Brett Rowland

Diabetes and Hypertension in Marshallese Adults: Results from Faith-Based Health Screenings

BackgroundThe Pacific Islander population in the USA is growing rapidly. However, research on Pacific Islanders in the USA is limited, or sometimes misleading due to aggregation with Asian Americans. This project seeks to add to the dearth of health literature by conducting a health assessment of Marshallese in northwest Arkansas.MethodsUsing a community-based participatory research approach, nine health screening events were conducted at local Marshallese churches. Participants completed the Behavioral Risk Factors Surveillance Survey core questionnaire and diabetes module if applicable. Biometric data, including Hemoglobin A1c, blood pressure, and body mass index, were gathered by an interprofessional team.ResultsFour hundred one participants completed health screenings. High proportions of diabetes, obesity, and hypertension were found. A high percentage of participants were uninsured, and multiple barriers to health care were found within the sample.DiscussionThis project represents one of the first broad health assessments of Pacific Islanders in the USA. Proportions of diabetes, hypertension, obesity, and uninsured found in the sample are much higher than national proportions.

A Social Ecological and Community-Engaged Perspective for Addressing Health Disparities Among Marshallese in Arkansas

Background: This article describes the case study of a community-based participatory research team that has used a social ecological approach to address significant health disparities in type 2 diabetes among Marshallese living in Arkansas. Methods: A case study approach is used to analyze the activities of the community-based participatory research partnership using a social ecological framework to describe how multiple factors across the social ecology are being addressed simultaneously. Results: In collaboration with the local Marshallese community and local organizations, the interprofessional team implemented interventions at each of the social ecological levels. Conclusion: Efforts to address health disparities should include interventions at multiple social ecological levels. Further, engaging diverse community partners contributes to success by leveraging the contextual and cultural knowledge, practices, and resources of all individuals and organizations involved. Finally, combining a social ecological perspective with a community-based participatory research approach contributes to sustainability of the interventions by engaging the broader community and ensuring the interventions reflect an understanding of and appreciation for the community’s culture.

Improving Culturally Appropriate Care Using a Community-Based Participatory Research Approach: Evaluation of a Multicomponent Cultural Competency Training Program, Arkansas, 2015-2016.

Introduction The United States continues to become more racially and ethnically diverse, and racial/ethnic minority communities encounter sociocultural barriers to quality health care, including implicit racial/ethnic bias among health care providers. In response, health care organizations are developing and implementing cultural competency curricula. Using a community-based participatory research (CBPR) approach, we developed and evaluated a cultural competency training program to improve the delivery of culturally appropriate care in Marshallese and Hispanic communities. Methods We used a mixed-methods evaluation approach based on the Kirkpatrick model of training evaluation. We collected quantitative evaluation data immediately after each training session (March 19, 2015–November 30, 2016) and qualitative data about implementation at 2 points: immediately after each session and 6 months after training. Individuals and organizational units provided qualitative data. Results We delivered 1,250 units of in-person training at 25 organizations. Participants reported high levels of changes in knowledge (91.2%), competence (86.6%), and performance (87.2%) as a result of the cultural competency training. Organizations reported making policy and environmental changes. Conclusion Initial outcomes demonstrate the value of developing and implementing cultural competency training programs using a CBPR approach. Additional research is needed to determine the effect on long-term patient outcomes.

Physical Activity and Diabetes-related Health Beliefs of Marshallese Adults

OBJECTIVE We sought to improve understanding of diabetes-related health beliefs and physical activity behaviors of Marshallese adults with and without type 2 diabetes (T2D). METHODS We used tests of comparison and regression analyses to examine data from 376 Marshallese adults collected at church-based events. RESULTS One in 5 (20.2%) respondents had received a T2D diagnosis. About one-fourth of the respondents fell into one of 4 physical activity levels: zero times per week (28.7%), one time per week (19.4%), 2-3 times per week (24.7%) and ≥4 times per week (26.9%). Using logistic regression, we found T2D diagnosis status was not statistically associated with level of physical activity. However, having time to be physically active was significantly associated with being physically active ≥4 times per week. Being obese, having less than a high school education, not having time, and not having a comfortable place to exercise were significantly associated with never being physically active. CONCLUSIONS These findings help fill gaps in Pacific Islander health literature and will inform public health interventions to improve rates of physical activity among the Marshallese and other Pacific Islander communities.

Cost-related Nonadherence to Medication Treatment Plans

Background: Adherence to medication treatment plans is important for chronic disease (CD) management. Cost-related nonadherence (CRN) puts patients at risk for complications. Native Hawaiians and Pacific Islanders (NHPI) suffer from high rates of CD and socioeconomic disparities that could increase CRN behaviors. Objective: Examine factors related to CRN to medication treatment plans within an understudied population. Research Design: Using 2014 NHPI-National Health Interview Survey data, we examined CRN among a nationally representative sample of NHPI adults. Bonferroni-adjusted Wald test and multivariable logistic regression were performed to examine associations among financial burden-related factors, CD status, and CRN. Results: Across CD status, NHPI engaged in CRN behaviors had, on an average, increased levels of perceived financial stress, financial insecurity with health care, and food insecurity compared with adults in the total NHPI population. Regression analysis indicated perceived financial stress [adjusted odds ratio (AOR)=1.16; 95% confidence intervals (CI), 1.10–1.22], financial insecurity with health care (AOR=1.96; 95% CI, 1.32–2.90), and food insecurity (AOR=1.30; 95% CI, 1.06–1.61) all increase the odds of CRN among those with CD. We also found significant associations between perceived financial stress (AOR=1.15; 95% CI, 1.09–1.20), financial insecurity with health care (AOR=1.59; 95% CI, 1.19–2.12), and food insecurity (AOR=1.31; 95% CI, 1.04–1.65) and request for lower cost medication. Conclusions: This study demonstrated health-related and non–health-related financial burdens can influence CRN behaviors. It is important for health care providers to collect and use data about the social determinants of health to better inform their conversations about medication adherence and prevent CRN.

Identifying and Understanding Barriers and Facilitators to Medication Adherence Among Marshallese Adults in Arkansas

Background: Significant health disparities are present in Marshallese adults residing in the United States, most notably a high incidence of type 2 diabetes and other chronic conditions. There is limited research on medication adherence in the Marshallese population. Objective: This study explored perceptions of and experiences with medication adherence among Marshallese adults residing in Arkansas, with the aim of identifying and better understanding barriers and facilitators to medication adherence. Methods: Eligible participants were Marshallese adults taking at least one medication for a chronic health condition. Each participant completed a brief survey and semistructured interview conducted in Marshallese by a bilingual Marshallese staff member. Interviews were recorded, transcribed, and translated from Marshallese to English. Qualitative data were coded for a priori and emergent themes. Results: A total of 40 participants were included in the study. The most common contributing factor for nonadherence was forgetting to take medication (82%). A majority of participants (70%) reported difficulty paying for medicine, 45% reported at least one form of cost-related nonadherence, and 40% engaged in more than one cost-related nonadherence practice. Family support and medication pill boxes were identified as facilitators for medication adherence. The majority of the participants (76.9%) stated that they understood the role of a pharmacist. Participants consistently desired more education on their medications from pharmacy providers. Conclusion: This is the first study to explore barriers and facilitators to medication adherence among Marshallese patients. The findings can be used to develop methods to improve medication adherence among Marshallese.

The Mediating Role of Sleep Quality and Quantity in the Link Between Food Insecurity and Obesity Across Race and Ethnicity

The objective of the study was to examine the mediating role of sleep quality and quantity in the relationship between food insecurity and obesity across races/ethnicities.

Improving Health while Alleviating Hunger: Best Practices of a Successful Hunger Relief Organization

Abstract Background Food insecurity affects millions each year in the United States. Hunger relief organizations work to reduce hunger and food insecurity; however, the foods they provide are often unhealthy. Objective The objective of this article is to document the policy, systems, and environmental changes that Samaritan Community Center made to their programs in order to better serve Washington County and Benton County, Arkansas. Methods With the use of a case-study approach, researchers held 17 meetings with key members of the organization and conducted >30 h of observations to document policy, systems, and environmental changes and best practices for implementing those changes. Results Researchers identified emergent themes and grouped best practices in the following categories: 1) removing stigma and empowering clients, 2) incremental steps to increase access to healthy foods, 3) embracing multiculturalism, 4) donation policies and procurement, 5) collaboration is key, 6) organizational culture, and 7) challenges and resolutions. Conclusions Samaritan Community Center has successfully implemented and adopted new programs and practices in order to improve the health of their clients. To our knowledge, this is the first case study to document best practices for making policy, systems, and environmental changes by a hunger relief organization to improve the nutritional quality of foods provided to their clients.

Health Research Participation, Opportunity, and Willingness Among Minority and Rural Communities of Arkansas

Prior research suggests that rural and minority communities participate in research at lower rates. While rural and minority populations are often cited as being underrepresented in research, population‐based studies on health research participation have not been conducted. This study used questions added to the 2015 Behavioral Risk Factor Surveillance System to understand factors associated with i) health research participation, ii) opportunities to participate in health research, and iii) willingness to participate in health research from a representative sample (n = 5,256) of adults in Arkansas. Among all respondents, 45.5% would be willing to participate in health research if provided the opportunity and 22.1% were undecided. Only 32.4% stated that they would not be willing to participate in health research. There was no significant difference in participation rates for rural or racial/ethnic minority communities. Furthermore, racial/ethnic minority respondents (Black or Hispanic) were more likely to express their willingness to participate.

Diabetes Self-Care Behaviors Among Marshallese Adults Living in the United States

Marshallese experience high rates of type 2 diabetes. Proper management of diabetes requires multiple self-care behaviors, yet little is known about Marshallese’s diabetes-related self-care behaviors. Survey data from 111 Marshallese adults with diabetes were used to examine relationships between self-care behaviors and socio-demographic characteristics. The most common self-care behavior was attending annual doctor visits, while the least common was maintaining a normal weight. Age group, education level, and having a regular doctor were significantly associated with engaging in self-care behaviors. Having a regular doctor had the most effect on performing self-care behaviors (p = 0.006); although, only 38.7% reported having a regular doctor. To minimize diabetes-related complications, efforts to improve self-care behaviors among the Marshallese should be developed. Alternatives to traditional healthcare providers, such as community health workers, may be a viable strategy with this population given only one-third reported having a regular doctor.