A Community-Wide Collaboration to Reduce Cardiovascular Disease Risk: The Hearts of Sonoma County Initiative.

Purpose And Objectives: Collaboration across multiple sectors is needed to bring about health system transformation, but creating effective and sustainable collaboratives is challenging. We describe outcomes and lessons learned from the Hearts of Sonoma County (HSC) initiative, a successful multi-sector collaborative effort to reduce cardiovascular disease (CVD) risk in Sonoma County, California.

Intervention Approach: HSC works in both clinical systems and communities to reduce CVD risk.

Low Health Literacy Predicts Misperceptions of Diabetes Control in Patients With Persistently Elevated A1C.

Purpose: The purpose of this study is to identify factors associated with perceived control of diabetes in a group of poorly controlled patients. Identifying factors associated with perceived control in these patients is an important step in improving actual control as measured by A1C. As health literacy is essential for understanding complex medical information, we hypothesized that low health literacy would be associated with inaccurate perceptions of diabetes control.

Acceptance of a community-based navigator program for cancer control among urban African Americans.

Patient navigation is now a standard component of cancer care in many oncology facilities, but a fundamental question for navigator programs, especially in medically underserved populations, is whether or not individuals will use this service. In this study, we evaluated acceptance of a community-based navigator program for cancer control and identified factors having significant independent associations with navigation acceptance in an urban sample of African Americans. Participants were African American men and women ages 50-75 who were residents in an urban metropolitan city who were referred for navigation.

Feasibility, acceptability and preliminary effectiveness of patient advocates for improving asthma outcomes in adults.

Background: Asthmatic adults from low-income urban neighborhoods have inferior health outcomes which in part may be due to barriers accessing care and with patient-provider communication. We adapted a patient advocate (PA) intervention to overcome these barriers.

Objective: To conduct a pilot study to assess feasibility, acceptability and preliminary evidence of effectiveness.

Building a patient-centered medical home: obtaining the patient's voice.

Purpose: Many primary care practices are currently attempting to transform into patient-centered medical homes (PCMHs), but little is known about how patients view aspects of the PCMH or how they define patient-centeredness.

Methods: We conducted 3 focus groups with patients from urban academic internal medicine practices. We asked questions about patients' perceptions of what patient-centered care should be; care quality, teams and access; diabetes self-management; and community connections and services.

Cultural, economic, and psychological predictors of colonoscopy in a national sample.

Background: Although colorectal cancer (CRC) is the second leading cause of cancer death among adults in the US and colonoscopy is efficacious in reducing morbidity and mortality from CRC, screening rates are sub-optimal. Understanding the socioeconomic, cultural, and health care context within which decisions about colonoscopy are made allows physicians to address patients' most salient beliefs and values and other constraints when making screening recommendations.

Objective: To evaluate the direct and interactive effects of socioeconomics, health care variables, psychological characteristics, and cultural values on colonoscopy use.

Cancer survivorship and agency model: implications for patient choice, decision making, and influence.

Relative to other types of health communication research (acute care physician patient communication, communication campaigns, compliance episodes, etc.), investigations of patient communication following the diagnosis of cancer are infrequent. Theoretically driven, empirical research is desperately needed in such postdiagnostic communication processes as survivorship, quality of life, palliative and hospice care, and loss, bereavement, and grief for those millions of people who have been diagnosed with the second leading cause of death in our nation.