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Ramírez-Ortiz D, Jean-Gilles M, Sheehan DM, Ladner R, Li T, Trepka MJ. Factors Associated With COVID-19 Vaccination Among Racial/Ethnic Minority Groups With HIV in South Florida. J Acquir Immune Defic Syndr 2024; 95:329-341. [PMID: 38133577 PMCID: PMC10922309 DOI: 10.1097/qai.0000000000003369] [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] [Received: 08/24/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Racial/ethnic minority groups with HIV in the United States are particularly vulnerable to COVID-19 consequences and can significantly benefit from increased uptake of COVID-19 vaccines. This study identified factors associated with full COVID-19 vaccination among people with HIV. SETTING Ryan White HIV/AIDS Program in Miami-Dade County, FL. METHODS Data were collected from 299 Ryan White HIV/AIDS Program adult clients during January-March 2022 using a cross-sectional phone survey. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). All analyses were weighted to be representative of the race/ethnicity and sex distribution of clients in the Ryan White HIV/AIDS Program. RESULTS Eighty-four percent of participants were fully vaccinated with a primary vaccine series; stratified by race/ethnicity, the percentages were 88.9% of Hispanic, 72.0% of black/African American, and 67.5% of Haitian participants. Fully vaccinated participants were less likely to be black/African American than Hispanic (aOR = 0.18; 95% CI: 0.05 to 0.67) and more likely to not endorse any misconceptions about COVID-19 vaccines (aOR = 8.26; 95% CI: 1.38 to 49.64), to report encouragement to get vaccinated from sources of information (aOR = 20.82; 95% CI: 5.84 to 74.14), and to perceive that more than 50% of their social network was vaccinated (aOR = 3.35; 95% CI: 1.04 to 10.71). Experiences of health care discrimination, structural barriers to access vaccines, and recommendations from HIV providers were not associated with full vaccination. CONCLUSIONS These findings highlight the importance of delivering accurate and positive messages about vaccines and engaging social networks to promote COVID-19 vaccination among people with HIV. This information can be leveraged to promote uptake of subsequent boosters and other recommended vaccines.
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Affiliation(s)
- Daisy Ramírez-Ortiz
- Department of Epidemiology, Florida International University, Miami, Florida, USA
| | - Michele Jean-Gilles
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
| | - Robert Ladner
- Behavioral Science Research Corporation, Coral Gables, Florida, USA
| | - Tan Li
- Department of Biostatistics, Florida International University, Miami, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
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Telles VM, Rodriguez S, Torres M, Schneider J, Haughton J, Maldonado M, Arredondo E. Barriers and facilitators to implementing a multilevel, multicomponent intervention promoting colorectal cancer screening in health centers: a qualitative study of key informant perspectives. BMC Health Serv Res 2024; 24:404. [PMID: 38553723 PMCID: PMC10981354 DOI: 10.1186/s12913-024-10749-y] [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] [Received: 08/28/2023] [Accepted: 02/19/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) continues to be a major cause of death in the U.S. despite the availability of effective screening tools. U.S. Latinos have lower rates of CRC screening and higher rates of death due to colorectal disease compared to non-Hispanic whites. Federally Qualified Health Centers (FQHCs) serve medically underserved populations, including many Latino patients. Given the low CRC screening rates, identifying culturally sensitive and cost-effective methods of promoting screening is a priority for many FQHCs. METHODS We interviewed FQHC leaders and providers using the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators to implementation of a multilevel, multicomponent (ML-MC) CRC screening intervention (i.e., promotor navigation and group-based education) in FQHCs. A rapid qualitative analysis approach was used to identify themes organized according to the following CFIR constructs: intervention characteristics, outer and inner settings, and characteristics of the individual. RESULTS We completed interviews with 13 healthcare professionals in leadership positions at six FQHCs. The participating FQHCs perceived the ML-MC screening CRC program as feasible and expressed interest in implementing the program at their sites. Facilitators included financial incentives for increasing screening rates, the need for patient education programming, and involving promotores to support the work of clinical teams. Barriers included concerns about available resources to implement new programs, lack of federal reimbursement for health education, competing priorities of other health concerns, and the need for more resources for confirmatory screening and treatment following a positive screen. CONCLUSIONS FQHCs provide essential primary care to millions of underserved patients in the U.S. and have the ability and motivation to provide screenings for colorectal cancer. Partnering with an academic institution to deliver a group-based, promotor-led CRC screening intervention for patients not up to date with screening could help increase screening rates. By identifying the specific barriers and facilitators to implementing CRC intervention, findings suggest that group-based, promotor-led interventions are a promising approach.
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Affiliation(s)
- V M Telles
- Joint Doctoral Program in Public Health at San Diego State University, University of California, San Diego, USA.
| | - S Rodriguez
- Department of Anthropology, University of California, Riverside, Riverside, USA
| | - M Torres
- Joint Doctoral Program in Public Health at San Diego State University, University of California, San Diego, USA
| | - J Schneider
- School of Public Health, San Diego State University Research Foundation, San Diego, USA
| | - J Haughton
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, USA
| | - M Maldonado
- School of Public Health, San Diego State University Research Foundation, San Diego, USA
| | - E Arredondo
- School of Public Health, San Diego State University Research Foundation, San Diego, USA
- Psychology Department, San Diego State University, San Diego, USA
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Martinez-Donate AP, Zumaeta-Castillo C, Yamasaki Y, Perez C, Martinez O, Hassrick EM, Ventimiglia J, Lazo-Elizondo M. Feasibility and acceptability of CRiSOL: A pilot peer-based intervention to address syndemic health issues afflicting Latino immigrants in the U.S. PLoS One 2023; 18:e0287248. [PMID: 37874795 PMCID: PMC10597517 DOI: 10.1371/journal.pone.0287248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 06/01/2023] [Indexed: 10/26/2023] Open
Abstract
Substance use, HIV/AIDS, domestic violence and mental health (SAVAME) are syndemic health issues that disproportionately burden Latinos in the U.S. Yet, there are limited evidence-based interventions to address these interrelated syndemic issues and their shared socio-ecological determinants. This study sought to test the feasibility and acceptability of CRiSOL, a peer-based, resilience-focused intervention to reduce the impact of the SAVAME syndemic on Latino immigrants. Fifteen Latino immigrant community leaders were recruited and trained to serve as health promotion agents in their naturally existing social networks. The training was implemented with high fidelity, received with high satisfaction by the peer leaders, and associated with significant improvements in their knowledge, leadership skills, and social capital. During an 8-month outreach phase, nine leaders remained active in the program and documented 825 one-on-one interactions with community members, during which they provided advice/counseling (52.2% of interactions), health information/education (32.5%), referrals to health and social services (38.5%), food aid (39.9%), and service navigation/assistance (10.2%). While future research must be conducted to establish the effectiveness of CRiSOL, findings from this pilot evaluation indicate the feasibility, acceptability, and high level of reach of this intervention and suggest significant potential to reduce the SAVAME syndemic burden in Latino communities.
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Affiliation(s)
- Ana P. Martinez-Donate
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Claudia Zumaeta-Castillo
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Yoshiaki Yamasaki
- The Philadelphia AIDS Consortium (TPAC)/World Health Care Infrastructures (WHCI), Philadelphia, Pennsylvania, United States of America
| | - Cristina Perez
- The Philadelphia AIDS Consortium (TPAC)/World Health Care Infrastructures (WHCI), Philadelphia, Pennsylvania, United States of America
| | - Omar Martinez
- College of Medicine, University of Central Florida, Orlando, Florida, United States of America
| | - Elizabeth McGhee Hassrick
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Jonas Ventimiglia
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Mariana Lazo-Elizondo
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
- Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, United States of America
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4
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Stern M, Rancourt D, Soca Lozano S, Buro AW, Gray HL, Rodriguez C, Bailey R, Redwine L. Delivering ADAPT+ to Latino Families Living in Rural Communities: Feasibility and Acceptability of Implementing a Health Promotion Program Including Mindfulness. J Pediatr Psychol 2023; 48:666-675. [PMID: 37541829 PMCID: PMC10468101 DOI: 10.1093/jpepsy/jsad049] [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] [Received: 04/21/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Obesity is a major public health crisis in Latino youth. Mounting evidence implicates stress in the development and maintenance of obesity. This study examined the feasibility and acceptability of having community health workers, i.e., promotoras, deliver Adaptando Dieta y Acción Para Todos (ADAPT)+, a family-based health promotion program integrating mindfulness strategies for stress reduction to underserved Latino families in rural communities. METHODS In an ORBIT model Phase IIb longitudinal quasi-cluster feasibility study, promotoras delivered the 6-session ADAPT+ intervention and 1-session Enhanced Usual Care (EUC) in rural Florida. Feasibility was assessed via sample size and recruitment, randomization by community, data collection completion, and intervention fidelity. Acceptability was assessed via participant retention and program satisfaction. Effect sizes of differences in parent stress and mindful eating between conditions at baseline, end of treatment, and 3-month follow-up were calculated. RESULTS Feasibility and acceptability were demonstrated. The recruitment target was 99% met (n = 95 recruited). Randomization was limited to site level due to coronavirus disease 2019-related challenges. Data collection procedures were feasible (100% completion). Retention was 86% at post-assessment and 82.6% at 3-month follow-up. All sessions were completed (100% fidelity). Mean program satisfaction was 3.91/4.00. ADAPT+ parents reported lower stress (difference = -3.04, medium-to-large effect, d = .70) and more mindful eating (difference = 2.00, medium effect, d = .44) than EUC parents at 3-month follow-up. CONCLUSION Study implementation and intervention delivery to rural Latino families using promotoras were feasible and acceptable. Promising findings regarding parent stress and mindful eating support a larger (ORBIT Phase III) efficacy trial. CLINICAL TRIAL REGISTRATION This trial was registered with ClinicalTrials.gov under identifier NCT04800432.
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Affiliation(s)
- Marilyn Stern
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA
| | - Diana Rancourt
- Department of Psychology, University of South Florida, USA
| | | | - Acadia W Buro
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA
| | - Heewon L Gray
- College of Public Health, University of South Florida, USA
| | | | | | - Laura Redwine
- Department of Family Medicine and Community Health, Miller School of Medicine, University of Miami, USA
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Ayala GX, Canale K, Ibarra L, Parada H, Crespo NC, Pérez R, Horton LA, Cherrington A. Facilitators of peer leader retention within a Type 2 diabetes intervention trial for US Latinos/Hispanics of Mexican origin. HEALTH EDUCATION RESEARCH 2023; 38:204-219. [PMID: 36848036 PMCID: PMC10203040 DOI: 10.1093/her/cyad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 12/06/2022] [Accepted: 01/30/2023] [Indexed: 05/24/2023]
Abstract
Peer support is effective in improving self-management behaviors and health outcomes among individuals with Type 2 diabetes. Volunteer peer support programs offer a cost-effective resource for diabetes self-management support; however, factors affecting the retention of volunteer peer leaders remain understudied. Herein, we examined factors associated with volunteer retention and satisfaction among 34 predominantly Mexican-origin peer leaders who assisted patients from a Federally Qualified Health Center located on the US/Mexico border with their diabetes management. Peer leaders completed surveys with open- and close-ended questions at baseline, 6 months and 12 months. Quantitative and qualitative data analyses were guided by the Volunteer Process Model. Using nonparametric Mann-Whitney U tests, self-efficacy as a peer leader at 6 months was most associated with interest to continue volunteering (P = 0.01), and satisfaction with support from the program at 12 months was most associated with interest to continue volunteering (P = 0.01). The qualitative data indicated that the relationship between the peer leaders and their patients was the primary factor for a satisfying volunteer experience. Future research should focus on increasing peer leaders' self-efficacy and satisfaction with program support and examine how organizations can support the development of the patient-peer relationship. Practitioners should consider appealing to volunteer peers' motivations to promote their retention.
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Affiliation(s)
- G X Ayala
- School of Public Health, Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Park Court, Suite 221, San Diego, CA 92123, USA
| | - K Canale
- School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - L Ibarra
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, 9245 Sky Park Court, Suite 221, San Diego, CA 92123, USA
| | - H Parada
- School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - N C Crespo
- School of Public Health, Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Park Court, Suite 221, San Diego, CA 92123, USA
| | - R Pérez
- Department of Anthropology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - L A Horton
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, 9245 Sky Park Court, Suite 221, San Diego, CA 92123, USA
| | - A Cherrington
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Birmingham, AL 35205, USA
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Vilasboas T, Le Q, Greaney ML, Lindsay AC. Brazilian Immigrant Parents' Preferences for Content and Intervention Modalities for the Design of a Family-Based Intervention to Promote Their Preschool-Age Children's Healthful Energy Balance-Related Behaviors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4817. [PMID: 36981726 PMCID: PMC10048827 DOI: 10.3390/ijerph20064817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Brazilians are a rapidly growing ethnic immigrant population in the United States (U.S.), and there is a lack of childhood obesity prevention interventions addressing the needs of Brazilian preschool-age children. Using the family ecological model (FEM) as a guide, this developmental cross-sectional study assessed the preferences (content, intervention modality, and language) of 52 individual Brazilian immigrant parents (27 mothers, 25 fathers) for a family-based intervention to promote healthful energy balance-related behaviors (EBRB). Overall, 85% or more of parents reported being interested or very interested in content related to five of the seven assessed EBRBs (increasing fruits and vegetables, reducing unhealthy foods and sugar-sweetened beverages, increasing physical activity, and reducing screen time). Parent-preferred intervention modalities were group sessions delivered by community health workers (CHWs, 86.5%), email (84.6%), and messaging (78.8%), with most parents (71.2%) indicating a preference for content in Portuguese. Interventions integrating multiple components, such as group sessions offered by CHWs and text messaging using SMS and WhatsApp, should be considered. Future steps for intervention development should include investigating different communication channels and their integration into a culturally and linguistically tailored family-based intervention designed to promote healthful EBRBs of preschool-age children in Brazilian families living in the U.S.
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Affiliation(s)
- Thaís Vilasboas
- Department of Biology, College of Science and Mathematics, University of Massachusetts Boston, Boston, MA 02125, USA
| | - Qun Le
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts—Lowell, Lowell, MA 01854, USA
| | - Mary L. Greaney
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA
| | - Ana Cristina Lindsay
- Department of Exercise and Health Sciences, Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA
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DeNunzio M, Miller M, Chase M, Kraak V, Serrano E, Misyak S. A Scoping Review of the Community Health Worker Model Used for Food Systems Interventions Within the United States. Am J Health Promot 2023; 37:401-419. [PMID: 36112805 DOI: 10.1177/08901171221125451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To document and analyze the food systems interventions delivered by community health workers (CHW) serving as educators within the United States (U.S.). DATA SOURCE Ten databases (ie, Agricola, CAB Abstracts, CINAHL, ERIC, Proquest Social Science and Education, Proquest Theses and Dissertations, PubMed, Scopus, SocIndex, Web of Science) and gray-literature repositories were searched for publications between 2005-2020. STUDY INCLUSION AND EXCLUSION CRITERIA English-language and U.S. studies included with CHW as educators or facilitators for food systems interventions. Food systems defined as processes of production, processing, distribution, marketing, access, preparation, consumption, and disposal of food products. Studies excluded for clinical settings; non-adult CHWs; CHWs with medical or public health credentials; and programming guides, reviews, and commentaries. DATA EXTRACTION Variables included CHW and intervention description, priority population, food system processes, and targeted and unexpected outcomes. DATA SYNTHESIS Data were analyzed by the lead investigator and described narratively. RESULTS Of 43 records, CHWs educated for consumption (n = 38), preparation (n = 33), and food access (n = 22) to improve health of priority populations. Community health workers educated for the highest number of food system processes in garden-based interventions. Programs reached many underserved racial and socioeconomic populations. CONCLUSIONS The CHW model has been used to educate in interventions for all food systems processes and reached many diverse underserved audiences. Future work must explore garden-based food systems education and CHWs as community change agents.
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Affiliation(s)
- Maria DeNunzio
- Department of Human Nutrition, Foods, and Exercise, 1757Virginia Tech, Blacksburg, VA, USA
| | - Makenzie Miller
- 4366Louisiana State University AgCenter, Baton Rouge, LA, USA
| | - Melissa Chase
- Department of Food Science and Technology, 118724Virginia Tech, Blacksburg, VA, USA
| | - Vivica Kraak
- Department of Human Nutrition, Foods, and Exercise, 1757Virginia Tech, Blacksburg, VA, USA
| | - Elena Serrano
- Department of Human Nutrition, Foods, and Exercise, 1757Virginia Tech, Blacksburg, VA, USA
| | - Sarah Misyak
- Department of Human Nutrition, Foods, and Exercise, 1757Virginia Tech, Blacksburg, VA, USA
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Zhang TM, Millery M, Aguirre AN, Kukafka R. A randomized controlled trial of generic and localized MedlinePlus-based information resources for hard-to-reach urban Hispanic community. J Am Med Inform Assoc 2023; 30:282-291. [PMID: 36350567 PMCID: PMC9846683 DOI: 10.1093/jamia/ocac213] [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] [Received: 07/21/2022] [Revised: 09/28/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To determine if the Conexion digital localized health information resource about diabetes and depression could increase patient activation among Hispanic low-income adults. MATERIALS AND METHODS A nonblinded randomized controlled trial was conducted (NCT03984929). Participants at least 18 years old living in Washington Heights/Inwood, New York, were recruited from the community between July 2019 and August 2020 and randomized 1:1 to either the intervention group (localization of MedlinePlus resources customized with community components) or the control group (no localized community components). The primary outcome, patient activation, and secondary outcomes, knowledge, self-efficacy, and behavior change, were collected through surveys at 1-month follow-up. RESULTS Of the 134 participants recruited, 50.7% (n = 68) completed the 1-month follow-up. We found no statistically significant differences in the sociodemographic and baseline characteristics between those who missed the 1-month survey and those who completed it. No significant differences were observed in patient activation at 1-month. However, patient activation among all participants (n = 68) significantly increased (P = .048). Statistically significant improvements were also found in self-efficacy (P < .03). In multivariate analysis, birth country outside the United States and higher self-rated attachment to the community emerged as significant predictors of higher patient activation scores. DISCUSSION While the trial did not detect significant differences between groups, all participants demonstrated increased patient activation scores and improved secondary outcomes. While other factors may have contributed to this increase, our study suggests that access to carefully selected high-quality health information materials delivered digitally in the context of a community may result in improvements comparable to localized content in a hard-to-reach urban Hispanic population. CONCLUSIONS Our study highlights the potential of making carefully selected digital information accessible to hard-to-reach communities.
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Affiliation(s)
- Tianmai M Zhang
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Mari Millery
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Alejandra N Aguirre
- Irving Institute for Clinical and Translational Research, Columbia University Irving Medical Center, New York, New York, USA
| | - Rita Kukafka
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
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9
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Community Health Workers and Stigma Associated with Mental Illness: An Integrative Literature Review. Community Ment Health J 2023; 59:132-159. [PMID: 35723768 DOI: 10.1007/s10597-022-00993-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 02/11/2022] [Indexed: 01/07/2023]
Abstract
Community health workers (CHWs) are facilitators between health services and service users, providing essential and effective support to those seeking health care. However, stigmatizing attitudes towards people with mental illness also exist among CHWs and are based on prejudicial and biasedopinions. This integrative review critically assessed evidence regarding CHWs approaches for addressing mental health issues. In total, 19 studies were included in this review. The results revealed that CHWs have limited knowledge about mental illness and also stigmatizing attitudes towards people with mental illness or substance use problems. Despite feeling unprepared, CHWs are favorable resources for mental health care and can contribute to reducing stigma due to the similarities they share with the communities that they serve. Task-sharing between health professionals and CHWs is an important strategy to improve access to health services and reducing stigma towards people with mental illness, provided that receive adequate training to perform the duties.
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10
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Reyna M, Almeida R, Lopez-Macha A, Fuller S, Duron Y, Fejerman L. Training promotores to lead virtual hereditary breast cancer education sessions for Spanish-speaking individuals of Latin American heritage in California. BMC Womens Health 2022; 22:336. [PMID: 35941639 PMCID: PMC9358079 DOI: 10.1186/s12905-022-01902-y] [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: 04/28/2022] [Accepted: 07/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Awareness about hereditary breast cancer and the preventative steps to minimize disease risk is lower in Hispanic/Latina individuals than non-Hispanic White women in the United States. For this reason, we developed a promotor-based hereditary breast cancer education and risk identification program for self-identified Hispanic/Latina women, which included training promotores in basic genetics and hereditary breast cancer. This study explored promotores’ experiences receiving training and participating in virtual practice sessions as well as changes in knowledge about hereditary breast cancer.
Methods
A total of ten promotores underwent a two-week basic training led by the promotores organization and an eight-hour in person hereditary breast cancer training workshop. Demographic information along with pre- and post-training surveys were completed by ten promotores who participated in the training workshop. Surveys were given to determine changes in knowledge of hereditary breast cancer and genetics. Of the ten promotores, two were selected to lead community education sessions and participated in 6 semi-structured interviews. All interviews and practice sessions were conducted using a virtual platform.
Results
The data revealed that after the 8-h workshop and practice sessions, promotores felt confident about their ability to conduct virtual education sessions with the community. Interviews identified key facilitators to success such as a supportive environment, practice presentations, and personal motivation. Learning the online platform was considered the biggest challenge by the promotores, as opposed to learning complex genetics topics.
Conclusions
These results provide further evidence supporting promotores’ willingness and ability to provide health education on relatively complex topics. It also offers insight into the challenges of presenting information to vulnerable populations using an online platform and the additional support that is required to ensure a positive outcome.
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11
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El-Khayat Y, Franco N, Miller L. Community Conversations About COVID-19. Med Ref Serv Q 2022; 41:223-235. [PMID: 35980632 DOI: 10.1080/02763869.2022.2095815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
"Community Conversations About COVID-19" was a multi-group program designed to address the need for culturally sensitive health information about COVID-19 for Latinx and Native American communities. Three medical librarians worked closely with Latinx and/or Spanish-speaking promotores, also known as community health workers (CHWs), and native patient navigators (NPNs) from Native American communities in Tucson, Arizona. In addition, the librarians collaborated with second-year medical students from the University of Arizona College of Medicine - Phoenix. The focus was to train the CHWs, NPNs, and students on how to access health information resources from the National Library of Medicine, National Institutes of Health, Centers for Disease Control and Prevention, and other reliable agencies. The second segment of the program provided the opportunity for the groups to learn from each other's experiences working with health information through this pandemic, which is especially important given the fact the CHWs and NPNs live in, care for, and were brought up in these communities.
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Affiliation(s)
| | - Nora Franco
- ZSFG Library, University of California San Francisco, USA
| | - Lara Miller
- Oxford College Library, Emory University, Georgia, USA
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12
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Taverno Ross SE, Liang HW, Cheng J, Fox A, Documet PI. Effectiveness of a Promotores Network to Improve Health in an Emerging Latino Community. HEALTH EDUCATION & BEHAVIOR 2022; 49:455-467. [PMID: 35473431 DOI: 10.1177/10901981221090161] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Latinos living in emerging communities (i.e., nontraditional destinations with a small but growing population) face obstacles to their mental and physical health. This study evaluated the effectiveness of a 6-month, promotor-led intervention on access to care, physical activity, dietary practices, and perceived social support among Latino adults living in an emerging community, compared with a nonrandomly assigned control group. METHOD Participants (n = 81 intervention; n = 86 control) were drawn from Allegheny county, Pennsylvania. Promotores used an intervention tool offering nondirective social support to assist participants in developing SMART goals to address their life concerns in eight domains (e.g., social, diet, and exercise/recreation); the control group received printed materials. Participants completed a survey in Spanish at baseline and follow-up to assess outcomes and had their height and weight measured. Adjusted linear mixed effects models compared change in outcomes over time. RESULTS There was a marginally significant improvement in dietary practices in the intervention group at follow-up, and no change in access to care. Both groups experienced an improvement in social support. There was a significant intervention-by-time interaction such that the intervention group increased physical activity by 259 minutes/week compared with the control group. CONCLUSION This study demonstrates the potential effectiveness of a promotores network in assisting individuals living in an emerging Latino community to address their life concerns and improve health behaviors. Future studies should include objective and more rigorous measures with a larger sample to replicate these results.
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Affiliation(s)
| | | | | | - Andrea Fox
- University of Pittsburgh, Pittsburgh, PA, USA
- Squirrel Hill Health Center, Pittsburgh, PA, USA
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Davis EM, Garcia D, Rothenberg WA, Barnett ML, Davidson B, Espinosa N, Tonarely NA, Robertson EL, Alonso B, San Juan J, Jent JF. A Preliminary Analysis of Parent-Child Interaction Therapy Plus Natural Helper Support to Increase Treatment Access and Engagement for Low-Income Families of Color. CHILDREN AND YOUTH SERVICES REVIEW 2022; 134:106370. [PMID: 35273422 PMCID: PMC8903162 DOI: 10.1016/j.childyouth.2022.106370] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Disparities in care for low-income children of color call for innovative culturally and linguistically responsive solutions to better engage marginalized populations in evidence-based interventions. In partnership with a community organization, the addition of natural helper support as an adjunct to Parent-Child Interaction Therapy (PCIT+NH) was examined as a strategy to increase recruitment, engagement, and retention in PCIT for families historically unreached by a university-based clinic. Natural helpers provided home-based skills practice and support for forty-two families whose parents were more racially and linguistically diverse and had lower income and lower caregiver education than the typical population served by the same program (i.e., program population). Families who received PCIT+NH had comparable or higher rates of engagement and improvements in clinical outcomes (i.e., decreased child externalizing and internalizing behaviors, increased child compliance, decreased caregiver stress, increased caregiver parenting skills) relative to the program population. Furthermore, higher doses of natural helper support were associated with higher rates on most measures of treatment engagement (i.e., treatment completion, completion of the Child Directed Interaction phase of treatment, PCIT sessions, homework in the Parent Directed Interaction phase of treatment), with the exception of homework in the Child Directed Interaction phase of treatment and overall session attendance rate. Next steps for testing the treatment engagement and clinical outcome effects of the PCIT+NH model are discussed.
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Affiliation(s)
- Eileen M. Davis
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Dainelys Garcia
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - W. Andrew Rothenberg
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
- Duke University Center for Child and Family Policy 302 Towerview Rd, Durham, NC, USA 27708
| | - Miya L. Barnett
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, Santa Barbara, CA, USA 93106-9490
| | - Bridget Davidson
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Natalie Espinosa
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Niza A. Tonarely
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Emily L. Robertson
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Betty Alonso
- ConnectFamilias 1111 SW 8 Street, Miami, FL, USA 33130
| | | | - Jason F. Jent
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
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14
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Flores I, Consoli AJ, Gonzalez JC, Sanchez EL, Barnett ML. " Todo Se Hace de Corazón:" An Examination of Role and Identity Among Latina Promotoras de Salud. JOURNAL OF LATINX PSYCHOLOGY 2022; 10:5-24. [PMID: 35112070 PMCID: PMC8802993 DOI: 10.1037/lat0000194] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Promotoras de salud are community health workers that mostly help the underserved members of Latinx communities. They seek to reduce health disparities through community engagement and work that is voluntary or mostly unpaid. While there is evidence that promotoras aid in prevention, follow-up care, and treatment adherence, little is known about promotoras themselves, specifically, the impact that fulfilling their roles has on their views of themselves and their service identities. Fourteen Spanish-speaking, Latina promotoras were interviewed individually about their experiences and their motivation for the role. Four themes emerged from the content analysis of the participant responses: "Uno Nace Siendo Promotora:" One is Born Being a Promotora, "Poner Esa Semillita:" To Plant a Seed by Sharing Knowledge, "Es un Regalo Ser Promotora:" It is a Gift to be a Promotora, and "Se Hace por Amor pero también Hay Necesidad:" A Labor of Love but there are Needs too. The findings show that assuming and enacting the promotora role had positive benefits, both personal and professional, despite the often-limited recognition they received. The findings have multiple implications for the development of health and prevention programs, particularly for those that involve promotoras de salud.
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Affiliation(s)
- Iliana Flores
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara
| | - Andrés J Consoli
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara
| | - J C Gonzalez
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara
| | - Erika Luis Sanchez
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara
| | - Miya L Barnett
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara
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15
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Joachim-Célestin M, Rockwood NJ, Clarke C, Montgomery SB. Evaluating the Full Plate Living lifestyle intervention in low-income monolingual Latinas with and without food insecurity. WOMEN'S HEALTH 2022; 18:17455057221091350. [PMID: 35404195 PMCID: PMC9006362 DOI: 10.1177/17455057221091350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Food insecurity has long been associated with poor physical and mental health, especially among women from underrepresented minorities. Despite efforts to reduce food insecurity, rates continue to rise and remain disproportionately high among Latinx living in the United States, a group reporting worse mental health symptoms than any other ethnic group during the COVID-19 pandemic. The need to reduce the health burden associated with food insecurity among Latinas is urgent and requires a more targeted and innovative approach. Interventions using a popular education approach have proven effective among underserved populations, especially when these are delivered by community health workers. However, food insecurity status of the participants is often unreported and it is not clear whether or not results vary between those with and without food insecurity. Objectives: The aim of this quasi-experimental study was to examine physical and mental health changes among Latinas with, and without, food insecurity following a multicomponent health intervention led by community health workers using a popular education approach. Methods: Enrolled obese Latinas (N = 98) with and without food insecurity responded to demographic, health behaviors and mental health surveys and completed biometric measurements at baseline, immediately following the intervention and at 3 months. Results: At baseline, participants with food insecurity reported more anxiety and depression than those without, but average body mass index was comparable. Depression, anxiety and body mass index were lower at 3 months post and no statistically significant differences were seen between the groups. Participants with food insecurity benefited as much from the intervention as those without. We found that, although community health workers are not licensed healthcare professionals, with proper training and support, they were able to successfully reduce the risk of chronic diseases and improve mental health symptoms among food-insecure Latinas. Conclusion: Given the promising results, similar interventions should be implemented on a larger scale in Latino communities among food insecure women. Long-term sustainability should also be explored.
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Affiliation(s)
| | | | - Camille Clarke
- School of Behavioral Health, Loma Linda University, Loma Linda, CA, USA
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16
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Ruiz-Sánchez HC, Macia L, Boyzo R, Documet PI. Community health workers promote perceived social support among Latino men: Respaldo. J Migr Health 2021; 4:100075. [PMID: 34927112 PMCID: PMC8646959 DOI: 10.1016/j.jmh.2021.100075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022] Open
Abstract
Promotores or community health workers are trusted community members who offer information and support to marginalized groups in society. Latinx immigrants in new growth communities or emerging communities (areas with a small yet growing Latinx population) confront many challenges in their settling processes. De la Mano con la Salud was a community-based participatory project that trained Latino immigrant men as promotores. Promotores recruited 182 Latino immigrant men helped them to attain their own goals, connected them with health and social services and connected them to the larger community. We present data from 23 in-depth interviews with project participants conducted after six months of enrollment. Qualitative analysis confirmed participants’ vulnerabilities and showed that promotores addressed many of the health, legal, and occupational needs of participants. Emerging themes showed that 1) participants had a thirst for a united Latinx community; and 2) felt that promotores had their back (respaldo). The need for community may reflect the current invisibility of this Latinx population, as well as the desires for recognition and ethnic identity affirmation. Respaldo strongly resembles perceived social support, which is the kind of support most associated with health outcomes. Future research can determine what intervention components best foster respaldo.
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Yeary KHCK, Ounpraseuth S, Wan F, Graetz I, Fagan P, Huff-Davis A, Kaplan C, Johnson K, Hutchins E. Assessing the Feasibility of an Online Training Designed to Enable Community Health Workers to Deliver a Comprehensive, Evidence-Based Weight Loss Intervention for Rural African Americans of Faith. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:1277-1284. [PMID: 32441002 PMCID: PMC7679277 DOI: 10.1007/s13187-020-01764-8] [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] [Indexed: 06/11/2023]
Abstract
Obesity is a critical modifiable risk factor in cancer prevention, control, and survivorship. Comprehensive weight loss interventions (e.g., Diabetes Prevention Program (DPP)) have been recommended by governmental agencies to treat obesity. However, their high implementation costs limit their reach, especially in underserved African American (AA) communities. Community health workers (CHWs) or trusted community members can help increase access to obesity interventions in underserved regions facing provider shortages. CHW-led interventions have increased weight loss. However, in-person CHW training can be costly to deliver and often requires extensive travel to implement. Web-based trainings have become common to increase reach at reduced cost. However, the feasibility of an online CHW training to deliver the DPP in AAs is unknown. The feasibility of an online CHW training to deliver the DPP adapted for AAs was assessed. The online training was compared to an in-person DPP training with established effectiveness. CHW effectiveness and satisfaction were assessed at baseline and 6 weeks. Nineteen participants (in-person n = 10; online n = 9) were recruited. At post-training, all scored higher than the 80% on a knowledge test required to deliver the intervention. All participants reported high levels of training satisfaction (88.9% of online participants and 90% of in-person participants rated the training as at least 6 on a 1-7 scale) and comfort to complete intervention tasks (78% of online participants and 60% of in-person participants scored at least 6 on a 1-7 scale). There were no significant differences in outcomes by arm. An online CHW training to deliver the DPP adapted for AAs faith communities produced comparable effectiveness and satisfaction to an evidence-based in-person CHW training. Further research is needed to assess the cost-effectiveness of different CHW training modalities to reduce obesity.
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Affiliation(s)
- Karen Hye-Cheon Kim Yeary
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm and Carton Streets, Buffalo, NY, 14263, USA.
| | - Songthip Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Fei Wan
- Department of Surgery, Washington University School of Medicine in St. Louis, 660 Euclid Avenue, St. Louis, MO, 63110, USA
| | - Ilana Graetz
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Suite 636, Atlanta, GA, 30322, USA
| | - Pebbles Fagan
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Anna Huff-Davis
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Cameron Kaplan
- The Gehr Center for Health Systems Science & Innovation, Keck School of Medicine of USC, 2020 Zonal Ave., Los Angeles, CA, 90033, USA
| | - Kemmian Johnson
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Ellen Hutchins
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
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Barnett ML, Luis Sanchez BE, Green Rosas Y, Broder-Fingert S. Future Directions in Lay Health Worker Involvement in Children's Mental Health Services in the U.S. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2021; 50:966-978. [PMID: 34554014 PMCID: PMC8633058 DOI: 10.1080/15374416.2021.1969655] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Nearly half of children meeting criteria for a mental health disorder in the United States (U.S.) do not receive the treatment they need. Unfortunately, lack of access to and engagement in mental health services can be seen at even higher rates for historically marginalized groups, including low-income, racial, and ethnic minority youth. Lay Health Workers (LHWs) represent a valuable workforce that has been identified as a promising solution to address mental health disparities. LHWs are individuals without formal mental health training who oftentimes share lived experiences with the communities that they serve. A growing body of research has supported the mobilization of LHWs to address service disparities around the globe; however, challenges persist in how to scale-up and sustain LHW models of care, with specific barriers in the U.S. In this paper, we describe LHWs' different roles and involvement in the mental health field as well as the current state of the literature around LHW implementation. We integrate the RE-AIM Framework with a conceptual model of how LHWs address disparities to outline future directions in research and practice to enhance equity in the reach, effectiveness, adoption, implementation, and maintenance of LHW models of care and evidence-based practices for historically marginalized communities within the U.S.
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Affiliation(s)
- Miya L Barnett
- Department of Counseling, University of California Santa Barbara
| | | | | | - Sarabeth Broder-Fingert
- Department of Pediatrics, University of Massachusetts Medical School
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School
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19
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Ayala GX, Monge-Rojas R, King AC, Hunter R, Berge JM. [Entorno social y obesidad infantil: implicaciones para la investigación y la práctica en Estados Unidos y en los países latinoamericanos]. Obes Rev 2021; 22 Suppl 5:e13350. [PMID: 34708540 PMCID: PMC9138052 DOI: 10.1111/obr.13350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/02/2022]
Abstract
The environments of children influence their risk for childhood obesity through, among other factors, a child's weight-related behaviors (i.e., diet and physical activity). In this article, we present evidence on social environmental factors associated with a child's diet and physical activity, and more generally, the prevention and control of childhood obesity among Hispanic/Latinx children in the United States and children from countries in Latin America. Using a socio-ecologic lens, we present evidence from cross-sectional and longitudinal studies conducted in the United States involving Hispanic/Latinx children, and evidence from studies involving children in Latin America. Studies examining parenting factors in the home environment (e.g., parenting strategies) are especially emphasized, with more limited evidence on social environmental factors in other lived contexts (e.g., school). The influence of acculturation on social relationships cuts across levels of the socio-ecological framework. Intervention research identified strategies and research gaps for intervening on social factors to promote healthy behaviors and reduce risk for childhood obesity. Community health workers and others forms of peer support were identified as relevant approaches at multiple levels of the socio-ecological framework. This article concludes with directions for future research to further understand the environment using newer information and communication technologies.
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Affiliation(s)
- Guadalupe X Ayala
- School of Public Health, San Diego State University, the Institute for Behavioral and Community Health, and the SDSU HealthLINK Center, San Diego, California, EE. UU
| | - Rafael Monge-Rojas
- Unidad de Salud y Nutrición, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica
| | - Abby C King
- Departments of Epidemiology & Population Health and Medicine (Stanford Prevention Research Center), Stanford University School of Medicine, Stanford, California, EE. UU
| | - Ruth Hunter
- Centre for Public Health, Queen's University Belfast, Irlanda del Norte, Belfast, Reino Unido
| | - Jerica M Berge
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, Mineápolis, Minesota, EE. UU
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20
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Ross SET, Tapia IS, Saunders RP, Documet PI, Pate RR. Implementation Monitoring of a Promotora-Led, Home-Based Obesity Prevention Pilot Study With Latino Preschool Children and Their Mothers. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021; 41:411-418. [PMID: 33143559 PMCID: PMC11117107 DOI: 10.1177/0272684x20970375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Latino preschool children have higher rates of obesity than children from other racial/ethnic backgrounds. Few effective, culturally-tailored obesity prevention interventions exist that have focused on Latino preschool children, and even fewer have published results of the process evaluation. The purpose of this paper was to monitor reach, fidelity, and completeness of implementation to determine whether ANDALE, a promising promotora-led, home-based pilot study to prevent obesity in Latino preschool children, was implemented as planned. METHODS Guided by a logic model, we assessed reach, implementation fidelity and completeness through descriptive analyses of multiple data sources. Reach was assessed through attendance records. Fidelity was assessed via observation checklist and completeness was assessed via survey with both parents and promotoras in a subsample of 12 families. RESULTS Promotoras recruited participants primarily through their own social networks and delivered the intervention to 50 families (mother-child dyads); the majority were of Mexican-origin, low-acculturation, dual-parent households. Nearly all (98%) families completed the whole 10-week intervention. Results demonstrated completeness and fidelity of implementation were acceptable in a subsample of 12 families. In sum, 75% of families in the subsample met the criteria (≥75%) for overall implementation of essential program elements (i.e., reach, completeness, and fidelity). CONCLUSION Evidence suggests that ANDALE was delivered with high levels of completeness and fidelity in this sample of Latino families with preschool-aged children. These results support implementation of ANDALE in a large, randomized trial.
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Affiliation(s)
- Sharon E. Taverno Ross
- Department of Health and Human Developmen, Health and Human Development, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | | | - Ruth P. Saunders
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, United States
| | - Patricia I. Documet
- Department of Behavioral and Community Health Sciences, Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Russell R. Pate
- Department of Exercise Science, Physical Activity Research Group, University of South Carolina, Columbia, South Carolina, United States
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21
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Ayala GX, Monge‐Rojas R, King AC, Hunter R, Berge JM. The social environment and childhood obesity: Implications for research and practice in the United States and countries in Latin America. Obes Rev 2021; 22 Suppl 3:e13246. [PMID: 33951272 PMCID: PMC8365653 DOI: 10.1111/obr.13246] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/17/2022]
Abstract
The environments of children influence their risk for childhood obesity through, among other factors, a child's weight-related behaviors (i.e., diet and physical activity). In this article, we present evidence on social environmental factors associated with a child's diet and physical activity, and more generally, the prevention and control of childhood obesity among Hispanic/Latinx children in the United States and children from countries in Latin America. Using a socio-ecologic lens, we present evidence from cross-sectional and longitudinal studies conducted in the United States involving Hispanic/Latinx children, and evidence from studies involving children in Latin America. Studies examining parenting factors in the home environment (e.g., parenting strategies) are especially emphasized, with more limited evidence on social environmental factors in other lived contexts (e.g., school). The influence of acculturation on social relationships cuts across levels of the socio-ecological framework. Intervention research identified strategies and research gaps for intervening on social factors to promote healthy behaviors and reduce risk for childhood obesity. Community health workers and others forms of peer support were identified as relevant approaches at multiple levels of the socio-ecological framework. This article concludes with directions for future research to further understand the environment using newer information and communication technologies.
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Affiliation(s)
- Guadalupe X. Ayala
- School of Public HealthSan Diego State University, the Institute for Behavioral and Community Health, and the SDSU HealthLINK CenterSan DiegoCaliforniaUSA
| | - Rafael Monge‐Rojas
- Health and Nutrition UnitCosta Rican Institute for Research and Education on Nutrition and Health (INCIENSA)CartagoCosta Rica
| | - Abby C. King
- Departments of Epidemiology & Population Health and Medicine (Stanford Prevention Research Center)Stanford University School of MedicineStanfordCaliforniaUSA
| | - Ruth Hunter
- Centre for Public HealthQueen's University Belfast, North IrelandBelfastUK
| | - Jerica M. Berge
- Department of Family Medicine and Community Health, Medical SchoolUniversity of MinnesotaMinneapolisMinnesotaUSA
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22
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Mojica CM, Almatkyzy G, Morales-Campos D. A Cancer Education-Plus-Navigation Intervention Implemented Within a Federally Qualified Health Center and Community-Based Settings. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:152-159. [PMID: 31463809 DOI: 10.1007/s13187-019-01611-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Despite the availability of effective cancer screening tests, Latinos are screened at lower rates than non-Hispanic Whites. We implemented and evaluated the effectiveness of an evidence-based community health worker (CHW) cancer education-plus-navigation intervention designed to increase cancer screening, knowledge of screening guidelines, and the benefit of early detection. The project included a community and clinic component and served a primarily Latino population. In collaboration with a federally qualified health center (FQHC) and three community-based organizations, bilingual/bicultural CHWs recruited men and women (not up-to-date with the cancer screening guidelines) from a FQHC and the community. Participants received education plus navigation and no-cost cancer screening tests. Together with the FQHC, we outlined eligibility criteria, project protocols, project implementation, and evaluation activities. With the community organizations, we outlined recruitment protocols-when to recruit, how to recruit, and connections with other organizations. CHWs enrolled 3045 men and women into the education-plus-navigation intervention. Overall, 71% received at least one cancer screening. Stratifying by gender, 72% of women received at least one cancer screening test whereas 63% of enrolled men received a test for colorectal cancer. Knowledge of screening guidelines and the belief in early detection also increased from baseline to follow-up. Our evidence-based education-plus-navigation intervention successfully reached large numbers of underserved men and women and yielded positive changes in cancer screening and knowledge of screening guidelines and the belief in early detection. The inclusion of a clinic and community component ensured success of the project.
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Affiliation(s)
- Cynthia M Mojica
- College of Public Health and Human Sciences, Oregon State University, 2250 SW Jefferson Way, Waldo 445, Corvallis, OR, 97331, USA.
| | - Gulaiim Almatkyzy
- College of Public Health and Human Sciences, Oregon State University, 2250 SW Jefferson Way, Corvallis, OR, 97331, USA
| | - Daisy Morales-Campos
- Latino Research Initiative, The University of Texas at Austin, 210 W. 24th Street|Mailcode F9200, GWB 2.102, Austin, TX, 78712, USA
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23
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Shelton RC, Brotzman LE, Johnson D, Erwin D. Trust and Mistrust in Shaping Adaptation and De-Implementation in the Context of Changing Screening Guidelines. Ethn Dis 2021; 31:119-132. [PMID: 33519162 PMCID: PMC7843040 DOI: 10.18865/ed.31.1.119] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To understand barriers and facilitators to the adaptation of programs reflecting changing scientific guidelines for breast/cervical cancer screening, including factors influencing the de-implementation of messaging, program components, or screening practices no longer recommended due to new scientific evidence. Setting National sample of NWP sites from across the United States. Design and Methods We conducted a convergent mixed-methods design in partnership with The National Witness Project (NWP), a nationally implemented evidence-based lay health advisor (LHA) program for breast/cervical cancer screening among African American (AA) women. Surveys were conducted among 201 project directors (PDs) and LHAs representing 14 NWP sites; in-depth interviews were conducted among 14 PDs to provide context to findings. Survey data and qualitative interviews were collected concurrently from January 2019-January 2020. Results Trust and mistrust were important themes that arose in quantitative and qualitative data. Common concerns about adapting to new guidelines included: 1) perceptions that new guidelines misalign with the personal values and beliefs of AA women; 2) mistrust of guidelines, providers, medical organizations; 3) confusion about inconsistent guidelines and concern they are based on studies that don't reflect the experience of AA women (who experience more aggressive tumors at younger ages); and 4) belief that breast self-exam (BSE) is an empowerment tool for AA women and should be included to promote awareness, given many women discovered lumps/cancer through BSE. Conclusion Findings highlight that trust and mistrust are important but understudied social determinants of health among AAs that should be considered in implementation science as they: 1) have critical implications for shaping health inequities; and 2) help explain and contextualize why new screening guidelines may not be fully embraced in the AA community.
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Affiliation(s)
- Rachel C. Shelton
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, New York, NY
| | - Laura E. Brotzman
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, New York, NY
| | | | - Deborah Erwin
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
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Neri Mini F, Saltzman JA, Simione M, Luo M, Perkins ME, Roche B, Blake-Lamb T, Kotelchuck M, Arauz-Boudreau A, Davison K, Taveras EM. Expectant Fathers' Social Determinants of Health in Early Pregnancy. Glob Pediatr Health 2020; 7:2333794X20975628. [PMID: 33294495 PMCID: PMC7705787 DOI: 10.1177/2333794x20975628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/15/2020] [Accepted: 11/02/2020] [Indexed: 11/18/2022] Open
Abstract
This cross-sectional, descriptive study examined unmet social and economic needs and health information requests of low-income, expecting fathers who participated in the First 1000 Days program. The First 1000 Days is a systems-level intervention aiming to prevent obesity among low-income mothers and infants across 3 community health centers in Greater Boston, MA, USA. Fathers who attended their partner's first prenatal care visit were invited to complete a program survey during early pregnancy. Among 131 fathers surveyed, 45% were white, 21% were Hispanic/Latino, 55% were foreign-born, and 69% reported an annual income under $50 000. Fathers reported elevated levels of food insecurity (18%) and 33% were unaware of someone that could provide a $50 loan; however, over 85% of fathers knew someone that could provide non-financial social support. Fathers requested information about pregnancy, birth preparation, and fatherhood. Findings support addressing fathers' unmet needs during pregnancy and providing father-specific perinatal information.
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Affiliation(s)
| | - Jaclyn A. Saltzman
- Massachusetts General Hospital, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Meg Simione
- Massachusetts General Hospital, Boston, MA, USA
| | - Man Luo
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | | | | | | | - Elsie M. Taveras
- Massachusetts General Hospital, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
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25
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King AC, Campero MI, Sheats JL, Castro Sweet CM, Hauser ME, Garcia D, Chazaro A, Blanco G, Banda J, Ahn DK, Fernandez J, Bickmore T. Effects of Counseling by Peer Human Advisors vs Computers to Increase Walking in Underserved Populations: The COMPASS Randomized Clinical Trial. JAMA Intern Med 2020; 180:1481-1490. [PMID: 32986075 PMCID: PMC7522781 DOI: 10.1001/jamainternmed.2020.4143] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Effective and practical treatments are needed to increase physical activity among those at heightened risk from inactivity. Walking represents a popular physical activity that can produce a range of desirable health effects, particularly as people age. OBJECTIVE To test the hypothesis that counseling by a computer-based virtual advisor is no worse than (ie, noninferior to) counseling by trained human advisors for increasing 12-month walking levels among inactive adults. DESIGN, SETTING, AND PARTICIPANTS A cluster-randomized, noninferiority parallel trial enrolled 245 adults between July 21, 2014, and July 29, 2016, with follow-up through September 15, 2017. Data analysis was performed from March 15 to December 20, 2018. The evidence-derived noninferiority margin was 30 minutes of walking per week. Participants included inactive adults aged 50 years and older, primarily of Latin American descent and capable of walking without significant limitations, from 10 community centers in Santa Clara and San Mateo counties, California. INTERVENTIONS All participants received similar evidence-based, 12-month physical activity counseling at their local community center, with the 10 centers randomized to a computerized virtual advisor program (virtual) or a previously validated peer advisor program (human). MAIN OUTCOMES AND MEASURES The primary outcome was change in walking minutes per week over 12 months using validated interview assessment corroborated with accelerometry. Both per-protocol and intention-to-treat analysis was performed. RESULTS Among the 245 participants randomized, 193 were women (78.8%) and 241 participants (98.4%) were Latino. Mean (SD) age was 62.3 (8.4) years (range, 50-87 years), 107 individuals (43.7%) had high school or less educational level, mean BMI was 32.8 (6.8), and mean years residence in the US was 47.4 (17.0) years. A total of 231 participants (94.3%) completed the study. Mean 12-month change in walking was 153.9 min/wk (95% CI, 126.3 min/wk to infinity) for the virtual cohort (n = 123) and 131.9 min/wk (95% CI, 101.4 min/wk to infinity) for the human cohort (n = 122) (difference, 22.0, with lower limit of 1-sided 95% CI, -20.6 to infinity; P = .02); this finding supports noninferiority. Improvements emerged in both arms for relevant clinical risk factors, sedentary behavior, and well-being measures. CONCLUSIONS AND RELEVANCE The findings of this study indicate that a virtual advisor using evidence-based strategies produces significant 12-month walking increases for older, lower-income Latino adults that are no worse than the significant improvements achieved by human advisors. Changes produced by both programs are commensurate with those reported in previous investigations of these behavioral interventions and provide support for broadening the range of light-touch physical activity programs that can be offered to a diverse population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02111213.
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Affiliation(s)
- Abby C King
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, California.,Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Maria Ines Campero
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jylana L Sheats
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California.,Now with Global Community Health and Behavioral Science Department, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Cynthia M Castro Sweet
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California.,Now with Omada Health, Inc, San Francisco, California
| | - Michelle E Hauser
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California.,Now with Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California.,Now with Primary Care, Veterans Affairs Palo Alto Health Care System, Livermore, California.,Now with Fair Oaks Health Center, San Mateo County Health System, Redwood City, California
| | - Dulce Garcia
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Aldo Chazaro
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - German Blanco
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jorge Banda
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California.,Now with Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana
| | - David K Ahn
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Juan Fernandez
- Khoury College of Computer Sciences, Northeastern University, Boston, Massachusetts
| | - Timothy Bickmore
- Khoury College of Computer Sciences, Northeastern University, Boston, Massachusetts
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26
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Parker A, Johnson-Motoyama M, Mariscal ES, Guilamo-Ramos V, Reynoso E, Fernandez C. Novel Service Delivery Approach to Address Reproductive Health Disparities within Immigrant Latino Communities in Geographic Hot Spots: An Implementation Study. HEALTH & SOCIAL WORK 2020; 45:155-163. [PMID: 32632448 DOI: 10.1093/hsw/hlaa014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/16/2019] [Accepted: 04/02/2019] [Indexed: 06/11/2023]
Abstract
Latinx youths continue to have the highest rates of teenage births in the United States and are at increased risk of acquiring sexually transmitted infections, including HIV/AIDS. A community-based research partnership piloted Families Talking Together, a brief, parent-based sexual risk reduction program using a novel and culturally relevant approach. This mixed-methods study examined the feasibility and acceptability of Spanish-speaking promotoras de salud (that is, community health workers) as implementers of an evidence-based intervention (EBI) to reach underserved immigrant communities. Findings suggest that promotoras are capable of implementing the EBI with positive organizational, client, and implementation outcomes. Furthermore, promotoras hold particular promise for addressing reproductive health disparities as they are indigenous and trusted members of the community who can reach members of marginalized Latino populations.
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Affiliation(s)
- Amittia Parker
- School of Social Welfare, University of Kansas, 1545 Lilac Lane, Lawrence, KS 66045
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27
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Meza RD, Kiche S, Soi C, Khairuzzaman AN, Nales CJR, Whetten K, Wasonga AI, Amanya C, Dorsey S. Barriers and facilitators of child and guardian attendance in task-shifted mental health services in schools in western Kenya. Glob Ment Health (Camb) 2020; 7:e16. [PMID: 32742674 PMCID: PMC7379319 DOI: 10.1017/gmh.2020.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/12/2020] [Accepted: 05/22/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Globally, nearly 140 million children have experienced the death of one or both parents, and as a result many experience higher rates of mental health problems. Trauma-focused cognitive behavioral therapy (TF-CBT) delivered by lay counselors has been shown to improve mental health outcomes for children experiencing traumatic grief due to parental loss; however, challenges with treatment attendance limit the public health impact of mental health services. This study used qualitative methods to assess barriers and facilitators of child and guardian attendance of school-based lay counselor delivered TF-CBT. METHODS Semi-structured interviews were conducted with 36 lay counselors (18 teachers; 18 community health volunteers) who delivered TF-CBT to explore their perceptions of barriers of facilitators of child and guardian attendance of group-based sessions delivered in schools. RESULTS Counselors identified attendance barriers and facilitators related to the delivery setting, resources, participant characteristics, intervention characteristics and counselor behaviors. The findings revealed a greater number of facilitators than barriers. Common facilitators included participant and counselor resources, counselor commitment behaviors and communication efforts to encourage attendance. Barriers were less frequently endorsed, with participant resources, child or guardian illness and communication challenges most commonly mentioned. CONCLUSIONS Attention to barriers and facilitators of attendance in the context in which mental health interventions are delivered allows for identification of ways to improve attendance and treatment engagement and achieve the potential promise of providing accessible mental health services.
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Affiliation(s)
- Rosemary D. Meza
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA98195, USA
| | - Sharon Kiche
- SMART Center, Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 110, Seattle, WA98115, USA
| | - Caroline Soi
- Department of Global Health, Harris Hydraulics Laboratory, University of Washington, 1510 San Juan Road, Seattle, WA98195, USA
| | - Alya N. Khairuzzaman
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA98195, USA
| | - Cristian J. Rivera Nales
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA98195, USA
| | - Kathryn Whetten
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Box 90519, Durham, NC27708, USA
- Terry Sanford Institute of Public Policy, Duke Global Health Institute, Duke University, Box 90239, Durham, NC27708, USA
| | | | - Cyrilla Amanya
- Research Department, Ace Africa Kenya, P.O. Box 1185, 50200 Bungoma, Kenya
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA98195, USA
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28
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Glanton E, Yarrington CD, Calderwood L, Torrey Sosa L, Connors PD. The importance of personalismo: Navigating obstacles in recruitment strategies for Spanish speakers in marginalized communities. J Genet Couns 2020; 29:391-398. [PMID: 32144873 DOI: 10.1002/jgc4.1240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/08/2020] [Accepted: 02/11/2020] [Indexed: 11/06/2022]
Abstract
Recruitment obstacles with Spanish-speaking individuals and members of marginalized communities have been documented in the literature in narrative form, but quantitative data on effective strategies are limited. Within our research protocol assessing the impact of a storytelling intervention on knowledge and uptake of cell-free DNA (cfDNA) aneuploidy screening, three different recruitment strategies were trialed and enrollment rates were compared. Throughout the study, field notes were collected from observations in recruitment efforts. We demonstrate the effectiveness of language-concordant, personal interactions, and culturally tailored materials for recruitment of Spanish-speaking participants into genomic research studies. We also offer commentary on the experience of the researchers that provides insights to inform recruitment methods for marginalized communities.
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Affiliation(s)
- Emily Glanton
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Christina D Yarrington
- Department of Obstetrics and Gynecology, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Laurel Calderwood
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
- Department of Pediatrics, Division of Medical Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Lillian Torrey Sosa
- Department of Obstetrics and Gynecology, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Philip D Connors
- Department of Obstetrics and Gynecology, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
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29
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De La Torre CL, Dumbauld JN, Haughton J, Gupta S, Nodora J, Giacinto RE, Ramers C, Bharti B, Wells K, Lopez J, Díaz M, Moody J, Arredondo EM. Development of a Group-Based Community Health Worker Intervention to Increase Colorectal Cancer Screening Among Latinos. HISPANIC HEALTH CARE INTERNATIONAL 2020; 19:47-54. [PMID: 32466687 DOI: 10.1177/1540415320923564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Latinos are at higher risk of colorectal cancer (CRC) mortality than non-Hispanic Whites due, in part, to disparities in cancer screening. There is a need to evaluate community-based CRC interventions as they may reach underinsured communities and those at highest risk for CRC. This article describes the development of a group-based CRC intervention (Juntos contra el Cancer). METHOD Purposive sampling was used to recruit Latino men and women aged 50 to 75 years not-up-to-date with CRC screening. The development of the intervention was guided by the socioecologic framework, a community needs assessment, literature reviews, five focus groups (n = 39) from the target community and feedback from a Community Advisory Board. RESULTS Findings from focus groups suggested that a group-based, promotor or community health worker (CHW) led, cancer prevention education with linkages to care would address barriers to CRC screening. CONCLUSION Development of community-based CRC screening interventions should be informed by early and sustained community engagement. Interventions led by CHWs with linkages to care are feasible and can reach populations not connected to health care settings.
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Affiliation(s)
- C L De La Torre
- 7117San Diego State University, Institute for Behavioral and Community Health (IBACH), San Diego, CA, USA
| | - J N Dumbauld
- 7117San Diego State University, Institute for Behavioral and Community Health (IBACH), San Diego, CA, USA
| | - J Haughton
- 7117San Diego State University, Institute for Behavioral and Community Health (IBACH), San Diego, CA, USA
| | - S Gupta
- San Diego Veterans Affairs Healthcare System, La Jolla, CA, USA
| | - J Nodora
- UC San Diego Moores Cancer Center, La Jolla, CA, USA
| | - R Espinoza Giacinto
- 7117San Diego State University, Institute for Behavioral and Community Health (IBACH), San Diego, CA, USA
| | - C Ramers
- 263965Family Health Centers of San Diego, San Diego, CA, USA
| | - B Bharti
- UC San Diego Moores Cancer Center, La Jolla, CA, USA
| | - K Wells
- 7117San Diego State University, Institute for Behavioral and Community Health (IBACH), San Diego, CA, USA
| | - J Lopez
- 263965Family Health Centers of San Diego, San Diego, CA, USA
| | - M Díaz
- 263965Family Health Centers of San Diego, San Diego, CA, USA
| | - J Moody
- UC San Diego School of Medicine, San Diego, CA, USA
| | - Elva M Arredondo
- 7117San Diego State University, Institute for Behavioral and Community Health (IBACH), San Diego, CA, USA
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30
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Patel BK, Ridgeway JL, Ghosh K, Rhodes DJ, Borah B, Jenkins S, Suman VJ, Norman A, Jewett M, Singh D, Vachon CM, Radecki Breitkopf C. Behavioral and psychological impact of returning breast density results to Latinas: study protocol for a randomized clinical trial. Trials 2019; 20:744. [PMID: 31852492 PMCID: PMC6921571 DOI: 10.1186/s13063-019-3939-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/26/2019] [Indexed: 01/07/2023] Open
Abstract
Background Breast cancer is the most common cancer and the leading cause of cancer mortality among Latinas. As more is learned about the association between mammographic breast density (MBD) and breast cancer risk, a number of U.S. states adopted legislation and now a federal law mandates written notification of MBD along with mammogram results. These notifications vary in content and readability, though, which may limit their effectiveness and create confusion or concern, especially among women with low health literacy or barriers to screening. The purpose of this study is to determine whether educational enhancement of MBD notification results in increased knowledge, decreased anxiety, and adherence to continued mammography screening among Latina women in a limited-resources setting. Methods Latinas LEarning About Density (LLEAD) is a randomized clinical trial (RCT) comparing the impact of three notification approaches on behavioral and psychological outcomes in Latina women. Approximately 2000 Latinas undergoing screening mammography in a safety-net community clinic will be randomized 1:1:1 to mailed notification (usual care); mailed notification plus written educational materials (enhanced); or mailed notification, written educational materials, plus verbal explanation by a promotora (interpersonal). The educational materials and verbal explanations are available in Spanish or English. Mechanisms through which written or verbal information influences future screening motivation and behavior will be examined, as well as moderating factors such as depression and worry about breast cancer, which have been linked to diagnostic delays among Latinas. The study includes multiple psychological measures (anxiety, depression, knowledge about MBD, perceived risk of breast cancer, worry, self-efficacy) and behavioral outcomes (continued adherence to mammography). Measurement time points include enrollment, 2–4 weeks post-randomization, and 1 and 2 years post-randomization. Qualitative inquiry related to process and outcomes of the interpersonal arm and cost analysis related to its implementation will be undertaken to understand the intervention’s delivery and transferability. Discussion Legislation mandating written MBD notification may have unintended consequences on behavioral and psychological outcomes, particularly among Latinas with limited health literacy and resources. This study has implications for cancer risk communication and will offer evidence on the potential of generalizable educational strategies for delivering information on breast density to Latinas in limited-resource settings. Trial registration ClinicalTrials.gov, NCT02910986. Registered on 21 September 2016. Items from the WHO Trial Registration Data Set can be found in this protocol.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Matt Jewett
- Mountain Park Health Center, Phoenix, AZ, USA
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Outcomes from a Male-to-Male Promotores Intervention in an Emerging Latino Community. J Immigr Minor Health 2019; 22:717-726. [PMID: 31617052 DOI: 10.1007/s10903-019-00939-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Emerging Latino communities experience social isolation and lack services tailored to their culture. Few male-to-male promotores (community health workers in Spanish) interventions exist. This 6-month participatory study aimed to improve social support, healthcare access, depressive symptoms, and decrease alcohol consumption among Latino immigrant men. Promotores delivered non-directive social support to participants recruited from community venues. We analyzed baseline and 6-month questionnaires data (n = 89) using paired chi square tests. All participants were immigrants; 47% had not finished high school, 29% had depression symptoms, 35% reported past month binge drinking and 93% were uninsured. The intervention significantly improved having a usual source of care (24 to 43%), doctor's visits (41 to 62%) and dentist's visits (27 to 42%) in the past year. Other outcomes did not improve. Male promotores increased healthcare access among vulnerable Latino men. Addressing drinking behavior and depression may require longer interventions or specialized providers.
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Barnett M, Miranda J, Kia-Keating M, Saldana L, Landsverk J, Lau AS. Developing and evaluating a lay health worker delivered implementation intervention to decrease engagement disparities in behavioural parent training: a mixed methods study protocol. BMJ Open 2019; 9:e028988. [PMID: 31324682 PMCID: PMC6661633 DOI: 10.1136/bmjopen-2019-028988] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Behavioural parent training (BPT) programmes are effective in preventing and treating early-onset conduct problems and child maltreatment. Unfortunately, pervasive mental health service disparities continue to limit access to and engagement in these interventions. Furthermore, challenges with parental engagement can impede the successful implementation of evidence-based practices (EBPs) in community settings that serve low-income, ethnic minority families. Lay health workers (LHWs)-individuals without formal mental health training-represent an important workforce to increase engagement, as they are members of the communities they serve. However, the mobilisation of LHWs has not been well studied as an implementation strategy to extend the reach or effectiveness of EBPs in the USA. LHW-delivered implementation interventions that specifically support the engagement of Latinx parents in evidence-based BPT programmes have the potential to improve clinical and implementation outcomes. METHODS AND ANALYSIS A community-partnered approach will use the Quality Implementation Framework (QIF) to tailor and implement an LHW-delivered implementation intervention that aims to promote Latinx parent engagement in BPT programmes. Steps from the QIF will guide study activities to (1) conduct a mixed methods needs assessment to fit the implementation intervention to the local context, (2) adapt LHW-delivered implementation strategies to promote parent access to and engagement in Parent-Child Interaction Therapy and (3) conduct a hybrid effectiveness-implementation pilot trial to examine the feasibility, acceptability and preliminary effectiveness of the LHW implementation intervention at increasing engagement. ETHICS AND DISSEMINATION Study procedures have been approved by the Institutional Review Board at the University of California, Santa Barbara. Results will be shared with the community-advisory group, at community-based meetings for other stakeholders involved in the pilot project, and submitted for publication in peer-reviewed journals.
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Affiliation(s)
- Miya Barnett
- Counseling, Clinical, and School Psychology, University of California Santa Barbara, Santa Barbara, California, USA
| | - Jeanne Miranda
- Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California, USA
- Center for Health Services and Society, University of California Los Angeles, Los Angeles, California, USA
| | - Maryam Kia-Keating
- Counseling, Clinical, and School Psychology, University of California Santa Barbara, Santa Barbara, California, USA
| | - Lisa Saldana
- Oregon Social Learning Center, Eugene, Oregon, USA
| | | | - Anna S Lau
- Psychology, University of California Los Angeles, Los Angeles, California, USA
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Bryant-Stephens T, Kenyon C, Apter AJ, Wolk C, Williams YS, Localio R, Toussaint K, Hui A, West C, Stewart Y, McGinnis S, Gutierrez M, Beidas R. Creating a community-based comprehensive intervention to improve asthma control in a low-income, low-resourced community. J Asthma 2019; 57:820-828. [PMID: 31082287 DOI: 10.1080/02770903.2019.1619083] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Asthma evidence-based interventions (EBI) are implemented in the home, school, community or primary care setting. Although families are engaged in one setting, they often have to navigate challenges in another setting.Objective: Our objective is to design and implement a comprehensive plan which integrates EBI's and connects the four sectors in underserved communities such as Philadelphia.Methods: September 2015-April 2016 we implemented a three-pronged strategy to understand needs and resources of the community including 1) focus groups and key informant interviews, 2) secondary data analysis and 3) pilot testing for implementation to determine gaps in care, and opportunities to overcome those gaps.Results: Analysis of the focus group and key informant responses showed themes: diagnosis fear, clinician time, home and school asthma trigger exposures, school personnel training and communication gaps across all four sectors. EBI's were evaluated and selected to address identified themes. Pilot testing of a community health worker (CHW) intervention to connect home, primary care and school resulted in an efficient transfer of asthma medications and medication administration forms to the school nurse office for students with uncontrolled asthma addressing a common delay leading to poor asthma management in school.Conclusion: Thus far there has been limited success in reducing asthma disparities for low-income minority children. This study offers hope that strategically positioning CHWs may work synergistically to close gaps in care and result in improved asthma control and reduced asthma disparities.
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Affiliation(s)
- Tyra Bryant-Stephens
- The Children's Hospital of Philadelphia Community Asthma Prevention Program, Philadelphia, PA, USA.,University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA
| | - C Kenyon
- The Children's Hospital of Philadelphia Community Asthma Prevention Program, Philadelphia, PA, USA.,University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA
| | - A J Apter
- University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA
| | - Courtney Wolk
- University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA.,Department of Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Yolanda S Williams
- The Children's Hospital of Philadelphia Community Asthma Prevention Program, Philadelphia, PA, USA
| | - R Localio
- University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA
| | - K Toussaint
- The Children's Hospital of Philadelphia Community Asthma Prevention Program, Philadelphia, PA, USA
| | - A Hui
- Philadelphia Health Management Corporation, Philadelphia, PA, USA
| | - C West
- Philadelphia Health Management Corporation, Philadelphia, PA, USA
| | | | - S McGinnis
- Philadelphia Health Management Corporation, Philadelphia, PA, USA
| | - M Gutierrez
- Philadelphia Health Management Corporation, Philadelphia, PA, USA
| | - R Beidas
- Department of Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, PA, USA
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34
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Borg A, Haughton CF, Sawyer M, Lemon SC, Kane K, Pbert L, Li W, Rosal MC. Design and methods of the Healthy Kids & Families study: a parent-focused community health worker-delivered childhood obesity prevention intervention. BMC OBESITY 2019; 6:19. [PMID: 31171975 PMCID: PMC6545743 DOI: 10.1186/s40608-019-0240-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 03/14/2019] [Indexed: 11/22/2022]
Abstract
Background One third of U.S. children and two thirds of adults are overweight or obese. Interventions to prevent obesity and thus avert threats to public health are needed. This paper describes the design and methods of the Healthy Kids & Families study, which tested the effect of a parent-focused community health worker (CHW)-delivered lifestyle intervention to prevent childhood obesity. Methods Participants were English or Spanish-speaking parent-child dyads (n = 247) from nine elementary schools (grades K-6) located in racial/ethnically diverse low-income communities in Worcester, Massachusetts. Using a quasi-experimental design with the school as the level of allocation, the study compared the lifestyle intervention vs. an attention-control comparison condition. The lifestyle intervention was guided by social cognitive theory and social ecological principles. It targeted the child’s social and physical home environment by intervening with parental weight-related knowledge, beliefs, and skills for managing child obesogenic behaviors; and addressed families’ needs for community resources supportive of a healthy lifestyle. The two-year CHW-delivered intervention was structured based on the 5As model (Agenda, Assess, Advise, Assist, Arrange follow up) and included two in person sessions and two telephone follow-ups per year with the parent, with a personalized letter and print materials sent after each contact. Parents also received quarterly newsletters, Facebook messages, and invitations to community events. The attention-control comparison condition used the same format and contact time as the intervention condition, but targeted positive parenting skills. Measurements occurred at baseline, and at 6-, 12-, 18- and 24-month follow-up. Assessments included anthropometrics, accelerometry, global positioning system (GPS), and self-report surveys. The primary outcome was child body mass index (BMI) z score. Secondary outcomes were parent BMI; and parent and child diet, physical activity, sedentariness, and utilization of community resources supportive of a healthy lifestyle. Discussion A CHW-delivered parent-focused lifestyle intervention may provide a translatable model for targeting the high priority public health problem of childhood obesity among low-income diverse communities. If demonstrated effective, this intervention has potential for high impact. Trial registration ClinicalTrials NCT03028233. Registered January 23,2017. The trial was retrospectively registered.
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Affiliation(s)
- Amy Borg
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Christina F Haughton
- Oak Hill Community Development Corporation, 74 Providence Street, Worcester, MA 01604 USA
| | - Mullen Sawyer
- 3Tufts University Friedman School of Nutrition and Policy, 150 Harrison Avenue, Boston, MA 02111 USA
| | - Stephenie C Lemon
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Kevin Kane
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Lori Pbert
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Wenjun Li
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Milagros C Rosal
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
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Burns BM, Merritt J, Chyu L, Gil R. The Implementation of Mindfulness-Based, Trauma-Informed Parent Education in an Underserved Latino Community: The Emergence of a Community Workforce. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 63:338-354. [PMID: 31177534 DOI: 10.1002/ajcp.12342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this practice-oriented program review, a mindfulness-based, trauma-informed parent intervention, called Safe, Secure and Loved™ (SSL), designed to strengthen nurturing parenting and children's resilience, was implemented in an underserved Latino community. Across 5 years, a volunteer community workforce of promotoras transformed an academic-community research partnership into a community-led program partnership and established sustainable agency parent education programming. To better understand this transformation, we used a modified implementation science (IS) framework to structure interviews from members of the academic-community research partnership. Findings suggest that the commitment and cultural expertise of the volunteer community workforce acted as the major leadership drivers to create the community-led program partnership. Employing mindfulness-based, trauma-informed parent education designed to promote nurturing parenting and children's resilience may be an effective training model to engage and mobilize a volunteer community workforce from an underserved community.
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Affiliation(s)
- Barbara M Burns
- Child Studies Program, Santa Clara University, Santa Clara, CA, USA
| | - Jennifer Merritt
- Ignatian Center for Jesuit Education, Santa Clara University, Santa Clara, CA, USA
| | - Laura Chyu
- Public Health Program, Santa Clara University, Santa Clara, CA, USA
| | - Roberto Gil
- Sacred Heart Community Service, San Jose, CA, USA
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Risica PM, Tovar A, Palomo V, Dionne L, Mena N, Magid K, Ward DS, Gans KM. Improving nutrition and physical activity environments of family child care homes: the rationale, design and study protocol of the 'Healthy Start/Comienzos Sanos' cluster randomized trial. BMC Public Health 2019; 19:419. [PMID: 30999881 PMCID: PMC6472069 DOI: 10.1186/s12889-019-6704-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early childhood is a crucial time to foster healthy eating and physical activity (PA) habits, which are critical for optimal child health, growth and development. Child care facilities are important settings to promote healthy eating and PA and prevent childhood obesity; however, almost all prior intervention studies have focused on child care centers and not family child care homes (FCCH), which care for over 1.6 million U.S. children. METHODS This paper describes Healthy Start/Comienzos Sanos, a cluster-randomized trial evaluating the efficacy of a multicomponent intervention to improve nutrition and PA environments in English and Spanish-speaking FCCH. Eligible child care providers complete baseline surveys and receive a two-day FCCH observation of the home environment and provider practices. Parent-consented 2-5 year-old children are measured (height, weight, waist circumference), wear accelerometers and have their dietary intake observed during child care using validated protocols. FCCH providers are then randomly assigned to receive an 8-month intervention including written materials tailored to the FCCH providers' need and interest, videos, peer support coaching using brief motivational interviewing, and periodic group meetings focused on either nutrition and PA (Intervention) or reading readiness (Comparison). Intervention materials focus on evidence-based nutrition and physical activity best practices. The initial measures (surveys, two-day observation of the FCCH and provider practices, child diet observation, physical measures, and accelerometer) are assessed again 8 and 12 months after the intervention starts. Primary outcomes are children's diet quality (Healthy Eating Index), time in moderate and vigorous PA and sedentary PA during child care. Secondary outcomes include FCCH provider practices and foods served, and PA environments and practices. Possible mediators (provider attitudes, self-efficacy, barriers and facilitators) are also being explored. Process evaluation measures to assess reach, fidelity and dose, and their relationship with dietary and PA outcomes are included. DISCUSSION Healthy Start/Comienzos Sanos fills an important gap in the field of childhood obesity prevention by rigorously evaluating an innovative multicomponent intervention to improve the nutrition and physical activity environments of FCCH. TRIAL REGISTRATION (# NCT02452645 ) ClinicalTrials.gov Trial registered on May 22, 2015.
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Affiliation(s)
- Patricia Markham Risica
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI 02912 USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912 USA
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881 USA
| | - Vanessa Palomo
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI 02912 USA
| | - Laura Dionne
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI 02912 USA
| | - Noereem Mena
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881 USA
| | - Kate Magid
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912 USA
| | - Diane Stanton Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7461 USA
| | - Kim M. Gans
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI 02912 USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912 USA
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT 06269 USA
- Institute for Collaboration in Health, Interventions and Policy, University of Connecticut, Storrs, CT 06269 USA
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Maxwell AE, Young S, Moe E, Bastani R, Wentzell E. Understanding Factors that Influence Health Care Utilization Among Mixtec and Zapotec Women in a Farmworker Community in California. J Community Health 2019; 43:356-365. [PMID: 28975501 DOI: 10.1007/s10900-017-0430-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This paper examines health care utilization among indigenous immigrants from Oaxaca, Mexico, who have settled in a farmworker community in southern California. In 2016, two trained Spanish-Mixteco and Spanish-Zapoteco bi-lingual interviewers conducted in-depth interviews with 44 indigenous women residing in Oxnard, California on issues that affect health care utilization. Interviews were conducted in Mixteco, Zapoteco and Spanish and were coded to identify structural, cultural, and provider-related barriers to health care utilization. Five bi-lingual Spanish-Mixteco indigenous interpreters employed at local clinics were also interviewed. Many women reported lack of health insurance, inability to pay, language barriers, long waiting times, rushed encounters with providers, and seeking western medical care only after home remedies did not work. However, several women were able to access routine health care services, often with support from indigenous interpreters employed at clinics. Interviews with five interpreters found that they provided assistance with interpretation during medical encounters and appointment making. They also educated patients about upcoming exams, identified low-cost services and insurance programs available to patients, assisted with paperwork and occasionally educated physicians on behalf of their patients. In addition to addressing barriers to health care access our findings suggest the importance of identifying and leveraging community assets, such as indigenous navigators, when developing programs for such underserved communities. Our findings can inform best practice in settings that provide health care to indigenous populations and may also apply to settings that provide health care to other immigrant communities that have very limited familiarity and contact with western health care.
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Affiliation(s)
- Annette E Maxwell
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA.
| | - Sandra Young
- Mixteco/Indigena Community Organizing Project, PO Box 20543, Oxnard, CA, 93034, USA
| | - Emily Moe
- Department of Anthropology, University of Iowa, Iowa City, IA, USA
| | - Roshan Bastani
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA
| | - Emily Wentzell
- Department of Anthropology, University of Iowa, Iowa City, IA, USA
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Carvajal SC, Huang S, Bell ML, Denman C, Guernsey de Zapien J, Cornejo E, Chang J, Staten LK, Rosales C. Behavioral and subjective health changes in US and Mexico border residing participants in two promotora-led chronic disease preventive interventions. HEALTH EDUCATION RESEARCH 2018; 33:522-534. [PMID: 30358830 PMCID: PMC6293312 DOI: 10.1093/her/cyy037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 09/25/2018] [Indexed: 06/08/2023]
Abstract
Chronic diseases are the primary health burden among Mexican-origin populations and health promotion efforts have not been able to change negative population trends. This research presents behavioral and subjective health impacts of two related community health worker (CHW) interventions conducted in the US-Mexico border region. Pasos Adelante (United States) and Meta Salud (Mexico) are 12-13 week CHW-led preventive interventions implemented with Mexico-origin adults. Curricula include active learning modules to promote healthy dietary changes and increasing physical activity; they also incorporate strategies to promote social support, empowerment and group exercise components responsive to their communities. Questionnaire data at baseline (N = 347 for Pasos; 171 for Meta Salud), program completion and 3-month follow-up were analyzed. Results showed statistically significant improvements in multiple reported dietary, physical activity and subjective health indicators. Furthermore, at follow-up across both cohorts there were ≥10% improvements in participants' meeting recommended physical activity guidelines, consumption of whole milk, days of poor mental health and self-rated health. While this study identifies some robust health improvements and contributes to the evidence base for these interventions current dissemination, the lack of change observed for some targeted behaviors (e.g. time sitting) suggests they may have stronger overall impacts with curricula refinement.
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Affiliation(s)
- S C Carvajal
- Mel and Enid Zuckerman College of Public Health, Health Promotion Sciences & Arizona Prevention Research Center
| | - S Huang
- Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, Tucson, AZ, USA
| | - M L Bell
- Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, Tucson, AZ, USA
| | - C Denman
- Centro de Estudios en Salud & Sociedad, El Colegio de Sonora, Hermosillo, Sonora, Mexico
| | - J Guernsey de Zapien
- Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, Tucson, AZ, USA
| | - E Cornejo
- Centro de Estudios en Salud & Sociedad, El Colegio de Sonora, Hermosillo, Sonora, Mexico
| | - J Chang
- Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, Tucson, AZ, USA
| | - L K Staten
- Social and Behavioral Sciences, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd, RG, Indianapolis, IN, USA
| | - C Rosales
- Division of Public Health Practice & Translational Research, Mel and Enid Zuckerman College of Public Health, University of Arizona, 714 E. Van Buren Street, Building 4 – UA Phoenix Plaza 119G, Phoenix, AZ, USA
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Loya JC. Systematic Review of Physical Activity Interventions in Hispanic Adults. HISPANIC HEALTH CARE INTERNATIONAL 2018; 16:174-188. [PMID: 30474403 DOI: 10.1177/1540415318809427] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Physical activity (PA) has demonstrated substantial physical and psychological benefits. However, Hispanics engage in less leisure-time PA when compared with other groups, putting them at higher risk for diseases associated with obesity, such as diabetes mellitus type 2. This literature review was conducted to identify best practices with regard to interventions designed to increase PA among Hispanic adults. METHODS Extensive searching located 21 randomized controlled studies conducted in the United States. RESULTS Common conceptual frameworks were the transtheoretical model and social cognitive theory. Most interventions used educational sessions with a variety of topics and many used promotoras to increase PA. Outcomes were predominantly examined using self-report PA measures. Walking was the most commonly reported PA behavior. Studies with significant results were those that measured moderate-to-vigorous PA and used theory to guide interventions. Male and older participants were underrepresented. CONCLUSIONS Effective culturally appropriate PA interventions for Hispanics adults are needed. Particular attention to intervention tailoring based on country of origin could enhance intervention effectiveness.
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Lai AYK, Stewart SM, Wan ANT, Shen C, Ng CKK, Kwok LT, Chan SS, Ho DSY, Lam TH. Training to implement a community program has positive effects on health promoters: JC FAMILY Project. Transl Behav Med 2018; 8:838-850. [PMID: 29961808 DOI: 10.1093/tbm/iby070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To ease the shortage of professionals, lay volunteers were trained to become health promoters and role models for a large community program to enhance physical activity, well-being, and neighborhood cohesion in socioeconomically disadvantaged groups in Hong Kong. This study aimed to examine the effects on health promoters (trainees) and the feasibility and acceptability of capability-building train-the-trainer workshops (TTTs) using Zero-time Exercise (ZTEx) to implement a community program for about 1,000 participants. A four-session (totally 8 hours) TTT introduced an evidence-based ZTEx intervention to enhance physical activity and well-being, and build capacity for community program implementation. Twenty-eight trainees actively participated in the TTT. Twenty-five and 21 trainees completed the 1- and 3-month questionnaires, respectively. Eleven trainees attended the 1-year focus group interview. Repeated measures analysis of variance and Friedman test were used to compare the parametric and nonparametric data, respectively. Qualitative data were analyzed using thematic content analysis. The trainees reduced their sedentary behavior and improved their interpersonal communication skills, knowledge, and attitude toward ZTEx, grip strength, balance, and perceived well-being. The community participants reported improvements in neighborhood cohesion and grip strength. The 1-year qualitative results supported the 3-month quantitative findings. This brief and innovative TTT affirmed the feasibility of using ZTEx and the role modeling approach for lay health promoters to reduce sedentary behavior and enhance physical activity, fitness, and well-being. They then contributed to the successful implementation of community programs that benefited many. This study provides a new model for building capacity for health promotion in the community.
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Affiliation(s)
- Agnes Y K Lai
- School of Public Health, The University of Hong Kong, Hong Kong, SAR, China
| | - Sunita M Stewart
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, United States of America
| | - Alice N T Wan
- School of Public Health, The University of Hong Kong, Hong Kong, SAR, China
| | - Chen Shen
- School of Public Health, The University of Hong Kong, Hong Kong, SAR, China
| | | | - Lit-Tung Kwok
- Christian Family Service Centre, Hong Kong SAR, China
| | - Sophia S Chan
- School of Nursing, The University of Hong Kong, Hong Kong, SAR, China
| | - Daniel S Y Ho
- School of Public Health, The University of Hong Kong, Hong Kong, SAR, China
| | - Tai-Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, SAR, China
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Serrano SE, Serafini K, Eller N, Torres VN, Donovan D, Ornelas IJ. Vida PURA: An assessment of the fidelity of promotor-delivered screening and brief intervention to reduce unhealthy alcohol use among Latino day laborers. J Ethn Subst Abuse 2018; 17:519-531. [PMID: 28375699 PMCID: PMC7141813 DOI: 10.1080/15332640.2017.1300557] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We assessed the fidelity of promotores conducting screening and brief intervention (SBI) to reduce unhealthy alcohol use among Latino immigrant day laborers in the Vida PURA study. We reviewed 32 audio-recorded brief interventions to assess promotor adherence to the intervention protocol and to evaluate their motivational interviewing (MI) technique with the Motivational Interviewing Treatment Integrity (MITI) 4.2.1 tool. Promotores delivered three core intervention steps in 78% of recordings and achieved basic MI competence across all domains and proficiency in 50% of measures. Our results suggest that promotores can be trained to deliver SBI in community settings with fidelity.
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Affiliation(s)
| | - Kelly Serafini
- b Swedish Family Medicine Residency , Seattle , Washington
| | - Nikki Eller
- a University of Washington , Seattle , Washington
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Understanding health decision making: An exploration of homophily. Soc Sci Med 2018; 214:118-124. [PMID: 30172920 DOI: 10.1016/j.socscimed.2018.08.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 08/21/2018] [Accepted: 08/23/2018] [Indexed: 11/20/2022]
Abstract
The phenomenon of homophily first was described in Lazarsfeld and Merton's classic 1954 friendship analysis as a tendency for friendships to form between those who are alike in some respect. Although theories of decision making address a host of factors that affect the process, the influence of individuals with homophilic ties remains unaccounted for and unexplained. The purpose of this paper is to review theories relevant to decision making and describe what is known about the relationship between homophily and health care decision making. Further, we provide new evidence suggesting the influence of homophily on decision making in results from a randomized, multi-center clinical trial of American men with localized prostate cancer. A diverse sample of 293 men with a new diagnosis of localized prostate cancer reported relevant personal factors influencing the care management decision before randomization to a decision aid or usual care, between 2013 and 2015. Among these personal factors were the level of influence or importance ascribed to various individuals at the time of the treatment decision. One month later, participants reported how prepared they were for decision making. 123 men (42%) reported friends and/or coworkers as information sources, of which 65 (53%) indicated that friends and/or coworkers influenced the care decision. Men who reported friends/coworkers as information sources had significantly higher one-month preparation scores. Our review of decision making theories and practical applicability suggests the influence of homophilic relationships manifests in health care decision making. Faced with a list of options to manage health conditions, decision makers turn to known individuals in their environments, particularly those individuals with whom the decision maker can identify. Clinicians may solicit information from patients about influential others and explain how that support fits into the health decision at hand without dishonoring the importance of the homophilic relationship.
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Molina Y, San Miguel LG, Tamayo L, Robledo C, Díaz CS, Lucio A, Coronado N, Ferrans CE. The "Empowering Latinas to Obtain Breast Cancer Screenings" study: Rationale and design. Contemp Clin Trials 2018; 71:1-8. [PMID: 29803815 DOI: 10.1016/j.cct.2018.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/08/2018] [Accepted: 05/22/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Latinas suffer disproportionately from breast cancer (BC) in part due to lower guideline-concordant screening. Multiple intervention approaches have been developed to promote screening through direct patient education and empowerment approaches (i.e., training community members to share BC information). This study compares the relative effects of these approaches on: 1) women's BC screening; and, 2) women's dissemination of BC information within their social networks. DESIGN/METHODS Our quasi-experimental trial is being implemented in community venues in two predominantly Latino neighborhoods in South and West Chicago. Eligible participants: 1) are female; 2) are 52-74 years old; 3) have not obtained a mammogram in the past 2 years; and, 4) have not previously participated in health-related volunteerism. Based on their geographic location, participants are assigned to one of two group-based interventions. Both interventions consist of three two-hour sessions, which includes BC early detection education. The education intervention sessions also covers BC prevention (diet, physical activity), whereas the empowerment intervention covers sharing information with family/friends, and health volunteerism. Navigation is provided for all women who wish to obtain mammograms. Primary outcomes include: 1) receipt of BC screening; and, 2) participants' dissemination of BC information. Secondary outcomes include positive changes in 1) participants' self-reported psychosocial facilitators; and, 2) social network members' BC behaviors. DISCUSSION The design of our program allows for a preliminary comparison of the effectiveness of these two approaches. This work will inform larger comparativeness trials and offers a new approach to intervention evaluation via social network analysis.
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Barnett ML, Lau AS, Miranda J. Lay Health Worker Involvement in Evidence-Based Treatment Delivery: A Conceptual Model to Address Disparities in Care. Annu Rev Clin Psychol 2018. [PMID: 29401043 DOI: 10.1146/annurev-clinpsy-050817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Mobilizing lay health workers (LHWs) to deliver evidence-based treatments (EBTs) is a workforce strategy to address mental health disparities in underserved communities. LHWs can be leveraged to support access to EBTs in a variety of ways, from conducting outreach for EBTs delivered by professional providers to serving as the primary treatment providers. This critical review provides an overview of how LHW-supported or -delivered EBTs have been leveraged in low-, middle-, and high-income countries (HICs). We propose a conceptual model for LHWs to address drivers of service disparities, which relate to the overall supply of the EBTs provided and the demand for these treatments. The review provides illustrative case examples that demonstrate how LHWs have been leveraged globally and domestically to increase access to mental health services. It also discusses challenges and recommendations regarding implementing LHW-supported or -delivered EBTs.
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Affiliation(s)
- Miya L Barnett
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, Santa Barbara, California 93106, USA;
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, California 90095, USA;
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California 90095, USA;
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Baquero B, Kava CM, Ashida S, Daniel-Ulloa J, Laroche HH, Haines H, Bucklin R, Maldonado A, Coronado Garcia M, Berto S, Sewell D, Novak N, Janz K, Gates C, Parker EA. Active Ottumwa: Adapting Evidence-Based Recommendations to Promote Physical Activity in a Micropolitan New Destination Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15050917. [PMID: 29734709 PMCID: PMC5981956 DOI: 10.3390/ijerph15050917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/26/2018] [Accepted: 04/30/2018] [Indexed: 11/16/2022]
Abstract
Background: Evidence-based interventions have been developed and tested to promote physical activity, but fewer studies have focused on identifying effective intervention strategies for mid-size rural communities, especially new immigrant destinations. We report here on the design and implementation of Active Ottumwa, a community-wide intervention using a lay health advisor approach to increase physical activity in a micropolitan new destination community in the rural state of Iowa. Methods: The Active Ottumwa study is part of a community-academic partnership in Ottumwa, IA. Evidence-based strategies recommended by the Community Guide for Preventive Services guided study implementation and included behavioral and social, campaign and informational, and environmental and policy approaches. Evaluation methods for this study are multi-faceted and include a cross-sectional community survey, longitudinal cohort assessment, observational data, key informant interviews, and project records. Results: We are currently in our second year of intervention implementation, with 45 lay health advisors (termed physical activity leaders here) trained to carry out behavioral and social intervention approaches, including walking groups, tai chi, and yoga. We have completed a communication and informational campaign utilizing five channels. Our longitudinal cohort has been recruited, with baseline and 12-month data collection completed. Conclusions: This study will assess the effectiveness and impact of a community-wide intervention to support physical activity.
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Affiliation(s)
- Barbara Baquero
- University of Iowa Prevention Research Center, Department of Community and Behavioral Health, University of Iowa College of Public Health, 145 N. Riverside Dr., Iowa City, IA 52240, USA.
| | - Christine M Kava
- University of Iowa Prevention Research Center, Department of Community and Behavioral Health, University of Iowa College of Public Health, 145 N. Riverside Dr., Iowa City, IA 52240, USA.
| | - Sato Ashida
- University of Iowa Prevention Research Center, Department of Community and Behavioral Health, University of Iowa College of Public Health, 145 N. Riverside Dr., Iowa City, IA 52240, USA.
| | - Jason Daniel-Ulloa
- University of Iowa Prevention Research Center, Department of Community and Behavioral Health, University of Iowa College of Public Health, 145 N. Riverside Dr., Iowa City, IA 52240, USA.
| | - Helena H Laroche
- Department of Internal Medicine, University of Iowa Carver College of Medicine, 451 Newton Rd., Iowa City, IA 52242, USA.
| | - Heidi Haines
- University of Iowa Prevention Research Center, Department of Community and Behavioral Health, University of Iowa College of Public Health, 145 N. Riverside Dr., Iowa City, IA 52240, USA.
| | - Rebecca Bucklin
- University of Iowa Prevention Research Center, Department of Community and Behavioral Health, University of Iowa College of Public Health, 145 N. Riverside Dr., Iowa City, IA 52240, USA.
| | - Adriana Maldonado
- University of Iowa Prevention Research Center, Department of Community and Behavioral Health, University of Iowa College of Public Health, 145 N. Riverside Dr., Iowa City, IA 52240, USA.
| | - Mayra Coronado Garcia
- Department of Biostatistics, University of Iowa College of Public Health, 145 N. Riverside Dr., Iowa City, IA 52240, USA.
| | - Sandy Berto
- University of Iowa Prevention Research Center, Department of Community and Behavioral Health, University of Iowa College of Public Health, 145 N. Riverside Dr., Iowa City, IA 52240, USA.
| | - Dan Sewell
- Department of Biostatistics, University of Iowa College of Public Health, 145 N. Riverside Dr., Iowa City, IA 52240, USA.
| | - Nicole Novak
- University of Iowa Prevention Research Center, Department of Community and Behavioral Health, University of Iowa College of Public Health, 145 N. Riverside Dr., Iowa City, IA 52240, USA.
| | - Kathleen Janz
- Department of Health and Human Physiology, University of Iowa College of Liberal Arts and Sciences, 240 Schaeffer Hall, Iowa City, IA 52242, USA.
| | - Claudia Gates
- Community Advisory Board representative, Ottumwa Prevention Research Center office, 205 E. Main St., Ottumwa, IA 52556, USA.
| | - Edith A Parker
- University of Iowa Prevention Research Center, Department of Community and Behavioral Health, University of Iowa College of Public Health, 145 N. Riverside Dr., Iowa City, IA 52240, USA.
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Taverno Ross SE, Barone Gibbs B, Documet PI, Pate RR. ANDALE Pittsburgh: results of a promotora-led, home-based intervention to promote a healthy weight in Latino preschool children. BMC Public Health 2018; 18:360. [PMID: 29548321 PMCID: PMC5857096 DOI: 10.1186/s12889-018-5266-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 03/07/2018] [Indexed: 11/11/2022] Open
Abstract
Background Latino preschool children have higher rates of obesity than preschool children from other racial/ethnic groups; however, few effective, culturally appropriate interventions exist targeting this group. The purpose of this study was to test the feasibility of a 10-week, promotora-mediated, home-based intervention to promote a healthy weight in Latino preschool children. Methods Trained promotoras (community health workers) delivered 10, 90-min weekly interactive and tailored sessions to Latino families living in Allegheny County. Participants were recruited through promotoras’ own social networks and community gatherings, flyers, and word of mouth. Primary outcome measures included child body mass index (BMI) z-score and percentile. Secondary outcome measures included child objectively measured physical activity and dietary intake, and the home social and physical environment (e.g., parent health behaviors, parent self-efficacy, parental support, physical activity equipment in the home). The final analysis sample included 49 of 51 participants who completed both baseline and follow-up assessments. Results Participants included mothers (33.5 ± 6.1 years old) and their preschool-aged children who were primarily 1st generation immigrants from Mexico (65%). The primary analyses of BMI percentile and z-score showed no change post-intervention. However, there was a significant decrease in child BMI percentile for overweight and obese children from baseline to follow-up (p < .05). We also saw significant pre/post increases in child daily fruit and vegetable intake, and parent moderate-to-vigorous physical activity, fruit and vegetable servings per day, and self-efficacy; and significant decreases in child saturated fat and added-sugar intake, and child and parent screen time (p’s < .05). Conclusions Despite the short duration of the intervention and follow-up, this pilot study showed promising effects of a promotora-mediated intervention to promote a healthy weight in Latino preschool children. Electronic supplementary material The online version of this article (10.1186/s12889-018-5266-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sharon E Taverno Ross
- Department of Health and Physical Activity, University of Pittsburgh, 32 Oak Hill Court, Pittsburgh, PA, 15261, USA.
| | - Bethany Barone Gibbs
- Department of Health and Physical Activity, University of Pittsburgh, 32 Oak Hill Court, Pittsburgh, PA, 15261, USA
| | - Patricia I Documet
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Russell R Pate
- Department of Exercise Science, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, USA
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Documet PI, Troyer MM, Macia L. Social Support, Health, and Health Care Access Among Latino Immigrant Men in an Emerging Community. HEALTH EDUCATION & BEHAVIOR 2018. [DOI: 10.1177/1090198118763870] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. To determine the association of social support with alcohol abuse, depression, and health care access among Latino immigrant men in an emerging Latino community (an area with a small yet growing Latino population). Methods. Cross-sectional baseline data of 140 men prior to a participatory male-to-male community health worker intervention among Latino immigrants were analyzed using logistic regression. Community health workers recruited community participants in Western Pennsylvania between 2011 and 2013. Results. Participants constituted a vulnerable group: 47% had not finished high school, 36% had moderate to severe depression, and 30% reported binge drinking in the past month. Health care access was low (insurance = 6%, usual source = 20%). In multivariable logistic regression high social support was associated with less binge drinking (odds ratio [OR] = 0.44; 95% confidence interval [CI] [0.20, 0.98]) and lower depression (OR = 0.22; 95% CI [0.09-0.54]). Social support was associated with having a dentist visit but not with other health care access measures. Conclusions. Results indicate that the role of social support seems important for drinking and depression but remains controversial for health care access. It raises the hypothesis that low social support may be one of the mechanisms for the increase in drinking that happens after immigration.
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Affiliation(s)
| | | | - Laura Macia
- University of Pittsburgh, Pittsburgh, PA, USA
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Barnett ML, Gonzalez A, Miranda J, Chavira DA, Lau AS. Mobilizing Community Health Workers to Address Mental Health Disparities for Underserved Populations: A Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 45:195-211. [PMID: 28730278 PMCID: PMC5803443 DOI: 10.1007/s10488-017-0815-0] [Citation(s) in RCA: 185] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This systematic review evaluates efforts to date to involve community health workers (CHWs) in delivering evidence-based mental health interventions to underserved communities in the United States and in low- and middle-income countries. Forty-three articles (39 trials) were reviewed to characterize the background characteristics of CHW, their role in intervention delivery, the types of interventions they delivered, and the implementation supports they received. The majority of trials found that CHW-delivered interventions led to symptom reduction. Training CHWs to support the delivery of evidence-based practices may help to address mental health disparities. Areas for future research as well as clinical and policy implications are discussed.
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Affiliation(s)
- Miya L Barnett
- Department of Counseling, Clinical, & School Psychology, University of California, Gervitz Graduate School of Education, Santa Barbara, CA, 93106-9490, USA.
| | - Araceli Gonzalez
- Department of Psychology, California State University, Long Beach, CA, USA
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Denise A Chavira
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, CA, USA
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Barnett ML, Lau AS, Miranda J. Lay Health Worker Involvement in Evidence-Based Treatment Delivery: A Conceptual Model to Address Disparities in Care. Annu Rev Clin Psychol 2018; 14:185-208. [PMID: 29401043 DOI: 10.1146/annurev-clinpsy-050817-084825] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Mobilizing lay health workers (LHWs) to deliver evidence-based treatments (EBTs) is a workforce strategy to address mental health disparities in underserved communities. LHWs can be leveraged to support access to EBTs in a variety of ways, from conducting outreach for EBTs delivered by professional providers to serving as the primary treatment providers. This critical review provides an overview of how LHW-supported or -delivered EBTs have been leveraged in low-, middle-, and high-income countries (HICs). We propose a conceptual model for LHWs to address drivers of service disparities, which relate to the overall supply of the EBTs provided and the demand for these treatments. The review provides illustrative case examples that demonstrate how LHWs have been leveraged globally and domestically to increase access to mental health services. It also discusses challenges and recommendations regarding implementing LHW-supported or -delivered EBTs.
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Affiliation(s)
- Miya L Barnett
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, Santa Barbara, California 93106, USA;
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, California 90095, USA;
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California 90095, USA;
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Daniel-Ulloa J, Ulibarri M, Baquero B, Sleeth C, Harig H, Rhodes SD. Behavioral HIV Prevention Interventions Among Latinas in the US: A Systematic Review of the Evidence. J Immigr Minor Health 2018; 18:1498-1521. [PMID: 26467788 DOI: 10.1007/s10903-015-0283-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Compared to White women, Latinas are 4 times more likely to contract HIV. In an effort to determine the overall state of the science meant to address this disparity, we reviewed the current HIV prevention intervention literature for U.S. Latinas. We searched 5 online electronic databases from their inception through July, 2014, for HIV prevention interventions including a majority sample of Latinas. Of 1041 articles identified, 20 studies met inclusion criteria. We documented study designs, participant characteristics, outcomes, theories used, and other intervention characteristics. Overall, HIV knowledge and attitudes were the predominant outcome; a small minority of studies included self-reported condom use or STD incidence. Strategies used to address cultural factors specific to Latinas and HIV included; lay health advisors, using ethnographic narratives, or using the Theory of Gender and Power, however few of the interventions adopted these strategies. This study identified several gaps in the intervention literature that need to be addressed. In addition to including more direct measures of decreased HIV risk (ex. condom use), more systematic use of strategies meant to address gender and cultural factors that may place Latinas at increased risk (e.g., gender inequity, traditional gender role norms such as machismo and marianismo, and relationship power dynamics).
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Affiliation(s)
- Jason Daniel-Ulloa
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, CPHB, CBH N436, 145 Riverside Dr, Iowa City, IA, 52242, USA. .,University of Iowa, Prevention Research Center, Iowa City, IA, USA. .,Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - M Ulibarri
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - B Baquero
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, CPHB, CBH N436, 145 Riverside Dr, Iowa City, IA, 52242, USA.,University of Iowa, Prevention Research Center, Iowa City, IA, USA
| | - C Sleeth
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, CPHB, CBH N436, 145 Riverside Dr, Iowa City, IA, 52242, USA.,University of Arizona College of Medicine, Tucson, AZ, USA
| | - H Harig
- University of Iowa, Prevention Research Center, Iowa City, IA, USA
| | - S D Rhodes
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
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