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Castellon-Lopez YM, Carson SL, Mansfield L, Garrison NA, Barron J, Morris D, Ntekume E, Vassar SD, Norris KC, Brown AF, Casillas A. "The System Doesn't Let Us in"-A Call for Inclusive COVID-19 Vaccine Outreach Rooted in Los Angeles Latinos' Experience of Pandemic Hardships and Inequities. Int J Environ Res Public Health 2022; 19:5785. [PMID: 35627322 PMCID: PMC9141159 DOI: 10.3390/ijerph19105785] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/23/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Latino adults in Los Angeles have experienced disproportionate cases, deaths, and socioeconomic impacts from the COVID-19 pandemic. This qualitative study aimed to explore community perspectives on readiness for COVID-19 vaccination and to identify culturally tailored vaccine outreach strategies. METHODS We conducted virtual focus groups with Los Angeles County Latino/a residents via Zoom between December 2020 to January 2021, as the first COVID-19 vaccines were receiving Emergency Use Authorization (EUA). Focus groups were facilitated in Spanish and English by bilingual members of the research team. Discussions were analyzed via Atlas.ti software using reflexive thematic analysis. RESULTS Three focus groups (n = 15; four to six people each; two Spanish focus groups; one English) were conducted. Thematic findings centered on Latino COVID-19 vaccine equity: (1) Disproportionate infection risk due to essential worker status and socioeconomic burdens, misinformation, and familial or cultural tensions (2) Concerns for inequitable vaccine access due to immigration fears and limited healthcare access, and (3) A need for community-centered COVID-19 vaccine outreach and access. CONCLUSIONS Our study on early Latino adult reactions to vaccine roll-out suggests the need for outreach strategies centering on validating community hardships, combating dis-/misinformation through trusted sources, and addressing socio-economic needs impacted by the pandemic.
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Affiliation(s)
- Yelba M. Castellon-Lopez
- Department of Family Medicine, UCLA David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Savanna L. Carson
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Lisa Mansfield
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Nanibaa’ A. Garrison
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
- Institute for Society & Genetics, College of Letters and Science, University of California, Los Angeles, CA 90095, USA
- Institute for Precision Health, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Juan Barron
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - D’Ann Morris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Ejiro Ntekume
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Stefanie D. Vassar
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Keith C. Norris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Arleen F. Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
- Olive View-UCLA Medical Center, Sylmar, CA 91342, USA
| | - Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
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Alvarez-Arango S, Tolson T, Knight AM, Presny SK, Cruz-Oliver DM, Aloe S, Contreras J, Dzamko N, Moore A, Stewart I, Golden SH, Page KR. Juntos: A Model for Language Congruent Care to Better Serve Spanish-Speaking Patients with COVID-19. Health Equity 2021; 5:826-833. [PMID: 35018315 PMCID: PMC8742298 DOI: 10.1089/heq.2020.0124] [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] [Accepted: 08/22/2021] [Indexed: 11/12/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) exacerbated pre-existing health disparities and disproportionately affected the Latino community. Clinicians identified communication barriers as a major challenge in care for COVID-19 Latino patients with limited English proficiency (LEP). To address these challenges, Juntos (Together) consult service was established to promote language-congruent care with cultural sensitivity, identify barriers to safe discharge, and facilitate referral to appropriate resources. Spanish speaking volunteer health care providers worked synergistically with medical teams caring for LEP Latino patients. Volunteers were trained on consultant responsibilities and discharge planning resources. The program was evaluated by a satisfaction survey distributed to providers who requested a Juntos consult and Juntos volunteers. Between May 5 and July 30, 2020, 19 individuals volunteered time to the Juntos consult service, 12 (63%) Latinos, 14 (74%) physicians, and 5 (26%) staff. The service supported 127 patients, 76 (60%) males, mean age 42 (±16), 83 (65%) uninsured, and 91 (72%) without primary care. The most common referral sources were medical units (52, 41%) and intensive care units (47, 37%). The most common services offered were family engagement (55, 43%), goals of care (35, 28%), and mental status assessment (26, 20%). The majority of providers who consulted Juntos were very satisfied (48/59, 81%) with the care delivered. The Juntos service offered critical support tailored to the patients' and primary teams' needs. The experience reinforced the need for cultural-based communication to provide optimal care to LEP patients. The Juntos consult service could be a model for providing language-congruent care even beyond COVID-19, but to do so will require institutional investment and rigorous outcomes evaluation.
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Affiliation(s)
| | - Tina Tolson
- Johns Hopkins Health System, Baltimore, Maryland, USA
| | - Amy M. Knight
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sophie K. Presny
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Health System, Baltimore, Maryland, USA
| | - Dulce M. Cruz-Oliver
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Health System, Baltimore, Maryland, USA
| | - Sabrina Aloe
- Johns Hopkins Health System, Baltimore, Maryland, USA
| | | | - Nicole Dzamko
- Johns Hopkins Health System, Baltimore, Maryland, USA
| | | | - Inez Stewart
- Johns Hopkins Health System, Baltimore, Maryland, USA
| | - Sherita H. Golden
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kathleen R. Page
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Shaibi GQ, Kullo IJ, Singh DP, Sharp RR, De Filippis E, Cuellar I, Hernandez V, Levey S, Radecki Breitkopf C, Olson JE, Cerhan JR, Mandarino LJ, Thibodeau SN, Lindor NM. Developing a Process for Returning Medically Actionable Genomic Variants to Latino Patients in a Federally Qualified Health Center. Public Health Genomics 2018; 21:77-84. [PMID: 30522109 DOI: 10.1159/000494488] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 05/14/2018] [Accepted: 10/14/2018] [Indexed: 12/14/2022] Open
Abstract
AIM To develop a process for returning medically actionable genomic variants to Latino patients receiving care in a Federally Qualified Health Center. METHODS Prior to recruitment, researchers met with primary care providers to (1) orient clinicians to the project, (2) establish a process for returning actionable and nonactionable results to participants and providers through the electronic health record, and (3) develop a process for offering clinical decision support for follow-up education and care. A Community Advisory Board was engaged to provide input on recruitment strategies and materials for conveying results to participants. Participants in the Sangre Por Salud (Blood for Health) Biobank with hyperlipidemia or colon polyps represented the pool of potentially eligible participants. RESULTS A total of 1,621 individuals were invited to participate and 710 agreed to an in- person consenting visit (194 no-showed and 16 declined). Over 12-months, 500 participants were enrolled. Participants were primarily Spanish-speaking (81.6%), female (74.2%), and enrolled because of hyperlipidemia (95.4%). All but 2 participants opted to receive primary (i.e., related to enrollment phenotypes) as well as secondary actionable results. CONCLUSION Efforts to bring precision medicine to community-based health centers serving minority patients may require multilevel engagement activities to include individuals, providers, health systems, and the community.
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Affiliation(s)
- Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA,
| | - Iftikhar J Kullo
- Department of Cardiovascular Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Richard R Sharp
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Idali Cuellar
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Sharon Levey
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Lawrence J Mandarino
- Division of Endocrinology, Department of Medicine, and Center for Disparities in Diabetes, Obesity, and Metabolism, University of Arizona, Tucson, Arizona, USA
| | - Stephen N Thibodeau
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Noralane M Lindor
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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