Objective: To identify barriers and facilitators to primary care access among the homeless using the Equity of Access to Medical Care Framework and to provide recommendations for medical and public health practitioners to improve health among this underserved population. Methods: A quasi-systematic review of the literature was conducted using the PubMed, CINAHL, and PsycINFO databases. Study elements from articles in the final analysis were extracted and categorized into dimensions of access from the Framework. Results: The review identified multiple barriers to primary care access for the homeless. This included lack of insurance coverage and competing priorities. Facilitators to access included tailored health care delivery systems and having a regular source of care. Conclusion: This review provides evidence that health policy initiatives, patient-centered care, and targeted interventions can assist with improving primary care access among the homeless.

Background: African American (AA) women bear a disproportionate burden of cardiovascular disease. Promoting ideal cardiovascular health is one strategy to promote health equity for this disparate population. The goal of this integrative review was to summarize and evaluate the research evidence for cardiovascular risk reduction interventions specifically targeting, tailored, or adapted for AA women. Materials and Methods: A review of the literature was conducted using the EBSCOHost platform. Study elements from articles in the final analysis were extracted. Results: Fourteen interventions were included in the final analysis (16 peer-reviewed articles). Most studies targeted two or more areas of cardiovascular health with the most common areas being physical activity and diet. Primary and secondary outcome measures varied; the most common measures were self-reported dietary intake, physical activity, and knowledge-related measures. Eleven studies reported health outcomes; only five reported long-term intervention effects. Most studies employed at least one cultural tailoring or adaptation strategy for AA women. The most common strategies included incorporating feedback from the target population before implementation and tailoring intervention material to reflect the target population. Conclusions: There is a need to develop and evaluate tailored or adapted evidence-based interventions for AA women. Additional research is needed to design interventions for subgroups of the population such as low-income or rural AA women.

Studies suggest that gender differences exist in the recognition of stroke warning signs. Poor recognition of stroke warning signs has been attributed to negative treatment-seeking behaviors, which can result in poor outcomes. The aim of this study was to examine gender differences in the recognition of traditional early warning signs of stroke and first action to initiate treatment in a sample of stroke survivors. We collected survey data to examine recognition of traditional stroke warning signs and appropriate first action to initiate treatment along with demographic (age, stroke age, education, usual source of care, and insurance) and clinical (health literacy and stroke knowledge) variables. Seventy-one stroke survivors participated in this pilot study. Women in the sample were significantly older than men at time of stroke (62 years old vs. 55 years old; p < .05). The two groups did not differ in clinical variables. Recognition of traditional individual stroke warning signs ranged from approximately 60% to 90%. There were no significant gender differences in the recognition of individual warning signs. Women were more likely to recognize all five traditional warning signs compared with men (67% vs. 42%; p = .04). Similarly, 58% of female participants recognized all five traditional stroke warning signs collectively and would call 9-1-1 as a first action compared with only 29% of men (p = .02). Although women recognized traditional stroke warning signs more often than men, educational programs should emphasize both traditional and nontraditional stroke warning signs among women and address these differences with their healthcare providers.