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Moore R, Callaghan-Koru J, Vincenzo JL, Patton SK, Spear MJ, Riklon S, Alik E, Padilla Ramos A, Takamaru S, McElfish PA, Curran GM. External relationships as implementation determinants in community-engaged, equity-focused COVID-19 vaccination events. Front Health Serv 2024; 4:1338622. [PMID: 38533190 PMCID: PMC10964718 DOI: 10.3389/frhs.2024.1338622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/21/2024] [Indexed: 03/28/2024]
Abstract
Background While relationships and connectedness among organizations have been included in implementation theories, models, and frameworks, the increased attention to health equity in implementation science raises the urgency of understanding the role of relationships external to the implementing organization. This paper addresses this gap through an exploration of the role of external relationships in community-based, equity-focused interventions. Methods This study focuses on an equity-focused, community-based COVID-19 vaccination intervention in Arkansas, drawing upon long-term community-engaged relationships among University of Arkansas for Medical Sciences and the Hispanic and Marshallese Islander communities. We used an exploratory qualitative descriptive design to examine barriers and facilitators to implementation of COVID-19 vaccination events analyzing in-depth qualitative interviews with implementation team members (n = 17). Results All participants described pre-existing relationships among the implementing organization, partner organizations, and communities as a key implementation determinant for this equity-focused program. At the inter-organizational level, external relationships included formal connections and informal relationships among staff (e.g., communication channels from prior partnerships). At the individual level, strong external relationships with the community were facilitators leveraging long-term engagement, community familiarity, and staff from the communities of focus. Strong external relationships facilitated program reach in underserved communities through three mechanisms: (1) reduced time required to establish functional working relationships among partners; (2) accessibility and cultural congruence of health services; and (3) increased trust among community members. Barriers to implementation also existed in external relationships, but had less influence than facilitators. Conclusions Achieving health equity in implementation science requires greater understanding of external relationships as implementation determinants. This exploratory study makes a significant contribution to the literature by describing the types of external relationships that facilitate equitable implementation and identifying the mechanisms through which they may work. We argue that approaches to community engagement drawn from community-engaged research approaches may be useful, as these processes require investment in building/maintaining formal and informal organizational and interpersonal relationships. Further research is needed to understand connections among external relationships and other implementation determinants.
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Affiliation(s)
- Ramey Moore
- Office of Community Health and Research, College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Jennifer Callaghan-Koru
- Office of Community Health and Research, College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Jennifer L. Vincenzo
- Geriatrics, College of Health Professions, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, United States
| | - Susan K. Patton
- Nursing, College of Education and Health Professions, University of Arkansas, Fayetteville, AR, United States
| | - Marissa J. Spear
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Sheldon Riklon
- Department of Family Medicine, Family Medicine Residency Training Program, College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, United States
| | - Eldon Alik
- Consulate General of Arkansas, Republic of the Marshall Islands, Springdale, AR, United States
| | - Alan Padilla Ramos
- Department of Family Medicine, Family Medicine Residency Training Program, College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, United States
| | | | - Pearl A. McElfish
- Office of Community Health and Research, College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Geoffrey M. Curran
- Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
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Morgan ER, Dillard D, Lofgren E, Maddison BK, Riklon S, McElfish P, Sinclair K. Moana: Alternate surveillance for COVID-19 in a Unique Population (MASC-UP). Contemp Clin Trials Commun 2024; 37:101246. [PMID: 38222877 PMCID: PMC10784670 DOI: 10.1016/j.conctc.2023.101246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/20/2023] [Accepted: 12/17/2023] [Indexed: 01/16/2024] Open
Abstract
Objective Create a longitudinal, multi-modal and multi-level surveillance cohort that targets early detection of symptomatic and asymptomatic COVID-19 cases among Native Hawaiian and Pacific Islander adults in the Continental US and identify effective modalities for participatory disease surveillance and sustainably integrate them into ongoing COVID-19 and other public health surveillance efforts. Materials and methods We recruited cohorts from three sites: Federal Way, WA; Springdale, AR; and remotely. Participants received a survey that included demographic characteristics and questions regarding COVID-19. Participants completed symptom checks via text message every month and recorded their temperature daily using a Kinsa smart thermometer. Results Recruitment and data collection is ongoing. Presently, 441 adults have consented to participate. One-third of participants were classified as essential workers during the pandemic. Discussion Over the past 18 months, we have improved our strategies to elicit better data from participants and have learned from some of the weaknesses in our initial deployment of this type of surveillance system. Other limitations stem from historic inequities and barriers which limited Native Hawaiian and Pacific Island representation in academic and clinical environments. One manifestation of this was the limited ability to provide study materials and support in multiple languages. We hope that continued partnership with the community will allow further opportunities to help restore trust in academic and medical institutions, thus generating knowledge to advance health equity. Conclusion This participatory disease surveillance mechanism complements traditional surveillance systems by engaging underserved communities. We may also gain insights generalizable to other pathogens of concern.
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Affiliation(s)
- Erin R. Morgan
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
| | - Denise Dillard
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
| | - Eric Lofgren
- Paul G. Allen School for Global Health, College of Veterinary Medicine, Washington State University, Pullman, WA, USA
| | | | - Sheldon Riklon
- Department of Family and Preventive Medicine, University of Arkansas for the Medical Sciences, Fayetteville, AR, USA
| | - Pearl McElfish
- Department of Internal Medicine, University of Arkansas for the Medical Sciences, Fayetteville, AR, USA
| | - Ka`imi Sinclair
- Institute for Research and Education to Advance Community Health, College of Nursing, Washington State University, Seattle, WA, USA
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Andersen JA, Willis DE, Kaholokula JK, Rowland B, Council S, Riklon S, McElfish PA. Experiences of Discrimination Among Native Hawaiians and Pacific Islanders Living in the USA. J Racial Ethn Health Disparities 2024; 11:184-191. [PMID: 36626048 PMCID: PMC9838348 DOI: 10.1007/s40615-022-01509-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/07/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023]
Abstract
Experiences of racism and discrimination are stressors that adversely affect the well-being of marginalized populations, including Native Hawaiians and Pacific Islanders (NHPI). However, commonly used data aggregation methods obscure information on NHPI communities and their lived experiences. The aim of our study is to understand the types and frequency of discrimination experienced by NHPI adults in the USA. The study utilized online survey data collected from 252 NHPI adults living in the USA between September and October 2021. Younger NHPI adults, those who report constantly thinking about their race/ethnicity, and those who are socially assigned a race/ethnicity that does not match their own report experiencing more types of discrimination. NHPI who constantly think about their race/ethnicity and those who are socially assigned a race/ethnicity that does not match their own report a greater frequency of discrimination. Findings indicate the need to understand the experiences of discrimination in this population.
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Affiliation(s)
- Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR 72762 USA
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR 72762 USA
| | - Joseph Keawe‘aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai’i at Manoa, 651 Ilalo St, Honolulu, HI 96813 USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR 72762 USA
| | - Sarah Council
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR 72762 USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR 72762 USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR 72762 USA
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Andersen JA, Rowland B, Gloster E, Felix HC, Riklon S, Jenkins D, Bing WI, Mendoza Kabua P, Hudson JS, Edem D, Niedenthal J, McElfish PA. Assessment of diabetes self-care behaviors and knowledge among Marshallese adults with type 2 diabetes in the Republic of the Marshall Islands. Prim Care Diabetes 2024; 18:74-78. [PMID: 38040537 PMCID: PMC10922376 DOI: 10.1016/j.pcd.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 10/09/2023] [Accepted: 11/19/2023] [Indexed: 12/03/2023]
Abstract
AIMS The aim of this study is to assess and document engagement in type 2 diabetes mellitus (T2DM) self-care behaviors and self-reported diabetes knowledge among Marshallese adults living in the Republic of the Marshall Islands (RMI). METHODS The study uses data from a T2DM health screening study completed in the RMI; survey and biometric data were captured as part of the health screenings. Study objectives were examined using descriptive statistics to describe the characteristics of the participants, their diabetes self-care behaviors, and their levels of self-reported diabetes knowledge. RESULTS Results indicate many Marshallese diagnosed with T2DM did not engage in adequate self-care behaviors, including blood sugar checks and foot examinations. Participants reported having forgone needed medical care and medication due to issues with cost and/or access, and participants reported low levels of diabetes knowledge. CONCLUSIONS The results demonstrate the need for further work in improving engagement in diabetes self-care by Marshallese living in the RMI. Increased engagement in self-care and diabetes education programs may help Marshallese with T2DM to improve control of their glucose and avoid long-term health complications, as well as reduce costs to the healthcare system.
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Affiliation(s)
- Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Erin Gloster
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Desiree Jenkins
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Williamina Ioanna Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Philmar Mendoza Kabua
- College of Nursing, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Jonell S Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Dinesh Edem
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Jack Niedenthal
- Republic of the Marshall Islands Ministry of Health & Human Services, PO Box 16, Majuro, MH 96960, MH
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA.
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Andersen JA, Willis DE, Kaholokula JK, Rowland B, Council S, Riklon S, McElfish PA. Correction to: Experiences of Discrimination Among Native Hawaiians and Pacific Islanders Living in the USA. J Racial Ethn Health Disparities 2024; 11:590. [PMID: 36877381 DOI: 10.1007/s40615-023-01547-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Affiliation(s)
- Jennifer A Andersen
- College of Medicine, Sciences Northwest, University of Arkansas for Medical, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Don E Willis
- College of Medicine, Sciences Northwest, University of Arkansas for Medical, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Joseph Keawe'aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Manoa, 651 Ilalo St, Honolulu, HI, 96813, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Sarah Council
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Sheldon Riklon
- College of Medicine, Sciences Northwest, University of Arkansas for Medical, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Pearl A McElfish
- College of Medicine, Sciences Northwest, University of Arkansas for Medical, 2708 S. 48th St, Springdale, AR, 72762, USA.
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Purvis RS, Moore R, Rojo MO, Riklon S, Alik E, Alik D, Maddison BK, McElfish PA. COVID-19 vaccine hesitancy among Marshallese in Northwest Arkansas (USA). J Public Health Res 2024; 13:22799036241231549. [PMID: 38440055 PMCID: PMC10910884 DOI: 10.1177/22799036241231549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/23/2024] [Indexed: 03/06/2024] Open
Abstract
Background COVID-19 has disproportionately affected Pacific Islander communities, with disparities in the prevalence of infection, serious illness, and death compared to non-Hispanic whites in the US. Marshallese Pacific Islanders face significant COVID-19 disparities. Design and methods This exploratory study aimed to understand Marshallese community attitudes about the COVID-19 vaccine to identify and implement culturally relevant strategies to encourage vaccine uptake. Data were collected from 17 participants in three focus groups. Results Using content analysis, researchers identified two global themes: (1) barriers to vaccination and (2) facilitators of COVID-19 vaccine uptake. Within these themes, participants described fear, lack of knowledge about vaccines, negative perceptions of the COVID-19 vaccine, health concerns, and transportation as barriers to vaccination. Participants described several factors influencing vaccine behavior, including location of and personnel at vaccine clinics, vaccine experiences, the need for trusted information, positive perceptions, cultural leaders, and mandates. Conclusions The qualitative study makes a significant contribution as the first to report community perceptions and experiences related to the COVID-19 vaccine in Marshallese participants' own words. Findings show that cultural influencers and brokers are crucial bridges for public health messaging related to COVID-19 vaccination targeted to this vulnerable and underserved population. Culturally appropriate and effective public health messaging can help achieve vaccine equity and improve COVID-19-related health disparities in the Marshallese community.
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Affiliation(s)
- Rachel S Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Martha O Rojo
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR, USA
| | - Eldon Alik
- Republic of the Marshall Islands Consulate, Springdale, AR, USA
| | - Derek Alik
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | | | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
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7
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Andersen JA, Rowland B, Gloster E, O’Connor G, Ioanna Bing W, Niedenthal J, Riklon S, McElfish PA. Undiagnosed hypertension and type 2 diabetes mellitus among Marshallese adults in the Republic of the Marshall Islands. J Med Access 2024; 8:27550834231225159. [PMID: 38282818 PMCID: PMC10812094 DOI: 10.1177/27550834231225159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024]
Abstract
Background Given the lack of healthcare access in the Republic of the Marshall Island (RMI) and the potential for complications related to type 2 diabetes mellitus (T2DM) and hypertension, it is crucial to examine these conditions among Marshallese in the RMI. Objectives This study aims to identify the proportion of Marshallese adults in the RMI with undiagnosed T2DM and hypertension. Design Using a community-based participatory research approach, screening events were conducted at 20 churches in Majuro Atoll. Methods Participants completed a questionnaire and biometric data measures, including hemoglobin A1c and blood pressure. Results Among participants with blood pressure data (N = 528), 11.9% had readings indicative of hypertension, and 38.1% were undiagnosed. Among participants with hemoglobin A1c (HbA1c) data (N = 450), 45.3% had readings indicative of T2DM, and 39.2% were undiagnosed. Conclusion This study utilized a community-based participatory research approach that promotes equitable and ethical research. Results reaffirm the need to identify strategies for increasing healthcare access and for research to address health disparities in the RMI.
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Affiliation(s)
- Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Erin Gloster
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Gail O’Connor
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Williamina Ioanna Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Jack Niedenthal
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
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Andersen JA, Rowland B, O'Connor G, Bing WI, Riklon S, Mendoza-Kabua P, McElfish PA. Faith-based health screenings for Marshallese adults living in the Republic of the Marshall Islands: Study design and results. Front Public Health 2023; 11:1075763. [PMID: 37056659 PMCID: PMC10089260 DOI: 10.3389/fpubh.2023.1075763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
IntroductionStriking health disparities exist in the Republic of the Marshall Islands (RMI). The RMI has one of the highest age-adjusted type 2 diabetes mellitus (T2DM) rates in the world (23.0%) compared to global (9.3%) and United States (US; 13.3%) rates. We conducted health screenings including clinical indicators of T2DM and hypertension among Marshallese in the RMI.MethodsScreenings were conducted at 20 churches on Majuro Atoll. Participants completed questionnaires and biometric data collection assessing glycated hemoglobin (HbA1c), blood pressure, and body mass index.ResultsScreenings included 528 participants and showed a high prevalence of T2DM, obesity, and hypertension. One-third of participants were referred to the non-communicable disease clinic. The percent of adults in this study with T2DM-indicative HbA1c (48.5%) is higher than observed at the national level (23.0%).DiscussionResults highlight the need for non-communicable disease-related programs in the RMI.
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Affiliation(s)
- Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Gail O'Connor
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Williamina Ioanna Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | | | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
- *Correspondence: Pearl A. McElfish
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Ayers BL, Purvis RS, Callaghan-Koru J, Reece S, CarlLee S, Manning N, Langston K, Riklon S, McElfish PA. Marshallese Mothers' and Marshallese Maternal Healthcare Providers' Perspectives on Contraceptive Use and Reproductive Life Planning Practices and Influences. Int J Environ Res Public Health 2023; 20:3949. [PMID: 36900960 PMCID: PMC10001766 DOI: 10.3390/ijerph20053949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/31/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Pacific Islander communities experience significant maternal and infant health disparities including high maternal and infant mortality. Contraception and reproductive life planning prevent approximately one-third of pregnancy-related deaths and neonatal deaths. We report the results of formative research devoted to understanding Marshallese mothers' as well as their maternal healthcare providers' practices and influences related to contraceptive use and reproductive life planning. This study used an exploratory, descriptive qualitative design to explore Marshallese mothers' and maternal healthcare providers' practices and influences of contraception use and reproductive life planning. Twenty participants were enrolled in the study, 15 Marshallese mothers and five Marshallese maternal healthcare providers. For the Marshallese mothers, two themes emerged: (1) Reproductive Life Planning Practices and Information; and (2) Reproductive Life Planning Influences. For the Marshallese maternal healthcare providers, two themes emerged: (1) Reproductive Life Planning Practices; and (2) Reproductive Life Planning Influences. This is the first study to document Marshallese mothers' and maternal healthcare providers' practices and influences with contraceptive use and reproductive life planning. Study results will inform the development of a culturally-adapted contraception and reproductive life planning tool with an educational program for Marshallese family units and maternal healthcare providers serving Marshallese women.
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Affiliation(s)
- Britni L. Ayers
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Jennifer Callaghan-Koru
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR 72701, USA
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR 72701, USA
| | - Nirvana Manning
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR 72205, USA
| | - Krista Langston
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR 72762, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
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Andersen JA, Purvis RS, Scott AJ, Henske J, Edem D, Selig JP, Hudson J, Bing WI, Niedenthal J, Otuafi H, Riklon S, Anzures E, George A, Alik D, McElfish PA. Lessons learned from the pilot family model of diabetes self-management intervention in the Republic of the Marshall Islands. Contemp Clin Trials Commun 2023; 32:101086. [PMID: 36817737 PMCID: PMC9929673 DOI: 10.1016/j.conctc.2023.101086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
Background The Republic of the Marshall Islands (RMI) has a high rate of type 2 diabetes mellitus (T2DM). To address the high rate of T2DM, we tested a culturally adapted family model of diabetes self-management education and support (F-DSMES). We report the results of the 12-month post-intervention data collection and describe the lessons learned from the delivery of the F-DSMES intervention. Methods Recruitment took place in four churches in Majuro and included 10 h of content delivered over 8-10 weeks. Forty-one participants with T2DM were included. The primary study outcome was glycemic control measured by a change in HbA1c. We also conducted participant interviews to document the participant-reported barriers encountered during the F-DSMES intervention. Results Participants did not show improvements in their biometric markers; however, participants did show improvement on multiple measures of diabetes knowledge and family support. We identified five areas to improve future interventions: 1) issues with recruitment, retention, and attendance; 2) needing help accessing information and additional healthcare provider counseling; 3) struggles with adhering to diet recommendations; 4) difficulty getting exercise, and 5) improving lessons within the intervention. Conclusion Although the biomarker data did not show improvement, valuable information was gained to improve the development of larger-scale trials. The results provide evidence of the need for these trials and the desire of participants to continue pursuing this effort. Others doing similar work in other low-to-middle income countries will need to take into consideration the potential barriers and facilitators within participants' social and physical environments.
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Affiliation(s)
- Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Aaron J. Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Joseph Henske
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Dinesh Edem
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - James P. Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Jonell Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Williamina Ioanna Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Jack Niedenthal
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH, 96960, USA
| | - Henry Otuafi
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH, 96960, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Edlen Anzures
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH, 96960, USA
| | - Ainrik George
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH, 96960, USA
| | - Derek Alik
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA,Corresponding author. College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA.
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11
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McElfish PA, Felix HC, Bursac Z, Rowland B, Yeary KHK, Long CR, Selig JP, Kaholokula JK, Riklon S. A Cluster Randomized Controlled Trial Comparing Diabetes Prevention Program Interventions for Overweight/Obese Marshallese Adults. Inquiry 2023; 60:469580231152051. [PMID: 36799349 PMCID: PMC9940234 DOI: 10.1177/00469580231152051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/15/2022] [Accepted: 01/03/2023] [Indexed: 02/18/2023]
Abstract
This study compared the effectiveness of two Diabetes Prevention Program (DPP) interventions on weight loss among overweight and obese Marshallese adults. The study was a two-arm cluster randomized controlled trial conducted in 30 churches in Arkansas and Oklahoma. Marshallese adults with a body mass index ≥25 kg/m2 were eligible for the study. The study sample included 380 participants. Participants received either a faith-based adaptation of the DPP or a family-focused adaptation of the DPP, each delivered over 24 weeks. The primary outcome was weight change from baseline. Secondary outcomes included changes in Hemoglobin A1c, blood pressure, dietary intake, family support for healthy behaviors, and physical activity. Outcomes were examined longitudinally using general linear mixed effects regression models, adjusting for baseline outcomes, sociodemographic covariates, and clustering of participants within churches. Reductions in weight were small for both groups. Overall, only 7.1% of all participants lost 5% or more of their baseline body weight. There were no significant differences in weight loss between the 2 arms at 6 months (P = .3599) or at 12 months (P = .3207). Significant differences in systolic and diastolic blood pressure were found between the 2 arms at 6 months (P = .0293; P = .0068, respectively). Significant within-arm changes were found for sugar-sweetened beverage consumption and family support for both arms at both follow-ups. Both interventions achieved a modest weight loss. While even modest weight loss can be clinically significant, future research is needed to identify chronic disease prevention interventions that can successfully reduce weight for this at-risk population.
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Affiliation(s)
- Pearl A. McElfish
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Holly C. Felix
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Zoran Bursac
- Florida International University, Miami, FL, USA
| | - Brett Rowland
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | | | | | - James P. Selig
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | | | - Sheldon Riklon
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
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12
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McElfish PA, Purvis RS, Riklon S, Willis DE. Complicity in sociology and community-based participatory research with Marshallese. Sociol Health Illn 2022; 44 Suppl 1:142-157. [PMID: 35213055 DOI: 10.1111/1467-9566.13452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
Complicity with colonialism can be reflected in a particular approach to research, whose interests it serves, and who has power or ownership over the research process. It can also be reflected in neglect, inaction or methodological erasure of groups historically subjected to domination by colonial empires. Social scientists have often failed to account for colonialism's role or the complicit role they have played. We provide a brief historical overview of colonialism in the Marshall Islands and the role social scientists-and their methodological and epistemological approaches-played in the US empire's expansion into the region. We discuss the tenets of Community Based Participatory Research (CBPR), setting the research agenda, co-direction of the research process, research team membership, collaboration challenges, and the action and outputs which have come from our team's health disparities research among the largest Marshallese population in the continental US. We argue CBPR is a promising but imperfect approach to guarding against complicity within medical sociology and situate our methodological approach within ongoing debates regarding objectivity and advocacy within sociology. We reflect on successes and shortcomings of our CBPR efforts to address health disparities among Marshallese, as well as how those successes and shortcomings overlap with questions of complicity.
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Rachel S Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
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13
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McElfish PA, Rowland B, Hall S, CarlLee S, Reece S, Macechko MD, Shah SK, Rojo MO, Riklon S, Richard-Davis G, Marin LP, Laelan M, Maddison BK, Alik E, Selig JP. Comparing community-driven COVID-19 vaccine distribution methods: Faith-based organizations vs. outpatient clinics. J Family Med Prim Care 2022; 11:6081-6086. [PMID: 36618221 PMCID: PMC9810872 DOI: 10.4103/jfmpc.jfmpc_327_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 11/11/2022] Open
Abstract
Background Minority and low socioeconomic communities may face practical barriers to vaccination, including decreased access to health care and less trust in healthcare organizations; however, few studies have focused on these barriers as the cause of differential vaccine uptake. We worked with community partners to implement and evaluate two community-driven approaches to COVID-19 vaccination distribution-through faith-based organizations (FBOs) and outpatient clinics-with a focus on understanding the differences between the populations who accessed each distribution method. Methodology Participants who came to the vaccination locations were approached and asked to complete a survey during their 15 min post-vaccination observation period. Differences between distribution locations were examined using Chi-square tests. Results The survey rendered 1,476 valid responses, with a total of 927 participants recruited at clinical locations and 519 at FBOs during vaccination events. There were significant differences by race/ethnicity, with distribution methods at FBOs reaching a higher proportion of Hispanic/Latino and Marshallese participants. The proportion of uninsured participants who had lower health literacy and had lower educational attainment was higher with the FBO distribution method. FBO participants were more likely to report "completely" trusting the COVID-19 vaccine. There was no significant difference between FBO and clinic participants with regard to the level of vaccine hesitancy. There were no statistically significant differences with regard to access. Conclusion A higher proportion of Hispanic/Latino and Marshallese participants utilized FBOs for vaccination, suggesting collaborations with FBOs can potentially increase vaccination uptake among minority communities and help mitigate vaccination disparities.
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Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA,Address for correspondence: Dr. Pearl A. McElfish, 1125 N. College Ave., Fayetteville, AR 72703, USA. E-mail:
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Spencer Hall
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Michael D. Macechko
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Sumit K. Shah
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Martha O. Rojo
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Gloria Richard-Davis
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Luis Paganelli Marin
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Melisa Laelan
- Arkansas Coalition of Marshallese, Springdale, Arkansas, USA
| | | | - Eldon Alik
- Republic of the Marshall Islands Consulate, Springdale, Arkansas, USA
| | - James P. Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
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14
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Ewing LE, Pathak R, Landes RD, Skinner CM, Binz R, Young SG, Riklon S, Stahr S, Su J, Boerma M, McElfish PA, Hauer-Jensen M, Koturbash I. Cytogenetic and epigenetic aberrations in peripheral lymphocytes of northwest Arkansas Marshallese. Int J Radiat Biol 2022; 99:644-655. [PMID: 35939319 PMCID: PMC9929030 DOI: 10.1080/09553002.2022.2110319] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/28/2022] [Accepted: 07/22/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Nuclear weapons testing in the northern Marshall Islands between 1946 and 1958 resulted in ionizing radiation (IR) exposure of the thousands of Marshallese. Furthermore, numerous islands were contaminated by radioactive fallout. Significant increases in cancer and metabolic syndrome incidences have been reported among Marshallese, and potential for further increases looms due to the latency of radiation-induced health effects. The purpose of this study was to investigate the genetic and epigenetic effects of exposure to IR that could be associated with radiation-induced disease among the Northwest Arkansas (NWA) Marshallese. MATERIALS AND METHODS We performed analysis of chromosomal aberrations and DNA methylation based on residential and exposure history of NWA Marshallese. RESULTS Analysis of chromosomal aberrations demonstrated higher incidence of genetic rearrangements in women with self-reported history of radiation exposure (95% CI: 0.10, 1.22; p=.022). Further clustering of study participants based on their residential history demonstrated that participants who spent substantial amounts of time (≥6 months) in the northern atolls (thus, in the proximity of nuclear tests) before 1980 had more chromosomal aberrations than their peers who lived only in the southern atolls (95% CI: 0.08, -0.95; p=.021), and that this difference was driven by women. A relationship between the time spent in the northern atolls and increase in chromosomal aberrations was observed: 0.31 increase in chromosomal aberrations for every 10 years spent at northern atolls (95% CI: 0.06, 0.57; p=.020). Finally, significant inverse correlations between the chromosomal aberrations and the extent of DNA methylation of four LINE-1 elements L1PA2, L1PA16, L1PREC1, and L1P4B were identified. CONCLUSIONS The results of this study provide first evidence of the presence of stable genetic and epigenetic rearrangements in peripheral lymphocytes of NWA Marshallese and warrant further studies to analyze the role of radiation exposure in health disparities experienced by this Pacific Island nation.
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Affiliation(s)
- Laura E. Ewing
- Department of Environmental and Occupational Health, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, Arkansas, USA
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, Arkansas, USA
| | - Rupak Pathak
- Division of Radiation Health, Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, AR, USA
| | - Reid D. Landes
- Department of Biostatistics, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, Arkansas, USA
| | - Charles M. Skinner
- Department of Environmental and Occupational Health, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, Arkansas, USA
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, Arkansas, USA
| | - Regina Binz
- Division of Radiation Health, Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, AR, USA
| | - Sean G. Young
- Department of Environmental and Occupational Health, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, Arkansas, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Shelbie Stahr
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, Arkansas, USA
| | - Joseph Su
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, Arkansas, USA
| | - Marjan Boerma
- Division of Radiation Health, Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, AR, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Martin Hauer-Jensen
- Division of Radiation Health, Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, AR, USA
| | - Igor Koturbash
- Department of Environmental and Occupational Health, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, Arkansas, USA
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15
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Kaholokula JK, AuYoung M, Chau M, Sambamoorthi U, Carson S, Thao C, Nguyen M, Alo A, Riklon S, Lepule T, Ma GX. Unified in Our Diversity to Address Health Disparities Among Asian Americans, Native Hawaiians, and Pacific Islanders. Health Equity 2022; 6:540-545. [PMID: 36186617 PMCID: PMC9518805 DOI: 10.1089/heq.2022.0034] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic disproportionately impacted Asian Americans, Native Hawaiians, and Pacific Islanders (AA/NHPIs) in the United States. AA/NHPIs have historically been subjected to discrimination, which was exacerbated by the pandemic. To bring attention to their unique concerns, an AA/NHPI Interest Group of the National Institutes of Health Community Engagement Alliance Against COVID-19 Disparities (CEAL) was formed. This article highlights major concerns raised by the Interest Group: The pervasive and arbitrary practice of data aggregation by public health agencies and health-related researchers, the lack of culturally responsive services in the context of cultural safety, and leadership underrepresentation.
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Affiliation(s)
- Joseph Keawe‘aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawai'i, USA
| | - Mona AuYoung
- Department of General Internal Medicine and Health Services Research, University of California, Los Angeles, California, USA
| | - Michelle Chau
- Department of Population Health, Grossman School of Medicine, New York University, New York City, New York, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy and Texas Center for Health Disparities, University of North Texas Health Sciences Center, Fort Worth, Texas, USA
| | - Savanna Carson
- Department of General Internal Medicine and Health Services Research, University of California, Los Angeles, California, USA
| | - Chia Thao
- Department of Public Health, University of California, Merced, California, USA
| | - May Nguyen
- Department of Health Systems and Population Health Sciences, College of Medicine, University of Houston College of Medicine, Houston, Texas, USA
| | - Audrey Alo
- Pacific Islander Health Partnership, Garden Grove, California, USA
| | - Sheldon Riklon
- Department of Family and Preventive Medicine and Center for Pacific Islander Health, University of Arkansas for Medical Sciences, Fayetteville, Arkansas, USA
| | - Tana Lepule
- Pacific Islander Collective of San Diego, San Diego, California, USA
| | - Grace X. Ma
- Department of Urban Health and Population Science, Center for Asian Health and Fox Chase Cancer Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
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16
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McElfish PA, Rowland B, Scott AJ, Boyers J, Long CR, Felix HC, Kaholokula JK, Sinclair K, Bursac Z, Riklon S. Examining the Relationship Between Physical Activity and Self-Efficacy for Exercise Among Overweight and Obese Marshallese Adults. J Immigr Minor Health 2022; 24:461-468. [PMID: 33837895 PMCID: PMC9540904 DOI: 10.1007/s10903-021-01194-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 01/26/2023]
Abstract
This study examined associations between physical activity frequency and self-efficacy for exercise (SEE) among Marshallese adults in the United States. Data were collected from overweight and obese Marshallese participants (N = 378) enrolled in a Diabetes Prevention Program trial. Logistic and ordinal logistic regressions were employed to examine associations between physical activity and SEE, adjusting for covariates. SEE was significantly associated with engaging in sufficient total physical activity [odds ratio (OR) = 1.70], moderate physical activity (OR = 2.23), and vigorous physical activity (OR = 2.13). Unemployment was associated with less frequent moderate physical activity (OR = 0.59). Younger age (OR = 0.98), being male (OR = 2.67), and reporting excellent health (OR = 3.14) or good health (OR = 2.06) were associated with more frequent vigorous physical activity. Physical activity is a modifiable lifestyle behavior associated with many chronic disease disparities faced by the Marshallese community, and the study results will be useful for practitioners and researchers working to address these disparities.
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA.
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Janine Boyers
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Christopher R Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Joseph Keawe'aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii At Manoa, Honolulu, HI, 96813, USA
| | - Ka'imi Sinclair
- Institute for Research and Education To Advance Community Health, College of Nursing, Washington State University, Seattle, WA, 98101, USA
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health, Florida International University, Miami, FL, 33199, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
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17
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Hallgren E, Moore R, Riklon S, Alik E, McElfish PA. Pandemic-Amplified Material Hardship and Community-Led Support among Marshallese Diasporic Communities in the United States. J Poverty 2022; 27:252-267. [PMID: 37346477 PMCID: PMC10281722 DOI: 10.1080/10875549.2022.2053924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
This article explores the experiences of Marshallese diasporic migrants in the United States (U.S.) during the COVID-19 pandemic in relation to material hardship and community-led relief efforts. Focus groups with 53 Marshallese migrants in three states revealed that material hardship, including food and housing insecurity, inadequate healthcare, and difficulty paying bills, intensified among their communities during the pandemic. In response, Marshallese community-based groups provided relief to their fellow community members, including food, cash assistance, and personal protective equipment. The findings fit a pattern of intensified hardship and community-led relief among marginalized communities in the U.S. during the COVID-19 pandemic.
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Affiliation(s)
- Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR 72703 USA
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR 72703 USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR 72703 USA
| | - Eldon Alik
- Consulate General of Arkansas, Republic of the Marshall Islands, 109 Spring St #3, Springdale, AR 72764 USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR 72703 USA
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18
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Purvis RS, Moore RA, Ayers BL, Felix HC, Riklon S, Andersen JA, Hudson JS, O'Connor G, Kelen M, Heely-Rolston LAN, Shields X, McElfish PA. Diabetes Self-Care Behaviors and Barriers to Clinical Care During COVID-19 Pandemic for Marshallese Adults. Sci Diabetes Self Manag Care 2022; 48:35-43. [PMID: 35023402 PMCID: PMC9082400 DOI: 10.1177/26350106211065390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the study was to explore experiences of Marshallese adults related to diabetes self-care behaviors during the COVID-19 pandemic. METHODS A qualitative descriptive design was utilized to understand participants' diabetes self-care behaviors during the pandemic. Nine focus groups with 53 participants were held via videoconference and conducted in English, Marshallese, or a mixture of both languages. A priori codes based on diabetes self-care behaviors provided a framework for analyzing and summarizing participant experiences. RESULTS Both increases and decreases in healthy eating and exercise were described, with improvements in health behaviors attributed to health education messaging via social media. Participants reported increased stress and difficulty monitoring and managing glucose. Difficulty obtaining medication and difficulty seeing their health care provider regularly was reported and attributed to health care provider availability and lack of insurance due to job loss. CONCLUSIONS The study provides significant insight into the reach of health education campaigns via social media and provides important information about the reasons for delays in care, which extend beyond fear of contracting COVID-19 to structural issues.
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Affiliation(s)
- Rachel S Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Ramey A Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Britni L Ayers
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Jonell S Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Gail O'Connor
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Meetu Kelen
- West Hawaii Community Health Center, Kailua-Kona, Hawaii
| | | | - Xochitl Shields
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
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19
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McElfish PA, Willis DE, Bogulski C, Kelen M, Riklon S, Alik E, Laelan M, Brown AL, Sinclair KA, Andersen JA, Amick BC, Williams M. COVID-19 Vaccine Willingness and Hesitancy Among Marshallese Pacific Islanders. J Patient Exp 2021; 8:23743735211056428. [PMID: 34825050 PMCID: PMC8609098 DOI: 10.1177/23743735211056428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
COVID-19 has disproportionally burdened racial and ethnic minorities. Minority populations report greater COVID-19 vaccine hesitancy; however, no studies document COVID-19 vaccine willingness among Marshallese or any Pacific Islander group, who are often underrepresented in research. This study documents United States (US) Marshallese Pacific Islanders': willingness to get the COVID-19 vaccine, willingness to participate in vaccine trials, and sociodemographic factors associated with willingness. From July 27, 2020-November 22, 2020, a convenience sample of US Marshallese adults were recruited through e-mail, phone calls, and a Marshallese community Facebook page to participate in an online survey. Of those surveyed (n = 120), 32.5% were extremely likely to get the COVID-19 vaccine; 20.8% were somewhat likely; 14.2% were unlikely or very unlikely; and 26.7% stated they did not know or were not sure. Only 16.7% stated they were willing to participate in a COVID-19 vaccine trial. Vaccine willingness was positively associated with older age, higher income, and longer US residence. Health insurance status and having a primary care provider were positively associated with vaccine willingness. Findings demonstrate within-group variation in COVID-19 vaccine willingness.
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Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Cari Bogulski
- Office of Community Health and Research, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Meetu Kelen
- West Hawaii Community Health
Center, Kailua, HI, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Eldon Alik
- Consul General – Arkansas, Republic of the Marshall Islands,
Springdale, AR, USA
| | - Melisa Laelan
- Arkansas Coalition of
Marshallese, Springdale, AR, USA
| | | | - Ka’imi A. Sinclair
- Institute for Research and Education to Advance Community Health
(IREACH), Washington State University, Pullman, WA, USA
- College of Nursing, Washington State University, Pullman, WA, USA
| | - Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Benjamin C. Amick
- Fay W. Boozman College of Public Health, University of Arkansas for Medical
Sciences, Little Rock, AR, USA
| | - Mark Williams
- Fay W. Boozman College of Public Health, University of Arkansas for Medical
Sciences, Little Rock, AR, USA
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20
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McElfish PA, Rowland B, Porter A, Felix HC, Selig JP, Semingson J, Willis DE, Smith M, Riklon S, Alik E, Padilla-Ramos A, Jasso EY, Zohoori N. Use of Community-Based Participatory Research Partnerships to Reduce COVID-19 Disparities Among Marshallese Pacific Islander and Latino Communities - Benton and Washington Counties, Arkansas, April-December 2020. Prev Chronic Dis 2021; 18:E91. [PMID: 34618667 PMCID: PMC8522500 DOI: 10.5888/pcd18.210124] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Marshallese and Latino communities in Benton and Washington counties, Arkansas, were disproportionately affected by COVID-19. We evaluated the effectiveness of a comprehensive community-based intervention to reduce COVID-19 disparities in these communities. We examined all laboratory-confirmed COVID-19 cases in the 2 counties reported from April 6, 2020, through December 28, 2020. A 2-sample serial t test for rate change was used to evaluate changes in case rates before and after implementation of the intervention. After implementation, the proportions of cases among Marshallese and Latino residents declined substantially and began to align more closely with the proportions of these 2 populations in the 2 counties. Infection rates remained lower throughout the evaluation period, and weekly incidence also approximated Marshallese and Latino population proportions. Leveraging community partnerships and tailoring activities to specific communities can successfully reduce disparities in incidence among populations at high-risk for COVID-19 .
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas.,1125 N College Ave, Fayetteville, AR 72703.
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Austin Porter
- Arkansas Department of Health, Little Rock, Arkansas
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | | | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Eldon Alik
- Republic of the Marshall Islands Consulate, Springdale, Arkansas
| | - Alan Padilla-Ramos
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Erika Y Jasso
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
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McElfish PA, Andersen JA, Rowland B, Niedenthal J, Otuafi H, Riklon S, George A, Anzures E, Selig J, Bing W, Felix H. Assessment of Diabetes-Related Health Disparities among the Marshallese Living in the Republic of the Marshall Islands. Hawaii J Health Soc Welf 2021; 80:235-241. [PMID: 34661118 PMCID: PMC8504294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
There is a high prevalence of type 2 diabetes mellitus (T2DM) among the Marshallese in the Republic of the Marshall Islands (RMI). However, no prior literature has examined self-reported health indicators, self-management activities, barriers to care, diabetes knowledge, and family support for diabetes management. This study examined health indicators among participants with T2DM (n=41). Clinical measures included glycated hemoglobin (HbA1c) and fasting glucose level, blood pressure, pulse pressure, and cholesterol levels. Survey items included participants' self-reported health indicators, self-management activities, barriers to care, diabetes knowledge, and family support for diabetes management. Clinical health indicators demonstrate the poor health status of the participants, including uncontrolled fasting glucose levels and HbA1c levels (61.9% had an HbA1c ≥9.0%), high blood pressure, elevated pulse pressure (65.9% had pulse pressure >40 mmHg), and high total cholesterol. Participants report limited knowledge and participation in diabetes self-management behaviors, limited family support, and faced numerous barriers to medical care, medications, and supplies. This study provides insight into the T2DM disparities experienced by Marshallese in the RMI. This study is the first to document the self-reported health indicators, self-management activities, barriers to care, diabetes knowledge, and family support for diabetes management. The results highlight the need for T2DM management interventions and will be used to refine a culturally adapted intervention for delivery in the RMI.
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Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR (PAM, JAA, SR)
| | - Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR (PAM, JAA, SR)
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR (BR, WB)
| | - Jack Niedenthal
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH (JN, HO, AG, EA)
| | - Henry Otuafi
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH (JN, HO, AG, EA)
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR (PAM, JAA, SR)
| | - Ainrik George
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH (JN, HO, AG, EA)
| | - Edlen Anzures
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH (JN, HO, AG, EA)
| | - James Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR (JS, HF)
| | - Wana Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR (BR, WB)
| | - Holly Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR (JS, HF)
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Andersen JA, Felix H, Selig J, Rowland B, Bing W, Hudson J, Niedenthal J, Otuafi H, Riklon S, Azures E, George A, McElfish PA. Feasibility and efficacy of a pilot family model of diabetes self-management intervention in the Republic of the Marshall Islands. Contemp Clin Trials Commun 2021; 23:100824. [PMID: 34401596 PMCID: PMC8349743 DOI: 10.1016/j.conctc.2021.100824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 07/06/2021] [Accepted: 07/24/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The Republic of the Marshall Islands (RMI) faces numerous health disparities, including one of the highest prevalence of type 2 diabetes mellitus (T2DM) in the world. Diabetes self-management education and support (DSMES) has shown efficacy in improving glycemic control and through increases in knowledge and self-management activities; however, there is limited research on DSMES in the RMI. This study evaluated the feasibility and efficacy of a culturally adapted family model of DSMES (F-DSMES) in the RMI. The F-DSME included 8 h of group educational classes delivered in churches by a community health worker. METHODS This pilot study assessed retention and dosage rates (e.g., class attendance) among the participants with T2DM (n = 41). Efficacy was evaluated by examining pre- and post-intervention differences in HbA1c, knowledge, family support, and self-management activities among those who completed the post-intervention data collection (n = 23). RESULTS The results indicate completion of post-intervention data collection and attendance were associated; 70% of participants who completed the post-intervention data collection received at least 6 h of intervention compared to 3 h for those who did not. Although the reduction in HbA1c was not statistically significant, participants demonstrated statically significant increases in knowledge, family support, and an increase in self-management including in checking of blood glucose and feet. CONCLUSIONS This study provides important information to help address T2DM disparities in the RMI, including the feasibility and efficacy of F-DSMES. Additional research will help in understanding how to translate improvements in knowledge, family support, and self-management activities into improvements in HbA1c. This may include addressing social ecological factors that affect glycemic control.
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Affiliation(s)
- Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Holly Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - James Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Wana Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Jonell Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Jack Niedenthal
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, 96960, MH, USA
| | - Henry Otuafi
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, 96960, MH, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Edlen Azures
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, 96960, MH, USA
| | - Ainrik George
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, 96960, MH, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
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Purvis RS, Ayers BL, Bogulski CA, Kaminicki KF, Haggard-Duff LK, Riklon LA, Iban A, Mejbon-Samuel R, Lakmis R, Riklon S, Thompson JW, McElfish PA. Multicomponent Informed Consent with Marshallese Participants. J Empir Res Hum Res Ethics 2021; 16:144-153. [PMID: 33780279 PMCID: PMC8238841 DOI: 10.1177/15562646211005651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pacific Islanders are the second fastest-growing population in the United States; however, Pacific Islanders, and Marshallese specifically, are underrepresented in health research. A community-based participatory research (CBPR) approach was used to engage Marshallese stakeholders and build an academic-community research collaborative to conduct health disparities research. Our CBPR partnership pilot tested a multicomponent consent process that provides participants the option to control the use of their data. Consent forms used concise plain language to describe study information, including participant requirements, risks, and personal health information protections, and were available in both English and Marshallese. This study demonstrates that when provided a multicomponent consent, the vast majority of consenting study participants (89.6%) agreed to all additional options, and only five (10.4%) provided consent for some but not all options. Our description of the development and implementation of a multicomponent consent using a CBPR approach adds a specific example of community engagement and may be informative for other indigenous populations.
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Affiliation(s)
- Rachel S. Purvis
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
| | - Britni L. Ayers
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
| | - Cari A. Bogulski
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
| | - Kyle F. Kaminicki
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
| | | | - Lynda A. Riklon
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
| | - Anita Iban
- Faith in Action Research and Resource Alliance (FARRA), Springdale (USA)
| | | | | | - Sheldon Riklon
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
| | | | - Pearl A. McElfish
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
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McElfish PA, Boyers J, Purvis RS, O'Connor B, Carleton A, Bing W, Rowland B, Molgaard C, George A, Tibon LR, Hoose D, Riklon S. Family model diabetes self-management education and support in faith-based organizations in the republic of the Marshall Islands study protocol. Contemp Clin Trials Commun 2021; 21:100710. [PMID: 33506140 PMCID: PMC7815654 DOI: 10.1016/j.conctc.2021.100710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/15/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Marshallese living in the Republic of the Marshall Islands (RMI) experience significant health disparities, with high rates of type 2 diabetes mellitus. In addition to health disparities, the RMI experienced nuclear testing that exposed inhabitants to nuclear fallout, unethical research practices, and contaminated natural food sources. OBJECTIVES This research uses a community-based participatory research (CBPR) approach to effectively engage community partners and honor their contributions in all stages of the research. A CBPR approach will leverage culturally situated knowledge and practices of the Marshallese community in the RMI to ensure the success of the research. METHODS This manuscript describes the methods used to test the feasibility of delivering a culturally adapted family model of diabetes self-management education and support in faith-based organizations in the RMI. CONCLUSIONS This manuscript describes the protocol for creating working with community partners and implementing a feasibility study in the RMI.
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Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Janine Boyers
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 7270, USA
| | - Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Betsy O'Connor
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 7270, USA
| | - Ayoola Carleton
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 7270, USA
| | - Williamina Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 7270, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 7270, USA
| | - Craig Molgaard
- College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR, 72205, USA
| | - Ainrik George
- Marshall Islands Postal Service Authority, Majuro, 96960, Marshall Islands
| | - Lydia R. Tibon
- Kora in Jiban Lorojake Ejmour, PO Box 372, G & L Building Ground Floor, Majuro, 96960, Marshall Islands
| | - Dalton Hoose
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
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25
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703.
| | - Rachel Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Don E Willis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Sheldon Riklon
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
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26
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Purvis RS, Long CR, James LP, Kimminau K, Riklon S, Carleton A, Netwon M, Clarence K, Iban A, Mejbon R, Lakmis R, McElfish PA. Dissemination Protocol for Community-Based Participatory Research Partnerships with Marshallese Pacific Islanders in Arkansas. Prog Community Health Partnersh 2021; 15:369-383. [PMID: 37934424 DOI: 10.1353/cpr.2021.0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The Pacific Islander population in the United States (U.S.) has rapidly increased since 2000, especially in southern states like Arkansas where the largest population of Marshallese in the continental U.S. reside. The Marshallese community faces significant health disparities with high prevalence of diabetes, obesity, obesity-related cancers, and other chronic conditions. OBJECTIVES Researchers have utilized a community-based participatory research (CBPR) approach that fully engages Marshallese stakeholders in research to address the community's health disparities. Sharing research findings with participants and stakeholders is a core principle of CBPR. METHODS This manuscript describes the methods that the academic-community research partnership used to develop a dissemination protocol for sharing results from multiple pilot studies and randomized control trials. Examples and details of specific activities that resulted from putting the dissemination plan in action are presented. CONCLUSIONS Implementation of CBPR principles ensures that researchers fully engage stakeholders in all aspects of research, including the dissemination of study results. This manuscript describes the dissemination protocol for an academic- community research partnership with the Marshallese community and provides a practical example for how to implement successful community-engaged dissemination.
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Okamoto L, Riklon S, Masaki K, Bell C, Tamai A, Maskarinec GG. Evolving Palliative Care Practices among Marshall Islanders in Hawai'i: Generational Comparisons. Hawaii J Health Soc Welf 2020; 79:82-88. [PMID: 32596684 PMCID: PMC7311949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Little is known about Marshallese palliative care practices. We explored traditional and contemporary Marshallese palliative care practices and examined generational differences. We performed three focus groups in 2011-2012 among Marshall Islanders in Hawai'i. A native speaking interpreter assisted group facilitators. Data were analyzed using classical thematic triangulation methods to identify specific Marshallese palliative care practices, the effect of economic and social challenges in Hawai'i, and generational differences comparing young and old. Nineteen persons (10 men and 9 women, youth aged 17-27 years, and elders as defined in Marshallese culture, aged 46-79) participated. A "good death" was defined as "peaceful and pain free," occurring from natural causes. Factors associated with a "good death" included gathering of family to absolve conflicts, and proper and timely cultural practices. Factors associated with "bad deaths" included young age, active suffering, accidents, suicides, "black magic/curses," or lack of timely or proper burial. Comparing generational differences, older Marshallese had differing opinions regarding preferred place of death, burial site, cultural practice preservation, artificial prolongation of life, and cremation. Barriers included mortuary fees, cost of transporting bodies, United States (US) government policies, and wait times for death certificates. Many cultural factors contribute to "good" or "bad" deaths. Attitudes toward palliative care practices differ by generation. Having previously documented different approaches by Yapese, a generalized "one size fits all" approach to Micronesians is inappropriate. Overcoming identified barriers may facilitate practices necessary for a good death in Micronesian populations in their home nations and as they migrate to communities throughout the US.
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Affiliation(s)
- Lauren Okamoto
- The John A. Hartford Foundation Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (LO, KM, CB)
| | - Sheldon Riklon
- University of Arkansas for Medical Sciences, Northwest Arkansas Campus, Fayetteville, AR (SK)
| | - Kamal Masaki
- The John A. Hartford Foundation Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (LO, KM, CB)
| | - Christina Bell
- The John A. Hartford Foundation Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (LO, KM, CB)
| | - Anna Tamai
- Japan Association for Development of Community Medicine, Taito Hospital, TaitoKu, Tokyo, Japan (AT)
| | - Gregory G. Maskarinec
- Office of Global Health and International Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (GGM)
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McElfish PA, Purvis RS, Riklon S, Yamada S. Compact of Free Association Migrants and Health Insurance Policies: Barriers and Solutions to Improve Health Equity. Inquiry 2020; 56:46958019894784. [PMID: 31823677 PMCID: PMC6906344 DOI: 10.1177/0046958019894784] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This commentary outlines the health insurance disparities of Compact of Free
Association (COFA) migrants living in the United States. Compact of Free
Association migrants are citizens of the Republic of the Marshall Islands, the
Federated States of Micronesia, and the Republic of Palau who can live, work,
and study in the United States without a visa. Compact of Free Association
migrants make up a significant proportion of the rapidly growing Pacific
Islander population in the United States. This article describes the historical
and current relationships between the United States and the Compact nations and
examines national policy barriers constraining health insurance access for COFA
migrants. In addition, the commentary describes the state-level health policies
of Arkansas, Hawai’i, and Oregon, which are the states where the majority of
COFA migrants reside. Finally, policy recommendations are provided to improve
health equity for COFA migrants.
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Affiliation(s)
- Pearl A McElfish
- University of Arkansas for Medical Sciences Northwest, Fayetteville, USA
| | - Rachel S Purvis
- University of Arkansas for Medical Sciences Northwest, Fayetteville, USA
| | - Sheldon Riklon
- University of Arkansas for Medical Sciences Northwest, Fayetteville, USA
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Dickey TA, Balli ML, Warmack TS, Rowland B, Hudson J, Seaton V, Riklon S, Purvis RS, McElfish PA. Perceptions and utilization of traditional healing among Marshallese adults residing in Arkansas. J Complement Integr Med 2020; 17:/j/jcim.ahead-of-print/jcim-2018-0198/jcim-2018-0198.xml. [PMID: 32284443 DOI: 10.1515/jcim-2018-0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 09/29/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Tiffany A Dickey
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - Michelle L Balli
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - T Scott Warmack
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - Jonell Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - Victoria Seaton
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR 72703-5011, USA
| | - Rachel S Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR 72703-5011, USA
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30
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McElfish PA, Ayers B, Riklon S, Selig JP, Yeary KHC, Carleton A, Wilmoth R, Laukon F, Gittelsohn J, Netwon M, Long CR. Study protocol for a multilevel diabetes prevention program for Marshallese Pacific Islanders in faith-based organizations. Contemp Clin Trials Commun 2020; 17:100528. [PMID: 32025587 PMCID: PMC6997497 DOI: 10.1016/j.conctc.2020.100528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/06/2020] [Accepted: 01/19/2020] [Indexed: 10/29/2022] Open
Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125, N. College Ave., Fayetteville, AR, 72703, USA
| | - Britni Ayers
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125, N. College Ave., Fayetteville, AR, 72703, USA
| | - Sheldon Riklon
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR, 72703, USA
| | - James P. Selig
- College of Public Health University of Arkansas for Medical Sciences, 4301 West Markham, #820, Little Rock, AR, 72205, USA
| | - Karen Hye-cheon Yeary
- Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm and Carton Streets, Buffalo, NY, 14263, USA
| | - Ayoola Carleton
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR, 72703, USA
| | - Ralph Wilmoth
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR, 72703, USA
| | - Faith Laukon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125, N. College Ave., Fayetteville, AR, 72703, USA
| | - Joel Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health 615 North Wolfe St, Baltimore, MD, 21205-2179, USA
| | - Morda Netwon
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR, 72703, USA
| | - Christopher R. Long
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR, 72703, USA
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McElfish PA, Purvis RS, Scott AJ, Haggard-Duff LK, Riklon S, Long CR. "The results are encouragements to make positive changes to be healthier:" qualitative evaluation of Marshallese participants' perceptions when receiving study results in a randomized control trial. Contemp Clin Trials Commun 2020; 17:100543. [PMID: 32140610 PMCID: PMC7044511 DOI: 10.1016/j.conctc.2020.100543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/27/2020] [Accepted: 02/16/2020] [Indexed: 12/14/2022] Open
Abstract
Background Study participants express a desire to receive the results of studies in which they have participated even when the results are not what researchers expected. Sharing results with participants is a core principle of community-based participatory research (CBPR), however, many researchers using a community-based participatory approach report that they encounter barriers to sharing results with study participants. Researchers at the University of Arkansas for Medical Sciences established a CBPR partnership with Marshallese community stakeholders in an effort to reduce the health disparities of this vulnerable population. Marshallese are a Pacific Islander population that faces significant health disparities and have a high prevalence of diabetes, obesity, obesity-related cancers, and other chronic diseases compared to the general US population. Methods A qualitative descriptive design was used to evaluate Marshallese participants' perceptions related to receiving results of a culturally adapted Diabetes Self-Management Education randomized control trial in which they participated. Participants were provided with a summary of their individual results as well as preliminary, overall aggregate study results. Interviews were conducted with half of (N = 111) of the 221 enrolled participants that provided them with the opportunity to share in-depth responses related to their perceptions of the study results they received. Results There was no statistically significant differences between study arms in participant desire to receive overall study results, desire to receive personal study results, or willingness to participate in future research. Participants described their desire for results and the effect of these results on their future behavior. Within the a priori theme of participants' desire for results, three subthemes emerged: 1) results showed current health status, 2) results showed improvement, and 3) demonstrated the overall results of the study. Within the a priori theme of effects of results on future behavior, two sub-themes emerged: 1) encourage future healthy behavior, and 2) encourage future research participation. Conclusions Participants overwhelmingly stated they wanted to receive personal and aggregate study results. This finding is consistent with previous qualitative studies that documented that participants want results. Marshallese participants also reported that receiving study results would affect their future health behavior. This study documents specifically how participants anticipate using the results of studies in which they participated. Clinical trials registration information The study is registered in clinicaltrials.gov (#NCT02407132).
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Affiliation(s)
- Pearl A McElfish
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, United States
| | - Rachel S Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, United States
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, United States
| | - Lauren K Haggard-Duff
- College of Nursing, University of Arkansas for Medical Sciences Northwest, United States
| | - Sheldon Riklon
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, United States
| | - Christopher R Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, United States
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McElfish PA, Rowland B, Riklon S, Aitaoto N, Sinclair KA, Ima S, Kadlubar SA, Goulden PA, Hudson JS, Mamis S, Long CR. Development and Evaluation of a Blood Glucose Monitoring YouTube Video for Marshallese Patients Using a Community-Based Participatory Research Approach. Policy Polit Nurs Pract 2019; 20:205-215. [PMID: 31537196 PMCID: PMC9524581 DOI: 10.1177/1527154419872834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to (a) describe the development of a culturally appropriate glucose monitoring video using a community-based participatory research approach and (b) assess the cultural appropriateness and effectiveness of the video. The topic of the video-using a glucometer and the importance of performing blood glucose checks-was chosen by Marshallese community stakeholders. The video was produced in Marshallese with English subtitles and disseminated through YouTube. Participants were recruited from August 16, 2016 to September 12, 2016 in a diabetes clinic that serves Marshallese patients in northwest Arkansas. Fifty participants completed a survey at pre- and postintervention, with questions capturing demographic information and questions on glucose monitoring self-efficacy using an adapted version of the Stanford Patient Education Research Center's Diabetes Self-Efficacy Scale. Twenty of those participants who completed the survey also completed semistructured interviews that assessed cultural appropriateness and effectiveness of the video. Participants reported significant increases in self-efficacy related to glucometer use and the importance of performing blood glucose checks (p < .001) and a 1.45% reduction in A1C between preintervention and 12 weeks postintervention (p = .006). Qualitative results indicated the video was both culturally appropriate and effective. The findings of this study were consistent with evidence in the literature, which shows health education videos can be effective at improving health behaviors. Using a community-based participatory research approach to prioritize video topics, and including members of the community in the creation and dissemination of the videos, could aid in ensuring the videos are effective and culturally appropriate.
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Sheldon Riklon
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Nia Aitaoto
- Nutrition & Integrative Physiology, University of Utah, Salt Lake City, UT, USA
| | | | - Shumona Ima
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Susan A Kadlubar
- Division of Medical Genetics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Peter A Goulden
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jonell S Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Sammie Mamis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Christopher R Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
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McElfish PA, Ayers BL, Felix HC, Long CR, Bursac Z, Kaholokula JK, Riklon S, Bing W, Iban A, Yeary KHCK. How stakeholder engagement influenced a randomized comparative effectiveness trial testing two Diabetes Prevention Program interventions in a Marshallese Pacific Islander Community. J Transl Med 2019; 17:42. [PMID: 30744647 PMCID: PMC6371527 DOI: 10.1186/s12967-019-1793-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/05/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Marshallese face significant health disparities, with particularly high rates of type 2 diabetes. Engaging stakeholders in the research process is essential to reduce health inequities. METHODS A community- and patient-engaged research approach was used to involve community Marshallese stakeholders in a randomized comparative effectiveness trial testing two Diabetes Prevention Program interventions. RESULTS The article outlines the engagement process and the specific influence that stakeholders had on the research planning and implementation, discussing the areas of agreement and disagreement between community and patient stakeholders and academic investigators and documenting changes to the research protocol. CONCLUSION The article provides an example of methods that can be used to design and conduct a randomized controlled trial testing with a population who has been underrepresented in research and suffered significant historical trauma.
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Affiliation(s)
- Pearl A. McElfish
- University of Arkansas for Medical Sciences, Northwest Campus, 1125 North College Ave, Fayetteville, AR 72703 USA
| | - Britni L. Ayers
- University of Arkansas for Medical Sciences, Northwest Campus, 1125 North College Ave, Fayetteville, AR 72703 USA
| | - Holly C. Felix
- University of Arkansas for Medical Sciences, Northwest Campus, 1125 North College Ave, Fayetteville, AR 72703 USA
| | - Christopher R. Long
- University of Arkansas for Medical Sciences, Northwest Campus, 1125 North College Ave, Fayetteville, AR 72703 USA
| | - Zoran Bursac
- Florida International University, 11200 SW 8th St., AMHC5-463, Miami, FL 33199 USA
| | | | - Sheldon Riklon
- University of Arkansas for Medical Sciences, Northwest Campus, 1125 North College Ave, Fayetteville, AR 72703 USA
| | - Williamina Bing
- University of Arkansas for Medical Sciences, Northwest Campus, 1125 North College Ave, Fayetteville, AR 72703 USA
| | - Anita Iban
- Springdale School District, Springdale, AR USA
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Balli ML, Dickey TA, Purvis RS, Warmack TS, Riklon S, McElfish PA. "You Want to Give the Best Care Possible, and You Know When They Leave Your Pharmacy, You Didn't Give the Best Care Possible Most of the Time": Pharmacist- and Community Health Worker-Identified Barriers and Facilitators to Medication Adherence in Marshallese Patients. J Racial Ethn Health Disparities 2019; 6:652-659. [PMID: 30737733 DOI: 10.1007/s40615-019-00563-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The Marshallese experience high rates of chronic diseases including hypertension and diabetes. Medication adherence is crucial to successful disease management, and healthcare providers play a crucial role in assisting their patients with medication adherence. METHODS A qualitative study design was used with individual interviews and focus groups with pharmacists and community health workers (CHWs) serving the Marshallese community in Northwest Arkansas. Participants were asked about their experiences with and perceptions of barriers and facilitators to medication adherence among Marshallese adults in Northwest Arkansas. RESULTS Eight pharmacists and nine CHWs were interviewed. Five themes emerged regarding barriers to medication adherence: (1) financial, (2) transportation, (3) language, (4) health literacy and understanding of Western medicine, and (5) mistrust. Four themes emerged regarding facilitators to medication adherence: (1) in-depth patient education strategies, (2) efforts to address the language barrier, (3) family engagement, and (4) public transportation and prescription home delivery. DISCUSSION Pharmacists and CHWs identified the same barriers to medication adherence, which are consistent with those documented in previous studies. Pharmacists also reported distress over their inability to confirm Marshallese patient understanding in relation to the use of prescribed medications.
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Affiliation(s)
- Michelle L Balli
- College of Pharmacy, University of Arkansas for Medical Sciences, Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Tiffany A Dickey
- College of Pharmacy, University of Arkansas for Medical Sciences, Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Rachel S Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - T Scott Warmack
- College of Pharmacy, University of Arkansas for Medical Sciences, Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences, Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences, Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA.
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Fields VS, Safi H, Waters C, Dillaha J, Capelle L, Riklon S, Wheeler JG, Haselow DT. Mumps in a highly vaccinated Marshallese community in Arkansas, USA: an outbreak report. Lancet Infect Dis 2019; 19:185-192. [PMID: 30635255 DOI: 10.1016/s1473-3099(18)30607-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/07/2018] [Accepted: 09/25/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND During 2000-15, Arkansas Department of Health, Little Rock, AR, USA, investigated between one and six cases of mumps each year. From Aug 5, 2016, to Aug 5, 2017, the department received notification of more than 4000 suspected mumps cases in the second largest outbreak in the USA in the past 30 years. METHODS Arkansas Department of Health investigated all reported cases of mumps to ascertain exposure, travel, and vaccination histories and identify close contacts. Cases were classified as confirmed if the patient had laboratory confirmation of mumps virus or probable if they had clinical symptoms and either a positive serological test or a known epidemiological link to a confirmed case. FINDINGS 2954 cases of mumps related to the outbreak were identified during the outbreak period: 1665 (56%) were laboratory confirmed, 1676 (57%) were in children aged 5-17 years, and 1692 (57%) were in Marshallese people. Among the 1676 school-aged cases, 1536 (92%) had previously received at least two doses of a vaccine containing the mumps virus. Although 19 cases of orchitis were reported, severe complications were not identified. Unusual occurrences, such as recurrent parotitis and prolonged viral shedding, were observed mostly in Marshallese individuals. Viral samples were characterised as genotype G. INTERPRETATION This large-scale outbreak, primarily affecting a marginalised community with intense household crowding, highlights the need for coordinated, interdisciplinary, and non-traditional outbreak responses. This outbreak raises questions about mumps vaccine effectiveness and potential waning immunity. FUNDING Council of State and Territorial Epidemiologists and US Centers for Disease Control and Prevention.
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Affiliation(s)
- Virgie S Fields
- Arkansas Department of Health, Little Rock, AR, USA; Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship, Atlanta, GA, USA
| | - Haytham Safi
- Arkansas Department of Health, Little Rock, AR, USA
| | | | | | - Lucy Capelle
- Arkansas Coalition of Marshallese, Springdale, AR, USA
| | - Sheldon Riklon
- University of Arkansas for Medical Sciences Northwest Campus, Fayetteville, AR, USA
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Palafox NA, Reichhardt M, Taitano JR, Nitta M, Garstang H, Riklon S, Taulung L, Buenconsejo-Lum LE. A Socio-Ecological Framework for Cancer Control in the Pacific: A Community Case Study of the US Affiliated Pacific Island Jurisdictions 1997-2017. Front Public Health 2018; 6:313. [PMID: 30483488 PMCID: PMC6243120 DOI: 10.3389/fpubh.2018.00313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/11/2018] [Indexed: 11/17/2022] Open
Abstract
The United States Affiliated Pacific Island Jurisdictions (USAPIJ) are politically associated to the United States (US) as US Territories (Guam, American Samoa), a US Commonwealth (Commonwealth of the Northern Mariana Islands), and as sovereign nations linked to the US through Compacts of Free Association [Federated States of Micronesia (FSM), Republic of the Marshall Islands (RMI), Republic of Palau (ROP)]. Cervical cancer incidence in the RMI is the highest in the world, mammography services are not available in the FSM and only Guam has on-island oncology services. Cancer risk factors such as obesity, tobacco, and Hepatitis B are prevalent. Twelve years of nuclear testing in the RMI adds to the cancer burden. A community-based, multi-national coalition with multi-system external partners the Pacific Regional Cancer Control Partnership (PRCP) was developed to address cancer prevention and control in the USAPIJ. Through the PRCP, local cancer coalitions, a regional cancer registry, 12 years of regional cancer control plans, and cancer prevention programs and research has been implemented. Methods: The PRCP is the subject of this community case study. The PRCP is analyzed through a socio-ecological theoretical framework to contextualize its typology, building blocks, and management. The respective roles and work of each partner and organization will be described and aligned with the levels of the socio-ecological framework. Results: The USAPIJs evolved a community-focused internal and external regional cancer prevention and control network over 20 years. The function and structure of the PRCP fits within a socio-ecological framework for cancer control. An adaptive management strategy has been used within the PRCP to manage its multi-national, multi-level, and multi-system partners. Conclusion: The PRCP has been able to advance cancer prevention and control programs with a community-centric model that functions in a multi-national, multi-cultural, low-resource, geographically dispersed environment over the last 20 years. The PRCP operates with a structure and management style that is consistent with a socio-ecological framework for cancer control. This case study provides a blueprint for the PRCP organizational structure and a mechanism for its function. The PRCP concept, a community-centric model for cancer control in multi-national resource-limited environments, may be scaled to other global environments.
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Affiliation(s)
- Neal A. Palafox
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States
| | | | - John Ray Taitano
- Cancer Council of the Pacific Islands, Tamuning, GU, United States
| | - Mavis Nitta
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States
| | - Helentina Garstang
- Republic of the Marshall Islands Ministry of Health, Majuro, Marshall Islands
| | - Sheldon Riklon
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, United States
| | | | - Lee E. Buenconsejo-Lum
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States
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McElfish PA, Balli ML, Hudson JS, Long CR, Hudson T, Wilmoth R, Rowland B, Warmack TS, Purvis RS, Schulz T, Riklon S, Holland A, Dickey T. Identifying and Understanding Barriers and Facilitators to Medication Adherence Among Marshallese Adults in Arkansas. J Pharm Technol 2018; 34:204-215. [PMID: 34860999 DOI: 10.1177/8755122518786262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Significant health disparities are present in Marshallese adults residing in the United States, most notably a high incidence of type 2 diabetes and other chronic conditions. There is limited research on medication adherence in the Marshallese population. Objective: This study explored perceptions of and experiences with medication adherence among Marshallese adults residing in Arkansas, with the aim of identifying and better understanding barriers and facilitators to medication adherence. Methods: Eligible participants were Marshallese adults taking at least one medication for a chronic health condition. Each participant completed a brief survey and semistructured interview conducted in Marshallese by a bilingual Marshallese staff member. Interviews were recorded, transcribed, and translated from Marshallese to English. Qualitative data were coded for a priori and emergent themes. Results: A total of 40 participants were included in the study. The most common contributing factor for nonadherence was forgetting to take medication (82%). A majority of participants (70%) reported difficulty paying for medicine, 45% reported at least one form of cost-related nonadherence, and 40% engaged in more than one cost-related nonadherence practice. Family support and medication pill boxes were identified as facilitators for medication adherence. The majority of the participants (76.9%) stated that they understood the role of a pharmacist. Participants consistently desired more education on their medications from pharmacy providers. Conclusion: This is the first study to explore barriers and facilitators to medication adherence among Marshallese patients. The findings can be used to develop methods to improve medication adherence among Marshallese.
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Affiliation(s)
- Pearl A McElfish
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Michelle L Balli
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Jonell S Hudson
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Christopher R Long
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Teresa Hudson
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Ralph Wilmoth
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Brett Rowland
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - T Scott Warmack
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Rachel S Purvis
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Thomas Schulz
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Sheldon Riklon
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Angel Holland
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Tiffany Dickey
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
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McElfish P, Bing W, Ayers BL, Smith L, Stephens M, Wilmoth R, Hudson J, Buron B, Warmack TS, Aitaoto N, Riklon S. Lessons learned through a partnership with Marshallese faith-based organizations to screen for hypertension and diabetes. JRMC 2018. [DOI: 10.24926/jrmc.v1i3.1044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
None at this time.
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McElfish PA, Long CR, Kaholokula JK, Aitaoto N, Bursac Z, Capelle L, Laelan M, Bing WI, Riklon S, Rowland B, Ayers BL, Wilmoth RO, Langston KN, Schootman M, Selig JP, Yeary KHCK. Design of a comparative effectiveness randomized controlled trial testing a faith-based Diabetes Prevention Program (WORD DPP) vs. a Pacific culturally adapted Diabetes Prevention Program (PILI DPP) for Marshallese in the United States. Medicine (Baltimore) 2018; 97:e0677. [PMID: 29742712 PMCID: PMC5959435 DOI: 10.1097/md.0000000000010677] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Pacific Islander populations, including Marshallese, face a disproportionately high burden of health disparities relative to the general population. OBJECTIVES A community-based participatory research (CBPR) approach was utilized to engage Marshallese participants in a comparative effectiveness trial testing 2 Diabetes Prevention Program (DPP) interventions designed to reduce participant's weight, lower HbA1c, encourage healthy eating, and increase physical activity. DESIGN To compare the effectiveness of the faith-based (WORD) DPP to the culturally adapted (Pacific Culturally Adapted Diabetes Prevention Program [PILI]) DPP, a clustered randomized controlled trial (RCT) with 384 Marshallese participants will be implemented in 32 churches located in Arkansas, Kansas, Missouri, and Oklahoma. Churches will be randomly assigned to WORD DPP arm or to PILI DPP arm. METHODS WORD DPP focuses on connecting faith and health to attain a healthy weight, eat healthy, and be more physically active. In contrast, PILI DPP is a family and community focused DPP curriculum specifically adapted for implementation in Pacific Islander communities. PILI focuses on engaging social support networks to maintain a healthy weight, eat healthy, and be more physically active. All participants are assessed at baseline, immediate post intervention, and 12 months post intervention. SUMMARY Both interventions aim to cause weight loss through improving physical activity and healthy eating, with the goal of preventing the development of T2D. The clustered RCT will determine which intervention is most effective with the Marshallese population. The utilization of a CBPR approach that involves local stakeholders and engages faith-based institutions in Marshallese communities will increase the potential for success and sustainability. This study is registered at clinicaltrials.gov (NCT03270436).
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Affiliation(s)
- Pearl Anna McElfish
- College of Medicine, University of Arkansas for Medical Sci10-1ences Northwest, 1125 N. College Avenue, Fayetteville, AR
| | - Christopher R. Long
- College of Medicine, University of Arkansas for Medical Sci10-1ences Northwest, 1125 N. College Avenue, Fayetteville, AR
| | | | - Nia Aitaoto
- Center for Pacific Islander Health, University of Arkansas for Medical Sciences Northwest, Fayetteville
| | - Zoran Bursac
- Division of Biostatistics, Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, TN
| | - Lucy Capelle
- Arkansas Coalition of Marshallese, Springdale, AR
| | | | - Williamina Ioanna Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville
| | - Sheldon Riklon
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville
| | - Britni L. Ayers
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville
| | - Ralph O. Wilmoth
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville
| | - Krista N. Langston
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville
| | - Mario Schootman
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St Louis, MO; Department of Biostatistics
| | - James P. Selig
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Karen Hye-cheon Kim Yeary
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR
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McElfish PA, Rowland B, Long CR, Hudson J, Piel M, Buron B, Riklon S, Bing WI, Warmack TS. Diabetes and Hypertension in Marshallese Adults: Results from Faith-Based Health Screenings. J Racial Ethn Health Disparities 2017; 4:1042-1050. [PMID: 27837454 PMCID: PMC5426989 DOI: 10.1007/s40615-016-0308-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Pacific Islander population in the USA is growing rapidly. However, research on Pacific Islanders in the USA is limited, or sometimes misleading due to aggregation with Asian Americans. This project seeks to add to the dearth of health literature by conducting a health assessment of Marshallese in northwest Arkansas. METHODS Using a community-based participatory research approach, nine health screening events were conducted at local Marshallese churches. Participants completed the Behavioral Risk Factors Surveillance Survey core questionnaire and diabetes module if applicable. Biometric data, including Hemoglobin A1c, blood pressure, and body mass index, were gathered by an interprofessional team. RESULTS Four hundred one participants completed health screenings. High proportions of diabetes, obesity, and hypertension were found. A high percentage of participants were uninsured, and multiple barriers to health care were found within the sample. DISCUSSION This project represents one of the first broad health assessments of Pacific Islanders in the USA. Proportions of diabetes, hypertension, obesity, and uninsured found in the sample are much higher than national proportions.
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Affiliation(s)
- Pearl Anna McElfish
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR, 72703, USA.
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR, 72703, USA
| | - Christopher R Long
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR, 72703, USA
| | - Jonell Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR, 72703, USA
| | - Michelle Piel
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR, 72703, USA
| | - Bill Buron
- College of Nursing, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR, 72703, USA
| | - Sheldon Riklon
- Department of Family Medicine, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR, 72703, USA
| | - Williamina Ioanna Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR, 72703, USA
| | - T Scott Warmack
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR, 72703, USA
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McElfish PA, Narcisse MR, Long CR, Ayers BL, Hawley NL, Aitaoto N, Riklon S, Su LJ, Ima SZ, Wilmoth RO, Schulz TK, Kadlubar S. Leveraging community-based participatory research capacity to recruit Pacific Islanders into a genetics study. J Community Genet 2017; 8:283-291. [PMID: 28689351 DOI: 10.1007/s12687-017-0313-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/08/2017] [Indexed: 12/14/2022] Open
Abstract
Pacific Islanders face many health disparities, including higher rates of cardiovascular disease, cancer, obesity, and diabetes compared to other racial and ethnic groups. Specifically, the Marshallese population suffers disproportionately from type 2 diabetes, with rates 400% higher than the general US population. As part of an ongoing community-based participatory research (CBPR) partnership, 148 participants were recruited for a study examining genetic variants to better understand diabetes. Participants provided a saliva specimen in an Oragene® DNA self-collection kit. Each participant provided approximately 2 mL volume of saliva and was asked qualitative questions about their experience. The study yielded a recruitment rate of 95.5%. Among the 148 persons who participated, 143 (96.6%) agreed to be contacted for future studies; 142 (95.9%) agreed to have their samples used for future IRB-approved studies; and 144 (97.3%) gave permission for the researchers to link information from this study to other studies in which they had participated. Qualitative responses showed that the majority of participants were willing to participate because of their desire to contribute to the health of their community and to understand the genetic influence related to diabetes. This study demonstrates willingness to participate in genetic research among Marshallese living in Arkansas. Willingness was likely enhanced because the feasibility study was part of a larger CBPR effort. This study is important to community stakeholders who have voiced a desire to collaboratively conduct genetic research related to diabetes, perinatal outcomes, and cancer.
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Affiliation(s)
- Pearl A McElfish
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, 1125 N. College Ave, Fayetteville, AR, 72701, USA.
| | - Marie-Rachelle Narcisse
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, 1125 N. College Ave, Fayetteville, AR, 72701, USA
| | - Christopher R Long
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, 1125 N. College Ave, Fayetteville, AR, 72701, USA
| | - Britni L Ayers
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, 1125 N. College Ave, Fayetteville, AR, 72701, USA
| | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Nia Aitaoto
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, 1125 N. College Ave, Fayetteville, AR, 72701, USA
| | - Sheldon Riklon
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, 1125 N. College Ave, Fayetteville, AR, 72701, USA
| | - L Joseph Su
- Department of Epidemiology, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Shumona Z Ima
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, 1125 N. College Ave, Fayetteville, AR, 72701, USA
| | - Ralph O Wilmoth
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, 1125 N. College Ave, Fayetteville, AR, 72701, USA
| | - Thomas K Schulz
- Department of Internal Medicine Division of Hematology/Oncology, UAMS College of Medicine, Northwest, 1125 N. College Avenue, Fayetteville, AR, USA
| | - Susan Kadlubar
- Division of Medical Genetics, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
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Yeary KH, Aitaoto N, Sparks K, Ritok-Lakien M, Hudson JS, Goulden P, Bing W, Riklon S, Rubon-Chutaro J, Mcelfish PA. Cultural Adaptation of Diabetes Self-Management Education for Marshallese Residing in the United States: Lessons Learned in Curriculum Development. Prog Community Health Partnersh 2017; 11:253-261. [PMID: 29056617 PMCID: PMC5792062 DOI: 10.1353/cpr.2017.0030] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Type 2 diabetes is a significant public health problem, with U.S. Pacific Islander communities bearing a disproportionate burden. The Marshallese are a Pacific Islander community that has significant inequities in diabetes, yet few evidence-based diabetes interventions have been developed to address this inequity. OBJECTIVES We used a community-based participatory research (CBPR) approach to adapt an evidence-based diabetes self-management education (DSME) intervention for the Marshallese. METHODS Our team used the Cultural Adaptation Process Model, in addition to an iterative process consisting of formative data and previous literature review, and engagement with community and academic experts. LESSONS LEARNED Specific cultural considerations were identified in adapting DSME components, including the dichotomous versus gradient conceptualization of ideas, the importance of engaging the entire family, the use of nature analogies, and the role of spirituality. CONCLUSIONS We identified key cultural considerations to incorporate into a diabetes self-management program for the Marshallese. The insights gained can inform others' work with Pacific Islanders.
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McElfish PA, Purvis RS, Maskarinec GG, Bing WI, Jacob CJ, Ritok-Lakien M, Rubon-Chutaro J, Lang S, Mamis S, Riklon S. Interpretive policy analysis: Marshallese COFA migrants and the Affordable Care Act. Int J Equity Health 2016; 15:91. [PMID: 27286831 PMCID: PMC4902953 DOI: 10.1186/s12939-016-0381-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 06/07/2016] [Indexed: 11/23/2022] Open
Abstract
Background Since the enactment of the Affordable Care Act (ACA), the rate of uninsured in the United States has declined significantly. However, not all legal residents have benefited equally. As part of a community-based participatory research (CBPR) partnership with the Marshallese community, an interpretative policy analysis research project was conducted to document Marshallese Compact of Free Association (COFA) migrants’ understanding and experiences regarding the ACA and related health policies. This article is structured to allow the voice of Marshallese COFA migrants to explain their understanding and interpretation of the ACA and related polices on their health in their own words. Methods Qualitative data was collected from 48 participants in five focus groups conducted at the local community center and three individual interviews for those unable to attend the focus groups. Marshallese community co-investigators participated throughout the research and writing process to ensure that cultural context and nuances in meaning were accurately captured and presented. Community co-investigators assisted with the development of the semi-structured interview guide, facilitated focus groups, and participated in qualitative data analysis. Results Content analysis revealed six consistent themes across all focus groups and individual interviews that include: understanding, experiences, effect on health, relational/historical lenses, economic contribution, and pleas. Working with Marshallese community co-investigators, we selected quotations that most represented the participants’ collective experiences. The Marshallese view the ACA and their lack of coverage as part of the broader relationship between the Republic of the Marshall Islands (RMI) and the United States. The Marshallese state that they have honored the COFA relationship, and they believe the United States is failing to meet its obligations of care and support outlined in the COFA. Conclusion While the ACA and Medicaid Expansion have reduced the national uninsured rate, Marshallese COFA migrants have not benefited equally from this policy. The lack of healthcare coverage for the Marshallese COFA migrants exacerbates the health disparities this underserved population faces. This article is an important contribution to researchers because it presents the Marshallese’s interpretation of the policy, which will help inform policy makers that are working to improve Marshallese COFA migrant health.
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Affiliation(s)
- Pearl Anna McElfish
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA.
| | - Rachel S Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Gregory G Maskarinec
- Department of Family Medicine and Community Health, University of Hawaii at Manoa, 95-390 Kuahelani Ave, Mililani, HI, 96789, USA
| | - Williamina Ioanna Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Christopher J Jacob
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Mandy Ritok-Lakien
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Jellesen Rubon-Chutaro
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Sharlynn Lang
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Sammie Mamis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Sheldon Riklon
- Department of Family Medicine and Community Health, University of Hawaii at Manoa, 95-390 Kuahelani Ave, Mililani, HI, 96789, USA
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Yamada S, Riklon S, Maskarinec GG. Ethical Responsibility for the Social Production of Tuberculosis. J Bioeth Inq 2016; 13:57-64. [PMID: 26715047 DOI: 10.1007/s11673-015-9681-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 11/26/2015] [Indexed: 06/05/2023]
Abstract
Approximately one in two hundred persons in the Marshall Islands have active tuberculosis (TB). We examine the historical antecedents of this situation in order to assign ethical responsibility for the present situation. Examining the antecedents in terms of Galtung's dialectic of personal versus structural violence, we can identify instances in the history of the Marshall Islands when individual subjects made decisions (personal violence) with large-scale ecologic, social, and health consequences. The roles of medical experimenters, military commanders, captains of the weapons industry in particular, and industrial capitalism in general (as the cause of global warming) are examined. In that, together with Lewontin, we also identify industrial capitalism as the cause of tuberculosis, we note that the distinction between personal versus structural violence is difficult to maintain. By identifying the cause of the tuberculosis in the Marshall Islands, we also identify what needs be done to treat and prevent it.
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Affiliation(s)
- Seiji Yamada
- Department of Family Medicine and Community Health, University of Hawai'i, 95-390 Kuahelani Avenue, Mililani, HI, 96789, USA.
| | - Sheldon Riklon
- Department of Family Medicine and Community Health, University of Hawai'i, 95-390 Kuahelani Avenue, Mililani, HI, 96789, USA
| | - Gregory G Maskarinec
- Department of Family Medicine and Community Health, University of Hawai'i, 95-390 Kuahelani Avenue, Mililani, HI, 96789, USA
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Len KA, Riklon S, Anegawa LJ, Burgess LP, Gavero GC, Lubimir KT, Omori JS, Savala MC, Shimamoto RT, Suares GA, Sakai DH. Medical School Hotline: Liaison Committee on Medical Education Accreditation, Part V: Clerkship Education. Hawaii J Med Public Health 2016; 75:78-81. [PMID: 27011889 PMCID: PMC4795334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Kyra A Len
- Faculty, John A. Burns School of Medicine, Honolulu, HI (KAL, SR, LJA, LPB, GCG, KTL, MCS, RTS, GAS)
| | - Sheldon Riklon
- Faculty, John A. Burns School of Medicine, Honolulu, HI (KAL, SR, LJA, LPB, GCG, KTL, MCS, RTS, GAS)
| | - Linda J Anegawa
- Faculty, John A. Burns School of Medicine, Honolulu, HI (KAL, SR, LJA, LPB, GCG, KTL, MCS, RTS, GAS)
| | - Lawrence P Burgess
- Faculty, John A. Burns School of Medicine, Honolulu, HI (KAL, SR, LJA, LPB, GCG, KTL, MCS, RTS, GAS)
| | - Gretchenjan C Gavero
- Faculty, John A. Burns School of Medicine, Honolulu, HI (KAL, SR, LJA, LPB, GCG, KTL, MCS, RTS, GAS)
| | - Karen T Lubimir
- Faculty, John A. Burns School of Medicine, Honolulu, HI (KAL, SR, LJA, LPB, GCG, KTL, MCS, RTS, GAS)
| | - Jill Sm Omori
- Faculty, John A. Burns School of Medicine, Honolulu, HI (KAL, SR, LJA, LPB, GCG, KTL, MCS, RTS, GAS)
| | - Michael C Savala
- Faculty, John A. Burns School of Medicine, Honolulu, HI (KAL, SR, LJA, LPB, GCG, KTL, MCS, RTS, GAS)
| | - Royce T Shimamoto
- Faculty, John A. Burns School of Medicine, Honolulu, HI (KAL, SR, LJA, LPB, GCG, KTL, MCS, RTS, GAS)
| | - Gregory A Suares
- Faculty, John A. Burns School of Medicine, Honolulu, HI (KAL, SR, LJA, LPB, GCG, KTL, MCS, RTS, GAS)
| | - Damon H Sakai
- Faculty, John A. Burns School of Medicine, Honolulu, HI (KAL, SR, LJA, LPB, GCG, KTL, MCS, RTS, GAS)
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Fernandes R, Riklon S, Langidrik JR, Williams SN, Kabua N. Collaboration between a US Academic Institution and International Ministry of Health to develop a culturally appropriate palliative care navigation curriculum. Healthc (Amst) 2014; 2:275-9. [PMID: 26250636 DOI: 10.1016/j.hjdsi.2014.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 08/10/2014] [Accepted: 08/13/2014] [Indexed: 11/18/2022]
Abstract
Implementation lessons: (1) The development and testing of a culturally appropriate palliative care navigation curriculum for countries facing high cancer and non-communicable diseases burden requires collaboration with the local Ministry of Health. (2) Lay volunteers from non-governmental and faith-based organizations are potential candidates to provide patient navigation services.
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Affiliation(s)
- Ritabelle Fernandes
- The Pacific Islands Geriatric Education Center and the John A. Hartford Foundation Center of Excellence in Geriatrics, Department of Geriatric Medicine, Division of Palliative Medicine, John A. Burns School of Medicine, University of Hawaii, United States.
| | - Sheldon Riklon
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii, United States
| | | | - Shellie N Williams
- Division of Geriatric Medicine, Department of Medicine, University of Chicago Medical Center, United States
| | - Neiar Kabua
- National Comprehensive Cancer Control Program, Ministry of Health, Republic of the Marshall Islands
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Fernandes R, Riklon S, Langidrik JR, Williams SN, Kabua N. Patient navigator training in the Republic of the Marshall Islands. J Palliat Med 2014; 17:133-4. [PMID: 24450416 DOI: 10.1089/jpm.2013.0550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ritabelle Fernandes
- 1 The Pacific Islands Geriatric Education Center and the John A. Hartford Foundation Center of Excellence in Geriatrics, Department of Geriatric Medicine, Division of Palliative Medicine, University of Hawaii , Honolulu, Hawaii
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Omori JSM, Riklon S, Wong VS, Lee DF. The Hawai'i Homeless Outreach and Medical Education Project: servicing the community and our medical students. Hawaii J Med Public Health 2012; 71:262-265. [PMID: 23115756 PMCID: PMC3443850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Jill S M Omori
- University of Hawai'i John A. Burns School of Medicine, Honolulu, HI, USA
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Saunders A, Schiff T, Rieth K, Yamada S, Maskarinec GG, Riklon S. Health as a human right: who is eligible? Hawaii Med J 2010; 69:4-6. [PMID: 20539993 PMCID: PMC3123152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In Hawaii, health care is a commodity, not a human right: those who can afford it receive care, those who cannot often don't. As health workers and health professional students, we witness the consequences that public policies and budget considerations have on people, on patients, on the health of those that we are dedicated to assisting. Beginning with a case study, we examine the historical antecedents leading to the increasing migration of Micronesians to Hawaii, examine the special relation that (Compact of Free Association) citizens have with the United States, and seek to reframe the political discussion regarding their health care status in this state as a debate in which medical considerations, not political or economic ones, should be the primary voice.
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Affiliation(s)
- Aaron Saunders
- John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96813, USA
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Riklon S, Alik W, Hixon A, Palafox NA. The "compact impact" in Hawaii: focus on health care. Hawaii Med J 2010; 69:7-12. [PMID: 20539994 PMCID: PMC3123150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The political, economic, and military relationship between the former Pacific Trust Territories of the United States is defined by the Compact of Free Association (COFA) treaty. The respective COFA treaties allow the United States military and strategic oversight for these countries, while COFA citizens can work, reside, and travel with unlimited lengths of stay in the United States. The unforeseen consequences of the diaspora of the people of the COFA nations to the United States and its territories is called the "Compact Impact." In 2007 the social, health, and welfare system costs attributed to the estimated 13,000 COFA migrants in Hawaii was $90 million. The US federal government does not take full responsibility for the adverse economic consequences to Hawaii due to COFA implementation. The lack of health and education infrastructure in the COFA nations, as well as the unique language, culture, political, and economic development of the region have contributed to the adverse elements of the Compact Impact. The Department of Human Services of Hawaii, once supportive of the COFA peoples, now looks to withdraw state sponsored health care support. This paper reviews the historical, political, and economic development, which surrounds the Compact Impact and describes Hawaii's government and community response. This paper attempts to understand, describe, and search for solutions that will mitigate the Compact Impact.
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Affiliation(s)
- Sheldon Riklon
- Department of Family Medicine and Community Health, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96813, USA.
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