HDRG Recap: Building Community Based Research through Community Coalitions

DannyEditedAt the November 2017, Health Disparities Research Group (HDRG) meeting, Danny Patterson, Coordinator, Collaborations and Partnerships, Gulf States Health Policy Center (GSHPC), shared about their experiences with coalition building to work for improving health outcomes. Working in 5 states (Alabama, Florida, Mississippi, Louisiana, and Texas) GSHPC united with community members, partner organizations, and service providers to form coalitions including 130 multi-sector community organizations in the states of Alabama (cities of Bayou La Batre, Mobile, Birmingham) and Mississippi (cities of Hattiesburg and Gulfport/Biloxi) and Louisiana via LSU in Baton Rouge. Coalition members represent a range of groups including faith-based organizations, government, education, primary care, mental health, housing, academia, public health, business, law enforcement, and other community-based organizations. GSHPC works with both local and national partners in their work. The work is supported by the National Institute of Minority Health Disparities.

With a focus on health policy research that leads to positive change, the coalition building process included three basic phases: member recruitment, development of strategic partnerships, and training of coalition members. Activities taking place throughout the process include community information meetings, coalition member recruitment, policy focus area identification, subject matter expert presentations, community forums/policy scans, literature reviews, community action plans (in development) and action plan implementation. The goal is to “empower communities and increase their capacity to improve health outcomes.”

The local coalition is currently working in 3 policy areas: health literacy, financial literacy, and educational literacy.  In terms of health literacy, the coalition is working on local practice or policy change by creating pathways for data sharing between Ozanam Charitable Pharmacy and Mobile Board of Health Clinics. The current research pilot, designed by the coalition, will recruit 50 diagnosed diabetes patients (as of November 6, 31 had been recruited). The two organizations serve mostly low-income and homeless individuals. The process under study will facilitate the sharing of information for the participating patients in order to provide more holistic care. To date, lack of transportation from the clinic to the pharmacy has been identified as one of the problems that will need to be addressed. The study will evaluate whether or not the increased communication between pharmacy and doctor translates into improved care and disease medication management for the patients.

During the question and answer phase of the HDRG meeting, Danny stressed the importance of transparency and open dialogue to build the coalition. Such an approach — a willingness to give a little while building something greater — helps develop the relationships needed to develop a healthy and impactful coalition.

Along with projects related to policy, the GSHPC coalition focuses on building community-based leadership capacity. This capacity is critical for sustainable once funding for the projects are over. The built capacity for local leaders to continue the policy work is essential for continued progress toward health equity.

Learn more about the Gulf States Health Policy Center.
Learn more about the Health Disparities Research Group.

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Upcoming HDRG Meeting

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 November 17, at 1:00 pm in Bio-medical Library Room 222-A. Danny Patterson, Coordinator, Collaborations and Partnerships, Gulf States Health Policy Center, will share about their work in his presentation “Building Community Based Research through Community Coalitions.” Danny’s presentation is based on a poster that he and colleagues presented at the 4th Annual Community Engagement Institute in Birmingham that won an award in the conceptual framework category.

Please join us on November 17.

HDRG Recap: Experiences with Community-Based Participatory Research

On October 20, 2017, the Health Disparities Research Group (HDRG) held its first meeting of the 2017-2018 academic year. Two speakers provided an overview of experiences related to health disparities and community-based participatory research.

Ms. Shelley-Tremblay, formerly the project manager for the Center for Healthy Communities and current Director of the Office of Community Engagement at the University of South Alabama, reported on her experience at the 2017 Summer Intensive hosted by the Community-Campus Partnerships for Health (CCPH). Titled “Structural Inequality: An On The Ground View”, the intensive provided a two-day experiential learning opportunity to the approximately 35 attendees who ranged in age from 16 to 86 and came from various walks of life. Each aspect of the Summer Intensive — 21C Museum Hotel, the University setting, the tour of Historic Stagville, and lecturers — was chosen to facilitate learning about the roots of structural inequality and how tools of Community-Based Participatory Research/Approach (CBPR) and Community Action Strategies can be used to address structural inequality.

In the session on the  “Groundwater” approach, presented by the Racial Equity Institute, LLC,  the group explored racism and inequity as touching and affecting all aspects of life. The facilitators used stories and data to demonstrate how racism is fundamentally structural in nature. With this framework for understanding and analyzing inequality, the final sessions explored how CBPR could be used in response. Shannon finished her presentation with questions for the HDRG group to consider:

  • How can we build on the work of HDRG to “help to ensure that the reality of community engagement and partnership matches the rhetoric?”
  • What role can we play in shifting the conversation about health in our community to an opportunities lens and away from the current focus on problems?
  • Is there value in bringing a similar experience to this region?
  • How can we leverage the assets in our region?
  • What aspects of our ongoing health disparities work can be expanded to make this focus on addressing the link between structural and inequality and health intentional?

In the second presentation of the day, Dr. Martha Arrieta, Director of the Research Core at the Center for Healthy Communities, informed the group of the recent publication of an article about the evolution of the HDRG in the Journal of Higher Education Outreach and Engagement. She explained that HDRG was starting its 13th year and had built a strong platform for health disparities research over its history. In exploring the history and accomplishments of the HDRG, Dr. Arrieta started by reviewing a 2008 publication which outlined the establishment of the group. She then provided an overview of the recent article on the strategies for consolidation. In doing so, she covered:

  • Promotion of Group Identity and Permanence: an overview of activities that were used to form the HDRG and develop connection and focus among the members.
  • Fostering Health Disparities Research Capacity: a review of research projects undertaken by the group over its history.
  • Engagement in Participatory Research: explanation of the partnership with the Bay Area Women’s Coalition and a diabetes research project with the Hands of Hope Clinic in Trinity Gardens.
  • Dissemination of CBPR Principles: an overview of the activities undertaken to disseminate CBPR and community engagement through the university campus.

Dr. Arrieta next discussed the challenges faced by the HDRG over the years and the keys to successfully overcoming those. She described the activities — such as faculty forums, meetings with university leadership, joint research projects, and community partnerships  — as contributing to establishing health disparities/health equity as a concern within the University and HDRG as a leader for community engagement on the campus. Dr. Arrieta ended her presentation by mentioning the plans for the community-engaged dissemination of the findings from the Sentinel Surveillance Project and the potential of work to promote bi-directional links between basic science labs on campus and the community -activities that become building blocks for continued work in community-engaged approaches to researching and addressing health disparities.

Downloads:

Presentation from Ms. Shannon Shelley-Tremblay.
Presentation from Dr. Arrieta.

New Publication: Consolidating the Academic End of a Community-Based Participatory Research Venture to Address Health Disparities

A recent article published in the Journal of Higher Education Outreach and Engagement explores the development of the Health Disparities Research Group (HDRG) at the University of South Alabama.  Written by a team led by Dr. Martha Arrieta, the article discusses

  • the formation process of the HDRG
  • Activities leading to the promotion of group identity and permanence
  • Activities to Foster Health Disparities Research Capacity
  • Activities Leading to Engagement in Participatory Research
  • Activities Leading to the Dissemination of CBPR Principles and Practice
  • Keys to Success in the Consolidation of HDRG
  • Challenges Encountered and Responses Devised

Read the full article.

HDRG Recap: “From Charity to Justice: Optimizing the Impact of Service Learning and Community Service”

The final Health Disparities Research Group (HDRG) meeting for the 2016-2017 academic year was held Friday, May 19th. Dr. Erik Goldschmidt, the Director of the Foley Community Service Center at Spring Hill College (Foley Center) was the presenter. Dr. Goldschmidt described the integral role community service plays in the mission of Spring Hill College and the ways in which the Foley Center advances community service efforts by supporting the volunteer work of nearly 50% of the student body each year.

The Foley Center administers service learning courses for many of the departments at Springhill. Service learning classes must provide students with opportunities for authentic interaction with community groups and the individuals they serve. Springhill strives to ensure that these authentic interactions result in student experiences that are characterized by substantial and sustained onsite service to local non-profit, direct-service organizations. This interaction focuses on building relationships which then become the vehicle for student development of self-knowledge, awareness of others, and systems thinking.

In addition, Dr. Goldschmidt discussed the Foley Center’s plans for future growth. A core principle driving the next phase of development is the goal of facilitating systemic engagement that advances beyond charitable work to justice oriented action. The College intends to support students as they work alongside partners to solve real-world problems. Ultimately the expectation is that there will be a “reciprocal learning process” that will improve the community while supporting students in their academic and spiritual journey.

The Foley Center is also exploring ways to bring community members on to the Spring Hill College campus for authentic interactions. One approach is “college exposure” days for students from area middle and high schools. More than a campus tour, the exposure day is designed for two way interaction between the 25 visiting students and approximately 70 faculty, staff and students involved with the group throughout the day. The day also provides for cooperative learning activities in the classes.

Another approach to bringing the community into the campus is a semester focus on one community partner. The partner organization’s leadership and staff can visit the campus, interact with students, and speak in various classes. The interaction includes asking, “what more could we be doing with you.”

Throughout his presentation, Dr. Goldschmidt stressed the potential for personal development of students of service learning, while reinforcing the need to authentically engage with partners with respect and humility.

 

Next HDRG Meeting

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.

 

HDRG Recap: Health Care Apartheid: Labor Markets, Race-Ethnicity, and Affordable Care

At the April 21, 2017, meeting of the Health Disparities Research Group (HDRG), Dr. Kenneth Hudson and his team presented findings from their research on the impact of the Patient Protection and Affordable Care Act (ACA) on insurance rates. This work is part of the research project The Impact of Labor Force/Labor Market  Status on Access to Health Care. The presentation focused on analysis of data from the  Current Population Survey (CPS).

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.

February HDRG Recap: Community Health Needs Assessment

At the February 17, 2017 meeting of the Health Disparities Research Group (HDRG) Dr. Thomas Shaw and Dr. Jaclyn Bunch of the Department of Political Science and Criminal Justice provided an overview of the 2015-2016 Community Health Needs Assessment (CHNA) they conducted for the USA Health System.  As director of the USA polling Group/Survey Research Center, Dr. Shaw was approached about conducting the assessment for the USA Medical System in March of 2016.

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.

chart-on-healthy-communitychart-on-health-issues
healcareservice-table

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.

Watch the presentation video.

October HDRG Recap: USA Faculty, Staff, and Students Serving the Community through Project Homeless Connect

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

Download the presentation.

Watch the video:

 

 

September HDRG Recap: Sustaining Community Health Advocates for the Long-term

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.

Read more about the work of the CHA program.