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Holman-Allgood I, Cline C, Durand C, Purvis RS, Mendoza Kabua P, Ayers BL. Providers' Perspectives of a Culturally Adapted CenteringPregnancy Intervention for Marshallese Women in Arkansas. Nurs Womens Health 2024; 28:117-127. [PMID: 38460942 PMCID: PMC10999336 DOI: 10.1016/j.nwh.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 08/24/2023] [Revised: 09/26/2023] [Accepted: 12/07/2023] [Indexed: 03/11/2024]
Abstract
OBJECTIVE To explore health care providers' perspectives on the successes, challenges, and suggestions for future directions regarding the implementation of CenteringPregnancy for Marshallese women in Arkansas. DESIGN A descriptive qualitative design was used as an exploratory method. SETTING/LOCAL PROBLEM This study took place in northwest Arkansas. Arkansas is home to the largest Marshallese Pacific Islander population in the United States. Marshallese Pacific Islanders residing in the United States have disproportionally high rates of poor maternal and infant health outcomes, even compared to other Pacific Islanders. PARTICIPANTS Seven CenteringPregnancy providers from the University of Arkansas for Medical Sciences Northwest. INTERVENTION/MEASUREMENTS Individual interviews were conducted from February to March of 2023. Data were managed using MAXQDA12 software. Content analysis was used to analyze the data. Initial coding was completed to identify each data segment with short summations of emergent themes. The focused thematic codes that emerged were used to identify and develop the most salient thematic categories of the data, which became the thematic codes. RESULTS Three overarching themes emerged: Implementation Successes, Challenges to Implementation, and Future Suggestions to Improve Implementation and Sustainability. Each theme had representative subthemes. CONCLUSION Findings provide insight for future implementation of CenteringPregnancy for Marshallese and other Pacific Islander individuals.
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Walter CS, Narcisse MR, Felix HC, Rowland B, Selig JP, McElfish PA. Association Between Physical Activity and Physical Function in a Marshallese Population with Type 2 Diabetes. J Immigr Minor Health 2024; 26:361-370. [PMID: 37864639 PMCID: PMC10983015 DOI: 10.1007/s10903-023-01551-9] [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] [Accepted: 09/27/2023] [Indexed: 10/23/2023]
Abstract
Physical activity can delay functional decline in people with type 2 diabetes (T2D), but these associations have not been studied within a sample of Native Hawaiian or Pacific Islander adults with T2D. Using data from a randomized control trial in which 218 Marshallese adults with T2D participated in a 10-week diabetes self-management education intervention, this study tested our hypothesis that physical activity would predict physical function when controlling for time and other variables. Levels of physical activity were positively associated with levels of physical function, even after controlling for time and other covariates. These findings provide a more robust understanding of the relationship between physical activity and physical function in a sample of minority adults with T2D. Future studies should further explore levels of physical activity needed to maintain and improve physical function so that culturally appropriate physical activity interventions can be developed.
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Affiliation(s)
- Christopher S Walter
- Department of Physical Therapy, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA.
| | - Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - James P Selig
- Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 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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Short E, Council SK, Bennett Milburn A, Ammerman A, Callaghan-Koru J, Mendoza Kabua P, Ayers BL. Assessing the acceptability and implementation feasibility of a culturally adapted parenting intervention for Marshallese mothers: A study protocol. Contemp Clin Trials Commun 2024; 37:101240. [PMID: 38261960 PMCID: PMC10796808 DOI: 10.1016/j.conctc.2023.101240] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/21/2023] [Accepted: 12/02/2023] [Indexed: 01/25/2024] Open
Abstract
Background Pacific Islanders, including the Marshallese, face higher rates of obesity and obesity-related chronic conditions. Early-life interventions targeting eating patterns during the first 1000 days of life are essential to promote proper nutrition and growth. Marshallese mothers and caregivers are important decision-makers for feeding practices that could affect childhood obesity rates in Marshallese children. However, little is known about dietary patterns and practices of Marshallese families from birth to 12 months. Culturally-adapted approaches using community-based assets and Pacific Islander cultural values/practices have demonstrated effectiveness in reducing obesity but have not been developed for children. Methods This article describes the protocol for a study to culturally adapt the Centering Parenting intervention for Marshallese mothers in Arkansas. Conclusion This will be the first study to culturally adapt and implement Centering Parenting with Marshallese women in the United States. This study will be an important first step to assess the feasibility and acceptability of an abbreviated parenting intervention to reduce childhood obesity in Marshallese communities.
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Affiliation(s)
- Eliza Short
- University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Sarah K. Council
- University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | | | - Alice Ammerman
- University of North Carolina at Chapel Hill, 1700 MLK, Chapel Hill, NC, 27599, USA
| | - Jennifer Callaghan-Koru
- University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Philmar Mendoza Kabua
- University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Britni L. Ayers
- University of Arkansas for Medical Sciences Northwest, 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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Wu B, Arslanian KJ, Nyhan K, Suss R, Mahoney M, McElfish PA, Muasau-Howard BT, Ekeroma A, Hawley NL. Preterm birth among Pacific Islanders in the United States and the US-affiliated Pacific Islands: A systematic review and meta-analysis. Birth 2023; 50:287-299. [PMID: 37060205 PMCID: PMC10577805 DOI: 10.1111/birt.12713] [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: 04/25/2022] [Revised: 01/17/2023] [Accepted: 01/21/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE To better understand the epidemiology of preterm birth among Pacific Islanders in the United States and the US-Affiliated Pacific Islands. METHODS Systematic searches of MEDLINE, Embase, CINAHL, PsycINFO, two nonindexed regional journals, and gray literature were conducted and finalized in September 2021. Observational studies published since January 2010 that documented preterm birth outcomes among Pacific Islanders in the United States and the US-Affiliated Pacific Islands were eligible for inclusion. Outcomes of interest included preterm birth prevalence, risk compared with white women, and risk factors for preterm birth among Pacific Islanders. RESULTS Fourteen of the 3183 screened articles were included in meta-analyses. Random-effects models were used for pooled estimates with 95% confidence intervals. The pooled prevalence of preterm birth among Pacific Islanders was 11.2%, 95% CI: 9.3%-13.6%. Marshallese women had the highest pooled prevalence (20.7%, 95% CI 18.6%-23.0%) among Pacific Islander subgroups. Compared with white women, Pacific Islander women had higher odds of experiencing preterm birth (OR = 1.40, 95% CI: 1.28-1.53). Four risk factors for preterm birth could be explored with the data available: hypertension, diabetes, smoking, and pre-pregnancy body mass index; hypertension and diabetes significantly increased the odds of preterm birth. CONCLUSIONS Existing literature suggests that United States Pacific Islanders were more likely to experience preterm birth than white women, although the pooled prevalence varied by Pacific Islander subgroup. Data support the need for disaggregation of Pacific Islanders in future research and argue for examination of subgroup-specific outcomes to address perinatal health disparities.
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Affiliation(s)
- Bohao Wu
- Ph.D. Candidate, Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT, USA
| | - Kendall J. Arslanian
- Postdoctoral Fellow, Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Kate Nyhan
- Research and Education Librarian, Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
- Lecturer, Department of Environmental Health Sciences, Yale University School of Public Health New Haven, CT, USA
| | - Rachel Suss
- B.A. Candidate, Yale College, Yale University, New Haven, CT, USA
| | - Madison Mahoney
- B.A. Candidate, Yale College, Yale University, New Haven, CT, USA
| | - Pearl A. McElfish
- Associate Professor, College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Bethel T. Muasau-Howard
- Chief, Department of Obstetrics and Gynecology, Lyndon B Johnson Tropical Medical Center, Pago Pago, American Samoa
| | - Alec Ekeroma
- Professor, National University of Samoa, Apia, Samoa
| | - Nicola L. Hawley
- Associate Professor, Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT, USA
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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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Shobe MA, Hill S, Murphy-Erby Y, Fateh B, Wang H. Food Security in the Time of COVID-19 for a Marshallese Community. Int J Environ Res Public Health 2023; 20:3189. [PMID: 36833883 PMCID: PMC9962343 DOI: 10.3390/ijerph20043189] [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: 01/23/2023] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
Using an individual and family ecological systems model, we explored food security among a Marshallese cohort in Northwest Arkansas during the COVID-19 pandemic. We hypothesized that Marshallese households were experiencing high rates of food insecurity due to socioeconomic and systemic risk factors. Seventy-one Marshallese adults shared socioeconomic information about their household via an online survey. Descriptive results indicate that 91% of respondents report food insecurity. In terms of systemic barriers, almost half of Marshallese respondents do not have health insurance. Additionally, while most respondents report feeling calm, peaceful, and energetic, paradoxically, 81% report feeling depressed and downhearted at least some of the time. Logistic regression findings suggest that food insecurity is significantly related to education levels and household economic strain. These results are analogous with national findings, whereby non-native households are more likely to experience higher levels of food insecurity, lower rates of education, and higher economic strain than native households. As a collective community, the Marshallese could benefit from culturally responsive individual and family systems approaches for improving educational, social, financial, and health opportunities through workforce development, household income and asset development, and food security initiatives. Additional implications for policy, practice, and research are provided.
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Affiliation(s)
- Marcia A. Shobe
- IDEALS Institute, Division of Diversity, Equity, and Inclusion, University of Arkansas, Fayetteville, AR 72701, USA
| | - Sophie Hill
- Fulbright College of Arts & Sciences, University of Arkansas, Fayetteville, AR 72701, USA
| | - Yvette Murphy-Erby
- Fulbright College of Arts & Sciences, University of Arkansas, Fayetteville, AR 72701, USA
| | - Baqir Fateh
- IDEALS Institute, Division of Diversity, Equity, and Inclusion, University of Arkansas, Fayetteville, AR 72701, USA
| | - Haixia Wang
- IDEALS Institute, Division of Diversity, Equity, and Inclusion, University of Arkansas, Fayetteville, AR 72701, USA
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Purvis RS, Vincenzo JL, Spear M, Moore R, Patton SK, Callaghan-Koru J, McElfish PA, Curran GM. Factors Associated With Marshallese and Hispanic Adults' Willingness to Receive a COVID-19 Booster Dose. J Prim Care Community Health 2023; 14:21501319231171440. [PMID: 37191303 DOI: 10.1177/21501319231171440] [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] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION/OBJECTIVES New variants of the SARS-CoV-2 virus that causes COVID-19 will continue to develop and spread globally. The Omicron variant identified in November 2021 has many lineages. Variants spread quickly and can infect previously vaccinated individuals, prompting the Centers for Disease Control and Prevention to update vaccination recommendations. While ~230 million Americans received the initially-recommended vaccine sequence, booster uptake has been much lower; less than half of fully vaccinated individuals report receiving a booster. Racial disparities also mark patterns of COVID-19 vaccination booster uptake. This study explored willingness and motivations to get a COVID-19 booster among a diverse sample of participants. METHODS We used convenience sampling to recruit participants 18 years of age or older who attended a community vaccine event. We conducted informal interviews during the recommended 15-min post-vaccination wait time with 55 participants who attended vaccine events at Marshallese and Hispanic community locations and comprised the recruitment pool for individual interviews. Using a qualitative descriptive design, we conducted in-depth follow-up interviews with 9 participants (Marshallese n = 5, Hispanic n = 4) to explore willingness and motivations to get boosted. We used rapid thematic template analysis to review informal interview summaries and formal interviews. The research team resolved data discrepancies by consensus. RESULTS Participants reported high willingness to get boosted, especially if boosters were recommended in the future to protect against serious illness and mitigate the spread of COVID-19. This finding underscores how essential including recommendations to get a COVID-19 booster from trusted sources in health messaging and educational campaigns may be for increasing booster uptake. Participants described their preference for receiving future COVID-19 boosters, reporting that they would attend similar vaccine events, especially those held at faith-based organizations and facilitated by the same community partners, community health workers, and research staff. This finding shows how community engagement can overcome barriers to vaccination (ie, transportation, language, and fear of discrimination) by providing services in preferred community locations with trusted community partners. CONCLUSIONS Findings document high willingness to get a COVID-19 booster, emphasize the role of recommendations from trusted sources in motivating booster uptake, and highlight the importance of community engagement to address disparities in vaccination coverage and reach.
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Affiliation(s)
- Rachel S Purvis
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Jennifer L Vincenzo
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Marissa Spear
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Ramey Moore
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | | | | | - Pearl A McElfish
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
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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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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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12
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Andersen JA, Willis DE, Malhis JR, Long CR, McElfish PA. The Association Between Education and Basic Needs Insecurity for Marshallese During the COVID-19 Pandemic. J Racial Ethn Health Disparities 2022; 9:1882-1887. [PMID: 34403123 PMCID: PMC8370049 DOI: 10.1007/s40615-021-01125-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study was to explore the prevalence of basic needs insecurity and to examine the association between education and basic needs insecurity during the COVID-19 pandemic for Marshallese living in the USA. METHODS Survey data describing Marshallese experiences during the pandemic were analyzed using descriptive statistics and complementary log-log regression to test the association between education and basic needs insecurity. RESULTS Marshallese respondents reported no usual source of care (46%), less healthcare (22.3%), and difficulty obtaining medication (34.8%). Nearly 80% reported being food insecure, and 47.5% reported being housing insecure. Marshallese with a high school education or less had higher odds of reporting being food and housing insecure. DISCUSSION Basic needs insecurities are a serious threat to the health of Marshallese during the pandemic. Results from this study can inform interventions addressing food and housing insecurity, access to healthcare, and medication access for Marshallese communities.
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Affiliation(s)
- Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Joseph R Malhis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Christopher R Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA.
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13
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McElfish PA, Riklon S, Purvis RS, Long CR, Felix HC, Hudson JS, Alik D, Henske J, Edem D, O'Connor G, Boyers J, Rowland B, Selig JP. Study protocol for family model diabetes self-management education with Marshallese participants in faith-based organizations. Contemp Clin Trials Commun 2022; 30:101007. [PMID: 36186543 DOI: 10.1016/j.conctc.2022.101007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/25/2022] [Accepted: 09/17/2022] [Indexed: 01/12/2023] Open
Abstract
Background Culturally-appropriate family models of diabetes self-management education and support (DSMES) using community health workers (CHWs) have been shown to help address barriers to improving type 2 diabetes mellitus (T2DM) self-management for racial/ethnic minority communities; however, there is limited DSMES research among Marshallese and other Pacific Islanders. Using a community-based participatory research approach, we engaged community stakeholders to co-design a study to implement a culturally adapted family model DSMES (F-DSMES) intervention in faith-based organizations (FBOs) (i.e., churches). Methods Using a cluster-randomized controlled trial design, we will assess the effectiveness of the F-DSMES intervention for Marshallese patients with T2DM in Arkansas and Oklahoma. Twenty-four FBOs (with 12 primary participants per FBO) will be randomized to one of two study arms: the intervention arm or the wait-list control arm. Primary participants must have at least one family member willing to attend education sessions and data collection events. The F-DSMES intervention consists of ten h of diabetes education delivered by CHWs over eight to ten weeks. Data will be collected from the intervention arm at pre-intervention (baseline), immediate post-intervention (12 weeks), and three months post-intervention. The wait-list control arm will complete a second pre-intervention data collection before receiving the intervention. The primary study outcome will be glycemic control, as measured by HbA1c. Secondary measures include glucose, weight, body mass index, blood pressure, diabetes self-management behaviors, and diabetes management self-efficacy. Conclusion The knowledge gained from this research will inform future DSMES and other health promotion interventions conducted with Marshallese and other Pacific Islander communities.
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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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Ayers BL, Bogulski CA, Bennett-Milburn A, Fisher A, Netwon M, McElfish PA. Dietary Practices during Pregnancy in a Marshallese Community: A Mixed Methods Analysis. Int J Environ Res Public Health 2022; 19:6360. [PMID: 35681944 PMCID: PMC9180099 DOI: 10.3390/ijerph19116360] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 12/10/2022]
Abstract
Dietary practices during pregnancy play a pivotal role in the health of women and their children and set the foundation for long-term health. Marshallese women have disproportionally higher rates of maternal and infant health disparities, yet little is known about the dietary practices during their pregnancy. The purpose of this study was to identify dietary practices during pregnancy among Marshallese women. From March 2019 to March 2020, a purposive sample of 33 pregnant Marshallese participants participated in a mixed methods study. Two primary themes emerged: (1) traditional beliefs about a healthy diet during pregnancy; and (2) dietary change during pregnancy. Within the first theme, four subthemes emerged: (1) should eat; (2) should not eat; (3) challenges to traditional diet; and (4) spiritual dietary customs during pregnancy. Within the second theme, three subthemes emerged: (1) a healthy diet for my baby; (2) autonomy and diet; and (3) sugar-sweetened beverages. The transition in discourse from traditional customs of dietary practices to an individualistic discourse highlights that acculturation is a complex process that should be included in maternal health education and interventions. Findings from this study provide insight into potential considerations for future interventions aiming to improve maternal and child health outcomes among Marshallese.
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Affiliation(s)
- Britni L. Ayers
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, USA; (C.A.B.); (M.N.); (P.A.M.)
| | - Cari A. Bogulski
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, USA; (C.A.B.); (M.N.); (P.A.M.)
| | - Ashlea Bennett-Milburn
- Bell Engineering Center, University of Arkansas Fayetteville, 800 W. Dickson St., Fayetteville, AR 72701, USA;
| | - Anna Fisher
- Department of Pediatrics, The University of Utah, 295 Chipeta Way, Salt Lake City, UT 84103, USA;
| | - Morda Netwon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, USA; (C.A.B.); (M.N.); (P.A.M.)
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, USA; (C.A.B.); (M.N.); (P.A.M.)
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16
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Ayers BL, Purvis RS, White A, CarlLee S, Andersen JA, Bogulski CA, McElfish PA. Best of Intentions: Influential Factors in Infant Feeding Intent among Marshallese Pregnant Women. Int J Environ Res Public Health 2022; 19:ijerph19031740. [PMID: 35162763 PMCID: PMC8834797 DOI: 10.3390/ijerph19031740] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/08/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 01/26/2023]
Abstract
The purpose of this study is to explore the beliefs, intentions, and influences that serve as barriers and facilitators to exclusive breastfeeding intent among Marshallese pregnant women in the United States (US). The study used a descriptive qualitative design. In total, 36 Marshallese women in their third trimester of pregnancy participated. Participants described exclusive breastfeeding as the preferred method of infant feeding, from both individual and community perspectives. Exclusive breastfeeding was viewed as the healthiest for the infant, viewed as offering protection against sickness, and viewed as better for the overall development of the infant. Of the 36 participants, 28 participants (77.8%) stated that their infant feeding intentions included a hybrid of breastfeeding and formula feeding. The dominant barrier to exclusive breastfeeding was the need to work outside of the home. Unexpected barriers to exclusive breastfeeding were the desire for autonomy and a preference to exclusively breastfeed female infants more than male infants. Exclusive breastfeeding facilitators included support from the Special Supplemental Nutrition Program for Women, Infants, and Children and support and encouragement from female family/community members. This study is the first to document beliefs, intentions, and influences that serve as barriers and facilitators to exclusive breastfeeding among Marshallese pregnant women residing in the US.
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Affiliation(s)
- Britni L. Ayers
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA; (R.S.P.); (S.C.); (J.A.A.); (P.A.M.)
- Correspondence: ; Tel.: +1-(479)-713-8662
| | - Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA; (R.S.P.); (S.C.); (J.A.A.); (P.A.M.)
| | - Alexis White
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA;
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA; (R.S.P.); (S.C.); (J.A.A.); (P.A.M.)
| | - Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA; (R.S.P.); (S.C.); (J.A.A.); (P.A.M.)
| | - Cari A. Bogulski
- Office of Community Health and Research, 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; (R.S.P.); (S.C.); (J.A.A.); (P.A.M.)
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Ayers BL, Bogulski CA, Andersen JA, Børsheim E, McElfish PA. Gestational weight gain influences, beliefs, and goals among Marshallese pregnant women in Arkansas: a mixed-methods analysis. Am J Transl Res 2021; 13:13993-14004. [PMID: 35035741 PMCID: PMC8748145] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/09/2021] [Indexed: 06/14/2023]
Abstract
Despite the high rate of maternal and child health disparities among the Marshallese, there are no studies documenting gestational weight gain influences, beliefs, and goals among the Marshallese. From March 2019 to March 2020, a purposive sample of 33 participants took part in the mixed methods study. Two themes emerged: (1) Gestational Weight Gain Influences and (2) Excessive Gestational Weight Gain Perceptions. In the first theme there were three subthemes: (a) Church and Familial Influence on Gestational Weight Gain; (b) Healthy Gestational Weight Gain; and (c) Lack of Healthcare Provider Influence on Gestational Weight Gain. In the second theme there were three subthemes: (a) Excessive Weight Gain and Pregnancy; (b) Excessive Gestational Weight Gain and Labor; and (c) Gestational Weight Gain Goals. This study will be used to culturally tailor interventions to help Marshallese women reduce maternal and infant health disparities in Marshallese communities.
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Affiliation(s)
- Britni L Ayers
- College of Medicine, University of Arkansas for Medical Sciences NorthwestFayetteville, AR 72703, USA
| | - Cari A Bogulski
- College of Medicine, University of Arkansas for Medical Sciences NorthwestFayetteville, AR 72703, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences NorthwestFayetteville, AR 72703, USA
| | - Elisabet Børsheim
- Arkansas Children’s Nutrition Center, University of Arkansas for Medical SciencesLittle Rock, AR 72212, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences NorthwestFayetteville, AR 72703, USA
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18
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Nguyen-Truong CKY, Davis A, Vuong VMN, Nguyen KQV, Truong AM, Leung J. Perceptions, Beliefs, and Experiences of Asians and Micronesian Islanders on Family Health History Genetic Cancer Screening Community Outreach. J Cancer Educ 2021; 36:1341-1353. [PMID: 34495435 PMCID: PMC8425315 DOI: 10.1007/s13187-021-02085-0] [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] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 06/13/2023]
Abstract
Cancer carries stigma, taboos, and shame including, for diverse communities, who can have difficulty understanding and communicating about family health history genetic cancer screening (GCS). The Oregon Health Authority ScreenWise Program reached out to our academic-community research team to explore Asians and Micronesian Islanders (MI) perceptions on public health education outreach on GCS due to having previously only worked with the Latinx community. The purpose of the qualitative description pilot study was to elicit perceptions, beliefs, experiences, and recommendations from Asian and MI community leaders and community members regarding family health history GCS outreach in communities. Twenty Asians (Chinese and Vietnamese) and Micronesian Islanders (Chuukese and Marshallese) were recruited from the US Pacific Northwest. Nineteen participants are immigrants with an average 21.4 and 18.5 years having lived in the USA, respectively. Individual in-depth interviews were conducted using a semi-structured, open-ended interview guide and analyzed using conventional content analysis. Three main transcultural themes were identified: (1) degree of knowing and understanding cancer screening versus family health history GCS, (2) needing culturally relevant outreach messaging on family health history GCS, and (3) communication and decision-making regarding discussing with family and health care providers about cancer screening and GCS. Culturally relevant messaging rather than generic messaging is needed for inclusive outreach. Healthcare providers are encouraged to assess a client's family health history routinely because Asian and MI clients may not understand the information requested, may be hesitant to offer, or unable to provide information about their personal or family history of cancer.
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Affiliation(s)
| | - Andra Davis
- School of Nursing, University of Portland, Portland, OR, USA
| | | | | | | | - Jacqueline Leung
- Micronesian Islander Community, Salem, OR, USA
- Health Human Performance, and Athletics with an emphasis in Public Health, Linfield University, Salem, OR, USA
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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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Rowland B, Bogulski CA, Willis DE, Scott AJ, Gloster EE, Andersen JA. Experiences of Marshallese Food Processing Workers during the COVID-19 Pandemic. J Agromedicine 2021; 27:292-302. [PMID: 34736373 DOI: 10.1080/1059924x.2021.2002222] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The goal of this study was to conduct an exploratory assessment of COVID-19 mitigation steps and compare workplace experiences during the COVID-19 pandemic with Marshallese workers in other occupations. Marshallese adults residing in the continental United States (US) and Hawaii took part in an online survey. The sample was divided into two categories: food processing workers and workers in all other occupations. To examine differences between food processing workers and workers from all other occupations, we used Wilcoxon-Mann-Whitney U tests and Fisher's Exact tests. Of those employed at the time of the survey (n = 113), 31 were employed in food processing plants, and 82 were employed in another occupation. Food processing workers and workers in other occupations differed significantly on level of education, length of residence in the US, English-speaking ability, and health literacy. More food processing workers reported that their employers installed barriers or provided shields (45%), provided temperature screenings (71%), and tested for COVID-19 (61%) compared with those in other occupations. A larger proportion of food processing workers reported having no sick leave compared with workers in other occupations, although they reported COVID-19 testing and being insured at similar rates. This is the first study to examine Marshallese food processing workers' experiences during the COVID-19 pandemic. Our findings show that while some food processing employers implemented government-recommended guidelines to prevent the spread of COVID-19, preventative and protective measures were not comprehensively applied across the food processing industry, despite efforts by public health agencies and community partners.
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Affiliation(s)
- Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Cari A Bogulski
- Office of Community Health and Research, 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
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Erin E Gloster
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
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Wang ML, McElfish PA, Long CR, Lee MS, Bursac Z, Kozak AT, Ko LK, Kulik N, Yeary KHCK. BMI and related risk factors among U.S. Marshallese with diabetes and their families. Ethn Health 2021; 26:1196-1208. [PMID: 31288554 PMCID: PMC6952582 DOI: 10.1080/13557858.2019.1640351] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/28/2019] [Indexed: 06/09/2023]
Abstract
Objective: Examine cross-sectional associations between body mass index (BMI) and related health behaviors, barriers and facilitators to health care, and perceived health status among a sample of U.S. Marshallese adults with Type 2 diabetes and evaluate associations of interest between participants and their family members.Design: Cross-sectional baseline data were analyzed from participants in a diabetes self-management education intervention trial.Setting: Data collection took place in home or community settings through a community-academic partnership in Arkansas.Participants: Study participants consisted of U.S. Marshallese adults with Type 2 diabetes (N = 221) and their family members (N = 211) recruited through community settings.Intervention(s): N/A.Main Outcome Measure(s): Participants' height and weight were measured using standard protocols to calculate BMI (kg/m2). Diet, physical activity, health care access, financial strain related to health care, perceived health status, and health care satisfaction were measured using self-report surveys.Results: Participants' mean BMI was 31.0 (95% CI: 30.2-31.7), with over half of study participants and their family members' BMI falling in the obese category. Participants' BMI was positively associated with spreading health care bill payments over time (β = 1.75 (SE = 0.87); p = 0.045). Positive associations between participants and their family members were observed for self-reported health status conditions, health care coverage, health care utilization, and health care satisfaction.Conclusion: Study findings highlight the high prevalence of obesity and related risk factors among U.S. Marshallese adults with Type 2 diabetes and emphasize the need for intervention strategies that build upon cultural strengths and target community, policy, systems, and environmental changes to address obesity and chronic disease in this marginalized community.
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Affiliation(s)
- Monica L. Wang
- Department of Community Health Sciences, Boston University School of Public Health
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest
| | | | - Morgan S Lee
- Health Sciences, Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado-Colorado Springs
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University
| | | | - Linda K. Ko
- Department of Health Services, University of Washington School of Public Health
| | - Noel Kulik
- College of Education, Wayne State University
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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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Ayers BL, Bogulski CA, Haggard-Duff L, Selig JP, McElfish PA. A mixed-methods longitudinal study of Marshallese infant feeding beliefs and experiences in the United States: a study protocol. Int Breastfeed J 2021; 16:64. [PMID: 34454559 PMCID: PMC8401343 DOI: 10.1186/s13006-021-00412-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/16/2021] [Indexed: 11/12/2022] Open
Abstract
Background Arkansas has the largest population of Marshallese Pacific Islanders residing in the continental United States. Marshallese are disproportionately burdened by poorer maternal and infant health outcomes. Exclusive breastfeeding can prevent or help mitigate maternal and infant health disparities. However, exclusive breastfeeding among United States Marshallese communities remains disproportionately low, and the reasons are not well documented. This paper describes the protocol of a mixed-methods concurrent triangulation longitudinal study designed to explore the beliefs and experiences that serve as barriers and/or facilitators to exclusive breastfeeding intention, initiation, and duration among Marshallese mothers in northwest Arkansas. Methods The mixed-methods design collects qualitative and quantitative data during simultaneous data collection events, at third trimester, six weeks postpartum, and six months postpartum. Quantitative and qualitative data will be analyzed separately and then synthesized during the interpretation phase. The research team will disseminate results to study participants, research stakeholders, the broader Marshallese community, and fellow researchers. Discussion Findings and results will be presented in subsequent manuscripts upon completion of the study. This study will be an important first step to better understand beliefs and experiences to exclusive breastfeeding intention, initiation, and duration in this community and will inform tools and interventions to help improve health outcomes. The study will also aid in filling the gap in research and providing essential information on the infant feeding beliefs and barriers among a Marshallese community in Arkansas. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-021-00412-1.
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Affiliation(s)
- Britni L Ayers
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA.
| | - Cari A Bogulski
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Lauren Haggard-Duff
- College of Nursing, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
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24
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McElfish PA, Andersen JA, Felix HC, Purvis RS, Rowland B, Scott AJ, Chatrathi M, Long CR. Relationship between sleep duration and quality and glycated hemoglobin, body mass index, and self-reported health in Marshallese adults. Sleep Health 2021; 7:332-338. [PMID: 33707104 DOI: 10.1016/j.sleh.2021.01.007] [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: 09/16/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To document sleep duration and sleep quality among a sample of Marshallese adults and to examine if sleep duration and quality are associated with type 2 diabetes, body mass index (BMI), and self-reported health in the Marshallese population. DESIGN Cross-sectional analysis of a staff-administered survey. SETTING Thirty Marshallese churches in Arkansas and Oklahoma. PARTICIPANTS The study includes 378 Marshallese participants, 56.6% female, with a mean age of 42.4 years (±11.6). Recruitment was limited to participants who were considered overweight, with a BMI >25 kg/m2. MEASURES Staff-administered surveys were used to collect data on sleep duration, sleep quality, and self-reported health. Clinical measures were collected by trained research personnel using standard tools and protocols. Kruskal-Wallis tests, Spearman's correlations, and nonparametric tests of trends were used to evaluate differences in HbA1c, BMIc, and self-reported health by sleep duration and quality. Multivariable analyses were used to test the associations, controlling for sociodemographic factors. RESULTS Fifty-four percent of the participants reported something other than normal sleep duration and 52.4% reported at least 1 night of difficult or interrupted sleep in the previous 2-week period. Longer sleep duration was associated with lower HbA1c and poorer sleep quality was associated with higher HbA1c. Poor sleep quality was associated with lower self-reported health. However, neither sleep duration nor quality was associated with BMI. The associations were found independent of sociodemographic factors. CONCLUSION This is the first study to document sleep duration and sleep quality, as well as the first study to examine the relationship between sleep and HbA1c, BMI, and self-reported health in Marshallese adults with a BMI >25 kg/m2. This research will be used to help develop sleep interventions to address type 2 diabetes health disparities in the Marshallese community.
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA.
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Rachel S Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Meena Chatrathi
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Christopher R Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
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25
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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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McElfish PA, Scott AJ, Chatrathi HE, Rowland B, Long CR, Nagarsheth N, Calcagni M, Patolia J, Haggard-Duff LK, Selig JP. Undiagnosed Hypertension and Undiagnosed Type 2 Diabetes among Overweight and Obese Marshallese Participants in a Diabetes Prevention Program. Yale J Biol Med 2021; 94:5-12. [PMID: 33795978 PMCID: PMC7995951] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypertension and type 2 diabetes (T2D) are major public health issues that disproportionately affect minority communities, including Native Hawaiians and Pacific Islanders (NHPI). Minority communities are also more likely to have undiagnosed hypertension and T2D. Marshallese Pacific Islanders have been shown to have high proportions of diagnosed and undiagnosed hypertension and T2D. Using survey and biometric data collected from 378 overweight/obese Marshallese Pacific Islander adults, this study documents the prevalence of hypertension and T2D, as well as the prevalence of undiagnosed hypertension and T2D. The study also examines associations between undiagnosed hypertension and undiagnosed T2D and age group, sex, health care access (defined by foregone care due to cost and health insurance status), and body mass index (BMI). Among participants with blood pressure readings indicative of hypertension, 68.4% were undiagnosed, and among participants with HbA1c indicative of T2D, 31.6% were undiagnosed. A quarter of participants (24.5%) had blood pressure and HbA1c measures indicative of both undiagnosed hypertension and undiagnosed T2D. Undiagnosed hypertension was significantly associated with age group (p's<0.0001) and sex (p=0.028). Undiagnosed T2D was significantly associated with age group (p's<0.05), forgone care due to cost (p=0.018), health insurance status (p=0.035), and BMI (p=0.001). Participants in this study had high proportions of undiagnosed hypertension and undiagnosed T2D. These findings will be immediately useful for those working to address hypertension and T2D disparities among Marshallese and other NHPI populations.
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Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Aaron J. Scott
- Office of Community Health and Research, University of
Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Harish E. Chatrathi
- Office of Community Health and Research, 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
| | - Christopher R. Long
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Nirav Nagarsheth
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Mikaila Calcagni
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Jay Patolia
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Lauren K. Haggard-Duff
- College of Nursing, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - James P. Selig
- Department of Biostatistics, University of Arkansas for
Medical Sciences, Little Rock, AR, USA
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Andersen JA, Felix HC, Eswaran H, Payakachat N, Willis DE, Bogulski C, McElfish PA. Factors Associated with First-Time Telehealth Utilization for Marshallese Living in the United States. Telemed Rep 2021; 2:217-223. [PMID: 34841421 PMCID: PMC8621619 DOI: 10.1089/tmr.2021.0023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 05/07/2023]
Abstract
Background: Mitigation efforts to prevent the spread of COVID-19 included the robust utilization of telehealth. However, racial/ethnic minority populations have demonstrated low telehealth utilization in the past. The aim of this study was to examine the first-time use of telehealth by Marshallese adults during the COVID-19 pandemic, using online survey data collected from 109 Marshallese respondents between July and November of 2020. Methods: To evaluate the relationships between sociodemographic characteristics, health care access, physical/mental health, and COVID-19-specific measures and the decision to use telehealth, we use bivariate analyses, including t-tests and chi-square analysis. Results: Eighteen respondents (16.5%) indicated they utilized telehealth for the first time during the pandemic. The number of chronic conditions reported was positively associated with the first-time use of telehealth (p = 0.013). Although not statistically significant, a higher proportion of Marshallese first-time telehealth users reported limited English proficiency, changes in health status, and changes in health insurance. Discussion: Although telehealth has been shown to reduce the absolute gaps in health disparities for minority populations, there is limited utilization by Marshallese communities. Conclusions: Significant research remains on the utilization of telehealth by Marshallese during the COVID-19 pandemic and to increase utilization in the future.
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Affiliation(s)
- Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Holly C. Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hari Eswaran
- Institute of Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nalin Payakachat
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Cari Bogulski
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
- *Address correspondence to: Pearl A. McElfish, PhD, MBA, College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR 72703, USA,
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McElfish PA, Chughtai A, Low LK, Garner R, Purvis RS. 'Just doing the best we can': health care providers' perceptions of barriers to providing care to Marshallese patients in Arkansas. Ethn Health 2020; 25:1004-1017. [PMID: 29726695 PMCID: PMC6215735 DOI: 10.1080/13557858.2018.1471670] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/26/2018] [Indexed: 06/08/2023]
Abstract
Introduction: Marshallese migrating to the United States encounter challenges in accessing health care. Previous literature has investigated Marshallese participants' perceptions of the barriers they face in accessing health care. For this study, health care providers managing the care of Marshallese patients were interviewed to understand the providers' perception of barriers that their Marshallese patients encounter. Methods: A qualitative research design was utilized to explore health care providers' perceptions of and experiences with the barriers faced by their Marshallese patients when accessing the US health care system. Results: The primary barriers identified were: (1) economic barriers; (2) communication challenges; (3) difficulty understanding and navigating the western health care system; and (4) structural and system barriers. Conclusion: This study provides insight on the barriers Marshallese patients face in accessing health care as well as the barriers providers face in delivering care to Marshallese patients. A better understanding of these barriers can help health care providers and educators to begin initiating improvements in the delivery of care to Marshallese patients.
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Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703 USA
| | - Almas Chughtai
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703 USA
| | - Lisa K. Low
- Community Health, Mercy Hospital Northwest Arkansas, 2710 S. Rife Medical Ln, Rogers, AR, 72758 USA
| | - Robert Garner
- College of Medicine, 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
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Nembhard WN, Ayers BL, Collins RT, Shan X, Rabie NZ, Chang D, Robbins JM, McElfish PA. Adverse Pregnancy and Neonatal Outcomes Among Marshallese Women Living in the United States. Matern Child Health J 2020; 23:1525-1535. [PMID: 31228148 DOI: 10.1007/s10995-019-02775-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/24/2022]
Abstract
Objective Despite heterogeneity among Pacific Islanders, most studies aggregate them regardless of origin. Thus, limited information is available about perinatal outcomes among various subgroups of Pacific Islanders in the United States, including immigrants from the Republic of the Marshall Islands. We sought to evaluate perinatal outcomes among Marshallese women. Methods We conducted a cross-sectional study of women with at least one singleton live birth between 1997 and 2013 in two Arkansas counties using birth certificate data from the Arkansas Department of Health. Unadjusted and adjusted prevalence ratios (PR) and 95% confidence intervals (CI) were calculated from modified Poisson regression models. Results Of the 91,662 singleton births in both counties during the study period, 2488 were to Marshallese women. In adjusted analyses, Marshallese women had higher prevalence of "other medical risk factors" (PR = 1.47; 95% CI 1.30, 1.65) than NH White women. Marshallese women had higher rates of precipitous labor and fetal distress during labor compared to NH White women (PR = 2.65; 95% CI 2.22, 3.17 and 1.89; 95% CI 1.62, 2.21, respectively). Marshallese were also more likely to have tocolysis (PR = 1.43; 95% CI 1.16, 1.76), forceps (PR = 1.68; 95% CI 1.16, 2.43) or vacuum (PR = 1.89; 95% CI 1.60, 2.22) used in delivery and cesarean section (PR = 1.13; 95% CI 1.01, 1.27). Marshallese infants had higher rates of anemia (PR = 3.10; 95% CI 2.01, 4.77), birth injury (PR = 2.13; 95% CI 1.50, 3.03), assisted ventilation < 30 min (PR = 2.11; 95% CI 1.64, 2.71), preterm birth (PR = 1.67; 95% CI 1.50, 1.83), and small-for-gestational age (PR = 1.25; 95% CI 1.12, 1.39) than NH White infants. Conclusions Marshallese women and infants had higher rates of adverse perinatal outcomes compared to their NH White counterparts. Additional studies are needed to determine if perinatal outcomes among the Marshallese differed from other Pacific Islander subgroups.
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Affiliation(s)
- Wendy N Nembhard
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #820, Little Rock, AR, 72205-7199, USA. .,Arkansas Children's Research Institute, Little Rock, AR, USA.
| | - Britni L Ayers
- College of Medicine, University of Arkansas for Medical Science, Fayetteville, AR, USA
| | - R Thomas Collins
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Xiaoyi Shan
- Arkansas Children's Research Institute, Little Rock, AR, USA.,Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nader Z Rabie
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tripler Army Medical Center, Honolulu, HI, USA
| | - Di Chang
- Arkansas Center for Health Improvement, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - James M Robbins
- Arkansas Children's Research Institute, Little Rock, AR, USA.,Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Science, Fayetteville, AR, USA
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McElfish PA, Long CR, Scott AJ, Hudson JS, Haggard-Duff L, Holland A, Schulz TK, Wilmoth RO, Selig JP. Pilot Implementation of Adapted-Family Diabetes Self-Management Education Into a Clinical Setting. J Prim Care Community Health 2020; 11:2150132720931289. [PMID: 32517573 PMCID: PMC7288836 DOI: 10.1177/2150132720931289] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 12/14/2022] Open
Abstract
Objectives: Marshallese are a Pacific Islander community that experience a disproportionate rate of type 2 diabetes. The purpose of this study is to evaluate the preliminary effectiveness and feasibility of an Adapted-Family Diabetes Self-Management Education (DSME) intervention among Marshallese adults diagnosed with type 2 diabetes and their family members when delivered in a clinical setting. Methods: Marshallese patients (primary participants) with type 2 diabetes (n = 10) and their family members (n = 10) enrolled in a pilot study deigned to evaluate an Adapted-Family DSME curriculum conducted by community health workers and a certified diabetes educator in a clinical setting. Primary and family participants' health information and biometric data (HbA1c, blood pressure, cholesterol, and body mass index) were collected at preintervention and 12 weeks postintervention. Results: All 10 primary participants and 8 of the family members received all 10 hours of the education intervention. Nine of the 10 primary participants and 8 of the 10 family members completed the pre- and postintervention data collection events. Primary participants demonstrated a mean decrease in HbA1c of 0.7%, from pre- to postintervention, as well as improved blood pressure and cholesterol. Family members demonstrated minor improvements in HbA1c and blood pressure. Conclusions: Results suggest preliminary effectiveness and feasibility of the Adapted-Family DSME in a clinic setting and will inform implementation of a fully powered study.
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Affiliation(s)
- Pearl A. McElfish
- University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Christopher R. Long
- University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Aaron J. Scott
- University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Jonell S. Hudson
- University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Lauren Haggard-Duff
- University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Angel Holland
- University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Thomas K. Schulz
- University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Ralph O. Wilmoth
- University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - James P. Selig
- University of Arkansas for Medical
Sciences, Little Rock, AR, USA
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Nguyen-Truong CKY, Leung J, Micky K. Cultural Narratives of Micronesian Islander Parent Leaders: Maternal and Children's Health, the School System, and the Role of Culture. Asian Pac Isl Nurs J 2020; 4:173-182. [PMID: 32055685 PMCID: PMC7014378 DOI: 10.31372/20190404.1078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: In Oregon in the United States' Pacific Northwest, Native Hawaiians/Pacific Islanders including Micronesian Islanders (MI) substantially grew by 68%; however, research is sparse. This is often due to data aggregation as Asian and Pacific Islanders and community members' reluctance and wariness to participate in research due to a history of unethical research in the Pacific. The MI community experienced miscarriages, stillbirths, and intellectual and developmental disabilities. Organizational MI community leaders expressed a need to explore the voices of MI parent leaders (MIPLs). The purpose of the community-based participatory qualitative descriptive pilot study was to explore the perceptions and experiences of MIPLs with maternal and children's health, the school system, and the influence of culture. Methods: A trained MI community health worker recruited eight MIPLs from an urban area of the Pacific northwest in the United States. A group level assessment included illustrative storytelling and is a participant-driven qualitative method that guided data collection and analysis with real-time involvement with MIPL. The discussions lasted for 90 minutes. MIPL shared stories by writing and drawing pictures onto the flip chart papers, transcribed main points, and analyzed the data with researchers. Researchers recorded field notes of the interactions. Researchers debriefed with MIPL to assure trustworthiness and credibility of the findings. Findings: MIPL are Compact of Free Association citizens. Their age ranged from 26 to 42 years, have lived in the United States an average of 12.63 years, and most reported having less than $15,000 total household income before taxes. Four main themes were identified: MI cultural identity, English language and MI culture disharmony, zero or delayed prenatal care, and uncertainty for the future of MI children who have disabilities or developmentally delayed as they progress through the school system. Conclusion: Health care providers including nurses and school officials need to have a culturally specific understanding of the MI community and must consider their needs, culture, and language barriers.
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Affiliation(s)
- Connie Kim Yen Nguyen-Truong
- Dr. Nguyen-Truong and Dr. Leung are co-first authors.
- Washington State University College of Nursing-Vancouver, Washington, United States
| | - Jacqueline Leung
- Dr. Nguyen-Truong and Dr. Leung are co-first authors.
- Micronesian Islander Community
- Oregon State University, College of Public Heath and Human Sciences in Global Health, Oregon, United States
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McElfish PA, Smith L, Sparks K, Bing WI, Lang S, Estes A, Stephens M. A Community-Based Participatory Approach to Promote Healthy Eating Among Marshallese. Hawaii J Health Soc Welf 2019; 78:332-337. [PMID: 31723940 PMCID: PMC6848001] [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: 06/10/2023]
Abstract
This article describes changes made to the menu served during the 2015 Marshallese May Day celebration in Northwest Arkansas, an annual Marshallese community event. The menu changes were part of a community-based participatory collaborative to improve nutrition and health in the Marshallese community. The 2015 May Day menu significantly reduced the 2014 May Day menu amount of calories, fat, carbohydrates, sodium, and cholesterol of foods offered by incorporating healthier ingredients and reducing portion sizes. Compared to the 2014 May Day menu, the total caloric value of the revised menu was reduced by more than 63%, declining from 1369 calories to 499 calories. The menu change affected an estimated 1,800 Marshallese in attendance for the 2015 May Day celebration. The successful implementation of the menu changes, which resulted in reductions in calories, fat, carbohydrates, sodium, and cholesterol offered to participants demonstrates the effectiveness of community-based participatory approaches in the implementation of policy, systems, and environmental strategies to promote health.
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Affiliation(s)
- Pearl Anna McElfish
- Pearl Anna McElfish PhD, MBA, MS; Office of Community Health and Research, 1125 N. College Ave Fayetteville, AR 72703;
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Ayers BL, Purvis RS, Bing WI, Ritok M, Iban A, Capelle L, Hawley NL, Delafield R, McElfish PA. Maternal Health Beliefs, Perceptions, and Experiences in a U.S. Marshallese Community. J Transcult Nurs 2019; 31:144-152. [PMID: 31184295 DOI: 10.1177/1043659619854525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: The purpose of this article is to review the beliefs, perceptions, and experience of maternal health among Marshallese women. Methodology: The study utilized a qualitative descriptive design with a brief survey of participant demographics. A purposive sample of 43 participants were enrolled. Results: The mean age of participants was 40 years. Four a priori themes were identified as follows: (a) family planning beliefs and experiences, (b) prenatal beliefs and experiences, (c) birthing beliefs and experiences, and (d) postpartum beliefs and experiences. Discussion: This study identified beliefs, perceptions, and experiences among Marshallese that have implications for policy and practice related to culturally congruent health care for Marshallese mothers.
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Affiliation(s)
- Britni L Ayers
- University of Arkansas for Medical Sciences, Fayetteville, AR, USA
| | - Rachel S Purvis
- University of Arkansas for Medical Sciences, Fayetteville, AR, USA
| | | | - Mandy Ritok
- University of Arkansas for Medical Sciences, Fayetteville, AR, USA
| | - Anita Iban
- Springdale School District, Springdale, AR, USA
| | - Lucy Capelle
- Arkansas Coalition for the Marshallese, Springdale, AR, USA
| | | | | | - Pearl A McElfish
- University of Arkansas for Medical Sciences, Fayetteville, AR, USA
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Ayers BL, Shreve MD, Scott AL, Seaton VA, Johnson KV, Hawley NL, Rowland B, Moore R, McElfish PA. Social and economic influences on infant and child feeding practices in a Marshallese community. Public Health Nutr 2019; 22:1461-70. [PMID: 30793680 DOI: 10.1017/S1368980018004007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The present study aimed to examine the key influences on infant and child feeding practices among a Marshallese community at each social ecological level. It is the first study to examine the key influences on infant and child feeding practices with Marshallese immigrant women in the USA and helps fill a gap in the previous literature that has included other immigrant women. DESIGN Community-based participatory research design with twenty-seven participants taking part in four qualitative focus groups. SETTING The study took place within the Marshallese community in Arkansas, USA.ParticipantsParticipants included Marshallese women with children aged 1-3 years and/or caregivers. Caregivers were defined as someone other than the parent who cares for children. Caregivers were often older women in the Marshallese community. RESULTS There were five primary themes within multiple levels of the Social Ecological Model. At the intrapersonal level, mothers' and caregivers' autonomy emerged. At the interpersonal level, child-led and familial influences emerged. At the organizational level, health-care provider influences emerged; and at the policy level, the Special Supplemental Nutrition Program for Women, Infants, and Children emerged as the most salient influence. CONCLUSIONS Marshallese immigrant women's infant and child feeding practices are influenced at intrapersonal, interpersonal, organizational and policy levels. Understanding these multidimensional influences is necessary to inform the creation of culturally tailored interventions to reduce health disparities within the Marshallese community.
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Johnson KV, Scott AL, Shreve M, Ayers BL, Seaton VS, McElfish PA. Marshallese Beliefs, Perceptions, and Practices Related to Child Feeding Among Marshallese in the United States: Implications for Childhood Obesity. Nutr Metab Insights 2019; 12:1178638819827609. [PMID: 30799933 PMCID: PMC6378467 DOI: 10.1177/1178638819827609] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/26/2018] [Indexed: 12/29/2022] Open
Abstract
Introduction: Obesity affects more than 40 million children globally. Efforts to promote proper nutrition in an attempt to reduce childhood obesity should consider maternal beliefs and cultural customs around food. Little is known regarding child feeding, including weaning practices and foods consumed in the first years of life among Marshallese children, a sub-group of Pacific Islanders, residing in the United States. Methods: This study aims to explore the influences on introduction of complementary foods among Marshallese mothers and caregivers residing in the United States, to serve as the basis for promotion of improved nutrition. Focus groups and demographic surveys were conducted with Marshallese mothers and caregivers (N = 27) to explore child-feeding beliefs, perceptions, and practices. Results: All mothers reported breastfeeding their infants, and 80% reported using some type of milk supplementation. There was a difference in mother and caregiver responses regarding which first foods to introduce and average age of introduction. Discussion: Analysis revealed three themes identified as being influential for child-feeding practices: Marshallese breastfeeding customs, introduction of solid foods, and Marshallese family feeding customs.
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Affiliation(s)
| | | | | | - Britni L Ayers
- University of Arkansas for Medical Sciences, Fayetteville, AR, USA
| | | | - Pearl A McElfish
- University of Arkansas for Medical Sciences, 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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Seaton VA, Dickey TA, Balli ML, Briggs BE, Baker JD, Hudson JS. Rate of positive depression screenings among Marshallese patients with diabetes in Northwest Arkansas. Ment Health Clin 2019; 9:36-40. [PMID: 30627502 PMCID: PMC6322817 DOI: 10.9740/mhc.2019.01.036] [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] [Indexed: 11/13/2022] Open
Abstract
Introduction The lifetime risk of developing depression is 16.6%, however the risk is 2-fold in patients with diabetes. The rate of diabetes is much higher for the Marshallese than the general US population, with a prevalence ranging from 25% to 50%, however the prevalence of depression is not well defined among this minority group. The primary objective of this study was to obtain the rate of positive depression screenings, using the Patient Health Questionnaire-2 (PHQ-2), among adult Marshallese patients with diabetes. Methods A retrospective chart review was performed for Marshallese adults receiving care in a student-led clinic in Northwest Arkansas. Marshallese adults with a documented PHQ-2 score and a diagnosis of type 1 or 2 diabetes, as outlined by the American Diabetes Association, were included. Demographic information was obtained from the medical records. The data were analyzed using descriptive statistics. Results The study included 96 patients. Ten patients scored a 3 or higher on the PHQ-2, indicating a positive screen. Of these, scores ranged from 3 to 6, with the majority of patients scoring 4 (N = 6). The average hemoglobin A1C for patients with a positive PHQ-2 score was 10.5%. Discussion This project identified a rate of 10.4% of patients with a positive PHQ-2 from the study sample. This finding is similar to the prevalence of depression for the general US population, however it is lower than rates cited in the literature for patients diagnosed with diabetes. Future studies should use Native Marshallese community health workers and focus groups to develop a multistep approach to obtain a culturally appropriate, translated tool with high sensitivity for patient response.
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Affiliation(s)
- Victoria A Seaton
- Assistant Professor, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, College of Pharmacy, Fayetteville, Arkansas,
| | - Tiffany A Dickey
- Assistant Professor, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, College of Pharmacy, Fayetteville, Arkansas
| | - Michelle L Balli
- Assistant Professor, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, College of Pharmacy, Fayetteville, Arkansas
| | - Bradley E Briggs
- Student, University of Arkansas for Medical Sciences, College of Pharmacy, Fayetteville, Arkansas
| | - Jessicca D Baker
- Student, University of Arkansas for Medical Science, College of Pharmacy, Fayetteville, Arkansas
| | - Jonell S Hudson
- Associate Professor, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, College of Pharmacy, Fayetteville, Arkansas
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Felix H, Rowland B, Long CR, Narcisse MR, Piel M, Goulden PA, McElfish PA. Diabetes Self-Care Behaviors Among Marshallese Adults Living in the United States. J Immigr Minor Health 2018; 20:1500-1507. [PMID: 29243017 DOI: 10.1007/s10903-017-0683-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 11/28/2022]
Abstract
Marshallese experience high rates of type 2 diabetes. Proper management of diabetes requires multiple self-care behaviors, yet little is known about Marshallese's diabetes-related self-care behaviors. Survey data from 111 Marshallese adults with diabetes were used to examine relationships between self-care behaviors and socio-demographic characteristics. The most common self-care behavior was attending annual doctor visits, while the least common was maintaining a normal weight. Age group, education level, and having a regular doctor were significantly associated with engaging in self-care behaviors. Having a regular doctor had the most effect on performing self-care behaviors (p = 0.006); although, only 38.7% reported having a regular doctor. To minimize diabetes-related complications, efforts to improve self-care behaviors among the Marshallese should be developed. Alternatives to traditional healthcare providers, such as community health workers, may be a viable strategy with this population given only one-third reported having a regular doctor.
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Affiliation(s)
- Holly Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Brett Rowland
- 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
| | - Marie-Rachelle Narcisse
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Michelle Piel
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Peter A Goulden
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA.
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Abstract
CONTEXT Arkansas currently has the largest Marshallese community in the continental US. The limited research available demonstrates that Marshallese have significant health disparities, with higher rates of obesity, diabetes, cardiovascular disease and infectious diseases than the US population. OBJECTIVES The purpose of this paper is 2-fold: (1) to describe the formation and capacity building efforts of a community-based participatory research partnership with the Marshallese community in Arkansas and (2) to describe key findings and lessons learned from 5 years of collaborative research. METHODS A community-based participatory research approach was implemented to build alliances and improve health disparities in a Marshallese community. RESULTS Overarching lessons learned from collaboration with the Marshallese community include the: (1) Intensive involvement of Marshallese from multiple sectors of the community and in multiple roles in the research process, (2) Importance of interprofessional teams, (3) Importance of church, (4) Consideration of sex, (5) Importance of family and definition of family, (6) Talk Story and qualitative methods and the (7) Importance of cultural humility. CONCLUSIONS This research helps fill important gaps in documenting the health disparities and interventions to address those disparities in the Marshallese community.
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Affiliation(s)
- Pearl A McElfish
- a Office of Community Health and Research , University of Arkansas for Medical Sciences, Northwest Campus , Fayetteville , AR , USA
| | - Ramey Moore
- b Department of Anthropology , University of Arkansas , Fayetteville , AR , USA
| | - Melisa Laelan
- c Arkansas Coalition of Marshallese , Springdale , AR , USA
| | - Britni L Ayers
- a Office of Community Health and Research , University of Arkansas for Medical Sciences, Northwest Campus , Fayetteville , AR , USA
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Ayers BL, Purvis RS, Bing WI, Rubon-Chutaro J, Hawley NL, Delafield R, Adams IK, McElfish PA. Structural and Socio-cultural Barriers to Prenatal Care in a US Marshallese Community. Matern Child Health J 2018; 22:1067-1076. [PMID: 29470813 DOI: 10.1007/s10995-018-2490-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives Pacific Islanders are disproportionately burdened by poorer perinatal health outcomes with higher rates of pre-term births, low birth weight babies, infant mortality, and inadequate or no prenatal care. The aim of this study is to examine Marshallese mothers' beliefs, perceptions, and experiences of prenatal care and to identify potential barriers. Methods Three focus groups were conducted with Marshallese mothers, who were 18 years or older, and living in Arkansas. Focus groups focused on mothers' beliefs, perceptions, and experiences of prenatal care. A thematic qualitative analysis was conducted to identify salient themes within the data. Results The results demonstrated that negotiating health insurance, transportation, and language barriers were all major structural barriers that constrain prenatal care. The social-cultural barriers that emerged included a lack of understanding of the importance of seeking early and consistent prenatal care, as well as how to navigate the healthcare process. The more complicated challenges that emerged were the feelings of shame and embarrassment due to the perception of their age or being unmarried during pregnancy not being acceptable in American culture. Furthermore, the participants described perceived discrimination from prenatal care providers. Lastly, the participants described fear as a barrier to seeking out prenatal care. Conclusions for Practice This study identified both structural and socio-cultural barriers that can be incorporated into suggestions for policy makers to aid in alleviating maternal health disparities among Pacific Islander women. Further research is needed to address the Marshallese mothers' perceived discrimination from maternal health care providers.
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Affiliation(s)
- 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
| | - Rachel S Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, 1125 N. College Ave, Fayetteville, AR, 72701, USA
| | - Williamina Ioanna Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, 1125 N. College Ave, Fayetteville, AR, 72701, USA
| | - Jellesen Rubon-Chutaro
- 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
| | - Rebecca Delafield
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Ingrid K Adams
- Department of Nutrition & Food Science, University of Kentucky, Lexington, KY, USA
| | - Pearl Anna McElfish
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, 1125 N. College Ave, Fayetteville, AR, 72701, USA.
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Ayers BL, Hawley NL, Purvis RS, Moore SJ, McElfish PA. Providers' perspectives of barriers experienced in maternal health care among Marshallese women. Women Birth 2017; 31:e294-e301. [PMID: 29126795 DOI: 10.1016/j.wombi.2017.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 06/28/2017] [Revised: 09/26/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
Abstract
PROBLEM Pacific Islanders are disproportionately burdened by poorer maternal health outcomes with higher rates of pre-term births, low birth weight babies, infant mortality, and inadequate or no prenatal care. PURPOSE The purpose of this study was twofold: (1) to explore maternal health care providers' perceptions and experiences of barriers in providing care to Marshallese women, and (2) providers perceived barriers of access to care among Marshallese women. This is the first paper to explore perceived barriers to maternal health care among a Marshallese community from maternal health care providers' perspectives in the United States. METHODS A phenomenological, qualitative design, using a focus group and in-depth interviews with 20 maternal health care providers residing in northwest Arkansas was chosen. FINDINGS Several perceived barriers were noted, including transportation, lack of health insurance, communication and language, and socio-cultural barriers that described an incongruence between traditional and Western medical models of care. There was an overall discord between the collectivist cultural identity of Marshallese families and the individualistic maternal health care system that merits further research. DISCUSSION Solutions to these barriers, such as increased cultural competency training for maternal health care providers and the incorporation of community health workers are discussed.
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Affiliation(s)
- Britni L Ayers
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, Fayetteville, AR, United States.
| | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States.
| | - Rachel S Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, Fayetteville, AR, United States.
| | - Sarah J Moore
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, Fayetteville, AR, United States.
| | - Pearl A McElfish
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, Fayetteville, AR, United States.
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Kim Yeary KHC, Long CR, Bursac Z, McElfish PA. Design of a randomized, controlled, comparative-effectiveness trial testing a Family Model of Diabetes Self-Management Education (DSME) vs. Standard DSME for Marshallese in the United States. Contemp Clin Trials Commun 2017; 6:97-104. [PMID: 29740640 PMCID: PMC5936863 DOI: 10.1016/j.conctc.2017.03.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 01/26/2017] [Revised: 03/24/2017] [Accepted: 03/28/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is a significant public health problem, with U.S. Pacific Islander communities-such as the Marshallese-bearing a disproportionate burden. Using a community-based participatory approach (CBPR) that engages the strong family-based social infrastructure characteristic of Marshallese communities is a promising way to manage T2D. OBJECTIVES Led by a collaborative community-academic partnership, the Family Model of Diabetes Self-Management Education (DSME) aimed to change diabetes management behaviors to improve glycemic control in Marshallese adults with T2D by engaging the entire family. DESIGN To test the Family Model of DSME, a randomized, controlled, comparative effectiveness trial with 240 primary participants was implemented. Half of the primary participants were randomly assigned to the Standard DSME and half were randomly assigned to the Family Model DSME. Both arms received ten hours of content comprised of 6-8 sessions delivered over a 6-8 week period. METHODS The Family Model DSME was a cultural adaptation of DSME, whereby the intervention focused on engaging family support for the primary participant with T2D. The Standard DSME was delivered to the primary participant in a community-based group format. Primary participants and participating family members were assessed at baseline and immediate post-intervention, and will also be assessed at 6 and 12 months. SUMMARY The Family Model of DSME aimed to improve glycemic control in Marshallese with T2D. The utilization of a CBPR approach that involves the local stakeholders and the engagement of the family-based social infrastructure of Marshallese communities increase potential for the intervention's success and sustainability.
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Affiliation(s)
- Karen Hye-cheon Kim Yeary
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, USA
| | - Christopher R. Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Zoran Bursac
- College of Medicine, University of Tennessee Health Science Center, 66 N. Pauline St., Memphis, TN 38163, USA
| | - Pearl Anna McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
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Sturman HW, Baker-Smemoe W, Carreño S, Miller BB. Learning the Marshallese Phonological System: The Role of Cross-language Similarity on the Perception and Production of Secondary Articulations. Lang Speech 2016; 59:462-487. [PMID: 28008802 DOI: 10.1177/0023830915614603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The current study determines the influence of cross-language similarity on native English speakers' perception and production of Marshallese consonant contrasts. Marshallese provides a unique opportunity to study this influence because all Marshallese consonants have a secondary articulation. Results of discrimination and production tasks indicate that learners more easily acquire sounds if they are perceptually less similar to native language phonemes. In addition, the degree of cross-language similarity seemed to affect perception and production and may also interact with the effect of orthography.
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Affiliation(s)
| | - Wendy Baker-Smemoe
- Department of Linguistics and English Language, Brigham Young University, USA
| | - Sofía Carreño
- Department of Linguistics and English Language, Brigham Young University, USA
| | - Bradley B Miller
- Department of Linguistics and English Language, Brigham Young University, USA
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McElfish PA, Goulden PA, Bursac Z, Hudson J, Purvis RS, Kim Yeary KH, Aitaoto N, Kohler PO. Engagement practices that join scientific methods with community wisdom: designing a patient-centered, randomized control trial with a Pacific Islander community. Nurs Inq 2016; 24. [PMID: 27325179 DOI: 10.1111/nin.12141] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2016] [Indexed: 11/26/2022]
Abstract
This article illustrates how a collaborative research process can successfully engage an underserved minority community to address health disparities. Pacific Islanders, including the Marshallese, are one of the fastest growing US populations. They face significant health disparities, including extremely high rates of type 2 diabetes. This article describes the engagement process of designing patient-centered outcomes research with Marshallese stakeholders, highlighting the specific influences of their input on a randomized control trial to address diabetes. Over 18 months, an interdisciplinary research team used community-based participatory principles to conduct patient-engaged outcomes research that involved 31 stakeholders in all aspects of research design, from defining the research question to making decisions about budgets and staffing. This required academic researcher flexibility, but yielded a design linking scientific methodology with community wisdom.
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Affiliation(s)
- Pearl Anna McElfish
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Peter A Goulden
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Zoran Bursac
- Division of Biostatistics and Center for Population Sciences, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jonell Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Rachel S Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | | | - Nia Aitaoto
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Peter O Kohler
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
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Scott A, Shreve M, Ayers B, McElfish PA. Breast-feeding perceptions, beliefs and experiences of Marshallese migrants: an exploratory study. Public Health Nutr 2016; 19:3007-16. [PMID: 27230629 DOI: 10.1017/S1368980016001221] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine perceptions, beliefs and experiences affecting breast-feeding in Marshallese mothers residing in Northwest Arkansas, USA. DESIGN A qualitative, exploratory study using a brief survey and focus groups. Marshallese women, 18 years or older who had a child under 7 years of age, were included in the study. SETTING Community-based organization in Northwest Arkansas. RESULTS The majority of mothers viewed breast milk as superior to formula, but had concerns about adequate milk supply and the nutritional value of their milk. The primary barriers to exclusive breast-feeding in the USA included public shaming (both verbal and non-verbal), perceived milk production and quality, and maternal employment. These barriers are not reported in the Marshall Islands and are encountered only after moving to the USA. Breast-feeding mothers rely heavily on familial support, especially the eldest female, who may not reside in the USA. The influence of institutions, including the Special Supplemental Nutrition Program for Women, Infants, and Children, is strong and may negatively affect breast-feeding. CONCLUSIONS Despite the belief that breast milk is the healthiest option, breast-feeding among Marshallese mothers is challenged by numerous barriers they encounter as they assimilate to US cultural norms. The barriers and challenges, along with the strong desire to assimilate to US culture, impact Marshallese mothers' perceptions, beliefs and experiences with breast-feeding.
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Tan C, Haumea S, Juarez DT, Grimm C. A descriptive study of Marshallese and Chuukese patients with diabetes in Hawai'i. Hawaii J Med Public Health 2014; 73:168-71. [PMID: 24959389 PMCID: PMC4064340] [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: 06/03/2023]
Abstract
Diabetes is a growing epidemic in the United States with significant racial and ethnic health disparities among minorities. In Pacific Islanders, diabetes ranks as the fifth leading cause of death, higher than the national average. Despite this, little is known about diabetes in this population, and even less so in subpopulations such as Micronesians. To target these high-risk individuals, a federally qualified health center on Hawai'i Island started a multi-disciplinary diabetes care program for two Micronesian populations. This manuscript describes the characteristics of the Marshallese and Chuukese patients with diabetes enrolled in this program. Program enrollees had low socioeconomic status and poor health literacy, as well as high prevalence of co-morbidities commonly linked with diabetes. These findings support the data available on Micronesian populations and highlight the need to develop approaches that will improve health outcomes and bridge health disparities for these individuals.
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Affiliation(s)
- Candace Tan
- The Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (CT, DTJ)
| | - Stacy Haumea
- The Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (CT, DTJ)
| | - Deborah Taira Juarez
- The Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (CT, DTJ)
| | - Charlotte Grimm
- The Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (CT, DTJ)
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Abstract
Several states in the United States have been experiencing an influx of migrants from an area of the world that most people have only heard of when learning about the atomic bomb and World War II. This area is the former U.S. Trust Territory of Pacific Islands now called the Freely Associated States. At the end of World War II, the United States took possession of many of these islands and in 1948, the United States formally took over administration of the Marshalls, the Carolines, Palau, and the Northern Marianas islands. Collectively this area is known as Micronesia. Micronesians come from areas that have high prevalence of several communicable diseases and there is growing concern that Micronesian immigrants may enable the spread of infectious disease to the United States from Asia. Data concerning Hansen's disease and tuberculosis support this claim. According to data from the Hawai'i State Department of Health, a 5-year trend examining new cases of tuberculosis in Hawai'i identified that 65 out of 77 new cases came from the Freely Associated States of Micronesia. Presented is an overview of the health concerns and health status of the people from the Federated States of Micronesia.
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