Search

Physician assistants (PAs) and medical degree students (MDs) often lack training in addressing the social determinants of health (SDOH). Social work students (SWs), meanwhile, have extensive SDOH training; however, few medical professionals have opportunities to engage in interprofessional training with SWs. This study examined the feasibility, acceptability, and students' perceptions of an interprofessional virtual reality (VR) simulated learning environment (SLE) for teaching health professions students about the SDOH.In January 2020, 15 students at Boston University School of Medicine attended web-based video conferences focused on SDOH, health equity, and team-based care. Subsequently, student dyads participated in a case-based learning activity using an immersive VR SLE to develop teamwork skills. Evaluation included a postsurvey and a focus group examining their experiences in the course to gauge feasibility and acceptability. Thematic analysis of open-ended survey responses from the postsurvey and focus group data was conducted.A total of 8 VR simulations were run. Findings indicated both MD and PA students learned patient engagement strategies from SW students, who enhanced their health care leadership capacity. Participants found the means of instruction acceptable, valued the hands-on VR interprofessional training, and expressed interest in learning more about the scope of one another's roles and the community resources available to patients.VR SLE is a feasible and acceptable means of instruction. It allowed students to connect across programmatic and geographic boundaries in a collaborative working environment mimicking the team approach to care they will use in their professional life. This experience illustrated for students the strengths a multidisciplinary team has to offer.

Background Reducing sugar-sweetened beverage (SSB) consumption is a promising dietary target for childhood obesity prevention. This paper describes the design and methods of a cluster randomized trial of H2GO!, a youth empowerment intervention to prevent childhood obesity through reducing SSB consumption among a low-income, ethnically diverse sample of youth. Methods This cluster randomized controlled trial is an academic-community partnership with the Massachusetts Alliance of Boys and Girls Clubs (BGC). Ten BGC sites will be randomly assigned to the H2GO! intervention or a wait-list, usual care control. Eligible study participants will be N = 450 parent-child pairs (youth ages 9–12 years and their parents/caregivers) recruited from participating BGCs. The 6-week in-person H2GO! intervention consists of 12 group-based sessions delivered by BGC staff and youth-led activities. An innovative feature of the intervention is the development of youth-produced narratives as a strategy to facilitate youth empowerment and parental engagement. Child outcomes include measured body mass index z scores (zBMI), beverage intake, and youth empowerment. Parent outcomes include beverage intake and availability of SSBs at home. Outcomes will be measured at baseline and at 2, 6, and 12 months. With a 75% retention rate, the study is powered to detect a minimum group difference of 0.1 zBMI units over 12 months. Discussion Empowering youth may be a promising intervention approach to prevent childhood obesity through reducing SSB consumption. This intervention was designed to be delivered through BGCs and is hypothesized to be efficacious, relevant, and acceptable for the target population of low-income and ethnically diverse youth. Trial registration ClinicalTrials.gov NCT04265794. Registered 11 February 2020.

This study is part of a larger Youth Participatory Action Research (YPAR) project engaging youth of color (YOC; aged 16–24 years) in a planning a multilevel health promotion campaign for a large safety net hospital. Analyses focus on youths’ conceptualizations of antiracism, and their recommendations on how to facilitate an intentionally antiracist YPAR. We answer the following questions: (a) How do YOC engaged in a YPAR project conceptualize and define antiracism? and (b) How do youth and adult allies conceptualize an antiracist YPAR project and what strategies do they use and/or recommend to this end? We employed instrumental case study methods and thematic analyses to code project data sources. Findings indicate that youths’ definitions of antiracism include elevating marginalized voices, actively resisting racism, incorporating an intersectional approach, and examining privilege, power, and positionality. YPAR members recommended strategies for creating an antiracist YPAR including prioritizing people of color in YPAR processes, creating space to acknowledge and process positionality and racialized dynamics, and engaging in ongoing education and dialogue. Moreover, both youth members and adult allies recognized that antiracist YPAR projects require time and resources to remain consistently antiracist, and such a goal can only be accomplished through a reiterative and reflexive process.

The Grand Challenges for Social Work initiative, led by the American Academy of Social Work and Social Welfare (AASWSW), aims to organize the social work profession around 12 entrenched societal challenges. Addressing the root causes of the Grand Challenges will take a coordinated effort across all of social work practice, but given their scale, macro social work will be essential. We use Santiago and colleagues’ Frameworks for Advancing Macro Practice to showcase how macro practices have contributed to local progress on two Grand Challenges. We offer recommendations and a call for the profession to invest in and heed the instrumental role of macro social work practice to address the Grand Challenges.

Community health workers (CHWs) integrated in human immunodeficiency virus (HIV) care teams undertake a variety of tasks to help patients navigate health care, develop care plans, and address social needs. Given the broad role of CHWs in HIV care, we sought to understand which client attributes are associated with various dimensions of CHW satisfaction using a sample of 204 people with HIV (PWH) from various geographic regions across the United States. Multivariable linear regressions were used to determine which client attributes were associated with complete satisfaction with CHWs using 10 validated measures. The mean age of participants was 40.6 years old (SD = 12.8) and over 70% were Black or African American. Adjusted models reveal clients who were female, have marginal health literacy, or have a substance use disorder diagnosis were more likely to not be completely satisfied across multiple dimensions (p ≤ .05). Conversely, being housed and having a mental health diagnosis were associated with being more likely to be completely satisfied (p ≤ .04). Clients’ sociodemographic characteristics and health conditions may be indicative of unique needs, leading to differing expectations of CHWs. CHW training modalities should consider the complex interplay of care needs based upon different client backgrounds and experiences among PWH. Addressing unique needs resulting from social determinants of health and that arise from conditions co-occurring with HIV, such as substance use disorders, should be incorporated into CHW service delivery.

We provide an overview of diverse forms of youth participation, with a focus on youth participatory action research (YPAR) and its synergies with life course intervention research to promote healthier development for young people and across the life span. We analyze why YPAR matters for research, practice, and policies related to the systems and settings in which young people develop. We also illustrate how young people perform YPAR work to improve the developmental responsiveness and equity of school and health systems, including descriptions of an innovative youth-led health center in Rwanda and a long-standing and evolving integration of YPAR into public high schools in the United States. We then briefly consider the adult capacities needed to do this work well, given that YPAR challenges typical youth-adult power relationships and broader assumptions about who can generate expert knowledge. We consider the alignment and potential challenges for integration of life course intervention research as well as YPAR and next steps for research and practice at this intersection.

In order to better understand factors that influence the health and well-being of Dominican immigrants, we explored the ways in which immigration influences cultural practices, health behavior, and health. Dominican immigrants (n = 42) took part in five reflective and unstructured group discussions and (n = 5) participated in an intergenerational photovoice group. The loss of the familial and social context in which Dominican dietary practices traditionally take place was a salient theme. For participants, eating became a rushed, perfunctory activity involving fewer people and less socializing. Dietary practices in the Dominican Republic are set in the context of familial norms and social processes, which provide support as well as opportunities for socializing and the transmission of cultural practices across generations. In the United States, broader sociopolitical forces are guided by individualism and do not support the development or maintenance of these factors for Dominicans. Policies that promote work–life balance may have important implications for dietary practices in new immigrant communities.

Young people are often the intended audience for health and social programs, yet they rarely participate in the decision-making processes that determine how these programs are designed, implemented, or evaluated. Failing to meaningfully engage young people, well-intended adults may miss opportunities to create relevant and effective programs and policies for youth. This article describes a youth-led health assessment conducted with researchers from an academic medical center accountable care organization and stakeholders from a local community center. We explain the process of recruiting and engaging youth in this project, along with health concerns they identified in their communities via a survey, including mental and sexual health, food access, and community safety, as well as recommendations the youth researchers developed for improving health and tackling inequities. Our findings show that youth participation fosters a deeper sense of empowerment and leadership potential. Policy makers and other health leaders should consider engaging young people as they make decisions about health care delivery.

To assess the impact of a Community Health Worker (CHW) intervention within HIV primary care on patient outcomes. We evaluated a 10-site initiative integrating CHWs into HIV care, examining changes...

PURPOSE. Social participation is a key determinant of healthy aging, yet little is known about how people with Parkinson’s disease manage social living. This study describes individual differences in social self-management practices and their association with symptom severity and health quality of life. METHODS. People with Parkinson’s disease (N = 90) completed measures of healthy routines, activities and relationships, symptom severity and health related quality of life. Cluster analysis identified profiles of social self-management practices. Analysis of variance tested differences between profiles in symptom severity and health quality of life. RESULTS. Participants clustered into one of seven groups according to different combinations of three practices: health resources utilization, activities in home and community, and social support relationships. The healthiest cluster engaged equally in all three practices at above sample average degree of engagement. Four clusters that engaged at or above sample average in activities in home and community experienced less health problems than three clusters that engaged below average. Variation in aspects of social lifestyle unrelated to health appeared also to contribute to profile diversity. CONCLUSION. Findings provide insight into similarity and variation in how people with Parkinson’s disease engage with social self-management resources and point to person-centered interventions.

Background The HEALing Communities Study (HCS) is a large-scale multisite study testing Community Engagement using coalition facilitation as an approach to addressing the worsening overdose crisis. Within Community Engagement, Community-Based Participatory Research (CBPR) principles guide researchers on best practices for working in partnership with communities, yet these principles have not been well researched in large complex multi-site studies. Methods This paper used ethnographic methods to explore how coalitions operationalized the CBPR principles during early coalition formation. Two coders independently analyzed 101 ethnographies from HCS coalition meetings in eight Massachusetts communities held between November 2019 and December 2020. Themes were developed through consensus between the coders followed by group discussions among the authorship team. Results We found mutual trust, shared goals, addressing power dynamics, meeting structure and attending to the sociopolitical community context could all serve as barriers or facilitators to operationalizing the CBPR principles. Conclusions These findings provide unique suggestions for future community-engaged multisite studies, and demonstrate the importance of research teams to mitigate inherent power imbalances by acknowledging and creating space for community ownership. The findings also highlight the value of a community engaged facilitator role to promote the CBPR principles. Strategies such as transparency, uniting over shared interests and bringing in a wide range of stakeholders were notable facilitators for operationalizing the principles.

Community-based participatory research (CBPR) is a growing practice by which academics and community partners conduct collaborative health-based research. While CBPR fosters productive partnerships, there is increasing research on interpersonal group dynamics and the ways that intersecting factors, such as gender and ethnicity, affect the social interactions within CBPR. This paper explores the tensions inherent in large interdisciplinary community-based participatory research partnerships, through the examination of a long-standing community–academic partnership focused on advancing public health. Nine qualitative interviews were conducted between November 2019 and January 2020 with steering committee members from a long-standing collaborative partnership that conducts research to inform public health action. While the collaborative process was generally positive, we also uncovered less pleasant aspects of CBPR projects that are infrequently discussed in the literature, such as role confusion and power dynamics. Leadership style was seen as the driving force shaping how other team concerns were perceived. Not having structures in place to facilitate relationship development, or clear documentation of procedures, rules and norms, led to team complications. Team members suggested that a renewed focus on organisational structure would contribute to role clarity and organisation. The results highlight the complexity of working on interdisciplinary mixed community–academic teams, specifically the ways in which interdisciplinary, collaborative research can be a complicated, meandering process, often without clear-cut answers to sometimes simple questions.

Background Participating in clinical trials is a metric of high-quality cancer care and improves survival. However, Black individuals with cancer are less likely to be enrolled in clinical trials and experience a disproportionate burden of cancer mortality compared to Whites. Patient-engaged research is one potential strategy to address racial inequities in clinical trials, but little is known about best practices for engaging Black individuals and communities impacted by cancer in research partnerships. Methods We used a community engaged research approach to establish a patient advisory council (PAC) representative of the patient population served by a safety net hospital cancer center. We outline the process of establishing the PAC and the lessons learned. Results The inaugural PAC included 7 members representative of the cancer center’s patient demographics. PAC members developed a patient centered vision, mission and action plan. PAC and community-academic research partners experienced the transformative power of centering the lived experiences of patients of color to promote health equity in cancer research. Conclusion Establishing a patient advisory council at a safety net hospital cancer care center provided a platform for engaging a hardly reached population in patient centered research. Supplementary Information The online version contains supplementary material available at 10.1186/s40900-021-00317-7., Plain English summary Participating in clinical trials is an important measure of high-quality cancer care and improves survival. However, Black individuals with cancer are less likely to participate in clinical trials and are more likely to die from cancer compared to Whites. Including Black patients as research partners is one way to improve racial equity in clinical trial participation. We established a patient advisory council (PAC) including patients and caregivers with similar racial demographics as the patients receiving care at a safety net hospital cancer center. PAC members partnered with the research team to develop a vision, mission, and action plan to improve research participation among patients of color. PAC members used their lived experiences and training from the research team to help develop a strategy to improve representation of patients of color in cancer research. This paper is focused on the PAC development process. Supplementary Information The online version contains supplementary material available at 10.1186/s40900-021-00317-7.

Community health workers (CHWs) are members of the frontline health workforce who serve as intermediaries between health services and communities. In the United States, the role of CHWs has begun to expand as they have been shown to improve outcomes and reduce inequities in care for chronic conditions. This study used qualitative methods to explore the experiences of clients in CHW programs to inform their implementation in HIV care. Thirty clients from 6 Ryan White HIV/AIDS Program care settings across the United States participated in individual semistructured interviews to learn more about their experiences working with a CHW. Four key themes arose from the client perspective. First, CHWs embodied key qualities. Some of the qualities clients attributed to CHWs included being caring and supportive, along with capable of fostering personal connections. Second, CHWs met clients where they were. Clients described the CHW approach as more holistic compared with other care team members; they emphasized CHWs were able to focus on whatever was needed in that moment. Third, CHWs occupied a unique role in the HIV care team. Clients noted CHWs had more time to dedicate to their interactions; they also saw CHWs as representing a different level of authority. Finally, CHWs influenced how clients engaged with care and accessed resources. This included empowering clients to access resources independently in the future. Overall, clients' perceptions of CHWs in terms of their qualities, approach, role, and influence on the HIV care experience suggest they are a valuable resource on the care team.

Memphis, Tennessee and its surrounding counties have been profoundly affected by the HIV epidemic. Using a participatory research approach this study identified from a community perspective: 1) the barriers and facilitators for providing support to achieve viral suppression to the most at-risk groups living with HIV in the Memphis Transitional Grant Area and 2) opportunities to strengthen the health care system through the use of community health workers (CHWs) to do outreach and engage with people living with HIV. Themes of barriers include intersectional stigma, HIV criminal laws, abstinence-only sex education, housing, transportation, and limited access to HIV case management and mental health services. Strategies to address these barriers included HIV education to youth in schools and community-wide campaigns, more testing sites, involving faith leaders, funding for housing options, innovative transportation services, rapid start of culturally appropriate HIV medical treatment, intensive case management services, and mental health counseling. Two opportunities to utilize CHWs to address the barriers identified in this geographic area are as policy advocates and as an integrated member of the HIV primary care team. The findings of this study can inform a strategy to build the CHW workforce which may have widespread implications for ending the HIV epidemic in this geographic area and across the United States.

Objectives: The integration of behavioral health and primary care services may be a way to reduce racial and ethnic inequities in medical and behavioral health care services and outcomes fo...

Summary Gentrification is changing the landscape of many cities worldwide, exacerbating economic and racial inequality. Despite its relevance to social work, the field has been conspicuously absent from scholarship related to gentrification. This paper introduces the dominant view of gentrification (a political economic lens), highlighting its contributions and vulnerabilities, then introduces four case studies that illuminate the distinct contributions of social work to broaden the ways in which gentrification is theorized and responded to within communities. Findings When gentrification is analyzed exclusively through a political economy lens, researchers, policy makers, and practitioners are likely to focus on changes in land and home values, reducing the adverse effects of gentrification to a loss of affordable housing. A singular focus on affordable housing risks paying insufficient attention to racial struggle, perpetuating damage-based views of poor people and neighborhoods, and obfuscating political, social, and cultural displacements. Social work practice—including social action group work, community organizing, community development, and participatory research and planning—offers a holistic approach to understanding, resisting, and responding to gentrification and advance equitable development in the city. Applications By exploring social work practice that amplifies residents’ and change makers’ efforts, advances existing community organizing, produces new insights, builds inter-neighborhood and interdisciplinary collaborations, and facilitates social action and policy change, this paper helps community practitioners to reimagine the role of social work research and practice in gentrifying neighborhoods.

Background Community Health Workers (CHWs) have long been integrated in the delivery of HIV care in middle- and low-income countries. However, less is known about CHW integration into HIV care teams in the United States (US). To date, US-based CHW integration studies have studies explored integration in the context of primary care and patient-centered medical homes. There is a need for research related to strategies that promote the successful integration of CHWs into HIV care delivery systems. In 2016, the Health Resources and Services Administration HIV/AIDS Bureau launched a three-year initiative to provide training, technical assistance and evaluation for Ryan White HIV/AIDS Program (RWHAP) recipient sites to integrate CHWs into their multidisciplinary care teams, and in turn strengthen their capacity to reach communities of color and reduce HIV inequities. Methods Ten RWHAP sites were selected from across eight states. The multi-site program evaluation included a process evaluation guided by RE-AIM to understand how the organizations integrated CHWs into their care teams. Site team members participated in group interviews to walk-the-process during early implementation and following the program period. Directed content analysis was employed to examine program implementation. Codes developed using implementation strategies outlined in the Expert Recommendations for Implementing Change project were applied to group interviews (n = 20). Findings Implementation strategies most frequently described by sites were associated with organizational-level adaptations in order to integrate the CHW into the HIV care team. These included revising, defining, and differentiating professional roles and changing organizational policies. Strategies used for implementation, such as network weaving, supervision, and promoting adaptability, were second most commonly cited strategies, followed by training and Technical Assistance strategies. Conclusions Wrapped up in the implementation experience of the sites there were some underlying issues that pose challenges for healthcare organizations. Organizational policies and the ability to adapt proved significant in facilitating CHW program implementation. The integration of the CHWs in the delivery of HIV care requires clearly distinguishing their role from the roles of other members of the healthcare delivery team.

In this manuscript, we explore the promise and challenges of youth participatory action research (YPAR), paying particular attention to ethical issues and power dynamics that emerge in the context of research partnerships between youth and adults. We begin by reviewing the key tenets of YPAR and then go on to discuss how these tenets are often at odds with dominant approaches to research. We describe the tension between the values of YPAR and the systems and structures embedded in the academy. Further, we elucidate how adultism and the capitalist nature of the academy intersect with white supremacy culture, posing significant barriers to meaningful youth participation in community research partnerships. We then describe ways in which participatory scholars can disrupt these systems as well as larger paradigm shifts in the culture of academia that will be required to elevate youth voices and to amplify their efforts for equity.

Social work scholars have increasingly adopted Community-Based Participatory Research (CBPR) approaches to center community voice in research and action to promote youth's healthy development. While valuable contributions have emerged to engage in further dialectical learning processes, limited research has examined in depth the participation, critical reflection, and training of social work graduate students pursuing CBPR. This article emphasizes the role of critical reflexivity and collaboration by presenting four social work doctoral students' efforts designed to engage community and youth in CBPR to enhance health promotion initiatives. We conclude by discussing the importance of engaging graduate social work students in CBPR, the influential role faculty and mentors play in providing opportunities for students to gain experience in CBPR, and recommendations and potential strategies for future social work education and training.

Health Lens Analysis (HLA) is a tool to facilitate collaboration among diverse community stakeholders. We employed HLA as part of a community-based participatory research (CBPR) and action study to mitigate the negative health effects of traffic-related air pollution TRAP and ultrafine particles (UFPs) in Somerville, MA. HLA is a Health in All Policies tool with previously limited implementation in a North American context. As part of the HLA, community and academic partners engaged residents from across near-highway neighborhoods in a series of activities designed to identify health concerns and generate recommendations for policies and projects to improve health over an 18-month planning period. Noise barriers, which may reduce TRAP exposure among residents in addition to reducing traffic noise, were seen as an acceptable solution by community stakeholders. We found HLA to be an effective means to engage stakeholders from across sectors and diverse community residents in critical discourse about the health impacts of near-roadway exposures. The iterative process allowed the project team to fully explore the arguments for noise barriers and preferred health interventions, while building a stakeholder base interested in the mitigation of TRAP, thus creating a shared language and understanding of the issue.

Background: Community Health Workers (CHWs) have long been integrated in the delivery of HIV care, in middle- and low-income countries. However, less is known about CHW integration into HIV care teams in the United States (US). To date, US based CHW integration studies have studies explored integration in the context of primary care and patient-centered medical homes.There is a need for research related to strategies that promote the successful integration of CHWs into HIV care delivery systems. In 2016, the Health Resources and Services Administration HIV/AIDS Bureau launched a three-year initiative to provide training, technical assistance and evaluation for Ryan White HIV/AIDS Program (RWHAP) recipient sites to integrate CHWs into their multidisciplinary care teams, and in turn strengthen their capacity to reach communities of color and reduce HIV inequities. Methods: Ten RWHAP sites were selected from across eight states. The multi-site program evaluation included a process evaluation guided by RE-AIM to understand how the organizations integrated CHWs into their care teams. Site team members participated in group interviews to walk-the-process during early implementation and following the program period. Directed content analysis was employed to examine program implementation. Codes developed using implementation strategies outlined in the Expert Recommendations for Implementing Change project were applied to group interviews (n=20). Findings: Implementation strategies most frequently described by sites were associated with organizational-level adaptations in order to integrate the CHW into the HIV care team. These included revising, defining, and differentiating professional roles and changing organizational policies. Strategies used for implementation, such as network weaving, supervision, and promoting adaptability, were second most commonly cited strategies, followed by training and TA strategies. Conclusions: Wrapped up in the implementation experience of the sites there were some underlying issues that pose challenges for health care organizations. Organizational policies and the ability to adapt proved significant in facilitating CHW implementation. The integration of the CHW role may present an occasion for health care delivery organizations to reassess policies that may unintentionally marginalize communities and both limit career opportunities and patient engagement.

This chapter presents a three-year, community-based health study of Boston Brazilian and Dominican transnational immigrants. A multi-level framework is used to understand the network factors that may impact how social, cultural, and health knowledge is shared between immigrants and immigrants and host society members. Results show that Brazilians in this study tended to have more heterogeneous networks, reported more close relationships with non-Brazilians, and more contact with non-Brazilians around health-seeking, as compared to Dominicans. Differences are discussed and framed in relation to macro-level structures, including racial hierarchies, transnationalism, and immigration laws. As such, we conclude with a discussion of how immigrant health is impacted at the intersections of immigration policy and health policy.

Background This paper explores strategies to engage community stakeholders in efforts to address the effects of traffic-related air pollution (TRAP). Communities of color and low-income communities are disproportionately impacted by environmental threats including emissions generated by major roadways. Methods Qualitative instrumental case study design was employed to examine how community-level factors in two Massachusetts communities, the City of Somerville and Boston’s Chinatown neighborhood, influence the translation of research into practice to address TRAP exposure. Guided by the Interactive Systems Framework (ISF), we drew on three data sources: key informant interviews, observations and document reviews. Thematic analysis was used. Results Findings indicate political history plays a significant role in shaping community action. In Somerville, community organizers worked with city and state officials, and embraced community development strategies to engage residents. In contrast, Chinatown community activists focused on immediate resident concerns including housing and resident displacement resulting in more opposition to local municipal leadership. Conclusions The ISF was helpful in informing the team’s thinking related to systems and structures needed to translate research to practice. However, although municipal stakeholders are increasingly sympathetic to and aware of the health impacts of TRAP, there was not a local legislative or regulatory precedent on how to move some of the proposed TRAP-related policies into practice. As such, we found that pairing the ISF with a community organizing framework may serve as a useful approach for examining the dynamic relationship between science, community engagement and environmental research translation. Social workers and public health professionals can advance TRAP exposure mitigation by exploring the political and social context of communities and working to bridge research and community action.