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Open Access Publications from the University of California

Scholarly Works (73 results)

  • Article
  • Peer Reviewed
UC San Francisco Previously Published Works (2020)
I miss my mom, who died last year, and I want to tell the happy story of her death, or perhaps the story of her happy death through her choosing and accomplishing medical aid in dying. My mom was 85 when she died, had atypical presentation of lymphoma which took time to diagnose, and went through 3 painful months of surgery, radiation, and a single horrific round of chemotherapy. She suffered a lot. When she was in the hospital recovering from chemo, I witnessed 3 amazing doctors being true to core values of their profession. But the most profound aspect and gift of the events surrounding her death was the way in which making an informed choice gave my mom back her presence-allowing her both peace and power in the end of her life.
    Cover page: The “Foresty Way”: My Mother’s Brave Choice of Medical Aid in Dying
    • Thesis
    • Peer Reviewed
    UC San Francisco Electronic Theses and Dissertations (2023)

    The COVID-19 pandemic has underscored the urgent need for equitable access to public health interventions, healthcare, and accurate health information. This dissertation aims to address health disparities and improve COVID-19 vaccine uptake through culturally tailored interventions and misinformation mitigation strategies.

    Paper 1 focuses on identifying barriers and enablers to COVID-19 vaccine uptake among participants in the San Francisco Department of Public Health contact tracing program. Seventeen interviews were conducted, and data analysis employed the Capability, Opportunity, Motivation Behavior model (COM-B) and the Behavior Change Wheel framework. Barriers to vaccine uptake included an unprepared health system, fear of side effects, limited knowledge, and conflicting information. Interventions targeting education, enablement, and environmental restructuring were identified as effective strategies.

    Paper 2 evaluates the impact of culturally and linguistically tailored informational videos delivered via social media campaigns on COVID-19 vaccine uptake in Indigenous Maya communities in Guatemala. Pre- and post-intervention surveys were collected from 1,572 participants, and logistic regression models were utilized. Results indicated that exposure to the intervention videos increased the odds of vaccination by 1.78 times compared to those who did not see the videos. Culturally sensitive information delivered through trusted sources on social media was found to positively influence vaccination uptake.

    Paper 3 addresses health misinformation among Spanish-speaking communities in the San Francisco Bay Area. Through formative interviews and workshops, a co-created checklist was developed to identify and counter health misinformation. Misinformation surrounding vaccine safety, side effects, and government control were identified as concerns. The checklist empowers Spanish-speaking communities to verify information sources, assess trustworthiness, and engage with reliable content.

    This dissertation highlights the importance of tailored interventions and misinformation mitigation strategies in addressing health disparities and increasing COVID-19 vaccine uptake. Culturally sensitive approaches, such as multilingual social media campaigns and community co-creation of tools, can effectively counter barriers and empower marginalized populations. By implementing these findings, public health departments can work towards achieving equitable access to healthcare and reducing health disparities during the COVID-19 pandemic and beyond. 

      Cover page: VACÚNATE: Vaccine Access Through Communication, Understanding, and Tailored Interventions
      • Article
      • Peer Reviewed
      UC San Francisco Previously Published Works (2016)
      A key reason for the consistent gaps between evidence and practice across all areas of medicine is that there has been little attempt to identify or target factors critical for successful implementation of an evidence-based intervention. There is either no explicit implementation strategy or the strategy is based on a best guess rather than on a systematic assessment of crucial barriers and enablers. A different approach is needed to close the evidence-practice gap and thereby achieve the triple aim of improved health, improved patient experience and reduced healthcare costs. We present three fundamental principles of implementation science, which is a methodology that offers a systematic and comprehensive approach to improving healthcare practice and a series of 'how to' steps to conduct implementation science research. In an accompanying article, a scoping review of the types of implementation science research conducted in emergency medicine is reviewed, and several of the principles related to this review are discussed.
        Cover page: Strategies for implementing implementation science: a methodological overview
        • Article
        • Peer Reviewed
        UC San Francisco Previously Published Works (2023)
        Throughout COVID-19, health officials have relied on data visualizations to communicate urgent messages about the spread of the virus and preventative measures. Relatively few efforts have employed participatory engagement with communities who have experienced a disproportionate burden of COVID-19 illness to shape these communications. Sociologist W.E.B. Du Bois viewed data visualization as an approach to changing the way people think about themselves. This paper describes a community-engaged approach to data literacy skill-building with bilingual Latina learners in an adult English program in Northern California, Bay Area. The curriculum combines data visualization activities with language instruction and preventive health themes. Early work on COVID-19 in 2020-21 emphasized improving health knowledge and message interpretation but later shifted to a critical data literacy perspective, focusing on myth-busting, improving risk messaging in their own social networks, and supporting learners to see the power of their own experiences in data story-telling processes. This pedagogical approach, guided by Charles Brigg's idea of communicative justice priorities, locates adult learners' data visualization work as part of a broader effort to be included in the perspectives that shape knowledge production in today's healthcare system. This approach can be used to examine disparities in information access in linguistically minoritized communities and guide future education interventions.
          Cover page: Working with Data in Adult English Classrooms: Lessons Learned about Communicative Justice during the COVID-19 Pandemic
          • Article
          • Peer Reviewed
          UC San Francisco Previously Published Works (2014)
          A reliance on the conceptualization of health literacy as functional skill has limited researchers' views of the adult English-as-a-second-language (ESL) context as a site for health literacy interventions. To explore the contributions of alternative views of literacy as social practice to health literacy research, the authors examined teacher survey data and learner outcomes data collected as part of a multiyear collaboration involving the California Diabetes Program, university researchers, and adult ESL teachers. The survey results (n=144 teachers) indicated that ESL teachers frequently model effective pedagogical practices that mediate social interaction around health content, the basis for acquiring new literacy skills and practices. In the classroom pilot (n=116 learners), the majority of learners reported they had learned about diabetes risk factors and prevention strategies, which affirmed existing healthy behaviors or prompted revision of unhealthy ones. About two thirds of the learners reported sharing preventive health content with members of out-of-school social networks. This study represents a first step in research efforts to account more fully for the mechanisms by which social interaction and social support facilitate health literacy outcomes in ESL contexts, which should complement what is already known about the development of health literacy as functional skill.
            Cover page: ESL Participation as a Mechanism for Advancing Health Literacy in Immigrant Communities
            • Article
            • Peer Reviewed
            UCSF Open Access Publishing Fund (2018)
              • Article
              • Peer Reviewed
              UC San Francisco Previously Published Works (2018)

              Background

              Clinicians have difficulty accurately assessing medication non-adherence within chronic disease care settings. Health information technology (HIT) could offer novel tools to assess medication adherence in diverse populations outside of usual health care settings. In a multilingual urban safety net population, we examined the validity of assessing adherence using automated telephone self-management (ATSM) queries, when compared with non-adherence using continuous medication gap (CMG) on pharmacy claims. We hypothesized that patients reporting greater days of missed pills to ATSM queries would have higher rates of non-adherence as measured by CMG, and that ATSM adherence assessments would perform as well as structured interview assessments.

              Methods

              As part of an ATSM-facilitated diabetes self-management program, low-income health plan members typed numeric responses to rotating weekly ATSM queries: "In the last 7 days, how many days did you MISS taking your …" diabetes, blood pressure, or cholesterol pill. Research assistants asked similar questions in computer-assisted structured telephone interviews. We measured continuous medication gap (CMG) by claims over 12 preceding months. To evaluate convergent validity, we compared rates of optimal adherence (CMG ≤ 20%) across respondents reporting 0, 1, and ≥ 2 missed pill days on ATSM and on structured interview.

              Results

              Among 210 participants, 46% had limited health literacy, 57% spoke Cantonese, and 19% Spanish. ATSM respondents reported ≥1 missed day for diabetes (33%), blood pressure (19%), and cholesterol (36%) pills. Interview respondents reported ≥1 missed day for diabetes (28%), blood pressure (21%), and cholesterol (26%) pills. Optimal adherence rates by CMG were lower among ATSM respondents reporting more missed days for blood pressure (p = 0.02) and cholesterol (p < 0.01); by interview, differences were significant for cholesterol (p = 0.01).

              Conclusions

              Language-concordant ATSM demonstrated modest potential for assessing adherence. Studies should evaluate HIT assessments of medication beliefs and concerns in diverse populations.

              Trial registration

              NCT00683020 , registered May 21, 2008.
                Cover page: Language-concordant automated telephone queries to assess medication adherence in a diverse population: a cross-sectional analysis of convergent validity with pharmacy claims
                • Article
                • Peer Reviewed
                UC San Francisco Previously Published Works (2022)
                The big data revolution presents an exciting frontier to expand public health research, broadening the scope of research and increasing the precision of answers. Despite these advances, scientists must be vigilant against also advancing potential harms toward marginalized communities. In this review, we provide examples in which big data applications have (unintentionally) perpetuated discriminatory practices, while also highlighting opportunities for big data applications to advance equity in public health. Here, big data is framed in the context of the five Vs (volume, velocity, veracity, variety, and value), and we propose a sixth V, virtuosity, which incorporates equity and justice frameworks. Analytic approaches to improving equity are presented using social computational big data, fairness in machine learning algorithms, medical claims data, and data augmentation as illustrations. Throughout, we emphasize the biasing influence of data absenteeism and positionality and conclude with recommendations for incorporating an equity lens into big data research.
                  Cover page: Risks and Opportunities to Ensure Equity in the Application of Big Data Research in Public Health
                  • Article
                  • Peer Reviewed
                  UC San Francisco Previously Published Works (2024)
                  Interventional researchers face many design challenges when assessing intervention implementation in real-world settings. Intervention implementation requires holding fast on internal validity needs while incorporating external validity considerations (such as uptake by diverse subpopulations, acceptability, cost, and sustainability). Quasi-experimental designs (QEDs) are increasingly employed to achieve a balance between internal and external validity. Although these designs are often referred to and summarized in terms of logistical benefits, there is still uncertainty about (a) selecting from among various QEDs and (b) developing strategies to strengthen the internal and external validity of QEDs. We focus here on commonly used QEDs (prepost designs with nonequivalent control groups, interrupted time series, and stepped-wedge designs) and discuss several variants that maximize internal and external validity at the design, execution and implementation, and analysis stages.
                    Cover page: Selecting and Improving Quasi-Experimental Designs in Effectiveness and Implementation Research
                    • Article
                    • Peer Reviewed
                    UC San Francisco Previously Published Works (2014)

                    Background

                    Chronic disease registries have been successful at promoting the delivery of guideline-concordant primary care for patients with diabetes and hypertension, but not for chronic kidney disease (CKD). To understand whether a registry could be designed to improve CKD management in primary care, we explored primary care provider attitudes about the benefits (or lack thereof) of a CKD registry compared with other chronic diseases and the key facilitators of successfully implementing a CKD registry in safety-net primary care.

                    Study design

                    Qualitative, using semistructured interviews.

                    Setting & participants

                    We conducted and recorded semistructured 1-hour interviews with medical directors and quality improvement champions from safety-net adult primary care clinics in San Francisco.

                    Analytic approach

                    Recordings were transcribed and analyzed using a grounded theory approach until thematic saturation was achieved.

                    Results

                    20 primary care providers were interviewed. 4 themes relevant to the development of a successful CKD registry for safety-net primary care were identified: (1) provider beliefs that a CKD registry could aid in the delivery of team-based high-quality CKD care; (2) clinic workflow redesign and staffing are key facilitators to successful implementation of a CKD registry; (3) unique complexities of CKD, such as varying etiologies, may limit the use of a CKD registry by nonphysicians; and (4) a CKD registry is aligned with current primary care priorities and health care delivery strategies.

                    Limitations

                    Small sample size and reliance on clinician leaders within one health care delivery system.

                    Conclusions

                    A CKD registry directed at the entire health care team, with the functionality to track, standardize, and enhance CKD care through decision support, has the potential to improve the management of CKD in safety-net primary care settings. These data directly informed the development of a CKD registry in these settings in San Francisco.
                      Cover page: Developing a CKD Registry in Primary Care: Provider Attitudes&nbsp;and Input
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