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Moore R, Callaghan-Koru J, Vincenzo JL, Patton SK, Spear MJ, Riklon S, Alik E, Padilla Ramos A, Takamaru S, McElfish PA, Curran GM. External relationships as implementation determinants in community-engaged, equity-focused COVID-19 vaccination events. Front Health Serv 2024; 4:1338622. [PMID: 38533190 PMCID: PMC10964718 DOI: 10.3389/frhs.2024.1338622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/21/2024] [Indexed: 03/28/2024]
Abstract
Background While relationships and connectedness among organizations have been included in implementation theories, models, and frameworks, the increased attention to health equity in implementation science raises the urgency of understanding the role of relationships external to the implementing organization. This paper addresses this gap through an exploration of the role of external relationships in community-based, equity-focused interventions. Methods This study focuses on an equity-focused, community-based COVID-19 vaccination intervention in Arkansas, drawing upon long-term community-engaged relationships among University of Arkansas for Medical Sciences and the Hispanic and Marshallese Islander communities. We used an exploratory qualitative descriptive design to examine barriers and facilitators to implementation of COVID-19 vaccination events analyzing in-depth qualitative interviews with implementation team members (n = 17). Results All participants described pre-existing relationships among the implementing organization, partner organizations, and communities as a key implementation determinant for this equity-focused program. At the inter-organizational level, external relationships included formal connections and informal relationships among staff (e.g., communication channels from prior partnerships). At the individual level, strong external relationships with the community were facilitators leveraging long-term engagement, community familiarity, and staff from the communities of focus. Strong external relationships facilitated program reach in underserved communities through three mechanisms: (1) reduced time required to establish functional working relationships among partners; (2) accessibility and cultural congruence of health services; and (3) increased trust among community members. Barriers to implementation also existed in external relationships, but had less influence than facilitators. Conclusions Achieving health equity in implementation science requires greater understanding of external relationships as implementation determinants. This exploratory study makes a significant contribution to the literature by describing the types of external relationships that facilitate equitable implementation and identifying the mechanisms through which they may work. We argue that approaches to community engagement drawn from community-engaged research approaches may be useful, as these processes require investment in building/maintaining formal and informal organizational and interpersonal relationships. Further research is needed to understand connections among external relationships and other implementation determinants.
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Affiliation(s)
- Ramey Moore
- Office of Community Health and Research, College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Jennifer Callaghan-Koru
- Office of Community Health and Research, College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Jennifer L. Vincenzo
- Geriatrics, College of Health Professions, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, United States
| | - Susan K. Patton
- Nursing, College of Education and Health Professions, University of Arkansas, Fayetteville, AR, United States
| | - Marissa J. Spear
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Sheldon Riklon
- Department of Family Medicine, Family Medicine Residency Training Program, College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, United States
| | - Eldon Alik
- Consulate General of Arkansas, Republic of the Marshall Islands, Springdale, AR, United States
| | - Alan Padilla Ramos
- Department of Family Medicine, Family Medicine Residency Training Program, College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, United States
| | | | - Pearl A. McElfish
- Office of Community Health and Research, College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Geoffrey M. Curran
- Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
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Purvis RS, Moore R, Rojo MO, Riklon S, Alik E, Alik D, Maddison BK, McElfish PA. COVID-19 vaccine hesitancy among Marshallese in Northwest Arkansas (USA). J Public Health Res 2024; 13:22799036241231549. [PMID: 38440055 PMCID: PMC10910884 DOI: 10.1177/22799036241231549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/23/2024] [Indexed: 03/06/2024] Open
Abstract
Background COVID-19 has disproportionately affected Pacific Islander communities, with disparities in the prevalence of infection, serious illness, and death compared to non-Hispanic whites in the US. Marshallese Pacific Islanders face significant COVID-19 disparities. Design and methods This exploratory study aimed to understand Marshallese community attitudes about the COVID-19 vaccine to identify and implement culturally relevant strategies to encourage vaccine uptake. Data were collected from 17 participants in three focus groups. Results Using content analysis, researchers identified two global themes: (1) barriers to vaccination and (2) facilitators of COVID-19 vaccine uptake. Within these themes, participants described fear, lack of knowledge about vaccines, negative perceptions of the COVID-19 vaccine, health concerns, and transportation as barriers to vaccination. Participants described several factors influencing vaccine behavior, including location of and personnel at vaccine clinics, vaccine experiences, the need for trusted information, positive perceptions, cultural leaders, and mandates. Conclusions The qualitative study makes a significant contribution as the first to report community perceptions and experiences related to the COVID-19 vaccine in Marshallese participants' own words. Findings show that cultural influencers and brokers are crucial bridges for public health messaging related to COVID-19 vaccination targeted to this vulnerable and underserved population. Culturally appropriate and effective public health messaging can help achieve vaccine equity and improve COVID-19-related health disparities in the Marshallese community.
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Affiliation(s)
- Rachel S Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Martha O Rojo
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR, USA
| | - Eldon Alik
- Republic of the Marshall Islands Consulate, Springdale, AR, USA
| | - Derek Alik
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | | | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
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McElfish PA, Rowland B, Hall S, CarlLee S, Reece S, Macechko MD, Shah SK, Rojo MO, Riklon S, Richard-Davis G, Marin LP, Laelan M, Maddison BK, Alik E, Selig JP. Comparing community-driven COVID-19 vaccine distribution methods: Faith-based organizations vs. outpatient clinics. J Family Med Prim Care 2022; 11:6081-6086. [PMID: 36618221 PMCID: PMC9810872 DOI: 10.4103/jfmpc.jfmpc_327_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 11/11/2022] Open
Abstract
Background Minority and low socioeconomic communities may face practical barriers to vaccination, including decreased access to health care and less trust in healthcare organizations; however, few studies have focused on these barriers as the cause of differential vaccine uptake. We worked with community partners to implement and evaluate two community-driven approaches to COVID-19 vaccination distribution-through faith-based organizations (FBOs) and outpatient clinics-with a focus on understanding the differences between the populations who accessed each distribution method. Methodology Participants who came to the vaccination locations were approached and asked to complete a survey during their 15 min post-vaccination observation period. Differences between distribution locations were examined using Chi-square tests. Results The survey rendered 1,476 valid responses, with a total of 927 participants recruited at clinical locations and 519 at FBOs during vaccination events. There were significant differences by race/ethnicity, with distribution methods at FBOs reaching a higher proportion of Hispanic/Latino and Marshallese participants. The proportion of uninsured participants who had lower health literacy and had lower educational attainment was higher with the FBO distribution method. FBO participants were more likely to report "completely" trusting the COVID-19 vaccine. There was no significant difference between FBO and clinic participants with regard to the level of vaccine hesitancy. There were no statistically significant differences with regard to access. Conclusion A higher proportion of Hispanic/Latino and Marshallese participants utilized FBOs for vaccination, suggesting collaborations with FBOs can potentially increase vaccination uptake among minority communities and help mitigate vaccination disparities.
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Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA,Address for correspondence: Dr. Pearl A. McElfish, 1125 N. College Ave., Fayetteville, AR 72703, USA. E-mail:
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Spencer Hall
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Michael D. Macechko
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Sumit K. Shah
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Martha O. Rojo
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Gloria Richard-Davis
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Luis Paganelli Marin
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Melisa Laelan
- Arkansas Coalition of Marshallese, Springdale, Arkansas, USA
| | | | - Eldon Alik
- Republic of the Marshall Islands Consulate, Springdale, Arkansas, USA
| | - James P. Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
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Hallgren E, Moore R, Riklon S, Alik E, McElfish PA. Pandemic-Amplified Material Hardship and Community-Led Support among Marshallese Diasporic Communities in the United States. J Poverty 2022; 27:252-267. [PMID: 37346477 PMCID: PMC10281722 DOI: 10.1080/10875549.2022.2053924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
This article explores the experiences of Marshallese diasporic migrants in the United States (U.S.) during the COVID-19 pandemic in relation to material hardship and community-led relief efforts. Focus groups with 53 Marshallese migrants in three states revealed that material hardship, including food and housing insecurity, inadequate healthcare, and difficulty paying bills, intensified among their communities during the pandemic. In response, Marshallese community-based groups provided relief to their fellow community members, including food, cash assistance, and personal protective equipment. The findings fit a pattern of intensified hardship and community-led relief among marginalized communities in the U.S. during the COVID-19 pandemic.
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Affiliation(s)
- Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR 72703 USA
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR 72703 USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR 72703 USA
| | - Eldon Alik
- Consulate General of Arkansas, Republic of the Marshall Islands, 109 Spring St #3, Springdale, AR 72764 USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR 72703 USA
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McElfish PA, Willis DE, Bogulski C, Kelen M, Riklon S, Alik E, Laelan M, Brown AL, Sinclair KA, Andersen JA, Amick BC, Williams M. COVID-19 Vaccine Willingness and Hesitancy Among Marshallese Pacific Islanders. J Patient Exp 2021; 8:23743735211056428. [PMID: 34825050 PMCID: PMC8609098 DOI: 10.1177/23743735211056428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
COVID-19 has disproportionally burdened racial and ethnic minorities. Minority populations report greater COVID-19 vaccine hesitancy; however, no studies document COVID-19 vaccine willingness among Marshallese or any Pacific Islander group, who are often underrepresented in research. This study documents United States (US) Marshallese Pacific Islanders': willingness to get the COVID-19 vaccine, willingness to participate in vaccine trials, and sociodemographic factors associated with willingness. From July 27, 2020-November 22, 2020, a convenience sample of US Marshallese adults were recruited through e-mail, phone calls, and a Marshallese community Facebook page to participate in an online survey. Of those surveyed (n = 120), 32.5% were extremely likely to get the COVID-19 vaccine; 20.8% were somewhat likely; 14.2% were unlikely or very unlikely; and 26.7% stated they did not know or were not sure. Only 16.7% stated they were willing to participate in a COVID-19 vaccine trial. Vaccine willingness was positively associated with older age, higher income, and longer US residence. Health insurance status and having a primary care provider were positively associated with vaccine willingness. Findings demonstrate within-group variation in COVID-19 vaccine willingness.
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Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Cari Bogulski
- Office of Community Health and Research, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Meetu Kelen
- West Hawaii Community Health
Center, Kailua, HI, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Eldon Alik
- Consul General – Arkansas, Republic of the Marshall Islands,
Springdale, AR, USA
| | - Melisa Laelan
- Arkansas Coalition of
Marshallese, Springdale, AR, USA
| | | | - Ka’imi A. Sinclair
- Institute for Research and Education to Advance Community Health
(IREACH), Washington State University, Pullman, WA, USA
- College of Nursing, Washington State University, Pullman, WA, USA
| | - Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Benjamin C. Amick
- Fay W. Boozman College of Public Health, University of Arkansas for Medical
Sciences, Little Rock, AR, USA
| | - Mark Williams
- Fay W. Boozman College of Public Health, University of Arkansas for Medical
Sciences, Little Rock, AR, USA
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McElfish PA, Rowland B, Porter A, Felix HC, Selig JP, Semingson J, Willis DE, Smith M, Riklon S, Alik E, Padilla-Ramos A, Jasso EY, Zohoori N. Use of Community-Based Participatory Research Partnerships to Reduce COVID-19 Disparities Among Marshallese Pacific Islander and Latino Communities - Benton and Washington Counties, Arkansas, April-December 2020. Prev Chronic Dis 2021; 18:E91. [PMID: 34618667 PMCID: PMC8522500 DOI: 10.5888/pcd18.210124] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Marshallese and Latino communities in Benton and Washington counties, Arkansas, were disproportionately affected by COVID-19. We evaluated the effectiveness of a comprehensive community-based intervention to reduce COVID-19 disparities in these communities. We examined all laboratory-confirmed COVID-19 cases in the 2 counties reported from April 6, 2020, through December 28, 2020. A 2-sample serial t test for rate change was used to evaluate changes in case rates before and after implementation of the intervention. After implementation, the proportions of cases among Marshallese and Latino residents declined substantially and began to align more closely with the proportions of these 2 populations in the 2 counties. Infection rates remained lower throughout the evaluation period, and weekly incidence also approximated Marshallese and Latino population proportions. Leveraging community partnerships and tailoring activities to specific communities can successfully reduce disparities in incidence among populations at high-risk for COVID-19 .
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas.,1125 N College Ave, Fayetteville, AR 72703.
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Austin Porter
- Arkansas Department of Health, Little Rock, Arkansas
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | | | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Eldon Alik
- Republic of the Marshall Islands Consulate, Springdale, Arkansas
| | - Alan Padilla-Ramos
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Erika Y Jasso
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
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