Clinical translational designs in communities: A case study

1. Clinical translational designs in communities: A case study India J. Ornelas Assistant Professor, Health Services KL2 Scholar

2. Building Relationship with CASA Latina • Started meeting them with when I came as a postdoc • Conducted interviews there on stress, discrimination and health • Presented the findings at CASA Latina staff meeting • High levels of stress • Depressive symptoms • Social isolation • Staff were interested in program to help address some of the findings from the study • I approached them with the idea of writing a grant to pilot a stress and coping curriculum

3. ALMA : Amigas Latinas Motivando el AlmaPilot Intervention in NC • Trained 40-45 local promotoras in Durham, Wake and Chatham counties • 6 sessions to train groups of 12-15 Latinas • Recruited through churches, community organizations and agencies • Skill building on coping strategies for isolation, anxiety, sadness • Appled relevant topics: immigration, isolation, family re-organization • Tangible items such as a comfort basket as potential strategies • Promotoras shared information with 2-3 other Latinas in their social network (Compañeras) • Promotoras teach self-help strategies to compañeras to improve compañeras’ coping skills and reduce their stress • Saw reductions in depressive symptoms, perceived stress and increase in coping skills

4. ITHS Community Pilot Grants https://www.iths.org/funding/TribeCommunityPractice • Funds can be used for small pilot research, quality improvement projects, or non-research activities that develop research capacity. All proposed research must be participatory, which means involving community, tribe and practice members in the health research processes.  • Examples include but are not limited to:  • Conference, seminar or course attendance(example only): • Attend a course, seminar, training workshop or conference related to community, tribe, or practice-based participatory health research that will help increase research capacity. • Organize a gathering of your community, practice or tribe(example only): • Organize a meeting for community or practice members to talk about research questions that are important to study (for example, Town Hall). • Conducting research or quality improvement work (examples only): • Hire a consultant to help write a research grant proposal. • Build research review or regulatory capabilities at your organization, community, or practice.  Examples include creating cultural or tribal review boards, institutional review boards (IRBs), or other regulatory systems. • Collect preliminary data from a community or practice to support a future grant proposal. • Conduct chart reviews to find gaps in services, such as racial and ethnic health disparities. • Conduct an interview or focus group (qualitative study) with providers and patients to learn why a health intervention does not work as well for some groups of people. • Survey a specific racial or ethnic group of people to learn about their views on cancer and cancer prevention

5. We got the money…..now what? • Negotiating responsibilities and budget • Changes to the curriculum

6. Training • Project Coordinator/Trainer came out from North Carolina to spend 2 days training CASA Latina staff on the curriculum and how to facilitate meetings • Half-day training with CASA Latina on data collection

7. CASA Latina Curriculum Session 1: Introduction to the program and to stress • Activity – Book and video about immigration story • Activity – Sponge, how much stress can you take? • Activity – How do you deal with stress? • Homework: Make a card for a loved one • Gift: Toolbox

8. Session 2: Separation • Activity –“Josefina’s Story” • Brainstorm – Healthy and Unhealthy ways of coping with stress • Activity – Writing with your bellybutton • Activity – Web of social support (with yarn) • “MiAbuelita Dice…” • Homework: Practice a healthy way of coping – like walking

9. Session 3: Adjusting to Life in Seattle • Information about social support • Activity: Share the cards they made • Activity: Social networks (here and there) • Activity: Introduction to meditation (raisin) • Gift: Frame for a photo of loved one Session 4: Coping with Stress • Activity: Loteria with Coping Strategies • Yoga and Meditation • Homework: Practice meditation • Gift: Relaxation CD and candle

10. Session 5: Seeking Mental Health Services • Invited therapists from SeaMar and Consejo to explain the how to seek mental health services and the role of a psychologist/social worker • Activity on holistic health • Reflection in pairs over the workshop • Gift: soap

11. Participants • Recruited 22 participants • Of those 12 came to at least one session • 9 attended all five sessions • An additional 6 came to at least one session after we did the pre-tests • Low-income, primarily from Mexico, Spanish dominant

12. Evaluation Results

13. Focus Group “I have a lot more abilities than what I believed.” “To value ourselves, to make time for ourselves…it is very valuable for me because I give all of my time….I have 4 sons.” “Free time is also for me…to get rid of stress and be better.” “The other day it was raining so hard, and I kept going without an umbrella…walking in the rain…I felt so good…not cold…and I said to myself, “yes, the ALMA sessions have done a lot for me.” “You have the ability to transform stress…to decrease stress…by a variety of ways, like meditating.” Purpose: To obtain feedback on the session content and how it was offered

14. What do you do differently now? “I learned to practice more exercise and that helps me control my anxiety” “I learned to walk my dog for [lowering] stress” “To put into practice the different tips [from actions to manage stress sheet] …I see it and I read it because I hung it up in my kitchen.” “Related to the relaxation [activity] was what I liked most…I am less tense” “I think that what called most to my attention was the relaxation [activity]…to learn how to relax because we lived so stressed” Managing Stress

15. Lessons Learned and Next Steps • Working in the community always takes longer than you think it will • Be mindful of the burden to the community • Be mindful to the burden on you • Be responsive to community needs • Follow through – our next step is to find funding to test and implement as promotora or stress reduction program