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Assessing the active living environment in three rural towns with a high proportion of Native Hawaiians and other Pacific Islanders.

ABSTRACT: Background: Existing literature on the built environment and physical activity in rural areas is very limited. Studies have shown that residents in rural areas are less likely to meet physical activity requirements than their counterparts living in urban and suburban areas. They are also less likely to have access to amenities and programs that promote physical activity. This study seeks to fill gaps in the literature by assessing the built environment in three rural towns in Hawai'i that have a high proportion of Native Hawaiians and other Pacific Islanders. Methods: The Rural Active Living Assessment (RALA) tools will be used to assess the built environment. The RALA has three components - Policy and Program Assessment (PPA), Town Wide Assessment (TWA), and Street Segment Assessment (SSA) which will be used to provide a comprehensive assessment of the active living environment. Assessments were completed in September and October 2016. Results: One assessment was completed in each town for the TWA and PPA. The SSA was completed with 60 segments (20 from each town). Conclusion: The RALA tools identified supports in these three rural towns. The assessment also identified barriers and gaps - especially with the town and school polices of each town.

SUBMITTER: Hafoka SF

PROVIDER: S-EPMC5497364 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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Project description:ObjectiveEfficient, effective health care requires rapid availability of patient information. We designed, implemented, and assessed the impact of a primary care electronic medical record (EMR) in three rural Kenyan health centers.MethodLocal clinicians identified data required for primary care and public health reporting. We designed paper encounter forms to capture these data in adult medicine, pediatric, and antenatal clinics. Encounter form data were hand-entered into a new primary care module in an existing EMR serving onsite clinics serving patients infected with the human immunodeficiency virus (HIV). Before subsequent visits, Summary Reports were printed containing selected patient data with reminders for needed HIV care. We assessed effects on patient flow and provider work with time-motion studies before implementation and two years later, and we surveyed providers' satisfaction with the EMR.ResultsBetween September 2008 and December 2011, 72 635 primary care patients were registered and 114 480 encounter forms were completed. During 2011, 32 193 unique patients visited primary care clinics, and encounter forms were completed for all visits. Of 1031 (3.2%) who were HIV-infected, 85% received HIV care. Patient clinic time increased from 37 to 81 min/visit after EMR implementation in one health center and 56 to 106 min/visit in the other. However, outpatient visits to both health centers increased by 85%. Three-quarters of increased time was spent waiting. Despite nearly doubling visits, there was no change in clinical officers' work patterns, but the nurses' and the clerks' patient care time decreased after EMR implementation. Providers were generally satisfied with the EMR but desired additional training.ConclusionsWe successfully implemented a primary care EMR in three rural Kenyan health centers. Patient waiting time was dramatically lengthened while the nurses' and the clerks' patient care time decreased. Long-term use of EMRs in such settings will require changes in culture and workflow.

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Assessing the active living environment in three rural towns with a high proportion of Native Hawaiians and other Pacific Islanders.

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