GHAH Research Proposal

Background/Previous work

In the state of Virginia, the Latino population has grown by 92% in 10 years, earning recognition as one of the “New Latino States” by the Pew Hispanic Center. Locally, the US Census shows that the Latino populations of the City of Charlottesville and Albemarle County have nearly doubled in size from 2000 to 2010. In the summer of 2013, we undertook a project to evaluate the health needs and available resources of the Latino population in Charlottesville. The project was two-pronged, involving 1) structured interviews with local health and social service providers and 2) surveys of Latino residents about health priorities and perceived barriers to care. This project illuminated a number issues related to health care of the Latino population in the Charlottesville area. Firstly, it appears that community members and health care providers have some significant areas of disagreement in terms of perceived priorities and barriers. Secondly, while the study identified many health-associated organizations with specific programs for Latinos, the local health care network was fragmented and demonstrates a lack of inter-organization communication and cooperation. Following presentation of this data to the stakeholders, a working group was convened drawing from UVA and community organizations including the Promotores de Salud. The working group aimed to unite local organizations working on Latino health issues and brainstorm a cohesive plan of action to reduce health disparities in the Charlottesville/Albemarle Latino community. Ultimately, a joint decision was made to revitalize the Promotores program using the combined resources and expertise of all of the working group partners.

Rationale:

The Charlottesville area Promotores program has existed since the 1990’s, although changes in funding and leadership in the last 5 years have rendered the program largely dysfunctional. The Promotores report a strong desire to continue their work as community leaders, although several issues stand in their way such as lack of English skills, lapse in skills and knowledge over time, and unavailability of compensation. As the Thomas Jefferson Health District seeks to re-vitalize the CHW program, UVA would like to play a role in developing a para-curriculum. This would be designed to complement, not replace, the existing Health Department curriculum by focusing on overarching skills such as English language acquisition and healthcare navigation. To ensure the success of this new undertaking, we must ensure that the program has a solid foundation in best practices for both CHW training and university-community program implementation.

Hypothesis/Research Question:

The purpose of this study is to investigate the current best practices in CHW program implementation and training in order to design and implement an effective and culturally-competent para-curriculum for local Promotores.

Our specific aims are as follows:

1. To conduct a thorough search of the literature regarding the philosophy and existing curricula for CHW training.
2. To identify and investigate model university-community partnerships in CHW program implementation.
3. To disseminate the data derived from this study with the para-curriculum working group.

Methodology:

1) Describe the site including mentors and available resources/services.

We will work closely with Dr. David Burt (Emergency Medicine) and Dr. Max Luna (Cardiology)  as our primary coordinating mentors. We will also be working closely with Dr. Kristen Wells (Department of Public Health Sciences). We will be visiting different sites around the country with well established CHW programs. In Charlottesville we will work closely with the Thomas Jefferson Health Department and the CHW working group.

2) Describe the population that you will be working with.

We will work with a diverse group of individuals who are a part of the CHW program at each respective site. This will include program coordinators, program instructors, community health workers, and individuals who have played a role in the development of each program. All of these communities will be representative of a university-community based CHW program. Because we do not plan to interview patients or access HIPAA-protected materials, this study does not require IRB approval.

3) Describe the methodology that you will use to collect data.

Melissa Ogden and Steven Nguyen will work together to conduct this study. During the first 2 weeks, we will conduct our literature review regarding the philosophy and curricula of CHW programs In addition, we will design a survey instrument that will help us to evaluate these programs in regards to program implementation and CHW training. Once we have developed our survey, we will identify programs that will serve as our site of research. The the last two weeks will be spent interviewing individuals from these programs in addition to performing preliminary qualitative analysis.

4) Describe your planned analysis of the data.

This study will generate primarily qualitative data, although some quantitative data about the programs (ex. number of CHWs) may also be collected. Interviews will be recorded and transcribed, and subsequently coded for recurrent themes which can be compared across programs. The results of this study will be analyzed with the help of Dr. Kristen Wells and the Generalist Scholars Program.

5) Briefly discuss alternative strategies to address your hypothesis in the event that your initial plans are untenable.

If it is not possible to schedule and conduct all of the site visits during this limited time period, we plan to conduct phone and video interviews with stakeholders from the various university-community partnerships.

Expected Outcomes:

First, this study will inform the restructuring and formation of the community health worker promotores de salud program at the Thomas Jefferson Health department. We believe that through evaluation of these programs, we will glean information regarding organizational structure, including participant recruitment/retention, training, program evaluation, and funding. Second, this study will provide information regarding best practices involved in the implementation of a community health worker program that is integrated into the wider healthcare system. Ultimately, this study will lead to the development of a revitalized, sustainable promotores program that will empower promotores to advocate for our community.