This content analysis seeks to extend what is already known in nursing and public health about the stigma attached to mental illness, and further understand the following evaluation question: How do members of communities targeted by Make It OK, a community initiative to reduce mental illness stigma, describe that stigma? The analysis of responses to open-ended questions included in a community-based survey followed deductive and inductive coding based on published frameworks and survey responses. The domains of stigma were categorized as actions toward people living with mental illness, beliefs about mental illness, and beliefs about people living with mental illness. These identified constructs build on the existing literature base of mental illness stigma in nursing and public health, illuminate the nuance of stigma, and can help tailor anti-stigma efforts.

Cannabis use among individuals with cancer is best understood using survey self-report. As cannabis remains federally illegal, surveys could be subject to nonresponse and measurement issues impacting data quality. We surveyed individuals using medical cannabis for a cancer-related condition in the Minnesota Medical Cannabis Program (MCP). Although survey responders are older, there are no differences by race and ethnicity, gender, or receipt of reduced cannabis registry enrollment fee. Responders made a more recent purchase and more recently completed an independent symptom assessment for the registry than nonresponders, suggesting some opportunity for nonresponse error. Among responders, self-report and MCP administrative data with respect to age, race, gender, registry certification, and cannabis purchase history were similar. Responders were less likely to report receipt of Medicaid than would be expected based on registry low-income enrollment eligibility. Although attention should be paid to potential for nonresponse error, surveys are a reliable tool to ascertain cannabis behavior patterns in this population.

Background:Care coordination is important for patients with complex needs; yet, little is known about the factors impacting implementation from the care coordinator perspective.Purpose:To understand how care coordination implementation differs across clinics and what care coordinators perceive as barriers and facilitators of effective coordination.Methods:Nineteen care coordinators from primary care clinics in Minnesota participated in interviews about their perceptions of care coordination. A team of analysts coded interviews using inductive thematic analysis.Results:Four major themes emerged: variety in care coordination implementation; importance of social needs; necessity for leader buy-in; and importance of communication skills.Conclusions:Described differences in care coordination implementation were often logistical, but the implications of these differences were foundational to care coordinator perceived effectiveness.

BackgroundThough prenatal nutrition information is critical, it is not known whether information is shared equitably by patient race, financial security, or English proficiency.PurposeTo evaluate whether delivery or receipt of ChooseYourFish.org nutrition information in the first prenatal visit differed by patient demographics.MethodsAnalysis of clinician-document electronic health record (EHR) or patient-reported surveys compared delivery and receipt of fish-related nutrition information in the first prenatal visit. Inferential statistics were used to compare delivery or receipt and race, ethnicity, payor, or interpreter use.ResultsEHR analysis (n = 2,329) revealed Medicaid patients who used an interpreter were half as likely to have the fish nutrition message in their after-visit summary compared to those with Medicaid who did not use an interpreter (OR = 0.54, 95% CL: 0.35-0.84). The same was not true for non-Medicaid patients. Survey analysis (n = 52) showed respondents identifying as Black or African American were 25% less likely to report receiving the after-visit summary compared to respondents who identified as white (p < .01).DiscussionThe results presented here illustrate how nutrition communication in the prenatal period can differ by patient race, financial security, and language.Translation to Health Education Practice: Culturally humble efforts to understand drivers of healthcare communication are needed to eliminate inequalities.

BACKGROUND:Care coordination is important for patients with complex needs; yet, little is known about the factors impacting implementation from the care coordinator perspective.PURPOSE:To understand how care coordination implementation differs across clinics and what care coordinators perceive as barriers and facilitators of effective coordination.METHODS:Nineteen care coordinators from primary care clinics in Minnesota participated in interviews about their perceptions of care coordination. A team of analysts coded interviews using inductive thematic analysis.RESULTS:Four major themes emerged: variety in care coordination implementation; importance of social needs; necessity for leader buy-in; and importance of communication skills.CONCLUSIONS:Described differences in care coordination implementation were often logistical, but the implications of these differences were foundational to care coordinator perceived effectiveness.

Background: Hypertension control is falling in the US yet efficacious interventions exist. Poor patient reach has limited the ability of pragmatic trials to demonstrate effectiveness. This paper uses quantitative and qualitative data to understand factors influencing reach in Hyperlink 3, a pragmatic hypertension trial testing an efficacious pharmacist-led Telehealth Care intervention in comparison to a physician-led Clinic-based Care intervention. Referrals to both interventions were ordered by physicians.Methods: A sequential-explanatory mixed methods approach was used to understand barriers and facilitators to reach. Reach was assessed quantitatively using EHR data, defined as the proportion of eligible patients attending intended follow-up hypertension care and qualitatively, via semi-structured interviews with patients who were and were not reached. Quantitative data were analyzed using descriptive and inferential statistics. Qualitative data were analyzed via combined deductive and inductive content analysis.Results: Of those eligible, 27% of Clinic-based (n = 532/1945) and 21% of Telehealth patients (n = 385/1849) were reached. In both arms, the largest drop was between physician-signed orders and patients attending initial intended follow-up care. Qualitative analyses uncovered patient barriers related to motivation, capability, and opportunity to attend follow-up care.Conclusions: Although the proportion of eligible patients with signed orders was high in both arms, the proportion ultimately reached was lower. Patients described barriers related to the influence of one's own personal beliefs or priorities, decision making processes, logistics, and patient perceptions on physician involvement on reach. Addressing these barriers in the design of pragmatic interventions is critical for future effectiveness.Trial Registration: NCT02996565