UH System Repository :: Browsing by Author "Pagan, Joan"

Browsing by Author "Pagan, Joan"

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Access to Care: Investigating the Perception and Experience of Native Hawaiian During COVID-19
(2021-06-08) Paikai, Kawailehua; Pagan, Joan; Daub, Katharyn
Native Hawaiian data collection and dissemination continue to be underrepresented and often inaccurate. While there is progress in how the government collects data on Native Hawaiian Pacific Islander (NHPI) populations, there is still a lack of accurate and reliable health data to assess access to care and healthcare utilization in the Native Hawaiian community. The COVID-19 pandemic exposed the need for data disaggregation and appropriate funding for Native Hawaiians and the organizations that serve them. Native Hawaiian health outcomes have been highly affected by the pandemic, and there is limited data to address access to care and health inequities. This project's scope is to pilot a screening tool to collect and analyze data from the Native Hawaiian population regarding their perception and experiences to access care during the COVID-19 pandemic.
Blood Pressure Management with the use of Technology in Rural Hawaii
(2023-05-27) Dowling, Autumn; Ayers-Kawakami, Jeanette; Pagan, Joan
The health care delivery system has evolved over centuries with the use of technology to manage care for those who live in rural communities. Due to the COVID-19 pandemic a public health emergency (PHE) has extended insurance policies so telehealth services (THS) could become available for primary care clinics. Although it became the new norm, and despite the benefits of THS, health care centers will continue to face challenges as new policies are in effect which may limit the delivery of health care options for primary care providers. Without innovative solutions to utilize technology as a part of primary care services, patient care will continue to be inadequate making it less cost-effective. One major challenge that providers will continue to encounter is the health literacy issues related to chronic disease management (CDM). One of the major risk factors for life threatening events is hypertension (HTN). Otherwise known as high blood pressure (HBP). The purpose of this project is to develop and deliver an interventional educational program (IEP) with the use of zoom and PowerPoint applications that focus on managing HBP among adults who reside within a rural community where access to primary care is limited. The chronic care model (CCM) and logic model (LM) was used as a guide to develop and design a project plan to implement the IEP in effort to increase health literacy core measures of one’s knowledge and confidence levels. Pre- and post- Hypertension Evaluation Lifestyle Management (HELM) scores and Blood Pressure Management Self Efficacy scale (BPMSES) scores were compared. The results indicated an increase in knowledge and confidence levels in all areas of managing HBP through lifestyle and treatment goals, the use of an automatic blood pressure monitor (ABPM), recognizing the 5 levels of BP numbers, and partnering with providers to manage HBP.
Chronic pain patient perceptions of primary care provider pain education
(2021-01-11) Gallegos, Angelina; Pagan, Joan; Daub, Katharyn
Chronic pain in the U.S. affects millions of adults and the numbers are expected to continue rising, alongside rates of chronic disease which often accompany chronic pain. It has become increasingly complex to manage chronic pain which is only further complicated by the opioid epidemic. While the primary care setting is most often where chronic pain patients are treated, the focus is often primarily on the physical complaints. Current best practices suggests primary care provider education incorporate a biopsychosocial approach to support the best possible outcomes. Current evidence suggests that holistic primary care provider education is necessary to achieve optimal outcomes and efforts should be focused on improving self-management. This project examined chronic pain management education delivery by primary care providers to identify potential gaps in education from the patient's perspective. A survey was developed with 40 items based on the Pain Assessment Screening Tool and Outcomes Registry (PASTOR), currently used by the military. The electronic survey was completed entirely online, with a total sample of 26 adult participants. The survey research revealed the largest deficits in pain education related to areas of behavioral change. The results indicated a need for improving education delivery to include a broader range of topics affecting chronic pain. Increasing knowledge of pain influencing factors can support more successful self-management in patients. The survey results informed practice improvement recommendations, using a two-pronged educational approach to improve chronic pain care education delivery in the primary care setting. Prong one was the development of a comprehensive patient pain education poster for primary care offices. Prong two was a provider education brochure detailing survey results and pain practice resources.
Early Screening for Breast-Cancer-Related Lymphedema Using Bioimpedance Spectroscopy
(2020-04-01) Lazarte, Melford; Pagan, Joan; Norris-Taylor, Joyce
Breast cancer is a common cancer diagnosis in women. Management generally includes chemotherapy, radiation, and or surgery. The surgical option involves the removal of a suspicious or cancerous lump, based on diagnostic imaging or a needle core biopsy, respectively. The decision for surgery then takes place. Surgery could mean lumpectomy or mastectomy, with sentinel node biopsy or full axillary dissection. Although the option for bilateral mastectomies is not required, it is discussed openly in addition to clinical history, personal risks, and recurrences. After any combination of recommended management is accomplished, the risk for breast-cancer-related lymphedema (BCRL) is increased. The use of bioimpedance spectroscopy (BIS), a non-invasive tool similar to standing on a weighing scale, is approved by the U.S. Food and Drug Administration (FDA) as a safe screening method for BCRL. Like other available screening measures, BIS should be adopted into clinical practice. Adoption carries the possibility to improve the quality of routine breast cancer care. Purpose: To bring awareness of early BCRL screening with the use of BIS and encourage its adoption. Conceptual Framework: Population, Intervention, Comparison, and Outcome (PICO) format. Theoretical Framework: The Diffusion of Innovation (DOI) theory. Method and Instrument: Anonymous survey via Survey Monkey or Word document based on participant preference. The survey contained 22 simple questionnaires in the form of categorical, nominal, dichotomous, ordinal, or rank-order data. After one month of data collection, data from all 22 questionnaires were extrapolated into Excel spreadsheets. Participants: n = 12 clinics/providers through non-probability or convenience sampling of practice settings located in widespread areas of Maui. Research Design: Non-experimental, descriptive, cross-sectional research at a single point in time. Statistical Analyses: Chi-square (x2) test – which included a null (H0) hypothesis, alternative (HA) hypothesis, degree of freedom (df), probability value (p-value) or alpha () value set at 0.05 – and 95% confidence interval (CI) in select data of 22 questionnaires. Results and Discussions: Specific characteristics of participants were identified and paralleled current literature. This Practice Inquiry Project (PIP) needed to delineate the type of clinic, define the term “future,” and ask the type of adopter explicitly. The x2 test determined possible associations, but could not anticipate or quantify variability. Statistically, participants were not ready or not likely to adopt BIS in the future, yet BIS was recommended. There was n = 1 participant that had the BIS device. Also supported by statistics, barriers existed. The two common barriers were organizational/institutional and insurance/financial. Implications: Clinical diagnosis became apparent as the most commonly utilized method to screen or diagnose BCRL. BIS was statistically recommended. The adoption of BIS was associated with variability, again, which was not anticipated and could not be quantified. Such variability was recognized later as relative advantage, compatibility, complexity, triability, and observability – all of which was an essential part of the DOI theory. Due to the small sample size (n = 12), there was inherent sharing or overlap of patients within each practice that was also not foreseen. The specific characteristics and barriers that were determined could be pivotal not only in coming up with strategies for adoption but also for primary prevention. Recommendations: The n = 1 participant could become a leading innovator and be a part of an extensive future study – to establish clinical information surrounding BCRL from screening, to diagnosis, management, costs, insurance coverage, and challenges, even patient experiences. Instead of an online survey, attending or presenting in a staff meeting would be considered. The timeframe and research design could be modified respectively, for a few months and be retrospective or prospective. Such n = 1 participant would be the target population and identify a sample population within it based upon specific characteristics found in this PIP. By extension, the inherent sharing or overlap of patients could be circumvented. The PICO and DOI frameworks may be kept. The type of clinic, type of adopter, and range of time for adoption must be investigated explicitly. Variability should also be addressed. More rank-order data might be warranted to apply not only the x2 test but also the 95% CI in select data. Conclusion: Statistically, participants were not likely to adopt but recommend the use of BIS in early BCRL screening. Barriers go hand in hand with any changes in clinical practice; thus, they need to be addressed with practical or individualized strategies ahead of time. Perhaps then, the momentum for adoption and method of primary prevention would be gained. Even more, the quality of routine breast cancer care could be elevated not just in one clinic or Maui but throughout the Hawai’i state at large.
Effects of Weight Loss on Diabetes: A Practice Inquiry Project
(2018-12-21) Brewer, Emily; Pagan, Joan; Ayers-Kawakami, Jeanette; Chino, Michelle
Purpose: The purpose of this practice inquiry project was to evaluate the impact of weight loss on type 2 diabetes mellitus (T2DM). The overall goal of this project was to learn improved ways of treating diabetes and how to better achieve glycemic control in these individuals. The expected primary outcome was improved hemoglobin A1c (HbA1c) as weight loss was achieved. Expected secondary outcomes included decreased serum glucose, weight, BMI, blood pressure, and waist circumference. Methods: A secondary analysis of quantitative data from the initiation of a weight management program and throughout patient participation was conducted. This information was collected and documented, and a series of statistical tests were conducted to examine the overall impact of the intervention on key indicators and test relationships between certain variables. The study sample included 21 patients, studied over a 90-day program. All participants had a diagnosis of T2DM, obesity, and hypertension. Measurements were taken at baseline, 30 days, 60 days, and 90 days. Measurements included weight in pounds, body mass index (BMI), blood pressure, body fat percentage, waist circumference, HbA1c, and glucose levels. Results: The participants experienced a significant reduction in these measurements at each of the four measurements (Baseline, 30, 60, 90 days), though not all were considered statistically significant. Conclusion: The weight loss program improved patient outcomes by decreasing weight, BMI, body fat percentage, waist circumference, glucose, and HbA1c levels. This reduction of risks and complications of diabetes improves the quality of life of patients with diabetes.
Healthcare Communication Tailored to the Health Needs of Alaska Natives and American Indians
(2019-12-31) Arteaga, David; Hensley, Patricia; Pagan, Joan; Daub, Katharyn
Healthcare in Alaska has been challenging throughout history due to the size of the state, the remoteness of Alaska Native villages, and the uniqueness of the different indigenous tribes. Numerous federal and national reports acknowledge that culturally sensitive healthcare can be achieved through partnership with patients and their families to meet the unique needs of each individual. Lack of congruent cultural communication with American Indian and Alaska Native (AI/AN) populations have continuously put these vulnerable populations at the highest risk for adverse health outcomes. The participants for this culturally congruent educational session were healthcare providers that care for AI/AN patients in Anchorage, Alaska. Participants of the educational session included physicians, nurses, mid-level providers, and healthcare administrators. The assessment tool was a pre and post-survey that identified common themes such as a desire to learn more about AI/AN cultures and the lack of culturally congruent education. The results of the session post-survey indicated increased in participant perception and the knowledge of AI/AN culture and culturally congruent Patient and Family-Centered Care (PFCC) methods.
Increasing Adult Awareness of Hawai’i Youth Vaping
(2020-06-08) Buck, David; Hensley, Patricia; Pagan, Joan
Vaping is a novel socially acceptable form of nicotine consumption used by youth as an alternative to traditional cigarettes. Electronic cigarette (e-cig) use in Hawaii County (HC) middle and high school students is higher than state and national rates. Due to the novel onset of youth e-cig use, long-term health implications are unknown. However, numerous federal, national and other evidence-based studies acknowledge the concerns of nicotine exposure to the developing brain, and e-cigs being a socially acceptable gateway to traditional cigarette and other drug use. Numerous studies indicate high youth e-cig rates amongst specific populations (i.e., rural, low socioeconomic status), the strong influence parents and adults have on youth tobacco abuse, and that current youth e-cig preventative strategies are unsuccessful. The rural Puna District has the highest users of both e-cigs and combustible cigarettes in the state of Hawaii. Thus, innovative strategies are needed to improve e-cig health literacy in this high risk population. Thirty participants participated in a project aimed at improving e-cig health literacy in the rural population through a community farmer’s market e-cig information booth. Participants’ level of concern, e-cig knowledge, and the resources utilized to obtain e-cig or other health information were assessed before and after project interventions. Data analysis indicated that for the majority of participants, project interventions changed perception, increased level of concern, knowledge, potential future advocacy against e-cigs, and potential future attendance to convenient health literacy booths. Convenient educational booths have the potential to improve health literacy in rural populations thus leading to improved prevention or management of community health issues.
Quality of Life of Community Elderly And Mindfulness Meditation/Mindfulness Training
(2023-05-15) Kim-Sunada, Cera; Pagan, Joan; Daub, Katharyn
Poor mental health can affect an older person's quality of life. The researchers found that older adults are at higher risk for depression. Negative stress significantly impacts older person's quality of life across physical, psychological, and social domains resulting in suffering and distress to older individuals. More effective interventions for improved quality of life for older persons are needed. Mindfulness meditation training can be beneficial in reducing symptoms of depression and stress and improving quality of life. (Amadpanah study, 2017). The goal of my PIP was to determine if older individuals (65 years or older) residing in the community can improve their quality of life by adding a mindfulness meditation program. The research question was "Can the introduction of the six weeks one-hour weekly mindfulness meditation class improve the quality of life of community-based older individuals?". The results of my PIP were lower perceived stress and depression reported by the participants after six weeks of mindfulness meditation class. Mindfulness meditation can help improve the quality of life of older individuals. Some participants stated that mindfulness meditation helped them become more "patient", sleep better, and have less pain (low back pain e.g., sciatica), and recent shoulder injuries).
Self-Assessment of the Clinical Healthcare Services at the University of Hawaii at Hilo Student Medical Services
(2019-04-25) Hirata, Heather; Pagan, Joan; Van Hoose, Diane
The purpose of this project was to assess the University of Hawaii Hilo (UHH) Student Medical Services using multiple methods, as a single assessment method is not enough to assess competencies. The American College Health Association’s (ACHA) Council for the Advancement of Standards (CAS) in Higher Education tool for Clinical Health Services was used for administrative program assessment. The findings were used to identify areas that administrators need to strengthen to comply with Federal, State and University regulations and increase program efficacy. The ACHA 2016 survey Health Assessment II 2016 survey for the University of Hawaii at Hilo (UHH), was used to determine the health status on campus, health information received and health information that students wanted was compared against self reported academic impacts. The ACHA 2016 survey of UHH students and the ACHA national reference group were used to determine how UHH student compared to national average in health issues. The basis of the literature review was current health concerns that seemed to affect university students .UHH students and the results of the survey served as a guide and context in which to assess the current program.
Suicide Prevention in Primary Care
(2022-06-07) Miho, Lauren; Pagan, Joan; Hensley, Patricia
Suicide is a complex and challenging topic to openly discuss with others, let alone discuss with healthcare providers. It is often talked about in private or not at all. Suicide is a crucial topic that is essential for healthcare providers and patients to talk through. A provider’s ability to readily identify and treat patients considering suicide is a critical skill that is often overlooked. This project aimed to improve healthcare providers’ confidence and competence to readily identify suicidal warning signs and ideations and increase the providers' knowledge on preventing their patients from self-harm. The evidence-based educational tool utilized in this project was the QPR Online Gatekeeper Training module. A logic model was used to guide the design and planning of the project, and the John Hopkins, PET Management Guide, aided the implementation and evaluation of this project. Participants completed an online educational module and a pre/post-survey. The results from the post-survey were then compared to pre-survey results to determine if the module successfully increased the knowledge regarding suicide prevention amongst HCPs that participated in the training.

Browsing by Author "Pagan, Joan"

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