Community-Academic Partnerships to Improve Hispanic Immigrant Health: Perspectives from a Doctoral Student
During my doctoral degree, I worked as a research assistant on a five–year National Institutes of Minority Health and Health Disparities (NIMHD)–funded study with the interdisciplinary research group the Mecklenburg Area Partnership for Primary Care Research (MAPPR). MAPPR is a practice–based research network designed to enhance healthcare access for underserved and vulnerable populations in Charlotte–Mecklenburg, NC. The core research team includes social and health scientists from the University of North Carolina at Charlotte and Carolinas Health-Care System.
MAPPR applies a community based participatory research (CBPR) approach, which involves community members and other stakeholders throughout the research process. During my time with MAPPR, I was actively involved in a study identifying the social determinants of health affecting Hispanic immigrants in Charlotte–Mecklenburg. I assisted [End Page 18] with the design, implementation, and evaluation of interventions to decrease health disparities and enhance access to primary care for this group. Partners included health and social service providers, educators, Hispanic foreign–born residents and a Community Advisory Board (CAB), which included representatives from the local school system, the County Health Department, and the City of Charlotte. In this essay, I reflect on the experience of engaging in community–academic partnerships as part of the intervention phase and as a doctoral student working ‘on the ground’ as part of MAPPR.
The research team employed a variety of methods (key informant interviews, focus groups, a Photovoice project, and community forums) to develop the interventions in collaboration with community members and partners. The first part of the intervention consisted of nine neighborhood–based health interventions at two elementary schools in two high–need areas. These events offered free check–ups, education, and representatives from a wide variety of social and health services (all in Spanish), as well as childcare. The academic team collected data in the form of participant surveys and health outcomes data.1 I recruited and trained over 50 volunteers that assisted in various capacities with the fairs—as interpreters, medical staff, in childcare, and as navigators, for instance. Without our community partners and committed volunteers, we would not have been able to hold these fairs. They were truly a collaborative effort that leveraged resources across sectors.
The community health interventions offered an opportunity for different groups to come together and learn from each other. Participants felt welcomed by friendly volunteers and volunteers reported learning more about the local Hispanic community. Volunteers and organizational representatives were also able to successfully connect with others. “It just builds comradery to see others outside of regular work environment,” a volunteer mentioned. Interestingly, immigrant participants were typically more positive about the intervention than the providers and organizational representatives. Participants were grateful to receive a check–up, speak with a provider, and receive information and education. Though emphasis was placed on getting participants connected to health and social services—to enhance sustainability of the intervention—providers and organizational representatives often felt frustrated by persistent financial, health insurance, or documentation status barriers. There are limited services available for low–income families and undocumented immigrants, and those services are typically already stretched thin.
We also encountered push–back and skepticism from some organizational representatives about research and sustainability components of our intervention. In one of the evaluation focus groups I facilitated, an organizational representative asked me: “you were asking us for some feedback, but who sees the recommendations and where does that go? I mean, I know you are trying to use it for another grant to continue but what ultimately is the outcome?” Another said: “It’s great all the information and the data and the research, and it’s obviously showing the needs out there, so what are we doing about those needs? (. . .) I know you have to sometimes follow what the grant says. (. .) But it makes me wonder if putting the research aspect of it should come as a second thing.” This points to the need for transparency when research teams are working with organizations and other partners. It also illustrates how the needs and goals of different stakeholders vary and meeting everyone’s objectives can be challenging. There was a tension between research and services goals of the intervention; community members and some of our partners saw us more as service providers, whereas other partners felt we focused too much on the research aspects and should be doing more for service provision and policy. Tensions with some partners challenged us to think critically about what/who MAPPR is and what our role(s) in the community are. Conversations among MAPPR members and the CAB in 2016 have [End Page 19] resulted in a revised strategy for the research team. Furthermore, though I see it as a strength that we conduct community–engaged research, this struggle returned as we sought out to disseminate our findings; our work has been well received at CBPR conferences and local avenues but we are challenged to make our work ‘academic’ enough in order to publish in health journals. Finding journals that publish interdisciplinary research that is different from the ‘traditional’ scientific approach is an ongoing challenge and I am continuously challenging myself to communicate my research more effectively to different audiences.
What made me hopeful was participants’ willingness to make changes in their health behaviors and lifestyle to improve their health, based on the information they received at the community health interventions. This astonished our providers: the “behavior change in that population is astounding; I can’t do that with primary patients in my own time.” An interpreter shared that: “Speaking not only as a volunteer but speaking as a Latino myself, I have to say that I didn’t give our people enough credit (. . .) I didn’t expect to see as much willingness to change and get those results and positive outcomes and actually getting to see it was impressive.” This reminds me there is a lot of room for education and health literacy in Hispanic immigrant communities.
The second component of the intervention involved establishing two Latina women’s groups, Hispanos en Accion (HA) and Hispanos Unidos (HU). We started incorporating opportunities for input, ownership, and leadership early on and throughout the 16–month engagement process. Participating community members drove the mission and goals of the groups. For HA, a colleague and I met with the women weekly, offered Zumba classes, and brought in speakers. Listening to the evaluation focus groups that took place 14 months after HA first started, participants reflect that they had a positive experience overall. They enjoyed the workout classes, learned a lot from the guest speakers, and became motivated to exercise and eat healthier.
However, HA faced several critical challenges in the formative and transition stages that prevented progression to a sustained group. For instance, while we had a consistent space for our meetings, we were unable to hold Zumba classes there (due to noise and poor building structure) and we were unsure if we could continue meeting there. Participants and MAPPR members continued to contact potential meeting places. Still, it was very hard to find space to meet because most places were too expensive (at apartment complexes or the school), too far away (churches), or too small (people’s homes). We all felt some frustration that we were not able to find a space. Additionally, we struggled with timeliness and declining/fluctuating participation. In general, participants were willing to take more active roles in the group, but other, more immediate, tasks and responsibilities were (understandably) more pressing. In a sense, barriers to participating in community groups are often similar to barriers for accessing health services, e.g. transportation, work schedules (long/irregular/changing hours), and child care responsibilities. For many participants, juggling life responsibilities and daily tasks took up most of their time and energy. As a result, regular participation in an organized program was possible but difficult enough. The talks and exercise opportunities we offered were much appreciated, but taking a leadership role was not an option.
The other women’s group, HU, was also interested in education and exercise but was more outward–oriented in terms of wanting to participate in volunteer and health events in the city. As they developed, they also received more support outside of MAPPR. For example, a local elementary school allowed them to meet there every other week and during the summer they met at a local YMCA (all for free). Thanks to a strong and ongoing partnership with this local YMCA, HU continues to exist three years after its founding. The YMCA provides a meeting space and their community engagement director supports the group and led them through a leadership development training.
Looking back at our study interventions, I am proud of our diverse and mutually beneficial collaborations. CAB members informed the work of MAPPR and vice versa. The successes of these community–academic partnerships can partially be attributed to a MAPPR project manager who is excellent at building and maintaining such partnerships. [End Page 20] Some collaborations showed to be stronger and longer–term than others. I also learned how structural and institutional impediments can continue to negatively affect Hispanic immigrant health, even when all the ‘right’ local partners are aligned. We cannot change the exorbitant cost of health care or somebody’s documentation status, for instance.
Our study interventions emphasized the importance of communicating with and across participants, volunteers, providers, organizational representatives, and research team members. This is time–consuming but helps clarify roles and responsibilities, which ultimately can help the quality of the partnerships and the outcomes. Providing comprehensive health and social service coverage for all Hispanic immigrants is challenging, though information about services available, how to navigate systems (health care, education, e.g.), and a healthy lifestyle can make positive impacts in the health and wellbeing of underserved Hispanic immigrants.
I feel privileged to have had the opportunity to work with an outstanding team and a wide variety of community partners, and to continue to be involved with MAPPR as part of their CAB. Being part of all steps of the research process taught me the strengths and complexities of CBPR, and shaped me as a community–engaged scholar. It provided a foundation for new community–academic partnerships in my dissertation, postdoctoral fellowship and beyond. I hope other graduate students are provided similar hands–on training and mentorship.
I would like to thank the community members that participated as part of the research, the MAPPR team, members of the Community Advisory Board and all other community partners.
Funding. This research is supported by Award Number R01MD006127 from the National Center On Minority Health and Health (NIMHD). The content is solely the responsibility of the author and does not necessarily represent the official views of the NIMHD or NIH.
1. All study materials were approved by the Carolinas Healthcare System Institutional Review Board (IRB). Participants enrolled in the study were compensated for their time in the form of gift cards.