Session
Human Rights Forum Poster Session
APHA 2022 Annual Meeting and Expo
Abstract
Development of Healthcare Navigation Roadmaps for Women in Prison
APHA 2022 Annual Meeting and Expo
Background: Due to misinformation, lack of support and access to technology, low literacy levels, and lived traumatic experiences, it is challenging for women leaving prison to access and have positive experiences with the healthcare system. Description: The IUPUI Grassroots Maternal and Child Health Initiative in partnership with the Transitional Healthcare Team within the Indiana Department of Correction, created a set of health promotion roadmaps to assist women in their engagement with the healthcare system post-release. We held focus groups with women in prison to discuss their healthcare experiences, assessed their healthcare needs, and worked with them to create materials to improve their interactions with the healthcare system. We coalesced evidence-based materials (e.g., CDC, WHO, NIH, ACOG) associated with an array of women’s health issues. Through partnership with a graphic designer, this content and the women’s perspectives were used to create visually-appealing infographics. Each infographic was designed with the principles of scalability, female-focused illustration, transparency, clarity, iteration, and user focus. Results/Lessons Learned: We created a set of roadmaps that covers 45 different topics associated with women’s healthcare. An implementation system was established for correctional staff to distribute a collection of roadmaps that meet each individual woman’s needs as she exits prison. Recommendations: Developing a system for the distribution and utilization of healthcare navigation roadmaps improves the capacity of a Transitional Healthcare Team to meet each woman’s needs, while concurrently building the women’s ability to advocate for themselves in a healthcare setting and increase autonomy over their reproductive health.
Abstract
COVID-19 in Minnesota Prisons and Jails: Community-engaged Strategies to Promote Vaccine Confidence
APHA 2022 Annual Meeting and Expo
Background: It is well-established that people who are incarcerated are at increased risk for COVID-19 infection. Since March 2020, at least 531,280 incarcerated people and 109,846 prison/jail staff have been infected with COVID-19. While the importance of vaccinating this population is clear, a key challenge to increasing COVID-19 vaccination rates is COVID-19 vaccine hesitancy.
Description: Our CDC-funded project, guided by an advisory board group of formerly incarcerated individuals, uses survey data and community expertise to better understand barriers to COVID-19 vaccination, and inform strategies to increase COVID-19 vaccine confidence.
Results: Survey findings indicate that distrust is one of the biggest barriers to vaccination among both people who are incarcerated and staff. Qualitative findings indicate a desire for more information, incentives, and utilizing trusted messengers to promote vaccine confidence. Using this information, our team developed a variety of interventions to promote vaccine confidence: tailored print and video educational materials; a peer education program for Minnesota prisons where incarcerated individuals provide peer support around COVID-19 vaccination; and more.
Recommendations:
1) Share timely and transparent information about COVID-19 vaccination with people who are currently incarcerated.
2) Tap into trusted sources of information to promote COVID-19 vaccine confidence.
3) Uplift and center communities who are directly impacted in this work, at every step of the process.
4) Work to build strong relationships with state agency partners to effectively implement interventions.
5) Acknowledge centuries of harm perpetrated by public health, medical, and carceral institutions, and work to validate the lived experiences of those who have been harmed.
Abstract
Advancing health literacy to enhance equitable response to COVID-19 within a county correctional facility
APHA 2022 Annual Meeting and Expo
Background: During the COVID-19 pandemic, carceral facilities throughout the U.S. often perpetuated outbreaks in facilities and surrounding communities. Medical mistrust among correctional facility staff has been evident through vaccine refusal and non-compliance with public health mandates. Mass incarceration combined with a history of unethical medical experimentation and low-quality healthcare in correctional settings, contribute to high medical mistrust among incarcerated residents.
Description: To address health literacy and distrust of the healthcare system among correctional staff and residents, the Westchester County Department of Health developed an evidence-based, dialogic education program bridging COVID-19-related health information with strategies to discern reliable health information, access healthcare services throughout the county, and use information to make health decisions. Aiming to reach 600 correctional officers and 400 residents, program staff and clinic nurses will attend each session to answer any medically related questions that arise.
Lessons Learned: Staff sessions will be completed in June while resident sessions will complete by November. Pre-post surveys will be used to formally evaluate outcomes. Staff sessions occur during mandated training days; compulsory attendance caused friction with officers before any sessions began. Abiding by COVID regulations meant the expansion of staff sessions across two classrooms, so not all staff received the same in-person educational session. Smaller sessions for both staff and residents encouraged more discussion and participation.
Recommendations: Allow for voluntary attendance to enable productive conversation and interaction between attendees and program staff. Keep discussion-based educational programming to a maximum of 30 staff attendees or 10 residents, encouraging more individualized attention.
Abstract
WaSH Insecurity and Psychosocial Distress Among Unhoused People Who Inject Drugs in the US-Mexico Border
APHA 2022 Annual Meeting and Expo
Background and Objectives: Water, sanitation, and hygiene (WaSH) represent foundational human rights, yet vulnerable communities may lack of access to basic WaSH services which increase the risk of water-related diseases and psychosocial stress. We examined relationships between WaSH insecurity and anxiety among people who inject drugs (PWID) living in the Tijuana (TJ)- San Diego (SD) border region.
Methods: From 2020-2021, PWID in TJ and SD underwent administered surveys. Using logistic regression, we assessed the association between having experienced WaSH insecurity and general anxiety (GAD-7) in the last 6 months.
Results: Among 386 PWID, 74% were male, 42% unhoused, 66% reside in SD, and 87% experienced forms of WaSH insecurity in the past 6-months. After adjusting for sex, housing status and city of residence, lack of access to basic drinking water (AdjOR: 2.02; 95% CI: 1.13-3.74), sanitation (AdjOR:1.65; 95% CI: 1.08-2.54), and daily shower (AdjOR: 2.04; 95% CI: 1.36-3.06) were associated with mild-severe anxiety. Upon further evaluation of a significant interaction between sex and housing status (p=0.001), we found that women living in temporary/unsheltered housing had higher odds of having mild to severe anxiety as compared to men (OR: 2.4, 95% CI: 0.66-8.48).
Conclusion: WaSH insecurity was associated with higher anxiety scores among PWID in the US/Mexico border region. Women living in unstably living conditions were especially vulnerable. WaSH interventions that provide safe, 24 hour access may reduce anxiety and health risks associated with WaSH insecurity.
Abstract
Lack of Access to Outpatient Pediatric Behavioral Health Services for Families with Limited English Proficiency (LEP)
APHA 2022 Annual Meeting and Expo
Background: Although there is widespread belief that children whose parents have limited English proficiency (LEP) have poor access to pediatric behavioral health care, to date there has been limited evidence to support this claim. This evidence gap limits health system design and implementation of interventions to redress this problem, thus reinforcing access barriers.
Objective: To examine outpatient, pediatric behavioral health scheduling for Spanish-language callers with simulated Medicaid-insured children in Pennsylvania and to compare scheduling experiences to those of English-language callers.
Methods: This study comprised paired English/Spanish phone calls to outpatient behavioral health facilities using a standardized script describing a simulated pediatric patient. 288 outpatient behavioral health facilities were selected from the outpatient facilities listed in the Pennsylvania Department of Human Services Online Provider Directory. A standardized protocol and semi-structured interview script was followed by an English-language caller who made up to two call attempts to each facility. The caller attempted to schedule an appointment for a simulated pediatric patient. Facilities that did not answer the phone, accept Medicaid, or see children were removed from the sample. A Spanish-language caller using the same protocol and script then made at least two call attempts to 162 eligible remaining facilities.
Results: Of 162 eligible facilities, 127 facilities in 36 Pennsylvania counties answered both the English and Spanish caller. For the English-language caller, 71% attempted to schedule an appointment and 100% communicated in the caller’s preferred language. In contrast, for the Spanish-language caller, 24% attempted to schedule an appointment and 25% communicated in the caller’s preferred language.
Conclusion: Among outpatient behavioral health facilities for children in Pennsylvania, there are profound system-level inequities in access to appointments for families with limited English proficiency.
Abstract
The Cycle of Re-Trafficking and Barriers to Escape
APHA 2022 Annual Meeting and Expo
Background: Human trafficking is a fundamental human rights violation that occurs in a milieu of disempowerment. Victims who are trafficked more than once, or re-trafficked, may be particularly vulnerable.
Objectives: To characterize the cyclical nature of human trafficking by describing the prevalence of re-trafficking and identifying barriers to escape.
Methods: This is a sub-analysis of a retrospective cohort study at the EMPOWER Center, a clinic serving victims of sexual- and gender-based violence in New York City. The medical records of all consenting patients were reviewed to identify victims of human trafficking. Data was collected on their trafficking experience.
Results:
Of the 275 patients enrolled in the EMPOWER Center cohort study since 2013, 91 (33%) were victims of human trafficking and included in this analysis. All were women. Most were trafficked for sex (n=82; 91.2%) and across international borders (n=82; 90.1%). The prevalence of re-trafficking was high, with 21 (23.1%) trafficked twice and 3 (3.3%) trafficked three times. Barriers to escape included threat of violence (n=25; 27.5%), financial dependence (n=17; 18.7%), immigration status (n=5; 5.5%), and threat of arrest (n=3; 3.3%). Almost half (n=40; 44.0%) reported lasting emotional trauma, 9 (9.9%) had forced drug use, and 9 (9.9%) had forced abortions.
Conclusions:
The prevalence of re-trafficking in our study highlights the cyclical nature of human trafficking. Common barriers to escape include the threat of violence and economic and legal disempowerment, especially in the context of international sex trafficking.
Abstract
The COVID-19 Pandemic Impact on the Deaf Adult Community’s Accessibility to Healthcare Services in Puerto Rico
APHA 2022 Annual Meeting and Expo
The COVID-19 pandemic exposed the daily impediments and inequity that the Deaf community faces specifically since safety measures like masking and social distancing impaired communication between Deaf patients and the community. Since there is scant evidence for this population in Puerto Rico, this study aimed to investigate and compare Deaf adults' accessibility to healthcare services and their ability to communicate with providers before and during the pandemic as well as create a demographic profile of healthcare disparities, needs and barriers in Deaf adults living on the island. This is an IRB-approved descriptive cross-sectional study. Subjects were enrolled using social media; Deaf participants were ≥21 years of age living in PR. Data was collected through online questionnaires between 07/12/2021–10/25/2021. Sixty-four subjects accessed the questionnaire, but only ten completed it. Seventy percent expressed that their access to healthcare services worsened after the pandemic. Before the pandemic, 80% of the patients used gestures and lip-reading, and 70% used family members as interpreters, however, these methods decreased by 70% and increased by 10%, respectively. Communication by writing on paper increased to 60%. Subjects reported worsening in satisfaction in their communication with physicians after the pandemic. Reasons for the dissatisfaction are related to their perception of the quality/quantity of the information discussed by the physician, the level of understanding of the information provided by the physician and the subjects perception of the physician’s understanding of their complaints. The enforcement on the use of personal protective equipment created a communication barrier for the Deaf population. Access, dissatisfaction with the clinical experience and loss of autonomy are realities faced by this population. Inability to properly communicate can lead to patient safety issues and decreased outcomes. The global crisis provoked by the pandemic managed to expose and deepen issues of societal exclusion for Deaf population. Deaf community’s access to healthcare services suffered a blow due to the pandemic, contributing to inequity. Healthcare providers should be aware of their individual responsibility in closing inequity gaps.
Abstract
Transgender Health In New Jersey: A Comparative Policy Analysis for Better Healthcare Access
APHA 2022 Annual Meeting and Expo
Access to healthcare is a human right. Yet some members of our society continue to face human right violations like discrimination, stigma, and a lack of access to essential services. In the U.S., transgender individuals experience significant inequalities in relationship to their access of care. The discrimination faced by this group leads to negative health outcomes from housing insecurity and employment; lack of access to healthcare; poorer physical and mental health; higher suicide rates when compared with their counterparts; to higher rates of imprisonment. Additionally, healthcare practitioners possess little or no training to serve the transgender population’s specific needs, which leads to worse health outcomes. This analysis focused on identifying policy gaps at the state-level in New Jersey (NJ) using a human rights approach. Additionally, the Socioecological Model and the Intersectionality Framework were used to deeply comprehend the complexities of the transgender population and the multiple tiers impacting their health and lack of well-being. These frameworks were also used to highlight the compounding impact of discrimination and oppression across multiple domains. A Comparative approach guided the analysis. N.J.’s state laws were compared to other states and against recommendations created by nationally recognized bodies that provide more robust protection. Evidence indicates a gap in NJ legislation leaving transgender patients vulnerable to discrimination and inappropriate care. Through a human rights framework, recommendations such as mandating LGBT non-discrimination policies, preparing staff through culture and competency training, and requiring LGBT continuing education for practitioners are proposed in this analysis.
Abstract
Complexities around opt-out HIV testing reported by health facility staff in Gaborone, Botswana
APHA 2022 Annual Meeting and Expo
Background:
Although important to achieve target levels of testing, opt-out HIV testing in Botswana may have unintended consequences.
Objectives:
To ensure testing of this stigmatized condition occurs with full consent and respects autonomy, we investigated complexities around the implementation of opt-out HIV testing in Botswana.
Methods:
Six semi-structured in-depth interviews were conducted in English with clinic staff. Interviews were conducted individually or in pairs. Participants worked at five different clinics in the Greater Gaborone Health District. They included: 1 medical officer, 2 nurses, 1 midwife, 2 health education assistants, 1 healthcare auxiliary worker, and 1 cleaner (N=8). Detailed notes taken during interviews were then thematically coded.
Results:
Participants reported individuals rarely, if ever, opt out of HIV testing. Participants reported variable levels of confidence in whether patients know that HIV testing is optional. All participants said that a patient who opts out of HIV testing will still receive care. Some participants held negative attitudes around the opt-out policy. Some noted that staff might not feel competent in providing care to a patient who opted out.
Conclusions:
Even when talking to a limited number of staff, several complexities emerged. Differences in perceptions of patients’ knowledge around opt-out HIV testing suggests a lack of consistency in experiences and treatment across providers and facilities. Some staff’s negative attitudes toward opting out may lead to anticipated stigma around opting out, possibly meaning patients will test even when they do not want to. Further research on patient perspectives is warranted.