Social connectedness and surviving at the margins: Findings from interviews with low-income Latino men in the U.S. Northeast.

OBJECTIVES: Structural and interpersonal discrimination can lead to social exclusion and limited social integration, inhibiting the use of support networks to gain access to health-protective material and social resources. Social support theories suggest that connectedness may moderate the link between discrimination and health risk. This study examined how risk factors (i.e., structural and interpersonal discrimination) further marginalize Puerto Rican men by limiting access to social support. We also aimed to identify resiliency factors, such as cultural values related to social interactions and community support, which may be protective for these men's well-being. METHOD: We conducted 40 semistructured interviews with a stratified purposeful sample of Puerto Rican (92.5%) men aged 25-70 (Mage = 50.7) in the U.S. Northeast. A hybrid deductive and inductive thematic qualitative analysis was used to analyze data. RESULTS: Participants discussed how structural and interpersonal discrimination result in inequities and barriers to resources and services (e.g., lack of adequate shelter, insecurity, employment) which impacted their well-being through the inability to access fundamental support for survival. The men identified cultural values (e.g., familismo, simpatía) and emphasized the importance of community support as protective factors that may provide a respite from the difficulties of navigating discrimination experiences. CONCLUSION: Findings suggest discrimination limits Puerto Rican men's ability to access resources, which has a detrimental impact on their well-being. Identifying social support beyond the family, and considering cultural values related to support, can enhance community interventions by focusing on incorporating multiple forms of support that may improve Puerto Rican men's health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The use of digital stories as a health promotion intervention: a scoping review.

BACKGROUND: It is challenging to develop health promotion interventions created in collaboration with communities affected by inequities that focus beyond individual behavior change. One potential solution is interventions that use digital stories (DS). Digital storytelling (DST) is an opportunity for reflection, connection with others, and the elevation of voices often absent from daily discourse. Consequently, public health researchers and practitioners frequently employ the DST workshop process to develop messaging that promotes health and highlights concerns in partnership with historically marginalized communities. With participants' permission, DS can reach beyond the storytellers through behavior or attitude change interventions for health promotion among communities who share the targeted health concern. Our goal was to synthesize the literature describing interventions that use DS for health promotion to identify gaps. METHODS: We conducted a scoping review. Our inclusion criteria were articles that: 1) described empirical research; 2) used DS that were developed using the StoryCenter DST method; 3) assessed an intervention that used DS to address the health promotion of viewers (individuals, families, community, and/or society) impacted by the targeted health issue 4) were written in English or Spanish. To synthesize the results of the included studies, we mapped them to the health determinants in the National Institute of Minority Health and Health Disparities (NIMHD) research framework. We assessed the number of occurrences of each determinant described in the results of each article. RESULTS: Ten articles met the eligibility criteria. All the included articles highlighted health equity issues. Our mapping of the articles with definitive results to the NIMHD research framework indicates that interventions that use DS addressed 17 out of 20 health determinants. All mapped interventions influenced intentions to change health behaviors (NIMHD level/domain: Individual/Behavioral), increased health literacy (Individual/Health Care System), and/or stimulated conversations that addressed community norms (Community/Sociocultural Environment). CONCLUSIONS: Interventions that use DS appear to positively affect the health promotion of participants across a range of health issues and determinants. Future research is needed in the Interpersonal, Community, and Societal levels and within the Biological, Physical/Built Environment, and Sociocultural Environment domains.

Participant Engagement and Ethical Digital Storytelling: The MOCHA Moving Forward Study.

African-American men continue to bear a disproportionate share of the burden of health disparities, in general, and chronic diseases, in particular. The Men of Color Health Awareness (MOCHA) Moving Forward study seeks to determine the effectiveness of an innovative, community-driven program to improve the health and quality of life of low-income African-American men between the ages of 35 to 70 years by reducing identified social risk factors for chronic disease for these men. The project uses digital storytelling (DST) to encourage African-American men to tell their stories, especially related to stress, gender role stereotypes, and mental and physical health and well-being. Thirty-six men were recruited to participate in one of four DST workshops, which resulted in each participant creating a 2- to 3-minute digital story. In this article, we describe and analyze three salient ethical dilemmas that arose in conducting the Men of Color Health Awareness Moving Forward study DST workshops with African-American men. The dilemmas can be traced to the distinct purposes for which DST can be used, data collection or intervention development, and the trade-offs between protecting and patronizing participants. We discuss potential ways to resolve or circumvent the identified issues.

"Scribble Scrabble": Migration, Young Parenting Latinas, and Digital Storytelling as Narrative Shock.

The nexus of migration and family offers a conjuncture to enrich understanding of teen pregnancy and parenting. This article draws findings from a project centered on participant-produced new media to reveal how young mothers negotiate reproductive health disparities. We focus on young mothers' experiences of migration and movement, captured in local vernacular through participants' digital story depictions and follow-up interviews. We argue that disparities link up with the single story of teen mothering, involve public shaming, continue hand-in-hand with institutional humiliation, and are exacerbated through migration and movement. To disrupt the normative notions that shadow young mothers, we take seriously the young women's narratives. We theorize how the richness of stories and storytelling may serve as a potent intervention-a narrative shock-for articulating meanings and cultivating dignity for young mothers and their families, especially those who do not fit the sedentary and age biases of parenting ideals.

Restor(y)ing Health: A Conceptual Model of the Effects of Digital Storytelling.

We currently see an interdisciplinary shift toward a "participatory turn" in health research and promotion under which community engagement, shared decision making and planning, and the use of visual and digital methods have become paramount. Digital storytelling (DST) is one such innovative and engaging method increasingly used in applied health interventions, with a growing body of research identifying its value. Despite its increasing use, a standard approach to empirically assess the impacts on individuals participating in DST interventions does not currently exist. In this article, we define DST as a distinct narrative intervention, illustrate key elements that inform the methodology, and present a conceptual model to examine how DST may contribute to increased socioemotional well-being and bolster positive health outcomes. Our proposed model is informed by elements of narrative theory, Freirian conscientization, multimodality, and social cognitive theory and can serve as a guide for public health practitioners and researchers interested in assessing the potential benefits of DST as an applied health intervention. Recommendations for practice call for a rigorous methodological approach to apply and test this model across a range of health contexts and populations.

Puerto Rican Latina Youth Coming Out to Talk About Sexuality and Identity.

Public health efforts focused on Latina youth sexuality are most commonly framed by the syndemic of teen pregnancy and sexually transmitted infections, a narrow and often heteronormative focus that perpetuates silences that contribute to health inequities and overlooks the growing need for increased education, awareness, and support for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. This article presents findings from the project Let's Talk About Sex: Digital Storytelling for Puerto Rican Latina Youth, which used a culturally centered, narrative-based approach for analyzing participants' own specifications of sexual values and practices. The strength of digital storytelling lies in its utility as an innovative tool for community-based and culturally situated research, as well as in its capacity to open up new spaces for health communication. Here we present two "coming out" case studies to illustrate the value of digital storytelling in supporting the development of meaningful and culturally relevant health promotion efforts for LGBTQ-identified Puerto Rican Latina youth across the life span.

Measuring Down: Evaluating Digital Storytelling as a Process for Narrative Health Promotion.

Digital storytelling (DST) engages participants in a group-based process to create and share narrative accounts of life events. We present key evaluation findings of a 2-year, mixed-methods study that focused on effects of participating in the DST process on young Puerto Rican Latina's self-esteem, social support, empowerment, and sexual attitudes and behaviors. Quantitative results did not show significant changes in the expected outcomes. However, in our qualitative findings we identified several ways in which the DST made positive, health-bearing effects. We argue for the importance of "measuring down" to reflect the locally grounded, felt experiences of participants who engage in the process, as current quantitative scales do not "measure up" to accurately capture these effects. We end by suggesting the need to develop mixed-methods, culturally relevant, and sensitive evaluation tools that prioritize process effects as they inform intervention and health promotion.

Digital Storytelling as a Narrative Health Promotion Process: Evaluation of a Pilot Study.

Digital storytelling (DST) engages participants in a group-based process to create and share narrative accounts of life events. The process of individuals telling their own stories has not been well assessed as a mechanism of health behavior change. This study looks at outcomes associated with engaging in the DST process for vulnerable youth. The project focused on the experiences of Puerto Rican Latinas between the ages of 15 to 21. A total of 30 participants enrolled in a 4-day DST workshops, with 29 completing a 1 to 3-minute digital story. Self-reported data on several scales (self-esteem, social support, empowerment, and sexual attitudes and behaviors) were collected and analyzed. Participants showed an increase in positive social interactions from baseline to 3-month post workshop. Participants also demonstrated increases in optimism and control over the future immediately after the workshop, but this change was not sustained at 3 months. Analysis of qualitative results and implications are discussed.

Bridging graduate education in public health and the liberal arts.

The University of Massachusetts Amherst is part of Five-Colleges Inc, a consortium that includes the university and four liberal arts colleges. Consortium faculty from the School of Public Health and Health Sciences at the university and from the colleges are working to bridge liberal arts with public health graduate education. We outline four key themes guiding this effort and exemplary curricular tools for innovative community-based and multidisciplinary academic and research programs. The structure of the consortium has created a novel trajectory for student learning and engagement, with important ramifications for pedagogy and professional practice in public health. We show how graduate public health education and liberal arts can, and must, work in tandem to transform public health practice in the 21st century.

A situated practice of ethics for participatory visual and digital methods in public health research and practice: a focus on digital storytelling.

This article explores ethical considerations related to participatory visual and digital methods for public health research and practice, through the lens of an approach known as "digital storytelling." We begin by briefly describing the digital storytelling process and its applications to public health research and practice. Next, we explore 6 common challenges: fuzzy boundaries, recruitment and consent to participate, power of shaping, representation and harm, confidentiality, and release of materials. We discuss their complexities and offer some considerations for ethical practice. We hope this article serves as a catalyst for expanded dialogue about the need for high standards of integrity and a situated practice of ethics wherein researchers and practitioners reflexively consider ethical decision-making as part of the ongoing work of public health.

Sensual sexuality education with young parenting women.

Comprehensive sexuality education curricula that incorporate sex positive and integrated approaches go beyond a presentation of facts and strategies for prevention to emphasize the promotion of sexual subjectivity and wellbeing. A pilot sensual sexuality education program was planned, implemented and informally evaluated with young parenting women at an alternative General Educational Development test preparation center. The program prioritized a sex positive framework, including topics such as pleasure, desire and sexual entitlement, and invited participants to explore sexuality through a multisensory orientation. Participants took part in small group discussions and activities that engaged their senses through arts-based methods. Grounded in holism, program topics were integrated with a focus on participants' everyday experiences. The pilot curriculum serves as a promising program for re-positioning young parenting women as sexual subjects, which is key to the promotion of health and wellbeing.

A culturally and gender responsive stress and chronic disease prevention intervention for low/no-income African American men: The MOCHA moving forward randomized control trial protocol.

Low/no-income, African American men are disproportionally burdened by chronic disease resulting from a complex interplay of systemic, sociocultural, and individual factors. These disparities are related to poverty, racism, gender role strain, high levels of stress, low levels of physical activity, and malnutritious diet. Men of Color Health Awareness (MOCHA) is a community-driven movement to address the physical, mental, social, and spiritual needs of men of color. As part of ongoing programming, the MOCHA Standard intervention consists of a 10-week program including: (1) small group discussions of issues particularly relevant to men of color, (2) classes on health topics focusing on chronic disease control, such as nutrition, obesity, high blood pressure, fitness, and the social determinants of health; and (3) 60-min of moderately intensive aerobic exercise twice a week. While the MOCHA Standard intervention has yielded positive results, feedback from previous participants warranted an in-depth sociocultural tailoring of the curriculum to improve community receptiveness, in particular, revising the sessions to "narrativize" the materials to strengthen their potential effectiveness. This manuscript describes the novel recruitment strategies; the development of an enhanced MOCHA+ Stories Matter program that uses narrative communication strategies; and the methodology used to assess the comparative effectiveness of the MOCHA Standard relative to MOCHA+ Stories Matter program in lowering stress and risk of chronic diseases in a randomized controlled trial. The results of this research will contribute to the identification of effective interventions to address health disparities in low-income African-American men and the dissemination of effective chronic disease prevention programming.

Culture, Health, and Science: A Multidisciplinary Liberal Arts Alternative to the Public Health Major.

Since the 2003 call by the Institute of Medicine to educate undergraduates in public health, various models have emerged for incorporating public health into the liberal arts and sciences. One model is a professionalized public health major that uses core public health competencies to prepare a workforce of health professionals. A second model offers a broad-based public health major rooted in liberal arts principles, resisting the utilitarian trend toward human capital formation. A third model resists even the label of "public health," preferring instead to introduce undergraduates to many ways of analyzing human health and healing. The multidisciplinary Culture, Health, and Science Program, based on six key commitments for preparing liberal arts students to analyze health and respond to global health challenges, is offered as an alternative to the public health major.

Bodies as evidence: Mapping new terrain for teen pregnancy and parenting.

Predominant approaches to teen pregnancy focus on decreasing numbers of teen mothers, babies born to them, and state dollars spent to support their families. This overshadows the structural violence interwoven into daily existence for these young parents. This paper argues for the increased use of participatory visual methods to compliment traditional research methods in shifting notions of what counts as evidence in response to teen pregnancy and parenting. We present the methods and results from a body mapping workshop as part of 'Hear Our Stories: Diasporic Youth for Sexual Rights and Justice', a project that examines structural barriers faced by young parenting Latinas and seeks to develop relevant messaging and programming to support and engage youth. Body mapping, as an engaging, innovative participatory visual methodology, involves young parenting women and other marginalised populations in drawing out a deeper understanding of sexual health inequities. Our findings highlight the ways body mapping elicits bodies as evidence to understand young motherhood and wellbeing.

Lessons learned from taking data collection to the "hood".

Culturally appropriate measures are needed to analyze the effectiveness of HIV prevention interventions. An effective strategy to ensure the culturally appropriateness of measures is the inclusion of participants from the targeted community via participatory action research. Conducting the research process within the community is one method of maximizing greater community participation. The purpose of this paper is to describe a method of pilot testing an instrument within community settings. Findings presented focus primarily on the process of the method, rather than on a statistical outcome testing of the instrument. The sample was 200 African-American women recruited in networks drawn from two rural and two mid-sized counties in North Florida. Methodological issues encountered and resolved through ongoing process evaluation are presented as lessons learned with recommendations and implications.