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How can dermatologists provide improved access to care for patients with housing instability?
Clinical Applications
Dr. Schwarzenberger is the former physician editor of DermWorld. She interviews the author of a recent study each month.
By Kathryn Schwarzenberger, MD, May 1, 2021
In this month’s Clinical Applications column, Physician Editor Kathryn Schwarzenberger, MD, talks with John Browning, MD, Kavina Patel, BS, Giselle Castillo, BS, and Farhan Ahmad, BS, about their recent JAAD abstract "Healthy skin for everyone: A bilingual health literacy program for homeless individuals."
DermWorld: You and your colleagues recently published the results of a bilingual health literacy program for homeless individuals. Can you describe your study for those who have not yet had the opportunity to read your abstract?
Dr. Browning et al: Many barriers to health care, and specifically dermatologic care and education, exist in homeless and underserved populations. Corazon Ministries is a local organization in San Antonio that serves our homeless and vulnerable populations by providing hot meals, clothing, haircuts, and access to medical care. We partnered with them to lead educational sessions during their weekly medical free clinic. Our educational sessions centered on the prevention and diagnosis of skin cancer because early screening and education can successfully prevent considerable morbidity and mortality. We wanted specifically to understand and address areas of weakness in the understanding of melanoma and sun protection. We administered several surveys identifying these gaps and then designed an educational curriculum centering around those gaps. Over 85% of our population speaks Spanish, so we created a bilingual curriculum that has been successful.
DermWorld: What made you choose to study this group of people?
Dr. Browning et al: About one in five Americans will develop skin cancer in their lifetime, and even higher rates are found in the homeless, indigent, and uninsured. With the additive factor of increased sun exposure in Texas, vulnerable populations in our community are even more at risk. We believe that education, awareness, and disease prevention can be accomplished by local homeless clinics and educational sessions as a first line of defense against skin cancer.
“About one in five Americans will develop skin cancer in their lifetime, and even higher rates are found in the homeless, indigent, and uninsured. With increased sun exposure in Texas, vulnerable populations in our community are even more at risk.”
─ Dr. John Browning
DermWorld: How did you conduct the study? Did you encounter any specific challenges when working with the homeless population?
Dr. Browning et al: Before attending the clinic, we had patients complete a needs-assessment survey. This bilingual survey was also read verbally to patients who could not read. We analyzed the surveys to see where the biggest gaps in understanding occurred. Big areas of weakness included knowing what melanoma is and knowing the warning signs of melanoma. We designed a bilingual curriculum centered on the ABCDEs for melanoma, sunscreen application instructions, and steps to follow once unusual skin lesions had been identified. During our sessions we conducted pre- and post-assessment surveys and distributed baseball caps and sunscreen to promote sun-protective behaviors. People experiencing homelessness typically have multiple complex health conditions and struggle accessing food, water, and proper hygiene products. It can be challenging discussing preventative health practices such as screening for skin cancer, when other complex problems require attention as well.
DermWorld: Did you learn anything you did not expect to learn from this study?
Dr. Browning et al: We learned about the power of education and the role of preventative medicine in dermatology. Spending a few extra minutes on educational efforts can go a long way in patient care, and it is something to keep in mind for all patient interactions. Certain areas of the curriculum such as knowing when to seek medical care and some of the risk factors for melanoma only had marginal increases in knowledge, so we learned that there might be gaps in our curriculum in these topic areas. The marginal increase also highlights the continued need for education. In the future, we would like to provide multiple exposures to the curriculum and revamp certain topic areas in order to expand the project.
DermWorld: Do you have any thoughts as to how dermatology as a specialty can better provide access to care for our patients with housing instability?
Dr. Browning et al: One of the best parts of dermatology is the skin’s visibility! This allows for the opportunity to provide care through telemedicine which is great for patients with housing instability. Teledermatology is a useful way to provide dermatologic support to remote and underserved communities. Patients can speak virtually to a health care professional, from wherever they prefer, without having to worry about transportation or requesting time off from work. Continuing to offer free skin cancer screenings and free dermatology clinics around town is another great way to increase access to dermatologic care. Promoting education on skin cancer and sun protection is always important for everyone, including individuals with housing instability.
Dr. Browning is the assistant professor of pediatrics and dermatology at Baylor College of Medicine and at the University of Texas Health Science Center at San Antonio. He also serves as the chief of dermatology at the Children’s Hospital of San Antonio.
Kavina Patel, BS, Giselle Castillo, BS, and Farhan Ahmad, BS, are medical students at UT Health San Antonio.
Their abstract was published in JAAD. They have no relevant commercial or financial conflicts of interest.
Disclaimer: The views and opinions expressed in this article do not necessarily reflect those of DermWorld.
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