The Health Disparities Research Group (HDRG) is a multidisciplinary assembly of faculty, students, staff, and community representatives with a vision “to become an integral facilitator in eliminating health disparities through partnerships with our community.” Held the 3rd Friday of each month throughout the academic year, the meetings provide an opportunity to share research and cultivate a positive atmosphere for community-engagement in addressing health disparities.
The next meeting is May 19 at 1:00 pm in Bio-medical Library Room 222-A. Dr. Erik Goldschmidt, Director of the Foley Community Service Center at Springhill College, will share about their work in his presentation “From Charity to Justice: Optimizing the Impact of Service-Learning & Community Service”.
Please join us for the final HDRG meeting of this academic year.
Dr. Hudson began his talk by outlining the theoretical foundations of and major influences on his work. Citing the work of Dr. William Julius Wilson on race and labor markets and the work of Clayton and Byrd on the history of minority health disparities, Dr. Hudson outlined three eras in American history focusing on race and labor relations, and the provision of medical care. After the civil rights movement, institutions such as hospitals couldn’t overtly discriminate on race, but they could, however, discriminate based on the ability to pay. Currently, the primary mechanism for covering the cost of health care in the United States is health insurance, which is usually provided by either an employer, family members, or a government program such as Medicare or Medicaid.
Within this context, Dr. Hudson relayed the findings from his team’s analysis of the health insurance data from the CPS. The findings reaffirmed what was already known; the ACA substantially reduced the rate of uninsured Americans. They also found that the expansion of Medicaid was the primary mechanism for this reduction, even though 19 states chose not to participate in the Medicaid expansion program..
Dr. Hudson and his team are currently preparing their findings for publication.
The CHNA is a requirement for not-for-profit hospitals under the Patient Protection and Affordable Care Act. The assessment, conducted every three years, “should define the community, solicit input regarding the health needs of the community, assess and prioritize those needs, identify relevant resources, and evaluate any actions taken since preceding CHNAs.” To this point, Dr. Shaw and Dr. Bunch explained the methodology for the 2015-2016 CHNA:
Specify the relevant community served by the USA Health System — USA Medical Center, USA Children’s and Women’s Hospital, and Mitchell Cancer Institute
Create a comprehensive demographic profile using secondary data sources that provides information on the makeup of the community and prevalent conditions.
Conduct a telephone survey of individuals living in the defined community (Mobile County)
In discussing the demographic profile, Dr. Bunch pointed out some concerning trends for Mobile county, including:
While the 20% of individuals living below the poverty line remained steady between 2010 and 2015, the percentage of individuals near poverty (100%-149% Federal Poverty Level) increased.
While the percentage of residents who have a high school diploma has increased in the county, it is still far behind the rest of the country in terms of those who obtain a bachelor’s degree.
Infant death rates rose from 7.5 in 2010 to 10.2 in 2014. Among African Americans, the increase was 11.5 in 2010 to 14.4 in 2014.
After the discussion of the demographic profile, Dr. Shaw explained that the telephone survey was modeled on a similar survey that Mobile Infirmary conducted with healthcare providers. They then compared the responses from the provider survey with the community survey. They used two key sampling elements:
General community survey using a standard random digit dialled survey of residents of Mobile County (both landline and cell phones). This segment included 263 respondents from Mobile County.
Focused community survey included 257 respondents from zip codes within Mobile County where most USA Health System patients reside. To be included in this focused sample, the zip code area had to have at least 50 patients visiting either the USA Medical Center or the USA Children’s and Women’s hospital in fiscal year 2015.
The responses from the community survey were compared with those of the Mobile Infirmary provider survey. The responses showed striking differences between community members and healthcare providers on the “features of a healthy community”and “most important health issues;” however, there was considerable agreement between the community and providers over what healthcare services were difficult to obtain in Mobile County.
The final CNHA was presented to the Board of Trustees in August of 2016. Both the report and the recommendations for actions were approved by the board. The researchers commended the Board on its willingness to undertake a stringent assessment process and the development of more focused, quantifiable recommendations for meeting needs.
The 2015-2016 Community Health Needs Assessment is available online from the Health System.
The October 2016 meeting of the Health Disparities Research Group (HDRG), featured a team of faculty and students from the University of South Alabama (USA) who shared their experiences of as founders and participants in Project Homeless Connect(PHC). This annual one day even provides various resources including medical services, legal services, dental and vision screenings, and access to housing assistance to homeless individuals and families in Mobile and Baldwin counties. The team from USA coordinates and provides all medical screenings and clinical services offered at the event.
Dr. Margaret Moore Nadler, USA College of Nursing, provided an overview of the experience of implementing PHC in Mobile and also the process through which the interprofessional team from the university became involved. The event began as a multi-agency and university partnership led by the Mobile-Baldwin Continuum of Care Board and Housing First (a local non-profit agency focused on advocacy and community collaboration to end homelessness). The original focus of the collaboration was to develop standards for counting the number of homeless individuals in the area in order to comply with Federal regulations that require “Point in Time” count every January. Through this collaborative process, the group learned that Birmingham and other cities across the nation put on annual service events often called Project Homeless Connect through which they provide a one day, one-stop opportunity for homeless individuals and families to access needed services and assistance under one roof. The Mobile collaborative group realized that such an event would be a great way to serve while also meeting the mandate of conducting the annual census.
During their presentation to HDRG, members of the interprofessional team focused on three key aspects of USA’s participation in PHC.
Benefits for the USA team
Working in an interprofessional team provides opportunities for developing understanding across disciplines and build relationships.
Through the service learning opportunities of PHC students are able to strengthen their cultural competency skills and are often challenged to expand their capacity for compassion and empathy. In demonstrating this point, Caleb Butler, a social work student, shared that while he was serving as an advocate at PHC he met someone who was his age, shared a similar family background, and came from the same hometown, yet he(Caleb), was a university student, while the other person was homeless. Caleb explained that through this experience his understanding of homelessness broadened, he developed more empathy, and he realized that anyone had the potential to become homeless.
Reciprocal learning between faculty and students occurs through the process of feedback and evaluation. Students from the College of Allied Health Professions, College of Medicine, and College of Nursing run the medical clinic with backup support from faculty and community providers. After each PHC the teams debrief and discuss what worked and what didn’t in order to help all involved improve their skills and to make plans and adjustments for the future.
Improvement and Development
After reviewing three years of participation in Project Homeless Connect, the team is developing a strategy for moving forward and improving care.
A 3-5 year strategic plan with the goal of expanding the health clinic portion of the PHC as a quarterly event. They plan to seek corporate sponsorships and grants to support this goal.
SMART objectives have been developed around providing better care, creating better health, and lowering costs.
Each area of clinical service will be evaluated to recognize what works and opportunities for improvement.
Marketing and advocacy strategies being developed to raise the profile of Project Homeless Connect both on campus and in the broader community. New partnerships are also being sought to enhance services offered.
Data Collection and Research
Through the forms that clients in Project Homeless Connect complete, an abundance of data is being collected and compiled in REDCap so that it can be that can be analyzed for trends and to inform performance improvement efforts. The goal is to have an accessible Homeless Health longitudinal data set that can be accessed by students, faculty and community partners who participate in Project Homeless Connect.
The team has identified research opportunities from this project:
Community Based Participatory Research
Readiness to change and patient referrals to community agencies
Use of motivational interviewing
Students participating in PHC: Attitudes towards the people who are homeless and now working
Needs assessment of USA student homelessness or risk factors for homelessness
Influence of interprofessional education collaboration
The presentation team consisted of:
Dr. Margaret Moore Nadler, College of Nursing
Dr. Kathy Bydalek, College of Nursing
Ms. Clista Clanton, Biomedical library
Dr. Pam Johnson,College of Nursing
Ms. Mary Meyer, College of Nursing
Mr. Caleb Butler, Social Work Student in the Department of Sociology, Anthropology, and Social Work
Mr. William Crittenden, third year medical student in the College of Medicine
At the September 16, 2016, meeting of the Health Disparities Research Group, Ms. Sarah Wraight, graduate research assistant with the Center for Healthy Communities and Master’s candidate in the department of Sociology, Anthropology, and Social Work, together with
Ms. Candis Patterson, Health Education Specialist with the Center for Healthy Communities, presented “Will they stay or will they go? Long term commitment to a community health advocacy program.” Based on interviews with the several of the longest serving and currently active Community Health Advocates (CHA), their presentation explored the factors that allowed this group of CHAs to continue working with the Center for Healthy Communities through the more than 10 years of the program’s history.
In describing the elements that have contributed to their continued relationship with the CHC, Ms. Wraight and Ms. Patterson discussed their findings with special emphasis on three key themes:
Spirituality and Community Trust
Support provided by individual pastors and churches
Key church ministries where CHAs can plug in the health advocacy work
Churches provide gathering place considered trustworthy and safe, providing an open space for health education activities
Self and Collective Efficacy
Pride in being able to give to their own community
Desire to pass the torch along to other individuals to continue the work
Professionalism and Networking
Professionalism comes from the support of the University staff in training and providing assistance with CHA events
Meetings and program activities provide opportunities to meet and brainstorm ideas for future projects
Ms. Wraight and Ms. Patterson also explained that in addition to describing the factors that kept them connected to the program, the CHAs interviewed shared their goals for future health advocacy efforts. The strongest themes regarding future CHA work included:
Developing more partnerships with organizations and institutions in Mobile
Moving into advocacy to directly influence policy change
Addressing mental health issues
The presentation was based on a poster presentation given by Ms. Wraight, Dr. Roma Hanks (Co-Director of the Community Engagement Core with the Center for Healthy Communities and Chair of the Department of Sociology, Anthropology, and Social Work), and Ms. Patterson at the Women’s Health Update Conference held at UAB in August. Dr. Hanks, who was unable to attend the HDRG meeting, has directed the CHA work for several years and designed the project methodology used for the research presented in the poster. They are currently drafting a manuscript to further detail their research on the continuity of the CHAs.
Community-Academic partnerships were a centerpiece of the CCPH conference. Of those HDRG members who attended the conference, several spoke of the way community members led many of the sessions with academic partners playing a supportive role. One example was a session led by the translational research coordinator/community navigator from the Vanderbilt Institute of Public Health. The session featured the work of integrating community members into research design decisions by including community representatives in a scientific advisory board and the “community engagement studio” which forms a consultant group for impacted community members to review research protocols and provide feedback and advice to researchers.
The importance of funding and how funders work to ensure community engagement garnered much discussion. Naima Wells, research coordinator from the USA Center for Healthy Communities Research (CHC) Core, described a meeting that she attended with leadership from CCPH and the Robert Wood Johnson Foundation. The session focused on two main questions: 1) Is philanthropy helpful?; and 2) Is there arrogance in philanthropy?. A strong vein coming from the discussion was the importance of considering community need, interest and infrastructure in developing calls for proposals. From the foundation perspective, there is a need for more community groups to respond to funding opportunities. From the research and community activist perspectives, the opportunities either don’t coincide with local need or are too cumbersome to allow for a proposal.
Community-Academic partnerships serve to foster the development of new participatory approaches. Shannon Shelley-Tremblay, project manager for the CHC, described a session on group level assessment developed by researchers at the University of Cincinnati. The model focuses on involving all key stakeholders in a process in which everyone is on the same level to discuss problems and solutions. In so doing, the model allows the use of different communication mechanisms such as drawing and speaking to ensure that all voices have a place in the discussion and allow for analysis within the group as well as data collection.
The impact of language on relationship and the views of the other was an underlying stream of discussion throughout the conference. Naima Wells mentioned that in many of the sessions that she attended individuals talked about the need to acknowledge the strengths within the communities where research is being done. The use of the word “empowerment” was questioned. The consensus was that ‘empowerment’ implies that marginalized communities do not have power and that researchers are giving them power. The reality is that these communities have always had power and strengths that researchers and other must recognize. Naima reported that two recommendations came out of the discussions: “in-powerment” and “redirect power.” The discussion was a reminder of the need to be cognizant of the language we use and the messages that are communicated through that language.
During the HDRG meeting, members of the Research Core reported on their own presentation during CCPH. They described the positive reception of the research apprentice concept and the very lively dialogue with the audience members. Sherron Dortch, senior research apprentice, talked about the individual feedback that she received from different conference attendees she met. She also expressed her appreciation for attending CCPH 2016 and learning more about the importance of health disparities research.
Addressing health disparities requires a broad understanding of the underlying causes as well as approaches to increasing health equity. Such understanding grows through the development of relationships and partnerships around specific issues and approaches. Community-Based Participatory Research (CBPR) offers opportunities for equitable relationships between community members and academic researchers to identify areas of research and intervention development. During its 10-year history, the Center for Healthy Communities’ Health Disparities Research Group (HDRG) has developed a track record of nurturing partnerships with community organizations, undertaking CBPR projects, and promoting the CBPR practice throughout the university.
Membership in HDRG is open to faculty, staff and students throughout the university community. Its multidisciplinary character is broad-based with members from seven colleges within the university and incorporating the disciplines of Public Health, Medicine, Nursing, Allied Health, Psychology, Sociology, Social Work, Political Science, Education, Business, Engineering, and Library Science. The richness of the collaboration growing from such interaction across disciplines can be seen in the research projects that have been undertaken by group members over the years. Informed by the values of CBPR, these projects not only include academic researchers from across disciplines but also community organizations such as a local health center based in a low income community, churches, and a local advocacy group.
One example of community engagement is HDRGs continuing relationship with the Bay Area Women’s Coalition, Inc. (BAWC). The partnership first developed around BAWC’s need to gather neighborhood health information as part of substantiating the need for a clinic in the Trinity Gardens community of Mobile County. Through the partnership, HDRG members and BAWC leadership worked together to develop and field a health status and access to care survey among neighborhood residents. As a part of the partnership, HDRG members assisted BAWC leadership and volunteers with training on research methodology, working with human subjects, and basic computing, and data analysis. The collaboration continues as BAWC leadership are included in new project proposals and research design processes.
With the experiences and capacities developed through conducting CBPR based research projects, HDRG has established a reputation for expertise and leadership in this area. The group is now focused on a CBPR dissemination plan to establish CBPR as a model for research at the Local, State and Regional levels.
HDRG Meetings are held every third Friday throughout the academic year. Individuals interested in attending should contact Shannon Shelley-Tremblay.
The discussion highlighted the research training experienced by the Research Apprentices who are members of the community who have a wide variety of backgrounds and interests, but no prior formal education in the research process. Additionally, the group provided an overview of the Sentinel Surveillance Project and why the inclusion of community members as a part of the research team is integral to meeting the goals of and adhering to the values of community-based participatory research. Structured in an interview format, the team described recruitment and training of research apprentices, the work done in collecting, managing, and analyzing data gathered from the community.
While describing their participation in the research team, the various research apprentices discussed both what they had brought to the research project and what they had learned. Sherron Dortch, a senior research apprentice, stated that her attention to detail and strong organizational skills allowed her to focus on quality data management while at the same time providing her with the opportunity to develop computer skills. At the same time, Sherron shared that through this research project she developed a deeper awareness and understanding of the health disparities that exist in a neighborhood and community where many of her friends and relatives live. This sentiment was echoed by Valerie Grimes and Carla Taylor who also work as Research Apprentices.
Marcellus Hudson, currently a Research Technician II with the Research Core, described his journey from Research Apprentice to a full-time staff member at the University. He talked about the many ways the experience provided avenues to foster his interest in computer programming and further enhanced his desire to learn and pursue his education. Marcellus also talked about the importance of uncovering the health situation in the community where he and many of his relatives live.