Master of Public Health Thesis and Capstone Presentations

Development and Evaluation of the Eastern Pennsylvania and Delaware Geriatric Education Center’s (EPaD GEC) Geriatric Oncology Online Toolkit

Mariana R. Kuperman — Mon, 15 Apr 2013 12:56:42 PDT

Older adults have higher cancer rates than younger adults. Treating geriatric cancer patients is a challenge because they present with comorbidities, poly-pharmacy, physical frailty, and/or cognitive impairment. The interprofessional oncology treatment team may not be adequately trained to meet the special needs of geriatric cancer patients. The EPaD GEC focuses on interprofessional geriatric education targeting students, faculty and practitioners by developing and disseminating interprofessional geriatric training programs, including self-directed online learning modules. The Geriatric Oncology Care Module focuses on specialized considerations in the treatment/care of older cancer patients. The purpose of this project is to develop a Geriatric Oncology toolkit as a companion to the online learning module, and assess its benefits for enhancement of interdisciplinary health providers’ knowledge and ability to assist older adult cancer patients and their families. Specific aims are to evaluate the organizational utility and content of the toolkit from the perspective of healthcare providers and student and its ability to improve their knowledge of resources for older cancer patients/families. A qualitative and quantitative survey was administered to a convenience sample of 23 interprofessional healthcare students and practitioners. Results using Survey Monkey demonstrate that practitioners from geriatric-related specialties are more familiar with the content, that the toolkit can improve efficiency and effectiveness, and an overall satisfaction with organizational utility and content. Results support the following recommendations to the EPaD GEC: use of toolkit as a training tool for residents and fellows in Oncology, Geriatrics, and Family Medicine, and targeted dissemination to practitioners in the same sub-specialties. There is a continuing need to educate interprofessional health care providers on the specialized needs of older cancer patients.

45 PowerPoint slides (no audio).

Type II Diabetes and Dietary Preferences in a Rapidly Urbanizing Region of West Africa

Megan Doherty — Mon, 15 Apr 2013 12:53:08 PDT

This study aims to identify themes in food preferences, knowledge, attitudes and behaviors (KAB) among a mix of rural and urban Ghanaians in the greater Kumasi region; to inform health interventions targeting better patient management of type II diabetes in a rapidly urbanizing region of Ghana; and to inform social marketing strategies by providing insight into consumption patterns. Urban centers in Sub-Saharan Africa have been especially impacted by the persistence of infectious disease and accompanying rise in non-communicable disease prevalence, including type II diabetes. In fact, type II diabetes recently registered as tenth among top causes of death in Kumasi, Ghana. To develop effective intervention programs, the World Health Organization recommends more research to understand the relationship between food consumption and the escalation of non-communicable disease. In this qualitative study, focus groups and semi-structured, individual interviews were used to assess KABs of people with diabetes as well as caregivers responsible for food preparation of such individuals. Additionally, hospital-based health talks were observed, a hospital dietician was interviewed, and educational documents were collected. A Ghanaian research assistant facilitated interpretation throughout the study, and checked the transcripts for accuracy. Prior to analysis stage, themes were identified and coded using Nvivo software. Findings suggest that certain messages regarding sugar-sweetened foods, fats, use of Maggi seasoning and meal timing are understood and followed. However, some confusion appears to exist regarding the impact of certain fruits, food portioning, plantains and processed foods on health outcomes for diabetic patients. Results also revealed a problem-solving approach to increasing vegetable consumption, and a concern about unhealthy food preferences among younger generations. Recommendations include consistent messaging on portion size, impact of plantains and other fruit, and processed foods; a campaign to promote local vegetable consumption; and a research-informed prevention campaign targeting food preferences among younger generations.

30 PowerPoint slides (no audio)

The Effects of a Standardized Patient Education Program on Self-Management Outcomes in Patients with HIV

Jason J. Schafer — Mon, 15 Apr 2013 12:48:18 PDT

The purpose of this pilot study was to determine the potential impact of a standardized HIV education program delivered during a provider visit on patient self-management of HIV as measured by adherence to care. Following a baseline assessment of HIV knowledge and adherence using validated tools, eligible patients were randomized to receive the standard of care normally provided in clinic, or the standard of care and a10-minute scripted educational presentation delivered during the clinic visit. Following the presentation, patients in the intervention group received the same knowledge assessment tool they received at baseline to identify knowledge changes. Patient adherence to care was then measured for both the intervention and control groups at the next scheduled visit 2-4 months later. Forty-five subjects were enrolled; 24 received the educational intervention and 21 were randomized to the control group. Baseline characteristics were similar between groups and included low rates of perfect adherence (medication, appointment and laboratory) and HIV knowledge. More specifically, only 29% and 33% had perfect adherence to care at baseline in the intervention and control groups, respectively (p = 0.763) and more than half in each group had imperfect HIV knowledge. Those with imperfect versus perfect HIV knowledge (23 versus 8) were more likely to be non-adherent to care at baseline (p = 0.042). Following the educational presentation, the number of subjects with perfect HIV knowledge improved in the intervention group (5/24 versus 16/24, p = 0.002). Additionally, at study visit two, subjects in the intervention group were more likely to have perfect adherence as compared to control patients (17/24 versus 5/21, p = 0.002). These findings while limited by a small number of patients and short duration of follow-up indicate a potentially positive impact of the educational intervention on both patient knowledge and overall adherence to care.

18 PowerPoint slides. (no audio)

Do Smoking Cessation Programs Tailored to Specific Audiences Improve Cessation Outcomes?

Neh Molyneaux — Mon, 15 Apr 2013 12:17:28 PDT

Smoking is the leading cause of preventable disease causing 443,000 deaths annually (CDC, 2012). Philadelphia has one of the highest adult smoking rates of the top 10 cities in the U.S. at 23.5% (PDPH, 2012). Relative to other large cities, Philadelphia has one of the lowest prices for cigarettes at $5.50 a pack (PDPH, 2010). Philadelphia also has over 4,500 tobacco retailers with a breakdown of one retailer for every 320-city residents - giving it one of the highest densities of tobacco retailers of major cities. To help reduce the smoking prevalence in Philadelphia County, The Philadelphia Department of Public Health (PDPH), Tobacco Policy and Control Program, has been offering general cessation programs at various locations in Philadelphia for several years and has contracted community agencies to provide “tailored” smoking cessation programs to Philadelphia County/City residents based on age, gender, and language. Secondary data analyses of 717 smokers, who reside in Philadelphia and attended a free community-based program from January 2009 through July 2010 were used to determine whether “tailored” programs offered in Philadelphia have higher quit/reduction rates than non-tailored programs. Analyses included Chi-square statistic, t-test, and Analyses of Variance. Among the 717 participants, 34.1% and 36.6% of the tailored and non-tailored groups quit smoking, respectively. Cut down rates for each program type were similar, a mean of 7.3 cigarettes per day for tailored programs and 8.5 cigarettes per day for non-tailored. Results of this study found no difference in smoking cessation or reduction rates between tailored and non-tailored programs based on the selected tailoring criteria. These results do not support previous studies that have reported that tailored cessation programs have a higher quit frequency than non-tailored programs. Recommendations include continued refinement of tailored programs by the PDPH, Tobacco Policy and Control Program.

Presentation: 35 minutes

The use of interpreters to improve the quality and safety of healthcare through better communication in obstetrical patients: Effect on primary cesarean delivery rate

Stephen A. Pearlman, MD — Mon, 04 Mar 2013 08:28:19 PST

Patients with limited English proficiency have poorer healthcare outcomes. An assessment of the cultural and linguistic competency of Christiana Care Health Systems revealed that our language services were not sufficiently robust and this was affecting care. Therefore, the purpose of this quality improvement study was to improve healthcare outcomes, specifically the rate of primary cesarean delivery, through improved language assistance, to patients with limited English proficiency presenting to labor and delivery. The methods employed included use of the TeamSTEPPS program to educate the staff on how to improve safety for patients with limited English proficiency, adding a live Spanish interpreter and augmented telephonic interpreter services. Our results showed that there were 3510 deliveries in the 6 month period before the intervention and 3176 deliveries following the intervention. The overall primary C-section rate did not change between the two epochs (21.94% vs. 21.45% p=0.69). Because the primary language of our patients is not captured by our information technology system we subdivided them according to ethnicity. There were decreases in the primary C-section rates in the Hispanic (17.8% pre vs. 15.6% post intervention, reduction 12.4% from baseline) and Asian populations (21.1% pre vs. 16.7% post intervention, reduction 20.9% from baseline) but these differences did not reach statistical significance. There was a significant reduction in the number of babies born weighing less than 2500 grams after the intervention (9.4 % pre vs. 7.4% post, p=0.004). Our conclusions are that staff education and the introduction of interpreter services in the Labor and Delivery department of a large teaching hospital improves the quality of care delivered.

Error-Choice Tests of Stigma Surrounding Mental Health at Thomas Jefferson University

Esther D. Moberg — Fri, 14 Dec 2012 07:01:58 PST

The objectives of this Capstone Project were to measure the current level of stigma around mental illness and to identify barriers to accessing care among Thomas Jefferson University (TJU) students. Stigma was measured using an Error-Choice Test (ECT). The ECT is a self-reported stigma test masked as a knowledge test, designed to measure stigma around mental health without drawing attention to the intent of the test. Three different ECT versions were disseminated electronically. Each ECT measured a distinct type of mental illness associated stigma: depression and mental illness, schizophrenia and mental illness, and mental illness alone. The ECT versions tested the hypothesized influence of the prevalence of stigma associated with each mental illness. Demographic factors, including gender, age, race, international student status, TJU College or School affiliation, and past mental health services utilization were also taken into account to predict stigma scores on all three ECTs. All degree-seeking students were invited to participate over a three-week period. A total of 933 responses were submitted. The ranges of the respective stigma scores were: Error-Choice Test Depression 0-10, Error-Choice Test Mental Illness 0-11, and Error-Choice Test Schizophrenia 0-11. It was found that race, international student status, and past utilization of counseling and/or medication for a behavioral health problem predict stigma scores. It was also found that there is considerable stigma associated with mental illness on campus.

Presentation: 21 minutes

The Low Enrollment into the Affordable Care Act's Pre-Existing Condition Insurance Plan

Preet K. Bassi, JD — Fri, 14 Dec 2012 06:57:59 PST

Before the Patient Protection and Affordable Care Act of 2010 (ACA), individuals with pre-existing conditions attempting to purchase coverage in the private individual market could be denied coverage, offered coverage at a higher-than-average premium, or offered coverage excluding care related to the pre-existing condition. As a result, millions of Americans remain uninsured, do not have access to adequate healthcare, or resort to less appropriate forms of healthcare, such as emergency rooms. As mandated by the ACA, beginning January 1, 2014, insurers in the individual market will be prohibited from denying coverage, increasing premiums, or restricting benefits because of a pre-existing condition. Until 2014, the ACA requires the establishment of a national high risk health insurance pool to provide affordable health insurance coverage to individuals with pre-existing conditions. The Pre-Existing Condition Insurance Plan (PCIP) was established in July 2010 and the enrollment was expected to be high. However, the enrollment has been much lower than expected. The PCIP is viewed as a pilot program of what will occur with the insurance exchanges in 2014. This study examines reasons for the low enrollment through literature review and key informant interviews. The informants were asked questions addressing three topic areas: (1) Reasons for low enrollment; (2) How enrollment may be increased into PCIP; (3) If similar enrollment trends are to be expected with the exchanges in 2014; and (4) Recommendations for 2014. Content analysis of responses to the major topics elicited four major themes: 1) Premiums too high; 2) The six-month rule is too harsh; 3) Lack of awareness; and 4) Lack of funding. Nevertheless, the program was considered a success by all key informants because it did provide 90,000 people insurance and access to care. Further study will be needed to track the impact on this population once the new mandate begins.

Presentation: 30 minutes

Root Cause Analysis Heart Failure Readmissions at Thomas Jefferson University Hospital

Moazzum N. Bajwa — Fri, 14 Dec 2012 06:52:39 PST

Under the Patient Protection and Affordable Care Act, the Centers for Medicare and Medicaid Services established significant financial penalties for hospitals that do not meet certain benchmarks for decreased readmission rates. Heart failure patients account for more readmissions in US hospitals than any other illness. While the rates of heart failure readmission are well-established, the patient perspectives behind these increased visits remain unclear. The purpose of this study is to identify the root causes for high hospital readmission rates for heart failure patients at Thomas Jefferson University Hospital (TJUH) in Philadelphia. Additionally, goals include assessing health status of recently readmitted patients and obtaining patient-perceived reasons behind hospital readmissions. These reasons are considered in the context of current programs that aim to decrease readmission rates. Individual patient interviews and a validated survey tool were conducted with twelve patients readmitted to TJUH within 30-days over a period from April 2012 to August 2012. The survey results were calculated quantitatively and the interviews were coded into common themes for qualitative analysis. Results identified several factors influencing readmission rates: missed follow-up appointments, medication non-compliance, dietary non-compliance, lack of education on health management, and lack of family or community support. Based on the findings, each step or change in medication management should be thoroughly outlined to the patient, as well as increased efforts by hospital staff to provide a sample meal plan for dietary restrictions. Furthermore, psychological counseling should be offered while in the hospital to any patient suffering from heart failure. The results of this study support a need for improved continuity of care between services provided at the hospital and those maintained through home health services (i.e. Jefferson Home Care).

Presentation: 27 minutes

An Urban Gardening Evaluation in Philadelphia: How a Garden Affects Social Capital, Health and Community

Julian Barkan — Fri, 14 Dec 2012 06:46:19 PST

The purpose of this project was to create an evaluation system for the Urban Tree Connection programs in Philadelphia, PA and their numerous community gardens across the city. A major evaluation of the organization has never been done and the goal was to create a system that could be used across all garden sites and participants. Also, an evaluation system would allow for quantitative data on the organization that can easily be disseminated to the communities surrounding the gardens and those individuals involved in the gardens. Three surveys were developed and pretested; one for youth, one for adolescents, and one for adults. The surveys were designed to assess key factors/determinants of interest to founding members and funders of the Urban Tree Connection. These factors include social capital, knowledge, attitudes, beliefs, entrepreneurship, family involvement, and community engagement. Although barriers such as safety and lack of community cohesion existed, preliminary conclusions showed that garden participation improved social capital, entrepreneurship, knowledge, attitudes, and behaviors among all age groups. However, further annual evaluation is needed as this was just an initial pre-test to ensure that the surveys created tested those factors that were of most interest to key stakeholders in the Urban Tree Connection.

Presentation in two parts: Part two is linked here.

Assessing the Impact of Patient Navigation in a Formerly Homeless Population with Substance Abuse and Psychiatric Disabilities

Kasia Kania — Fri, 14 Dec 2012 06:40:05 PST

Pathways to Housing (PTH-PA), a supported housing program and mental health agency, serves the chronically homeless through the Housing First model, incorporating immediate access to permanent independent scattered-site housing and supportive treatment services in areas of mental and physical health, substance abuse, education, and employment. Many PTH clients are medically complex and encounter logistical, educational, and cultural barriers that prevent the delivery of high-quality preventive, specialty, and primary health care. The purpose of this Capstone was to examine whether patient navigation is an effective strategy for addressing barriers to healthcare for the client population. The pilot study used a mixed methods research design that included EHR chart reviews to assess medical/psychosocial needs and appointment completion rates, and client surveys and interviews to assess barriers to accessing care and satisfaction with navigation services. Five intervention group participants were selected using a convenience sample based on upcoming appointments and current medical needs. Five comparison group participants were selected from the same team based on completion of a previous appointment with a team member. Comparing clients who received navigation services to those who received regular health services at PTH, interview responses suggest that clients receiving navigation services were less likely to miss specialty appointments and more likely to keep appointments for preventive services. Clients highly valued the emotional support and advocacy assistance provided, and support from the navigator while in the exam room and reported improved two-way communication with the physician. The yearly navigator caseload was determined as 24 clients. The pilot project demonstrates that navigation may improve appointment adherence and client satisfaction, and may offer additional health support services. The pilot project is an initial examination of navigation among a formerly chronically homeless population dually diagnosed with mental health and substance abuse disorders, and suggests a potential service tool for addressing client barriers and providing targeted, individualized health services.

Presentation: 33 minutes

Improving Medical Student Education about Preventive Services

David Skhirtladze, MD — Fri, 14 Dec 2012 06:27:36 PST

The majority of clinical preventive services are underused in primary care contributing to premature death and illness. Educational gaps on the topics of wellness and prevention in medical schools may lead to less use of preventive services among medical students as they start to practice medicine. Research suggests that incorporation of prevention education interventions into medical schools core curriculum leads to increased use of clinical preventive services in primary care. The purpose of the project was to develop an innovative prevention education module for third-year medical students and evaluate its impact on their knowledge, attitudes, behavior and self-efficacy regarding clinical preventive services. Eighty-two medical students were recruited when they started their rotation in family medicine during their third year of Jefferson Medical College. The project employed a pretest-posttest quasi-experimental design in which we compared students who received the educational intervention and those who did not receive the intervention within the same rotation period. Descriptive analysis was conducted to for all outcome variables and participant characteristics. A two-way (2x2) repeated-measures ANOVA was used to analyze all outcome variables. Thirty-two medical students in the intervention group were compared with forty-nine medical students in the comparison group. All completed the pre and post education questionnaire. The mean age of subjects was 25.6 (SD=2.3, range=22-33) with no difference between the groups. Students in the intervention group showed greater change in knowledge, and improvement in self-efficacy compared to the control group. Since increased knowledge and self-efficacy are known determinants of behaviour change, this approach may result in behavior and practice change among medical students with regard to use of preventive services.

Presentation: 25 minutes

A Qualitative Assessment of African Americans' Knowledge, Attitudes and Beliefs about Hospice Care

Stephanie Reed — Wed, 27 Jun 2012 07:58:53 PDT

In 2010, 1.58 million patients received services from hospice in the United States; of these patients only 8.9% were African American (African Americans make up 12.6% of the US population), compared to 77.3% Caucasians. The purpose of this study was to assess African Americans’ knowledge, attitudes and beliefs about hospice care. Three 3 focus groups were conducted with a total of 27 people participating (12 males and 15 females).All focus groups were audio taped and transcribed. Transcripts were coded using an apriori coding scheme and entered into an Excel file. Consensus and triangulation methods were used to help investigators assess themes based on strength within and across focus groups. Five major themes emerged: 1) knowledge of hospice 2) attitudes and beliefs 3) decision making process 4) barriers to hospice use and 5) raising awareness about hospice in the African American community. This study supports findings from previous literature that examines the key factors that contribute to the underuse of hospice services by members of the African American community. A new barrier to hospice use, “family discord” also emerged in the focus group discussions In order to overcome hospice barriers the unanimous recommendation is to increase knowledge, awareness and access to culturally appropriate educational materials. Based on the thematic analysis findings, the next step is to develop a culturally tailored hospice photonovel to raise awareness about hospice care among African Americans. An initial meeting has already been conducted with an advisory committee that was formed from participants from the three focus groups. The 1^st draft of the phot novel script has been written based on the advisory committee’s decisions. Work will continue with the advisory group and funding to be sought for creation and printing of the photonovel.

Presentation: 29 minutes

Cigarette Smoking and Ovarian Cancer Risk, Disease Severity, and Survival

Oluwatosin Odunsi — Wed, 27 Jun 2012 07:50:12 PDT

Ovarian cancer is the leading cause of gynecologic cancer deaths. Although there are mechanisms by which cigarette smoking may affect cancer risk, severity, and survival, the epidemiological link in ovarian cancer is inconsistent. The current study examines the association between smoking and ovarian cancer through a secondary data analysis of two de-identified cancer data sets: the Hormone and Ovarian cancer PrEdiction (HOPE) study and the Patient Epidemiology Data System (PEDS) study. The HOPE dataset included 902 cases with histologically confirmed primary epithelial ovarian, fallopian tube, or peritoneal cancer diagnosed between February 2003 and November 2008. Controls were matched by 5-year age group to cases in a ratio of approximately 2:1. The PEDS dataset included 394 cases with primary incident, invasive ovarian cancer treated at Roswell Park Cancer Institute between 1982-1998. Survival information was obtained from the institute’s tumor registry. Descriptive analyses included t-tests for differences in means between cases and controls for continuous variables, and Chi²tests for categorical variables. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Cox regression was used to compute adjusted hazard ratios (aHRs) and 95% confidence intervals. Age started smoking, years of smoking, number of cigarettes, pack-years of smoking, and second hand smoke were not associated with ovarian cancer risk. Duration of living with smokers was associated with stage (p

Presentation: 25 minutes

Assessing the Barriers and Knowledge of Patients Regarding Non-Emergent Emergency Department Utilization

Colleen Payton — Wed, 27 Jun 2012 07:43:50 PDT

Patients who go to the emergency department (ED) for non-emergent care instead of a primary care practice can cause overcrowding of the ED, which can lead to decreased quality of care and increased medical costs (Trzeciak, S. & Rivers, E., 2003). Previous studies have shown that primary care practices have characteristics that may affect how patients utilize the ED (National Quality Forum, 2010). The purpose of this study was to identify ED utilization by Jefferson Family Medicine Associates’ (JFMA) patients for non-emergent/ambulatory care sensitive conditions, analyze patients’ reasons for using the ED rather than JFMA for these conditions, and assess patients’ awareness of JFMA hours of operation and other services available to reduce ED misuse. Telephone interviews were conducted and demographic information was collected from patients who went to the ED for non-emergent care. Results showed that most patients went to the ED on Monday (20.3%), and 10AM (8.5%) was the most common time throughout the week. Barriers to patient utilization of JFMA included difficulty booking an appointment (26.7%), long waits in the waiting room (10%), lack of insurance (10%), costs of copays (10%), and housing difficulties (6.7%). The majority of patients interviewed were unaware of the practice hours (80%). These findings suggest quality improvement interventions can address barriers to primary care in order to decrease misuse of the ED.

Presentation: 22 minutes

Assessing the Health Literacy Environment: Three Domains of Literacy Evaluated in a Pediatric Diabetes Clinic

Erin Winterhalter — Wed, 27 Jun 2012 07:36:27 PDT

As many as nine out of ten adults lack the skills needed to manage their health and the health of others. In the setting of a pediatric diabetes clinic, a child’s health outcomes are often determined by their caregivers’ literacy level. The purpose of this study is to assess the health literacy (HL) environment in a pediatric diabetes clinic. The study was conducted in the Endocrinology Department in an academic pediatric hospital. 70 staff members were asked to complete a survey on their use of predefined low HL techniques. A walk through assessment was performed to evaluate ease of navigating the clinic. Readability and suitability testing occurred by analyzing 5 randomly selected patient education materials, out of 137 patient education documents. I. Provider Survey: All but three providers (92.3 %) reported using simple language when working with patients and all but six providers used printed educational materials (84.6%). Teach-back (38.5%), follow up phone calls to the patient (30.8%), and using models to explain or educate (25.6%) were not being used routinely by more than half of the total respondents. II. Readability/Suitability of Materials. The FRY scores ranged from 5^th to 9^th grade and by the Flesch-Kincaid scores ranged from 4^th to 7^th grade. Three out of five education documents scored superior according to the Suitability Assessment of Materials. III. Navigation. The Center scored higher in helpfulness, employees being present, and staff wearing identification. Hallways were equipped with consistent signage, however, maps were still lacking and all signs were only written in English. The telephone tree proved to need improvement. Recommendations: enhance education for providers and staff on health literacy techniques, consider Fry Readability testing rather than using the Flesch-Kincaid score when assessing grade level, increase signage, especially in languages other than English, increase access to handheld maps, and improve the telephone tree.

Presentation: 24 minutes

Blood Pressure Screenings at a Farmers' Market: A Pilot Study

Amy Potts — Wed, 27 Jun 2012 07:29:53 PDT

The aim of this study is to assess a hospital farmers market located at an urban academic medical center as a community-based venue for blood pressure screening, health education, and disease management. Blood pressure screenings were held monthly at the Jefferson Farmers’ Market in 2011. Participants had two recorded elevated pressures (>121/80 without history of hypertension or >140/90 with known history of hypertension). Participants in the study were asked to complete a behavioral survey and a personal action plan. The screener/researcher contacted each participant via phone or e-mail two weeks after the screening to determine their success with their action plan, compliance with recommendations/referrals, and to remind them about attending the next blood pressure screening. There were a total of 20 participants in the study. 35% of participants were community residents, 55% of participants were employees and 10% of participants were patients. 2 visits were the average number of visits to the blood pressure screening. 65% of participants followed-up: 70% of the possible follow up visits were attended, 92% that followed-up reported following their action plan. 8 participants had improvement in their blood pressure, 7 had improvement in both systolic and diastolic. The overall mean blood pressure improved from hypertension (140/90) to pre-hypertension (134/87). There was not a significant correlation between blood pressure improvement and the number of return visits. The study showed that farmers’ markets on an urban hospital campus are a viable venue for health education and disease prevention, more study needs to be done to show the viability of hospital-based farmers’ market as a venue for disease management.

Presentation: 21 minutes

The Green Pursuit: Seeking Grant Dollars to Fund the Urban Farming and Environmental Education Program (UFEED)

Janet Milliman — Wed, 27 Jun 2012 07:25:28 PDT

The purpose of the project was to design a program that mitigates food desert issues, and to develop language that will be utilized to apply for multiple grant funding opportunities. The mission of the proposed UFEEd Program is to increase nutritional self-reliance at the individual and community level and provide access to affordable, healthy foods in food desert communities through an educational initiative that aims to establish a local, community-based, sustainable food system. The program will address these aims by teaching low-tech, season-extension cultivation techniques, nutrition and cooking skills, and business management methods. Five appropriate grants were identified and their requests for proposal were scrutinized to identify overlapping emergent themes as well as distinctions that set some apart from others. Interviews were held with experts to inform certain aspects of the program and strengthen the methods and evaluation sections of the grant proposal. Boilerplate language was developed to satisfy the requirements of all funders’ requests. Many short versions of various sections of the proposal were drafted to create a customizable finished product that can be continually utilized in future attempts to secure funds.

Presentation: 24 minutes

Putting Something of Value at Risk - Assessing Problem Gambling in the Five-County Philadelphia Area

Katie Cranston — Wed, 27 Jun 2012 07:18:49 PDT

When people gamble they are putting something they value at risk. The purpose of this Capstone project was to examine the relationships between public health and problem gambling in the five-county Philadelphia area. A secondary data analysis was conducted using the Public Health Management Corporation’s Community Health Data Base, specifically the 2010 Southeastern Pennsylvania Household Health Survey. In 2010, three gambling-related variables were added to the biannual telephone survey for the first time: ever bet money, ever felt the need to bet more and more money, and ever had to lie about how much gambled. Socio-demographic subgroups, health status indicators, and co-occurring mental health disorders were identified for communities at greatest risk for problem gambling. This data was used to conduct a needs assessment by discussing relationships between public health and problem gambling, specific to the five-county Philadelphia area, via an epidemiological approach. Problem gambling was found to be higher among individuals with lower socioeconomic status, those that lived in closer proximity to a casino, and had poor health. Problem gamblers were found to be: either Native American or Other race, residents of Philadelphia County, had a low SES, were in poor health, had a diagnosed mental health condition, and once had an alcohol or drug problem. Looking at gambling from a public health perspective it appears that people are not just putting their money at risk, but potentially other things they value as well, such as their physical and mental health. As additional casinos open, this project will offer baseline data in order to determine the extent of problem gambling in the five-county Philadelphia area and the prevention programs and the public health education and awareness needed.

Presentation: 21 minutes

Functional Health Literacy and Diabetes Self-Care Adherence

Sabrina Chen — Thu, 03 May 2012 11:46:14 PDT

Previous studies have shown conflicting results regarding a relationship between functional health literacy, self-efficacy, and diabetic self-management. The mechanisms that may explain the relationship are unclear. The purpose of the study was to assess the relationship between functional health literacy (FHL), self-efficacy, and self-care activities for diabetes patients living in Philadelphia and attending a patient centered primary care practice. The study was cross-sectional. All patients with diabetes between August and October 2011 were invited to participate. After assessing FHL with an established tool, patients completed a survey instrument independently that asked questions regarding self-care activities, such as diet, physical activity, self-efficacy, and other FHL related questions, such as their reading ability related to health materials. Seventy-nine percent of patients agreed to participate. Fifty-eight percent had adequate FHL, and 42% had inadequate FHL. Similar proportions of patients in the adequate and inadequate groups responded that they needed help reading health related materials. Functional health literacy in the adequate and inadequate groups did not predict behaviors of self-care and self-efficacy. The numbers in the lowest literacy group were too few to draw reliable inferences. The majority (67%) preferred to know the risk for a health condition described in words as compared to describing the risk as numbers (30%). FHL scores were positively correlated with self-efficacy scores (r = 0.198, p = 0.046). Results also showed that self-efficacy was positively associated with healthy diet (r = 0.393, p < 0.0001) and physical activity (r = 0.222, p = 0.034). These findings suggest that self-efficacy may be an important mediator between FHL and health behaviors related to diet and physical activities. Future studies should investigate the association between diabetes self-efficacy and other variables. More work is needed to explore these relationships.

Diabetes Mellitus in Camden: The Healthcare Worker's Perspective

Dhvani Doshi — Thu, 03 May 2012 11:41:01 PDT

Managing diabetes is complex for both patients and caregivers and requires a unique coordination of care between patients, primary care providers, specialists, and other health care services. The Camden Coalition of Healthcare Providers is an organization that seeks to improve healthcare delivery in Camden and has identified a need to improve the quality of diabetes care in Camden. The aim of this qualitative study is to identify the personal and systemic barriers to optimal diabetes management in Camden from the perspective of the healthcare workers in the region. Other aims include evaluating the impact of diabetes self-management education (DSME) classes and identifying recommendations for care improvement. One-on-one case interviews with pre-determined questions were conducted with healthcare employees of two primary care offices located in Camden. The interviews were audio-recorded and transcribed. Transcriptions were coded into themes and codes were compared and analyzed within and across interview responses. The results showed that general barriers to managing patients with diabetes included individual personal factors, such as patient knowledge and attitudes, and inadequate continuity of care, such as insufficient communication and access to specialty services. The impact of DSME classes on patients included an increase in awareness and knowledge about diabetes among patients, patient activation in self-care, and improved health outcomes. Factors enhancing diabetes care included patient motivation and readiness to learn, regular communication with follow-up care, electronic medical records, and community resources such as the Camden Coalition. Recommendations include maximizing enrollment in DSME classes, addressing patient motivation in care, increasing electronic information sharing with electronic medical records and the use of email, increasing patient social support with adult day care centers and family-included classes, increasing follow-up communication between office staff and patients, using Camden Coalition resources to access specialty services, and addressing obesity as a health issue in Camden in the future.