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Mangan J, del Cid Nunez P, Daou S, Richandi GEK, Siddiqui A, Wong J, Birk-Urovitz L, Bond A, Orkin AM. Peer and lay health work for people experiencing homelessness: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003332. [PMID: 38913605 PMCID: PMC11195950 DOI: 10.1371/journal.pgph.0003332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/20/2024] [Indexed: 06/26/2024]
Abstract
Homelessness poses complex health obstacles for individuals and communities. Peer and lay health worker programs aim to increase access to health care and improve health outcomes for PEH by building trust and empowering community-based workers. The scope and breadth of peer and lay health worker programs among PEH has not been synthesized. The primary objective of this scoping review is to understand the context (setting, community, condition or disease) encompassing peer and lay health worker programs within the homelessness sector. The secondary objective is to examine the factors that either facilitate or hinder the effectiveness of peer and lay health worker programs when applied to people experiencing homelessness (PEH). We searched CINHAL, Cochrane, Web of Science Core Collection, PsycINFO, Google Scholar and MEDLINE. We conducted independent and duplicate screening of titles and abstracts, and extracted information from eligible studies including study and intervention characteristics, peer personnel characteristics, outcome measures, and the inhibitors and enablers of effective programs. We discuss how peer and lay health work programs have successfully been implemented in various contexts including substance use, chronic disease management, harm reduction, and mental health among people experiencing homelessness. These programs reported four themes of enablers (shared experiences, trust and rapport, strong knowledge base, and flexibility of role) and five themes of barriers and inhibitors (lack of support and clear scope of role, poor attendance, precarious work and high turnover, safety, and mental well-being and relational boundaries). Organizations seeking to implement these interventions should anticipate and plan around the enablers and barriers to promote program success. Further investigation is needed to understand how peer and lay health work programs are implemented, the mechanisms and processes that drive effective peer and lay health work among PEH, and to establish best practices for these programs.
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Affiliation(s)
- Jessica Mangan
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Pablo del Cid Nunez
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sara Daou
- Population Health Services, Inner City Health Associates, Toronto, Ontario, Canada
| | | | - Amna Siddiqui
- Population Health Services, Inner City Health Associates, Toronto, Ontario, Canada
| | - Jonathan Wong
- Family Health Team, Inner City Health Associates, Toronto, Ontario, Canada
- St Michael’s Hospital, Toronto, Ontario, Canada
| | - Liz Birk-Urovitz
- Population Health Services, Inner City Health Associates, Toronto, Ontario, Canada
| | - Andrew Bond
- Inner City Health Associates, Toronto, Ontario, Canada
- National Health Fellow, McMaster University, Hamilton, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Canadian Network for the Health and Housing of People Experiencing Homelessness, Toronto, Ontario, Canada
| | - Aaron M. Orkin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Inner City Health Associates, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Unity Health, Toronto, Ontario, Canada
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Nyamathi A, Salem BE, Lee D, Yu Z, Hudson A, Saab S, Shin SS, Jones-Patten A, Yadav K, Alikhani M, Clarke R, Chang A, White K, Gelberg L. Exploratory assessment: Nurse-led community health worker delivered HCV intervention for people experiencing homelessness. Public Health Nurs 2023; 40:641-654. [PMID: 37132164 PMCID: PMC10524682 DOI: 10.1111/phn.13204] [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: 02/03/2023] [Revised: 03/27/2023] [Accepted: 04/09/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Getting and maintaining Hepatitis C Virus (HCV) cure is challenging among people experiencing homelessness (PEH) as a result of critical social determinants of health such as unstable housing, mental health disorders, and drug and alcohol use. OBJECTIVES The purpose of this exploratory pilot study was to compare a registered nurse/community health worker (RN/CHW)-led HCV intervention tailored for PEH, "I am HCV Free," with a clinic-based standard of care (cbSOC) for treating HCV. Efficacy was measured by sustained virological response at 12 weeks after stopping antivirals (SVR12), and improvement in mental health, drug and alcohol use, and access to healthcare. METHODS An exploratory randomized controlled trial design was used to assign PEH recruited from partner sites in the Skid Row Area of Los Angeles, California, to the RN/CHW or cbSOC programs. All received direct-acting antivirals. The RN/CHW group received directly observed therapy in community-based settings, incentives for taking HCV medications, and wrap-around services, including connection to additional healthcare services, housing support, and referral to other community services. For all PEH, drug and alcohol use and mental health symptoms were measured at month 2 or 3 and 5 or 6 follow-up, depending on HCV medication type, while SVR12 was measured at month 5 or 6 follow-up. RESULTS Among PEH in the RN/CHW group, 75% (3 of 4) completed SVR12 and all three attained undetectable viral load. This was compared with 66.7% (n = 4 of 6) of the cbSOC group who completed SVR12; all four attained undetectable viral load. The RN/CHW group, as compared to the cbSOC, also showed greater improvements in mental health, and significant improvement in drug use, and access to healthcare services. DISCUSSION While this study shows significant improvements in drug use and health service access among the RN/-CHW group, the sample size of the study limits the validity and generalizability of the results. Further studies using larger sample sizes are necessitated.
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Affiliation(s)
- Adeline Nyamathi
- University of California, Irvine, Sue & Bill Gross School of Nursing, Irvine, California
| | - Benissa E Salem
- University of California, Los Angeles, School of Nursing, Los Angeles, California
| | - Darlene Lee
- University of California, Irvine, Susan Samueli Integrative Health Institute, Irvine, California
| | - Zhaoxia Yu
- University of California, Irvine, Department of Statistics, School of Information and Computer Sciences, Irvine, California
| | | | - Sammy Saab
- Adult Liver Transplant Program, University of California, Los Angeles, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Sanghyuk S Shin
- University of California, Irvine, Sue & Bill Gross School of Nursing, Irvine, California
| | | | - Kartik Yadav
- University of California, Irvine, Sue & Bill Gross School of Nursing, Irvine, California
| | - Mitra Alikhani
- University of California, Los Angeles, School of Nursing, Los Angeles, California
| | - Richard Clarke
- University of California, Irvine, Sue & Bill Gross School of Nursing, Irvine, California
| | - Alicia Chang
- Los Angeles County Department of Public Health, Community Field Services, Inglewood, California
| | - Kathryn White
- Los Angeles Christian Health Centers, Los Angeles, California
| | - Lillian Gelberg
- David Geffen School of Medicine at UCLA, UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
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Herren OM, Gillman AS, Marshall VJ, Das R. Understanding the Changing Landscape of Health Disparities in Chronic Liver Diseases and Liver Cancer. GASTRO HEP ADVANCES 2022; 2:505-520. [PMID: 37347072 PMCID: PMC10281758 DOI: 10.1016/j.gastha.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Liver disease and liver cancer disparities in the U.S. are reflective of complex multiple determinants of health. This review describes the disproportionate burden of liver disease and liver cancer among racial, ethnic, sexual, and gender minority, rural, low socioeconomic status (SES) populations, and place-based contexts. The contributions of traditional and lifestyle-related risk factors (e.g., alcohol consumption, evitable toxin exposure, nutrition quality) and comorbid conditions (e.g., viral hepatitis, obesity, type II diabetes) to disparities is also explored. Biopsychosocial mechanisms defining the physiological consequences of inequities underlying these health disparities, including inflammation, allostatic load, genetics, epigenetics, and social epigenomics are described. Guided by the National Institute on Minority Health and Health Disparities (NIMHD) framework, integrative research of unexplored social and biological mechanisms of health disparities, appropriate methods and measures for early screening, diagnosis, assessment, and strategies for timely treatment and maintaining multidisciplinary care should be actively pursued. We review emerging research on adverse social determinants of liver health, such as structural racism, discrimination, stigma, SES, rising care-related costs, food insecurity, healthcare access, health literacy, and environmental exposures to pollutants. Limited research on protective factors of liver health is also described. Research from effective, multilevel, community-based interventions indicate a need for further intervention efforts that target both risk and protective factors to address health disparities. Policy-level impacts are also needed to reduce disparities. These insights are important, as the social contexts and inequities that influence determinants of liver disease/cancer have been worsened by the coronavirus disease-2019 pandemic and are forecasted to amplify disparities.
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Affiliation(s)
- Olga M. Herren
- Extramural Scientific Programs, Division of Integrative Biological and Behavioral Sciences
| | - Arielle S. Gillman
- Extramural Scientific Programs, Division of Integrative Biological and Behavioral Sciences
| | - Vanessa J. Marshall
- Office of the Director National Institute on Minority Health and Health Disparities (NIMHD), Bethesda, MD
| | - Rina Das
- Extramural Scientific Programs, Division of Integrative Biological and Behavioral Sciences
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Meunier É, Alohan D, Tellone S, Silvera R, Cohall A, Baran A, Wakefield M, Grov C, Fisher CB. Attitudes Toward Peer-Delivered Sexual-Health Services Among New York City Sexual and Gender Minority Individuals Who Have Sex with Men and Attend Collective Sex Venues. QUALITATIVE HEALTH RESEARCH 2022; 32:1167-1184. [PMID: 35584703 PMCID: PMC9253071 DOI: 10.1177/10497323221101714] [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: 06/03/2023]
Abstract
Collective sex venues such as sex clubs are strategic sites to promote sexual health among sexual and gender minority individuals. We present qualitative findings from a multiple-method study on the acceptability of sexual-health services at collective sex venues in New York City (NYC) among attendees who identified as men, transgender, or gender non-conforming. In a survey used for sample selection (n = 342), most respondents (82.7%) agreed that "having outreach workers at sex venues is a good thing." Interviewees (n = 30) appreciated how on-site services could promote sexual health in their community. They felt peer workers should be familiar with collective sex venues and share demographic characteristics with attendees. Some participants felt workers should keep some boundaries from attendees, while others felt they could be fully integrated in the environment, suggesting that either peer outreach or popular-opinion leader types of interventions could be feasible.
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Affiliation(s)
- Étienne Meunier
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Daniel Alohan
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, GA
| | - Stephen Tellone
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
- ProHealth, New York, NY
| | - Richard Silvera
- Icahn School of Medicine at Mount Sinai, Department of Medicine, Division of Infectious Diseases
| | - Alwyn Cohall
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
| | | | | | - Christian Grov
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York NY
| | - Celia B. Fisher
- Center for Ethics Education and Department of Psychology, Fordham University, Bronx, NY
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Nyamathi AM, Gelberg L, Lee D, Arce N, Patten-Jones A, Yadav K, Goodwine M, Alikhani M, Yao M, Chang AH, Salem BE. Perceptions of Homeless Adults and Their Providers on Coping With the Impact of COVID-19 Pandemic on Mental Health, Substance Use, and Harm Reduction Services. Glob Qual Nurs Res 2022; 9:23333936221108712. [PMID: 35912133 PMCID: PMC9335488 DOI: 10.1177/23333936221108712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
Adults experiencing homelessness experience a disproportionate burden of health disparities which has further exacerbated mental health, substance use, and coping during the COVID-19 pandemic. As limited data is available to understand the experience of adults experiencing homelessness and their health during this time, the purpose of this study was to explore how COVID-19 may have impacted their mental health, substance use, and ways of coping in this population. Using community-based participatory research, a community advisory board was established and remote individual interviews with 21 adults experiencing homelessness and 10 providers were conducted in Skid Row, Los Angeles. Using a qualitative, data analytic approach, the following major themes emerged: (1) Negative Impact of COVID-19 on Mental Health; (2) Negative Impact of COVID-19 on Limitation of Harm Reduction Services; and (3) Coping Strategies Utilized During the COVID-19 Pandemic. More research is needed to understand the impact of this pandemic on underserved communities.
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Affiliation(s)
| | - Lillian Gelberg
- David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Darlene Lee
- University of California, Irvine, California, USA
| | | | | | - Kartik Yadav
- University of California, Irvine, California, USA
| | | | | | - Maritas Yao
- University of California, Los Angeles, California, USA
| | - Alicia H Chang
- Los Angeles County Department of Public Health, California, USA
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