Reproducibility and implementation of a rapid, community-based COVID-19 "test and respond" model in low-income, majority-Latino communities in Northern California.

OBJECTIVE: To evaluate implementation of a community-engaged approach to scale up COVID-19 mass testing in low-income, majority-Latino communities. METHODS: In January 2021, we formed a community-academic "Latino COVID-19 Collaborative" with residents, leaders, and community-based organizations (CBOs) from majority-Latinx, low-income communities in three California counties (Marin/Merced/San Francisco). The collaborative met monthly to discuss barriers/facilitators for COVID-19 testing, and plan mass testing events informed by San Francisco's Unidos en Salud "test and respond" model, offering community-based COVID-19 testing and post-test support in two US-census tracts: Canal (Marin) and Planada (Merced). We evaluated implementation using the RE-AIM framework. To further assess testing barriers, we surveyed a random sample of residents who did not attend the events. RESULTS: Fifty-five residents and CBO staff participated in the Latino collaborative. Leading facilitators identified to increase testing were extended hours of community-based testing and financial support during isolation. In March-April 2021, 1,217 people attended mass-testing events over 13 days: COVID-19 positivity was 3% and 1% in Canal and Planada, respectively. The RE-AIM evaluation found: census tract testing coverage of 4.2% and 6.3%, respectively; 90% of event attendees were Latino, 89% had household income <$50,000/year, and 44% first-time testers (reach), effectiveness in diagnosing symptomatic cases early (median isolation time: 7 days) and asymptomatic COVID-19 (41% at diagnosis), high adoption by CBOs in both counties, implementation of rapid testing (median: 17.5 minutes) and disclosure, and post-event maintenance of community-based testing. Among 265 non-attendees surveyed, 114 (43%) reported they were aware of the event: reasons for non-attendance among the 114 were insufficient time (32%), inability to leave work (24%), and perceptions that testing was unnecessary post-vaccination (24%) or when asymptomatic (25%). CONCLUSION: Community-engaged mass "test and respond" events offer a reproducible approach to rapidly increase COVID-19 testing access in low-income, Latinx communities.

Chronic illness and Hmong shamans.

Among the challenges health care personnel in California's central valley face has been finding ways to help Hmong Americans manage chronic illness. Interviews were conducted with 11 Hmong shamans diagnosed with diabetes or hypertension and were qualitatively analyzed to ascertain respondents' understanding and management of their illnesses. Hmong shamans are influential individuals within their communities and are often the resource persons to whom patients turn for information on health. Understanding the shamans' perspective on chronic illness was seen as a gateway to understanding how the broader Hmong American community perceived these conditions. The concept of chronic illness was not well understood, resulting in sporadic medication and dietary regimens, limited awareness of potential complications, and a persistent impression that these illnesses could be cured rather than managed. Suggestions for patient educators include family and community involvement in care regimens and the use of descriptive terminology to identify the disease.

Shamans in a Hmong American community.

OBJECTIVE: To increase understanding of the process and meanings of shamanic care from patient complaint through diagnosis, treatment, and outcome. DESIGN: Information collected from 924 patient contact forms completed by 36 shamans over an 18-month period included basic demographic information on the patients, their complaints, treatments suggested by the shamans and the shamans' perceptions of the outcomes of treatment. These data were translated and entered into a computer database. LOCATION: A Hmong American community in California's Central Valley. METHODS: Quantitative descriptions of the sample were generated and integrated with qualitative analysis of the content of the text from the diagnostic, treatment and outcome categories was performed to systematically identify patterns in the data. RESULTS: Patients sought shamanic help for an array of physical, emotional, and psychologic complaints--problems that the shamans frequently diagnosed as being caused by soul loss or bad spirits. CONCLUSIONS: The data suggest the persistence of the need for the spiritual healing provided by the shamans within this immigrant community. Shamans' rituals affirmed and strengthened connections to family, culture, and community.

Afterbirths in the afterlife: cultural meaning of placental disposal in a Hmong American community.

Interviews were conducted with 94 Hmong Americans in California's Central Valley to explore attitudes regarding placental disposition and the cultural values that affect those attitudes. Research indicated a persistence of the traditional belief that placentas should be buried at home. The placenta is perceived to be essential for travel by the soul of the deceased into the spirit world to rejoin ancestors. Older respondents (older than age 35) and those who self-identified as animists were most likely to believe in the importance of home placental burial. Comments by respondents indicated some reluctance on the part of Hmong patients to ask health care providers for permission to take placentas home. Incorporating non-Western patients' traditional health care practices into Western health care delivery may be facilitated by an awareness of the reluctance of some patients to verbalize their wishes.