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J. Clin. Med. 2019, 8(2), 154; https://doi.org/10.3390/jcm8020154

A General Pathway Model for Improving Health Disparities: Lessons from Community and Cultural Involvement in Improving Cervical Cancer Screening in Vietnamese Women

1
Department of Cardiology, The Cardiometabolic Research Institute, Houston, TX 77054 USA
2
New York Institute of Technology, Old Westbury, NY 11568, USA
3
Alzheimer’s Disease Center, NYU Langone Medical Center, New York, NY 10016, USA
*
Author to whom correspondence should be addressed.
Received: 14 November 2018 / Revised: 19 January 2019 / Accepted: 28 January 2019 / Published: 29 January 2019
(This article belongs to the Section Obstetrics & Gynecology)
Full-Text   |   PDF [1256 KB, uploaded 29 January 2019]   |  

Abstract

Objective: Chronic diseases have become dominant in the global health landscape. Despite remarkable advances in basic science, pharmacology, surgery, and technology, progress in lifestyle improvements, now considered essential, has been disappointing. Patient adherence to medications and other instructions play the greatest role in individual outcome shortfalls. Classically medicine has approached management using a high-risk model, targeting clinical manifestations of disease with progressively intensive therapies, in contrast with population-based models. In an effort to identify effectiveness among the many models available, the “pathways model” is reevaluated. Methods: Relying upon secondary data from prior studies in which Papanicolaou (Pap) test utilization was successfully improved, a “pathway model” is qualitatively reexamined in which characteristics of patients, providers, and the health system—as impacted by culture, beliefs, values, and habits—are acknowledged and incorporated by community resources into treatment plans. In so doing, health disparities are also addressed. Observations: The culturally inclusive pathways model using immersion community-based participation was successful in modifying behaviors when applied to a high-risk population in great need of improving Pap test adherence. Conclusions: In populations characterized by recognized cultural barriers contributing to low adherence, the pathways model may improve chronic disease outcomes. This model emphasizes a high degree of immersion within a culture and community as vehicles to improve patient behavior and address inequities. Central features are concordant with current concepts in guidelines, scientific statements, manuals, and advisories concerning the conduct of community-based research and social determinants of health. The pathways model deserves consideration for use in other chronic illnesses, such as cardiometabolic disease. View Full-Text
Keywords: Papanicolaou tests; pathway model; health-delivery models; community-based participatory research; health disparities; social determinants of health; community developed intervention; chronic disease model; lay health workers Papanicolaou tests; pathway model; health-delivery models; community-based participatory research; health disparities; social determinants of health; community developed intervention; chronic disease model; lay health workers
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Kones, R.; Rumana, U.; Arain, F. A General Pathway Model for Improving Health Disparities: Lessons from Community and Cultural Involvement in Improving Cervical Cancer Screening in Vietnamese Women. J. Clin. Med. 2019, 8, 154.

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