Community Health Advocates Research Articles

Off to a Jump Start: Using Immersive Activities to Integrate Continuity Clinic and Advocacy.

BACKGROUNDTraining in advocacy is an important component of graduate medical education. Several models have been implemented by residency programs to address this objective. Little has been published regarding application of immersive advocacy activities integrated into continuity clinic.OBJECTIVETo create an Integrated Community Health and Child Advocacy Curriculum (ICHCA) by integrating advocacy activities that were immersive and contextualized in a continuity clinic setting and to familiarize interns with continuity clinic immediately at the beginning of their training.METHODSWe utilized a socio-constructivist lens, Kern's Six-step curriculum development and a published curriculum mapping tool to create the curriculum. Twenty residents completed ICHCA in 2019. Evaluations from key stakeholders including participants, support staff and attendings were analyzed on four levels of Kirkpatrick's model. We compared results before intervention, immediately following intervention and ten months following intervention.RESULTSWe demonstrated improvement in learner satisfaction, knowledge and behaviors with respect to advocacy in the clinical environment. Response rate was 70% (7/10) for attendings, 75% for support staff (15/20) and 72.5% for residents (29/40). Our intervention was feasible, no cost, and required no additional materials or training as it relied on learning in real time.CONCLUSIONSAn integrated advocacy curriculum utilizing the mapping tool for curricular design and evaluation is feasible and has value demonstrated by improvements in reaction, knowledge, and behaviors. This model improves understanding of social responsibility and can be implemented similarly in other residency programs.

Sounding the Alarm: Six Strategies for Medical Students to Champion Anti-Racism Advocacy.

Every year, incoming medical students take the Hippocratic Oath and pledge that they: “will be an advocate for patients in need and strive for justice in the care of the sick,” yet guidance on how to engage in community and public health advocacy is not a mandatory component of medical education. Therefore, students often feel insufficiently qualified to engage in advocacy efforts. As the nation has struggled with a viral pandemic (COVID-19) and witnessed an uprising against anti-Black racism and police brutality, it became immediately apparent that activism that marries medicine to anti-racism advocacy was needed. Further, we deduced that anti-racism activism at medical institutions would need to position medical students, often low in the medical hierarchy, as essential to the response. With the support of our leaders and mentors, we created a concerted series of strategies for medical students to become front and center in advocacy efforts. In this paper, we outline six strategies for medical students across the nation to champion anti-racism advocacy, based on our successful experiences in Central Ohio. This approach may have utility for other medical schools across the nation. These strategies include: embracing a common agenda; establishing formal structures; engaging affinity groups and allies; endorsing legislative advocacy; encouraging curricular reform; and enriching the pipeline. It is our hope that medical students will feel empowered and activated to lead and organize “good trouble” efforts that will ultimately improve the lives and health of the communities and patients they are being trained to serve.

Community-Based Participatory Research Strategies to Collect, Analyze, and Disseminate Qualitative Data

Project 1: Community Health Advocates participated in a photovoice project that evolved into an invited installation at the Alabama Contemporary Art Center, giving statewide exposure to health issues in communities in South Alabama that had been identified as those with the highest health disparities. The context of the project was a multi-generational approach to community health advocacy. Project 2: This project focused on employing CBPR methods in Cambodian and Laotian immigrant communities in South Alabama to discover barriers to disaster preparedness, response, and recovery and to better understand the intersections of culture, spirituality, and social justice along the path to community empowerment and resiliency. Community engagement in the development of emergency plans is typically at the organization-to-organization level. This paper analyzes multi-generational, multi-disciplinary, multi-method approaches using qualitative data to build effective strategies for advocacy through community engagement in research.

Community Health and Urban Revitalization in the 21st Century

The new millennium has brought an interwoven constellation of new public health and medical terminologies, new diseases, new methodologies, and new policies. Concepts such as globalization and revitalization have led to practices where outcomes result in increased interconnection of people and places. In practice, “revitalization” or “regentrification” focuses on urban renewal and rebuilding of inner-city communities, with strategies for advances in transport, communication, and information technologies that impact political, economic, and public health convergence. This article will seek to raise discussion concerning the new revitalization of inner-city communities, and the challenges public health providers, community health advocates, and community organizers face as they seek to build community resilience through improved health equity, healthcare access, health promotion, health education, and disease prevention.

The Frank H. Netter MD School of Medicine at Quinnipiac University.

The Frank H. Netter MD School of Medicine at Quinnipiac University.

Liberation Medicine: a Community Partnership and Health Advocacy Curriculum for Internal Medicine Residents.

Liberation Medicine: a Community Partnership and Health Advocacy Curriculum for Internal Medicine Residents.

A conceptual framework for measuring community health workforce performance within primary health care systems

BackgroundWith the 40th anniversary of the Declaration of Alma-Ata, a global effort is underway to re-focus on strengthening primary health care systems, with emphasis on leveraging community health workers (CHWs) towards the goal of achieving universal health coverage for all. Institutionalizing effective, sustainable community health systems is currently limited by a lack of standard metrics for measuring CHW performance and the systems they work within. Developed through iterative consultations, supported by the Bill & Melinda Gates Foundation and in partnership with USAID and UNICEF, this paper details a framework, list of indicators, and measurement considerations for monitoring CHW performance in low- and middle-income countries.MethodsA review of peer-reviewed articles, reports, and global data collection tools was conducted to identify key measurement domains in monitoring CHW performance. Three consultations were successively convened with global stakeholders, community health implementers, advocates, measurement experts, and Ministry of Health representatives using a modified Delphi approach to build consensus on priority indicators. During this process, a structured, web-based survey was administered to identify the importance and value of specific measurement domains, sub-domains, and indicators determined through the literature reviews and initial stakeholder consultations. Indicators with more than 75% support from participants were further refined with expert qualitative input.ResultsTwenty-one sub-domains for measurement were identified including measurement of incentives for CHWs, supervision and performance appraisal, data use, data reporting, service delivery, quality of services, CHW absenteeism and attrition, community use of services, experience of services, referral/counter-referral, credibility/trust, and programmatic costs. Forty-six indicators were agreed upon to measure the sub-domains. In the absence of complete population enumeration and digitized health information systems, the quality of metrics to monitor CHW programs is limited.ConclusionsBetter data collection approaches at the community level are needed to strengthen management of CHW programs and community health systems. The proposed list of metrics balances exhaustive and pragmatic measurement of CHW performance within primary healthcare systems. Adoption of the proposed framework and associated indicators by CHW program implementors may improve programmatic effectiveness, strengthen their accountability to national community health systems, drive programmatic quality improvement, and plausibly improve the impact of these programs.

Emergency Physicians as Community Health Advocates

Emergency Physicians as Community Health Advocates

NYS braces for new campaign to support investments in human services sector

Observing that rising costs for New York state's nonprofit human services employees have been unaddressed for more than a decade, the state's behavioral health provider community and mental health advocates are waging an all‐out attack to convince the state legislature and the governor to invest in across‐the‐board increases for the field.

Abstract P081: Applying Precision Public Health Tools to Address Health Disparities Among African-Americans in Alachua County, Florida

Precision Public Health (PPH) is the application of public health tools to population subsets with tailored interventions resulting in quantitative improvements in overall population health. The goal of PPH is to move from general impact to specific impact with interventions while maintaining a population focus in our outcomes. Precision Public Health at the University of Florida (PPH@UF) is a multi-disciplinary workgroup established in 2017 for the purpose of pursuing PPH practices. The primary product of the workgroup is the PPH@UF Libguide: a PPH focused tool designed to be a single place for public health workers to find necessary resources they need to understand their community and create effective interventions. Using the resources in this tool can help existing or new public health workers and researchers move from general population analysis towards precision in their interpretation of the data. This poster has two goals: 1) To show how the resources from the PPH@UF Libguide can be used to address health disparities among African-Americans in Alachua County and 2) To provide an example of how a PPH tool can increase the precision in population analysis aimed toward recommending interventions. The study utilized the PPH@UF Libguide to investigate a commonly known disparity between African-American and Caucasian diabetes deaths in Alachua County. By translating demographic data and investigating diabetes hospitalization, prevalence of diabetes by age over time, and population characteristics of relevant census tracts in Alachua County, we identified two specific census tracts that have significantly higher density of these individuals at risk. Using data from the Centers for Disease Control and presented by the Robert Wood Johnson Foundation, we were also able to observe that these tracts had very high rates of annual doctor visits but very low insurance rates and few locally available core preventative services. This indicates that interventions focusing on preventative care outside of doctor’s offices and connecting individuals to currently available community resources may be most helpful. The PPH@UF Libguide includes many different community partners who would be able to supply these types of resources and can serve not only as a research tool but also as a way to sort community health providers. Any intervention would include training individuals to access information on the PPH@UF Libguide for the needs of community members. By identifying a major community issue and providing a more precise geographic scope, supportive and integrated data, and a practical focus, the PPH@UF Libguide shows its ability to make efforts to address disparities among African-Americans in our community more effective. In conclusion, community health workers and advocates can utilize PPH tools similar to the PPH@UF Libguide to increase the impact and value of their community interventions.

Association between adolescent motherhood and maternal and child health indices in Maiduguri, Nigeria: a community-based cross-sectional study

IntroductionAdolescent motherhood (childbearing below 18 years of age) is a major global health and social problem. Understanding the impact of early motherhood on maternal and child health indices is important...

3073 Development and implementation of a faith-based community Health Advocate training programme for type-2 diabetes remission: A model for community-based non-communicable disease control

OBJECTIVES/SPECIFIC AIMS: The aim of this study is two-fold (1) to include a participatory action research design in the development of a community-based health advocate (HA) training programme which empowers community members to support the Barbados diabetes remission study 2 protocol – a low-calorie intervention for T2DM remission (2) to study the implementation of this programme with in select faith-based organisations (FBOs) which will act as community hubs. METHODS/STUDY POPULATION: Translation was informed using the RE-AIM framework. The target population were members of select FBOs. We assessed the readiness of FBOs to become community hubs in relation to human resources (the HA team must include someone with a clinical degree), infrastructure capacity (a private room for interviews) and the perspective (knowledge and attitude) of the FBO leadership to both the training and diabetes remission programmes. An open recruitment for HAs was made to the FBO membership and all who responded were accepted to the programme; which consisted of 8 weeks of face to face sessions inclusive of lectures and practical demonstrations and exercises specific to NCDs e.g. assessment of basic clinical parameters, ethics and nutrition. This was followed by a simulation exercise and a formal objective structured clinical examination (OSCE). HAs will participate in focus groups aimed at exploring the barriers and facilitators to the use of social media as a support system; this will be followed by participatory design workshops where the HAs will design support systems, inclusive of social media support, to assist participants in the diabetes remission intervention. RESULTS/ANTICIPATED RESULTS: All three FBOs that were approached responded favourably and the programme was described as ‘necessary’ and ‘timely’ by the leadership. The FBOs were assessed and found to be ready. Thirty-eight persons signed up for the programme (more than the 21 we anticipated); 31 (82%) attended at least 1 session and 29 completed the training; this indicates that implementation in the community is feasible. All who completed the programme attained an overall passing grade indicating the effectiveness of, and fidelity to the training. Initial feedback on the programme from HAs and volunteers indicates that it was acceptable. DISCUSSION/SIGNIFICANCE OF IMPACT: This community-based training programme was successful in terms of reach, as both the FBO and the individual HA responded favourably; and effectiveness as measured by the expanded skill set of the HA. Initial feedback suggests that implementation of the programme is feasible in the community and acceptable to the HAs. Although this model focusses on diabetes remission utilising FBOs as hubs, it can be easily adapted to other NCDs e.g. hypertension and mental health; other disciplines e.g. surveillance; and other communities e.g. workplaces, homeless shelters.

Aligning systems science and community-based participatory research: A case example of the Community Health Advocacy and Research Alliance (CHARA).

Partnered research may help bridge the gap between research and practice. Community-based participatory research (CBPR) supports collaboration between scientific researchers and community members that is designed to improve capacity, enhance trust, and address health disparities. Systems science aims to understand the complex ways human-ecological coupled systems interact and apply knowledge to management practices. Although CBPR and systems science display complementary principles, only a few articles describe synergies between these 2 approaches. In this article, we explore opportunities to utilize concepts from systems science to understand the development, evolution, and sustainability of 1 CBPR partnership: The Community Health Advocacy and Research Alliance (CHARA). Systems science tools may help CHARA and other CBPR partnerships sustain their core identities while co-evolving in conjunction with individual members, community priorities, and a changing healthcare landscape. Our goal is to highlight CHARA as a case for applying the complementary approaches of CBPR and systems science to (1) improve academic/community partnership functioning and sustainability, (2) ensure that research addresses the priorities and needs of end users, and (3) support more timely application of scientific discoveries into routine practice.

Implementing Healthy Planning and Active Living Initiatives: A Virtuous Cycle

Factors including internal local government functioning, collaboration and the use of co-benefits have been noted to assist in the uptake of healthy planning policies and projects by local governments. However, less commonly noted is a possible reverse relationship: that implementation of healthy planning projects can contribute positively to organisational functioning and collaboration, and can result in a range of co-benefits that then can be used to support projects. Such a concept is explored in this paper, with a focus at the local government level in Australia. Findings from surveys with local government practitioners and in-depth interviews with healthy planning and community health advocates are presented. The findings indicate four key areas through which the implementation of healthy planning policies and projects and active living initiatives demonstrates a ‘virtuous cycle’. These areas include (1) project ‘wind-up’, or circumstances in which implementation and/or health outcomes exceed initial expectations; (2) improved partnerships that can create opportunities for future initiatives; (3) improved internal organisational functioning; and (4) greater project sustainability. The paper concludes by exploring some possible repercussions of these emerging findings, which indicate that beneficial settings to healthy planning considerations can be a result of as well as a contributor to healthy planning and active living initiative implementation. In turn, this presents another potential co-benefit of project uptake and implementation to those commonly identified.

RISING AIR POLLUTION: DEMAND ACTION-DRIVEN ADVOCACY AND BEHAVIOUR CHANGE FOR HEALTHER LIVES

Air pollution is a major environmental health problem affecting the developing and the developed countries alike. The effects of air pollution on health are very complex as there are many different sources and their individual effects vary from one to the other. It is not only the ambient air quality in the cities but also the indoor air quality in the rural and the urban areas that are causing concern. In fact in the developing world the highest air pollution exposures occur in the indoor environment. Air pollutants that are inhaled have serious impact on human health affecting the lungs and the respiratory system; they are also taken up by the blood and pumped all-round the body. These pollutants are also deposited on soil, plants, and in the water, further contributing to human exposure. (1) Governments alone are not responsible for addressing such issues and health care professionals (HCPs) need to consider whether their duty of care should extend beyond normal clinical boundaries. When considering the ethics around the generation and effects of air pollution, especially in relation to justice and health care, actions taken by HCPs (e.g. in a country such as India) potentially extend beyond treating individual patients one-at-a-time for toxic effects of emissions and include advocating on behalf of others. (2) This paper covers the health impacts arising from ambient and household air pollution globally and at the national level (India) and recommends policy measures to reduce the health impact from air pollution in the national context. (3) Community health advocacy is also considered as of the main tasks of public health. Health professionals try to solve health problems with effective strategies. One of them is, specifically, community health advocacy. To act on health problems in the global context, participation and communitarian perspective is a choice. In addition to this behaviour change towards healthier lives by modifications in specific practices pertaining to rationale use of energy, water, cooking etc. is crucial for quality of life.

Tobacco Control Policy Adoption Dynamics: A Case Study of Missouri Communities.

Tobacco control policies reduce the health and economic burden caused by tobacco. With over half of the United States communities lacking adequate protective policies, an examination of policy adoption factors can provide insights to facilitate policy adoption. A case study approach examines the rate of adoption, prominent media frames, policy leaders' perceptions and coalition activities for smokefree and Tobacco 21 policies adopted in Missouri. Findings show compared to smokefree policy, Tobacco 21 requires a considerably shorter timeframe and fewer resources for adoption. Tobacco 21 coalitions target a small group of stakeholders compared to smokefree coalitions' emphasis on broad community engagement. Both policies are formally opposed, but elected officials perceive less political risk supporting Tobacco 21. As a new tobacco control policy tool, Tobacco 21 has relative advantage that should be considered by community health advocates.

Preparing Mexican-Origin Community Health Advocates (Promotores) to Conduct SBIRT for Problem Drinking in the Emergency Room.

Community Health Advocates (CHAs), known as Promotores in Spanish-speaking communities, are an important resource for the mobilization, empowerment, and the delivery of health education messages in Hispanic/Latino communities. This article focuses on understanding cultural, didactic, and logistical aspects of preparing CHAs to become competent to perform a brief intervention and referral to treatment (SBIRT) in the emergency room (ER). The CHAs training emphasizes making connections with Mexican-origin young adults aged 18-30, and capitalizing on a teachable moment to effect change in alcohol consumption and negative outcomes associated with alcohol use. We outline a CHA recruitment, content/methods training, and the analysis of advantages and challenges presented by the delivery of an intervention by CHAs.

Dementia Awareness Campaign in the Latino Community: A Novel Community Engagement Pilot Training Program with Promotoras

ABSTRACTObjectives: To create a curriculum about Alzheimer’s disease and dementia, and to train Promotoras affiliated with a local community education and health advocacy organization, in order to raise awareness and knowledge of what dementia is, and how it can be recognized, in persons of Hispanic/Latino descent.Methods: Community based participatory research (CPBR) model was used to create materials, implement training, and engage/empower Promotoras to educate the local community.Results: Pre-post findings indicated a positive learning experience for the Promotoras and willingness to share new dementia information with their community. One year post-evaluative survey with a subset showed outreach to an average of 15–25 community members, indicating positive reception of this new information.Conclusions: CPBR model is a successful education and outreach tool with Latino communities. Our Dementia Awareness Campaign was a success with the first 20 Promotoras trained; at present we plan to train additional groups in nearby communities with significant Hispanic/Latino populations.Clinical Implications: In order to get Latinos to seek early detection, we need to first educate them about dementia, win trust, and encourage treatment-seeking. Early intervention, diagnosis, and prevention will benefit from educational campaigns using the CBPR model.

A patient's perspective of chronic pain.

Sara Gilbert Nadler speaks to Jade Parker, Commissioning Editor: Sara has obtained a Bachelor's Degree and Master's in social work. Her field of practice in social work has been in the field of medical social work. Sara has worked in the field of medical social work for over 20 years; her work has spanned from acute care hospitals to skilled nursing facilities. Her professional responsibilities include case management, discharge planning, financial management, counselling patients and their families in regard to their medical conditions as well as making referrals to home care agencies and other care providers if necessary. At present she is a volunteer at Community Health Advocates, New York. She works on the telephone help line, handles health insurance issues along with answering questions in regard to the affordable care act. She also advocates if a client is having issues with their health insurance company in terms of coverage issues. She works with the client and their insurance company and any other agency that needs to advocate on their behalf.

A Place-Based Community Health Worker Program: Feasibility and Early Outcomes, New York City, 2015

IntroductionThis study examined feasibility of a place-based community health worker (CHW) and health advocate (HA) initiative in five public housing developments selected for high chronic disease burden and described early outcomes.MethodsThis intervention was informed by a mixed-method needs assessment performed December 2014–January 2015 (representative telephone survey, n=1,663; six focus groups, n=55). Evaluation design was a non-randomized, controlled quasi-experiment. Intake and 3-month follow-up data were collected February–December 2015 (follow-up response rate, 93%) on 224 intervention and 176 comparison participants, and analyzed in 2016. All participants self-reported diagnoses of hypertension, diabetes, or asthma. The intervention consisted of chronic disease self-management and goal setting through six individual CHW-led health coaching sessions, instrumental support, and facilitated access to insurance/clinical care navigation from community-based HAs. Feasibility measures included CHW service satisfaction and successful goal setting. Preliminary outcomes included clinical measures (blood pressure, BMI); disease management behaviors and self-efficacy; and preventive behaviors (physical activity).ResultsAt the 3-month follow-up, nearly all intervention participants reported high satisfaction with their CHW (90%) and HA (76%). Intervention participants showed significant improvements in self-reported physical activity (p=0.005) and, among hypertensive participants, self-reported routine blood pressure self-monitoring (p=0.013) compared with comparison participants. No improvements were observed in self-efficacy or clinical measures at the 3-month follow-up.ConclusionsHousing-based initiatives involving CHW and HA teams are acceptable to public housing residents and can be effectively implemented to achieve rapid improvements in physical activity and chronic disease self-management. At 3-month assessment, additional time and efforts are required to improve clinical outcomes.