Updates on Charlottesville census data + maps!

Building on the census finding work I did a few weeks, I've started to map out the Latino community in Charlottesville using the following sources:
- GIS Data folder of Scholars Lab computers in UVA's Alderman Library
- http://www.charlottesville.org/Index.aspx?page=1674 (Charlottesville's GIS data source!)
- http://censusviewer.com/city/VA/Charlottesville 
- http://quickfacts.census.gov/qfd/states/51/51540lk.html 

Mapping Exercise #1 - Where is the Latino community concentrated in Charlottesville? 

May be hard to see, but the  Latino population is indicated by the blue dots. 

In this map, we note the Latino populations by the blue dots and the non-Latino populations are in pink. If you zoom in, you can see the blue mass around Southwood and some around Rio Rd, as well.

Mapping Exercise #2 - Where are health, social, and community services located in Charlottesville?

Definitely a work in progress, this is the first map I've made with ArcGIS! The services that are labeled here in blue are from dataset of the cultural organizations around Charlottesville kept on the Scholar's Lab computers in Alderman. 

Next steps are to enhance the second map to include the following layers - 1) the locations of the services we interviewed and addressed in the community survey, 2) the Latino community in Charlottesville, and 3) Charlottesville bus routes. Just e-mailed our contact at Albermarle's GIS office to see if we can get our hands on this data! Keep your fingers crossed and stay tuned for the next update.

Latino Health Survey Update

    Initially my search consisted of using "latino health survey" and "community health survey" as keywords for the search. I found mostly nationally based surveys , and some community based surveys. However, these surveys focused more on the different types of illnesses Latinos faced, not the barriers they face in receiving health care.
     Therefore, I changed the search to "latino health barrier survey" and "latino health disparities survey" as keywords. I found surveys describing the different health barriers faced by Latinos such as language, culture, transportation, and documentation at a community or state level. All of these directly relate to our research now. Additionally these surveys describe their methodology, most received their information from focus groups, and they also conducted interviews with service providers.

Here are some examples of the results of the surveys:
1.)




Source:

http://www.clac.state.mn.us/issues/CLAC%20Health%20Report.pdf

2.)

Source:http://www.bowenresearchcenter.iupui.edu/brc_lectures/BowenLecture2003-09-11.pdf

Patient Navigators in Primary Care

Hello all, my first blog post!

I did a significant amount of research on Patient Navigators in primary care, general care, and Latino specific care. Here is a quick summary of some of my findings.

http://www.jabfm.org/content/23/6/736.long
The one article I found that pertained to patient navigators in primary care discussed how the main role of the patient navigators was to provide information about resources, make phone calls to arrange appointments, enhance physician- patient communication, and various other office work. It was found that patient navigators would not be necessary in the actual clinic. This study also found that the biggest barrier to adopting a patient navigator program in clinics would be the upfront cost. In relation to our study, it is interesting to see how having patient navigators specifically for Latino community members could be adopted.

http://www.innovations.ahrq.gov/content.aspx?id=2564
Another article discussed the concept of a culturally competent community health worker serving low income Latinos. This study mainly focused on helping to connect "low-income Latinos to insurance and affordable health care services by delivering personalized education and assistance designed to improve participants' knowledge and attitudes about health insurance, health care access, and preventive services." The program was successful in increasing enrollment in health care insurance and increasing access to follow up care. Although this article did not specify their program for primary care, it seems as though this program could compliment the patient navigator's role in primary care clinics.

http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No2-May-2012/Transformacion-Para-Salud-Patient-Navigation-Model.html

The transformacion para salud is a patient navigation model that was developed to be a culturally specific patient navigation program. The patient navigator was trained with cultural sensitivity in mind to provide support and guidance throughout care.  There was a 91.7% reduction in ER visits and a 50% reduction in inpatient stay. One way in which health care delivery will be meaningful to recipients of care is by first providing a context of the care to be delivered, and then that this contextual approach should be individualized to the patient. Use of the TFH framework integrates the social determinants that have to be dealt with before one can focus on those demands. The TPS program which delivers care using that framework has achieved significant outcomes in terms of facilitating and sustaining behavioral changes needed for chronic disease self-management. With such success observed in chronic disease management, one can see the efficacy of a similar program for individuals needing primary care.

In general, the patient navigation programs were generally successful. All of the articles showed the efficacy of the program and suggested there were many avenues to go with it. It is certainly possible to think Latino patient navigation in primary care will save countless dollars and less congestion in the emergency department. Furthermore, patient navigation in primary care can provide Latino community members with a trusted culturally competent liason between the community and clinic. A patient navigator to help provide support and guidance as well as facilitate in assessing financial barriers could be a critical component in the next generation of primary care.

On another note, we had a firestorm of interviews today! We went to the Church of Incarnation, and our contact their was so nice. She made a great introduction for us, and Vianca followed up with an excellent introduction of our research goals.

I am excited for where this project can go and am fortunate to be part of such a great group of individuals!

August Thoughts 7.26.13

This weekend will be our last for awhile- Steven and Melissa are starting school next Thursday, and everyone else is taking a well-deserved vacation. With that in mind, we've decided to cap the summer part of our research on August 1st. While we will continue to collect data after that date, only the summer data will be used to present to MSSRP, CGH, and GSP. Hopefully, we can present to all of the stakeholders (maybe at a CJ meeting) a more thorough write up.

Following that, it looks like we've got a 2 or 3 week research hiatus before data collection starts up again. We can use this time to work on data analysis, especially on fitting together both the Stakeholder and Community Member surveys. I think we'll meet in late August to reassess, and formulate a plan to continue data collection and further analysis.

Thoughts moving forward 7.23.13

There were a couple of things that came up talking to Steven today that I wanted to make sure we had a record of somewhere. Also, we can use this as a springboard- I'd love to hear thoughts from everyone else involved.

Analysis Plan

• Individually, analysis for each survey should be fairly straightforward (descriptive)
• Next week: coding (stakeholders) and data entry (community members)
• With some preliminary data, we can start thinking about how to link the two surveys
• Steven, can we get some early data by Friday 8/2 maybe? 
• We also need to set a deadline for data to be presented- even if we keep collecting past that, we should cut off in early Aug. for MSSRP/CGH/GSP purposes 

Intervention

• Healthcare navigator: thinking too specifically?
• part of a larger project down the road
• Maybe we need to start more broadly, get people connected and talking to each other
• Possible model: Mental Health Coalition in Cville
• brings together service providers to make sure no one falls through the cracks
• raised funds to hire a coordinator and psychiatrist --> possibility to hire a navigator down the road in our scenario 

Field Work Update 7.21.13

Valuable lesson learned: best turnout is on weekends. We got 2 surveys on Tuesday, 3 on Thursday, and then 9 on Saturday. There was a mix up about surveying at Incarnation Church today, so we didn't get any, but it's clear that this is the way we need to go as we continue surveying in the community. Here's some other topics that have come up:

• How to survey a participant. Pairs, or alone? We tried out both this week during training. Working in pairs (one person asks the questions, another writes down the answers) is a real confidence booster, and I think allows better communication between the two people talking. You don't have to worry about finding the right code, you can just talk. However, it's not time-efficient, and adding a third person's impressions can exacerbate existing language difficulties. In the end, we decided it was best for the same person to ask the questions and code the answers.
• Question 115. This question asks how the respondent chose a doctor (ex. cost, insurance coverage, did they speak Spanish?). No one seems to understand the question- I think most people either go to the ER, or never see a doctor. I guess this is more for my notes than anyone else's edification, but this question should be thrown out.
• Use of UVA. So... not that many people go to UVA. That means that, in a vast majority of cases, half of our survey isn't even being answered. Without a doubt, we're going to have to do a Phase 2 of surveys in a population that uses heath services. Right now, we're thinking UVA and the Charlottesville Free Clinic- I'm pretty sure this means IRB re-submission. I don't know what's the best way to sample in UVA... Do we follow translation services? Or do we post up in waiting rooms and approach patients in Spanish? The first seems more efficient, but is a biased sample (especially when we ask about experiences with translation services).
• Church of the Incarnation. Still not 100% sure what the mix up was today, but here's what we're doing: Vianca is going to get in touch with Fanny (from Incarnation), and forward a blurb about the project that can be shown to the priest. Vianca will handle the announcement next Sunday, and we should be in place to interview people around 3 pm after services.

Field Notes Day 1 7.16.13

What worked:

• Set up: table, folders, snacks, water
• Working in pairs: easy to fill in for each other when someone loses their train of thought
• Being friendly: greet as the person goes into the store, catch them on their way out
• Guilt trips: you're out there sweating in the heat, make sure they know it!
• Being prepared: have a little speech to sell people, and be ready to jump into the introduction/consent process as soon as they seem like they're considering it.

What didn't work: 

• Being timid: better to ask too many people than too few
• Clothing: ridiculously hot outside. Forget the dress code, wear breezey clothing and LOTS of sunscreen. Bring a really cold water bottle.
• No one seems to use health services... we're going to have to sample at UVA too
• Time of day: we're going to have to do a lot of weekend work, unfortunately. Hardly anyone was around. This did make it nice to practice though!

All alone!

Keeping track of expenses 7.16.13

This is more for Steven, but here's the page to keep track of expenses! This way if we lose receipts, we still have everything recorded in one place.

Community Member Update 7.15.13

We're ready to start field work for the second part of our project, the community member survey!

We kicked off our first week of field work with a tour of some of the Latino neighborhoods of Charlottesville. Linda met us at 10:00, and together we drove through the Rio Road-Hydraulic area, stopping at apartment complexes, trailer parks, churches, laundromats, and stores frequented by Latinos. Here is a full list of stops we made, which I'm going to eventually try to put into a map:

• Abbington Crossing
• Church of the Incarnation
• Putt Putt neighborhoods- Mallside and Rio Hill
• Berkmar
• Townwood
• University Commons
• Turtle Creek
• Commonwealth neighborhoods
• Mercado World Foods
• Bubbles Laundromat
• Southwood 

Vianca, Steven, and Ariel on our tour!

Right now, we have IRB approval to work in the public locations (churches, laundromats, stores), but not in neighborhoods. Over the next few weeks, we'll concentrate on interviewing in the places we already have permission, and we can begin to think about places to expand our study to get a more representative sample. Besides the neighborhoods listed here, we've considered also interviewing at UVA, Social Services, and the Free Clinic. This way, we'd be able to get more information specifically from Latinos who do access the healthcare system.

Our priority for this week is Mercado World Foods. We'll do surveys this week from about 4-7 pm Tuesday (Vianca), Wednesday (Ariel), and Thursday (Vatsal). Remember to keep checking the schedule! For Ariel and Vatsal, let's plan to meet at 3 so we can warm up in Spanish before we start. And we'll play the times by ear- if we're getting a lot of people we'll stay until 7, but we might pack up early if it's empty. We'll decide on Friday in the meeting where we want to go for the weekend shifts! Looking forward to starting, thanks everyone for your patience and hard work!

Stakeholder Interview Prep and Update 7.10.13

Ariel and Steven worked on finalizing the stakeholder survey. They worked with Linda Hemby, our community mentor, and practiced running through the interview to make sure that questions were on point and the interview questions flowed.

We made final edits and are ready for our first three interviews this week. The interviews will be with the Department of Family Medicine (UVA Hospital), the Medicaid Unit under Social Services at UVA (government organization), and  United Way (NGO). These next three interviews will allow us to test our survey instrument with a diverse range of service providers. If needed, edits will be made to the stakeholder survey after these three interviews.

Two new interviews have been scheduled since the last update:

7/12 from 3:00 - 4:30 pm: Interview with representative from United Way

7/17 from 10:00 to 11:30 pm: Interview with social worker at UVA Medical Associates

Two more interviews are almost scheduled, one with Habitat for Humanity and one with UVA Language Assistance Services. Steven is continuing to contact and organize the rest of the stakeholders.

Training Complete 7.10.13

After a wonderful dinner Monday night, we started training in earnest on Tuesday. The first order of business was a cultural sensitivity training with Linda Hemby, who has been an amazing asset to our project. After her introduction, the team worked through all of the surveys in depth. Here's a quick overview of training.

Linda Hemby leads a discussion on the Latino population of Charlottesville.

Latinos in Charlottesville - Linda Hemby

• Health trends at US, VA, and Charlottesville level
• Health disparities: prevention, screening, misdiagnosis, medication problems
• Charlottesville population: age, income, ethnicity, living situation, documentation status
• Barriers to healthcare: language, transportation, childcare, education, experience in healthcare system
• Needs from providers: language/cultural training, awareness in interpersonal interactions

Service Providers - Steven Nguyen

• Goals, specific aims, purpose of study
• Development/structure of the interview guide
• Interview procedure
• Stakeholders overview: who they are, what they do
• Interview schedule 
• Coding... TBD
• Mock interview with Linda Hemby 7/10
• NEW RESOURCES: check the GoogleDrive

Community Members - Melissa Ogden

• Approaching community members and the oral consent process
• Structure/overview of the survey
• Survey delivery and coding instructions
• Anticipation of questions and sources of confusion
• Next steps- location visits, timing of interviews (nights and weekends)
• Coding- an Excel spreadsheet is being set up for data entry to begin immediately

Steven familiarizes Vianca and Ariel with all of the stakeholders.

Field Worker Dinner/Training 7.8.13

We finally met face to face with the rest of our research team tonight at dinner at Mellow Mushroom. We had a great time talking and getting to know everyone a little bit better!

Some highlights from this meeting:

• We reviewed project overview
• We updated each other on research
• **With research from now on, we will add findings to the documents in the "Background Research" folder. List your findings with the paragraph summary and ranking of importance (1 - 3)
• We reviewed expected working environment and personal working styles
• We discussed project goals and personal goals for each person

Next Steps:

• 1. Send picture and short blurb/bio to Melissa
• 2. Review the "Organizational Health" folder 
• 3. Electronically sign your name in the Working Environment doc
• 4. Add your info to the Working Styles and Personal Goals doc
• 5. Add your contact information into the Researcher Contact Sheet
• 6. Prepare for training tomorrow: review surveys and bring notebook and computer

*Please complete 1-5 before Friday 7/12 at our 10:30 am check-in meeting. 

We will see everyone tomorrow (Tues.) at 10:30 am in the Health Sciences Library Rm 1326 for the official day of training!

Melissa and Vianca are so excited for pizza!!

Scheduled Stakeholder Interviews

Checking in with scheduled stakeholder interviews so far. We have three lined up and several in the stages of being scheduled. The three that are scheduled are listed below:

7/11 from 10:30 am - 12:00 pm: Interview with Dr. Fern Hauck (Director of International Family Medicine Clinic, UVA Dept. of Family Medicine)

7/12 from 12:30 pm - 2:00 pm: Interview with Ms. Wanda Hoerman (Program Manager of the Medicaid Unit, UVA Financial Services)

7/23 from 1:00 pm - 1:15 pm: Interview with Ms. Chris Worsham (Patient Care Director, Charlottesville Free Clinic)

I created a document in the Stakeholder Survey Docs folder that keeps a running tab of the stakeholders that I have contacted and their status. It is called the "Stakeholder Status Sheet." You can refer to this document to see where progress has been made with scheduling.

Searching for Latino Health Surveys

By looking at different Latino health surveys from U.S and Virginia will help for future data comparison with our data as well as give us further information about other Latino communities and the disparities they face. Currently, information will come from surveys, and different pilot programs that have compiled data about different Latino communities. 

These surveys provide important profiles of Latinos in the United States and smaller communities. This information will hopefully compliment the census data 

From the Pew Hispanic Center (PHC) survey of Latino adults (national representative sample of 4,014 hispanic adults. There is also an analysis of the data compiled from this survey at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2764038/.

(http://pewhispanic.org/files/reports/91.pdf)

(http://pewhispanic.org/files/reports/91.pdf)

Another Hispanic/Latino Profile comes from the U.S department of Health and Human Services of Minority health. This website provides an overview of the demographics of Latinos in the U.S.  This website also provides links to different census conducted. 

From the “Income, Poverty, and Health Insurance Coverage in the United States”

(http://www.census.gov/prod/2011pubs/p60-239.pdf)

Overall, I am finding more surveys conducted on a national level rather than surveys on a community level.  If you all have suggestions please let me know! 

Sources:

http://pewhispanic.org/files/reports/91.pdf

http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=54

Census Data Updates

The hunt for census data begins!

Here are the guiding questions for this search:
1) What is the Hispanic make-up of the Charlottesville, VA community (population #, %, etc.) ?
2) How is the Hispanic community of Charlottesville geographically concentrated?

This search will utilize the census data most available, which is in this case from the year 2010. Some Google searches, reviews of census.gov data, and help from Vatsal addressed the first of these questions:

Charlottesville, VA 2010 Total Population: 43,475
Charlottesville, VA 2010 Hispanic/Latino Population: 2,223 (5.1%)
Broken down by                    #      %

Mexican	954	2.2
Puerto Rican	200	0.5
Cuban	119	0.3
Other Hispanic or Latino [5]	950	2.2

Charlottesville, VA 2010 Hispanic/Latino Population Breakdown by Age: 

Graph: Population by Age and Hispanic or Latino Origin, 2010 Census - Charlottesville, Virginia

Population by Hispanic or Latino Origin (of any race), 2000 Census - Charlottesville, Virginia	Counts	Percentages	Color
Persons of Hispanic or Latino Origin	1,102	2.45%
Persons Not of Hispanic or Latino Origin	43,947	97.55%

Sources:
http://censusviewer.com/city/VA/Charlottesville (comes with an interactive map!)
http://quickfacts.census.gov/qfd/states/51/51540lk.html (summary of Charlottesville census data and population projections)

This is, of course, of a very rough and preliminary start! Some feedback is more than welcome on what kind of data we want (spatial, numeric, health-related, etc.)!

Field worker meeting 7.1.13

Steven and I actually got Skype to work today and met with Vianca and Ariel! We had a super technologically-dysfunctional meeting last week, so we wanted to catch up today in preparation for getting started next week!

What was covered:
-walk through the blog, Google Drive, surveys instruments, and field work schedule
-first week tentative schedule: Monday dinner, Tuesday meeting, Linda Hemby training eventually
-clarification of research roles: Vianca- Latino health surveys, Ariel- Census data

Next steps:
-blog updates this weekend with research progress
-review surveys (including Spanish version)- all in Google Drive
-come to dinner Monday with questions and expectations (What do you guys want to get out of this project? What is your working style? What can Steven and I do to make sure things run smoothly?)
-write a brief bio and upload a picture onto the Meet the Researchers page (let Melissa know if you need help!)

Looking forward to meeting everyone in person on Monday! Post in the comments what you think about dinner... Boylan, Basil, Mellow, Virginian?