Browsing by Author "Neelamegam, Malinee"
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Item Acculturation Stress Among Older Indian Americans: Understanding the Challenges of Cultural Transition.(2024-03-21) PATIL, SHILPA; Nhpang, Roi San; Griner, Stacey; Kline, Nolane; Neelamegam, MalineeBackground: Acculturation involves the process through which immigrants assimilate the attitudes, values, traditions, beliefs, and practices of a new culture. Acculturation stress, a form of psychological distress stemming from conflicts between an immigrant or ethnic minority group's values and those of the dominant culture, is a prevalent concern among Asian Indians. This study examines acculturation stress among older Asian Indian Americans, a growing subpopulation facing unique challenges in navigating cultural transitions. Methods: The study adopted a mixed-method approach targeting older Asian Indian Americans (aged 55 and above) in the DFW area, combining survey responses with in-depth interviews. Financial incentives were provided to participants. Utilizing a qualitative framework, the research analyzed participant responses to a series of statements to elucidate their experiences of cultural stress, including perceptions of discrimination, feelings of foreignness, identity conflicts, and concerns over cultural assimilation. Data analysis was conducted using descriptive statistics in SAS 9.4, offering insights into the acculturation stress experienced by this demographic. Results: Respondents comprised of 74.19% (n=23) women and 25.81% (n=8) men. Ages range from 12.90 % (n = 4) at 50-54 years, 32.26% (n = 10) at 55-64, 35.48% (n=11) at 65-74 years, and 19.35% (n=6) at 75 and older. Several significant acculturation stress themes were identified. Key issues include identity conflict, leading to feelings of isolation; discrimination, contributing to marginalization; cultural loss, causing grief and anxiety; intergenerational conflict, straining family dynamics; and adverse mental health outcomes like depression. Most participants feel acculturated, except for notable feelings of missing their home country and family. Conclusion: The findings highlight the complexity of acculturation stress among older Asian Indian Americans, revealing a significant impact of identity conflict, discrimination, cultural loss, intergenerational conflict, and mental health issues. While age appears to be a notable factor in acculturation experiences, further research is essential to explore additional variables affecting acculturation, such as immigration status, age at immigration, and geographical location. This study underscores the need for a broader understanding of the multifaceted acculturation process within the Asian Indian American community to inform targeted support and interventions.Item Assessing the impact of targeted continuing education training on improving dental hygienists’ HPV-related knowledge(2023) Farris, Alexandra; Neelamegam, Malinee; Cotter, Jane; Dickinson, Charlene; Johnson, Kaeli; Kline, Nolan; Thompson, Erika; Griner, StaceyBackground Human papillomavirus (HPV) is the most prevalent sexually transmitted infection in the United States and is attributable to various cancers. Approximately 70% of oropharyngeal cancer diagnoses are linked with an HPV infection. HPV vaccination is an effective prevention method that can protect against multiple high-risk strains including those directly associated with oropharyngeal cancer. Given the connection between HPV and oropharyngeal cancer and the frequency of dental visits compared to annual primary care visits, dental hygienists are uniquely positioned to help reduce the risk of HPV infection among their patients through vaccine education and promotion. The goal of this project is to evaluate the impact of a continuing education (CE) training on dental hygienists’ knowledge about HPV and the HPV vaccine. Methods This study used pre- and post-test survey design to collect data from dental hygienists. The CE training was presented at the Southwest Dental Conference on August 26th, 2022, in Dallas, Texas. Prior to the training, all attendees were asked to complete an online survey assessing their knowledge about HPV and the HPV vaccine. Knowledge questions included modes of transmission, types and sites of HPV-related cancers, and vaccine recommendations and indication. For example, "HPV is transmitted through skin-to-skin contact” was asked as a true or false question. With a total of 18 questions on the knowledge scale, participants were awarded 1 point per correct answer and no points for incorrect answers. Higher averages indicated higher knowledge, with 18 being the highest possible score. Following the 45-minute CE, participants completed a second online survey assessing their knowledge. Data were analyzed in SPSS using t-tests to assess for changes from pre-test to post-test. A p-value of <0.05 was considered statistically significant. Results While a total of 453 oral health providers were registered, only practicing dental hygienists (n=112) who had matched pre- and post-surveys were included in this analysis. Out of 18 items, the average number of correct responses pre-CE was 13.7 (SD=2.7), which was significantly higher following the CE (16.8 correct, SD=1.0; p<0.001). The item with the most significant knowledge increase pertained to the type of vaccine available for HPV (a virus-like particle vaccine, 39.1% pre-CE; 92.0% post-CE, p<0.001). Additional items with increases in knowledge included the various types of cancers directly linked to HPV such as anal cancer (54.9% pre-CE; 99.1% post-CE, p<0.001) and penile cancer (50.4% pre-CE; 97.3% post-CE, p<0.001). Conclusions The HPV vaccine is an FDA-approved form of cancer prevention, and the best predictor of HPV vaccination uptake is recommendation from a healthcare provider. The CE training resulted in increased knowledge regarding HPV-related cancers and the HPV vaccine, indicating a need for similar trainings that can help dental hygienists make stronger, more informed vaccination recommendations to their patients. Equipping dental hygienists with the most up-to-date knowledge, effective communication skills, and confidence to promote HPV vaccination among their patients could greatly reduce the number of missed clinical opportunities to recommend and refer for the HPV vaccine.Item Oral Health Educational Needs Among HIV Health Care Providers in North Texas(2024-03-21) Garcia-Ponce, Alejandra; Teplitskiy, Nathaniel; McRae, Alison; Hodge, Crystal; Brosnan, Amanda; Neelamegam, Malinee; Allison, Waridibo; Griner, StaceyPurpose: Understanding connections between HIV and oral health is vital for providing comprehensive care to people with HIV (PWH). Due to compromised immune function associated with HIV, PWH are more susceptible to oral health disease and infections. In Texas, there is a need for improved access and provision of oral healthcare services for PWH, particularly amongst marginalized populations. The purpose of this study is to identify HIV/AIDS healthcare providers’ (HCPs) and non-clinical providers’ gaps in oral health knowledge and preferred educational strategies and models. Results can inform educational programming for providers, ultimately improving the quality of oral healthcare to PWH in North Texas. Methods: A targeted needs assessment (Qualtrics survey) was conducted among a sample of major HIV organizations in North Texas to assess the educational and training needs of their HCPs. The survey, administered in January 2024, featured multiple-choice and open-ended questions. Participants were presented with lists of topics based on existing programming and literature: (i) topics on oral health and HIV, such as oral microbiome and antiretroviral therapy; (ii) key populations, such as pregnant persons; and (iii) preferred learning models, such as workshops, webinars, and case studies. They were asked to select all topics of interest. Results: Of the 33 total responses, 8 were excluded due to incomplete surveys. The respondent’s credentials included DMD/DDS (n=4), MD/DO (n=1), PharmD (n=1), RN/NP (n=2), RDH (n=2), LSW/LPC (n=2). When prompted about general areas of interest within the HIV/AIDS care continuum, there was interest in learning about approaches to reduce patients lost to care, reduce HIV stigma in healthcare settings, and expand pre-exposure prophylaxis in routine oral care. Substance use disorder as it relates to HIV and oral healthcare was reiterated as an educational need. Specific educational gaps included oral manifestations of HIV (60%), HIV-related oral cancers (56%), and therapeutics such as antiretroviral therapy (48%) and other emerging treatments (48%). Clinical management of oral health conditions and HIV, dental implants and prosthetics, and innovations in diagnostics in the dental setting were other educational needs selected. Additionally, respondents indicated a need to learn more about specific key populations such as people living with substance use disorders (80%), people living without housing (76%), and transgender and gender diverse communities (64%). Pregnant persons, incarcerated persons, and aging populations were other groups of interest. Results indicate a significant preference for webinar (68%), seminar (52%), and workshop (44%) learning models. Podcasts (24%) and case studies (20%) were also selected often, but other major telementoring models (ECHO, self-paced learning and adapted community health clubs) did not receive the same preference. Conclusion: The results of this survey reveal knowledge gaps and oral healthcare needs among HCPs that should be addressed in order to enhance oral healthcare for PWH in North Texas. While synchronous educational methods like webinars and workshops were favored, HCPs may benefit from additional active learning models (e.g., ECHO) into their continuing education. By developing and implementing education on the identified topics, HCPs can advance efforts to end the HIV epidemic and ensure PWH receive comprehensive care, including addressing their oral health needs.Item Role of Patient-Provider Relationship in Overall Health and Well-being of Older LGBTQ Adults(2024-03-21) Hwang, Jimin; Neelamegam, Malinee; Nhpang, RoiSanPurpose: LGBTQ aging encompasses the experiences and challenges encountered by lesbian, gay, bisexual, transgender, and queer individuals as they progress through life. LGBTQ individuals face unique obstacles related to their sexual orientation, gender identity, and the historical context in which they have lived. To effectively meet the specific needs of LGBTQ older adults, it's crucial to offer culturally sensitive healthcare and social support within nurturing healthcare communities. We aim to explore how the doctor-patient relationship impacts the overall well-being of LGBTQ seniors. Methods: A secondary analysis of the AARP survey titled "Maintaining Dignity: Understanding Challenges of Older LGBT Americans," was done. The online survey was conducted between October 27 and November 12, 2017, among adults aged 45 and older who identified as LGBTQ. Data analysis was conducted on SAS statistical analysis software. Descriptive statistics were completed to determine survey participant characteristics. Logistic regression was conducted to assess the association between the patient-provider relationship and overall health after adjusting for demographics and chronic health conditions. Results: Participants were predominantly white (67.08%), between ages 45-54 years (34.6%) and 55-64 years (34.1%). The majority of the participants self-identified as gay (43%) or lesbian (43%). Most participants described their overall health as "good" or better (85.5%), 71.93% informed their physician about their sexual identity (71.93%) and described their physician-patient relationship as open and honest (71.43%). The patient-provider relationship influenced the overall self-reported health status in our study population. Compared to those who had open and honest discussions with their healthcare providers, individuals with difficult relationships with their providers were less likely to have good overall health (OR 0.098, 95% CI 0.032, 0.298). Conclusion: In conclusion, the well-being of older LGBTQ adults is significantly influenced by the quality of their relationship with their healthcare providers, emphasizing the crucial role of fostering supportive patient-provider connections and highlighting the imperative for healthcare professionals to be knowledgeable and compassionate in their care of LGBTQ patients.Item Transgender Healthcare and The Impact of Increased Politicization of Medicine(2023) Gill, Lily; Kline, Nolan; Navid, Daniel; Rice, Ellie; Webb, Natey; Johnson, Kaeli; Griner, Stacey; Neelamegam, MalineePurpose Transgender (trans) people have a unique set of health needs that are often misunderstood and/or ignored in health settings. Such misunderstandings contribute to mental and physical health disparities when compared to the cisgender population, such as increased rates of anxiety, depression, suicide, substance abuse, adverse cardiovascular events, and other chronic health conditions. Addressing these disparities requires greater access to gender-affirming care (GAC) with providers who are comfortable and knowledgeable about trans individuals’ unique health needs. However, recently there has been an increase in anti-transgender legislation across the United States. This raises questions about provider regulation and ability to provide culturally appropriate care to trans patients, and potentially widening access and care disparities among trans individuals. Future providers, including medical students, who are being trained during moments of heightened anti-transgender politics, may not feel sufficiently prepared to care for trans patients. This exploratory study examined 1) current medical students’ knowledge and attitudes towards treating trans patients 2) gaps in transgender-focused content in medical curricula, and 3) medical trainings and their degree of impact on transgender healthcare. Methods A literature review was conducted by searching scholarly databases including PubMed using the terms related to transgender health, policy, medical students, gender-affirming care, health providers, and gender dysphoria. Articles that were 1) published after 2014 2) in English, and 3) available as full text were included. The search yielded 52 articles that were then reviewed for content on medical students’ knowledge and attitudes about trans patients, gaps in medical curricula, and perceived efficacy of trans-focused trainings and educational interventions. Results Existing literature suggests that trans health disparities are largely related to provider lack of knowledge and training. Despite potentially positive attitudes regarding this population, most medical students feel their curricula lacks transgender-centered content. This includes diagnosing gender dysphoria, hormone-therapy, puberty blockers, and sex reassignment surgeries. Although some students may feel knowledgeable about trans individuals’ needs overall, many report they still feel ill-prepared to work with trans patients. They request more clinical exposure to gain confidence with proper history taking and interview skills. When assessing the training modalities preferred by medical students, interactive interventions including direct communication with trans patients yield the greatest increase in perceived confidence levels. The most recommended training modalities for practicing physicians are attending professional conferences, acquiring direct clinical mentorship, and implicit bias self-awareness workshops. Conclusion This synthesis of current research highlights the need for increased trans-focused support in medical education, which will contribute to improving overall health outcomes, ease barriers, and ameliorate disparities for transgendered persons. In the current political context, physicians who provide GAC are faced with a unique set of social and legal challenges. Government intrusion of clinical decision-making may force physicians to forgo their obligations to transgender patients, thereby directly eliciting harm to an already marginalized population. Accordingly, current and future providers may need to engage in trans-focused advocacy efforts.