Objective: To explore California local health department leaders' experiences planning, implementing, and evaluating nutrition promotion and obesity prevention programs for low-income families. Design: Qualitative, cross-sectional study using semi-structured in-depth interviews and panel interviews conducted in 2015−2016. Setting: California local health departments (LHDs) funded by the California Department of Public Health to implement Supplemental Nutrition Assistance Program−Education (SNAP-Ed). Participants: The authors recruited SNAP-Ed leaders from all 58 California LHDs implementing SNAP-Ed. Leaders from 49 LHDs participated: 36 in hour-long, in-depth interviews and 13 in 1 of 3 90-minute group panel interviews. Phenomenon of Interest: Processes, facilitators, and barriers connected to delivering SNAP-Ed reported by leaders in planning, implementing, and evaluating local programs.Analysis: Interviews were transcribed, coded, and analyzed using Dedoose software. Results: Leaders grappled with introducing, implementing, and integrating policy, systems, and environmental change interventions (PSEs). Information used to make planning decisions varied widely across LHDs. Partnership with nontraditional organizations was described as a resource-intensive, nonlinear process with recognized potential for benefit. Rural programs reported specific and different experiences compared with their urban counterparts. Conclusions and Implications: Implementing new, complex interventions to improve diet and activity environments and behaviors is both exciting and challenging for local leaders. They expressed a desire for additional resources and capacity building to facilitate success, particularly related to policy, systems, and environmental change programs. Attention to the specific needs of rural counties is needed.
Obesity affects more than one-third of Americans and is a leading cause of preventable death. Integrating patient perspectives into obesity treatment can help primary care providers (PCPs) intervene more effectively. In this study, we describe patients' experiences with PCPs concerning the diagnosis and treatment of obesity and offer suggestions for patient-centered care in weight management. We conducted four focus groups with patients of a university medical system-associated family practice who had a BMI ≥ 30. Interview questions addressed general weight management perceptions and preferences for weight management support in a primary care setting. Patients completed a brief demographic survey at the conclusion of the group. Four authors independently coded focus group notes to identify themes and determine saturation using qualitative thematic analysis. We resolved discrepancies by team discussion. Thirty primary care patients participated, of whom 23 were female and whose average age was 50. Twenty-four had attempted to lose weight in the past 12 months and had discussed management with their providers. Analyses identified four themes regarding weight management in a primary care setting: motivation and weight management, the provider-patient relationship, desire for concrete weight loss plans, and limitations of the primary care setting. Motivation was named as a weight management obstacle. Participants felt that PCPs need to be partners in weight management efforts and also recognized limitations of PCP time and expertise. They endorsed an integrated behavioral approach that includes physical activity and nutrition support. Improving PCP delivery of evidence-based treatment for obesity will lead to increased patient attempts to lose weight. Incorporating patients' desires for concrete plans, ongoing support, and referral to integrated service (e.g., nutritionists, care managers, behavioral health providers) programs can increase patient engagement and success. The chronic disease care and Patient Centered Medical Home models offer guidance for ensuring sustainability of weight management services.
Background: The human papillomavirus (HPV) virus is a known pathogen and carcinogen causing deadly cancers of the genitalia and head and neck. The HPV vaccine is a safe, effective cancer-preventing vaccine recommended for girls and boys at ages 11-12. Full HPV vaccine coverage is available through health insurance plans and the state of California, yet no data were readily available to describe California state-wide coverage of HPV vaccination. The Data Workgroup of the California HPV Vaccination Roundtable aimed to map State-level HPV vaccine coverage. Methods: Workgroup collected, analyzed, and mapped 2018 HPV vaccination data from the NIS-T survey, quality performance metrics from public and private health plans, and the statewide CAIR. NIS-T provides state-level estimates of routine adolescent vaccines, including HPV. Performance data were obtained from Medi-Cal and commercial health plans, administrative claims, and medical records. CAIR contains individual-level, provider-reported immunizations. HPV vaccination coverage for adolescents were estimated at the state and county level. Maps of county-level HPV vaccination and HPV-related cancer rates were built. Results: Rates of HPV-related cancers ranged from 6-12 per 100,000. Regarding HPV vaccination, there were considerable variation in the metrics and limitations of each data source, therefore estimates are not easily comparable. CAIR estimates of HPV vaccination coverage (28%) are lower than those for Medi-Cal managed care (45%) and commercial HMO members (50%). In 2018, aggregated results showed that overall 50% of 13 year old were vaccinated. We observed in the CAIR data that boys and girls are vaccinated at similar rates. However, significant county/regional HPV vaccination rates exist ranging from 9% (rural, northern) to 55% (urban, western). Northern, rural country have both the lowest HPV vaccination completion rates for 13-year-olds (9%), and the highest HPV-attributable cancer rates in the state (12 cases per 100,000 persons. Race/ethnic variations exist for HPV vaccination and HPV- related cancers–especially cervical cancer. Conclusions: This state-level data report approach may facilitate practice and policy action and help other states in developing their own reports for HPV vaccine improvements. Stakeholders are encouraged to utilize this Report when planning HPV vaccination interventions. We recommend that health systems: 1) assess HPV vaccination rates for 13-year-olds, 2) establish data exchange with CAIR, 3) implement recommended strategies to improve coverage, 4) collaborate with health plans and clinicians and 5) partner with community advocacy groups and clinic/hospital parent/patient advisory groups to improve data accuracy, as well as reduce HPV vaccine hesitance and promote at least 80% HPV vaccination completion by 2026. Citation Format: Jaime Adler, Raquel Arias, Kimlin Tam Ashing, Shauntay Davis-Patterson, Hilary Gillette-Walch, Jeffrey Klausner, Jim Knox, Beverly Mitchell, Autumn Ogden-Smith, Jane Pezua, Rita Singhal, Hoa Su. Human papillomavirus vaccination: California state-level mapping to identify gaps and inform practice and policy [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-273.
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