Author contributions. RK, LG and PR conceived the article. LG wrote the introduction and development sections. RK, PR and TC composed the section on GSH.LG, HG and JS were responsible for the partnership section.RK, LG, PR and CC wrote on identifying patients. LG and RK compiled the community resources section. All co-authors reviewed the article, added comments and made editorial changes, which were included by LG.Funding. None. Conflicts of interest.None.

BackgroundWith an increased emphasis on patient‐centred outcomes and research, investigators seek to understand aspects of health care that are most important to patients. Such information is essential for developing report cards that present health‐care quality information for consumers, which many states are adopting as a strategy to promote consumer choice.ObjectiveThis study examined the processes that women in Medicaid follow for selecting health plans and explored their definitions of ‘good’ and ‘poor’ quality health care.DesignWe conducted focus groups with Medicaid beneficiaries in four Texas communities, using quota sampling to ensure representation of different racial/ethnic, eligibility and geographic groups.ResultsWe conducted 22 focus groups with 102 participants between October 2012 and January 2013. In a free‐list exercise, ‘doctors’ represented the most important aspect of health care to participants, followed by cost, attention, coverage and respect. Discussions of health‐care quality revealed an even mix of structural factors (e.g. timeliness) and interpersonal factors (e.g. communication), although few differences were observed by beneficiary characteristics. Participants linked themes in their overall framing of ‘quality’ – revealing processes of care that affect health outcomes (e.g. discontinuity of care resulting from poor communication with providers) and which were often mediated by advocate providers who assisted patients experiencing barriers to services.Discussion and conclusionsFindings support other studies that highlight the importance of the patient–provider relationship. Patient‐centred definitions of health‐care quality can complement predominant provider‐centred conceptual frameworks and better inform initiatives for public reporting of quality measures in these populations.

To improve early identification and linkage to treatment and preventive services for hepatitis B virus (HBV) in persons born in countries with intermediate or high (>2%) HBV prevalence, the University of Florida Center for HIV/AIDS Research, Education, and Services (UF CARES) employed community-engaged strategies to implement the Hepatitis B Awareness and Service Linkage (HBASL) program. In this brief report, we present a summary of program components, challenges, and successes. Faith and community-based networks were established to improve HBV testing and screening and to increase foreign born nationals (FBNs) access to HBV care. A total of 1516 FBNs were tested and screened for hepatitis B. The majority were females (50.4%), Asians (62.8%), non-Hispanic (87.2%), and they also received post-test counseling (54.8%). Noted program advantages included the development of community networks and outreach to a large population of FBNs. The major challenges were institutional delays, pressures related to meeting program deliverables, and diversity within FBNs populations. Community health workers in the United States can replicate this program in their respective communities and ensure success by maintaining a strong community presence, establishing partnerships and linkage processes, developing a sustainability plan, and ensuring the presence of dedicated program staff.

Purpose Recruiting and enrolling low income, racially and ethnically diverse adolescents into research studies can be a challenge. This paper details our research team’s methodology in the recruitment and enrollment of low income and racially/ethnically diverse adolescents in three cities as part of a broader study to understand adolescent perceptions of a health risks. Methods Our team used Florida’s Medicaid and Children’s Health Insurance Plan (CHIP) administrative databases to identify a sample of adolescents for focus group participation. Utilizing Geographic Information Systems software we generated maps of racial and ethnic group clusters in 3 cities and identified community centers within each cluster to hold the focus groups. We mailed initial focus group introduction letters, conducted follow-up phone calls for recruitment and further implemented techniques to optimize participant confidentiality and comfort. Results We enrolled 35 participants for 8 focus groups in 3 cities at a total cost of $264 per participant, including personnel, materials, travel, and incentives costs. As a result of our efforts, groups were fairly evenly distributed by both race and gender. Conclusion Administrative databases provide opportunities to identify and recruit low income and racially/ethnically diverse adolescents for focus groups that might not otherwise have the opportunity to participate in research studies. It is important that researchers ensure these populations are represented when conducting health assessment tool evaluations.

Unhealthy diet is one of the leading contributors for chronic disease related morbidity and mortality in African-American (AA) women living in the USA. The purpose of this study was to describe eating habits and intention to change using the stages of change (SOC) model in a sample of AA women. A cross-sectional population-based study was conducted in Florida with AA women. A total of 292 AA women participated. Outcome variables were eating breakfast, foods having low to no fat, fruits and vegetables, whole grain products, foods with low to no salt, and few to no snacks. SOC was the main independent variable. Almost half (48 %) seldom added salt to meals, 45 % consumed low-fat foods, 32 % consumed breakfast every day, and 32 % consumed primarily whole grain products. Women in action and maintenance SOC were significantly more likely to eat breakfast (odds ratio (OR)=1.50, 95 % confidence interval (CI): 1.10-2.03), mostly or only low-fat foods (OR=4.11, 95 % CI: 2.59-6.51), ≥4 servings of fruits and vegetables (OR=1.75, 95 % CI: 1.09-2.83), and whole grain products (OR=2.05, 95 % CI: 1.42-2.97). AA women want to eat healthier but do not always practice healthy diets. Understanding SOC can be essential to develop interventions for improving AA women's eating habits.

The purpose of this study was to examine the direct and indirect ecological influences of teacher and friend social support on body weight and diet behaviors in African-American adolescent females. Using a quantitative, cross-sectional research design, a convenience sample of 182 urban African-American adolescent females (12–17 years old) completed a 39-item questionnaire. The questionnaire assessed perceived teacher social support, friend social support, nutrition self-efficacy, and diet behaviors (with internal reliability values of scale items: alpha=0.74, 0.81, 0.77, and 0.69 respectively). Anthropometric assessments were conducted to measure height and weight to compute BMI. Majority of the participants were in middle or early high school (65 %) and were overweight or obese (57.7 %). Both teacher social support and friend social support demonstrated a positive, indirect influence on child weight status through nutrition self-efficacy and diet behaviors following two different and specific paths of influence. Diet behaviors, in turn, demonstrated a positive, direct effect on child weight status. In the structural model, teacher social support had the greatest effect on diet behaviors, demonstrating a direct, positive influence on diet behaviors (B=0.421, p<0.05), but its direct effect on nutrition self-efficacy was not significant. Friend social support demonstrated a positive, direct effect on nutrition self-efficacy (B=0.227, p<0.05), but its direct effect on diet behaviors was not statistically significant. The study’s findings call for actively addressing the childhood obesity epidemic in the school environment by implementing health behavior change strategies at various social and ecological environmental levels.

Lack of physical activity is a leading contributor to obesity in the US. The unusually high rates of obesity in African-American (AA) women corroborate with lack of recommended levels of exercise in this population. The purpose of this study was to describe exercise behaviors and intention to change using the stages of change (SOC) model in a sample of AA women. A population-based observational study was conducted with 292 AA women in Florida. Outcome variables were engaging in aerobic, strength-based, and stretching exercise. More than half (61.25 %) did not engage in strength-based exercise, more than a third (37.7 %) did not engage in aerobic exercise, and a little less than half (45.9 %) did not participate in stretching exercise. SOC was the main independent variable. Women in action and maintenance SOC were significantly more likely to engage in aerobic exercise (OR 16.1, 95 % CI 7.09-25.7), strength-based exercise (OR 15.4, 95 % CI 6.58-22.7), and stretching exercise (OR 3.80, 95 % CI 1.91-7.52). The SOC is reflective of actual exercise behavior in AA women. A large number of AA women do not engage in regular recommended levels of exercise. Understanding SOC can be essential to developing culturally appropriate and motivation matched interventions for improving AA women's exercise habits.

A qualitative mini-case study of I. King Jordan and his leadership style explores the influence of a transformational leader on Gallaudet University and the Deaf community. The study features a template-style semistructured interview with Jordan regarding his perceptions of leadership and his personal insights. The study highlights the attributes of transformational leadership and encourages further research into leadership as a tool for change in the Deaf community and the disability rights movement. This exploration of the leadership style of Gallaudet’s first Deaf president is especially timely; the study was conducted between Jordan’s retirement announcement and the Gallaudet Board of Trustees’ decision to rescind an offer to his announced successor to become the university’s next president. That tumultuous transition accentuated the disconnect between Jordan’s transformational, charismatic leadership style, which affected generations of the Deaf community, and his followers’ dissatisfaction with his management and successor planning.