RSS Annual Conference 2012 Chicago

RSS 75th Annual Meeting
Diversity Gathering Room
Community Research with Rural
Hispanics in Southern Illinois:
Issues, Approaches and Challenges
Panel –
Cathy Bless- Shawnee Health
Services Aurelia Zaragoza
Southern Illinois Hispanic Ministry
Ben Mueller
Avicenna Community Health
Center

Panel Overview: Telling our Story
• Background of the Panelists
• Roles we have played using the
Community Participatory Research
Approach
– Partnership Building
– Assessment and data collection
– Problems/Issues Identification
– Program development and implementation
– Evaluation and Dissemination
• Questions and Discussion

Before we get started: Rationale
for CBPAR and its Linkages to
Local Solutions to Inequality
• My CBPAR Research grounded in Human Rights and Social
Justice perspectives
– Undocumented Hispanic Immigrant population
– Uninsured and underinsured families with health disparities
– Rebuilding a local safety net for at risk families with Free Clinics
• Faith-based free clinics
• FQHCs and community healthcare partnerships
• My Discipline Expertise
– Community Health research and outreach
– Rural Community and Economic Development
– Multi-media Studies

A Social Justice Perspective as it
relates to Health Disparities
• Health Disparity/Equity Frameworks (NIH
2002; DHHS 2000; WHO 1986)

• Equity in health is the absence of systematic
disparities in health (or in the major social
determinants of health) between groups with
different levels of underlying social
advantage/disadvantage (e.g. wealth, power,
prestige) – Starfield, 2000

Community, Evaluation and
Dissemination Research: Frameworks,
Models and Approaches: Health
Disparities Research
• Vulnerability Model (Shi and Stevens, 2005)
• CBPAR approach (Israel 2003; Fals-Borda
1987; Freire 1982)
• Evidence based practice approach (Brownson
1999; CDC 2001)
• Practice based evidence approach (Green,
2007)

Community Research Strategic
Objectives equity…
– …to address health disparity and promote health

• Identify and engage community partners in the joint conduct of in
health-related research to reduce health and health care disparities
using evidence-based disease prevention and intervention activities in
rural underserved communities in Illinois

• Implement and evaluate a practice based evidence model of
community research using a participatory approach that encourages
and equips the community in addressing their own health-related
priorities

• Build capacity in the community to create and deliver health
information that is culturally sensitive and appropriate to needs of
rural and underserved populations

• Enhance the abilities of community members and health providers to
identify and resolve health and health care disparities

What is Health Disparity?
• Differences in the incidence, prevalence, mortality and burden of
diseases and other adverse health conditions and health states that
exist among specific population groups (NIH, 2000)

• Disparity manifests as shorter life expectancy and higher rates of
CVD, cancer, infant mortality, birth defects, diabetes, stroke, STD’s
and mental illness among others

• Disparity among population groups is also evident at the health care
delivery system level, in differential rates of access and use of services

Types of Health Disparities

• Health Status AND/OR Health Outcomes

• Individual personal factors – biological/genetic,
sociodemographic, socioeconomic, disabilities, residency,
cultural norms and values, literacy levels, familial influences,
environmental/occupational exposures

• Societal/System factors – Social resource distribution,
social and political advantages such as knowledge and social
connections, insurance status, transportation/geography,
distribution of health resources (clinics, health professionals
training and approaches or patterns in providing care)

Social Justice Linkages:
Vulnerability Model

• In rural communities, health disparities in
underserved populations have adverse effects on
health care institutions, schools and business
• Negative social/economic impacts are related to
access/navigational issues in the health care
institutions (System)
• Susceptibility to risk factors aligned to cultural
background (Individual)

Social Justice Linkages:
Vulnerability Model
Vulnerability Model of Perceived Access Barriers for Rural Hispanic Immigrants

Individual Models Systems Models
Health insurance Health insurance
High costs of High costs of
Healthcare services Healthcare services
Communication Communication
Legal Status / Legal Status /
Documentation and Individual and Systems Interaction
Discrimination Model
Transportation Documentation and
Discrimination
Transportation

Community Based Participatory Action Research
(CBPAR): Historical Foundations of Social Justice

• PAR
– Commitment to social transformation
– Origins in Latin America (Fals-Borda, Freire)
– Focus on oppressed and underserved populations

• CBPR
– Commitment to evidence-based scientific rigor
– Emphasis on diverse partnership building
– Grounding in ecological model of health

RSS Annual Conference 2012 Chicago

Partnership Formation: EXPORT formed
Hispanic Health Advisory Committees

• Formed and supported 10 pilot Hispanic Health Advisory
Committees (HHAC) in 14 IL communities
• Stakeholders involved (based on preliminary HHAC evaluation;
n=35):
• Community Hospitals (5) • Non-Hispanic CBOs (1)
• •
State/County Government Org (5) City Officials (1)
• School Districts (3) • Social Service Org (1)
• Higher Education Org (12) • State Legislator (1)
• Community Foundations (2) • Private Healthcare Providers
• Hispanic CBOs (2) (1)
• FBOs (2) • Private Clinics (1)

Assessment Objectives

– Assess rural Illinois Hispanics’ major health concerns
in order to identify health disparity issues and help
focus prevention efforts

– Disseminate results to Hispanic Health Advisory
Committees (HHACs) to inform their local
implementation plans; and to rural practitioners to
inform their clinical or public health practice

Assessment Phase

• Identify needs and appropriate research
questions

– Examine existing data (epidemiological,
behavioral, archival, ethnographic, etc) and
identify data needs
– Develop exploratory research questions in
collaboration with the partnerships

Research Questions

• What are rural Illinois Hispanics’ major…
– perceived health concerns?
– perceived risk factors?
– perceived barriers to access healthcare?
– preferred health education strategies?

Implementation Phase:

– Develop a minigrant proposal based on the
findings from the Assessment phase

• Problem description (use of assessment results)
• Partnership description
• Proposed activities
• Budget
• Timeline
• Technical assistance needs

Importance of Evaluation

The whole evaluation process has to lead to self-
determination. This means that any evaluation
process has to be empowering to the
stakeholders/community and give them something
that benefits them…something that gives them more
knowledge about what is happening in the project,
the program and/or the community.

Dissemination Phase:
• Translational Research Framework

• Translation Research characterizes the sequence of events (i.e., process) in which a
proven scientific discovery is successfully institutionalized integrated into established
practice and policy. Comprised of dissemination research, implementation research
and diffusion research.

• Dissemination Research is the systematic study of how the targeted distribution of
information and intervention materials to a specific public health audience can be
successfully executed to increase spread of knowledge.
•
• Implementation Research is the systematic study of how a specific set of activities
and designed strategies are used to successfully integrate an evidence-based public
health intervention within specific settings.
•
• Diffusion Research is the systematic study of the factors necessary for successful
adoption by stakeholders and the targeted population of an evidence-based
intervention which results in widespread use.

Dissemination Phase: Activities

Dissemination Efforts/Activities Number
of
Products
Produced

Assessment Reports 840
Flyers: Health Ed/Capacity Building 5,700
Newsletter Articles 1,250
News Releases/Newspaper Articles 18
Resources Guides/Newsletters 3,000
Mass Media (TV and Radio) 6
Community Informational Activities 4
Health Fairs 3
Educational Workshops 37

Some Final Reflections to Communicate:
Evidence and Practice
Practice and Evidence

• If we want more evidence-based practice, we need
more practice-based evidence.
• Recognize the importance of practitioners and
other end-users in shaping the research questions.
• Practitioners and their organizations represent the
structural links (and barriers) to addressing the
important health issues. Engage them.

• Green, LW. From research to “best practices” in other settings and populations. Am J Health Behavior
25:165-178, April-May 2001.

Acknowledgments

• NIH/NCMHD (5 P20 MD000524) – Project EXPORT
Center of Excellence in Rural Health
• National Center for Rural Health Professions
• UIC College of Medicine at Rockford
• UI Extension
• Community Health Advisory Committees

Hispanic
Health
Advisory
Committee

United
Methodist Faith-based Catholic
Church Partners Church
Cobden Carbondale

The Old
School
Carbondal
e

Hispanic Community
Health Assessment
The Old
School,
Carbondal
e
Catholic
Church
Carbondal
e
Methodist
Church
Cobden

Bilingual group interviewer
and recorder

Gender separation is an important
means of getting Hispanic men and
women to open up

Having a “conversation” about
health care needs

Researchers present assessment results
back to the community
Diabetes
Lack of •participants
Medical
Interpreters
validate
results
Mini-grant
• HHAC
Chronic
Respiratory selects
Illnesses
2 problems to
Sexually
Transmitted address
Infections
Dental Problems

NOT EVERY
BILINGUAL
PERSON CAN BE
AN INTERPRETER

Interpreters must…

• Be fluent in both
languages
• Follow Code of Ethics
• Be culturally competent
• Be assertive
• Understand medical
terminology
• Understand systems
(hospital, mental health
and health center
settings)

Culture Club celebrates
Valentine’s Day

A woman with diabetes undergoes
a personal transformation

HEALTH SCREENINGS

HEALTH FAIRS

Health Fair
Crossings Mobile Home Park

Health Chat
• Blood Sugar
• Diabetic education and supplies
• High Blood Pressure
• First Aid
• Information, referral and case management

Volleyball for Adults and Teens

Coach
Pedro
Infante

Black’s Martial
Arts Academy

Hiking in Shawnee National Forest

“Clubs Vida” and the
Community Work of Aurelia
Zaragoza,
Health Outreach Director
in Cobden, IL

(Prepared by Cathy Bless for Aurelia
Zaragoza)

Aurelia organized a summer
tutoring program
• Held at her church community center
• Focused on students having trouble in
school
• Encouraged parents to keep their kids in
school
• Worked as coordinator for 6 years as part
of her volunteer work in the community

Action Research Partnership in
Southern Illinois
Cobden and Carbondale worked
together to form a Hispanic
Health Advisory Committee

Hispanic
Health
Advisory
Committee
of Cobden
2005

Partnerships
• Southern Illinois Hispanic Ministry, Inc
• Jesus Es El Senor UMC
• Hispanic Health Advisory Committee of
Carbondale
• University of Illinois
• Grace United Methodist Church, Carbondale
• Shawnee Health Service, Family Counselor

Implementation: Minigrant
• $4,999 minigrant awarded
• Four youth leaders and 5 youth volunteers, ages 17-
28, met with the mental health grant coordinator
team, reviewed the assessment findings and created
the “Clubs Vida” program
• 3 Life Clubs were formed
– Club El Cafecito—for seniors 65 or older
– Kid’s Club—for 5-12 year olds
– Tween Club—for 12-16 year olds
• 2 clubs met weekly and 1 met biweekly during June
and July, 2009

Purpose of Clubs Vida Program
Improve mental health by preventing:
Loneliness
Depression
Despair
Aggression

“These feelings create persons with social
dysfunction that create disunity in the community
and increase a sense of isolation. Problems of
domestic violence, substance and alcohol abuse are
increasing in our communities.”

•Improve mental and physical
health by:
•Providing physical and cultural
activities for groups that are age
appropriate
•Promoting social belonging,
camaraderie, stability and unity

•Develop and strengthen youth
leaders by:
•Involving them in all aspects of
the program planning process

Club “El Cafecito”
• Ten seniors participated weekly
• Club members took turns hosting at their
apartments at the migrant camp or own homes
• Seniors told “their stories”—Oral histories, photos
• Cooking classes
• Out to restaurant X 2
• Traditional meal to celebrate completion of “Club
Cafecito Photo and Story Album”
• Field trip—day spa for facials, hairdos, manicures

Kid’s Club
• 30-41 children participated weekly;
½ Hispanic and ½ African American
• Club members resided primarily in or near the
Crossings Mobile Home Park in Carbondale
• Most club meetings were held outdoors at
“The Crossings”
• Youth leaders organized an outdoor clean-up,
painted cemented area, mowed the area and
set up open air tents for the weekly activities

• Weekly activities—arts & crafts, family
values classes, physical activities, bible
stories, etc. inside tents and surrounding
area
• Kid’s Fair—41 children attended.
– Soccer games, sack races, Frisbee tag
– Posters and artwork
– Healthy snacks
– Prizes

Tween’s Club
• 3 youth leaders and 2 youth volunteer
organized the club
• 15 teens participated regularly
• Teens were recruited form the migrant camp
and surrounding area; Cobden, Murphysboro
and Carbondale (lots are settled out)
• Biweekly field trips—bowling, pizza party,
movie and Dairy Queen afterwards, Six Flags
in St. Louis

Evaluation
• Three youth leaders, Pastor Adrian and his
wife, Lilly and Ben Mueller met with Aurelia,
the minigrant coordinator, and 2 other adult
leaders and talked about how the clubs went
and how to further develop youth leadership.
• Youth leaders words paraphrased:
– El Cafecito—It was very important to the seniors
just to have someone to talk to and they greatly
looked forward to the weekly program

• Meetings must take place when parents of the
grandchildren are not working
• Seniors want to continue the program over the
winter for those who are settled out
• Seniors who were not able to travel were
willing and took pride in hosting meetings
• Kid’s Club—It was very important to provide
transportation for the children
• Hispanic and African American children
showed a lot of affection toward youth leaders
and invited them to their homes but this was
not allowed

• Grace United Methodist Church wants to help
maintain the program over the winter; indoor
space at the trailer park is being explored
• Tween’s Club—Teens made new friends
• It was a safe escape from some risky homes
• It helped teens stay away from risky
behaviors
• At first, 5 teens from the migrant camp were
reclusive but later they came out of their shell
and were more sociable
• At the bowling activity club members cheered
for members who were loners

• Activities gave teens a break from caregiver
activities and allowed them just to be kids
• Youth Leadership—Live what you preach and
love and care about others
• When planning, make a vision that tells the
purpose of the activity, see what is needed for
the activity and solve problems as they come up
• Listen to suggestions and criticisms
• Work to include people who are less involved
• Be a voice for the persons you are trying to help

Dissemination
• Pastor Adrian promoted the program during
church, recruited participants, and talked to
the congregation about the program during all
its phases.
• The program was presented to other
congregations; i.e., Aurelia talked to St.
Mathews Church, Belleville, IL
• Pastor at Grace United Methodist Church
talked with his congregation about the
program

•Announcements about
the program were printed
in:
• “Jesus Es El Senor”
church bulletin
•Souther Illinois Hispanic
Ministries bulletin

Perspectives From Cobden
• Benefits:
– Youth leaders participated freely and with great enthusiasm
– Kids, teens and elderly participants felt connected to their age cohorts
and community

• Challenges:
– Recruiting and retaining club participants
– Fronting the money for grant programs

• Next Steps:
– Youth are committed to continue to be involved with the Kid’s Club
and Club Cafecito
– Recruit new youth leaders
– Look for funds to continue high quality social programs
– Continue to publicize the success of the program with other churches
in the region

Acknowledgments
• Karen Peters, University of Illinois at Chicago
• Benjamin Mueller, University of Illinois at Urbana-
Champaign
• Andiara Schwingel, University of Illinois at Urbana-
Champaign
• Lisa Beni, Legal Foundation of Chicago
• Administrator, Crossings Mobile Home Park
• Pastor and Youth Pastor of Grace United Methodist
Church, Carbondale, IL
• Cathy Bless, President Hispanic Health Advisory
Committee of Carbondale

RSS Annual Conference 2012 Chicago

More Related Content

What's hot (20)

Similar to RSS Annual Conference 2012 Chicago (20)

Recently uploaded (20)

RSS Annual Conference 2012 Chicago

Editor's Notes