RESUMEN
Community-clinical linkage models (CCLM) have the potential to reduce health disparities, especially in underserved communities; however, the COVID-19 pandemic drastically impacted their implementation. This paper explores the impact of the pandemic on the implementation of CCLM intervention led by community health workers (CHWs) to address diabetes disparities among South Asian patients in New York City. Guided by the Consolidated Framework for Implementation Research (CFIR), 22 stakeholders were interviewed: 7 primary care providers, 7 CHWs, 5 community-based organization (CBO) representatives, and 3 research staff. Semi-structured interviews were conducted; interviews were audio-recorded and transcribed. CFIR constructs guided the identification of barriers and adaptations made across several dimensions of the study's implementation context. We also explored stakeholder-identified adaptations used to mitigate the challenges in the intervention delivery using the Model for Adaptation Design and Impact (MADI) framework. (1) Communication and engagement refers to how stakeholders communicated with participants during the intervention period, including difficulties experienced staying connected with intervention activities during the lockdown. The study team and CHWs developed simple, plain-language guides designed to enhance digital literacy. (2) Intervention/research process describes intervention characteristics and challenges stakeholders faced in implementing components of the intervention during the lockdown. CHWs modified the health curriculum materials delivered remotely to support engagement in the intervention and health promotion. (3) community and implementation context pertains to the social and economic consequences of the lockdown and their effect on intervention implementation. CHWs and CBOs enhanced efforts to provide emotional/mental health support and connected community members to resources to address social needs. Study findings articulate a repository of recommendations for the adaptation of community-delivered programs in under-served communities during a time of public health crises.
RESUMEN
This study examined differences in colorectal cancer screening across sociodemographic, migration, occupational, and health-related factors in a sample of male taxi drivers. Male drivers eligible for colorectal cancer screening (CRCS) (≥ 50 years old) were recruited in 55 community-based health fairs conducted during November 2015 to February 2017 in 16 taxi garages or community locations located in Queens, Brooklyn, Manhattan and Bronx. Participants completed a survey that included sociodemographic, migration, occupational, health-related, and cancer screening practices. For this study 33 questions were analyzed. The sample consisted of 137 male drivers, 27% of them had undergone CRCS. Occupation-related factors, including night shifts and driving high numbers of weekly hours, were associated with lower CRCS rates; having a family history of cancer, health insurance, a regular source of primary care, and a routine check-up in the last year, were associated with higher CRCS rates. The findings suggest that drivers with health insurance and better access to primary care are more likely to be up-to-date with CRCS. The results provide important information that can inform occupation-based public health interventions.
