Patricia Dunphy Suplee PhD, RNC-OB Rutgers University-Camden Bonnie Jerome-D’Emilia PhD, MPH, RN Rutgers University-Camden Marcia R. Gardner PhD, RN, CPNP,

Using Community Based Participatory Research to

Understand the Health Needs of Urban Hispanic

Women and ChildrenPatricia Dunphy Suplee PhD, RNC-OB

Rutgers University-Camden

Bonnie Jerome-D’Emilia PhD, MPH, RN

Rutgers University-Camden

Marcia R. Gardner PhD, RN, CPNP, CPN

Seton Hall University

The study was supported by research grants from Eta Mu Chapter, Sigma Theta Tau International Xi Chapter, Sigma Theta Tau International

We appreciate the support of clergy and staff of St. Anthony of Padua Church, Camden, N.J. & two RN/BSN students – Vivian Velez & Jenny Gomez for their assistance with data collection

Acknowledgements

Community needs assessments are critical to the development of health care services and health policy

Inequities in access and use of health services likely contribute to health disparities

Hispanic population is the largest minority group and fastest growing immigrant population in U.S.

Hispanic population: ◦ Poverty◦ Lack of education◦ Uninsured◦ Language and cultural barriers◦ Disparity in use of preventive services

Overview

Racial/Ethnic Disparities(Schor et al., 2011)

Receive recommended screening & preventive care

Insurance by Race/Ethnicity

Preventive care0

102030405060708090

100

WhiteBlackHispanic

Uninsured status0

102030405060708090

100

WhiteBlackHispanic

69% Hispanic (47%-Camden City) 41% below federal poverty line (38%) 40% of families with female head of household (FHH) (39%) 56% of Camden families with FHH below federal poverty line (CamConnect, 2008)

Women make most of the health care decisions for their families.

Setting: Cramer Hill Neighborhood Camden, NJ

Camden, NJ

Draw attention to the healthcare needs and concerns of this population of low income Hispanic women with the hope of gaining knowledge and community connection that would allow for the development of interventions to empower women by improving their ability to access care

By improving a woman’s ability to access care for herself - she will improve her ability to access care for her children; therefore the health status of the family would ultimately improve

Overarching Goals

Encourage community participation in a needs assessment survey process

Use key informants & community based focus groups to validate a research team developed, population specific survey

Administer the survey to women from a predominantly poor, medically underserved Hispanic community of Camden, NJ

Objectives

Framework Social-ecological

perspective Informed by Community-

based participatory approaches◦ Partnership◦ Local champions◦ Community advisory group◦ Community knows itself and

creates solutions◦ Bridging gap between

generation of evidence and translation to practice and use

(CDC, http://www.cdc.gov/ViolencePrevention/overview/social-ecologicalmodel.html)

Societal

Community

Relationship

Individual

Method

Phase I Phase II

Development of 94 item Health Needs Assessment Survey (HNAS)

Translation & back translation

Semi-structured interview & elicitation prompts• Focus group #1: Spanish-

fluent college & nursing students

• Focus group #2: Community champions

Cross sectional research design

Convenience sample of women attending Sunday church services

Sample 66 self-identified

Hispanic women Mean age =46 (21-79) Married=42% U.S. citizens = 67% Non-citizens =32%

◦ 48% Undocumented (n=10)

◦ 52% Green Card (n=11)

Employed =61%

<High school education=26%

High school graduate= 74%

Parent of child 0-18 years =50%

Mean age at first birth =24.5 years (15-45 y)

Mean number of births =3 (1-8)

15%

29%

32%

14%

Origin by self report

MexicanPuerto RicanDominicanUnited States

Sample

Sources of Care 37% - use emergency

department (ED) as primary source of care

6% - have no usual primary source

57% - use MD or clinic as primary source

Undocumented women – 45.5% use ED as primary source of care

Women with MD or clinic as usual source of care – 59% had to wait more than a week for an appointment

15% 3%

29%

1%

52%

Employer Spouse Medicaid

Medicare Uninsured

Insurance Status

16%

13%

23%13%

35%cost of care distance or transportation

hours not convenient staff uncaring

linguistic dissonance

Reasons for Dissatisfaction with Care

HP variables0

10

20

30

40

50

60

70

80

90

100 BMI>25

PAP smear

BP check

Physical exam

Eye exam

Mammogram

Blood sugar

Colonoscopy

Health Promotion

Average BMI = 28.265% had BMI >25 and of those 26% had BMI

>3058% of women felt they were overweight32% thought weight was just right67% reported trying to lose weight

Significance: the majority of women who were overweight & all of the women considered obese were trying to lose weight (p=0.002)

Weight

HTNDiabetesPreterm birthOtherNone of these

Prenatal Conditions

Stressors0

10

20

30

40

50

60

70

80

90

100 Food access

Location

Other

Children's Health

My Health

Bills

Sources of Stress

access or own0

102030405060708090

100

computer & internet

cell phone

text message

Access to Technology

27% use ED for routine illness care 45% use doctor’s office; 12% use clinic 15% report no usual source of care 92% satisfied all or most of time with care Women who use the ED for their child’s care were more likely to report satisfaction with care all of the time & those who used clinic were more likely to report satisfaction some of the time (p=0.01)

Child care Patterns

15% (n=5) of women reported having a child identified with a developmental problemSpeech delaysCerebral palsyAutism

Two of these mothers were dissatisfied with their children’s treatment

Children’s Developmental Health

Large number of undocumented “invisible” individuals in community

Higher than expected rate of uninsured Use of ED for primary care services Low rates of preventive care use Primary reason for dissatisfaction with

current health care services – language barriers

Majority of women were overweight or obese Majority have access to technology

Major Points

Partnering with faith-based organization worked--grounded in CBPR

Multi-phase methodology for development of culturally-sensitive instrument

Understanding of health care access patterns and community needs

Need to develop targeted, culturally appropriate interventions via CBPR methods• access to technology• church as fulcrum

Continue student & community engagement

Implications

Interventions should specifically focus on:◦ weight reduction programs for women◦ improving access to primary care thus decreasing use of the

ED◦ decreasing wait time for primary care appointments◦ ensuring cultural competence in local providers

With full implementation of the ACA in 2014, more of these women will be eligible for Medicaid, which may facilitate access to care

Potential shortages of primary care providers & inadequate federal financing for charity care institutions may delay any real benefit that these women can expect to receive

Future

Convenience sample – Church community

Small sample sizeDiverse Hispanic population

Limitations

CamConnect (2008). Camden Facts. Retrieved from http://www.camconnect.org/fact/map_main.html

Center for Disease Control and prevention (CDC). 2009. Retrieved from http://www.cdc.gov/ViolencePrevention/overview/social-ecologicalmodel.html)

Child and Adolescent Health Measurement Initiative. 2005/2006 National Survey of Children with Special Health Care Needs, Data Resource Center for Child and Adolescent Health website. Retrieved from http://www.cshcndata.org

D’Emilia, B. & Suplee, PD. (2012). The ACA and the undocumented. American Journal of Nursing,112(4), 21-7.

Kaiser Family Foundation. (KFF) (2010).The uninsured: A primer. The Kaiser Commission on Medicaid and the Uninsured. Retrieved from http://www.state.nj.us/health/rhc/finalreport/documents/entire_finalreport.pdf

Pew Hispanic Center (2010). Statistical profiles of the Hispanic and foreign-born populations in the U.S. Retrieved from: http://pewhispanic.org/

Schor, E., Berenson, J., Shi, A., Collins, S.R. , Schoen, C. ,Riley, P. & Dermody, C. (2011). Ensuring equity: A post-reform framework to achieve high performance healthcare for vulnerable populations. Retrieved from http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2011/Oct/1547_Schor_ensuring_equity_postreform_vulnerable_populations_v2.pdf

References