Our Approach:
▶️Moving from Social Determinants of Health to ACTION
- via -
▶️By Using Community Based Participatory Research - Community Health Worker Models
in order to
▶️Influence and Inform Stakeholders and System Players
WE STARTED IN 2012. WE SAW THE IMPACT DURING COVID-19.
SDOH, the social determinants of health defined by the Center for Disease Control (CDC) is a conceptual framework supported by research that has now been widely accepted. These determinants include poverty, unsafe and unaffordable housing, low wages, and racism, factors which cannot be addressed alone by improving "access". But as one VP for a major health insurance corporation stated at a Greensboro housing panel, his corporation didn't know how to "do" SDOH. That is, take action.
COVID-19 overwhelmingly demonstrated the health gaps, limits and failures of large corporations and institutions charged with responding, as well as the key roles played by grassroots groups, and community-based organizations like MDA, to inform, educate, and intervene to provide basic life-saving supplies.
Since 2012, researchers working with MDA had adopted community-based participatory research (CBPR) practices and used the community health worker (CHW, or promotores) model to conduct research, build community capacity, inform and educate families, and intervene in order to deliver a wide range of services. For our network, the CHW model solved two critical issues, intervention during the course of research and "give back" at the project's conclusion.
Example 1: Proof of Concept
Following the Great Recession, through MDA we were aware that Montagnard families were suffering from food shortages due to the longer economic recovery Greensboro and the Triad region were experiencing compared to Raleigh, Durham, Chapel Hill, and Charlotte. Through a combination of funding sources, we selected and trained two older women we knew through MDA's own ESOL class. Although their formal education level was very low, 0 and five years, they were respected and well liked among women and across tribes. They were multilingual and natural helpers, able to spot family and health problems and initiate medical interventions. Their work interviewing 50 families resulted in published research*, funding for their own neighborhood women's life skills classes, backyard gardens, job training and eventual employment for many stay at home moms.
Jigna M. Dharod , Huaibo Xin , Sharon D. Morrison , Andrew Young & Maura Nsonwu (2013) Lifestyle and Food-Related Challenges Refugee Groups Face Upon Resettlement: Do We Have to Move Beyond Job and Language Training Programs?, Journal of Hunger & Environmental Nutrition, 8:2, 187-199, DOI: 10.1080/19320248.2012.761574
Example 2: Ahead of Our Time
In 2013, we unsuccessfully proposed to the regional health provider that it help us retain our two trained CHWs and fund us to increase their number. We argued that two years after we had introduced unlicensed Montagnard medical doctors to hospital staff, there was still no interest in training or employing them in any capacity. Instead, we proposed very modestly paid community health workers such as the older mothers we had already trained to act as community cultural experts able to bridge the serious gaps that existed between health providers and community members. Again, we received no response.
Montagnard Health Meeting: Status of a Triad Refugee Community https://youngprojects.blogspot.com/2011/11/montagnard-health-meeting.html
Community Health: No Longer a Rational Argument? https://youngprojects.blogspot.com/2013/12/community-health-any-simpler-than-this.html
Example 3: Preventible Chronic Disease
For the Montagnard Hypertension Project, we developed a Montagnard dictionary of hypertension-specific terminology and conducted two focus group discussions (FGD), 131 biological assessments (blood pressure, height, weight, waist circumference, scalp hair and saliva sample collection), and 127 behavioral surveys. We implemented two health fairs that offered services to the community. Through this inaugural CBPR study, we collected baseline information and increased our understanding of community perspectives, internal disagreements, and conflicts. We provided examples of complex issues encountered and how these were navigated in research with community constituents—students, CHWs, medical professionals, tribal elders, church leaders, congregants, and women—who were committed to the project.
Morrison SD, Sudha S, Young A, Dharod J, Nie YB, Siu HW, Siu L, Ksor HV, Sayers J, Bernot K, Malotky M, Nsonwu M. When Community Calls, We Collaborate! Community-Based Participatory Research With the Multilanguage Montagnard Refugee Community. Prog Community Health Partnersh. 2018;12(2):179-186. doi: 10.1353/cpr.2018.0038. PMID: 30270228.
Example 4: COVID-19 and Applied SDOH
With extensive CHW experience, MDA was prepared at the start of COVID-19 to expand its partnerships with other refugee communities in order to help them secure COVID-19-related funding and deliver help through CHWs enlisted by the communities themselves and trained by MDA staff and Research Network members. Bhutanese, Cambodian, Swahili-speaking, Liberian, Karenni and other teams successfully delivered life-saving supplies and fact-based information, held vaccination clinics, and provided family and neighbothood-level help during the crisis. Today, MDA's deployment of CHWs from refugee-origin communities has been the basis of other important community empowering activities and new avenues for researchers.
Example 5: Kayah Li Lay Klo: Karenni Heritage Project
A big strength is the Research Network's collective capacity and resources. We are very good about shaping issues and framing them with our partners in ways that can attract funding while staying true to their community values and needs. Capacity building, another way of saying team-building and training, is often the missing link in a community's ability to organize. In late 2020, we made contact with Tee Reh, an MPH candidate completing his degree from his home in Greensboro. MDA hired him as a community health worker to reach out to the community spread between Greensboro and Winston-Salem. As he completed his studies he passed on his position to Marthalenar Nya Mar whose Winston-Salem home put her closer in touch with the bulk of the community's families. The Karenni youth team she organized met with network members based in Wake Forest University who were able to assist the team with meeting space and grant writing. Their current proposal, “Kayah Li Lay Klo: Karenni Heritage Project” (KLLK),” will promote mental health through art and cultural preservation and connect the Karenni to the regional healthcare system.
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See
In 2013, we unsuccessfully proposed to the regional health provider that it help us retain our two trained CHWs and fund us to increase their number.
