Global and Community Health Research
This section includes Class of 2023 Embark Projects within the Global and Community research fields. These projects include a wide range of topics with the common thread of a goal to have a positive impact within our local, regional, and/or global community.
Patient Medication Adherence to Free Medications in Free Health Clinic Setting
Omar Bukhsh, B.S.1, Justin Brox, M.D.2, David Thomas, Ph.D.1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Gary Burnstein Community Health Clinic, Pontiac, Michigan
INTRODUCTION
Medication adherence is the extent to which a patient follows their physician’s instructions about the timing, dosage, and frequency of prescribed medicines. Different research teams have used unique combinations of questions to determine medication adherence rates in their specific demographic groups. This project examined patients at the Gary Burnstein Community Health Clinic (GBCHC) during the COVID-19 Pandemic. Their medication adherence rates were then compared to national medication adherence rates to understand how greatly the COVID-19 Pandemic affected patients.
METHODS
This project used a modified version of the Morisky Medication Adherence Scale. This is a 6-question survey that is commonly used in studies aiming to identify medication adherence rates. The Qualtrics online survey tool was used to create our survey and to store results. Because this project occurred during the COVID-19 Pandemic, we called patients who visited GBCHC and input their results for them into Qualtrics. Landline phones at GBCHC were used when calling patients who had been to the clinic within the past year.
RESULTS
The data suggested that 63% of the patients surveyed were adherent to their medications during the COVID-19 Pandemic. We did not identify a correlation between adherence or non-adherence when examining gender, race, or the total number of medications prescribed to each patient. The data suggested that patients are more likely to be adherent to their medications. the older they are.
CONCLUSIONS
This study demonstrated that GBCHC patients were more medication adherent during the COVID-19 Pandemic than the national average, which is about 40% adherence. Additional research can occur to determine how to improve patients’ medication adherence further. One of the survey questions was “Do you sometimes not refill your prescription medicine on time?” The majority of patients responded “no.” Future studies may offer more insight to determine why certain patients do not refill their medications on time.
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Self-Triage Among Patients Who Are Homeless
Jimmy Clemmens, B.S.1, Jason Wasserman, Ph.D.2,3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
3Department of Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
People who are homeless present to urban emergency departments at a higher rate per 1000 people than those who are housed.1 With those added difficulties, people who are homeless frequently turn to Emergency Departments for primary, rather than only emergency, health care treatment.2,3 There is great need for investigation into the thought process for the self-triage of the patient who is homeless. This study was undertaken to survey adults at HOPE adult shelter about their ability to determine the most appropriate place to seek treatment for different common conditions of varying acuity, as well as to evaluate the efficacy of an educational resource used to help identify where appropriate medical treatment can be sought.
METHODS
23 people who are homeless participated in a 7-question survey with different common medical conditions that was delivered before and after an education session adapted from the HOPE “Know Where To Go” tool. Participants were encouraged to share reasoning as to why they may seek care at one setting versus another.
RESULTS
The percentage of correct answers in the pre-test survey was 56% vs. 71% in the post-test survey group (p=0.02). Participants cited various reasoning behind decision to seek care in certain settings including: No phone to call and make appointments, frequent relocation, no internet for insurance registration/guidance, transportation, mistrust, fear of being held in a hospital against their will.
CONCLUSIONS
While knowledge gaps exist in the ability of the population of people who are homeless in regards to self-triage, educational initiatives can work to close this gap. However, many patients who are homeless likely choose where to seek care based on availability, convenience, expectations, and prior experiences versus acuity of symptoms. Therefore, education alone may not significantly change where patients who are homeless seek medical care.
Text2StayOnTrack: Improving Diabetes Self-management and Health During COVID-19 Using Personalized Text Messages
Jody Esguerra, M.A.1, Suraj Goyal, M.S.2, Eduardo Leon, M.D.1, Justin Brox, M.D.3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Electrical and Computer Engineering, Oakland University, Rochester, Michigan
3Gary Burnstein Community Health Clinic, Pontiac, Michigan
INTRODUCTION
Literature suggests type 2 diabetes mellitus (T2DM) disproportionately affects minorities and the underserved in the United States. The outbreak of the COVID-19 pandemic compounded the public health challenge for these already vulnerable populations. T2DM was shown to increase one’s risk of complications associated with COVID-19. There existed a need to support individuals with T2DM within social distancing guidelines to achieve optimal glycemic control, a measure thought to reduce susceptibility and severity of COVID-19 infection. The primary objective of this pilot study, Test2StayOnTrack (T2SOT), was to develop an educational text messaging program for patients with T2DM who receive care at a free health clinic.
METHODS
This prospective pilot study used a mixed-methods, pre/post-test design. Patients with T2DM who received care at a clinic in Pontiac, Michigan were enrolled (n=8). Participants completed pre-intervention quizzes to assess diabetes knowledge (DK) and health literacy level (HLL). Patients were assigned to a low (LL, n=2) or high literacy (HL, n=6) group. Automated, bidirectional text messages were sent on three days a week for six weeks. The messages were personalized according to HLL and preferred language—Spanish or English. Pre and post-intervention quiz scores were compared using a two-sample t-test.
RESULTS
Post-intervention DK scores between the two groups were significantly different (p = 0.0424). The HL group demonstrated a significant improvement in functional health literacy compared to the LL group. All patients reported the messages were informative and easy to understand.
CONCLUSIONS
T2SOT resulted in high patient satisfaction and demonstrated that a larger study is feasible within this patient population. The intervention increased access to care for patients in a low resource setting without utilizing excess personal protective equipment or diverting staff responsibilities. SMS-based programs have the potential to impact a hard-to-reach population and may address barriers to care for vulnerable populations during an ongoing pandemic.
Perceptions of Oakland University Nursing Students Towards the Human Papillomavirus Vaccine
Rania Fardous, B.A.1, Inaya Hajj Hussein, Ph.D.2, Kristen Munyan, DNP3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
3Oakland University School of Nursing, Rochester, Michigan
INTRODUCTION
It is well established that the level and depth of knowledge will affect the attitudes, behaviors and practices of nursing students towards the Human Papilloma Virus (HPV) vaccination as a preventive measure against contracting the virus. This study aims to assess levels of knowledge of the Oakland University (OU) nursing students and change in attitudes and perceptions before they learn about the vaccine through educational materials.
METHODS
The study is a cross-sectional survey presented in the form of an online self-administered questionnaire which was administered to approximately 150 OU nursing students. The survey encompassed the following sections: general non-identifying information, knowledge of HPV vaccination, attitudes towards HPV vaccination, and expected intents/tendencies towards HPV vaccination. Participants were evaluated based on their knowledge of the HPV vaccination and attitudes towards the HPV vaccination after learning about it through the survey.
RESULTS
45 nursing students responded to our survey, with students scoring an average of 64.2% on questions assessing their knowledge of the vaccine before given educational materials. After reviewing educational materials and learning about the vaccine, 27 students strongly agreed that they would now encourage patients to get vaccinated and 29 responded that they no longer have hesitations to recommend the vaccine.
CONCLUSIONS
The results display that there are some gaps in knowledge of nursing students towards the HPV vaccine, but after learning about the vaccine through educational materials, nursing students display positive attitudes and beliefs towards recommending the HPV vaccine to patients. Following this, the materials can be incorporated into the Oakland University School of Nursing curriculum to promote better perceptions and increased knowledge towards HPV vaccination.
Evaluating the Accuracy and Quality of the Information on Pulmonary Rehabilitation Videos Shared on YouTube amidst the COVID-19 pandemic
Payaum Fotovat-Ahmadi, B.S.1, Bilal M. Ali, B.S.1, Bhavinkumar Dalal, M.D.1,2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Beaumont Hospital, Royal Oak, Michigan
INTRODUCTION
YouTube is a visual library that is growing at incredible pace, especially with the rise of COVID-19 pandemic. Pulmonary rehabilitation refers to the rehabilitation treatment of patients with chronic pulmonary diseases. YouTube has made it possible to practice remote rehabilitation, the effectiveness of which have been proven non-inferior to traditional approaches.
METHODS
YouTube was queried for the keywords “pulmonary rehabilitation”, and 3 similar terms, and search results were categorized based on source and content. Popularity was evaluated with the video power index (VPI). The quality, educational quality, and accuracy of the source of information were measured using the Journal of American Medical Association (JAMA) score, Global Quality Score (GQS), and Pulmonary Rehabilitation Score (PRS). JAMA score: 1 point for each of 5 criteria. GQS: rated on a 5-point scale. PRS: 13-point scale with positive correlation with information quality on pulmonary rehabilitation.
RESULTS
The mean view ratio was 174.3. The videos had 1073.1, likes versus 29.6 dislikes. The mean like ratio was 97.3. The mean VPI was calculated as 169.6. The videos had a mean JAMAS of 1.29, GQS of 1.63, and PRS of 2.97. Academic videos had significantly higher JAMAS, GQS, and PRS compared to other sources (P<0.05), yet VPI was significantly lower than the others (P < 0.05). A positive correlation of 31.9% between PRS and JAMAS, of 56% between PRS and GQS, and of 40.7% between GQS and JAMAS were detected. A positive correlation of 73% was observed between number of views and VPI.
CONCLUSIONS
The results showed that quality of the information on pulmonary rehabilitation acquired from YouTube is poor according to the results of standardized assessment tools. Physicians should possess the knowledge about the type of information the patients can acquire before presentation, in order to get themselves ready for the negative effects due to poor or inadequate information.
Pillow CPR: Using a Low Resource Method to Teach Hands-Only CPR to Hispanic Adolescents in a Community Setting
Benjamin Goldstein, B.A.1, Ekaterina Clark, B.S.1, Alan Silverman, D.O.1, Virginia Uhley, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Hands-only Cardiopulmonary resuscitation (CPR) training for adolescents in community settings is often limited by training device availability. This pilot study’s objective was to investigate the feasibility, participant knowledge gains, and attitude changes through hands-only CPR training using a pillow for skill development.
METHODS
In collaboration with a community agency program, we offered hands-only CPR training for adolescents. Participants watched a CPR demonstration followed by interactive CPR practice with medical student mentors using a pillow. A customized pillow case was used to show hand position and review information; each participant kept their pillowcase to support future practice. Using a one-group pre/post-test design, participants (n=16) completed questionnaires which included questions that evaluated CPR knowledge and opinions. A five-point Likert scale was used to assess attitudes/knowledge about CPR; as well as confidence and willingness to perform CPR.
RESULTS
In the pre-test 14 participants (87.5%) indicated no prior CPR training and supported that all adults should be CPR trained. Post-test results indicated that knowledge regarding compression depth increased 34% (9 to 15) while speed of compression increased 44% (5 to 12). In a paired analysis of pre/post results: willingness to perform CPR increased 25% (gain=0.69, pre test=2.73, p=0.011), confidence to perform CPR, 33% (gain=0.75, pre test=2.25, p=0.018), likeliness to practice in the next year, 18% (gain=0.44, pre test=2.44, p=0.110).
CONCLUSIONS
Adolescent participation in hands-only CPR training using a low resource device for practice resulted in knowledge gains and improved attitudes in the areas of willingness and confidence to perform CPR, and skills practice likeliness. This pillow training method was feasible and provides an accessible and cost-effective means for providing CPR training for adolescents. Future plans include continuing to collect outcome measures of this pillow method for CPR training in greater numbers of adolescents in community settings.
Post-Polio Syndrome and Polio Survivor Biography
Marlin Amy Halder, B.S.1, Lucas Nelson, M.D.1, Tracey Wunderlich-Barillas, Ph.D.1, Tracey A.H. Taylor, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
With polio infection nearly eradicated from the globe due to unprecedented vaccination success, the population of individuals who have experienced natural polio infection is now limited. The aim of this research project is to focus on the intersection of quality of life and life course theory related to a sample of polio survivors in the United States by interviewing participants from Southeast Michigan Post-Polio Support Group. The long-term goal is to illuminate physicians and society about the intricacies of caring for polio survivors as well as individuals living with other chronic illness.
METHODS
Data were collected through individual interviews and focus groups with 19 polio survivors, to date. Demographic information along with Quality-of-Life data were also collected. From the transcripts, a codebook was developed based on both themes determined a priori from publicly available survivor stories as well as new data collected as part of this research. The interviews have been coded by four different research personnel.
RESULTS
Preliminary results indicate common themes including, determination and perseverance, stigma as well as the use of metaphors to describe the illness experience. We anticipate unveiling other themes as coding of interviews continues. Some advice for future physicians has been revealed, such as learning more about the disease, trying to be aggressive with treatment and always being willing to listen to patients. These advice themes are salient throughout our medical education and were reinforced by the participants.
CONCLUSIONS
Through an expanded understanding of the effects and implications of chronic illness on individuals who have spent a lifetime dealing with its ramifications, we hope to gain a better understanding of the salient factors that can lead to improvements in physical, social and psychological well-being for patients dealing with chronic illness such as post-polio syndrome.
Factors Affecting LGBTQ+ Healthcare Behaviors
Charlene L. Hsia, B.S.1, Michele R. Parkhill, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Psychology, Oakland University, Rochester, Michigan
INTRODUCTION
Individuals who are lesbian, gay, bisexual, transgender, queer, or are part of another nonheteronormative gender and sexuality group (LGBTQ+) face greater barriers in equitable access to good healthcare and have different health care seeking behaviors than heteronormative individuals. In order to begin changing healthcare practices to be more inclusive and mindful of the experiences of LGBTQ+ people and address the community’s health disparities, we must first identify the specific concerns and needs of the LGBTQ+ community. This study aims to qualitatively identify those needs through interviews, which can then create a foundation for changes made by healthcare providers.
METHODS
Thirteen LGBTQ+ adult community members in the Metro Detroit area were interviewed for this study. Participants between the ages of 26-64 years old were recruited through physical postings or email listservs at established community organizations whose operations service LGBTQ+ individuals. Each individual participated in a 45-60 minute virtual interview conducted on a secure platform that included one interviewer and one study participant. All sessions were recorded, transcribed, de-identified, and coded for similar themes and responses.
RESULTS
Three common themes emerged from the data: healthcare provider-related, patient-related, and systemic barriers. Many participants believed healthcare providers did not have enough training related to providing affirmative care for LGBTQ+ patients. Participants indicated that providers used heteronormative language and practices, with some indicating improvement if the providers used inclusive language and signs of inclusivity were present in the environment. Others shared personal experience of medical discrimination and historical discrimination against LGBTQ+ populations as reasons to avoid healthcare altogether. Finally, many participants indicated systemic issues related to health insurance.
CONCLUSIONS
The themes found support the hypothesis that improving the healthcare of LGBTQ+ individuals should center on educating and training healthcare providers to provide inclusive and affirmative care for their patients.
Exploration of Lead Education Materials: A Qualitative Approach using the Health Belief Model
Cheryne M. Kim, B.A.1, Matthew P. Lico, M.S.2, Andrea T. Kozak, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Psychology, Oakland University, Rochester, Michigan
INTRODUCTION
Lead exposure is a persistent, yet preventable threat to child development. In Oakland County alone, 204 of 15,784 samples for children under the age of 6 were positive for elevated blood lead levels (EBLL’s) in 2017. A large body of research supports that primary prevention is the most effective method of addressing EBLL’s in children. A key component is equipping families with the resources to recognize and eliminate sources of lead, but what must be prioritized is public engagement and further research on the design of these resources. The goal of this project is to explore Oakland County community members’ knowledge and beliefs about lead exposure and gauge their perceptions of existing lead education materials through the lens of the Health Belief Model (HBM).
METHODS
A total of 10 individuals participated in semi-structured interviews via teleconference. They were either 1) a parent/guardian of a child enrolled in a Head Start program or 2) a home visiting service client and a parent/guardian of a child under the age of 6. They examined four different fact sheets within the HBM framework of perceived susceptibility, perceived barriers, and cues to action.
RESULTS
Before reading the fact sheets, participants perceived their children as having little to no susceptibility to lead exposure, cited multiple barriers to lead poisoning prevention, and identified the Flint Water Crisis as a cue to action. Upon examining the fact sheets, listing both well-known and lesser known lead exposure risks contributed to increased perceived susceptibility. Furthermore, the fact sheets did not adequately address the perceived lack of financial resources in minimizing water-specific lead exposure risks.
CONCLUSIONS
The results of this study shed light on effective features and unanticipated shortcomings of existing lead education materials. They will inform primary prevention efforts in re-envisioning future outreach strategies for the Oakland County community.
Compassion Fatigue Seen in EMS Workers Treating Chronic Opioid Users
Amelia Kruse, B.S.1, Jason Wasserman, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Opioid use and misuse has been rising nationwide since 1999, as have the number of opioid-related deaths. This has not been limited to illicit drug use, but accelerated by prescribing practices that have ignored concerns about addiction. Emergency services have seen an increasingly high volume of opioid overdose and injury patients, but little additional support to respond to this crisis. This study seeks to investigate EMS workers perceptions of the opioid crisis and the barriers they face to providing adequate response.
METHODS
Semi-structured, open-ended interviews were conducted anonymously, one-on-one with emergency medicine providers from two Oakland County, Michigan EMS companies. The facilities were chosen because they serve different patient populations served, despite their close geographical proximity. All interviews were done at their place of work in a private room and took an average of 25 minutes. Data were analyzed using coding techniques derived from Grounded Theory, to identify emergent themes.
RESULTS
Completed interviews consisted of 11 individuals (9 makes, 2 females). Common themes included the lack in long-term impactful care they were able to provide, and the ways in which many of these cases have changed their outlook on those struggling with addiction. Those working in the same facility had similar perspectives, underscoring that the phenomenon may be geographically bounded. Those working in the more affluent area did not perceive a significant uptick in opioid-related cases in the previous several years.
CONCLUSIONS
While some of those interviewed were uncomfortable discussing the issue, others were overjoyed to be able to share their experiences with someone. Importantly, resources for opioid response by EMS should consider the geography of the crisis. Further, results highlight the importance of providing EMS workers both emotional as well as medical tools.
The Social Effects of Summer Camp Attendance in Adolescents with Autism: A Pilot Study
Nicole Lewis, B.S.1, Kyeorda Kemp, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Autism spectrum disorder (ASD) describes a developmental disorder associated with deficits in socialization and restricted or repetitive sensory-motor behaviors. Surveys have shown that individuals with autism report higher rates of loneliness, depression, and anxiety compared to their typically developing peers. Summer camps offer social integration and support, which both have well-established positive impacts on the overall wellness of individuals with ASD, including health benefits through physical activity. The primary goal of this pilot study is to explore a potential social benefit to adolescents with autism that may result from attending a summer camp.
METHODS
11 caregivers of adolescents 11-18 years old attending summer camp (“campers”) were surveyed regarding observed social skills of campers before and after attending camp. The quantitative section of the survey is a minimally modified version of the Autism Social Skills Profile (ASSP), which yields three subscale scores: social reciprocity, social participation, and detrimental social behaviors. Caregivers and campers were allotted space to provide additional comments.
RESULTS
Of the 11 caregiver respondents to the pre-camp survey, 9 were parents or adult siblings of campers with ASD (autism group), whereas the other 2 were parents of campers without ASD (neurotypical group). All 6 post-camp survey respondents were from the autism group. There was no statistically significant difference between the matched pre- and post-camp responses. Moreover, the qualitative feedback provided by both campers and caregivers was all positive in nature.
CONCLUSIONS
The results are limited and statistically insignificant given the limited number of respondents, so future studies will have to explore further whether camps are an effective way to improve social skills.
Outbreak Risks at Religious Schools: Prevalence of Nonmedical Vaccination Exemptions Among Michigan Kindergartens
Flora Martz, B.A.1, Patrick Karabon, M.S.1, Mark Navin, Ph.D.1,2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Philosophy, Oakland University, Rochester, Michigan
INTRODUCTION
Religious community membership is relevant to immunization policy, as in the case of 2019 US measles outbreaks clustered in Orthodox Jewish communities. US immunization policy focuses on school enrollment requirements, which apply both to public and private (usually religiously-affiliated) schools. Most US states exempt students from these requirements for nonmedical reasons, including religious reasons, though some states, including New York, California, and Maine, have recently eliminated nonmedical exemptions. This study uses 2017-18 data from the state of Michigan to illuminate relationships between nonmedical exemption (NME) rates and attendance at religious schools with the aim of providing information about high-value targets for future vaccination policy to increase compliance and decrease vaccine-preventable diseases.
METHODS
Using data from Michigan Health and Human Services, Michigan’s Center for Educational Performance and Information, and the American Community Surveys conducted by the US Census Bureau, this study describes key relationships between exemption rates, school types, and county demographics in order to draw conclusions about the most effective targets for future vaccine exemption legislation.
RESULTS
This study finds that NME rates were higher among religious school students, but that religious schools were much less likely to have any NMEs among their entering kindergarten cohorts, due to their smaller size.
CONCLUSIONS
Higher NME rates in religious schools may not correspond to increased risks of outbreaks. Additionally, this study finds that choice of utilization of either philosophical or religious waivers does not correlate to religious or non-secular institutions. And finally, this study identifies key demographic characteristics correlated with NME rates such as higher household median income and lower minority population.
Childhood Sexual Abuse and Resiliency in Underserved Communities
Mena Misiak, B.S.1, Elizabeth Taylor, M.S.2, Michele P. Parkhill, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Psychology, Oakland University, Rochester, Michigan
INTRODUCTION
Child abuse is a public health problem. Research shows that 1 in 10 children will be abused before their 18th birthday. The prevalence of child sexual abuse (CSA) has a long-lasting impact on the mental health of the victims. The project goal is to determine if children who reside in underserved, low-income communities are more prone to being victims of CSA. The first aim of this project is to determine which factors predispose children to abuse and the second aim to understand what type of resilience is employed by those children as a coping mechanism.
METHODS
With 175 participants (50.6% male; ages 18-72), participants were recruited via MTurk to complete a survey with questions regarding CSA and resilient strengths. Data analysis was done using a descriptive statistics and regressions.
RESULTS
Individuals who were not fostered or adopted and whose parents received government assistance were more likely to report CSA. Counterintuitively, those who reported higher socioeconomic status were more likely to experience CSA. Regarding resilient strengths, those high in endurance and community support reported more CSA, while those with low in self-reliance and relational motivation reported more CSA.
CONCLUSIONS
In this study, the hypothesis stated that children in underserved communities are more likely to experience childhood sexual abuse, but the results showed that lower placement in the SES ladder was not related to more CSA and children can experience sexual abuse anywhere in the ladder. Even though it is important to focus on lower SES families, we cannot disregard that this could also be happening to higher SES families.
Barriers of Access to Gender-Affirming Surgery: A Scoping Review
Mary Najjar, B.S.1, Amalia Elvira Gomez-Rexrode, B.S.2, Megan Lane, M.D.3, Judith Smith, M.S4, Sydney Proudlock5, Lorena Miss Ozuna5
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2University of Michigan Medical School, Ann Arbor, Michigan
3University of Michigan, Department of Surgery, Section of Plastic Surgery, Ann Arbor, Michigan
4University of Michigan, Taubman Health Sciences Library, Ann Arbor, Michigan
5University of Michigan, Ann Arbor, Michigan
INTRODUCTION
While gender-affirming surgeries remain a key component in healthcare for transgender patients, access to these procedures remains elusive for many patients. Barriers to accessing this care exist on multiple levels. This scoping review seeks to identify these barriers and provide recommendations to allow for an increase in access to care.
METHODS
This study was conducted following the Arksey and O'Malley framework. Texts were identified for inclusion based on identified key terms and included texts published through March 14, 2022 and were identified across seven databases. Three researchers analyzed titles and abstracts to determine publications for full text extractions. Two researchers conducted independent text extractions on the identified articles. The data extracted included the methodology of the study, barriers to gender-affirming surgery, and demographic information.
RESULTS
There were 5, 719 articles initially identified by the search. 139 of these articles were reviewed for the full text extractions and 56 ultimately included. The review identified many barriers of access to care with the most common barriers being insurance coverage (n=32), finances, including direct and indirect costs (n=31), preoperative medical eligibility and letters (n=19), healthcare provider attitudes (n=15), lack of healthcare provider knowledge (n=15), and lack of patient educational resources (n=14). In addition, the availability of surgeons, fear of surgery, complications, recovery, pain after surgery, stigma, and uneven geographic distribution of surgeons were cited as common barriers.
CONCLUSIONS
This scoping review evaluated the current literature to categorize and analyze barriers in hopes of providing a framework to address them. The data collected demonstrates a need for a standardized approach from insurance companies in what coverage they will provide and consistent pre-operative eligibility requirements. There was also a demonstrable area for improvement in terms of medical education and healthcare provider attitudes. Further education for medical students and practicing residents and physicians would increase knowledge amongst providers.
Online resources for Hepatitis B: Analyzing the effectiveness of the most popular Hepatitis B websites in the United States
Paul Patel, M.S.1, Misa Mi, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Hepatitis B is a vaccine preventable disease that greatly predisposes an infected individual to hepatocellular carcinoma. Serological evidence has shown approximately 30% of the world’s population to have a current or past infection with Hepatitis B, and Asian Americans comprise 60% of individuals afflicted by chronic Hepatitis B. Studies have shown that at risk Asian Americans for Hepatitis B use the internet as their most common form of health information. The aim of this study was to evaluate the quality, content, and readability of the most popular Hepatitis B websites in the United states based on design, credibility, accessibility, literacy, engagement, content, and cultural sensitivity.
METHODS
Eight of the top Hepatitis B websites in the United States were identified through a comprehensive, multiple-query search. Using the first two pages of search results, eight common websites were identified using each possible combination of engines, web browsers, and individual MeSH terms based on the PubMed MeSH database. The multimeric evaluation of each website was performed based on seven factors: design, credibility, accessibility, literacy, engagement, content, and cultural sensitivity.
RESULTS
Data analysis revealed that all eight websites in general performed well on most of the criteria on design, accessibility, credibility, engagement, and content. However, 6 out of the 8 websites were lacking in the criteria of literacy while 4 out of the 8 websites were lacking in the criteria of cultural sensitivity.
CONCLUSIONS
The results of the study help inform healthcare providers about the most popular and accessible information circulating on the internet about Hepatitis B. Moreover, the study shows a need for culturally sensitive Hepatitis B resources offered at more appropriate literacy levels and languages for at risk populations.
Agreement with popular HPV vaccine myths among Michigan adults
Siddharth Ramanathan, B.S.1, Inaya Hajj-Hussein, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Human Papillomavirus (HPV) remains one of the most common risk factors for malignancy. Although 90% of these malignancies can prevented by vaccination, the Michigan HPV vaccination rate remains behind the US average. We sought to estimate the proportion of Michigan adults who believed in several misconceptions about the HPV vaccine.
METHODS
We aimed to provide estimates of the proportion of Michigan adults who agreed with several misconceptions about the HPV vaccine using surveys. Adults at Relay For Life events were approached for inclusion in the study, and after documenting consent, the survey was administered. Demographic data were collected and agreement with popular HPV vaccine myths was assessed using “True/False” questions.
RESULTS
A total of 389 participants (30.4% male and 63.2% parents) with average age 43.7 years, consented. When asked whether the HPV vaccine was unsafe, 35.5% agreed. When asked whether the vaccine has potentially serious side effects 36.5% agreed, 26.0% agreed that the vaccine causes fertility issues, and 27.8% believed the vaccine contained significant quantities of harmful ingredients. When asked who the HPV vaccine was intended for, 21.1% believed the vaccine was only for sexually active individuals and 24.4% of participants believed the HPV vaccine was only for women. When asked whether they thought that the HPV vaccine does not prevent cancer, 21.8% agreed.
CONCLUSIONS
HPV vaccination rates in Michigan remain significantly below the national average. We conducted a pilot study surveying adults in southeast Michigan to understand beliefs about the HPV vaccine. Over one-third of survey participants believed that the HPV vaccine was unsafe or could cause serious side effects, and over one-quarter believed that the vaccine could lead to fertility issues or that the vaccine contained harmful chemicals. We hope this study spurs future research on how to ameliorate the public perception of the HPV vaccine.
Program Evaluation of New Day Foundation: A Financial Support Organization for Patients Diagnosed with Cancer
Joseph Rodriguez, B.S.1, Dwayne Baxa, Ph.D.2, Gina Kell Spehn3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
3New Day Foundation, Rochester Hills, Michigan
INTRODUCTION
New Day Foundation provides financial and emotional support to cancer patients and their families before they hit financial limitations. Financial Toxicity, defined as increased monthly expenses coupled with the loss of income and subjective financial distress, can create significant stressors while receiving treatment. Cancer statistics show that the median age of diagnosis is 66 years, with African American males being the most affected. With this program evaluation, the goal is to determine if the appropriate groups are being serviced.
METHODS
An electronic survey was sent out via e-mail to 1,000+ New Day Foundation members. Using Qualtrics, the variables studied included patients’ demographics, markers of toxicity, education, income level and impression of the process. Data was collected over a six-month period. An unpaired T-Test was used to compare data.
RESULTS
Of the 108 respondents, 85% of participants were female and 63% were Caucasian. 93% of the participants were less than 60 years old. 80% of participants were employed prior to a diagnosis of cancer while only 32% were employed after treatment was completed. 67% of respondents had an income level below $50k. 68% had at least completed their Associate’s degree. Participants over 61 rated the simplicity of the process at 7.33, while those under 61 rated it as 9.02, p-value of 0.029. 10% of participants wanted follow-up after receiving aid and 5% were confused about the process and did not receive aid.
CONCLUSIONS
Most patients partaking in this survey were Caucasian females less than 60 years old. The data was skewed to a younger population because New Day Foundation offers financial assistance to those with dependents. Only 5% of participants were African American males despite that being the demographic with the highest cancer incidence in the U.S. Most of the participants were below the median income in the United States.
Evaluating Emotional Distress Among Michigan Food Insecure Communities During the COVID-19 Pandemic
Abiba Salahou, B.A.1, Deidre Hurse, Ph.D.2, Angela Gill,HS-BCP, Ph.D.3, James F. Grogan, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
3Light House of Oakland County
INTRODUCTION
Increasing data has shown that in order to understand the pathogenesis and widespread effects of COVID-19 fully, we must broaden the public health discussion surrounding COVID and consider how access to food has impacted the well-being of racially diverse communities. While the neuropsychological impacts of the COVID-19 Pandemic have been well established, there is limited data on whether the pandemic has influenced the prevalence of emotional distress among food-insecure communities. The purpose of this research study is to evaluate how the COVID-19 Pandemic has influenced self-reported emotional distress among persons experiencing food insecurity in Southeast Michigan.
METHODS
Food insecure individuals living in Southeast Michigan completed a 15 multiple choice question survey evaluating emotional distress during the COVID-19 Pandemic. Food insecurity was defined as persons who self-reported that they “in the last 12 months were worried whether their household would run out of food before they were able to get more”. Participants were recruited from food banks in Southeast Michigan. Exclusion criteria included participants younger than 18 years of age. Categorical variables were analyzed using Fisher’s exact tests.
RESULTS
96% of participants reported increased anxiety about providing food for themselves and their families since the start of the COVID-19 Pandemic. 88% of participants reported that since the start of the COVID-19 Pandemic, worrying about their food insecurity has caused them increased feelings of emotional distress and depression. Participants who self reported being food insecure during the COVID-19 Pandemic suffered from new onset or worsened depression (P= 0.024).
CONCLUSIONS
Racially diverse food insecure communities living in Southeast Michigan have experienced increased depression and emotional distress since the start of the Covid-19 Pandemic. These results depict an alarming trend in the severity of mental health burden amongst marginalized communities during the pandemic and highlight the need for increased mental health advocacy in clinical practice.
Evaluating the Financial Support Referral Processes for Cancer Patients
Andrew Shanholtzer, B.S.1, Gina Kell Spehn, B.A.2, Dwayne Baxa, Ph.D.3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2New Day Foundation, Pontiac, Michigan
3Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Financial toxicity (FT) refers to the detrimental effects of excess financial strain caused by diagnosis of cancer. With increases in cancer treatment costs, FT has become an important consideration in patient care. New Day Foundation and similar organizations lessen the burden of FT through financial aid and navigation. New Day Foundation primarily receives clients via social worker referrals. The primary aim of this research is to conduct a survey of these social workers to discover the financial need evaluation and referral processes.
METHODS
90 Michigan oncology social workers were emailed a Qualtrics survey. Variables of interest include affiliated hospital/ cancer center, referral numbers, and the factors incorporated into financial evaluation.
RESULTS
38 surveys responses were collected. 30 responses were complete, representing 20 hospitals. 50% of hospitals admitted to having a formal evaluation process. Typical evaluation topics included income level at diagnosis (75%) and expected income changes (75%), while education level (10%) and finance knowledge (20%) were less frequently assessed. Chi-square analysis comparing high referral centers (100 or more referrals per year) to low referral centers (less than 100 referrals per year) resulted in a p-value of 0.28.
CONCLUSIONS
The results revealed that there is a heterogeneity in the financial need evaluation process and referral system. This difference was not statistically significant between high and low referral centers. Frequently addressed factors include income level at diagnosis and expected income changes. Limitations of this study include low response rate and allowing the questions on Qualtrics to be optional, leading to incomplete responses and unintended skipped questions.
Given the lack of uniformity in addressing financial toxicity between hospital systems, we are currently performing a follow up study consisting of virtual interviews to better understand each hospital’s process. This information will hopefully lead to more patients receiving the financial aid they require.
