Improving the asthma disparity gap with legal advocacy? A qualitative study of patient-identified challenges to improve social and environmental factors that contribute to poorly controlled asthma

Harris, Drew; Mainardi, Anne; Iyamu, Osatohamwen; Rosenthal, Marjorie S.; Bruce, R. Douglas; Pisani, Margaret A.; Redlich, Carrie A.

doi:10.1080/02770903.2017.1373393

Cited by 15 publications

(11 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The landlord-related challenges reported by study participants may help explain the observed association between rentership and lower testing rates [17]. Renters face similar challenges with their landlords when addressing asthma triggers in their homes, including a lack of knowledge about tenant rights, lack of financial resources, and a fear of retribution [33]. Policy interventions may be necessary to address landlord-related barriers to well stewardship.…”

Section: Discussionmentioning

confidence: 92%

Private well stewardship within a rural, agricultural Latino community: a qualitative study

VanDerGeest

Karr

et al. 2020

BMC Public Health

View full text Add to dashboard Cite

Background: Nitrate contamination in groundwater disproportionately impacts agricultural Latino communities, creating a significant hazard for Latinos that rely on private wells. Private well users must conduct water testing and other well stewardship behaviors to ensure that their well water is safe to drink. This study sought to identify the key factors impacting private well water testing behavior in rural, agricultural Latino communities. Methods: We conducted 4 focus groups with private well users, 2 in Spanish and 2 in English. We recruited 37 participants from the Lower Yakima Valley, Washington State, a rural, agricultural community with a large Latino population and elevated nitrate concentrations in groundwater. A semi-structured interview guide was developed to capture factors impacting testing as guided by the Risk, Attitudes, Norms, Ability, and Self-Regulation (RANAS) model. Inductive thematic analysis was conducted by two coders to identify common themes. Results: Themes emerged around the factors impacting well stewardship, including well water testing, treatment, and maintenance, and were not specific to nitrate contamination. Private well users reported many of the same factors reported in other communities, with the exception of home repair experience and challenges around landlords and neighbors on shared wells, which have not been reported previously. In addition to landlords and neighbors, lack of actionable information, economic limitations, and lack of technical support emerged as factors that made well stewardship burdensome for individuals. The majority of participants reported using bottled water, including many who used point-of-use or point-of-entry water treatment systems. Conclusions: The burden of well stewardship in rural, agricultural Latino communities may suggest the need for interventions at the community, county, or state levels and not at the individual level alone. Additionally, the role of landlords, neighbors on shared wells, and home repair experience in well stewardship represent important areas of exploration for researchers and public health practitioners.

show abstract

Section: Discussionmentioning

confidence: 92%

Private well stewardship within a rural, agricultural Latino community: a qualitative study

VanDerGeest

Karr

et al. 2020

BMC Public Health

View full text Add to dashboard Cite

show abstract

“…The landlord-related challenges reported by study participants may help explain the observed association between rentership and lower testing rates [17]. Renters face similar challenges with their landlords when addressing asthma triggers in their homes [33]. These challenges include a lack of knowledge about tenant rights, lack of financial resources, and a fear of retribution [33].…”

Section: Discussionmentioning

confidence: 96%

“…Renters face similar challenges with their landlords when addressing asthma triggers in their homes [33]. These challenges include a lack of knowledge about tenant rights, lack of financial resources, and a fear of retribution [33]. Policy interventions may be necessary to address landlord-related barriers to well stewardship.…”

Section: Discussionmentioning

confidence: 99%

Private well stewardship within a rural, agricultural Latino community: a qualitative study

VanDerGeest

Karr

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Nitrate contamination in groundwater disproportionately impacts agricultural Latino communities, creating a significant hazard for Latinos that rely on private wells. Private well users must conduct water testing and other well stewardship behaviors to ensure their well water is safe to drink. This study sought to identify the key behavioral factors of private well water testing in rural, agricultural Latino communities. Methods: We conducted four focus groups with private well users, two in Spanish and two in English. We recruited 37 participants from the Lower Yakima Valley, Washington State, a rural, agricultural community with a large Latino population and elevated nitrate concentrations in groundwater. A semi-structured interview guide was developed to capture factors impacting testing as guided by the Risk, Attitudes, Norms, Ability, and Self-Regulation (RANAS) model. Inductive thematic analysis was conducted by two coders to identify common themes. Results: Themes emerged around the behavioral factors impacting well stewardship, including well testing, treatment, and maintenance, and were not specific to nitrate contamination. Private well users reported many of the same factors reported in other communities. Lack of actionable information, economic limitations, and lack of technical support were reported as factors that made well stewardship burdensome and encouraged bottled water use. Home repair experience among Spanish focus group participants and challenges around landlords and shared wells emerged as themes that have not been reported in the literature previously. Conclusions The burden of well stewardship in rural, agricultural Latino communities may suggest the need for interventions at the community, county, or state levels. As these solutions are being developed, well stewardship programs may want to prioritize providing actionable information and technical support to private well users. The role that landlords, shared well users, and home repair experience play in well stewardship represent important areas of exploration for researchers and public health practitioners.

show abstract

“…Past studies have reported underutilization of workers' compensation insurance by injured workers, 29 fear of divulging PTSD symptoms by police after September 11, 30 patients' fear of retaliation after reporting work-related exacerbation of asthma, 31 and reluctance by coal miners to participate in a program to identify and track the progress of lung disease. 32 Investigating and developing CDS to help manage discussions about this and similar sensitive issues could help guide development of the most effective CDS for this purpose.…”

Section: Barriersmentioning

confidence: 99%

Clinical Decision Support for Worker Health: A Five-Site Qualitative Needs Assessment in Primary Care Settings

et al. 2020

View full text Add to dashboard Cite

Background Although patients who work and have related health issues are usually first seen in primary care, providers in these settings do not routinely ask questions about work. Guidelines to help manage such patients are rarely used in primary care. Electronic health record (EHR) systems with worker health clinical decision support (CDS) tools have potential for assisting these practices. Objective This study aimed to identify the need for, and barriers and facilitators related to, implementation of CDS tools for the clinical management of working patients in a variety of primary care settings. Methods We used a qualitative design that included analysis of interview transcripts and observational field notes from 10 clinics in five organizations. Results We interviewed 83 providers, staff members, managers, informatics and information technology experts, and leaders and spent 35 hours observing. We identified eight themes in four categories related to CDS for worker health (operational issues, usefulness of proposed CDS, effort and time-related issues, and topic-specific issues). These categories were classified as facilitators or barriers to the use of the CDS tools. Facilitators related to operational issues include current technical feasibility and new work patterns associated with the coordinated care model. Facilitators concerning usefulness include users' need for awareness and evidence-based tools, appropriateness of the proposed CDS for their patients, and the benefits of population health data. Barriers that are effort-related include additional time this proposed CDS might take, and other pressing organizational priorities. Barriers that are topic-specific include sensitive issues related to health and work and the complexities of information about work. Conclusion We discovered several themes not previously described that can guide future CDS development: technical feasibility of the proposed CDS within commercial EHRs, the sensitive nature of some CDS content, and the need to assist the entire health care team in managing worker health.

show abstract

Improving the asthma disparity gap with legal advocacy? A qualitative study of patient-identified challenges to improve social and environmental factors that contribute to poorly controlled asthma

Abstract: Patients with poorly controlled asthma in a disadvantaged urban northeast community identified common barriers in both the domestic and work environments that impeded attainment of symptom control. These challenges may be best addressed through legal advocacy for those most at risk.

Cited by 15 publications

References 35 publications

Private well stewardship within a rural, agricultural Latino community: a qualitative study

Private well stewardship within a rural, agricultural Latino community: a qualitative study

Private well stewardship within a rural, agricultural Latino community: a qualitative study

Clinical Decision Support for Worker Health: A Five-Site Qualitative Needs Assessment in Primary Care Settings

Contact Info

Product

Resources

About