A WHOLE COMMUNITY APPROACH TO HEALTH DISPARITIES AND SOCIAL - - PowerPoint PPT Presentation

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 9th Ward

(70117)

• All Souls Church
• Broadmoor (70125)
• Gloria Dei Church

CURRICULUM OVERVIEW

Session T

• pics

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 Score (%), SE Median Pre-Test Score %, (IQR) Mean Post-Test Score % Median Post- Test 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

• f 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