"We make the path by walking it": building an academic community partnership with Boston Chinatown

Language and racial disparities in treatment initiation for patients with pulmonary non-tuberculous mycobacteria

OBJECTIVE

Disparities in testing and treatment of pulmonary nontuberculous mycobacteria (P-NTM) warrant further investigation into language and race's impact on treatment initiation. The objective of the study is to compare the length of treatment initiation for P-NTM patients assessed in the pulmonary and infectious diseases clinics through language and race.

RESULTS

The cohort included 63 patients; 28 patients received treatment, and 35 patients did not receive treatment. According to the IDSA/ATS guidelines for diagnosis of pulmonary NTM, 55% of patients met all three categories, 40% of patients did not fulfill all three categories and 5% of patient charts were inconclusive. Charts were considered inconclusive if a comprehensive NTM evaluation was not conducted, such as no CT imaging, only one culture sent, or lost to follow up.

Low frequency of allergy referral for penicillin allergy evaluation in an urban Boston primary care setting

Background

A key strategy to combat the public health crisis of antimicrobial resistance is to use appropriate antibiotics, which is difficult in patients with a penicillin allergy label.

Objective

Our aim was to investigate racial and ethnic differences related to penicillin allergy labeling and referral to allergy/immunology in primary care.

Methods

This was a retrospective study of Tufts Medical Center's Boston-based primary care patients in 2019. Univariable and multivariable logistic regression models were used to examine demographic associations with (1) penicillin allergy label and (2) allergist referral.

Results

Of 21,918 primary care patients, 2,391 (11%) had a penicillin allergy label; of these, 249 (10%) had an allergist referral. In multivariable logistic regression models, older age (adjusted odds ratio [aOR] = 1.06 [95% CI = 1.04-1.09]) and female sex (aOR = 1.58 [95% CI = 1.44-1.74]) were associated with higher odds of penicillin allergy label carriage. Black race (aOR = 0.77 [95% CI = 0.69-0.87]) and Asian race (aOR = 0.47 [95% CI = 0.41-0.53]) were associated with lower odds of penicillin allergy label carriage. In multivariable regression, allergist referral was associated with female sex (aOR = 1.52 [95% CI = 1.10-2.10]) and Black race (aOR = 1.74 [95% CI = 1.25-2.45]). Of 93 patients (37%) who completed their allergy visit, 26 (28%) had received penicillin allergy evaluation or were scheduled to receive a penicillin allergy evaluation at a future visit.

Conclusions

There were racial differences in penicillin allergy labeling and referral. Allergy referral for penicillin allergy assessment was rare. Larger studies are needed to assess penicillin allergy labeling and delabeling with an equity focus on optimizing patient health outcomes.

Catalyzing Storytelling in Communication Infrastructure Theory: A Study of Local Ethnic Media

Communication infrastructure theory (CIT) suggests that an ethnic enclave's communication infrastructure (CI) shapes the community's unique social processes that give rise to social determinants of health. A well-integrated CI in ethnic enclaves that includes community-based organizations (CBOs), local ethnic media, and resident networks is positively associated with residents' health outcomes. Through storytelling, CBOs and other community actors obtain and disseminate information, develop a sense of belonging to the community, and participate in problem-solving activities, including health-related ones. Local ethnic media can play an important role in building a network of neighborhood storytellers by catalyzing storytelling about local resources and problems. We propose three main categories of "catalyzing storytelling" by local ethnic media: 1) CBO stories, 2) geo-ethnic stories, and 3) presentation of root causes and solutions for community problems. This study examines the content of Boston Chinatown's local ethnic news media outlet, Sampan, to assess the three categories of catalyzing stories. We analyzed a total of 340 news articles and one interview with the editor. The findings showed that Sampan tells stories in all three categories. Based on our findings, we further develop the concept of catalyzing as a communication process in CIT. This new concept in CIT has practical implications for public health communication as it demonstrates a process through which local ethnic media can foster community engagement and health. Health communicators should seek opportunities to work collaboratively with local ethnic media in ways that will serve to catalyze community.

Communication Infrastructure in an Asian Immigrant Community

The health benefits of having a supportive community and access to community resources are well documented and for many immigrant communities, community-based organizations (CBOs) play an important role by providing culturally competent services. The current study uses communication infrastructure theory (CIT) to examine the associations between connections to CBOs, civic engagement, and protective health behaviors within the context of Boston Chinatown's Chinese immigrant community. According to CIT, neighborhood communication resources encourage residents to engage in civic activities and health-related problem-solving behaviors. To assess these associations, data from a needs assessment survey (N = 360) were analyzed. Results showed that connections to CBOs had a positive association with total number of protective health behaviors. Civic engagement was not found to be associated with health behaviors. We also found no indirect effect of connections to CBOs on the protective health behaviors via civic engagement. These results carry important theoretical and practical implications.

An Evaluation of an Environmental Health Infographic in Community Settings

Background: Infographics are an effective way of communicating complex information due to their reliance on concise language and clear, uncluttered visuals. Research indicates that traffic-related ultrafine particles (UFPs) in air pollutions adversely affect human health, including respiratory and cardiovascular diseases. In this study, we work with community-based adult literacy programs to develop an infographic about UFPs in air pollution with the goal of community-driven problem solving related to traffic-related UFPs within affected neighborhoods. Objective: In this paper, we discuss the development and evaluation of an infographic about the dangers of UFPs from traffic pollution, and actions that readers in affected communities can take to protect their health. We used the infographic format to conceptualize UFP pollution and its health effects visually for community members many of whom are new immigrants and do not speak English as their first language. Methods: We conducted 1 focus group and 4 interviews over Zoom, and collected 74 anonymous surveys among Boston Chinatown and Somerville, MA residents. Community partner organizations assisted us in recruiting participants by sending a recruitment flyer to their email contacts and identifying specific people who were interested in participating. Key Results: Data from the surveys, focus group, and interviews yielded 8 themes that guided the revision of the infographic. The majority of the participants responded positively to the infographic: 95.9% (n = 71) of respondents reported that the purpose of the infographic was clear, that the infographic contained a clear message, and that the infographic uses images to explain important points. Conclusions: Our experience developing and evaluating an infographic about near highway pollution in environmental justice communities suggests that infographics can be a viable communication tool in this context. Further research with infographics of a similar nature but in diverse communities is needed to strengthen our conclusion.

A Community-Academic Partnership for School-Based Nonviolence Education: The Healthy Power Program

BACKGROUND

Youth violence is a significant problem affecting community health. Community-academic partnerships can advance youth nonviolence education by synergizing the strengths of collaborators while working toward a common goal. We describe a collaboration between an urban public middle school, community nonprofit, and university-based graduate school of nursing in implementing and evaluating the Healthy Power program, a school-based youth nonviolence program for middle-school boys.

METHODS

A participatory program evaluation approach was used to plan and implement evaluation of the Healthy Power program with a cohort of 8 students. Collaborative planning allowed for the selection of measures that reflected program objectives and were of value to community partners while also scientifically sound. A mixed-methods approach included a focus group and a pretest-posttest with quantitative items and open-ended questions.

RESULTS

While the quantitative pre-posttest did not show any significant change, the open-ended questions and focus group suggested that students had advanced their understanding and application of conflict resolution skills.

CONCLUSIONS

The findings support the usefulness of community-academic partnerships for peace/conflict resolution education and program evaluation. Such programs may benefit from mixed methods of evaluation.

Lessons learned from developing and sustaining a community-research collaborative through translational research

Introduction

The goal of this project was to document the current state of a community-academic partnership, identifying early successes and lessons learned.

Methods

We employed qualitative methods, semi-structured interviews and document analysis, from 2 data sources to (1) show how the principles of community-based participatory research are enacted through the activities of Addressing Disparities in Asian Populations through Translational Research (ADAPT) and (2) elucidate the barriers and facilitators to adhering to those principles from the perspectives of the members themselves.

Results

In addition to established community-based participatory research values, understanding individuals’ motivations for participation, the challenges aligning the priorities of community organizations and academic partners, and definitions of success are themes that emerged as key to the process of maintaining this partnership.

Conclusion

As the emphasis on community-academic partnerships grows, there is potential for clinical and translational science awards to use community engagement to facilitate translational research beyond the traditional medical spheres of influence and to forge relationships with affected communities.

Increasing Research Capacity in Underserved Communities: Formative and Summative Evaluation of the Mississippi Community Research Fellows Training Program (Cohort 1)

Background

The Mississippi Community Research Fellows Training Program (MSCRFTP) is a 15-week program conducted in Jackson, MS, USA consisting of training in the areas of evidence-based public health, research methods, research ethics, and cultural competency. The purpose of the program was to increase community knowledge and understanding of public health research, develop community-based projects that addressed health disparity in the participants’ community, increase individual and community capacity, and to engage community members as equal partners in the research process.

Methods

A comprehensive evaluation of the MSCRFTP was conducted that included both quantitative and qualitative methods. All participants were asked to complete a baseline, midterm, and final assessment as part of their program requirements. Knowledge gained was assessed by comparing baseline assessment responses to final assessment responses related to 27 key content areas addressed in the training sessions. Assessments also collected participants’ attitudes toward participating in research within their communities, their perceived influence over community decisions, and their perceptions of community members’ involvement in research, satisfaction with the program, and the program’s impact on the participants’ daily practice and community work.

Results

Twenty-one participants, the majority of which were female and African-American, completed the MSCRFTP. Knowledge of concepts addressed in 15 weekly training sessions improved significantly on 85.2% of 27 key areas evaluated (p < 0.05). Two mini-grant community based participatory research projects proposed by participants were funded through competitive application. Most participants agreed that by working together, the people in their community could influence decisions that affected the community. All participants rated their satisfaction with the overall program as “very high” (76.2%, n = 16) or “high” (23.8%, n = 5).

Conclusion

The evaluation of the MSCRFTP demonstrates that participants have the necessary knowledge to engage as research partners, and the pilot projects provided an opportunity for application of this objective to be realized. Overall, the MSCRFTP was an intervention that assisted community members in identifying their communities’ strengths and weaknesses, interpret knowledge in a meaningful way, and create a self-reflective community of inquiry for change.

Community-based participatory research for the study of air pollution: a review of motivations, approaches, and outcomes

Neighborhood level air pollution represents a long-standing issue for many communities that, until recently, has been difficult to address due to the cost of equipment and lack of related expertise. Changes in available technology and subsequent increases in community-based participatory research (CBPR) have drastically improved the ability to address this issue. However, much still needs to be learned as these types of studies are expected to increase in the future. To assist, we review the literature in an effort to improve understanding of the motivations, approaches, and outcomes of air monitoring studies that incorporate CBPR and citizen science (CS) principles. We found that the primary motivations for conducting community-based air monitoring were concerns for air pollution health risks, residing near potential pollution sources, urban sprawl, living in "unmonitored" areas, and a general quest for improved air quality knowledge. Studies were mainly conducted using community led partnerships. Fixed site monitoring was primarily used, while mobile, personal, school-based, and occupational sampling approaches were less frequent. Low-cost sensors can enable thorough neighborhood level characterization; however, keeping the community involved at every step, understanding the limitations and benefits of this type of monitoring, recognizing potential areas of debate, and addressing study challenges are vital for achieving harmony between expected and observed study outcomes. Future directions include assessing currently unregulated pollutants, establishing long-term neighborhood monitoring sites, performing saturation studies, evaluating interventions, and creating CS databases.

A Retrospective on the Vision for Progress in Community Health Partnerships: Research, Education, and Action

The organizers founded Progress in Community Health Partnerships with a commitment to improving our understanding of community-based participatory research (CBPR) and its use in community-academic/institutional health partnerships. Following Rogers's Diffusion of Innovations, they reasoned that expanded adoption would occur through academic and community partner recognition of CBPR's relative advantage over previous approaches; its compatibility with the values, past experience and needs of potential adopters; its ease of understanding and use; its capacity for experimentation and refinement; and its production of observable results. We now assess the journal's progress toward realizing the vision, as well as issues and problems the organizers identified. We map the journal's content over its first decade onto the initial vision by examining the record of submissions and publications across the eight types of articles and the journal's record of rejections and publications. In remembering that Rogers's study of innovations requires both technical and social change, we discuss the difference between understanding how to do something and actually putting an innovation into action that becomes standard practice at both individual and systemic levels. We observe that the large number of Original Research and Works-in-Progress/Lessons Learned manuscripts, submitted and published, reflect traditional expectations for faculty research productivity. We suggest that sustainability, which rated of lower importance within the initial vision, has gained in importance among community and academic partners; however, it will gain added attention only with changed university expectations of researchers. We further suggest that the study of partnerships involved in researching and improving public health should be expanded beyond the current focus on CBPR.