Integration of social epidemiology and community-engaged interventions to improve health equity

Calling all stakeholders: group-level assessment (GLA)-a qualitative and participatory method for large groups

Group-level assessment (GLA) is a qualitative and participatory large group method in which timely and valid data are collaboratively generated and interactively evaluated with relevant stakeholders leading to the development of participant-driven data and relevant action plans. This method is useful across a wide range of evaluation purposes in many environments. GLA involves bringing a large group of participants together to build a common database through the co-identification of relevant needs, judgments, and priorities. The GLA process proceeds through the following seven steps: climate setting, generating, appreciating, reflecting, understanding, selecting, and action. This article describes the methodological development and process of conducting a GLA and its various applications across the evaluation spectrum. We highlight several exemplars where GLA was used in order to demonstrate the particular nuances of working with different sizes and types of groups and to elaborate on our learnings from the wide applicability of the method.

Community capacity building: a collaborative approach to designing a training and education model

BACKGROUND

Successful community-academic research partnerships require building the capacity of both community-based organizations (CBOs) and academics to conduct collaborative research of mutual interest and benefit. Yet, information about the needs and goals of research-interested CBOs is lacking. Our partnership aimed to conduct a community research needs assessment and to use results to develop future capacity-building programs for CBOs.

METHODS

Based on our review of the literature, informal interviews with research-interested CBOs and community-engaged research groups locally and nationally, we developed a needs assessment survey. Key domains of this survey included history and experience with research collaboration, interest in specific research topics, and preference for learning format and structure. We trained community health workers (CHWs) to recruit senior leaders from CBOs in New York City (NYC) and encourage them to complete an on-line survey.

RESULTS

Fully 54% (33/61) of CBOs completed the needs assessment. Most (69%) reported involvement with research or evaluation in the last 2 years and 33% had some funding for research. Although 75% had collaborated with academic institutions in the past, 58% did not rate this experience well. The four areas respondents prioritized for skills building were program evaluation, developing needs assessments, building surveys, and understanding statistical analyses. They were less interested in learning to build collaborations with academics.

CONCLUSIONS

A formal needs assessment of research training and educational needs of CBOs revealed that most had experience, albeit negative, with academic collaborations. CBO leaders wanted to build skills to conduct and analyze assessments and program evaluations. Our community-academic partnership is using these findings to develop a research capacity-building course. Other partnerships should consider conducting such assessments to transform the capacity of CBOs to be active research partners and leaders.

Maternal differences and birth outcome disparities: Diversity within a high risk prenatal clinic

BACKGROUND

We examined the influence of race/ethnicity on appointment attendance, maternal psychiatric and medical diagnoses, and birth outcomes within a diverse, low income, high risk pregnant population to determine whether birth outcome disparities would be lessened in a sample with high biopsychosocial risk across all groups.

METHODS

Data were retrospectively obtained on all women scheduled for appointments in the San Francisco Genera Hospital (SFGH) High-Risk Obstetrics (HROB) clinic during a three-month period. General linear model and logistic regression procedures were used to examine the associations of race/ethnicity with maternal characteristics, clinic attendance, and birth outcomes.

RESULTS

Our sample included 202 maternal-infant pairs (Hispanic 57%, Black 16%, Asian 15%, White 12%). Racial/ethnic differences were seen in language (p < .001), gravidity (p < .001), parity (p = .005), appointment attendance (p < .001), diabetes (p = .005), psychiatric diagnosis (p = .02), illicit drug use (p < .001), smoking (p < .001). These maternal characteristics, including rate of attendance at specialized prenatal appointments, did not predict birth outcomes with the exception of an association between diabetes and earlier gestational age (p = .03). In contrast, Black maternal race/ethnicity was associated with earlier gestational age at birth (p = .004) and lower birth weight (p < .001) compared to Whites.

CONCLUSIONS

Within a diverse maternal population of high biopsychosocial risk, racial/ethnic disparities in birth outcomes persist. These disparities have implications for infant health trajectory throughout the lifecourse and for intervention implementation in high risk groups.

Community building and mental health in mid-life and older life: evidence from China

The Chinese government has adopted a "community building" strategy nationwide to build community capacity by expanding community-based services since the mid-1980s. This study empirically examines whether the mental health among middle-aged and older Chinese adults is associated with the spearhead of this strategy, measured by the number of the amenities and organizations set within the community, and the years the community residents' committee has been in existence. Multilevel mixed regression analyses in SAS 9.2 of the data from The Chinese Health and Retirement Longitudinal Study (CHARLS) 2008 Pilot Survey indicated that these two community-level variables explained the variances in mental health among middle-aged and older Chinese adults. Additionally, the number of amenities and organizations within the community was significantly associated with the mental health in midlife and later life, even after controlling for the individual-level socioeconomic and social ties and for support predictors. The empirical evidence from this study indicates that developing the community capacity by establishing the community-based grassroots organizations and semi-public spaces will benefit an individual's mental health in current China.

Analysis of the Systematic Relationships among Social Determinants of Health (SDH) and Identification of Their Prioritization in Iran Using DEMATEL Technique

BACKGROUND

Social determinants, similar to equity, have been considered by policymakers in many countries. However, there is not a correct and complete understanding of them. This study aimed to analyze the systematic relationships among social determinants of health (SDH) and identify their prioritization in Iran.

METHODS

This cross-sectional descriptive-analytical study was conducted in 2012. The target population consisted of 30 experts on SDH. Required data was collected using a questionnaire, as well as, nominal group technique (NGT). Then collected data were analyzed using MATLAB 7.9.0 and SPSS 18.0.

RESULTS

Determinants of early life (EL), social gradient (SG), unemployment (U), stress (S) and addiction (A) were certainly affecting determinants on the system, which were placed in the cause group and ranked as the first to fifth priorities, respectively. While social exclusion (SE), food (F), social support (SS), work (W) and transport (T) were partially affected determinants and were placed in the effect group and ranked as the sixth to tenth priorities, respectively. Early life and transport were identified as the most affecting and affected determinants with the coordinates (2.16 and 0.75) and (1.68 and -0.47) on the SDH diagram, respectively.

CONCLUSION

Improving the social and economic status, considering the early life, increasing the quality of education, and reducing unemployment and stress have effects on the other social determinants of health and provide opportunities for increasing equity.

Six paths for the future of social epidemiology

Social epidemiology is now an accepted part of the academic intellectual landscape. However, in many ways, social epidemiology also runs the risk of losing the identity that distinguished it as a field during its emergence. In the present article, we scan the strengths of social epidemiology to imagine paths forward that will make the field distinct and useful to the understanding of population health in future. We suggest 6 paths to such a future, each emerging from promising research trends in the field in which social epidemiologists can, and should, lead in coming years. Each of these paths contributes to the formation of distinct capacities that social epidemiologists can claim and use to elaborate or fill in gaps in the already strong history of social epidemiology. They present an opportunity for the field to build on its strengths and move forward while leading in new and critical areas in population health.

An Integrated Approach to Diabetes Prevention: Anthropology, Public Health, and Community Engagement

Diabetes is an enormous public health problem with particular concern within Hispanic communities and among individuals with low wealth. However, attempts to expand the public health paradigm to include social determinants of health rarely include analysis of social and contextual factors considered outside the purview of health research. As a result, conceptualization of the dynamics of diabetes health disparities remains shallow. We argue that using a holistic anthropological lens has the potential to offer insights regarding the nature of the interface between broader social determinants, health outcomes and health disparity. In a primarily Hispanic, immigrant community in Albuquerque, New Mexico, we conducted a mixed methods study that integrates an anthropological lens with a community engaged research design. Our data from focus groups, interviews, a survey and blood sampling demonstrate the need to conceptualize social determinants more broadly, more affectively and more dynamically than often considered. These results highlight a need to include, in addition to individual-level factors that are traditionally the focus of public health and more innovative structural factors that are currently in vogue, an in-depth, qualitative exploration of local context, social environment, and culture, and their interactions and intersectionality, as key factors when considering how to achieve change. The discussion presented here offers a model for culturally situated and contextually relevant scientific research. This model achieves the objectives and goals of both public health and anthropology while providing valuable insights and mechanisms for addressing health disparity such as that which exists in relation to diabetes among Hispanic immigrants in New Mexico. Such an approach has implications for how research projects are designed and conceptualizing social determinants more broadly. The discussion presented provides insights with relevance for both disciplines.

Working with culture: lessons learned from a community-engaged project in a Chinese aging population

Despite growing interest in the community-based participatory research method, limited empirical research exists on how to overcome cultural and linguistic barriers in applying community-based participatory research principles within the Chinese elderly community. This article reports on the implementation of a participatory process to assess the health needs of an aging Chinese population. We recorded challenges faced and lessons learned in collecting pilot data on issues pertaining to the health of a community-dwelling older Chinese population (over 60 years of age) in Chicago’s Chinatown (Chicago, IL, USA). We have learned that establishing partnerships with a humble approach, acknowledging community diversity in languages and cultures, building on community strengths, and empowering community through education are important considerations in this collaboration. Implications of these findings for research and practice are discussed.