Community assessment in a suburban Hispanic community: a description of method

Hispanic Adolescent Farmworkers’ Perceptions Associated with Pesticide Exposure1

The migrant farmworker population in the United States is a vulnerable and understudied population whose characteristics are constantly shifting. The number of youth involved in agriculture work is increasing, and they, in particular, may be at increased risk for occupational hazards, such as pesticide exposure. The present study utilized an ecological framework for focus group discussions with 33 adolescent migrant farmworkers in Oregon. Adolescents’ risk perception and health beliefs associated with pesticide exposure are examined on four levels of environmental influence: microenvironment, organizational environment, social/community environment, and macroenvironment. Adolescents provided insight on such topics as perceived vulnerability of illness due to pesticide exposure, attitudes toward farmwork, influence of their boss, knowledge of occupational hazards, safety training, and barriers to occupational choice. Cultural influences on occupational safety and health are discussed and increased attention to safety training is recommended.

Patients’ Transcultural Needs and Carers’ Ethical Responses

Many Turkish people migrated to Germany between 1955 and 1975. This study was carried out in Göttingen, Germany. Fifty Turkish people (described as patients) were asked about the care they had received from German health care personnel, and 50 German nurses and 50 German physiotherapists were questioned about care they had given to Turkish patients. Significant findings were the needs of the Turkish patients for good communication, physical contact and understanding of their culture-based expressions of illness. The German nurses and physiotherapists expressed the need for language barriers to be minimized and for education in the specific culture of Turkish patients. Our findings are discussed from an ethical viewpoint. The International Council of Nurses’ code of ethics is used to guide the ethical debate about the findings within the context of transcultural and multicultural care. Suggestions for better transcultural health care paradigms are made for relating to patients from different cultures when patients and care providers have little understanding of each other’s needs and expectations.

Cancer assessment methodology in a native Hawaiian community

BACKGROUND

Limited data have been collected on cancer in Native Hawaiian communities, although Native Hawaiians tend to have higher cancer mortality rates than other ethnic groups in Hawaii.

OBJECTIVES

We sought to describe the community-based participatory research (CBPR) process used to deliver a culturally tailored protocol, combining traditional Native Hawaiian practices and random sampling methods, to determine cancer screening practices and program preferences of residents of a Hawaiian Homes (HH) community.

METHODS

Following a culturally tailored protocol, we attempted to survey half of the 644 households in the Waimanalo Hawaiian Homes Community (WHHC). Pairs of Native Hawaiian college students performed the majority of data collection; a community member joined them if available. Visits to the selected homes were tracked and participation rates estimated. Additional information on this methodology emerged from discussions between researchers and community members.

RESULTS

Of the 449 households accessed, 187 (42%) completed the survey, with an average of two visits per household. Individuals at 63 (14%) households refused outright. The remaining 199 (44%) homes were visited up to five times, but produced no response. Although some homes were vacant, often it appeared that residents were home but unresponsive. Our sampling procedure (targeting every other house and requiring accrual of 75 individuals in each of four age-gender groups) reduced participation.

CONCLUSIONS

The use of CBPR built capacity for all partners by engaging them in all levels of research. The results, however, suggest the need for a more inclusive sampling strategy and the continued use of CBPR.

Cervical cancer among Hispanic women: assessing the impact on farmworkers

The purpose of this paper was to review the literature on Hispanic populations to outline: 1) demographics; 2) general health status; 3) cervical cancer incidence and mortality; 4) Pap smear screening rates; and 5) barriers to preventive care services. The methods: MEDLINE, Med66, Med75, and Med85 files, from 1966 to 1999, were searched for key words Hispanic health, cervical cancer and Hispanics, cervical cancer and Mexico, migrants and health, agricultural occupational health, farmworkers and cancer, and farmworker health. AGRICOLA (1982-98) was searched for key words farmworker health, agricultural workers and health, and agriculture and cancer. The results show that Hispanic immigrant women may have cervical cancer incidence rates ranging between the California rates for 1991-93 (19.8/100,000) and for Mexico in 1990 (115-220 per 100,000). Mortality rates for the same periods were 3.9/100,000 and 16.11/100,000 respectively. While survey results report Hispanic Pap smear rates above 70%, these surveys count urban women who do not share the barriers to care experienced by poor rural Hispanics. Since validated self-reports of survey responses are 20-50% lower than reported lower rates and Pap smear screening persist in Hispanic Pap evaluations and are reflected in higher morbidity and mortality from cervical cancer. That targeted community interventions have been successful in raising Pap smear rates among poor Spanish-speaking women. Such interventions should be a priority for preventive health care policy and practice.

A participatory action research approach for identifying health service needs of Hispanic immigrants: implications for occupational therapy

SUMMARY Recently, the field of Community Occupational Therapy has started to enter into new research areas, one being participatory research. This paper illustrates a participatory research methodology adapted by community residents and a research team to identify the service needs of an underserved Hispanic population as well as set action agendas to meet their needs. In order to plan and implement health programs, community residents participated actively in the needs assessment, action agenda development and brainstorming of solutions to address health and community needs and concerns. Concerns identified included the lack of affordable bilingual dentists and youth involvement in gangs, drugs, and alcohol. The results of the needs assessment were shared and discussed during five public forums in which 180 Hispanics from the community discussed the dimensions of the issues and alternative solutions. This process resulted in an agenda of health issues and ideas for improvement from the perspective of Hispanics. We emphasized the advantages of using participatory methodologies when developing health and community services within Hispanic communities. Additionally, the implications for advancing a Scholarship of Practice agenda for Community Occupational Therapy are discussed.

Latinos' health care access: financial and cultural barriers

This study aimed at investigating how income, culture, and language affect health care access. Data from a structured questionnaire administered to a random sample of 206 Latinos was analyzed using multivariate logistic regression. Qualitative data served to explain quantitative results. Point estimates for various access measures were similar to national data. In multivariate logistic regression, income and education determined having health insurance (OR 6.8 and 7.4; 95% CI 2.7-17.3 and 2.9-19.0, respectively). Time in the U.S. and health insurance determined having a regular source of care (OR 4.6 and 5.8; 95% CI 1.7-12.8 and 2.1-16.0, respectively). Having a source of care and being female determined visit to the doctor in the past year (OR 6.14 and 6.73; 95% CI 2.3-16.5 and 2.4-19.3, respectively). Language and culture showed no statistically significant effect on access measures, but qualitative data showed they were related to health care barriers.

Earthquakes in El Salvador: a descriptive study of health concerns in a rural community and the clinical implications, part I

INTRODUCTION

This is the first article in a series that evaluates the health concerns of people living in a Salvadoran rural community after major earthquakes. Part I reviews the background, methods, and results of post-earthquake conditions with regards to healthcare, access to healthcare, housing, food, water and sanitation. Part II reviews the implications of these results and recommendations for improvements within the community. Part III investigates the psychosocial and mental health consequences of the earthquakes and provides suggestions for improved mental health awareness, assessment, and intervention.

BACKGROUND

El Salvador experienced 2 major earthquakes in January and February 2001. This study evaluates the effects of the earthquakes on the health practices in the rural town of San Sebastian.

METHODS

The research was conducted with use of a convenience sample survey of subjects affected by the earthquakes. The sample included 594 people within 100 households. The 32-question survey assessed post-earthquake conditions in the areas of health care and access to care, housing, food and water, and sanitation.

RESULTS

Communicable diseases affected a number of family members. After the earthquakes, 38% of households reported new injuries, and 79% reported acute exacerbations of chronic illness. Rural inhabitants were 30% more likely to have an uninhabitable home than were urban inhabitants. Concerns included safe housing, water purification, and waste elimination.

CONCLUSION

The findings indicate a need for greater public health awareness and community action to adapt living conditions after a disaster and prevent the spread of communicable disease.

Assessment of a Newark neighborhood: process and outcomes

In 1996, the members of the St. Columba Collaboration conducted a grassroots neighborhood assessment of a Hispanic area in Newark, New Jersey. This assessment was undertaken during an era of significant political and policy change in New Jersey. As a community-driven and implemented effort, the processes, methods, and outcomes of this assessment provide lessons on community activism, political awareness, and strategic planning. Quantitative surveys were distributed to local residents as well as users of the various services provided through Collaboration programs. Ten qualitative focus groups were held among various Collaboration groups. A total of 471 surveys were returned from a door-to-door distribution and 295 surveys were returned from users of Collaboration programs. Findings from both the quantitative and qualitative components were surprisingly similar. It was striking to note that youth violence, domestic violence, crime, and lack of job skills surpassed poor housing and chronic health problems, including HIV/AIDS and drug and alcohol addiction, as the most noted neighborhood problems. Overwhelmingly, social, welfare, and environmental issues were identified as priority items in a neighborhood marked by extreme poverty, poor childhood immunization rates, high HIV/AIDS rates, and high incidence of childhood asthma. Focus group findings revealed that stressful daily life events and circumstances far overshadowed health and wellness concerns. Recommendations emanating from the St. Columba Neighborhood needs assessment included: (a) establishment of principled partnerships between the Collaboration and other regional entities to extend capacity to design and implement solutions (e.g., partnerships with other higher education institutions, health care agencies); (b) development of strategic planning processes and procedures within the Collaboration; (c) establishment of collaborative partnerships with other Hispanic community-based organizations for political activism; and (d) reorganization of the Collaboration's internal structure and functions to capitalize on opportunities for change. Significant outcomes from this process, in evidence 4 years after the 1996 neighborhood assessment, include: (a) a successful grant application to study violence against Hispanic women, (b) a research program investigating the nature and extent of clinical depression among Hispanic women, (c) establishment of a teenage pregnancy program, (d) English classes for Hispanic women seeking language skills and eventual employment, and (e) partnership extended to the New Jersey Institute of Technology.