St. Louis, MO (April 23, 2018) – Not everyone benefits equally from the type of evidence-based behavioral health interventions being developed by public health experts today. For people who struggle to meet basic needs such as food, housing, or transportation, healthy behaviors, and consequently, good health outcomes, are harder to achieve.
That’s why researchers at the Envolve Center for Health Behavior ChangeTM are working with Centene health plans to determine the role of unmet life needs on health behaviors among low income populations. Preliminary results from an initial survey of 100 Medicaid members in Louisiana with type 2 diabetes provided convincing evidence that additional supports may be needed.
Health plan members reported more stress, worse sleep, and difficulty with certain cognitive functioning skills, which were positively associated with unmet basic needs. Asked about specific concerns likely to arise during the next month, members responded as follows:
68 % will not have enough money to deal with unexpected expenses
47% will have trouble sleeping because of stress or worry
36% will have trouble finding or paying for child care if they need it
31% will not have enough money for necessities like food, shelter and clothing
24% will have problems paying for medical care or medicine
“It’s no surprise you would have a much harder time showing up to appointments, getting screenings, adhering to medications, being active, and eating nutritious foods,” said Dr. Amy McQueen, associate professor of Medicine at Washington University in St. Louis, during an Envolve Center presentation to Centene employees. In the diabetic population, she noted, these obstacles translate into worse blood-sugar levels, more complications, and more acute emergency care instead of preventive screenings.
Half of those surveyed reported having three or more unmet basic needs. Having more unmet needs was associated with more perceived stress, diabetes distress, activity limitations, and hospitalizations. It was also associated with worse attention, cognitive functioning, mental health, sleep, diabetes self-care activities and self-reported health. Of particular concern is that 65 percent said they had fair or poor health, which has been associated with increased morbidity and mortality.
In exploring the idea of additional support, the research team asked members if they would be interested in receiving help from a “navigator,” or non-healthcare professional. Fifty-nine percent expressed interest in assistance with health needs and 49 percent with basic needs. As might be expected, the more unmet needs, the greater the interest in a navigator.
Perhaps most exciting, according to McQueen, was the ability to demonstrate the different associations between unmet basic needs and the team’s conceptual model. While most other studies focus on just one basic need, this one looked at a variety, along with other factors like stress, sleep and executive functioning. “That we have so many great associations reflected, even with the small sample, provides a great contribution…and good estimates as to what we can expect in a larger study,” said McQueen.
The basic needs survey also demonstrated the value of the Envolve Center partnership, proving that those in academia could successfully work with a managed care organization to enroll members and conduct a research study. The rich data collected lays the groundwork for future investigation with additional health plans across more health conditions.
Ilene Lefland – Senior Wellness Communications Writer, Envolve PeopleCare
Ilene has worked in the health and wellness industry for many years. She focuses on strategic communications planning – looking at the end goal and figuring out how to get there through integrated communications programs and platforms that speak to the target audience.
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