Abigail Gerding

Partnering with the Hispanic Community in Northeast Tennessee: Their Response and the Influences on Health Care Delivery

Gail Gerding — Wed, 28 Sep 2011 15:29:58 PDT

In 2003 La Coalicion Hispano-Americano de la Salud (CHAS) was initiated by interdisciplinary faculty researchers from East Tennessee State University (ETSU) and representatives from the Hispanic community. Utilizing CDC funds, the members of CHAS and ETSU faculty engaged in community-based participatory research focused on diabetes prevention and treatment. CHAS identified two priorities: 1) to prepare CHAS members with an increased understanding of the critical health issues for local Hispanics; 2) to use this understanding to offer health fairs and useful health screening to community members. CHAS members requested and received training on diabetic care and prevention, domestic violence, depression, IRB certification and HIPAA standards. Armed with Spanish-language/Mexican cultural videos about diabetes, health equipment and resources for referral, the team implemented thirteen “chequeos” (health screenings) and informational sessions serving approximately 400 people.

The Hispanic community responded to this project by increasing trust with ETSU and members of the health care community. Increased utilization of the Johnson City Downtown Clinic (JCDC) resulted in doubling the number of Hispanic diabetic patients from approximately 50 to 100; CHAS members were included in at least 3 advisory health boards throughout Johnson City. A pilot study using Promotoras to deliver health information to Hispanic families was initiated by CHAS resulting in increased awareness of DM, high blood pressure and other related health issues. ETSU interdisciplinary students worked with CHAS members to implement programs focused on the need for interpretive services and cultural awareness specifically in hospitals and other agencies and in educating Hispanic children on nutrition and safety. The use of interdisciplinary students and faculty increased cultural awareness within multiple disciplines. As a result of this study development of culturally-appropriate methods of delivering health promotion and preventive care to Hispanic Appalachians will expand the community’s capacity to address the issue of DM through health advocacy.

Collective Efficacy as a Community Level Prevention Strategy

Gail Gerding — Wed, 28 Sep 2011 15:29:57 PDT

Introduction to Home Health Care

Gail Gerding et al. — Wed, 28 Sep 2011 15:29:56 PDT

Collective Efficacy: A Community Level Health Promotion and Prevention Strategy

Gail Gerding — Wed, 28 Sep 2011 15:29:55 PDT

Hispanic-Americans are almost twice as likely to die from diabetes, than Caucasians. In an effort to improve health outcomes of Hispanic Appalachians, faculty researchers from East Tennessee State University (ETSU) and representatives from the Hispanic community came together in 2003 to form La Coalicion Hispano-Americano de la Salud (CHAS). Using CDC funds, the members of CHAS and ETSU faculty engaged in community-based participatory research (CBPR) focused on diabetes prevention. The team implemented thirteen health screenings and informational sessions serving approximately 400 people. Increased utilization of a local clinic resulted in a 30% increase in Hispanic diabetic patients. CHAS members were included in at least 3 advisory health boards throughout the city. Continued collaboration as a community resulted in other types of health promotion and prevention activities. These findings indicated that CBPR is an effective mechanism for strengthening community capacity for change. Collective efficacy is the linkage of mutual trust and a shared willingness to intervene for the good of the community. By increasing the ability of the community to work together to address health issues, collective efficacy becomes a significant community level intervention.

Perceptions of Coordination of Care Between Hospice and Skilled Nursing Facility Care Providers

Kim Martz et al. — Wed, 28 Sep 2011 15:29:53 PDT

The number of older Americans who are finding Nursing Homes (NH) or Skilled Nursing Facilities (SNF) as their final place of care is increasing each year, especially the fastest growing segment of the national population who are 85 years and older ¹. Although the majority of older adults would prefer to die in their homes, the frailty and complexities of advanced age are leading many to the nursing home setting ^{2, 3}. In 2020, it is reported that 40% of deaths of older adults will occur in the nursing home setting^{4, 5}. Many studies have shown that NH/SNFs are not meeting the resident or families’ end-of-life care needs for comfort, pain relief and emotional and spiritual support1, ^6-10. Hospice care in nursing homes has been associated with decreased hospitalizations, high quality pain management and a collaborative opportunity to provide palliative care to dying residents ¹¹.

Culturally Tailored Cancer Communication, Education, and Research: The Highways and Back Roads of Appalachia

Kelly A. Dorgan et al. — Wed, 28 Sep 2011 15:29:51 PDT

We have varying experiences with Appalachia, yet we all agree that there is a unique relationship between Appalachians and cancer. Two of us are nurses who have worked with various communities. Two of us grew up here; 1 watched several of her relatives battle cancer in their Appalachian homes. All of us are scholars who want to talk with practitioners and researchers who are developing culturally tailored cancer control interventions. This goal to have a dialogue emerged after we had a series of discussions about cancer in Appalachia, discussions resulting in our developing a list of cultural traits that seem to be related to this region’s high cancer morbidity and morality (Table). For example, in one of our previous publications we describe the association between the traditional Appalachian oral culture and the cancer experience, finding that cancer stories appeared to pass from 1 generation to the next (1). In turn, these stories seem to affect some community members' willingness to be screened. Our essay's purpose is not to justify the elements presented in the Table. Rather, we write to consider the following: What are the advantages and disadvantages of making generalizations about a culture that has already been marginalized by overgeneralizations?