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Health Disparity Research: Opportunities and Challenges

Health Disparity Research: Opportunities and Challenges. David Smith United Way of Greater Houston Dr. Katharine Ball-Ricks University o f Texas Health Science Center at Houston School of Public Health.

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Health Disparity Research: Opportunities and Challenges

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  1. Health Disparity Research:Opportunities and Challenges David SmithUnited Way of Greater Houston Dr. Katharine Ball-Ricks University of Texas Health Science Center at Houston School of Public Health

  2. “…populations where there is a significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates in the population as compared to the health status of the general population” • National Institutes of Health, 2013 • Populations generally affected • African Americans • Hispanics/Latinos • American Indians, Native Hawaiians & other Pacific Islanders • Asian Americans • Socioeconomically disadvantaged • Rural populations Health Disparities

  3. Generally a result of: • Poverty • Environmental threats • Inadequate access to health care • Individual and behavioral factors • Educational inequalities (lack of education) Health Disparities OR Inequalities

  4. Health Disparities Research • Community Based Participatory Research and may include research on: • Cancer • Cardiovascular Disease • Chronic Kidney Disease • Diabetes • HIV and AIDS • Maternal and Child Health • Mental Health and Substance Abuse • Environmental (air quality, mold) • Obesity and Exercise

  5. Cross-CPCRN Study Administered in four 2-1-1 Systems

  6. Purnell, Kreuter, Eddens, Ribsl, Hannon, Fernandez, Jobe, Gemmel, Morris & Fagin. Cancer control needs of 2-1-1 callers in Missouri, North Carolina, Texas and Washington. Under review at Journal of Health Care for the Poor and Underserved. Pooled Analysis Results

  7. Pairing 2-1-1 systems and researchers • Combining, refining, and analyzing data • Providing evaluation and funding assistance • Laying ground rules for collaboration • Setting a research agenda 2-1-1 Health and Human Services Research Consortium

  8. Houston Pilot Results in 2010

  9. Goals and Aims To increase the use of cancer control strategies among disadvantaged adults who call 2-1-1, we will: • Develop and pilot test an intervention • Provide risk assessment and referral services • Determine the effectiveness and cost effectiveness of the 211 Telephone Cancer Control Navigator Program Increasing Cancer Screening and HPV Vaccination among Underserved Texans: A Collaboration with Texas 2-1-1

  10. Participating Call Centers: • Houston (CPRIT funded) • Weslaco (CPRIT funded) • El Paso (CNP funded; now CPRIT funded) Preliminary Findings

  11. Preliminary Results of the Needs Assessment: Cancer Risk Factors & Prevention Needs

  12. How To Get Started

  13. How your 211 data can help • Knowing the needs of your community • Health Department Priorities • Internet Research Your Research/Knowing Your Community

  14. Calling or Visiting • Schools of Public Health • Prevention Research Centers • Cancer Prevention and Control Research Networks • Community Network Programs • Clinical and Translational Science Award (CTSA) Community Engagement leaders • Community Organizations • Inviting University Professors to sit on boards, committees • Sending out “Calls for Proposals” Ways to Make Contact with Educational Institutions

  15. An Example

  16. Activity / Discussion

  17. Make a list of the major universities in your service area. • Google search – university + “health disparities research” • Yes, it’s that easy. Let’s Practice

  18. Brown Bag Meetings • 211 Open House • Educate the community • Thought leader in the work • Community Committees • Networking Getting Your Foot in the Door

  19. Pre-Grant Proposal • Letters of Support • State and nation-wide partnerships (CNP, CPCRN) • During Grant-Writing Process • Sharing approach and previous work • First year of the study • Intervention Development/Training • Kick-off Meeting • Capacity Assessment/ Capacity Building • Implementation • Weekly meetings at 2-1-1 Houston/ weekly update e-mail • Transparent Protocols & Processes/ Ongoing Quality Assurance • Collaboration: meetings, events, conferences and publications Strategies for Collaboration

  20. Challenges From the academic perspective

  21. Lower acceptance and retention rate • Site Differences • Tailor strategies based on organizational culture • Research-based vs. Service-oriented • Balance each party’s interests: reciprocal relationships • Change in Site personnel • Need to “Over-train” • Variation in staff morale • Introduce different incentives Challenges & Lessons Learned

  22. 2-1-1 Competing responsibilities • Commitment of collaborators • Implementation practices • Quality control • Support & Continuity Implementation Challenges for Further Investigation

  23. 2-1-1 Challenges

  24. This is not unique to academic research, but pricing is an area where many struggle – effort versus results. Our Approach • Make a commitment based upon # of FTEs • 1 FTE -- coach/navigator • 2 FTE -- Recruiters • 10% of a manager’s time. • Convert to an hourly rate. • Expand out over the project timeline. • X # of hours for helpline specialists at $Y per hour • X # of hours of manager at $Y per hour. Know Your Pricing Strategy

  25. Selecting Staff Make a commitment based upon # of FTEs 1 FTE -- coach/navigator 2 FTE -- Recruiters 10% of a manager’s time. • Build an org chart that doubles the FTE commitment • 2 coaches • 4 recruiters

  26. Not Everyone Was a Successful Recruiter • Questions are too intrusive – we should not be asking. • Attached to the outcomes • Trouble switching gears/focus from a 3 to 5 minute I&R call to a 20 to 30 minute survey call. • Result : Burn out lead to “taking breaks” Selecting Staff

  27. Longest Documented Call Francis Potakey Time: 2 hours 0 minutes Comments : “Very Talkative Caller. Digresses a lot for every question that you ask.” Runner-Up Vallery Arnold: 1 hour 26 minutes.

  28. All participants have to be certified in Human Subjects Research training. (Ethics) • Takes 8 hours to complete, plus 2 hours refresher every two years. • Project start-up training will vary, but ours have been averaging an additional 20 hours from selection to the start of recruiting. Training

  29. Have to be able to provide informed consent • IRB will not approve attempts to based upon age (under 18) or vulnerable populations (mental illnesses or intellectual disabilities) without additional safeguards. • Researchers will generally exclude from study recruitment, unless they have a specific interest. • AIRS Standards = we are ethically obligated to provide information and referral services to all of these populations. • Need to discuss at the start of the contract. Ethics

  30. Pareto Principle – 80/20 in action

  31. Opportunity : Smoke Free Homes

  32. 2-1-1 Systems take an estimated 16 million calls annually With the potential of reaching 5 million smokers, 3.1 million women in need of Pap tests, 2.6 million women needing mammograms, 2.3 million women needing the HPV vaccination, Potential Public Health Impact 1.9 million with daughters in need of the HPV vaccination, 1.9 million in need of colonoscopies

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