A Social Ecological and Community-Engaged Perspective for Addressing Health Disparities Among Marshallese in Arkansas

Pearl Anna McElfish,Jennifer Post,Brett Rowland

doi:10.15344/2394-4978/2016/191

Pearl Anna McElfish, Jennifer Post + Show 1 more

Open Access

https://doi.org/10.15344/2394-4978/2016/191

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Abstract

Background: This article describes the case study of a community-based participatory research team that has used a social ecological approach to address significant health disparities in type 2 diabetes among Marshallese living in Arkansas. Methods: A case study approach is used to analyze the activities of the community-based participatory research partnership using a social ecological framework to describe how multiple factors across the social ecology are being addressed simultaneously. Results: In collaboration with the local Marshallese community and local organizations, the interprofessional team implemented interventions at each of the social ecological levels. Conclusion: Efforts to address health disparities should include interventions at multiple social ecological levels. Further, engaging diverse community partners contributes to success by leveraging the contextual and cultural knowledge, practices, and resources of all individuals and organizations involved. Finally, combining a social ecological perspective with a community-based participatory research approach contributes to sustainability of the interventions by engaging the broader community and ensuring the interventions reflect an understanding of and appreciation for the community’s culture.

Highlights

While overall health and length of life have improved for most communities living in the United States, not all communities benefit from advances in health and health care
Combining a social ecological perspective with a community-based participatory research approach contributes to sustainability of the interventions by engaging the broader community and ensuring the interventions reflect an understanding of and appreciation for the community’s culture
Policy Level: At a policy level, the Community-based participatory research (CBPR) team focused on advocacy for Medicaid coverage for Compact of Free Association (COFA) migrants

Summary

Introduction

While overall health and length of life have improved for most communities living in the United States, not all communities benefit from advances in health and health care. The SEM acknowledges the interdependent, reciprocal, and cumulative influence of both individual differences and contextual factors on health [6]. The SEM suggests that health improvements are best facilitated by interventions that target influential factors across multiple levels simultaneously to leverage complimentary environmental and behavioral effects [4,6,1013]. The SEM suggests that interventions at more distal contextual levels will produce more widespread influence [10,11,12,13]. Many researchers argue that single-level interventions focused on individual behavioral changes alone are generally not sufficient to produce or sustain widespread improvements in health, and if individual change is not supported socially and structurally, behavior will likely revert to a pre-intervention state [10,11,12]

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