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Loeb TB, Albarran GI, Lee E, McEwan JA, Dyer KE, Cooley-Strickland M, Norwood-Scott E, Ramm K, Kesblyan D, Barnes A, Novacek D, Chin D. Identifying social determinants of health in populations exposed to structural inequities: a qualitative study of the COVID-19 pandemic experiences of Black and Latinx people living with HIV and cardiovascular risks. Front Public Health 2024; 12:1336184. [PMID: 38873288 PMCID: PMC11169879 DOI: 10.3389/fpubh.2024.1336184] [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: 11/13/2023] [Accepted: 05/20/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction Black and Latinx communities experience inequities in the social determinants of health (SDOH) and high rates of chronic illnesses [e.g., cardiovascular disease (CVD), HIV]. The COVID-19 pandemic amplified these long-standing SDOH disparities. However, scant attention has been paid to the pandemic-related experiences of populations exposed to structural inequities. Methods Using a semi-structured interview guide, 60 in-depth telephone interviews were conducted with Black and Latinx people living with HIV (PLWH) and CVD risks to assess: (1) perceived personal and community risk for COVID-19; (2) knowledge of and access to COVID-19 public health information; (3) barriers to COVID-19 public health recommendations and vaccine uptake; and (4) perceptions of HIV, CVD, and COVID-19. Interviews were professionally transcribed into either English or Spanish. Spanish transcripts were translated into English. Rapid qualitative analysis was used to summarize each transcript into a structured templaicte corresponding to interview guide domains. Summaries were combined into matrices for identification and comparison of themes across domains. Results Participants reported risks for COVID-19 due to being immunocompromised and SDOH, including transportation, exposure to risks conferred by others, living in under-resourced neighborhoods, and housing insecurity. Participants engaged in protective countermeasures by adhering to public health mandates. Relationships with providers, participating in community support groups, and digital inclusion and literacy were salient with respect to dissemination of COVID-19 information and vaccine uptake. Experiences with managing a chronic illness facilitated vaccine acceptance. Participants described language barriers, experiences of discrimination, and a historical lack of trust in medical systems and vaccines. Discussion This study provides a real-time narrative from PLWH and CVD risks who were vulnerable during the height of the COVID-19 pandemic. Implications include the need for continuity with providers and established community networks, increasing internet access and digital health literacy, and addressing historical trauma incurred in medical settings. It is critical to understand the impact of traditional SDOH on those living with chronic illness as well as other social determinants that shed light on access to public health information, adherence to public health recommendations, and vaccine uptake among populations exposed to structural inequities.
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Affiliation(s)
- Tamra Burns Loeb
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Graciela I. Albarran
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Ethan Lee
- Research Volunteer, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jenna Alarcon McEwan
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Karen E. Dyer
- Independent Researcher, Los Angeles, CA, United States
| | - Michele Cooley-Strickland
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Enricka Norwood-Scott
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kate Ramm
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, United States
| | - David Kesblyan
- Research Volunteer, University of California, Los Angeles, Los Angeles, CA, United States
| | - Aleeja Barnes
- Independent Volunteer, Los Angeles, CA, United States
| | - Derek Novacek
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Desert Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Dorothy Chin
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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Rodriguez Espinosa P, Vázquez E, AuYoung M, Zaldivar F, Cheney AM, Sorkin D, Zender R, Corchado CG, Burke NJ. Partnering With Community Health Workers to Address COVID-19 Health Inequities: Experiences of the California Alliance Against COVID-19. Am J Public Health 2024; 114:S45-S49. [PMID: 38207262 PMCID: PMC10785166 DOI: 10.2105/ajph.2023.307471] [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] [Accepted: 09/24/2023] [Indexed: 01/13/2024]
Abstract
With funding from the National Institutes of Health's Community Engagement Alliance, starting in fall 2020, 11 academic medical centers and 75 community partners came together as the California Alliance Against COVID-19 to address COVID-19 inequities in California. Using data from focus groups, statewide meetings, and a statewide partner survey, we describe how promotoras and community health workers (P/CHWs; n = 540) helped to promote access to COVID-19 information, testing, and vaccination. We highlight opportunities to promote health equity among other public health collaborators with a P/CHW model. (Am J Public Health. 2024;114(S1):S45-S49. https://doi.org/10.2105/AJPH.2023.307471).
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Affiliation(s)
- Patricia Rodriguez Espinosa
- Patricia Rodriguez Espinosa is with the Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford, CA. Evelyn Vázquez and Ann Marie Cheney are with the Department of Social Medicine Population and Public Health, University of California Riverside School of Medicine. Mona AuYoung is with the Department of General Internal Medicine and Health Services Research, Geffen School of Medicine, University of California, Los Angeles. Frank Zaldivar, Dara Sorkin, and Robynn Zender are with the Institute for Clinical and Transnational Sciences, University of California, Irvine. Claudia G. Corchado is with Cultiva la Salud, United Way of Merced County, Merced, CA. Nancy J. Burke is with the Department of Public Health, University of California, Merced
| | - Evelyn Vázquez
- Patricia Rodriguez Espinosa is with the Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford, CA. Evelyn Vázquez and Ann Marie Cheney are with the Department of Social Medicine Population and Public Health, University of California Riverside School of Medicine. Mona AuYoung is with the Department of General Internal Medicine and Health Services Research, Geffen School of Medicine, University of California, Los Angeles. Frank Zaldivar, Dara Sorkin, and Robynn Zender are with the Institute for Clinical and Transnational Sciences, University of California, Irvine. Claudia G. Corchado is with Cultiva la Salud, United Way of Merced County, Merced, CA. Nancy J. Burke is with the Department of Public Health, University of California, Merced
| | - Mona AuYoung
- Patricia Rodriguez Espinosa is with the Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford, CA. Evelyn Vázquez and Ann Marie Cheney are with the Department of Social Medicine Population and Public Health, University of California Riverside School of Medicine. Mona AuYoung is with the Department of General Internal Medicine and Health Services Research, Geffen School of Medicine, University of California, Los Angeles. Frank Zaldivar, Dara Sorkin, and Robynn Zender are with the Institute for Clinical and Transnational Sciences, University of California, Irvine. Claudia G. Corchado is with Cultiva la Salud, United Way of Merced County, Merced, CA. Nancy J. Burke is with the Department of Public Health, University of California, Merced
| | - Frank Zaldivar
- Patricia Rodriguez Espinosa is with the Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford, CA. Evelyn Vázquez and Ann Marie Cheney are with the Department of Social Medicine Population and Public Health, University of California Riverside School of Medicine. Mona AuYoung is with the Department of General Internal Medicine and Health Services Research, Geffen School of Medicine, University of California, Los Angeles. Frank Zaldivar, Dara Sorkin, and Robynn Zender are with the Institute for Clinical and Transnational Sciences, University of California, Irvine. Claudia G. Corchado is with Cultiva la Salud, United Way of Merced County, Merced, CA. Nancy J. Burke is with the Department of Public Health, University of California, Merced
| | - Ann Marie Cheney
- Patricia Rodriguez Espinosa is with the Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford, CA. Evelyn Vázquez and Ann Marie Cheney are with the Department of Social Medicine Population and Public Health, University of California Riverside School of Medicine. Mona AuYoung is with the Department of General Internal Medicine and Health Services Research, Geffen School of Medicine, University of California, Los Angeles. Frank Zaldivar, Dara Sorkin, and Robynn Zender are with the Institute for Clinical and Transnational Sciences, University of California, Irvine. Claudia G. Corchado is with Cultiva la Salud, United Way of Merced County, Merced, CA. Nancy J. Burke is with the Department of Public Health, University of California, Merced
| | - Dara Sorkin
- Patricia Rodriguez Espinosa is with the Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford, CA. Evelyn Vázquez and Ann Marie Cheney are with the Department of Social Medicine Population and Public Health, University of California Riverside School of Medicine. Mona AuYoung is with the Department of General Internal Medicine and Health Services Research, Geffen School of Medicine, University of California, Los Angeles. Frank Zaldivar, Dara Sorkin, and Robynn Zender are with the Institute for Clinical and Transnational Sciences, University of California, Irvine. Claudia G. Corchado is with Cultiva la Salud, United Way of Merced County, Merced, CA. Nancy J. Burke is with the Department of Public Health, University of California, Merced
| | - Robynn Zender
- Patricia Rodriguez Espinosa is with the Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford, CA. Evelyn Vázquez and Ann Marie Cheney are with the Department of Social Medicine Population and Public Health, University of California Riverside School of Medicine. Mona AuYoung is with the Department of General Internal Medicine and Health Services Research, Geffen School of Medicine, University of California, Los Angeles. Frank Zaldivar, Dara Sorkin, and Robynn Zender are with the Institute for Clinical and Transnational Sciences, University of California, Irvine. Claudia G. Corchado is with Cultiva la Salud, United Way of Merced County, Merced, CA. Nancy J. Burke is with the Department of Public Health, University of California, Merced
| | - Claudia G Corchado
- Patricia Rodriguez Espinosa is with the Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford, CA. Evelyn Vázquez and Ann Marie Cheney are with the Department of Social Medicine Population and Public Health, University of California Riverside School of Medicine. Mona AuYoung is with the Department of General Internal Medicine and Health Services Research, Geffen School of Medicine, University of California, Los Angeles. Frank Zaldivar, Dara Sorkin, and Robynn Zender are with the Institute for Clinical and Transnational Sciences, University of California, Irvine. Claudia G. Corchado is with Cultiva la Salud, United Way of Merced County, Merced, CA. Nancy J. Burke is with the Department of Public Health, University of California, Merced
| | - Nancy J Burke
- Patricia Rodriguez Espinosa is with the Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford, CA. Evelyn Vázquez and Ann Marie Cheney are with the Department of Social Medicine Population and Public Health, University of California Riverside School of Medicine. Mona AuYoung is with the Department of General Internal Medicine and Health Services Research, Geffen School of Medicine, University of California, Los Angeles. Frank Zaldivar, Dara Sorkin, and Robynn Zender are with the Institute for Clinical and Transnational Sciences, University of California, Irvine. Claudia G. Corchado is with Cultiva la Salud, United Way of Merced County, Merced, CA. Nancy J. Burke is with the Department of Public Health, University of California, Merced
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Rodriguez Espinosa P, Martinez Mulet Y, Chen WT, Kirk C, Tran C, Gonzalez M, Rosas LG. Community of Practice of Promotoras de Salud to address health inequities during and beyond the COVID-19 pandemic. Front Public Health 2023; 11:1260369. [PMID: 38026325 PMCID: PMC10679433 DOI: 10.3389/fpubh.2023.1260369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Using principles of Community-Based Participatory Research, we describe a community of practice for community health workers and promotoras (CHW/Ps) to address COVID-19 inequities in the Latinx community. We offer a concrete example of how programs can engage CHW/Ps as full partners in the research process, and how programs can support CHW/Ps' capacity and workforce development during implementation. We conducted four focus groups with CHW/Ps (n = 31) to understand needs and invited 15 participants to the community of practice to work on issues identified by the group. We examined impact according to number of community members reached, types of outreach activities, surveys, and online views of educational materials. Process evaluation involved two focus groups with seven organizations and a Ripple Effects Mapping session with the CHW/Ps. Our community of practice has built CHW/Ps' capacity via 31 workshop and co-created culturally and linguistically relevant COVID-19 materials that have reached over 40,000 community members and over 3 million people online. The community of practice proved effective in supporting CHW/Ps to address COVID-19 inequities in the Latinx community. Our evaluations demonstrated benefits for community-academic partnerships, for CHW/Ps, and for the community. This model represents an innovative workforce training model to address health inequities and can be applied to other health topics.
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Affiliation(s)
- Patricia Rodriguez Espinosa
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, United States
- Office of Community Engagement, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Yessica Martinez Mulet
- Office of Community Engagement, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Wei-ting Chen
- Office of Community Engagement, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Cary Kirk
- Office of Patient Experience, Stanford Health Care, Palo Alto, CA, United States
| | - Cindy Tran
- Office of Patient Experience, Stanford Health Care, Palo Alto, CA, United States
| | - Mike Gonzalez
- Santa Clara Family Health Plan, San José, CA, United States
| | - Lisa G. Rosas
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, United States
- Office of Community Engagement, Stanford University School of Medicine, Palo Alto, CA, United States
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Rabin BA, Cain KL, Watson P, Oswald W, Laurent LC, Meadows AR, Seifert M, Munoz FA, Salgin L, Aldous J, Diaz EA, Villodas M, Vijaykumar S, O'Leary ST, Stadnick NA. Scaling and sustaining COVID-19 vaccination through meaningful community engagement and care coordination for underserved communities: hybrid type 3 effectiveness-implementation sequential multiple assignment randomized trial. Implement Sci 2023; 18:28. [PMID: 37443044 DOI: 10.1186/s13012-023-01283-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/18/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND COVID-19 inequities are abundant in low-income communities of color. Addressing COVID-19 vaccine hesitancy to promote equitable and sustained vaccination for underserved communities requires a multi-level, scalable, and sustainable approach. It is also essential that efforts acknowledge the broader healthcare needs of these communities including engagement in preventive services. METHODS This is a hybrid type 3 effectiveness-implementation study that will include a multi-level, longitudinal, mixed-methods data collection approach designed to assess the sustained impact of a co-created multicomponent strategy relying on bidirectional learning, shared decision-making, and expertise by all team members. The study capitalizes on a combination of implementation strategies including mHealth outreach with culturally appropriate messaging, care coordination to increase engagement in high priority preventive services, and the co-design of these strategies using community advisory boards led by Community Weavers. Community Weavers are individuals with lived experience as members of an underserved community serving as cultural brokers between communities, public health systems, and researchers to co-create community-driven, culturally sensitive public health solutions. The study will use an adaptive implementation approach operationalized in a sequential multiple assignment randomized trial design of 300 participants from three sites in a Federally Qualified Health Center in Southern California. This design will allow examining the impact of various implementation strategy components and deliver more intensive support to those who benefit from it most. The primary effectiveness outcomes are COVID-19 vaccine completion, engagement in preventive services, and vaccine confidence. The primary implementation outcomes are reach, adoption, implementation, and maintenance of the multicomponent strategy over a 12-month follow-up period. Mixed-effects logistic regression models will be used to examine program impacts and will be triangulated with qualitative data from participants and implementers. DISCUSSION This study capitalizes on community engagement, implementation science, health equity and communication, infectious disease, and public health perspectives to co-create a multicomponent strategy to promote the uptake of COVID-19 vaccination and preventive services for underserved communities in San Diego. The study design emphasizes broad engagement of our community and clinic partners leading to culturally sensitive and acceptable strategies to produce lasting and sustainable increases in vaccine equity and preventive services engagement. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05841810 May 3, 2023.
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Affiliation(s)
- Borsika A Rabin
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA.
- Dissemination and Implementation Science Center, University of California San Diego Altman Clinical and Translational Research Institute, La Jolla, CA, USA.
| | - Kelli L Cain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Paul Watson
- The Global Action Research Center, San Diego, CA, USA
| | | | - Louise C Laurent
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - Audra R Meadows
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Marva Seifert
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | | | | | | | - Miguel Villodas
- Department of Psychology, San Diego State University, CA, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Santosh Vijaykumar
- Department of Psychology, Northumbria University, Newcastle Upon Tyne, UK
| | - Sean T O'Leary
- Department of Pediatrics-Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nicole A Stadnick
- Dissemination and Implementation Science Center, University of California San Diego Altman Clinical and Translational Research Institute, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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Wong MS, Brown AF, Washington DL. Inclusion of Race and Ethnicity With Neighborhood Socioeconomic Deprivation When Assessing COVID-19 Hospitalization Risk Among California Veterans Health Administration Users. JAMA Netw Open 2023; 6:e231471. [PMID: 36867407 PMCID: PMC9984969 DOI: 10.1001/jamanetworkopen.2023.1471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
IMPORTANCE Despite complexities of racial and ethnic residential segregation (hereinafter referred to as segregation) and neighborhood socioeconomic deprivation, public health studies, including those on COVID-19 racial and ethnic disparities, often rely on composite neighborhood indices that do not account for residential segregation. OBJECTIVE To examine the associations by race and ethnicity among California's Healthy Places Index (HPI), Black and Hispanic segregation, Social Vulnerability Index (SVI), and COVID-19-related hospitalization. DESIGN, SETTING, AND PARTICIPANTS This cohort study included veterans with positive test results for COVID-19 living in California who used Veterans Health Administration services between March 1, 2020, and October 31, 2021. MAIN OUTCOMES AND MEASURES Rates of COVID-19-related hospitalization among veterans with COVID-19. RESULTS The sample available for analysis included 19 495 veterans with COVID-19 (mean [SD] age, 57.21 [17.68] years), of whom 91.0% were men, 27.7% were Hispanic, 16.1% were non-Hispanic Black, and 45.0% were non-Hispanic White. For Black veterans, living in lower-HPI (ie, less healthy) neighborhoods was associated with higher rates of hospitalization (odds ratio [OR], 1.07 [95% CI, 1.03-1.12]), even after accounting for Black segregation (OR, 1.06 [95% CI, 1.02-1.11]). Among Hispanic veterans, living in lower-HPI neighborhoods was not associated with hospitalization with (OR, 1.04 [95% CI, 0.99-1.09]) and without (OR, 1.03 [95% CI, 1.00-1.08]) Hispanic segregation adjustment. For non-Hispanic White veterans, lower HPI was associated with more frequent hospitalization (OR, 1.03 [95% CI, 1.00-1.06]). The HPI was no longer associated with hospitalization after accounting for Black (OR, 1.02 [95% CI, 0.99-1.05]) or Hispanic (OR, 0.98 [95% CI, 0.95-1.02]) segregation. Hospitalization was higher for White (OR, 4.42 [95% CI, 1.62-12.08]) and Hispanic (OR, 2.90 [95% CI, 1.02-8.23]) veterans living in neighborhoods with greater Black segregation and for White veterans in more Hispanic-segregated neighborhoods (OR, 2.81 [95% CI, 1.96-4.03]), adjusting for HPI. Living in higher SVI (ie, more vulnerable) neighborhoods was associated with greater hospitalization for Black (OR, 1.06 [95% CI, 1.02-1.10]) and non-Hispanic White (OR, 1.04 [95% CI, 1.01-1.06]) veterans. CONCLUSIONS AND RELEVANCE In this cohort study of US veterans with COVID-19, HPI captured neighborhood-level risk for COVID-19-related hospitalization for Black, Hispanic, and White veterans comparably with SVI. These findings have implications for the use of HPI and other composite neighborhood deprivation indices that do not explicitly account for segregation. Understanding associations between place and health requires ensuring composite measures accurately account for multiple aspects of neighborhood deprivation and, importantly, variation by race and ethnicity.
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Affiliation(s)
- Michelle S. Wong
- Veterans Affairs (VA) Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Arleen F. Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA)
- Olive View–UCLA Medical Center, Sylmar, California
| | - Donna L. Washington
- Veterans Affairs (VA) Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA)
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