Perspectives on Finances and Mental Health Status among Low-Income Los Angeles Latinas

Abstract Research has established a link between financial challenges and mental health outcomes. Understanding this linkage among low-income Latinas who face unique experiences and challenges in relation to managing their household finances is important. This study utilized a community-based participatory qualitative research method to explore perspectives on financial and mental health among Latinas residing in Los Angeles County. The implications of this study are applicable when conducting a culturally responsive financial therapy program. Three focus groups were conducted with mainly immigrant, Spanish-speaking, low-income Latinas (n = 37). The study found that though participants face financial stressors tied to managing finances, they were eager to learn new skills and tools for improved financial practices and mental health therapies. For financial education interventions targeted to Latinas, it is best to use interventions that incorporate peer-support groups, improve knowledge about financial management tools and financial products available in the community, and therapeutic interventions to address financial stress. Key words: immigrants, household financial decision-making, savings, formal financial services, financial stres

Bridging the gap between research, policy, and practice: Lessons learned from academic-public partnerships in the CTSA network.

A primary barrier to translation of clinical research discoveries into care delivery and population health is the lack of sustainable infrastructure bringing researchers, policymakers, practitioners, and communities together to reduce silos in knowledge and action. As National Institutes of Health's (NIH) mechanism to advance translational research, Clinical and Translational Science Award (CTSA) awardees are uniquely positioned to bridge this gap. Delivering on this promise requires sustained collaboration and alignment between research institutions and public health and healthcare programs and services. We describe the collaboration of seven CTSA hubs with city, county, and state healthcare and public health organizations striving to realize this vision together. Partnership representatives convened monthly to identify key components, common and unique themes, and barriers in academic-public collaborations. All partnerships aligned the activities of the CTSA programs with the needs of the city/county/state partners, by sharing resources, responding to real-time policy questions and training needs, promoting best practices, and advancing community-engaged research, and dissemination and implementation science to narrow the knowledge-to-practice gap. Barriers included competing priorities, differing timelines, bureaucratic hurdles, and unstable funding. Academic-public health/health system partnerships represent a unique and underutilized model with potential to enhance community and population health

The People of the Forest: Indigenous Voices for Agency, Sustainability, and Health in Forest Conservation

Forest conservation is a global strategy for sequestering carbon and mitigating climate change, but the protection of forests can have unintended negative impacts on local populations, particularly on indigenous and other highly forest-dependent populations. Historically, a lack of inclusion of local populations in conservation planning and policy has impacted the cultural integrity and community well-being of local forest-dependent populations. To understand how forest conservation programs and policies have impacted local forest-dependent populations, we conducted first-person interviews with four communities living near the Dja Faunal Reserve in Cameroon, a UN World Heritage Site. Study findings include insights into communities concern for lack of inclusion in forest management, decreased forest resources, desire for sustainable livelihood-based opportunities to promote conservation outcomes, and knowledge of and attitudes towards health challenges and assets. Interviews illustrated distinct concerns from indigenous populations for loss of traditional knowledge and culture, how forest management has affected their livelihood and identified health determinants related to migration, loss of traditional lands, and institutional marginalization. Interviews present local challenges within forest conservation projects and provide evidence for rights-based inclusion of local populations in forest management going forward. Dialogue with local forest-dependent communities helps to gain an understanding of culture, livelihood, the forest-human relationship, environmental health, and self-determinism which are essential to identify opportunities to improve the health and sustainability of these populations in forest management

Pediatric Program Leadership's Contribution Toward Resident Wellness

BackgroundResidency program leaders are required to support resident well-being, but often they do not receive training in how to do so.ObjectiveTo determine frequency in which program leadership provides support for resident well-being, comfort in supporting resident well-being, and factors associated with need for additional training in supporting resident well-being.MethodsNational cross-sectional web-based survey in June 2015 of pediatric program directors, associate program directors, and coordinators about their experiences supporting resident well-being. Univariate and bivariate descriptive statistics compared responses between groups. Generalized linear modeling, adjusting for program region, size, program leadership role, and number of years in role determined factors associated with need for additional training.ResultsThe response rate was 39.3% (322/820). Most respondents strongly agreed that supporting resident well-being is an important part of their role, but few reported supporting resident well-being as part of their job description. Most reported supporting residents' clinical, personal, and health issues at least annually, and in some cases weekly, with 72% spending >10%of their time on resident well-being. Most program leaders desired more training. After adjusting for level of comfort in dealing with resident well-being issues, program leaders more frequently exposed to resident well-being issues were more likely to desire additional training (P < .02).ConclusionsProgram leaders spend a significant amount of time supporting resident well-being. Although they think that supporting resident well-being is an important part of their job, opportunities exist for developing program leaders through including resident wellness on job descriptions and training program leaders how to support resident well-being

Evaluation of COVID-19 vaccine implementation in a large safety net health system

ObjectivesTo evaluate rapid COVID-19 vaccine clinic implementation from January-April 2021 in the Los Angeles County Department of Health Services (LACDHS), the second-largest US safety net health system. During initial vaccine clinic implementation, LACDHS vaccinated 59,898 outpatients, 69% of whom were Latinx (exceeding the LA County Latinx population of 46%). LACDHS is a unique safety net setting to evaluate rapid vaccine implementation due to system size, geographic breadth, language/racial/ethnic diversity, limited health staffing resources, and socioeconomic complexity of patients.MethodsImplementation factors were assessed through semi-structured interviews of staff from all twelve LACDHS vaccine clinics from August-November 2021 using the Consolidated Framework for Implementation Research (CFIR) and themes analyzed using rapid qualitative analysis.ResultsOf 40 potential participants, 25 health professionals completed an interview (27% clinical providers/medical directors, 23% pharmacist, 15% nursing staff, and 35% other). Qualitative analysis of participant interviews yielded ten narrative themes. Implementation facilitators included bidirectional communication between system leadership and clinics, multidisciplinary leadership and operations teams, expanded use of standing orders, teamwork culture, use of active and passive communication structures, and development of patient-centered engagement strategies. Barriers to implementation included vaccine scarcity, underestimation of resources needed for patient outreach, and numerous process challenges encountered.ConclusionPrevious studies focused on robust advance planning as a facilitator and understaffing and high staff turnover as barriers to implementation in safety net health systems. This study found facilitators that can mitigate lack of advance planning and staffing challenges present during public health emergencies such as the COVID-19 pandemic. The ten identified themes may inform future implementations in safety net health systems

A qualitative study of COVID-19 vaccine decision making among urban Native Americans

BackgroundSignificant disparities in COVID-19 morbidity and mortality exist for Native American (NA) people, the majority of whom live in urban areas. COVID-19 vaccination is a key strategy for mitigating these disparities; however, vaccination disparities affect NA communities. The current study investigated COVID-19 vaccine decision-making before widespread vaccine rollout occurred, among urban NA communities. We aimed to understand vaccine decision-making factors to develop recommendations about COVID-19 vaccine outreach.MethodsWe conducted three in-depth virtual focus groups with 17 NA adults living in an urban community (Los Angeles County) between December 2020 and January 2021. Participants were recruited through NA community-based organizations and community stakeholders. Reflexive thematic analysis was conducted using Atlas.ti.FindingsParticipants in this study identified two overarching themes with implications for health vaccination campaigns. First, participants described a need for tailored information and outreach, including NA vaccine outreach that addresses misconceptions about vaccine development to calm fears of experimentation and support communication of vaccine evidence specific to NA people. Second, participants suggested strategies to improve public health resources in the urban NA community, such as the need for unified, proactive communication across trusted NA entities, navigation support to improve vaccine accessibility, and adequately resourcing health partnerships with and among trusted NA community agencies for improved reach.ConclusionIn this qualitative study, we found that urban NA participants reported several factors that affected their vaccine decision-making, including a lack of tailored information for their communities. Our findings also underscore the need to work with tribes, tribal leadership, and urban NA serving organizations to coordinate vaccine communication and distribution to urban communities where the majority of NAs now reside. Further, these findings have implications for COVID-19 vaccine outreach among urban NA communities and demonstrate the need for clear and tailored engagement about the COVID-19 vaccine