MRISP Pilot Projects
A Model Colorectal Cancer Screening Training Program for Primary Care Residents
Mohsen Bazargan, PhD, PI
Given the benefits of early detection of colorectal cancer (CRC), low
utilization of CRC screening by minority populations is a major
concern. Inner-city, safety-net clinics represent a critical
opportunity for CRC screening of underserved minority populations. The
objective of this study is to improve the delivery and short-term
outcomes of CRC screening among minority patients by providing their
physicians with a one-session brief motivational intervention (BMI) on
the importance of CRC screening.
Specific aims of this study are to:
- Develop a model CRC screening training for primary care physicians in inner-city, safety-net outpatient clinics.
- Measure changes in: a) knowledge, attitudes, and practices of CRC
screening; and b) perceived barriers to CRC screening adoption among
primary care residents who attend the BMI.
- Test the effectiveness of the BMI on access to CRC screening for underserved minority patients.
Health Literacy Augmentation in Minority Populations (Health LAMP)
José Luís Calderón, MD, PI
Any way health and literacy are defined or measured, they are
inextricably linked. Research in several countries has repeatedly
documented the negative effect of limited literacy on virtually all
aspects of health including overall levels of morbidity and mortality,
accidents and a wide range of diseases including diabetes,
cardiovascular disease, and rheumatoid arthritis.
Disease and violent death are more prevalent in areas with low levels
of literacy. Hospital utilization by children is highest in
communities with limited literacy levels. The impacts of literacy on
health are both direct an indirect. Persons with low literacy find it
difficult to access, understand and use health information and
services. Those with less than proficient literacy encounter
difficulties at every level of the health care system, especially
completing forms, informed consents and interacting with health care
providers. They may have trouble seeking timely appropriate
intervention, administering medication, following treatment regimens,
and engaging in self-care. Not only is literacy a major
determinant of health; it also is closely associated with other
socio-economic conditions that indirectly influence health, such as
income, social status, employment opportunities, social support, and
early childhood development.
People with limited literacy are relegated to low-paying jobs and so
are likely to live in poverty with limited food supplies, poor quality
housing in unsafe neighborhoods, low quality schools, high stress, low
self-esteem, and isolation. Thus, they are likely to have poorer
health, higher rates of injury, chronic disease and earlier
death. Parents with low literacy skills and low functional
literacy face significant barriers to fostering healthy development and
school readiness in their children. Immigrants and racial/ethnic
vulnerable populations who are culturally diverse, tend to have poorer
health status, limited literacy skills, limited English proficiency and
may comprise about 45% of the general population by 2050.
Although they have the greatest need for health information that may
contribute to improved health status, they can be expected to benefit
the least from currently used written health information.
Specific aims of this study are to:
- Develop a culturally and linguistically appropriate very easy to
read and highly illustrated story book on diabetes (VERIS-D) and to
qualitatively assess it’s cultural and linguistic appropriateness in
Spanish and English using rigorous focus group methods.
- Measure the health literacy, diabetes knowledge, health-related
quality of life, and preferred sources of health information in a
random sample of Latino and African American diabetics.
- Compare diabetes knowledge before and after using either the
VERIS-D or NIDDK easy to read information on diabetes in a sample of
African American and Latino diabetics and non-diabetics.
Racial and Ethnic Trends in Preventable,
Non-Discretionary Utilization of Health Care Resources: The Role of
Community Health Resources and Neighborhood Context.
Paul Robinson, PhD, PI
Specific aims of this study are to:
- Examine the relationship between preventable hospitalizations and
variation in community health resources in the state of
California.
- Examine the relationships between preventable hospitalizations
and individual predisposing and enabling characteristics, as they
interact with health resources.
We are now constructing the analytic model that will best address the
gaps in our existing knowledge concerning the relationship between
preventable hospitalizations and accessibility to health care resources
within communities. Our initial results are consistent with
previous findings that have found that low-income areas with
predominantly African Americans and/or Hispanic populations have higher
rates of preventable hospitalizations. Our results are also
consistent in that they indicate independent relationships between
preventable hospitalizations and the availability of primary care
providers within a community.
We are now working to address a gap in the existing literature which
fails to address the how place based characteristics influence
preventable hospitalizations and what the thresholds are in that
relationship. Understanding the specific mechanisms that maintain
the observed disparities in preventable hospitalization rates,
particularly those that are related to geographic access to health care
services requires the appropriate use of the available data.
