Browsing by Author "Boyd, David Lorenzo"
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Item Open Access Assessing the Health Needs and Barriers to Accessing Health Care in a Predominantly Latinx Immigrant Community in North Florida(2020-04-18) Sharma, AnuOn average, the Latinx population in the US has a higher rate of being uninsured and faces numerous social determinants, such as lower educational attainment and lower income, which can impede access to healthcare services. In addition, the passage of recent targeted immigration policies in Florida raise concerns over a possible chilling effect on health services utilization in this population. While previous research has indicated higher prevalence of chronic diseases in the predominantly rural areas of North Florida, the health concerns and barriers to accessing care of Latinx immigrants in these regions have been largely understudied. The goal of this thesis is to understand the healthcare context of a Latinx immigrant population in North Florida by using programmatic data collected by the Rural Women’s Health Project (RWHP), a health justice nonprofit based in Gainesville, FL. One of RWHP’s programs, Project SALUD (PS), is a community-based patient navigation program active in three counties in North Florida which improves linkage to care for participants. This study examined the data collected on participant intake forms during the PS registration process and included demographic measures, as well as information on the participant’s greatest health concerns and barriers to accessing care. Chi-squared analyses were conducted using R Studio. The study demonstrated that PS has catered to a predominantly female population (75.6%) who are by and large working age adults, with a median age of 37. Participants most commonly list their region of origin as Mexico, followed by Central America. The overwhelming majority speak little to no English (87.0%) and are medically uninsured (87.2%). PS has been most commonly accessed to address a need for dental care (30.4%). In terms of differences by gender, female participants were more likely to indicate a need for cancer screening or general health when compared to males. Insurance status also generally increased by age as did English proficiency. Participants from Central America were significantly more likely to indicate that cost was a barrier to accessing healthcare. This data will enable RWHP to evaluate the impact of the program from 2016 to present and can serve as baseline data for future studies to longitudinally monitor the programmatic goals of PS. It may also guide PS to reach communities that were previously not participating in the program, offer more services tailored to specific needs, and collaborate with community partners to increase the accessibility of health care and social services to address health disparities in North Florida.Item Open Access Evaluation of an Eight-week Yoga Program for Children Living in Orphanages in Haiti: A Preliminary Study of Child Mental Health(2014) Culver, KathrynObjective: Posttraumatic stress due to trauma exposure in childhood disconnects the mind and body, producing a chronic state of anxiety and ill health that worsens into adulthood. In order to mitigate the harmful effects of trauma experienced by children living in low-resource settings worldwide, evidence-based research on the effect of feasible mind-body interventions to reduce trauma-related symptoms among this vulnerable population is needed. The complementary and alternative medicine (CAM) practice of yoga holds promise as a mind-body approach to child mental and physical wellbeing. The purpose of this preliminary study was to evaluate the effectiveness, feasibility, and acceptability of an 8-week yoga intervention to reduce trauma-related symptoms and emotional and behavioral difficulties among children living in orphanages in Haiti.
Methods: The study design is a case-control study with random assignment to yoga or aerobic dance plus a non-randomized wait-list control group. The UCLA PTSD Reaction Index and the Strengths and Difficulties Questionnaire measured trauma-related symptoms and emotional and behavioral difficulties, respectively. A supplementary questionnaire evaluated participants' experience in the yoga program.
Results: Our main findings include that participation in either 8-weeks of yoga or aerobic dance classes predicted a reduction in trauma-related symptoms and emotional and behavioral difficulties, though not statistically significant (p > .05). The average yoga class attendance was 14.65 (SD = 2.17) out of 16 classes. Ninety-two percent of respondents (N = 26) reported being satisfied with the yoga program and all reported positive changes in wellbeing.
Conclusion: Although the reductions in trauma-related symptoms and emotional and behavioral difficulties among children in the yoga and aerobic dance groups were not statistically significant, positive feedback suggests that yoga is a feasible, acceptable, and enjoyable activity with benefits to child mental and physical health. Further research is needed to evaluate the effect of yoga to relieve trauma-related mental illness among Haitian youth and to promote sustained health into adulthood. Yoga programs designed to improve health and resilience to stress are essential social justice approaches for investing in the wellbeing of our global youth and creating peace within the community at large.
Item Open Access Examining Trends in Birth Location and Birth Attendance Among Women in the Amarakaeri Communal Reserve(2018) Jones, ClayDespite global improvements in maternal mortality rates, preventable maternal deaths are still an issue for many populations. Indigenous populations, especially those in Latin America, often do not utilize delivery services for a number of reasons, not the least of which are cultural beliefs, geographic challenges, and ability to pay for services. The primary objective of this study is to examine the birth location and birth attendance trends across time of Amazonian Indigenous women compared to women of Andean Highland decent. Additionally, the study aims to compare the education levels, urban status, and income levels of these populations. This analysis uses survey data from families in Amarakaeri Communal Reserve in Amazonian Peru. Bivariate analysis and multivariate logistic regression were used to examine birth location and birth attendance across time. Since 1990, Amazonian Indigenous women in the study sample are increasingly giving birth at health posts in the attendance of nurses, but most still elect to give birth at home with a relative as an attendant. From this, it is concluded that women of Amazonian Indigenous decent are increasingly seeking out skilled birth attendants, but barriers to utilization may remain. Further descriptive research is necessary to ascertain the reasons why Amazonian Indigenous women still prefer giving birth at home, and additional modeling is necessary to determine the effects of potential influencing variables, such as urban status, education levels, and income levels.
Item Open Access Is Alternative Rite of Passage the Key to Abandonment of Female Genital Cutting? A case study of the Samburu of Kenya(2016-04-25) Mepukori, NashWhile Female Genital Cutting (FGC) has been condemned worldwide and seen as a violation of women’s right, individuals in communities that still practice the rite claim that it is an integral and respectable component of their culture. Up to date, there have been numerous NGO- and government-led grassroots programs geared towards eradication of FGC. Yet, there remains a wide gap in the literature evaluating the impact of such anti-FGC interventions (WHO, 2011). This dearth of information poses a significant threat to the project of FGC abandonment as policy-makers are unable to assess which interventions have worked and why, and which ones are failing, and why. This study, which focuses on Female Genital Cutting among the Samburu of Kenya, seeks to begin bridging this knowledge gap by evaluating the Alternative Rite of Passage (ARP) intervention program. For close to a decade now, Amref Health Africa, an international NGO based in thirty African countries, has been implementing the Alternative Rite of Passage in the Samburu community. A key objective of this study is to conceptualize the ways in which stories and understandings of Female Genital Cutting in Samburu have changed (if at all), in light of Amref’s Alternative Rite of Passage program. Using qualitative data collected through Focus Group Discussions and Key Informant in-depth interviews, this study attempts to piece together a complex puzzle that brings together history, politics, economics, customs, and beliefs. Analysis of data will reveal present community attitudes towards female circumcision and the ARP program. Furthermore, the complex role of the NGO in the battle against FGC will be addressed leading to a discussion around the suitability and sustainability of alternative rites of passage in this community.Item Open Access Positive Mental Health and Self-Efficacy in Management of Chronic Kidney Disease: a Mixed-Methods Study in a Rural, Minority Population(2017) Wang, Daphne WeihsuanBackground: Chronic kidney disease (CKD) is a progressive, irreversible condition that affects 15% of the US population, causing poor health outcomes and enormous social and economic burden. Rural and minority populations bear significant disparity in CKD outcome. Self-management of CKD and comorbid conditions is important in slowing the progression of CKD and preventing end stage renal disease.
Methods: This study uses a mixed-methods study design to investigate the association between positive mental health and self-efficacy and to qualitatively explore the dimensions of positive mental health that influence self-efficacy. A cross-sectional study involving 257 individuals was conducted from May to July 2016. Quantitative data collection involved administration of a questionnaire and clinical assessment of kidney function. Participants were asked about their medical history and attitudes on the chronic disease management (self-efficacy for chronic disease management, coping, social support, and perceived stress), and mental health and illness (positive mental health, depression, anxiety, and PTSD). Ordered logistic regression was used to assess the relationship between positive mental health and self-efficacy, controlling for depression, the interaction between positive mental health and depression, and other covariates. Qualitative data collection involved conducting six focus group discussions involving 35 individuals who experience significant life impact due to kidney disease to explore facilitators and barriers of CKD self-management.
Results: Individuals with flourishing positive mental health were significantly more likely to have high self-efficacy compared to individuals with languishing positive mental health (p < 0.001, Figure 10). Overall, in the fully adjusted model, the proportional odds ratio of improved self-efficacy was 2.89 (95% CI 1.29-6.47), all else held constant. For individuals with CKD, the proportional odds ratio of improved self-efficacy was 7.67 (95% CI 2.42-24.29), all else held constant. For individuals without CKD, positive mental health was not a significant predictor of self-efficacy (p-value > 0.05). Qualitative data showed support for the broaden and build theory as a possible mechanism linking positive mental health and CKD self-management. Positive emotions derived from positive mental health allowed individuals to acquire personal and social resources such as resilience, optimism, and social support that encourage self-management of CKD.
Conclusion: These findings suggest that positive mental health should be incorporated into existing CKD self-management programs to fully address the psychosocial needs of patients and effectively encourage sustainable behavioral changes for CKD self-management. Future efforts should focus on identifying positive mental health interventions that builds on the strong familial relationships, and spiritual and religious organizations in the community to improve positive mental health in this population.