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PubMed2000

Investing in self-care: a midrange theory of self-care grounded in the lived experience of low-income HIV-positive white women.

Little is known about the types of interventions that invite low-income women into partnerships that motivate self-care practices when living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). The increasing incidence of HIV infection in low-income women with histories of inattention to self-care calls for nursing theories that address self-care practices. The purpose of this article is to describe a midrange theory developed from grounded theory research and to discuss implications of theoretical construction for future knowledge development. For the 12 women in this study, self-care practices developed over time and through four categories: focusing self, fitting resources, feeling emotions, and finding meaning. The core category, investing in self-care, linked the categories and carried explanatory power for developing midrange theory. Implications for nursing knowledge development through partnerships with low-income women are discussed.

Adaptation, Psychological↗
PubMed2005

Alcohol consumption among low-income pregnant Latinas.

BACKGROUND: Due to changing cultural norms, Latinas of childbearing age residing in the U.S. may be at increasing risk of drinking harmful levels of alcohol during pregnancy, and may also be unaware of the risks for Fetal Alcohol Spectrum Disorders associated with this behavior. We assessed the prevalence of alcohol consumption in a sample of low-income pregnant Latinas and examined risk factors for alcohol use in the periconceptional period. METHODS: As part of a larger intervention trial, a cross-sectional in-home interview study was conducted among a sample of 100 pregnant low-income Latinas receiving services from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in San Diego County, California. RESULTS: Fifty-seven percent of respondents indicated they were either life-time abstainers or had not consumed any alcohol in the periconceptional period. Forty-three percent reported some alcohol use in the three months prior to recognition of the current pregnancy, and 20% reported at least one binge episode of four or more standard drinks during that time frame. Five percent reported drinking seven or more drinks per week, and 8% continued drinking alcohol after recognition of pregnancy. Significant predictors of any alcohol use in the periconceptional period included English language/higher level of acculturation, younger maternal age, lower parity, higher level of education, younger age at first drink, and having ever smoked. Women who were aware of alcohol warning messages and /or had more knowledge of the Fetal Alcohol Syndrome (FAS) were significantly more likely to have consumed alcohol in the periconceptional period. Frequency of periconceptional use of alcohol did not differ between women who planned or did not plan the pregnancy. CONCLUSION: The prevalence and pattern of early pregnancy alcohol consumption in this sample of Latinas is similar to patterns noted in other race/ethnic groups in the U.S. Level of knowledge about FAS and awareness of warning messages was not protective for early pregnancy alcohol consumption, suggesting that specific knowledge was insufficient to prevent exposure or that other factors reinforce maintenance of alcohol consumption in early pregnancy. Selective interventions in low-income Latinas are warranted, and should be focused on women of reproductive age who are binge or frequent drinkers and who are at risk of becoming pregnant.

Acculturation↗
PubMed2005

The epidemiology of herpes simplex virus type 2 infection in low-income urban populations in coastal Peru.

OBJECTIVE: The objective of this study was to determine the epidemiology of herpes simplex virus type 2 (HSV-2) in general and socially marginalized populations of low-income, urban, coastal Peru. STUDY: Two low-income populations were administered an epidemiologic survey and serologic tests, determining risk behavior, HSV-2, and HIV prevalence. RESULTS: In the socially marginalized population, HSV-2 prevalence was 72.3% in men who have sex only with men (MSOM), 42.5% in women, and 20.7% in men. In the general population, HSV-2 prevalence was 20.5% in women and 7.1% in men. In all groups except the male general population, HSV-2 prevalence increased with age or number of sexually active years (both P <0.001). HSV-2 infection was associated with HIV infection in MSOM (P <0.023) and other socially marginalized men (P <0.01). CONCLUSION: HSV-2 was common in both low-income populations, and control programs are needed in Peru given high prevalence and association with HIV infection. Prevention of HSV-2 infection should target individuals before they become sexually active.

Adolescent↗
PubMed2005

Does the use of standardized history and physical forms improve billable income and resident physician awareness of billing codes?

OBJECTIVES: Resident physician knowledge of financial reimbursement guidelines for patient encounters is limited. We determined whether the use of standardized history and physical examination forms by residents for hospital admissions plus a brief lecture would increase the level of billing codes, increase billable income, and increase resident awareness of billing guidelines. METHODS: Residents used history and physical examination forms after a brief documentation lecture. Pretrial and posttrial surveys measured awareness of billing guidelines. The admission billing codes for a 6-month period were obtained, and the percentages were compared with a control 6-month period. RESULTS: There was an absolute increase of 14.5% in the highest code between the two study periods (P < 0.0001). Billable income increased by $10,385. Resident documentation awareness also increased (P < 0.001). CONCLUSIONS: The use of history and physical examination forms, combined with a brief lecture, significantly increased the percentage of highest billing codes, which increased billable income. Resident awareness of documentation requirements significantly improved.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2026

Ventriculostomy-Related Infections by Country-Income Level: A Systematic Review and Bayesian Hierarchical Meta-analysis.

Our objective was to perform a systematic review and meta-analysis of published literature on ventriculostomy-related infection (VRI) and evaluate temporal and global trends. We conducted a systematic review and Bayesian hierarchical random-effects meta-analysis of VRI rates in adults, stratified by country-income level (high-income countries [HIC]; low- or middle-income countries [LMIC]), study design, sample size, enrollment period, VRI intervention, and VRI definition. We identified 159 articles published between 1989 and 2025 that included 523,704 patients with 7293 VRIs. The pooled VRI rate was 8.64% [95% CI: 7.44-9.97], with moderate heterogeneity and good model fit. The leave-one-out sensitivity analysis showed a mean absolute change of 0.06% and a maximum change of 0.2%, indicating robust analysis. Five of the 33 represented countries had VRI rates below the global pooled rate of 8.64%. Four were HICs: Singapore (VRI rate 3.3% [0.8-7]), the United States (VRI rate 4.6% [3.4-5.9]), Germany (VRI rate 6.1% [1.1-18.9]), Norway (8.3% [0.3-68.4]), with 1 LMIC: China (8.5% [5.4-12.4]). VRI was significantly higher in studies using definitions beyond CSF culture alone for VRI (+3.16% [0.11- 6.52]) and in those from Europe (+7.29% [4.62-10.10]) and the Western Pacific (+4.09% [1.55-6.98]). No other subgroup demonstrated significant differences. This Bayesian meta-analysis provides global estimates and factors associated with VRI. Standardization of VRI definitions is critical for future benchmarking of VRI rates.

Humans↗
PubMed1999

Early discharge: its impact on low-income mothers and newborns in the state of Hawaii.

OBJECTIVES: The objectives of this survey were to investigate whether, in the state of Hawaii, early discharge had a negative effect on the health of new mothers and their infants, especially those at high sociodemographic risk, and whether early discharge was implemented in compliance with the early-discharge guidelines of the American Academy of Pediatrics (AAP), and the American College of Obstetricians and Gynecologists (ACOG). METHODS: This statewide survey was conducted from June 17 through July 12, 1996. The data was collected and recorded by perinatal providers at 14 PSS (Perinatal Support Services) sites through interviews of mothers using questionnaires. This report is based on the 108 questionnaires that were returned from the PSS sites. A descriptive analysis was performed, using the statistical/epidemiologic program EPI INFO 6. RESULTS: The survey reveals that the practice of early discharge had been implemented extensively but not in compliance with AAP/ACOG early discharge guidelines. The neonatal readmission rate for this survey group was 6.5% among low-income mothers and infants. This was found to be among the highest rates reported in the United States and Canada; in the United States, reported neonatal readmission rates vary from 1 to 4%. CONCLUSIONS: Early discharge greatly contributes to negative outcomes among low-income mothers and infants. This paper reports on the results of this survey in Hawaii and recommends a comprehensive approach for promoting the health and well-being of low-income mothers and infants.

Adolescent↗
PubMedDate not supplied

Child care and low-income children's development: direct and moderated effects.

A large literature has documented the influence of child care on young children's development, but few studies have examined low-income children in community care arrangements. Using data from Welfare, Children, and Families: A Three-City Study (N = 204), this study examined the influence of child care quality and the extent of care on low-income children's (ages 2-4 years) cognitive and socioemotional development over time. Higher levels of child care quality were modestly associated with improvements in children's socioemotional development, and extensive hours in child care were linked to increases in children's quantitative skills and decreases in behavior problems. Analyses suggest that child care quality may be particularly salient for subgroups of children from low-income families.

Adaptation, Psychological↗
PubMed2003

Variability in asthma care and services for low-income populations among practice sites in managed Medicaid systems.

OBJECTIVE: To characterize and describe variability in processes of asthma care and services tailored for low-income populations in practice sites participating in Medicaid managed care (MMC). STUDY SETTING: Eighty-five practice sites affiliated with five not-for-profit organizations participating in managed Medicaid (three group-model health maintenance organizations [HMOs] and two Medicaid managed care organizations [MCOs]). STUDY DESIGN/DATA COLLECTION: We conducted a mail survey of managed care practice site informants using a conceptual model that included chronic illness care and services targeting low-income populations. The survey asked how frequently a number of processes related to asthma care occurred at the practice sites (on a scale from "never" to "always"). We report mean and standard deviations of item scores and rankings relative to other items. We used within-MCO intraclass correlations to assess how consistent responses were among practice sites in the same MCO. PRINCIPAL FINDINGS: Processes of care related to asthma varied gready in how often practice sites reported doing them, with information systems and self-management support services ranking lowest. There was also significant variation in the availability of services targeting low-income populations, specifically relating to cultural diversity, communication, and enrollee empowerment. Very little of the site-to-site variation was attributable to the MCO. CONCLUSIONS: Our conceptual framework provides a means of assessing the provision of chronic illness care for vulnerable populations. There is room for improvement in provision of chronic asthma care for children in managed Medicaid, particularly in the areas of self-management support and information systems. The lack of consistency within MCOs on many processes of care suggests that care may be driven more at the practice site level than the MCO level, which has implications for quality improvement efforts.

Asthma↗
PubMed1994

Health status and timing of onset of prenatal care: is there an association among low-income women?

We examined medical obstetric conditions predating pregnancy and current symptoms as predictors of the timing of the start of prenatal care among low-income women in Snohomish County, Washington. The investigation was a cross-sectional survey with retrospective record review. Subjects were 473 women who sought care through the community health center network, which was the only provider of prenatal care for low-income women in the county at the time of the study. Women with a history of two or more medical or obstetric conditions were more likely than those without such histories to seek prenatal care early in pregnancy. Women who, in the current pregnancy, had few physical symptoms were more likely to delay seeking prenatal care than symptomatic women. Among this relatively homogeneous group, sociodemographic characteristics were not associated with the timing of entry into prenatal care. The findings help to explain the patterns of prenatal care use of certain groups, and suggest avenues for intervention to improve use among low-income women.

Adult↗
PubMed1995

Using critical feminist principles to analyze programs for low-income urban women.

Public health nurses are committed to promoting the health of vulnerable populations, including the economically disadvantaged. One of the perspectives that can be used to work with low-income women is feminist theory. In this paper, we analyze program descriptions from 45 community agencies whose services are accessed by urban low-income women. The purpose of the analysis is to identify congruence between agency programs and selected feminist principles. As a result of the content analysis, empirical referents and examples were identified for each principle. Public health nursing programs can incorporate feminist principles by responding to the perspectives of the vulnerable and facilitating their efforts to change the conditions that led to their vulnerability. Questions are presented that could guide public health nurses in stimulating reflection and in facilitating dialogue in the process of developing programs for low-income women.

Alberta↗
PubMed1998

Nursing research on the health of low-income women.

The purpose of this paper is to describe the scope of published nursing research on the health of low-income women. Williams' (1990) model of the relationship between socioeconomic status and health was used as a framework for the analysis. This model includes three major components: Medical Care, Psychosocial Factors, and Health Outcomes. There is a body of published nursing research that addresses a range of health issues of low-income women. Our search of English language literature published between 1989 and 1995 retrieved 49 articles that met the inclusion criteria. Most of the nursing studies examined a portion of Williams' model but did not address multiple components. The most frequently addressed component was Psychosocial Factors, particularly health practices, stress and coping, and social ties. Williams' model was an effective framework to classify nursing research. Results of our analysis suggest that further research is needed on the pathways by which low income influences health and on the effectiveness of nursing interventions.

Adolescent↗
PubMed2006

Beliefs about asthma and complementary and alternative medicine in low-income inner-city African-American adults.

BACKGROUND: The gap in asthma prevalence, morbidity, and mortality is increasing in low-income racial/ethnic minority groups as compared with Caucasians. In order to address these disparities,alternative beliefs and behaviors need to be identified. OBJECTIVE: To identify causal models of asthma and the context of conventional prescription versus complementary and alternative medicine(CAM) use in low-income African-American (AA) adults with severe asthma. DESIGN: Qualitative analysis of 28 in-depth interviews. PARTICIPANTS: Twenty-six women and 2 men, aged 21 to 48, who self-identified as being AA, low-income, and an inner-city resident. APPROACH: Transcripts of semi-structured in-depth qualitative interviews were inductively analyzed using the constant comparison approach. RESULTS: Sixty-four percent of participants held biologically correct causal models of asthma although 100% reported the use of at least 1 CAM for asthma. Biologically based therapies, humoral balance, and prayer were the most popular CAM. While most subjects trusted prescription asthma medicine, there was a preference for integration of CAM with conventional asthma treatment. Complementary and alternative medicine was considered natural, effective, and potentially curative. Sixty-three percent of participants reported non adherence to conventional therapies in the 2 weeks before the research interview. Neither CAM nor nonmedical causal models altered most individuals(93%) willingness to use prescription medication. Three possibly dangerous CAM were identified. CONCLUSIONS: Clinicians should be aware of patient-generated causal models of asthma and use of CAM in this population. Discussing patients' desire for an integrated approach to asthma management and involving social networks are 2 strategies that may enhance patient provider partnerships and treatment fidelity.

Adult↗
PubMed1998

Factors associated with domestic violence in low-income Lebanese families.

PURPOSE: To analyze the cultural context of domestic violence in low-income Moslem and Christian-Armenian families living in Lebanon. Analysis also included an identification of family stressors, conflict management strategies, and Moslem and Christian-Armenian cultural differences. The study was part of a larger project designed to identify patterns of wife and child abuse in low-income Middle Eastern families living in Lebanon and Egypt. DESIGN: Qualitative content analysis of descriptive narratives by 60 low-income women who self-reported spouse abuse in two urban Lebanese clinics during a 2-month period in 1992. METHODS: Narratives describing exemplary incidents were obtained during a semi-structured interview and recorded in the participant's native language then translated to English for coding and content analysis. FINDINGS: Contextual factors for violence included unmet gender role expectations, conflict with husband's relatives, and alcohol abuse. Family stressors were: emotional, financial, and work. Women used three types of conflict management: negotiation, taking initiative, and passive resignation. CONCLUSION: From a cultural perspective, the analysis revealed both strengths and vulnerabilities of Lebanese women who experienced domestic violence. The study raised several questions, including whether it is appropriate to apply Western-generated domestic violence theories to a Middle Eastern population. Culturally-specific nursing interventions should be directed toward bolstering strong family and social resources to cope with family stressors and to modify patterns of maladaptive communication.

Adaptation, Psychological↗
PubMed2005

Gastroesophageal reflux disease in a low-income region in Turkey.

OBJECTIVES: Detailed population-based data regarding the prevalence and symptom profile of gastroesophageal reflux disease (GERD) in underdeveloped and developing Caucasian countries are lacking. The aim of this study was to determine the prevalence and clinical spectrum of GERD in a low-income region in Turkey. METHODS: We used a previously validated reflux questionnaire, which was translated into Turkish and culturally adapted. The questionnaire was applied to 630 randomly selected participants greater than 20 yr old living in a population of 8,857 adults, with a low mean income of 75 dollars/person/month. The reliability and reproducibility of the questionnaire were calculated using the kappa statistic (test-retest). Endoscopy and/or 24-h intraesophageal pH monitoring were used to ascertain its validity in identifying patients with reflux. RESULTS: The prevalence of GERD symptoms was 10% for heartburn, 15.6% for regurgitation, and 20% for either symptom experienced at least weekly (95% CI). Heartburn and regurgitation were associated with noncardiac chest pain (37.3%), dysphagia (35.7%), dyspepsia (42.1%), odynophagia (35.7%), globus, hoarseness, cough, hiccup, nausea, vomiting, belching, and NSAID use, but not with body mass index in both frequent and occasional symptom groups. The prevalence of heartburn symptoms, but not regurgitation, increased significantly with age. CONCLUSIONS: The prevalence of GERD in a low-income population in Turkey was similar to that of developed countries, although with a different symptom profile, namely, a lower incidence of heartburn and a higher incidence of regurgitation and dyspepsia. These findings support the contention that there are a large number of patients worldwide in underdeveloped nations with poorly recognized and largely undertreated GERD.

Adult↗
PubMed2005

Low-income mothers, nutrition and health: a systematic review of qualitative evidence.

Diet is a key issue for UK health policies, particularly in relation to poorer socio-economic groups. From a public health perspective, the government's role is to help low-income families to make healthy food choices, and to create the conditions to enable them to make healthy decisions. Arguably, however, current policy on nutrition and health is influenced by individualist and behavioural perspectives, which fail to take into account the full impact of structural factors on food choices. This paper draws on a systematic review of qualitative studies that prioritize low-income mothers' accounts of 'managing' in poverty, synthesizing a subset of studies that focus on diet, nutrition and health in poor families. Synthesis findings are explored in the context of dominant discourses concerning individual responsibility for health and gendered societal values concerning 'good' mothering. The paper concludes that a shift in emphasis in health policies, affording a higher priority to enabling measures that tackle the underlying determinants of health, would be advantageous in reducing nutritional inequities for low-income mothers and their children.

Child↗
PubMed1995

Health insurance coverage and use of services among low-income elders: does residence influence the relationship?

This research uses a nationally representative sample of 1,425 low-income elders from the 1987 National Medical Expenditure Survey (NMES) to assess the independent and interaction effects of health insurance coverage and residence on the use of seven health care services: doctor visits, visits to other personnel, telephone contact, emergency room visits, overnight hospital stays, outpatient visits, and prescription medicines. It is hypothesized that (a) elders without insurance to supplement Medicare; (b) those who lived in nonmetropolitan areas use fewer health services; and (c) insurance status and residence interact to influence use of health services, with nonmetropolitan elders using fewer services than those living in metropolitan areas, regardless of insurance type. Using multivariate statistical analyses with both main effects and interaction term models, the data indicate that the type of insurance that low-income elders have is associated with their use of health services, and that residence has only modest effect. Individuals who have Medicaid, and to a lesser extent private supplements, use services more frequently than do those without supplements. Finally, despite the hypothesis, residence does not interact with insurance status in influencing use of services; the relationship between insurance and use of services does not vary across area of residence. The data suggest that the ability to pay, rather than supply constraints associated with nonmetropolitan areas, are of primary importance in determining health care use among low-income elders.

Aged↗
PubMed1995

Dental care satisfaction: the reliability and validity of the DSQ in a low-income population.

OBJECTIVES: Studies examining satisfaction with dental health care among the poor are quite rare. This study was done to confirm the internal structure and reliability of the Dental Satisfaction Questionnaire (DSQ), a measure of dental care satisfaction, among a low-income population, and provide normative data regarding dental satisfaction among low-income people. METHODS: Subjects were 895 mothers of school-aged children who were administered the DSQ as part of a larger study of dental utilization and dental fears in Seattle. RESULTS: Factor analysis largely confirmed the factor structure of the DSQ. Results also suggested subjects in this sample were less satisfied with pain management than nonpoor people. Self-reported dental health and dental appearance were associated with satisfaction with pain management, quality of care, access to care, and overall satisfaction. Race/ethnicity, education level, marital status, nation of origin, and type of insurance predicted differences in satisfaction with pain management and access. CONCLUSIONS: Barriers to dental care and quality of care among low-income populations are discussed. Uses and research with the DSQ are suggested.

Attitude to Health↗
PubMed1992

Food in low-income families.

This descriptive study used both quantitative and qualitative research methods to examine the food and nutrient intake, food purchasing patterns and budgeting strategies of 29 sole-parent low-income families with dependent children living in Corio Shire, Victoria, in 1989-90. Expenditure on food and nonalcoholic beverages when compared with the average for all Australian households showed that the study families allocated a greater proportion, but similar amounts of money to cereals, dairy products, fruit and vegetables and miscellaneous foods, and less to meat, nonalcoholic beverages and food eaten away from home. Despite large differences in the amount of money spent in the first and second weeks of a social security payment period, the nutrient density of the parents' diets was maintained at a similar level in both weeks. The only exception was vitamin C, for which the median intake was significantly lower in the second week, consistent with reduced purchases of fruit and vegetables in the same period. In interviews with 13 of the parents a variety of purchasing and budgeting strategies were described, indicating common concerns with making the most of their limited resources. The data from this study support the notion that low-income families give priority to food purchases above other expenses such as recreation. They also support the view that low-income families are concerned about health and nutrition and manage to consume nutritionally sound diets under difficult circumstances. Nutrition education programs could support them in this endeavour.

Adult↗