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Lohr AM, Pratt R, Dirie H, Ahmed Y, Elmi H, Nur O, Osman A, Novotny P, Mohamed AA, Griffin JM, Sia IG, Wieland ML. The Association Between Perceived Discrimination, Age and Proportion of Lifetime in the United States Among Somali Immigrants: A Cross-Sectional Analysis. J Immigr Minor Health 2024:10.1007/s10903-024-01589-3. [PMID: 38578534 DOI: 10.1007/s10903-024-01589-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 04/06/2024]
Abstract
Discrimination is detrimental to health. Little is known about perceived discrimination among Somali immigrants. We examined whether age or proportion of lifetime in the United States was associated with perceived discrimination among Somali immigrants. Guided by Intersectionality, we described a secondary analysis of Everyday Discrimination Scale (EDS) survey data from the Healthy Immigrant Community study. Younger participants ( ≤40 years) experienced more discrimination than older participants ( >40 years). Higher education, being male, and earning $20,000-$39,999 was associated with more perceived discrimination. These findings suggest that Somali immigrants who are younger, more formally educated, male, and/or earn $20,000-$39,000 report more discrimination than their counterparts. Possible explanations include exposure to discrimination outside the Somali community or more awareness about racism. Alternatively, the EDS may not capture the discrimination experienced by Somali women or older adults. Further research is needed to address the discrimination experienced by Somali immigrants. Clinical Trial Registration: NCT05136339, November 29,2021.
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Affiliation(s)
- Abby M Lohr
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA.
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, USA.
| | - Rebekah Pratt
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Hana Dirie
- Community Based Research, Mayo Clinic, Rochester, MN, USA
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yahye Ahmed
- Community Based Research, Mayo Clinic, Rochester, MN, USA
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hindi Elmi
- Intercultural Mutual Assistance Association, Rochester, MN, USA
| | - Omar Nur
- Somali American Social Service Association, Rochester, MN, USA
| | - Ahmed Osman
- Intercultural Mutual Assistance Association, Rochester, MN, USA
| | - Paul Novotny
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, 55902, USA
| | - Ahmed A Mohamed
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, USA
| | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Irene G Sia
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mark L Wieland
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, USA
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Lohr AM, Capetillo GP, Molina L, Goodson M, Smith K, Griffin JM, Wieland ML, Sia IG. Development of a Digital Storytelling Intervention to Increase Breast, Cervical, and Colorectal Cancer Screening in the Hispanic/Latino Community: a Qualitative Evaluation. J Canc Educ 2024; 39:160-167. [PMID: 38044415 DOI: 10.1007/s13187-023-02389-3] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/05/2023]
Abstract
Digital storytelling (DST) interventions may be one way to address disparities in cancer screening experienced by the Hispanic/Latino population. Digital stories are short, first-person narratives that include voice-over narration and images. With storytellers' permission, researchers can screen digital stories as a health intervention. Digital stories can inspire viewers to adopt or change their behavior, such as completing cancer screening. Rochester Healthy Community Partnership (a 20-year community-based participatory research partnership) together with eight Hispanic/Latino, Spanish speaking cancer survivors, co-survivors, or recently screened individuals, developed digital stories about breast, cervical, and colorectal cancer screening. Here, we describe our qualitative evaluation of the DST workshop. To understand what the storytellers thought viewers would find relatable in their digital stories, we applied Narrative Theory. We also assessed workshop successes and opportunities for improvement. We used the constant comparative method for data analysis. We learned that the storytellers anticipated their stories would be engaging and that viewers would connect with Hispanic/Latino cultural values. During the workshop, the storytellers felt like they were making an important contribution. The storytellers highlighted specific opportunities for improvement including sharing the stories more quickly after the workshop. Future research is needed to test whether this intervention follows the Narrative Theory causal pathway by persuading viewers to complete recommended cancer screenings.
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Affiliation(s)
- Abby M Lohr
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA.
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, USA.
| | | | - Luz Molina
- Community Based Research, Mayo Clinic, Rochester, MN, USA
| | - Miriam Goodson
- Community Based Research, Mayo Clinic, Rochester, MN, USA
| | - Kaitlyn Smith
- Community Based Research, Mayo Clinic, Rochester, MN, USA
| | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Mark L Wieland
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, USA
| | - Irene G Sia
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
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Mohamed AA, Shah V, Njeru JW, Wieland ML, Rutten LJF, Prokop LJ, Murad MH. Interventions to Increase Cancer Screening Adherence Among Somali Immigrants in the US and Europe: A Systematic Review. J Immigr Minor Health 2024; 26:385-394. [PMID: 37612453 DOI: 10.1007/s10903-023-01532-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
Cancer screening rates among immigrant and refugee populations in high income countries is significantly lower than native born populations. The objective of this study is to systematically review the effectiveness of interventions to improve screening adherence for breast, cervical and colorectal cancer among Somali immigrants. A literature search was conducted for the years 2000-2021 and eight studies met eligibility criteria. The following intervention components were found to increase adherence to cervical cancer screening: home HPV test, educational workshop for women and education for general practitioners. A patient navigator intervention was found to increase screening for breast cancer. Educational workshops motivated or increased knowledge regarding cancer screening for breast, cervical and colorectal cancer. However, most of the studies had limitations due to methodology with potential for introduction of bias. Therefore, future studies comparing effectiveness of specific intervention components to reduce disparities in cancer screening among Somali immigrants and refugees are encouraged.
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Affiliation(s)
- Ahmed A Mohamed
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Vishal Shah
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Jane W Njeru
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Mark L Wieland
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | | | | | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, USA
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Tranby BN, Sia IG, Clark MM, Novotny PJ, Lohr AM, Pardo LS, Patten CA, Iteghete SO, Zeratsky KA, Rieck TM, Molina L, Capetillo GP, Ahmed Y, Drie H, Wieland ML. Negative Mood is Associated with Sociobehavioral Factors Contributing to Cardiovascular Risk in an Immigrant Population. Res Sq 2024:rs.3.rs-3934645. [PMID: 38559259 PMCID: PMC10980105 DOI: 10.21203/rs.3.rs-3934645/v1] [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] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background Immigrants to the United States, on average, accumulate cardiovascular risk after resettlement, including obesity. There is a need to co-create interventions to address these disparities, and mood may be an important mediating factor. Methods The Healthy Immigrant Community (HIC) study, set in southeast Minnesota, enrolled 475 adult participants in a weight loss intervention to reduce cardiovascular risk. Baseline questionnaires assessed mood, nutrition, physical activity, self-efficacy for healthy eating and physical activity, social support, and cohesion. A single-item mood rating of poor or fair was considered "negative", while ratings of good, very good, or excellent were considered "positive". Results A total of 449 HIC participants (268 Hispanic/Latino and 181 Somali) with complete baseline measures and were included in this analysis. Participants endorsing negative mood compared to those endorsing positive mood had lower scores for healthy eating (p = 0.02) and physical activity levels (p = 0.03), lower confidence in eating a healthy diet (p = 0.001), and felt less of a sense of belonging to their community (p = 0.01). Those endorsing negative mood also reported receiving less social support from their family and friends to eat healthy (p = < 0.001) and be physically active (p = 0.01), and less often accessed community resources for healthy eating (p = 0.001) and physical activity (p = < 0.01) compared to participants reporting positive mood. Conclusions Negative mood was associated with less healthy nutrition, lower confidence in eating healthy, sedentary lifestyle, and perceived lack of belonging to the community. Integrating mood management and self-efficacy strategies may enhance the effectiveness of lifestyle interventions among immigrants who report negative mood. ClinicalTrialsgov registration NCT05136339; April 23, 2022.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Hana Drie
- Rochester Healthy Community Partnership
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Wieland ML, Molina L, Goodson M, Capetillo GP, Osman A, Ahmed Y, Elmi H, Nur O, Iteghete SO, Torres-Herbeck G, Dirie H, Clark MM, Lohr AM, Smith K, Zeratsky K, Rieck T, Herrin J, Valente TW, Sia IG. Healthy immigrant community study protocol: A randomized controlled trial of a social network intervention for cardiovascular risk reduction among Hispanic and Somali adults. Contemp Clin Trials 2024; 138:107465. [PMID: 38309526 PMCID: PMC10923143 DOI: 10.1016/j.cct.2024.107465] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/18/2023] [Accepted: 01/28/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Immigrants to the United States face structural barriers that contribute to rising cardiovascular risk factors and obesity after immigration. This manuscript describes the development of the Healthy Immigrant Community protocol and baseline measures for a stepped wedge cluster randomized trial to test the effectiveness of a social network intervention for cardiovascular risk reduction among two immigrant populations. METHODS We developed a social network-informed, community-based, participatory research-derived health promotion intervention with Hispanic and Somali immigrant communities in Minnesota consisting of mentoring, educational and motivational sessions, group activities, and a community toolkit for healthy weight loss delivered by culturally concordant health promoters (HPs) to their social networks. Using a stepped wedge cluster randomized design, social network-based groups were randomly assigned to receive the intervention either immediately or after a delay of one year. Outcomes, measured at baseline, 6 months, 12 months, and 24 months, were derived from the American Heart Association's "Life's Simple 7": BMI and waist circumference, blood pressure, fasting blood glucose, total cholesterol, physical activity level, and dietary quality. RESULTS A total of 51 HPs were enrolled and randomized (29 Hispanic; 22 Somali). There were 475 participants enrolled in the study, representing a mean social network group size of 8 (range, 5-12). The mean BMI of the sample (32.2) was in the "obese" range. CONCLUSION Processes and products from this Healthy Immigrant Community protocol are relevant to other communities seeking to reduce cardiovascular risk factors and negative health behaviors among immigrant populations by leveraging the influence of their social networks.
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Affiliation(s)
- Mark L Wieland
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, USA; Rochester Healthy Community Partnership.
| | | | - Miriam Goodson
- Rochester Healthy Community Partnership; Alliance for Chicanos, Hispanics, and Latin Americans, Rochester, MN, USA
| | - Graciela Porraz Capetillo
- Rochester Healthy Community Partnership; Department of Language Services, Mayo Clinic, Rochester, MN, USA
| | - Ahmed Osman
- Rochester Healthy Community Partnership; Intercultural Mutual Assistance Association, Rochester, MN, USA
| | - Yahye Ahmed
- Rochester Healthy Community Partnership; Somali American Social Service Association, Rochester, MN, USA
| | - Hindi Elmi
- Rochester Healthy Community Partnership; Intercultural Mutual Assistance Association, Rochester, MN, USA
| | - Omar Nur
- Rochester Healthy Community Partnership; Somali American Social Service Association, Rochester, MN, USA
| | | | - Gloria Torres-Herbeck
- Rochester Healthy Community Partnership; Alliance for Chicanos, Hispanics, and Latin Americans, Rochester, MN, USA
| | | | - Matthew M Clark
- Rochester Healthy Community Partnership; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Abby M Lohr
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, USA; Rochester Healthy Community Partnership
| | | | - Katherine Zeratsky
- Rochester Healthy Community Partnership; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Thomas Rieck
- Rochester Healthy Community Partnership; Department of Integrative Medicine and Health, Mayo Clinic, Rochester, MN, USA
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Thomas W Valente
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Irene G Sia
- Rochester Healthy Community Partnership; Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
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Wingo MT, Andersen CA, Bornstein SL, Huber JM, Szostek JH, Wieland ML. Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2023. Am J Med 2024:S0002-9343(24)00099-8. [PMID: 38403180 DOI: 10.1016/j.amjmed.2024.02.017] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/27/2024]
Abstract
The expansive scope of internal medicine can make it challenging for clinicians to stay informed about new literature that changes practice. Guideline updates and synthesis of relevant evidence can facilitate incorporation of advancements into clinical practice. The titles and abstracts from the seven general medicine journals with highest impact factors and relevance to outpatient internal medicine were reviewed by six internal medicine physicians. Coronavirus disease 19 research was excluded. The New England Journal of Medicine (NEJM), The Lancet, Journal of the American Medical Association (JAMA), The British Medical Journal (BMJ), Annals of Internal Medicine, JAMA Internal Medicine, and Mayo Clinic Proceedings were reviewed. Additionally, article synopsis collections and databases were evaluated: American College of Physicians Journal Club, NEJM Journal Watch, BMJ Evidence-Based Medicine, McMaster ACCESSSS/DynaMed Evidence Alerts, and Cochrane Reviews. A modified Delphi method was used to gain consensus based on clinical relevance to outpatient internal medicine, potential impact on practice, and strength of evidence. Article qualities and importance were debated until consensus was reached. Clusters of articles pertinent to the same topic were considered together. In total, seven practice-changing articles were included.
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Affiliation(s)
- Majken T Wingo
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - Carl A Andersen
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Shari L Bornstein
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Jill M Huber
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Jason H Szostek
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Mark L Wieland
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, MN
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Atunah-Jay SJ, Phelan S, Anderson AT, Behl S, McTate EA, Gorfine MC, Sood G, Taylor KK, Brockman J, Salinas M, Biggs BK, Wieland ML, Asiedu GB. Promoting Safe and Supportive Health Care Spaces for Youth Experiencing Racism. Acad Pediatr 2024:S1876-2859(24)00009-3. [PMID: 38244857 DOI: 10.1016/j.acap.2024.01.009] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 11/23/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE This qualitative study applies a community-based participatory research approach to elicit formative data on pediatric patient experiences of racism in the health care setting and to explore clinic-based opportunities for supporting pediatric patients experiencing racism. METHODS The study is situated within the outpatient practice of a large tertiary academic medical center in a midsize Midwestern city. Community partners were involved in all aspects of the research, including research protocol design, recruitment, data analysis, community dissemination, and manuscript preparation. Participants were youth between 11 and 18 years, in middle or high school, self-identifying as a person of color, Latinx or Indigenous who answered yes to the question "have you ever experienced race-related prejudice and discrimination?" Parent/guardians of youth meeting inclusion criteria participated in separate focus groups. Data were analyzed using an interpretative phenomenological analysis approach. RESULTS Major findings were divided into 2 categories: 1) racism-related experiences in the health care setting; and 2) patient and parent/guardian recommendations to support pediatric patients experiencing racism. Among health care setting experiences, primary emerging themes included racism experienced in the health care setting, patient-clinician communication around racism, patient-clinician concordance, and high-quality clinical care. Recommendations were presented within the 4 domains of racism: intrapersonal, interpersonal, structural, and institutional. CONCLUSIONS Racism experiences worsen child biological, psychological, and behavioral functioning, yet research is lacking on how health care professionals may best support pediatric patients experiencing racism. Study findings suggest opportunities for providing safer and more supportive health care spaces for youth experiencing racism.
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Affiliation(s)
- Sarah J Atunah-Jay
- Mayo Clinic Alix School of Medicine (SJ Atunah-Jay), Mayo Clinic College of Medicine and Science, Rochester, Minn.
| | - Sean Phelan
- Division of Health Care Delivery Research (S Phelan and GB Asiedu), Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minn
| | - Ashaunta T Anderson
- Department of Pediatrics (AT Anderson), Keck School of Medicine of the University of Southern California, Children's Hospital Los Angeles
| | - Supriya Behl
- Department of Pediatric and Adolescent Medicine (S Behl), Mayo Clinic, Rochester, Minn
| | - Emily A McTate
- Department of Pediatric and Adolescent Medicine (EA McTate), Mayo Clinic College of Medicine and Science, Rochester, Minn; Department of Psychology (EA McTate and BK Biggs), Mayo Clinic College of Medicine and Science, Rochester, Minn
| | - Mary Conboy Gorfine
- Rochester-Olmsted Youth Commission and Rochester Community Engaged Research Advisory Board (Mayo Clinic) (MC Gorfine), Minn
| | - Gauri Sood
- Rochester-Olmsted Youth Commission (G Sood and KK Taylor), Minn
| | - Kashanti K Taylor
- Rochester-Olmsted Youth Commission (G Sood and KK Taylor), Minn; Howard University (KK Taylor), Washington, DC
| | - Jack Brockman
- Pediatric Advisory Board (J Brockman), Mayo Clinic, Rochester, Minn
| | - Manisha Salinas
- Center for Health Equity and Community Engagement Research (M Salinas), Mayo Clinic College of Medicine and Science, Jacksonville, Fla
| | - Bridget K Biggs
- Department of Psychology (EA McTate and BK Biggs), Mayo Clinic College of Medicine and Science, Rochester, Minn
| | - Mark L Wieland
- Division of Community Internal Medicine (ML Wieland), Mayo Clinic College of Medicine and Science, Rochester, Minn
| | - Gladys B Asiedu
- Division of Health Care Delivery Research (S Phelan and GB Asiedu), Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minn
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Odedina FT, Wieland ML, Barbel-Johnson K, Crook JM. Community Engagement Strategies for Underrepresented Racial and Ethnic Populations. Mayo Clin Proc 2024; 99:159-171. [PMID: 38176825 DOI: 10.1016/j.mayocp.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 01/06/2024]
Abstract
The representation of racial and ethnic minority populations in clinical trials continues to be a challenge despite mandates, good intentions, and concerted efforts by funding agencies, regulatory bodies, and researchers to close the clinical trials gap. A lack of diversity in research results in both continued disparities and poorer health outcomes. It is thus imperative that investigators understand and effectively address the challenges of clinical trials participation by underrepresented populations. In this paper, we expound on best practices for participatory research by clearly defining the community, highlighting the importance of proper identification and engagement of strong community partners, and exploring patient- and provider-level barriers and facilitators that require consideration. A clearer understanding of the balance of power between researchers and community partners is needed for any approach that addresses clinical trials representation. Unintended biases in study design and methods may continue to prevent racial and ethnic minority participants from taking part, and significant organizational changes are necessary for efficient and transparent relationships. Comprehensive community engagement in research includes dissemination of clinical trial results within and in partnership with community partners. Through careful deliberation and honest reflection, investigators, institutions, and community partners can develop the tailored blueprints of research collaborations essential for true equity in clinical trials.
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Affiliation(s)
| | - Mark L Wieland
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN
| | | | - Jennifer M Crook
- Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Jacksonville, FL
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Lalika M, Salinas M, Asiedu GB, Jones C, Richard M, Erickson J, Weis J, Abbenyi A, Brockman TA, Sia IG, Wieland ML, White RO, Doubeni CA, Brewer LC. Perspectives of African American Church Leaders in Response to COVID-19 Emergency Preparedness and Risk Communication Efforts Within a Community Engaged Research Partnership: COVID-19 emergency risk communication. Disaster Med Public Health Prep 2023; 17:e532. [PMID: 37830352 PMCID: PMC11017953 DOI: 10.1017/dmp.2023.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Affiliation(s)
- Mathias Lalika
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Manisha Salinas
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Jacksonville, FL, USA
| | - Gladys B. Asiedu
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Jennifer Weis
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA
| | - Adeline Abbenyi
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA
| | - Tabetha A. Brockman
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA
| | - Irene G. Sia
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA
- Division of Infectious Diseases, Mayo Clinic Department of Medicine, Rochester, MN, USA
| | - Mark L. Wieland
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA
- Division of Community Internal Medicine, Mayo Clinic Department of Medicine, Rochester, MN, USA
| | - Richard O. White
- Division of Community Internal Medicine, Mayo Clinic Department of Medicine, Jacksonville, FL, USA
| | - Chyke A. Doubeni
- Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - LaPrincess C. Brewer
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA
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10
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Mohamed AA, Chamberlain AM, Yost KJ, Jenkins G, Finney Rutten LJ, Wieland ML, Njeru JW. Cancer incidence in the Somali population of Olmsted County: A Rochester epidemiology project study. Cancer Med 2023; 12:20027-20034. [PMID: 37740603 PMCID: PMC10587927 DOI: 10.1002/cam4.6558] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/29/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Somali immigrants and refugees constitute one of the largest African ethnic groups immigrating to the United States over the past three decades with the majority resettling in the state of Minnesota. Previous studies have documented significant cancer screening disparities between the Somali population and the general population. However, little is known about cancer incidence among Somali groups living in the United States. METHODS We determined the incidence of 18 types or sites of malignancy using ICD-9 and ICD-10 codes and compared them between Somali and non-Somali populations in Olmsted County, Minnesota utilizing the Rochester Epidemiology Project medical records-linkage infrastructure for the years 2000-2020. Poisson regression models were used to model the rates for each malignancy. RESULTS There was a higher incidence and relative risk of liver malignancies among the Somali population versus non-Somali population, but lower relative risk and incidence of the following malignancies: breast, cervical, and melanoma. After direct age-sex adjustment to the United States 2000 Census population, liver was the most common cancer in Somali men, while breast cancer was the most common malignancy in women. CONCLUSION Malignancies related to infectious agents such as viral hepatitis have a higher incidence in the Somali immigrant population of Olmsted County. There is a lower incidence of malignancies related to lifestyle factors in this Somali population. Findings of this study may help inform cancer prevention and screening strategies among Somali communities in the United States.
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Affiliation(s)
| | - Alanna M. Chamberlain
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
- Department of Cardiovascular MedicineMayo ClinicRochesterMinnesotaUSA
| | - Kathleen J. Yost
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Gregory Jenkins
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | | | | | - Jane W. Njeru
- Department of MedicineMayo ClinicRochesterMinnesotaUSA
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Huber JM, Wieland ML, Bornstein SL, Mauck KF, Szostek JH, Post JA, Wingo MT. Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2022. Am J Med 2023; 136:869-873. [PMID: 37245787 DOI: 10.1016/j.amjmed.2023.05.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 05/30/2023]
Abstract
It can be difficult for clinicians to stay updated on practice-changing articles. Synthesis of relevant articles and guideline updates can facilitate staying informed on important new data impacting clinical practice. The titles and abstracts from the 7 general internal medicine outpatient journals with highest impact factors and relevance were reviewed by 8 internal medicine physicians. Coronavirus disease 2019 research was excluded. The New England Journal of Medicine (NEJM), The Lancet, the Journal of the American Medical Association, The British Medical Journal (BMJ), the Annals of Internal Medicine, JAMA Internal Medicine, and Public Library of Science Medicine were reviewed. Additionally, article synopsis collections and databases were reviewed: American College of Physicians Journal Club, NEJM Journal Watch, BMJ Evidence-Based Medicine, McMaster/DynaMed Evidence Alerts, and Cochrane Reviews. A modified Delphi method was used to gain consensus based on clinical relevance to outpatient internal medicine, potential impact on practice, and strength of evidence. Article qualities and importance were debated until consensus was reached. Clusters of articles pertinent to the same topic were considered together. In total, 5 practice-changing articles were included, along with a highlight of key guideline updates.
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Affiliation(s)
- Jill M Huber
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, Minn.
| | - Mark L Wieland
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Shari L Bornstein
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Karen F Mauck
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Jason H Szostek
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Jason A Post
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Majken T Wingo
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, Minn
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12
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Lohr AM, Neumbo KC, Njeru JW, Molina L, Hasley R, Ahmed Y, Quirindongo-Cedeno O, Torres-Herbeck GA, Goodson ML, Osman A, Weis JA, Wieland ML, Sia IG. Addressing COVID-19 inequities using bidirectional crisis and emergency risk communication and vaccine clinic interventions: a descriptive study. BMC Public Health 2023; 23:1517. [PMID: 37558981 PMCID: PMC10413496 DOI: 10.1186/s12889-023-16410-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Im/migrants (immigrants and migrants, including refugees, asylum seekers, and individuals without legal documentation) experience unique assets and needs in relation to coronavirus disease 2019 (COVID-19). Community-based participatory research (CBPR) is one way to engage im/migrant communities. Rochester Healthy Community Partnership (RHCP) is a CBPR partnership in Rochester, Minnesota. RHCP partners noted that credible COVID-19 information was not available to their communities. In response, RHCP formed a COVID-19 Task Force and adapted the Centers for Disease Control and Prevention's Crisis and Emergency Risk Communication (CERC) framework to create an intervention that prioritized im/migrant groups experiencing health disparities. In the CERC intervention, communication leaders delivered COVID-19 health messages to their social networks and documented related concerns. RHCP relayed these concerns to regional leaders to ensure that im/migrant experiences were included in decision making. Once vaccines were available, RHCP continued to deploy the CERC intervention to promote vaccination equity. The aims of this paper are to (1) describe the implementation of a bidirectional CERC intervention for vaccination equity, and (2) describe a community-engaged and community-based vaccine clinic intervention. METHODS First, we surveyed participants (n = 37) to assess COVID-19 experiences, acceptability of the CERC intervention, and motivation to receive a COVID-19 vaccination. Second, we collaborated with community partners to hold vaccine clinics. We report descriptive statistics from each intervention. RESULTS When asked about the acceptability of the CERC intervention for vaccine equity, most participants either reported that they 'really liked it' or 'thought it was just ok'. Most participants stated that they would recommend the program to family or friends who have not yet received the COVID-19 vaccine. Almost all participants reported that they felt 'much more' or 'somewhat more' motivated to receive a COVID-19 vaccine after the intervention. We administered 1158 vaccines at the vaccination clinics. CONCLUSIONS We found that participants viewed the CERC intervention for vaccination equity as an acceptable way to disseminate COVID-19-related information. Nearly all participants reported that the intervention convinced them to receive a COVID-19 vaccine. In our experience, community-engaged and community-based clinics are a successful way to administer vaccines to im/migrant communities during a pandemic.
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Affiliation(s)
- Abby M Lohr
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, USA.
| | | | - Jane W Njeru
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, USA
| | - Luz Molina
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, USA
- Community Based Research, Mayo Clinic, Rochester, USA
| | | | - Yahye Ahmed
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, USA
- Community Based Research, Mayo Clinic, Rochester, USA
| | - Onelis Quirindongo-Cedeno
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, USA
| | - Gloria A Torres-Herbeck
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, USA
- Community Based Research, Mayo Clinic, Rochester, USA
- Alliance of Chicanos, Hispanics, and Latin Americans, Rochester, USA
| | - Miriam L Goodson
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, USA
- Community Based Research, Mayo Clinic, Rochester, USA
- Alliance of Chicanos, Hispanics, and Latin Americans, Rochester, USA
| | - Ahmed Osman
- Intercultural Mutual Assistance Association, Rochester, USA
| | - Jenny A Weis
- Research Administrative Services, Mayo Clinic, Rochester, USA
| | - Mark L Wieland
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, USA
| | - Irene G Sia
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, USA
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13
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Lohr AM, Vickery KD, Hernandez V, Ford BR, Gonzalez C, Kavistan S, Patten CA, Njeru JW, Novotny PJ, Larkey LK, Singh D, Wieland ML, Sia IG. Stories for change protocol: A randomized controlled trial of a digital storytelling intervention for Hispanic/Latino individuals with type 2 diabetes. Contemp Clin Trials 2023; 126:107093. [PMID: 36682492 PMCID: PMC9998363 DOI: 10.1016/j.cct.2023.107093] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hispanic/Latino adults are disproportionately impacted by type 2 diabetes mellitus (T2D). The Stories for Change (S4C) Diabetes digital storytelling intervention promotes T2D self-management among Hispanic/Latino people. We describe the S4C protocol and participant baseline characteristics. METHODS Study eligibility criteria: Hispanic or Latino, age 18-70 years, ≥1 office visit within a year at a participating clinic, T2D diagnosis for ≥6 months, HbA1c ≥ 8%, and intention to continue care at the recruitment clinic. We used a two-group, parallel randomized controlled trial design and an intervention derived through a community-based participatory research approach. All participants received usual diabetes care and two cards describing how to engage healthcare teams and access diabetes-related resources. At baseline, the intervention group additionally viewed the 12-min, intervention video (four stories about diabetes self-management). To encourage subsequent video viewing, participants received five monthly text messages. The messages prompted them to self-rate their motivation and self-efficacy for T2D management. The control group received no additional intervention. Bilingual (English/Spanish) staff collected data at baseline, six weeks, three months, and six months including biometric measurements and a survey on diabetes self-management outcomes, theory-based measures, and the number of video views. We reviewed the number of diabetes-related appointments attended using electronic medical record data. RESULTS Participants (n = 451; 70% women, mean age = 53 years) had an average HbA1C ≥9%. Intervention participants reported identifying with the storytellers and engaging with the stories. CONCLUSION We present a digital storytelling intervention protocol that provides a template for future health promotion interventions prioritizing health disparity populations. CLINICALTRIAL gov#NCT03766438.
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Affiliation(s)
- Abby M Lohr
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA; Center for Clinical and Translational Science, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
| | - Katherine Diaz Vickery
- Health, Homelessness & Criminal Justice Lab, Hennepin Healthcare Research Institute, 730 S 8th St, Minneapolis, MN 55415, USA
| | | | - Becky R Ford
- Health, Homelessness & Criminal Justice Lab, Hennepin Healthcare Research Institute, 730 S 8th St, Minneapolis, MN 55415, USA
| | - Crystal Gonzalez
- Mountain Park Health Center, 635 E Baseline Rd, Phoenix, AZ 85042, USA
| | - Silvio Kavistan
- Health, Homelessness & Criminal Justice Lab, Hennepin Healthcare Research Institute, 730 S 8th St, Minneapolis, MN 55415, USA
| | - Christi A Patten
- Center for Clinical and Translational Science, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA; Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Jane W Njeru
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Paul J Novotny
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Linda K Larkey
- Edson College of Nursing and Health Innovation, Arizona State University, 550 N 3rd Street Ac, Phoenix, AZ 85004, USA
| | - Davinder Singh
- Mountain Park Health Center, 635 E Baseline Rd, Phoenix, AZ 85042, USA
| | - Mark L Wieland
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA; Center for Clinical and Translational Science, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Irene G Sia
- Center for Clinical and Translational Science, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA; Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
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14
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Lohr AMM, Raygoza J, Porraz Capetillo M(GD, Nur O, Molina L, Osman A, Elmi H, Mohamed AA, Valente TW, Griffin JM, Wieland ML, Sia IG. Abstract P650: Addressing Cardiovascular Disease Inequities: Qualitative Process Evaluation From a Co-Investigation With Im/Migrants Exploring How to Sustain a Community-Driven, Social Network Intervention Using a Racism-Conscious Approach. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Introduction:
Health promotion programs focused on cardiovascular disease are underutilized with im/migrants. The one-time referral to group-based interventions model ignores (1) the complex sociocultural influences on behavior change and (2) the socio-historical context of migration, racialization of immigrants and refugees, and the roles these play in differential social integration of refugees. One solution may be to apply community-based participatory research (CBPR) and Public Health Critical Race Praxis (PHCRP) to social network interventions with opinion leaders. Yet, these interventions are challenging to scale. There is a critical need to understand how to scale community-driven social network interventions to effectively address cardiovascular disease inequities resulting from systemic racism experienced by im/migrant populations. Developed using CBPR and informed by PHCRP, this work builds upon
Healthy Immigrant Community
(HIC), a collaborative effort between Latinx and Somali im/migrant partners and Rochester Healthy Community Partnership. Our aim is to explore opinion leader recruitment, their characteristics, and expectations for HIC scale-up.
Qualitative Hypothesis:
Learning more about the opinion leaders’ background and experience in the
Healthy Immigrant Community
social network intervention will prepare us for a future efficacy study.
Methods:
We conducted a process evaluation by: (1) interviewing community partners who recruited opinion leaders (n=8) and (2) conducting three pre-intervention focus groups with opinion leaders (Latinx n=4; Somali women n=8; Somali men n=8). We used PHCRP to deductively form codes yet allowed for new ideas that arose from the data by inductively generating additional codes.
Results:
Interview participants described their decision-making process, qualities considered, recruitment strategies, and expectations for an implementation study. Focus group participants discussed their personal motivations for participation, how they hoped the study would help their community, and the barriers to health they experience because of structural determinism (macro-level forces that sustain inequities).
Conclusions:
This work will enhance our ability to translate HIC to other communities by expanding our knowledge of opinion leader characteristics that are important in a community-driven, social network intervention. Because social network interventions have been demonstrated to cause positive behavior change, further adapting these interventions in a community setting would be expected to provide a more effective approach compared to individually targeted behavior change strategies. Additionally, selecting OLs is neither time nor resource intensive and could enhance organizational strategies for implementing health promotion programming.
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Affiliation(s)
| | | | | | - Omar Nur
- Somali American Social Service Organization, Rochester, MN
| | | | - Ahmed Osman
- Intercultural Mutual Assistance Association, Rochester, MN
| | - Hindi Elmi
- Intercultural Mutual Assistance Association, Rochester, MN
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15
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Wieland ML, Njeru JW, Weis JA, Lohr A, Nigon JA, Goodson M, Osman A, Molina L, Ahmed Y, Capetillo GP, Nur O, Sia IG. Rochester Healthy Community Partnership: Then and now. Front Public Health 2023; 10:1090131. [PMID: 36703848 PMCID: PMC9871468 DOI: 10.3389/fpubh.2022.1090131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Community-engaged research partnerships promote health equity through incorporation of regional contexts to inform partnership dynamics that shape research and interventions that reflect community voice and priorities. Long-term partnerships build trusted relationships and promote capacity building among community and academic partners, but there are many structural barriers to sustaining long-term partnerships. Here we describe lessons learned from sustaining Rochester Healthy Community Partnership (RHCP), an 18-year community-based participatory research (CBPR) partnership in Southeast Minnesota. RHCP collaborates with immigrant and refugee populations to co-create interventions that promote health equity for community health priorities. Challenges to sustainability include a tension between project-based funding and the needs of long-term community-based research infrastructure. These challenges can be met with a focus on shared CBPR principles, operating norms, partnership dynamics, and governance. RHCP began in 2004 through identification of a community health priority, defining the community, and establishment of CBPR principles. It grew through identification of broader community health priorities, capacity building for community and academic partners, and integration of diverse learners. We describe the capacity for RHCP to respond to new societal contexts, the importance of partnership dynamics as a barometer for partnership health, and lessons learned about sustainability of the CBPR partnership.
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Affiliation(s)
- Mark L. Wieland
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, United States,Rochester Healthy Community Partnership, Rochester, MN, United States,*Correspondence: Mark L. Wieland ✉
| | - Jane W. Njeru
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, United States,Rochester Healthy Community Partnership, Rochester, MN, United States
| | - Jennifer A. Weis
- Rochester Healthy Community Partnership, Rochester, MN, United States,Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, United States
| | - Abby Lohr
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, United States,Rochester Healthy Community Partnership, Rochester, MN, United States
| | - Julie A. Nigon
- Rochester Healthy Community Partnership, Rochester, MN, United States,Hawthorne Education Center, Rochester, MN, United States
| | - Miriam Goodson
- Rochester Healthy Community Partnership, Rochester, MN, United States,Alliance of Chicanos, Hispanics, and Latin Americans, Rochester, MN, United States
| | - Ahmed Osman
- Rochester Healthy Community Partnership, Rochester, MN, United States,Intercultural Mutual Assistance Association, Rochester, MN, United States
| | - Luz Molina
- Rochester Healthy Community Partnership, Rochester, MN, United States,Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, United States
| | - Yahye Ahmed
- Rochester Healthy Community Partnership, Rochester, MN, United States,Somali American Social Service Association, Rochester, MN, United States
| | - Graciela Porraz Capetillo
- Rochester Healthy Community Partnership, Rochester, MN, United States,Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, United States
| | - Omar Nur
- Rochester Healthy Community Partnership, Rochester, MN, United States,Somali American Social Service Association, Rochester, MN, United States
| | - Irene G. Sia
- Rochester Healthy Community Partnership, Rochester, MN, United States,Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, United States
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16
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James JK, Jeffery MM, Campbell RL, Wieland ML, Ryu AJ. Demographic Trends in Emergency Department Visits for Psychiatric Concerns During the COVID-19 Pandemic. Mayo Clin Proc Innov Qual Outcomes 2022; 6:436-442. [PMID: 35966029 PMCID: PMC9359487 DOI: 10.1016/j.mayocpiqo.2022.07.003] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/20/2022] Open
Abstract
Objective To describe changes in emergency department (ED) psychiatric visits during the pandemic in both rural and nonrural regions in the United States. Methods This cohort study was performed across 22 EDs in the Midwest and Southern United States from January 1, 2019 to April 22, 2021. Prevalence of psychiatric visits before and after the COVID-19 pandemic, defined as starting on March 1, 2020, were compared. Psychiatric and nonpsychiatric visits were defined on the basis of primary clinician-assigned diagnosis. The primary end point was average daily visits normalized to the average daily visit count before the pandemic, labeled as relative mean daily visits (RMDVs). Results Psychiatric visits decreased by 9% [RMDVs, 0.91; 95% confidence interval (CI), 0.89-0.93] during the pandemic period, whereas nonpsychiatric visits decreased by 17% (RMDVs, 0.83; 95% CI, 0.81-0.84). Black patients were the only demographic group with a significant increase in psychiatric visits during the pandemic (RMDVs, 1.12; 95% CI, 1.04-1.19). Periods of outbreaks of psychiatric emergencies were identified in most demographic groups, including among male and pediatric patients. However, the outbreaks detected among Black patients sustained the longest at 6 months. Unlike older adults who experienced outbreaks in the spring and fall of 2020, outbreaks among pediatric patients were detected later in 2021. Conclusion In this multisite study, total ED visits declined during the pandemic; however, psychiatric visits declined less than nonpsychiatric visits. Black patients experienced a greater increase in psychiatric emergencies than other demographic groups. There is also a concern for increasing outbreaks of pediatric psychiatric visits as the pandemic progresses.
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Affiliation(s)
- Jose K. James
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Molly M. Jeffery
- Division of Health Care Policy & Research, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | - Mark L. Wieland
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Alexander J. Ryu
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
- Correspondence: Address to Alexander J. Ryu, MD, Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, 1216 2nd St SW, Old Marian Hall, 4th Fl, Rochester, MN 55902.
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17
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Wieland ML, Grover M. Inclusive Clinical Trials for Disorders of Gut-Brain Interactions. Gastroenterology 2022; 163:583-585. [PMID: 35780870 DOI: 10.1053/j.gastro.2022.06.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Mark L Wieland
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, Minnesota.
| | - Madhusudan Grover
- Division of Gastroenterology and Hepatology, Enteric Neuroscience Program, Mayo Clinic, Rochester, Minnesota
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18
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Wingo MT, Huber JM, Bornstein SL, Sundsted KK, Mauck KF, Szostek JH, Post JA, Wieland ML. Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2021. Am J Med 2022; 135:1069-1074. [PMID: 35367181 DOI: 10.1016/j.amjmed.2022.02.043] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/19/2022]
Abstract
It can be challenging to identify new evidence that may shift clinical practice within internal medicine. Synthesis of relevant articles and guideline updates can facilitate staying informed of these changes. The titles and abstracts from the 7 general internal medicine outpatient journals with highest impact factors and relevance were reviewed by 8 internal medicine physicians. Coronavirus disease 2019 research was excluded. The New England Journal of Medicine (NEJM), The Lancet, Journal of the American Medical Association (JAMA), The British Medical Journal (BMJ), Annals of Internal Medicine, JAMA Internal Medicine, and Public Library of Science Medicine were reviewed. Additionally, article synopsis collections and databases were reviewed: American College of Physicians Journal Club, NEJM Journal Watch, BMJ Evidence-Based Medicine, McMaster/DynaMed Evidence Alerts, and Cochrane Reviews. A modified Delphi method was used to gain consensus based on clinical relevance to outpatient internal medicine, potential impact on practice, and strength of evidence. Article qualities and importance were debated until consensus was reached. Clusters of articles pertinent to the same topic were considered together. In total, 8 practice-changing articles were included.
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Affiliation(s)
- Majken T Wingo
- Division of Community Internal Medicine, Geriatrics and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, Minn.
| | - Jill M Huber
- Division of Community Internal Medicine, Geriatrics and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Shari L Bornstein
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Karna K Sundsted
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Karen F Mauck
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Jason H Szostek
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Jason A Post
- Division of Community Internal Medicine, Geriatrics and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Mark L Wieland
- Division of Community Internal Medicine, Geriatrics and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, Minn
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19
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Lohr AM, Raygoza Tapia JP, Valdez ES, Hassett LC, Gubrium AC, Fiddian-Green A, Larkey L, Sia IG, Wieland ML. The use of digital stories as a health promotion intervention: a scoping review. BMC Public Health 2022; 22:1180. [PMID: 35698097 PMCID: PMC9192132 DOI: 10.1186/s12889-022-13595-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/31/2022] [Indexed: 11/12/2022] Open
Abstract
Background It is challenging to develop health promotion interventions created in collaboration with communities affected by inequities that focus beyond individual behavior change. One potential solution is interventions that use digital stories (DS). Digital storytelling (DST) is an opportunity for reflection, connection with others, and the elevation of voices often absent from daily discourse. Consequently, public health researchers and practitioners frequently employ the DST workshop process to develop messaging that promotes health and highlights concerns in partnership with historically marginalized communities. With participants’ permission, DS can reach beyond the storytellers through behavior or attitude change interventions for health promotion among communities who share the targeted health concern. Our goal was to synthesize the literature describing interventions that use DS for health promotion to identify gaps. Methods We conducted a scoping review. Our inclusion criteria were articles that: 1) described empirical research; 2) used DS that were developed using the StoryCenter DST method; 3) assessed an intervention that used DS to address the health promotion of viewers (individuals, families, community, and/or society) impacted by the targeted health issue 4) were written in English or Spanish. To synthesize the results of the included studies, we mapped them to the health determinants in the National Institute of Minority Health and Health Disparities (NIMHD) research framework. We assessed the number of occurrences of each determinant described in the results of each article. Results Ten articles met the eligibility criteria. All the included articles highlighted health equity issues. Our mapping of the articles with definitive results to the NIMHD research framework indicates that interventions that use DS addressed 17 out of 20 health determinants. All mapped interventions influenced intentions to change health behaviors (NIMHD level/domain: Individual/Behavioral), increased health literacy (Individual/Health Care System), and/or stimulated conversations that addressed community norms (Community/Sociocultural Environment). Conclusions Interventions that use DS appear to positively affect the health promotion of participants across a range of health issues and determinants. Future research is needed in the Interpersonal, Community, and Societal levels and within the Biological, Physical/Built Environment, and Sociocultural Environment domains.
Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13595-x.
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Affiliation(s)
- Abby M Lohr
- Department of Community Internal Medicine, Mayo Clinic, Rochester, USA.
| | | | - Elizabeth Salerno Valdez
- Department of Community Health Education, School of Public Health and Health Sciences, University of Massachusetts, Amherst, USA
| | | | - Aline C Gubrium
- Department of Community Health Education, School of Public Health and Health Sciences, University of Massachusetts, Amherst, USA
| | - Alice Fiddian-Green
- School of Nursing and Health Professions, University of San Francisco, San Francisco, USA
| | - Linda Larkey
- College of Nursing and Health Innovation, Arizona State University, Tempe, USA
| | - Irene G Sia
- Department of Infectious Diseases, Mayo Clinic, Rochester, USA
| | - Mark L Wieland
- Department of Community Internal Medicine, Mayo Clinic, Rochester, USA
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20
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Mohamed AA, Ridgeway JL, Njeru JW, Molina LE, Ahmed YA, Goodson M, Osman A, Porraz Capetillo GD, Nur O, Sia IG, Wieland ML. The Recruitment to Dissemination Continuum in Community-based Participatory Research. Prog Community Health Partnersh 2022; 16:169-179. [PMID: 35662144 DOI: 10.1353/cpr.2022.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dissemination of research findings to participants and communities, particularly among traditionally marginalized groups, is a systemic challenge. In community-based participatory research (CBPR), long-term partnerships may foster a link between recruitment to research studies, dissemination of results, and recruitment to future studies. OBJECTIVES To analyze the recruitment to dissemination continuum of a CBPR study and its potential impact on partnership processes and future research. METHODS We conducted a qualitative study with four focus groups with community members and academic partners who participated in the recruitment and the dissemination of research findings from a study of Hispanic and Somali social networks in Rochester, Minnesota. Thematic analysis and coding of focus group transcripts was conducted by investigators. The CBPR conceptual model for this partnership guided the analysis. RESULTS Trust, relationship building, and capacity building were key features for successful participant recruitment and research dissemination strategies. Strategies, resources, and relationships used or developed during the recruitment phase of research were directly applied to planning a dissemination event. Participants and members of their communities said they were more likely to participate in future research studies as a result of attending a dissemination event. CONCLUSIONS This study demonstrated the ways in which recruitment of marginalized populations to research studies and dissemination of study results can manifest as a continuum. This continuum is nurtured by trust, longitudinal relationships, and robust partnership dynamics. These factors fit well within an existing CBPR conceptual model.
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Mohamed AA, Ridgeway JL, Njeru JW, Molina LE, Ahmed YA, Goodson M, Osman A, Porraz Capetillo GD, Nur O, Sia IG, Wieland ML. The Recruitment to Dissemination Continuum in Community-based Participatory Research. Prog Community Health Partnersh 2022. [DOI: 10.1353/cpr.2022.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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22
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Mohamed AA, Lantz K, Ahmed YA, Osman A, Nur MA, Nur O, Njeru JW, Sia IG, Wieland ML. An Assessment of Health Priorities Among a Community Sample of Somali Adults. J Immigr Minor Health 2022; 24:455-460. [PMID: 33740189 PMCID: PMC7975235 DOI: 10.1007/s10903-021-01166-y] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/30/2022]
Abstract
Somali immigrants are one of the largest African populations to resettle in the United States since 1990. There is an emerging literature base of disease-specific studies among Somali immigrants. However, we are aware of no studies on the health priorities for Somalis from the community's perspective. Somali adults in Minnesota completed a survey conducted by a community-based participatory research partnership on individual and community health priorities. Data were reported as counts and frequencies. 646 participants completed the survey. The most important health issues for individuals and their families were health behaviors (22.7%), diabetes (18.2%), and hypertension (14.4%), while those of the community were diabetes (22.5%), hypertension (18.8%) and weight (15.9%). This study found a significant overlap of health priorities among Somali individuals and their families compared to the community. These health priorities underscore the need to focus on non-communicable diseases among Somali immigrants.
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Affiliation(s)
- Ahmed A Mohamed
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Kiley Lantz
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Yahye A Ahmed
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Ahmed Osman
- Intercultural Mutual Assistance Association, Rochester, MN, USA
| | - Mohamud A Nur
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Omar Nur
- Somali American Social Service Association, Rochester, MN, USA
| | - Jane W Njeru
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Irene G Sia
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Mark L Wieland
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
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23
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Wieland ML, Asiedu GB, Njeru JW, Weis JA, Lantz K, Abbenyi A, Molina L, Ahmed Y, Osman A, Goodson M, Torres-Herbeck G, Nur O, Porraz Capetillo G, Mohamed AA, Sia IG. Community-Engaged Bidirectional Crisis and Emergency Risk Communication With Immigrant and Refugee Populations During the COVID-19 Pandemic. Public Health Rep 2022; 137:352-361. [PMID: 35023414 PMCID: PMC8900245 DOI: 10.1177/00333549211065514] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study was conducted to assess an intervention that was created by a community-academic partnership to address COVID-19 health inequities. We evaluated a community-engaged bidirectional pandemic crisis and emergency risk communication (CERC) framework with immigrant and refugee populations during the COVID-19 pandemic. METHODS A 17-year community-engaged research partnership adopted a CERC framework in March 2020 to address COVID-19 prevention, testing, and socioeconomic impacts with immigrant and refugee groups in southeast Minnesota. The partnership used bidirectional communication between communication leaders and their social networks to refine messages, leverage resources, and advise policy makers. We conducted a mixed-methods evaluation for intervention acceptability, feasibility, reach, adaptation, and sustainability through multisource data, including email communications, work group notes, semistructured interviews, and focus groups. RESULTS The intervention reached at least 39 000 people in 9 months. It was implemented as intended and perceived efficacy was high. Frequent communication between community and academic partners allowed the team to respond rapidly to concerns and facilitated connection of community members to resources. Framework implementation also led to systems and policy changes to meet the needs of immigrant and refugee populations. CONCLUSIONS Community-engaged CERC is feasible and sustainable and can reduce COVID-19 disparities through shared creation and dissemination of public health messages, enhanced connection to existing resources, and incorporation of community perspectives in regional pandemic mitigation policies.
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Affiliation(s)
- Mark L. Wieland
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Gladys B. Asiedu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Jane W. Njeru
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jennifer A. Weis
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
| | - Kiley Lantz
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA
| | - Adeline Abbenyi
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA
| | - Luz Molina
- Language Services, Mayo Clinic, Rochester, MN, USA
| | - Yahye Ahmed
- Somali American Social Services Association, Rochester, MN, USA
| | - Ahmed Osman
- Intercultural Mutual Assistance Association, Rochester, MN, USA
| | - Miriam Goodson
- Alliance of Chicanos, Hispanics and Latin Americans, Rochester, MN, USA
| | | | - Omar Nur
- Somali American Social Services Association, Rochester, MN, USA
| | | | - Ahmed A. Mohamed
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Irene G. Sia
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
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Vickery KD, Novotny PJ, Ford BR, Lantz K, Kavistan S, Singh D, Hernandez V, Sia IG, Wieland ML. Experiences of Hispanic Safety Net Clinic Patients With Diabetes During the COVID-19 Pandemic. Sci Diabetes Self Manag Care 2022; 48:87-97. [PMID: 35118926 PMCID: PMC9044409 DOI: 10.1177/26350106221076037] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to characterize the material, health (general and diabetes-specific), and social impacts of the COVID-19 pandemic on Hispanic adults with type 2 diabetes who did not experience COVID-19 infection. METHODS This cross-sectional and longitudinal study used surveys within a clinical trial of 79 Hispanic adult clinic patients with type 2 diabetes. Cross-sectional measures included the Coronavirus Anxiety Scale, items from the Coronavirus Impact Scale, and the Pandemic Impacts Inventory. Longitudinal measures included the Summary of Diabetes Self-Care, health care utilization, and measures of diabetes self-efficacy, social support, and quality of life. RESULTS Participants were majority low-income, Spanish-speaking females with poor diabetes control. Coronavirus anxiety was low despite majority of participants having an affected family member and frequent access barriers. More than half of participants reported moderate/severe pandemic impact on their income. Diabetes self-care behaviors did not change between prepandemic and pandemic measures. Diabetes self-efficacy and quality of life improved despite fewer diabetes-related health care visits. CONCLUSIONS Despite high levels of access barriers, financial strain, and COVID-19 infection of family members, Hispanic adults with type 2 diabetes continued to prioritize their diabetes self-management and demonstrated substantial resilience by improving their self-efficacy and quality of life.
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Affiliation(s)
- Katherine D Vickery
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota.,Division of General Internal Medicine, Hennepin Healthcare, Minneapolis, Minnesota.,Health Care for the Homeless, Hennepin County Public Health Department, Minneapolis, Minnesota
| | - Paul J Novotny
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, and Phoenix, Arizona
| | - Becky R Ford
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Kiley Lantz
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, and Phoenix, Arizona
| | - Silvio Kavistan
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Davinder Singh
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, and Phoenix, Arizona.,Mountain Park Health Center, Phoenix, Arizona
| | | | - Irene G Sia
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, and Phoenix, Arizona
| | - Mark L Wieland
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, and Phoenix, Arizona
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25
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Wieland ML, Njeru JW, Asiedu GB, Zeratsky KA, Clark MM, Goetze R, Patten CA, Kelpin SS, Novotny P, Lantz K, Ahmed Y, Molina L, Porraz Capetillo G, Osman A, Goodson M, Sia I. Pilot Social Network Weight Loss Intervention With Two Immigrant Populations During the COVID-19 Pandemic. Am J Health Promot 2022; 36:458-471. [PMID: 35073499 PMCID: PMC8792912 DOI: 10.1177/08901171211053450] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To examine the feasibility and acceptability of a social network weight loss intervention delivered by lay health promoters (HPs) to immigrant populations. Design Single-arm, non-randomized, pilot study of a social network weight loss intervention developed by a community-based participatory research partnership and delivered by HPs. Setting Community-based setting in Southeastern Minnesota, United States. Sample Somali and Hispanic immigrants to the United States: 4 social networks of adults (2 Hispanic and 2 Somali) with 39 network participants. Intervention Twelve-week behavioral weight loss intervention delivered by HPs (4 weeks in-person and then 8 weeks virtual). Measures Feasibility was assessed by recruitment and retention rates. Acceptability was assessed by surveys and focus groups with HPs and participants. Behavioral measures included servings of fruits and vegetables, drinking soda, and physical activity. Physiologic measures included weight, blood pressure, glucose, cholesterol, and triglycerides. Analysis Paired t-tests of pre- to post-intervention changes at the end of 12 weeks of treatment. Results Recruitment was feasible and post-intervention was 100%. Participants highly rated the intervention on satisfaction, motivation, and confidence to eat a healthy diet, be physically active, and lose weight. Participants were motivated by group social support and cohesion of their social networks. On average, participants lost weight (91.6 ± 15.9 to 89.7 ± 16.6 kg, P < .0001), lowered their systolic blood pressure (133.9±16.9 to 127.2 ± 15.8 mm Hg; P < .001), lowered their diastolic blood pressure (81 ± 9.5 to 75.8 ± 9.6 mm Hg; P < .0001), had more servings of vegetables per day (1.9 ± 1.2 to 2.6 ± 1.4; P < .001), and increased their physical activity (2690 ± 3231 to 6595 ± 7322 MET-minutes per week; P = .02). Conclusion This pilot study of 2 immigrant communities who participated in a peer-led weight loss social network intervention delivered during the COVID-19 pandemic demonstrated high feasibility and acceptability. Participants lost weight, improved their health status, and improved their health behaviors.
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Affiliation(s)
- Mark L Wieland
- Division of Community Internal Medicine, 6915Mayo Clinic, Rochester, MN, USA
| | - Jane W Njeru
- Division of Community Internal Medicine, 6915Mayo Clinic, Rochester, MN, USA
| | - Gladys B Asiedu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 6915Mayo Clinic, Rochester, MN, USA
| | - Katherine A Zeratsky
- Division of Endocrinology, Department of Nutrition, 6915Mayo Clinic, Rochester, MN, USA
| | - Matthew M Clark
- Department of Psychiatry and Psychology, 6915Mayo Clinic, Rochester, MN, USA
| | - Rachel Goetze
- Department of Psychiatry and Psychology, 6915Mayo Clinic, Rochester, MN, USA
| | - Christi A Patten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 6915Mayo Clinic, Rochester, MN, USA
| | - Sydney S Kelpin
- Department of Psychiatry and Psychology, 6915Mayo Clinic, Rochester, MN, USA
| | - Paul Novotny
- Health Sciences Research, Biomedical Statistics and Informatics, 6915Mayo Clinic, Rochester, MN, USA
| | - Kiley Lantz
- Division of Infectious Diseases, 6915Mayo Clinic, Rochester, MN, USA
| | - Yahye Ahmed
- Somali American Social Services Association, Rochester, MN, USA
| | - Luz Molina
- Language Services, 6915Mayo Clinic, Rochester, MN, USA
| | | | - Ahmed Osman
- Intercultural Mutual Assistance Association, Rochester, MN, USA
| | - Miriam Goodson
- Alliance of Chicanos, Hispanics and Latin Americans, Rochester, MN, USA
| | - Irene Sia
- Division of Infectious Diseases, 6915Mayo Clinic, Rochester, MN, USA
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26
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Ridgeway JL, Njeru JW, Breitkopf CR, Mohamed AA, Quirindongo-Cedeño O, Sia IG, Wieland ML. Closing the Gap: Participatory Formative Evaluation to Reduce Cancer Screening Disparities among Patients with Limited English Proficiency. J Cancer Educ 2021; 36:795-803. [PMID: 32052262 DOI: 10.1007/s13187-020-01706-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Patients with limited English proficiency (LEP) have disproportionately lower rates of cancer screening than English-proficient patients. Given the multifactorial nature of screening disparities, strategies to improve screening rates must address barriers within and outside of the clinic setting. The objectives of this study were to understand local barriers from multiple stakeholder perspectives, to identify potential multilevel intervention approaches, and to mobilize community-engaged intervention decision making and planning. This participatory formative evaluation approach employed needs assessment and user engagement in order to enhance intervention usefulness and relevance. The study took place in several stages and involved clinic and community partners in a small metropolitan area of the Midwest USA. Interviews were conducted with LEP patients (n = 9) who had not completed three recommended screenings (breast, cervical, and colorectal), primary care providers (n = 5), medical interpreter (n = 5), and community members (n = 3). These highlighted multilevel barriers including limited patient understanding of preventive health, time and cost constraints, and variable roles of language interpreters. The literature was also reviewed to identify interventions used with similar populations. Findings from this review suggest that interventions are largely focused on single population groups or address single screening barriers. Finally, a community-academic summit (n = 48 participants) was held to review results and develop recommendations for community and clinic interventions. Findings from this study indicate that it is possible to engage a diverse group of stakeholders in strategies that are responsive to health care providers and patients, including LEP patients from heterogeneous backgrounds.
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Affiliation(s)
- Jennifer L Ridgeway
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Jane W Njeru
- Division of Community Internal Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | | | - Ahmed A Mohamed
- Division of Community Internal Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | | | - Irene G Sia
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Mark L Wieland
- Division of Community Internal Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
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27
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Hill JC, Njeru JW, Wieland ML, Rutten LJ, Jacobson DJ, Jenkins GD, Fan C. Disparities Among Limited English Proficient Patients in Colon Cancer Screening with Multi-target DNA Stool Test. J Immigr Minor Health 2021; 24:556-559. [PMID: 33991265 DOI: 10.1007/s10903-021-01214-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 11/25/2022]
Abstract
Racial and language minority groups in the U.S. are at a higher risk for morbidity and mortality from colorectal cancer (CRC), partially due to lower screening rates. This is a retrospective cohort study comparing successful multi-target stool DNA test (mt-sDNA) test completion among patients with limited English proficiency (LEP) and English proficient (EP) patients, from 2015 to 2018. Patients with LEP were frequency matched to EP patients by age at a 3:1 ratio. The percentage of mt-sDNA tests without useful results was 53% among patients with LEP compared to 29% among EP patients (p < 0.0001). The median number of days from order placement to test completion was 62.5 among patients with LEP compared to 33 for EP patients (p = 0.003). This study demonstrates a significant disparity in CRC screening completion using the mt-sDNA test among populations with LEP, which may widen existing disparities in CRC mortality.
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Affiliation(s)
- James C Hill
- Community Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA.
| | - Jane W Njeru
- Community Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA
| | - Mark L Wieland
- Community Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA
| | - Lila J Rutten
- Community Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA
| | - Debra J Jacobson
- Community Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA
| | - Gregory D Jenkins
- Community Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA
| | - Chun Fan
- Community Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA
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28
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Santilli AR, Wieland ML. Falsely Elevated Creatinine on Enzymatic Assay in a Patient Receiving Subcutaneous IgG Therapy. J Gen Intern Med 2021; 36:1427-1428. [PMID: 33547577 PMCID: PMC8131470 DOI: 10.1007/s11606-021-06631-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 01/17/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Ashley R Santilli
- Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN, USA.
| | - Mark L Wieland
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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29
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Rockey NG, Weiskittel TM, Linder KE, Ridgeway JL, Wieland ML. A mixed methods study to evaluate the impact of a student-run clinic on undergraduate medical education. BMC Med Educ 2021; 21:182. [PMID: 33766015 PMCID: PMC7992336 DOI: 10.1186/s12909-021-02621-y] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/16/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the extent to which a longitudinal student-run clinic (SRC) is meeting its stated learning objectives, including providing critical community services and developing physicians who more fully appreciate the social factors affecting their patients' health. METHODS This was a mixed methods program evaluation of an SRC at Mayo Clinic Alix School of Medicine (MCASOM). A survey was conducted of medical students who had participated in the clinic and seven interviews and three focus groups were conducted with SRC patients, students, faculty, staff, and board members. Transcripts were coded for systematic themes and sub-themes. Major themes were reported. Survey and interview data were integrated by comparing findings and discussing areas of convergence or divergence in order to more fully understand program success and potential areas for improvement. RESULTS Greater than 85% of student survey respondents (N = 90) agreed or strongly agreed that the SRC met each of its objectives: to provide a vital community service, to explore social determinants of health (SDH), to understand barriers to healthcare access and to practice patience-centered examination. Qualitative data revealed that the SRC contextualized authentic patient care experiences early in students' medical school careers, but the depth of learning was variable between students. Furthermore, exposure to SDH through the program did not necessarily translate to student understanding of the impact of these social factors on patient's health nor did it clearly influence students' future practice goals. CONCLUSIONS The MCASOM SRC experience met core learning objectives, but opportunities to improve long-term impact on students were identified. Participation in the SRC enabled students to engage in patient care early in training that is representative of future practices. SRCs are an avenue by which students can gain exposure to real-world applications of SDH and barriers to healthcare access, but additional focus on faculty development and intentional reflection may be needed to translate this exposure to actionable student understanding of social factors that impact patient care.
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Affiliation(s)
- Nathan G. Rockey
- Mayo Clinic Alix School of Medicine, 200 First Street SW, Rochester, MN 55905 USA
| | - Taylor M. Weiskittel
- Mayo Clinic Graduate School of Biomedical Sciences, 200 First Street SW, Rochester, MN 55905 USA
| | - Katharine E. Linder
- Mayo Clinic Alix School of Medicine, 200 First Street SW, Rochester, MN 55905 USA
| | - Jennifer L. Ridgeway
- Center for the Science of Healthcare Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Mark L. Wieland
- Division of Community Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
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30
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Wieland ML, Njeru JW, Alahdab F, Doubeni CA, Sia IG. Community-Engaged Approaches for Minority Recruitment Into Clinical Research: A Scoping Review of the Literature. Mayo Clin Proc 2021; 96:733-743. [PMID: 33004216 DOI: 10.1016/j.mayocp.2020.03.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/15/2020] [Accepted: 03/31/2020] [Indexed: 01/14/2023]
Abstract
Underrepresentation of racial and ethnic minority populations in clinical research persists in the United States, highlighting the unmet ideals of generalizability and equity of research findings and products. Previous systematic reviews exploring various facets of this phenomenon concluded that community engagement with minority groups may effectively promote recruitment and retention, but the ways in which community-engaged approaches have been used for recruitment have not been examined. We performed a scoping review of the literature to identify studies of community-engaged recruitment processes. The search resulted in 2842 articles, of which 66 met inclusion criteria. These articles demonstrated a relatively large literature base of descriptive studies conveying details of community engagement approaches to enhance recruitment of minority research participants. We summarize key aspects of current practices across the spectrum of community engagement. A gap in the literature is the relative lack of the comparative studies among different engagement strategies.
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Affiliation(s)
- Mark L Wieland
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Jane W Njeru
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN
| | - Fares Alahdab
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN
| | - Chyke A Doubeni
- Center for Health Equity and Community Engagement Research and Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Irene G Sia
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
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31
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Meiers SJ, Dyce E, Wieland ML, Patten C, Clark MM, Hanza MMK, Bronars C, Nigon JA, Sia IG. Lay health worker as interventionist training: reflective writing in US family health promotion practice. Health Promot Int 2021; 36:1739-1752. [PMID: 33619566 DOI: 10.1093/heapro/daaa143] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Lay health worker-led health promotion interventions are well received within racial and ethnic minority communities. Increasing numbers of trained lay health workers will be needed to meet global health goals. The purpose of this process evaluation was to gain insights about how lay health worker as interventionists used theory-based approaches within a nutrition and physical activity health behavior change intervention in a clinical trial enrolling immigrant and refugee families. Data were comprised of ongoing reflective writing statements from four health workers about their implementation of the intervention. Using content analysis three themes emerged: (i) encouraging setting of small, family focused and relevant goals, (ii) being flexible in content delivery and (iii) being personally transformed (i.e. gained a sense of meaning from their experience). Lay health worker interventionist reflections on practice revealed they delivered the intervention within the primacy of the family partnering relationship by attending to unique family needs, and adjusting educational content and goal setting accordingly. Our results provide guidance for training and process evaluation of lay health worker intervention delivery in ethnically and racially diverse populations. Incorporating real-time reflection upon what was learned about skills of facilitating family motivation and family confidence enhanced affective learning and may be useful in future research studies and health promotion practice. The processes identified including setting small goals, flexibility and personal transformation could be considered in future lay health worker-delivered health promotion interventions.
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Affiliation(s)
- Sonja J Meiers
- Department of Graduate Nursing, Winona State University, Rochester, MN 55904, USA
| | - Evan Dyce
- Department of Graduate Nursing, Winona State University, Rochester, MN 55904, USA.,Department of Family Medicine, CentraCare, Big Lake, MN 55309, USA
| | - Mark L Wieland
- Division of Primary Care Internal Medicine, Rochester, MN 55905, USA
| | - Christi Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Carrie Bronars
- Department of Mental Health, Minneapolis Veterans Administration Health Care System, Minneapolis, MN 55417, USA
| | - Julie A Nigon
- Hawthorne Education Center, Rochester Public Schools Rochester, Rochester, MN 55902, USA
| | - Irene G Sia
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA
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32
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Tai DBG, Shah A, Doubeni CA, Sia IG, Wieland ML. The Disproportionate Impact of COVID-19 on Racial and Ethnic Minorities in the United States. Clin Infect Dis 2021; 72:703-706. [PMID: 32562416 PMCID: PMC7337626 DOI: 10.1093/cid/ciaa815] [Citation(s) in RCA: 715] [Impact Index Per Article: 238.3] [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: 05/14/2020] [Accepted: 06/15/2020] [Indexed: 12/19/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected racial and ethnic minority groups, with high rates of death in African American, Native American, and LatinX communities. Although the mechanisms of these disparities are being investigated, they can be conceived as arising from biomedical factors as well as social determinants of health. Minority groups are disproportionately affected by chronic medical conditions and lower access to healthcare that may portend worse COVID-19 outcomes. Furthermore, minority communities are more likely to experience living and working conditions that predispose them to worse outcomes. Underpinning these disparities are long-standing structural and societal factors that the COVID-19 pandemic has exposed. Clinicians can partner with patients and communities to reduce the short-term impact of COVID-19 disparities while advocating for structural change.
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Affiliation(s)
| | - Aditya Shah
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Chyke A Doubeni
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Irene G Sia
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark L Wieland
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota, USA.,Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Hanza MM, Reese AL, Abbenyi A, Formea C, Njeru JW, Nigon JA, Meiers SJ, Weis JA, Sussman AL, Boursaw B, Wallerstein NB, Wieland ML, Sia IG. Outcomes of a Community-Based Participatory Research Partnership Self-Evaluation: The Rochester Healthy Community Partnership Experience. Prog Community Health Partnersh 2021; 15:143. [PMID: 34248057 DOI: 10.1353/cpr.2021.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hanza MM, Reese AL, Abbenyi A, Formea C, Njeru JW, Nigon JA, Meiers SJ, Weis JA, Sussman AL, Boursaw B, Wallerstein NB, Wieland ML, Sia IG. Outcomes of a Community-Based Participatory Research Partnership Self-Evaluation: The Rochester Healthy Community Partnership Experience. Prog Community Health Partnersh 2021; 15:161-175. [PMID: 34248061 DOI: 10.1353/cpr.2021.0019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Community-based participatory research (CBPR) can effectively address health disparities among groups that are historically difficult to reach, disadvantaged, of a minority status, or are otherwise underrepresented in research. Recent research has focused on the science of CBPR partnership constructs and on developing and testing tools for self-evaluation. Because CBPR requires substantial investment in human and material resources, specific factors that support successful and sustainable research partnerships must be identified. We sought to describe the evolution, implementation, and results of a self-evaluation of a CBPR partnership. METHODS Academic and community members of the Rochester Healthy Community Partnership (RHCP) and researchers from the University of New Mexico-Center for Participatory Research collaborated to evaluate RHCP with qualitative and quantitative research methods and group analysis. RESULTS The self-evaluation was used to provide an overall picture of the "health" of the partnership, in terms of sustainability and ability to effectively collaborate around community priorities. RHCP members revisited the partnership's mission and values; identified associations between partnership practices, dynamics, and outcomes; and elicited insight from community and academic partners to help guide decisions about future directions and the sustainability of the partnership. Positive partnership dynamics were associated with perceived improvements in health and equity outcomes. CONCLUSIONS Although engaging in a comprehensive self-evaluation requires substantial investment from stakeholders, such assessments have significant value because they enable partners to reflect on the mission and values of the partnership, explore the history and context for its existence, identify factors that have contributed to outcomes, and plan strategically for the future.
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Carlson LM, Ridgeway JL, Asiedu GB, Wieland ML, Sia IG, Porraz Capetillo G, Bernard ME, Hanza MM, Njeru JW. Facilitated Stories for Change: Digital Storytelling as a Tool for Engagement in Facilitated Discussion for Reduction of Diabetes-Related Health Disparities Among Rural Latino Patients With Diabetes. J Transcult Nurs 2020; 32:707-715. [PMID: 33350356 DOI: 10.1177/1043659620980816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Latino populations, particularly those living in rural areas, experience a disproportionately high prevalence and poorer outcomes of type 2 diabetes mellitus (T2DM). The purpose of this study was to test the acceptability and perceived effectiveness of a group-based, facilitated digital storytelling intervention for T2DM self-management among rural Latino patients. METHOD Twenty Latino adults with T2DM participated in facilitated storytelling discussions at two primary clinics. Participants viewed a 12-minute T2DM self-management digital storytelling intervention, followed by a facilitated group discussion. Surveys, observations, and focus groups were used to assess for acceptability and perceived effectiveness of the intervention through descriptive and qualitative analysis, informed by narrative and social cognitive theory. RESULTS All participants found the intervention interesting and useful and reported improvement in confidence, motivation, and behavioral intentions for T2DM self-management. Themes mapped closely with narrative theory models, further suggestive of the behavior change potential. DISCUSSION Facilitated discussions may add value to viewing of digital stories and represent a scalable approach to provide culturally congruent health care for Latino patients with diabetes in rural settings. Within the paradigm of group-based diabetes educational programs, this lends itself well to critical transcultural nursing care.
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Brewer LC, Asiedu GB, Jones C, Richard M, Erickson J, Weis J, Abbenyi A, Brockman TA, Sia IG, Wieland ML, White RO, Doubeni CA. Emergency Preparedness and Risk Communication Among African American Churches: Leveraging a Community-Based Participatory Research Partnership COVID-19 Initiative. Prev Chronic Dis 2020; 17:E158. [PMID: 33301390 PMCID: PMC7769077 DOI: 10.5888/pcd17.200408] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 11/26/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) crisis has disproportionately affected the African American population. To mitigate the disparities, we deployed an emergency preparedness strategy within an existing community-based participatory research (CBPR) partnership among African American churches to disseminate accurate COVID-19 information. We used the Centers for Disease Control and Prevention Crisis and Emergency Risk Communication framework to conduct a needs assessment, distribute emergency preparedness manuals, and deliver COVID-19–related messaging among African American churches via electronic communication platforms. A needs assessment showed that the top 3 church emergency resource needs were financial support, food and utilities, and COVID-19 health information. During an 8-week period (April 3–May 31, 2020), we equipped 120 churches with emergency preparedness manuals and delivered 230 messages via social media (Facebook) and email. For reach, we estimated that 6,539 unique persons viewed content on the Facebook page, and for engagement, we found 1,260 interactions (eg, likes, loves, comments, shares, video views, post clicks). Emails from community communication leaders reached an estimated 12,000 church members. CBPR partnerships can be effectively leveraged to promote emergency preparedness and communicate risk among under-resourced communities during a pandemic.
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Affiliation(s)
- LaPrincess C Brewer
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota.,Mayo Clinic, 200 First St SW, Rochester, MN 55905.
| | - Gladys B Asiedu
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Jennifer Weis
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota.,Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota
| | - Adeline Abbenyi
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota.,Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota
| | - Tabetha A Brockman
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota.,Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota
| | - Irene G Sia
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota.,Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota.,Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Mark L Wieland
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota.,Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Richard O White
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota.,Division of Community Internal Medicine, Mayo Clinic, Jacksonville, Florida
| | - Chyke A Doubeni
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota.,Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota.,Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
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Abstract
Immigrants may have variable access to chronic disease screening and treatment in their countries of origin and host country, often limited by their immigration status. Immigrants face barriers to chronic disease management and preventive care, including health insurance access, linguistic challenges, lack of culturally sensitive care, limited records, and acculturation. Health care providers should prioritize chronic disease screening and follow up regularly to encourage preventive care and self-management of chronic disease.
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Affiliation(s)
- Colleen Payton
- School of Nursing and Public Health, Moravian College, 1200 Main Street, Bethlehem, PA 18018, USA.
| | - Sarah Kimball
- Immigrant & Refugee Health Center, Boston Medical Center, 725 Albany Street, 43 Suite 5b, Boston, MA 02118, USA; Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - Nicole Chow Ahrenholz
- International Medicine Clinic, Harborview Medicine Center, 325 9th Avenue Box 359895, Seattle, WA 98104, USA; University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Mark L Wieland
- Community Internal Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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Affiliation(s)
- Mark L Wieland
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN; Division of Community Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Chyke A Doubeni
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN; Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Irene G Sia
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN; Division of Infectious Diseases, Mayo Clinic, Rochester, MN
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Abstract
IMPORTANCE Health disparities continue to exist despite the call to increase education of health care practitioners. An assessment of health disparities education has not been previously studied in a national cohort. OBJECTIVE To describe and compare the curriculum on health disparities from the perspective of program directors and perceptions of training among internal medicine residents. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional survey study used a survey of US internal medicine program directors, the 2015 Association of Program Directors in Internal Medicine annual survey, which included questions about health disparities curriculum, and a 1-time survey of US internal medicine residents that asked questions related to their training in health disparities on the American College of Physicians 2015 Internal Medicine In-Training Examination. All internal medicine program directors who were members of Association of Program Directors in Internal Medicine (368 of 396 accredited programs), and internal medicine residents who took the Internal Medicine In-Training Examination were eligible. Final analysis of the merged data set was completed in 2018. EXPOSURES Questions were included on the annual Association of Program Directors in Internal Medicine survey and the Internal Medicine In-Training Examination. MAIN OUTCOMES AND MEASURES Program directors reported on presence of health disparities curriculum, educational methods, quality, barriers and challenges to curriculum, and Clinical Learning Environment Review. Residents reported whether they received training and quality of the training in health disparities. RESULTS A total of 227 program directors (response rate, 61.7%) and 22 723 residents (response rate, 87.2%) responded to the surveys. A total of 90 program directors (39.6%) reported a curriculum in health disparities, but among these, only 16 program directors (17.8%) felt quality of their education was very good or excellent. In more than half of the programs (52 programs [55.9%]), outcomes of the curriculum were not measured. After merging, the combined data set included 18 883 residents from 366 APDIM member programs with 225 program director responses. Among these, 13 251 residents (70.2%) reported some training in caring for patients at risk for health disparities. Of residents who reported receiving training, 10 494 (79.2%) rated the quality as very good or excellent. CONCLUSIONS AND RELEVANCE These findings suggest that that despite the Clinical Learning Environment Review mandate and Accreditation Council for Graduate Medical Education required competencies for training in health disparities, relatively few internal medicine programs in the US provided educational curriculum. Additionally, the existence of health disparities curricula in internal medicine training programs was not associated with resident's perception of training or its quality.
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Affiliation(s)
- Denise M. Dupras
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Mark L. Wieland
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | | | | | | | - Linda Harris
- Research Center, American College of Physicians, Philadelphia, Pennsylvania
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Wingo MT, Bornstein SL, Szostek JH, Mauck KF, Post JA, Wieland ML. Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2019. Am J Med 2020; 133:789-794. [PMID: 32247820 DOI: 10.1016/j.amjmed.2020.02.033] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 02/13/2020] [Accepted: 02/16/2020] [Indexed: 10/24/2022]
Abstract
Clinicians are challenged to stay informed of new and changing medical literature. To facilitate knowledge updates and synthesis of practice-changing information, a group of 6 internists reviewed the titles and abstracts in the 7 outpatient general internal medicine journals with the highest impact factors and relevance to outpatient internal medicine physicians: New England Journal of Medicine (NEJM), Lancet, Annals of Internal Medicine, Journal of the American Medical Association (JAMA), JAMA Internal Medicine, British Medical Journal (BMJ), and Public Library of Science (PLoS) Medicine. The following collections of article synopses and databases were also reviewed: American College of Physicians Journal Club, NEJM Journal Watch, BMJ Evidence-Based Medicine, McMaster/DynaMed Evidence Alerts, and Cochrane Reviews. A modified Delphi method was used to gain consensus based on clinical relevance to outpatient internal medicine, potential impact on practice, and strength of evidence. Article qualities and importance were debated until consensus was reached. Clusters of articles pertaining to the same topic were considered together. In total, 7 practice-changing articles were included.
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Affiliation(s)
- Majken T Wingo
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn.
| | - Shari L Bornstein
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Jason H Szostek
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Karen F Mauck
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Jason A Post
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Mark L Wieland
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
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Wieland ML, Njeru JW, Okamoto JM, Novotny PJ, Breen-Lyles MK, Goodson M, Porraz Capetillo GD, Molina LE, Sia IG. Association of social network factors with weight status and weight loss intentions among hispanic adults. J Behav Med 2020; 43:155-165. [PMID: 31894451 PMCID: PMC7071972 DOI: 10.1007/s10865-019-00131-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 12/17/2019] [Indexed: 01/02/2023]
Abstract
Hispanic adults have the highest obesity prevalence in the United States, but little is known about weight-related social network influences. A community-based sample of 610 Hispanic participants completed height/weight and a survey. The proportion of overweight or obese (OW/OB) network members was higher for OW/OB respondents compared to normal weight respondents. Participants with high weight loss intentions reported more positive social norms for weight control, social support, and social cohesion. If most or all of OW/OB participant's social contacts were trying to lose weight, the odds that they were likely to try to lose weight was four times higher than other participants. The relationship between weight loss intentions and number of social contacts trying to lose weight was strongly mediated by social norms for weight control and social support. These results suggest that social contacts and functional network characteristics may impact weight status and weight control intentions among Hispanic adults.
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Affiliation(s)
- Mark L Wieland
- Department of Medicine, Mayo Clinic, Rochester, MN, USA.
- Division of Community Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Jane W Njeru
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Community Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Janet M Okamoto
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ, USA
| | - Paul J Novotny
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - Miriam Goodson
- Alliance of Chicanos, Hispanics, and Latin Americans, Rochester, MN, USA
| | - Graciela D Porraz Capetillo
- Alliance of Chicanos, Hispanics, and Latin Americans, Rochester, MN, USA
- Department of Language Services, Mayo Clinic, Rochester, MN, USA
| | - Luz E Molina
- Alliance of Chicanos, Hispanics, and Latin Americans, Rochester, MN, USA
- Department of Language Services, Mayo Clinic, Rochester, MN, USA
| | - Irene G Sia
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Biggs BK, Tolleson E, Millerbernd J, Bronars C, Meiers SJ, Slowiak K, Olson M, Lebow J, Ridgeway JL, Patten CA, Clark MM, Sia IG, Wieland ML. Identifying Opportunities to Promote Physical Activity in a Diverse Low-Income Population: A Mixed-Method Study at a Boys & Girls Club Site. Child Youth Care Forum 2020; 49:171-200. [PMID: 33833490 PMCID: PMC8025775 DOI: 10.1007/s10566-019-09521-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prevalence and consequences of obesity and sedentary lifestyle are well-documented public health concerns for youth in the United State of America (U.S.A) that disproportionally affect children from low income and minority families. OBJECTIVE This mixed-method study focused on estimating levels of physical activity and sedentary behavior and prevalence of overweight and obesity among the child members served in one Boys and Girls Club in the Midwest U.S.A. We aimed to better understand opportunities for improving children's engagement in physical activity through focus groups with members, staff, and parents/caregivers of members. METHODS Social cognitive learning theory, the ecological model of health behavior, and community based participatory research principles provided the study framework. Members completed assessments of physical activity, sedentary activity, height, and weight. Focus groups with members, staff, and parents/caregivers identified barriers, facilitators, and opportunities for promoting physical activity. RESULTS: Nearly 50% of members were overweight or obese. Most (87%) participants reported at least 60 minutes physical activity every day across the 3-day recall. Fewer than half (41%) reported 2 hours or less of sedentary screen time every day across the 3 day recall. Focus group themes identified opportunities for addressing needs associated with health disparities in physical activity and pediatric obesity. CONCLUSIONS Findings suggest stakeholder interest in physical activity promotion through afterschool programs. We discuss study implications regarding needs specific to individuals from diverse, low-income households that may not be adequately addressed with existing empirically-supported treatments and opportunities to address health disparities in physical activity and pediatric obesity through afterschool programs.
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Njeru JW, Wieland ML, Okamoto JM, Novotny PJ, Breen-Lyles MK, Osman A, Ahmed YA, Nur MA, Nur O, Sia IG. Social networks and obesity among Somali immigrants and refugees. BMC Public Health 2020; 20:238. [PMID: 32066416 PMCID: PMC7026979 DOI: 10.1186/s12889-020-8315-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 02/03/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Somali immigrants and refugees to the United States are at high risk for obesity and related cardiovascular risk. Social network factors influence health behaviors and are important contributors to the obesity epidemic. The objective of this study was to describe social networks and obesity-related characteristics among adult Somali immigrants in a Minnesota city in order to inform a community-based, participatory, research-derived, social network intervention to decrease obesity rates. METHODS Survey data (demographics, general health measures, and sociobehavioral and network measures) and height and weight measures (for calculating body mass index) were collected from adult Somali immigrants by bilingual study team members at community locations. Descriptive statistics were used to report the survey and biometric data. Logistic regression models were used to describe the basic associations of participants and network factors. Network data were analyzed to identify nodes and ties, to visualize the network, and to identify potential interventionists for a future social network intervention. RESULTS Of the 646 participants, 50% were overweight or affected by obesity. The network had 1703 nodes with 3583 ties between nodes, and modularity was high (0.75). Compared with respondents of normal weight, participants who were overweight or affected by obesity had more network members who were also overweight or obese (odds ratio [OR], 2.90; 95% CI, 1.11-7.56; P = .03); this was most notable for men (OR, 4.58; 95% CI, 1.22-17.22; P = .02) and suggestive for those 50 years or older (OR, 24.23; 95% CI, 1.55-377.83; P = .03). Weight loss intention among participants who were overweight or affected by obesity was associated with number of family members and friends trying to lose weight, enabling functional network factors (social norms for weight loss, social support for healthy eating, and social cohesion), and less favorable obesogenic social norms. CONCLUSIONS In this community sample of Somali immigrants, distinct social networks are clustered by weight status, and social contacts and functional network characteristics are related to individuals' weight loss intentions. These factors should be considered in weight loss interventions and programs. A social network intervention targeting weight loss, within a community-based participatory research framework, is feasible in this vulnerable population.
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Affiliation(s)
- Jane W Njeru
- Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| | | | | | - Paul J Novotny
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - Ahmed Osman
- Somali Community Resettlement Services, Rochester, MN, USA
| | - Yahye A Ahmed
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mohamud A Nur
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Omar Nur
- Somalia Rebuild Organization, Rochester, MN, USA
| | - Irene G Sia
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Reese AL, Hanza MM, Abbenyi A, Formea C, Meiers SJ, Nigon JA, Osman A, Goodson M, Njeru JW, Boursaw B, Dickson E, Wieland ML, Sia IG, Wallerstein N. The Development of a Collaborative Self-Evaluation Process for Community-Based Participatory Research Partnerships Using the Community-Based Participatory Research Conceptual Model and Other Adaptable Tools. Prog Community Health Partnersh 2019; 13:225-235. [PMID: 31564663 DOI: 10.1353/cpr.2019.0050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Established community-based participatory research (CBPR) partnerships need tools to assist with self-evaluation of the effectiveness and engagement with CBPR principles and to inform ongoing work. A growing part of the CBPR field is focused on the evaluation of partnering processes and outcomes. OBJECTIVES The Rochester Healthy Community Partnership (RHCP), a partnership with more than a decade of engagement in health promotion research, performed a self-evaluation in collaboration with the University of New Mexico Center for Participatory Research (UNM-CPR). METHODS We collaboratively developed and implemented a facilitated self-evaluation using adaptations of existing tools and the CBPR conceptual model. Partners contributed through surveys and qualitative interviews. Initially, data were analyzed collaboratively by members of RHCP and UNM-CPR, but RHCP partners further processed and consolidated findings, leading to the development of key questions that guided a full partnership discussion of action steps. RESULTS Our process confirmed the adaptability of existing tools and the CBPR conceptual model for the purpose of partnership reflection and self-evaluation. We offer the key findings of our assessment of partnering practices and directions for the future, and share our approach to collaborative analysis and dissemination. Our discussion includes lessons learned, with applicability to other established partnerships. CONCLUSIONS Our experience indicates that collective reflection is empowering for members of established partnerships, which can be facilitated by engagement in self-evaluation through the use of adapted, available tools. The incorporation of participatory processes adds complexity, but leads to a level of resonance and usefulness that would not have been obtained from a traditional evaluation.
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Wingo MT, Szostek JH, Sundsted KK, Post JA, Mauck KF, Wieland ML. Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2018. Am J Med 2019; 132:926-930. [PMID: 30853473 DOI: 10.1016/j.amjmed.2019.02.023] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 11/15/2022]
Abstract
The expansive scope of general internal medicine makes it difficult to identify practice-changing medical literature. Clinical updates can be facilitated by synthesizing relevant articles and implications for practice. Six internal medicine physicians reviewed the titles and abstracts in the 7 general internal medicine clinical outpatient journals with the highest impact factor and relevance to the internal medicine outpatient physician: New England Journal of Medicine (NEJM), Lancet, Annals of Internal Medicine, Journal of the American Medical Association (JAMA), JAMA-Internal Medicine, British Medical Journal (BMJ), and Public Library of Science (PLoS) Medicine. The following collections of article synopses and databases were also reviewed: American College of Physicians Journal Club, NEJM Journal Watch, BMJ Evidence-Based medicine, McMaster/DynaMed Evidence Alerts, and Cochrane Reviews. A modified Delphi method was used to gain consensus on articles based on clinical relevance to outpatient Internal Medicine, potential impact on practice, and strength of evidence. Article qualities and importance were debated until consensus was reached. Clusters of articles pertinent to the same topic were considered together. In total, 7 practice-changing articles were included.
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Affiliation(s)
- Majken T Wingo
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn.
| | - Jason H Szostek
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Karna K Sundsted
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Jason A Post
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Karen F Mauck
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Mark L Wieland
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
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Barwise A, Cheville A, Wieland ML, Gajic O, Greenberg-Worisek AJ. Perceived knowledge of palliative care among immigrants to the United States: a secondary data analysis from the Health Information National Trends Survey. Ann Palliat Med 2019; 8:451-461. [PMID: 30943736 DOI: 10.21037/apm.2019.02.06] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/27/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Immigrants to North America receive more interventions at end of life potentially due to knowledge gaps. The primary objective of this study was to measure and describe levels of perceived knowledge about palliative care among immigrants to the United States (US) compared to those born in the US. Our secondary objective was to identify trusted sources for seeking information about palliative care among immigrants and compare these trusted sources with those born in the US. We hypothesized that immigrants would have less knowledge of palliative care than those born in US and would trust different sources for information about palliative care. METHODS We analyzed data from the nationally representative 2018 Health Information National Trends Survey (HINTS 5, cycle 2). Questionnaires were administered via mail between January and May 2018 to a population-based sample of adults. The primary outcome of interest was assessed using the item "How would you describe your level of knowledge about palliative care?" The secondary outcome of interest was determined using the item "Imagine you had a strong need to get information about palliative care, which of the following would you most trust as a source of information about palliative care?" Descriptive statistics were calculated, and bivariate analyses run between the outcomes of interest and sociodemographic characteristics (age, sex, education, race/ethnicity, nativity, fluency with English). Multivariable logistic regressions were conducted to assess the role of nativity, controlling for relevant sociodemographic variables. Jackknife weighting was used to generate population-level estimates. RESULTS About 70% of those born in the US and 77% of immigrants (weighted) responded that they had "never heard of palliative care." Trusted sources of palliative care were very similar between the groups (all P>0.05). Both groups' preferred trusted source of palliative care knowledge was "health care provider," with over 80% of respondents in each group selecting this option. Printed materials and social media were the least popular trusted sources among both groups. After adjusting for relevant sociodemographic characteristics, we found no association between poor knowledge of palliative care and nativity (P=0.22). Female respondents had 2.5-fold increased odds of reporting low levels of perceived knowledge of palliative care (OR =2.58, 95% CI, 1.76-3.78; P<0.001). Education was an important predictor of perceived knowledge of palliative care; as education level increased, so did perceived knowledge of palliative care (P<0.001). CONCLUSIONS Perceived knowledge of palliative care is poor generally, regardless of birthplace. Trusted sources for palliative care are similar between immigrants and those born in the US. Education is important and is a strong predictor of perceived knowledge of palliative care. Women perceive they have lower levels of knowledge of palliative care (PC) than men. Differences in end of life care between immigrants and non-immigrants cannot be explained by knowledge differences.
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Affiliation(s)
- Amelia Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Andrea Cheville
- Division of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark L Wieland
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Reese AL, Hanza MM, Abbenyi A, Formea C, Meiers SJ, Nigon JA, Osman A, Goodson M, Njeru JW, Boursaw B, Dickson E, Wieland ML, Sia IG, Wallerstein N. The Development of a Collaborative Self-Evaluation Process for Community-Based Participatory Research Partnerships Using the Community-Based Participatory Research Conceptual Model and Other Adaptable Tools. Prog Community Health Partnersh 2019. [DOI: 10.1353/cpr.2019.0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Leppin AL, Okamoto JM, Organick PW, Thota AD, Barrera-Flores FJ, Wieland ML, McCoy RG, Bonacci RP, Montori VM. Applying Social Network Analysis to Evaluate Implementation of a Multisector Population Health Collaborative That Uses a Bridging Hub Organization. Front Public Health 2018; 6:315. [PMID: 30450355 PMCID: PMC6224340 DOI: 10.3389/fpubh.2018.00315] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/15/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Multisector collaboratives are increasingly popular strategies for improving population health. To be comprehensive, collaboratives must coordinate the activities of many organizations across a geographic region. Many policy-relevant models encourage creation and use of centralized hub organizations to do this work, yet there is little guidance on how to evaluate implementation of such hubs and track their network reach. We sought to demonstrate how social network analysis (SNA) could be used for this purpose. Methods: Through formative research, we defined and conceptualized key characteristics of a bridging hub network and identified a set of candidate measures—(1) network membership, (2) network interaction, (3) role and reach of the bridging hub, and (4) network collaboration—to evaluate its implementation within a pre-determined geographic region of Southeast Minnesota, USA. We then developed and administered a survey to assess outcomes as part of a SNA. We commented on the feasibility and usefulness of the methods. Results: The initial surveyed network consisted of 50 healthcare organizational sites and 50 community organizations representing sectors of public health, education, research, health promotion, social services, and long-term care and supports. Fifty-three of these organizations responded to the survey. The network's level of collaboration was “Cooperation” (level 2 of 5) and reported levels of collaboration varied by organization. Thirty-eight additional, unsurveyed organizations were identified as collaborators by respondents, pushing the theoretical network denominator up to 138 organizations. These additional organizations included grocery stores, ambulance services, and smaller, independent healthcare and community-based services focused on meeting the needs of underserved populations. The bridging hub organization had the highest betweenness centrality and was in good position to bridge healthcare and the community, although its organizational reach was estimated at only 51%. The SNA methods were feasible and useful for identifying opportunities and guiding implementation. Conclusions: Bridging hub organizations are not likely to link—or even be aware of—all relevant organizations in a geographic region at initial implementation. SNA may be a useful method for evaluating the value and reach of a bridging hub organization and guiding ongoing implementation efforts. Trial registration: http://ClinicalTrials.gov; #NCT03046498
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Affiliation(s)
- Aaron L Leppin
- Knowledge and Evaluation Research Unit, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, United States
| | - Janet M Okamoto
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ, United States
| | - Paige W Organick
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States
| | - Anjali D Thota
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States
| | | | - Mark L Wieland
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Rozalina G McCoy
- Division of Primary Care Internal Medicine, Division of Health Care Policy and Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Robert P Bonacci
- Department of Family and Community Medicine, Mayo Clinic, Rochester, MN, United States
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States
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Barwise A, Jaramillo C, Novotny P, Wieland ML, Thongprayoon C, Gajic O, Wilson ME. Differences in Code Status and End-of-Life Decision Making in Patients With Limited English Proficiency in the Intensive Care Unit. Mayo Clin Proc 2018; 93:1271-1281. [PMID: 30100192 PMCID: PMC7643629 DOI: 10.1016/j.mayocp.2018.04.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/28/2018] [Accepted: 04/17/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine whether code status, advance directives, and decisions to limit life support were different for patients with limited English proficiency (LEP) in the intensive care unit (ICU) as compared with patients whose primary language was English. PATIENTS AND METHODS We conducted a retrospective cohort study in adult patients admitted to 7 ICUs in a single tertiary academic medical center from May 31, 2011, through June 1, 2014. RESULTS Of the 27,523 patients admitted to the ICU, 779 (2.8%) had LEP. When adjusted for severity of illness, sex, education level, and insurance status, patients with LEP were less likely to change their code status from full code to do not resuscitate during ICU admission (odds ratio [OR], 0.62; 95% CI, 0.46-0.82; P<.001) and took 3.8 days (95% CI, 1.9-5.6 days; P<.001) longer to change to do not resuscitate. Patients with LEP who died in the ICU were less likely to receive a comfort measures order set (OR, 0.38; 95% CI, 0.16-0.91; P=.03) and took 19.1 days (95% CI, 13.2-25.1 days; P<.001) longer to transition to comfort measures only. Patients with LEP were less likely to have an advance directive (OR, 0.23; 95% CI, 0.18-0.29; P<.001), more likely to receive mechanical ventilation (OR, 1.26; 95% CI, 1.07-1.48; P=.005), and more likely to have restraints used (OR, 1.36; 95% CI, 1.11-1.65; P=.003). The hospital length of stay was 2.7 days longer for patients with LEP. Additional adjustment for religion, race, and age yielded similar results. CONCLUSION There are important differences in end-of-life care and decision making for patients with LEP.
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Affiliation(s)
- Amelia Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Biomedical Ethics Program, Mayo Clinic, Rochester, MN.
| | | | - Paul Novotny
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Mark L Wieland
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Michael E Wilson
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Biomedical Ethics Program, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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Wieland ML, Szostek JH, Wingo MT, Post JA, Mauck KF. Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2017. Am J Med 2018; 131:896-901. [PMID: 29496500 DOI: 10.1016/j.amjmed.2018.01.046] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 01/09/2023]
Abstract
Clinicians are challenged to identify new practice-changing articles in the medical literature. To identify the practice-changing articles published in 2017 most relevant to outpatient general internal medicine, 5 internists reviewed the following sources: 1) titles and abstracts from internal medicine journals with the 7 highest impact factors, including New England Journal of Medicine, Lancet, Journal of the American Medical Association, British Medical Journal, Public Library of Science Medicine, Annals of Internal Medicine, and JAMA Internal Medicine; 2) synopses and syntheses of individual studies, including collections in the American College of Physicians Journal Club, Journal Watch, and Evidence-Based Medicine; 3) databases of synthesis, including Evidence Updates and the Cochrane Library. Inclusion criteria were perceived clinical relevance to outpatient general medicine, potential for practice change, and strength of evidence. This process yielded 140 articles. Clusters of important articles around one topic were considered as a single-candidate series. A modified Delphi method was utilized by the 5 authors to reach consensus on 7 topics to highlight and appraise from the 2017 literature.
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Affiliation(s)
- Mark L Wieland
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Mayo Clinic School of Medicine, Rochester, Minn.
| | - Jason H Szostek
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Mayo Clinic School of Medicine, Rochester, Minn
| | - Majken T Wingo
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Mayo Clinic School of Medicine, Rochester, Minn
| | - Jason A Post
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Mayo Clinic School of Medicine, Rochester, Minn
| | - Karen F Mauck
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Mayo Clinic School of Medicine, Rochester, Minn
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