Supporting community health workers during the COVID-19 pandemic: A mixed methods pilot study.

OBJECTIVE: To examine how the COVID-19 Project ECHO program may have influenced the mental health of community health workers (CHWs) from South Texas. The program was designed around case-based learning and mentorship to provide support to CHWs and help them gain expertise to provide services to their communities. DESIGN: An explanatory sequential mixed methods pilot study. SAMPLE: Fifteen CHWs who were enrolled in the program participated in this study. MEASUREMENTS: The Center for Epidemiological Studies-Depression (CES-D) and the Perceived Stress Scale (PSS) were used to measure the differences pre- and post-intervention. Qualitative description was used to explore the experiences of the participating CHWs. RESULTS: The PSS post-test mean (12.53) showed a statistically significant decrease from the pretest mean (17.01) (t (14 = 2.456, p = .028). The CHWs explained that the death of loved ones, feelings of isolation, and work-related concerns influenced their mental health. CHWs expressed that the program provided them with emotional support and resources for their clients. CONCLUSIONS: The impact of the COVID-19 pandemic on disadvantaged and medically underserved areas will be long-lasting; therefore, the need is greater than ever for CHWs to receive mental health support and be able to connect communities with vital resources.

Teaching Person-Centered Care and Interprofessional Collaboration through a Virtual Mental Health World Café: A Mixed Methods IPE Pilot Project.

The purpose of this convergent mixed methods interprofessional education (IPE) pilot project was to help health profession students gain valuable insight about the experiences of people living with mental illness, to help them have a better understanding of person-centered care and have greater knowledge about the importance of interprofessional collaboration. A developmental workgroup which consisted of mental health consumers, four interdisciplinary students, and our team developed and implemented a virtual Mental Health World Café IPE event. Twelve other students attended the World Café event. A paired sample t-test was used to examine group differences between pre- and post-test scores for the Interprofessional Socialization and Valuing Scale and the Texas AHEC Survey measures among the four student leaders and the 12 student participants of the virtual Mental Health World Cafe. We conducted individual interviews with the four student leaders and collected reflective journals from the 12 students who attended the World Café event. We examined to what extent the statistically significant quantitative results supported the qualitative results separately for the student leaders and for the student participants of the virtual World Café. We also examined how both the quantitative and qualitative findings aligned with the key components of the Patient-Centered Care in Interprofessional Collaborative Practice Model. While the project allowed the students to reflect upon how they may apply the principles of person-centered care and interprofessional collaboration, the impact of the consumers on the student's experiences was profound and resulted in widespread engagement of the students who attended the event.

Measuring capability for healthy diet and physical activity.

PURPOSE: Patterns of diet and physical activity, major drivers of morbidity and mortality, are contingent on people's feasible opportunities to pursue healthy behaviors. Our objective for this mixed methods study was to develop measures of feasible opportunities for diet and activity. METHODS: The Capability Approach framework for evaluating people's real freedoms to pursue their values guided the research. A community-based participatory model was applied to conduct focus groups of adults with obesity or diabetes mellitus from an economically disadvantaged Latino community. Focus group themes were developed into survey items that assess how individual circumstances and neighborhood contexts influence opportunities for diet and activity. The prevalence of different influences was explored in a sample of 300 patients from a primary care safety net clinic. Scales measuring different aspects of opportunity were created through principal components analysis. RESULTS: Availability, convenience, safety, cost of food, and activity resources interact with individual circumstances, such as illness, depression, family and nonfamily supports, and scope of personal agency, to shape practical opportunities. Multiple vulnerabilities in availability of resources and moderators of resource use commonly occur together, intensifying challenges and creating difficult trade-offs. Only one-half of participants reported that physicians understood their difficulties pursuing activity, and just one-third for diet. CONCLUSIONS: Our results suggest that practical opportunities for healthy behavior can be measured as a primary target for clinical and public health assessment and intervention. The Capability Approach holds promise as a framework for developing interventions responsive to both personal and environmental determinants.

Advanced primary care in San Antonio: linking practice and community strategies to improve health.

Improving health among people living in poverty often transcends narrowly focused illness care. Meaningful success is unlikely without confronting the complex social origins of illness. We describe an emerging community of solution to improve health outcomes for a population of 6000 San Antonio, Texas, residents enrolled in a county health care program. The community of solution comprises a county health system, a family medicine residency program, a metropolitan public health department, and local nonprofit organizations and businesses. Community-based activities responding to the needs of individuals and their neighborhoods are driven by a cohort of promotores (community health workers) whose mission encompasses change at both the individual and community levels. Centered on patients' functional goals, promotores mobilize family and community resources and consider what community-level action will address the social determinants of health. On the clinical side, care teams implement population-based risk assessment and nurse care management with a focus on care transitions as well as other measures to meet the needs of patients with high morbidity and high use of health care. Population-based outcome metrics include reductions in hospitalizations, emergency department and urgent care visits, and the associated charges. Promotores also assess patients' progress along the trajectory of their selected functional goals.

Community-based violence awareness.

Violence against women is a major influence on women's mental health. We used popular education techniques to train 14 Spanish-speaking women as promotoras (community health workers) to increase awareness about violence against women in low income Texas communities. These women then conducted over 80 presentations in Spanish in local community settings. The impact of the program on the promotoras and on women attending the presentations was evaluated using qualitative methods. This research lends support to the idea that nurses working in community mental health settings must use innovative primary prevention strategies and evaluation mechanisms to change awareness about violence against women.