Browsing by Subject "Barriers"
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Item 3 A mobile health-supported bundle to improve routine childhood vaccine completion rate in Nigeria(Cambridge University Press, 2024-04-03) Ekhaguere, Osayame; Oluwafemi, Rosena O.; Mendonca, Eneida A.; Pediatrics, School of MedicineOBJECTIVES/GOALS: Barriers to childhood vaccine completion include forgeting vaccine appointments, lack of clinic access (distance and funds), and vaccine hesitancy. We tested the impact of automated and real-time appointment reminders, vaccine hesitancy counseling, and targeted vaccine drives on receiving the third dose of the diphtheria vaccine. METHODS/STUDY POPULATION: An implementation study to determine the feasibility and impact of implementing a mobile health-supported intervention bundle. A digital vaccine registry was developed to manage vaccine uptake data. The intervention bundle was applied sequentially: each registered parent received an automated appointment phone reminder (text and voice). If they delayed for >5 days, they received a real time reminder phone call. If during the real time call vaccine hesitancy was deemed to be a barrier, counseling was provided. If access - lack of funds or long distance - to the clinic was the barrier, vaccination was performed at patient's home on the monthly vaccine drives. We compared vaccine completion (all childhood vaccines before 18 months) during the implementation to the preceding three years. RESULTS/ANTICIPATED RESULTS: We anticipate the implementation will be feasible as >90% of all eligible children will be registered. We expect providers will be accepting and would recommend the intervention to other providers. We anticipate the intervention will result in a >10% increase in childhood vaccine completion compared to the average of the past three years. DISCUSSION/SIGNIFICANCE: We anticipate applying a multifaceted intervention will be acceptable to providers, feasible to implement, and significantly improve childhood vaccine completion rates moving Nigeria closer to achieving the global target of >95% childhood vaccine completion rate.Item A human-centered designed outreach strategy for a youth contraception navigator program(Elsevier, 2022) Wilkinson, Tracey A.; Hawryluk, Bridget; Moore, Courtney; Peipert, Jeffrey F.; Carroll, Aaron E.; Wiehe, Sarah; Fortenberry, J. Dennis; Pediatrics, School of MedicineObjective: To identify key elements of an outreach strategy for a youth contraception navigator program designed to help young people overcome barriers to contraception access. Methods: A human-centered design approach was used to engage adolescents aged 15-17 in co-design sessions. Human-centered design techniques, such as affinity diagramming and model building were used to inform key elements of the communication model and the final outreach strategy messages. Results: Messages focused on the individual, normalizing talking about birth control, acknowledging the challenges to obtaining birth control, explaining how the navigator program works resonate with young people. Having images of diverse participants, offering information about birth control, and showing images of reputable sources will enhance trust. Conclusions: A name (IN Control) and key elements of an outreach strategy were determined for the navigator program. It is important to work with key stakeholders and co-design the optimal strategy and messages to assure that the intended audience is reached, and the desired behavior change is achieved. Innovation: Human-centered design techniques can be used to provide insight into programmatic outreach strategies for a contraception navigator program to increase their impact and ultimate success.Item Barriers to mental health service use among hematopoietic SCT survivors(Springer, 2010) Mosher, C.E.; Duhamel, K.N.; Rini, C.M.; Li, Y.; Isola, L.; Labay, L.; Rowley, S.; Papadopoulos, E.; Moskowitz, C.; Scigliano, E.; Grosskreutz, C.; Redd, W.H.This study examined barriers to mental health service use and the demographic, medical and psychosocial correlates of these barriers among hematopoietic SCT (HSCT) survivors. A sample of 253 HSCT survivors who were 1 to 3 years posttransplant completed measures of demographic, physical, psychological and social characteristics as well as a newly modified measure of barriers to mental health service use. Only 50% of distressed HSCT survivors had received mental health services. An exploratory factor analysis of the barriers to mental health service use scale yielded four factors: scheduling barriers, knowledge barriers, emotional barriers and illness-related barriers. Patients with higher social constraints (perceived problems discussing the illness experience with significant others) reported higher levels of all four types of barriers. General distress and transplant-related posttraumatic stress symptoms were positively associated with emotional, knowledge and illness-related barriers to mental health service use, whereas physical and functional well-being were inversely associated with these barriers. Having more knowledge barriers and more emotional barriers predicted a lower likelihood of receiving mental health services, as did lower levels of education and general distress. Results suggest that a significant number of HSCT survivors may benefit from education about mental health services that is tailored to individual barriers.Item Barriers to mental health service use and preferences for addressing emotional concerns among lung cancer patients(Wiley, 2014-07) Mosher, Catherine E.; Winger, Joseph G.; Hanna, Nasser; Jalal, Shadia I.; Fakiris, Achilles J.; Einhorn, Lawrence H.; Birdas, Thomas J.; Kesler, Kenneth A.; Champion, Victoria L.; Psychology, School of ScienceOBJECTIVE: This study examined barriers to mental health service use and preferences for addressing emotional concerns among lung cancer patients (N=165) at two medical centers in the Midwestern United States. METHODS: Lung cancer patients completed an assessment of anxiety and depressive symptoms, mental health service use, barriers to using these services, and preferences for addressing emotional concerns. RESULTS: Only 45% of distressed patients received mental health care since their lung cancer diagnosis. The most prevalent patient-reported barriers to mental health service use among non-users of these services (n=110) included the desire to independently manage emotional concerns (58%) and inadequate knowledge of services (19%). In addition, 57% of distressed patients who did not access mental health services did not perceive the need for help. Seventy-five percent of respondents (123/164) preferred to talk to a primary care physician if they were to have an emotional concern. Preferences for counseling, psychiatric medication, peer support, spiritual care, or independently managing emotional concerns also were endorsed by many patients (range=40-50%). Older age was associated with a lower likelihood of preferring to see a counselor. CONCLUSIONS: Findings suggest that many distressed lung cancer patients underuse mental health services and do not perceive the need for such services. Efforts to increase appropriate use of services should address patients' desire for autonomy and lack of awareness of services.Item Developing a Youth Contraception Navigator Program: A Human-Centered Design Approach(Elsevier, 2022) Wilkinson, Tracey A.; Hawryluk, Bridget; Moore, Courtney; Peipert, Jeffrey F.; Carroll, Aaron E.; Wiehe, Sarah; Fortenberry, J. Dennis; Pediatrics, School of MedicinePurpose: To determine key elements of a contraception navigator program that provides a personalized approach to overcoming patient-specific barriers by a trained navigator in central Indiana. Methods: A human-centered design approach was used to engage adolescents and community stakeholders in co-design sessions. Sessions incorporated techniques, such as divergent brainwriting and journey maps, which led to the exploration of various themes that were ultimately used to inform key elements of the contraception navigator program. Results: Adolescents aged 15-17 years (N = 35) and community stakeholders (N = 11) participated in co-design sessions. Analysis verified that the process of obtaining contraception for pregnancy prevention could be intimidating for young people. The importance of language, the presence of stigma, and the knowledge of side effects were all discussed. Essential elements of a contraceptive navigator program included building trust to ultimately co-create a plan that can overcome patient-specific barriers. Having a variety of communication methods available, as well as contraceptive side-effect support, will be essential. Discussion: Using human-centered design techniques to engage adolescent and community stakeholders can help inform the development of a contraceptive navigator program. A trusted navigator that can address patient-specific barriers to contraception access both before and after contraception is obtained is a key element identified by stakeholders.Item Development of the Barriers to Error Disclosure Assessment Tool(Wolters Kluwer, 2017-06-30) Welsh, Darlene; Zephyr, Dominique; Pfeifle, Andrea L.; Carr, Douglas E.; Fink III, Joseph L.; Jones, Mandy; Surgery, School of MedicineOBJECTIVES: An interprofessional group of health colleges' faculty created and piloted the Barriers to Error Disclosure Assessment tool as an instrument to measure barriers to medical error disclosure among health care providers. METHODS: A review of the literature guided the creation of items describing influences on the decision to disclose a medical error. Local and national experts in error disclosure used a modified Delphi process to gain consensus on the items included in the pilot. After receiving university institutional review board approval, researchers distributed the tool to a convenience sample of physicians (n = 19), pharmacists (n = 20), and nurses (n = 20) from an academic medical center. Means and SDs were used to describe the sample. Intraclass correlation coefficients were used to examine test-retest correspondence between the continuous items on the scale. Factor analysis with varimax rotation was used to determine factor loadings and examine internal consistency reliability. Cronbach α coefficients were calculated during initial and subsequent administrations to assess test-retest reliability. RESULTS: After omitting 2 items with intraclass correlation coefficient of less than 0.40, intraclass correlation coefficients ranged from 0.43 to 0.70, indicating fair to good test-retest correspondence between the continuous items on the final draft. Factor analysis revealed the following factors during the initial administration: confidence and knowledge barriers, institutional barriers, psychological barriers, and financial concern barriers to medical error disclosure. α Coefficients of 0.85 to 0.93 at time 1 and 0.82 to 0.95 at time 2 supported test-retest reliability. CONCLUSIONS: The final version of the 31-item tool can be used to measure perceptions about abilities for disclosing, impressions regarding institutional policies and climate, and specific barriers that inhibit disclosure by health care providers. Preliminary evidence supports the tool's validity and reliability for measuring disclosure variables.Item Equity by Design : Examining Law & Policy for Undocumented Immigrant Students through the pK-20 Pipeline(Midwest & Plains Equity Assistance Center (MAP EAC), 2017) Nguyễn, David Hòa KhoaThe purpose of this Equity Brief is to provide some guidance for educators with regard to the challenges around supporting undocumented students in the midst of uncertain times and continued concerns surrounding Deferred Action for Childhood Arrivals (DACA). Many youth in the DACA Program have made the United States their home and have lived in the country the majority of their lives. Since its inception, DACA has been a source of contention for many, opponents argue that DACA has decreased the educational budget whereas others proponents of DACA focus on the educational opportunities it presents.Item Girls STEM Institute – Identity Formation for Black Girls in STEM Fields(Indiana Medical Student Program for Research and Scholarship (IMPRS), 2022) Abufares, Sabria A.; Hill Morton, Crystal; Messmore, NikiBackground: Women of color are disproportionately represented in STEM fields. While many systemic barriers exist due to institutional racism, other barriers begin in school that impact students’ perceptions of self and STEM. Identity formation is an integral part of learner development but adverse learning experiences have drastic effects on Black girls’ perceptions and self-efficacy within STEM fields. Girls STEM Institute (GSI) is an organization that develops a transformative space to empower girls of color through exploration of STEM concepts in meaningful, culturally-grounded ways. The purpose of this study is to examine and explore how the GSI experience impact students’ interest and attitudes towards STEM fields. Methods: The STEM semantics survey measuring students’ interest in STEM subjects and careers was conducted amongst 42 scholars. Student perceptions of their GSI experience were obtained through journal reflections. A literature review was conducted to gain an understanding of the intersectionality of the Black girl experience, especially within STEM topics. Results: The study is currently in progress. Preliminary data has been obtained but further data analysis is required. Potential Impact: While the inequities that minoritized students face have been well researched and documented, critically developing initiatives to reform these inequities have been limited to individual pipeline programs and undergraduate research programs focused on diversity. While these programs have been beneficial in increasing inclusivity of minoritized students in collegiate settings, it is not enough to study and discuss the barriers that minoritized students face. It is essential to transform communities through the empowerment of youth, especially Black girls. GSI provides a framework for holistically engaging with the girls to develop their self-identity, instilling the confidence to pursue STEM careers, and providing career readiness experiences, which can cultivate a strong STEM-minded identity for Black girls.Item Missing the Target for Routine Human Papillomavirus Vaccination: Consistent and Strong Physician Recommendations Are Lacking for 11- to 12-Year-Old Males(American Association for Cancer Research, 2016-10) Vadaparampil, Susan T.; Malo, Teri L.; Sutton, Steven K.; Ali, Karla N.; Kahn, Jessica A.; Casler, Alix; Salmon, Daniel; Walkosz, Barbara; Roetzheim, Richard G.; Zimet, Gregory D.; Giuliano, Anna R.; Pediatrics, School of MedicineBACKGROUND: Rates of routine human papillomavirus (HPV) vaccination of adolescent males in the United States are low. Leading health organizations advocate consistent and strong physician recommendations to improve HPV vaccine dissemination. This study describes the prevalence and correlates of consistent and strong physician recommendations for HPV vaccination of adolescent males. METHODS: We surveyed pediatric and family medicine physicians in Florida about their HPV vaccine recommendations for male vaccine-eligible age groups (11-12, 13-17, 18-21 years). Descriptive statistics compared consistency and strength of HPV recommendations across age groups. Multivariable logistic regression examined factors associated with consistent and strong recommendations for 11- to 12-year-olds. RESULTS: We received 367 completed surveys (51% response rate). Physicians most often consistently and strongly recommended HPV vaccine to males ages 13 to 17 (39%) compared with ages 11 to 12 (31%) and 18 to 21 (31%). Consistent and strong recommendation for 11- to 12-year-old males was more likely to be delivered by Vaccine for Children providers and less likely among physicians who reported more personal barriers to vaccination, particularly concerns about vaccine safety, concerns about adding vaccines to the vaccine schedule, and difficulty in remembering to discuss HPV vaccination. CONCLUSIONS: Physicians' current consistency and strength of HPV vaccine recommendations do not align with national recommendations. Interventions to improve HPV vaccine recommendations must also consider the influence of physicians' personal barriers to HPV vaccine delivery. IMPACT: As one of the first studies to examine both consistency and strength of physicians' HPV vaccine recommendations for males, our findings can inform future interventions focused on facilitating physicians' recommendations. Cancer Epidemiol Biomarkers Prev; 25(10); 1435-46. ©2016 AACR.Item Pediatric hematology and oncology physician and nurse practitioner views of the HPV vaccine and barriers to administration(Taylor & Francis, 2023) Miller, Meagan E.; Rahim, Mahvish Q.; Coven, Scott L.; Jacob, Seethal A.; Zimet, Gregory D.; Meagher, Carolyn G.; Ott, Mary A.; Medicine, School of MedicineRates of Human papilloma virus (HPV) vaccination among pediatric survivors of cancer and patients with sickle cell disease are lower than the national average. While recent attention has focused on patient HPV vaccine hesitancy and refusal, less is known about provider-level and system-level barriers to vaccinations in pediatric hematology/oncology (PHO) populations. Applying thematic analysis to qualitative interviews with 20 pediatric hematology/oncology physicians and nurse practitioners, we examine their views regarding HPV vaccination, with a focus on access and barriers to providing HPV vaccination in PHO practices. Results demonstrated that despite 90% of interviewees supporting HPV vaccination in their population, the number of pediatric hematology/oncology providers who reported that they counsel about HPV or provide HPV vaccination was 45%, even in stem cell and sickle cell clinics, where other childhood vaccines are commonly provided. Clinicians identified provider-level, clinic-level, and system-level barriers to giving the HPV vaccination, including but not limited to time/flow constraints, lack of resources, and continued education regarding the HPV vaccine. These barriers impede the ability for pediatric hematology/oncology providers to counsel and provide HPV vaccination to this specialized population.