Thursday, October 26, 11:00
a.m.-12:30 p.m.
Moderator
Wanda Jones, Dr. P.H.
Deputy Assistant Secretary for Health (Women's Health), Office of the
Secretary
Presentations
INDIAN HEALTH SERVICE'S INTEGRATED CASE MANAGEMENT TOOL – ICARE
Cynthia Gebremariam, R.N.
Analex Corporation for Indian Health Service, Tucson, AZ
The Indian Health Service (IHS) is the principal Federal healthcare provider for American
Indians and Alaska Natives (AI/AN). Many of the people served by the IHS live in some of
the most remote and poverty-stricken areas of the country, and these health services
represent their only source of health care.
IHS provides culturally sensitive, comprehensive health services to 1.7 million AI/AN
through 144 Service Units composed of more than 500 direct healthcare delivery facilities.
Facilities are in both urban and rural areas. The existing electronic health information
system supports the Agency's ability to provide high-quality health care.
Appropriate, proactive patient management improves the delivery of care, as well as outcomes.
In addition, there are documented fiscal benefits when this type of management is introduced
into the healthcare business process model. The IHS's Office of Information Technology (OIT)
has developed a new clinical application in response to field requests that an IT tool be
developed that will assist providers in identifying and managing multiple, customizable
groups of patients.
This new software application, iCare, is part of the Clinical Decision Support suite of
applications and will help clinicians manage any patient in the database within the context
of his or her entire health. It will display individual patient data including labs,
radiology, pharmacy, health summaries, health reminders, visit notes, and demographic
information. iCare is intended for use by both general and specialist healthcare providers.
In addition, iCare incorporates the ability to track clinical performance measures
for individual patients, as well as for groups of patients. Several of these measures
emphasize disease prevention and promotion of health. It has been demonstrated that
compliance with these standards ensures that quality health care is delivered, which
is critical to this historically underserved population.
WHO CHOOSES? PREVENTIVE SERVICES AND BARRIERS IDENTIFIED BY HISPANICS
IN THE SOUTH CAROLINA LOW COUNTRY
Charlene A. Pope, Ph.D., M.P.H., C.N.M.;
Deborah Williamson, D.H.A., M.S.N., C.N.M.
Medical University of South Carolina College of Nursing, Charleston, SC
Hispanic residents of South Carolina tripled in the last decade, making the state the
fourth fastest growing U.S. Hispanic population. More than 50 percent of these Hispanics
speak little or no English. Elsewhere, language barriers, poverty, and cultural differences
are associated with poorer utilization of preventive services, increased use of hospital
emergency rooms, and less satisfaction with care among Hispanics. Limited English proficiency
contributes to more diagnostic studies and more hospitalizations for preventable conditions.
Indicators of poor preventive services include higher teen pregnancy rates, unintended
pregnancy, tobacco usage, and suicide. Late prenatal care, associated with difficulty accessing
health services, is higher among Hispanic women (40%) in South Carolina than among African
Americans (30%) or whites (15%).
This descriptive study incorporates and expands the Hispanic Health Needs Assessment
survey developed by the National Alliance for Hispanic Health in a region that lacks data
about Hispanics. At the time this survey began, South Carolina and Centers for Disease
Control and Prevention data absorbed Hispanics into a category called
"Blacks and Others," making group-specific preventive service planning difficult.
English as a Second Language (ESL) classes provided initial pilot testing sites so that
Hispanics could alter the survey to address their needs. The final survey presents baseline
preventive knowledge, attitudes, and practices concerning preventive care.
To accommodate low literacy, oral and written surveys were administered at health fairs,
churches, workplaces, and day care in Spanish and English by student and faculty volunteers
for a sample of 245. A series of similar interviews with 15 administrative stakeholders at
local institutions supplemented the consumer needs assessment. Results portray the contrasting
perspectives between health institutions and the Hispanic community they serve. Reported
occupations and age ranges dispute current stereotypes. Hispanic respondents identified
prevention of adult accidents, diabetes, and alcoholism as well as pediatric dental care,
learning problems, and childhood obesity as needs for future interventions.
TAILORING RISK COMMUNICATIONS FOR UNDERSERVED COMMUNITIES: DIFFERENTIAL
SOURCE PREFERENCES AND RESPONSES
David L. Driscoll, Ph.D., M.P.H.; Ben Beatty, M.P.H.;
Asta Sorensen, M.A.; Laurel Clayton; Ellen Wilson, Ph.D.
RTI International, Research Triangle Park, NC
Tailoring risk communications for specific audience segments is an important step toward
achieving preferred behavior change, particularly in public health crises. The steps are well
defined but can be difficult to achieve, and include understanding perceptions and preferences
regarding sources of information. This presentation describes a recent environmental risk
communication program to promote the capacity of residents of African American, Latino, and
Native American communities in North Carolina to seek information on how to avoid a shared
health threat from environmental contamination.
The study design included formative data collection using in-depth individual and group
interviews with community residents along with individual cognitive interviews for materials
testing and refinement. An evaluation component involved further individual interviews with
community residents as well as with representatives of resource organizations preferred by
the residents of each community as sources of public health information. Tailored informational
toolkits were developed, tested, and distributed in each of the three communities. Changes
in information-seeking behavior were evaluated.
Findings include practices by residents of all three communities to identify information
sources that were both culturally sensitive and credible, preferences in information sources,
and differential success in promoting capacity for public health information-seeking behaviors
between the three communities
ADDRESSING HEALTH DISPARITIES: USING A CULTURALLY RELEVANT COMMUNITY-PARTNERED MOBILE CLINIC
TO PROVIDE HEALTH CARE TO HIGH-RISK WOMEN IN AN URBAN SETTING
Rita Singhal, M.D., M.P.H.1; Ellen Eidem, M.S.2;
Amy Y. Chan, M.P.H.2; Lucie McCoy, M.P.H.2
11Los Angeles County Public Health, Office of Women's Health, Los Angeles, CA
2Los Angeles County Department of Health Services, Los Angeles, CA
Uninsured low-income women in urban communities represent an ethnically diverse group that is
disproportionately affected by disease while having decreased access to health care. The Los
Angeles County Office of Women's Health, in collaboration with community partners, developed a
mobile clinic outreach program that provides preventive health care and referrals for additional
health services to this high-risk population.
The program is culturally and linguistically tailored to reach eight targeted ethnicities.
Free health screenings for hypertension, hyperlipidemia, diabetes, obesity, and cervical and
breast cancers are provided using a multicultural staff. Venues are selected by community-based
organizations working within the targeted communities and include religious institutes,
community centers, consulates, festivals, and health fairs.
Over 3 years, 2,597 women with a mean age of 47 years were seen at 130 events. Seventy-five
percent preferred a language other than English, more than 80 percent were foreign born, and
94 percent lived at or below 200 percent of the Federal poverty level. Ninety-four percent
were uninsured, and more than 77 percent lacked a regular source of care. Thirty-four percent
of the women had not seen a physician in over 2 years. Of those screened, 57 percent were
overweight or obese, 19 percent screened positive for diabetes, 23 percent had an elevated
blood pressure, and 26 percent had hyperlipidemia. Five percent had an abnormal Pap smear,
and 4 percent had an abnormal breast exam. Central American and Armenian women were twice as
likely to have hyperlipidemia compared to other women, and African American women were 50
percent more likely to have hypertension. Central American women were significantly more
likely to have diabetes and an abnormal Pap smear.
This community-partnered mobile clinic overcame numerous access barriers to reach a
high-risk population. Targeted and tailored interventions utilizing community-based
partnerships and culturally relevant methods are required to reduce health disparities
among women in urban communities. Culturally tailored programs addressing ethnic groups
with high disease prevalence are critical.
For questions or more information, please contact
summit@hhs.gov.
