Immigrant women implementing participatory research in health promotion

The impact of social violence on HIV risk for women in Colombia: A concurrent mixed methods study

Gender, violence, and migration structurally impact health. The Venezuelan humanitarian crisis comprises the largest transnational migration in the history of the Americas. Colombia, a post-conflict country, is the primary recipient of Venezuelans. The Colombian context imposes high levels of violence on women across migration phases. There is little information on the relationship between violence and HIV risk in the region and how it impacts these groups. Evidence on how to approach the HIV response related to Venezuela's humanitarian crisis is lacking. Our study seeks to 1) understand how violence is associated with newly reported HIV/AIDS case rates for women in Colombian municipalities; and 2) describe how social violence impacts HIV risk, treatment, and prevention for Venezuelan migrant and refugee women undergoing transnational migration and resettlement in Colombia. We conducted a concurrent mixed-methods design. We used negative binomial models to explore associations between social violence proxied by Homicide Rates (HR) at the municipality level (n = 84). The also conducted 54 semi-structured interviews with Venezuelan migrant and refugee women and key informants in two Colombian cities to expand and describe contextual vulnerabilities to HIV risk, prevention and care related to violence. We found that newly reported HIV cases in women were 25% higher for every increase of 18 homicides per 100,000, after adjusting for covariates. Upon resettlement, participants cited armed actors' control, lack of government accountability, gender-based violence and stigmatization of HIV as sources of increased HIV risk for VMRW. These factors impose barriers to testing, treatment and care. Social violence in Colombian municipalities is associated with an increase in newly reported HIV/AIDS case rates in women. Violence hinders Venezuelan migrant and refugee women's access and engagement in available HIV prevention and treatment interventions.

Intersecting Communities and PrEP Uptake among US-based Latinx Sexual Minority Men

The Latinx community in the USA continues to be disproportionately burdened by the HIV epidemic, especially among Latinx sexual minority men (LSMM). Research indicates that up to two-thirds of new HIV infections occur among men who have sex with men (MSM) within primary partnerships. One promising biomedical approach for HIV prevention includes community scale-up of pre-exposure prophylaxis (PrEP) among LSMM. We examine the relationship between community connectedness (with the Latinx and gay communities) and PrEP uptake among 307 partnered LSMM who reported casual partner sex (i.e., non-monogamous relationships). Within the sample, approximately thirty percent (29.7%) of participants were on PrEP, and 43.3% reported partner approval for PrEP (i.e., my partner is in favor of PrEP generally), while only 7.2% were opposed to PrEP. Insurance status and income levels were significantly associated with PrEP uptake. There was a significant interaction term (gay community connectedness and Latinx group membership), which was positively associated with PrEP uptake (OR = 2.18; p = .007). Findings suggest that there may be structural barriers preventing this population from seeking and initiating PrEP care. Results point to the utility of integrating culturally relevant content related to intersecting identities and their corresponding communities when conceptualizing community-based and culturally informed interventions to improve the PrEP care cascade among LSMM.

Examining life in detention: A process of survey translation and adaptation through an ecological and collaborative approach

This paper illustrates the process we engaged in to translate and adapt a survey to examine life in an immigration detention center in Italy from the perspective of the migrants detained therein. The process consisted of: the forward translation of the original measure performed by four independent translators; a blind backward translation to identify misinterpretations or incorrect cross-cultural and contextual adaptations; a synthesis of all translations to obtain a semifinal version; the creation of an Expert Committee composed of scholars, practitioners, and migrants with experience of detention to assess equivalence and content validity; and, finally, pretesting with a group of 15 detained persons. Through this multi-step process we obtained a measure capable of grasping the context-specific meanings, needs and experiences that characterize life in detention. The challenges and benefits of a collaborative and ecological approach to measurement translation and adaption are discussed in the final section.

Codesigning person-centred quality indicators with diverse communities: A qualitative patient engagement study

Introduction

Effective engagement of underrepresented communities in health research and policy remains a challenge due to barriers that hinder participation. Our study had two objectives: (1) identify themes of person‐centred care (PCC) from perspectives of diverse patients/caregivers that would inform the development of person‐centred quality indicators (PC‐QIs) for evaluating the quality of PCC and initiatives to improve PCC and (2) explore innovative participatory approaches to engage ethnocultural communities in qualitative research.

Methods

Drawing on participatory action research methods, we partnered with a community‐based organization to train six ‘Community Brokers’ from the Chinese, Filipino, South Asian, Latino‐Hispanic, East African and Syrian communities, who were engaged throughout the study. We also partnered with the provincial health organization to engage their Patient and Family Advisory, who represented further aspects of diversity. We conducted focus group discussions with patients/caregivers to obtain their perspectives on their values, preferences and needs regarding PCC. We identified themes through our study and engaged provincial stakeholders to prioritize these themes for informing the development of PC‐QIs and codesign initiatives for improving PCC.

Results

Eight focus groups were conducted with 66 diverse participants. Ethnocultural communities highlighted themes related to access and cost of care, language barriers and culture, while the Patient and Family Advisory emphasized patient and caregiver engagement. Together with provincial stakeholders, initiatives were identified to improve PCC, such as codesigning innovative models of training and evaluation of healthcare providers.

Conclusion

Incorporating patient and community voices requires addressing issues related to equity and understanding barriers to effective and meaningful engagement.

Patient or Public Contribution

Patient and public engagement was central to our research study. This included partnership with a community‐based organization, with a broad network of ethnocultural communities, as well as the provincial health service delivery organization, who both facilitated the ongoing engagement of diverse patients/caregiver communities throughout our study including designing the study, recruiting participants, collecting and organizing data, interpreting findings and mobilizing knowledge. Drawing from participatory action research methods, patients and the public were involved in the codesign of the PC‐QIs and initiatives to improve PCC in the province based on the findings from our study.

Health promotion focusing on migrant women through a community based participatory research approach

Background

Migrants are often more vulnerable to health issues compared to host populations, and particularly the women. Therefore, migrant women’s health is important in promoting health equity in society. Participation and empowerment are central concepts in health promotion and in community-based participatory research aimed at enhancing health. The aim of this study was to identify conditions for health promotion together with women migrants through a community-based participatory research approach.

Methods

A community-based participatory research approach was applied in the programme Collaborative Innovations for Health Promotion in a socially disadvantaged area in Malmö, Sweden, where this study was conducted. Residents in the area were invited to participate in the research process on health promotion. Health promoters were recruited to the programme to encourage participation and a group of 21 migrant women participating in the programme were included in this study. A qualitative method was used for the data collection, namely, the story-dialogue method, where a process involving issue, reflections and actions guided the dialogues. The material was partly analysed together with the women, inspired by the second-level synthesis.

Results

Two main health issues, mental health and long-term pain, were reflected upon during the dialogues, and two main themes were elaborated in the process of analysis: Prioritising spare time to promote mental health and Collaboration to address healthcare dissatisfaction related to long-term pain. The women shared that they wanted to learn more about the healthcare system, and how to complain about it, and they also saw the togetherness as a strategy along the way. A decision was made to start a health circle in the community to continue collaboration on health promotion.

Conclusions

The community-based participatory research approach and the story dialogues constituted an essential foundation for the empowerment process. The health circle provides a forum for further work on conditions for health promotion, as a tool to support migrant women’s health.

Patient-oriented research competencies in health (PORCH) for researchers, patients, healthcare providers, and decision-makers: results of a scoping review

PLAIN ENGLISH SUMMARY

Background The Canadian Institutes of Health Research funded a program, "patient-oriented research" (POR), to change the way health research is done. POR involves patients and their families/caregivers as equal partners on research teams with researchers, healthcare providers and decision-makers. The authors of this paper work through a unit in British Columbia, Canada that functions to help research teams learn how to do patient-oriented research. We felt that we could not train people if we didn't first understand what others had learned about what competencies (knowledge, skills and attitudes) were helpful for members of these research teams. Method We used a method called a scoping review to search literature on patient-involved research. Our search included papers in academic journals as well as information on websites, training manuals, conference proceedings, governmental documents and statements from health organizations. Findings Writers reported the usefulness of many competencies for researchers and patients, with fewer competencies for healthcare providers or decision-makers. The main competencies for researchers had to do with participation, communication and conflict management; for patients they had to do with research knowledge and skills, cultural competence and participation. It was helpful that all team members want to work as part of a group for the public good. Conclusions We worked with an advisory group of people representing patients and their families/caregivers, researchers, healthcare providers and decision-makers to review our findings. We concluded that our competency statements are helpful for people to determine what they need to know or learn as they join research teams.

ABSTRACT

Background The Canadian Institutes of Health Research (CIHR) launched an initiative called the Strategy for Patient-Oriented Research (SPOR) encouraging patient-oriented research (POR) that engages patients as equal partners in research teams alongside researchers, healthcare providers and health system decision-makers. Other countries have launched similar initiatives (POR-related work) yet there has never been full review of the competencies needed by individuals engaging in this work. Purpose and methods Our purpose was to summarize existing knowledge on POR and POR-related competencies by conducting a scoping review of peer-reviewed and grey literature. Our objectives were to systematically explore literature, articulate competencies necessary for research team members, identify research gaps and provide recommendations for further research. Using standard health databases and search methods, a total of 2036 sources was retrieved. Data were extracted from 35 peer-reviewed papers and 38 grey literature sources. We used an iterative process to reach consensus on competency statements. Findings and conclusions The main competencies for researchers were in categories of participation, communication and teamwork and conflict/tension management; for patients the main competencies were in research knowledge and skills, cultural competence/context and participation. While fewer competencies were documented for the other stakeholder groups, the need for understanding patient involvement in research and knowledge of the needs that research partners have are noted as competencies for healthcare providers and decision-makers. Attitudes demonstrating inclination to conduct the work were noted for all. The competencies can be used to consider learning needs of research team members and for team members wishing to assess their own readiness to serve on a POR or POR-related research team. Incidentally, we noted the lack of a common vocabulary used to describe patient-involved research, a situation making research and literature review/retrieval quite challenging. Recommendations for future research and for achieving consistency in language are addressed.

Methodological Challenges in Conducting Research with Refugee Women

The purpose of this pilot study was to evaluate the acceptability and feasibility of a 10-week community-based, culturally tailored mental health intervention, called Healthy Sudanese Families, with 12 South Sudanese refugee women living in a metropolitan area of the Midwestern United States. This mixed-methods study used the Dinka and Arabic versions of the Hopkins Symptoms Checklist-25 to measure indicators of anxiety and depression and a final focus group to evaluate the women's responses to the intervention. The women found the mental health intervention acceptable and relevant. Methodological challenges encountered in cross-cultural research with refugees are discussed.

ReseArch with Patient and Public invOlvement: a RealisT evaluation – the RAPPORT study

Background

Patient and public involvement (PPI) is a prerequisite for many funding bodies and NHS research ethics approval. PPI in research is defined as research carried out with or by the public rather than to, about or for them. While the benefits of PPI have been widely discussed, there is a lack of evidence on the impact and outcomes of PPI in research.

Objectives

To determine the types of PPI in funded research, describe key processes, analyse the contextual and temporal dynamics of PPI and explore the experience of PPI in research for all those involved. Mechanisms contributing to the routine incorporation of PPI in the research process were assessed, the impact of PPI on research processes and outcomes evaluated, and barriers and enablers to effective PPI identified.

Design

A three-staged realist evaluation drawing on Normalisation Process Theory to understand how far PPI was embedded within health-care research in six areas: diabetes mellitus, arthritis, cystic fibrosis, dementia, public health and learning disabilities. The first two stages comprised a scoping exercise and online survey to chief investigators to assess current PPI activity. The third stage consisted of case studies tracked over 18 months through interviews and document analysis. The research was conducted in four regions of England.

Participants

Non-commercial studies currently running or completed within the previous 2 years eligible for adoption on the UK Clinical Research Network portfolio. A total of 129 case study participants included researchers and PPI representatives from 22 research studies, and representatives from funding bodies and PPI networks.

Results

In the scoping 51% (n = 92) of studies had evidence of PPI and in the survey 79% (n = 80), with funder requirements and study design the strongest influence on the extent of PPI. There was little transparency about PPI in publicly accessible information. In case studies, context–mechanism–outcome configurations suggested that six salient actions were required for effective PPI. These were a clear purpose, role and structure for PPI; ensuring diversity; whole research team engagement with PPI; mutual understanding and trust between the researchers and lay representatives; ensuring opportunities for PPI throughout the research process; and reflecting on, appraising and evaluating PPI within a research study. PPI models included a ‘one-off’ model with limited PPI, a fully intertwined model in which PPI was fully embedded and an outreach model with lay representatives linking to broader communities. Enabling contexts included funder, topic/design, resources, research host, organisation of PPI and, most importantly, relationships. In some case studies, lack of coherence in defining PPI persisted, with evidence of a dual role of PPI representative/study participant. Evidence of PPI outcomes included changes to study design, improvements to recruitment materials and rates, and dissemination.

Conclusions

Six salient actions were required for effective PPI and were characterised by a shared understanding of moral and methodological purposes of PPI, a key individual co-ordinating PPI, ensuring diversity, a research team positive about PPI input and fully engaged with it, based on relationships that were established and maintained over time, and PPI being evaluated in a proactive and systematic approach. Future work recommendations include exploring the impact of virtual PPI, cost analysis and economic evaluation of the different models of PPI, and a longer-term follow-up study of the outcomes of PPI on research findings and impact on services and clinical practice.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Korean immigrant women's physical activity experience: a situation-specific theory

To develop successful physical activity promotion programs for midlife immigrant women, especially for Korean immigrant midlife women, concrete theoretical bases are needed. However, virtually no theoretical frameworks and/or theories exist that can explain the influences of immigration transition on the physical activity experience of midlife immigrant women in general or Korean immigrant midlife women in specific. The purpose of this article is to present a situation-specific theory on physical activity experience of Korean immigrant midlife women (SPAKIM) with its development process. An integrative approach was used to develop the theory based on the midlife women's attitudes toward physical activity (MAPA) theory, the transitions theory, a review of the relevant literature, and two studies on midlife women's attitudes toward physical activity. The proposed theory includes nature of transitions, nonmodifiable and modifiable transition conditions, contexts of daily life, patterns of response, and nursing therapeutics as major concepts, and each major concept includes several related subconcepts. Because several concepts of the theory were developed mainly based on the literature review, the major concepts and related subconcepts need to be further developed and evaluated in future studies.

Community health workers in Canada and other high-income countries: A scoping review and research gaps

OBJECTIVES

Community health workers (CHWs) have been deployed to provide health-related services to their fellow community members and to guide them through often complex health systems. They help address concerns about how marginalized populations in many countries experience health inequities that are due, in part, to lack of appropriate primary health care services, possibly resulting in inappropriate use of higher-cost health services or facilities. This paper reviews studies on CHW interventions in a number of high-income countries, including Canada, to identify research gaps on CHW roles.

METHODS

A scoping review using 68 sources of interventions involving CHWs was undertaken. The five-step Arksey and O'Malley model guided this review with the aim of summarizing research findings and identifying research gaps in the existing literature on CHWs in Canada (23 sources). A standardized extraction tool was employed to synthesize the literature.

SYNTHESIS

We found that CHWs provide a wide range of health-related services but in a manner that, in Canada, is unrecognized and unregulated. In highincome countries, CHW interventions have contributed to health-related issues in communities and demonstrated potential to both reduce health inequity in marginalized populations and reduce the cost of medical services.

CONCLUSION

CHWs are an under-recognized, and therefore underutilized, public health workforce, which has a promising capacity to reduce health inequities in marginalized populations in Canada. There is growing support to suggest that CHW roles need to be better integrated within the broader health and social services systems to enable their full potential to be realized.

Mapping the impact of patient and public involvement on health and social care research: a systematic review

BACKGROUND

There is an increasing international interest in patient and public involvement (PPI) in research, yet relatively little robust evidence exists about its impact on health and social care research.

OBJECTIVE

To identify the impact of patient and public involvement on health and social care research.

DESIGN

A systematic search of electronic databases and health libraries was undertaken from 1995 to 2009. Data were extracted and quality assessed utilizing the guidelines of the NHS Centre for Reviews and Dissemination 2009 and the Critical Appraisal Skills Programme (CASP). Grey literature was assessed using the Dixon-Woods et al. (2005) checklist.

INCLUSION CRITERIA

All study types that reported the impact PPI had on the health and/or social care research study.

MAIN RESULTS

A total of 66 studies reporting the impact of PPI on health and social care research were included. The positive impacts identified enhanced the quality and appropriateness of research. Impacts were reported for all stages of research, including the development of user-focused research objectives, development of user-relevant research questions, development of user-friendly information, questionnaires and interview schedules, more appropriate recruitment strategies for studies, consumer-focused interpretation of data and enhanced implementation and dissemination of study results. Some challenging impacts were also identified.

CONCLUSION

This study provides the first international evidence of PPI impact that has emerged at all key stages of the research process. However, much of the evidence base concerning impact remains weak and needs significant enhancement in the next decade.

If I was going to kill myself, I wouldn't be calling you. I am asking for help: challenges influencing immigrant and refugee women's mental health

It is estimated that 37% of Canadians experience some types of mental health problem. As a result of the migration process, many immigrant and refugee women suffer serious mental illness such as depression, schizophrenia, posttraumatic stress disorder, suicide, and psychosis. The purpose of this exploratory qualitative study, informed by the ecological conceptual framework and postcolonial feminist perspectives, was to increase understanding of the mental health care experiences of immigrant and refugee women by acquiring information regarding factors that either support or inhibit coping. Ten women (five born in China and five born in Sudan) who were living with mental illness were interviewed. Analysis revealed that (a) women's personal experience with biomedicine, fear, and lack of awareness about mental health issues influences how they seek help to manage mental illness; (b) lack of appropriate services that suit their needs are barriers for these women to access mental health care; and (c) the women often draw upon informal support systems and practices and self-care strategies to cope with their mental illnesses and its related problems. The authors discuss implications for practice and make recommendations for intervention strategies that will facilitate women's mental health care and future research.

Researching mental health in minority ethnic communities: reflections on recruitment

In this article we reflect on the recruitment of research participants to two related studies of experiences of mental health problems in Black and minority ethnic communities in the United Kingdom. A total of 65 people were recruited via three main strategies: the employment of bicultural recruiters, intensive information sharing about the studies, and work through local community groups. Three main issues seemed to affect recruitment: gatekeepers' attitudes, the (non)payment of participants, and reciprocal arrangements with local community groups. The type of strategy employed resulted in recruits with differing characteristics (although our sample was too small to draw generalizable conclusions). We conclude that to ensure that research participation is accessible to all, researchers must employ flexible recruitment methods that permit adaptation to specific needs arising out of health status, level of involvement with services, culture, and socioeconomic status. Systematic research into this part of the research process is needed.

Within the eyes of the people: using a photonovel as a consciousness-raising health literacy tool with ESL-speaking immigrant women

OBJECTIVES

This research examines if the process of creating and using a participatory photonovel can empower immigrant ESL-speaking women and also act as a tool to educate these women about a specific health topic.

METHODS

Data were collected through a) two separate interviews with each participant, b) two focus groups, c) field notes during the meetings the author had with the women once a week, and d) photographs of the photonovel project.

RESULTS

The women created a participatory photonovel about nutrition entitled From Junk Food to Healthy Eating: Tanya's Journey to a Better Life (to view this photonovel go to: http://www.photonovel.ca). The findings demonstrate that the photonovel can be an effective health literacy tool for immigrant ESL-speaking women, that it created community among the women, that it helped the women feel important and that it shifted their consciousness about nutrition in Canada.

DISCUSSION

More funding should be given towards participatory research to ensure that ways to address the health literacy needs of ESL-speaking immigrant women in Canada match their needs. This means researching ways to create health literacy materials that have visuals that are representative of the diverse population of Canadians and with language that can be understood. In order to ensure that health literacy materials are going to be effective, it is essential that the participants be involved in the process.

Community-based violence awareness

Violence against women is a major influence on women's mental health. We used popular education techniques to train 14 Spanish-speaking women as promotoras (community health workers) to increase awareness about violence against women in low income Texas communities. These women then conducted over 80 presentations in Spanish in local community settings. The impact of the program on the promotoras and on women attending the presentations was evaluated using qualitative methods. This research lends support to the idea that nurses working in community mental health settings must use innovative primary prevention strategies and evaluation mechanisms to change awareness about violence against women.

Cultural responses to health among Mexican American women and their families

Based on an in-depth analysis of current empirical research, this article presents a framework for understanding the cultural experience of the Mexican American population and presents implications for innovative health promotion practices with women and their families. The framework sheds light on the complex ways in which individuals from this population integrate their cultural values in their everyday responses to health. Three patterns emerge: (a) cultural expectations and beliefs can be shared by and work complementarily in the family and the larger social context; (b) cultural beliefs can be a source of tension and stress as a result of pressures in the environment; and (c) cultural values can become less important than other concerns, such as problems related to access when dealing with the healthcare system.

Health Promotion in the Practice Setting: Findings from a Review of Clinical Issues

BACKGROUND

Many agencies over the last few decades have called for the explicit inclusion and application of health promotion in all aspects of nursing practice. This article reviews the body of empirical (research-based) and theoretical (conceptual) literature addressing health promotion in nursing clinical practice, to uncover its nature, intention, and impact.

APPROACH

The aim of this review was to identify from the nursing literature what is reported on in relation to health promotion activity, both theoretical and clinical in the practice setting. An extensive review identified that literature pertaining to these issues clustered around the categories of: theorising and conceptualising the meaning and purpose of health promotion in nursing practice, the development and testing of tools and models for practice, and the exploration of attitudes, behaviours, roles and functions of nurses and health professionals in practice.

FINDINGS

Against more recent trends in health promotion, the literature shows that broader and wide-ranging health promotion reform has yet to have universal impact, whereas conventional health education activities remain the mainstay for the majority of "health promotion" activities in nursing practice. Where nurses purport to be conducting "health promotion" they are often conducting behavioural, lifestyle, and risk-orientated health education. The findings of this review therefore support the notion that much of nursing-related health practice is firmly located in reactive ill health and disease risk-specific preventive locations, instead of incorporating and instilling broader societal, economic, ecological, and political dimensions of health promotion. Recommendations for wider reform, developed from personal opinion and supported by the literature, are presented.

CONCLUSIONS

It is argued that nursing bodies, as well as individual nurses themselves, should seek current health promotion locations in nursing practice, and find effective ways to implement health promotion strategies and, subsequently, equip practitioners with the necessary resources and skills to engage with other health promotion agencies. Future research should be aimed at implementing and evaluating broad health promotion processes.

Community-based participatory research in practice-based research networks

PURPOSE

We wanted to describe community-based participatory research in practice-based research networks in the United States.

METHODS

We surveyed all identified practice-based research networks (PBRNs) in the United States to find out whether they had a mechanism for obtaining feedback or involvement from the community of patients served by PBRN physicians. We asked open-ended questions on how they involve community members and whether they had plans for future involvement of community members and/or patients.

RESULTS

We received 46 completed questionnaires (71% response rate). Twenty-four reported that they have some mechanism to involve community members and/or patients in their research. No PBRN reported full participatory methods; however, several PBRNs reported active involvement by community members to generate research ideas, review research protocols, interpret results, and disseminate findings.

CONCLUSION

While perhaps not meeting the classical definition of CBPR, some PBRNs are involving community members and patients in their research. There is a wide spectrum of involvement by community members in PBRN research. Many PBRNs reported plans to involve community members in their research. We believe that community involvement will enhance PBRN research.