Community-Based Settings and Sampling Strategies: Implications for Reducing Racial Health Disparities Among Black Men, New York City, 2010–2013

Introduction Rates of screening colonoscopies, an effective method of preventing colorectal cancer, have increased in New York City over the past decade, and racial disparities in screening have declined. However, vulnerable subsets of the population may not be reached by traditional surveillance and intervention efforts to improve colorectal cancer screening rates. Methods We compared rates of screening colonoscopies among black men aged 50 or older from a citywide random-digit–dial sample and a location-based sample focused on hard-to-reach populations to evaluate the representativeness of the random-digit–dial sample. The location-based sample (N = 5,568) was recruited from 2010 through 2013 from community-based organizations in New York City. Descriptive statistics were used to compare these data with data for all black men aged 50 or older from the 2011 cohort of the Community Health Survey (weighted, N = 334) and to compare rates by community-based setting. Results Significant differences in screening colonoscopy history were observed between the location-based and random-digit–dial samples (49.1% vs 62.8%, P \u3c .001). We observed significant differences between participants with and without a working telephone among the location-based sample and between community-based settings. Conclusions Vulnerable subsets of the population such as those with inconsistent telephone access are excluded from random-digit–dial samples. Practitioners and researchers should consider the target population of proposed interventions to address disparities, and whether the type of setting reaches those most in need of services

Protocol for the DREAM Project (Diabetes Research, Education, and Action for Minorities): a randomized trial of a community health worker intervention to improve diabetic management and control among Bangladeshi adults in NYC

BACKGROUND: New York City (NYC) is currently home to the largest Bangladeshi population in the United States (US) at approximately 62,000 individuals. The high prevalence of Type 2 diabetes mellitus (T2DM) among Bangladeshis has been well documented in Bangladesh, as well as in Canada and the United Kingdom (UK). However, little is known about the diabetes prevalence and management practices of US Bangladeshis. This paper describes the protocol for a Community Health Worker (CHW) intervention to improve diabetic management and control among Bangladeshis with diabetes in NYC. METHODS/DESIGN: For a two-arm, randomized controlled trial (RCT), investigators will recruit a sample of 256 participants, all of whom are 1) of Bangladeshi descent, 2) residing in NYC, 3) diagnosed with T2DM and a recent Hemoglobin A1c (HbA1c) of ≥ 6.5, and 4) between the ages of 21–85. The treatment group receives a six-month CHW-led intervention consisting of five monthly group educational sessions, two one-on-one visits, and follow-up phone calls as needed from a CHW. The control group receives an introductory educational session only. Primary and secondary outcomes include clinical and behavioral measures, such as HbA1c and weight change, access to and utilization of care (i.e. appointment keeping and use of specialty care), and knowledge and practice of physical activity and healthful eating. Additionally, information regarding CHW characteristics, the processes and mechanisms for influencing healthful behavior change, and fidelity of the intervention are collected. Outcomes are measured at Baseline, 3-Months, 6-Months for both groups, and at 12-Months for the treatment group. DISCUSSION: To our knowledge, this study represents the first attempt to document the efficacy of T2DM management strategies in the NYC Bangladeshi population. Thus, future qualitative and quantitative findings of the submitted protocol will fill an important gap in the health disparities literature. TRIAL REGISTRATION: NCT0204159

A Culturally Adapted Diabetes Prevention Intervention in the New York City Sikh Asian Indian Community Leads to Improvements in Health Behaviors and Outcomes

Sikh Asian Indians are an underserved, minority group demonstrating high rates of diabetes. Community health workers (CHWs) are effective in addressing health disparities by reaching socially and linguistically isolated populations. There are no culturally adapted programs for diabetes prevention among Sikh Asian Indians, thus, this study tests the efficacy of a culturally tailored CHW intervention to improve diabetes prevention-related outcomes among Sikh Asian Indians at risk for diabetes. A quasi-experimental two-arm intervention among Sikh Asian Indian adults at risk for diabetes and living in New York City (n = 160) was conducted in 2013-2014. The treatment group received six monthly CHW group education sessions and ten follow-up phone calls; the control group received the first session. Main outcome categories included weight, body mass index (BMI), blood pressure (BP), physical activity (PA), diet, and health self-efficacy. Positive and significant changes in weight, BMI, and diabetes prevention-related indicators were seen among both study groups. However, only treatment group participants showed significant changes over time for weight, BMI, PA self-efficacy, and health-related self-efficacy. Significant between-group differences were seen in adjusted analyses for weight, BMI, systolic BP, total weekly PA, PA self-efficacy, PA social interaction, portion control, barriers to healthy eating, and health self-efficacy. At 6 months, treatment participants were more likely to lose ≥ 5% and ≥ 7% of their weight compared to control participants (p = .071, and p = .015, respectively). Findings demonstrate that a culturally adapted CHW diabetes prevention program in the Sikh community is efficacious, adding to the growing literature on CHWs’ capacity to address health inequity among underserved populations

Awareness of high blood pressure by nativity among black men : implications for interpreting the immigrant health paradox

Unidad de excelencia María de Maeztu MdM-2015-0552This publication is in the public domain and is therefore without copyright. All text from this work may be reprinted freely. Use of these materials should be properly citedIntroduction: differences in the social determinants of health and cardiovascular health outcomes by nativity have implications for understanding the immigrant health paradox among black immigrants. We aimed to understand whether blood pressure awareness, a precursor to achieving blood pressure control among hypertensive patients, varied by nativity among a sample of black men. - Methods: data were collected from 2010 through 2014. In 2016, we conducted logistic regression models using data from a large sample of urban-dwelling middle-aged and older black men. All men in the study had measured high blood pressure at the time of enrollment and were also asked whether they were aware of having high blood pressure. Independent variables included demographics, socioeconomic status, access to care, and health-related behaviors. - Results: foreign-born participants were significantly less likely than US-born participants to report awareness of having high blood pressure (P < .001). We observed a significant positive relationship between proportion of life spent in the US and being aware of having hypertension (β = 0.863; 95% CI, 0.412-1.314; P < .001). This relationship remained after adjusting the model for salient independent variables (β = 0.337; 95% CI, 0.041-0.634; P = .03). - Conclusions: difference in hypertension awareness by nativity may skew surveillance estimates used to track health disparities by large heterogeneous racial categories. Our results also indicate that prior health care experience and circumstances should be considered when studying the immigrant health paradox

The Asian American Hepatitis B Program: Building a Coalition to Address Hepatitis B Health Disparities

Background: Community coalitions are increasingly recognized as important strategies for addressing health disparities. By providing the opportunity to pool resources, they provide a means to develop and sustain innovative approaches to affect community health. Objectives: This article describes the challenges and lessons learned in building the Asian American Hepatitis B Program (AAHBP) coalition to conduct a community-based participatory research (CBPR) initiative to address hepatitis B (HBV) among New York City Asian-American communities. Methods: Using the stages of coalition development as a framework, a comprehensive assessment of the process of developing and implementing the AAHBP coalition is presented. Lessons Learned: Findings highlight the importance of developing a sound infrastructure and set of processes to foster a greater sense of ownership, shared vision, and investment in the program. Conclusion: Grassroots community organizing and campus-community partnerships can be successfully leveraged to address and prevent a significant health disparity in an underserved and diverse community.http://muse.jhu.edu/journals/progress_in_community_health_partnerships_research_education_and_action/v005/5.3.trinh-shevrin.htm

Protocol for project IMPACT (improving millions hearts for provider and community transformation): a quasi-experimental evaluation of an integrated electronic health record and community health worker intervention study to improve hypertension management among South Asian patients

Background: The Million Hearts® initiative aims to prevent heart disease and stroke in the United States by mobilizing public and private sectors around a core set of objectives, with particular attention on improving blood pressure control. South Asians in particular have disproportionately high rates of hypertension and face numerous cultural, linguistic, and social barriers to accessing healthcare. Interventions utilizing Health information technology (HIT) and community health worker (CHW)-led patient coaching have each been demonstrated to be effective at advancing Million Hearts® goals, yet few studies have investigated the potential impact of integrating these strategies into a clinical-community linkage initiative. Building upon this initiative, we present the protocol and preliminary results of a research study, Project IMPACT, designed to fill this gap in knowledge. Methods: Project IMPACT is a stepped wedge quasi-experimental study designed to test the feasibility, adoption, and impact of integrating CHW-led health coaching with electronic health record (EHR)-based interventions to improve hypertension control among South Asian patients in New York City primary care practices. EHR intervention components include the training and implementation of hypertension-specific registry reports, alerts, and order sets. Fidelity to the EHR intervention is assessed by collecting the type, frequency, and utilization of intervention components for each practice. CHW intervention components consist of health coaching sessions on hypertension and related risk factors for uncontrolled hypertensive patients. The outcome, hypertension control ((BP) andBP), is collected at the aggregate- and individual-level for all 16 clinical practices enrolled. Discussion: Project IMPACT builds upon the evidence base of the effectiveness of CHW and Million Hearts® initiatives and proposes a unique integration of provider-based EHR and community-based CHW interventions. The project informs the effectiveness of these interventions in team-based care approaches, thereby, helping to develop relevant sustainability strategies for improving hypertension control among targeted racial/ethnic minority populations at small primary care practices. Trial registration: This study protocol has been approved and is made available on Clinicaltrials.gov by NCT03159533 as of May 17, 2017

A Place-Based Community Health Worker Program: Feasibility and Early Outcomes, New York City, 2015

Introduction: This study examined feasibility of a place-based community health worker (CHW) and health advocate (HA) initiative in five public housing developments selected for high chronic disease burden and described early outcomes. Methods: This intervention was informed by a mixed-method needs assessment performed December 2014–January 2015 (representative telephone survey, n¼1,663; six focus groups, n¼55). Evaluation design was a non-randomized, controlled quasi-experiment. Intake and 3-month follow-up data were collected February–December 2015 (follow-up response rate, 93%) on 224 intervention and 176 comparison participants, and analyzed in 2016. All participants self-reported diagnoses of hypertension, diabetes, or asthma. The intervention consisted of chronic disease self-management and goal setting through six individual CHW-led health coaching sessions, instrumental support, and facilitated access to insurance/ clinical care navigation from community-based HAs. Feasibility measures included CHW service satisfaction and successful goal setting. Preliminary outcomes included clinical measures (blood pressure, BMI); disease management behaviors and self-efficacy; and preventive behaviors (physical activity). Results: At the 3-month follow-up, nearly all intervention participants reported high satisfaction with their CHW (90%) and HA (76%). Intervention participants showed significant improvements in self-reported physical activity (p¼0.005) and, among hypertensive participants, self-reported routine blood pressure self-monitoring (p¼0.013) compared with comparison participants. No improvements were observed in self-efficacy or clinical measures at the 3-month follow-up. Conclusions: Housing-based initiatives involving CHW and HA teams are acceptable to public housing residents and can be effectively implemented to achieve rapid improvements in physical activity and chronic disease self-management. At 3-month assessment, additional time and efforts are required to improve clinical outcomes

Improving access to health care for chronic hepatitis B among migrant Chinese populations: a systematic mixed methods review of barriers and enablers.

Migrant Chinese populations in Western countries have a high prevalence of chronic hepatitis B but often experience poor access to healthcare and late diagnosis. This systematic review aimed to identify obstacles and supports to timely and appropriate health service use among these populations. Systematic searches resulted in 48 relevant studies published between 1996 and 2015. Data extraction and synthesis were informed by models of healthcare access that highlight the interplay of patient, provider and health system factors. There was strong consistent evidence of low levels of knowledge among patients and community members; but interventions that were primarily focused on increasing knowledge had only modest positive effects on testing and/or vaccination. There was strong consistent evidence that Chinese migrants tend to misunderstand the need for healthcare for hepatitis B and have low satisfaction with services. Stigma was consistently associated with hepatitis B and there was weak but consistent evidence of stigma acting as a barrier to care. However, available evidence on the effects of providing culturally appropriate services for hepatitis B on increasing uptake is limited. There was strong consistent evidence that health professionals miss opportunities for testing and vaccination. Practitioner education interventions may be important but evidence of effectiveness is limited. A simple prompt in patient records for primary care physicians improved the uptake of testing; and a dedicated service increased targeted vaccination coverage for new-borns. Further development and more rigorous evaluation of more holistic approaches that address patient, provider and system obstacles are needed

Chinese Americans’ Views and Use of Family Health History: A Qualitative Study

Objective Family health history (FHH) plays a significant role in early disease detection and preven- tion. Although Asian Americans are the fastest growing U.S. immigrant group, no data exists regarding Chinese Americans’ (the largest Asian subgroup) views and use of FHH. This study examines this important issue. Methods Forty-nine adults from southern U.S. Chinese American communities participated in this qualitative, semi-structured, in-depth interview study. Interviews were audio recorded, tran- scribed, and analyzed with a content analysis approach. Results Although the majority of participants perceived the importance of collecting FHH, most lacked FHH knowledge and failed to collect FHH information. Barriers affecting FHH collec- tion and discussion among family members included long-distance separation from family members, self-defined “healthy family,� and Chinese cultural beliefs. Lack of doctors’ inqui- ries, never/rarely visiting physicians, self-defined “healthy family,� perceived insignificance of discussing FHH with doctors, and Chinese cultural beliefs were the obstacles in commu- nicating FHH with physicians. Conclusions Chinese Americans had limited usage of their FHH and faced cultural, distance, knowl- edge-, and healthcare system-related barriers that influenced their FHH use. Developing FHH education programs for Chinese Americans is highly recommended