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PURPOSE Access to health care is a long-standing concern for rural patients; however, administrative measures fail to capture the subjective patient experience of accessing health care. The purpose of this review was to synthesize the qualitative literature on patient and caregiver experiences of accessing health care services for chronic disease management among US residents of rural areas. METHODS We searched Embase, MEDLINE, PsycInfo, CINAHL, and Scopus to identify qualitative studies published during 2010-2019. A thematic synthesis approach was used to analyze findings from included studies. RESULTS A total of 62 studies involving 1,354 unique participants were included. The largest share of studies (24.2%) was focused on the experience of patients with cancer, followed by behavioral health (16.1%), HIV and AIDS (14.5%), and diabetes (12.9%). We identified 4 primary analytic themes of barriers and facilitators associated with the experience of accessing health care services for chronic disease management in rural areas: (1) navigating the rural environment, (2) navigating the health care system, (3) financing chronic disease management, and (4) rural life (ie, common elements of a distinct 'rural' way of thinking and behaving). CONCLUSIONS In this comprehensive review, we found that important cultural, structural, and individual factors influenced the rural patient's experience of health care access and use, including barriers and facilitators posed by geographic and built environments, and distinct rural mores. Our findings can inform policies and programs that both facilitate structural aspects of access and include culturally appropriate interventions. Key words: rural health; health care access; barriers; facilitators; chronic disease management; systematic review; qualitative research; vulnerable populations; public health Ann Fam Med 2022;20:266-272. https://doi.org/10.1370/afm.2798, INTRODUCTION Nearly 1 in 5 people in the United States live in rural areas. (1) Chronic health conditions are both more prevalent and associated with higher rates of disease-attributable mortality [...]

This mixed-methods study sought to identify pharmacotherapy preferences among 40 noninsulin-treated adults with type 2 diabetes receiving care at two U.S. health care systems. Participants ranked by relative importance various health outcomes and medication attributes and then contextualized their rankings. Most participants ranked blindness (63%), death (60%), heart attack (48%), and heart failure (48%) as the most important health outcomes and glucose-lowering efficacy (68%) as the most important medication attribute, followed by oral administration (45%) and lack of gastrointestinal side effects (38%). [ABSTRACT FROM AUTHOR]

Purpose: To compare three methods for identifying patient preferences (MIPPs) at the point of decision-making: analysis of video-recorded patient-clinician encounters, post-encounter interviews, and post-encounter surveys. Patients and Methods: For the decision of whether to use a spinal cord stimulator device (SCS), a video coding scheme, interview guide, and patient survey were iteratively developed with 30 SCS decision-making encounters in a tertiary academic medical center pain clinic. Burke's grammar of motives was used to classify the attributed source or justification for a potential preference for each preference block. To compare the MIPPs, 13 patients' encounters with their clinician were video recorded and subsequently analyzed by 4 coders using the final video coding scheme. Six of these patients were interviewed, and 7 surveyed, immediately following their encounters. Results: For videos, an average of 66 (range 33– 106) sets of utterances potentially indicating a patient preference (a preference block), surveys 33 (range 32– 34), and interviews 25 (range 18– 30) were identified. Thirty-eight unique themes (75 subthemes), each a preference topic, were identified from videos, surveys 19 themes (12 subthemes), and interviews 39 themes (54 subthemes). The proportion of preference blocks that were judged as expressing a preference that was clearly important to the patient or affected their decision was highest for interviews (72.8%), surveys (68.0%), and videos (27.0%). Videos mostly attributed preferences to the patient's situation (scene) (65%); interviews, the act of receiving or living with SCS (43%); surveys, the purpose of SCS (40%). Conclusion: MIPPs vary in the type of preferences identified and the clarity of expressed preferences in their data sets. The choice of which MIPP to use depends on projects' goals and resources, recognizing that the choice of MIPP may affect which preferences are found. [ABSTRACT FROM AUTHOR]

PURPOSE Patients are frequently asked to share their personal health information, The objective of this study was to compare the effects on patient experiences of 3 electronic consent (e-consent) versions asking patients to share their health records for research, METHODS A multi-arm randomized controlled trial was conducted from November 2017 through November 2018. Adult patients (n = 734) were recruited from 4 family medicine clinics in Florida, Using a tablet computer, participants were randomized to (1) a standard e-consent (standard), (2) an e-consent containing standard information plus hyperlinks to additional interactive details (interactive), or (3) an e-consent containing standard information, interactive hyperlinks, and factual messages about data protections and researcher training (trust-enhanced), Satisfaction (1 to 5), subjective understanding (0 to 100), and other outcomes were measured immediately, at 1 week, and at 6 months, RESULTS A majority of participants (94%) consented to future uses of their health record information for research. No differences in study outcomes between versions were observed at immediate or 1-week follow-up, At 6-month follow-up, compared with the standard e-consent, participants who used the interactive e-consent reported greater satisfaction (B = 0,43; SE = 0,09; P CONCLUSIONS Patients who used e-consents with interactive research details and trust-enhancing messages reported higher satisfaction and understanding at 6-month follow-up, Research institutions should consider developing and further validating e-consents that interactively deliver information beyond that required by federal regulations, including facts that may enhance patient trust in research, Key words: consumer health informatics; electronic health records; informed consent; health communication; trust https://doi.org/10.1370/afm.2610, INTRODUCTION Growing use of electronic health record (EHR) data for research has created practical and ethical challenges for health systems and researchers. (1,2-4) In 2018, the Federal Policy for the [...]

Background: The National School Breakfast Program (SBP) is a federally funded program that allows states to offer nutritious breakfast to K-12 students. However, rates of SBP participation are low in some rural states, and the reasons are not well understood. The purpose of the study was to explore administrators' perceptions, attitudes, and beliefs related to the SBP, and factors they identify as barriers or facilitators to increased participation. Methods: Data were collected from a cross-sectional, online survey of K-12 school administrators (N = 152) in a rural, midsized Midwestern state fielded over an academic year. Descriptive statistics were calculated and open-ended questions were coded and analyzed for relevant themes. Results: Administrators identified busing schedules, time constraints, and a lack of flexibility within the school schedule to accommodate breakfast as primary structural barriers to SBP participation. Administrators described family-centered norms as reasons for low participation in rural areas. Administrators are at varying stages of readiness to work on improving participation. Conclusions: Low SBP participation can be explained in part by a convergence of factors related to access, community norms, and structural barriers. Results may be used to inform ways in which administrators at the state, district, and school level can work to increase participation.

Purpose/Objectives: This study was designed to explore the professional networks of rural school food service directors (FSD), the resources they use for implementing the Healthy, Hunger-free Kids Act of 2010 (HHFKA), and their needs for information and support to continue to implement successfully. Methods: Rural FSD participated in an in-depth telephone interview (n = 67) and an online survey (n = 57). The interview asked respondents about the resources and support they used and still needed to assist with implementing the HHFKA changes, while the online survey focused on professional networks and communication among FSD. The interviews were analyzed by thematic coding, while descriptive statistics were used to summarize survey data. Results: Respondents reported making extensive use of professional networks by communicating with FSD in other districts. They both sought and gave advice during this communication, and the topic discussed most frequently was implementation of HHFKA requirements. Mapping of network nodes showed that networks of communication were often geographically bound. Respondents reported using a variety of resources to implement the HHFKA and disclosed that they often relied on their colleagues in other districts for support. Self-identified needs included staffing support, additional networking opportunities, and technology support. Perceived support varied and several responses indicated that rural FSD feel isolated when implementing the HHFKA requirements. Applications to Child Nutrition Professionals: Rural FSD would benefit from enhanced professional networks that are tailored to their needs and constraints. It may be the case that rural schools need more support overall because existing challenges make HHFKA implementation more difficult than in larger, urban, or better-funded school districts.

Purpose/Objectives: The purpose of this study was to investigate parent awareness and perceptions of changes to the National School Lunch Program (NSLP) implemented as a result of the Healthy, Hunger-Free Kids Act (HHKA) of 2010. Methods: An online survey of parents of school age (K-12) children in a Midwestern state was conducted (n = 2,189). The survey collected information on the grade of oldest child and child's participation in school lunch, and measured parental awareness and perceptions. Open-ended responses were coded by three coders. Chi-square tests, t-tests, and analysis of variance (ANOVA) were conducted to examine possible differences in parents' perceptions according to child's grade, participation in school lunch, and school district size. Results: Most parents (84%) were aware of the school lunch changes, and, of those, 75% reported their child had discussed the changes with them. Parents with an oldest child in grades K-8 had significantly more positive perceptions of school meals than did parents with an oldest child in grades 9-12. Parents reported mixed perceptions about school lunch. Some parents indicated their child ate more fruits (15.7%) and vegetables (11.6%) since the meal changes. Applications to Child Nutrition Professionals: Parents' awareness and concern about school meals are high. Future governmental and school efforts to promote school lunch should include communication components that provide parents with accurate information and feedback opportunities. At the local level, district professionals can harness family support for school meals in ways tailored to the unique contexts of their school community.

Purpose/Objectives This study was designed to explore the professional networks of rural school food service directors (FSD), the resources they use for implementing the Healthy, Hunger-free Kids Act of 2010 (HHFKA), and their needs for information and support to continue to implement successfully. Methods Rural FSD participated in an in-depth telephone interview (n = 67) and an online survey (n = 57). The interview asked respondents about the resources and support they used and still needed to assist with implementing the HHFKA changes, while the online survey focused on professional networks and communication among FSD. The interviews were analyzed by thematic coding, while descriptive statistics were used to summarize survey data. Results Respondents reported making extensive use of professional networks by communicating with FSD in other districts. They both sought and gave advice during this communication, and the topic discussed most frequently was implementation of HHFKA requirements. Mapping of network nodes showed that networks of communication were often geographically bound. Respondents reported using a variety of resources to implement the HHFKA and disclosed that they often relied on their colleagues in other districts for support. Self-identified needs included staffing support, additional networking opportunities, and technology support. Perceived support varied and several responses indicated that rural FSD feel isolated when implementing the HHFKA requirements. Applications to Child Nutrition Professionals Rural FSD would benefit from enhanced professional networks that are tailored to their needs and constraints. It may be the case that rural schools need more support overall because existing challenges make HHFKA implementation more difficult than in larger, urban, or better-funded school districts. [ABSTRACT FROM AUTHOR]