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Perceptions of How Integrated Care Impacts Treatment in Rural Settings
Get PDFBackground: In light of the changing face of health care, it is important that practitioners and researchers begin to think strategically regarding comprehensive and accessible care. The purpose of this research study is to provide a deeper understanding of change among health care providers who work on multidisciplinary teams and the impact on patient outcomes.
Methods: This research was designed as an exploratory phenomenological research study. The experience of interest was how providers described changes in care when working in an integrated care context. Eight semistructured in-depth interviews were conducted with physicians, nurse practitioners, social workers, and psychologists from locations in Southern Ohio, Central Maine, and Eastern Tennessee. Data were analyzed using qualitative coding to find patterns with and across participants associated with their perceptions of health integration.
Results: Final developed themes described provider perceptions of working in an integrated care environment, and included access to care, interprofessional education, communication between providers.
Conclusion: Through interviews and a review of the literature, we have found that as integrated care is employed throughout the country, patients have better health outcomes and providers experience efficient and effective work environments. Providers have adapted to the changing environment of integrative medicine; through this study we see that these changes have been for the benefit of the patients. Patients who disproportionately suffer from a lack of health care resources, such as those in rural areas, may benefit greatly from an integrated care model
The Importance of Communication in Collaborative Community Development: Lessons Learned from Three Cases
Get PDFCollaborative community development projects aimed at promoting economic vitality, with attendant consequences as a key social determinant of health, necessarily pose questions about how to best communicate between developers, project partners, and community members. Many such projects are taking place across the United States, including in Ohio. This commentary draws on examples from 3 communities (2 outside of our state of Ohio, and another in the Linden neighborhood of Columbus, Ohio) to distill 3 key lessons in the area of communication. First, we argue that communication should be proactive, not reactive. Second, we explain why planners should be consistent in the provision of updates related to progress or lack thereof in real time on websites and apps, all while ensuring that information remains current. Third, though communication remains an under-appreciated aspect of partnership-based community development work, including explicitly health-oriented work, we argue that communicating progress to community members is not only logistically important, but part of a broader effort to build trust within communities in order to create long-lasting and sustainable change. This trust, after all, is a necessary foundation for community-focused workconcerned with addressing the social determinants of health
Defying the odds: A self-reflection of an Indigenous woman lawyer with a disability in Ghana
No full textNo abstract available
Health Disparities in Liver Cancer: An Analysis of the Ohio Cancer Incidence Surveillance System
Get PDFBackground: We explored associations between neighborhood deprivation and tumor characteristics, treatment, and 5-year survival among primary hepatocellular carcinoma (HCC) patients in Ohio diagnosed between 2008 and 2016.
Methods: We used data from the Ohio Cancer Incidence Surveillance System and limited our analysis to adult (>18 years of age) HCC patients with known census tract information based on address at diagnosis. Using principal components analysis, we created a neighborhood deprivation index (NDI) using 9 census tract-level variables. We examined associations between tumor characteristics (stage and tumor size) and NDI quintile using chi-square tests and analysis of variance (ANOVA). Associations between guideline-concordant care and NDI using log-binomial regression adjusted for sex, race, age at diagnosis, metropolitan status, cancer stage, and year of diagnosis were conducted. For 5-year survival, we utilized Cox proportional hazards models with a similar adjustment set.
Results: Neighborhood deprivation index was not associated with stage or tumor size. Individuals living in the most deprived neighborhoods were 16% less likely to receive guideline-concordant care as compared to individuals living in the least deprived neighborhoods (adjusted prevalence ratio [PR]: 0.84; 95% confidence interval [CI]: 0.74-0.94). Similarly, individuals living in the most deprived neighborhoods were 15% less likely to survive 5 years compared to individuals living in the least deprived neighborhoods (adjusted Hazard Ratio: 1.15; 95% CI: 1.01-1.29).
Conclusion: Our results suggest a negative association between neighborhood deprivation on guideline-concordant care and survival among HCC patients. Interventions targeting disparities of HCC should focus not only on individual-level factors but address larger neighborhood level factors as well
A Snapshot into Challenges of Policing Rural Zimbabwe
Get PDFPolicing and security in remote and rural areas are under-resourced and under-researched. The situation is amplified in developing nations such as Zimbabwe, where the most immediate form of local governance for rural dwellers is that of traditional, customary and informal institutions. This research note aims to further discuss policing rural areas in places like Zimbabwe, where patriarchal state structures are entangled with policing. The research note will rely on examples of the key challenges experienced in rural Zimbabwe and engage in a theoretical discussion that paints a picture of policing of the rural developing world. Discussions will centre around how the lack of access to police is exacerbated by distance and the nature of policing, which further excludes individuals based on political affiliation, gender, and poverty. Taking all this into consideration, police-community relations and engagement in rural Zimbabwe will be examined with the aim that the discussion leads to further research on how policing rural communities can better consider the security needs, vulnerabilities, and potential of these communities
“I Can't Really Work Any ‘Normal’ Job:” Disability, Sexual Ableism, and Sex Work
No full textScholars studying sex work are often guided by compulsory able-bodiedness, asking sex workers for demographic information such as race, gender, and socio-economic position but not about disabilities. In addressing sexual ableism and the reproduction of compulsory able-bodiedness in studies of sex work, I demonstrate how disability is both a factor determining sex work participation and how sex work is a vehicle for disabled workers to explore their sexuality and disrupt tired stereotypes regarding disability and sexuality. In this article, I draw from data from two different studies 1) a five-year mixed-methods study on the erotic webcam industry and 2) an interview-based study on the workplace experiences of transmasculine and non-binary escorts. I use these data to demonstrate the role of disability, especially chronic illness, in individual motivations for entry into sex work. Research on sex work generally relies upon and proffers economically deterministic theories that show how whether, by choice or circumstance, people look to sex work for the same reasons they look for any job in a capitalist system—wages. However, the use of an intersectional frame yields richer results. Here, I also explore the convergence of cissexism and ableism in the lives of disabled trans sex workers, demonstrating how, for the most marginal, sex work is often a lifeline. Further, I examine the implications of these findings for thinking about disability justice movements and pushing back on capitalist, white supremacist, and ableist notions of productivity that have come to govern our lives
Putas y Discas: Sex Work Activism and Disability Justice in Argentina
No full textThis article examines how mutual aid efforts between sex work activists and disability activists straddled the tension between respectability politics and subversive work to invigorate feminist disability justice in Argentina. I specifically focus on a 2021 Instagram Live conversation titled "Putas y Discas" to elucidate how public debates during a pandemic and in the digital age contribute to the conceptualization of 'access intimacy,' a term introduced by disability activist Mia Mingus. I attended the event as a user taking notes and paying attention to how labor rights, disability justice, and online censorship converge in the Global South to strengthen the solidarity between sex work and disability activists, featuring digital platforms as a potential arena to uphold access intimacy. The juncture of sex work and disability activisms in Argentina informs notions of interdependency more broadly and reconfigures the relationships between vulnerability and resistance, especially in the pandemic context. "Putas y Discas" invites us to include sex as integral to health demands and recognize sexual assistance as part of a bundle of disability policies covered by healthcare. A more inclusive politics of desire can also identify the labor of sex workers as communal care and consider how the more revolutionary aspects of sex work can inform the broader politics of labor. In the form of access intimacy, sex work activism and disability activists contest the malfunctioning healthcare system that bypasses sexuality as integral health, displaying the vitality of collectives and the possibilities for digital activism.