Session
Participatory Approaches to Address Social and Structural Determinants of Health
APHA 2022 Annual Meeting and Expo
Abstract
Leveraging Platicas in Community Health Research to Mobilize Community to Increase Access to Health Care Coverage among Undocumented Older Adults
APHA 2022 Annual Meeting and Expo
Background: The PARTNER-SELA program centers community-driven research to mobilize Southeast Los Angeles (SELA) residents for health equity. The program leveraged a community empowerment framework (Friere, 1996; Minker & Wallerstein, 2011) and platicas methodology (Bernal, 2020) to explore solutions to increase health care access among Southeast Los Angeles’ undocumented communities through California’s Health4All Seniors legislation.
Methods: In February 2021, PARTNER-SELA led a platica to explore (i) barriers community residents face accessing health care, (ii) potential barriers incoming Medi-Cal eligible undocumented older (+50) adults may face, (iii) identify solutions to improve both problems. Six break-out rooms (4 Spanish-speaking and 2 English-speaking) were facilitated by community leaders who partnered with researchers and staff at the AltaMed Institute for Health Equity, within a federally qualified health center. Community leaders led outreach for the platica via social media and through activating parents at schools.
Results: The virtual platica engaged 80 community members, 50% of whom were primarily Spanish-speaking. Community narratives highlighted challenges in accessing healthcare such as (1) transportation (2) navigation and (3) structural barriers and potential barriers undocumented Med-Cal eligible older adults may face such as (1) insurance eligibility and (2) policy barriers.
Conclusions and Implications: Platica participants offered specific recommendations that would help to close the gap in health care access through the equitable implementation of the program. Researchers alone may not be able to reach undocumented populations, yet by partnering with community leaders and expanding methods to those that honor culturally-relevant knowledge production methods, researchers and health systems can be more effective in advancing health equity.
Abstract
Multilevel barriers and supports culturally and linguistically diverse immigrant caregivers of youth with disabilities experience in the transition planning through multilingual community based participatory research
APHA 2022 Annual Meeting and Expo
Background: Culturally and Linguistically Diverse (CLD) immigrant caregivers of youth with intellectual and developmental disabilities as well as co-occurring mental health (IDD-MHD) conditions struggle to access culturally and linguistically responsive resources in their preferred languages. As a result, CLD families have poor health outcomes, particularly during the transition planning process which is essential to facilitate successful postsecondary education, vocational training, and employment. Limited research has employed Community-Based Participatory Research (CBPR), intersectionality, and multilingual approaches to investigate determinants that promote effective transition after high school.
Methods: A multilingual CBPR multi-phase study was co-developed and implemented in partnership with CLD immigrant caregivers. Three online multilingual focus groups framed as a multilingual family institute were conducted with CLD caregivers (n=12) speakers of the three largest non-English linguistic groups in Massachusetts (i.e. Spanish, Portuguese, and Chinese) and of youth with IDD-MH ages 14-22. Data was analyzed using thematic analysis and concept mapping. Data is currently being disseminated to multiple stakeholders.
Results and Conclusion: CLD immigrant caregivers’ leadership, collaboration, and community-based resources are promoting factors to health equity in the transition planning process. Access to culturally and linguistically information relevant to caregivers’ rights promoted effective navigation of healthcare and special education systems. Additionally, CLD immigrant caregivers reported multilevel barriers including anti-immigration policies, cultural assimilation, health insurance restrictions, financial insecurity, and limited accessible information in CLD caregivers’ preferred languages. Participatory and systematic transdisciplinary multilevel interventions should consider CLD immigrant caregivers’ valuable experiences to strengthen culturally and linguistically responsive service provision, research, training, and policymaking.
Abstract
The Abundant Birth Project: Community-driven methods to design and evaluate a guaranteed income program for Black and Pacific Islander pregnant women and birthing people
APHA 2022 Annual Meeting and Expo
Issues:
Government benefits programs implement stringent eligibility restrictions and perpetuate racist and stigmatizing practices that leave vulnerable populations feeling unsupported and frustrated. This is problematic for Black and Pacific Islander pregnant women and birthing people, who experience inequities in birth outcomes that could be mitigated by greater financial security. Guaranteed income programs are a promising strategy to help alleviate financial stress during pregnancy as they provide income free of restrictions.
Description:
To design a guaranteed income program that centers the specific needs of Black and Pacific Islander pregnant women and people, we used a community-based participatory approach. We established a working group of community members with birth justice experience, hired and trained community researchers with lived experience to participate in program and evaluation design and activities, and conducted a needs assessment and human-centered design process with community members. The resulting Abundant Birth Project offers an alternative to existing benefits programs by offering a $1000 income supplement during pregnancy and through six months postpartum, free of stipulations or restrictions. Decision-making for the program and evaluation continue to be guided by the community researchers and working group.
Lessons Learned:
Prioritizing meaningful community engagement requires flexibility in program and research design, resources for training and equitably compensating community members, and redistribution of power.
Recommendations:
Government benefits programs that aim to support marginalized pregnant people should consider a community-driven approach, including time and budget for community engagement efforts, and prioritize recipients' needs, dignity, and self-determination by providing unrestricted benefits.
Abstract
Community-engaged team science – a green schoolyards case study
APHA 2022 Annual Meeting and Expo
Issues: Extensive research indicates that access to parks and green space is associated with improved health and well-being, including increased physical activity, decreased obesity, and improved mental health. Currently, â…“ of Americans live without access to a park within a 10-minute walk (½ mile) of home. One of the largest park access gaps in WA state is in Tacoma (WA). The Trust for Public Land (TPL) launched the “Tacoma Green Schoolyards initiative to pilot community-engaged schoolyard renovations. These changes will improve park access and create a community amenity that is open after hours and on weekends.
Description: Our presentation highlights a case study of broadly engaged team science that leveraged community partner and academic collaboration to promote park access and study associated health outcomes. Supported by the Interdisciplinary Research Leaders (IRL) program of the Robert Wood Johnson Foundation (RWJF) the project employs a quasi-experimental design and mixed methods. Multiple outcome measures (including positive psychology and physical activity) are being applied by a multidisciplinary team.
Lessons Learned: The presentation will showcase how the community-academic partnership formed, the health equity challenges we addressed, and the research aims and methods used. We will also discuss how COVID-19 pandemic related closures and restrictions necessitated modifications to our original plans.
Recommendations: Community engaged team science is well suited to advancing understanding of the impact of a participatory approach to understanding nature-based health programs in communities, including greening schoolyards. Our experiences will inform the development of a toolkit for evaluating other green space projects that involve children.