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BackgroundThe human immunodeficiency virus (HIV) continues to be a major health issue in the United States, and an estimated 1.2 million people in the United States are living with HIV. As part of Healthy People 2020, the Office of Disease Prevention and Health Promotion has targeted the persistent demographic and geographic disparities in HIV prevalence and management. Preliminary evidence suggests that mobile health technology (smartphone apps) may be a promising way to support HIV self-management among vulnerable populations of people living with HIV (PLWH) who lack access to appropriate health care services. ObjectiveThis study examines the association between individual characteristics of PLWH and level of interest in using a free mobile phone app for HIV self-management. MethodsThis study was conducted using cross-sectional survey data collected in the Florida Cohort Study between 2014 and 2016 (N=766). Associations between individual characteristics of PLWH and level of interest in using a free mobile phone app for HIV self-management were examined using bivariate analysis and logistic regression. ResultsOverall, 85.5% (655/766) of respondents were interested in using a free mobile phone app that supports HIV self-management. Participants expressed the highest interest in app functions that facilitate communication with health care providers (568/740, 76.8%) or help to identify relevant health care services (556/745 74.6%). Age (OR 0.959, 95% CI 0.936-0.982), education (OR 1.281, 95% CI 1.027-1.598) and disability or inability to work (OR 0.296, 95% CI 0.145-0.606) were all significantly associated with being interested in using a free mobile phone app for HIV self-management. ConclusionsThis study indicates that a majority of PLWH are interested in using a free mobile phone app to self-manage their condition. The findings can inform the development of mobile phone apps that support effective HIV self-management.

BACKGROUND: Top managers transformational leadership is associated with significant influence on subordinates. Yet little is known about the extent to which top managers transformational leadership influences middle managers implementation leadership and, ultimately, frontline staff delivery of evidence-based health care practices. PURPOSE: To test a multilevel leadership model examining the extent to which top managers transformational leadership, as mediated by implementation leadership of middle managers (i.e., those who supervise direct clinical services), affects staff attitudes toward evidence-based practices (EBPs) and their implementation. METHODOLOGY/APPROACH: We used data collected in 2013 from 427 employees in 112 addiction health services programs in Los Angeles County, California. We relied on hierarchical linear models with robust standard errors to analyze multilevel data, individuals nested in programs. We conducted two path models to estimate multilevel relationships with two EBPs: contingency management and medication-assisted treatment. RESULTS: Findings partially supported our theory-driven multilevel leadership model. Specifically, results demonstrated that middle managers implementation leadership mediated the relationship between top managers transformational leadership and attitudes toward EBPs. At the same time, they showed the mediated relationship for delivery of contingency management treatment was only marginally significant (standardized indirect effect = .006, bootstrap p = .091). We did not find a mediation effect for medication-assisted treatment. DISCUSSION: Findings advance leadership theory in health care, highlighting the importance of middle managers implementation leadership in transmitting the influence of top managers transformational leadership on staff attitudes toward EBPs. The full path model shows the extent to which transformational leadership may influence staff implementation of innovative practices as mediated through staff attitudes toward EBPs and middle managers implementation leadership. PRACTICE IMPLICATIONS: Our findings have implications for developing a multilevel leadership approach to implementation in health care. Leadership development should build on different competencies based on managers level but align managers priorities on the same implementation goals.

Background: Proactive behaviors at work refer to discretionary actions among workers that are self-starting, change oriented, and future focused. Proactive behaviors reflect the idiosyncratic actions by individual workers that shape the delivery and experience of professional services, highlight a bottom-up perspective on workers' agency and motivation that can influence organizational practices, and are associated with a variety of employee and organizational outcomes. Purpose: This systematic review aims to understand the various forms of proactive behaviors in health care workers that have been studied, and how these proactive behaviors are associated with employee-level outcomes and quality of care. Methods: Systematic review of articles published to date on proactive behaviors in health care workers. Results: Based on the identification of 40 articles, we find that job crafting, active problem solving, voice, extra-role behaviors, and idiosyncratic deals have been investigated as proactive behaviors among health care workers. Among these, job crafting is the most commonly studied (35% of articles), and it has been conceptualized and measured in the most consistent way, including as individual- and group-level phenomena, and as organizational interventions. Studies on active problem solving, which refers to workers accepting responsibility, exercising control, and taking action around anticipated or experienced problems at work, have not been consistently investigated as a form of proactive behavior but represent 25% of the articles identified in this review. Overall, this review finds that proactive behaviors in health care is a burgeoning area of research, with the majority of studies being cross-sectional in design and published after 2010, and focused on workers' job satisfaction as the outcome. Practice Implications: Health care workers and managers should consider the distinct influences and contributions of proactive behaviors as ways to improve employee-level outcomes and quality of care. [ABSTRACT FROM AUTHOR]

BackgroundUtilization of specialty care may not be a discrete, isolated behavior but rather, a behavior of sequential movements within the health care system. Although patients may often visit their primary care physician and receive a referral before utilizing specialty care, prior studies have underestimated the importance of accounting for these sequential movements.MethodsThe sample included 6,772 adults aged 18 years and older who participated in the 2001 Survey on Disparities in Quality of Care, sponsored by the Commonwealth Fund. A sequential logit model was used to account for movement in all stages of utilization: use of any health services (i.e., first stage), having a perceived need for specialty care (i.e., second stage), and utilization of specialty care (i.e., third stage). In the sequential logit model, all stages are nested within the previous stage.ResultsGender, race/ethnicity, education and poor health had significant explanatory effects with regard to use of any health services and having a perceived need for specialty care, however racial/ethnic, gender, and educational disparities were not present in utilization of specialty care. After controlling for use of any health services and having a perceived need for specialty care, inability to pay for specialty care via income (AOR = 1.334, CI = 1.10 to 1.62) or health insurance (unstable insurance: AOR = 0.26, CI = 0.14 to 0.48; no insurance: AOR = 0.12, CI = 0.07 to 0.20) were significant barriers to utilization of specialty care.ConclusionsUse of a sequential logit model to examine utilization of specialty care resulted in a detailed representation of utilization behaviors and patient characteristics that impact these behaviors at all stages within the health care system. After controlling for sequential movements within the health care system, the biggest barrier to utilizing specialty care is the inability to pay, while racial, gender, and educational disparities diminish to non-significance. Findings from this study represent how Americans use the health care system and more precisely reveals the disparities and inequalities in the U.S. health care system.

Objective: To evaluate school immunization records and document the immunization coverage and compliance level of children enrolled in kindergarten in Phoenix during the 2001-2002 school year. The purpose was to obtain information on: 1) immunization status by age two; 2) under-immunization in kindergarten; 3) administration error; and 4) transcription error. Methods: Vaccination levels were estimated by conducting a retrospective immunization coverage survey of the immunization records of children in SW, SE, NE, and NW regions of Phoenix. A two-stage cluster design was used. Schools were randomly selected with the regions and students were systematically selected within the schools. Setting: Twelve schools from Phoenix were surveyed. Immunization records for 865 student records were assessed. Children who had incomplete or unknown records were identified. Information on date of birth and dates of vaccination of each dose of vaccine was collected. Results: Of the 857 records included in the analyses, 30.6 per cent were from the NE, 19.9 per cent from the NW, 17.8 per cent from the SE and 31.7 per cent were from the SW. Private school students comprised 18.4 per cent of the sample, 78.3 per cent were from public schools and 3.4 per cent from charter schools. Examining the sample, 30.5 per cent did not have the shots required by age two (four Dtap, three Polio, one MMR), 11.4 per cent of shots were administered before the minimum age and/or interval, 16.0 per cent did not have the shots required for entrance to kindergarten (four Dtap, three Polio, two MMR, three HEP B) and 10.8 per cent of the records contained transcription errors. Conclusion: The data showed that vaccination rates varied by region. None of the schools were in full compliance with the Arizona goal of 95 per cent of all kindergarten students being up to date. The vaccination levels were also below the National 2010 goal of 90 per cent by age two. The high administration error rate indicates that providers need to administer vaccines according to the recommended schedule. Further assessment must be done to determine effective interventions to target specific populations. (Contains 2 tables.)

Objective To determine participation in polio supplementary immunization activities (SIAs) in sub-Saharan Africa among users and nonusers of routine immunization services and among users who were compliant or non-compliant with the routine oral poliovirus vaccine (OPV) immunization schedule. Methods Data were obtained from household-based surveys in non-polio-endemic sub-Saharan African countries. Routine immunization service users were children (aged < 5 years) who had ever had a health card containing their vaccination history; non- users were children who had never had a health card. Users were considered compliant with the OPV routine immunization schedule if, by the SIA date, their health card reflected receipt of required OPV doses. Logistic regression measured associations between SIA participation and use of both routine immunization services and compliance with routine OPV among users. Findings Data from 21 SIAs conducted between 1999 and 2010 in 15 different countries met inclusion criteria. Overall SIA participation ranged from 70.2% to 96.1%. It was consistently lower among infants than among children aged 1-4 years. In adjusted analyses, participation among routine immunization services users was > 85% in 12 SIAs but non-user participation was > 85% in only 5 SIAs. In 18 SIAs, participation was greater among users (P < 0.01 in 16, 0.05 in 1 and < 0.10 in 1) than non-users. In 14 SIAs, adjusted analyses revealed lower participation among non-compliant users than among compliant users (P < 0.01 in ] 0, < 0.05 in 2 and < 0.10 in 2). Conclusion Large percentages of children participated in SIAs. Prior use of routine immunization services and compliance with the routine OPV schedule showed a strong positive association with SIA participation. Objectif Determinerla participation auxcampagnes de supplementation vaccinale en Afrique subsaharienne parmi les utilisateurs et les non-utilisateurs des services de vaccination de routine et parmi les utilisateurs conformes ou non-conformes au protocole de vaccination antipoliomyelitique orale. Methodes Les donnees ont ete obtenues a partir d'enquetes de menages conduites dans des pays non-polio-endemiques d'Afrique subsaharienne. Les utilisateurs des services de vaccination de routine etaient des enfants (ages de moins de 5 ans) ayant possede un jour un carnet de sante contenant leur historique vaccinal; les non-utilisateurs etaient des enfants n'ayant jamais possede de carnet de sante. Les utilisateurs ont ete consideres comme conformes au protocole de vaccination antipoliomyelitique orale si, a la date de la campagne, leur carnet de sante refletait I'administration des doses de vaccination antipoliomyelitique orale requises. Une regression Iogistique a mesure les associations entre la participation a la campagne et tant le recours aux services de vaccination de routine que la conformite au protocole de vaccination antipoliomyelitique orale des utilisateurs. Resultats Les donnees provenant de 2] campagnes de supplementation vaccinale menees entre 1999 et 2010 dans 14 pays differents ont satisfait les des criteres d'inclusion. La participation globale aux campagnes variait de 70,2% a 96,1%. Elle etait toujours plus faible chez les nourrissons que chez les enfants ages de 1 a 4 ans. Dans les analyses ajustees, la participation parmi les utilisateurs des services de vaccination de routine etait >85% dans 12 campagnes, mais la participation des non-utilisateurs etait >85% pour seulement 5 campagnes. Dans 18 campagnes, la participation etait plus elevee chez les utilisateurs (P Conclusion Un pourcentage eleve d'enfants ont participe a des campagnes. Le recours anterieur aux services de vaccination de routine et la conformite au protocole de vaccination orale ont montre une forte correlation positive avec la participation aux campagnes. Objetivo Determinar la participacion en las actividades suplementarias de inmunizacion (ASI) contra la poliomielitis en el Africa subsahariana entre los usuarios y no usuarios de los servicios de inmunizacion sistematica, asi como entre los usuarios que se atuvieron o no al calendario de vacunacion antipoliomielitica oral (OPV). Metodos Los datos se obtuvieron a traves de encuestas de hogares en paises del Africa subsahariana en los que la poliomielitis no es endemica. Los usuarios del servicio de inmunizacion sistematica fueron niflos (con edades inferiores a cinco aflos) que disponian de una tarjeta sanitaria con sus antecedentes de vacunacion; los no usuarios fueron niflos que nunca habian tenido una tarjeta sanitaria. Se considero que los usuarios cumplian con el calendario de vacunacion OPV si, al iniciar la campafla, sus tarjetas sanitarias retlejaban que habian recibido las dosis OPV obligatorias. La regresion logistica midio las relaciones existentes entre la participacion en las ASI, el uso de ambos servicios de inmunizacion sistematica y la conformidad con la OPV sistematica entre los usuarios. Resultados Los datos de 21 ASI realizadas entre 1999 y 2010 en 15 paises diferentes reunieron los criterios de inclusion. De manera global, la participacion en las ASI fue de entre e170,2% y e196,1%, y fue sistematicamente menor entre lactantes que entre niflos con edades comprendidas entre uno y cuatro aflos. En los analisis ajustados, la participacion entre los usuarios de los servicios de inmunizacion sistematica fue superior al 85% en 12 ASI, mientras que la participacion de no usuarios fue superior al 85% en solo cinco ASI. En 18 de las actividades suplementarias de inmunizacion, la participacion fue mayor entre usuarios (P < 0,01 en 16 de ellas, 0,05 en una y < 0,10 en una) que entre no usuarios. En 14 de las ASI, los analisis ajustados revelaron una participacion menor entre usuarios que no se ajustaban al calendario de vacunacion que entre aquellos que si lo hacian (P< 0,01 en 10, < 0,05 en 2 y Conclusion Un porcentaje amplio de ninos participaron en las actividades suplementarias de inmunizacion. El uso previo de servicios de inmunizacion sistematica y la conformidad con el calendario de OPV mostraron una relacion positiva muy fuerte con la participacion en las ASI., Introduction Since the late 1980s, use of supplementary immunization activities (SIAs) has been a key strategy of the Global Polio Eradication Initiative (GPEI). SIAs are mass vaccination campaigns that aim [...]

Objectives. We examined the effects of maternal and provider characteristics on the up-to-date immunization status of children. Methods. We used data from the 2003 National Immunization Survey to determine variations in children's up-to-date status in the 4:3:1:3 immunization series. Results. Low maternal educational levels and low socioeconomic status were associated with high 4:3:1:3 series completion rates. Also, completion rates were high in Hispanic and non-Hispanic Black families with low income-to-poverty ratios. Conclusions. We found that children of less educated mothers and children in Hispanic and non-Hispanic Black families with low income-to-poverty ratios were more likely to have completed the 4:3:1:3 series. Although the reasons for these results need further exploration in other data sets, possible factors are Hispanics' positive cultural attitudes regarding the needs and importance of young children and provision of information on immunizations to low-income minority mothers who access government-subsidized health care programs. (Am J Public Health. 2007;97:259-266. doi:10.2105/AJPH.2005.076661)

Abstract Background The adoption of health information technology has been recommended as a viable mechanism for improving quality of care and patient health outcomes. However, the capacity of health information technology (i.e., availability and use of multiple and advanced functionalities), particularly in federally qualified health centers (FQHCs) on improving quality of care is not well understood. We examined associations between health information technology (HIT) capacity at FQHCs and quality of care, measured by the receipt of discharge summary, frequency of patients receiving reminders/notifications for preventive care/follow-up care, and timely appointment for specialty care. Methods The analyses used 2009 data from the National Survey of Federally Qualified Health Centers. The study included 776 of the FQHCs that participated in the survey. We examined the extent of HIT use and tested the hypothesis that level of HIT capacity is associated with quality of care. Multivariable logistic regressions, reporting unadjusted and adjusted odds ratios, were used to examine whether ‘FQHCs’ HIT capacity’ is associated with the outcome measures. Results The results showed a positive association between health information technology capacity and quality of care. FQHCs with higher HIT capacity were significantly more likely to have improved quality of care, measured by the receipt of discharge summaries (OR=1.43; CI=1.01, 2.40), the use of a patient notification system for preventive and follow-up care (OR=1.74; CI=1.23, 2.45), and timely appointment for specialty care (OR=1.77; CI=1.24, 2.53). Conclusions Our findings highlight the promise of HIT in improving quality of care, particularly for vulnerable populations who seek care at FQHCs. The results also show that FQHCs may not be maximizing the benefits of HIT. Efforts to implement HIT must include strategies that facilitate the implementation of comprehensive and advanced functionalities, as well as promote meaningful use of these systems. Further examination of the role of health information systems in clinical decision-making and improvements in patient outcomes are needed to better understand the benefits of HIT in improving overall quality of care.