Community Health Outreach Research Articles

The role of prehealth student volunteers at a student-run free clinic in New York, United States.

Purpose:The medical student-run Einstein Community Health Outreach Clinic provides free healthcare to the uninsured adult population of New York, the United States. During the summer, prehealth student volunteers are recruited to assist with clinic operations.Methods:We designed a survey study to identify the baseline characteristics of the volunteers between June and August of 2013 and 2014 in order to evaluate the influence of working in a medical student-run free clinic on their education, impressions, and career goals.Results:A total of 38 volunteers (response rate, 83%) participated in the study. The volunteers were demographically diverse and interested in primary care specialties and community service.Conclusion:After the Einstein Community Health Outreach program, the volunteers showed an improved understanding of the healthcare process and issues relevant to uninsured patients. They also developed favorable attitudes towards primary care medicine and an increased level of interest in pursuing careers in primary care.

Development and Implementation of a Culturally and Linguistically Centered Nutrition Education Program for Promotoras de Salud (Community Health Workers) to Foster Community Health Education and Outreach in Texas Border Colonias

Promotora Nutrition Empowerment Initiative (PNEI) was developed in response to requests by 7 promotora-researchers in the Construyendo Communidades Fronterizas Mas Sanas (Building Healthier Border Communities) research and outreach program to better equip them in the Texas border colonias they serve. This effort provided a framework for evidence-based, culturally and linguistically centered nutrition education and skill-building modules. Eight educational workshops (4 hours per month) comprised of in-depth nutrition education and skill-building lessons were conducted (December 2012–July 2013). Student’s paired sample t test and Wilcoxon signed-rank test compared pre- and posttest nutrition knowledge scores for each workshop; scores were significantly improved (P = .02). Medial assessment focus group analysis suggested that nutrition education workshops provided worth, impact, and empowerment. Results suggest that collaborative community efforts involving promotoras/community health workers empower and allow for greater opportunities for outreach and delivery of evidence-based community health education to hard-to-reach residents.

Extension Educators Widen Reach Through Community-Focused Undergraduate Online Teaching

This new online course, taught by extension nutrition educators, aims to increase undergraduate students’ knowledge of community interventions that address obesity and related chronic diseases. Juniors/Seniors enrolled at the State University. Historically, the educational domain of Extension Nutrition Educators has been community, not campus, settings, where they utilize practical experience in fostering behavior change to decrease the risk of chronic disease. A new opportunity provided a forum for experienced Extension Nutrition Educators to bring their technical knowledge and teaching/interpersonal skills in the area of obesity and chronic disease prevention to undergraduate students for the first time. Often, universities and their surrounding communities co-exist but remain divided. Teaching online undergraduate courses has allowed Extension faculty to connect students to the larger community, helping to narrow that divide. An online Junior/Senior colloquium course was created by Extension Educators with nutrition and public health expertise. The course focuses on understanding the causes, assessment, and treatment of obesity and related chronic diseases, as well as an opportunity to explore first hand community programs which target obesity prevention and management. The course is part of a new Extension-sponsored minor in Community Health Outreach which includes a practicum that pairs students with county-based Extension Nutrition Educators for real-world experience in nutrition education and health promotion. After 3 semesters, and a total of 75 enrolled students, university course evaluations have indicated favorable reviews. Extension Nutrition Educators can broaden their reach and engage and benefit new audiences through application of their knowledge and skills in undergraduate online teaching.

Community coalition-driven interventions to reduce health disparities among racial and ethnic minority populations.

Racial and ethnic disparities in health status are pervasive at all stages of the life cycle. One approach to reducing health disparities involves mobilizing community coalitions that include representatives of target populations to plan and implement interventions for community level change. A systematic examination of coalition-led interventions is needed to inform decision making about the use of community coalition models. To assess effects of community coalition-driven interventions in improving health status or reducing health disparities among racial and ethnic minority populations. We searched MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Social Science Citation Index, Dissertation Abstracts, System for Information on Grey Literature in Europe (SIGLE) (from January 1990 through September 30, 2013), and Global Health Library (from January 1990 through March 31, 2014). Cluster-randomized controlled trials, randomized controlled trials, quasi-experimental designs, controlled before-after studies, interrupted time series studies, and prospective controlled cohort studies. Only studies of community coalitions with at least one racial or ethnic minority group representing the target population and at least two community public or private organizations are included. Major outcomes of interest are direct measures of health status, as well as lifestyle factors when evidence indicates that these have an effect on the direct measures performed. Two review authors independently extracted data and assessed risk of bias for each study. Fifty-eight community coalition-driven intervention studies were included. No study was considered to be at low risk of bias. Behavioral change outcomes and health status change outcomes were analyzed separately. Outcomes are grouped by intervention type. Pooled effects across intervention types are not presented because the diverse community coalition-led intervention studies did not examine the same constructs or relationships, and they used dissimilar methodological designs. Broad-scale community system level change strategies led to little or no difference in measures of health behavior or health status (very low-certainty evidence). Broad health and social care system level strategies leds to small beneficial changes in measures of health behavior or health status in large samples of community residents (very low-certainty evidence). Lay community health outreach worker interventions led to beneficial changes in health behavior measures of moderate magnitude in large samples of community residents (very low-certainty evidence). Lay community health outreach worker interventions may lead to beneficial changes in health status measures in large samples of community residents; however, results were not consistent across studies (low-certainty evidence). Group-based health education led by professional staff resulted in moderate improvement in measures of health behavior (very low-certainty evidence) or health status (low-certainty evidence). Adverse outcomes of community coalition-led interventions were not reported. Coalition-led interventions are characterized by connection of multi-sectoral networks of health and human service providers with ethnic and racial minority communities. These interventions benefit a diverse range of individual health outcomes and behaviors, as well as health and social care delivery systems. Evidence in this review shows that interventions led by community coalitions may connect health and human service providers with ethnic and racial minority communities in ways that benefit individual health outcomes and behaviors, as well as care delivery systems. However, because information on characteristics of the coalitions themselves is insufficient, evidence does not provide an explanation for the underlying mechanisms of beneficial effects. Thus, a definitive answer as to whether a coalition-led intervention adds extra value to the types of community engagement intervention strategies described in this review remains unattainable.

Role of community health outreach program "living for health" in improving access to federally qualified health centers in Miami-dade county, Florida: a cross-sectional study.

BackgroundCare of the underserved remains one of the most compelling challenges to American healthcare. Federally Qualified Health Centers (FQHCs) address uninsurance and underinsurance by providing primary and preventive care to vulnerable populations with fees charged based on ability to pay. Our goal is to study the effectiveness of FQHCs system in engaging patients and the barriers to utilization, which have not been well defined.MethodsRetrospective analysis was performed on data from “Living for Health” (L4H) program participants from 2008 to 2012. Univariate and multivariate logistic regression analysis were performed to determine factors associated with FQHC utilization.ResultsAmong 9453 subjects screened, 1889 were referred to a FQHC, but only 201(11%) actually sought treatment. Public insurance, non-Hispanic ethnicity, and hypertension were associated with higher rates of FQHC utilization. Inability to afford costs, cultural factors and inflexible appointment times were the most common reasons for FQHC underutilization.ConclusionThe current status of FQHC utilization is sub-optimal. Community outreach programs like L4H can improve the access and utilization of FQHCs.

IMPACT ON DIET QUALITY AND RESILIENCE IN URBAN COMMUNITY DWELLING OBESE WOMEN WITH A NUTRITION AND PHYSICAL ACTIVITY INTERVENTION

Objective: To examine the effect of a Tai Chi, resistance training, and behaviorally-based diet education intervention on dietary quality as well as resilience and physical resilience in obese older women. Design: Community health outreach with a quasi-experimental design. Setting: An urban senior center in Rhode Island. Participants: Thirty-three women, 85% were minorities, with mean age of 65±8.2 years and BMI of 37.3±4.6 kg/m2, were enrolled in the study at baseline however only 17 women in the intervention (EXD) group and 9 women in the wait-list control (CON) group completed the study. Measurement: Dietary quality and nutrition risk were measured using the Dietary Screening Tool (DST), resilience was measured by the Resilience Scale, and physical resilience was examined using the Physical Resilience Scale. Intervention: Participants in the EXD group engaged in 12 weeks of Tai Chi, resistance training, and behaviorally-based diet education. The diet education was based off of the modified Dietary Approaches to Stop Hypertension (DASH) diet and led by a Registered Dietitian. Results: There was no change in dietary quality by group or time. However the EXD group had significantly higher dietary quality compared to the control group (p=0.025) at post intervention, although there was no difference in nutrition risk category. There was no change seen in overall resilience, however the EXD group improved physical resilience (p=0.048). Conclusion: A community health outreach that involved Tai Chi, resistance training, and behaviorally-based diet education may promote higher dietary quality as well as improve physical resilience in obese older women.

A new approach to prevent HIV transmission: Project Protect intervention for recently infected individuals

Past research suggests that as many as 50% of onward human immunodeficiency virus (HIV) transmissions occur during acute and recent HIV infection. It is clearly important to develop interventions which focus on this highly infectious stage of HIV infection to prevent further transmission in the risk networks of acutely and recently infected individuals. Project Protect tries to find recently and acutely infected individuals and prevents HIV transmission in their risk networks. Participants are recruited by community health outreach workers at community-based HIV testing sites and drug users' community venues, by coupon referrals and through referrals from AIDS clinics. When a network with acute/recent infection is identified, network members are interviewed about their risky behaviors, network information is collected, and blood is drawn for HIV testing. Participants are also educated and given prevention materials (condoms, syringes, educational materials); HIV-infected participants are referred to AIDS clinics and are assisted with access to care. Community alerts about elevated risk of HIV transmission are distributed within the risk networks of recently infected. Overall, 342 people were recruited to the project and screened for acute/recent HIV infection. Only six index cases of recent infection (2.3% of all people screened) were found through primary screening at voluntary counseling and testing (VCT) sites, but six cases of recent infection were found through contact tracing of these recently infected participants (7% of network members who came to the interview). Combining screening at VCT sites and contact tracing the number of recently infected people we located as compared to VCT screening alone. No adverse events were encountered. These first results provide evidence for the theory behind the intervention, i.e., in the risk networks of recently infected people there are other people with recent HIV infection and they can be successfully located without increasing stigma for project participants.

The Yo me cuido® Program: Addressing Breast Cancer Screening and Prevention Among Hispanic Women.

Breast cancer is less likely to be diagnosed at the earliest stage in Hispanic/Latino (Hispanic) women compared to non-Hispanic White women, even after accounting for differences in age, socioeconomic status, and method of detection. Moffitt Cancer Center created a comprehensive health education program called Yo me cuido (®) (YMC) to address and reduce breast cancer disparities among Spanish- and English-speaking Hispanic women by providing breast cancer and healthy lifestyles awareness and education, and promoting breast cancer screenings, reminders, and referrals for women 40 years and older. The purpose of this paper is to showcase the innovative approaches and methods to cancer prevention and early detection of the YMC program, and to promote it as an effective tool for improving outcomes in community health education, outreach, and engagement activities with Hispanic populations. Key components of the program include educational workshops, mammogram referrals, and a multimedia campaign. The YMC program is unique because of its approaches in reaching the Hispanic population, such as delivering the program with compassionate services to empower participants to live a healthier lifestyle. Additionally, direct follow-up for mammography screenings is provided by program staff. From 2011 to 2013, YMC has educated 2,226 women and 165 men through 93 workshops. About 684 (52 %) women ages 40 and older have had a screening mammogram within their first year of participating in the program. The YMC program is an innovative cancer education and outreach program that has demonstrated a positive impact on the lives of the Hispanic community in the Tampa Bay region.

Thirty Years of Disparities Intervention Research

A systematic scan of the disparities intervention literature will allow researchers, providers, and policymakers to understand which interventions are being evaluated to improve minority health and which areas require further research. We systematically categorized 391 disparities intervention articles published between 1979 and 2011, covering 11 diseases. We developed a taxonomy of disparities interventions using qualitative theme analysis. We identified the tactic, or what was done to intervene; the strategy, or a group of tactics with common characteristics; and the level, or who was targeted by the effort. The taxonomy included 44 tactics, 9 strategies, and 6 levels. Delivering education and training was the most common strategy (37%). Within education and training, the most common tactics were education about disease (14%) and self-management (11%), whereas communication skills training (3%) and decision-making aids (1%) were less frequent. The strategy of actively engaging the community through tactics such as community health workers and outreach efforts accounted for 6.5% of tactics. Interventions most commonly targeted patients (50%) and community members who were not established patients of the intervening organization (32%). Interventions targeting providers (7%), the microsystem (immediate care team) (9%), organizations (3%), and policies (0.1%) were less common. Disparities researchers have predominantly focused on the patient as the target for change; future research should also investigate how to improve the system that serves minority patients. Areas for further study include interventions that engage the community, educational interventions that address communication barriers, and the impact of policy reform on disparities in care.

Promotora Nutrition Empowerment Initiative: A Culturally and Linguistically-Centered Education Program for Promotoras De Salud (Community Health Workers) to Foster Community Health Education and Outreach in Texas Border Colonias

Understand the role of the promotora-researcher and apply evidence-based concepts in the development of culturally and linguistically-centered nutrition education programs to empower promotoras to educate their communities.

Faith and Masculinity

Males may experience several barriers to seeking health care, including unfamiliarity with procedures (e.g. colonoscopy), stigma and fear of a given health issue, perceived breach of masculinity (machismo), and fear of feeling vulnerable. Evidence suggests church-based interventions are an effective way to strengthen the connection between promotional message content and participant conceptualization of the risks and benefits of health screenings. However, there is a lack of evidence demonstrating such effectiveness in men’s health, and there is even more of a dearth of research focusing on Latinos. This discussion presents trends from a series of 4 community-based seminars during the 2010-2011 academic year conducted with Latino faith-based groups on men’s health issues. Approximately 70 Latino men attended a series of seminars on health and wellness as it pertains to cancer screening procedures offered after church services. A particular emphasis was placed on perceived masculinity (machismo) and gender roles within the social environment, and how they influence health screenings among men, particularly for colorectal, prostate, and testicular cancer. The seminar series were a first step in laying the foundations for future formal effectiveness testing of faith-based facilities serving as a conduit for health promotion efforts among Latinos. This paper presents lessons learned from this new approach in community health outreach efforts. We advocate that faith-based groups can be an efficient and effective way to raise awareness and promote wellness among Latino men.

Capacity Building in the Latino Community: Lessons from the Promotora Project in Eastern North Carolina

In June 2009, the Association of Mexicans in North Carolina (AMEXCAN), a leading Latino grassroots organization based in Pitt County, North Carolina, received funding from the Pitt Memorial Hospital Foundation to implement the project "Community Health Advisors Promoting Healthy Nutrition and Physical Activity in the Latino Community" (henceforth the Promotora [Promoter] Project). The goals of the project were to train a group of seven women from the Latino community (henceforth promotoras) to promote healthy nutrition and physical activity and to develop a model of community health outreach relying on the trained promotoras' own natural social networks. The project was designed, implemented, and evaluated through a university-community partnership involving AMEXCAN and university faculty from the Departments of Anthropology and Nutritional Sciences, the College of Nursing, and the School of Social Work, all authors of this paper. Students from these academic units were involved through curricular and non-curricular service learning activities. The project derived from a previous collaboration between AMEXCAN and the anthropology faculty, whose goal was to promote diabetes prevention through a series of informative workshops in local churches.

Epidemiology and socio-economic consequences of malaria in pregnant women in Imo State Nigeria

Human infected with malaria parasites (Plasmoodium sp.) and its socio-economic consequences were investigated in parts of Imo State Nigeria between August 2007 and September 2008 using standard parasitological and socio-economic methods. Blood samples were collected by vein puncture from 2,871 consenting pregnant women registered for ante natal care at Federal Medical Centre, Owerri, Imo State University Teaching Hospital, Orlu and Okigwe General Hospital Okigwe as well as Imo State University Teaching Hospital Community Health Outreach Centre, Ogbaku, Mbaitoli L. G. A. The samples were analysed parasitologically for detection of malaria parasite using three different methods namely Quantitative Buffy Coat (QBC) technique, Slide smear technique and Plasmodium falciparium antigen. Similarly, questionnaires were administered to the same patients to elicit vital information on socio-economic consequences of malaria. The results showed that out of 2,871 persons examined, 2,323 (80.9%), 2,301 (80.1%) and 1,801 (62.7%) had malaria parasite determined by the QBC stained smear and P. falciparium antigen techniques respectively. The total loss due to malaria in pregnancy within a six month period was estimated at 5.8 million naira. The study has confirmed that the burden of malaria in pregnant women in Imo State Nigeria is high. Key words: Epidemiology, socio-economic, consequences, malaria, pregnant women, Imo State, Nigeria.

Exploring Strategies to Encourage Community Health Outreach by Health Promotion Volunteers in Japan

Japan's health promotion volunteers (HPVs) are individuals who act as a natural helping resource in the community. This study explored the factors associated with vigorous community health outreach by HPVs who promote healthy lifestyles. A cross-sectional survey was conducted in December 2009 that included 822 HPVs in 2 areas. Multiple logistic regression analysis indicated that higher motivation for initial involvement as an HPV, stronger neighborhood networks, and a stronger sense of belonging to the community where they worked were related to vigorous outreach. These findings reveal challenges that HPVs encounter, and also provide recommendations for training HPVs to encourage effective community health outreach.

Training Community Health Workers About Cancer Clinical Trials

Innovative projects to reduce disparities in cancer treatment and research include partnerships between academic and community cancer centers, patient navigation programs and strategies to promote community awareness, education and engagement. A 4h training program about cancer clinical trials was developed through a needs assessment and in collaboration with community health workers who served as consultants and a larger advisory board comprised of community health workers, educators and clinical trialists. This program was delivered first as a collaboration between a phsycian who is experienced in the conduct of clinical research and two community health workers, and subsequently by the community health workers alone. We report on four workshops attended by a total of 61 community health workers recruited from Boston-area hospitals, community health centers and outreach programs. Support for and knowledge of clinical trials was measured in a pretest and post-test, which also included a satisfaction rating. Participants had a range of prior experience with clinical trials in the context of their personal and professional experience. Mean accuracy of knowledge about clinical trials increased from 72 to 84%, support for clinical trials improved considerably, and satisfaction with the training experience was high. Knowledge gaps and low levels of support for cancer clinical trials among community health workers can be improved with a short training program delivered by other community health workers. Further research is needed to identify the impact of this training on accrual to cancer clinical trials.

Clinical legal medicine – community health outreach, results of a follow-up pan-European survey

In a follow-up 2007/2008 to the first pan-European survey of legal medicine contributions to community health responses to gender violence, child and elderly abuse in 2003/2004, we investigated strategies legal...

A Situation-Specific Theory of Migration Transition for Migrant Farmworker Women

This article proposes a situation-specific theory of migration transition for migrant farmworker women (MFW). The following themes were identified: (a) migration patterns, (b) awareness of critical markers, (c) time between awareness and engagement, (d) decision making, (e) differences between expected and actual transition experiences, and (f) personal identities. Participants identified conditions that supported and prevented a healthy migration transition including personal identities, family support, faith-based and community health outreach services, immigration/documentation status, and respect. Women recognized a sense of peace as a healthy transition response. The proposed theory offers an understanding of migration transition and provides a practical theoretical perspective for nurses and other health care professionals who implement and coordinate health care for MFW.

Letters

Letters

The RARE Model of Rapid HIV Risk Assessment

The impact of the HIV/AIDS epidemic on minority communities called for interventions to stem the increase in new HIV infections and identify HIV-positive individuals for referral to care and treatment services. The Rapid Assessment, Response and Evaluation (RARE) project was designed to provide highly affected communities with a tool that would quickly identify conditions that fuel new infections and serve as barriers to HIV-positive individuals getting HIV testing, care, and treatment. RARE brought indigenous community health outreach workers and key community-level stakeholders together to advocate for the transfer of findings into programmatic and policy responses in places where high risk behaviors were practiced. This article describes RARE's qualitative methods that captured the voice of those most affected by the HIV/AIDS threat and identified critical insights and dynamics about factors that lead to HIV infections and those that can move positive individuals into care and treatment.

Promotores de Salud

Background: Age-adjusted cardiovascular disease (CVD) mortality rates for Hispanics are lower than for non-Hispanics. However, CVD is the leading cause of death among Hispanics, and there is an increasing heart health problem among this population. One strategy for preventing CVD is the use of community health workers (CHWs). A CHW is a member of the community who disseminates information, attempts to foster healthy behavior, and provides education, advice, social support, and assistance to the community. Although the efficacy of CHWs has been tested, few studies have examined their effectiveness in educating communities and facilitating behavior change. Purpose: This study explored whether trained CHWs can effectively deliver education on heart-healthy behaviors among Hispanics. Methods: Two group of participants received education programs delivered by CHWs, popularly known in the Hispanic community as promotores de salud. A pretest/post-test design was implemented to assess intervention effect. Analyses included sample t-test, chi-square (χ2), and Mann-Whitney U Test. Results: The two groups differed in demographics and pre-existing risk factors (p<.05). Participants in both groups significantly improved their healthy behaviors (p<.01). Discussion: Observed improvement in healthy behaviors in both participant groups strengthens the argument that the community health outreach promotores model may be effective and can be adapted to a variety of settings. Translation to Health Education Practice: The results of this study support the utilization of CHWs.