Strategies to promote language inclusion at 17 CTSA hubs

The prioritization of English language in clinical research is a barrier to translational science. We explored promising practices to advance the inclusion of people who speak languages other than English in research conducted within and supported by NIH Clinical Translational Science Award (CTSA) hubs. Key informant interviews were conducted with representatives (n = 24) from CTSA hubs (n = 17). Purposive sampling was used to identify CTSA hubs focused on language inclusion. Hubs electing to participate were interviewed via Zoom. Thematic analysis was performed to analyze interview transcripts. We report on strategies employed by hubs to advance linguistic inclusion and influence institutional change that were identified. Strategies ranged from translations, development of culturally relevant materials and consultations to policies and procedural changes and workforce initiatives. An existing framework was adapted to conceptualize hub strategies. Language justice is paramount to bringing more effective treatments to all people more quickly. Inclusion will require institutional transformation and CTSA hubs are well positioned to catalyze change.

Communities catalyzing change with data to mitigate an invisible menace, traffic-related air pollution

OBJECTIVES

To identify strategies and tactics communities use to translate research into environmental health action.

METHODS

We employed a qualitative case study design to explore public health action conducted by residents, organizers, and public health planners in two Massachusetts communities as part of a community based participatory (CBPR) research study. Data sources included key informant interviews (n = 24), reports and direct observation of research and community meetings (n = 10) and project meeting minutes from 2016-2021. Data were coded deductively drawing on the community organizing and implementation frameworks.

RESULTS

In Boston Chinatown, partners drew broad participation from community-based organizations, residents, and municipal leaders, which resulted in air pollution mitigation efforts being embedded in the master planning process. In Somerville, partners focused on change at multiple levels, developer behavior, and separate from the funded research, local legislative efforts, and litigation.

CONCLUSIONS

CBPR affords communities the ability to environmental health efforts in a way that is locally meaningful, leveraging their respective strengths. External facilitation can support the continuity and sustainment of community led CBPR efforts.

Advancing Environmental Justice in the Community Using Charrette: A Case Study in Boston Chinatown

Background

Community research partners in Boston Chinatown implemented a planning charrette as a part of a community-based participatory study focused on near highway research and public health action to mitigate traffic-related air pollution (TRAP). Charrettes are intensive workshops for solution-oriented design and planning used to bring together diverse stakeholders to address complex environmental health concerns.

Methods

The planning charrette included three phases: (1) community meetings and resident interviews, (2) a planning charrette to address community health concerns and air pollution within larger community wellness goals, and (3) development of a Master Planning document with policy, project, and practice recommendations to guide future community advocacy.

Outcomes

Intergenerational residents, community leaders, planners, researchers, and volunteers (N = 90) joined a day-long planning charrette to inform the Chinatown Master Plan. Workshops were informed by resident interviews focused on finding solutions to three resident identified priorities: Healthy Housing, Healthy Mobility, and Healthy Public Realm. Air pollution mitigation strategies were embedded in discussions around each priority area.

Discussion

The charrette provided an opportunity for community stakeholders to voice concerns about TRAP as part of a new framework focused on health and wellness. Concerns about pedestrian safety, housing access, and expansion of green and recreational spaces were highlighted by participants as important areas for further development.

Conclusions

Boston Chinatown residents reaffirmed their investment in the community by highlighting concerns about TRAP within the context of other health-related concerns. Charrettes offer a vehicle to advance environmental justice in communities through collective problem-solving and decision making.

Nuestra Recuperación [Our Recovery]: using photovoice to understand the factors that influence recovery in Latinx populations

BACKGROUND

Photovoice is a form of visual ethnography intended to engage impacted communities in research followed by action to ameliorate the injustices under study. Photovoice has increased in use, especially in collaboration with Latinx communities addressing health inequities. The Latinx population comprises nearly 18% of the overall United States population and according to the census is projected to reach just under 30% by 2060. This diverse panethnic community faces significant structural barriers in accessing services. Racism and the resulting marginalization, specifically, contributes to limited access to recovery services and treatment. Making meaningful advances in substance use disorder training, intervention and policy necessitates learning alongside the Latinx community.

METHODS

We partnered with a Latinx serving integrated behavioral health and primary care setting in Boston Massachusetts to explore barriers and facilitators to recovery using photovoice. Spanish-speaking Latinx adults with a substance use disorder participated. The group met for three photovoice sessions over a six-week period. Together group members critically analyzed photographs using the SHOWeD method.

RESULTS

Findings indicate a sense of purpose and meaning, security, faith and housing are important elements of recovery. The results illustrated the importance of sources of connection in maintaining sobriety. Through this photovoice project, Latinx Spanish speaking participants highlighted barriers and facilitators to their substance use disorder recovery which spanned individual, community, and structural levels.

CONCLUSIONS

The experiences and voices of the Latinx community are crucial to drive discussions that advance policy (e.g., housing stability and access), enhance providers' understanding of Latinx Spanish-speakers' substance use disorder recovery, and inform culturally and linguistically appropriate services. This study demonstrated that photovoice is highly acceptable and feasible among Latinx clients receiving substance use disorder services. Visual images related to housing, faith, etc. communicate challenges, power structures, as well as hopes to policymakers at multiple levels (e.g., institution/ agency, state).

Project AquiLá: Community-engaged Planning to Explore the Relationship between Culture and Health

BACKGROUND

Elements of charrette planning were employed to develop and examine the relationship between transnationalism, culture and health.

OBJECTIVE

This paper describes the partnership, the first two stages of the planning charrette and lessons learned.

METHODS

During charrette planning phase 1 we collected data through social network interviews (n = 58), cultural conversations (n = 88), and photovoice (n = 9). In the second phase we performed five charrette planning meetings. Data were synthesized by the planning team.

LESSONS LEARNED

The issue centered focus facilitated trust among partners. The holistic, iterative process to planning and interpreting preliminary data provided a deeper understanding of the issues under investigation. Community partners at the table held us accountable to the communities we were studying and infused an undercurrent of social justice in our work.

CONCLUSIONS

There are advantages in employing a community engaged transdisciplinary team-based approach to the study of transnationalism, culture and health.

Virtual Reality Simulated Learning Environments: A Strategy to Teach Interprofessional Students About Social Determinants of Health

PURPOSE

Physician assistants (PAs) and medical degree students (MDs) often lack training in addressing the social determinants of health (SDOH). Social work students (SWs), meanwhile, have extensive SDOH training; however, few medical professionals have opportunities to engage in interprofessional training with SWs. This study examined the feasibility, acceptability, and students' perceptions of an interprofessional virtual reality (VR) simulated learning environment (SLE) for teaching health professions students about the SDOH.

METHOD

In January 2020, 15 students at Boston University School of Medicine attended web-based video conferences focused on SDOH, health equity, and team-based care. Subsequently, student dyads participated in a case-based learning activity using an immersive VR SLE to develop teamwork skills. Evaluation included a postsurvey and a focus group examining their experiences in the course to gauge feasibility and acceptability. Thematic analysis of open-ended survey responses from the postsurvey and focus group data was conducted.

RESULTS

A total of 8 VR simulations were run. Findings indicated both MD and PA students learned patient engagement strategies from SW students, who enhanced their health care leadership capacity. Participants found the means of instruction acceptable, valued the hands-on VR interprofessional training, and expressed interest in learning more about the scope of one another's roles and the community resources available to patients.

CONCLUSIONS

VR SLE is a feasible and acceptable means of instruction. It allowed students to connect across programmatic and geographic boundaries in a collaborative working environment mimicking the team approach to care they will use in their professional life. This experience illustrated for students the strengths a multidisciplinary team has to offer.

El Sancocho, la Bandera y la Familia: La vida social de los alimentos y sus implicaciones para la salud y el bienestar de los inmigrantes dominicanos

Para comprender mejor los factores que influyen en la salud y el bienestar de los inmigrantes dominicanos, exploramos las formas en que la inmigración influye en las prácticas culturales, el comportamiento de salud y la salud. Los inmigrantes dominicanos (n = 42) participaron en cinco discusiones grupales reflexivas y no estructuradas y (n = 5) participaron en un grupo de fotovoz intergeneracional. La pérdida del contexto familiar y social en el que tradicionalmente se llevan a cabo las prácticas dietéticas dominicanas fue un tema destacado. Para los participantes, comer se convirtió en una actividad apresurada y superficial que involucraba a menos personas y menos socialización. Las prácticas dietéticas en la República Dominicana se establecen en el contexto de las normas familiares y los procesos sociales, que brindan apoyo, así como oportunidades para la socialización y la transmisión de prácticas culturales a través de las generaciones. En los Estados Unidos, las fuerzas sociopolíticas más amplias se enfocan en el individualismo y no apoyan el desarrollo o mantenimiento de patrones culturales para los dominicanos. Las políticas que promueven el equilibrio entre el trabajo y la vida personal pueden tener implicaciones importantes para las prácticas dietéticas en las nuevas comunidades de inmigrantes.

Critical Reflections From Doctoral Students Engaging in Local and Transnational Community-Based Participatory Research (CBPR) Approaches to Health Promotion

Social work scholars have increasingly adopted Community-Based Participatory Research (CBPR) approaches to center community voice in research and action to promote youth's healthy development. While valuable contributions have emerged to engage in further dialectical learning processes, limited research has examined in depth the participation, critical reflection, and training of social work graduate students pursuing CBPR. This article emphasizes the role of critical reflexivity and collaboration by presenting four social work doctoral students' efforts designed to engage community and youth in CBPR to enhance health promotion initiatives. We conclude by discussing the importance of engaging graduate social work students in CBPR, the influential role faculty and mentors play in providing opportunities for students to gain experience in CBPR, and recommendations and potential strategies for future social work education and training.

El Sancocho, la Bandera y la Familia: The Social Life of Food and its Implications for Dominican Immigrant Health and Well-Being

In order to better understand factors that influence the health and well-being of Dominican immigrants, we explored the ways in which immigration influences cultural practices, health behavior, and health. Dominican immigrants (n = 42) took part in five reflective and unstructured group discussions and (n = 5) participated in an intergenerational photovoice group. The loss of the familial and social context in which Dominican dietary practices traditionally take place was a salient theme. For participants, eating became a rushed, perfunctory activity involving fewer people and less socializing. Dietary practices in the Dominican Republic are set in the context of familial norms and social processes, which provide support as well as opportunities for socializing and the transmission of cultural practices across generations. In the United States, broader sociopolitical forces are guided by individualism and do not support the development or maintenance of these factors for Dominicans. Policies that promote work-life balance may have important implications for dietary practices in new immigrant communities.

'There You Enjoy Life, Here You Work': Brazilian and Dominican Immigrants' Views on Work and Health in the U.S

Structural inequalities in the U.S. work environment place most immigrants in low paying, high-risk jobs. Understanding how work experiences and influence the health of different immigrant populations is essential to address disparities. This article explores how Brazilian and Dominican immigrants feel about their experiences working in the U.S. and how the relationship between work and culture might impact their health. In partnership with the Dominican Development Center and the Brazilian Worker Center, we held five cultural conversations (CCs) with Brazilians (n = 48) and five with Dominicans (n = 40). CCs are participatory, unstructured groups facilitated by representatives from or embedded in the community. Brazilian immigrants focused on physical health and the American Dream while Dominicans immigrants emphasized concerns about the influence of work on mental health. Dominicans' longer tenure in the U.S. and differences in how Brazilians and Dominicans are racialized in the region might account for the variation in perspectives between groups. Future studies should further investigate the relationship between health and how immigrants' work lives are shaped by culture, race and immigrant status.