Understanding and Reducing Underutilization of Traditional Health Care and Telehealth by Black Older Adults with Multiple Chronic Diseases: A Perceived Racism, Poverty, and
Cultural Insensitivity Responsive Approach (UTT)
The impetus for the UTT program is the alarming fact that premature death is disproportionately higher among minorities, individuals with low incomes, and older adults than among other populations. In particular, older adults with low incomes who have multiple chronic diseases and are Black are at highest risk for premature death. The study is divided into three aims:
Aim 1: To examine perceived racism, physical stress, cultural insensitivity, cultural mistrust, distrust of provider, low interpersonal control in the health care process, and unsatisfactory health care as significant predictors of underutilization of traditional (in-person) health care and/or telehealth video visits by 300 older Blacks (ages 55 or older) with two or more chronic diseases;
Aim 2: To use virtual focus groups to identify common motivators of and barriers to using in-person health care and/or telehealth video visits as perceived by a subsample (160) of the above-mentioned 300 older Blacks; and
Aim 3: To pilot-test the comparative impact on receptiveness to using telehealth video visits by a subsample (120) of the above-mentioned 300 older Blacks after watching one of three videos of a White male physician explaining telehealth video visits to an older Black man—one video (watched by 40 participants) that does not address the focus group-identified motivators and barriers, one video (watched by 40 participants) that does address these motivators and barriers, and one video (watched by 40 participants) that includes focus group-identified racists comments or behaviors by the physician (but does not address the focus group-identified motivators and barriers).
The study has completed its first two aims with resounding success, and its third aim is underway.
The Tele-Mental Health and Wellbeing Support Coaching Program for Black Adults and Youth (MHC)
Mental health was ranked second among the ten biggest health problems in Alachua County. Common mental health problems identified include prolonged stress, anxiety, depression, and grief, all of which have been exacerbated by COVID 19 impacts. Black adults and youth additionally experience stress and anger due to social injustice and racism. Yet, most Blacks do not seek mental health counseling due to limited access to and culture-related stigma associated with such counseling. Spiritual leaders (e.g., pastors, youth church leaders) attempt to provide mental health counseling, but they typically do not have the needed training to do so.
Thus, the goals of the MHC program are to (1) train 20 adult spiritual leaders and 20 youth spiritual leaders from three large churches in the low-income, mostly-Black area of Gainesville, FL (called East Gainesville) to be mental health and wellbeing support coaches (MHWBS coaches) by involving them in the evidence-supported Tele-Mental Health and Wellbeing Support Coaching Program and (2) have the MHWBS coaches implement stress-, depression-, grief-, and anger management support groups with 100 Black adults (aged 18+) and 100 Black youth (ages 12-17), respectively, each year for three years. The program is currently underway for its first year. This program is funded through a multi-year grant from the Florida Blue Foundation.
The Pastoral Tele-Mental Health Coach Training Program to Promote the Well-being of Seniors in Low-Income Communities within Jacksonville, Florida (PTMCT)
The purpose of the PTMCT program is to empower seniors and their pastors who live or serve in low-income communities across Jacksonville, Florida to take charge of their well-being (i.e., mental health, happiness, health, and the ability to manages stress and other emotions such as depression and anger) under whatever conditions that exist in their lives.
The PTMCT Program components, which are designed to be feasible and sustainable, include the following: (a) training pastoral teams at mostly small churches to be pastoral mental health coaches who implement tele-mental health support groups to promote mental health and well-being of seniors; (b) providing seniors who want to participate in the aforementioned support groups with needed technological training to access the groups, to use the internet to obtain mental health and other health information, and (c) having pastoral teams at each of 20 churches over two years conduct Zoom-delivered mental health support groups for their senior church/community members and connect these seniors to mental health resources after providing them with information to reduce the stigma and mistrust associated with seeing a psychologist or mental health counselor.
Culturally Sensitive, Primary Care Clinic-Based Interventions by Community Health Workers and Trained Physicians to Promote and Sustain Weight Loss among Black Women Patients with Obesity
(Health-Smart for Weight Loss Program)
The purpose of the Health-Smart for Weight Loss (HSWL) Program is to address the problem of obesity that negatively impacts the health and health-related quality of life of many Black women. Notably, Black women have the highest prevalence of obesity in the U.S. with more than half (56.6%) of Black women experiencing obesity. This disease increases the likelihood of having diabetes and other chronic diseases, and decreases quality of life and life expectancy. The U.S. Preventive Services Task Force recommends that all adults who have obesity participate in an evidence-based, intensive, multicomponent behavioral treatment for this disease. Such treatment has been shown to produce clinically significant weight-loss among patients; however, this weight-loss is typically not sustained over time. Health care professionals nationally agree that treatment of obesity should be occurring and evaluated in primary care settings.
The HSWL program is a multi-component, multi-partnered program that is designed to empower participants to take charge of their health under whatever conditions that exist in their lives. The program tests the effectiveness of a culturally sensitive, evidence-based, multi-component, behavioral program for treating obesity called Health-Smart.TM This program will be implemented for 6 months in 20 UF Health Jacksonville primary care clinics by Community Health Workers (CHWs) with Black women patients who have obesity, and followed by either of two physician-implemented behavioral counseling weight loss maintenance programs that are applied quarterly over 12 months to prevent weight gain. Specifically, we will compare the effects on weight-loss and weight-loss maintenance of (1) Health-Smart plus the Patient-Centered, Culturally Sensitive Weight Loss Maintenance Program (PCS-WLM), and (2) Health-Smart plus the Standard Behavioral Weight Loss Maintenance Program (SB-WLM). We expect that (a) the PCS-WLM will result in significantly greater weight-loss and weight-loss maintenance compared to SB-WLM, and (b) that the model used to integrate CHWs into the health care team at each clinic will result in high ratings of this integration by the CHWs and other clinic staff involved with this study. The program is being funded by a $2,099,943, three-year grant from the Patient-Center Outcomes Research Institute.
Health-Smart Holistic Health and Wellness Program to Promote Social Connection and Food Security among Minority, Underserved and/or Low-Income Jacksonville Seniors
(Health-Smart Holistic Health Program for Seniors)
The purpose of the Health-Smart Holistic Health (HSHH) Program for Seniors is to address the problems of social isolation, food insecurity, and financial insecurity that negatively impact the health and health-related quality of life of many seniors in Jacksonville, Florida. This program will specifically address these problems by promoting social connection, food security, financial security, and asset security among seniors in the target communities directly or through promoting financial security and asset security among family members of these seniors who contribute financially to the health and wellbeing of these seniors.
The HSHH Program is a multi-component, multi-partnered program that is designed to empower seniors to take charge of their social, mental, spiritual, and physical health under whatever conditions that exist in their lives. The major component of this program is the culturally sensitive, evidence-based, 9-week Health-Smart Behavior ProgramTM (called Health-Smart) adapted to promote Health-Smart behaviors (healthy eating, physical activity and depression and stress management behaviors) and social connection among seniors, and designed to be primarily implemented by members of the target communities.
The program is implemented through two health and wellness centers of UF Health that are based in the target communities and that will be transformed through the program to become Health-Smart Holistic Health Centers. Program successes have been indicated by increased social connections, lower loneliness ratings, increased food security ratings, increased health-smart behaviors, and improved health outcomes (e.g., reduced weight) among the program participants. The program will soon be undergoing its fourth year, and has been funded by multiple generous grants from the Humana Foundation. The following video includes testimonials from several participants regarding the impact Year 3 of the Health-Smart program had on them:
Additionally, the following is an advertisement that will be aired in Jacksonville in 2022, promoting the aforementioned Health-Smart Web App: