Advancing Health Equity in Medical Family Therapy Research

Lewis, Melissa E.; Myhra, Laurelle L.; Walker, Monique D.

doi:10.1007/978-3-319-03482-9_17

Cited by 6 publications

(4 citation statements)

References 59 publications

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“…For instance, some community members may view prescription medications as a symbol of historical trauma and colonization, given the context of U.S. government–provided health care. We acknowledge past historical atrocities perpetrated by the U.S. government and the legacy of medical racism (Brave Heart & DeBruyn, 1998; Burnette & Figley, 2017; Evans-Campbell, 2008; Lewis et al, 2014) that help us understand justifiable mistrust and historically rooted causes of not using medications or using medications in a manner which could be deemed as “nonadherent.” In addition, others have noted limitations of the MMAS-4, such as potentially missing reasons for nonadherence, and instances of inconsistent relationship with clinical outcomes (Tan, Patel, & Chang, 2014). The MMAS-4 was chosen as it best fit the present study design (Clifford, Perez-Nieves, Skalicky, Reaney, & Coyne, 2014), but these limitations should be considered when interpreting our findings.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, a majority of studies addressing these issues exclude American Indians (AI), despite the fact that many AI communities experience disproportionate rates of mental distress and type 2 diabetes (Beals et al, 2005; Centers for Disease Control and Prevention, 2017). Furthermore, contexts of medical mistreatment, racism, and historical trauma (Brave Heart & DeBruyn, 1998; Burnette & Figley, 2017; Evans-Campbell, 2008; Lewis, Myhra, & Walker, 2014) may in part fuel lower medication adherence rates for AI diabetes patients (Schmittdiel et al, 2014).…”

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confidence: 99%

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The Mediating Role of Diabetes Distress and Depressive Symptoms in Type 2 Diabetes Medication Adherence Gender Differences

2019

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Background. Medication adherence is negatively related to both diabetes distress (DD) and depressive symptoms (DS). Past research suggests gender differences in adherence, DD, and DS. A gap exists in determining if gender differences in adherence are mediated by DD and DS, or if gender moderates differences in adherence by DD/DS. Aims. This study investigated the relationship between gender, DD, DS, and medication adherence and tested for mediating and moderating effects on medication adherence among American Indian adults with type 2 diabetes. Method. The Maawaji idi-oog mino-ayaawin (Gathering for Health) study was a community-based participatory research collaboration with five American Indian tribes. Participants, randomly recruited from clinic records, shared information during computer-assisted personal interviews. This study includes the 166 participants who reported using medications to treat their diabetes. The relationship between gender, DD, DS, and medication adherence are explored. Possible mediating and moderating effects on medication were tested using regression and path analysis. Results. Females had higher levels of DD and DS and lower levels of medication adherence. Higher levels of DD and DS were both associated with lower medication adherence. No evidence was found that gender moderates the relationship between DD or DS and medication adherence. Instead, DD and DS mediated the relationship between gender and medication adherence. Conclusions. Medication adherence differences in male and female patients may be attributable to DD and DS. The present research highlights both DD and DS as targets for clinicians and researchers alike.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

The Mediating Role of Diabetes Distress and Depressive Symptoms in Type 2 Diabetes Medication Adherence Gender Differences

2019

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“…Cultural awareness and sensitivity for MedFTs also includes an understanding of indicated interventions that are most appropriate for and have relevant outcomes with specific minoritized populations, rather than identifying interventions that have only been successful with majority populations and applying them to all individuals, couples, or families regardless of their social location (Hodgson et al, 2018 ; Lewis et al, 2014 ; Shin, et al, 2003 ). The lessons learned through cultural humility have been countless, through numerous ongoing interactions with patients, MedFT students, MedFT supervisors, the larger IBHC team, and CHC providers and leadership.…”

Section: Lessons Learnedmentioning

confidence: 99%

Medical Family Therapy in Rural Community Health: A Longitudinal “Peek” into Integrated Care Successes

et al. 2022

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Integrated behavioral health care (IBHC) continues to grow as an evidence-based service delivery model adopted by healthcare systems all over the world to better care for the holistic needs of patients and their families. Medical family therapy (MedFT), as a field, has offered innovation to IBHC models by delivering biopsychosocial-spiritual (BPS-S), relational, and family-oriented care across a variety of healthcare contexts. This article details a longitudinal review of a program, spanning 16 years, that grew from no behavioral health services to one that is highly integrated, and embeds MedFTs in a number of rural community health centers. This model highlights the importance of interdisciplinary teams, including Peek’s clinical, operational, financial, and training worlds, as well as decision-making metrics for systems that predominately care for underserved and minoritized populations. The authors illustrate a framework for how the levels of primary care/behavioral healthcare collaboration relate to the work and practice of MedFTs as conceptualized through the MedFT Health Care Continuum and meet the BPS-S needs of diverse populations seeking pediatric, adult, and dental healthcare services. Also described are shifts made in the model over time based on (a) growth in cultural humility, (b) relationally-oriented practice, operations, finance, and training data, and (c) research informed decisions. Recommendations include ways MedFTs can facilitate provider and administrative buy-in, assess model fidelity, and strive for quality outcomes for patients.

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“…We used the principles of community-based participatory research 23 as well as a decolonizing methodology 24 , 25 to embrace and gather knowledge from the local community around what content should be included in a medical school curriculum to improve the health of the local Indigenous community and to improve patient–provider interactions. The community-based participatory research approach invites a multidisciplinary team, using a flattened hierarchy, to approach an issue that has been prioritized by community members.…”

Section: Guiding Principlesmentioning

confidence: 99%

The Development of an Indigenous Health Curriculum for Medical Students

Lewis

Prunuske

2017

Academic Medicine

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Indigenous populations experience dramatic health disparities; yet, few medical schools equip students with the skills to address these inequities. At the University of Minnesota Medical School, Duluth campus, a project to develop an Indigenous health curriculum began in September 2013. This project used collaborative and decolonizing methods to gather ideas and opinions from multiple stakeholders, including students, community members, faculty, and administration, to guide the process of adding Indigenous health content to the curriculum to prepare students to work effectively with Indigenous populations. A mixed-methods needs assessment was implemented to inform the instructional design of the curriculum. In June 2014, stakeholders were invited to attend a retreat and complete a survey to understand their opinions of what should be included in the curriculum and in what way. Retreat feedback and survey responses indicated that the most important topics to include were cultural humility, Indigenous culture, social/political/economic determinants of health, and successful tribal health interventions. Stakeholders also emphasized that this content should be taught by tribal members, medical school faculty, and faculty in complementary departments (e.g., American Indian Studies, Education, Social Work) in a way that incorporates experiential learning.Preliminary outcomes include the addition of a seven-hour block of Indigenous content for first-year students taught primarily by Indigenous faculty from several departments. To address the systemic barriers to health and well-being and provider bias that Indigenous patients experience, this project sought to gather data and opinions regarding the training of medical students through a process of Indigenizing research and education.

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Advancing Health Equity in Medical Family Therapy Research

Cited by 6 publications

References 59 publications

The Mediating Role of Diabetes Distress and Depressive Symptoms in Type 2 Diabetes Medication Adherence Gender Differences

The Mediating Role of Diabetes Distress and Depressive Symptoms in Type 2 Diabetes Medication Adherence Gender Differences

Medical Family Therapy in Rural Community Health: A Longitudinal “Peek” into Integrated Care Successes

The Development of an Indigenous Health Curriculum for Medical Students

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