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BACKGROUND: Asthma is a leading cause of children's hospitalizations, emergency department visits, and missed school days. Our school-based asthma intervention has reduced asthma exacerbations for children experiencing health disparities in the Denver Metropolitan Area, due partly to addressing care coordination for asthma and social determinants of health (SDOH), such as access to healthcare and medications. Limited dissemination of school-based asthma programs has occurred in other metropolitan and rural areas of Colorado. We formed and engaged community advisory boards in socioeconomically diverse regions of Colorado to develop two implementation strategy packages for delivering our school-based asthma intervention - now termed "Better Asthma Control for Kids (BACK)" - with tailoring to regional priorities, needs and resources. METHODS: In this proposed type 2 hybrid implementation-effectiveness trial, where the primary goal is equitable reach to families to reduce asthma disparities, we will compare two different packages of implementation strategies to deliver BACK across four Colorado regions. The two implementation packages to be compared are: 1) standard set of implementation strategies including Tailor and Adapt to context, Facilitation and Training termed, BACK-Standard (BACK-S); 2) BACK-S plus an enhanced implementation strategy, that incorporates network weaving with community partners and consumer engagement with school families, termed BACK-Enhanced (BACK-E). Our evaluation will be guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, including its Pragmatic Robust Implementation Sustainability Model (PRISM) determinants of implementation outcomes. Our central hypothesis is that our BACK-E implementation strategy will have significantly greater reach to eligible children/families than BACK-S (primary outcome) and that both BACK-E and BACK-S groups will have significantly reduced asthma exacerbation rates ("attacks") and improved asthma control as compared to usual care. DISCUSSION: We expect both the BACK-S and BACK-E strategy packages will accelerate dissemination of our BACK program across the state - the comparative impact of BACK-S vs. BACK-E on reach and other RE-AIM outcomes may inform strategy selection for scaling BACK and other effective school-based programs to address chronic illness disparities. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT06003569, registered on August 22, 2023, https://classic. CLINICALTRIALS: gov/ct2/show/NCT06003569 .
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Asma , Serviços de Saúde Escolar , Humanos , Asma/terapia , Asma/prevenção & controle , Criança , Colorado , Serviços de Saúde Escolar/organização & administração , Adolescente , Populações Vulneráveis , Ciência da Implementação , FemininoRESUMO
Addressing housing insecurity contributes to health care programs as stable housing has positive health benefits. Home environmental hazards may reduce these potential health benefits and could increase morbidity for conditions such as asthma. This study examined housing and indoor air quality among urban low-income households in Colorado to inform housing-insecurity interventions. We conducted a community-engaged study among residents of motels, mobile homes, apartments, and single-family homes that included a survey on the home environment, health, and sociodemographic factors, spirometry, and indoor air quality measurement. We enrolled 60 households: 50% single-family homes, 37% apartments, and 13% residential motels. Perceived stress and depression were higher among motel residents compared with other housing types. We did not find differences in lung function by housing type. Indoor fine particulate matter (PM2.5) and black carbon concentrations were higher in motels than in other housing types. The differential health impacts of housing type support housing programs that jointly address security and quality.
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Poluição do Ar em Ambientes Fechados , Habitação , Pobreza , Humanos , Feminino , Masculino , Habitação/estatística & dados numéricos , Poluição do Ar em Ambientes Fechados/análise , Adulto , Pessoa de Meia-Idade , Colorado , Material Particulado/análise , Nível de Saúde , Estresse PsicológicoRESUMO
Patients who speak languages other than English are frequently excluded from research. This exclusion exacerbates inequities, biases results, and may violate federal regulations and research ethics. Language justice is the right to communicate in an individual's preferred language to address power imbalances and promote equity. To promote language justice in research, we propose a method to translate and culturally-adapt multifaceted research materials into multiple languages simultaneously. Our method involves a multistep approach, including professional translation, review by bilingual expert panels to refine and reach consensus, and piloting or cognitive interviews with patients and families. Key differences from other translation approaches (eg, the World Health Organization) include omitting back-translation, given its limited utility in identifying translation challenges, and limiting expert panelist and piloting-participant numbers for feasibility. We detail a step-by-step approach to operationalizing this method and outline key considerations learned after utilizing this method to translate materials into 8 languages other than English for an ongoing multicenter pediatric research study on family safety-reporting. Materials included family brochures, surveys, and intervention materials. This approach took â¼6 months overall at a cost of <$2000 per language (not including study personnel costs). Key themes across the project included (1) tailor scope to timeline, budget, and resources, (2) thoughtfully design English source materials, (3) identify and apply guiding principles throughout the translation and editing process, and (4) carefully review content and formatting to account for nuances across multiple languages. This method balances feasibility and rigor in translating participant-facing materials into multiple languages simultaneously, advancing language justice in research.
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Multilinguismo , Humanos , Tradução , Pesquisa Biomédica/ética , CriançaRESUMO
Introduction: Little is known about the experiences of immigrant families with COVID-19 illness. This mixed methods study compared child and household experiences at the time of a child's COVID-19 diagnosis between immigrant and US-born parents and explored immigrant Latino perspectives on underlying causes of COVID-19 disparities between immigrant and US-born families. Methods: Study data includes surveys of parents of a child with a positive SARS-CoV2 test resulting at Children's Hospital Colorado and focus groups with Latino immigrant adults. We compared household COVID-19 experiences, use of mitigation measures, vaccine intention and sociodemographic information between survey participants stratified by nativity and completed thematic qualitative data analysis. Results: Findings from quantitative data were reinforced by qualitative data including: lower socio-economic status and higher employment in essential services increased infections and spread in immigrant families and higher risk of limited information access related to language barriers and prevalent misinformation. Survey results showed no difference in COVID-19 vaccine intention by nativity. Focus group participants reported limited access to non-English language culturally-tailored vaccine information and competing work demands decreased uptake. Conclusion: Avoiding exacerbating disparities in the face of another public health emergency requires focused investments in policies and approaches specifically directed at immigrant communities.
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COVID-19 , Emigrantes e Imigrantes , Criança , Adulto , Feminino , Humanos , Vacinas contra COVID-19 , Teste para COVID-19 , Pandemias , RNA Viral , COVID-19/epidemiologia , SARS-CoV-2RESUMO
OBJECTIVE: Models of pragmatic social care program evaluations are needed as many are clinical services programs and are not focused on research, limiting the ability to address key evidence gaps. We describe the use of the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to conduct a pragmatic evaluation of a pediatric ambulatory social care program. METHODS: Our evaluation was based on automated electronic health record data on clinics, community partners, social care program processes, and social needs screen data linked to patient sociodemographic characteristics from February 2020 to September 2021. Two Reach outcomes were assessed: 1) the proportion of eligible patients that completed social needs screening and 2) the proportion of positive screens that receive social care program follow-up. The Effectiveness outcome was meeting families' resource need(s). RESULTS: Reach among eligible patients who completed screening was 79.2%. Reach for positive screens receiving social care program referrals demonstrated a higher proportion of referrals among patients with a preferred healthcare language (PHL) of Spanish (45.1%) compared to English (31.2%, P < .001). Effectiveness analyses demonstrated that overall, 75.1% of social care program referrals had all social resource needs met, 17.5% had some needs met, and 7.4% had no needs met. The percent of patients with all resource needs met was higher for patients with PHL of Spanish or Non-English, Non-Spanish (79% for each respectively) compared to English (73%, P = .023). CONCLUSIONS: Maximizing automated data collection is likely the most feasible way for social care programs to complete evaluation activities outside of the research context.
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Assistência Ambulatorial , Apoio Social , Criança , Humanos , Avaliação de Programas e Projetos de SaúdeRESUMO
Introduction: To examine the associations between child and neighborhood characteristics and incidence of COVID-19 infection during the first 19 months of the pandemic. Study Design: We utilized individual electronic health record data and corresponding census tract characteristics for pediatric SARS-CoV-2 cases (age <18 years) from March 23, 2020 to September 30, 2021 with molecular tests resulted at a children's health system in Colorado. We compared associations between individual SARS-CoV-2 cases and census tract SARS-CoV-2 positivity rates over three time periods (TP1: March-September 2020; TP2: October 2020-March 2021; TP3: April-September 2021) using multinomial logistic regression for individual associations and negative binomial regression for census tract associations. Results: We included 7498 pediatric SARS-CoV-2 cases and data from 711 corresponding census tracts. Spanish preferred health care language was associated with SARS-CoV-2 positivity for TP1 (odds ratio [OR] 4.9, 95% confidence interval [CI] 3.7-6.5) and TP2 (OR 2.01, 95% CI 1.6-2.6) compared with TP3. Other non-English preferred health care language was associated with SARS-CoV-2 positivity in TP1 (OR 2.4, 95% CI 1.4-4.2). Increasing percentage internationally born in a census tract was associated with SARS-CoV-2 positivity for TP1 (multivariable incident rate ratio [IRR]=1.040, p<0.0001), TP2 (multivariable IRR=1.028, p<0.0001), and in all TP combined (multivariable IRR=1.024, p<0.0001). Discussion: Our study is notable for the identification of COVID-19 disparities among children in immigrant families and communities, particularly early in the pandemic. Addressing disparities for immigrant communities requires targeted investments in public health infrastructure.
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One in four US children is a child in an immigrant family. Children in immigrant families (CIF) have distinct health and health care needs that vary by documentation status, countries of origin, and health care and community experience caring for immigrant populations. Health insurance access and language services are fundamental to providing health care to CIF. Promoting health equity for CIF requires a comprehensive approach to both the health and social determinants of health needs of CIF. Child health providers can promote health equity for this population through tailored primary care services and partnerships with immigrant-serving community organizations.
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Serviços de Saúde da Criança , Emigrantes e Imigrantes , Equidade em Saúde , Humanos , Criança , Promoção da Saúde , Acessibilidade aos Serviços de SaúdeRESUMO
Background: Emerging research demonstrates telehealth disparities for patients who communicate in languages other than English. A better understanding of pediatric telehealth use with families who communicate in languages other than English is needed to inform interventions to promote telehealth equity. Methods: We conducted a mixed methods study of telehealth care in a children's hospital health system using electronic health record data for outpatient video telehealth encounters from April 2020 to July 2021 and qualitative interviews with clinical staff and Spanish-speaking parents of telehealth patients. Results: The 16-month study period included 102,387 telehealth encounters; 5% of which were encounters in languages other than English. 83% of languages other than English encounters were with patients/families with a preferred healthcare language of Spanish. 11% of providers conducted ≥10 languages other than English telehealth encounters. This subset of providers conducted 71% of all languages other than English encounters. We conducted 25 interviews with clinical staff (n=13) and parents (n=12). Common themes identified across interviews were: (I) technology barriers affect access to and quality of telehealth; (II) clinical staff and parents are uncertain about the future role of telehealth for patients/families who communicate in languages other than English; (III) the well-known impact of language barriers on in-person healthcare access and quality for patients who communicate in languages other than English is also evident in telehealth. Conclusions: Patients who communicate in languages other than English were underrepresented among telehealth encounters and encounters were concentrated among few providers. Promoting equitable telehealth care requires investment to address technology barriers, increase the readiness of providers and clinics to provide telehealth care in languages other than English, and continued attention to reducing the healthcare impact of language barriers.
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Objectives: Asthma is one of the most prevalent chronic conditions affecting approximately 8.5% of children in Colorado. Our school-based asthma program (SBAP) has effectively improved asthma control and reduced asthma disparities among children but has been largely limited to the Denver area. We interviewed community stakeholders in 5 regions of Colorado to understand community needs for broader dissemination of SBAPs. Methods: In-depth, semistructured key informant interviews were conducted with school nurses, parents, pediatric healthcare providers, public health professionals, and community resource organization representatives. Inductive and deductive analyses were informed by the practical, robust, implementation, and sustainability model, an implementation science framework. Results: Participants (n=52) identified 6 types of needs for successful future implementation of our SBAP: (1) buy-in from stakeholders; (2) asthma prioritization; (3) improved relationships, communication, and coordination among school nurses, healthcare providers, and community organizations that address social determinants of health (SDOH) and children/families; (4) resources to address healthcare and SDOH needs and awareness of existing resources; (5) asthma education for children/families, school staff, and community members; and (6) improved coordination for School Asthma Care Plan completion. These needs mapped to a 3-tiered, progressive structure of foundational, relational, and functional needs for implementation success. Conclusion: These 6 types of needs illuminate factors that will allow this SBAP to work well and program delivery approaches and implementation strategies that may need modification to be successful. Next steps should include tailoring implementation strategies to variations in local context to support fit, effectiveness, and sustainment.
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Asma , Pesquisa Qualitativa , Serviços de Saúde Escolar , Humanos , Asma/terapia , Colorado , Serviços de Saúde Escolar/organização & administração , Criança , Feminino , Masculino , Avaliação das Necessidades , Entrevistas como AssuntoRESUMO
BACKGROUND: Latinx children in immigrant families have disproportionately high obesity rates; effective obesity treatment for this subset of Latinx children is critically needed. OBJECTIVES: To inform the development of weight management interventions we explored: 1) community facilitators and barriers to achieving childhood healthy weight through photovoice; and 2) participant reflections on the photovoice process. METHODS: Photovoice was conducted using established methods in a local church. After photovoice, participants completed semi-structured interviews to reflect on their experience. Transcripts were analyzed using a general thematic analysis approach to arrive at preliminary themes, which were presented to participants for validation. Participant input was used to finalize the themes. RESULTS: Six adults and two youth Latinx immigrants identified photograph themes over seven sessions. Four themes emerged regarding community barriers and facilitators to achieving childhood healthy weight: 1) family habits, 2) cultural influences on food, 3) built environment, and 4) food marketing. Participant reflections revealed they were motivated to participate in photovoice to learn more about health, recognized personal growth as a result of group sharing, valued representation as a community, and felt empowered to be role models. CONCLUSIONS: Findings from both photovoice and participant reflections reinforced the need for multi-level approaches to treating childhood obesity. Though participant reflections were gathered to inform continued engagement of Latinx families, they ultimately had a significant impact on our conclusions about priority intervention components.
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Obesidade Infantil , Adolescente , Adulto , Criança , Pesquisa Participativa Baseada na Comunidade/métodos , Nível de Saúde , Humanos , Obesidade Infantil/prevenção & controleRESUMO
Our school-based asthma program has reduced asthma exacerbations for youth with health disparities in the Denver metropolitan area, due partly to addressing social determinants of health, such as access to health care and medications. Dissemination and implementation (D&I) science approaches accelerate the translation of evidence-based programs into routine practice. D&I methods are being applied more commonly to improve health equity. The purpose of this publication was to give an overview of D&I research methods, using our school-based asthma program as an example. To successfully scale out our program across the state of Colorado, we are applying a D&I framework that guides the adaptation of our existing implementation approach to better meet our stakeholders' local context-the Exploration, Preparation, Implementation, Sustainment framework. In a pragmatic trial design, we will evaluate the outcomes of implementing the program across 5 Colorado regions, with attention to health equity, using a second commonly used D&I framework-Reach, Effectiveness, Adoption, Implementation, and Maintenance. Our central hypothesis is that our program will have broad and equitable reach to eligible students (primary outcome) and will reduce asthma attacks and symptoms. This D&I approach accelerates dissemination of our program and is an applicable process for translating other effective allergy/asthma programs to address asthma and allergy-related disparities.
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Asma , Adolescente , Asma/terapia , Atenção à Saúde , Humanos , Projetos de Pesquisa , Instituições AcadêmicasRESUMO
OBJECTIVE: Examine racial/ethnic differences in parent activation and associations with child obesity risk behaviors in low-income families. METHODS: Cross-sectional survey study of 300 low-income Black, Latinx, and White parents of patients aged 2 to 5 years receiving primary care within 2 health care systems (Systems 1 & 2). In-person and phone surveys were conducted. Parent activation, defined as parents' knowledge, confidence, and willingness to act concerning their child's health, was measured using the standardized 13-item Parent Patient Activation Measure (P-PAM). Differences in parent activation by race/ethnicity were assessed using analysis of variance. Multivariate regression analyses were used to test associations between parent activation and child obesity risk behaviors. RESULTS: In pooled unadjusted analyses, Latinx parents had significantly lower activation compared to Black parents (P = .023), but these differences were no longer statistically significant after adjusting for other sociodemographic characteristics (P = .06). Higher activation was associated with slightly greater odds of consuming ≥ 5 daily servings of fruits and vegetables for System 2 only (odds ratio: 1.04, 95% confidence interval: 1.01, 1.07). Associations between parental activation and child screen time or physical activity were not significant. CONCLUSIONS: Findings highlight potential measurement limitations of the P-PAM including the inability of the measure to capture barriers to health system navigation and cultural and linguistic considerations. Further attention to the nuanced interplay between parental activation and contextual and sociodemographic risk factors (eg, food availability, immigrant status, economic opportunity, language proficiency) should be considered in the development of early childhood obesity interventions in primary care settings.
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Obesidade Infantil , Criança , Pré-Escolar , Estudos Transversais , Etnicidade , Humanos , Pais , PobrezaRESUMO
OBJECTIVE: Research shows NICU Latino parents with limited English proficiency (LEP) feel less comfortable asking questions and participating in medical decision-making, which may negatively affect transition to community healthcare. Question prompt lists (QPL), suggested questions sometimes drawn from families and providers, can improve family-centered communication. We explored clinician and parent perceptions to inform development of and pilot a NICU discharge QPL. METHODS: Focus groups with NICU and primary care providers explored perceived educational needs of Latino parents LEP and barriers to effective transition to community healthcare. Semi-structured interviews with Latino parents LEP explored perceptions of knowledge gaps and recommendations to improve the transition process. A Spanish audio QPL for parents and an English written version for providers were developed and pilot tested for acceptability. RESULTS: Provider focus groups (n = 27) and parent interviews (n = 19) identified themes: decreased parent activation, knowledge gaps, limited-use interpreters, unfamiliarity with healthcare system, and social isolation as barriers to smooth NICU-to-home transition. Providers (n = 11) and parents (n = 10) favored QPL introduction early in NICU admission, finding it useful to improve communication and transition processes for families. CONCLUSION: Our QPL may address challenges faced by Latino parents LEP when transitioning home. PRACTICE IMPLICATIONS: QPLs may improve Latino NICU infants' healthcare outcomes.
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Proficiência Limitada em Inglês , Alta do Paciente , Comunicação , Barreiras de Comunicação , Hispânico ou Latino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , PaisRESUMO
INTRODUCTION: To inform efforts to provide healthcare to uninsurable, immigrant youth, we describe The Access Partnership (TAP) hospital-based charity care program and compare healthcare utilization and diagnoses among TAP and Medicaid patients. METHODS: We use propensity scores to match each TAP patient to three Medicaid patients receiving care at a pediatric clinic from October 2010 to June 2015 on demographic characteristics. We use descriptive statistics to compare healthcare visits and diagnoses. RESULTS: TAP (n = 78) and Medicaid patients (n = 234) had similar healthcare utilization, though Medicaid patients had more outpatient visits (10.8 vs. 7.7, p = .002), and TAP patients were more likely to have ever received subspecialty care (38.5% vs. 22.2%, p = .005). Diagnoses were similar between groups, with some exceptions: TAP patients more likely to present with genital and reproductive disease (33.3% vs. 19.7%, p = .013); Medicaid patients more likely to present with endocrine, metabolic, and nutritional disease (52.1% vs. 28.2%, p < .001), psychiatric, behavioral disease, and substance abuse (41.0, 26.9%, p = .026). CONCLUSIONS: TAP patients had similar healthcare utilization and diagnoses to matched sample of Medicaid patients. Findings indicate policy proposals that extend public health insurance to all children would likely benefit immigrant children and not incur higher costs than those of low-income U.S. citizen children.
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Emigrantes e Imigrantes , Seguro Saúde , Adolescente , Criança , Acessibilidade aos Serviços de Saúde , Humanos , Medicaid , Aceitação pelo Paciente de Cuidados de Saúde , Estados UnidosRESUMO
BACKGROUND: The U.S. Preventive Services Task Force recommends referral of all obese children to intensive weight management programs. When available, programs are limited to clinical settings and do not address social determinants of health barriers to healthy weight among Latinx immigrant families. Active and Healthy Families, a Spanish-language, culturally tailored group visit intervention has demonstrated effectiveness in decreasing child body mass index but does not address barriers to frequent engagement with the health care system nor social determinants other than immigration. Adapting the intervention for community-based delivery, and to address additional social determinants, may facilitate participation and increase acceptability and engagement among Latinx immigrant families. PURPOSE: To engage a stakeholder network in planning adaptations of an evidence-based weight management intervention for community-based implementation. METHOD: Guided by the intervention mapping-adapt process, we solicited feedback from a stakeholder network from August 2018 to March 2020. The stakeholder network assessed fit, planned adaptations and identified essential intervention components using photovoice, a Participatory Action Research method, and meetings incorporating user-centered design approaches. RESULTS: The stakeholder network membership included Latinx immigrant families, community leaders, health care delivery experts, and researchers. Planned adaptations included curriculum changes to discuss social determinants barriers to behavior change and goal setting to mitigate them. CONCLUSIONS: We successfully engaged a stakeholder network and, using a systematic process, identified adaptations of an evidence-based weight management intervention to allow for community-based implementation. Sustainably addressing obesity disparities for Latinx children also requires addressing structural factors to reduce social determinants of health barriers at the population level.
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Emigrantes e Imigrantes , Obesidade Infantil , Índice de Massa Corporal , Criança , Humanos , Sobrepeso/prevenção & controle , Obesidade Infantil/prevenção & controle , Determinantes Sociais da SaúdeRESUMO
INTRODUCTION: Development of mHealth interventions to address health disparities for Latino children in immigrant families requires understanding access to and use of information and communication technology. METHODS: We examined access to information and communication technology and use of common applications/programs by low-income immigrant Latino parents of infants to inform development of mHealth interventions for this population. Latino immigrant parents reported technology use and access of common applications/software via survey. RESULTS: Of the 157 participants, we found nearly all parents owned a smartphone and that 60% accessed the internet only via their smartphone. Around one-quarter of participants had access to unlimited data. Frequent use of text messaging was common, but frequent email use was less common. Less than 10% of participants frequently used health-oriented applications. DISCUSSION: Our findings suggest that mHealth interventions that use data, email, or an application interface may not have the intended reach or effectiveness among low-income immigrant Latino parents. Consideration of these findings is important in guiding the development of future mHealth programs for the low-income Latino population. This study was registered at clinicaltrials.gov (NCT02647814).
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Emigrantes e Imigrantes , Telemedicina , Acesso à Informação , Hispânico ou Latino , Humanos , Pais , TecnologiaRESUMO
PURPOSE: Social and behavioral determinants of health (SBDH) are important factors that affect the health of individuals but are not routinely captured in a structured and systematic manner in electronic health records (EHRs). The purpose of this study is to generate recommendations for systematic implementation of SBDH data collection in EHRs through (1) reviewing SBDH conceptual and theoretical frameworks and (2) eliciting stakeholder perspectives on barriers to and facilitators of using SBDH information in the EHR and priorities for data collection. METHOD: The authors reviewed SBDH frameworks to identify key social and behavioral variables and conducted focus groups and interviews with 17 clinicians and researchers at Johns Hopkins Health System between March and May 2018. Transcripts were coded and common themes were extracted to understand the barriers to and facilitators of accessing SBDH information. RESULTS: The authors found that although the frameworks agreed that SBDH affect health outcomes, the lack of model consensus complicates the development of specific recommendations for the prioritization of SBDH data collection. Study participants recognized the importance of SBDH information and individual health and agreed that patient-reported information should be captured, but clinicians and researchers cited different priorities for which variables are most important. For the few SBDH variables that are captured, participants reported that data were often incomplete, unclear, or inconsistent, affecting both researcher and clinician responses to SBDH barriers to health. CONCLUSIONS: Health systems need to identify and prioritize the systematic implementation of collection of a high-impact but limited list of SBDH variables in the EHR. These variables should affect care and be amenable to change and collection should be integrated into clinical workflows. Improved data collection of SBDH variables can lead to a better understanding of how SBDH affect health outcomes and ways to better address underlying health disparities that need urgent action.
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Coleta de Dados/métodos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Confiabilidade dos Dados , Atenção à Saúde/normas , Feminino , Grupos Focais/métodos , Disparidades em Assistência à Saúde/legislação & jurisprudência , Humanos , Entrevistas como Assunto/métodos , Masculino , Avaliação de Resultados em Cuidados de Saúde/tendências , Participação dos Interessados , Fluxo de TrabalhoRESUMO
Latino children have disproportionately high childhood obesity rates, and U.S.-born Latino children of immigrant parents experience higher overweight/obesity rates than other Latino children. Community-based participatory research (CBPR) to engage Latino immigrant families and Latino-serving community organizations is one mechanism to address the lack of effective and practical interventions addressing childhood obesity disparities among Latino children. We present lessons learned from applying CBPR methods to a partnership focused on developing a child obesity treatment program for Latino immigrant families in an emerging Latino immigrant destination to inform the use of CBPR methods in other partnerships in emerging immigrant communities. We encountered challenges working within the partnership related to entrenched sociopolitical hierarchies that were not inclusive of immigrant community leaders, capacity building for partners with limited literacy and administrative experience, and how best to useâ¯complementary methods and frameworks to support a community-engaged research process. This work is one way to promote shared learning among the community of researchers using CBPR and other engagement methods to partner with emerging immigrant communities. Together with our community partners, we can identify strategies to more effectively partner to promote health equity and work toward social justice for all members of our communities.
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Emigrantes e Imigrantes , Obesidade Infantil , Criança , Pesquisa Participativa Baseada na Comunidade , Promoção da Saúde , Hispânico ou Latino , Humanos , Obesidade Infantil/prevenção & controleRESUMO
System barriers to effective healthcare engagement and navigation contribute to healthcare disparities among Latino children with immigrant parents in the US. We evaluated a nine-minute educational video supporting healthcare navigation and engagement skills of Spanish-speaking Latino parents of infants. Participants viewed the video at their child's 2-month well-visit, completed a pre-and post-video knowledge evaluation, and answered open-ended questions on video style. A paired t test was used to examine differences in knowledge and open-ended responses were coded using an iterative, consensus-based process. Of the 79 participants, 63.3% had an education level below high school diploma/GED and 84.8% were at risk for limited health literacy. There was a significant gain in healthcare navigation and engagement knowledge after watching the video (p < 0.001). Parents expressed that the video was interesting and provided useful information. Parents valued the knowledge gained and preferred videos over written materials for receiving culturally and linguistically tailored health education.
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Emigrantes e Imigrantes , Hispânico ou Latino , Criança , Escolaridade , Disparidades em Assistência à Saúde , Humanos , Lactente , PaisRESUMO
BACKGROUND: The majority of Latino immigrants have been shown to have a mobile phone. Cellular phones offer a low-cost method of reaching larger populations and have the potential for increased tailoring and interactivity. This supports the development of mHealth interventions to address healthcare disparities in this population. In this study we sought to evaluate the feasibility and acceptability of interactive Spanish-language text messages sent throughout a child's first year of life in a low-income, limited-English proficient (LEP) Latino population to support families in accessing and using pediatric primary care more effectively. METHODS: Participants (n=79) received interactive text messages over a period of 12 months as a part of a multi-modal mHealth intervention conducted at an urban academic pediatric primary care practice. Inclusion criteria were: singleton infant <2 months of age, enrollment in public health insurance, parent age >18, parent preferred healthcare language of Spanish, and at least one household cellular phone. Interactive text messages were designed to promote increased healthcare engagement and prompted participant responses through preprogramed algorithms. Text message sequences included clinic appointment reminders, support for obtaining medicine and completing referral appointments, monitoring of illness care needs and use, and parent support program reminders. Descriptive analyses were used to examine text message volume, usability, and participant response to text sequences. RESULTS: Among participants, mean parent age was 30.1 years (SD: 6.1 years); mean years in the US was 7.5 years (SD: 5.1 years). 63.3% of parents had less than a high school education and 84.8% of parents had possible/high likelihood of limited health literacy. Participants completed the majority of sequences with appointment reminder sequences having the quickest response time. The top quartile of responders completed 88.3% of sequences; lower educational attainment was associated with lower text message sequence completion. Participants rated the program positively, especially the appointment reminders. CONCLUSIONS: LEP Latino parents successfully engaged with interactive Spanish-language text sequences and parent acceptability was high. This study demonstrates feasibility for interventions employing this technology. Text message interventions may be a feasible approach to reduce healthcare disparities and costs for vulnerable populations.