Advancing)Health)Equity)in)Asian)American) - - PowerPoint PPT Presentation
Advancing)Health)Equity)in)Asian)American) Communities:))Context,)Challenges,)and) Opportunity American)Academy)of)Health)Behavior March)6 th ,)2018 Nadia)Islam,)PhD Associate)Professor Department)of)Population)Health NYU)School)of)Medicine
American)Academy)of)Health)Behavior March)6th,)2018 Nadia)Islam,)PhD Associate)Professor Department)of)Population)Health NYU)School)of)Medicine
Source:(Woolf(SH,(Purnell(JQ.(The(Good(Life:(Working( Together(to(Promote(Opportunity(and(Improve(Population( Health(and(WellCbeing. JAMA. 2016I315(16):1706C1708.
IDENTITY CONTEXT AGENCY
OPPORTUNITY
Source:&Pew&Research&Center
In$NYC,"60%"of"Asians"citywide"are"LEP"with"rates"varying"across" Asian"ethnic"groups"(Chinese:"67%@"Korean"63%@"Vietnamese"61%@" Hindi"30%).
proficiency)
Asian&Americans&are&popularly&believed&to&have:
Sources:&Cheng,&J&of&Applied&Behavioral&Science&1997H&Kawai,&The& Howard&Journal&of&Communication.&2005.
Aug$31,$1987
The$Scripps$National$Spelling$Bee$Has$Co5Champions,$Again
Katy%Steinmetz @katysteinmetz May%28,%2015
14.3 16.5 10.7 19.0 10.8 9.3 Blacks Hispanics Asians
Asian Indians Koreans Chinese
Islam&N,@Wyatt@L,@Kapadia@S,@Marian@R,@TrinhIShevrin@C,@Kwon@S.@Diabetes@and@Associated@Risk@Factors@among@Asian@American@ Subgroups@in@New@York@City.@Diabetes@Care.@2013T@36:@e5.@@PMCID@3526197
3.23 3.06 3.31 2.56 2.91 1.83 2.73 2.00 2.14 0.81 1.16 1.98 Mean0yearly0HbA1c0checks0by doctor Mean0yearly0feet0checks0by doctor Blacks Hispanics Asians0overall Asian0Indians Koreans Chinese
Islam&NS,0et0al.0Asian0Americans0in0New0York0City0Face0Disparities0in0Diabetes0Management0Compared0to0Other0Racial/Ethnic0Minority0Groups0 (2014).0American&Journal&of&Public&Health.[Supplement03,02015,0Vol0105,0No.0S3
“We…focused+on+non-Hispanic+ Whites,+non-Hispanic+Blacks,+and+ Hispanics+in+line+with+much+of+the+ literature+on+health+disparities.”
Source:(Ahmad,(Farah(Z,(and(Christian(E.(Weller,(Reading(Between(the(Data:(The( Incomplete(Story(of(Asian(Americans,(Native(Hawaiians(and(Pacific(Islanders,(Center(for( American(Progress(,(February(2014. Source:(Asian(American(Center(for(Advancing(Justice,(A(Community(of(Contrasts:( Asian(Americans(in(the(United(States:(2011.
14 22 25 29 5 10 15 20 25 30 35 2012$Poverty$Rate,$% Non+Hispanic2White Non+Hispanic2Black Hispanic Non+Hispanic2Asian
Asian$Americans$are$a$Low$Income$Group$in$New$York$City
Source:(The(Center(for(Economic(Opportunity((CEO)(Poverty(Measure,(2005(@ 2012.(An( Annual(Report(from(the(Office(of(the(Mayor.(
We#will# consider# your#input# and#give# feedback# about#how# it#informed#
decisions We#will# ensure#that# your#input# is# considered# among#the# choices#we# implement We#will# work# together# and# incorporate# your#views# as#much#as# possible (CBPR)
We#will# implement# what#you# decide (CBPR)
! Fundamental*Principles*of*CBPR:
Funder(s): NIMHD(&(CDC
Overall(Goal: To(develop,(implement,(and(test(the(efficacy(of(a( CHW(intervention(designed(to(improve(diabetes(control(and( management(in(the(Bangladeshi(community(of(NYC
! 54% LEP ! 31% live in poverty ! 74% foreign-born
US-Census,-2010*
List of countries with the highest number of estimated cases of diabetes for 2000 and 2030
DREAM& Project& Coalition
Ethnic&Media Faith6Based& Organizations Community& Leaders&and& Representatives&
Community
CHWs%are%frontline%public%health% professionals%who%have%an%unusually% close%understanding%of%the%communities% they%serve%through%shared%ethnicity,% culture,%language,%and%life%experiences. Also%referred%to%as%… Promotor.es/.as Outreach$Workers Community$Health$Representatives Patient$Navigators/
! Improve(access(to(health(care(resources ! Improve(the(quality(and(cultural(appropriateness(of(service(delivery ! Help(others(integrate(disease(prevention(and(management(into(their( daily(lives( ! Organize(communities(to(improve(environmental,(physical(and(social( wellbeing ! Negotiate(cultural(&(linguistic(barriers(to(health ! Help(others(become(active(participants(in(their(own(health
USAID,(Community)and)Formal)Health)System)Support for)Enhanced)Community)Health)Worker Performance)Report,(2012 http://www.coregroup.org/storage/Program_Learning/Community _Health_Workers/chw%20evidence%20summit%20final%20rep
I/E&Eligibility: ! Bangladeshi&NYC&resident,&ages&25&– 85 ! Confirmed&Hemoglobin&A1c&of&≥&6.5 ! Cannot&be&pregnant,&on&renal&dialysis,&or&have&had&coronary& event&within&the&3&months&preceding&the&intervention
Study&Design:&RCT& Treatment Control+ 5&monthly&education&sessions&&&&&&&&&&&&&&&&&&&&&Introductory&Session&Only& 2&1v1&Visits&with&a&CHW “Wait&list”*Control*group*receives*introduction*education*session*only.**
Systems
Community
Individual
! Culturally(tailored(health(education ! Linguistically(tailored(access(to(care(and(patient(navigation ! Culturally(tailored(health(promotion(strategies ! Empowerment(&(enhancing(self:efficacy ! Providing(linkages(to(housing,(immigration,(and(other(services
!Promoting)positive) health)contexts)that) changes)access)to) material)resources " Increasing)access)to) affordable)physical) fitness)opportunities " Environmental) changes)in)faith: based)organizations,) ethnic)grocery) stores,)and) restaurants !Building)organizational) capacity
! Promoting)cultural) competency)within) healthcare)systems ! Advocating)for) responsive)healthcare) system)&)data) disaggregation)) ! Mechanisms)for)CHW) reimbursement)and) sustainability ! Integration)of)CHWs) within)primary)care) teams
Randomized (n = 336, 38%)
Allocated to Treatment Group (n = 176) Completed Intervention (n =135, 77%) Received Partial Intervention (n = 41, 23%) Allocated to Control Group (n = 160) Received BL Session (n = 160, 100%)
Screened for Eligibility (n =879)
Completed 6-month survey (n=144) Lost to follow-up (n=31) HbA1c Analyzed (n = 132, 75%) HbA1c Analyzed (n = 115, 72%) Completed 6-month survey (n=127) Lost to follow-up (n=14)
Total Excluded (n = 543), 62% I/E Criteria (n = 106), 20% Declined (n = 126), 23% Lost to Follow-Up (n = 311), 57%
*Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. Ann Intern Med 2001;134:657-62.
Allocation Follow-Up Analysis Enrollment
36.3 35.0 37.2 24.6 28.3 22.2 Overall0(p=0.034) Females0(p=0.446) Males0(p=0.035)
Proportion0of0Study0Participants0that0Achieved0 HbA1c0Control0at0Follow0Up
Intervention Control
0.2 0.7* 1.3** 2.4*** 0.0 0.2 0.4 0.6 0.0 0.5 1.0 1.5 2.0 2.5
Overall HbA1c5≥58.0 HbA1c5≥59.0 HbA1c5≥510.0
Treatment Control
*P=.0155A5**p=.001A5***p=.0115
52(y/o(Bangladeshi((Female,( Diabetic(for(3½((Years Initially(felt(uncomfortable(traveling(to( and(from(the(hospital(by(herself.(( Empowered(by(a(CHW(to(learn(how(to( travel(via(public(transportation,(and( take(charge(of(her(own(health.((Since( 2011,(she(has(referred(several(friends( and(family(members(into(the(project( and(remains(an(active(volunteer.
replication'of'CHW'model
strategy
https://med.nyu.edu/asian> health/research/dream/dream>project> materials
Asian&Americans&are& understudied&and&clear&lack&of& evidence&base&of&what&works& and&doesn’t&work Asian&American&communities&have& the&capacity and&desire to& engage&in&health&research.
Model&Minority&Stereotype& remains&a&persistent&challenge.
Support&for data&disaggregation&and&policy& translation
Community.health.worker. approaches.are.feasible,. acceptable,.and.effective. Place>based&strategies&&& community>clinical&linkages to. reach.LEP.and.linguistically. isolated.communities Harnessing.EHR.and.healthcare. reform.efforts
CONTEXT OPPORTUNITY
Nadia.islam@nyumc.org
med.nyu.edu/asianChealth |%facebook.com/NYU.CSAAH |% @NYU_CSAAH
This%presentation%was%supported%in%part%by%the%NYU%Center%for%the%Study%of%Asian%American%Health%(NIH% National%Institute%for%Minority%Health%&%Health%Disparities%grant%#%P60MD000538),%the%NYUCHHC%Clinical% and%Translational%Science%Institute%(NIH%National%Center%for%Advancing%Translational%Sciences%grant% #UL1TR001445),%and%the%NYUCCUNY%PRC%(Centers%for%Disease%Control%and%Prevention%cooperative% agreement%number%#U48DP005008).