Building Resilience Among Disadvantaged Communities: Gulf Region Health Outreach Program Overview

Using health belief model constructs to understand the role of perceived disease threat and resilience in responding to COVID-19 among people who use drugs: a cluster analysis

Introduction

The Health Belief Model (HBM) has been successfully applied to understanding adherence to COVID-19 prevention practices. It has not, however, been used to understand behavior in people who use drugs (PWUD). The aim of this study was to use the HBM to better understand COVID-19 perceptions among PWUD and understand how resiliency affects those perceptions.

Materials and methods

A cross-sectional survey was completed from September to December 2021 with PWUD (n = 75) who utilize services at a large harm reduction organization in Philadelphia. Segmentation analysis was done using a k-means clustering approach. Two clusters emerged based on perceived COVID-19 personal impact and resiliency (Less COVID impact/High resilience (NoCOV/HR) and High COVID impact/Low resilience (COV/LR). Differences in responses by cluster to perceptions of COVID-19 and individual pandemic response grouped by HBM constructs were assessed using Student's t-test and chi squares.

Results

Significant differences in HBM constructs were seen between clusters. Those in the COV/LR cluster were more likely to think they were susceptible to getting COVID-19 and less likely to believe they knew how to protect themselves. The NoCOV/HR cluster believed they were able to protect themselves from COVID-19 and that they were able to easily understand messages about protecting themselves.

Conclusion

Understanding how PWUD conceptualize disease threat and using HBM can better inform interventions to improve future pandemic response. Findings suggest that resilience is key to protecting PWUD from future infectious disease outbreaks. Interventions aimed at increasing resiliency among PWUD may improve preventative behavior and decrease disease burden in this vulnerable population.

A Community-Based Participatory Research Approach to Hurricane Katrina: When Disasters, Environmental Health Threats, and Disparities Collide

In 2005, Hurricane Katrina resulted in long-term flooding of 80% of New Orleans, Louisiana. Mold-infested homes gave rise to concerns about increased childhood asthma. To address these concerns, a diverse community-academic partnership used a community-based participatory research (CBPR) approach to implement the Head-off Environmental Asthma in Louisiana (HEAL) study in 2007.The study examined the relationship between post-Katrina mold and other environmental exposures and asthma morbidity, while testing an asthma counselor (AC) intervention. Both the AC intervention and the CBPR approach were effectively implemented in the postdisaster setting. However, homes had lower levels of mold and other allergens than expected, possibly because of the timing of environmental sampling. Also, HEAL illustrated the vulnerability of the study community, especially to the interconnected threats of health disparities, environmental health stressors, and disasters.We examine the implications of these threats for public health science, policy, and practice, not only through the lens of Hurricane Katrina but also for future disasters faced by communities in the Gulf Coast and nationally.

Community Health Workers as Organizational Actors in Community Health Centers in 4 Gulf Coast States

Community health workers (CHWs) are recognized for bridging communities and health care systems; yet, there is limited discussion of CHWs' roles as organizational actors within and outside clinics. Individual semistructured interviews (n = 21) were conducted in 4 Gulf Coast states with CHWs and supervisors to examine the bridging function of CHWs from a community health center's perspective. Results highlight that CHWs can function as gatekeepers and ambassadors who extend the clinics' reach in the community, enhance patient access to resources, and improve organizational efficiency. This study demonstrates the value that CHWs can bring for clients and clinics as organizational actors.

Broadening the Mandate of the Incident Command System to Address Community Mental and Behavioral Health Effects as Part of the Federal Response to Disasters

PURPOSE OF REVIEW

In the United States, the Federal Incident Command System (ICS) directs response to major oil spills. Its initial imperative is to prevent immediate impacts on human health and safety. Subsequently, the ICS primarily turns its attention to environmental concerns, including considering vulnerable ecosystems. There is a growing body of evidence that disasters such as major oil spills lead to adverse psychosocial effects; yet, preventing such effects has not been formally incorporated into ICS disaster mitigation considerations.

RECENT FINDINGS

Community mental and behavioral effects are increasingly recognized as a significant impact of disasters. Standardized ecosystem analytical frameworks are key to ICS responses to its mandate for environmental protection. Similar frameworks have only begun to be developed for mental and behavioral effects. Providing the ICS with a formal mandate would likely lead to the prevention of community mental and behavioral effects being more systematically incorporated into ICS disaster responses.

Enterprise Evaluation: A New Opportunity for Public Health Policy

Standard evaluation practice in public health remains limited to evaluative measures linked to individual projects, even if multiple interrelated projects are working toward a common impact. Enterprise evaluation seeks to fill this policy gap by focusing on cross-sector coordination and ongoing reflection in evaluation. We provide an overview of the enterprise evaluation framework and its 3 stages: collective creation, individual data collection, and collective analysis. We illustrate the application of enterprise evaluation to the Gulf Region Health Outreach Program, 4 integrated projects that aimed to strengthen health care in Louisiana, Mississippi, Alabama, and the Florida Panhandle after the Deepwater Horizon oil spill. Shared commitment to sustainability and strong leadership were critical to Gulf Region Health Outreach Program's success in enterprise evaluation. Enterprise evaluation provides an important opportunity for funding agencies and public health initiatives to evaluate the impact of interrelated projects in a more holistic and multiscalar manner than traditional siloed approaches to evaluation.