Download CERC Update (Dr. Callwood) - caribbean exploratory nimhd

Caribbean Exploratory
(NCMHD) Research Center
Update
Gloria B. Callwood, PhD, RN
Presented at
Caribbean Exploratory Research Center
2nd ANNUAL HEALTH DISPARITIES INSTITUTE
October 15, 2009
Objectives
This presentation will:
 Describe the organizational structure of the
Caribbean Exploratory Research Center on
Health Disparities
 Provide an overview of significant health issues
and health care barriers in the Virgin Islands
 Identify key self reported health related
concerns of residents
 Share information on Center activities and
overview of data emerging from the Center’s
efforts
Caribbean Exploratory Research
Center on Health Disparities
Where we are located
Who we are
Caribbean Exploratory Research Center
on Health Disparities US Virgin Islands
St. Thomas Campus
St. Croix Campus
Who are Virgin Islands Residents?
The Virgin Islands is a blended multicultural
Society with a direct affect on the culture
and health of the population
 Black 76.2%,
 White 13.1%,
 Asian 1.1%,
 Other 6.1%,
 Mixed 3.5% (2000 census)
Caribbean Exploratory Research Center
on Health Disparities (CERC)


A National Center for Minority and Health
Disparities funded Project (#1P20MD002286-03)
Organized into four cores
 Administrative
 Research
 Research Education and Training
 Community Engagement/Outreach
Caribbean Exploratory Research Center
on Health Disparities (CERC)

Organized to:
 Conduct research on health disparities
 Provide mentoring and training opportunities
for students, junior faculty and researchers
 Provide health screening, health promotion
and health information dissemination
activities
 Establish partnerships with community based
organizations
Significance of Exploratory Center for
the Virgin Islands
 Health disparities among African
American, African Caribbean and Hispanic
population sub-groups in the US Virgin
Islands have been well documented in
national and territorial reports
 There is a paucity of research focused on
factors that interact to create health
disparities in the US Virgin Islands.
Significance of Exploratory Center for
the Virgin Islands
Research is needed to:
 Generate
sources of reliable data
 Identify, develop, and evaluate
intervention strategies that will
most effectively reduce or
eliminate health disparities in the
Virgin Islands.
Mortality
Leading causes of death
Cardiovascular Disease
Cancer
Morbidity

Diabetes #4 in US at 9%*

High blood pressure #28 in US at 24.8%*

High Cholesterol # 37 in US at 31.5%*

Rated #2 in nation per 100,000 for HIV/AIDS** (DC #1)

TB-10.83 per 100,000 (2005)*
 Treatment success only 50 % 1995 (World
Development Indicators database )
Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance
System Survey Data, 2004*
CDC HIV/AIDS Surveillance Report: Cases of HIV Infection and AIDS in the United States and Dependent Areas,
2007,**
Barriers Contributing to Disparities

Three potential sources of Unequal
Treatment



Health systems-level factors – financing,
structure of care; cultural and linguistic
barriers
Patient-level factors – including patient
preferences, refusal of treatment, poor
adherence, biological differences
Disparities arising from the clinical encounter
Health systems-level factors

Large percentage of uninsured 18-64
years


Large immigrant population


32.7% (BRFSS, 2006)
Limited translation capability
Access



Fragmented services
Poor public transportation
Hours of service
Patient-level factors

Low percentage preventive screening

Colorectal Cancer Screening 14.8 %

Women aged 40+ who have had a
mammogram within the past two years
61.3%

Visited the dentist or dental clinic within the
past year for any reason 61%
(BRFSS 2006)
Patient-level factors

Patient preferences


Level of confidence in the health care
system
Adherence


Cannot be separated from cost/insurance
issues
Health literacy

Hesitancy to question provider
Clinical Encounter
Waiting time for service
 Time spent with provider
 Level of explanation of
condition/treatment
 Requirement to pay provider out of
pocket

Insights From Focus Groups

Ranked health issues in the Virgin Islands
1.
2.
3.
Disease and disease management
Financial concerns
Services



Facilities
Personnel
Customer services
Center Research Activities

Begun under Capacity building EXPORT
Center Grant (Studies completed or in
progress)



A church based diabetes survey for St. Thomas
in the US Virgin Islands
Focus study of patient/provider breast cancer
risk communication and breast cancer risk
management
Factors and life experiences affecting self
management among a population of type 2
diabetic patients in the United States Virgin
Islands
Center Research Activities cont.



Health Status and Access to healthcare among
African American and African Caribbean
Women
Knowledge, attitudes, perceptions and decision
making of pregnant and parenting women of
African heritage at risk for or living with
HIV/AIDS: an international perspective
Abuse status and health consequences for
African Caribbean and African American
women Study (ACAAWS)
One Study Key Results

Focus study of patient/provider breast
cancer risk communication and breast
cancer risk management




N-178 aged 30-74
12.1% projected to be at moderate to high risk
for breast cancer
Historical information relative to personal and
family health was not routinely collected from
subjects
The majority of subjects did not comply with
recommended breast cancer screening
guidelines
Key Study Results

Women reporting having had discussions with
health care providers about their personal
breast cancer risk were more likely to express
an interest in medical strategies for the
management of breast cancer risk
Implications for Research, Practice
and Education



Need for the development of more focused
programs of research, education and outreach to
promote breast health among women in the USVI
Need to enhance systems responsible for
monitoring and reporting cancer trends relative
to cancer incidence, mortality and survival within
the territory
Need for forums for investigators, faculty,
students and the community to discuss the
breast health needs and concerns of women
across the territory
Implications for Research, Practice
and Education cont.



Need for educational programming for women in
the community that focuses on breast cancer,
breast cancer risk, breast cancer screening, and
breast cancer risk management
Need for educational programming for women in
the community that enhance communication with
health care providers
Need for educational programming for women in
the community that focus on the relationship
between personal health and family health
Implications for Research, Practice
and Education cont.
Need for training of health care providers
(i.e., physicians, nurse practitioners,
oncology nurse specialists, etc.) relative to
the assessment and communication of
breast cancer risk
 Need for the development of programs of
research to address issues relevant to
breast cancer detection and control among
women in the USVI across the care
continuum.

Caribbean Exploratory Research Center
Next Steps
Follow up on recommendations from
reported studies
 Facilitate the completion of ongoing
studies through presentation to peers,
publication and implementation of relevant
interventions to reduce disparities
 Host conferences aimed at garnering
involvement in community based
participatory, and culturally relevant
research

Next Steps cont.
Provide support for pilot studies
addressing health disparities
 Mentor students, faculty and community
researchers in evidenced based
approaches to address disparities
 Engage the community through CBOs in
educational, wellness and preventative
activities

Next Steps Cont.

Seek additional funding sources
Three grant applications submitted through the
Center in response to the American Recovery
and Reinvestment Act call for proposals
 Thousands of applications submitted from
across the nation
 One of the three submitted proposals funded
for $600,000 over a two year period.
We will continue to seek opportunities for
additional support of what we consider vital
work to improve the health of Virgin Islanders.


Resources





CDC National Center for Chronic Disease Prevention and
Health Promotion Behavioral Risk Factor Surveillance
System (2004, 2006)
CDC HIV/AIDS Surveillance report , 2007
HEALTHY VIRGIN ISLANDS 2010: Improving Health For
All(2003) Virgin Islands Department of Health
Underwood, S., Ramsay-Johnson, E., Callwood, G., Evans,
E. (2007) Promoting Breast Health among Women in the
U.S. Virgin Islands: A Focused Study of the Needs of
Caribbean Women, JNBNA Vol. 18 (2)
Unequal Treatment: Confronting Racial and Ethnic
Disparities in Healthcare (2003) Institute of Medicine

U S Census Bureau (2000)
Thank You
Questions?
Supported by a grant from NIH NCMH-HD
#1P20MD002286-03