A WHOLE COMMUNITY APPROACH TO HEALTH DISPARITIES AND SOCIAL DETERMINANTS AUTHORS: MIRANDA POLLOCK, JEANETTE GUSTAT PHD, MPH, JULIA SILVER, ASHLEY WENNERSTROM PHD, MPH
BACKGROUND The infant mortality rate (IMR) in Louisiana is 8.16 (per 1,000 live births), while the national average is 5.98. The IMR in Louisiana was 12.3 (per 1,000 live births) for Black mothers, while only 5.7 for White mothers.
BACKGROUND (CONT.) Many disparities in MCH populations are due to the social determinants of health, such as poverty, educational status, gender, and race. MCH Life Course experts point toward whole community approaches and collaborative, networked models at each level of care to eliminate health disparities and reduce chronic illness.
OVERVIEW Goal: Develop capacity of community residents to make changes in social determinants of health Strategy: Train community residents on strategies to improve social determinants of health
METHODS Hosted two community training institutes called New Orleans Leadership Education and Action on health Disparities (NOLA LEADs) Covered health disparities, leadership skills, community assessment, understanding data, coalition building, change strategies and communicating with policymakers
SELECTION CRITERIA & RECRUITMENT • Not working in public health currently • Interesting in improving community health • Lived in N.O. for 3+ years • Not planning to move away from N.O.
TRAINING LOCATIONS Churches in two communities with low life expectancy Lower 9 th Ward (70117) All Souls Church Broadmoor (70125) Gloria Dei Church
CURRICULUM OVERVIEW Session T opics 1 Overview of health disparities and social determinants of health 2 Defining and developing leadership skills 3 Coalition building 4 Community assessment 5 Making change part 1: Strategies and planning 6 Making change part 2: Communicating with policymakers
DATA COLLECTION Baseline survey Pre-post knowledge tests each day Class evaluations each day 6-month follow-up (Begins in March for Cohort 1)
PARTICIPANTS CHARACTERISTICS (2 COHORTS) Demographic Characteristics of Community Health Training Participants Characteristics N (=42) % Sex Female 38 92.7 Male 3 7.3 Ethnicity African-American 38 92.7 White 3 7.1 Education Less than high school 2 4.9 High school or GED 10 24.4 Some college 14 34.2 Bachelor’s degree 9 22.0 Graduate degree 6 14.6
PARTICIPANT CHARACTERISTICS CONTINUED Annual household income n % Less than $10,000 9 4.6 $10,000-$19,999 10 30.6 $20,000-$29,999 3 8.3 $30,000-$39,999 2 5.6 $40,000-$49,999 4 11.1 $50,000 or more 5 19.4 Occupational type Works full-time 8 23.3 Works part-time 1 4.7 Retired 13 30.2 Unemployed 18 41.9 Age (median years, SD) 61.5, 13.9 Range (years) 29.0 – 76.0 25% Quartile 55 75% Quartile 71
DATA ANALYSIS Pre/Post Survey Data Session Mean Pre-Test Median Pre-Test Mean Post-Test Median Post- Test Score (%), SE Score %, (IQR) Score % Score % (IQR) 1 65.94%, 3.37 60% (20) 65.14%, 4.87 60% (60) 2 69.23%, 3.27 80% (20) 75.26%, 3.95 80% (40) 3 25.88, 4.182 20% (40) 52.73%, 6.67 60% (60) 4 22.42%, 4.15 20% (40) 38.12%, 5.41 40% (60) 5 26.31%, 2.83 20% (20) 60.00%, 5.90 60% (40) 6 68.48%, 4.15 80% (20) 80.65, 4.40 80% (40) Total 47.60%, 1.84 46.66% (13.33) 62.25%, 2.64 56.86% (30)
DATA ANALYSIS With the exception of Session 1, there was a significant (p ≤ .05) difference in pre- and post- scores between all of the sessions Follow-up to assess longer-term changes will consist of re-administering the baseline survey, and conducting in- depth interviews with participants at 6 months post- training.
PARTICIPANT PERCEPTIONS OF PROGRAM "This is an ongoing process, but I am learning how to be part of the solution. "Can't hardly wait for next Saturday. I really enjoyed the class. It was educational and informative." "The information was very informative. Presentation was great. Learned a whole lot that I can take back to my family and friends." "Every guest speaker has been outstanding in their presentation. The speakers are informative, educated and willing to share their knowledge with us. Very thankful and grateful for these classes."
CONCLUSIONS We anticipate this new model of training will strengthen community capacity to affect change. Involving people outside the public health workforce may be a strategy for promoting health equity. Health equity and community capacity in New Orleans may lead to better MCH outcomes.
THANK YOU! PI: Ashley Wennerstrom, PhD, MPH awenners@Tulane.edu 504-988-4007 Co-PI: Jeanette Gustat, PhD, MPH Gustat@Tulane.edu 504-988-1029 Research Assistants: Miranda Pollock Julia Silver Krewe de Lose representative: Nina Red
REFERENCES Stats on the State of Louisiana. Centers for Disease Control and Prevention. 2013; https://www.cdc.gov/nchs/pressroom/states/la_2014.pdf. Accessed January 8, 2017. Maternal and Child Health Data Indicators. Louisiana Department of Health. 2012; http://dhh.louisiana.gov/assets/oph/CenterPHCH/CenterPH/maternal/IndicatorProfiles/Louisiana_12.pdf. Accessed January 8, 2017. Braveman P , Gottlieb L. The social determinants of health: it's time to consider the causes of the causes. Public Health Rep. Jan-Feb 2014;129(Suppl 2):19-31. United States Census Bureau State and County Quick Facts. http://quickfacts.census.gov/qfd/states/22/2255000.html. Accessed 5 April 2015. Bureau USC. American FactFinder datafiles from 2006-2010 ACS 5-Year Estimates: New Orleans, LA2010. Halfon, N, Larson, Lu, M Tullis, E, Russ, S. Lifecourse Health Development: Past, Present and Future. Maternal and Child Health Journal. 2014;18:344–365
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