Introduction: Poor diet is the leading risk factor for death globally. Community-based programs can have a positive impact on promoting healthy dietary attitudes and behaviors. The American Heart Association and Aramark’s initiative, Healthy for Life 20 by 20 aims to change food and health confidence and behaviors, equipping individuals with new skills for healthy living. The program includes healthy cooking demonstrations, hands-on skills practice and nutrition and heart health workshops. Objectives: To examine the effectiveness of the Healthy for Life program over time, specifically: -Changes in participant confidence in the preparation of healthy foods at home -Changes in participant consumption of fruits, vegetables, and whole grains -Changes in participant frequency of healthy shopping habits Methods: A community engagement program was implemented and evaluated in 22 community centers. Sessions were focused on enhancement of confidence and behaviors around healthy shopping, cooking and consumption. Two delivery methods were offered: 10 classes over 24 weeks or 4 classes over 8-12 weeks. Community center facilitators administered the same paper survey to participants at the first educational experience, and then again at the final experience or every 3 months following the first educational experience. Results: Analysis was conducted with 418 participants to measure change in healthy behaviors and confidence over time. Participants were predominately female (83%), 55 or older (55.9%), African American (68.4%) and non-Hispanic (81.6%). About half (44.7%) had a college degree or higher, nearly a fifth (17.9%) received benefits from SNAP and almost half (48.3%) indicated they are the only person in their household preparing meals. Almost half (42%) of respondents attended 4 or more educational experiences. On average, respondents statistically significantly increased their daily fruit & vegetable consumption by .43 serving(s). After taking classes, 119 of 394 (30.2%) respondents increased their level of confidence to prepare healthy meals at home and 128 of 379 (33.8%) respondents increased their level of confidence to substitute healthier cooking and food preparation methods. Similarly, 120 of 385 (31.2%) respondents reported increased frequency of reading food labels and checking the nutritional values when purchasing food. Conclusions: The Healthy for Life community program involving a skills-based format can be an effective health promotion model in improving confidence and dietary behaviors over time. However, additional research studies are required to further assess the long-term health impacts of this type of intervention.
Introduction: Telemedicine (TM) is a promising solution for providing timely and efficient care for patients experiencing a stroke in rural and underserved areas . Although TM services are available in many Critical Access Hospitals (CAHs), wide adoption has been limited by a multitude of barriers. Purpose: To describe current utilization practices and identify barriers to utilization of TM services in assessment and treatment of stroke patients in North Dakota CAHs. Methods: Directors of Nursing (DONs) at Acute Stroke Ready CAHs in North Dakota were recruited to participate in data collection efforts using a mixed methods approach including a survey and in-person focus groups. An online survey was disseminated via email to DONs (response rate=74%) and a semi-structured interview guide was used to conduct three focus groups (n=16). Sessions were digitally recorded and field notes with abridged transcripts were analyzed for recurrent themes using content analysis. Results: Most participants (91.3%) indicated CAH staff have access to TM services that include consultation with emergency medicine physicians, but only 17.4% indicated their services include consultation with a neurologist. Despite wide availability, participants reported staff forget to use existing TM services or are unaware of specific services available. Most frequently used TM services include assistance with patient documentation, medication dosage checks, and assistance with patient transport. Least frequently used TM services include ePharmacist consults and physician assistance with stroke assessments. Identified barriers to utilization of TM services include high confidence level of attending providers in performing independent assessments, staff concerns that decisions will be questioned, and preference of attending providers to directly contact physicians at accepting Primary Stroke Centers. Conclusions: While general TM services are widely available in North Dakota CAHs, services are underutilized. Access to specialized neurology services via TM is also limited. Targeted efforts to enhance understanding and utilization of existing TM services, particularly for stroke patients, will be beneficial to improving stroke systems of care in North Dakota.
Introduction: In predominantly rural states, effective and efficient response of Emergency Medical Services (EMS) to stroke cases is often delayed by geographically large, sparsely populated service areas and limited access to healthcare professionals and services. North Dakota is a rural state with 36 of 53 counties designated as Frontier (less than six persons per square mile) and a total population estimated at 755,393. Purpose: To identify barriers experienced by EMS professionals in North Dakota when responding to, assessing, providing care, and transporting potential stroke patients. Methods: EMS providers were recruited to participate in in-person focus groups. Four focus groups were performed (n=24) using a semi-structured interview guide. Sessions were digitally recorded and field notes with abridged transcripts were analyzed for recurrent themes using content analysis. Results: Participants were 37.5% male, 91.7% non-Hispanic White and included unpaid EMS volunteers (29.0%). Several common themes were identified, including: 1) importance of public awareness for timely recognition of stroke symptoms and the importance of calling 9-1-1 at early onset of symptoms; 2) frequent receipt of inaccurate/insufficient information from Dispatch; 3) difficulties notifying accepting hospitals due to loss of cell service in rural areas; 4) perceptions that accepting hospital staff due not trust EMS clinical assessments; 5) technical barriers and time restraints experienced when providing written and verbal patient reports to hospitals; and 6) lack of formal feedback from hospitals to EMS agencies regarding stroke patients transported by EMS agencies. Conclusions: EMS providers in North Dakota experience several challenges inhibiting their ability to provide timely pre-hospital care to stroke patients. Although several barriers were identified, most are modifiable and can be remedied with enhanced education and training focused on improving effectiveness and efficiency of EMS communications with dispatch and hospitals.
Introduction: Urban and rural stroke care disparities are pervasive for post-acute stroke rehabilitation. Mission:Lifeline Stroke conducted a needs assessment to identify needs and gaps in care for stroke rehabilitation throughout rural Nebraska (NE). Purpose: The assessment included surveys of healthcare providers (HCPs) and stroke survivors to inform a robust understanding of stroke rehabilitation needs across NE, addressing barriers and facilitators to care, including outpatient therapy, social support, equipment, and patient-facing resources. Methods: HCPs were recruited through the Nebraska Stroke Advisory Council to complete a 17-question online survey. Survivors in NE were recruited through social media and existing stroke support groups to complete a 26-question online survey. Results: Respondents of the HCP survey (N=260) identified the top barrier to providing care to survivors as lack of insurance (62%), lack of caregiver support (42%), and lack of specialized services (42%). Respondents of the survivor survey (N=30) identified top barriers as lack of insurance (74%), financial burden (64%), and lack of caregiver/social support (50%). Both HCPs’ and survivors identified lack of caregiver and social support as resources missing from their community, and survivors identified communication about support groups or sources of emotional support (n=4) as the top missing resource. In addition, 39% of survivors indicated an interest in attending a support group. HCPs indicated missing resources primarily include specialized rehab equipment, technology, and services (52%), and professional opportunities for staff (37%). Regarding resources provided to survivors, most HCPs indicated community resources (94%) are provided, proceeded by follow-up/continued outpatient therapy (88%). In slight contrast, survivors indicated the top resources they learned of when discharged were outpatient physical therapy (82%), outpatient occupational therapy (70%), and outpatient speech therapy (56%). Conclusion: Although both healthcare providers and survivors identified outpatient therapies are made available, there is a need for more communication about support groups and physical resources such as rehab equipment, technology, and services.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.