Unmet basic needs and health intervention effectiveness in low-income populations

Abstract

In the face of unmet basic needs, low SES adults are less likely to obtain needed preventive health services. The study objective was to understand how these hardships may cluster and how the effectiveness of different health-focused interventions might vary across vulnerable population sub-groups with different basic needs profiles. From June 2010–2012, a random sample of low-income adult callers to Missouri 2-1-1 completed a cancer risk assessment and received up to 3 health referrals for needed services (mammography, pap testing, colonoscopy, HPV vaccination, smoking cessation and smoke-free home policies). Participants received either a verbal referral only (N=365), verbal referral + tailored print reminder (N=372), or verbal referral + navigator (N=353). Participants reported their unmet basic needs at baseline and contacts with health referrals at 1-month post-intervention. We examined latent classes of unmet basic needs using SAS. Logistic regression examined the association between latent classes and contacting a health referral, by intervention condition. A 3 class solution best fit the data. For participants with relatively more unmet needs (C2) and those with money needs (C3), the navigator intervention was more effective than the tailored or verbal referral only conditions in leading to health referrals contacts. For participants with fewer unmet basic needs (C1), the tailored intervention was as effective as the navigator intervention. The distribution and nature of unmet basic needs in this sample of low-income adults was heterogeneous, and those with the greatest needs benefitted most from a more intensive navigator intervention in helping them seek needed preventive health services.

Quitting the quitline: a qualitative study of patient experience of electronic referrals to quitlines

“…Several recent studies have highlighted the importance of providing additional support to manage the stressors (e.g. lack of food, shelter, safety) that can impede smokers' ability to engage in programs and make/sustain behavior change (31)(32)(33). Integrating support for smoking cessation with referrals to communitybased resources to address unmet basic needs has shown promise in several studies (31,33,34).…”

“…lack of food, shelter, safety) that can impede smokers' ability to engage in programs and make/sustain behavior change (31)(32)(33). Integrating support for smoking cessation with referrals to communitybased resources to address unmet basic needs has shown promise in several studies (31,33,34). In one such study, smoking cessation rate did not differ by a request for a community referral, but the small number of participants who did use their referral (n=24) were more likely to quit than those who did not (43.6%vs 15.3%; P < .001) (35).…”

Quitting the quitline: a qualitative study of patient experience of electronic referrals to quitlines

“…Several recent studies have highlighted the importance of providing additional support to manage the stressors (e.g. lack of food, shelter, safety) that can impede smokers' ability to engage in programs and make/sustain behavior change (30)(31)(32).…”

“…Integrating support for smoking cessation with referrals to community-based resources to address unmet basic needs has shown promise in several studies (30,32,33). In one such study, smoking cessation rate did not differ by a request for a community referral, but the small number of participants who did use their referral (n=24) were more likely to quit than those who did not (43.6%vs 15.3%; P < .001) (34).…”

Identifying Stress Landscapes in Boston Neighborhoods

“…A possible explanation of this observation is that neighborhoods with higher rates of unmet social needs, such as Roxbury and Jamaica Plain, may be less likely to perceive stressors that are unrelated to basic necessity. 28 , 29 If residents are unable to perceive stressors that may be influencing health problems in their community, there is little hope in affecting these potential upstream pathways. It is essential to further illuminate the relationship between neighborhood stressors and the resultant stress-related health problems and behaviors if we hope to empower residents to make meaningful changes that influence their health.…”