| Description |
Part I- Power Dynamics Present in Health Education Classes at a Free Clinic Objective: The purpose of this paper is to analyze dynamics between patients, staff, and volunteers at a free clinic. Certain power dynamics within health care are inherent and beneficial, such as a provider prescribing medication; however, other dynamics can be harmful. Unnecessary power dynamics include the oppression of less privileged individuals through intentional studies that utilize exploitation, programs that make modifications to serve certain populations without allowing the participants to be a part of the modification process, and a lack of recognizing the stress of acculturation amongst immigrant populations. This paper examines and dissects these dynamics. Paulo Friere's ideas about education and systems of power are used as a template for comparison. Part II- Self-Reported Diagnosis of Type 1 and Type 2 Diabetes and Lifestyle Change Among Uninsured Primary Care Patients Objective: The purpose of this study is to examine self-reported diagnosis of type 1 and type 2 diagnoses and lifestyle change amongst uninsured primary care patients utilizing a free clinic. Methods: Free clinic patients participated in a self-administered survey in May and June 2016. Patients with the following self-reported diagnoses were analyzed: Type 2 diabetes only (n=84), type 1 diabetes only, or both (n=43). Results: Participants who reported having type 2 diabetes only and/or were patients of the diabetes clinic were less likely to have modified diet and/or physical activity to manage diabetes compared to those with type 1 diabetes and/or those who were not patients of the diabetes clinic. Participants with hypertension were more likely to have changed diet and/or physical activity compared to those without hypertension. Conclusions: Uninsured primary care patients may not know what type of diabetes they have: type 1 or type 2. This is problematic, as type 1 and type 2 diabetes require different prevention and selfmanagement strategies. Future studies should examine the impact of misunderstandings of two types of diabetes on health behaviors and outcomes and explore the context of the misunderstandings. Part III: A Direct Observation Study of Health Education Classes for Uninsured Primary Care Patients Objective: Lifestyle related health issues are a significant concern in the United States. In safetynet primary care clinics such as free clinics, health education programs have the potential to reduce the prevalence of lifestyle related health issues amongst vulnerable, low socioeconomic populations. The purpose of this study is to describe health education programs for underserved populations at a free clinic using direct observations based on the Theory of Planned Behavior (TPB). The primary data source of this study were field notes based on observations of health education classes at a free clinic. Nine health education classes were observed in October and November in 2016 (total number of participants = 55). Participants were most receptive when conversations were dialogue instead of lecture based within the informal classes. Within the formal class, the lecture format proved to be effective. In both types of classes, participants felt they had adequate information on certain topics but lacked the accountability or will power necessary to make health-related behavior changes. Participants explained that the health education classes were effective in reminding them about certain aspects of health that they did not think about daily. The TPB seems to be a useful model to study health behavior change within the setting of free clinic informal waiting room classes. To promote behavioral changes, perceived behavioral control would be one of the key areas to focus on in health education classes. Future projects should develop health education programs, which respond to the results of this study and evaluate the programs. |
