PLACE-BASED HEALTH DISPARITIES: FUNCTIONAL DISABILITY IN APPALACHIAN WEST VIRGINIA

Abstract Place-based health disparities contribute to disability across the lifespan. Additional examinations of contributors to morbidity and disability at mid-and late-life are needed to inform policies and programs. Using data from the 2020 Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS), we examine some of the social determinants of health (e.g., age, gender, education, income) as predictors of access to health care and predictors of functional ability. The study included 5,880 adults living in West Virginia all between the ages of 18 to 65+ years. Access to healthcare was indexed by three variables, including whether one had medical insurance, saw personal physicians, and avoided medical treatment due to cost. Functional ability was indexed by reports of difficulty in three ADLs and the number of chronic health conditions. Although most paths were significant, our initial model fit the data poorly, X2 (DF = 39, N =5880) = 2503.6, p < .001, CFI = .70, RMSEA = 1.0. We re-ran the model, using age as a moderator. In this set of analyses, the model fit well for middle-aged and older adults, but a different set of predictors characterized the relations for younger adults. Our results suggest that policies and programs that increase medical access for current middle-aged and older adults might decrease functional disability. Moreover, as younger adults age into midlife, they enter with lower economic and educational resources, further exacerbating their lack of access to health care and increasing disability.

experiencing multimorbidity, it is imperative to identify shared priorities and target holistic interventions considering their experiences to enhance outcomes.

PATIENT PARTICIPATION IN HEALTHCARE ACTIVITIES: NURSES' AND PATIENTS' PERSPECTIVES IN TAIWAN
Hsueh-Fen Kao 1 , Chang-Chiao Hung 2 , Bih-O Lee 3 , Su-Ling Tsai 2 , and Oscar Moreno 4 , 1.The University of Texas at El Paso, El Paso, Texas, United States, 2. Chung-Gung University of Science and Technology,Puzi City,Chiayi,Taiwan (Republic of China),3. Kaohsiung Medical University,Kaohsiung,Kaohsiung,Taiwan (Republic of China),4. M B Care Home Health,LLC,El Paso,Texas,United States Patient participation in healthcare activities is key to producing successful patient-centered care.However, little is known about both nurses' and patients' perspectives regarding patient participation in East Asia.This paper compared and contrasted perspectives of patient participation in healthcare activities between nurses and patients (age=61.53±8.75), using a qualitative study with a purposive sample of 39 nurses and 15 patients.Inclusion criteria for patient participants were: (1) speaking Mandarin Chinese or Taiwanese dialect, (2) aged 20 or older, (3) hospitalized at the unit for at least 3 days, (4) able to provide written informed consent, and (5) well enough to endure 40-50 minutes of individual interview.A semi-structured interview was applied to focus groups for nurses, and to face-to-face interviews for patients to prevent nosocomial infection.Content analysis was utilized to analyze the data, common themes and subthemes were identified showing three similarities in perspectives between nurses and patients-authoritative culture, participation behaviors, and obstacles to participation, as well as two differences-sources of acquiring patient-related health information, and responsible party.Nurses and patients did not entirely view participation in healthcare activities congruently.Relevant clinical practices are also suggested, including respecting patients' autonomy, nurses' using layman's language for explanations, patients' understanding the meaning behind their participation behaviors, recognizing obstacles faced in enhancing patient participation with adjusted nursing workload, actively providing needed health information, and leading patients to realize that they will be responsible for their health behaviors after discharge.

PLACE-BASED HEALTH DISPARITIES: FUNCTIONAL DISABILITY IN APPALACHIAN WEST VIRGINIA
Carly Pullen, Kareem Ibrahim-Bacha, and Julie Hicks Patrick, West Virginia University, Morgantown, West Virginia, United States Place-based health disparities contribute to disability across the lifespan.Additional examinations of contributors to morbidity and disability at mid-and late-life are needed to inform policies and programs.Using data from the 2020 Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS), we examine some of the social determinants of health (e.g., age, gender, education, income) as predictors of access to health care and predictors of functional ability.The study included 5,880 adults living in West Virginia all between the ages of 18 to 65+ years.Access to healthcare was indexed by three variables, including whether one had medical insurance, saw personal physicians, and avoided medical treatment due to cost.Functional ability was indexed by reports of difficulty in three ADLs and the number of chronic health conditions.Although most paths were significant, our initial model fit the data poorly, X2 (DF = 39, N =5880) = 2503.6,p < .001,CFI = .70,RMSEA = 1.0.We re-ran the model, using age as a moderator.In this set of analyses, the model fit well for middle-aged and older adults, but a different set of predictors characterized the relations for younger adults.Our results suggest that policies and programs that increase medical access for current middle-aged and older adults might decrease functional disability.Moreover, as younger adults age into midlife, they enter with lower economic and educational resources, further exacerbating their lack of access to health care and increasing disability.Patient-provider relationships have a direct impact on patient outcomes.This study explored patient-provider relationships among an understudied geriatric population of color-foreign-born Latinos¬ participating in an all-inclusive specialized program aimed at controlling patients' costs and enhancing access to care.Thirteen older adult Latinos with multimorbidities from nine Program of All-Inclusive Care for the Elderly (PACE) centers in Southern California were recruited.Researchers conducted three in-depth interviews in Spanish with each participant (39 interviews total) over 13 months.The first interviews were conducted face-to-face and lasted one hour on average.Subsequent interviews were conducted over the phone (Range: 60-90 minutes).Data were analyzed using codes, identifying categories and themes.The concepts of time and trust were used to analyze the process of relationship development and to capture changes over time.The patient-provider relationship developed on a continuum across time and trust, establishing three stages to the patient-provider relationship.In the first stage emerged the concept of el buen doctor (the good doctor).In the second stage, trust was perceived to have been established, and was only strengthened as the doctor continued to demonstrate trustworthy characteristics over time.The third stage embodied all that a person of trust was plus an additional advocacy dimension.The longitudinal and specialized geriatric program design illuminated the nature of quality of care and patients' perceptions on relationship development over time.Controlling patient/provider costs and enhancing access to care in an all-inclusive program are beneficial in enhancing patient-provider relationships.

ADVANCE CARE PLANNING FOR SPANISH-LANGUAGE SPEAKERS: PATIENT, FAMILY, AND INTERPRETER PERSPECTIVES
Geraldine Puerto 1 , Germán Chiriboga 1 , Susan DeSanto-Madeya 2 , Vennesa Duodu 1 , Dulce Cruz-Oliver 3 , and Jennifer Tjia 1 , 1. University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States, 2. University of Rhode Island,Providence,Rhode Island,United States,3. Johns Hopkins Medical School,Baltimore,Maryland,United States Language access is a challenge to advance care planning (ACP).Spanish-language speakers are the largest non-English speaking population in the US.While ACP tools have been translated into Spanish, it is unclear how heterogeneity in country of origin may affect the generalizability of translations across diverse US Spanishspeaking populations.The study objective is to describe challenges and facilitators to ACP for diverse populations of Spanish-language speakers.We conducted 3 focus groups with a total of 29 participants from members of Spanish-language speaking communities whose countries of origin were predominantly from the Caribbean, Central, and South America.Eligibility included being 18 years or older, being a native Spanish-speaker, and having direct experience with ACP as a patient, caregiver, or medical interpreter.We conducted thematic analysis with axial coding.Themes include: 1. Linguistic Challenges with Current ACP Translations; 2. Effect of Country of Origin and Culture on ACP Understanding; 3. Impact of Local Healthcare System Cultural on ACP; and 4. Need for ACP to be Normalized into the Local Community.ACP is both a cultural practice and a clinical practice.Recommendations for improving ACP completion for non-English speakers extend far beyond translation, since simply translating ACP tools without a cultural context is neither equitable nor inclusive.A key step is normalizing ACP into the local community.Understanding the intersection of local healthcare systems of ACP practice with the patient's and family's cultures of origin will facilitate introducing ACP in a culturally sensitive manner.

COLORECTAL CANCER SCREENING (CRC) DISPARITIES: A ZIP CODE-LEVEL ANALYSIS
Roshni Singh, Carla Parraga, Rachel Lin, Leonardo Tamariz, and Ana Palacio, University of Miami Miller School of Medicine, Miami, Florida, United States CRC is the third leading cause of cancer-related deaths among older adults in the US.CRC screening can prevent disease by early identification, yet there are disparities in CRC screening.This study aimed to determine the impact of race, social determinants, and geographic location at zipcodes level on CRC screening.We conducted a retrospective cross-sectional study of CRC screening among different races, evaluating the relationship with the social deprivation index (SDI) and annual income as health determinant factors using the public available data of 2016-2019 CDC 500 cities project and PLACES project 2020 database combined with 2019 American Community Survey for zip code-based analysis.We conducted a multivariate analysis and a confirmatory factor analysis among race, income, lack of health insurance, access to check-up visits and SDI.Increasing SDI tertile increased the likelihood of being Black and Hispanic and having lower median household income (p< 0.01).Lack of health insurance and lower regular checkup visits were less common in the third tertile of SDI (p< 0.01).The multivariate analysis showed that being Rosana Bravo 1 , and Angela Gutierrez 2 , 1.Western University of Health Sciences, Pomona, California, United States, 2. Ohio University, Heritage College of Osteopathic Medicine, Athens, Ohio, United States