Nevin Manimala

J Health Care Poor Underserved. 2025;36(4):1445-1462. doi: 10.1353/hpu.2025.a975595.

ABSTRACT

Despite the critical role of well-child visits (WCVs) in preventive care, many Medicaid-enrolled children miss these appointments, leading to gaps in early intervention and immunization. Existing research has largely focused on either quantitative analyses of visit rates and predictors or qualitative insights into patient and provider experiences. This study employs a mixed-methods, community-based approach to examine barriers to WCV attendance among Medicaid-enrolled families in North Dakota who missed all WCVs in 2021. Through administrative data analysis (n=64,364), surveys (n=1,294), and focus groups (n=40), findings reveal structural, economic, and cultural obstacles, including cost concerns, lack of Medicaid transparency, and logistical challenges. Community-informed recommendations emphasize improved Medicaid communication, culturally responsive care, and enhanced appointment accessibility. Addressing these barriers could promote equitable access to WCVs, improve child health outcomes, and reduce disparities in preventive care for underserved populations.

PMID:41355651 | DOI:10.1353/hpu.2025.a975595

J Health Care Poor Underserved. 2025;36(4):1389-1411. doi: 10.1353/hpu.2025.a975593.

ABSTRACT

There is a growing population of adults under 65 with disabilities needing to access long-term care (LTC). Rural areas are seeing this population rise while also experiencing growing nursing home closures. Medicaid, the largest payer of LTC, already pays for more LTC in rural areas than in urban areas. Therefore, state Medicaid expansion may increase insurance coverage for newly eligible individuals needing to use rural nursing homes. Using LTC Focus from 2011-2019, this paper conducts a Callaway Sant’Anna Difference-in-Differences analysis to understand the impacts of Medicaid expansion on rural nursing home admission demographics. Results indicated no significant effect of expansion on the percentage of Medicaid-dependent admissions and the percentage of under-65 admissions. Expansion was associated with a decrease in the percentage of admissions accounted for by Black individuals (-0.97** CI: -1.62, -0.33) in the included counties. More research must be conducted to study why the percent of Black admissions declined.

PMID:41355649 | DOI:10.1353/hpu.2025.a975593

J Health Care Poor Underserved. 2025;36(4):1317-1343. doi: 10.1353/hpu.2025.a975590.

ABSTRACT

The Pre to 3 Program in Vanderburgh County, Indiana (United States) was designed to affect maternal-infant health in medically underserved populations through community health worker (CHW) led initiatives. This program provides free, hands-on support for infants, parents, and families from the first trimester of pregnancy until the child’s third birthday. The CHW-driven Pre to 3 Program demonstrates improved outcomes in breastfeeding initiation, safe sleep practices, adequate prenatal care, child vaccination rates, food security, housing stability, and employment status. The Vanderburgh County Health Department Pre to 3 Program presents the state of Indiana, and similarly medically underserved counties, the opportunity to improve maternal-infant health through expanded implementation. With increased financial resources, and subsequently more program personnel, there is significant potential for positive impact on the health outcomes of high-risk communities.

PMID:41355646 | DOI:10.1353/hpu.2025.a975590

J Health Care Poor Underserved. 2025;36(4):1300-1316. doi: 10.1353/hpu.2025.a975589.

ABSTRACT

Vision loss in high-risk populations may be prevented in many cases with the early detection and management of eye diseases. The Kress Vision Program (KVP) is a free-of-charge community-based vision screening, referral, and treatment program for uninsured New Yorkers. This retrospective analysis describes the prevalence of ocular diseases among participants seen at the KVP, as well as the referral rates, treatment, and follow-up at an academic ophthalmology department. From October 2020-January 2023, 26 community-based organizations (CBOs) referred 887 participants, and 618 (69.7%) were screened; participants were predominantly female (70.9%) and Hispanic (63.9%), and had an income less than 100% of the federal poverty level (74.8%). Of 305 (49.4%) patients referred for further care, 238 (78%) attended their appointment. Common referrals included glaucoma suspect (85) or needing a comprehensive (61), retinal (76), or cataract evaluation (35). By establishing relationships with CBOs, the KVP improves eye care utilization in a high-risk population, serving as an effective model for a free vision screening and treatment program.

PMID:41355645 | DOI:10.1353/hpu.2025.a975589

J Health Care Poor Underserved. 2025;36(4):1287-1299. doi: 10.1353/hpu.2025.a975588.

ABSTRACT

INTRODUCTION: The objective of this study was to examine liver-related mortality trends in a large cohort of homeless-experienced adults.

METHODS: We linked a cohort of 60,092 adults who received care at Boston Health Care for the Homeless Program (BHCHP) from 2003-2017 to death occurrence files. We evaluated temporal trends in age-standardized liver-related mortality and identified leading causes of liver-related death compared with the Massachusetts population, reporting standardized mortality rate ratios (SRRs).

RESULTS: Of the 7,130 deaths in the cohort, 652 (9.1%) were liver-related. Liver-related mortality decreased on average 3.5% annually, though remained significantly higher than the Massachusetts population. Leading causes of liver-related death were cirrhosis (n=157, SRR 3.2), liver cancer (n=148, SRR 2.4), alcohol-related liver disease (n=140, SRR 4.4), and viral hepatitis (n=99, SRR 7.2).

CONCLUSION: Efforts to address alcohol use disorder and viral hepatitis in this population may reduce the substantial disparity seen in liver-related mortality in this population.

PMID:41355644 | DOI:10.1353/hpu.2025.a975588

J Health Care Poor Underserved. 2025;36(4):1277-1286. doi: 10.1353/hpu.2025.a975587.

ABSTRACT

Gastrointestinal diseases (GI), such as gastritis and peptic ulcer disease, are common, especially among Hispanics, among whom over 60% are infected with Helicobacter pylori (H. pylori), a leading cause of ulcers and a known carcinogen. Traditionally, esophagogastroduodenoscopy (EGD) has been the standard diagnostic method for chronic gastrointestinal symptoms. This study evaluates the feasibility and acceptability of magnetically controlled capsule endoscopy (MCCE) as a diagnostic tool for upper GI symptomatology in Hispanic immigrants residing in the U.S. Of 31 studies performed, 41.9% identified no findings. Pathological findings included acute gastritis (32.3%) and ulceration (16.1%). Patients tolerated MCCE well, with no side effects reported. Satisfaction rates were high, with 100% of respondents willing to recommend the procedure. Findings indicate that MCCE is a culturally adaptable, well acceptable, non-invasive alternative, addressing significant health care barriers.

PMID:41355643 | DOI:10.1353/hpu.2025.a975587

J Health Care Poor Underserved. 2025;36(4):1255-1276. doi: 10.1353/hpu.2025.a975586.

ABSTRACT

Geographic barriers and long travel distances contribute significantly to urban/rural health disparities, making online technology use a vital tool for improving individual and community health in rural areas. However, factors related to technology use, particularly in the Deep South (a historically under-resourced U.S. region characterized by high poverty, limited access to healthcare and education, and a predominantly African American population), remain understudied. Guided by the notion of a digital divide, we explore social determinants of online technology use for seeking health information among rural residents through a cross-sectional survey (N=157). Multiple linear regression analysis (R2=.52) revealed that lower social isolation was associated with reduced online technology use. In contrast, greater social media use, higher education, and improved health literacy were linked to increased use. These findings underscore the need for coordinated efforts among researchers, practitioners, and policymakers to expand access to (and engagement with) health-related online technologies in rural communities.

PMID:41355642 | DOI:10.1353/hpu.2025.a975586

J Health Care Poor Underserved. 2025;36(4):1240-1254. doi: 10.1353/hpu.2025.a975585.

ABSTRACT

Universal health care aims to provide effective and affordable health services to everyone. However, immigrant women often experience worse maternal and child health outcomes than their indigenous counterparts, including higher risks of mental health issues, premature child births, and maternal mortality. This study examined the barriers and facilitators to maternal health service use among immigrants in the Tamale Metropolis in Ghana. Using a qualitative approach, 30 immigrant women, including pregnant women and new mothers, were recruited through snowball sampling. Key informant interviews were conducted at six health facilities. The findings identified barriers to accessing care, such as language difficulties, concerns about privacy, and perceived discrimination. On the other hand, supportive factors included social support, perceived quality of care, accessibility of National Health Insurance, and outreach programs. To improve maternal and child health services for immigrant women, it is essential to address these barriers and strengthen the supportive factors.

PMID:41355641 | DOI:10.1353/hpu.2025.a975585

J Health Care Poor Underserved. 2025;36(4):1209-1224. doi: 10.1353/hpu.2025.a975583.

ABSTRACT

This study examined the association of rental assistance receipt with cost-related medication nonadherence (CRN) engagement in low-income adults with diabetes. Using National Health Interview Survey (NHIS) data from 2016 through 2019 and 2020 through 2022, we included low-income adults who were 1) diagnosed with diabetes, 2) prescribed medications, and 3) renters. Propensity score weighting approach created a sample in which receipt of rental assistance was independent of observed sociodemographic characteristics. Logistic regression examined the association of rental assistance receipt with CRN, respectively. Lack of receipt of rental assistance was significantly associated with higher odds of CRN engagement in NHIS 2016-2019 (Odds ratio=2.32; 95% confidence interval=(1.59, 3.37); p<.0001) and NHIS 2020-2022 (Odds ratio=1.74; 95% confidence interval=(1.04, 2.91); p=.03). Given the shortage of affordable housing in the United States, findings suggest that expansion of affordable housing could be critical for improving health outcomes in low-income adults with diabetes.

PMID:41355639 | DOI:10.1353/hpu.2025.a975583

J Health Care Poor Underserved. 2025;36(4):1193-1208. doi: 10.1353/hpu.2025.a975582.

ABSTRACT

Dental care remains an optional benefit for adults with Medicaid, with coverage varying across states. Recent expansions increased periodontal service coverage, but the scope of coverage and the policies that govern that scope remain unknown. This study analyzed coverage policies and fees for four periodontal services across 43 Medicaid programs between January and March 2024. Frequency limitations were the most common coverage policies identified, followed by prior authorization requirements, clinical requirements, and quadrant limitations. Veteran Health Administration fees were roughly three times higher than Medicaid fees across the four dental services. Current coverage policies may not consider the multidimensional and nuanced pathogenesis of periodontitis and the need for individualized treatment plans based on patient risk factors and disease progression. Furthermore, low reimbursement rates and administrative challenges may discourage dentists from participating.

PMID:41355638 | DOI:10.1353/hpu.2025.a975582