A Social Ecological and Community-Engaged Perspective for Addressing Health Disparities Among Marshallese in Arkansas

McElfish, Pearl A.; Post, Jennifer C.; Rowland, Brett

doi:10.15344/2394-4978/2016/191

Cited by 20 publications

(16 citation statements)

References 22 publications

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“…Based on the interpretive analysis used in social phenomenology, rst-level broad construction of CE was done, followed by secondlevel typical constructs, deliberated through critical events or performance of CE 'duties' and 'responsibilities' throughout the tenure of the decisionmakers [47]. Categories conceptually corresponded with the Social Ecological Model, which has been used to study vaccination uptake and health disparities [41]. Given this loose pre-existing framework, a general inductive approach was used [46].…”

Section: Discussionmentioning

confidence: 99%

A qualitative analysis of vaccine decision-makers’ conceptualization and fostering of ‘community engagement’ in India

Dutta

Meyerson

Agley

et al. 2020

Preprint

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Background: Globally, and in India, research has highlighted the importance of community engagement in achieving national vaccination goals and in promoting health equity. However, community engagement is not well-defined and remains an underutilized approach. There is also paucity of literature on community engagement’s effectiveness in achieving vaccination outcomes. To address that gap, this study interviewed Indian vaccination decisionmakers to derive a shared understanding of the evolving conceptualization of community engagement, and how it has been fostered during India’s Decade of Vaccines (2010-2020).Methods: Semi-structured interviews were conducted with 25 purposefully sampled national-level vaccine decisionmakers in India, including policymakers, immunization program heads, and vaccine technical committee leads. Participants were identified by their ‘elite’ status among decisionmakers in the Indian vaccination space. Schutz’ Social Phenomenological Theory guided development of an a priori framework derived from the Social Ecological Model. The framework helped organize participants’ conceptualizations of communities, community engagement, and related themes. Inter-rater reliability was computed for a subsample of coded interviews, and findings were validated in a one-day member check-in meeting with study participants and teams. Results: The interviews successfully elucidated participants’ understanding of key terminology (“community”) and approaches to community engagement propagated by the vaccine decisionmakers. Participants conceptualized ‘communities’ as vaccine-eligible children, their parents, frontline healthcare workers, and vaccination influencers. Engagement with those communities was understood to mean vaccine outreach, capacity-building of healthcare workers, and information dissemination. However, participants indicated that there were neither explicit policy guidelines defining community engagement nor pertinent evaluation metrics, despite awareness that community engagement is complex and under-researched. Examples of different approaches to community engagement ranged from vaccine imposition to empowered community vaccination decision-making. Finally, participants proposed an operational definition of community engagement and discussed concerns related to implementing it.Conclusions: Although decisionmakers had different perceptions about what constitutes a community, and how community engagement should optimally function, the combined group articulated its importance to ensure vaccination equity and reiterated the need for concerted political will to build trust with communities. At the same time, work remains to be done both in terms of research on community engagement as well as development of appropriate implementation and outcome metrics.

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Section: Discussionmentioning

confidence: 99%

A qualitative analysis of vaccine decision-makers’ conceptualization and fostering of ‘community engagement’ in India

Dutta

Meyerson

Agley

et al. 2020

Preprint

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“…After two years of engagement, which included a broad-based mixed methods study and multiple focus groups to document the community's top priorities, the community chose T2D as their top health concern and recommended a family approach to address T2D [76] . Over the past three years, our partnership has conducted several pilot studies related to diabetes beliefs and behaviors [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] . Consistent with CBPR principles [85] , development of the intervention, study design, and proposed evaluation and dissemination plans were conducted collaboratively between community and academic partners [76] , [83] .…”

Section: Methodsmentioning

confidence: 99%

Design of a randomized, controlled, comparative-effectiveness trial testing a Family Model of Diabetes Self-Management Education (DSME) vs. Standard DSME for Marshallese in the United States

Yeary

Long

Bursac

et al. 2017

Contemporary Clinical Trials Communications

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BackgroundType 2 diabetes (T2D) is a significant public health problem, with U.S. Pacific Islander communities—such as the Marshallese—bearing a disproportionate burden. Using a community-based participatory approach (CBPR) that engages the strong family-based social infrastructure characteristic of Marshallese communities is a promising way to manage T2D.ObjectivesLed by a collaborative community-academic partnership, the Family Model of Diabetes Self-Management Education (DSME) aimed to change diabetes management behaviors to improve glycemic control in Marshallese adults with T2D by engaging the entire family.DesignTo test the Family Model of DSME, a randomized, controlled, comparative effectiveness trial with 240 primary participants was implemented. Half of the primary participants were randomly assigned to the Standard DSME and half were randomly assigned to the Family Model DSME. Both arms received ten hours of content comprised of 6–8 sessions delivered over a 6–8 week period.MethodsThe Family Model DSME was a cultural adaptation of DSME, whereby the intervention focused on engaging family support for the primary participant with T2D. The Standard DSME was delivered to the primary participant in a community-based group format. Primary participants and participating family members were assessed at baseline and immediate post-intervention, and will also be assessed at 6 and 12 months.SummaryThe Family Model of DSME aimed to improve glycemic control in Marshallese with T2D. The utilization of a CBPR approach that involves the local stakeholders and the engagement of the family-based social infrastructure of Marshallese communities increase potential for the intervention's success and sustainability.

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“…While there are a limited number of studies that document the health status of Marshallese in the RMI and in Hawaii [14–19], there are no health status data published on Marshallese living in Arkansas. From 2013 to 2016, the research team has engaged a community-based participatory research (CBPR) collaborative to identify and address the most pressing health issues in the Marshallese community in Arkansas [20–31]. The CBPR approach was essential because of historical context.…”

Section: Introductionmentioning

confidence: 99%

Diabetes and Hypertension in Marshallese Adults: Results from Faith-Based Health Screenings

McElfish

Rowland

Long

et al. 2016

J. Racial and Ethnic Health Disparities

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Background The Pacific Islander population in the United States is growing rapidly. However, research on Pacific Islanders in the US is limited, or sometimes misleading due to aggregation with Asian Americans. This project seeks to add to the dearth of health literature by conducting a health assessment of Marshallese in northwest Arkansas. Methods Using a community-based participatory research approach, nine health screening events were conducted at local Marshallese churches. Participants completed the Behavioral Risk Factors Surveillance Survey core questionnaire and diabetes module if applicable. Biometric data, including Hemoglobin A1c, blood pressure, and body mass index, was gathered by an interprofessional team. Results 401 participants completed health screenings. High proportions of diabetes, obesity, and hypertension were found. A high percentage of participants were uninsured, and multiple barriers to health care were found within the sample. Discussion This project represents one of the first broad health assessments of Pacific Islanders in the US. Proportions of diabetes, hypertension, obesity, and uninsured found in the sample are much higher than national proportions.

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A Social Ecological and Community-Engaged Perspective for Addressing Health Disparities Among Marshallese in Arkansas

Cited by 20 publications

References 22 publications

A qualitative analysis of vaccine decision-makers’ conceptualization and fostering of ‘community engagement’ in India

A qualitative analysis of vaccine decision-makers’ conceptualization and fostering of ‘community engagement’ in India

Design of a randomized, controlled, comparative-effectiveness trial testing a Family Model of Diabetes Self-Management Education (DSME) vs. Standard DSME for Marshallese in the United States

Diabetes and Hypertension in Marshallese Adults: Results from Faith-Based Health Screenings

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