National surveys, conducted by the various governmental organizations, are usually characterized ... more National surveys, conducted by the various governmental organizations, are usually characterized with a complex sample design. The characteristics of a complex sample design may include clustering, stratification, disproportionate sampling, and multiple stages of sample selection. Analyzing data from a complex sample survey cannot be done accurately using the standard SAS Procedures such as MEANS, UNIVARIATE, REG, or GLM. When using these procedures, it is assumed that the data are selected from a simple random sample.
Carolina Digital Repository (University of North Carolina at Chapel Hill), 2017
Background: Individuals living in lower-income areas face an increased prevalence of chronic dise... more Background: Individuals living in lower-income areas face an increased prevalence of chronic disease and, oftentimes, greater barriers to optimal self-management. Disparities in disease management are seen across the lifespan, but are particularly notable among middle-aged adults. Although evidence-based Chronic Disease Self-management Education courses are available to enhance self-management among members of this at-risk population, little information is available to determine the extent to which these courses are reaching those at greatest risk. The purpose of this study is to compare the extent to which middle-aged adults from lower-and higher-income areas have engaged in CDSME courses, and to identify the sociodemographic characteristics of lower-income, middle aged participants. Methods: The results of this study were produced through analysis of secondary data collected during the Communities Putting Prevention to Work: Chronic Disease Self-Management Program initiative. During this initiative, data was collected from 100,000 CDSME participants across 45 states within the United States, the District of Columbia, and Puerto Rico. Results: Of the entire sample included in this analysis (19,365 participants), 55 people lived in the most impoverished counties. While these 55 participants represented just 0.3% of the total study sample, researchers found this group completed courses more frequently than participants from less impoverished counties once enrolled. Conclusion: These results signal a need to enhance participation of middle-aged adults from lower-income areas in CDSME courses. The results also provide evidence that can be used to inform future program delivery choices, including decisions regarding recruitment materials, program leaders, and program delivery sites, to better engage this population.
Carolina Digital Repository (University of North Carolina at Chapel Hill), 2015
Criminal convictions are often associated with collateral consequences that limit access to the f... more Criminal convictions are often associated with collateral consequences that limit access to the forms of employment and social services on which disadvantaged women most frequently relyregardless of the severity of the offense. These consequences may play an important role in perpetuating health disparities by socioeconomic status and gender. We examined the extent to which research studies to date have assessed whether a criminal conviction might influence women's health by limiting access to Temporary Assistance for Needy Families (TANF) and employment, as a secondary, or "collateral" criminal conviction-related consequence. We reviewed 434 peer-reviewed journal articles retrieved from three electronic article databases and 197 research reports from three research organizations. Two reviewers independently extracted data from each eligible article or report using a standardized coding scheme. Of the sixteen eligible studies included in the review, most were descriptive. None explored whether receiving TANF modified health outcomes, despite its potential to do so. Researchers to date have not fully examined the causal pathways that could link employment, receiving TANF, and health, especially for disadvantaged women. Future research is needed to address this gap and to understand better the potential consequences of the criminal justice system involvement on the health of this vulnerable population.
The concept of environment is considered fundamental to the paradigm of nursing. Nurse scientists... more The concept of environment is considered fundamental to the paradigm of nursing. Nurse scientists, however, often do not consider how public policy (other than" health" policy) in the broader socioeconomic environment affects health. Adopting an ecological health ...
Instead of speaking it [justice], I make it understood by my acts.-Socrates Social justice is a c... more Instead of speaking it [justice], I make it understood by my acts.-Socrates Social justice is a core ethical principle of public health nursing; yet, nurses' work as social activists has largely diminished over the past century. Reengagement in social justice activities is essential to change the current social, economic, and health differentials perpetuated by market justice ideologies. Social capital has emerged in the public health literature as a promising concept for developing community interventions that diminish disparities. Public health nurses, however, must be wary of uncritically adopting social capital as a panacea for inequalities; advocating for interventions seeking to build social capital may be as harmful as the inequalities themselves.
BackgroundTo describe how pediatric cancer–induced financial distress and perceptions of their so... more BackgroundTo describe how pediatric cancer–induced financial distress and perceptions of their social role affected fathers’ psychological responses to this distress, and quality of life (QOL) for them and their families.ProcedureWe analyzed father‐only responses from a larger cross‐sectional survey study about the impact of pediatric cancer–induced financial distress on parents. Our analytic sample was n = 87 fathers who participated in the larger study. We analyzed their data using descriptive statistics and directed content analysis.ResultsConflicting role responsibilities (be there for child; work to maintain income and insurance coverage) seemed to generate responses resembling characteristic posttraumatic stress symptoms in reaction to acute declines in family finances and/or the chronic stress of insufficient finances to meet financial demands, that is, financial trauma. Fathers’ personal sense of not being able to adequately provide for their child with cancer and also meet ...
BackgroundPediatric cancer–induced financial burden is source of stress for parents, particularly... more BackgroundPediatric cancer–induced financial burden is source of stress for parents, particularly mothers, single parents, and parents with lower incomes. This financial burden has been linked to poorer family quality of life (QOL) in terms of new onset material hardships, and could also affect individual QOL in terms of parents’ stress‐related symptoms. Our purpose was to describe pediatric cancer–induced financial burden among parents of children with that diagnosis, its effects on their stress‐related symptoms (distress, anxiety, cognition impairment, sleep impairment), and associations between select risk factors (relationship to the child, marital status, income) and the extent that financial burden affected parents’ symptoms.ProcedureWe recruited via two parent‐led groups and collected data using an online survey. We calculated frequencies of demographic characteristics, financial burden, and symptoms. We used chi‐square statistics to examine bivariate associations between the...
Background: Increasing the diversity of the nursing workforce is a high priority for addressing t... more Background: Increasing the diversity of the nursing workforce is a high priority for addressing the nursing shortage and for developing a workforce capable of meeting the cultural needs of an increasingly diverse population. The purpose of this study was to identify student perspectives on the (1) influence of family, friends and others on nursing as a career choice and (2) optimal recruitment strategies to enhance diversity in schools of nursing. Method: Twenty-two diverse, underrepresented baccalaureate nursing students (including underrepresented ethnic minorities, economically disadvantaged students, and men) participated in two focus groups. Applied thematic analysis was used to organize the data and identify major themes. Results: Participants perceptions involved two major thematic areas: (a) misconceptions of nursing, and (b) closing the gap, which had two sub-themes: facilitating support and encouragement and marketing nursing to younger groups. Recommendations for recruitment strategies included: providing applicants information to overcome myths and stereotypes about nursing, incorporating family members and friends into the recruitment process, highlighting nursing as a STEM field grounded in science and evidence-based practice, and engaging in outreach to educate elementary, middle, and high school students about the nursing profession. Conclusion: Findings provide direction for developing programming and collaborations to enhance recruitment of underrepresented students to nursing. Nurses constitute the largest workforce among all healthcare professions, and they play a major role in addressing the healthcare needs of the population in the United States. Increasing diversity among the nursing workforce, involves increasing the number of students who are underrepresented ethnic minorities (UREM), socioeconomically disadvantaged, and/or men (AACN, 2018; American Association of Colleges of Nursing [AACN], 2019; Hodges et al., 2017). The AACN has identified this as a priority to address the nursing shortage and to develop a workforce capable of meeting the cultural needs of an increasingly diverse population. Approximately 38% of the nations population are members of racial/ethnic minority groups (Colby and Ortman, 2014), but only 19% of registered nurses represent these communities (Smile et al., 2019), and men make up only 9.1% of all nurses (Smile et al., 2019). Review of the literature To meet the overall healthcare needs of our nation, there is a specific need to aggressively and strategically recruit students to enhance racial, ethnic, socioeconomic, and gender diversity (Sullivan Commission, 2004). In The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine reported a need for the nursing profession to represent the community it serves (Institute of Medicine, 2010). Although all healthcare providers should receive training to provide culturally-relevant care, research also demonstrates that healthcare systems can provide better quality care when healthcare
BackgroundAlthough the Chronic Disease Self‐Management Program (CDSMP) improves chronic disease o... more BackgroundAlthough the Chronic Disease Self‐Management Program (CDSMP) improves chronic disease outcomes, little is known about CDSMP participation in populations less than 65 years of age. We explore study and CDSMP participation rates by demographic characteristics with younger (40–64 years old), lower‐to‐middle wage workers with chronic disease in a randomized clinical trial (RCT) conducted in North Carolina.MethodsDescriptive statistics and regression models were used to examine associations between demographic, chronic disease burden, and employment variables, and time‐dependent study enrollment and intervention participation outcomes that ranged from initiating consent (n = 1,067) to CDSMP completion (n = 41).ResultsOverall, participation among non‐Whites was disproportionately higher (43%–59%) than that of Whites (42%–57%) relative to the age‐matched racial composition of North Carolina (31% non‐White and 69% White). Among participants randomized to the CDSMP, racial and ethn...
Purpose: We examined the extent to which demographic, chronic disease burden, and financial strai... more Purpose: We examined the extent to which demographic, chronic disease burden, and financial strain characteristics were associated with a preference for engaging in the Chronic Disease Self-Management Program (presented as a “health self-management program” [HSMP]) over a financial self-management program (FSMP) and a no program preference (NPP) group among employed adults. Design: Cross-sectional, correlation design using baseline data from a randomized controlled trial (RCT). Subjects: The analytic sample included 324 workers aged 40 to 64 years with 1 or more chronic disease conditions recruited into the RCT from 2015 to 2017. Measures: Chronic disease burden measures included the number of chronic conditions, body mass index (BMI), and the 8-item and 15-item Patient Health Questionnaire (PHQ-8 and PHQ-15). Financial strain was measured as the inability to purchase essentials and food assistance receipt. Both individual and household measures of income were assessed. Analyses: Mu...
A dearth of effective and affordable treatment options has rendered nonpharmacological self-manag... more A dearth of effective and affordable treatment options has rendered nonpharmacological self-management a crucial part of living with migraine-a debilitating neurobiological condition without cure that disproportionately disables vulnerable women. The aim of the study was to describe the development and use of a systems thinking, problem-structuring data collection approach that was applied to the study of migraine self-management with women in diverse social locations. Two systems mapping activities were developed for use in focus groups: one to unpack a migraine episode (system support map) and the other (connection circle [CC]) to construct a mental model of self-management. Later in the process, a strengths-based problem-solving tool was developed to replace the CC. The CCs-often enlightening for affluent participants-left marginalized women feeling overwhelmed and defeated, as a solution to one challenge became the cause of another. Through constant comparison analysis, we recal...
The purpose of this article is to explicate a conceptual framework for financial toxicity in pedi... more The purpose of this article is to explicate a conceptual framework for financial toxicity in pediatric oncology to guide nursing practice and research. The framework is based on one for financial outcomes of severe illness attributed to Scott Ramsey and adapted by the National Cancer Institute to describe relationships between preexisting factors, a cancer diagnosis, financial distress, and health outcomes for adult cancer patients and survivors. The adaption for pediatric oncology was informed by the results of a systematic scoping review to identify advances and gaps in the recent literature about the personal costs of illness to parents in the pediatric oncology context. The conceptual model for pediatric oncology indicates that existing and dynamic parent and family factors, other risk and protective factors, the child’s diagnosis and treatment, and treatment-related financial costs can affect parent financial coping behaviors and parent health and family financial outcomes, all...
Although the number of men entering the nursing profession over the past century has increased in... more Although the number of men entering the nursing profession over the past century has increased incrementally, the proportion of men remains low in contrast to the U.S. On matriculation into nursing school, men face stereotypes about the nursing profession and the characteristics of the men who enter it. Men may also face a number of gender-based barriers, including lack of history about men in nursing, lack of role models, role strain, gender discrimination, and isolation. This article describes each of these barriers and provides strategies to improve male students' learning experience. The efforts of one nursing school to address many of these barriers are also described. Through acknowledging gender barriers and taking intentional steps to address them with prenursing and nursing students, schools of nursing may create a more inclusive environment and enhance the profession's diversity. [J Nurs Educ. 2017;56(5):295-299.].
Background: Public health nursing (PHN) interventions have shown promise in improving outcomes in... more Background: Public health nursing (PHN) interventions have shown promise in improving outcomes in populations at greatest risk for health disparities. Despite this, research describing the effect of a nursing "dose" on these populations, as well as information on which individuals may require greater doses is lacking. Methods: This is a descriptive analysis of the nurse dose received by study participants (n=214) in the intervention group of a randomized controlled trial (RCT) studying the effects of PHN case-management on health and functional status outcomes in women receiving public assistance. Nurse dose was calculated in minutes between enrollment in the study and a three-month follow-up appointment with the nurse. It included direct minutes spent with the nurse (visits and phone calls where there was face-to-face contact or the PHN spoke with the participant) and indirect minutes (time spent contacting participants such as leaving a phone message, contact via a lette...
National surveys, conducted by the various governmental organizations, are usually characterized ... more National surveys, conducted by the various governmental organizations, are usually characterized with a complex sample design. The characteristics of a complex sample design may include clustering, stratification, disproportionate sampling, and multiple stages of sample selection. Analyzing data from a complex sample survey cannot be done accurately using the standard SAS Procedures such as MEANS, UNIVARIATE, REG, or GLM. When using these procedures, it is assumed that the data are selected from a simple random sample.
Carolina Digital Repository (University of North Carolina at Chapel Hill), 2017
Background: Individuals living in lower-income areas face an increased prevalence of chronic dise... more Background: Individuals living in lower-income areas face an increased prevalence of chronic disease and, oftentimes, greater barriers to optimal self-management. Disparities in disease management are seen across the lifespan, but are particularly notable among middle-aged adults. Although evidence-based Chronic Disease Self-management Education courses are available to enhance self-management among members of this at-risk population, little information is available to determine the extent to which these courses are reaching those at greatest risk. The purpose of this study is to compare the extent to which middle-aged adults from lower-and higher-income areas have engaged in CDSME courses, and to identify the sociodemographic characteristics of lower-income, middle aged participants. Methods: The results of this study were produced through analysis of secondary data collected during the Communities Putting Prevention to Work: Chronic Disease Self-Management Program initiative. During this initiative, data was collected from 100,000 CDSME participants across 45 states within the United States, the District of Columbia, and Puerto Rico. Results: Of the entire sample included in this analysis (19,365 participants), 55 people lived in the most impoverished counties. While these 55 participants represented just 0.3% of the total study sample, researchers found this group completed courses more frequently than participants from less impoverished counties once enrolled. Conclusion: These results signal a need to enhance participation of middle-aged adults from lower-income areas in CDSME courses. The results also provide evidence that can be used to inform future program delivery choices, including decisions regarding recruitment materials, program leaders, and program delivery sites, to better engage this population.
Carolina Digital Repository (University of North Carolina at Chapel Hill), 2015
Criminal convictions are often associated with collateral consequences that limit access to the f... more Criminal convictions are often associated with collateral consequences that limit access to the forms of employment and social services on which disadvantaged women most frequently relyregardless of the severity of the offense. These consequences may play an important role in perpetuating health disparities by socioeconomic status and gender. We examined the extent to which research studies to date have assessed whether a criminal conviction might influence women's health by limiting access to Temporary Assistance for Needy Families (TANF) and employment, as a secondary, or "collateral" criminal conviction-related consequence. We reviewed 434 peer-reviewed journal articles retrieved from three electronic article databases and 197 research reports from three research organizations. Two reviewers independently extracted data from each eligible article or report using a standardized coding scheme. Of the sixteen eligible studies included in the review, most were descriptive. None explored whether receiving TANF modified health outcomes, despite its potential to do so. Researchers to date have not fully examined the causal pathways that could link employment, receiving TANF, and health, especially for disadvantaged women. Future research is needed to address this gap and to understand better the potential consequences of the criminal justice system involvement on the health of this vulnerable population.
The concept of environment is considered fundamental to the paradigm of nursing. Nurse scientists... more The concept of environment is considered fundamental to the paradigm of nursing. Nurse scientists, however, often do not consider how public policy (other than" health" policy) in the broader socioeconomic environment affects health. Adopting an ecological health ...
Instead of speaking it [justice], I make it understood by my acts.-Socrates Social justice is a c... more Instead of speaking it [justice], I make it understood by my acts.-Socrates Social justice is a core ethical principle of public health nursing; yet, nurses' work as social activists has largely diminished over the past century. Reengagement in social justice activities is essential to change the current social, economic, and health differentials perpetuated by market justice ideologies. Social capital has emerged in the public health literature as a promising concept for developing community interventions that diminish disparities. Public health nurses, however, must be wary of uncritically adopting social capital as a panacea for inequalities; advocating for interventions seeking to build social capital may be as harmful as the inequalities themselves.
BackgroundTo describe how pediatric cancer–induced financial distress and perceptions of their so... more BackgroundTo describe how pediatric cancer–induced financial distress and perceptions of their social role affected fathers’ psychological responses to this distress, and quality of life (QOL) for them and their families.ProcedureWe analyzed father‐only responses from a larger cross‐sectional survey study about the impact of pediatric cancer–induced financial distress on parents. Our analytic sample was n = 87 fathers who participated in the larger study. We analyzed their data using descriptive statistics and directed content analysis.ResultsConflicting role responsibilities (be there for child; work to maintain income and insurance coverage) seemed to generate responses resembling characteristic posttraumatic stress symptoms in reaction to acute declines in family finances and/or the chronic stress of insufficient finances to meet financial demands, that is, financial trauma. Fathers’ personal sense of not being able to adequately provide for their child with cancer and also meet ...
BackgroundPediatric cancer–induced financial burden is source of stress for parents, particularly... more BackgroundPediatric cancer–induced financial burden is source of stress for parents, particularly mothers, single parents, and parents with lower incomes. This financial burden has been linked to poorer family quality of life (QOL) in terms of new onset material hardships, and could also affect individual QOL in terms of parents’ stress‐related symptoms. Our purpose was to describe pediatric cancer–induced financial burden among parents of children with that diagnosis, its effects on their stress‐related symptoms (distress, anxiety, cognition impairment, sleep impairment), and associations between select risk factors (relationship to the child, marital status, income) and the extent that financial burden affected parents’ symptoms.ProcedureWe recruited via two parent‐led groups and collected data using an online survey. We calculated frequencies of demographic characteristics, financial burden, and symptoms. We used chi‐square statistics to examine bivariate associations between the...
Background: Increasing the diversity of the nursing workforce is a high priority for addressing t... more Background: Increasing the diversity of the nursing workforce is a high priority for addressing the nursing shortage and for developing a workforce capable of meeting the cultural needs of an increasingly diverse population. The purpose of this study was to identify student perspectives on the (1) influence of family, friends and others on nursing as a career choice and (2) optimal recruitment strategies to enhance diversity in schools of nursing. Method: Twenty-two diverse, underrepresented baccalaureate nursing students (including underrepresented ethnic minorities, economically disadvantaged students, and men) participated in two focus groups. Applied thematic analysis was used to organize the data and identify major themes. Results: Participants perceptions involved two major thematic areas: (a) misconceptions of nursing, and (b) closing the gap, which had two sub-themes: facilitating support and encouragement and marketing nursing to younger groups. Recommendations for recruitment strategies included: providing applicants information to overcome myths and stereotypes about nursing, incorporating family members and friends into the recruitment process, highlighting nursing as a STEM field grounded in science and evidence-based practice, and engaging in outreach to educate elementary, middle, and high school students about the nursing profession. Conclusion: Findings provide direction for developing programming and collaborations to enhance recruitment of underrepresented students to nursing. Nurses constitute the largest workforce among all healthcare professions, and they play a major role in addressing the healthcare needs of the population in the United States. Increasing diversity among the nursing workforce, involves increasing the number of students who are underrepresented ethnic minorities (UREM), socioeconomically disadvantaged, and/or men (AACN, 2018; American Association of Colleges of Nursing [AACN], 2019; Hodges et al., 2017). The AACN has identified this as a priority to address the nursing shortage and to develop a workforce capable of meeting the cultural needs of an increasingly diverse population. Approximately 38% of the nations population are members of racial/ethnic minority groups (Colby and Ortman, 2014), but only 19% of registered nurses represent these communities (Smile et al., 2019), and men make up only 9.1% of all nurses (Smile et al., 2019). Review of the literature To meet the overall healthcare needs of our nation, there is a specific need to aggressively and strategically recruit students to enhance racial, ethnic, socioeconomic, and gender diversity (Sullivan Commission, 2004). In The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine reported a need for the nursing profession to represent the community it serves (Institute of Medicine, 2010). Although all healthcare providers should receive training to provide culturally-relevant care, research also demonstrates that healthcare systems can provide better quality care when healthcare
BackgroundAlthough the Chronic Disease Self‐Management Program (CDSMP) improves chronic disease o... more BackgroundAlthough the Chronic Disease Self‐Management Program (CDSMP) improves chronic disease outcomes, little is known about CDSMP participation in populations less than 65 years of age. We explore study and CDSMP participation rates by demographic characteristics with younger (40–64 years old), lower‐to‐middle wage workers with chronic disease in a randomized clinical trial (RCT) conducted in North Carolina.MethodsDescriptive statistics and regression models were used to examine associations between demographic, chronic disease burden, and employment variables, and time‐dependent study enrollment and intervention participation outcomes that ranged from initiating consent (n = 1,067) to CDSMP completion (n = 41).ResultsOverall, participation among non‐Whites was disproportionately higher (43%–59%) than that of Whites (42%–57%) relative to the age‐matched racial composition of North Carolina (31% non‐White and 69% White). Among participants randomized to the CDSMP, racial and ethn...
Purpose: We examined the extent to which demographic, chronic disease burden, and financial strai... more Purpose: We examined the extent to which demographic, chronic disease burden, and financial strain characteristics were associated with a preference for engaging in the Chronic Disease Self-Management Program (presented as a “health self-management program” [HSMP]) over a financial self-management program (FSMP) and a no program preference (NPP) group among employed adults. Design: Cross-sectional, correlation design using baseline data from a randomized controlled trial (RCT). Subjects: The analytic sample included 324 workers aged 40 to 64 years with 1 or more chronic disease conditions recruited into the RCT from 2015 to 2017. Measures: Chronic disease burden measures included the number of chronic conditions, body mass index (BMI), and the 8-item and 15-item Patient Health Questionnaire (PHQ-8 and PHQ-15). Financial strain was measured as the inability to purchase essentials and food assistance receipt. Both individual and household measures of income were assessed. Analyses: Mu...
A dearth of effective and affordable treatment options has rendered nonpharmacological self-manag... more A dearth of effective and affordable treatment options has rendered nonpharmacological self-management a crucial part of living with migraine-a debilitating neurobiological condition without cure that disproportionately disables vulnerable women. The aim of the study was to describe the development and use of a systems thinking, problem-structuring data collection approach that was applied to the study of migraine self-management with women in diverse social locations. Two systems mapping activities were developed for use in focus groups: one to unpack a migraine episode (system support map) and the other (connection circle [CC]) to construct a mental model of self-management. Later in the process, a strengths-based problem-solving tool was developed to replace the CC. The CCs-often enlightening for affluent participants-left marginalized women feeling overwhelmed and defeated, as a solution to one challenge became the cause of another. Through constant comparison analysis, we recal...
The purpose of this article is to explicate a conceptual framework for financial toxicity in pedi... more The purpose of this article is to explicate a conceptual framework for financial toxicity in pediatric oncology to guide nursing practice and research. The framework is based on one for financial outcomes of severe illness attributed to Scott Ramsey and adapted by the National Cancer Institute to describe relationships between preexisting factors, a cancer diagnosis, financial distress, and health outcomes for adult cancer patients and survivors. The adaption for pediatric oncology was informed by the results of a systematic scoping review to identify advances and gaps in the recent literature about the personal costs of illness to parents in the pediatric oncology context. The conceptual model for pediatric oncology indicates that existing and dynamic parent and family factors, other risk and protective factors, the child’s diagnosis and treatment, and treatment-related financial costs can affect parent financial coping behaviors and parent health and family financial outcomes, all...
Although the number of men entering the nursing profession over the past century has increased in... more Although the number of men entering the nursing profession over the past century has increased incrementally, the proportion of men remains low in contrast to the U.S. On matriculation into nursing school, men face stereotypes about the nursing profession and the characteristics of the men who enter it. Men may also face a number of gender-based barriers, including lack of history about men in nursing, lack of role models, role strain, gender discrimination, and isolation. This article describes each of these barriers and provides strategies to improve male students' learning experience. The efforts of one nursing school to address many of these barriers are also described. Through acknowledging gender barriers and taking intentional steps to address them with prenursing and nursing students, schools of nursing may create a more inclusive environment and enhance the profession's diversity. [J Nurs Educ. 2017;56(5):295-299.].
Background: Public health nursing (PHN) interventions have shown promise in improving outcomes in... more Background: Public health nursing (PHN) interventions have shown promise in improving outcomes in populations at greatest risk for health disparities. Despite this, research describing the effect of a nursing "dose" on these populations, as well as information on which individuals may require greater doses is lacking. Methods: This is a descriptive analysis of the nurse dose received by study participants (n=214) in the intervention group of a randomized controlled trial (RCT) studying the effects of PHN case-management on health and functional status outcomes in women receiving public assistance. Nurse dose was calculated in minutes between enrollment in the study and a three-month follow-up appointment with the nurse. It included direct minutes spent with the nurse (visits and phone calls where there was face-to-face contact or the PHN spoke with the participant) and indirect minutes (time spent contacting participants such as leaving a phone message, contact via a lette...
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Papers by Shawn Kneipp