Recent studies reveal differences in the number of calories consumed by women residing in rural communities compared to individuals living in urban areas. Research suggests that there are many physical activity (PA) barriers for these women. Certain environmental and social factors hinder PA engagement, including environmental safety concerns as well as lack of PA facilities. For the current study, survey administration commenced on September 2018 and concluded October 2018. Researchers partnered with Grays Harbor Community Hospital to administer a 32-item electronic survey to N= 237 female employees. Inclusionary criteria included, English-speaking and self-identify as overweight/obese. My research team conducted a thematic analysis of a single open-ended question, “Are there any barriers to you engaging in any type of physical activity?” and the respondent was asked to explain the barriers as a follow-up. In total, 60 women completed the health surveys, (25% response rate). The mean age of respondents was 53.2 years of age, with a mean BMI of 32.2 (obese status), and majority were healthcare professionals in the hospital. We analyzed the data by conducting iterated evaluations of responses to the question and then deriving themes to characterize respondents’ perspectives. In response to the question of barriers to PA engagement two emergent themes were evident (1) daily life obligations (family and career hinderances) and (2) acute/chronic health concerns that limited physical activity engagement (arthritis, fibromyalgia and back pain concerns). In view of our findings, rural women appear to experience barriers to physical activity engagement. These barriers can help us to identify strategies that specifically target the health needs of residents in rural communities.

Asthma is a very common chronic childhood illness, affecting approximately 10% of US children. It can lead to significant morbidity and decreased quality of life (QOL) in pediatric patients and their caregivers, on whom the burden of daily asthma management may take a significant toll. However, existing research does not sufficiently describe the relationship between asthma control and parent- and child-reported QOL. The purpose of this study, therefore, is to describe asthma-related QOL in school-aged children and their caregivers and to determine whether asthma control is predictive of QOL. Children aged 6-11 and one caregiver participated in this cross-sectional study. Child-caregiver dyads completed the Childhood Asthma Control Test, Paediatric Asthma Quality of Life Questionnaire, and the Paediatric Asthma Caregiver’s Quality of Life Questionnaire. Descriptive statistics were used to describe the sample demographics and asthma control. Pearson correlations and linear regressions were computed to assess the relationship between asthma control and parent- and child-reported QOL. The study included 33 child-caregiver dyads (child mean age 8.4 years). The children were predominantly male (52.9%), non-Hispanic (73.5%) and white (70.6%). 51.5% had asthma that was not well-controlled. Asthma control is associated with child-reported QOL (r(33)=.49, p=.004) and the parent-reported activity QOL (r(33)=.44, p=.011). While there was not a significant difference in QOL between children with controlled versus uncontrolled asthma, there was a significant difference in parent QOL (t(33)=-2.3, p=.02). A regression analysis found that child asthma control was a significant predictor of child QOL (F(1,31)=9.90, p=.004, R2=.24) but not parent QOL. Parent and child QOL and child asthma control appear to be related, though additional research is needed to clarify this relationship. Our preliminary findings suggest that clinical efforts to improve asthma control might not only decrease risk for asthma-associated morbidity, but also positively impact how patients feel and function in day-to-day activities.

Safety-net systems in the United States are crucial in ensuring that low-income and low-resourced, marginalized communities have access to healthcare. Many of the individuals accessing safety-net clinics within their communities are transgender, people of color, and/or Spanish speakers who often-times have unique healthcare needs compared to the general population. The aim of this study is to understand which needs of safety-net patients are not currently being supported by community health clinics, so that they can be considered and implemented in future healthcare frameworks. Our study team reviewed data from a sample of 61 patients from community and human services centers in Washington, DC. The patients who agreed to participate and met the eligibility criteria were taken to a private room where they completed a 47-item self-administered questionnaire. Using thematic qualitative analyses, we evaluated the responses to a single item addressing patients’ perceptions of how the healthcare system can address their healthcare needs. Themes that emerged from our analyses of the single item include the following: (1) safety-net patients seek more resources to support decision-making, (2) patients require accessible and affordable healthcare services, (3) transgender patients require improved gender-related healthcare, and (4) Spanish-speaking patients require more attention and compassion from clinical staff. These findings imply that even with access to healthcare, certain populations continue to face significant barriers to achieving good health outcomes within the safety-net system.

In the United States, women in rural communities face a lot of barriers to healthy eating due to their food environments. Many barriers are associated with busy lifestyles, cost of purchasing healthy foods, lack of healthy food options, and lack of will-power which can lead women to eat less fruits and vegetables and consume more unhealthy foods. The purpose of my project is to evaluate the barriers to unhealthy eating among a sample of rural middle-aged women. Partnering with Grays Harbor Community Hospital, a 32-item electronic questionnaire was administered to N = 237 female employees and 60 surveys were received back (25% response rate). Inclusionary criteria included, English-speaking and self-identifying as overweight/obese. My research team did a thematic analysis of a single open-ended question from the questionnaire, “Are there any barriers to you eating healthy (at least 2 servings of fruits and 3 servings of vegetables each day)?” The respondent was also asked to explain what the barriers were. The mean age of respondents was 53.2 years, they reported a mean BMI of 32.2 (obese status), and majority were healthcare professionals in the hospital. We recorded the responses to the question of barriers to healthy eating and conducted a thematic analysis by deriving codes, codeword clusters and themes. Emergent themes indicated that the barriers to healthy eating among rural obese women were time constraints, affordability, dietary restrictions and nutritional preferences. These findings suggest that perceived barriers are strongly related to their dietary behaviors and this information can offer important insight about helping women to manage their health behaviors.

Efforts to improve population health outcomes in the United States have often focused on health information and technology advancements, such as better disease management or development of new drugs, with limited success. Evidence suggests that social determinants of health (SDOH), including factors such as access to education, economic opportunities, neighborhoods/built environment, and community context, play a much larger role in population health outcomes. Nurses are pivotal to the provision of quality patient care and patient advocacy; they are uniquely positioned to assess and address SDOH at the point of care, yet best practices for how this should be accomplished is lacking. The purpose of this study is to understand the barriers nurses face in assessing/addressing SDOH at the point of care, especially with respect to differences in resource availability associated with urban vs. less urban practice settings. Data from 37 nurse focus groups conducted in counties across Washington State were collected and transcribed by the Washington Nursing Action Coalition. Participants were asked to describe how they assessed/addressed SDOH and barriers they encountered in doing this work. Transcripts were coded and analyzed using both deductive and inductive approaches to thematic analysis with examination of inter-coder reliability. Results from this study will provide information on the elements of the practice setting, nurse characteristics, organization, and systems of power that create barriers for assessing/addressing SDOH in different contexts. An improved understanding of how nurses in Washington State assess and address SDOH in their communities could help guide organizational policies and practices that enable nurses to better care for all aspects of their patients' health.

Although curable, tuberculosis (TB), remains a global health threat. The long (6-9 months) daily antibiotic regimen is one of many challenges for patients and providers in completing treatment. Patient-centered innovative strategies are recommended that promote self-management and support during TB treatment. The World Health Organization endorses mHealth, mobile devices facilitating health information/services, as an under-explored area of potential patient-centered strategies. To help address this gap, Dr. Iribarren with her team iteratively developed a mobile application (app) with end-users and experts. 42 patients underwent pilot testing in Argentina, randomly assigned to use the app or not. The app includes daily medication tracking, symptom tracking, a paper based test-strip to detect the presence of drug metabolites in urine and resources surrounding treatment and disease processes. In addition, the intervention supports interactive communication with the participant and the treatment coordinator, a registered nurse. As an honors student, my goal is to gain insight on how the 20 patients assigned to use app are engaging through qualitative analysis of the interactive communication within the text-intervention using Atlas.ti. A codebook was iteratively built to classify the types of interactions and define with representative quotes. The main participant themes surrounded questions on side effects and medication, reinforcement of good compliance and reasons for not reporting. The relationship between codes are described, for example, the nurse inquiring about missed report(s) triggers a patient response. To understand how experience in treatment affects usage quantitative analysis compared codes by month in treatment showing higher occurrence trends during first two months. This research will inform further refinement of app, with stakeholders in mind. The goal of understanding the communication themes is to suggest areas where adaption to the app could improve ease of use and support for participant while decreasing the burden to treatment supporter through automated responses where appropriate. 
 

Social determinates of health are such factors as lack of education, low income and low social support that can lead to health disparities. Presence of health disparities can lead to poor communication between patients and providers and consequent poor health decisions among patients. Marginalized populations such as racial/cultural minorities, elderly and the mentally ill are shown to face many of these unique challenges when accessing care. This study aims to determine the ways in which the healthcare system can better support the needs of these safety-net patients. In Washington state, electronic surveys were administered to patients accessing services at a community health center that offers healthcare to disadvantaged and low-resourced communities. The questionnaire was a 47-item instrument that evaluated patients' perception of health services recieved. We were tasked with conducting a qualitative evaluation of a single item on the questionnaire that asked about patients' perceptions of how the healthcare system can best meet their healthcare needs. Using a thematic analyses approach, we evaluated survey responses from 61 patients by reviewing responses for codewords, codeword clusters, and finally, themes that accurately captured perceptions. Two themes were derived in response to the query of how the healthcare system can best support healthcare needs. (1) Accessibilty of affordable resources. (2) Availability of healhcare resources that can support decision making. These finding show that even with access to health resources, low-recourced populations still face barriers to fully gaining access to affordable care to meet healthcare needs.