees. This study suggests a continuous examination of the degree of food insecurity in this population and its attendant health impacts.
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- 2023
24. Public support for policies to regulate flavoured tobacco and e-cigarette products in rural California
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Payán, Denise Diaz, Burke, Nancy J, Persinger, Jamie, Martinez, Juliette, Barker, Lisa Jones, and Song, Anna V
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Policy and Administration ,Public Health ,Health Sciences ,Human Society ,Basic Behavioral and Social Science ,Clinical Research ,Behavioral and Social Science ,Tobacco ,Cancer ,Lung ,Tobacco Smoke and Health ,Prevention ,Good Health and Well Being ,Quality Education ,Adolescent ,Humans ,Female ,Male ,Electronic Nicotine Delivery Systems ,Nicotiana ,Tobacco Products ,Vaping ,Policy ,California ,Flavoring Agents ,priority ,special populations ,public opinion ,public policy ,prevention ,priority/special populations - Abstract
IntroductionFlavoured tobacco control policy exemptions and electronic cigarette products may contribute to increased youth access and tobacco use disparities.MethodsWe assessed public support among California Central Valley residents for four policies to regulate flavoured tobacco products and e-cigarettes. The probability-based, multimode survey was conducted with English-speaking and Spanish-speaking registered voters (n=845) across 11 counties between 13 and 18 August 2020. Weighted logistic regression analyses measured odds of policy support, adjusting for predictor variables (attitudes and beliefs) and covariates.ResultsThe weighted sample was 50% female and predominantly Latino (30%) or non-Hispanic white (46%); 26% had a high school education or less, and 22% an annual household income DiscussionFindings add to mounting evidence of support for policies to regulate flavoured tobacco and e-cigarette products. Results on attitudes and beliefs elucidate how these factors influence support.
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- 2023
25. Inclusionary Trials: A Review of Lessons Not Learned
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Adkins-Jackson, Paris B, Burke, Nancy J, Espinosa, Patricia Rodriguez, Ison, Juliana M, Goold, Susan D, Rosas, Lisa G, Doubeni, Chyke A, Brown, Arleen F, and Groups, The STOP COVID-19 California Alliance Trial Participation and Vaccine Hesitancy Working
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Health Services and Systems ,Public Health ,Health Sciences ,Vaccine Related ,Immunization ,Generic health relevance ,Good Health and Well Being ,Humans ,United States ,Pandemics ,COVID-19 ,Community Participation ,Community-Based Participatory Research ,clinical trials ,community-based ,inclusion ,inclusive participation ,minority recruitment ,vaccine trials ,STOP COVID-19 California Alliance Trial Participation and Vaccine Hesitancy Working Groups ,Medical and Health Sciences ,Epidemiology ,Public health - Abstract
The COVID-19 pandemic revealed weaknesses in the public health infrastructure of the United States, including persistent barriers to engaging marginalized communities toward inclusion in clinical research, including trials. Inclusive participation in clinical trials is crucial for promoting vaccine confidence, public trust, and addressing disparate health outcomes. A long-standing body of literature describes the value of community-based participatory research in increasing marginalized community participation in research. Community-based participatory research emphasizes shared leadership with community members in all phases of the research process, including in the planning and implementation, interpretation, and dissemination. Shared leadership between academic and industry with marginalized communities can assist with inclusive participation in vaccine trials and increase public trust in the development of the vaccines and other therapies used during public emergencies. Nevertheless, epidemiologic and clinical research do not yet have a strong culture of community partnership in the scientific process, which takes time to build and therefore may be difficult to develop and rapidly scale to respond to the pandemic. We outline practices that contribute to a lack of inclusive participation and suggest steps that trialists and other researchers can take to increase marginalized communities' participation in research. Practices include planning for community engagement during the planning and recruitment phases, having regular dialogues with communities about their priorities, supporting them throughout a study, and navigating complex structural determinants of health. Additionally, we discuss how research institutions can support inclusive practices by reexamining their policies to increase participation in clinical trials and instilling institutional trustworthiness.
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- 2022
26. “Housing Is Health Care”: Treating Homelessness in Safety‐net Hospitals
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Hanssmann, Christoph, Shim, Janet K, Yen, Irene H, Fleming, Mark D, Van Natta, Meredith, Thompson‐Lastad, Ariana, Rasidjan, Maryani Palupy, and Burke, Nancy J
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Human Geography ,Policy and Administration ,Human Society ,Clinical Research ,Health Services ,Social Determinants of Health ,8.1 Organisation and delivery of services ,Generic health relevance ,Anthropology ,Medical ,Health Personnel ,Ill-Housed Persons ,Housing ,Humans ,Safety-net Providers ,homelessness ,housing ,hospitals ,marginalized populations ,inequity ,Anthropology ,Public Health ,Sociology - Abstract
As medicine integrates social and structural determinants into health care, some health workers redefine housing as medical treatment. This article discusses how health workers in two U.S. urban safety-net hospitals worked with patients without stable housing. We observed ethnographically how health workers helped patients seek housing in a sharply stratified housing economy. Analyzing in-depth interviews and observations, we show how health workers: (1) understood housing as health care and navigated limits of individual care in a structurally produced housing crisis; and (2) developed and enacted practices of biomedical and sociopolitical stabilization, including eligibilizing and data-tracking work. We discuss how health workers bridged individually focused techniques of clinical care with structural critiques of stratified housing economies despite contradictions in this approach. Finally, we analyze the implications of providers' extension of medical stabilization into social, economic, and political realms, even as they remained caught in the structural dynamics they sought to address.
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- 2022
27. STOP COVID-19 CA: Community engagement to address the disparate impacts of the COVID-19 pandemic in California
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Casillas, Alejandra, Rosas, Lisa G, Carson, Savanna L, Orechwa, Allison, North, Gemma, AuYoung, Mona, Kim, Gloria, Guereca, Jesus A, Ramers, Christian B, Burke, Nancy J, Corchado, Claudia G, Aguilar-Gaxiola, Sergio, Cheney, Ann, Rabin, Borsika A, Stadnick, Nicole A, Oswald, William, Cabrera, Abby, Sorkin, Dara H, Zaldivar, Frank, Wong, Wennie, Yerraguntala, Anusha S, Vassar, Stefanie D, Wright, Aziza Lucas, Washington, Donna L, Norris, Keith C, and Brown, Arleen F
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Health Services and Systems ,Health Sciences ,Coronaviruses ,Emerging Infectious Diseases ,Infectious Diseases ,Coronaviruses Disparities and At-Risk Populations ,Health Disparities ,Good Health and Well Being ,COVID-19 ,community engagement ,health disparities ,social determinant of health ,community partnered participatory research ,state health policies - Abstract
ObjectiveTo describe the early activities and lessons of the Share, Trust, Organize, Partner COVID-19 California Alliance (STOP COVID-19 CA), the California awardee of the NIH-funded multi-state Community Engagement Alliance (CEAL) against COVID-19. The Alliance was established to ensure equity in Coronavirus-19 disease (COVID-19) research, clinical practice, and public health for communities most impacted by the COVID-19 pandemic.Study settingThe STOP COVID-19 CA Alliance network of 11 universities and affiliated partner community-based organizations (CBOs) across California.Study designMixed methods evaluation consisting of an analysis of activity (August 2020 to December 2021) detailed in reports submitted by community-academic teams and a survey (August 2021) of academic investigators and affiliated community-based organization (CBO) partners.Data collectionWe summarized activities from the 11 community-academic teams' progress reports and described results from an online survey of academic investigators and CBO partners in the California Alliance.Principal findingsA review of progress reports (n = 256) showed that teams fielded surveys to 11,000 Californians, conducted 133 focus groups, partnered with 29 vaccine/therapeutics clinical trials, and led more than 300 town halls and vaccine events that reached Californians from communities disproportionately impacted by COVID-19. Survey responses from academic investigators and CBO partners emphasized the importance of learning from the successes and challenges of the California Alliance teams' COVID-19 initiatives. Both academic and CBO respondents highlighted the need for streamlined federal and institutional administrative policies, and fiscal practices to promote more effective and timely operations of teams in their efforts to address the numerous underlying health and social disparities that predispose their communities to higher rates of, and poor outcomes from, COVID-19.ConclusionsSTOP COVID-19 CA represents a new and potentially sustainable statewide community engagement model for addressing health disparities in multiethnic/multicultural and geographically dispersed communities.
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- 2022
28. Managing the “hot spots”
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FLEMING, MARK D, SHIM, JANET K, YEN, IRENE, DUBBIN, LESLIE, THOMPSON‐LASTAD, ARIANA, HANSSMANN, CHRISTOPH, and BURKE, NANCY J
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Policy and Administration ,Criminology ,Human Society ,Health Services ,Clinical Research ,8.1 Organisation and delivery of services ,Peace ,Justice and Strong Institutions ,Good Health and Well Being ,Anthropology ,Political Science ,Cultural Studies - Abstract
Health care systems in the United States are experimenting with a form of surveillance and intervention known as "hot spotting," which targets high-cost patients-the so-called "super-utilizers" of emergency departments-with intensive health and social services. Through a calculative deployment of resources to the costliest patients, health care hot spotting promises to simultaneously improve population health and decrease financial expenditures on health care for impoverished people. Through an ethnographic investigation of hot spotting's modes of distribution and its workings in the lives of patients and providers, we find that it targets the same individuals and neighborhoods as the police, who maintain longer-standing practices of hot spotting in zones of racialized urban poverty. This has led to a convergence of caring and punitive strategies of governance. The boundaries between them are shifting as a financialized logic of governance has come to dominate both health and criminal justice. [health care, chronic illness, governance, policing, poverty, United States].
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- 2021
29. Keeping Each Other Accountable
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Kenny, Jazmine D, Tsoh, Janice Y, Nguyen, Bang H, Le, Khanh, and Burke, Nancy J
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Health Services and Systems ,Public Health ,Health Sciences ,Human Society ,Prevention ,Clinical Research ,Tobacco ,Tobacco Smoke and Health ,Behavioral and Social Science ,Prevention of disease and conditions ,and promotion of well-being ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Cancer ,Respiratory ,Stroke ,Cardiovascular ,Good Health and Well Being ,Asian ,Family ,Female ,Healthy Lifestyle ,Humans ,Male ,Middle Aged ,Smoking ,Smoking Cessation ,family-based intervention ,lay health worker ,smoking cessation ,social support ,Vietnamese American ,Public Health and Health Services ,Public health ,Development studies - Abstract
Vietnamese American males have high smoking rates. This study explored social support mechanisms provided by lay health workers (LHWs) and family members through a smoking cessation intervention. Eight focus groups (N = 54) were conducted in Vietnamese stratified by intervention arms (Tobacco [experimental] and healthy living [control]) with 18 smokers, 18 family members, and 18 LHWs. Smokers reported feeling more accountable for their health behaviors, and smoking changes were reinforced by family members, peers, and LHWs through conversations facilitated during and outside the program. Culturally appropriate interventions with multiple social support mechanisms may reduce smoking in minority populations.
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- 2021
30. Neighborhood Ethnic Composition and Self-rated Health Among Chinese and Vietnamese American Immigrants
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Guan, Alice, Kim-Mozeleski, Jin E, Vyas, Priyanka, Stewart, Susan L, Gildengorin, Ginny, Burke, Nancy J, Ma, Kris, Pham, Amber T, Tan, Judy, Lu, Qian, McPhee, Stephen J, and Tsoh, Janice Y
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Epidemiology ,Public Health ,Health Sciences ,Human Society ,Demography ,Human Geography ,Health Disparities ,Prevention ,Clinical Research ,Clinical Trials and Supportive Activities ,Basic Behavioral and Social Science ,Behavioral and Social Science ,Aetiology ,2.3 Psychological ,social and economic factors ,Asian ,China ,Emigrants and Immigrants ,Ethnicity ,Health Status ,Humans ,Residence Characteristics ,White People ,Asian American ,Ethnic density ,Neighborhood effects ,Self-rated health ,Public Health and Health Services ,Public health ,Sociology - Abstract
Immigrants tend to live in areas with higher co-ethnic density, and the effect of neighborhood ethnic composition could be particularly salient for health. This study explored associations between neighborhood ethnic composition and self-rated health among Asian immigrants. We analyzed data collected at baseline from 670 Chinese and Vietnamese immigrants enrolled in a lifestyle intervention trial. Residential addresses were geocoded and combined with neighborhood socio-demographic profiles based on census data. We used generalized estimating equations to examine neighborhood ethnic composition and self-rated health. Independent of individual-level factors, living in neighborhoods more densely populated by whites was associated with poor/fair self-rated health. Neighborhood household income and density of participants' own ethnic group were not associated with poor/fair self-rated health. More research is warranted to disentangle reasons why Chinese and Vietnamese immigrants living in white-concentrated neighborhoods reported poorer self-rated health, including investigating effects of discrimination, relative deprivation, and availability of social resources.
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- 2021
31. Primary Care Physicians’ Perceived Barriers to Follow-Up of Abnormal Mammogram Results: Opportunities for Systems-Level Interventions
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Flynn, Sarah J., Livaudais-Toman, Jennifer, Kaplan, Celia P., Kerlikowske, Karla, Burke, Nancy J., Pathak, Sarita, and Karliner, Leah S.
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- 2023
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32. Family Support and Readiness to Consider Smoking Cessation among Chinese and Vietnamese American Male Smokers.
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Daniel, Joan A, Kim-Mozeleski, Jin E, Poudel, Krishna C, Sun, Angela, Burke, Nancy J, and Tsoh, Janice Y
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Tobacco ,Clinical Research ,Tobacco Smoke and Health ,Prevention ,Substance Abuse ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Cancer ,Cardiovascular ,Stroke ,Respiratory ,Cardiorespiratory Medicine and Haematology ,Public Health and Health Services - Abstract
IntroductionSmoking prevalence is disproportionately high among Asian American immigrant men with limited English proficiency. Understanding the role of family support may provide insights on culturally acceptable strategies to promote smoking cessation.AimsThis study examined how family support was associated with readiness to consider smoking cessation among Chinese and Vietnamese American male daily smokers.MethodsWe analyzed baseline data (N=340) from a cluster randomized trial of a family-based healthy lifestyle intervention. We assessed the frequency of receiving family support in various forms (encouraging use of cessation resources; praising efforts; checking-in; reminding of familial role). Multiple regression analysis was used to determine associations between family support areas and readiness to consider smoking cessation, controlling for covariates.Results/findingsReporting a higher frequency of receiving praise and encouragement for one's efforts to quit was positively associated with readiness to consider cessation. Other areas of family support were not significant.ConclusionsThese findings provide evidence to explore specific areas of family support in enhancing Asian American smokers' readiness to consider cessation. As there is high interest from Asian American family members to support their smokers for quitting, culturally specific and acceptable strategies are needed to promote smoking cessation among Asian Americans.
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- 2021
33. Laughing in the face of cancer
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Burke, Nancy J., primary
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- 2023
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34. Organization Communication Factors and Abnormal Mammogram Follow-up: a Qualitative Study Among Ethnically Diverse Women Across Three Healthcare Systems
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Kenny, Jazmine D, Karliner, Leah S, Kerlikowske, Karla, Kaplan, Celia P, Fernandez-Lamothe, Ana, and Burke, Nancy J
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Health Services and Systems ,Health Sciences ,Health Services ,Biomedical Imaging ,Prevention ,Clinical Research ,Cancer ,Good Health and Well Being ,Breast Neoplasms ,Communication ,Delivery of Health Care ,Female ,Hispanic or Latino ,Humans ,Mammography ,San Francisco ,White People ,abnormal mammogram ,facility communication ,delay ,Clinical Sciences ,General & Internal Medicine ,Clinical sciences ,Health services and systems ,Public health - Abstract
BackgroundRegular mammogram screening for eligible average risk women has been associated with early detection and reduction of cancer morbidity and mortality. Delayed follow-up and resolution of abnormal mammograms limit early detection efforts and can cause psychological distress and anxiety.ObjectiveThe goal of this study was to gain insight from women's narratives into how organizational factors related to communication and coordination of care facilitate or hinder timely follow-up for abnormal mammogram results.DesignWe conducted 61 qualitative in-person interviews with women from four race-ethnic groups (African American, Chinese, Latina, and White) in three different healthcare settings (academic, community, and safety-net).ParticipantsEligible participants had an abnormal mammogram result requiring breast biopsy documented in the San Francisco Mammography Registry in the previous year.ApproachInterview narratives included reflections on experience and suggested improvements to communication and follow-up processes. A grounded theory approach was used to identify themes across interviews.Key resultsParticipants' experiences of follow-up and diagnosis depended largely on communication processes. Twenty-one participants experienced a follow-up delay (> 30 days between index mammogram and biopsy). Organizational factors, which varied across different institutions, played key roles in effective communication which included (a) direct verbal communication with the ability to ask questions, (b) explanation of medical processes and terminology avoiding jargon, and (c) use of interpretation services for women with limited English proficiency.ConclusionHealth organizations varied in their processes for abnormal results communication and availability of support staff and interpretation services. Women who received care from institutions with more robust support staff, such as bilingual navigators, more often than not reported understanding their results and timely abnormal mammogram follow-up. These reports were consistent across women from diverse ethnic groups and suggest the value of organizational support services between an abnormal mammogram and resolution for improving follow-up times and minimizing patient distress.
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- 2020
35. Disentangling individual and neighborhood differences in the intention to quit smoking in Asian American male smokers
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Vyas, Priyanka, Tsoh, Janice Y, Gildengorin, Ginny, Stewart, Susan L, Yu, Edgar, Guan, Alice, Pham, Amber, Burke, Nancy J, and McPhee, Steven J
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Public Health ,Health Sciences ,Prevention ,Basic Behavioral and Social Science ,Substance Misuse ,Behavioral and Social Science ,Minority Health ,Clinical Research ,Tobacco Smoke and Health ,Drug Abuse (NIDA only) ,Cancer ,Tobacco ,Health Disparities ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Stroke ,Respiratory ,Good Health and Well Being ,Tobacco use ,Asian Americans ,Tobacco retailers ,Neighborhood characteristics ,Geographic variation ,Public Health and Health Services ,Epidemiology ,Health services and systems ,Public health - Abstract
Numerous studies have assessed individual-level factors associated with intention to quit smoking. However, fewer studies have assessed how neighborhood and built environment also contribute towards individual-level behavior. We used baseline data of 340 Chinese and Vietnamese male daily smokers from August 2015 to November 2017 living in the San Francisco Bay Area, who enrolled in a lifestyle intervention trial. The outcome variable was intention to quit in 30 days. To understand the role of contextual factors participants' residential addresses were geocoded, and neighborhood median income, ethnic composition, and tobacco retail density were computed. Individual level analysis suggested that Vietnamese American men had greater intention to quit smoking (OR = 2.90 CI = 1.59, 5.26) in comparison to Chinese Americans. However, after adding neighborhood level factors to the model, no ethnic group difference was observed. Neighborhood household median income (OR = 0.74, CI = 0.64, 0.86) and tobacco retail counts (OR = 0.79, CI = 0.67, 0.94) were negatively associated with intention to quit. Years lived in the U.S. was the only individual level factor associated with intention to quit. By comparing two Asian American groups that live in heterogeneous neighborhoods, we identify key environmental and policy drivers that are associated with quit intention. Future studies aimed at influencing individual-level behavior should take into consideration the neighborhood context and built environment characteristics.
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- 2020
36. Unpacking the ‘black box’ of lay health worker processes in a US-based intervention
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Burke, Nancy J, Phung, Kristine, Yu, Filmer, Wong, Ching, Le, Khanh, Nguyen, Isabel, Nguyen, Long, Guan, Alice, Nguyen, Tung T, and Tsoh, Janice Y
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Health Services and Systems ,Public Health ,Health Sciences ,Behavioral and Social Science ,Prevention ,Clinical Trials and Supportive Activities ,Clinical Research ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Respiratory ,Good Health and Well Being ,Aged ,Asian ,California ,Community Health Workers ,Culture ,Family ,Female ,Health Promotion ,Healthy Lifestyle ,Humans ,Male ,Middle Aged ,Multilingualism ,Smoking Cessation ,Teaching ,Wit and Humor as Topic ,lay health worker ,smoking cessation ,diet and physical activity ,Vietnamese Americans ,Public Health and Health Services ,Curriculum and Pedagogy ,Public health ,Policy and administration - Abstract
Prior studies have supported the effectiveness of the use of Lay Health Workers (LHWs) as an intervention model for managing chronic health conditions, yet few have documented the mechanisms that underlie the effectiveness of the interventions. This study provides a first look into how LHWs delivered a family-based intervention and the challenges encountered. We utilize observation data from LHW-led educational sessions delivered as part of a randomized controlled trial (RCT) designed to test a LHW outreach family-based intervention to promote smoking cessation among Vietnamese American smokers. The RCT included experimental (smoking cessation) and control (healthy living) arms. Vietnamese LHWs were trained to provide health information in Vietnamese to groups of family dyads (smoker and family member). Bilingual, bicultural research team members conducted unobtrusive observations in a subset of LHW educational sessions and described the setting, process and activities in structured fieldnotes. Two team members coded each fieldnote following a grounded theory approach. We utilized Atlas.ti qualitative software to organize coding and facilitate combined analysis. Findings offer a detailed look at the 'black box' of how LHWs work with their participants to deliver health messages. LHWs utilized multiple relational strategies, including preparing an environment that enables relationship building, using recognized teaching methods to engage learners and co-learners as well as using humor and employing culturally specific strategies such as hierarchical forms of address to create trust. Future research will assess the effectiveness of LHW techniques, thus enhancing the potential of LHW interventions to promote health among underserved populations.
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- 2020
37. Serious quit attempts and cessation implications for Asian American male smokers
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Guan, Alice, Kim-Mozeleski, Jin E, Tan, Judy Y, McPhee, Stephen J, Burke, Nancy J, Sun, Angela, Cheng, Joyce W, and Tsoh, Janice Y
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Public Health ,Health Sciences ,Behavioral and Social Science ,Substance Misuse ,Tobacco ,Tobacco Smoke and Health ,Clinical Research ,Cancer ,Prevention ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Respiratory ,Cardiovascular ,Stroke ,Good Health and Well Being ,Adult ,Aged ,Aged ,80 and over ,Asian ,California ,Health Behavior ,Humans ,Male ,Middle Aged ,Physician-Patient Relations ,Smokers ,Smoking Cessation ,Asian American ,Tobacco use ,Health disparities ,Smoking cessation ,Public Health and Health Services ,Psychology ,Substance Abuse ,Public health ,Biological psychology ,Clinical and health psychology - Abstract
IntroductionSmoking prevalence remains high among Asian American immigrant men, particularly those with limited English proficiency. Understanding ways to promote serious quit attempts (defined as a quit attempt lasting at least 24 h) could be crucial for reducing tobacco-related health disparities in this population. This study examines correlates of serious past year quit attempts among Chinese and Vietnamese American male daily smokers.MethodsBaseline survey data were collected between 2015 and 2017 from a lifestyle intervention trial (N = 340 Chinese and Vietnamese male daily smokers). Data analysis was conducted in 2019. Multivariable logistic regression analysis was used to identify factors associated with serious past year quit attempts.ResultsLess than half (43.2%) of the study participants had at least one serious past year quit attempt. Significant correlates of serious quit attempts included utilizing evidence-based methods (OR = 12.83, 95% CI 5.17-31.84) or other methods (OR = 3.92, 95% CI 3.92-13.73) to facilitate quitting compared to those who did not attempt to quit. Also, participants who had a physician encounter in the past year were more likely to have had a serious quit attempt (OR = 2.25, 95% CI 1.12-4.53). Discussing smoking during a past year doctor's visit, however, was not a significant correlate of serious quit attempts.ConclusionsOur findings underscore the importance of promoting the use of smoking cessation resources, and potentially utilizing healthcare encounters to facilitate cessation. Investigations are warranted to understand better how patient-physician interactions can enhance smoking cessation.
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- 2020
38. Engaging limited English proficient and ethnically diverse low-income women in health research: A randomized trial of a patient navigator intervention
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Nickell, Alyssa, Stewart, Susan L, Burke, Nancy J, Guerra, Claudia, Cohen, Elly, Lawlor, Catherine, Colen, Susan, Cheng, Janice, and Joseph, Galen
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Health Services and Systems ,Public Health ,Health Sciences ,Cancer ,Women's Health ,Behavioral and Social Science ,Minority Health ,Clinical Trials and Supportive Activities ,Clinical Research ,Prevention ,Good Health and Well Being ,Access to Information ,Aged ,Biomedical Research ,Breast Neoplasms ,Female ,Humans ,Interviews as Topic ,Limited English Proficiency ,Middle Aged ,Patient Navigation ,Poverty ,Prospective Studies ,Surveys and Questionnaires ,Patient navigation ,Clinical trials ,Disparities ,Information-Seeking behavior ,LEP ,Limited English proficient ,Community based participatory research ,CBPR ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Health services and systems - Abstract
ObjectiveEvaluate a community-based navigator intervention to increase breast cancer patients' and survivors' access to information about health research participation opportunities.MethodsIn the context of a Community Based Participatory Research collaboration, we conducted a prospective randomized controlled trial of the Health Research Engagement Intervention with pre- and post-intervention surveys (n = 133). The primary outcome was health research information-seeking behavior. Secondary outcomes were health research knowledge, willingness to participate in health research, and health empowerment. Qualitative interviews (n = 11) elucidated participant perspectives on the intervention.ResultsThere was no statistically significant difference between intervention and control groups' information-seeking behavior. Knowledge that not all health research studies are about drugs or treatments increased significantly from pre- to post-test among intervention group participants (32% to 48%, p = 0.012), but not in the control group (43% to 30%, p = 0.059); the difference between arms was statistically significant (p = 0.0012). Although survey responses indicated willingness to participate, qualitative interviews identified competing priorities that limited participants' motivation to seek enrollment information.Conclusions and practice implicationsCommunity-based navigators are a trusted, and therefore promising link between health research and low-income underserved communities. However, systemic barriers in health research infrastructures need to be addressed to include low income, LEP and immigrant populations.
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- 2019
39. Stratified citizenship, stratified health: Examining latinx legal status in the U.S. healthcare safety net
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Van Natta, Meredith, Burke, Nancy J, Yen, Irene H, Fleming, Mark D, Hanssmann, Christoph L, Rasidjan, Maryani Palupy, and Shim, Janet K
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Health Services and Systems ,Health Sciences ,Human Society ,Health Services ,Patient Safety ,Clinical Research ,Generic health relevance ,Good Health and Well Being ,Adult ,Anthropology ,Cultural ,Chronic Disease ,Delivery of Health Care ,Emigrants and Immigrants ,Emigration and Immigration ,Female ,Hispanic or Latino ,Humans ,Male ,Middle Aged ,Poverty ,Safety-net Providers ,Social Determinants of Health ,United States ,Immigration status ,Social determinants of health ,Healthcare systems ,Chronic illness ,Health inequalities ,Medical and Health Sciences ,Economics ,Studies in Human Society ,Public Health ,Health sciences ,Human society - Abstract
Our paper explores how legal status stratification shapes the health and health care of low-income patients with chronic illnesses in the U.S. healthcare safety net. Drawing on data from over two years of ethnographic fieldwork at urban safety-net clinics, we examine efforts by Complex Care Management (CCM) teams to stabilize patients with uncontrolled chronic illnesses through primary care-integrated support. We show that stratified citizenship and geographic variability correspond to different possibilities for health care. We suggest an approach to immigration as a structural determinant of health that accounts for the complex, stratified, and changing nature of citizenship status. We also highlight how geographical differences and interactions among local, state, and federal policies support the notion that citizenship is stratified across multiple tiers with distinctive possibilities and constraints for health. While county-based health plans at each of the study sites include residents with varying legal status, lack of formal legal status remains a substantial obstacle to care. Many immigrants are unable to take full advantage of primary and specialty care, resulting in unnecessary morbidity and mortality. In some cases, patients have returned to their country of origin to die. While CCM teams provide an impressive level of support to assist immigrant patients in navigating healthcare and immigration bureaucracies, legal and geographic stratification limit their ability to address broader aspects of these patients' social context.
- Published
- 2019
40. Unpacking the 'black box' of lay health worker processes in a US-based intervention.
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Burke, Nancy J, Phung, Kristine, Yu, Filmer, Wong, Ching, Le, Khanh, Nguyen, Isabel, Nguyen, Long, Guan, Alice, Nguyen, Tung T, and Tsoh, Janice Y
- Subjects
Health Services and Systems ,Public Health ,Health Sciences ,Prevention ,Clinical Research ,Behavioral and Social Science ,Clinical Trials and Supportive Activities ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Respiratory ,Good Health and Well Being ,Public Health and Health Services ,Curriculum and Pedagogy ,Public health ,Policy and administration - Abstract
Prior studies have supported the effectiveness of the use of Lay Health Workers (LHWs) as an intervention model for managing chronic health conditions, yet few have documented the mechanisms that underlie the effectiveness of the interventions. This study provides a first look into how LHWs delivered a family-based intervention and the challenges encountered. We utilize observation data from LHW-led educational sessions delivered as part of a randomized controlled trial (RCT) designed to test a LHW outreach family-based intervention to promote smoking cessation among Vietnamese American smokers. The RCT included experimental (smoking cessation) and control (healthy living) arms. Vietnamese LHWs were trained to provide health information in Vietnamese to groups of family dyads (smoker and family member). Bilingual, bicultural research team members conducted unobtrusive observations in a subset of LHW educational sessions and described the setting, process and activities in structured fieldnotes. Two team members coded each fieldnote following a grounded theory approach. We utilized Atlas.ti qualitative software to organize coding and facilitate combined analysis. Findings offer a detailed look at the 'black box' of how LHWs work with their participants to deliver health messages. LHWs utilized multiple relational strategies, including preparing an environment that enables relationship building, using recognized teaching methods to engage learners and co-learners as well as using humor and employing culturally specific strategies such as hierarchical forms of address to create trust. Future research will assess the effectiveness of LHW techniques, thus enhancing the potential of LHW interventions to promote health among underserved populations.
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- 2018
41. Complex care and contradictions of choice in the safety net
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Van Natta, Meredith, Burke, Nancy J, Yen, Irene H, Rubin, Sara, Fleming, Mark D, Thompson‐Lastad, Ariana, and Shim, Janet K
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Health Services and Systems ,Health Sciences ,Human Society ,Health Services ,Clinical Research ,Health and social care services research ,8.1 Organisation and delivery of services ,Adult ,Anthropology ,Cultural ,Choice Behavior ,Chronic Disease ,Delivery of Health Care ,Emergency Service ,Hospital ,Female ,Health Status Disparities ,Humans ,Longitudinal Studies ,Male ,Middle Aged ,Safety-net Providers ,Chronic illness ,determinants of health ,healthcare systems ,patient centredness ,health behaviour ,inequalities ,social inequalities in health status ,inequalities/social inequalities in health status ,Public Health and Health Services ,Sociology ,History and Philosophy of Specific Fields ,Public Health ,Public health ,Anthropology - Abstract
This article explores the complicated and often-contradictory notions of choice at play in complex care management (CCM) programmes in the US healthcare safety net. Drawing from longitudinal data collected over two years of ethnographic fieldwork at urban safety-net clinics, our study examines the CCM goal of transforming frequent emergency department (ED) utilisers into 'active' patients who will reduce their service utilisation and thereby contribute to a more rational, cost-effective healthcare system. By considering our data alongside philosopher Annemarie Mol's (2008) conceptualisation of the competing logics of choice and care, we argue that these premises often undermine CCM teams' efforts to support patients and provide the care they need - not only to prevent medical crises, but to overcome socio-economic barriers as well. We assert that while safety-net CCM programmes are held accountable for the degree to which their patients successfully transform into self-managing, cost-effective actors, much of the care CCM staff provide in fact involves attempts to intervene on structural obstacles that impinge on patient choice. CCM programmes thus struggle between an economic imperative to get patients to make better health choices and a moral imperative to provide care in the face of systemic societal neglect. (A virtual abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA).
- Published
- 2018
42. Importance of Content and Format of Oral Health Instruction to Low-income Mexican Immigrant Parents: A Qualitative Study.
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Chang, Corissa P, Barker, Judith C, Hoeft, Kristin S, Guerra, Claudia, Chung, Lisa H, and Burke, Nancy J
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Pediatric Research Initiative ,Nutrition ,Dental/Oral and Craniofacial Disease ,Pediatric ,Behavioral and Social Science ,Prevention ,Basic Behavioral and Social Science ,Clinical Research ,7.1 Individual care needs ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Prevention of disease and conditions ,and promotion of well-being ,Management of diseases and conditions ,Oral and gastrointestinal ,California ,Child ,Child ,Preschool ,Dental Care for Children ,Dental Clinics ,Diet ,Emigrants and Immigrants ,Female ,Health Education ,Health Education ,Dental ,Health Knowledge ,Attitudes ,Practice ,Humans ,Male ,Mexican Americans ,Oral Hygiene ,Parents ,Poverty ,Qualitative Research ,Role ,Teach-Back Communication ,United States ,ORAL HYGIENE ,HEALTH EDUCATION ,TEACH-BACK COMMUNICATION ,Dentistry ,Paediatrics and Reproductive Medicine - Abstract
PurposeThis study's purpose was to explore how content and format of children's oral health instruction in the dental clinic is perceived by parents and might affect parents' knowledge and behaviors.MethodsThirty low-income Mexican immigrant parents of children age five years and under were recruited from dental clinics in 2015 to 2016. In-person qualitative interviews in Spanish about their children's and their own experiences of dental care and home oral hygiene practices were conducted, digitally recorded, translated, and transcribed. Data analysis involved iteratively reading text data and developing and refining codes to find common themes.ResultsTwenty-five of 30 parents recalled receiving oral hygiene instruction, and 18 recalled receiving nutrition instruction and were included in analyses. The format and effectiveness of instruction varied. More engaging educational approaches were recalled and described in more detail than less engaging educational approaches. As a result of oral hygiene and nutritional instruction, most parents reported changing their oral hygiene home behaviors for their children; half aimed to reduce purchasing sugary foods and drinks.ConclusionsMost parents recalled receiving oral hygiene and nutrition instruction as part of their child's dental visit and reported incorporating the instruction and recommendations they received into their children's home routine.
- Published
- 2018
43. Assessing Patient Activation among High-Need, High-Cost Patients in Urban Safety Net Care Settings
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Napoles, Tessa M, Burke, Nancy J, Shim, Janet K, Davis, Elizabeth, Moskowitz, David, and Yen, Irene H
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Health Services and Systems ,Health Sciences ,Clinical Research ,Behavioral and Social Science ,7.1 Individual care needs ,Management of diseases and conditions ,No Poverty ,Health Services Needs and Demand ,Humans ,Patient Acceptance of Health Care ,Patient Participation ,Poverty ,Safety-net Providers ,United States ,Urban Health Services ,Patient activation measure ,Patient enablement instrument ,Complex care management ,Safetynet ,Urban ,Super-utilizer ,High-need ,high-cost ,HNHC ,Health disparities ,High-need ,high-cost ,Safety net ,Human Movement and Sports Sciences ,Public Health and Health Services ,Public Health ,Public health - Abstract
We sought to examine the literature using the Patient Activation Measure (PAM) or the Patient Enablement Instrument (PEI) with high-need, high-cost (HNHC) patients receiving care in urban safety net settings. Urban safety net care management programs serve low-income, racially/ethnically diverse patients living with multiple chronic conditions. Although many care management programs track patient progress with the PAM or the PEI, it is not clear whether the PAM or the PEI is an effective and appropriate tool for HNHC patients receiving care in urban safety net settings in the United States. We searched PubMed, EMBASE, Web of Science, and PsycINFO for articles published between 2004 and 2015 that used the PAM and between 1998 and 2015 that used the PEI. The search was limited to English-language articles conducted in the United States and published in peer-reviewed journals. To assess the utility of the PAM and the PEI in urban safety net care settings, we defined a HNHC patient sample as racially/ethnically diverse, low socioeconomic status (SES), and multimorbid. One hundred fourteen articles used the PAM. All articles using the PEI were conducted outside the U.S. and therefore were excluded. Nine PAM studies (8%) included participants similar to those receiving care in urban safety net settings, three of which were longitudinal. Two of the three longitudinal studies reported positive changes following interventions. Our results indicate that research on patient activation is not commonly conducted on racially and ethnically diverse, low SES, and multimorbid patients; therefore, there are few opportunities to assess the appropriateness of the PAM in such populations. Investigators expressed concerns with the potential unreliability and inappropriate nature of the PAM on multimorbid, older, and low-literacy patients. Thus, the PAM may not be able to accurately assess patient progress among HNHC patients receiving care in urban safety net settings. Assessing progress in the urban safety net care setting requires measures that account for the social and structural challenges and competing demands of HNHC patients.
- Published
- 2017
44. Defining trauma in complex care management: Safety-net providers' perspectives on structural vulnerability and time
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Thompson-Lastad, Ariana, Yen, Irene H, Fleming, Mark D, Van Natta, Meredith, Rubin, Sara, Shim, Janet K, and Burke, Nancy J
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Health Services and Systems ,Health Sciences ,Human Society ,Brain Disorders ,Physical Injury - Accidents and Adverse Effects ,Violence Research ,Behavioral and Social Science ,8.1 Organisation and delivery of services ,Peace ,Justice and Strong Institutions ,Delivery of Health Care ,Health Services Accessibility ,Humans ,Patient Care Management ,Perception ,Safety-net Providers ,United States ,Vulnerable Populations ,Wounds and Injuries ,Complex care management ,Trauma-informed care ,Structural competency ,Trauma ,Chronic illness ,Social determinants of health ,Medical and Health Sciences ,Economics ,Studies in Human Society ,Public Health ,Health sciences ,Human society - Abstract
In this paper, we delineate how staff of two complex care management (CCM) programs in urban safety net hospitals in the United States understand trauma. We seek to (1) describe how staff in CCM programs talk about trauma in their patients' lives; (2) discuss how trauma concepts allow staff to understand patients' symptoms, health-related behaviors, and responses to care as results of structural conditions; and (3) delineate the mismatch between long-term needs of patients with histories of trauma and the short-term interventions that CCM programs provide. Observation and interview data gathered between February 2015 and August 2016 indicate that CCM providers define trauma expansively to include individual experiences of violence such as childhood abuse and neglect or recent assault, traumatization in the course of accessing health care and structural violence. Though CCM staff implement elements of trauma-informed care, the short-term design of CCM programs puts pressure on the staff to titrate their efforts, moving patients towards graduation or discharge. Trauma concepts enable clinicians to name structural violence in clinically legitimate language. As such, trauma-informed care and structural competency approaches can complement each other.
- Published
- 2017
45. Patient engagement at the margins: Health care providers' assessments of engagement and the structural determinants of health in the safety-net
- Author
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Fleming, Mark D, Shim, Janet K, Yen, Irene, Thompson-Lastad, Ariana, Rubin, Sara, Van Natta, Meredith, and Burke, Nancy J
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Health Services and Systems ,Health Sciences ,Human Society ,Health Disparities ,Clinical Research ,Patient Safety ,Behavioral and Social Science ,Health Services ,8.1 Organisation and delivery of services ,8.3 Policy ,ethics ,and research governance ,7.1 Individual care needs ,Generic health relevance ,Good Health and Well Being ,Adult ,California ,Female ,Health Personnel ,Humans ,Income ,Male ,Middle Aged ,Patient Acceptance of Health Care ,Patient Participation ,Qualitative Research ,Racial Groups ,Social Determinants of Health ,Socioeconomic Factors ,Trust ,United States ,Patient engagement ,Poverty ,Health inequalities ,Safety-net ,Super utilizers ,Medical and Health Sciences ,Economics ,Studies in Human Society ,Public Health ,Health sciences ,Human society - Abstract
Increasing "patient engagement" has become a priority for health care organizations and policy-makers seeking to reduce cost and improve the quality of care. While concepts of patient engagement have proliferated rapidly across health care settings, little is known about how health care providers make use of these concepts in clinical practice. This paper uses 20 months of ethnographic and interview research carried out from 2015 to 2016 to explore how health care providers working at two public, urban, safety-net hospitals in the United States define, discuss, and assess patient engagement. We investigate how health care providers describe engagement for high cost patients-the "super-utilizers" of the health care system-who often face complex challenges related to socioeconomic marginalization including poverty, housing insecurity, exposure to violence and trauma, cognitive and mental health issues, and substance use. The health care providers in our study faced institutional pressure to assess patient engagement and to direct care towards engaged patients. However, providers considered such assessments to be highly challenging and oftentimes inaccurate, particularly because they understood low patient engagement to be the result of difficult socioeconomic conditions. Providers tried to navigate the demand to assess patient engagement in care by looking for explicit positive and negative indicators of engagement, while also being sensitive to more subtle and intuitive signs of engagement for marginalized patients.
- Published
- 2017
46. Care in the time of COVID-19
- Author
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Burke, Nancy J., primary
- Published
- 2021
- Full Text
- View/download PDF
47. Introduction
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Wahlberg, Ayo, primary, Burke, Nancy J., additional, and Manderson, Lenore, additional
- Published
- 2021
- Full Text
- View/download PDF
48. Suffering in Silence
- Author
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Petersen, Anne Berit, Tsoh, Janice Y, Nguyen, Tung T, McPhee, Stephen J, and Burke, Nancy J
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Health Services and Systems ,Health Sciences ,Substance Misuse ,Clinical Research ,Behavioral and Social Science ,Tobacco Smoke and Health ,Cancer ,Prevention ,Tobacco ,Respiratory ,Good Health and Well Being ,Asian American ,family communication ,qualitative research ,smoking cessation ,Nursing - Abstract
The goal of this project was to explore family communication dynamics and their implications for smoking cessation. We conducted 39 in-depth dyadic and individual qualitative interviews with 13 immigrant smoker-family member pairs of Vietnamese ( n = 9 dyads, 18 individuals) and Chinese ( n = 4 dyads, 8 individuals) descent, including seven current and six former smokers and 13 family members. All 13 dyadic and 26 individual interviews were analyzed using a collaborative crystallization process as well as grounded theory methods. We identified three interrelated pathways by which tobacco use in immigrant Vietnamese and Chinese families impacts family processes and communication dynamics. Using a two-dimensional model, we illustrate how the shared consequences of these pathways can contribute to a dynamic of avoidance and noncommunication, resulting in individual family members "suffering in silence" and ultimately smoking being reinforced. We discuss the implications of these findings for development of smoking cessation interventions.
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- 2016
49. Suffering in Silence: Impact of Tobacco Use on Communication Dynamics Within Vietnamese and Chinese Immigrant Families.
- Author
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Petersen, Anne Berit, Tsoh, Janice Y, Nguyen, Tung T, McPhee, Stephen J, and Burke, Nancy J
- Subjects
Asian American ,family communication ,qualitative research ,smoking cessation ,Nursing - Abstract
The goal of this project was to explore family communication dynamics and their implications for smoking cessation. We conducted 39 in-depth dyadic and individual qualitative interviews with 13 immigrant smoker-family member pairs of Vietnamese ( n = 9 dyads, 18 individuals) and Chinese ( n = 4 dyads, 8 individuals) descent, including seven current and six former smokers and 13 family members. All 13 dyadic and 26 individual interviews were analyzed using a collaborative crystallization process as well as grounded theory methods. We identified three interrelated pathways by which tobacco use in immigrant Vietnamese and Chinese families impacts family processes and communication dynamics. Using a two-dimensional model, we illustrate how the shared consequences of these pathways can contribute to a dynamic of avoidance and noncommunication, resulting in individual family members "suffering in silence" and ultimately smoking being reinforced. We discuss the implications of these findings for development of smoking cessation interventions.
- Published
- 2016
50. Survivorship Care Plan Information Needs: Perspectives of Safety-Net Breast Cancer Patients
- Author
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Burke, Nancy J, Napoles, Tessa M, Banks, Priscilla J, Orenstein, Fern S, Luce, Judith A, and Joseph, Galen
- Subjects
Health Services and Systems ,Nursing ,Health Sciences ,Cancer ,Breast Cancer ,Clinical Research ,Health Services ,Management of diseases and conditions ,Health and social care services research ,7.1 Individual care needs ,8.1 Organisation and delivery of services ,Adult ,Aged ,Breast Neoplasms ,Continuity of Patient Care ,Female ,Focus Groups ,Health Knowledge ,Attitudes ,Practice ,Humans ,Literacy ,Middle Aged ,Survival Rate ,Survivors ,United States ,General Science & Technology - Abstract
PurposeDespite the Institute of Medicine's (IOM) 2005 recommendation, few care organizations have instituted standard survivorship care plans (SCPs). Low health literacy and low English proficiency are important factors to consider in SCP development. Our study aimed to identify information needs and survivorship care plan preferences of low literacy, multi-lingual patients to support the transition from oncology to primary care and ongoing learning in survivorship.MethodsWe conducted focus groups in five languages with African American, Latina, Russian, Filipina, White, and Chinese medically underserved breast cancer patients. Topics explored included the transition to primary care, access to information, knowledge of treatment history, and perspectives on SCPs.ResultsAnalysis of focus group data identified three themes: 1) the need for information and education on the transition between "active treatment" and "survivorship"; 2) information needed (and often not obtained) from providers; and 3) perspectives on SCP content and delivery.ConclusionsOur data point to the need to develop a process as well as written information for medically underserved breast cancer patients. An SCP document will not replace direct communication with providers about treatment, symptom management and transition, a communication that is missing in participating safety-net patients' experiences of cancer care. Women turned to peer support and community-based organizations in the absence of information from providers.Implications for cancer survivors"Clear and effective" communication of survivorship care for safety-net patients requires dedicated staff trained to address wide-ranging information needs and uncertainties.
- Published
- 2016
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