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Ayers BL, Short E, Cline C, Ammerman AS, Council SK, Kabua PM. Assessing the acceptability of a culturally adapted group-based pediatric intervention, Kokajjiriri, for Marshallese mothers and infants to improve nutrition and prevent childhood obesity. Child Care Health Dev 2024; 50:e13311. [PMID: 39056267 DOI: 10.1111/cch.13311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/25/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Marshallese Pacific Islanders experience higher rates of obesity than other racial and/or ethnic communities. Despite the obesity rates experienced in this community, there are currently no childhood obesity prevention interventions designed for Marshallese Pacific Islanders in the United States. The purpose of this study is to assess the acceptability and feasibility of a culturally adapted group-based pediatric intervention, Kokajjiriri, with Marshallese mothers to improve nutrition and reduce childhood obesity. METHODS A multi-methods design was used to culturally adapt the Kokajjiriri intervention for Marshallese mothers in Arkansas (n = 17). In phase one, we conducted 24-h dietary recalls with 20 Marshallese mothers to inform the cultural adaptation of the group-based pediatric intervention, and then in phase two, we culturally adapted and piloted three sessions of the intervention to determine the acceptability and feasibility of the intervention. RESULTS Participants found the adapted intervention to be acceptable and feasible, found the location to be convenient and found the facilitator to be knowledgeable. Four themes emerged from the qualitative data: (1) Lactation Support; (2) Introducing Healthy Solids; (3) Rice Portion Control; and (4) Finding Resources. CONCLUSIONS This is the first study to assess the acceptability and feasibility of a culturally adapted group-based pediatric intervention, Kokajjiriri, with Marshallese mothers to improve nutrition and reduce childhood obesity. The results from this culturally adapted group-based pediatric intervention, Kokajjiriri, will be used to inform future adaptations and implementation of the full intervention for Marshallese women and children.
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Affiliation(s)
- Britni L Ayers
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Eliza Short
- Gretchen Swanson Center for Nutrition, Omaha, Nebraska, USA
| | - Chloe Cline
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Alice S Ammerman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah K Council
- Institute for Community Health Innovation, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Philmar Mendoza Kabua
- Institute for Community Health Innovation, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
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Moore R, Callaghan-Koru J, Vincenzo JL, Patton SK, Spear MJ, Riklon S, Alik E, Padilla Ramos A, Takamaru S, McElfish PA, Curran GM. External relationships as implementation determinants in community-engaged, equity-focused COVID-19 vaccination events. FRONTIERS IN HEALTH SERVICES 2024; 4:1338622. [PMID: 38533190 PMCID: PMC10964718 DOI: 10.3389/frhs.2024.1338622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/21/2024] [Indexed: 03/28/2024]
Abstract
Background While relationships and connectedness among organizations have been included in implementation theories, models, and frameworks, the increased attention to health equity in implementation science raises the urgency of understanding the role of relationships external to the implementing organization. This paper addresses this gap through an exploration of the role of external relationships in community-based, equity-focused interventions. Methods This study focuses on an equity-focused, community-based COVID-19 vaccination intervention in Arkansas, drawing upon long-term community-engaged relationships among University of Arkansas for Medical Sciences and the Hispanic and Marshallese Islander communities. We used an exploratory qualitative descriptive design to examine barriers and facilitators to implementation of COVID-19 vaccination events analyzing in-depth qualitative interviews with implementation team members (n = 17). Results All participants described pre-existing relationships among the implementing organization, partner organizations, and communities as a key implementation determinant for this equity-focused program. At the inter-organizational level, external relationships included formal connections and informal relationships among staff (e.g., communication channels from prior partnerships). At the individual level, strong external relationships with the community were facilitators leveraging long-term engagement, community familiarity, and staff from the communities of focus. Strong external relationships facilitated program reach in underserved communities through three mechanisms: (1) reduced time required to establish functional working relationships among partners; (2) accessibility and cultural congruence of health services; and (3) increased trust among community members. Barriers to implementation also existed in external relationships, but had less influence than facilitators. Conclusions Achieving health equity in implementation science requires greater understanding of external relationships as implementation determinants. This exploratory study makes a significant contribution to the literature by describing the types of external relationships that facilitate equitable implementation and identifying the mechanisms through which they may work. We argue that approaches to community engagement drawn from community-engaged research approaches may be useful, as these processes require investment in building/maintaining formal and informal organizational and interpersonal relationships. Further research is needed to understand connections among external relationships and other implementation determinants.
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Affiliation(s)
- Ramey Moore
- Office of Community Health and Research, College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Jennifer Callaghan-Koru
- Office of Community Health and Research, College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Jennifer L. Vincenzo
- Geriatrics, College of Health Professions, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, United States
| | - Susan K. Patton
- Nursing, College of Education and Health Professions, University of Arkansas, Fayetteville, AR, United States
| | - Marissa J. Spear
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Sheldon Riklon
- Department of Family Medicine, Family Medicine Residency Training Program, College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, United States
| | - Eldon Alik
- Consulate General of Arkansas, Republic of the Marshall Islands, Springdale, AR, United States
| | - Alan Padilla Ramos
- Department of Family Medicine, Family Medicine Residency Training Program, College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, United States
| | | | - Pearl A. McElfish
- Office of Community Health and Research, College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Geoffrey M. Curran
- Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
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Mohottige D. Paving a Path to Equity in Cardiorenal Care. Semin Nephrol 2024; 44:151519. [PMID: 38960842 DOI: 10.1016/j.semnephrol.2024.151519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Cardiorenal syndrome encompasses a dynamic interplay between cardiovascular and kidney disease, and its prevention requires careful examination of multiple predisposing underlying conditions. The unequal distribution of diabetes, heart failure, hypertension, and kidney disease requires special attention because of the influence of these conditions on cardiorenal disease. Despite growing evidence regarding the benefits of disease-modifying agents (e.g., sodium-glucose cotransporter 2 inhibitors) for cardiovascular, kidney, and metabolic (CKM) disease, significant disparities remain in access to and utilization of these essential therapeutics. Multilevel barriers impeding their use require multisector interventions that address patient, provider, and health system-tailored strategies. Burgeoning literature also describes the critical role of unequal social determinants of health, or the sociopolitical contexts in which people live and work, in cardiorenal risk factors, including heart failure, diabetes, and chronic kidney disease. This review outlines (i) inequality in the burden and treatment of hypertension, type 2 diabetes, and heart failure; (ii) disparities in the use of key disease-modifying therapies for CKM diseases; and (iii) multilevel barriers and solutions to achieve greater pharmacoequity in the use of disease-modifying therapies. In addition, this review provides summative evidence regarding the role of unequal social determinants of health in cardiorenal health disparities, further outlining potential considerations for future research and intervention. As proposed in the 2023 American Heart Association presidential advisory on CKM health, a paradigm shift will be needed to achieve cardiorenal health equity. Through a deeper understanding of CKM health and a commitment to equity in the prevention, detection, and treatment of CKM disease, we can achieve this critical goal.
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Affiliation(s)
- Dinushika Mohottige
- Institute for Health Equity Research, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, NY; Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
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Morgan ER, Dillard D, Lofgren E, Maddison BK, Riklon S, McElfish P, Sinclair K. Moana: Alternate surveillance for COVID-19 in a Unique Population (MASC-UP). Contemp Clin Trials Commun 2024; 37:101246. [PMID: 38222877 PMCID: PMC10784670 DOI: 10.1016/j.conctc.2023.101246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/20/2023] [Accepted: 12/17/2023] [Indexed: 01/16/2024] Open
Abstract
Objective Create a longitudinal, multi-modal and multi-level surveillance cohort that targets early detection of symptomatic and asymptomatic COVID-19 cases among Native Hawaiian and Pacific Islander adults in the Continental US and identify effective modalities for participatory disease surveillance and sustainably integrate them into ongoing COVID-19 and other public health surveillance efforts. Materials and methods We recruited cohorts from three sites: Federal Way, WA; Springdale, AR; and remotely. Participants received a survey that included demographic characteristics and questions regarding COVID-19. Participants completed symptom checks via text message every month and recorded their temperature daily using a Kinsa smart thermometer. Results Recruitment and data collection is ongoing. Presently, 441 adults have consented to participate. One-third of participants were classified as essential workers during the pandemic. Discussion Over the past 18 months, we have improved our strategies to elicit better data from participants and have learned from some of the weaknesses in our initial deployment of this type of surveillance system. Other limitations stem from historic inequities and barriers which limited Native Hawaiian and Pacific Island representation in academic and clinical environments. One manifestation of this was the limited ability to provide study materials and support in multiple languages. We hope that continued partnership with the community will allow further opportunities to help restore trust in academic and medical institutions, thus generating knowledge to advance health equity. Conclusion This participatory disease surveillance mechanism complements traditional surveillance systems by engaging underserved communities. We may also gain insights generalizable to other pathogens of concern.
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Affiliation(s)
- Erin R. Morgan
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
| | - Denise Dillard
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
| | - Eric Lofgren
- Paul G. Allen School for Global Health, College of Veterinary Medicine, Washington State University, Pullman, WA, USA
| | | | - Sheldon Riklon
- Department of Family and Preventive Medicine, University of Arkansas for the Medical Sciences, Fayetteville, AR, USA
| | - Pearl McElfish
- Department of Internal Medicine, University of Arkansas for the Medical Sciences, Fayetteville, AR, USA
| | - Ka`imi Sinclair
- Institute for Research and Education to Advance Community Health, College of Nursing, Washington State University, Seattle, WA, USA
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Andersen JA, Rowland B, Gloster E, Felix HC, Riklon S, Jenkins D, Bing WI, Mendoza Kabua P, Hudson JS, Edem D, Niedenthal J, McElfish PA. Assessment of diabetes self-care behaviors and knowledge among Marshallese adults with type 2 diabetes in the Republic of the Marshall Islands. Prim Care Diabetes 2024; 18:74-78. [PMID: 38040537 PMCID: PMC10922376 DOI: 10.1016/j.pcd.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 10/09/2023] [Accepted: 11/19/2023] [Indexed: 12/03/2023]
Abstract
AIMS The aim of this study is to assess and document engagement in type 2 diabetes mellitus (T2DM) self-care behaviors and self-reported diabetes knowledge among Marshallese adults living in the Republic of the Marshall Islands (RMI). METHODS The study uses data from a T2DM health screening study completed in the RMI; survey and biometric data were captured as part of the health screenings. Study objectives were examined using descriptive statistics to describe the characteristics of the participants, their diabetes self-care behaviors, and their levels of self-reported diabetes knowledge. RESULTS Results indicate many Marshallese diagnosed with T2DM did not engage in adequate self-care behaviors, including blood sugar checks and foot examinations. Participants reported having forgone needed medical care and medication due to issues with cost and/or access, and participants reported low levels of diabetes knowledge. CONCLUSIONS The results demonstrate the need for further work in improving engagement in diabetes self-care by Marshallese living in the RMI. Increased engagement in self-care and diabetes education programs may help Marshallese with T2DM to improve control of their glucose and avoid long-term health complications, as well as reduce costs to the healthcare system.
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Affiliation(s)
- Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Erin Gloster
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Desiree Jenkins
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Williamina Ioanna Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Philmar Mendoza Kabua
- College of Nursing, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Jonell S Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Dinesh Edem
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Jack Niedenthal
- Republic of the Marshall Islands Ministry of Health & Human Services, PO Box 16, Majuro, MH 96960, MH
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA.
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Purvis RS, Moore R, Rojo MO, Riklon S, Alik E, Alik D, Maddison BK, McElfish PA. COVID-19 vaccine hesitancy among Marshallese in Northwest Arkansas (USA). J Public Health Res 2024; 13:22799036241231549. [PMID: 38440055 PMCID: PMC10910884 DOI: 10.1177/22799036241231549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/23/2024] [Indexed: 03/06/2024] Open
Abstract
Background COVID-19 has disproportionately affected Pacific Islander communities, with disparities in the prevalence of infection, serious illness, and death compared to non-Hispanic whites in the US. Marshallese Pacific Islanders face significant COVID-19 disparities. Design and methods This exploratory study aimed to understand Marshallese community attitudes about the COVID-19 vaccine to identify and implement culturally relevant strategies to encourage vaccine uptake. Data were collected from 17 participants in three focus groups. Results Using content analysis, researchers identified two global themes: (1) barriers to vaccination and (2) facilitators of COVID-19 vaccine uptake. Within these themes, participants described fear, lack of knowledge about vaccines, negative perceptions of the COVID-19 vaccine, health concerns, and transportation as barriers to vaccination. Participants described several factors influencing vaccine behavior, including location of and personnel at vaccine clinics, vaccine experiences, the need for trusted information, positive perceptions, cultural leaders, and mandates. Conclusions The qualitative study makes a significant contribution as the first to report community perceptions and experiences related to the COVID-19 vaccine in Marshallese participants' own words. Findings show that cultural influencers and brokers are crucial bridges for public health messaging related to COVID-19 vaccination targeted to this vulnerable and underserved population. Culturally appropriate and effective public health messaging can help achieve vaccine equity and improve COVID-19-related health disparities in the Marshallese community.
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Affiliation(s)
- Rachel S Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Martha O Rojo
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR, USA
| | - Eldon Alik
- Republic of the Marshall Islands Consulate, Springdale, AR, USA
| | - Derek Alik
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | | | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
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Andersen JA, Rowland B, Gloster E, O’Connor G, Ioanna Bing W, Niedenthal J, Riklon S, McElfish PA. Undiagnosed hypertension and type 2 diabetes mellitus among Marshallese adults in the Republic of the Marshall Islands. THE JOURNAL OF MEDICINE ACCESS 2024; 8:27550834231225159. [PMID: 38282818 PMCID: PMC10812094 DOI: 10.1177/27550834231225159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024]
Abstract
Background Given the lack of healthcare access in the Republic of the Marshall Island (RMI) and the potential for complications related to type 2 diabetes mellitus (T2DM) and hypertension, it is crucial to examine these conditions among Marshallese in the RMI. Objectives This study aims to identify the proportion of Marshallese adults in the RMI with undiagnosed T2DM and hypertension. Design Using a community-based participatory research approach, screening events were conducted at 20 churches in Majuro Atoll. Methods Participants completed a questionnaire and biometric data measures, including hemoglobin A1c and blood pressure. Results Among participants with blood pressure data (N = 528), 11.9% had readings indicative of hypertension, and 38.1% were undiagnosed. Among participants with hemoglobin A1c (HbA1c) data (N = 450), 45.3% had readings indicative of T2DM, and 39.2% were undiagnosed. Conclusion This study utilized a community-based participatory research approach that promotes equitable and ethical research. Results reaffirm the need to identify strategies for increasing healthcare access and for research to address health disparities in the RMI.
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Affiliation(s)
- Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Erin Gloster
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Gail O’Connor
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Williamina Ioanna Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Jack Niedenthal
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
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Essex W, Mera J, Comiford A, Winters A, Feder MA. Assessing the Feasibility, Acceptability, and Effectiveness of a Pilot Hepatitis C Screening Program at Food Distribution Sites in Cherokee Nation, Oklahoma. J Community Health 2023; 48:982-993. [PMID: 37531046 PMCID: PMC10558369 DOI: 10.1007/s10900-023-01264-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2023] [Indexed: 08/03/2023]
Abstract
Compared with other racial and ethnic groups in the United States, American Indian and Alaska Native (AI/AN) people experience the highest incidence of acute hepatitis c (HCV). Cherokee Nation Health Services (CNHS) implemented a pilot health screening program from January through May 2019 to assess whether conducting HCV and other preventive health screenings at food distribution sites is a feasible, acceptable, and effective strategy to increase health screening among underserved community members. Data were collected among 340 eligible participants. Most (76%) participants reported being very comfortable receiving health screenings at food distribution sites and that getting screened at food distribution sites is very easy (75.4%). Most (92.1%, n = 313) participants received HCV screening, with 11 (3.5%) individuals testing positive for HCV antibodies. Of the 11 HCV seropositive individuals, six were confirmed to have active HCV infection of which four initiated treatment. Most (55.7%) participants exhibited a body mass index in the obese range, 33.1% exhibited high hemoglobin A1C (> 6.0), 24.5% exhibited high (> 200) cholesterol, 44.6% exhibited high blood pressure ( > = 140/90), and 54.8% did not have a current primary care provider. This project demonstrated that conducting HCV and other health screenings at food distribution sites within Cherokee Nation was an effective strategy to engage AI/AN people in preventive health screenings. Future programs are needed to scale-up preventive health screenings outside of traditional medical facilities as these types of screenings may help to decrease the HCV disparities among AI/AN people.
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Affiliation(s)
- Whitney Essex
- Department of Infectious Diseases, Cherokee Nation Outpatient Health Center, Cherokee Nation Health Services, 19600 East Ross St, Tahlequah, Ok, 74464, USA.
| | - Jorge Mera
- Department of Infectious Diseases, Cherokee Nation Outpatient Health Center, Cherokee Nation Health Services, 19600 East Ross St, Tahlequah, Ok, 74464, USA
| | - Ashley Comiford
- Department of Infectious Diseases, Cherokee Nation Outpatient Health Center, Cherokee Nation Health Services, 19600 East Ross St, Tahlequah, Ok, 74464, USA
| | - Amanda Winters
- Cardea Services, 1809 7th Ave #600, Seattle, WA, 98101, USA
| | - Molly A Feder
- Cardea Services, 1809 7th Ave #600, Seattle, WA, 98101, USA
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Narruhn RA, Espina CR. "I've Never Been to a Doctor": Health Care Access for the Marshallese in Washington State. ANS Adv Nurs Sci 2023; 46:424-440. [PMID: 36094285 DOI: 10.1097/ans.0000000000000456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Ri Majel (Marshallese) migrants of Washington State have endured health inequities and unique laws dictating their access to health care once they arrive to the United States. These health inequities can be seen to be a result of historical trauma and militarization of their islands. The research question was an inquiry regarding access to health care for the Ri Majel in Washington State. We first provide detailed historical data in the background to contextualize our research inquiry. We interviewed 12 people and using manifest content analysis found 2 main themes regarding the health of the Ri Majel: (1) health care access and inequity and (2) historical trauma and embodiment. Health care access was impeded by (1) ongoing effects of radiation, (2) repeated denial of services, (3) lack of health care and insurance, (4) lack of language interpretation during health care visits, and (5) poverty. Historical trauma and embodiment were evidenced by these findings: (1) illness and early mortality; (2) provider lack of knowledge and understanding of the Ri Majel; (3) structural discrimination; (4) feelings of sadness and despair; (5) shyness and humility; and (6) a sense of "cannot/will not" and fatalism. Our findings demonstrate the need to examine structural factors when assessing health inequities and a need to understand and mitigate the effects of historical trauma enacted by structural racism, violence, and colonialism. Strategies to mitigate the embodiment of historical trauma require further investigation.
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Affiliation(s)
- Robin A Narruhn
- College of Nursing, Seattle University, Seattle, Washington (Dr Narruhn); and RN-to-BSN Program, Department of Health & Community Studies, Western Washington University, Bellingham (Dr Espina)
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Reece S, McElfish PA, Andersen JA, Ayers BL, Tiwari T, Willis DE, Rowland B, Norris JD, Beasley K, Mendoza Kabua P, Brown CC. Application Status Among Women Enrolled in a Healthy Start Program in Arkansas for the Special Nutrition Program for Women and Children. J Community Health 2023; 48:724-730. [PMID: 37000375 PMCID: PMC10063932 DOI: 10.1007/s10900-023-01215-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 04/01/2023]
Abstract
This study aimed to examine the demographic characteristics of pregnant women in a Healthy Start program who are presumed eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), but who have not yet applied for WIC benefits. We used a cross sectional evaluation of data collected from pregnant women (n=203) participating in a Healthy Start program. Data came from surveys administered at enrollment in the Healthy Start program from July 15th, 2019 until January 14th, 2022. The primary outcome was WIC application status, which was determined by whether the woman had applied or was receiving benefits at the time of enrollment. Covariates included race/ethnicity, marital status, insurance, education, income, age, employment, and having previous children/pregnancies. Fisher exact tests and logistic regression were used to examine associations. Approximately 65% of women had not yet applied for WIC benefits. Marshallese women (80.9%) and other NHPI women (80.0%) had the highest need for assistance. In adjusted analyses, White women (p = 0.040) and Hispanic women (p = 0.005) had lower rates of needing assistance applying for WIC than Marshallese women. There were higher rates of needing assistance in applying for women with private insurance or with no insurance and for those with higher incomes. Nearly two out of every three pregnant women who were eligible for WIC had not yet applied for benefits. The findings highlight the need for outreach for all populations that may be eligible, particularly among racial/ethnic minorities and those with higher incomes.
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Affiliation(s)
- Sharon Reece
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, AR 72703 USA
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703 USA
| | - Pearl A. McElfish
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 2708 S. 48th Street, Springdale, AR 72762 USA
| | - Jennifer A. Andersen
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 2708 S. 48th Street, Springdale, AR 72762 USA
| | - Britni L. Ayers
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 2708 S. 48th Street, Springdale, AR 72762 USA
| | - Tanvangi Tiwari
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th Street, Springdale, AR 72762 USA
| | - Don E. Willis
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 2708 S. 48th Street, Springdale, AR 72762 USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th Street, Springdale, AR 72762 USA
| | - Jacqueline D. Norris
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703 USA
| | - Kristen Beasley
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, AR 72703 USA
| | - Philmar Mendoza Kabua
- College of Nursing, University of Arkasnas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703 USA
| | - Clare C. Brown
- University of Arkansas for Medical Sciences Fay W Boozman College of Public Health, 4301 W. Markham St, Little Rock, AR 72205 USA
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Long CR, Narcisse MR, Selig JP, Willis DE, Gannon M, Rowland B, English ES, McElfish PA. Prevalence and associations between food insecurity and overweight/obesity among native Hawaiian and Pacific Islander adolescents. Public Health Nutr 2023; 26:1338-1344. [PMID: 37069046 PMCID: PMC10346012 DOI: 10.1017/s1368980023000769] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/20/2023] [Accepted: 04/01/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE This study estimates the prevalence of, and associations between, family food insecurity and overweight/obesity among Native Hawaiian and Pacific Islander (NHPI) adolescents and explores socio-demographic factors which might have a moderation effect on the association. DESIGN Cross-sectional study using 2014 NHPI-National Health Interview Survey data reported by a parent or guardian. Family-level food security was assessed by the US Department of Agriculture 10-item questionnaire. BMI for age and sex ≥ 85th and 95th percentiles defined overweight and obesity, respectively, according to US Centers for Disease Control and Prevention criteria. SETTING The USA, including all 50 states and the District of Columbia. PARTICIPANTS 383 NHPI adolescents aged 12-17 in the USA. RESULTS A third (33·5 %) of NHPI adolescents aged 12-17 were overweight (19·1 %) or obese (14·4 %); 8·1 % had low food security; and 8·5 % had very low food security. Mean family food security score was 1·06, which corresponds to marginal food security. We found no association between family food insecurity and adolescent overweight/obesity or between any other covariates and overweight/obesity, except for family Supplemental Nutrition Assistance Program (SNAP) participation. Odds of being overweight/obese were 77 % lower for adolescents in families participating in SNAP (OR: 0·23, 95 % CI: 0·08, 0·64, P = 0·007). The association between SNAP participation and lower odds of overweight/obesity was particularly pronounced for adolescent girls in food-insecure families. CONCLUSIONS The association between SNAP participation and lower odds of overweight/obesity suggests potential benefit of research to determine whether interventions to increase SNAP enrollment would improve NHPI adolescents' health outcomes.
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Affiliation(s)
- Christopher R Long
- University of Arkansas for Medical Sciences Northwest, College of Medicine, Fayetteville, AR72703, USA
| | - Marie-Rachelle Narcisse
- University of Arkansas for Medical Sciences Northwest, College of Medicine, Fayetteville, AR72703, USA
| | - James P Selig
- University of Arkansas for Medical Sciences Northwest, Fay W. Boozman College of Public Health, Fayetteville, AR, USA
| | - Don E Willis
- University of Arkansas for Medical Sciences Northwest, College of Medicine, Fayetteville, AR72703, USA
| | - Matthew Gannon
- University of Arkansas for Medical Sciences Northwest, Office of Community Health and Research, Fayetteville, AR, USA
| | - Brett Rowland
- University of Arkansas for Medical Sciences Northwest, Office of Community Health and Research, Fayetteville, AR, USA
| | - Emily S English
- University of Arkansas for Medical Sciences Northwest, College of Medicine, Fayetteville, AR72703, USA
| | - Pearl A McElfish
- University of Arkansas for Medical Sciences Northwest, College of Medicine, Fayetteville, AR72703, USA
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Short E, Gannon MA, Bounds K, Faitak B, Martin P, Moore S, Shannon D, Selig JP, English ES, Felix HC, Haggard-Duff L, Mejia-Otero J, McElfish PA, Long CR. An integrated approach to address diabetes in the context of food insecurity: Delivering health study protocol. Contemp Clin Trials Commun 2023; 33:101139. [PMID: 37215390 PMCID: PMC10195850 DOI: 10.1016/j.conctc.2023.101139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 05/24/2023] Open
Abstract
Background Diabetes self-management education and support (DSMES) interventions among food insecure individuals with type 2 diabetes (T2D) have found modest improvements in nutrition and health outcomes but are limited by barriers to attendance and retention. This study applies a community-based participatory research approach, engaging community members at all levels of intervention planning, development, implementation, and dissemination, to deliver a plain-language DSMES curriculum to food insecure community members with T2D. Methods This is a single-arm, pre-post design assessing the efficacy of a 12-week home-delivered DSMES curriculum and T2D-appropriate food box intervention to improve the nutrition and health outcomes of food insecure individuals with T2D. The intervention consists of a weekly food box delivery and handout with video links on key DSMES topics, developed and refined using community advisor feedback. Up to 100 English-, Spanish-, or Marshallese-speaking adult participants with T2D (HbA1c ≥ 7%) and food insecurity are being recruited from food pantries in northwest Arkansas. Data is collected at pre-intervention and immediately post-intervention. The primary study outcome is change in HbA1c. Secondary measures include diet quality (Healthy Eating Index-2015, calculated from 3 24-h dietary recall interviews via phone), body mass index, blood pressure, skin carotenoids, food security, T2D self-management behaviors, T2D self-efficacy, and T2D-related distress. Results Recruitment began in August 2021 and enrollment is anticipated to be complete in March 2023. Conclusion Findings from this study will provide a rich understanding of diabetes-related health outcomes and dietary patterns of individuals with food insecurity and T2D and inform future food-focused DSMES interventions in this setting.
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Affiliation(s)
- Eliza Short
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Matthew A. Gannon
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Kelsey Bounds
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Bonnie Faitak
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Pam Martin
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Sarah Moore
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - DeAnna Shannon
- Samaritan Community Center, 1211 W. Hudson Rd., Rogers, AR, 72756, USA
| | - James P. Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Emily S. English
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Holly C. Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Lauren Haggard-Duff
- College of Nursing, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Juan Mejia-Otero
- Department of Pediatric Endocrinology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Christopher R. Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
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Andersen JA, Rowland B, O'Connor G, Bing WI, Riklon S, Mendoza-Kabua P, McElfish PA. Faith-based health screenings for Marshallese adults living in the Republic of the Marshall Islands: Study design and results. Front Public Health 2023; 11:1075763. [PMID: 37056659 PMCID: PMC10089260 DOI: 10.3389/fpubh.2023.1075763] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Introduction Striking health disparities exist in the Republic of the Marshall Islands (RMI). The RMI has one of the highest age-adjusted type 2 diabetes mellitus (T2DM) rates in the world (23.0%) compared to global (9.3%) and United States (US; 13.3%) rates. We conducted health screenings including clinical indicators of T2DM and hypertension among Marshallese in the RMI. Methods Screenings were conducted at 20 churches on Majuro Atoll. Participants completed questionnaires and biometric data collection assessing glycated hemoglobin (HbA1c), blood pressure, and body mass index. Results Screenings included 528 participants and showed a high prevalence of T2DM, obesity, and hypertension. One-third of participants were referred to the non-communicable disease clinic. The percent of adults in this study with T2DM-indicative HbA1c (48.5%) is higher than observed at the national level (23.0%). Discussion Results highlight the need for non-communicable disease-related programs in the RMI.
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Affiliation(s)
- Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Gail O'Connor
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Williamina Ioanna Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | | | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
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Ayers BL, Purvis RS, Callaghan-Koru J, Reece S, CarlLee S, Manning N, Langston K, Riklon S, McElfish PA. Marshallese Mothers' and Marshallese Maternal Healthcare Providers' Perspectives on Contraceptive Use and Reproductive Life Planning Practices and Influences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3949. [PMID: 36900960 PMCID: PMC10001766 DOI: 10.3390/ijerph20053949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/31/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Pacific Islander communities experience significant maternal and infant health disparities including high maternal and infant mortality. Contraception and reproductive life planning prevent approximately one-third of pregnancy-related deaths and neonatal deaths. We report the results of formative research devoted to understanding Marshallese mothers' as well as their maternal healthcare providers' practices and influences related to contraceptive use and reproductive life planning. This study used an exploratory, descriptive qualitative design to explore Marshallese mothers' and maternal healthcare providers' practices and influences of contraception use and reproductive life planning. Twenty participants were enrolled in the study, 15 Marshallese mothers and five Marshallese maternal healthcare providers. For the Marshallese mothers, two themes emerged: (1) Reproductive Life Planning Practices and Information; and (2) Reproductive Life Planning Influences. For the Marshallese maternal healthcare providers, two themes emerged: (1) Reproductive Life Planning Practices; and (2) Reproductive Life Planning Influences. This is the first study to document Marshallese mothers' and maternal healthcare providers' practices and influences with contraceptive use and reproductive life planning. Study results will inform the development of a culturally-adapted contraception and reproductive life planning tool with an educational program for Marshallese family units and maternal healthcare providers serving Marshallese women.
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Affiliation(s)
- Britni L. Ayers
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Jennifer Callaghan-Koru
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR 72701, USA
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR 72701, USA
| | - Nirvana Manning
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR 72205, USA
| | - Krista Langston
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR 72762, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
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15
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McElfish PA, Felix HC, Bursac Z, Rowland B, Yeary KHK, Long CR, Selig JP, Kaholokula JK, Riklon S. A Cluster Randomized Controlled Trial Comparing Diabetes Prevention Program Interventions for Overweight/Obese Marshallese Adults. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231152051. [PMID: 36799349 PMCID: PMC9940234 DOI: 10.1177/00469580231152051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/15/2022] [Accepted: 01/03/2023] [Indexed: 02/18/2023]
Abstract
This study compared the effectiveness of two Diabetes Prevention Program (DPP) interventions on weight loss among overweight and obese Marshallese adults. The study was a two-arm cluster randomized controlled trial conducted in 30 churches in Arkansas and Oklahoma. Marshallese adults with a body mass index ≥25 kg/m2 were eligible for the study. The study sample included 380 participants. Participants received either a faith-based adaptation of the DPP or a family-focused adaptation of the DPP, each delivered over 24 weeks. The primary outcome was weight change from baseline. Secondary outcomes included changes in Hemoglobin A1c, blood pressure, dietary intake, family support for healthy behaviors, and physical activity. Outcomes were examined longitudinally using general linear mixed effects regression models, adjusting for baseline outcomes, sociodemographic covariates, and clustering of participants within churches. Reductions in weight were small for both groups. Overall, only 7.1% of all participants lost 5% or more of their baseline body weight. There were no significant differences in weight loss between the 2 arms at 6 months (P = .3599) or at 12 months (P = .3207). Significant differences in systolic and diastolic blood pressure were found between the 2 arms at 6 months (P = .0293; P = .0068, respectively). Significant within-arm changes were found for sugar-sweetened beverage consumption and family support for both arms at both follow-ups. Both interventions achieved a modest weight loss. While even modest weight loss can be clinically significant, future research is needed to identify chronic disease prevention interventions that can successfully reduce weight for this at-risk population.
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Affiliation(s)
- Pearl A. McElfish
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Holly C. Felix
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Zoran Bursac
- Florida International University, Miami, FL, USA
| | - Brett Rowland
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | | | | | - James P. Selig
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | | | - Sheldon Riklon
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
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Andersen JA, Willis DE, Malhis JR, Long CR, McElfish PA. The Association Between Education and Basic Needs Insecurity for Marshallese During the COVID-19 Pandemic. J Racial Ethn Health Disparities 2022; 9:1882-1887. [PMID: 34403123 PMCID: PMC8370049 DOI: 10.1007/s40615-021-01125-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study was to explore the prevalence of basic needs insecurity and to examine the association between education and basic needs insecurity during the COVID-19 pandemic for Marshallese living in the USA. METHODS Survey data describing Marshallese experiences during the pandemic were analyzed using descriptive statistics and complementary log-log regression to test the association between education and basic needs insecurity. RESULTS Marshallese respondents reported no usual source of care (46%), less healthcare (22.3%), and difficulty obtaining medication (34.8%). Nearly 80% reported being food insecure, and 47.5% reported being housing insecure. Marshallese with a high school education or less had higher odds of reporting being food and housing insecure. DISCUSSION Basic needs insecurities are a serious threat to the health of Marshallese during the pandemic. Results from this study can inform interventions addressing food and housing insecurity, access to healthcare, and medication access for Marshallese communities.
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Affiliation(s)
- Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Joseph R Malhis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Christopher R Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA.
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Study protocol for family model diabetes self-management education with Marshallese participants in faith-based organizations. Contemp Clin Trials Commun 2022; 30:101007. [PMID: 36186543 PMCID: PMC9515595 DOI: 10.1016/j.conctc.2022.101007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/25/2022] [Accepted: 09/17/2022] [Indexed: 01/12/2023] Open
Abstract
Background Culturally-appropriate family models of diabetes self-management education and support (DSMES) using community health workers (CHWs) have been shown to help address barriers to improving type 2 diabetes mellitus (T2DM) self-management for racial/ethnic minority communities; however, there is limited DSMES research among Marshallese and other Pacific Islanders. Using a community-based participatory research approach, we engaged community stakeholders to co-design a study to implement a culturally adapted family model DSMES (F-DSMES) intervention in faith-based organizations (FBOs) (i.e., churches). Methods Using a cluster-randomized controlled trial design, we will assess the effectiveness of the F-DSMES intervention for Marshallese patients with T2DM in Arkansas and Oklahoma. Twenty-four FBOs (with 12 primary participants per FBO) will be randomized to one of two study arms: the intervention arm or the wait-list control arm. Primary participants must have at least one family member willing to attend education sessions and data collection events. The F-DSMES intervention consists of ten h of diabetes education delivered by CHWs over eight to ten weeks. Data will be collected from the intervention arm at pre-intervention (baseline), immediate post-intervention (12 weeks), and three months post-intervention. The wait-list control arm will complete a second pre-intervention data collection before receiving the intervention. The primary study outcome will be glycemic control, as measured by HbA1c. Secondary measures include glucose, weight, body mass index, blood pressure, diabetes self-management behaviors, and diabetes management self-efficacy. Conclusion The knowledge gained from this research will inform future DSMES and other health promotion interventions conducted with Marshallese and other Pacific Islander communities.
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Bogulski CA, Willis DE, Williams CA, Ayers BL, Andersen JA, McElfish PA. Stressful life events and social support among pregnant Marshallese women. Matern Child Health J 2022; 26:1194-1202. [PMID: 35551586 PMCID: PMC9095441 DOI: 10.1007/s10995-022-03404-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 01/12/2022] [Accepted: 03/03/2022] [Indexed: 11/26/2022]
Abstract
Introduction Women from racial and ethnic minority groups in the United States are disproportionately likely to experience adverse perinatal outcomes such as preterm birth, low birthweight infants, and infant mortality. Previous research has demonstrated that exposure to stressful life events and social support may influence perinatal outcomes. Although studies have documented stressful life events and social support for the general United States population and minority groups, less is known about the experiences of Pacific Islander women in the United States, and no prior studies have documented these experiences in Marshallese Pacific Islander women. Methods The present study examined data collected from pregnant Marshallese women (n = 67) in northwest Arkansas participating in a women’s health program using descriptive analyses (means, standard deviations, proportions). Results Results indicated a high prevalence of three stressful life events: experiencing a family member going into the hospital (35.8%), someone close to them dying (29.9%), and being unable to pay bills (53.7%). Food insecurity was higher than previously reported for pregnant women or Pacific Islanders (83.7%). Social support was high among the sample. A majority of women reported receiving help with daily chores (86.6%), help when sick (88.1%), and support on how to deal with personal problems (85.1%). Discussion This study is the first to document the prevalence of stressful life events and social support in a sample of pregnant Marshallese women living in the United States. The findings provide important information to guide efforts to reduce adverse perinatal outcomes in a Pacific Islander population.
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Affiliation(s)
- Cari A. Bogulski
- University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, 72703-1908 Fayetteville, AR United States
| | - Don E. Willis
- University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, 72703-1908 Fayetteville, AR United States
| | - Christina A. Williams
- University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, 72703-1908 Fayetteville, AR United States
| | - Britni L. Ayers
- University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, 72703-1908 Fayetteville, AR United States
| | - Jennifer A. Andersen
- University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, 72703-1908 Fayetteville, AR United States
| | - Pearl A. McElfish
- University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, 72703-1908 Fayetteville, AR United States
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McElfish PA, Rowland B, Scott AJ, Niemeier J, Hoose DV, Long CR. Sugar-sweetened beverage consumption is associated with higher body mass index among Marshallese adults in Arkansas. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2021.1915907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, Arkansas USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, Arkansas USA
| | - Aaron J. Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, Arkansas USA
| | - Jill Niemeier
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, Arkansas USA
| | - Dalton V. Hoose
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, Arkansas USA
| | - Christopher R. Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, Arkansas USA
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Yang HH, Dhanjani SA, Chwa WJ, Cowgill B, Gee G. Disparity in Obesity and Hypertension Risks Observed Between Pacific Islander and Asian American Health Fair Attendees in Los Angeles, 2011-2019. J Racial Ethn Health Disparities 2022; 10:1127-1137. [PMID: 35426057 PMCID: PMC9009494 DOI: 10.1007/s40615-022-01300-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The Pacific Islander American population is understudied due to being aggregated with Asian Americans. In this study, we conduct a comparative analysis of directly measured body mass index (BMI), body fat percentage (%BF), and blood pressure (BP) between Pacific Islander Americans and Asian Americans from health screenings in Los Angeles, California. We hope to reveal intra-APIA health disparities masked by this data aggregation. METHODS We analyzed BMI, %BF, and BP that were objectively measured by trained personnel at health screenings in Los Angeles between January 2011 and December 2019. We performed multivariable multinomial logistic regression models with obesity and hypertensive categories as outcome variables and ethnicity as the primary independent variable of interest. Models controlled for year of visit, participant age, sex, income, education level, years living in the USA, employment status, English proficiency, regular doctor access, and health insurance status. RESULTS A total of 4,832 individuals were included in the analysis. Multivariable analyses revealed that Pacific Islander participants were at significantly higher risks for being classified as obese compared with all Asian American subgroups studied, including Chinese, Korean, Thai, Vietnamese, Filipino, and Japanese. Pacific Islanders also exhibited significantly lower predicted probability of having a normal blood pressure compared with Chinese and Thai participants. Some variation between Asian subgroups were also observed. CONCLUSIONS Pacific Islander participants had higher risk of several sentinel health problems compared to Asian American participants. Disaggregation of PI Americans from the APIA umbrella category in future studies is necessary to unmask the critical needs of this important community.
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Affiliation(s)
- Hong-Ho Yang
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Won Jong Chwa
- Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Burton Cowgill
- Fielding School of Public Health, Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA, USA
| | - Gilbert Gee
- Fielding School of Public Health, Department of Community Health Sciences, University of California, Los Angeles, 650 Charles Young Drive South, 46-081C, CHS, Los Angeles, CA, 90095, USA.
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McElfish PA, Rowland B, Scott AJ, Boyers J, Long CR, Felix HC, Kaholokula JK, Sinclair K, Bursac Z, Riklon S. Examining the Relationship Between Physical Activity and Self-Efficacy for Exercise Among Overweight and Obese Marshallese Adults. J Immigr Minor Health 2022; 24:461-468. [PMID: 33837895 PMCID: PMC9540904 DOI: 10.1007/s10903-021-01194-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 01/26/2023]
Abstract
This study examined associations between physical activity frequency and self-efficacy for exercise (SEE) among Marshallese adults in the United States. Data were collected from overweight and obese Marshallese participants (N = 378) enrolled in a Diabetes Prevention Program trial. Logistic and ordinal logistic regressions were employed to examine associations between physical activity and SEE, adjusting for covariates. SEE was significantly associated with engaging in sufficient total physical activity [odds ratio (OR) = 1.70], moderate physical activity (OR = 2.23), and vigorous physical activity (OR = 2.13). Unemployment was associated with less frequent moderate physical activity (OR = 0.59). Younger age (OR = 0.98), being male (OR = 2.67), and reporting excellent health (OR = 3.14) or good health (OR = 2.06) were associated with more frequent vigorous physical activity. Physical activity is a modifiable lifestyle behavior associated with many chronic disease disparities faced by the Marshallese community, and the study results will be useful for practitioners and researchers working to address these disparities.
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA.
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Janine Boyers
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Christopher R Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Joseph Keawe'aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii At Manoa, Honolulu, HI, 96813, USA
| | - Ka'imi Sinclair
- Institute for Research and Education To Advance Community Health, College of Nursing, Washington State University, Seattle, WA, 98101, USA
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health, Florida International University, Miami, FL, 33199, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
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22
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Hallgren E, Moore R, Riklon S, Alik E, McElfish PA. Pandemic-Amplified Material Hardship and Community-Led Support among Marshallese Diasporic Communities in the United States. JOURNAL OF POVERTY 2022; 27:252-267. [PMID: 37346477 PMCID: PMC10281722 DOI: 10.1080/10875549.2022.2053924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
This article explores the experiences of Marshallese diasporic migrants in the United States (U.S.) during the COVID-19 pandemic in relation to material hardship and community-led relief efforts. Focus groups with 53 Marshallese migrants in three states revealed that material hardship, including food and housing insecurity, inadequate healthcare, and difficulty paying bills, intensified among their communities during the pandemic. In response, Marshallese community-based groups provided relief to their fellow community members, including food, cash assistance, and personal protective equipment. The findings fit a pattern of intensified hardship and community-led relief among marginalized communities in the U.S. during the COVID-19 pandemic.
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Affiliation(s)
- Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR 72703 USA
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR 72703 USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR 72703 USA
| | - Eldon Alik
- Consulate General of Arkansas, Republic of the Marshall Islands, 109 Spring St #3, Springdale, AR 72764 USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR 72703 USA
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23
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Purvis RS, Moore RA, Ayers BL, Felix HC, Riklon S, Andersen JA, Hudson JS, O'Connor G, Kelen M, Heely-Rolston LAN, Shields X, McElfish PA. Diabetes Self-Care Behaviors and Barriers to Clinical Care During COVID-19 Pandemic for Marshallese Adults. Sci Diabetes Self Manag Care 2022; 48:35-43. [PMID: 35023402 PMCID: PMC9082400 DOI: 10.1177/26350106211065390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the study was to explore experiences of Marshallese adults related to diabetes self-care behaviors during the COVID-19 pandemic. METHODS A qualitative descriptive design was utilized to understand participants' diabetes self-care behaviors during the pandemic. Nine focus groups with 53 participants were held via videoconference and conducted in English, Marshallese, or a mixture of both languages. A priori codes based on diabetes self-care behaviors provided a framework for analyzing and summarizing participant experiences. RESULTS Both increases and decreases in healthy eating and exercise were described, with improvements in health behaviors attributed to health education messaging via social media. Participants reported increased stress and difficulty monitoring and managing glucose. Difficulty obtaining medication and difficulty seeing their health care provider regularly was reported and attributed to health care provider availability and lack of insurance due to job loss. CONCLUSIONS The study provides significant insight into the reach of health education campaigns via social media and provides important information about the reasons for delays in care, which extend beyond fear of contracting COVID-19 to structural issues.
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Affiliation(s)
- Rachel S Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Ramey A Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Britni L Ayers
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Jonell S Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Gail O'Connor
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Meetu Kelen
- West Hawaii Community Health Center, Kailua-Kona, Hawaii
| | | | - Xochitl Shields
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
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24
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Long CR, Narcisse MR, Bailey MM, Rowland B, English E, McElfish PA. Food insecurity and chronic diseases among Native Hawaiians and Pacific Islanders in the US: results of a population-based survey. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022; 17:53-68. [PMID: 35432687 PMCID: PMC9012098 DOI: 10.1080/19320248.2021.1873883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Data from the 2014 Native Hawaiian and Pacific Islander (NHPI) National Health Interview Survey were used to examine associations between food security and individual chronic diseases, total number of chronic diseases, and general health status among 637 NHPI adults with income below 200 percent federal poverty level. Very low food security was associated with hypertension, diabetes, and asthma. Very low food security and marginal food security were associated with having any chronic disease and with having a higher number of chronic diseases. Risk for food insecurity increased as health status decreased. These associations had not previously been documented for NHPI.
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Affiliation(s)
- Christopher R. Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Avenue, Fayetteville, AR, USA
| | - Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Avenue, Fayetteville, AR, USA
| | - Mary M. Bailey
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N College Avenue, Fayetteville, AR, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N College Avenue, Fayetteville, AR, USA
| | - Emily English
- Department of Pediatrics, University of Arkansas for Medical Sciences Northwest, 1125 N College Avenue, Fayetteville, AR, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Avenue, Fayetteville, AR, USA
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25
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Ayers BL, Bogulski CA, Andersen JA, Børsheim E, McElfish PA. Gestational weight gain influences, beliefs, and goals among Marshallese pregnant women in Arkansas: a mixed-methods analysis. Am J Transl Res 2021; 13:13993-14004. [PMID: 35035741 PMCID: PMC8748145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/09/2021] [Indexed: 06/14/2023]
Abstract
Despite the high rate of maternal and child health disparities among the Marshallese, there are no studies documenting gestational weight gain influences, beliefs, and goals among the Marshallese. From March 2019 to March 2020, a purposive sample of 33 participants took part in the mixed methods study. Two themes emerged: (1) Gestational Weight Gain Influences and (2) Excessive Gestational Weight Gain Perceptions. In the first theme there were three subthemes: (a) Church and Familial Influence on Gestational Weight Gain; (b) Healthy Gestational Weight Gain; and (c) Lack of Healthcare Provider Influence on Gestational Weight Gain. In the second theme there were three subthemes: (a) Excessive Weight Gain and Pregnancy; (b) Excessive Gestational Weight Gain and Labor; and (c) Gestational Weight Gain Goals. This study will be used to culturally tailor interventions to help Marshallese women reduce maternal and infant health disparities in Marshallese communities.
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Affiliation(s)
- Britni L Ayers
- College of Medicine, University of Arkansas for Medical Sciences NorthwestFayetteville, AR 72703, USA
| | - Cari A Bogulski
- College of Medicine, University of Arkansas for Medical Sciences NorthwestFayetteville, AR 72703, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences NorthwestFayetteville, AR 72703, USA
| | - Elisabet Børsheim
- Arkansas Children’s Nutrition Center, University of Arkansas for Medical SciencesLittle Rock, AR 72212, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences NorthwestFayetteville, AR 72703, USA
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26
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McElfish PA, Willis DE, Bogulski C, Kelen M, Riklon S, Alik E, Laelan M, Brown AL, Sinclair KA, Andersen JA, Amick BC, Williams M. COVID-19 Vaccine Willingness and Hesitancy Among Marshallese Pacific Islanders. J Patient Exp 2021; 8:23743735211056428. [PMID: 34825050 PMCID: PMC8609098 DOI: 10.1177/23743735211056428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
COVID-19 has disproportionally burdened racial and ethnic minorities. Minority populations report greater COVID-19 vaccine hesitancy; however, no studies document COVID-19 vaccine willingness among Marshallese or any Pacific Islander group, who are often underrepresented in research. This study documents United States (US) Marshallese Pacific Islanders': willingness to get the COVID-19 vaccine, willingness to participate in vaccine trials, and sociodemographic factors associated with willingness. From July 27, 2020-November 22, 2020, a convenience sample of US Marshallese adults were recruited through e-mail, phone calls, and a Marshallese community Facebook page to participate in an online survey. Of those surveyed (n = 120), 32.5% were extremely likely to get the COVID-19 vaccine; 20.8% were somewhat likely; 14.2% were unlikely or very unlikely; and 26.7% stated they did not know or were not sure. Only 16.7% stated they were willing to participate in a COVID-19 vaccine trial. Vaccine willingness was positively associated with older age, higher income, and longer US residence. Health insurance status and having a primary care provider were positively associated with vaccine willingness. Findings demonstrate within-group variation in COVID-19 vaccine willingness.
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Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Cari Bogulski
- Office of Community Health and Research, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Meetu Kelen
- West Hawaii Community Health
Center, Kailua, HI, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Eldon Alik
- Consul General – Arkansas, Republic of the Marshall Islands,
Springdale, AR, USA
| | - Melisa Laelan
- Arkansas Coalition of
Marshallese, Springdale, AR, USA
| | | | - Ka’imi A. Sinclair
- Institute for Research and Education to Advance Community Health
(IREACH), Washington State University, Pullman, WA, USA
- College of Nursing, Washington State University, Pullman, WA, USA
| | - Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Benjamin C. Amick
- Fay W. Boozman College of Public Health, University of Arkansas for Medical
Sciences, Little Rock, AR, USA
| | - Mark Williams
- Fay W. Boozman College of Public Health, University of Arkansas for Medical
Sciences, Little Rock, AR, USA
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Rowland B, Bogulski CA, Willis DE, Scott AJ, Gloster EE, Andersen JA. Experiences of Marshallese Food Processing Workers during the COVID-19 Pandemic. J Agromedicine 2021; 27:292-302. [PMID: 34736373 DOI: 10.1080/1059924x.2021.2002222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The goal of this study was to conduct an exploratory assessment of COVID-19 mitigation steps and compare workplace experiences during the COVID-19 pandemic with Marshallese workers in other occupations. Marshallese adults residing in the continental United States (US) and Hawaii took part in an online survey. The sample was divided into two categories: food processing workers and workers in all other occupations. To examine differences between food processing workers and workers from all other occupations, we used Wilcoxon-Mann-Whitney U tests and Fisher's Exact tests. Of those employed at the time of the survey (n = 113), 31 were employed in food processing plants, and 82 were employed in another occupation. Food processing workers and workers in other occupations differed significantly on level of education, length of residence in the US, English-speaking ability, and health literacy. More food processing workers reported that their employers installed barriers or provided shields (45%), provided temperature screenings (71%), and tested for COVID-19 (61%) compared with those in other occupations. A larger proportion of food processing workers reported having no sick leave compared with workers in other occupations, although they reported COVID-19 testing and being insured at similar rates. This is the first study to examine Marshallese food processing workers' experiences during the COVID-19 pandemic. Our findings show that while some food processing employers implemented government-recommended guidelines to prevent the spread of COVID-19, preventative and protective measures were not comprehensively applied across the food processing industry, despite efforts by public health agencies and community partners.
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Affiliation(s)
- Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Cari A Bogulski
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Erin E Gloster
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
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28
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Wang ML, McElfish PA, Long CR, Lee MS, Bursac Z, Kozak AT, Ko LK, Kulik N, Yeary KHCK. BMI and related risk factors among U.S. Marshallese with diabetes and their families. ETHNICITY & HEALTH 2021; 26:1196-1208. [PMID: 31288554 PMCID: PMC6952582 DOI: 10.1080/13557858.2019.1640351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/28/2019] [Indexed: 06/09/2023]
Abstract
Objective: Examine cross-sectional associations between body mass index (BMI) and related health behaviors, barriers and facilitators to health care, and perceived health status among a sample of U.S. Marshallese adults with Type 2 diabetes and evaluate associations of interest between participants and their family members.Design: Cross-sectional baseline data were analyzed from participants in a diabetes self-management education intervention trial.Setting: Data collection took place in home or community settings through a community-academic partnership in Arkansas.Participants: Study participants consisted of U.S. Marshallese adults with Type 2 diabetes (N = 221) and their family members (N = 211) recruited through community settings.Intervention(s): N/A.Main Outcome Measure(s): Participants' height and weight were measured using standard protocols to calculate BMI (kg/m2). Diet, physical activity, health care access, financial strain related to health care, perceived health status, and health care satisfaction were measured using self-report surveys.Results: Participants' mean BMI was 31.0 (95% CI: 30.2-31.7), with over half of study participants and their family members' BMI falling in the obese category. Participants' BMI was positively associated with spreading health care bill payments over time (β = 1.75 (SE = 0.87); p = 0.045). Positive associations between participants and their family members were observed for self-reported health status conditions, health care coverage, health care utilization, and health care satisfaction.Conclusion: Study findings highlight the high prevalence of obesity and related risk factors among U.S. Marshallese adults with Type 2 diabetes and emphasize the need for intervention strategies that build upon cultural strengths and target community, policy, systems, and environmental changes to address obesity and chronic disease in this marginalized community.
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Affiliation(s)
- Monica L. Wang
- Department of Community Health Sciences, Boston University School of Public Health
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest
| | | | - Morgan S Lee
- Health Sciences, Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado-Colorado Springs
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University
| | | | - Linda K. Ko
- Department of Health Services, University of Washington School of Public Health
| | - Noel Kulik
- College of Education, Wayne State University
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29
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McElfish PA, Rowland B, Porter A, Felix HC, Selig JP, Semingson J, Willis DE, Smith M, Riklon S, Alik E, Padilla-Ramos A, Jasso EY, Zohoori N. Use of Community-Based Participatory Research Partnerships to Reduce COVID-19 Disparities Among Marshallese Pacific Islander and Latino Communities - Benton and Washington Counties, Arkansas, April-December 2020. Prev Chronic Dis 2021; 18:E91. [PMID: 34618667 PMCID: PMC8522500 DOI: 10.5888/pcd18.210124] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Marshallese and Latino communities in Benton and Washington counties, Arkansas, were disproportionately affected by COVID-19. We evaluated the effectiveness of a comprehensive community-based intervention to reduce COVID-19 disparities in these communities. We examined all laboratory-confirmed COVID-19 cases in the 2 counties reported from April 6, 2020, through December 28, 2020. A 2-sample serial t test for rate change was used to evaluate changes in case rates before and after implementation of the intervention. After implementation, the proportions of cases among Marshallese and Latino residents declined substantially and began to align more closely with the proportions of these 2 populations in the 2 counties. Infection rates remained lower throughout the evaluation period, and weekly incidence also approximated Marshallese and Latino population proportions. Leveraging community partnerships and tailoring activities to specific communities can successfully reduce disparities in incidence among populations at high-risk for COVID-19 .
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas.,1125 N College Ave, Fayetteville, AR 72703.
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Austin Porter
- Arkansas Department of Health, Little Rock, Arkansas
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | | | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Eldon Alik
- Republic of the Marshall Islands Consulate, Springdale, Arkansas
| | - Alan Padilla-Ramos
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Erika Y Jasso
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
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Rehuher D, Hishinuma ES, Goebert DA, Palafox NA. A Historical and Contemporary Review of the Contextualization and Social Determinants of Health of Micronesian Migrants in the United States. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:88-101. [PMID: 34661132 PMCID: PMC8504325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Hawai'i's Pacific Islander (PI) population has suffered a higher burden of coronavirus disease 2019 (COVID-19) infections, hospitalizations, and deaths compared to other groups in the state. The Hawai'i Emergency Management Agency Community Care Outreach Unit conducted an assessment across the state to gain an understanding of the impact of the COVID-19 pandemic on the health and social welfare of households. Survey data was collected from individuals across the state during a period of 3 weeks (August 12-September 5, 2020). The following are resulting recommendations from the Pacific Island community to mitigate the impact and disparities of the pandemic as immediate and medium-term structural requests: (1) ensure that Pacific Island communities are proactively represented in state and county committees that develop health interventions to ensure that relevant language and culturally tailored communications and strategies are included, (2) provide consistent funding and community centered support to ensure consistent COVID-19 impact services for the Pacific Island families, (3) enhance the capacity of PI health care navigators and interpreters through increased funding and program support, and (4) engage state policy makers immediately to understand and address the systemic structural barriers to health care and social services for Pacific Islanders in Hawai'i. These recommendations were developed to address the generational inequities and disparities that exist for Pacific islanders in Hawai'i which were exacerbated by the COVID-19 pandemic.
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Affiliation(s)
- Davis Rehuher
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (DR, ESH, DAG)
| | - Earl S. Hishinuma
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (DR, ESH, DAG)
| | - Deborah A. Goebert
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (DR, ESH, DAG)
| | - Neal A. Palafox
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (DR, ESH, DAG)
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31
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Andersen JA, Felix H, Selig J, Rowland B, Bing W, Hudson J, Niedenthal J, Otuafi H, Riklon S, Azures E, George A, McElfish PA. Feasibility and efficacy of a pilot family model of diabetes self-management intervention in the Republic of the Marshall Islands. Contemp Clin Trials Commun 2021; 23:100824. [PMID: 34401596 PMCID: PMC8349743 DOI: 10.1016/j.conctc.2021.100824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 07/06/2021] [Accepted: 07/24/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The Republic of the Marshall Islands (RMI) faces numerous health disparities, including one of the highest prevalence of type 2 diabetes mellitus (T2DM) in the world. Diabetes self-management education and support (DSMES) has shown efficacy in improving glycemic control and through increases in knowledge and self-management activities; however, there is limited research on DSMES in the RMI. This study evaluated the feasibility and efficacy of a culturally adapted family model of DSMES (F-DSMES) in the RMI. The F-DSME included 8 h of group educational classes delivered in churches by a community health worker. METHODS This pilot study assessed retention and dosage rates (e.g., class attendance) among the participants with T2DM (n = 41). Efficacy was evaluated by examining pre- and post-intervention differences in HbA1c, knowledge, family support, and self-management activities among those who completed the post-intervention data collection (n = 23). RESULTS The results indicate completion of post-intervention data collection and attendance were associated; 70% of participants who completed the post-intervention data collection received at least 6 h of intervention compared to 3 h for those who did not. Although the reduction in HbA1c was not statistically significant, participants demonstrated statically significant increases in knowledge, family support, and an increase in self-management including in checking of blood glucose and feet. CONCLUSIONS This study provides important information to help address T2DM disparities in the RMI, including the feasibility and efficacy of F-DSMES. Additional research will help in understanding how to translate improvements in knowledge, family support, and self-management activities into improvements in HbA1c. This may include addressing social ecological factors that affect glycemic control.
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Affiliation(s)
- Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Holly Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - James Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Wana Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Jonell Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Jack Niedenthal
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, 96960, MH, USA
| | - Henry Otuafi
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, 96960, MH, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Edlen Azures
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, 96960, MH, USA
| | - Ainrik George
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, 96960, MH, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
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32
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Ayers BL, Bogulski CA, Haggard-Duff L, Selig JP, McElfish PA. A mixed-methods longitudinal study of Marshallese infant feeding beliefs and experiences in the United States: a study protocol. Int Breastfeed J 2021; 16:64. [PMID: 34454559 PMCID: PMC8401343 DOI: 10.1186/s13006-021-00412-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/16/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Arkansas has the largest population of Marshallese Pacific Islanders residing in the continental United States. Marshallese are disproportionately burdened by poorer maternal and infant health outcomes. Exclusive breastfeeding can prevent or help mitigate maternal and infant health disparities. However, exclusive breastfeeding among United States Marshallese communities remains disproportionately low, and the reasons are not well documented. This paper describes the protocol of a mixed-methods concurrent triangulation longitudinal study designed to explore the beliefs and experiences that serve as barriers and/or facilitators to exclusive breastfeeding intention, initiation, and duration among Marshallese mothers in northwest Arkansas. METHODS The mixed-methods design collects qualitative and quantitative data during simultaneous data collection events, at third trimester, six weeks postpartum, and six months postpartum. Quantitative and qualitative data will be analyzed separately and then synthesized during the interpretation phase. The research team will disseminate results to study participants, research stakeholders, the broader Marshallese community, and fellow researchers. DISCUSSION Findings and results will be presented in subsequent manuscripts upon completion of the study. This study will be an important first step to better understand beliefs and experiences to exclusive breastfeeding intention, initiation, and duration in this community and will inform tools and interventions to help improve health outcomes. The study will also aid in filling the gap in research and providing essential information on the infant feeding beliefs and barriers among a Marshallese community in Arkansas.
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Affiliation(s)
- Britni L. Ayers
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR USA
| | - Cari A. Bogulski
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR USA
| | - Lauren Haggard-Duff
- College of Nursing, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR USA
| | - James P. Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR USA
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Purvis RS, Ayers BL, Bogulski CA, Kaminicki KF, Haggard-Duff LK, Riklon LA, Iban A, Mejbon-Samuel R, Lakmis R, Riklon S, Thompson JW, McElfish PA. Multicomponent Informed Consent with Marshallese Participants. J Empir Res Hum Res Ethics 2021; 16:144-153. [PMID: 33780279 PMCID: PMC8238841 DOI: 10.1177/15562646211005651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pacific Islanders are the second fastest-growing population in the United States; however, Pacific Islanders, and Marshallese specifically, are underrepresented in health research. A community-based participatory research (CBPR) approach was used to engage Marshallese stakeholders and build an academic-community research collaborative to conduct health disparities research. Our CBPR partnership pilot tested a multicomponent consent process that provides participants the option to control the use of their data. Consent forms used concise plain language to describe study information, including participant requirements, risks, and personal health information protections, and were available in both English and Marshallese. This study demonstrates that when provided a multicomponent consent, the vast majority of consenting study participants (89.6%) agreed to all additional options, and only five (10.4%) provided consent for some but not all options. Our description of the development and implementation of a multicomponent consent using a CBPR approach adds a specific example of community engagement and may be informative for other indigenous populations.
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Affiliation(s)
- Rachel S. Purvis
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
| | - Britni L. Ayers
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
| | - Cari A. Bogulski
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
| | - Kyle F. Kaminicki
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
| | | | - Lynda A. Riklon
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
| | - Anita Iban
- Faith in Action Research and Resource Alliance (FARRA), Springdale (USA)
| | | | | | - Sheldon Riklon
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
| | | | - Pearl A. McElfish
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
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McElfish PA, Long CR, Bursac Z, Scott AJ, Chatrathi HE, Sinclair KA, Nagarsheth N, Calcagni M, Patolia J, Narcisse MR. Examining elevated blood pressure and the effects of diabetes self-management education on blood pressure among a sample of Marshallese with type 2 diabetes in Arkansas. PLoS One 2021; 16:e0250489. [PMID: 33886693 PMCID: PMC8062061 DOI: 10.1371/journal.pone.0250489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/05/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Hypertension is a leading risk factor for heart attack and stroke. Undiagnosed hypertension increases the risk of heart attack and stroke. The risk of hypertension is increased for those with type 2 diabetes mellitus (T2DM). Diabetes self-management education (DSME) has been shown to be effective at improving clinical outcomes, including reducing blood pressure, but few studies have evaluated the effects of DSME for Native Hawaiians and Pacific Islanders. METHODS This study examined the baseline prevalence of diagnosed hypertension and undiagnosed high blood pressure and differences in health care access between those with diagnosed hypertension versus undiagnosed high blood pressure. The sample consisted of 221 Marshallese adults with T2DM participating in a DSME randomized controlled trial in northwest Arkansas. The study also examined the effects of DSME interventions on participants' blood pressure, comparing an Adapted-Family DSME with a Standard DSME. RESULTS Nearly two-thirds of participants had blood pressure readings indicative of hypertension, and of those, over one-third were previously undiagnosed. The frequency of doctor visits was significantly lower for those with undiagnosed high blood pressure. There were no differences in health insurance coverage or forgone medical care between those with undiagnosed high blood pressure versus diagnosed hypertension. Across all participants, a significant reduction in systolic blood pressure occurred between baseline and post intervention, and a significant reduction in diastolic blood pressure occurred between baseline and post-intervention, 6 months, and 12 months post-intervention. No differences were observed by study arm. CONCLUSION This study is the first to document the prevalence of diagnosed hypertension and undiagnosed high blood pressure, as well as the effects of DSME on blood pressure among a sample of Marshallese adults with T2DM.
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Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, United States of America
| | - Christopher R. Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, United States of America
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, United States of America
| | - Aaron J. Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, United States of America
| | - Harish E. Chatrathi
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, United States of America
| | - Ka‘imi A. Sinclair
- College of Nursing, Washington State University, Seattle, Washington, United States of America
| | - Nirav Nagarsheth
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, United States of America
| | - Mikaila Calcagni
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, United States of America
| | - Jay Patolia
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, United States of America
| | - Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, United States of America
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Moncla LH, Black A, DeBolt C, Lang M, Graff NR, Pérez-Osorio AC, Müller NF, Haselow D, Lindquist S, Bedford T. Repeated introductions and intensive community transmission fueled a mumps virus outbreak in Washington State. eLife 2021; 10:66448. [PMID: 33871357 PMCID: PMC8079146 DOI: 10.7554/elife.66448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/15/2021] [Indexed: 12/20/2022] Open
Abstract
In 2016/2017, Washington State experienced a mumps outbreak despite high childhood vaccination rates, with cases more frequently detected among school-aged children and members of the Marshallese community. We sequenced 166 mumps virus genomes collected in Washington and other US states, and traced mumps introductions and transmission within Washington. We uncover that mumps was introduced into Washington approximately 13 times, primarily from Arkansas, sparking multiple co-circulating transmission chains. Although age and vaccination status may have impacted transmission, our data set could not quantify their precise effects. Instead, the outbreak in Washington was overwhelmingly sustained by transmission within the Marshallese community. Our findings underscore the utility of genomic data to clarify epidemiologic factors driving transmission and pinpoint contact networks as critical for mumps transmission. These results imply that contact structures and historic disparities may leave populations at increased risk for respiratory virus disease even when a vaccine is effective and widely used.
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Affiliation(s)
- Louise H Moncla
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, United States
| | - Allison Black
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, United States.,Department of Epidemiology, University of Washington, Seattle, United States
| | - Chase DeBolt
- Office of Communicable Disease Epidemiology, Washington State Department of Health, Shoreline, United States
| | - Misty Lang
- Office of Communicable Disease Epidemiology, Washington State Department of Health, Shoreline, United States
| | - Nicholas R Graff
- Office of Communicable Disease Epidemiology, Washington State Department of Health, Shoreline, United States
| | - Ailyn C Pérez-Osorio
- Office of Communicable Disease Epidemiology, Washington State Department of Health, Shoreline, United States
| | - Nicola F Müller
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, United States
| | - Dirk Haselow
- Arkansas Department of Health, Little Rock, United States
| | - Scott Lindquist
- Office of Communicable Disease Epidemiology, Washington State Department of Health, Shoreline, United States
| | - Trevor Bedford
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, United States.,Department of Epidemiology, University of Washington, Seattle, United States
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Towne SD, Kim Yeary KH, Narcisse MR, Long C, Bursac Z, Totaram R, Rodriguez EM, McElfish P. Inequities in Access to Medical Care Among Adults Diagnosed with Diabetes: Comparisons Between the US Population and a Sample of US-Residing Marshallese Islanders. J Racial Ethn Health Disparities 2021; 8:375-383. [PMID: 32529423 PMCID: PMC9972993 DOI: 10.1007/s40615-020-00791-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We examined barriers to accessing medical care for migrant US-residing Marshallese Islanders. METHODS Cross-sectional analyses were conducted to identify potential inequities. Surveys from largely migrant diabetic Marshallese Islanders (n = 255) were compared with nationally representative data. Two major outcomes were assessed including 1-whether or not one reported having forgone medical care in the past year because of cost-and 2-whether or not one reported not having a usual source of care. RESULTS Overall, 74% and 77% of Marshallese Islanders reported forgone care and no usual source of care, respectively, versus 15% and 7% of the US diabetic population. In multivariable analyses, being younger; uninsured; unemployed; male; of lower education; Native American or Hispanic (versus White); and residing in the South were associated with forgone care nationwide, whereas only lacking insurance was associated with forgone care among Marshallese Islanders. Nationwide being younger; uninsured; unmarried; female; of lower education; Native American or Hispanic (versus White); and residing in the South were associated with not having a usual source of care, whereas only being younger and uninsured were associated with not having a usual source of care among Marshallese Islanders. CONCLUSION The largest group of diabetic Marshallese Islanders in the continental US faces severe healthcare access inequities necessitating policies that increase access to health insurance options and associated resources.
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Affiliation(s)
- Samuel D. Towne
- Department of Health Management and Informatics, University of Central Florida, Orlando, FL 32816, USA,Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL 32816, USA,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843, USA,Southwest Rural Health Research Center, Texas A&M University, College Station, TX 77843, USA,Center for Population Health and Aging, Texas A&M University, College Station, TX 77843, USA
| | - Karen H. Kim Yeary
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, AR 72703, USA
| | - Chris Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, AR 72703, USA
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health, Florida International University, 11200 SW 8th Street AHC5, Miami, FL, USA
| | - Rachel Totaram
- Department of Health Management and Informatics, University of Central Florida, Orlando, FL 32816, USA
| | - Elisa M. Rodriguez
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - Pearl McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, AR 72703, USA
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McElfish PA, Andersen JA, Felix HC, Purvis RS, Rowland B, Scott AJ, Chatrathi M, Long CR. Relationship between sleep duration and quality and glycated hemoglobin, body mass index, and self-reported health in Marshallese adults. Sleep Health 2021; 7:332-338. [PMID: 33707104 DOI: 10.1016/j.sleh.2021.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To document sleep duration and sleep quality among a sample of Marshallese adults and to examine if sleep duration and quality are associated with type 2 diabetes, body mass index (BMI), and self-reported health in the Marshallese population. DESIGN Cross-sectional analysis of a staff-administered survey. SETTING Thirty Marshallese churches in Arkansas and Oklahoma. PARTICIPANTS The study includes 378 Marshallese participants, 56.6% female, with a mean age of 42.4 years (±11.6). Recruitment was limited to participants who were considered overweight, with a BMI >25 kg/m2. MEASURES Staff-administered surveys were used to collect data on sleep duration, sleep quality, and self-reported health. Clinical measures were collected by trained research personnel using standard tools and protocols. Kruskal-Wallis tests, Spearman's correlations, and nonparametric tests of trends were used to evaluate differences in HbA1c, BMIc, and self-reported health by sleep duration and quality. Multivariable analyses were used to test the associations, controlling for sociodemographic factors. RESULTS Fifty-four percent of the participants reported something other than normal sleep duration and 52.4% reported at least 1 night of difficult or interrupted sleep in the previous 2-week period. Longer sleep duration was associated with lower HbA1c and poorer sleep quality was associated with higher HbA1c. Poor sleep quality was associated with lower self-reported health. However, neither sleep duration nor quality was associated with BMI. The associations were found independent of sociodemographic factors. CONCLUSION This is the first study to document sleep duration and sleep quality, as well as the first study to examine the relationship between sleep and HbA1c, BMI, and self-reported health in Marshallese adults with a BMI >25 kg/m2. This research will be used to help develop sleep interventions to address type 2 diabetes health disparities in the Marshallese community.
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA.
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Rachel S Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Meena Chatrathi
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Christopher R Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
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Walter CS, Narcisse MR, Vincenzo JL, McElfish PA, Felix HC. Description of Variation in Age of Onset of Functional Limitations of Native Hawaiian and Pacific Islanders Compared to Other Racial and Ethnic Groups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052445. [PMID: 33801411 PMCID: PMC7967566 DOI: 10.3390/ijerph18052445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 02/05/2023]
Abstract
(1) Background: The purpose of this exploratory study was to describe variation in age of onset of functional limitations of Native Hawaiian and Pacific Islanders (NHPI) compared to other racial and ethnic groups. (2) Methods: Adults age 45 years and older who responded to the Functioning and Disability module within the 2014 National Health Interview Survey (NHIS) were included (n = 628 NHPI; 7122 non-Hispanic Whites; 1418 Blacks; 470 Asians; and 1216 Hispanic adults). The NHIS Functioning and Disability module included 13 items, which we organized into three domains of functional limitations using factor analysis: Mobility, Gross Motor Skills, and Fine Motor Skills. Responses were summed within each domain. (3) Results: After adjusting for age and sex, we found that racial/ethnic minority groups, with the exception of Asians, experience more functional limitations than Whites. Results further indicate that NHPI adults experienced an earlier surge in all three domains of functional limitations compared to other racial/ethnic groups. (4) Conclusions: These findings are novel and provide additional evidence to the existence of disparities in functional health outcomes across racial/ethnic groups. Future studies are needed to develop targeted and culturally tailored interventions for those most in need.
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Affiliation(s)
- Christopher S. Walter
- Department of Physical Therapy, University of Arkansas for Medical Sciences, 1125 N. College Ave, Fayetteville, AR 72703, USA;
- Correspondence: ; Tel.: +1-479-713-8611
| | - Marie-Rachelle Narcisse
- Office of Community Health and Research, University of Arkansas for Medical Sciences, 1125 N. College Ave, Fayetteville, AR 72703, USA; (M.-R.N.); (P.A.M.)
| | - Jennifer L. Vincenzo
- Department of Physical Therapy, University of Arkansas for Medical Sciences, 1125 N. College Ave, Fayetteville, AR 72703, USA;
| | - Pearl A. McElfish
- Office of Community Health and Research, University of Arkansas for Medical Sciences, 1125 N. College Ave, Fayetteville, AR 72703, USA; (M.-R.N.); (P.A.M.)
| | - Holly C. Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
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McElfish PA, Scott AJ, Chatrathi HE, Rowland B, Long CR, Nagarsheth N, Calcagni M, Patolia J, Haggard-Duff LK, Selig JP. Undiagnosed Hypertension and Undiagnosed Type 2 Diabetes among Overweight and Obese Marshallese Participants in a Diabetes Prevention Program. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2021; 94:5-12. [PMID: 33795978 PMCID: PMC7995951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypertension and type 2 diabetes (T2D) are major public health issues that disproportionately affect minority communities, including Native Hawaiians and Pacific Islanders (NHPI). Minority communities are also more likely to have undiagnosed hypertension and T2D. Marshallese Pacific Islanders have been shown to have high proportions of diagnosed and undiagnosed hypertension and T2D. Using survey and biometric data collected from 378 overweight/obese Marshallese Pacific Islander adults, this study documents the prevalence of hypertension and T2D, as well as the prevalence of undiagnosed hypertension and T2D. The study also examines associations between undiagnosed hypertension and undiagnosed T2D and age group, sex, health care access (defined by foregone care due to cost and health insurance status), and body mass index (BMI). Among participants with blood pressure readings indicative of hypertension, 68.4% were undiagnosed, and among participants with HbA1c indicative of T2D, 31.6% were undiagnosed. A quarter of participants (24.5%) had blood pressure and HbA1c measures indicative of both undiagnosed hypertension and undiagnosed T2D. Undiagnosed hypertension was significantly associated with age group (p's<0.0001) and sex (p=0.028). Undiagnosed T2D was significantly associated with age group (p's<0.05), forgone care due to cost (p=0.018), health insurance status (p=0.035), and BMI (p=0.001). Participants in this study had high proportions of undiagnosed hypertension and undiagnosed T2D. These findings will be immediately useful for those working to address hypertension and T2D disparities among Marshallese and other NHPI populations.
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Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Aaron J. Scott
- Office of Community Health and Research, University of
Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Harish E. Chatrathi
- Office of Community Health and Research, University of
Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Brett Rowland
- Office of Community Health and Research, University of
Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Christopher R. Long
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Nirav Nagarsheth
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Mikaila Calcagni
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Jay Patolia
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Lauren K. Haggard-Duff
- College of Nursing, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - James P. Selig
- Department of Biostatistics, University of Arkansas for
Medical Sciences, Little Rock, AR, USA
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McElfish PA, Purvis R, Willis DE, Riklon S. COVID-19 Disparities Among Marshallese Pacific Islanders. Prev Chronic Dis 2021; 18:E02. [PMID: 33411668 PMCID: PMC7845552 DOI: 10.5888/pcd18.200407] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703.
| | - Rachel Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Don E Willis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Sheldon Riklon
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
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Andersen JA, Felix HC, Eswaran H, Payakachat N, Willis DE, Bogulski C, McElfish PA. Factors Associated with First-Time Telehealth Utilization for Marshallese Living in the United States. TELEMEDICINE REPORTS 2021; 2:217-223. [PMID: 34841421 PMCID: PMC8621619 DOI: 10.1089/tmr.2021.0023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 05/07/2023]
Abstract
Background: Mitigation efforts to prevent the spread of COVID-19 included the robust utilization of telehealth. However, racial/ethnic minority populations have demonstrated low telehealth utilization in the past. The aim of this study was to examine the first-time use of telehealth by Marshallese adults during the COVID-19 pandemic, using online survey data collected from 109 Marshallese respondents between July and November of 2020. Methods: To evaluate the relationships between sociodemographic characteristics, health care access, physical/mental health, and COVID-19-specific measures and the decision to use telehealth, we use bivariate analyses, including t-tests and chi-square analysis. Results: Eighteen respondents (16.5%) indicated they utilized telehealth for the first time during the pandemic. The number of chronic conditions reported was positively associated with the first-time use of telehealth (p = 0.013). Although not statistically significant, a higher proportion of Marshallese first-time telehealth users reported limited English proficiency, changes in health status, and changes in health insurance. Discussion: Although telehealth has been shown to reduce the absolute gaps in health disparities for minority populations, there is limited utilization by Marshallese communities. Conclusions: Significant research remains on the utilization of telehealth by Marshallese during the COVID-19 pandemic and to increase utilization in the future.
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Affiliation(s)
- Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Holly C. Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hari Eswaran
- Institute of Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nalin Payakachat
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Cari Bogulski
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
- *Address correspondence to: Pearl A. McElfish, PhD, MBA, College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR 72703, USA,
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English E, Long CR, Langston K, Faitak B, Brown AL, Echegoyen A, Gardner J, Cowan C, Rambo D, Perritt B, Laubenstein B, Snyder A, Bourke P, Lelan M, McElfish PA. A Community Partnership for Home Delivery of Food Boxes to COVID-19 Quarantined and Isolated Families. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2020. [DOI: 10.1080/19320248.2020.1863284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Emily English
- Office of Community Health and Research, Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, Arkansas, USA
| | - Christopher R. Long
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, Arkansas, USA
| | - Krista Langston
- Office of Community Health and Research, Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, Arkansas, USA
| | - Bonnie Faitak
- Office of Community Health and Research, Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, Arkansas, USA
| | - April L. Brown
- Marshallese Education Initiative, Springdale, Arkansas, USA
| | | | - Joel Gardner
- Ozark Regional Transit, Springdale, Arkansas, USA
| | - Casey Cowan
- Northwest Arkansas Food Bank, Bethel Heights, Arkansas, USA
| | - Debbie Rambo
- Samaritan Community Center, Rogers, Arkansas, USA
| | | | | | | | | | - Melisa Lelan
- Arkansas Coalition of Marshallese, Springdale, Arkansas, USA
| | - Pearl A. McElfish
- Office of Community Health and Research, Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, Arkansas, USA
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McElfish PA, Narcisse MR, Felix HC, Cascante DC, Nagarsheth N, Teeter B, Faramawi MF. Race, Nativity, and Sex Disparities in Human Papillomavirus Vaccination Among Young Adults in the USA. J Racial Ethn Health Disparities 2020; 8:1260-1266. [PMID: 33033889 PMCID: PMC9753349 DOI: 10.1007/s40615-020-00886-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
Research has demonstrated that the human papillomavirus (HPV) vaccine is a safe and effective way to decrease HPV-related cervical cancers; however, the vaccination rate in the USA is suboptimal. The current study examined racial and ethnic disparities in HPV vaccination among a nationally representative sample, including Native Hawaiian and Pacific Islanders (NHPI). This study also investigated the associations between nativity and vaccination, and sex differences between race/ethnicity and vaccination and nativity and vaccination. A cross-sectional study was conducted with a sample of adults aged 18-26 years drawn from the 2014 NHPI National Health Interview Survey (n = 2590) and the general 2014 National Health Interview Survey (n = 36,697). Log-binomial models were fitted to examine differences in vaccination. There was a statistically significant racial/ethnic difference in HPV vaccination (p = 0.003). More women than men were vaccinated (41.8% vs. 10.1%) (p < 0.001). There was a significant difference in HPV vaccination based on nativity: 27.4% of adults aged 18 to 26 years who were born in the USA and 27.7% born in a US territory received the HPV vaccine compared with 14.3% among those not born in the USA or a US territory (p < 0.001). The association of HPV vaccination with nativity and race/ethnicity differed by sex and showed several nuanced differences. Overall, the prevalence of HPV vaccination was low. The study's findings demonstrate the need for public health strategies to increase vaccination rates among all populations, with the critical need to identify strategies that are effective for men, racial/ethnic minorities, and immigrant women born outside the USA.
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, AR, 72703, USA.
| | - Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, AR, 72703, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Diana C Cascante
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Nirav Nagarsheth
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, AR, 72703, USA
| | - Ben Teeter
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Mohammed F Faramawi
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
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McElfish PA, Chughtai A, Low LK, Garner R, Purvis RS. 'Just doing the best we can': health care providers' perceptions of barriers to providing care to Marshallese patients in Arkansas. ETHNICITY & HEALTH 2020; 25:1004-1017. [PMID: 29726695 PMCID: PMC6215735 DOI: 10.1080/13557858.2018.1471670] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/26/2018] [Indexed: 06/08/2023]
Abstract
Introduction: Marshallese migrating to the United States encounter challenges in accessing health care. Previous literature has investigated Marshallese participants' perceptions of the barriers they face in accessing health care. For this study, health care providers managing the care of Marshallese patients were interviewed to understand the providers' perception of barriers that their Marshallese patients encounter. Methods: A qualitative research design was utilized to explore health care providers' perceptions of and experiences with the barriers faced by their Marshallese patients when accessing the US health care system. Results: The primary barriers identified were: (1) economic barriers; (2) communication challenges; (3) difficulty understanding and navigating the western health care system; and (4) structural and system barriers. Conclusion: This study provides insight on the barriers Marshallese patients face in accessing health care as well as the barriers providers face in delivering care to Marshallese patients. A better understanding of these barriers can help health care providers and educators to begin initiating improvements in the delivery of care to Marshallese patients.
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Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703 USA
| | - Almas Chughtai
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703 USA
| | - Lisa K. Low
- Community Health, Mercy Hospital Northwest Arkansas, 2710 S. Rife Medical Ln, Rogers, AR, 72758 USA
| | - Robert Garner
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703 USA
| | - Rachel S. Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703 USA
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Ayers BL, Bogulski CA, Haggard-Duff L, Andres A, Børsheim E, McElfish PA. Documenting and characterising gestational weight gain beliefs and experiences among Marshallese pregnant women in Arkansas: a protocol for a longitudinal mixed-methods study. BMJ Open 2020; 10:e037219. [PMID: 32994238 PMCID: PMC7526321 DOI: 10.1136/bmjopen-2020-037219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/15/2020] [Accepted: 08/14/2020] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Arkansas has the largest population of Marshallese Pacific Islanders residing in the continental USA. The Marshallese have higher rates of obesity, type 2 diabetes, pre-term births, low birthweight babies, infant mortality, and inadequate or no prenatal care. Despite the high rates of cardiometabolic and maternal and child health disparities among Marshallese, there are no studies documenting gestational weight gain or perceptions about gestational weight gain among the Marshallese population residing in the USA. METHODS AND ANALYSIS This paper describes the protocol of a mixed-methods concurrent triangulation longitudinal study designed to understand gestational weight gain in Marshallese women. The mixed-methods design collects qualitative and quantitative data during simultaneous data collection events, at both first and third trimester, and then augments that data with postpartum data abstraction. Quantitative and qualitative data will be analysed separately and then synthesised during the interpretation phase. ETHICS AND DISSEMINATION The study used a community engaged approach approved by the University of Arkansas for Medical Sciences Institutional Review Board (#228023). The research team will disseminate results to study participants, research stakeholders (clinics, faith-based organisations and community-based organisation), the broader Marshallese community and fellow researchers. Results will be disseminated to study participants through a one-page summary that show the aggregated research results using plain language and infographics.
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Affiliation(s)
- Britni L Ayers
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Cari A Bogulski
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Lauren Haggard-Duff
- College of Nursing, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Aline Andres
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Elisabet Børsheim
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
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Long CR, Rowland B, McElfish PA, Ayers BL, Narcisse MR. Food Security Status of Native Hawaiians and Pacific Islanders in the US: Analysis of a National Survey. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:788-795. [PMID: 32184077 PMCID: PMC8202531 DOI: 10.1016/j.jneb.2020.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/06/2020] [Accepted: 01/17/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To document food insecurity prevalence among a nationally representative sample of Native Hawaiian and Pacific Islander (NHPI) adults and compare differences in food security status across races/ethnicities in the US. METHODS Using 2014 National Health Interview Survey and 2014 NHPI-National Health Interview Survey data, food insecurity among the NHPI population is described and food security status across racial/ethnic groups is compared using Rao-Scott chi-square and multinomial logistic regression. RESULTS Food insecurity prevalence was 20.5% among NHPI adults, and NHPI had significantly higher odds of experiencing low and very low food security than white individuals. Food insecurity among Hispanic individuals, black people, and other races/ethnicities was also significantly higher than that among white people. Significant variation in food security status was observed by race/ethnicity (P < .001). CONCLUSIONS AND IMPLICATIONS This study provides documentation of food insecurity prevalence among NHPI adults and will inform chronic disease and nutrition research and programs conducted with NHPI communities in the US.
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Affiliation(s)
- Christopher R Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR.
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
| | - Britni L Ayers
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
| | - Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
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McElfish PA, Yeary K, Sinclair IA, Steelman S, Esquivel MK, Aitaoto N, Kaholokula K, Purvis RS, Ayers BL. Best Practices for Community-Engaged Research with Pacific Islander Communities in the US and USAPI: A Scoping Review. J Health Care Poor Underserved 2020; 30:1302-1330. [PMID: 31680100 DOI: 10.1353/hpu.2019.0101] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This scoping review identifies the best practices of community-based participatory research with Pacific Islanders in the United States and United States Affiliated Pacific Islands. Eighty-four articles from January 2000 to December 2017 were included in the review. Best practices included the importance of engaging Pacific Islander community leaders as research staff, community co-investigators, and community advisory board members. Best practices also focused on removing barriers to research by using participants' native languages, conducting research within the geographic community, and spending significant time to build trust. Novel best practices included honoring Pacific Islanders' cultural practices such as protocols for engagement, reciprocity, and social and spiritual inclusiveness and honoring Pacific Islanders' collectivist cultural structure. The goal of this scoping review is to aid community-academic partnerships working to improve the health of Pacific Islanders.
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Felix HC, Narcisse MR, Long CR, McElfish PA. Effects of a family diabetes self-management education intervention on the patients' supporters. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2020; 38:121-129. [PMID: 32281816 PMCID: PMC7292793 DOI: 10.1037/fsh0000470] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Diabetes self-management education (DSME) programs that engage the families of patients with diabetes have shown to be effective in improving diabetes-related outcomes of the patients. The health effects of these "family models" of DSME on participating family members are rarely studied. Opportunity exists for the participating family members to benefit from the healthy lifestyle recommendations offered through such programs. METHOD Using data from a randomized controlled trial to assess the effect of family DSME compared to standard DSME among Marshallese adults with Type 2 diabetes, this study examined baseline to 12-month changes in A1c, body mass index (BMI), food consumption, and physical activity among participating family members, comparing outcomes of family members based on attended at least 1 (n = 98) versus attended no (n = 44) DSME sessions. RESULTS Overall, family member attendance was low. There were no differences in the level of change from baseline to 12 months for A1c, BMI, food consumption, and physical activity between groups. After controlling for attendance and sociodemographic measures, lowering of BMI was the only significant predictor of not having an A1c level indicative of diabetes at 12 months. DISCUSSION Future research on family DSME should consider ways to improve family member attendance; have them set their own health improvement goals; and integrate healthy lifestyle education, such as healthy eating and being physically active, along with the DSME core content to create an added benefit of diabetes prevention for participating family members. The limitations of this study and recommendations for future research are provided. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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McElfish PA, Purvis RS, Riklon S, Yamada S. Compact of Free Association Migrants and Health Insurance Policies: Barriers and Solutions to Improve Health Equity. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 56:46958019894784. [PMID: 31823677 PMCID: PMC6906344 DOI: 10.1177/0046958019894784] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This commentary outlines the health insurance disparities of Compact of Free
Association (COFA) migrants living in the United States. Compact of Free
Association migrants are citizens of the Republic of the Marshall Islands, the
Federated States of Micronesia, and the Republic of Palau who can live, work,
and study in the United States without a visa. Compact of Free Association
migrants make up a significant proportion of the rapidly growing Pacific
Islander population in the United States. This article describes the historical
and current relationships between the United States and the Compact nations and
examines national policy barriers constraining health insurance access for COFA
migrants. In addition, the commentary describes the state-level health policies
of Arkansas, Hawai’i, and Oregon, which are the states where the majority of
COFA migrants reside. Finally, policy recommendations are provided to improve
health equity for COFA migrants.
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Affiliation(s)
- Pearl A McElfish
- University of Arkansas for Medical Sciences Northwest, Fayetteville, USA
| | - Rachel S Purvis
- University of Arkansas for Medical Sciences Northwest, Fayetteville, USA
| | - Sheldon Riklon
- University of Arkansas for Medical Sciences Northwest, Fayetteville, USA
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Dickey TA, Balli ML, Warmack TS, Rowland B, Hudson J, Seaton V, Riklon S, Purvis RS, McElfish PA. Perceptions and utilization of traditional healing among Marshallese adults residing in Arkansas. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2020; 17:/j/jcim.ahead-of-print/jcim-2018-0198/jcim-2018-0198.xml. [PMID: 32284443 DOI: 10.1515/jcim-2018-0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 09/29/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Tiffany A Dickey
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - Michelle L Balli
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - T Scott Warmack
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - Jonell Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - Victoria Seaton
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR 72703-5011, USA
| | - Rachel S Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR 72703-5011, USA
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