General Public Health
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21686
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Browsing General Public Health by Author "Chhetri, Shlesma"
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Item Details and Deadlines: What Predicts Health Goal Completion Among Residents of Permanent Supportive Housing?(2017-03-14) Chhetri, Shlesma; Crayton, Leeshia; Walters, Scott; Spence-Almaguer, Emily; Ahmed, HijabBackground: Permanent Supportive Housing (PSH) is an intervention designed to solve chronic homelessness in the United States and includes supportive services to assist people with living independently. In Tarrant County, these services are augmented by m.chat, a health coaching program that is intended to improve the overall quality of life of PSH residents. Participants meet monthly with health coaches to establish health and wellness goals which are are documented using an online health coaching program. Purpose:This study examined the association between different “SMART” (Specific, Measurable, Attainable, Realistic and Time-limited) characteristics and goal completion among m.chat participants. Methods:There were 329 participants with 1057 recorded goals over the intervention period. We excluded inactive goals, and data from the first and last three months of the participant’s involvement. Each goal was coded based on SMART traits using a binary choice (0 and 1 for absence or presence of trait, respectively). The outcome of interest was goal completion status (completed vs. active). Results: Participants were almost equally divided between females (51%) and males (49%). The mean age was 52 years. Descriptive tests revealed that 73% of goals were specific and measurable and 21.5% of goals were time-limited. The characteristics of being attainable and realistic lacked variability and were not included in further analysis. At the participant’s most recent coaching visit, 30% of the goals were completed and 70% were still active. Out of active goals, 70.5% were specific and measurable and of the completed goals, 78.9% were specific and measurable (Chi square p=0.005). Likewise, of active goals, 19.3% goals were time-limited compared to 26.5% of completed goals that were time-limited (Chi square p=0.009). Logistic regression revealed that the odds of specific and measurable goals being completed was 46% higher than those not specific and measurable (p=0.023). Similarly, the odds of timely goals being completed was 39% higher compared to non-time limited (p=0.045). Conclusions: Successful health goals were more likely to be specific, measurable, and time-limited. Limitations of this study included difficulties in standard appraisal of attainability. Future studies could further establish a temporal link between SMART traits and goal completion.Item Looking Beyond the Injuries: Identifying the complex healthcare needs among survivors of interpersonal violence(2017-03-14) Andrews, Alita; Spence-almaguer, Emily; Grace, Jessica; Carlson, Erin; Chhetri, ShlesmaBackground: More than 1 in 3 women in America (35.6%) experience some form of interpersonal violence (IPV) during their lifetime (Black et al, 2011). The long-term negative impact on the physical and mental health of women experiencing violence has been well documented in the literature. There is evidence that IPV survivors have complex health needs and high health care utilization patterns (Rivara et al., 2007). However, a gap exists in the alignment of the nature of services provided versus the needs of IPV survivors. Services offered by IPV organizations are often geared towards meeting immediate needs for housing, financial assistance, and other forms of tangible support, particularly for individuals using emergency shelter services. Furthermore, these crisis periods are also aggravated by an increased risk for physical violence and stalking, and/or involvement in the criminal justice system. The purpose of this study was to understand the complex and holistic health needs of survivors who are utilizing IPV services. Methods: This study utilized data collected during a needs assessment conducted among 99 women residing in Tarrant County. Participants were recruited from three service providers actively providing services to IPV survivors. The survey tool incorporated questions regarding victimization history, healthcare utilization, and Self-Regulation Questionnaires (SRQ-20) to capture the distress symptoms demonstrated by IPV survivors. Results: The majority (80%) of participants reported at least one chronic health condition, yet 30% of the women mentioned not going to the doctor for routine healthcare. One-third of participants reported utilizing the ER for non-emergency reasons. While 70% of the sample reported having a place to go when sick and injured, 43% identified that place to be the ER. Among the participants, 53% reported experiencing 7 or more psychosomatic distress symptoms, meeting the WHO threshold for psychiatric distress. Conclusions: This study illustrated that the needs of IPV survivors are complex and extend beyond physical injuries. It is imperative to look beyond the crisis indicators and address the stress and strains resulting from the violence that not only becomes burdensome for survivors but also results in greater health care utilization. Currently, the Technology Enhanced Screening and Supportive Assistance (TESSA) project is using this data to support the integration of IPV and healthcare services in the community.