Building Health Equity Through Participatory Health Assessment

Jessie Schwiesow, BS, Yvette Castaneda, MPH, Emily Bray, MA, Anna Mayer, Jennifer Hebert-Beirne, PhD, MPH*

Participatory Qualitative Analysis

Background Since summer 2011, academic and community partners from UIC SPH and Little Village (LV), have been working together on an iterative assessment to better understand health in LV. For this study, health is defined by the World Health Organization’s definition which encompasses “a complete state of physical, mental, and social well-being, not merely the absence of disease or infirmity” (WHO, 2014).

This mixed-methods assessment is a Community Based Participatory Research (CBPR) effort with all assessment activities guided by community partner organizations which actively engaged in health and well-being efforts in LV. Traditional public health assessment approaches and methods are not designed to explore root causes of poor health. Nor are they able to name the complex influences that affect the health of predominantly immigrant and racial/minority communities. This pilot research is a deliberate attempt to advance community health assessment methods so that they go beyond describing racial and ethnic characteristics of residents and instead name and understand factors in the social environment that impact the conditions in which one lives and the opportunities they have to be healthy – key issues to understanding racial and ethnic health inequities.

Major Themes

Methodology employed through the participatory research process include:

• Secondary data analysis of existing health and social data • Community Health Survey (pending) • Interviews (12) • Focus groups (10) • Oral histories (20).

Methodology

Interview guides were created with equitable feedback from community and academic stakeholders. The open-ended questions posed to participants provided rich contextual information not typically captured in health assessments.

Participatory qualitative analysis occurred through bimonthly “think-tank” meetings held locally within the community and at UIC SPH. Phenomenology was employed as an epistemological lens emphasizing underlying meanings of experiences and perspectives relayed by research participants.

Mental Health • Primary concern across all age groups

•  Compounded by exposure to daily cumulative economic and social stressors.

•  Includes fear of gang, community and interpersonal violence, deportation and the unknown. • Barriers to mental health seeking include social and cultural stigma and fear.

Community-identified stakeholders were interviewed through focus groups and individual interviews. The map to the left represents the geo-distribution of participants.

Secondary Data Analysis Quantitative data analysis of existing health and social data, initially organized around 6 Chicago Department of Public Health (CDPH) identified health priority areas, including:

CDPH Priorities •  Violence Prevention •  Access to Care •  Adolescent Health •  Obesity •  Healthy Moms &

Babies •  Healthy Homes

Tailored Topics •  Mental Health •  Occupation •  Immigration •  Community Assets

Major Data Sources: •  2007-2011 American Community

Survey (see map above) • Chicago Department of Public

Health Health and Social Indicators

• Behavioral Risk Factor Surveillance and Youth Risk Behavior Surveillance

* Research Partners

Ongoing member checking with community partners has been a fundamental component throughout the research process.

Impact of Migration and Acculturative Strain on Community Health

• Migration influences occupation and social position leaving few opportunities for social mobility.

• Engage in low wage high risk work which increases the risk for injury, disability, and exploitation. Also impacts family dynamic and shifts caregiver roles.

• Documentation status can be divisive at community level. People fear deportation which can cause isolation and changes in health and help seeking.

Hope/Optimism •  The combination of cultural,

financial and familial assets makes Little Village a powerhouse.

•  Strength and power of community members was identified as a major asset, particularly in youth

•  Strong safety net of nonprofits and community resources were identified as a major asset and vehicle for change.

Perceived Community Inequities • Research participants in Little Village may not have

access to other health promoting opportunities available in more affluent communities across the city suggesting that Little Village did not have a strong enough civic voice

Fear • Restricts help seeking, civic engagement, health

behaviors and may influence youth to engage in risky behavior

• General attitudes expressed: Little Village did not have equal access to education, police protection, city services compared to other communities in the city

Methodology Continued

Quantitative findings were used to contextualize and inform qualitative findings, and were presented at community health chats called Platicás.

Participatory Qualitative Analysis Continued Major Themes Continued

Community Partners Dolores & Yvette Castaneda Enlace Chicago, Simone Alexander Erie Neighborhood House, Evelyn Rodriguez and Sandy De Leon Esperanza Health Center, David Moreno, Gregory Hampton Hope Response Coalition, Erica Rangel Latinos Progressando, Luis Guitierrez Marshall Square Resource Network Telpochcalli, Livia Spilotro and Ernesto Morales, Maria Velasquez Roots to Wellness, Kevin Rak Taller de Jose, Sr. Kathy Brazda, Kerry McGuire, Anna Mayer

Research Partners University of Illinois, Chicago School of Public Health, Epidemiology and Biostatistics, Vicky Persky, MD Community Health Sciences Noel Chavez, PhD, RD, LDN Joan Kennelly, PhD, MPH Jennifer Hebert-Beirne, PHD, MPH EOHS Linda Forst, MD, MPH School of Nursing, Kamal Eldeirawi, PhD University of Miami School of Education, Dina Birman, PhD

Graduate Students Brian Bamberger Emily Bray Laura Campbell Jennifer Felner Ana Genkova Sylvia Gonzales Sarah Hernandez Marissa Hoover Melissa Martin Regina Meza Jimenez Rebecca Rapport Rachel Reichlin Jessie Schwiesow