Low-income Housing Communities Research Articles

Unpacking interactions among student teams in a practice-based IPE setting: a qualitative evaluation study

ABSTRACT In many healthcare settings, teams change composition regularly, so healthcare students must be trained to function effectively in dynamic teams before entering the workforce. Interprofessional clinical rotations provide an ideal venue for learners to practice these skills, but little is known about how student teams interact in such settings. In this qualitative observational evaluation, learners from multiple health professions at a single institution participated in scheduled clinics in low-income housing communities for older adults. Interprofessional student teams met with program participants for care coordination, health and wellness assessments, and assistance in setting and achieving health goals; team composition changed from week-to-week. A purposive sample was selected from video-recorded encounters between student teams and their program participants. The aim of this study was to explore team interactions and document learner behaviors. Two researchers independently reviewed discrete segments of each video, recorded their observations and reflections, and then the team discussed, categorized, and identified relevant examples of both effective and ineffective behaviors. Four major themes were observed: inclusiveness, leadership, joy of practice, and sharing of clinical knowledge. Students demonstrated both positive and negative examples of behaviors that aligned with each theme. Understanding how students behave on teams in dynamic settings where patient care is taking place can help educators establish practice-based interprofessional education models that better prepare learners to function effectively and strategies that may improve team interactions.

STRATEGIES FOR ENGAGING LOW-INCOME SENIOR HOUSING RESIDENTS IN INTERDISCIPLINARY WELLNESS CLINICS

Abstract Engaging residents in low-income senior housing communities in health and wellness services can be challenging. Despite the significant healthcare needs of residents in senior housing communities, numerous barriers to engaging residents exist including the mistrust of academic or healthcare institutions, stigma about health conditions and treatment, and lack of awareness about services available. To successfully implement Interdisciplinary Wellness Clinics, a participatory approach was used through engagement of stakeholders in the housing communities. The Interdisciplinary Wellness Clinic team worked closely with the Senior Program Manager and the community and regional property managers to establish a plan for implementation. The needs of the communities, day and timing of the clinics that would fit with their schedules, and a plan for ways to invite and engage the residents was developed. Flyers were made by the interdisciplinary team for visits at each community and sign-up sheets for the services provided on any given month. The flyers were posted on bulletin boards within the communities or in a central location for residents to access them by the community property managers. Intermittently, associated with holidays for example, we also held raffles for gifts for anyone who attended the clinic. Regular meetings were held with the property managers at each of the senior housing communities to solicit their input and brainstorm strategies for continued engagement of residents and identify new approaches to increase engagement in wellness clinic services.

Medication self-management capacity among older adults living in low-income housing communities

BackgroundMedication self-management capacity (MMC) is essential to safe and independent living. There is a need to understand the challenges low-income older adults face during the routine use of medications to promote safe medication use and healthy aging in place. ObjectiveTo assess the cognitive and physical deficiencies in MMC and the impact of using pharmaceutical aids/services on MMC among low-income older adults. MethodsThis was a cross-sectional study of 107 older residents of 5 low-income housing buildings in Richmond, VA. The Medication Management Instrument for Deficiencies in the Elderly was used to measure MMC during individual in-person interviews. Participants were asked whether they used any medication aids, including medication lists, organizers, or reminders, or pharmacy services such as specialized medication packaging, medication synchronization, prescription home delivery, or mail order services. Multiple regression modeling was used to assess the relationship between MMC and the use of pharmaceutical aids/services. ResultsEighty-nine percent of participants were African American with a mean (standard deviation [±SD]) age of 68.5 (7.2) years. The mean deficit in MMC was 3 (±2.0). The most challenging skill was naming all the medications (69.2%), followed by stating their indications (46.7%) and knowing how or when all of the medications should be taken (38.3%). Seventy-nine percent used at least 1 pharmaceutical aid/service; using 1 pharmaceutical aid/service was significantly associated with better MMC (P = .0285). Low educational level and health literacy were associated with deficits in MMC (P < .05). ConclusionMany older adults residing in low-income housing had impaired capacity to manage their medications independently. Inadequate medication knowledge affected their cognitive ability to manage medications. Using a pharmaceutical aid/service was associated with better MMC. Greater attention to developing medication self-management skills for older adults with low health literacy and adverse social determinants of health is needed.

Confronting misconceptions of public housing communities: A qualitative report of community-informed narratives by community members and partners.

Objectives were (a) to understand a community-informed narrative, as told by community members (CMs) and community partners (CPs), about the strengths, experiences, and perspectives of public housing communities; and (b) to analyze similarities and differences between CMs' and CPs' experiences and perspectives. Qualitative interviews were conducted with 22 CMs of public housing (ages 26-58, 100% female caregivers, 96% Black, 4% multiethnic) and 43 CPs (ages 28-78, 67.4% female, 81.4% Black and African American). Four themes were derived from the CM and CP interviews: (1) counters to public narratives, (2) disinvestment begets disinvestment, (3) community conditions should be better, and (4) community cohesion and connection. Findings from this study present community-centered narratives and experiences that were counter to stereotyped public narratives and could influence public perceptions and behavior to inform policy changes related to improving living conditions and supporting CMs in public and low-income housing communities.

'When the bedbugs come, that's another problem': exploring the lived experiences of bedbug infestations among low-income older adults and service providers who support them.

Older adults in low-income housing communities are more vulnerable to bedbug infestations. Prior research, however, has predominately focused on the effectiveness of integrated pest-management strategies, with little attention given to the lived experiences of tenants struggling with infestations. We used a qualitative approach to explore what it is like to live with and treat bedbug infestations from the perspectives of low-income older adults and service providers. Participants included low-income older adults (n = 58) and service providers (n = 58) who offer supports directly in the buildings. Semi-structured qualitative interviews and focus groups were used to explore the challenges of preparing and treating units for bedbugs, and examine how bedbugs impact access to support services. Bedbugs were a widespread issue, and underlying physical, mental, social, and financial challenges made it difficult for older tenants to prepare their units and access treatment. Tenants also faced bedbug stigma from community services, as many were unwilling to provide services in infested units. Although some service providers utilized strategies to minimize exposure, many were concerned these strategies created additional stigma. Our findings highlight an urgent need to increase public health funding to support older adults with the costs of bedbug elimination and to enhance pest-management strategies through partnerships with health and social service agencies to improve outcomes for older adults.

Motives Driving Non-healthcare Community Organizations to Engage in Health Promotion Activities.

While health promotion is not the primary mission of many community organizations (e.g., libraries, religious organizations), it is well documented that many still engage in health promotion activities, even when their resources may be constrained. What is less understood are the driving forces that spur community organizations to divert finite resources to health promotion when it may not directly align with their primary mission. The current study explores the reasons why various community organizations might choose to engage in health promotion, particularly in the context of the COVID-19 pandemic. We conducted interviews with leaders of 22 mosques, public libraries, low-income housing communities, and university-affiliated fraternities/sororities in the state of Maryland and qualitatively analyzed the data using template analysis. Four themes detailing reasons these community organizations engage in health promotion were identified including Organizational perceptions of health, Identifying and addressing issues of accessibility, Organizational responsibility, and Member interest and initiative. Understanding the reasons community organizations outside of the healthcare setting engage in health promotion, especially during a global pandemic, can allow public health researchers and practitioners to develop increasingly relevant and, in turn, effective strategies for recruitment of community organizations and sustainment of partnerships with these organizations. This has implications for population-level health impacts by improving reach to those that may not engage with traditional healthcare providers.

Exposure to community violence and depressive symptoms: Examining community, family, and peer effects among public housing youth.

Exposure to community violence is an epidemic problem that causes debilitating effects on youth mental health. However, the relationships between violence exposure and youth mental health remain unclear when examining co-occurring socioecological risk and protective factors. The purpose of this study is to clarify the observed gaps in knowledge by utilizing structural equation modeling (SEM) to examine the mediating role of community violence exposure on the relationship between perceived neighborhood risk factors, parental behaviors, and peers on depressive symptoms in a sample of urban youth in low-income public housing communities (n=320). Results indicate that community violence exposure and exposure to delinquent peers mediates the effects of perceived neighborhood risk and parenting behaviors on depressive symptoms. These findings suggest that while interventions that limit exposure to community violence and delinquent peers could reduce depressive symptoms, interventions that reduce community violence are essential to improve youth mental health.

The rental system in Ghana’s low-income housing communities, challenges and adaptation strategies

The rental system in Ghana’s low-income housing communities, challenges and adaptation strategies

How Perceived Structural Racism and Discrimination and Medical Mistrust in the Health System Influences Participation in HIV Health Services for Black Women Living in the United States South: A Qualitative, Descriptive Study.

There are racial and geographic disparities for HIV in the United States; Black women have nearly 20 times the risk of White women in being infected with HIV, and lifetime HIV risk is greatest for people living in the southern United States. These disparities, layered with the structural racism and discrimination that is more prominent in the south, is a public health issue. The purpose of this article is to share Black women's perspectives of how perceived structural racism and discrimination, and medical mistrust in the health care system contribute to their participation in health services. In this formative study, we conducted seven focus groups among women living in 10 low-income housing communities. Results indicate that there are barriers to the utilization of health services that are grounded in personal experiences and historical mistrust for the health care system. Understanding these barriers is critical to combating the HIV epidemic for this population.

“I learned that I am loved”: Older adults and undergraduate students mutually benefit from an interprofessional service-learning health promotion program

ABSTRACT Although benefits of service-learning and interprofessional education (IPE) have been well documented to be effective for students in gerontology, few curricula appear to integrate both aspects into a single experience for undergraduate students in public health. We discuss the development and implementation of an IPE service-learning health promotion program embedded within two different departments at a mid-sized university. Students worked in interdisciplinary teams and acquired IPE learning outcomes while they engaged in their first experiences working with diverse older adults at a low-income independent-living housing community. Twenty-five students each team-taught two sessions on nutrition, physical activity, and stress reduction techniques in a 10-week program. Qualitative and quantitative results showed significant learning outcomes from the students about the needs of the aging population and increased comfort working with seniors. Older participants in the program also reported positive health and psychological outcomes from participation. Challenges, next steps, and recommendations are also discussed.

Exposure to Violence and Posttraumatic Stress Among Youth in Public Housing: Do Community, Family, and Peers Matter?

This study examines the mediating roles of neighborhood risk factors, parental behaviors, and peers on the relationship between community violence exposure and posttraumatic stress in a sample of urban youth in low-income public housing communities. Data are from 320 African-American youth living in public housing in a northeastern city in the USA. Structural equation modeling was utilized to examine the stated relationships. Study results point to significant effects of violence exposure on posttraumatic stress in urban youth. While findings indicated indirect effects of neighborhood risk, parenting practices, and exposure to delinquent peers on posttraumatic stress, each of these paths operates through their relationship with violence exposure, with exposure to delinquent peers having the strongest mediating effect. Exposure to delinquent peers mediates the effects of neighborhood risks and parental behaviors on exposure to community violence, representing one potential intervention point to disrupt the deleterious effects of exposure to violence among youth. Our findings suggest interventions that address peer influence, and group norms may serve as protective factors against the risk of youth violence exposure. Overall, results highlight the co-occurring socioecological context of community violence exposure for youth living in public housing.

SOCIAL CONNECTIONS AND HEALTH AMONG OLDER ADULTS IN SENIOR HOUSING COMMUNITIES

Our study describes social connections among residents in two low-income senior housing communities and then examines if these connections influence their well-being. Operationalization of social connections included social network size, informal social support, social engagement, and loneliness. The Convoy Model of Social Relations guides our study in identifying objective and subjective social connections and examining how they affect well-being. Most residents maintained active connections: 53% saw five or more family members in the previous month, 52% felt they could rely on their family members and over 60% participated in group and/or Church activities; however, 70% of residents were moderately or severely lonely. Greater loneliness and less informal social support were associated with worse self-rated physical health, worse mental health, and lower life satisfaction. This residential setting offers promise for developing interventions to decrease loneliness and strengthen social connections to improve residents’ health and well-being.

PRESIDENTIAL SYMPOSIUM: HARNESSING SOCIAL NETWORKS TO OPTIMIZE ENVIRONMENTAL CONTEXTS FOR DIVERSE AGING EXPERIENCES

Social networks provide opportunities for engagement with others and structure the receipt and provision of emotional, instrumental, informational and appraisal support. Indeed scholars in this field have documented the importance of having strong social networks in influencing older adults’ well-being and quality of life. The three papers in this symposium draw on the convoy model of social relations and ecological model to examine and better understand the micro, mezzo, macro contexts that shape and influence how older people engage with and benefit from their networks in three areas: low-income senior housing communities, urban areas specifically targeting older Latinos with dementia, and disaster preparedness in micropolitan counties in eastern Iowa. The first paper, a cross-sectional study focusing on social connections in senior housing communities, examines levels of social networks, engagement, support and loneliness and their relationship with well-being outcomes. The second paper, a community-based participatory research project, reports an intervention that seeks to train natural helpers in a predominantly Latino urban neighborhood to identify and refer older Latinos with dementia to bilingual assessment services. The third paper, synthesizing findings from interventions targeting network building at the individual and state levels as well as a community-based network analysis, presents ways to strengthen networks at the mezzo and macro levels as well as environmental contexts that enable better disaster preparedness for community-based older adults. These papers will consider practice, policy and research implications in strengthening social networks and engagement to optimize older adults’ well-being in various settings.

REDUCING OPIOID OVERDOSE RISK IN A COMMUNITY CARE COORDINATION CLINIC: RICHMOND HEALTH AND WELLNESS PROGRAM

Objective Opioid safety is increasingly important in the care of older adults due to higher risk for negative opioid-related outcomes related to higher prevalence of chronic pain, multimorbidity, polypharmacy, and age-associated changes in drug metabolism and elimination. Evidence-based practices for screening and safe opioid use for older adults are needed. Our project aims to develop, implement, and evaluate a care-coordination workflow and interprofessional clinical opioid misuse screening, support, and referral training to support older adult care. Methods Our research occurs in context of the Richmond Health and Wellness Program (RHWP), a community-based interprofessional care coordination initiative, with interprofessional faculty and students providing on-site integrated care to residents in low-income senior housing communities. Curriculum development, and interprofessional clinical faculty, peer support, and health professions student training have been conducted. Results will discuss the findings from the health professions student training. Findings The Opioid Overdose Risk Reduction Curriculum was delivered via Blackboard and in-person during student orientation. Pre (n=66)/Post (n=59) assessment indicated that after the training, there was an increase in knowledge, specifically change from 50% at baseline, 60% recognized Tramadol as an opioid, change from 80% to 97% understanding that MME represents Morphine Milligram Equivalent, and change from 62% to 93% understanding that 50 MME level greatly increases overdose risk. Only 20%, change from 60%, reported not being able to calculate MME. Conclusions Our findings indicate that opioid safety training within community care coordination is feasible. Future works needs to explore the impact on resident health as the workflow is implemented.

Children as community planners: embodied activities, visual-spatial thinking, and a re-imagined community

ABSTRACT This qualitative research endeavor explored the role of embodiment as a pathway to visual-spatial thinking. The researchers relied on an interdisciplinary approach using geography and theater rooted in kinesthetic and empathetic embodied activities to facilitate visual-spatial thinking within the context of a community redevelopment project. The participants consisted of 14 elementary and middle school aged girls attending a Girls Inc. program within a low-income housing community. The researchers situated the findings using McCormack’s ([1998. Visual/Spatial Thinking: An Essential Element of Elementary School Science. Washington, DC: Council for Elementary School Science]; [2011. “Don’t Verbalize, Visualize!” NSTA WebNews Digest. Accessed June 15, 2016. http://www.nsta.org/publications/news/story.aspx?id=58298]) visual-spatial thinking typology and theories of embodiment. The findings revealed that the girls exhibited three types of visual-spatial thinking, which ranged from foundational to highly advanced ways of thinking about space, to include visual-spatial perception, memory, and creative thinking. The results also illustrate that embodied activities that engage sensorimotor functions through an interdisciplinary approach, can facilitate visual-spatial thinking.

Let’s Face Adverse Childhood Experiences (FACE) It: Parent Education and Empowerment

Adverse childhood experiences (ACEs) are a major public health concern in the United States as childhood trauma can lead to long-term health and mental health consequences. They disproportionally affect low-income children of diverse backgrounds; however, parent education can potentially reduce ACEs among low-income young children. This study aims to examine whether parents’ perceptions toward ACEs changed after exposure to ACEsrelated infographic education. In this study, we identified three main themes across the focus group interviews that highlight the importance of ACEs-related educational intervention. Following the ACEs-related education, our study found that the vast majority of participants’ attitudes toward and perceptions of ACEs changed from normalizing ACEs to acknowledging and accepting the consequences of ACEs; the participants also reported feeling empowered to prevent the cycle of ACEs. More importantly, the participants recognized that ACEs could cause long-term traumatic damage to the exposed child’s health outcomes, and they felt empowered to seek resources for ACEs-related interventions. These findings shed positive light on the significance of educating parents on ACEs, which should be considered for policy implications and program interventions to prevent child maltreatment in the United States. We propose an intervention model using the health literacy and educational empowerment frameworks along with other policy recommendations that highlight the importance of culturally and linguistically appropriate services for diverse families living in low-income housing communities.

Space transformation in a low-income housing community in Danukusuman, Surakarta

PurposeWithin low-income communities in urban slums, access to housing is limited because individuals in these communities cannot afford to purchase homes. One area of Indonesia with these conditions is Kampung Kajen, Danukusuman, Surakarta, where, oftentimes, a single house is inhabited by several families and is passed down from generation to generation. This causes a change in space, a narrowing of that which is inhabited by the next generation. This paper aims to examine the transformation of space within low-income homes in Kampong Kajen.Design/methodology/approachThe research method was a qualitative case study approach, and data were collected through direct interviews and field observation. Informants in this study were classified into three groups: residents, non-residents and government agencies.FindingsThe space transformation that occurred in the studied samples was partial. The transformation continued to occur as the new families grew, and the area of space used by the new families experienced a narrowing for future generations.Originality/valueThe novelty of this research is in regard to the findings about the partial transformation of the house from generation to generation, which details changes in the layout and the extent of the house interior, the narrowing of the house, the change of owners and the changing behaviour of the house inhabitants. Partial transformation continues to occur in line with the addition of new families living in one house.

Social Networks and Physical Activity in Senior Housing: A Pilot Feasibility Study.

Only 16% of people aged >65 years engage in recommended levels of physical activity, putting a vast majority at risk for multiple chronic conditions including heart disease. Physical activity is even lower among older adults with fewer economic resources. Research is needed to develop context-specific approaches to pair with physical activity interventions to increase effectiveness. In this pilot study, we examine social ties and physical activity levels of older adults living in a US Department of Housing and Urban Development subsidized senior housing community to test feasibility of a social network-based approach to physical activity interventions. This study is grounded in Social Contagion Theory and the Convoy Model of Social Relations, which argue health and health-related behaviors are facilitated through network ties. Data were collected through face-to-face interviews conducted over the course of three months (September-November 2018) with 46 residents living in a low-income senior housing community in southeast Michigan. Residents were asked about physical activity, people they know in the community, and their close social network composition. Residents reported knowing, on average, six other residents and approximately 28% of those in their close networks were also residents. Sociocentric network analysis identified two socially engaged (known by seven or more other residents) physically active residents, whereas ego-centric analysis identified four (60% or more of their network comprised residents). This study demonstrates potential feasibility of a strategic partnership that involves pairing social resources with physical activity interventions in affordable senior housing. Multiple approaches, which need to be evaluated, exist to identify socially engaged residents.

Social Networks and Physical Activity in Senior Housing: A Pilot Feasibility Study

Objective: Only 16% of people aged &gt;65 years engage in recommended levels of physical activity, putting a vast major­ity at risk for multiple chronic conditions including heart disease. Physical activity is even lower among older adults with fewer economic resources. Research is needed to develop context-specific approaches to pair with physical activity interventions to increase effectiveness. In this pilot study, we examine social ties and physical activity levels of older adults living in a US Depart­ment of Housing and Urban Development subsidized senior housing community to test feasibility of a social network-based approach to physical activity interventions. This study is grounded in Social Contagion Theory and the Convoy Model of Social Relations, which argue health and health-related behaviors are facilitated through network ties.Methods: Data were collected through face-to-face interviews conducted over the course of three months (September- November 2018) with 46 residents living in a low-income senior housing community in southeast Michigan. Residents were asked about physical activity, people they know in the community, and their close social network composition.Results: Residents reported knowing, on average, six other residents and approxi­mately 28% of those in their close networks were also residents. Sociocentric network analysis identified two socially engaged (known by seven or more other residents) physically active residents, whereas ego-centric analysis identified four (60% or more of their network comprised residents).Conclusions: This study demonstrates potential feasibility of a strategic partnership that involves pairing social resources with physical activity interventions in afford­able senior housing. Multiple approaches, which need to be evaluated, exist to identify socially engaged residents.Ethn Dis. 2019;29(Suppl 1): 201-208; doi:10.18865/ ed.29.S1.201.

“I Would Say It’s Almost Like a Crime Against, You Know, the Soul”: Building a Culture of Health in Low-Income Housing Communities Through Addressing Childhood Trauma

ABSTRACTThe purpose of this article is to examine parental perceptions of child maltreatment to inform services that target families living in low-income housing communities in Fresno, California, through focus group interviews. We identified three main themes across all focus group interviews that describe the child maltreatment among our participants: (a) acknowledging child maltreatment as a problem, and its negative consequences; (b) normalizing or justifying child maltreatment as part of growing up; and (c) seeing child maltreatment as intergenerational. Additionally, parents discussed types of help to address child maltreatment. We then propose a prevention model using a public health framework along with other policy recommendations that highlight the importance of culturally and linguistically appropriate services for diverse families living in low-income housing communities.