Stakeholder Perspectives on the Impact of COVID-19 on the Implementation of a Community-Clinic Linkage Model in New York City.

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.

Help seeking and mental health outcomes among South Asian young adult survivors of sexual violence in the New York State Region.

BACKGROUND: Sexual violence is a growing issue faced across diverse South Asian American communities under the backdrop of a distinct religious and cultural environment that intersects with the ability to prevent and manage this public health crisis. There is also growing attention on sexual violence experienced by younger or second-generation South Asian Americans, although little is known on the prevalence of this violence and its impact on health outcomes. Using data from a community-driven sexual violence survey, this study describes the experience of sexual violence and related help seeking behaviors and mental health outcomes among 18-34-year-old South Asian Americans living near the New York (NY) State region. METHODS: Participants were recruited via social media to participate in an anonymous survey developed in partnership with an advisory board of South Asian young adult representatives. Data was analyzed descriptively and through adjusted logistic regression models. RESULTS: Overall, responses from 335 sexual assault survivors were analyzed. Types of assault experienced included no-contact (97.6%), contact (75.2%), rape attempts (50.2%), rape (44.6%), and multiple rape (19.6%). Many reported perpetrators were South Asian (65.1%) or family members (25.1%). Only 27.6% indicated they had reported assaults to authorities or received services. In adjusted analyses, odds of help seeking were higher among participants who were older (AOR:1.10, 95%CI:1.02-1.20), were a sexual minority (lesbian, gay, bisexual) (1.98, 1.05-3.71), had a family member as the perpetrator (1.85, 1.01-3.40), had lower disclosure stigma (1.66, 1.16-2.44), and experienced depression (2.16, 1.10-4.47). Odds of depression were higher among sexual minority participants and lower among those with higher sexual assault disclosure stigma (3.27, 1.61-7.16; 0.68, 0.50-0.93). CONCLUSIONS: Findings call for greater targeted policy interventions to address the prevention of sexual violence among young South Asian Americans and greater focus on improving help seeking behaviors and improving mental health outcomes among survivors.

Sexual violence among LGB+ South Asian Americans: Findings from a community survey.

Lesbian, gay, bisexual, and other sexual minority (LGB+) South Asian Americans represent a disproportionately underserved and often invisible community in the United States. While issues of sexual violence have been documented in the South Asian American community, little is known on its impact among LGB+ individuals. This study explores the experience of sexual violence, related attitudes, and mental health outcomes among LGB+ South Asian Americans. A community-informed online survey of 18-34-year-old South Asian Americans living near the New York State region, recruited from online social media platforms, was conducted. Study design, implementation, and evaluation occurred in partnership with an advisory board of South Asian young adult representatives; data was analyzed both descriptively and through multivariable logistic regression models. Of the 385 participants who reported their sexuality, LGB+ participants comprised 24.1% (n = 93) of the sample. LGB+ participants were more likely to have experienced rape multiple times (17.2% vs. 9.6%) in bivariate analyses, and higher odds of depression (AOR:3.47, 95%CI:1.61-8.17) in adjusted analyses. Overall, LGB+ South Asian Americans displayed a disproportionate burden of sexual violence and depression. Findings identify policy and research pathways to address sexual violence among LGB+ South Asians.

Loneliness and mental health outcomes among South Asian older adult immigrants in the United States: a cross-sectional study.

BACKGROUND: There is growing concern of mental health issues among South Asian immigrant populations, although limited disaggregated data on determinants of these issues exists. The aim of this study was to examine factors associated with mental health outcomes among South Asian older adult immigrants living in New York City (NYC). METHODS: Data were sourced from a needs assessment among self-identified South Asians aged 60+ conducted by an NYC-based frontline agency and nonprofit organization. Variables assessed included the 9-item Patient Health Questionnaire, degree of difficulty experienced due to depression, loneliness, emotional distress, as well as sociodemographic, living situation, acculturation, general health, and financial related indicators. RESULTS: Among the 682 responses, 9.4% of participants displayed symptoms of mild or moderate depression (16% of Caribbean-origin, 10% of Pakistani, 9% of Bangladeshi, and 8% of Indian participants). About a third of participants (29.9%) reported feeling lonely sometimes and 39.1% experienced any type of emotional distress. When compared to those with excellent or very good self-rated health, having fair, poor, or terrible self-rated health was associated with a greater adjusted odds ratio (AOR) of having mild or moderate depression (AOR: 8.42, 95% confidence interval [CI]: 22.09) and experiencing emotional distress (AOR: 3.03, 95% CI: 1.88-4.94). Those experiencing emotional distress were more likely to be younger (AOR: 0.97, 95% CI: 0.95-1.00) and live alone (AOR: 2.06, 95% CI: 1.21-3.53). DISCUSSION: Findings support the need for tailored mental health interventions targeting concerns, such as poor self-rated health, among South Asian older adult immigrants, as well as specific subpopulations such as Indo-Caribbeans who may be experiencing a disproportionate burden.