Queering whole person care in a pandemic

How can health care providers (HCPs) working with 2SLGBTQ+ patients enact a whole person care approach during the SARS-CoV-2 pandemic and its aftermath, and in such desperate times, is it even reasonable to expect them to? In this presentation, a nurse/nursing educator and a health care researcher/frequent patient discuss their observations and experiences of whole person care during the SARS-CoV-2 pandemic. The conversation highlights that in the immediate chaos early on, and in the face of exhaustion, trauma, and burnout as the pandemic progressed, attending to the whole personhood of patients was/is paramount for HCPs and for the people they treat. The presenters reflect on the amplified significance of a whole person approach for 2SLGBTQ+ people who may have had negative health care experiences in the past, and may fear that they will not receive equitable care in the chaotic context of a pandemic. A whole person care approach is perhaps most necessary when it is also most difficult. In a period of such profound distress, a deeper sense of connectedness to patients may help HCPs manage feelings of helplessness they are likely to encounter, and surely helps the people they treat. The goal of this presentation is to begin a discussion about the ways that whole person approaches benefit 2SLGBTQ+ patients as well as their HCPs, with the hope that it will spark ideas for attendees to develop in their own practices.

Using Facebook Advertisements for Women’s Health Research: Methodology and Outcomes of an Observational Study

Background Recruitment of diverse populations for health research studies remains a challenge. The COVID-19 pandemic has exacerbated these challenges by limiting in-person recruitment efforts and placing additional demands on potential participants. Social media, through the use of Facebook advertisements, has the potential to address recruitment challenges. However, existing reports are inconsistent with regard to the success of this strategy. Additionally, limited information is available about processes that can be used to increase the diversity of study participants. Objective A Qualtrics survey was fielded to ascertain women’s knowledge of and health care experiences related to breast density. This paper describes the process of using Facebook advertisements for recruitment and the effectiveness of various advertisement strategies. Methods Facebook advertisements were placed in 2 rounds between June and July 2020. During round 1, multiple combinations of headlines and interest terms were tested to determine the most cost-effective advertisement. The best performing advertisement was used in round 2 in combination with various strategies to enhance the diversity of the survey sample. Advertisement performance, cost, and survey respondent data were collected and examined. Results In round 1, a total of 45 advertisements with 5 different headlines were placed, and the average cost per link click for each headline ranged from US $0.12 to US $0.79. Of the 164 women recruited in round 1, in total 91.62% were eligible to complete the survey. Advertisements used during recruitment in round 2 resulted in an average cost per link click of US $0.11. During the second round, 478 women attempted the survey, and 87.44% were eligible to participate. The majority of survey respondents were White (80.41%), over the age of 55 years (63.94%), and highly educated (63.71%). Conclusions Facebook advertisements can be used to recruit respondents for health research quickly, but this strategy may yield participants who are less racially diverse, more educated, and older than the general population. Researchers should consider recruiting participants through other methods in addition to creating Facebook advertisements targeting underrepresented populations.

Through the Lens: Youth Experiences with Cancer in Rural Appalachian Kentucky Using Photovoice

Rural Appalachian Kentucky experiences disproportionately high cancer incidence and mortality rates. This cancer burden is due to social determinants of health and cultural factors prominent in the region. The firsthand experiences of community members—especially young people—can highlight these factors and identify areas for improvement. The purpose of this study was to encourage Appalachian Kentucky youth to consider determinants of cancer and visualize the effects that cancer has on their families or communities by asking them to take photographs of cancer-related objects around them. Content analysis was performed on 238 photographs submitted by 25 students, and photographs were organized into themes, subthemes, and subtopics. The six themes that emerged were risk factors and exposures, marketing, awareness and support, health care, experiences, and metaphorical representations. Many of the submitted photographs aligned with cultural, environmental and/or situational factors prevalent in Appalachian Kentucky. Of the submitted photographs, 54 were displayed as an installment in two Kentucky art galleries. Viewer comments at the exhibitions demonstrated that young community members can educate and motivate change in those around them. Ultimately, this project demonstrates that young community members can recognize cancer-related issues around them and connect personal experiences back to the larger Appalachian Kentucky cancer disparity while also having an impact on other community members.

Advanced Access in Primary Health Care: experiences from Brazil and Canada

Access is the timely use of services in order to meet the needs of the user. As an alternative to the traditional model, the Advanced Access (AA) model appears in Canada , with schedules restricted to specific cases. Objectives: The purpose of this article is to analyze the existing scientific production about the Advanced Access model in Primary Health Care. Methods: Integrative literature review using the descriptors (1) “Health Care Accessibility” OR “Primary Health Care” AND and (2) "Advanced Access" in the PubMed, Scopus and BIREME databases. Selection criteria were studies published in the last five years, available in Portuguese, English or Spanish and dealing with the theme. Results: Eight studies were selected, six were grouped into two categories of analysis: “The Canadian experience with AA : a model in consolidation”; and “The Brazilian experience with AA: local experiments” and the other two contributed to enrich the discussion. The AA stands out to balance capacity and demand with physical infrastructure and adequate staff, both in the international arena, as the experiences of municipalities, improving the quality of APS. Conclusion: Studies that detail the AA in its practice, as well as the challenges and needs, can inspire other health units to study it and consider its implementation if it is appropriate for its context, aiming to improve the health and care of its population.

Emotional Health Work of Women With Female Genital Cutting Prior to Reproductive Health Care Encounters

We used institutional ethnography to explore the social relations that shaped the reproductive health care experiences of women with female genital cutting. Interviews with eight women revealed that they engaged in discourse that opposed the practices of cutting female genitals as a human-rights violation. This discourse worked to protect those affected by the practices, but also stigmatized female genital cutting, making participants anticipate experiencing stigmatization during health care. Women’s engagement in this discourse shaped their emotional health work to prepare for such encounters. This work included navigating feelings of worry, shame, and courage to understand what to expect during their own appointment; learning from family/friends’ experiences; and seeking a clinic with the reputation of best care for women with female genital cutting. It is important to strive for more inclusive health care in which women do not have to engage in emotional health work to prepare for their clinical encounters.

“Making a Way Out of No Way:” Understanding the Sexual and Reproductive Health Care Experiences of Transmasculine Young Adults of Color in the United States

Research focusing on the specific and unique sexual and reproductive health care experiences of transmasculine young adults of color are extremely scarce. We conducted five focus group discussions with 19 Black, Latinx, Asian, Native, and other transmasculine individuals of color aged 18–25 years in the greater Boston area. Using thematic analysis, we found that transmasculine young adults of color experienced cissexism, heterosexism, and racism in accessing and utilizing sexual and reproductive health services. These multiple forms of discrimination undermined participants’ receipt of high-quality sexual and reproductive health information and care from competent health care providers who shared their lived experiences. Participants relied on support from their lesbian, gay, bisexual, transgender, and queer peers to obtain needed sexual and reproductive health resources and minimize harm during clinical encounters. Multilevel interventions are needed to promote access to person-centered and structurally competent sexual and reproductive health care among transmasculine young adults of color.

Health care experiences during the COVID-19 pandemic by race and social determinants of health among adults age ≥ 58 years in the REGARDS study

Background Understanding health care experiences during the COVID-19 pandemic may provide insights into patient needs and inform policy. The objective of this study was to describe health care experiences by race and social determinants of health. Methods We conducted a telephone survey (July 6, 2020-September 4, 2021) among 9492 Black and White participants in the longitudinal REasons for Geographic And Racial Differences in Stroke cohort study, age 58–105 years, from the continental United States. Among participants with symptoms of COVID-19, outcomes were: 1. Sought care or advice for the illness; 2. Received a SARS-CoV-2 test for the illness; and 3. Tested positive. Among participants without symptoms of COVID-19, outcomes were: 1. Wanted a test; 2. Wanted and received a test; 3. Did not want but received a test; and 4. Tested positive. We examined these outcomes overall and in subgroups defined by race, household income, marital status, education, area-level poverty, rural residence, Medicaid expansion, public health infrastructure ranking, and residential segregation. Results The average age of participants was 76.8 years, 36% were Black, and 57% were female. Among participants with COVID-19 symptoms (n = 697), 74% sought care or advice for the illness, 50% received a SARS-CoV-2 test, and 25% had a positive test (50% of those tested). Among participants without potential COVID-19 symptoms (n = 8795), 29% wanted a SARS-CoV-2 test, 22% wanted and received a test, 8% did not want but received a test, and 1% tested positive; a greater percentage of participants who were Black compared to White wanted (38% vs 23%, p < 0.001) and received tests (30% vs 18%, p < 0.001) and tested positive (1.4% vs 0.8%, p = 0.005). Conclusions In this national study of older US adults, many participants with potential COVID-19 symptoms and asymptomatic participants who desired testing did not receive COVID-19 testing.