Browsing by Author "Golembiewski, Elizabeth H."

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    Does an interactive trust-enhanced electronic consent improve patient experiences when asked to share their health records for research? A randomized trial
    (Oxford University Press, 2019-07) Harle, Christopher A.; Golembiewski, Elizabeth H.; Rahmanian, Kiarash P.; Brumback, Babette; Krieger, Janice L.; Goodman, Kenneth W.; Mainous, Arch G., III; Moseley, Ray E.; Health Policy and Management, School of Public Health
    Objective In the context of patient broad consent for future research uses of their identifiable health record data, we compare the effectiveness of interactive trust-enhanced e-consent, interactive-only e-consent, and standard e-consent (no interactivity, no trust enhancement). Materials and Methods A randomized trial was conducted involving adult participants making a scheduled primary care visit. Participants were randomized into 1 of the 3 e-consent conditions. Primary outcomes were patient-reported satisfaction with and subjective understanding of the e-consent. Secondary outcomes were objective knowledge, perceived voluntariness, trust in medical researchers, consent decision, and time spent using the application. Outcomes were assessed immediately after use of the e-consent and at 1-week follow-up. Results Across all conditions, participants (N = 734) reported moderate-to-high satisfaction with consent (mean 4.3 of 5) and subjective understanding (79.1 of 100). Over 94% agreed to share their health record data. No statistically significant differences in outcomes were observed between conditions. Irrespective of condition, black participants and those with lower education reported lower satisfaction, subjective understanding, knowledge, perceived voluntariness, and trust in medical researchers, as well as spent more time consenting. Conclusions A large majority of patients were willing to share their identifiable health records for research, and they reported positive consent experiences. However, incorporating optional additional information and messages designed to enhance trust in the research process did not improve consent experiences. To improve poorer consent experiences of racial and ethnic minority participants and those with lower education, other novel consent technologies and processes may be valuable.
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    Employment Trends Among Public Health Doctoral Recipients, 2003-2015
    (American Public Health Association, 2018-09) Brown-Podgorski, Brittany L.; Holmes, Ann M.; Golembiewski, Elizabeth H.; Jackson, Joanna R.; Menachemi, Nir; Health Policy and Management, School of Public Health
    OBJECTIVES: To examine postgraduation employment trends among graduates of doctoral programs in public health from 2003 to 2015. METHODS: We analyzed pooled cross-sectional data from a census of graduates receiving a research doctorate from US accredited institutions. The outcome of interest was employment status. Covariates included public health discipline, sociodemographic characteristics, and institutional attributes. RESULTS: Of 11 771 graduates, nearly two thirds secured employment in either academic (34.8%) or nonacademic (31.4%) settings at the time of graduation. The proportion of those still seeking employment increased over time. Individuals who were White, younger, trained in either biostatistics or epidemiology, or from an institution with the highest level of research intensity were significantly more likely to secure employment. Academic employment was the most common setting for all 5 public health disciplines, but we observed differences in employment patterns (e.g., government, nonprofit, for-profit) across disciplines. CONCLUSIONS: Certain characteristics among public health doctoral recipients are correlated with postgraduation employment. More research is needed, but the observed increase in individuals still seeking employment may be attributable to increases in general public health graduates from for-profit institutions.
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    Health Care and Policy Interventions to Improve the Health of Patients Experiencing Homelessness
    (2019-08) Golembiewski, Elizabeth H.; Harle, Christopher A.; Blackburn, Justin; Holmes, Ann M.; Menachemi, Nir
    Housing instability and homelessness are associated with significant health burdens, including high rates of chronic and infectious disease, disproportionate vulnerability to violence and injury, and increased risk of premature death and disability. In addition, between 28-57% of nonelderly homeless adults lack health insurance coverage. Consequently, homelessness is associated with reduced access to outpatient primary care services and increased rates of emergency department (ED) visits, which are costly and inefficient for both health systems and patients. In the context of mounting emphasis on value-based reimbursement structures, health systems and policymakers have a vested interest in reducing high-cost utilization and addressing social determinants of health, including housing. Therefore, in this dissertation, I address three research questions at the intersection of housing needs and the United States health care delivery system. The first study is a systematic review of the peer-reviewed literature evaluating interventions to reduce ED utilization among adults who experience homelessness. The second study uses state-level panel data to examine the impact of Medicaid expansion on rates of adult homelessness by comparing states that opted to expand their Medicaid eligibility requirements under the Affordable Care Act (ACA) with states that did not. Finally, the third study uses multiple years of national data to assess clinical quality performance among a subset of federally qualified health centers that received Health Care for the Homeless (HCH) funding from 2014-2017 to provide homeless-tailored primary care services. Key findings include the need for larger, more generalizable studies with rigorous designs to assess the effectiveness of strategies to reduce ED use among homeless patients; expanding Medicaid eligibility may mitigate the impact of large or unexpected medical expenses among families with children who are at risk of homelessness; and finally, HCH-funded health centers have demonstrated improvements on several clinical quality indicators over time and have distinct organizational characteristics that are associated with performance on these indicators. Collectively, these studies sought to answer timely health policy and management questions about individuals who experience housing needs, a group that comprises one of the most under-resourced and socially disadvantaged patient populations in the United States.
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    Health equity engineering: Optimizing hope for a new generation of healthcare
    (Cambridge University Press, 2024-05-23) Enders, Felicity T.; Golembiewski, Elizabeth H.; Balls-Berry, Joyce E.; Brooks, Tayla R.; Carr, Allison R.; Cullen, John P.; DiazGranados, Deborah; Gaba, Ayorkor; Johnson, Leigh; Menser, Terri; Messinger, Shari; Milam, Adam J.; Orellana, Minerva A.; Perkins, Susan M.; Chisholm Pineda, Tiffany D.; Thurston, Sally W.; Periyakoil, Vyjeyanthi S.; Hanlon, Alexandra L.; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
    Medical researchers are increasingly prioritizing the inclusion of underserved communities in clinical studies. However, mere inclusion is not enough. People from underserved communities frequently experience chronic stress that may lead to accelerated biological aging and early morbidity and mortality. It is our hope and intent that the medical community come together to engineer improved health outcomes for vulnerable populations. Here, we introduce Health Equity Engineering (HEE), a comprehensive scientific framework to guide research on the development of tools to identify individuals at risk of poor health outcomes due to chronic stress, the integration of these tools within existing healthcare system infrastructures, and a robust assessment of their effectiveness and sustainability. HEE is anchored in the premise that strategic intervention at the individual level, tailored to the needs of the most at-risk people, can pave the way for achieving equitable health standards at a broader population level. HEE provides a scientific framework guiding health equity research to equip the medical community with a robust set of tools to enhance health equity for current and future generations.
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    Interdisciplinary Dissertation Research Among Public Health Doctoral Trainees, 2003-2015
    (SAGE Publications, 2018-03) Golembiewski, Elizabeth H.; Holmes, Ann M.; Jackson, Joanna R.; Brown-Podgorski, Brittany L.; Menachemi, Nir; Health Policy and Management, School of Public Health
    Given the call for more interdisciplinary research in public health, the objectives of this study were to (1) examine the correlates of interdisciplinary dissertation completion and (2) identify secondary fields most common among interdisciplinary public health graduates. METHODS: We analyzed pooled cross-sectional data from 11 120 doctoral graduates in the Survey of Earned Doctorates, 2003-2015. The primary outcome was interdisciplinary dissertation completion. Covariates included primary public health field, sociodemographic characteristics, and institutional attributes. RESULTS: From 2003 to 2015, a total of 4005 of 11 120 (36.0%) doctoral graduates in public health reported interdisciplinary dissertations, with significant increases observed in recent years. Compared with general public health graduates, graduates of environmental health (odds ratio [OR] = 1.74; P < .001) and health services administration (OR = 1.38; P < .001) doctoral programs were significantly more likely to report completing interdisciplinary dissertation work, whereas graduates from biostatistics (OR = 0.51; P < .001) and epidemiology (OR = 0.76; P < .001) were less likely to do so. Completing an interdisciplinary dissertation was associated with being male, a non-US citizen, a graduate of a private institution, and a graduate of an institution with high but not the highest level of research activity. Many secondary dissertation fields reported by interdisciplinary graduates included other public health fields. CONCLUSION: Although interdisciplinary dissertation research among doctoral graduates in public health has increased in recent years, such work is bounded in certain fields of public health and certain types of graduates and institutions. Academic administrators and other stakeholders may use these results to inform greater interdisciplinary activity during doctoral training and to evaluate current and future collaborations across departments or schools.
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    Patient preferences toward an interactive e-consent application for research using electronic health records
    (Oxford University Press, 2017-12-19) Harle, Christopher A.; Golembiewski, Elizabeth H.; Rahmanian, Kiarash P.; Krieger, Janice L.; Hagmajer, Dorothy; Mainous III, Arch G.; Moseley, Ray E.; Health Policy and Management, School of Public Health
    Objective: The purpose of this study was to assess patient perceptions of using an interactive electronic consent (e-consent) application when deciding whether or not to grant broad consent for research use of their identifiable electronic health record (EHR) information. Materials and Methods: For this qualitative study, we conducted a series of 42 think-aloud interviews with 32 adults. Interview transcripts were coded and analyzed using a modified grounded theory approach. Results: We identified themes related to patient preferences, reservations, and mixed attitudes toward consenting electronically; low- and high-information-seeking behavior; and an emphasis on reassuring information, such as data protections and prohibitions against sharing data with pharmaceutical companies. Participants expressed interest in the types of information contained in their EHRs, safeguards protecting EHR data, and specifics on studies that might use their EHR data. Discussion: This study supports the potential value of interactive e-consent applications that allow patients to customize their consent experience. This study also highlights that some people have concerns about e-consent platforms and desire more detailed information about administrative processes and safeguards that protect EHR data used in research. Conclusion: This study contributes new insights on how e-consent applications could be designed to ensure that patients' information needs are met when seeking consent for research use of health record information. Also, this study offers a potential electronic approach to meeting the new Common Rule requirement that consent documents contain a "concise and focused" presentation of key information followed by more details.
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    Structural and Contextual Patterns in Family Health History Knowledge among African American Adults: A Mixed-Methods Social Network Analysis Study
    (INSNA, 2019) Hood, Sula M.; Golembiewski, Elizabeth H.; Sow, Hadyatoullaye; Benbow, Kyle; Prather, Jeremy; Robison, Lisa D.; Martin-Hagler, Elisabeth; Social and Behavioral Sciences, School of Public Health
    Background: Family health history is a strong risk factor for many chronic diseases. Ethnic minorities have been found to have a low awareness of their family health history (FHH), which may pose a contributing factor to health disparities. Purpose: The purpose of this mixed-methods social network analysis study was to identify structural and contextual patterns in African American adults’ FHH knowledge based on interpersonal communication exchanges with their family members. Methods: African American adults completed individually administered family network interviews. Participants’ 3-generation family pedigree served as a visual aid to guide their interview. Our primary outcome of interest for this analysis was whether a family member was reported as someone who talks to the participant about their own (i.e., the family member’s) health, which we refer to as a “personal health informant.” To contextualize quantitative findings, participants were asked to describe how they learned about the health history of the relatives they identified during their interview. Results: Participants (n=37) reported an average family network size of 29.4 relatives (SD = 15.5; Range = 10-67). Each participant, on average, named 17% of their familial network as personal health informants. Multivariate regression results showed that participants were more likely to name an alter as a personal health informant if the alter was female (OR = 2.14, p = 0.0519), from the maternal side of the participant’s family (OR = 1.12, p = 0.0006), had one or more chronic health conditions (OR = 2.41, p = 0.0041), was someone who has discussions with the participant about the participant’s health (OR = 16.28, p < 0.0001), was a source of family health information (OR = 3.46, p = 0.0072), and was someone whose health the participant helps to monitor or track (OR = 5.93, p = 0.0002). Complementary qualitative findings indicate that FHH knowledge is facilitated by open, direct communication among relatives. Personal health informants were described as disclosing information for the purposes of informing others for preventive purposes and for gaining social support. Participants also learned about FHH via other methods, including direct observation, during caretaking, and following a relative’s death. Conclusions: Communication and disclosure practices is an important determinant of African Americans’ FHH knowledge. More culturally and contextually meaningful public health efforts are needed to promote family health history sharing, especially regarding paternal family health history, siblings, and extended relatives.